NURSING HISTORY

 IDENTIFICATION DATA
 NAME - MR. ASHOK SHARMA
 AGE - 58 YEAR
 SEX - MALE
 HOSPITAL NAME - MEDANTA THE MEDICITY
 REGISTRATION NO/ I.P. NO. - 664507
 UNIT/ WARD - ICU 2
 BED NO. - 54
 ADDRESS - LAJPAT NAGAR, DELHI
 MEDICAL DIAGNOSIS - MYOCARDIAL INFRACTION
 DATE OF ADMISSION - 20/11/2015
 DATE OF DISCHARGE - NOT YET PLANNED
 DATE OF CARE STARTED - 23/11/2015
 DATE OF CARE ENDED - 24/11/2015

 SOCIO ECONOMIC DATA

 RELIGION - HINDU
 CASTE - BRAHMIN
 EDUCATION - 12TH
 OCCUPATION - BUSINESSMAN
 MARITAL STATUS - MARRIED
 SPIRITUAL BELIEF - HE HAS BELIEF IN LORD GANESHA
 INCOME (PER MONTH/ ANNUAL) - 40,000/ MONTH
 LANGUAGE KNOWN
 ABLE TO UNDERSTAND - HINDI, ENGLISH
 ABLE TO SPEAK - HINDI
 ABLE TO READ AND WRITE - HINDI, ENGLISH

 FAMILY COMPOSITION

S. NAME AG SEX RELATION EDUCAT OCCUPA HEALTH REMA

N E SHIP ION TION STATUS RK
O
1 MR. 58 M PATIENT 12TH BUSINES SICK
ASHOK SMAN
2 MRS. 54 F WIFE 10TH HOUSE HEALTHY
MADHU YE WIFE
AR
3 MR. M SON M.B.A. JOB HEALTHY
ASHISH 26
YE
AR
FAMILY PEDIGREE

KEYWORD:

MALE -

FEMALE -

CLIENT -

 HEALTH HISTORY
 REASON FOR HOSPITALIZATION- PATIENT HAVING BREATHING
DIFFICULTY, AND CHEST PAIN.

 MODE OF COMING TO HOSPITAL/WARD- BY OWN CAR

 PRESENT ILLNESS
 MEDICAL- MR. ASHOK WAS ADMITTED WITH THE COMPLAIN OF
HEAVINESS IN CHEST WITH BREATHLESSNESS SINCE 7AM ON 20/11/2015.
IT INCREASED ON EXERTION AND RELIVED AT REST.
 SURGICAL- MR. ASHOK DOES NOT UNDER GONE ANY SURGICAL
PROCEDURE.

 PAST ILLNESS:
 MEDICAL- MR. ASHOK HAS HISTORY OF HYPERTENSION SINCE 2 YEARS.
 SURGICAL- MR. ASHOK DOES NOT GONE ANY PAST SURGICAL
PROCEDURE.
 FAMILY HISTORY- MR. ASHOK LIVING IN SMALL FAMILY. HE IS HAVING
GOOD RELATIONSHIP WITH HIS FAMILY MEMBER.
 ALLERGIC HISTORY- MR. ASHOK HAS NO HISTORY OF ANY ALLERGY WITH
FOOD AND MEDICINE.
 DIETARY PATTERN
 DIET: BOTH (VEGETARIAN AND NON VEGETARIAN)
 LIKES: CHICKEN AND RICE
 DISLIKES: CABBAGE
 HABITS: MR. ASHOK KUMAR HAS A HABIT OF SMOKING SINCE 10 YEARS.

 GORDONS FUNCTIONAL HEALTH PATTERN ASSESSMENT:

 HEALTH PERCEPTION:
 HEALTH MANAGEMENT PATTERN: MR. ASHOK MAINTAINS HIS HEALTH
STATUS. AT PRESENT HIS HEALTH IS IMPROVED AND HE IS CONSCIOUS
ABOUT HIS HEALTH.

 NUTRITION:
METABOLIC HEALTH PATTERN: MR. ASHOK IS USED TO HAVE FOOD TWICE
A DAY. HE IS BOTH VEGETARIAN AND NON VEGETARIAN.

 ELIMINATION PATTERN: MR. ASHOK HAS NORMAL ELIMINATION

PATTERN. HE HAS HAVING URINATION OF 4-5 TIMES.

 ACTIVITY PATTERN:
EXERCISE PATTERN: MR. ASHOK IS ABLE TO PERFORM RANGE OF MOTION
EXERCISE BUT FOR SHORT PERIOD.
 SLEEP:
REST PATTERN: MR. ASHOK USE TO SLEEP 8 HOURS OF A DAY. HE SLEEPS
REGULARLY.

