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Caring for the Elderly With Acute Myocardial Infarction (Killips IV), Hypoxic Ischemic Encephalopathy Secondary to Cardiac

c Arrest.

OBJECTIVES
At the end of the case presentation, the evaluators will be able to: Knowledge Define the case of my patient basing upon the Pathophysiology. Identify the signs and symptoms that mark Killips 4 of acute MI. Enumerate the present medications the client has. Rationalize nursing interventions performed. Correct any errors in the case study.

Skills

Note down the important info. presented. Listen attentively all throughout the case presentation Raise questions that is relevant to the case Answer the questions given after the case presentation

Attitude

Respect the discussion time of the case by listening only Show interest in the presentation Acknowledge Gods guidance before starting and after the case presentation

DEMOGRAPHIC DATA
oName: Mr. Good Boy oAge: 58

oSex: Male
oStatus: Married oAddress: F.T. Geslani Drive Taculing Bacolod City, Negros Occidental 6100 oReligion: SDA oType of community: Urban

oChief Complaints: Chest Pain


oMedical Diagnosis: Acute Myocardial Infarction (Killips IV), Hypoxic Ischemic Encephalopathy Secondary to Cardiac Arrest.

FAMILY BACKGROUND
oOccupation: None oParents: Father: Deceased, Liver Cirrhosis oMother: Deceased, Unrecalled oRank Among Siblings: 5 oNumber of Siblings: 8

oSouse: Live( DM2)


oNumber of Children: 3

DEVELOPMENTAL DATA
Erik

Eriksons Eight Stages of Development

Adapted to life according to limitations Decreased productivity

Robert

Havighursts Developmental Task Theory

Achieved adult civic and social responsibility. Established and maintained an economic standard of living. Assisted teenage children to become responsible and happy adults. Developed adult leisure-time activities Related oneself to ones spouse as a person. Accepted and adjusted to the physiologic changes or middle age.

HEALTH HISTORY

Personal History: Mr. Good Boy is a past smoker and alcoholic drinker, has a past diet of high cholesterol foods and caffeinated beverages, especially when there are celebrations in his family and works overtime to provide daily family needs as stated by SO.

Past Illness: Mr. Good Boy was known hypertensive since 2000 and was experiencing angina, palpitations, dyspnea, seizures/ syncope long ago since he experienced 4 attacks before and was hospitalized twice. The start of the disease was unrecalled as stated by SO.

Present Illness: Prior to admission, SO states that client was not able to sleep well for 8 days with sleeping hours of 3-4 after a family reunion. The next day client got angry with his brother because of a problem and then got angry with his wife for not preparing his daily coffee. Pt. felt an aching pain on his chest and went with his wife to the hospital. Pt had an arrest at the hospital but was revived.

Health

GORDONS FUNCTIONAL MODEL


Perception Health management Pattern Metabolic Pattern

The client takes multivitamins not prescribed by the physician. SO aids pt in general hygiene feeding, grooming and exercise. The client has some discomfort in swallowing hard foods and eats only soft diet foods such as lugaw fish vegetables and fruit. Client usually eats orange fruits. The client eats three times a day but sometimes looses his appetite for 2 days. He is given bread mixed in milk at these times. Typical fluid intake is to 2 glasses of water/day. Number of teeth 2

Nutrition

Elimination

Pattern

The client urinates 3 to 4 a day as counted every penile diaper change. No difficulty or pain in urination. Bowel frequency is 2 to 3 times per day. Character is semi formed. Uses provimin every day to soften stool passage.

Activity

Exercise Pattern

The client is able to perform limited forms of ADLs. Needs assistance in bathing, changing of clothes, moving from bed to wheel chair and eating. Able to move upper extremities effectively. Pinky finger on the left hand has calcified. Lower extremities are both weak and spastic when moved or touched. (+) Babinskis Reflex. Passive range of motion is done every 30 min. both in upper and lower extremities.

