Republic of the Philippines

GOLDEN GATE COLLEGES

P.Prieto St. Batangas City
COLLEGE OF NURSING, CAREGIVING AND MIDWIFERY

CASE STUDY

Acute Coronary Syndrome

RLE-GROUP 3A2- 2

BUHAT, Fatima Mae R.

BUISAN, Aniway F.

BULASAG, Kimberly

CABATAY, Sharnelle Nicolle

CATEDRILLA, Kristine Joy

CLARIN, John Michael F.

DAGOS, Kaila Antonette D.

DE CASTRO, Camila Jean

DE CASTRO, Maria Aliza Gwen D.

DEL ROSARIO, Joricel P.

GALDIANO, Paula Angela

GALLARDO, Kimberly Anne E.

Clinical Instructor

Miss Beverly Anne E. Guerra, RN, LPT, MAN, CLSSYB

 TABLE OF CONTENTS

I. Introduction 2

II. Clinical History 2

a. Patient's Profile
b. Present Illness History
c. Past Medical History
d. Family History

III. Physical Assessment 3

IV. Anatomy and Physiology 4

V. Pathophysiology 6

VI. Laboratory Diagnostic Examination with Analysis 7

VII. Drug Study 10

VIII. Nursing Care Plan 15

IX. Prognosis 17

XI. Discharge Planning

X. Proposed Actions & Recommendations 17

1
INTRODUCTION Buisaan, Aniway F.

Acute coronary syndrome is a term that describes a range of conditions related to

sudden, reduced blood flow to the heart. Acute coronary syndrome, or ACS, is an
umbrella term for three medically serious heart ailments: unstable angina and two types
of myocardial infarction or heart attack. What the three have in common is a severe
reduction or stoppage of blood flow to the heart, resulting either from the rupture or
blockage of the coronary arteries. A heart attack happens when cell death damages or
destroys heart tissue. Any occurrence of ACS is potentially life-threatening and should
be treated as a medical emergency. This is because blood stoppage leads to rapid cell
death and irreparable heart damage. Unstable angina occurs when blood flow to the
heart decreases. An acute coronary syndrome (ACS) is a constellation of signs and
symptoms associated with insufficient flow through the coronary tree and the resultant
acute ischemia of the myocardium. The classic symptom of ACS is substernal chest pain
or chest discomfort often described as crushing or pressure-like feeling, radiating to the
jaw and/or left arm and it can be accompanied by shortness of breath, diaphoresis, and
sometimes an impending sense of doom. This classic presentation is not always seen,
and the presenting complaint can be very vague and subtle with chief complaints often
being difficulty breathing, lightheadedness, isolated jaw or left arm pain, nausea,
epigastric pain, diaphoresis, and weakness. Female gender, patients with diabetes, and
older age are all associated with ACS presenting with vague symptoms.

Acute coronary syndrome (ACS) refers to a spectrum of acute myocardial ischaemia

and/or infarction. Classically ACS has been divided into three clinical categories
according to the presence or absence of ST-segment elevation on the initial ECG,
together with measurement of myocardial biomarkers, such as high-sensitivity cardiac
troponins.The location of the blockage, the length of time that the blood flow is blocked,
and the amount of damage that occurs determines the type of acute coronary syndrome.
The term ACS usually encompasses three different subtypes of clinical presentations,
unstable angina, (unstable angina, involves sudden, unexpected chest pain or
pressure, even while resting. It is a warning sign of heart attack and occurs when stable
angina worsens. And non-ST (-segment) elevation myocardial infarction (NSTEMI), (a
heart attack that a provider can detect with blood test but not with an electrocardiogram
(ECG) means coronary arteries aren’t fully blocked or were blocked for a short amount
of time. Lastly, ST (-segment) elevation myocardial infarction (STEMI) is a much more
severe heart attack that providers can detect with blood tests and ECG. It occurs when

2
blood flow to your heart is fully blocked for a long time, affecting the large part of the
heart. ACS is a manifestation of CHD (coronary heart disease) and usually a result of
plaque disruption in coronary arteries (atherosclerosis) restricts the flow of blood and
therefore the delivery of oxygen to the heart. Plaque is made up of cholesterol, fat, cells,
and other substances. The common risk factors for the disease are smoking,
hypertension, diabetes, hyperlipidemia, male sex, physical inactivity, family obesity, and
poor nutritional practices. Cocaine abuse can also lead to vasospasm. A family history of
early myocardial infarction (55 years of age) is also a high-risk factor.

