Question

In: Nursing

Mr. Lopez a 58 year-old male a retired bank employee, a smoker consumes 1 pack per...

Mr. Lopez a 58 year-old male a retired bank employee, a smoker consumes 1 pack per day for 15 years,
drinks alcohol occasionally, hypertensive and live a sedentary lifestyle was rushed in to hospital for chief
complaints of severe chest pain, In the ER he was given 0xygen 7-10 LPM via oxygen mask, nitroglycerin
given for 3 doses after 45 minutes the pain still there. Morphine administered stat. Vital Signs as follows:
BP– 150/100, PR – 122 with cardiac arrhythmia, RR – 20, T – 37.8C.

Doctor’s order:
PNSS1L X 42 gtts/min.
Nitroglycerin drip to titrate
Amlodipine 10 mg OD PM
Omeprazole 40 mg IV
Monitor vital signs Q1 hour
Monitor I and O Q 1 hour

Medical Diagnosis: Myocardial Infarction

Laboratory:
CBC – normal
Urinalysis – normal
LDL – elevated
HDL- decrease
Triglyceride – elevated
Total Cholesterol – elevated
TROPONIN T – elevated

DIAGNOSTICS:
ECG – ST segment elevated, T wave inverted

Present Medical History
1 day prior to admission patient experience dizziness, palpitations and tachycardia, he just took a rest and
stay to his room all day. 1-hour PTA patient experience stomach pain, cold clammy skin, and diaphoresis.

Past Medical History
Patient has coronary artery disease 2 years now, the pain started when the patient joins the fun run
organized by his company. At first he experiences slight chest pain, pallor and sweating, and easily relieved
by rest, and a single dose of Nitroglycerin 5 mg sublingual, he was advised to quit smoking and given
maintenance medication for hypertension, after a couple of months he consulted a doctor for experiencing
moderate chest pain and difficulty in breathing and given a maintenance nitroglycerin 5 mg sublingual, for
chest pain, Losartan 50 mg. OD in AM, Amlodipine 5 mg. OD in PM. The patient continues to eat foods to
avoid. He loves to eat pork sisig, lechon, shrimp, and fatty foods like adobo and grilled pork chop. Most of
the time he forgot to comply to his maintenance medication.

Family History
(-) Tuberculosis
(+) Hypertension
(-) Cancer
(+) Cardiovascular disease
(+) DM
(-) Asthma

QUESTION:
1. What factors made the condition of Mr. Lopez got worst?
2. What really causes the pain to trigger when the patient exerts effort? Explain
3. What will your advice to Mr. Lopez to prevent the attack of pain

Solutions

Expert Solution

1. What factors made the condition of Mr. Lopez got worst?

Mr.Lopez had many risk factors

  • Cigarette smoking ( 1pack per day for 15 years)
  • Hypertension
  • Sedentary life style because of the non physical nature of his job and daily activities
  • LDL, total cholesterol, triglycerides elevated because of fat rich diet

Mr Lopez has past history of Coronary artery disease for 2 years now. He also have family history of cardiovascular disease, hypertension and diabetes mellitus.

2. What really causes the pain to trigger when the patient exerts effort? Explain

Pain, pressure, tightness, or different discomfort originating in or radiating to the chest constitutes an vital indicator of doubtlessly serious cardiac or cardiovascular disorders.

Chest pain. The first thing you may also think of is heart attack. Certainly chest pain is now not some thing to ignore. But you must be aware of that it has many possible causes. In fact, as much as a quarter of the U.S. population experiences chest pain that is not related to the heart. Chest pain might also also be caused by using troubles in your lungs, esophagus, muscles, ribs, or nerves, for example. Some of these stipulations are serious and lifestyles threatening. Others are not. If you have unexplained chest pain, the solely way to confirm its cause is to have a medical doctor evaluate you.

Patient may feel chest pain anywhere from your neck to your upper abdomen. Depending on its cause, chest pain may be:

  • Sharp
  • Dull
  • Burning
  • Aching
  • Stabbing
  • A tight, squeezing, or crushing sensation

3. What will your advice to Mr. Lopez to prevent the attack of pain?

  • Primary prevention

Life style

Physical recreation can limit the threat of cardiovascular disease, and human beings at danger are suggested to interact in a hundred and fifty minutes of moderate or 75 minutes of vigorous-intensity aerobic exercise a week. Keeping a healthy weight, drinking alcohol within the advocated limits, and quitting smoking reduce the risk of cardiovascular disease.

Medication

Statin drugs  that act to decrease blood cholesterol, reduce the incidence and mortality prices of myocardial infarctions.They are often endorsed in those at an elevated threat of cardiovascular diseases.

  • Secondary prevention

There is a large crossover between the lifestyle and undertaking suggestions to stop a myocardial infarction, and these that can also be adopted as secondary prevention after an preliminary myocardial infarct. Recommendations include stopping smoking, a gradual return to exercise, eating a healthy diet, low in saturated fat and low in cholesterol, and drinking alcohol within advocated limits, exercising, and trying to obtain a wholesome weight. Exercise is each secure and advantageous even if human beings have had stents or heart failure, and is advocated to begin progressively after 1–2 weeks. Counselling need to be provided relating to medicines used, and for warning signs of depression. Previous studies suggested a advantage from omega-3 fatty acid supplementation but this has now not been confirmed.


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