 COGNITIVE:
PERCEPTUAL PATTERN: MR. ASHOK HAS GOOD SENSORY FUNCTION OF
HEARING, TOUCH, SMELL AND PAINS ARE NORMAL. PATIENT’S RECENT,
IMMEDIATE AND REMOTE MEMORY IS INTACT.
 SELF PERCEPTION PATTERN: THE VOICE PATTERN OF CLIENT IS DULL.

 ROLE:
RELATIONSHIP PATTERN: MR. ASHOK HAVING GOOD RELATIONSHIP WITH
FAMILY AND SOCIETY.

 SEXUALITY:
REPRODUCTIVE PATTERN: MR. ASHOK IS MARRIED AND HE IS HAVING NO
DISEASE RELATED TO REPRODUCTIVE SYSTEM.

 COPING:
STRESS TOLERANCE PATTERN: MR. ASHOK CAN COPE UP WITH THE
DISEASE CONDITION. HE IS AWARE OF HIS HEALTH PROBLEM.

PHYSICAL EXAMINATION

 GENERAL HEALTH STATUS:

 LEVEL OF CONSCIOUSNESS - CONSCIOUS
 HEIGHT - 165CM
 WEIGHT -75 KG
 APPEARANCE - FATTY
 COMPLEXION - WHITISH
 HEAD TO TOE ASSESSMENT
  GENERAL APPEARANCE
OBSERVATIONS - PATIENT IS FATTY AND INACTIVE
COLOR - WHITISH
SKIN - DRY

 VITAL SIGNS

VITAL SIGNS PATIENT VALUE NORMAL VALUE REMARK

(ORAL/AXILLA
TEMPERATURE IN IN IN IN NORMAL
CELSIUS FAHRENHEIT CELSIUS FAHRENHEIT
37 C 98 F 37.2 98.7 F
PULSE 90B/MIN 72-80B/MIN INCREASED
RESPIRATION 18-20B/MIN 16-20B/MIN NORMAL
BLOOD 140/100 MM HG 120/100 MM HG INCREASED
PRESSURE

HEAD AND FACE

 SIZE-
 SYMMETRY - SYMMETRICAL
 SHAPE - OVAL
 COLOR -WHITISH
 PAIN - ABSENT
 TENDERNESS - ABSENT
 LESION - ABSENT
 EDEMA - ABSENT
 SCALP-
 COLOUR - WHITE
 TEXTURE - HYDRATED
 SCALES - ABSENT
 LUMPS - ABSENT
 LESIONS - ABSENT
 INFLAMMATION - ABSENT
 HAIR
 COLOUR -BLACK
 FACE:
 SHAPE - ROUND
 COLOUR - WHITISH
 MOVEMENT - NORMAL
 EXPRESSION - ANXIOUS
 PIGMENTATION - ABSENT
 ACNE - ABSENT
 TICS - ABSENT
  TREMORS - ABSENT
 SCARS - ABSENT

EYES:

ACUITY:
 GLASSES - ABSENT
 VISUAL LOSS -NORMAL
 DIPLOPIA -ABSENT
 PHOTOPHOBIA -ABSENT
 PAIN BURNING - ABSENT
 EYELIDS-
 COLOR - BLACK
 POTOSI’S - ABSENT
 EDEMA - ABSENT
 STY - ABSENT
 EXTRA OCULAR MOVEMENT-
 POSITION AND ALIGNMENT OF EYES: SYMMETRICAL
 STRABISMUS: ABSENT
 NYSTAGMUS: ABSENT
 CONJUNCTIVA-
 COLOUR: RED
 DISCHARGE: ABSENT
 VASCULAR CHANGES: ABSENT
 IRIS-
 COLOUR: AMBIGUOUS
 VASCULARITY: PRESENT
 JAUNDICE: ABSENT
 PUPILS-
 SIZE: 2 MM
 SHAPE: NORMAL
 EQUALITY: NORMAL
 REACTION TO LIGHT: REACTIVE

EARS-

 ACUITY
 HEARING LOSS: ABLE TO HEAR
 HEARING AID: ABSENT
 PAIN: ABSENT
 TINNITUS: ABSENT
 EXTERNAL EAR-
 LOBE: NORMAL
 AURICLE: PRESENT
 EAR CANAL: PRESENT
o INNER EAR
  VERTIGO:

