Myocardial Infarction Case Study
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Patient Profile
D.M., a 51-year-old, white, successful executive, is
rushed to the hospital by ambulance after experiencing crushing substernal chest pain that radiates down
his left arm. He also complains of dizziness and
nausea.
Subjective Data
• Has a history of chronic stable angina and
hypertension
• States he is “borderline diabetic”
• Overweight but recently lost 10 pounds
• Rarely exercises
• Has three teenage children who are causing “problems”
• Recently experienced loss of best friend and business partner, who
died from cancer
Objective Data
Physical Examination
• Diaphoretic, short of breath, nauseous
• BP 165/100 mm Hg, pulse rate 120/min, respiratory rate 26/min
Diagnostic Studies
• 12-lead ECG shows sinus tachycardia with ST elevation in leads II, III,
aVF, V5, V6 with occasional premature ventricular contractions
• Cardiac-specific troponin I level elevated
• Cholesterol 350 mg/dL (9.1 mmol/L)
• Hb A1C 9.0%
• Inferolateral wall MI
Collaborative Care
Emergency Department
• Oxygen 2 L/min via nasal cannula, titrate to keep O2 saturation above
93%
• Continuous ECG monitoring
• Aspirin 325 mg (chewable)
• Eptifibatide (Integrilin) IV
• Weight-based heparin IV
• Nitroglycerin IV, titrate to relieve chest pain; hold for systolic BP below
100 mm Hg
• Morphine 2 to 4 mg IV q5min PRN for chest pain unrelieved by
nitroglycerin
• Vital signs, pulse oximetry every 10 minutes
• Preparation of patient for transfer to cardiac catheterization laboratory
for possible PCI
Discussion Questions
1. Which coronary artery(ies) is (are) most likely occluded in D.M.’s coronary circulation?
2. Explain the pathogenesis of CAD. What risk factors contribute to its
development? What risk factors were present in D.M.’s life?
3. What is angina? How does chronic stable angina differ from angina
associated with acute coronary syndrome?
4. Explain the pathophysiologic basis for the clinical manifestations that
D.M. exhibited.
5. Explain the significance of the results of the laboratory tests and the
12-lead ECG findings.
6. Provide a rationale for each treatment measure ordered for D.M.
7. Priority Decision: Based on the assessment data presented, what
are the priority nursing diagnoses? Identify any collaborative
problems.
8. Priority Decision: What are the priority nursing interventions for D.M.
immediately after his MI? Immediately after his PCI?
9. Delegation Decision: Identify activities that can be delegated to unlicensed assistive personnel (UAP).
10. Evidence-Based Practice: Two days after an uncomplicated PCI and
the placement of two stents, D.M. wants to know what the most
effective strategies are to prevent another MI. Based on his clinical
situation, what would you tell him?
iStockphoto/Thinkstock• Aspirin 325 mg (chewable)
• Eptifibatide (Integrilin) IV
• Weight-based heparin IV
• Nitroglycerin IV, titrate to relieve chest pain; hold for systolic BP below
100 mm Hg
• Morphine 2 to 4 mg IV q5min PRN for chest pain unrelieved by
nitroglycerin
• Vital signs, pulse oximetry every 10 minutes
• Preparation of patient for transfer to cardiac catheterization laboratory
for possible PCI
Discussion Questions
1. Which coronary artery(ies) is (are) most likely occluded in D.M.’s coronary circulation?
2. Explain the pathogenesis of CAD. What risk factors contribute to its
development? What risk factors were present in D.M.’s life?
3. What is angina? How does chronic stable angina differ from angina
associated with acute coronary syndrome?
4. Explain the pathophysiologic basis for the clinical manifestations that
D.M. exhibited.
5. Explain the significance of the results of the laboratory tests and the
12-lead ECG findings.
6. Provide a rationale for each treatment measure ordered for D.M.
7. Priority Decision: Based on the assessment data presented, what
are the priority nursing diagnoses? Identify any collaborative
problems.
8. Priority Decision: What are the priority nursing interventions for D.M.
immediately after his MI? Immediately after his PCI?
9. Delegation Decision: Identify activities that can be delegated to unlicensed assistive personnel (UAP).
10. Evidence-Based Practice: Two days after an uncomplicated PCI and
the placement of two stents, D.M. wants to know what the most
effective strategies are to prevent another MI. Based on his clinical
situation, what would yo
Myocardial Infarction Case Study Essay
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