Nursing Case Study Assignment: Acute Coronary Syndrome Analysis

This nursing case study assignment focuses on Acute Coronary Syndrome (ACS), a critical condition and leading cause of death. The paper examines a patient presenting with ACS symptoms, delving into modifiable and non-modifiable risk factors like smoking and lack of exercise, alongside health promotion strategies. It explores the pathophysiology of STEMI and NSTEMI, explaining how blood clots obstruct blood flow to the heart, causing chest pain and other symptoms, and the homeostatic mechanisms leading to referred pain and skin changes. The assignment further outlines crucial nursing care interventions, including pain management, patient education, and continuous monitoring to improve health outcomes. The role of the nurse in managing ACS, from hospital care to patient education for long-term health, is emphasized.

Running head: NURSING CASE STUDY ASSIGNMENT
Nursing Case Study Assignment
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Nursing Case Study Assignment
Acute coronary syndrome (ACS) is one of the leading causes of death in the world today.
According to Mayo Clinic, ACS is caused by the blockage of blood flow to the heart leading to
chest pain and other discomfort in the patient. The condition may cause sudden death of the
patient or slow weakening that eventually leads to death. ACS is an emergency medical
condition that requires emergency interventions to improve save life and continued nursing care
that seek to help the patient avoid future incidents of ACS. This paper reviews the risk factors
and health promotion, pathophysiology, homeostatic mechanisms, nursing care, and activities
from Roper and Tierney model of living in a case study of a patient that reported to the hospital
with signs and symptoms of ACS.
Modifiable and non-modifiable Risk Factors and Health Promotion
Several factors contribute to myocardial infarction, a condition under the umbrella of
ACS, and some of these factors can be modified. Mr. Papas myocardial infarction is caused by
some of the factors that he describes to have been doing. According to the case study, Mr. Papas
explains that he is a frequent smoker where he smokes at least fifteen cigars a day and also
drinks socially. He is fifty-four years old and does little exercise due to the nature of his work.
As an IT expert, he hardly moves around because he spends most of his time in office. These are
among the factors that Bhartia and Naik (2013) list as risk factors for myocardial infarction in
patients above the age of forty years. Additionally, Mr. Papas explains that there is no history of
ACS in his family, indicating that this condition is a product of his lifestyle. As a result the
health promotion interventions should target modifying his lifestyle so that he can alter his life to
avoid future incidents of ACS. However, age as a risk factor cannot be modified. This is because
age is an irreversible process and Mr. Papas will not manage to alter it.

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The first health promotion intervention is education on how the Mr. Papas could alter his
lifestyle and help him respond positively to medication while at the same time avoiding the
incidents of MI in future. Mr. Papas should be told that his lifestyle is having an impact on his
life and this is leading to myocardial infarction. Cigarette smoking contributes to myocardial
infarction in two ways. First, the amount of carbon monoxide in cigarettes reduces oxygen
supplied to the heart, contributing to high chances of developing myocardial infarctions
(Esmaeili et al., 2013). Additionally, cigarettes reduce the lining of arteries, damaging them
(Danhoff & Huecker, 2016). This may cause blood clot that blocks the flow of blood to the
heart. Lack of physical exercises as in the case of Mr. Papas also leads to high fats in arteries
that reduce their sizes, leading to increasing chances of myocardial infarction when arteries
rupture as blood strives to flow to the heart (Chaves et al., 2015). This can be prevented when
the patient understands that his lifestyle is exposing him to risk factors associated with
myocardial infarction.
Education will also help the patient to understand the need for taking medications and
why he should consider quitting alcohol and engaging in frequent physical exercises. Generally,
education acts as a health promotional tool for managing the MI condition and improving health
outcomes (Kiani, F., Hesabi, N., & Arbabisarjou, 2015). Educational intervention seeks to
modify behavior by encouraging the patient to undertake frequent exercise, avoid risk factors,
and engage monitor diets to avoid exposure to conditions that may increase the risk of worsening
the condition. If the condition is not worse, the intervention can be delivered at home or within
the community nursing setting where the patient can access the services. Education also targets
the family of the patient to make sure that they are informed of the characteristics of the MI and
other associated conditions for them to take early interventions whenever they realize the

