Case Study Mr. Bernhard Wolfgang, a 56-year-old German immigrant who works as an
ID: 90805 • Letter: C
Question
Case Study Mr. Bernhard Wolfgang, a 56-year-old German immigrant who works as an engineer, is admitted with chest pain and shortness of breath. Mr. Wolfgang is admitted to the coronary care unit to rule out myocardial infarction. Immediately after admission, Mr. Wolfgang's wife comes to the coronary care unit with personal items such as family portraits, some roses from the client's garden, and some personal clothing. However, since the coronary care unit is restricted in space, personal items are not allowed and the wife is instructed to take the items home. On admission, Mr. Wolfgang's vital signs are stable and his color is good. He reports that the chest pain is not debilitating and is more or less an occasional dull ache. After 2 days, the diagnosis of myocardial infarction is confirmed, and Mr. Wolfgang remains restricted to bed but is transferred to a semiprivate room in the coronary care step-down unit. After admission to the coronary care step-down unit, the nurse observes that Mr. Wolfgang is anxious, somewhat withdrawn, and unable to express his needs and feelings.
3. Identify markers that would indicate Mr. Wolfgang's need for the establishment of a temporary territorial space.
Explanation / Answer
Answer:myocardial infraction is usually caused by reduced or decreased blood flow in a coronary artery due to rupture of an atherosclerotic plague and subsequent occulsion of the artery by a thromus.
Clinical manifestations of MI:
-Chest pain:Chest pain occurs suddenly ,severe immobilisation chest pain that not relieved by rest ,medications.
-Bp may be elevated because of sympathetic stimulation or may decrese due to decresed contractility.
-ECG may show tachycardia,bradycardia,or dysarrythmias.
-pulmonary edema,or congestion,cool,pale appearance of skin and many other factors.
Medical management:
1.Minimize myocardial damage
2.Preserve myocardial damage and prevent complications
3.It is also reducing myocardial oxygen demand and increasing oxygen supply .
Cardiac rehabilation:
It is a long term that involves periodic evaluation ,prescribed education and exercise and counselling about cardiac risk factors modification.
Nursing management for patients with myocardial infraction:
1.Achieving a balance between myocardial oxygen supply and oxygen demand.
2.These are achieved via oxygen administration and medication(Nitroglycerin).
3.Prevention of complications and monitoring of cardiac functions.
4.Continous ECG monitoring and monitor and record intake and urine output.
5.Prevent complications associated with MI particularly dysrhythmia and cardigenic shock.
6.Emotional and psychological support.
7.Provide information about disease and treatment process.
Nusing diagnosis:
.1.Ineffective cardiac tissue perfusion related to reduced coronary blood flow from coronary thrombus and atherosclerotic plague.
2.Risk of imblanved fluid.
3.Death of anxiety
4.Deficient knowledge about post MI and self care.
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