‫‪Case Study‬‬
‫)قسم( ‪Emergency‬‬
‫( الشهر ‪) ٤ – ٣‬‬
‫‪Student Name:‬‬
‫عبدهللا صالح سالمان نصر هللا‬
‫‪1‬‬
Case Study
Sociodemographic data
Special unit : emergency
Patient’s name: Heba Mostafa Ahmed.
Date of admission: 22/4/2023
Stay period: 1 day
Age:38
Sex: Female
Level of education: Bechalor degree
Occupation: Teacher
Marital status: Married
Religious: Muslim
Present History:
-Diagnosis/ Present illness: Angina
-Chief complaints on admission: pain on chest and nausea
-Predisposing factors: obesity, not enough exercise and high blood pressure
-Reliving measures and its effect: Taking alot of rest , drinking plenty of water, exercise
and lose weight
Past History:
 Medical: (patient ha no medical history)
-Diagnosis / Duration:………………………………………………………………….
 Surgical: (patient has no surgical history)
-Name of surgery / Duration:…………………………………………………………..
Allergy history: (patient has no allergy history)
Family history:
-Diagnosis / Relation: Father had myocardial infarction (MI) at age 43
Life style habit : Diet rich in fats and carbohydrates, low-fiber diet, sedentary
lifestyle, low physical activity,
Patient’s physical assessment:
Vital signs: Blood Pressure: 140/100 mmHg , Pulse: 76b/m, Temperature: 37.2C
,Respiratory rate is 16/minute
General appearance: Conscious and oriented, facial grimace
Skin: good skin integrity, skin is warm , good skin turgor.
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Head: Hair is equal distributed, absence of dandruff and alopecia
Eyes:Both eyes are normal able to move both eyes , good response to light source, no
discharge
Ears: No discharge, able to her sound clearly
Nose: Pink nasal mucosa , no discharge
Mouth: Pink oral mucosa, tongue and uvula in midline position, teeth are properly
aligned without dentures
Neck and throat: No tenderness noted, no palpable mass and lesion
Chest and lungs: Thoraxic is symmetric on inspection, clear breath sound
Cardiovascular: Normal heart sound , normal heart rate, Apical pulse is 88b/m
Upper and lower extremities: Normal range of motion
Abdomen: Bowel sounds are normal,on palpation abdomen is slightly enlarged,
tenderness in the upper right portion.
Genitourinary system: No discharge
Gastrointestinal: No bowel obstruction present, abdominal pain present
Neurologic : Patient is mentally alert and oriented , able to follow commands, no
neurovascular deficit.
Definition of disease: Angina is chest pain or discomfort that occurs when your heart
doesn’t get as much blood and oxygen as it needs. In angina, the need for increased blood flow
isn’t met for a short time. When increased demand for blood goes away, angina symptoms go
away too
Pathophysiology\ types: There are different types of angina. The type depends on the
cause and whether rest or medication relieve symptoms.
Stable angina. Stable angina is the most common form of angina. It usually happens during
activity and goes away with rest or angina medication. Stable angina pain is predictable and
usually similar to previous episodes of chest pain. The chest pain typically lasts a short time,
perhaps five minutes or less.
Unstable angina (a medical emergency). Unstable angina is unpredictable and occurs at rest.
Or the angina pain is worsening and occurs with less physical effort. It's typically severe and
lasts longer than stable angina, maybe 20 minutes or longer. The pain doesn't go away with
rest or the usual angina medications. If the blood flow doesn't improve, the heart is starved of
oxygen and a heart attack occurs. Unstable angina is dangerous and requires emergency
treatment.
Variant angina (Prinzmetal angina). Variant angina, also called Prinzmetal angina, isn't due
to coronary artery disease. It's caused by a spasm in the heart's arteries that temporarily
reduces blood flow. Severe chest pain is the main symptom of variant angina. It most often
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occurs in cycles, typically at rest and overnight. The pain may be relieved by angina
medication.
Refractory angina. Angina episodes are frequent despite a combination of medications and
lifestyle changes.
Etiology
According to patient
According to literature
1- coronary arteries disease
- reduced blood flow to the heart
muscle
2- sedentary lifestyle and imbalance
diet
- Atherosclerosis, spasm of coronary
arteries
3- plaques in a blood vessel rupture or a blood
clot forms, it can quickly block reduce flow- Oxygen when decrease in blood flow
through a narrowed artery.