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problem with the patient. Family members may extend services such as helping Mr. Papas
whenever he is in distress or taking him to hospital whenever they realize that he heeds
immediate and urgent medical attention.
Pathophysiology behind the ST Elevated Myocardial Infarction (STEMI) and its
Difference from Non-ST Elevated Myocardial Infarction
Myocardial infarction occurs when blood clot occurs in the arteries, leading to the
blockage of the blood flow to the heart. Generally, the heart acts as an engine that pumps blood
to all parts of the body. Blood flows from other parts of the body to the heart through arteries
and leaves the heart through veins. The heart pumps blood continuously to and from the heart to
all other parts of the body. STEMI may be caused by partial clotting of blood or complete
clotting. Whether partial or complete, the occurrence of a clot within the blood vessels is serious
condition because blood will continue coagulating on the clot until the point where the diameter
of the blood vessel can no longer sustain the clot. This eventually leads to complete blockage of
the artery. The heart pumps blood automatically and it is not aware that there is a clot in the path
of the blood. As a result, the heart will respond by using excessive force to overcome resistance
to the flow of blood. Depending on the size of the clot, the force may force it into the heart or
cause the blood vessel to rapture, releasing the blood into the body.
Compared to STEMI, the non-STEMI (NSTEMI) condition occurs due to partial
coagulation or clotting of blood within the coronary artery. The primary difference between
NSTEMI and STEMI is that while STEMI may be sudden and fatal, NSTEMI does not cause a
hundred percent blockage of the coronary artery. The heart may still manage to pump blood
through the artery due to the weakened or narrowed artery, but it still uses excessive force than
normal. If NSTEMI is caused by a clot in the coronary, it can still be a fatal condition because

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continuous accumulation and deposition of blood and fats around the clot increases the size of
the clot (Malik et al. 2015). With time, the size of the clot may increase beyond the sustenance
of the coronary artery and this may cause the rapturing of the coronary artery. This can be a fatal
condition because it indicates that NSTEMI has translated to the STEMI condition. The other
difference is that NSTEMI occurs can be diagnosed when there is the damage to the heart and no
blood clot in the coronary artery. When the damage is detected, there is a need to expose one to
medication to avoid further damage to the heart.
Homeostatic Mechanisms that lead to Radiation of Pain to Shoulders and Left Arm,
Pallor, and Clamminess
The radiation of pain in the chest and shoulders is one of the early symptoms to be
noticed for people with myocardial infarction. According to Cervellin and Rastelli (2016), the
occurrence of myocardial infarction affects the supply of blood to the vital organs including the
heart itself. Chest pain and pain in the left arm is caused by lack of blood supply and also
oxygen because the heart is located on the left side of the body. Lack of oxygen supply to the
heart and the left side of the arm causes a condition called Ischemia. Ischemia is a serious
condition as it denies the left side of the arm the supply of oxygen, causing the death of cells and
tissues. This is because mitochondrion in cells requires oxygen to carry out respirational
processes. In the absence of oxygen, blood tissue cannot function and this causes the pain and
pressure to the heart as it attempts to work without blood supply or oxygen due to blocked
coronary artery that supplies oxygenated blood.
Myocardial infarction causes the heart to fail in supply of oxygen to vital organs like the
skin, heart, kidney, and the liver. While these organs are internal, the skin may exhibit the
problem in the supply of oxygen when it appears pale. The reason for the pallor skin is due to

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lack of supply of oxygen and the imbalance in glucose level (Perez et al., 2018). The skin also
appears pallor due to an imbalance between oxygen and carbon IV oxide that accumulates in the
body as discussed in Ferari and Cammici (2017). For body to maintain its homeostatic function,
all conditions must be balanced. An imbalance in the supply of oxygen interferes with the
respirational process as mitochondria cannot break down glucose to provide energy and oxygen
to the skin and other vital organs.
Myocardial infarction interferes with the normal functioning of the heart, forcing it to use
excessive force to pump blood through arteries. When the heart is overworked, it forces blood
through or around the clot that has blocked blood in arteries. This causes severe pressure to the
arteries and they skin responds by releasing sweat to keep the skin temperature balanced.
Additionally, the stressed arteries have to endure the exertion as the force from the heart exerts
pressure on the coronary artery to keep the body functioning. The condition is called clamminess
because the skin has to sweat excessively even when one is not working to balance the body
temperatures.
Nursing Care for Mr. Papas’ Myocardial Infarction
Nurses play a crucial role in managing of MI conditions. Their presence in the coronary
care units (CCUs) play a significant role in managing the condition and alerting other caregivers
or family members on the progress that the patient is making and probable interventions that can
improve health outcomes (Lenferink et al., 2017). Since the myocardial infarction damages the
myocardium, it is necessary that the nurse stays close to the patient to monitor the progress and
promote the healing process (Rosiek & Leksowski, 2016). The primary intervention of the nurse
in the hospital setting is to help in pain management. Once the patient has been placed in the
acute care setting, Aggarwal, Selvendran, and Vassilou (2016) explain that there is a need for the