CLINICAL HISTORY Dagos, Kaila Antonette D.

PATIENT’S PROFILE

Patients name: X
Age: 60 year-old
Sex: Male
Religion: Roman Catholic
Date of Birth: January 16, 1963
Nationality: Filipino
Address: 0182, Balagtasin, San Jose, Batangas
Occupation: Bakery owner
Admission Date: October 11, 2023
Chief Complaint: Epigastric pain

PRESENT HISTORY

One week prior to admission, the patient experiences epigastric pain

and sweats, and observed pale skin. The pain was tolerable at the first few
days, but the pain became so severe with a 10/10 pain scale on the day of
admission. He asked her wife to take him to the hospital because he can no
longer tolerate the pain. He was rushed to the emergency room of San Jose
District Hospital.
An hour prior to admission, a 60 male patient was presented on
October 11, 2023 with epigastric pain as chief complaint. He was transferred
from San Jose District Hospital to United Doctors of St.Camillus De Lellis
Hospital and Medical Center as referred by Dr. Villanueva, the patient’s

3
 attending physician in San Jose. The patient was accompanied by his wife.
He was received with oxygen via nasal cannula and foley catheter connected
to urine bag in the ER. Furthermore, the patient was transferred in the ICU of
Camillus.

PAST MEDICAL HISTORY

Patient X has a history of cholecystitis and had undergone
cholecystectomy 5 years ago. In addition, he was previously admitted to NL
Villa Memorial Medical Center 8 years ago and was diagnosed with
cardiomegaly. It was manifested through shortness of breath, difficulty of
breathing and severe headache. This condition made him stop working. He
used to smoke at least 6 sticks of cigarettes a day before but he stopped
smoking together with alcohol consumption 18-20 years ago. The patient also
had a history of hypertension and Gastroesophageal Reflux Disease (GERD).
On the other hand, the patient does not have any history of asthma and
diabetes mellitus. He also does not have any allergies in food and
medications.

FAMILY HISTORY
Patient X is a 60 year old male and is currently living at 0182,
Balagtasin, San Jose, Batangas together with his family. He has a wife and
four children who are all male. Patient X revealed that they have a family
history of heart problems. The patient’s eldest sibling and the one before him
has heart problems.

PHYSICAL ASSESSMENT Del Rosario, Joricel P.

GENERAL SURVEY: Awake, Alert, and Responsive

BP: 100/7 mmHg SPO2: 97%

TEMP: 36.5 WEIGHT: 68 kilograms

RR: 21 bpm HEIGHT: 162 cm

PR: 73 bpm

4
 I. Gordon’s Functional Health Pattern

Gordon’s Functional Health Pattern

Prior to the lack of awareness or symptoms related to his

1. Health disease, the patient experienced severe epigastric pain.
Perception/Health Due to that, the patient is on time taking all of the drugs
Management prescribed to him and is getting regular checks of his BP to
be aware of any further improvements to the patient's
condition.

The patient used to smoke at least 6 sticks of cigarettes a

2. Nutritional day before but he stopped smoking together with alcohol
Metabolic consumption 18-20 years ago. The patient's nutritional and
metabolic status have been affected. Losing weight of 4 kg.
The doctors prescribed a specific diet, which is Low Salt
and Low Fat. Although the patient can now eat and drink, it
is still strictly advised to monitor because the patient is at
risk for aspiration.

The patient has a brown soft stool and eliminates once a

3. Elimination day. He uses a foley catheter for urination. Urine output
Pattern was monitored every hour.

The patient does not do any activities, so he is being

4. Activity-Exercise positioned every 1 to 2 hours to prevent bed sores and to
Pattern. promote circulation

The patient was normal as before in his cognitive and

5. Cognitive- perceptual pattern. He responds clearly and
Perceptual well-understood. He has no sensory deficit. He responds
Pattern appropriately to verbal and physical stimuli and obeys
simple commands.

6. Sleep-Rest The patient has no difficulty sleeping and sleeps around

Pattern 6-8 hours. He feels comfortable in the hospital.

7. Self-Perception/ The patient is hopeful to recover, because he always

Self Concept listens to his child and wife. He also believed that being in
Pattern the hospital would allow him to be treated better than at
home. He never feels alone when there is someone there
for him.