NOSE-

 SMELL: PRESENT
 SYMMETRY: SYMMETRICAL
 FLARING: ABSENT
 SNEEZING: PRESENT
 DEFORMITIES: ABSENT

MUCOSA

 COLOR: RED
 EDEMA: ABSENT
 EXUDATES: ABSENT
 PAIN TENDENCIES: ABSENT
 SINUS TENDERNESS: ABSENT

MOUTH AND THROAT

 ODOR: FOUL SMELLING

 PAIN: INFLAMMATORY
 ABILITY TO SPEAK: CLEAR
 CHEW: NOT
 SWALLOW: NO PROBLEM
 LIPS-
 HYDRATION: DRY LIPS
 LESIONS: ABSENT
 BLISTER: ABSENT
 SWELLING: ABSENT
 NUMBNESS: ABSENT
 GUMS-
 COLOUR: PINK
 EDEMA: NON PITTING EDEMA
 BLEEDING: ABSENT
 TEETH-
 NUMBER: 32
 MISSING: NO
 CARIES: ABSENT
 TONGUE-
 SYMMETRY: SYMMETRICAL
 COLOR: COATED TONGUE
 HYDRATION: DRY
 PROTRUSION: ABSENT
 ULCERS: ABSENT
 SWELLING: ABSENT
  THROAT-
 GAG REFLEX: PRESENT
 SORENESS: NON SENSITIVE
 COUGH: DRY
 SPUTUM: THIN
 HEMOPTYSIS: ABSENT
 VOICE-
 HOARSENESS: ABSENT
 LOSS: DYSPHONIC
 NECK
 SYMMETRY: SYMMETRICAL
 MOVEMENT: PASSIVE
 RANGE OF MOTION: PRESENT
 MASSES: ABSENT
 SCARS: ABSENT
 PAIN: ABSENT
 STIFFNESS: ABSENT
 TRACHEA-
 DEVIATION:
 THYROID-
 SYMMETRY: SYMMETRICAL
 TENDERNESS: ABSENT
 ENLARGEMENT: ABSENT
 NODULES: NON PALPABLE
 SCARES: ABSENT
 LYMPH NODES-
 SIZE: NORMAL
 SHAPE: ROUND
 MOBILITY: ABSENT
 TENDERNESS: ABSENT
 ENLARGEMENT: ABSENT

CHEST

 SIZE: NORMAL
 SYMMETRY: SYMMETRICAL
 DEFORMITIES: ABSENT
 PAIN: ABSENT
 TENDERNESS: ABSENT
 SKIN-
 COLOR: WHITISH
 RASHES: ABSENT
 SCARS: ABSENT
 HAIR DISTRIBUTION: REGULAR
  TURGOR: GOOD
 TEMPERATURE: NORMAL

LUNGS

 BREATHING PATTERN: IREEGULAR

 RATE: 14 BREATH/ MIN
 REGULARITY: IRREGULAR
 DEPTH: SHORT
 USE OF ACCESSORY MUSCLES: PASSIVE
 SOUND: CRACKLED

HEART

 CARDIAC PATTERNS-
 RATE: SLIGHTLY INCREASED 98 BEATS/MIN.
 RHYTHM: NORMAL
 REGULARITY: REGULAR
 SKIPPED OR EXTRA BEATS: ABSENT

 IMPLANTED PACEMAKER: ABSENT

ABDOMEN

 SYMMETRY: SYMMETRICAL
 MUSCLE TONE: GOOD
 TURGOR: GOOD
 HAIR DISTRIBUTION: REGULAR
 SCARS: SURGICAL
 UMBILICUS: INVERTED
 DISTENTION: ABSENT
 SOUND: NORMAL
 LIVER BORDER: PALPITATION

KIDNEY

 URINARY OUTPUT:
 AMOUNT: 450ML/ DAY
 COLOUR: YELLOW
 FREQUENCY: NORMAL
 DRIBBLING: ABSENT
 INCONTINENCE: ABSENT
 HEMATURIA: ABSENT
 NOCTURIA: ABSENT

GENITALIA
  MALE- PENIS
 DISCHARGE: ABSENT
 ULCERATION: ABSENT
 PAIN: ABSENT
 SCROTUM: PRESENT
 SWELLING: ABSENT
 TENDERNESS: ABSENT
 TESTIS:
 SIZE: NORMAL
 SHAPE: NORMAL
 SWELLING: ABSENT
 MASSES: ABSENT

RECTUM

 PIGMENTATION: ABSENT
 HEMORRHOID: ABSENT
 RASHES: ABSENT
 MASSES: ABSENT
 LESIONS: ABSENT
 TENDERNESS: ABSENT
 PAIN: ABSENT
 ITCHING: ABSENT
 BURNING SENSATION: ABSENT
 BACK-
 SCARS: ABSENT
 EDEMA: ABSENT
 SPIRAL ABNORMALITIES: ABSENT
 PAIN: ABSENT
 TENDERNESS: PRESENT/ ABSENT

EXTREMITIES

 UPPER EXTREMITIES-
 SYMMETRY: SYMMETRICAL
 JOINT: NORMAL
 MUSCLE: NORMAL
 EDEMA: ABSENT
 OTHER SYMPTOMS: ABSENT
 LOWER EXTREMITIES-
 SYMMETRY: SYMMETRICAL
 JOINT: NORMAL
 MUSCLE: ABSENT
 EDEMA: ABSENT
 OTHER SYMPTOMS: ABSENT
 REFLEXES

 BICEPS AND TRICEPS REFLEXES: PRESENT

 PATELLAR REFLEX: PRESENT
 PLANTAR REFLEX: PRESENT

FOCAL ASSESSMENT: MR. ASHOK DIAGNOSE AS MYOCARDIAL INFARCTION.