Clinical manifestations
According to patient
According to literature
1-Pain may also be felt in the arms
- Squeezing
2- chest pain and discomfort
- Fatigue,Nausea
Shortness of breath
3- Stomach (abdominal) pain
- Sweating
4- Nausea
5- Shortness of breath
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Complications
According to patient
According to literature
1- Pain extending beyond the chest to the - Pressure, fullness or a squeezing pain in the
shoulder, arm
center of the chest that lasts for more than a
few minutes
2- Increasing episodes of chest pain,
Nausea and vomiting
- Fainting,Impending sense of doom
3- Shortness of breath,Sweating.
- Continued pain in the upper belly area
(abdomen).
Diagnostic measures
Lab investigation:
According to literature
Lab Investigation
According to patient
Patient's Results
Normal Range
Hemoglobin (hb)
12.7g/dl
12-16.5g/dl
HCT
42.6%
41-50%
RBCs
4.3x10*12/L
4-5.9 x 10*12/L
WBCs
19.800/L
4.5-11.0 × 109/L
PLT
320.000
Glucose
109 mg/dL
Potassium (k+)
4.1 mEq/L
150.00-450.000
/mcl
less than 140
mg/dl
3.5-5 mmol/L
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Nursing
Considerations
INR
1.2
1.1 or below
CK-MB
2.12 ng/mL
urea
25 mg/dL
below 0.02
ng/mL
6 to 24 mg/dL
creatinine
0.72 mg/dL
total cholesterol
184 mg/dL
triglycerides
54 mg/dL
0.59 to 1.04
mg/dL
less than 200
mg/dL
150 (mg/dL)
sodium(Na+)
136 mEq/L
135-145 mEq/L
Radiological examination:
According to literature
Type of examination
According to patient
Check for
what done
The ECG at rest
Patient's Results
Nursing Considerations
showed a sinus
rhythm, a heart rate
of 82 bpm, a PR
interval of 160 ms,
QRS duration of
110 ms, QT of 360
ms, left atrial
enlargement
Unsatisfactory
CT scan
Medical management according to patient
No.
Drug name
Route
Dose / FrequencyAction
1
2
Nitrates
Aspirin
sublingual 0.3-0.6 mg
Oral
75to100mg
3
(Plavix)
Oral
4
Propranolol IV
Nursing Consideratio
75mg
Vasodilation
nonsteroidal antiinflammatory drug
antiplatelet
1mg/mL
Beta blocker
6
5
Verapamil
6
Normal
IV
Saline
Glucose 5% IV
7
IV
500ml/tid
calcium-channel
blockers
Solution
500ml/bd
Solution
Surgical management
According to patient
According to literature
Non
-coronary artery bypass graft (CABG)
-coronary angioplasty and stent insertion
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Nursing management
According to patient
According to literature
- Assess patient's pain scale and perception- To identify onset , intensity and
duration of pain
- provide comfort measures (backrub, position
change, environmental control)
- Monitoring cardiac enzymes and ECG
- Encourage deep breathing exercises
- To reduce pain and provide
relaxation
- Teach divertional activities
(listening to music)
- To assist breath muscles
- Monitor vital signs
- To distract patient from pain
- Administer pain medication per
doctor 's order prior to activities of
daily living
- To identify intensity of pain
- Manage chest pain and Bed rest
- To relieve the pain
- Provide oxygen and Administer aspirin and
nitroglycerin
- Place patient with head of the bed elevated at
45 degrees.
-Make patient comfortable and Hook up to
monitor and Obtain ECG
-Provide oxygen
- Management of hypertension if present - to improve sedentary lifestyle
- Maximizes expansion of lungs to
prevent respiratory complication
- Provide clear liquids in small amount,
and progress diet as tolerated
-Administer aspirin and nitroglycerin
- Elevate the head of bed, maintain
low-Fowler’s position.
- To maintain muscles function.
- Monitoring Pulse oximetry,ECG,
- To enhance patient's relaxation
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Cardiac enzymes and Respiration
and reduce the negative impact of
the surrounding environment.
-Listen to the chest for rales
- see doctor if have Tachypnea,
Dyspnea and Altered mental status
- Initial exercise and balance diet
- less anxiety or emotional stress
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