5
8. Role- The patient is married with four children. He lives with his
Relationship wife and young son, and he loves his family. His wife is
Pattern always there to assist him, they call each other if they are
not together. Their family wants to assure that he is okay
and always there for him.

9. Sexuality-
Reproductive The patient is married, but with his condition, he said that
Pattern they do not have an active sexual life.

10. Coping / Stress Patient copes with stress by taking care of himself. He likes
Tolerance Pattern watching action movies together with his family to relieve
stress, he also visits his brother to lessen the stress and
problems.

11. Value-Belief The patient is Roman Catholic and truly faithful to God. He
Pattern regularly prays and attends church every Sunday with his
family. Their personal and religious beliefs influence the
treatment plans and healthcare decisions they make.

II. REVIEW OF SYSTEMS

System Assessment Normal Actual Remarks

Findings Findings

Integumentary
System Skin, hair and
nails:
Skin Color Normal Skin The patient Normal
Color has normal
skin color
(brown).

Temperature Normal skin The skin Normal

temperature temperature of
for healthy the patient is
adult’s ranges mostly ranging
between 92.3 from 37°C- 37.4
and 98.4 °C which is
Fahrenheit or normal.
33-37 Celsius.

6
Condition The skin is Smooth with Normal
neither too dry good skin
nor too oily. turgor
Excessive No signs of No signs of
sweating excessive excessive Normal
sweating. sweating.

Rashes No signs of No signs of Normal

rashes. rashes.

Lesions It has regular Lesions are

texture, no not present in Normal
imperfections the patient.
and a clean,
soft
appearance,
and does not
need special
care.

Balding No signs of No signs of

Normal
balding balding

Head and
neck:
Headache No signs of No signs of Normal
headache headache

Swelling No swelling No swelling Normal

Stiffness of No stiffness No stiffness Normal

neck

Difficulty No signs of No signs of Normal

swallowing difficulty of difficulty of
swallowing swallowing

Eyes: 20/20 vision is The patient Normal

Vision normal vision has a normal
acuity (the vision

7
 clarity or
sharpness of
vision)
measured at a
distance of 20
feet.

No signs of No signs of
Eye infections eye infections. Normal
eye infections.

Normal color Patient has

Redness Normal
is white. normal color of
sclera
Excessive No signs of
No signs of Normal
tearing excessive
excessive
tears.
tears.

Halos around No signs of

No signs of Normal
lights halos around
halos around
lights
lights.

Blurring No presence
No presence
of blurred Normal
of blurred
vision.
vision.

Ears: The 'normal' No signs of Normal

Hearing hearing hearing loss
frequency
range of a
healthy young
person is
about 20 to
20,000Hz

Mouth,
throat, nose
and sinuses:

Condition of Healthy teeth No signs of Normal

teeth and are white or tooth decay
gums slightly
off-white in
color, with

8
 smooth
surfaces and
well-defined
edges.

Respiratory Thorax and Observation of No presence Normal

system lungs: breathing of difficulty
Difficulty pattern should breathing.
breathing include an
assessment of
rate (12 to 20
breaths per
minute is
normal)

Wheezing No signs of No signs of

Normal
wheezing. wheezing.

Pain No signs of No signs of Normal

chest pain. chest pain.

Shortness of No signs of No signs of

breath during shortness of shortness of Normal
routine activity breath during breath during
routine activity routine activity.

Orthopnea The patient

No incidence Normal
of orthopnea. has not
experienced
orthopnea.

No signs of No signs of
Cough or
cough or cough or Normal
sputum
sputum sputum

Hemoptysis
No signs of
No signs of hemoptysis. Normal
hemoptysis.

Respiratory No signs of
respiratory Normal
infections No signs of

9
 respiratory infections.
infections.

Cardiovascular Heart and Normal blood The patient Hypertension

system neck vessels: pressure for present blood is one of the
Last blood most adults is pressure is predominant
pressure defined as a 100/70 risk factors for
systolic the Acute
pressure of Coronary
less than 120 Syndrome that
and a diastolic are
pressure of experienced
less than 80. by the patient.

