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Original Question

The purpose for this case study is to enable students to produce a nurse-led case management plan, using evidence-based information relevant to nurses and up-to-date Australian statistics, for improving the health and quality of life for an older adult who have suffered a myocardial infarction. Content should include discussion on pathophysiological treatment options, based on national guidelines and implications for nursing practice. Patient profile Kath Harris is a 65-year old lady who lives alone. Kath was doing light cleaning around the house, prior to the onset of her pain. Mrs. Harris has a history of unstable angina, hypertension and diabetes mellitus type 2. She is a cigarette smoker, smoking two packets of cigarettes a day, for approximately 40 years. A recent history of indigestion suggests an active peptic ulcer. She is also obese (her body mass index is 32). She has had a history of head trauma due to an incident a few months ago, where she fell down a set of stairs. Mrs Harris’ current medication includes; GTN spray, carvedilol, and metformin. Subjective data • She had taken three glyceryl trinitrate tablets, which had little effect on reducing her chest pain. • Has an 6/10 chest pain • Pt is nauseated • Appears distressed Objective data Physical examination • GCS 15 • BP 92/58mmHg, HR 92 bpm, Temp 37 0Celsius, Resp 28 bpm, SaO2 91% RA, • Skin was pale • Peripheries were cool Diagnostic studies Lipid Studies • Total lipid 9.2 • Triglycerides 6.5 • Total cholesterol 7.95 • HDL cholesterol 2.1 • LDL cholesterol 5.97 2 Electrolytes • Sodium 138 • Potassium 4.9 • Chloride 97 • Bicarbonate 21 • Glucose 11.2 • Iron 5.4 • HbA1c 7.9 Your assignment is to produce a written piece of work addressing the following areas; PATHOPHYSIOLOGY • Briefly explain the pathophysiology of myocardial infarction in this patient. In your answer identify the clinical manifestations of an MI demonstrated by Kath Harris and why these are occurring. Identify the risk factors evident within this case study. How would you manage Mrs Harris’ care? MANAGEMENT • Outline the immediate nursing and medical management Mrs Harris requires in the treatment of an acute MI. In your answer include the pharmacological management required by a patient with an acute coronary syndrome. MEDICATIONS • Identify three medications that would be used in the treatment of an MI and outline the indication for use, mechanism of action, administration method, side effects, and nursing care required for these medications

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