Nursing Assignment: Myocardial Infarction Case Study Analysis

This case study examines a 54-year-old Greek man, Mr. Papas, who presented to the emergency department with central chest pain, nausea, diaphoresis, and pain radiating to both shoulders and his left arm, indicating a myocardial infarction. The assessment details his lack of cardiac history, lifestyle factors (smoking, social drinking, sedentary work), and physical presentation (pale, clammy). The study explores the pathophysiology of myocardial infarction, discussing the blockage of the coronary artery, radiation of pain, pallor, and clamminess. It emphasizes the importance of immediate nursing care, including the MONA treatment (Morphine, Oxygen, Nitrates, Aspirin), frequent ECG monitoring, blood pressure, heart rate monitoring, and administration of heparin. The nursing care section also highlights the importance of monitoring troponin levels and administering medications like metoprolol. The case study stresses the need for continuous patient monitoring, emotional support, and the avoidance of stressful situations, concluding that myocardial infarction is an acute disease linked to lifestyle factors, emphasizing the possibility of a normal life through lifestyle changes.

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ASSESSMENT- CASE STUDY

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Contents
Introduction:....................................................................................................................................3
Pathophysiology:.............................................................................................................................3
Homeostatic Mechanisms:...............................................................................................................4
Radiation of pain to shoulders and left arm:.................................................................................5
Pallor:............................................................................................................................................5
Clamminess:.................................................................................................................................6
Nursing Care:...................................................................................................................................7
Conclusion:......................................................................................................................................9
Reference:........................................................................................................................................9

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Introduction:
Myocardial infarction is actually is a process. It is also referred to as a heart attack or
stroke or cardiac arrest. When the blood circulation stops inside the heart, the heart stops
working partially and heart muscles are damaged. In such cases the patients feel severe chest
pain, feeling pain in the left shoulder and arms, suffering from breathing problem also. In such
cases the patients need immediate medications sometimes patients need surgery as well which is
commonly known as angioplasty.
Pathophysiology:
Mr Papas admitted to the local hospital due to heavy chest pain. He is now admitted in
the emergency department of that hospital. Doctors suspect that he is suffering from
myocardial infarction. But there is no past medical history throughout his life. He was never
suffering from any kind of cardiac disease before this. None of his family members gets
affected by any kind of cardiac disease before him. All of his symptoms like having nausea,
chest pain, anxiety, dizziness, diaphoresis, high body temperature are indicating that he is
suffering from this life-threatening disease (Cabello et al., 2016). This will lead his heart
toward a massive heart attack or cardiac arrhythmia.
When the heart attack occurs due to ST- elevation of myocardial infarction this will
leads patients towards death. These kinds of condition are found at electrocardiogram

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technique (Akbar et al., 2017). This kind of abnormalities in heart occurs due to the blockage
of the coronary artery which is the main part of the heart which supplies blood into it. This
kind of situation arose due to heavy smoking, drinking and consuming a high amount of
unsaturated fats and less exercise. Mr Papas leads a very hectic life. He worked in the IT
department which is considered a quiet hectic job. He did not get much time for exercise and
he smokes regularly (Anderson & Morrow, 2017, p. 2058). We can consider him as a chain
smoker also. This kind of myocardial infarction need s to be treated as soon as possible as this
condition is considered as life-threatening. In the emergency situation, most of the patients are
treated with surgery which is called angioplasty.
Some of the people are also suffered from a heart attack but their condition is not as
serious as Mr Papas, as they will be getting affected with ST elevation of myocardial
infarction. This type of heart attacks is less dangerous than STEMI (Reed, Rossi & Cannon,
2017). This kind of situation found only when people are suffering from another chronic
disease for years. Some of them are diabetes or kidney diseases etc. Though this is less
dangerous than the STEMI still this kind of disease also need to be treated as early as possible.
Homeostatic Mechanisms:
In the case of Mr Papas, it is quite confirmed that he is suffering from myocardial
infarction as all of his symptoms are indicating towards this.
Radiation of pain to shoulders and left arm:
In the case of acute or severe myocardial infarction pain in the chest is one of the very
natural and common symptoms. It is often referred to like the sensation of the pressure,

