NSC2103-Myocardial Infarction In Australia

NSC2103-Myocardial Infarction In Australia

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NSC2103-Myocardial Infarction In Australia

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NSC2103-Myocardial Infarction In Australia

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Course Code: NSC2103
University: Edith Cowan University

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Country: Australia

Case Study
Kath Harris is a 65–year-old women who lives alone. She presented to the emergency department, complaining of chest pain for 2 hours. Kath was doing light cleaning around the house. Prior to the onset of her pain, she had taken three glyceryl trinitrate tablets, which had little effect on reducing her chest pain. Following her admission, she was diagnosed with an acute myocardial infarction.
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 overweight (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.
On arrival at the emergency department, Mrs. Harris’ skin was pale, and her peripheries were cool. Her observations and pathology results were as follows:

1.Outline the statistics (incidence and prevalence) of myocardial infarction in Australia.
2.Identify the clinical manifestations of an acute myocardial infarction that Mrs. Harris experienced.  Explain the physiological rationale for each of these manifestation. How would you manage Mrs. Harris’ care?
3.Identify Mrs. Harris’ four risk factors and develop a multifaceted plan that could modify these risk factors.
4.Identify issues /problems associated with thrombolytic/ fibrinolytic therapy from the case study.

The essay brings about the discussion on the assessment of the myocardial infarction in Australia, and the relevant aspects and concepts. It describes the particular problem or issue, in context to the given case study. The case study is about a 65-year old woman, Kath Harris, who lived alone, and suffered from the problem of chest pain for about 2 hours. The essay includes the description of the case study, which includes implementing a nurse-led case management plan which is in relation and up-to-date with the Australian statistics. The plan to be implemented and assessed considers the purpose to ensure a quality life for the elderly people, who have suffered a myocardial infarction. The essay in the later part, discusses the pathophysiological treatment options, which is based on the principles and national guidelines, including the implications for nursing practice (Bandstein et al., 2014).
The case study is about a 65-year old woman, Kath Harris who was admitted to the emergency department complaining about the chest pain for about 2 hours. She took some medicines that helped her in reduced chest pain, and after a proper diagnosis, she had the problem of acute myocardial infarction. Discussing about her clinical history, past few years she had problems of unstable angina, which refers to the condition in which the heart of the person is not able to get enough blood or oxygen. Angina is the term, which defines about the chest discomfort that is caused due to poor through the blood vessels of the heart muscle.  Number of other issues such as hypertension, diabetes mellitus type 2 was also identified, which further disclosed about her smoking habits. A recent history of indigestion also described about her problem of acute peptic ulcer. Therefore, analysing all these things mentioned above in relation to the case, myocardial infarction is to be taken for the study and research in context to the country Australia (Randall et al., 2016). 
Discussing about the relevance and prevailing rates of the problem of myocardial infarction in Australia, first it is necessary to understand the meaning of the term and related aspects. Myocardial infarction is the medical term or the name of heart attack. Heart attack refers to the life-threatening issue or problem, which occurs when there is a blockage in the flow of blood to the heart muscle, which leads to the damage in the tissue. The reason behind the development of this blockage is the plague, or presence of a substance in the body, which is mostly made of fat, cholesterol, and cellular waste product. The person or patient in the case was also identified with the problem of diabetes mellitus type 2, and active peptic ulcer, which mentions about other health problems (Ahmad et al., 2015). Peptic ulcer is the sores in the lining of oesophagus, stomach, or duodenum, and one of the main symptoms of this problem is the pain in the upper abdominal area. As in the case study, Kath Harris experienced the problem of indigestion, which may be due to her poor lifestyle or bad habits of smoking (Soo Hoo, Gallagher & Elliott, 2016). 
The intensity of heart diseases or heart attacks is largely found in Australia, which indicates about the high incidence and prevalence of cardiovascular disease. It has been analysed that the cardiovascular diseases (CVD) is found to be one of the major causes of deaths in Australia, with about 43,963 deaths in Australia in the year 2016. Cardiovascular disease kills one Australian every 12 minutes, and is considered as one of the largest health problems   (Demaerschalk et al., 2016).
According to the statistical information, in Australia it is found that over 400,000 Australians have had the problem of heart attack. Each year, it is estimated that around 54,000 Australians suffer from the problem of heart attack, which means one heart attack every 10 minutes. In the year 2016, it is a known fact that an average of 22 Australians died from a heart attack each day, which is further equivalent to one death from a heart attack in every 66 minutes. Thus, the  above data describes that there is a high incidence and prevalence of the heart diseases or heart attack in Australia past few years and is still continued with the major impact on the health of the individuals (Diouf et al., 2016).  
