Introduction

A heart beat signifies life, from the day it starts to beat in the womb, till it stops, and where death conquers us. The heart beats not only to one tune but it also responds to the tune of emotions and physical stress. As some of us may have also experience moments of joy or sorrow and the heart may feel pain or pleasure. In medicine, an acute disease is a disease with a rapid onset or a short course. The term Acute may often be confused by the general public to mean severe, however, this has a different meaning. Coronary, may refer to as the heart or relating to the heart. While syndrome is defined as a set of signs and symptoms that tend to occur together and which reflect the presence of a particular disease or an increased chance of developing a particular disease.

Acute Coronary Syndrome is defined as a spectrum of conditions involving chest discomfort or other symptoms caused by lack of oxygen to the heart muscle (the myocardium). The unification of these manifestations of coronary artery disease under a single term reflects the understanding that these are caused by a similar pathophysiology (sequence of pathologic events) characterized by erosion, fissuring, or rupture of a pre-existing plaque, leading to thrombosis (clotting) within the coronary arteries and impaired blood supply to the heart muscle.

According to the morbidity rate, taken from the records of the Department of Health for region X, the occurrence of cardiovascular diseases per 100,000 populations is 3,356. This data is taken from the 2001-2005, a 5 years average record. While the occurrence rate for cardiovascular disease for region X by 2006 is recorded to be 4,373 per 100,000 populations.

OBJECTIVES OF THE STUDY

The study aims to explore the concepts about the condition and the quality of nursing care being rendered to our client Mrs. F that was diagnosed with Acute Coronary Syndrome.

In order to learn more about the health condition of the patient, the study wants to fathom about the predisposing and precipitating factors, anatomy and physiology and the pathophysiology of the condition

experienced by the client. Basically the main goal of this study in relation to knowledge is to identify the nursing interventions after the condition of patient Mrs. F.

The study aims to critically analyze the qualitative and quantitative data gathered in order to establish connection between the different manifestations experienced by the patient with that of the disease process. To be able to improve skills, the students also endeavors to come up with nursing care plans that will alleviate Mrs. F.s condition. The presentors also intend to compare and contrast the ideal management for Acute Coronary Syndrome with that of the actual management. In addition, the study seeks to disseminate essential information to everybody for awareness.

SCOPE AND LIMITATIONS OF THE STUDY

This case study tackles about Acute Coronary Sydrome specifically on the case of patient Mrs. F. It includes essential concepts in relation to the said condition such as the patients profile and health history, nursing assessment and clinical manifestations, drug study and diagnostic exams done. The anatomy and physiology is also included as well as the pathophysiology of Acute Coronary Syndrome with its associated factors. The Medical and Nursing Management along with the discharge plans with its referrals are also being covered. The prognosis is also given.

The scope of the plan encompasses during the Recovery Phase which was on September 17 and 18 wherein the assigned students who have assessed the client with cumulative interaction and good rapport to the patient and significant others. Nursing Management covers the above mentioned dates which encompasses the clients Recovery Phase. The areas of concerns are limited to the discussions of Acute Coronary Syndrome and the quality of Nursing Care to the patient. The quantity and quality of the information are limited to the data gathered from the client, significant others and his medical records.

Immediate family background is limited because the patient has difficulty in recalling necessary information that would aid in the data gathering. Data gathering was limited in the confines of Tarlac provincial Hospital. Generally, the content of the report is limited to the elaboration of the diagnosis given to the patient and the corresponding Nursing Management.

PATIENTS PROFILE Name: Mr. F Age: 53 years old Sex: male Birthday: June 3, 1958 Birth rank: 2nd to the eldest Number of siblings: 7 Religion: Roman Catholic Civil Status: Married Number of children: 4 Nationality: Filipino Height: 5Ft.6in Weight: 63 kg Address: Conception, Tarlac Occupation: House wife Income: Php. 15,000/ mo. Educational Attainment: College Graduate Date Admitted: September 14, 2011 Time Admitted: 12: 05 PM Chief Compliant: Shortness of breath and chest pain Final Diagnosis: Acute Coronary Syndrome, hypertension, Myocardial Infarction

Significance of the study

The study is significant to the following people, the client, the clients family, the researchers, nursing student, and future researchers.

