Outline of the Disease Case Study 2022

Running head: CASE STUDY
CASE STUDY
Name of the student:
Name of the university:
Author note

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CASE STUDY
Question 1:
Outline of the disease:
Myocardial infarction’ is defined as a life-threatening event which is observed in the
patient when a blood vessel supplying the blood to the heart muscles blocked and threatened to
damage the heart muscle, resulting in ischemia and necrosis (Chew et al., 2014). The common
symptoms include shortness of breath, angina, radiating pain in the arms (Khan et al., 2016).. In
severe cases, the patients also experience cerebrovascular accidents which impact the healthy
life. The case study highlighted that Mr. Tupa Savea is a 54-year who has been transferred to
coronary acute care from the emergency department due to chest pain. His ECG report suggested
that he has an ST-segment elevated myocardial infarction and his blood report showed elevated
troponin and cardiac enzymes
Cause:
Myocardial infarction is observed in patients when one or more arteries are blocked. Over
time, due to the presence of risk factors, coronary artery becomes narrow from the buildup of
various substances which in turn block the arteries and impact heart muscles. (Khan et al., 2016).
Due to blockage, the lack of blood trigger myocardial infarction. The common risk factors for
this disease include high blood pressure, cholesterol, obesity, increasing age, male, and history of
smoking (Ryan et al., 2016). In this case, the patient was obese male, had a habit of smoking and
drinking with high blood pressure, indicating he represents all the risk factors that can give rise
to myocardial infarction.
Prevalence and incidence:

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In Australia, approximately 430,000 Australians have experienced myocardial infarction
at some point of lives (The Heart Foundation, 2019). Moreover, approximately 40,000
Australians in Australia under the age of 55 had experienced a heart attack (Chew et al., 2014).
Considering the incidence, one in three individuals in Australia are not aware of the disease and
the symptoms of the disease. One in 5 people is experiencing a heart attack which disrupts their
quality of life (The Heart Foundation, 2019). National Hospital Morbidity Database, suggested
that Heart attack destroyed more than 7,813 lives in 2017 whereas 21 lives per day (Chew et al.,
2014). Hence, the impact of the myocardial infarction is drastic that not only reduce the quality
of life of the patient but also influence the family members of the patients who are suffering from
the myocardial infarction.
Impact on family members:
Considering the impact of myocardial infarction on the family members of the patients,
De Gruyter, Ford & Stavreski (2016), suggested that patients are subjected to high psychological
distress such as anxiety, depression which further hinder faster recovery. The patients tend to
feel helpless and dependent on family members. Family members exhibit a negative impact
which affects family relationships (Soo Hoo, Gallagher & Elliott, 2016). They also experiences
fear, anxiety, guilt, and sadness. In this case, nurses must provide safe and responsive care to the
patients suffering from myocardial infractions by empathies them, boost their self-esteem.
Question 2:
Common signs and symptoms Physiology of the disease
Angina or chest pain In the healthy individuals, the mitral valve

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acts as a one-way valve which helps the blood
to move from the left auricle to left ventricle.
Due to prevalent risk factors such as
hypertension, high cholesterol, obesity,
smoking and drinking, this mitral valve
stenosis observed where mitral valve
narrowed and restrict the amount and rate of
blood flow (Welsh et al., 2019). Heart pump
harder to provide adequate blood to the
cardiac tissues. Consequently, patients
experience angina or chest pain (French et al.,
2016). The heart rate of the patient also
increased. The case study suggested that the
pulse rate of the patient is 90bpm, indicating a
high heart rate. While normal pulse rate is in
between 60 to 100bpm, the patient exhibited
90bpm, indicating the heart is pumping harder
to provide adequate blood to the patient.
Shortness of breath ( dysphonea) In the healthy individuals, the heart is
involved in the transportations of oxygen to
your body and remove the carbon die oxide
from the blood (Jennings, 2016). However, in
case of myocardial infraction, the disruption

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of blood supply cause heart cells to die. The
damage of the heart muscles decrease the
pumping function of left ventricle in
patients. Consequently, left ventricle failure is
observed and fluids buildup observed
(Jennings, 2016). The respiratory tissues also
deprived of the adequate oxygenated blood
and reduce oxygen saturation in the body.
Hence, patient experience shortness of breath.
High blood pressure The patient with high blood pressure at high
risk of developing myocardial infraction as
observed in this case. The excess strain on the
heart muscle and associated damage have
been observed in a patient who has
experienced high blood pressure (Aliprandi-
Costa et al., 2016). Consequently, high blood
pressure induces the coronary arteries serving
the heart to slowly become narrowed from a
buildup of the plaques containing cholesterol
and other substances and patient experience
myocardial infraction. As observed in this
context, the patient had a high blood pressure
of 150/100 whereas, in the case of normal

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individuals, it is 120/80 (Aliprandi-Costa et
al., 2016). Hence, high blood pressure in the
patient further subject him at high risk of
developing myocardial infarction.