Signs and symptoms of the problem of cardiovascular disease or myocardial infarction include major chest pain, and the shortness of breath. Other symptoms include pain in the chest, back, jaw or the upper body parts, sweating, nausea, vomiting, increased heart rate. These are some of the signs and symptoms of the issue of acute myocardial infarctions in the human body. There are several factors, which lead to a blockage in the coronary arteries, causing the problem of heart attack (Oliveira,  Avezum & Roever, 2015). These factors include bad cholesterol, saturated fats, or trans-fat. There are certain risk factors, which leads to increased possibilities of heart attack and other heart diseases. It has found that the people with certain symptoms or risk factors are prone to the cardio-vascular disease such as heart attack. These risk factors include people with high blood pressure, high cholesterol levels, diabetes and high sugar levels, obesity, age, and smoking are some of the factors, which causes heart-attack. In context to the given case study, Kath Harris is found with the smoking habits, which can be one of the reasons behind her problem of myocardial infarction. Cardiovascular diseases may occur with the person more than 18 years in age. The rationales related to treat patients with such symptoms, clinical rationale include using morphine for the pain, which is associated with the MI (Myocardial infarction). Therefore, to link with the given case study it was found that the patient Harris was given glyceryl trinitrate, which are used for reducing chest pain.  The use of these medicines had least effect on her body.
A myocardial infarction requires urgent medical attention, to treat the patient suffering from these problems. Treatment or management of the person, in the case Harris in this case may aim to preserve as much heart muscles as possible, and to prevent further complications. Treatment or management of Harris problem may include unblocking of blood vessels, reducing blood clot enlargement, and modifying risk factors for any future complication (Parodi et al., 2015).
A number of steps may be mentioned to manage her problem of myocardial infarction, giving medications, which may reduce her chest pain such as nitro-glycerine, or morphine. Nitro-glycerine may improve the blood supply of the patient. Other includes anticoagulation, and cardiac rehabilitation, which should be initiated soon after the discharge from the hospital. The program for cardiac rehabilitation includes changes in the lifestyle, suggesting the person to involve in daily exercise, and social support from people (Rentrop & Feit, 2015).
Risk factors refer to any attribute, characteristic, or the exposure of an individual, which increases the possibility of developing a disease or an injury. The important risk factors for the heart diseases are high blood pressure, high cholesterol, diabetes, obesity, and unhealthy diet.  In context to the case, the main risk factors, which can be identified for Kath Harris, consist of high blood pressure, older age, actively smoking. These are also referred to as modifiable risk factors, and the effect influence of these factors can be reduced by improved lifestyle and other changes (Van Hout et al., 2016). Non-modifiable factor include age, ethnic background, and family history of heart disease. Age, the older a person is the person becomes prone to the coronary diseases or to have any cardiac misadventure or heart attack.  Ethnic background, for an example South Asians who are living in UK are more likely, to have possibilities of developing coronary heart disease, in comparison to the rest of UK population (Vernon et al., 2017).
The pharmacological treatment of the patient with the acute myocardial infarction includes basic therapies such as routine administration of oxygen, nitro-glycerine, and aspirin. Cardio-active agents such as beta-andregenic antagonists should be considered (Bonaca et al., 2014). Despite the advancements in the pharmacological management of the acute myocardial infarction, there are still new developed ways of the non-pharmacological treatment. This may include positive airway pressure therapy, it also mentions about helping the patient comply with the disease, treatment, and the self-help strategies. Diet taking proper diet, and nutrition, advising the patient about consumption of alcohol, in obese patients (Adams & Urban, 2015). 
Nursing management in the case of the patient with acute MI includes achieving a balance between myocardial oxygen supply and demand. This is achieved through oxygen administration, and medication. The next step is to ensure prevention of complications, and continuous monitoring of cardiac functions. Continuous ECG monitoring, monitor and record input and following monitoring of urine output. Developing a multifaceted plan for the improvement of the condition of the patient, with the myocardial infarction involves a number of steps, which may refer to non-pharmacological treatment. First step in this case, is the open disclosure, which means informing the patient or the person about the disease, and the prevention strategies. The nursing management or the plan includes advising the heart failure patients to do moderate exercises with some stable, and then advising the heart failure patient to reduce the salt intake, and monitor their weight daily. Other interventions or plan may include suggesting and referring the person to the specialist (Ibanez et al., 2017).