INSPECTION: HE IS HAVING CHEST PAIN.

PALPITATION: PERIPHERAL PULSE PALPABLE

AUSCULTATION: CRACKLE SOUND PRESENT

PERCUSSION: NO JUGLAR VEIN DISTENTION

INVESTIGATION:

S. NO DATE NAME OF THE PATIENT NORMAL INFERENCE

INVESTIGATION VALUE VALUE
1 20\11\2015 CBC- HB 13GM/DL 13-18 GM/ NORMAL
DL
2 20\11\2015 TOTAL COUNT 12,500 4000-10,000 INCREASED
3 20\11\2015 CPK 1454U/L 24-1950/L INCREASED
4 20\11\2015 UREA 23 MG/DL 10 – 50 NORMAL
MG/DL
5 20\11\2015 PROTHROMBIN TIME 11 SEC 12 – 20 SEC NORMAL
6 20\11\2015 CHOLESTEROL 300 MG/ DL <225 MG/DL INCREASED

 2D ECHO DONE
 X RAY CHEST DONE
 USG ABDOMEN DONE

MEDICAL TREATMENT:

S. NAME PHARMAC DOSE ROU FREQUE ACTION CONTRA SIDE NURSES

N OF THE OLOGICL TE NCY INDICAT EFFECTS RESPON
O MEDICA NAME ION SIBLITY
TION
1 ECOSPI ASPIRIN 150M ORA OD ANALGESI ALLERG GI: TABLET
RIN G LLY CS, Y TO ULCERS, SHOULD
ANTI NSAIDS, BLEDDI BE
 PYRETIC, ASTHMA NG STORED
NSAIDS IN ROOM
TEMPRA
TURE.

2 CLOPID CLOPIDOG 75MG ORA BD ANTI CV: HEADAC ADVICE

OL RAL LLY SWELLI HE, TO
COAGULA NG, NAUSEA, AVOID
NTS HIGH HEART DRINK
B.P. BURN ALCOHO
LS
3 SIMVAS SIMVAST 40MG ORA HS DYSLIPIDI ALD, HEADAC ALWAYS
ATIN LLY MIC PREGNA HE, GI FOLLOW
AGENT NCY DISTURB RIGHTS
ED
4 MONOT ISOSORBI 20 ORA BD NITRATE ALLERGI
RATE D MG LLY CLASS C
MONONIT DRUG REACTIO
RATE USED FOR NS
THE
PROPHYL
ACTIC
TREATME
NT

CRITICAL PATHWAY

S.NO NAME OF THE DAY ONE DAY TWO DAY THREE DAY FOUR
INVESTIGATION AND
VALUE
1 TLC TAB- TAB- TAB- TAB-
ECOSPIRIN ECOSPIRIN ECOSPIRIN ECOSPIRIN
150 MG 150 MG 150 MG 150 MG

INTAKE AND OUT PUT CHART

DATE INTAKE OUTPUT

TIME BY MOUTH TUBE PARENT URINE EMESIS SUCTI
RAL VOIDED CATHETER ON
7AM TEA- 50ML RL500M 250 ML
POHA 150ML L
9AM MILK- 200ML
12 PM 100ML
2 PM SOUP- 100
ML
LUNCH AND
WATER- 300
ML
TOTAL 650 ML 500ML 450 ML
3PM- NS 500 300ML
11PM COCONUT ML
5PM WATER- 250ML
100ML
8PM TEA- 50 ML 200ML
DINNER
AND
WATER- 250
ML

TOTAL 400 ML 750ML

11PM
-7AM 250 ML
WATER-100
11PM ML

100 ML 250 ML

24 1350 ML 1000ML 1500ML

HOUR
T

MYOCARDIAL INFRACTION
INTRODUCTION: ACUTE MYOCARDIAL INFARCTION IS THE MEDICAL TERM AS
FOR AN EVENT COMMONLY KNOWN AS HEART ATTACK. IT HAPPENS WHEN
BLOOD STOPS FLOWING PROPERLY TO PART OF THE HEART AND HEART AND
HEART MUSCLES IS INJURED DUE TO NOT RECEIVING ENOUGH OXYGEN. ACUTE
MYOCARDIAL INFRACTIONS REMAIN A LEADING CAUSE OF MORBIDITY AND
MORTALITY WORLDWIDE. MYOCARDIAL INFARCTION OCCURS WHEN
MYOCARDIAL ISCHEMIA, A DIMINISHED BLOOD SUPPLY TO THE HEART,
EXCEEDS A CRITICAL THERE HOLD AND OVER WHELMS MYOCARDIAL
CELLULAR REPAIR MECHANISMS DESIGNED TO MAINTAIN NORMAL OPERATING
FUNCTION AND HOMEOSTASIS. ISCHEMIA AT THIS CRITICAL THERE HOLD LEVEL
FOR AN EXTENDED PERIOD RESULTS IN IRREVERSIBLE MYOCARDIAL CELL
DAMAGE OR DEATH.