Urinary system Male

genitalia:

Excessive or The normal The patient The patient is

painful range for has a painful taking
urination 24-hour urine urination due medication
volume is 800 to catheter which contains
to 2,000mL Hydrochlorothi
per day (with a azide, which is
normal fluid a "water pill"
intake of about (diuretic) that
2L per day). causes the
body to make
more urine,
which helps
the body get
rid of extra salt
and water.

The normal The patient

Frequency or urine output is The
number of medications
urine daily because
times to intakes result
urinate per of the
furosemide in frequent
day is urination.
between 6 – 7
in a 24-hour
period.

Musculoskeletal Musculoskele
system tal:

10
 Swelling No signs of No signs of Normal
swelling. swelling.

Pain No signs of No signs of Normal

pain at upper pain at upper
and lower and lower
extremities extremities

No stiffness of No stiffness of Normal

Stiffness of joints. joints.
joints

Ability to Being The patient Normal

perform physically can perform
activities of active can minimal daily
daily living improve your activity.
brain health,
help manage
weight, reduce
the risk of
disease,
strengthen
bones and
muscles, and
improve your
ability to do
everyday
activities.

Muscle Having good The patient Normal

strength muscle has good
strength can muscle
help you to strength
perform for
daily living.

Nervous Neurologic:
system
General mood A good mood The patient is Normal
is usually in a good
defined as a mood
generally
positive state,

11
 although
people usually
cannot
pinpoint
exactly why
they are in a
good mood.

Normal
Coordination The patient is
coordination
in normal Normal
requires that
coordination.
the motor,
cerebellar,
vestibular, and
sensory
system
function in an
integrated
manner.

Difficulty Can respond Can respond

speaking verbally. verbally
Normal

Age-associate
Memory d memory The patient
problems impairment is has a good
considered to memory Normal
be a normal
part of aging.

No signs of
Strange strange No signs of
thoughts thoughts strange
thoughts Normal
and/or actions and/or actions
and/or actions.

ANATOMY AND PHYSIOLOGY Gallardo, Kimberly Anne E.

CARDIOVASCULAR SYSTEM

12
The cardiovascular system, also known as the circulatory system, is a complex
network of organs and blood vessels that transports oxygen, nutrients, hormones,
and waste products throughout the body. Its primary functions are to deliver oxygen
and nutrients to cells, remove carbon dioxide and other waste products, and help
regulate various bodily processes. The cardiovascular system is essential for
maintaining homeostasis and sustaining life.

Key components of the cardiovascular system include:

1. Heart: The heart is a muscular organ that acts as a pump. It contracts rhythmically
to push blood through the blood vessels. It has four chambers: two atria (upper
chambers) and two ventricles (lower chambers).

2. Blood Vessels: Blood vessels are a network of tubes that carry blood throughout
the body. There are three main types of blood vessels:
- Arteries: These carry oxygenated blood away from the heart to the body's tissues
and organs.
- Veins: These return deoxygenated blood from the body's tissues and organs back
to the heart.
- Capillaries: These are tiny, thin-walled vessels that facilitate the exchange of
oxygen, nutrients, and waste products between the blood and the body's cells.

3. Blood: Blood is a fluid connective tissue that flows through the blood vessels. It
consists of red blood cells, white blood cells, platelets, and plasma. Red blood cells
carry oxygen, white blood cells are part of the immune system, platelets are involved
in blood clotting, and plasma carries nutrients and waste products.

The cardiovascular system plays a vital role in maintaining the body's overall health
and functionality. It helps regulate body temperature, transport hormones, and defend
against infections and diseases. Disorders and diseases of the cardiovascular
system, such as heart disease, hypertension, and atherosclerosis, can have
significant health consequences and may require medical intervention to manage.

13
ST-segment elevation myocardial infarction (STEMI) is a severe form of acute
coronary syndrome (ACS) and represents a heart attack where there is a complete
and prolonged blockage of a coronary artery. In a STEMI, one of the major coronary
arteries that supply oxygen and nutrients to a portion of the heart muscle becomes
suddenly and completely obstructed. Here's what happens in the cardiovascular
system during a STEMI:

1. Coronary Artery Blockage: In STEMI, a coronary artery is almost completely

blocked, often due to the formation of a blood clot at the site of a previously narrowed
or damaged artery. This results in a sudden cessation of blood flow to a part of the
heart muscle.

2. Severe Ischemia: The complete blockage of the coronary artery leads to severe
and sustained ischemia, which means the affected region of the heart muscle is
entirely deprived of oxygen and nutrients. This lack of blood flow causes that portion
of the heart to begin to die.