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CASE STUDY
Question 3:
The patient experienced myocardial infarction and to manage his health condition, he
was administrated with sublingual glyceryl trinitrate. Sublingual glyceryl trinitrate is nitrate
class of drug which widen the blood vessels for reduction of myocardial infarction. The
pharmacodynamics and pharmacokinetics of sublingual glyceryl trinitrate are the following:
Pharmacodynamics:
Nitrate class of drugs are vasodilators which induce the relaxation of vascular smooth
muscles by dilating vascular arteries and veins. These drugs also take part in the reduction of the
cardiac preload and afterload, minimize spasm of coronary arteries, minimize systemic vascular
resistance and reduce the high blood pressure in patients (Asrress et al., 2017). The excessive
strain on the heart for pumping blood effectively reduced by nitroglycerin which in turn reduce
the angina pain of the patient. The molecular-level mechanism of the drug is that mitochondrial
aldehyde dehydrogenase converts it into nitric oxide for mode of action (Asrress et al., 2017).
This class of drug activates dephosphorylation of myosin smooth muscle for relaxation and
increase the blood flow of the vain, cardiac tissues.
Pharmacokinetics of the study:
Absorption:
It rapidly absorbed and it is often used in an emergency. A sublingual dose of 0.5 mg of
nitroglycerin is absorbed where after administration, peak concentration was reached by 4.4

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minutes and bioavailability of this drug is 40% which is highly dependent on mucosal
metabolism and hydration status (Boden et al., 2016).
The volume of distribution:
The volume of distribution in the case of nitrate is approximately 3 L/kg
Protein binding:
This class of drugs binds to plasma protein with an approximate range from 50 to 500 ng/ml. the
protein binding is approximately is about 60% (Boden et al., 2016).
Metabolism:
Aldehyde dehydrogenase activates the class of drug where it metabolized to nitrite, 1, 3
glyceryl di-nitrate and 1, 2-glyceryl di-nitrate. This nitrite, in turn, metabolized to nitric oxide or
S-nitrosothiol. The nitrate metabolized to mono nitrites and act on blood vessels.
Route of elimination: metabolism is the main route by which this drug metabolized.
Question 4:
In this current context of the case study, three priorities are following:
Nursing goal Intervention rationale
1. Reduction of
shortness of breath
within 8 hours with
the assistance of
oxygen therapy
The patient can be
administrated with oxygen
therapy for reduction of
shortness of breath
The rationale behind oxygen
therapy is that oxygen
therapy is used to maintain
enough oxygen while inhaled
anesthetics are given.
Sepehrvand et al. (2018)

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CASE STUDY
suggested that
Hyperbaric oxygen therapy is
a type of oxygen therapy that
increases oxygen in the blood
vessels of the patients with
dysphonia. An increase in
oxygen in blood temporarily
restore the level of blood
gases, tissue and cell
functions which further
promote healing and a faster
recovery in patients. Hence,
in this current context,
oxygen therapy is an
excellent nursing intervention
which can be provided to the
patient. The nurse must assess
and monitor the shortness of
breath and oxygen saturation
of the patient to ensure that
he is receiving an adequate
amount of oxygen or
breathing.

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2. The reduction of chest
pain through
morphine within 8
hours. The patient
would be able to
verbalize.
For reduction of chest pain,
the patient can be provided
with morphine.
While other pain management
drugs are present, morphine is
the excellent pain
management drug to reduce
pain within 8 hours. Nielsen
et al. (2016), suggested that
morphine binds to the opioid
receptors to blocks the
transmission of nociceptive
signals. It acts as the
antagonist of mu and the
kappa opioid receptors and
blocks the activity (Crow,
2016). By blocking the
receptor, it further activates
the signaling of pain-
modulating neurons in the
spinal cord and hinders the
transmission from primary
afferent nociceptors to the
dorsal horn sensory
projection cells (Rijkenberg
et al., 2015). However,

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morphine has certain side
effects which further impact
the quality of life. The
excessive consumption of
morphine changes synaptic
neuroplasticity mainly in the
postsynaptic sites, dendritic
terminals, and modifications
in the density. Hence, nurses
must provide adequate dose
for reduction of chest pain.
The pain assessment of the
patient is required to do with
the assistance of a pain scale.
The patient must verbalize
the pain and pain score
should be 0 within 1 to 10
scale (Rijkenberg et al.,
2015).
3. Stabilization of blood
pressure to 120/80
from 150 / 100 with
the assistance of beta
Since hypertension one of
the major reasons behind
myocardial infraction, beta
blocker can be provided to
The rationale behind using
Beta-blockers as a drug for
reduction of hypertension is
that these are the medications

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blocker the patient. which work by blocking the
effects of a hormone named
epinephrine (Kotecha et al.,
2017). The hormone is also
known as adrenaline. Beta-
blockers reduce the heartbeat
by reduction of pulse rate and
it also reduces the force,
which in turn lowers blood
pressure (Kotecha et al.,
2017). Hence, it is the most
suitable intervention for
reduction of blood pressure.

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Reference:
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