DEFINITION: MYOCARDIAL INFARCTION IS THE DESTRUCTION OF HEART

TISSUE RESULTING FROM OBSTRUCTION OF THE BLOOD SUPPLY TO THE HEART
MUSCLE.

ANATOMY AND PHYSIOLOGY: THE HEART IS A HOLLOW MUSCULAR ORGAN

THAT PUMPS BLOOD THROUGH OUT TO THE BLOOD VESSELS TO VARIOUS PART
OF THE BODY BY REPEATED, RHYTHMIC CONTRACTIONS. IT IS FOUND IN ALL
ANIMALS WITH CIRCULATORY SYSTEMS, WHICH INCLUDES THE VERTEBRATES.
THE VERTEBRATE HEART IS PRINCIPALLY COMPOSED OF CARDIAC MUSCLE SIS
AN INVOLUNTARY STRIATED MUSCLE TISSUE SPECIFIC TO THE HEART AND IS
RESPONSIBLE FOR THE HEARTS ABILITY TO PUMP BLOOD. THE AVERAGE
HUMAN HEART, BEATING AT 72BEATS PER MINUTE, WILL BEAT
APPROXIMATELY 2.5 BILLION TIMES DURING AN AVERAGE 66 YEAR LIFESPAN,
AND PUMPS APPROXIMATELY 4.7-5.7 LITER OF BLOOD PER MINUTE. IT WEIGHS
APPROXIMATELY 250 TO 300 GRAMS (9 TO 11 OZ) IN FEMALE AND 300 TO 350GM.
THE ADULT HUMAN HEART HAS A MASS OF BETWEEN 250 AND 250 GRAMS AND
IS ABOUT THE SIZE OF A FIST. IT IS LOCATED ANTERIOR TO THE VERTEBRAL
COLUMN AND POSTERIOR TO THE STERNUM. IT IS ENCLOSED IN A DOUBLE
WALLED SAC CALLED THE PARTIAL PERICARDIUM AND THE INNER ONE THE
VISCERAL PERICARDIUM. BETWEEN THEM THERE IS SOME PERICARDIUM FLUID
WHICH FUNCTIONS TO PERMIT THE INNER AND OUTER WALLS TO SIDE EASILY
OVER ONE ANOTHER WITH THE HEART MOVEMENTS OUTSIDE THE PARTIAL
PERICARDIUM IS A FIBROUS LAYER CALLED THE FIBROUS PERICARDIUM WHICH
IS ATTACHED TO THE MEDIASTINAL FASCIATHIS SAC PROTECTS THE HEART
AND ANCHORS TO THE SURROUNDING STRUCTURES THE OUTER WALL OF THE
HUMAN HEART IS COMPOSED OF THREE LAYERS. THE OUTER LAYER IS CALLED
THE EPICARDIUM, OR VISCERAL PERICARDIUM SINCE IT IS ALSO THE INNER
WALL OF THE PERICARDIUM. THE MIDDLE LAYER IS CALLED MYOCARDIUM AND
IS COMPOSED OF CONTRACTILE CARDIAC MUSCLE. THE INNER LAYER IS
CALLED THE ENDOCARDIUM AND IS CONTACT WITH THE BLOOD THAT THE
HEART PUMPS, ALSO IT MERGES WITH THE INNER LINING OF BLOOD VESSELS
AND COVERS HEART VALVES.

FUNCTION OF THE HEART: THE HEART PUMPS BLOOD WHICH CARRIED

MATERIALS NECESSARY FOR OUR ORGANS TO FUNCTION. A HUMAN HEART
CONTRACTS NEARLY 2.5 BILLION TIMES DURING AN AVERAGE HUMAN LIFE AND
DURING THIS PERIOD, 180 MILLION LITERS OF BLOOD ARE PUMPED IN TO THE
VESSELS.

ETIOLOGY:

IN BOOK IN PATIENT

ATHEROSCLEROSIS ATHEROSCLEROSIS

SMOKING SMOKING

LACK OF EXERCISE LACK OF EXERCISE

JOB STRESS JOB STRESS

HIGH LDL CHOLESTEROL LEVEL

HIGH B.P.