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tightness and squeezing (Prabhu & Frangogiannis, 2016, p. 102). The pain actually circulates
around the left shoulder and left arm of the body. It also affects the neck, lower jaw and upper
abdomen. This kind of pain circulates due to the unusual flow of blood in the coronary artery.
Thus at that point of time heart is beating very fast and the blood pressure becomes very low
(Gyöngyösi et al., 2015). In the case of Mr Papas, his blood pressure becomes 106/ 62 which is
much lower than normal. Fresh blood is the main source of oxygen into the human body
system. The fresh blood is carried by the coronary artery. Due to its blockage heart cannot get
much oxygen which it demands the contraction. Thus the myocardial infarction happens due to
the lack of oxygen supply inside the heart and heart muscles (Yeh et al.,2015, p. 2218).
Pallor:
Due to the blockage into the coronary artery, the heart and the heart muscles cannot get
an adequate amount of blood and oxygen for their normal contractions. Heart valves will not be
working properly due to such an inconvenient situation (O’Donoghue et al., 2016, p. 1593). As
we all know the heart is the main source of the fresh blood which contains oxygen and it
circulates and provides the fresh blood to the other systems which are inside the human body.
Due to the lack of fresh blood supply other system starts collapsing immediately (Stub et al.,
2015, p. 2146). The skin of that patient becomes pale. This thing does not happen with is a day.
This is a long term process. This is actually giving us the signs from a long period of time. The
cholesterols are being accumulated into the coronary artery which actually leads the blockage
situation. Mr Papas skin becomes pallor due to nausea and dizziness (Ibanez et al., 2017, p.
153). All of the essential nutrients and minerals of his body cannot give him the proper and

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adequate amount of energy which he requires.
Clamminess:
Clamminess has seen the skin of those patients who are suffering from some life-
threatening diseases. We all know our body is made up of 70 per cent water and 30 per cent
nutrients and minerals (Gibson et al., 2019). Our skin actually stores the maximum amount of
water. When our body generates heat that actually activates our sweat glands which resides in
our skin. At this point of time, the moisture and the water comes out throughout our body and
generates a large amount of heat as well. In the presence of the water and moisture body
become wet and reduce some heat (Jolly et al., 2016, p. 130). This kind of situation generally
arouses when the respiratory rate becomes higher than normal and the heart beats fast. This
will leads to the metabolism rate higher. As the metabolism rate becomes higher the body
naturally requires more oxygen whereas it does not get much due to the blockage of the
coronary artery (Li et al., 2015, p. 448). In the case of Mr Papas, his respiratory rate is 20
breaths/ min which is quite higher than normal. His oxygen saturation is also 96 per cent which
means he certainly suffering from some chest related issues.
Nursing Care:
In the case of Mr Papas, we can see he is admitted to the hospital in a serious situation.
He needs immediate medicines and treatments which may save him from cardiac arrest. There
are some nursing techniques or interventions are approached which is very important for Mr
Papas as follows:

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 It is clear now that there is a blockage in his coronary artery thus he needs
to be given the MONA treatment. This treatment must be followed is a proper order.
Firstly nurses must inject morphine inside his body (Hausenloy et al., 2016, p. 937). This
can slightly reduce chest pain. Then the patient must be given oxygen as he is struggling
with the respiration process. In the case of the oxygen supply, Mr Papas blood
circulation inside the body gets stabilized for a while. Then he must be given nitro-
glycerine and aspirin together as nitrates are very useful for pain (White et al., 2015, p.
180). These medicines actually clear the paths of blood vessels and with the help of this
blood can flow normally.
 Myocardial contraction is the main cause behind the chest pain and this
situation can be found out with the help of electrocardiogram. In such situation patient
must be observed as frequently as possible (Verouhis et al., 2016, p. 69). Nurses must
monitor Mr Papas with frequent electrocardiograms. Patient’s heart condition is
understandable only with the help of ECG.
 The blood pressure and heart rate must be measured frequently. As in this
scenario when the blood pressure becomes high there is a tendency of the blood clot
inside the heart which is the result of cardiac arrest. Thus he must be given heparin as
well. Heparin is an anticoagulant which can prevent blood from clotting (Sabaté et al.,
2016, p. 363). Though it is already present in the heart in case of myocardial infarction,
the heparin level also gets lower than normal. This treatment is known as thrombosis
treatment. Thrombosis is a process which can prevent the blood coagulation inside the
body (Carrick et al., 2016).
 Nurses need to monitor the troponin level inside his body. According to

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the vital checkups his tropinin level is 2.4 which is much higher than normal. He needs
to give proper medication which can reduce the level of troponin inside his body (Parodi
et al., 2015).
 He needs to give some medicines which consist of metoprolol, pindolol,
atenolol, nadolol, propranolol etc. These substances can reduce chest pain and also can
control the effect of blockage. These substances also reduce the heart rate, oxygen
demand in cardiac muscle and systolic blood pressure.
 To nursing the patient it is important to stay 24 hours beside him. Most of
the cardiac cases the patients are sustained into a critical situation for panicking and
sometimes become anxious. In such cases, they need to be calmed and as relaxed as
possible (Roolvink et al., 2016, p. 2710). The nurses must encourage him to keep
himself out from each and every stressful thought or situation. Anger, grief, sadness,
fear, anxiety are the most dangerous things in order to this case.
Conclusion:
Myocardial infarction is an acute disease which may lead to cardiac ischemia also. This
kind of situation comes due to an abnormal lifestyle and abnormal food habits. Those who love
to take fast foods have a high chance to get affected with this disease. Regular smoking and
drinking are also behind the cause of this disease. One can lead a normal life definitely by
avoiding this kind of habits or situations.

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