Nursing Care of Patients with Acute ST-Elevation Myocardial Infarction: Two Case Comparative Studies

Abstract

This study is a comparative analysis of nursing care for two patients with acute myocardial infarction, specifically STEMI, who were treated in the emergency room of Silalad Hospital. The study was conducted from July to December 2024, using data collection methods such as interviews, observations, and medical records. The assessment of the patients' health status was based on Gordon's 11 health patterns, and nursing diagnoses were established in conjunction with the nursing process concepts applied in patient care. The results indicated that both case studies received care according to the physician's treatment plan and followed the nursing process during the critical emergency phase, the ongoing phase, and the transfer phase. It was found that both case studies exhibited a clear similarity in symptoms, specifically chest pain. Case Study 1: A 62-year-old male denied any pre-existing medical conditions. He presented to the emergency room with symptoms of chest tightness radiating to both arms, experiencing pain for about 30 minutes before arriving at the hospital, which was 2 hours before. An immediate electrocardiogram revealed ST elevation in leads V2-V4. The doctor diagnosed him with Anterior wall STEMI. After receiving thrombolytic therapy, a follow-up ECG showed reperfusion, and the patient's chest pain decreased. He was safely transferred to Sisaket Hospital. Case Study 2: A 72-year-old female with a history of hypertension (HT) but lacking continuous treatment, having not taken her blood pressure medication for approximately 8 months. She presented to the emergency room with symptoms of chest pain radiating to the back, lasting about 20 minutes, occurring 1 hour before arriving at the hospital. An electrocardiogram (ECG) was performed immediately, revealing ST elevation in leads V3-V6. The physician diagnosed her with Anterior wall STEMI. After receiving thrombolytic therapy, a repeat ECG showed no reperfusion. She was transferred to Sisaket Hospital for rescue PCI. During the transfer, no complications were observed. The patient was closely monitored until safely reaching Sisaket Hospital. In both case studies, five nursing diagnoses were found to be the same. The patient received care according to standard guidelines and was transferred according to the STEMI fast track system of Sisaket Hospital.