3. ST-Segment Elevation: On an electrocardiogram (ECG or EKG), a characteristic

feature of a STEMI is the elevation of the ST segment. This elevation is a sign of
acute myocardial injury and is used to diagnose a STEMI.

4. Symptoms: Patients with a STEMI experience severe chest pain or discomfort,

which is often described as crushing, heavy, or squeezing in nature. The pain may
radiate to the left arm, neck, jaw, or back. Other symptoms can include shortness of
breath, nausea, vomiting, cold sweats, and a sense of impending doom.

5. Myocardial Infarction (Heart Attack): In a STEMI, the prolonged blockage of the

coronary artery can lead to a significant portion of the heart muscle being damaged,
resulting in a heart attack. The extent of damage depends on the location and
duration of the blockage. The sooner blood flow is restored, the less damage occurs.

14
PATHOPHYSIOLOGY Buhat, Fatima Mae & Catedrilla, Kristine Joy

LABORATORY AND DIAGNOSTICS Galdiano, Paula Angela

Test Result Normal Value Result Normal Value

Sodium 140 136-145 140.00 136-145

mmol/L mmol/L

Potassium 5.1 3.50-5.10 5.10 3.50-5.10

mmol/L
mmol/L

Magnesium 0.80 0.70-1.00 1.92 1.68-2.40

mmol/L
mmol/L

15
 Ionized Calcium 1.00 1.12-1.32 1.00 1.12-1.32
mmol/L mmol/L

The Blood chemistry test was done to measure the level of Sodium, Potassium,
Magnesium, and Ionized Calcium on the patient’s body. The four tests were all normal.

Test Result Normal Test Result Normal

Value Value

CK-MB 9.94 ng/ml <5.0 ng/ml NT-pron >3500 <300 pg/ml

BNP pg/ml

TROP I 1.61 ng/ml <0.50 ng/ml D-Dimer >10.08 <0.51mg/l

mg/l

Myoglobin 194.0 <70.0 ng/ml

ng/ml

A SOB Panel was conducted with a above normal range result.

Test Result Normal Test Result Normal

Value Value

Hemoglobin 144 120-160 g/L MCH 30.6 27.0-34.0 pg

Hematocrit 40.7 40.0-54.0 % MCHC 7.7 6.5-12.0 fl

RBC 4.70 4.00-5.50 RDW-CV 353 320-360 g/l

10^12/l

WBC 6.41 4.00-10.00 RDW-SD 15.0 11.0-16.0 %

10^9/l

Neutrophils 66.3 50.00-70.00 Platelet 52.8 f 35.0-56.0 fl

% Count

Lymphocytes 20.8 20.0-40.0 % MEV 237 150-450

10^9/l

Monocytes 11.1 3.0-12.0 % PPLO 86.6 80.0-100.0 fl

Eosinophils 1.6 0.5-5.0 % ABG 15.6 9.0-17.0

16
 Test Result Normal Test Result Normal
Value Value

Hemoglobin 144 120-160 g/L MCH 30.6 27.0-34.0 pg

Hematocrit 40.7 40.0-54.0 % MCHC 7.7 6.5-12.0 fl

Basophils 0.2 0.0-1.0 %

A hematology was conducted with a normal result.

WHOLE ABDOMEN ULTRASOUND

The liver appears normal in size with homogeneously increased parenchymal echogenicity.
No focal lesion seen. No evidence of intra or extra hepatic biliary duct dilation. Normal
caliber of portal vein and CBD.

The gallbladder was surgically removed.

The pancreas and spleen appear normal in size and echogenicity.

The abdominal aorta appears unremarkable.

Both kidneys are normal in size and echogenicity. The right kidney measured 10.56 x 4.37
cm and the left kidney measured 9.77 x 4.75 cm. No calculi or hydronephrosis seen.

No focal lesion identified.

The urinary bladder is filled well with normal wall thickness.

No calculus or focal lesion seen.

Folley catheter is seen in place.

The prostate gland appears normal in size and echogenicity with a total computed volume of
approximately 20-95 cm3.

No evidence of free fluid or retroperitoneal lymphadenopathy.