DIABETES

CKD

 ATHEROSCLEROSIS: MI RESULTS FROM ATHEROSCLEROSIS

INFLAMMATION IS KNOWN TO BE AN IMPORTANT STEP IN THE PROCESS
OF ATHEROSCLEROTIC PLAQUE FORMATION.
 SMOKING: SMOKING APPEARS TO BE THE CAUSE OF ABOUT 36% AND
OBESITY THE CAUSE OF 20% OF CORONARY ARTERY DISEASE.
 LACK OF EXERCISE: LACK OF EXERCISE HAS BEEN LINKED TO 7-12% OF
CASES.
 DIABETES MELLITUS: PATIENT HAVE DIABETES MELLITUS 1
SUBSTANTIALLY GREATER RISK OF ATHEROSCLEROTIC VASCULAR
DISEASE IN THE HEART AS WELL AS IN OTHER VASCULAR BEDS.

PATHOPHYSIOLOGY:

DUE TO ATHEROSCLEROSIS

REDUCED BLOOD FLOW IN A CORONARY ARTERY

VASOSPASM DECREASED OXYGEN SUPPLY

ISCHEMIA DEVELOPS, CELLULAR INJURIES OCCURRED

LACK OF OXYGEN RESULTS N INFRACTION

SIGN AND SYMPTOMS:

IN BOOK IN PATIENT

CHEST PAIN CHEST PAIN

DYSPNEA DYSPNEA

DIAPHORESIS DIAPHORESIS

LOSS OF CONSCIOUSNESS

 CHEST PAIN IS A MAJOR SYMPTOMS OF HEART ATTACK. YOU MAY FEEL

THE PAIN IN ONLY ONE PART OF YOUR BODY, OR IT MAY MOVE FROM
YOUR CHEST TO YOUR ARMS, SHOULDER, NECK, TEETH, JAW, BELLY
AREA, OR BACK.
 A TIGHT BAND AROUND THE CHEST
 SOMETHING HEAVY SITTING ON YOUR CHEST

DIAGNOSTIC EVALUATION:

IN BOOK IN PATIENT

ECG ECG

SERUM ENZYME SERUM ENZYME

ECHO CARDIOGRAM ECHO

CARDIOGRAM

 ELECTRO CARDIOGRAM: AN ECG IS A RECORDING OF THE ELECTRICAL

ACTIVITY OF THE HEART. ABNORMALITIES IN THE ELECTRICAL ACTIVITY
USUALLY OCCUR WITH HEART ATTACKS AND CAN IDENTIFY THE AREAS
OF HEART MUSCLE.
 BLOOD TEST: CARDIAC ENZYMES ARE PROTEINS THAT ARE RELEASED
INTO THE BLOOD BY DYING HEART MUSCLES. THESE CARDIAC ENZYMES
ARE CREATININE, PHOSPHOKINASE (CPK), AND TROPONIN AND THEIR
LEVEL SCAN BE MEASURED IN BLOOD.
 ANGIOPLASTY: DURING ANGIOPLASTY, A THIN, FLEXIBLE TUBE WITH A
BALLOON ON THE END IS THREADED THROUGH A BLOOD VESSEL TO THE
BLOCKED CORONARY ARTERY.

MANAGEMENT:

MEDICAL MANAGEMENT:

IN BOOK IN PATIENT

ACTIVITY RESTRICTION COPE UP WITH

STRESS
EFFECTIVE COPE UP WITH THE STRESS

SMOKING

CAFFEINE INTAKE REDUCTION

EXERCISE AND WEIGHT REDUCTION

 KEEP YOUR BLOOD PRESSURE, BLOOD SUGAR AND CHOLESTEROL UNDER

CONTROL.
 DON’T SMOKE.
 EAT A LOW FAT DIET RICH IN FRUITS AND VEGETABLES.
 EXERCISE DAILY OR SEVERAL TIMES A WEEK.
 LOSE WEIGHT IF YOU ARE OVERWEIGHT.

PHARMACOLOGICAL MANAGEMENT:

IN BOOK IN PATIENT

THROMBOLYTIC TAB. ECOSPIRIN 150

MG

ANALGESICS TAB. CLOPID 75 MG

ACE INHIBITORS TAB. SIMVAS 40 MG

ASPIRIN TAB. MONOTRATE 20

MG

SURGICAL MANAGEMENT:

IN BOOK IN PATIENT

CABG CABG

PTCA PTCA TO LAD

NUTRITIONAL MANAGEMENT:

IN BOOK IN PATIENT

LOW FAT DIET LOW FAT DIET

LOW CHOLESTEROL DIET LOW

CHOLESTEROL DIET

o EAT A LOW FAT DIET RICH IN FRUITS AND VEGETABLES AND LOW
ANIMAL FAT.
 o EAT FISH TWICE A WEEK. BAKED OR GRILLED FISH IS BETTER THAN FRIED
FISH.
o LOSE WEIGHT.
o EXERCISE DAILY OR SEVERAL TIMES A WEEK.

