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Case Study on Nursing Assignment

   

Added on  2021-04-17

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Running head: Nursing Case StudyNursing Assignment- Case study of Mr. SipoisName of the StudentName of the UniversityAuthor Note

1Nursing Case StudyRisk Factors and Health promotion (for Myocardial infaction) STEMI or ST elevation myocardial infarction is a type of heart attack that is causeddue to blockage of blood for a prolonged time to a significant portion of the heart (Heart.org2018). Acute coronary syndromes are usually differentiated based on the absence or presenceof ST elevation on the ECG, and is called Non STEMI and STEMI respectively. Patientssuffered from Acute Myocardial Infarction require immediate therapy without delay withpercutaneous coronary interventionPPCI done within 90 minutes of first medical contact(Camaro & de Boer 2015, p. 243).The term ‘risk factor’ was coined by the researchers of Framingham Heart Study,USA for cardiovascular diseases (CVD). The studies showed factors like high bloodcholesterol, smoking, hypertension, ECG abnormalities can increase the risk for CVD. Therisk factors can be divided into modifiable and non modifiable risks (metalyse.com 2018). Several modifiable risk factors are associated with Myocardial Infarction, like:smoking, abnormal blood lipids, diabetes, hypertension, abdominal obesity, inadequatephysical activity, psychosocial factors, inadequate consumption of fibre, alcoholconsumption.Smoking is considered as a significant risk for myocardial infarction. Studies showthat the risk of cardiac arrest can increase directly proportionally to the number of cigarettessmoked without any upper limit. Smoking or inhaling products other than cigarettes can alsoincrease risks for myocardial infarction, although not as much as cigarettes (Aygül et al.2008, p. 4). Studies by Aygül et al. (2009, p 5) supports this data, showing that smoking wasfound to be more prevalent among STEMI patients. This suggests that the smoking habit ofthe patient might be related to the condition.

2Nursing Case StudyStudies show that regular exercise in moderate to intense levels can reduce the risk ofmyocardial infaction. Though regular exercise, the normal functioning of the cardiovascularsystem can be maintained. It also improves respiration and, cardiac output as well asmaintains an efficient heart rate and stroke volume and therefore prevents the onset ofcardiovascular diseases (Agarwal 2018, p. 541). The patient admitted that he does very littleexercise, and works as a computer programmer (which possibly keeps him restricted to hiswork desk for prolonged periods of time). This can also explain the onset of STEMI in thepatient.Other modifiable risk factors like hypertension, obesity, diabetes, abnormal bloodlipids have not been reported for the patient, however it is important to check his dietaryintake as well as any signs of psychosocial factors like depression, stress and adverse lifeeffects. Studies have linked cardiovascular disease with psychosocial stressors and poor diet(Lagraauw et al. 2015, p. 19; Reedy et al. 2014, p. 882)Non modifiable risks includes: age, gender, genetic factors, racial and ethnicbackground. Studies by Dhingra and Vasan (2012, p. 88) shows that age is an independentrisk factor for CVD and can increase by the presence of other risk factors. The risk of CVDincreases significantly after the age of 65. Also, the propensity of CVD earlier in life is moreprobable for males than in females. A family history of CVD in a first degree relative canalso increase risks for cardiovascular problems. The patient is 55 years of age, which placeshim closer to the non modifiable risk for CVD, as well as his gender. Any family history ofCVD should be investigated.Intervention strategies for the patient should include: immediate cessation of smoking,including daily- regular to vigorous exercise, including fibre in diet and restricting the intakeof fats. The patient can be referred to a diet consultant as well as an occupational therapist

3Nursing Case Studyand lifestyle modification support. He also might need regular follow-up with generalphysician to monitor his cardiac activity.Pathophysiology (for STEMI and non-STEMI) STEMI is caused due to a complete and persistence blockage of the coronary artery(the vessel that supplies blood to the muscles of the heart) by the formation of a blood clot(thrombus). This blockage leads to damage to the cardiac muscles (and is called a myocardialdamage), and the damage increases with the length of time of the blockage, due to increasingdamaged muscles of the heart. In animal models, the myocardial injury due to a blockage ofthe coronary artery spreads in the form of waves, starting from the inner layers of the cardiacmuscles to the outer layers, and during infarction, the full thickness of the cardiac muscles areaffected. Among patients who have survived STEMI, the infracted or damaged muscle isgradually replaced with a scar tissue (by a process called fibrosis), and the damage isdetermined by the stroke volume and efficiency of the heart (Ncbi.nlm.nih.gov 2018).Non-STEMI or NSTEMI is caused by an imbalance between the myocardial demandand supply of oxygen. This is caused due to a lowered blood flow through the coronaryvessels. This can be caused by a partial or non-occlusive blood clot (or thrombus) that formsin a disrupted plaque. The clot causes a near complete blockage of coronary artery. Differentsequence of events can lead to NSTEMI like: rupture of a plaque with superimposed bloodclot which is non-occlusive causing vascular obstruction; dynamic obstruction of cardiacvessels; narrowing of the arteries (reducing the flow of blood); inflammatory reaction;conditions (like hypoxemia, hypotension and hypovolemia) that can cause lowering of bloodflow through the coronary vessels. The most common cause of NSTEMI is the rupture of aplaque, causing a blood clot, which prevents or reduces the flow of blood. The ruptureusually occurs near the shoulder region and contains a large number of inflammatory cells.

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