Impression:

Fatty liver

S/P cholecystectomy

17
Ultrasound of the rest of the whole abdomen is within normal limits.

CHEST X-RAY

Cardiomegaly and lungs are clear

ECG

18
 DRUG STUDY De Castro, Maria Aliza Gwen

NAME CLASSIFICATION MECHANISM OF ACTION INDICATIONS SIDE EFFECTS NURSING RESPONSIBILITIES

Generic: Therapeutic: ● Clopidogrel is a ● Reduction of CNS: ● Assess blood pressure
Clopidogrel platelet prodrug that must atherosclero depression, dizziness, periodically and compare it to
aggregation be metabolized by tic events fatigue, headache normal values.
Brand: inhibitors CYP 2C19 to be (MI, stroke, ● ensure the correct dosage,
Plavix effective vascular EENT: route, and timing
Pharmacologic: death) in epistaxis ● Monitor patients who take
Dose/Route: antiplatelet agents ● Inhibits platelet patients at aspirin for bleeding.
75 mg tablet PO aggregation by risk for such CV: ● Monitor for allergic
irreversibly events, chest pain, edema, reactions especially at the
inhibiting the including hypertension. beginning of the treatment.
binding of ATP to recent MI, ● Observe for signs and
platelet receptors. acute GI: symptoms of hepatic insufficiency
coronary GI BLEEDING, during clopidogrel therapy.
Therapeutic effects: syndrome abdominal pain, ● Monitor signs of
● Decreased (unstable diarrhea, dyspepsia, thrombotic thrombocytopenic
occurrence of angina/non– gastritis purpura, such as purplish spots on
atherosclerotic Q-wave MI), the skin, decreased
events in patients stroke, or HEMAT: consciousness, fatigue, weakness,
at risk. peripheral BLEEDING, shortness of breath on exertion,
vascular NEUTROPENIA, and tachycardia. Report these
disease THROMBOTIC signs to the physician or nursing
THROMBOCYTOPENIC staff immediately.
PURPURA.
patients with active
pathological DERM:
bleeding such as pruritus, purpura,
peptic ulcer or rash
intracranial
hemorrhage.

19
 NAME CLASSIFICATION MECHANISM OF ACTION INDICATIONS SIDE EFFECTS NURSING RESPONSIBILITIES
Generic: Therapeutic: ● Spironolactone ● Essential CNS: ● ensure the correct dosage,
Spironolactone diuretics, acts both as a HTN. dizziness, clumsiness, route, and timing
potassium-sparing diuretic and as an ● Short-term headache ● monitor intake and output
Brand: diuretics antihypertensive pre-op treatment ● monitor blood pressure
Aldactone drug by this of patients w/ EENT: ● monitor potassium levels
Pharmacologic: mechanism. It primary gynecomastia (in and renal panel
Dose/Route aldosterone may be given hyperaldosteronis males), breast ● monitor for dehydration
25 mg tablet PO antagonists alone or with m. Diagnosis of tenderness, and electrolyte imbalances
other diuretic primary deepening of voice, that can occur with
agents that act hyperaldosteronis increased hair growth excessive diuresis, such as
more proximally in m. CHF (alone or in (in females) dryness of mouth, thirst,
the renal tubule. combination w/ weakness, lethargy,
standard therapy), CV: drowsiness, restlessness,
Therapeutic effects: including severe arrhythmias muscle pains or cramps,
● weak diuretic and heart. muscular fatigue,
antihypertensive GI: hypotension, oliguria,
responses when GI irritation tachycardia, arrhythmia, or
compared with ● Hypersensiti gastrointestinal
other diuretics. vity. GU: disturbances such as
Conservation of ● Anuria. erectile dysfunction, nausea and vomiting.
potassium. ● Severe renal dysuria
impairment,
acute renal F&E:
insufficiency. hyperkalemia,
● Addison's hyponatremia,
disease hyperchloremic
metabolic acidosis.

