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Myocardial InfarctionMolly ChaffinDenielle SaittaClaire HolladayLauren MitchellKarly Childress+What is a myocardial infarction?A heart attack occurs when blood flow to the heart muscle is decreased or blocked completely, keeping the heart from getting enough oxygen, which can damage or destroy part of the heart muscle. Heart attacks are most often caused by the buildup of plaque in the arteries that lead to the heart. Plaque is the accumulation of calcium and fatty acids such as cholesterol and triglyceride.
+Figure A shows a heart with dead heart muscle caused by a heart attack. Figure B is a cross-section of a coronary artery with plaque buildup and a blood clot2What are the symptoms?Most common warning symptoms of a heart attack:Chest pain or discomfortUpper body discomfortShortness of breathOther possible symptoms of a heart attack include:Breaking out in a cold sweatFeeling unusually tired for no reason, sometimes for days (especially if you are a woman)Nausea and vomitingLight-headedness or sudden dizziness+Chest pain or discomfort: Most heart attacks involve discomfort in the center or left side of the chest. The discomfort usually lasts more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. It can also can feel like heartburn or indigestion.Upper body discomfort: You may feel pain or discomfort in one of both arms, the back, shoulders neck, jaw, or upper part of the stomach Shortness of breath: this may be your only symptom, or it may occur before or along with chest pain or discomfort. It can occur when you are resting or doing a little bit of physical activity
Not all heart attacks begin with the sudden, crushing chest pain. The symptoms of a heart attach can vary from person to person. Some people can have few symptoms and are surprised to learn theyve had a heart attack. 3What is angioplasty?Angioplasty is a nonsurgical procedure to open narrowed or blocked coronary arteries that supply blood to the heart. A coronary artery stent is a small, metal mesh tube with a balloon that expands inside a coronary artery which is placed during or after an angioplasty. The stent helps prevent blockages in the artery in the future.
+Once in place, the balloon is inflated to compress the plaque against the wall of the artery. This restores blood flow through the artery.4Meet James Klosterman+Client History (CH)Personal History61 y.o. maleOccupation: Lutheran MinisterMarital Status: Married, with grown childrenTobacco use: 1 ppd for 40 yearsAlcohol use: 1 glass of wine per dayPatient Medical HistoryBrought to emergency room by his wife after having severe chest pain returning home from work. He described having pressure-like pain radiating to his jaw and left arm and had an episode of emesis and nausea
+Client History (CH)Medical History contSurgical History: AppendectomyCholecystectomy (10 years prior)Allergies: noneFamily HistoryFather: Coronary Artery Disease; MI age 59
+Client History (CH)Treatments/ Therapy Alternative MedicineSurgical treatmentDiagnosed as myocardial infarctionAngioplasty of distal right coronary arteryStent placement to stabilize patient
+Anthropometric Measurements (AD)Height: 5 feet 10 inchesWeight: 185 poundsBMI: 26.6 kg/m2Unplanned Weight Loss: N/A+Nutrition-Focused Physical Findings (PD)Overall AppearanceSlightly overweight, pale, distressedNerves and CognitionAlert and focusedVital SignsTemp: 98.4BP: 118/78Pulse: 92 bpmRespiratory rate: 20 bpm+Biochemical Data, Medical Tests and Procedures (BD)ChemistryDay 1Day 2Day 3Ref. RangeCarbon Dioxide (CO2, mEq/L)20 L242623-30Glucose (mg/dL)136 H10610470-110ALT (U/L)30215 H185 H4-36AST (U/L)25245 H175 H0-35CPK (U/L)75500 H335 H55-170 (M)CPK-MB (U/L)075 H55 H 0Lactate Dehydrogenase (U/L)325685 H365208-378+Biochemical Data, Medical Tests and Procedures (BD)ChemistryDay 1Day 2Day 3Ref. RangeTroponin I (ng/dL)2.4 H2.8 H200mg/dL, HDL 130mg/dLPES #2: Physical inactivity related to sedentary lifestyle as evidenced by only walking 15 minutes each day
ADIME Notes, contIntervention PES #1:Nutrition Rx: Modify diet to consume less than 5-6% of daily calories from saturated fats; this translates to less than 162 calories or 18 grams of fat for Mr. Klosterman.Nutrition intervention: This can be done by decreasing dietary consumption of saturated fats by choosing a lower fat milk option. Provide nutrition education to promote healthy cooking and appropriate portion sizes. Also, continue to replace butter with oil when cooking and reduce fried foods. Participate in the DASH diet to reduce sodium intake and have a better heart healthy diet and help reduce BMI.PES #2:Nutrition Rx: Increase physical activity to 150 minutes per week of moderate intensity physical activity (1).Nutrition intervention: Increase walking to 30 minute per day, five or more times per week. Discuss other options for physical activity to decrease sedentary time. Gradually increase daily activity time to add up to 300 minutes per week until healthy weight is reached.ReferencesNahikian-Nelms, Marcia, and Sara Long. Roth. Medical Nutrition Therapy: A Case Study Approach. Belmont, CA: Wadsworth/Thomson Learning, 4th ed., copyright 2014. Print. Internet ResourcesAmerican Heart Association: http://www.heart.org/Academy of Nutrition and Dietetics: http://www.eatright.orgNutrition Care Manual: http://www.nutritioncaremanual.orgNational Heart, Lung, and Blood Institute: http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/+