NMS3201 Clinical Science: Myocardial Infarction Nurse-Led Plan

This nursing assignment presents a case study of Kath Harris, a 65-year-old woman with a history of unstable angina, hypertension, and diabetes mellitus type 2, who was admitted to the emergency department with chest pain and diagnosed with an acute myocardial infarction. The essay discusses the prevalence and relevance of myocardial infarction in Australia, highlighting the high incidence of cardiovascular diseases and associated mortality rates. It outlines a nurse-led case management plan aimed at improving the health and quality of life for elderly individuals post-myocardial infarction, incorporating pathophysiological treatment options based on national guidelines and implications for nursing practice. The plan includes pharmacological treatments, risk factor modification, and lifestyle changes, while also considering therapies like thrombolytic therapy and its suitability based on the patient's condition and medical history. The essay concludes by emphasizing the importance of comprehensive care and management to address myocardial infarction and reduce its impact on individuals' health.

Running Head: NURSING ASSIGNMENT 0
Nursing Assignment
10/4/2018

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The essay brings about the discussion on the assessment of the myocardial infarction
in Australia, and the relevant aspects and concepts. It describes the particular problem or
issue, in context to the given case study. The case study is about a 65-year old woman, Kath
Harris, who lived alone, and suffered from the problem of chest pain for about 2 hours. The
essay includes the description of the case study, which includes implementing a nurse-led
case management plan which is in relation and up-to-date with the Australian statistics. The
plan to be implemented and assessed considers the purpose to ensure a quality life for the
elderly people, who have suffered a myocardial infarction. The essay in the later part,
discusses the pathophysiological treatment options, which is based on the principles and
national guidelines, including the implications for nursing practice (Bandstein et al., 2014).
The case study is about a 65-year old woman, Kath Harris who was admitted to the
emergency department complaining about the chest pain for about 2 hours. She took some
medicines that helped her in reduced chest pain, and after a proper diagnosis, she had the
problem of acute myocardial infarction. Discussing about her clinical history, past few years
she had problems of unstable angina, which refers to the condition in which the heart of the
person is not able to get enough blood or oxygen. Angina is the term, which defines about the
chest discomfort that is caused due to poor through the blood vessels of the heart muscle.
Number of other issues such as hypertension, diabetes mellitus type 2 was also identified,
which further disclosed about her smoking habits. A recent history of indigestion also
described about her problem of acute peptic ulcer. Therefore, analysing all these things
mentioned above in relation to the case, myocardial infarction is to be taken for the study and
research in context to the country Australia (Randall et al., 2016).
Discussing about the relevance and prevailing rates of the problem of myocardial
infarction in Australia, first it is necessary to understand the meaning of the term and related
aspects. Myocardial infarction is the medical term or the name of heart attack. Heart attack
refers to the life-threatening issue or problem, which occurs when there is a blockage in the
flow of blood to the heart muscle, which leads to the damage in the tissue. The reason behind
the development of this blockage is the plague, or presence of a substance in the body, which
is mostly made of fat, cholesterol, and cellular waste product. The person or patient in the
case was also identified with the problem of diabetes mellitus type 2, and active peptic ulcer,
which mentions about other health problems (Ahmad et al., 2015). Peptic ulcer is the sores in
the lining of oesophagus, stomach, or duodenum, and one of the main symptoms of this
problem is the pain in the upper abdominal area. As in the case study, Kath Harris

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experienced the problem of indigestion, which may be due to her poor lifestyle or bad habits
of smoking (Soo Hoo, Gallagher & Elliott, 2016).
The intensity of heart diseases or heart attacks is largely found in Australia, which
indicates about the high incidence and prevalence of cardiovascular disease. It has been
analysed that the cardiovascular diseases (CVD) is found to be one of the major causes of
deaths in Australia, with about 43,963 deaths in Australia in the year 2016. Cardiovascular
disease kills one Australian every 12 minutes, and is considered as one of the largest health
problems (Demaerschalk et al., 2016).
According to the statistical information, in Australia it is found that over 400,000
Australians have had the problem of heart attack. Each year, it is estimated that around
54,000 Australians suffer from the problem of heart attack, which means one heart attack
every 10 minutes. In the year 2016, it is a known fact that an average of 22 Australians died
from a heart attack each day, which is further equivalent to one death from a heart attack in
every 66 minutes. Thus, the above data describes that there is a high incidence and
prevalence of the heart diseases or heart attack in Australia past few years and is still
continued with the major impact on the health of the individuals (Diouf et al., 2016).
Signs and symptoms of the problem of cardiovascular disease or myocardial
infarction include major chest pain, and the shortness of breath. Other symptoms include pain
in the chest, back, jaw or the upper body parts, sweating, nausea, vomiting, increased heart
rate. These are some of the signs and symptoms of the issue of acute myocardial infarctions
in the human body. There are several factors, which lead to a blockage in the coronary
arteries, causing the problem of heart attack (Oliveira, Avezum & Roever, 2015). These
factors include bad cholesterol, saturated fats, or trans-fat. There are certain risk factors,
which leads to increased possibilities of heart attack and other heart diseases. It has found that
the people with certain symptoms or risk factors are prone to the cardio-vascular disease such
as heart attack. These risk factors include people with high blood pressure, high cholesterol
levels, diabetes and high sugar levels, obesity, age, and smoking are some of the factors,
which causes heart-attack. In context to the given case study, Kath Harris is found with the
smoking habits, which can be one of the reasons behind her problem of myocardial
infarction. Cardiovascular diseases may occur with the person more than 18 years in age. The
rationales related to treat patients with such symptoms, clinical rationale include using
morphine for the pain, which is associated with the MI (Myocardial infarction). Therefore, to