20
 NAME CLASSIFICATION MECHANISM OF ACTION INDICATIONS SIDE EFFECTS NURSING RESPONSIBILITIES
Generic: Therapeutic: ● Produce analgesia ● Inflammator HEMAT: ● Assess for an allergy to
Aspirin antipyretics, and reduce y disorders, anemia, hemolysis NSAIDs or acetylsalicylic.
nonopioid inflammation and including ● Assess for pain by having
Brand: analgesics fever by inhibiting Rheumatoid EENT: the patient rate on a scale
Bayer the production of arthritis, tinnitus of 1-10, and describe
Pharmacologic: prostaglandins. Osteoarthriti characteristics, duration,
Dose/Route: salicylates Decreases platelet s. DERM: and frequency.
80 mg tablet PO aggregation. Mild-to-mod rash, urticaria ● ensure the correct dosage,
erate pain. route, and timing
Therapeutic effects: Fever. GI: ● Routinely monitor the
● Analgesia. Prophylaxis GI BLEEDING, effectiveness of aspirin by
Reduction of transient dyspepsia, epigastric assessing pain levels and
inflammation. ischemic of distress, nausea, fever reduction.
Reduction of fever. attacks and abdominal pain, ● Monitor for signs of
Decreased MI. anorexia, toxicity: diplopia, EKG
incidence of hepatotoxicity, changes, seizures,
transient ischemic vomiting. hallucinations,
attacks and MI. ● patients with hyperthermia, oliguria,
known GU: acute renal failure,
allergy to erectile dysfunction, irritability, restlessness,
NSAIDs and dysuria tremor, confusion, lethargy,
in patients and anaphylaxis.
with asthma,
rhinitis, and
nasal polyps.

21
 NAME CLASSIFICATION MECHANISM OF ACTION INDICATIONS SIDE EFFECTS NURSING RESPONSIBILITIES
Generic: Therapeutic: ● Blocks stimulation ● Hypertensio CNS: ● Assess for contraindications
Carvedilol antihypertensives of n. CHF dizziness, fatigue, or cautions
beta1(myocardial) (ischemic or weakness, anxiety, ● ensure the correct dosage,
Brand: Pharmacologic: and beta2 cardiomyopa depression, route, and timing
Karvi beta blockers (pulmonary, thic) with drowsiness, insomnia, ● Provide patient education
vascular, and digoxin, memory loss, mental about drug effects and
Dose/Route: uterine)–adrenerg diuretics, status changes, warning signs to report to
6.25 mg tablet PO ic receptor sites. and ACE nervousness, enhance knowledge about
Also has alpha1 inhibitors. nightmares drug therapy and promote
blocking activity, Left compliance.
which may result ventricular EENT: ● physical assessment to
in orthostatic dysfunction blurred vision, dry monitor for any potential
hypotension. after eyes, nasal stuffiness. adverse effects.
myocardial ● Monitor heart rate and
Therapeutic effects: infarction. CV: blood pressure closely and
● Decreased heart BRADYCARDIA, CHF, frequently for changes
rate and blood PULMONARY EDEMA ● Institute safety measures to
pressure. prevent injury if the patient
Improved cardiac ● asthma, GI: experiences weakness,
output, slowing of bronchitis, diarrhea, dizziness, or orthostatic
the progression of emphysema, constipation, nausea hypotension.
CHF and severe liver ● Provide comfort measures
decreased risk of disease, or a GU: to help patient cope with
death. serious heart erectile dysfunction, drug effects.
condition decreased libido.
such as heart
block, "sick DERM:
sinus itching, rashes
syndrome,"
or slow heart
rate.

22
 NAME CLASSIFICATION MECHANISM OF ACTION INDICATIONS SIDE EFFECTS NURSING RESPONSIBILITIES
Generic: Therapeutic: ● Inhibits the ● Edema due CNS: ● Obtain a comprehensive
Furosemide diuretics reabsorption of to heart blurred vision, medical history,
sodium and failure, dizziness, headache, ● Regularly monitor blood
Brand: Pharmacologic: chloride from the hepatic vertigo pressure, heart rate, and
Lasix Loop diuretics loop of Henle and impairment, respiratory rate.
distal renal tubule. or renal EENT: ● Administer furosemide as
Dose/Route: Increases renal disease. hearing loss, tinnitus. prescribed, ensuring the
10 mg IV excretion of water, Hypertensio correct dosage, route, and
sodium, chloride, n. CV: timing
magnesium, hypotension ● Document the patient’s
potassium, and fluid intake and output,
calcium. GI: daily weights, and assess
Effectiveness anorexia, for signs of fluid overload
persists in constipation, or dehydration.
impaired renal diarrhea, dry mouth, ● Assess the patient’s fluid
function ● patients with dyspepsia, nausea, balance, including input
anuria and in pancreatitis, vomiting and output measurements,
Therapeutic effects: patients with daily weights, and signs of
● Diuresis and a history of GU: fluid overload or
subsequent hypersensitiv excessive urination dehydration.
mobilization of ity to ● Continuously monitor
excess fluid furosemide. F&E: blood pressure to assess
(edema, pleural dehydration, the patient’s response to
effusions). hypocalcemia, furosemide therapy.
Decreased blood hypochloremia,
pressure hypokalemia,
hypomagnesemia,
hyponatremia,
hypovolemia,
metabolic alkalosis.