NURSING THEORY APPLICATION:

VIRGINIA HENDERSON THEORY: SHE DEVELOPS HER DEFINITION BASED ON

SCIENCES OF PHILOSOPHY MEDICINE, PSYCHOLOGY AND PHYSICS. IN THIS SHE
EMPHASIZES THE CARE OF SICK AND WEEK INDIVIDUALS. ACCORDING TO HER
SHE ASSISTS THE PATIENT WITH ESSENTIAL ACTIVITIES TO MAINTAIN HEALTH,
ECOVER FROM ILLNESS OR PEACEFUL DEATH.

ASSESSMENT:

 ASSESS THE BREATHLESSNESS AND BREATHING PATTERN.

 ASSESS FOR LEVEL OF PAIN, CHEST COMFORT.
 ASSESS FOR NUTRITION PATTERN AND ANOREXIA.
 ASSESS FOR ANXIETY AND FEAR.

NURSING INTERVENTION:

 PROVIDE COMFORTABLE POSITION

 PROVIDE OXYGEN THERAPY
 PROVIDE SMALL AND FREQUENT DIET

HENDERSON THEORY:

 BREATH NORMALLY
 MOVE AND MAINTAIN DESIRABLE POSITIONS.
 EAT AND DRINK ADEQUATELY.
 ELIMINATE BODY WASTE.

NEED OF THE PATIENT:

 NEED TO MANAGE FOR THE CHEST PAIN.

 NEED FOR NORMAL BREATHING.
 NEED FOR THE MAINTENANCE OF NUTRITIONAL STATUS.

NURSING DIAGNOSIS:

 INEFFECTIVE BREATHING PATTERN RELATED TO INADEQUATE

OXYGENATION AS MANIFESTED BREATHLESSNESS.
 CHEST PAIN RELATED TO DECREASED CARDIAC OUTPUT AS MANIFESTED
BY FACIAL EXPRESSION AND BODY POSTURE.
 ACTIVITY INTOLERANCE RELATED TO DECREASED CARDIAC OUTPUT AS
MANIFESTED BY INABILITY TO PERFORM ACTIVITIES.
  DISTURBED SLEEP PATTERN RELATED TO SHORTNESS OF BREATH AND
PHYSICAL DISCOMFORT AS MANIFESTED BY VERBALIZATION.
 ANXIETY AND STRESS RELATED TO ITS PROGNOSIS AND DISCOMFORT AS
MANIFESTED BY QUERIES DONE BY THE PATIENT.

PLANNING

ASSESS NURSING GOALS INTERVENTI IMPLEMENTA RATIONALE EVALUA

MENT DIAGNOS ON TION TION
IS
INEFFECT PATIEN CHECK THE CHECKED TO SEE THE PATIENT
SUBJECT IVE T WILL VITAL SIGN. THE VITAL SIGNS OF GOT
IVE BREATHI MAINT SIGN. BREATHLESS RELIVED
DATA: NG AIN THE CHECK THE NESS FROM
PATIENT PATTERN NORMA OXYGEN CHECKED BREATH
SAYS RELATED L LEVEL WITH THE OXYGEN TO DETECT LESSNES
THAT HE TO BREAT PULSE LEVEL WITH THE CHANGES S AS
IS INADEQU HING OXIMETRE. PULSE IN OXYGEN MANIFE
HAVING ATE PATTER OXIMETRE. LEVEL. STED BY
SHORTN OXYGEN N. PROVIDE RESPIRA
ESS OF ATION AS FOWLER’S TORY
BREATH. MANIFES POSITION TO PROVIDED RATE.
OBJECTI TED BY THE FOWLER’S FOWLERS
VE SHORTNE PATIENT. POSITION TO POSITION
DATA: I SS OF THE DESCENDS
OBSERV BREATH. PROVIDE PATIENT. THE
ED THAT OXYGEN DIAPHRAGM
PATIENT SUPPLY. AND GIVES
HAVING MORE SPACE
DIFFICU PROVIDED TO LUNGS
LTY OXYGEN FOR
SUPPLY. EXPANSION.

OXYGEN
HELPS TO
MAINTAIN
THE
SATURATION
LEVEL.