The study is significant to the client, because it enlightens the clients queries and doubts regarding her condition. Allowing her to understand the situation of her present state, this would allow her to be more aware of the importance of following the treatment regimen.

Clients family must also be aware of the condition of the client. With the study, the clients family will be able to participate in the clients treatment, and they will be able realize the importance of the support system in participating in the clients care.

The study is also important to the researchers, since it allows them to explore the clients condition, giving them first hand experience in observing the manifestations of the disease condition and allowing them to apply theoretical knowledge regarding nursing managements for the manifested signs and symptoms.

Nursing students and future researchers may use the study for reference or basis purposes in planning an intervention or understanding a condition which could be similar or related to the study presented.

Health History
Family History History of hypertension was present to both paternal and maternal side, in addition to the given datas from the informant; theres no history of CA on the clients lineages. However, on her maternal side a history of diabetes mellitus and heart problems was present. Mr. F.s grandfather (father side) died due to liver abscess. It was known that his grandfather was a chain tobacco smoker consuming 24 sticks or approximately 1pack of cigarette per day and drinks alcoholic beverages such as tuba. Additionally, patients grandmother (father side) died due to normal aging with high blood pressure. Patients maternal side history revealed that grandparents died due to aging. Furthermore, patients father died due to normal aging with hypertension. It was mentioned that his father was also a smoker, consuming 15-20 estimated sticks of cigarette per day. He also drinks alcoholic beverages like tuba. Her mother died at her 88 years of age due to normal aging process. On the siblings of the clients father side, all had hypertension. Some of her mothers siblings had hypertension and one had CVA. Significance of the study The study is significant to the following people, the client, the clients family, the researchers, nursing student, and future researchers.

The study is significant to the client, because it enlightens the clients queries and doubts regarding her condition. Allowing her to understand the situation of her present state,

this would allow her to be more aware of the importance of following the treatment regimen.

Clients family must also be aware of the condition of the client. With the study, the clients family will be able to participate in the clients treatment, and they will be able realize the importance of the support system in participating in the clients care.

The study is also important to the researchers, since it allows them to explore the clients condition, giving them first hand experience in observing the manifestations of the disease condition and allowing them to apply theoretical knowledge regarding nursing managements for the manifested signs and symptoms.

Nursing students and future researchers may use the study for reference or basis purposes in planning an intervention or understanding a condition which could be similar or related to the study presented. 5

Health History
Family History History of hypertension was present to both paternal and maternal side, in addition to the given datas from the informant; theres no history of CA on the clients lineages. However, on her maternal side a history of diabetes mellitus and heart problems was present. Mrs. F.s grandfather (father side) died due to liver abscess. It was known that her grandfather was a chain tobacco smoker consuming 24 sticks or approximately 1pack of cigarette per day and drinks alcoholic beverages such as tuba. Additionally, patients grandmother (father side) died due to normal aging with high blood pressure. Patients maternal side history revealed that grandparents died due to aging. Furthermore, patients father died due to normal aging with hypertension. It was mentioned that her father was also a smoker, consuming 15-20 estimated sticks of cigarette per day. He also drinks alcoholic beverages like tuba. Her mother died at her 88 years of age due to normal aging process. On the siblings of the clients father side, all had hypertension. Some of her

mothers siblings had hypertension and one had CVA. Personal Social history

Mrs. F. had her menarche at the age of 13 years old. At the age of 20 years old, Mrs. F. met Mr. S. at Baungon, Bukidnon and got married. Mrs. F.s reproductive profile was G13, P13, T13, P0, A0, and L10. She has 13 children. Her first pregnancy was on February 3, 1947 with their first child named Sohrab through Normal Spontaneous Vaginal Hospital delivery. Sorab died on January 29, 1989 due to an accident. Second delivery was a pregnancy uterine full term, normal Spontaneous delivery with a baby 6 boy named after his father, Santiago Jr. History divulges that the patients second child died after birth. Third pregnancy was still a normal spontaneous vaginal delivery. The baby was named Leopoldo, Leopoldo died due to measles at the age of 3months. Her fourth pregnancy was still normal named her third child Elleonor with an educational attainment of High School level who was born February 22, 1949. Mrs. F.s 10 remaining pregnancies were all full term and were all delivered through normal spontaneous vaginal delivery. The remaining 10 children were the following: Gemma who was born on December 18 1950, married and with an educational attainment of High School Grad, Rosalina born aug. 18, 1951 with an educational attainment of High School graduate ,married (female), Efren born Sept. 18 1952 with an educational attainment of High School level and is married (male), Salvacion born on Feb. 15, 1953 a High School level and is married (female), Marjorie born on Oct. 16, 1962 a High School graduate and is married (female), Jose born on 0ct. 18, 1963 a High School level and is single (male), Marites born on Dec. 10, 1964 a High School level and is married (female), Nancy born on Aug. 22, 1966 a college graduate and is married (female),Edgardo born on Nov. 2 1967 a High School Grad and is single(male). Patients husband, Mr. S. was the Former vice Mayor of Baungon, Bukidnon. On the year 19631965.Being a wife of the vice mayor, she participated well in politics and has a lot of programs and campaigns for her husband. She was also a member of the Catholic Womens League and has done a lot of outreach programs for the church. Their family social status was at peak that time, but then a great downfall happened in their lives. At the age of 39 years old, Mr. Santiago was stabbed due to political conflicts which caused his death. She hardly accepted it because of the traumatic experience they had.