In context to the heart attack or heart failure and related health issues, there are some of the therapies, which can be used to treat or lessen the effect on the body of the individual. One of the therapies includes thrombolytic therapy, which refers to use of drugs to break up or dissolve blood clots, which are the main cause of the heart attack or stroke to any person. These are the drugs, which are also known as thrombolytics or clot-busting drugs, and they are given only for some particular type of heart attack. This type of heart attack is called as ST segment elevation myocardial infarction (STEMI); in this case, certain changes are noticed on ECG. These drugs must be given immediately soon after the occurrence of first chest pain. Therefore, this therapy is useful in some cases, if used appropriately to treat the patient. This is given to the patient through veins, and in context to the case study, it does not relate to the woman as she had peptic ulcers. It was found that this therapy is not suitable for the patients with certain factors or issues. The issue in this case includes the people who had bleeding inside the head or a stroke, brain abnormalities such as tumours or poorly formed blood vessel (Xie et al., 2016). The person in case had a head injury within the past 6 months, a history of usage of blood thinners, major internal bleeding, or severe high blood pressure. The rationale or purpose of the use of thrombolytic therapy or drugs in case of myocardial infarction states that the patients who receive thrombolytic therapy obtain a constant survival benefit when they are compared to the control patients (Ryan et al., 2016). 
To conclude the above discussion on the essay of nursing assignment, it has been analysed that the Myocardial infarction and other cardio vascular diseases are prevailing at a higher rate in Australia. Myocardial infarction in general refers to heart attack and other heart problems to the individuals. It is referred to the condition when the blood flow decreases or stops to a particular part of the heart, causing damage to the heart muscle. With context to the case study, the most common symptom identified was the chest pain to the woman in the case. There were many risk factors associated with the problem or issue with the woman that led to the occurrence of myocardial infarction. The patients with these problems or the woman in the case must be treated and suggested for some self-help strategies along-with the medications and other therapies. Major changes in the lifestyle choices or self-help strategies can help such patients to deal with these problems, and proper medications and support from the family members can help the person deal with heart failure or heart diseases. Hence, proper management or care plan must be implemented for these patients to prevent any further complications. 
Adams, M. P. & Urban, C. (2015). Pharmacology: Connection to Nursing. Pearson Education.
Ahmad, Y., Sen, S., Shun-Shin, M. J., Ouyang, J., Finegold, J. A., Al-Lamee, R. K. & Francis, D. P. (2015). Intra-aortic balloon pump therapy for acute myocardial infarction: a meta-analysis. JAMA internal medicine, 175(6), 931-939.
Bandstein, N., Ljung, R., Johansson, M. & Holzmann, M. J. (2014). Undetectable high-sensitivity cardiac troponin T level in the emergency department and risk of myocardial infarction. Journal of the American College of Cardiology, 63(23), 2569-2578.
Bonaca, M. P., Bhatt, D. L., Braunwald, E., Cohen, M., Steg, P. G., Storey, R. F. & Sabatine, M. S. (2014). Design and rationale for the prevention of cardiovascular events in patients with prior heart attack using ticagrelor compared to placebo on a background of aspirin–thrombolysis in myocardial infarction 54 (PEGASUS-TIMI 54) trial. American heart journal, 167(4),  437-444.
Demaerschalk, B. M., Kleindorfer, D. O., Adeoye, O. M., Demchuk, A. M., Fugate, J. E., Grotta, J. C. & Saposnik, G. (2016). Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 47(2), 581-641.
Diouf, I., Magliano, D. J., Carrington, M. J., Stewart, S. & Shaw, J. E. (2016). Prevalence, incidence, risk factors and treatment of atrial fibrillation in Australia: The Australian Diabetes, Obesity and Lifestyle (AusDiab) longitudinal, population cohort study. International journal of cardiology, 205, 127-132.
Ibanez, B., James, S., Agewall, S., Antunes, M. J., Bucciarelli-Ducci, C., Bueno, H. & Hindricks, G. (2017). ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology. European heart journal, 39(2), 119-177.
Oliveira, G. B., Avezum, A. & Roever, L. (2015). Cardiovascular disease burden: evolving knowledge of risk factors in myocardial infarction and stroke through population-based research and perspectives in global prevention. Frontiers in cardiovascular medicine, 2, 32.
Parodi, G., Bellandi, B., Xanthopoulou, I., Capranzano, P., Capodanno, D., Valenti, R. & Alexopoulos, D. (2015). Morphine is associated with a delayed activity of oral antiplatelet agents in patients with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention. Circulation: Cardiovascular Interventions, 8(1), 1593.
Randall, S. M., Zilkens, R., Duke, J. M., & Boyd, J. H. (2016). Western Australia population trends in the incidence of acute myocardial infarction between 1993 and 2012. International journal of cardiology, 222, 678-682.
Rentrop, K. P. & Feit, F. (2015). Reperfusion therapy for acute myocardial infarction: Concepts and controversies from inception to acceptance. American heart journal, 170(5), 971-980.
Ryan, K., Greenslade, J., Dalton, E., Chu, K., Brown, A. F., & Cullen, L. (2016). Factors associated with triage assignment of emergency department patients ultimately diagnosed with acute myocardial infarction. Australian Critical Care, 29(1), 23-26.
Soo Hoo, S. Y., Gallagher, R. & Elliott, D. (2016). Predictors of cardiac rehabilitation attendance following primary percutaneous coronary intervention for ST?elevation myocardial infarction in Australia. Nursing & health sciences, 18(2), 230-237.
Van Hout, G. P., Bosch, L., Ellenbroek, G. H., De Haan, J. J., Van Solinge, W. W., Cooper, M. A. & Hoefer, I. E. (2016). The selective NLRP3-inflammasome inhibitor MCC950 reduces infarct size and preserves cardiac function in a pig model of myocardial infarction. European heart journal, 38(11), 828-836.
Vernon, S. T., Coffey, S., Bhindi, R., Soo Hoo, S. Y., Nelson, G. I., Ward, M. R. & O’sullivan, J. F. (2017). Increasing proportion of ST elevation myocardial infarction patients with coronary atherosclerosis poorly explained by standard modifiable risk factors. European journal of preventive cardiology, 24(17), 1824-1830.
Xie, X., Atkins, E., Lv, J., Bennett, A., Neal, B., Ninomiya, T. & Chalmers, J. (2016). Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. The Lancet, 387(10017), 435-44

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