Nursing care of acute myocardial infarction patients with Emergency Department: Two case studies

Abstract

Acute myocardial infarction is a cardiovascular disease that is the leading cause of death in Thailand. It is a crisis that causes the sudden death of a patient. AMI is a life-threatening heart muscle that is abruptly cut off, causing tissue damage. This is usually the result of a blockage in one or more of the coronary arteries and high complications if not treated promptly. Treatment in the role of a community hospital at the Emergency Department, providing nursing care 3 phases 1) First admitted to the emergency department. 2) Early nursing care in the emergency department 3) Referral nursing. This study was aim to report was to study the prognosis, treatment, and nursing characteristics of two patients with acute myocardial infarction in a case study of the patient. Research method was Case study in two specific cases diagnosed with acute myocardial infarction who received thrombolytic drugs admitted to the emergency department of Ranot Hospital, Songkhla Province, fast track system,  conducted between 1 December 2022 to 30 June 2023. The tools used were interviews, observation of symptoms and medical records, patient assessments according to the 11 health plans of Gordon, and determination of the patient's nursing diagnosis according to the guidelines of the North American Nursing Diagnosis Association, providing 3 phases of nursing care: 1) Emergency nurses are) first admitted to the Emergency Accident and Forensic Department. 2) Early nursing care while in the Emergency Accident and Forensic Department. 3) Referral nursing.

This study found that: Case 1: The patient comes to with chest pain penetrating the back. These signs occurred before I went to the hospital for about 4 hours. He was immediately screened into the emergency room and had an electrocardiogram. The doctor diagnosed anterolateral wall STEMI and treated it with streptokinase. The patient developed cardiogenic shock after the clot-dissolving drug was completely administered. A repeat electrocardiogram found that there was reperfusion. total time in care was 2 hours 57 minutes. Refer to the host hospital, no complications. Case 2nd patient coming to with chest pain 4 hours. She was immediately screened into the emergency room and had an electrocardiogram. The doctor diagnosed Inferno-lateral wall STEMI and treated him with streptokinase. While receiving a blood clot-dissolving drug, Cardiogenic shock, after the blood clot-dissolving drug ran out, repeated ECG examinations found that there was no reperfusion. The patient was immediately transferred for treatment at the host hospital. The total time in care was 1 hour and 38 minutes.

Conclusion: The role of nurses in caring for patients with acute myocardial infarction in the critical stage is very important in assessing and screening patients correctly and quickly upon arrival at the hospital. This allows patients to receive a correct diagnosis and receive treatment with blood clot-dissolving drugs quickly. Nurses must know about administering medications and monitoring for abnormal conditions that may always occur in patients. From the time the patient is admitted until they are transferred to a hospital with higher capacity, it results in reducing the death rate of the patient.