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hospital management to make sure that there is a nurse assigned to the patient to make sure that
the quality of service extended to the patient is maximum and efficient. Such services include
medication services, education the patient and the extended family members of Mr. Papas on
when and how to take medication, and informing him on the symptoms of the myocardial
infarction for proper early intervention in case there is a need for intervention.
Apart from helping Mr. Papas recover from the MI condition, the nursing intervention
also seeks to improve the recovery process. For this case, Mr. Papas is experiencing pain due to
damage on the myocardium. This creates a need for proper intervention in terms of educating
him on how to avoid some foods that may worsen the condition as well as educating him and the
extended family members or friends on how to identify early symptoms of the disease and
promote the health outcome. According to Reeder (2018), a person that has experienced an MI
condition requires constant monitoring to make sure that the present condition does not get
worse. Liu, Shi, Willis, Wu, and Johnson (2017) explain that patients with myocardial
infarctions are often confined to beds to reduce the oxygen requirements of the damaged
myocardium tissue. During the period of confinement, t is necessary that the caregiver nurse
uses that moment to explain to the patient why the person requires rest and what is to be done in
future to avoid the problem. For a patient like Mr. Papas who is a frequent smoker, the nurse
could use this time to explain to him the reason why he should consider quitting smoking and
other proper physical fitness interventions that could lead to a desired health outcome in the
patient.
For improved outcome, there is a need to place the patient on a plan of care. This is to
prevent formation of further clots in the coronary artery that could lead to heart attack. Some of
the recommended nursing interventions in the plan of care include making sure that the patient is

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placed on heparin medication. Heparin prevents the formation of breaks the formed clots as well
as preventing their formation, making sure that the chances of developing the MI condition are
minimized. Sharma, Chomayil, Karim, and Parambil (2015) recommend that the patient should
be placed on three to five lead monitoring even when there is no presence of a clot in the body.
The purpose of this intervention is to make sure that there are no chances of heart attack or risks
of formation of a clot in the already damaged myocardium.
The Activities of living that may be altered for Mr. Papas
Due to the health status of Mr. Papas, there are modifications in the twelve activities of
living that will be altered to improve his health status. One of the activities is the mobility (Patel
& Singh, 2011). Mr. Papas explained that his work does not allow him to move around and that
is why he spends most of the time in office. The nurse could introduce a recovery plan for Mr.
Papas so that he involves him in movement activities to introduce him to physical exercises.
During the confinement on bed to reduce oxygen requirement by myocardium, Mr. Papas will
not be allowed to move around freely as this may worsen his condition (Crea & Libby, 2017).
However, after close monitoring and determining that he has fully recovered, it could be
recommended that he is introduced to physical exercise activities to prevent formation of clots in
the narrowed arteries.
The other activity that may be altered is the activity of eating and drinking. Generally,
there is a need to monitor the diet of people with cardiac problems. Mr. Papas stated that he
drinks at least fifteen cigarettes a day. This is a significant number and there is a need to
intervene to help prevent his condition from worsening. According to Sharma, Chomayil, Karim,
and Parambil (2015), cigarette smoking is among the risk factors associated with myocardial
infarction. Mr. Papas will need to take necessary measures to reduce the intake of cigarettes.

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Cigarettes contain a lot of carbon IV oxide which interferes with the little amount of oxygen
available in the body. Reducing smoking will improve the condition of the heart as well as
reduce the onset of the heart attack in future.
The registered nurse could also help Mr. Papas in regulating the working and playing
activities. After Mr. Papas has recovered, the nurse could prepare a plan of care that entails
change in work and movement activities. Since he works in the office, the nurse could
recommend that he takes a walk in the evening with his pet or takes a walk to the bus stage
instead of driving. According to Arrigo (2016), physical exercises and movements reduce the
accumulation of glucose in the coronary artery. Respirational processes also increase the rate at
which fats are burned, making sure that Mr. Papas does not have excess fats that could increase
the narrowing of the coronary artery.
In conclusion, Myocardial infarction can be managed to minimize further damage to
myocardium. Mr. Papas’ smoking habits, drinking of alcohol, and lack of regular movements
could have contributed to his present condition. A registered nurse could help him by educating
him and the family members about the need to monitor the health as well as avoiding some of
the factors that could lead to severe damage to myocardium. His living activities can also be
monitored to help him recover.

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