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link with the given case study it was found that the patient Harris was given glyceryl
trinitrate, which are used for reducing chest pain. The use of these medicines had least effect
on her body.
A myocardial infarction requires urgent medical attention, to treat the patient
suffering from these problems. Treatment or management of the person, in the case Harris in
this case may aim to preserve as much heart muscles as possible, and to prevent further
complications. Treatment or management of Harris problem may include unblocking of blood
vessels, reducing blood clot enlargement, and modifying risk factors for any future
complication (Parodi et al., 2015).
A number of steps may be mentioned to manage her problem of myocardial
infarction, giving medications, which may reduce her chest pain such as nitro-glycerine, or
morphine. Nitro-glycerine may improve the blood supply of the patient. Other includes
anticoagulation, and cardiac rehabilitation, which should be initiated soon after the discharge
from the hospital. The program for cardiac rehabilitation includes changes in the lifestyle,
suggesting the person to involve in daily exercise, and social support from people (Rentrop &
Feit, 2015).
Risk factors refer to any attribute, characteristic, or the exposure of an individual,
which increases the possibility of developing a disease or an injury. The important risk
factors for the heart diseases are high blood pressure, high cholesterol, diabetes, obesity, and
unhealthy diet. In context to the case, the main risk factors, which can be identified for Kath
Harris, consist of high blood pressure, older age, actively smoking. These are also referred to
as modifiable risk factors, and the effect influence of these factors can be reduced by
improved lifestyle and other changes (Van Hout et al., 2016). Non-modifiable factor include
age, ethnic background, and family history of heart disease. Age, the older a person is the
person becomes prone to the coronary diseases or to have any cardiac misadventure or heart
attack. Ethnic background, for an example South Asians who are living in UK are more
likely, to have possibilities of developing coronary heart disease, in comparison to the rest of
UK population (Vernon et al., 2017).
The pharmacological treatment of the patient with the acute myocardial infarction
includes basic therapies such as routine administration of oxygen, nitro-glycerine, and
aspirin. Cardio-active agents such as beta-andregenic antagonists should be considered
(Bonaca et al., 2014). Despite the advancements in the pharmacological management of the

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acute myocardial infarction, there are still new developed ways of the non-pharmacological
treatment. This may include positive airway pressure therapy, it also mentions about helping
the patient comply with the disease, treatment, and the self-help strategies. Diet taking proper
diet, and nutrition, advising the patient about consumption of alcohol, in obese patients
(Adams & Urban, 2015).
Nursing management in the case of the patient with acute MI includes achieving a
balance between myocardial oxygen supply and demand. This is achieved through oxygen
administration, and medication. The next step is to ensure prevention of complications, and
continuous monitoring of cardiac functions. Continuous ECG monitoring, monitor and record
input and following monitoring of urine output. Developing a multifaceted plan for the
improvement of the condition of the patient, with the myocardial infarction involves a
number of steps, which may refer to non-pharmacological treatment. First step in this case, is
the open disclosure, which means informing the patient or the person about the disease, and
the prevention strategies. The nursing management or the plan includes advising the heart
failure patients to do moderate exercises with some stable, and then advising the heart failure
patient to reduce the salt intake, and monitor their weight daily. Other interventions or plan
may include suggesting and referring the person to the specialist (Ibanez et al., 2017).
In context to the heart attack or heart failure and related health issues, there are some
of the therapies, which can be used to treat or lessen the effect on the body of the individual.
One of the therapies includes thrombolytic therapy, which refers to use of drugs to break up
or dissolve blood clots, which are the main cause of the heart attack or stroke to any person.
These are the drugs, which are also known as thrombolytics or clot-busting drugs, and they
are given only for some particular type of heart attack. This type of heart attack is called as
ST segment elevation myocardial infarction (STEMI); in this case, certain changes are
noticed on ECG. These drugs must be given immediately soon after the occurrence of first
chest pain. Therefore, this therapy is useful in some cases, if used appropriately to treat the
patient. This is given to the patient through veins, and in context to the case study, it does not
relate to the woman as she had peptic ulcers. It was found that this therapy is not suitable for
the patients with certain factors or issues. The issue in this case includes the people who had
bleeding inside the head or a stroke, brain abnormalities such as tumours or poorly formed
blood vessel (Xie et al., 2016). The person in case had a head injury within the past 6 months,

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a history of usage of blood thinners, major internal bleeding, or severe high blood pressure.
The rationale or purpose of the use of thrombolytic therapy or drugs in case of myocardial
infarction states that the patients who receive thrombolytic therapy obtain a constant survival
benefit when they are compared to the control patients (Ryan et al., 2016).
To conclude the above discussion on the essay of nursing assignment, it has been
analysed that the Myocardial infarction and other cardio vascular diseases are prevailing at a
higher rate in Australia. Myocardial infarction in general refers to heart attack and other heart
problems to the individuals. It is referred to the condition when the blood flow decreases or
stops to a particular part of the heart, causing damage to the heart muscle. With context to the
case study, the most common symptom identified was the chest pain to the woman in the
case. There were many risk factors associated with the problem or issue with the woman that
led to the occurrence of myocardial infarction. The patients with these problems or the
woman in the case must be treated and suggested for some self-help strategies along-with the
medications and other therapies. Major changes in the lifestyle choices or self-help strategies
can help such patients to deal with these problems, and proper medications and support from
the family members can help the person deal with heart failure or heart diseases. Hence,
proper management or care plan must be implemented for these patients to prevent any
further complications.

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