PLANNING

ASSESSM NURSING GOALS INTERVEN IMPLEMEN RATIONALE EVALUA

ENT DIAGNOSIS TION TATION TION

SUBJECTI ACTIVITY PATIE MONITOR MONITORE TO KNOW PATIENT

VE DATA: INTOLERA NT THE D THE ABOUT THE MAINTAI
PATIENT NCE WILL PATIENT PATIENT ACTIVITY NED THE
SAYS RELATED IMPRO LEVEL OF LEVEL OF OF PATIENT. NORMAL
THAT HE TO VE ACTIVITY. ACTIVITY. ACTIVITI
IS BREATHLE THE ES AS
HAVING SSNESS AS ACTIVI PROVIDE PROVIDED GOOD SLEEP MANIFE
WEAKNE MANIFESTE TY. COMFORT COMFORT INDUCES STED BY
SS AND D BY ABLE ABLE THE PERFOR
FATIGUE. FATIGUE, POSITION POSITION ENERGY MED HIS
WEAKNESS TO THE TO THE LEVEL. DAILY
OBJECTIV AND PATIENT. PATIENT. ACTIVITI
E DATA: INABILITY ES.
HE TO TEACH TAUGHT TO ACHIEVE
CANNOT PERFORM ABOUT ABOUT MAXIMUM
DO THE ABILITY. ENERGY ENERGY INDEPENDE
ACTIVITY CONSERV CONSERVA NCE FOR
HE ATION TION SELF CARE.
NEEDS TECHNIQU TECHNIQU
ASSISTA E. E.
NCE.

PLANNING

ASSESSM NURSING GOALS INTERVEN IMPLEMEN RATIONALE EVALUAT

ENT DIAGNOSIS TION TATION ION

SUBJECTI ANXIETY TO ASSESS ASSESSED TO KNOW ANXIETY

VE DATA: RELATED RELIE THE THE LEVEL HOW MUCH LEVELS
PATIENT TO DISEASE VE LEVEL OF OF ANXIOUS REDUCED
SAYS CONDITION THE ANXIETY. ANXIETY. HE IS. AS
THAT I AS ANXIE MANIFES
AM MANIFESTE TY. VERBALIZ VERBALIZE IT HELPS TO TED BY
FEELING D BY E WITH D WITH THE REDUCE VERBALI
VERY RESTLESSN THE PATIENT. THE ZE.
FEAR ESS AND PATIENT. ANXIETY.
ABOUT VERBALIZE GIVEN THE
THE . GIVE THE PATIENT IT HELPS TO
DISEASE. PATIENT PSYCHOLO RELIEVE
PSYCHOL GICAL HER
OBJECTIV OGICAL SUPPORT. ANXIETY
E DATA: SUPPORT. . TO SOME
PATIENT . EXTENT.
WAS
VERY
ANXIOUS
AND
DEPRESS
ED.

NURSING MANAGEMENT:

IN BOOK IN PATIENT

ADVICE THE PATIENT TO STOP ADVICE THE PATIENT TO STOP

SMOKING. SMOKING.

ADVICE HIM TO DO DAILY EXERCISE ADVICE HIM TO DO DAILY EXERCISE

REGULARLY. REGULARLY.

ADVICE TO KEEP WEIGHT. ADVICE TO KEEP WEIGHT

ADVICE TO EAT A LOW FAT DIET. ADVICE TO EAT A LOW FAT DIET.

HEALTH EDUCATION:

 NUTRITION
TO EAT MORE VEGETABLES
TO INCREASE THE INTAKE OF WATER.
AVOID FRIED AND SPICY FOOD.
 MEDICATION:
ADVICE TO TAKE MEDICINE AS PER DOCTOR ORDER.
ADVICE TO TAKE MEDICINE AFTER MEALS.
 EXERCISE:
EDUCATE THE PATIENT TO AVOID EXERCISE WHICH MAKES HIM MORE
TIRED AND STENEOUS.
 FOLLOW UP:
ADVICE HIM TO DO AS FOLLOW UP.

PROGNOSIS: THE PROGNOSIS AFTER MI VARIES GREATLY DEPENDING ON

PERSONS HEALTH, THE EXTENT OF THE HEART, DAMAGE AND TREATMENT
GIVEN.

SUMMARY: MR. ASHOK WAS ADMITTED IN ICU WITH THE DIAGNOSIS OF MI. I
TOOK HISTORY, PHYSICAL EXAMINATION, VITAL SIGNS.
CONCLUSION: MR. ASHOK IS DIAGNOSED AS MI AND HE HAS TO UNDERGO
SURGICAL MANAGEMENT AFTER THE IMPROVEMENT AND AFTER THE
STABILITY OF HIS HEALTH.

PRAGYAN COLLEGE OF NURSING

BHOPAL
 NURSING CARE PAN

SUBJECT: ADVANCED NURSING PRACTICE

TOPIC: SUBARACHNOID HEMORRHAGE

REMARKS:

SUBMITTED TO SUBMITTED BY
MR. MEJO PHILIP MS. MEENA KHANDKURE
ASSISTANT PROFESSOR M. SC (N) 1ST YEAR

DATE OF SUBMISSION: 1/3/16

PRAGYAN COLLEGE OF NURSING, BHOPAL
 NURSING CAR PLAN

SUBJECT: ADVANCED NURSING PRACTICE

TOPIC: SUBARCKNOID HEMORRHAGE

REMARKS:

SUBMITTED TO
SUBMITTED BY
MR. MEJO PHILIP MS. MEENA
KHANDKURE
ASSISTANT PROFESSOR M. SC (N)
1STYEAR

DATE OF SUBMISSION: 1/3/16