After two years, Mrs. F. got married to Mr. V. He is a Cebuano who came to Baungon, Bukidnon in search for work and found more than what he had expected. Mr. V was afraid in marrying her because he has to face all of her children to ask for the hands of their mother. Luckily, all of her children understood and accepted him and they got married. Mr. V. and Mrs. F. were not blessed with children somehow blessed with their adopted children who were Margie and Kristine. 7

They have their own house in Baungon, Bukidnon and took cared by her adopted daughter Margie. When visiting in Cagayan de Oro wherein her sons and daughters are residing in the same area, they stay in her daughters house Marites in Aluba, Coca-cola compound where they are warmly welcomed. Our clients source of income is only P15,000 pesos a month from her pension pay. Past medical History On 1965, the year of Mr. S.s death, Mrs. F. had traumatic experience that caused her psychological and physical stress. It was claimed by the informant that at the year 1984, patient was admitted to City Hospital due to her first stroke attack. That admission lasts for a week and she was diagnosed to have Cerebro Vascular Accident or CVA. Her, second attack was on year 1991 at Madonna Hospital Intensive Care Unit (ICU). After a couple of years from her 2nd admission, patient suffered from persistent chest pain thus gave way to her third admission at Maria Reyna Hospital the year 2006. After that admission, patient was given home medications to be maintained which are: Telmisartan (pritor) 40mg 1 tab/day, Clopidogrel (Plavix) 75mg 1 tab OD, Metroprolol 50mg tab BID, Amniodarone (Cordarone) 200mg 1 tab TID, ASA 80mg 1 tab OD, Atorvastatin (Lipitor) 80mg 1 TAB OD @ hs, SMN (imdur) 60mg 1 TAB BID. One year after her third admission patient underwent surgery on her left eye. An Extra Capsular Cataract Lens Extraction (ECCLE) was done on the year 2007. History of Present Illness

One week prior to admission patient experienced blurring of vision and headache which continue until the day of admission. She didnt do anything because she thought that its just a symptom of her cataract.

3days prior to adm. Client took Isodril for her moderate chest pains radiating from the left shoulder to her back but wasnt relieved. Informant stated that, 1 day prior to admission, patient had shortness of breath with8

inability to lie flat on bed and the night of the same date (February 4, 2008), patient noted and complained for moderate chest pain radiating to her left shoulder and back. On the 5th day of February 2008, Severe Chest pain suffered by the patient persisted with difficulty in breathing and shortness of breath which prompt her admission at Maria Reyna Hospital and was initially diagnosed with Hypertensive Cardiovascular disease. The client was ruled with the final diagnosis of Acute Coronary Syndrome and was under the observation and medical treatment of Dr. Alenton. Chief Complaint Shortness of breath 9

Developmental Data
GROWTH AND DEVELOPMENT

Patient: Mrs. F Gender: Female Age: 81 years old Psychosocial Theory Erik Erikson Erik Eriksons theory of psychosocial development is one of the best-known theories of personality in psychology. His theory describes the impact of social experience across the whole lifespan. In each stage, Erikson believed people experience a conflict that serves as a turning point in development. In Eriksons view, these conflicts are centered on either developing a psychological quality or failing to develop that quality. During these times, the potential for personal growth is high, but so is the potential for failure.