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NURSING CARE PLAN Bulasag, Kimberly

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PROGNOSIS Camila Jean G. De Castro

Life expectancy of patients suffering a STEMI nowadays is intimately linked to

survival in the first 30 days. After one year, the risk of death for both men and women
seems similar to that of the general population. Global risk should be estimated via
formal clinical scores or a combination of the following high-risk features:

● Recurrent angina/ischemia at rest or during low-level activity

● Heart failure
● Worsening mitral regurgitation
● HIgh-risk stress test result
● Hemodynamic instability
● Tachycardia
● Diabetes mellitus
● Hypertension

Hypertension
Hypertension (high blood pressure) is when the pressure in your blood
vessels is too high (130/90 mmHg or higher). Although there is currently no
treatment for hypertension, it can be managed with dietary and pharmaceutical
adjustments. The primary objective of nursing care for hypertensive patients is to
reduce and control blood pressure with minimal side effects and expense.
Men are more likely than women to have hypertension, and people over 65
are more likely to have it than those under 65. It is serious because those who have
it run a higher risk of developing heart disease and other illnesses than those who
have normal blood pressure. Regular blood pressure monitoring and the prompt
treatment of hypertension can help prevent serious complications like
atherosclerosis, heart attacks, strokes, an enlarged heart, and kidney damage.

Myocardial Infarction
Age gradually raises the prevalence and incidence of acute myocardial
infarction. According to the DOH's official data, MI has been the main cause of
death since 2014 due to the exponentially rising mortality rate with age. Compared to
younger patients, elderly people are less likely to report chest pain. Up to 20% of
individuals over the age of 85 may report with confusion or a change in mental status
as a symptom of MI. MIs that are "silent" or go undiagnosed, as well as MIs without
ST-segment elevation, are more common in older people.

PROPOSED ACTIONS AND RECOMMENDATIONS Sharnelle Nicolle A. Cabatay

Treatment

The immediate goals of treatment for acute coronary syndrome are to:

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 ● Relieve pain and distress.
● Improve blood flow.
● Restore heart function quickly and as much as possible.

Long-term treatment goals are to help the heart work better, manage risk factors and
lower the risk of a heart attack. Treatment may include medicine and surgical
procedures.

Surgery and other procedures

Your health care provider may recommend one of these treatments to restore blood
flow to the heart:

● Angioplasty and stenting. This treatment uses a thin, flexible tube and
tiny balloon to open clogged heart arteries. A surgeon inserts the tube in
a blood vessel, usually in the groin or wrist, and guides it to the narrowed
heart artery. A wire with a deflated balloon on the tip goes through the
tube. The balloon is inflated, widening the artery. The balloon is deflated
and removed. A small mesh tube is usually placed in the artery to help
keep it open. The mesh tube also is called a stent.
● Coronary artery bypass surgery. This major surgery involves taking a
healthy blood vessel from the chest or leg area. This piece of healthy
tissue is called a graft. A surgeon attaches the ends of the graft below a
blocked heart artery. This creates a new path for blood to flow to the
heart.

XI. Discharge Planning

MEDICATION MANAGEMENT

· Instructed patient to adhere to home medications religiously.

· Teach the patient each of the medications basic drugs action, side effect and
adverse effect

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· Educate the patient about the importance of taking medication on time

EXERCISE

· Encourage the patient to continue the performing active in range of motion

exercise every morning such as flexion extension hyperexension of neck, both
arms and legs as tolerated

· Instructed the patient to perform deep-breathing ang coughing exercise regularly

· Encourage patient to gradually increase and establish rest periods between

activites

DIETARY MODIFICATIONS

· Explain to the patient to signification of low salt and fat diet

· Encourage the patient to avoid the processed foods, sugar, salt, and reduce fat
intake

· Provide to list of foods and beverage that are low in sugar, salt and saturated fat

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