Sleep

Rest Pattern

The client usually sleeps for at least 8 to 10 hours. Sleeps every 10am to 11am in the morning, 1pm to 3 pm at noon and 8pm in the evening after the worship and wakes up at 6am in the morning. The client frequently sleeps during day time and the SO/family member only wakes him up to eat his meal. Sleeping problems start when bowel movement and irritability start at night.

Sexuality

Reproductive

SO states he is unresponsive in his sexual pattern since the disease.

Cognitive

Self-Perception/Self-Concept

Dysarthria is marked. Signs of memory loss is evident, unable to recall most of past events. Seldom recalls family members and close family ties. Has low level of concentration and may get confused. Decision making and learning abilities still enact. Regression of intelligence level to a grade schooler. SO states before the illness, he would get angry and annoyed of people who would hurt his family. He would get depressed when he could not hug his daughter because she does not come near him when he smokes. So states he was happy to let his children finish school and feels fulfilled and satisfied of what his life and childrens life had become. Client could not articulate answers to questions clearly.

Perceptual Pattern

Role Relationship Pattern

Coping Stress Tolerance

The client is a father of 3 children with a composition of a nuclear family. Residing at their home in Taculing. Their only family problem is in the financial area. SO states that he was able to grow his family without relationship problems. The family states that the illness was tragic but thankful that he was given a chance to live.

Values and Beliefs

SO states that when he was still well he goes out to drink alcohol with his friends or family members whenever he was stressed. He also smokes and eats any food when in stress. When in anger he lets his emotions out before calming down.
The client was a converted SDA. SO states that he has fulfilled his important plans for his family and prays to God for every trials that comes his way. He usually attend to church services every Saturday but due to his condition he was not able to go to church.

MEDICAL TREATMENT AND MANAGEMENT


CBC Results:

HCT: 0.36%
HGB: 127 g/L WBC: 3.40 10^9/L Lymph: 0.14%

deficient dietary intake, anemia


deficient dietary intake, anemia dietary deficiency sepsis

EO: 0.04%

allergic reaction
infection gout myocardial infarction

Polys: 0.75 % Uric Acid: 10.4 mg/dl ALT: 90 u/L

PT Time Result: Pt Time - 9.8 sec indicates short time of blood to clot Serum Electrolytes, Cholesterol, Triglycerides, Creatinin - Normal CT Scan Brain Plain - Impression: hypoxic ischemic encephalopathy. Chest X-Ray - Impression: Atherosclerotic aorta ECG ; Ventricular Fibrilation. ABG: PCO2- 25.7 mmol/L alkalosis; PO2-233 mmol/L alkalosis; HCO317.6 mmol/L acidic. Urinalysis ; Normal Surgery ; Tracheostomy Troponin 1 ; (+) myocardial damage

MEDICATION
Generic/Trade Names Omega-3-acid ethyl esters (Lovaza) Metropolol (Neoblock) Action Decreases the amount of TG produced by the liver and increases the removal of TG by the liver Exerts mainlybeta1 adrenergic blocking activity SNS influence, also blocksbeta-2receptors at high doses Anti-ischemic (anti - anginal) metabolic agent, which improves myocardial glucose utilization through inhibition of fatty acid metabolism, also known as fatty acid oxidation inhibitor. (shifts energy production from fatty acids to glucose oxidation) Side Effects Upset stomach, burping, and strange tastes in may occur. Fatigue, dizziness, bradycardia, edema, hypotension, nausea, diarrhea, dyspnea, rash, vomiting, dry eyes Nausea, vomiting Contraindications -hypersensitive to fish. Sinus bradycardia, 2nd or 3rd degree heart block, Cardiogenic shock , heart failure Hypersensitivity to any component of Vestar. Generally not recommended during breast feeding

Trimetazidine (Vastarel)

PATHOPHYSIOLOGY

NURSING CARE PLANS