In this theory, the patient has the task of Integrity vs. Despair which is the final task of psychosocial theory which ranges at 65 years old until death. This phase occurs during old age and is focused on reflecting back on life. Those who are unsuccessful during this phase will feel that their life has been wasted and will experience many regrets. The individual will be left with feelings of bitterness and despair. Those who feel

proud of their accomplishments will feel a sense of integrity. Successfully completing this phase means looking back with few regrets and a general feeling of satisfaction. These individuals will attain wisdom, even when confronting death. The patient has developed a feeling of despair. Shes destructed by her worries for things that might worsen her condition and for things that might happen to her offspring. Patient was even afraid of facing death because she felt that she hasnt done

the four heart chambers. Although a considerable amount of external adipose tissue is present on the heart surface for cushioning, most heart models do not show this. Cardiac muscle tissue that composes the heart walls has its own blood supply and circulation, the coronary (corona_ crown) circulation. Coronary blood vessels encompass the heart similar to a crown and are found in sulci. On the anterior surface of the heart, the right and left coronary arteries branch off the base of the ascending aorta just superior to the aortic semilunar valve, and travel in the sulcus separating the atria and ventricles. These small arteries are supplied with blood when the ventricles are resting. When the ventricles contract, the cusps of the aortic valve open to cover the openings to the coronary arteries.

A clinically important branch of the left coronary artery is the anterior interventricular branch, also known as the left anterior descending (LAD) branch that lies between the right and left ventricles and supplies both ventricles with oxygen-rich blood. This coronary artery is commonly occluded which can result in a myocardial infarct and, at times, death. Great Vessels of the Heart

The great veins of the heart return blood to the atria and the great arteries carry blood away from the ventricles. The superior vena cava, inferior vena cava, and coronary sinus return oxygen-poor blood to the right atrium. The superior vena cava returns blood from the head, neck, and arms; the inferior vena cava returns blood from the body inferior to the heart. The coronary sinus is a smaller vein that returns blood from the coronary circulation. Blood leaves the right atrium to enter the right ventricle. From here, oxygen-poor

blood passes out the pulmonary trunk, the only vessel that removes blood from the right ventricle. This large artery divides into the right and left pulmonary arteries that carry blood to the lungs where it is oxygenated. Oxygen-rich blood returns to the left atrium through two right and two left pulmonary veins. The blood then passes into the left ventricle that pumps blood into the large aorta. The aorta distributes blood to the systemic circulation. The aorta begins as a short ascending aorta, curves to the left to form the aortic arch, descends posteriorly and continues as the descending aorta.

The heart has four valves that control the one-way flow of blood: two atrioventricular (AV) valves and two semilunar valves (semi- _ half;lunar _ moon). Blood passing between the right atrium and the right ventricle goes through the right AV valve, the tricuspid valve (tri _ three;cusp _ flap). The left AV valve, the bicuspid valve, is between the left atrium and the left ventricle. This valve clinically is called the mitral valve (miter _ tall, liturgical headdress) because the open valve resembles a bishops headdress. String-like cords called chordae tendineae (tendinous strands) attach and secure the cusps of the AV valves to enlarged papillary muscles that project from the ventricular walls. Chordae tendinae allow the AV valves to close during ventricular contraction, but prevent their cusps from getting pushed up into the atria. The two semilunar valves allow blood to flow from the ventricles to great arteries and exit the heart. Blood in the right ventricle goes through the pulmonary (semilunar) valve to enter the pulmonary trunk, a large artery. The aortic (semilunar) valve is located between the left ventricle and the aorta. These two semilunar valves are identical, with each having three pockets that fill with blood, preventing blood from flowing back into the ventricles. The two ventricles have a thick wall between them called the interventricular septum. Between the two atria is a thinner interatrial septum. Coronary Circulation

There are two major coronary arteries: the right and the left. These two arteries branch out of theaorta immediately after the aortic valve. The right coronary artery splits into the marginal branch, which feeds blood into the right ventricle, and the posterior interventricular branch, which supplies the left ventricle. The left coronary artery is notably larger than the right coronary artery because it feeds the left heart, which, as a result of it's more powerful contractions, requires a more vigorous blood flow. The left coronary artery splits into the anterior interventricular branch and a circumflex branch. The anterior interventricular branch runs towards the apex of the

37