Myocardial infarction is one of the leading causes of death around the world where patients who have survived a cardiac infarction are at a high risk for a subsequent heart attack. This risk has been shown to be reduced if the patient makes life style changes and reliably adheres to prescribed medication. In particular, older patients with myocardial infarction frequently suffer from comorbid conditions that can lead to multiple medications, reduced quality of life, and readmission to the hospital. Cost-effective solutions that improve these elderly patients’ health are more necessary than ever.
According to Seidl et al. (2016), regular information programs provided by trained nurses produced positive effects such improved muscle strength and blood fat levels with less significant physical restrictions and healthier diets for elderly post-infarct persons. Their results provide scientific evidence that supplementary care in a nurse-led case management program can cost-effectively improve the health and quality of life of elderly patients following myocardial infarction.
Part 1 – Case Study Poster
• Create an electronic poster (using Microsoft PowerPoint) to be displayed at a conference for nurses (NOTE: target audience is peers). Ensure the content of the poster is relevant for this audience; an example is provided on the Bb site to guide in regards to the depth of information expected.
• Select a topic of interest from one of the poster topics below. Choice of a broad overview or specific topical content is left to the researcher(s) who formulates the update.
• Poster must include (but is not restricted to):
o Brief introduction of topic;
o Up-to-date Australian statistics (relevant or contrasting international examples may be included); use charts, tables or figures;
o Evidence-based information relevant to nurses (e.g. pathophysiological concepts, clinical Australian guidelines, and treatment options);
o Health promotion, prevention and intervention strategies (current practices, future possibilities and developments)
• Create the poster
o Refer to “How to create a PowerPoint poster”;
o Refer to “What is a poster presentation?” to design the poster;
o Refer to the Camtasia video “Camtasia for Poster Guidance” for link to online poster templates (if desired) and instructions to format and upload your poster to Turnitin;
o Poster is a single PowerPoint slide – (use the Camtasia video “Camtasia for Poster Guidance” to set up the slide for the poster).
o Do NOT use any other program than Microsoft Power Point. The ECU IT system cannot support other formats;
o Save the PowerPoint file as a pdf prior to submission through Turnitin;
o Do not submit the rubric with your assignment; it is embedded within Turnitin.
o The Resource Bibliography (Part 2) is a subsequent pdf file (see the Camtasia video “Camtasia for Poster Guidance”)
Poster Topics- (Choose One)
• Case Study One (Mable) – Changes in the nature of cardiovascular disease and self-management due to aging.
A married 74-year-old female who lives in her own home was admitted to hospital with progressive increase in breathlessness, orthopnoea and ankle oedema over the previous 3 weeks. Her general practitioner had since prescribed oral coamilofruse.
She was apyrexic yet tachypnoeic. Sitting blood pressure was 110/70 mm Hg. ECG confirmed sinus tachycardia with Q waves of a previous infarction, chest X-ray confirmed cardiomegaly and interstitial oedema. Routine chemistry showed Na+ 128 mmol/L; K+ 5.8 mmol/L; urea 9 mmol/L; creatinine 155 mmol/L. A creatine kinase series was unremarkable. Echocardiography showed a dilated heart compatible with previous anterior myocardial infarction. The posterior wall was contracting vigorously.
This is a common clinical presentation of progressive systolic dysfunction after an unheralded myocardial infarction. The patient was symptomatically improved by initial intravenous diuretics and supplemental oxygen; correction of the fluid imbalance (1.5 L fluid restriction; oral coamilofruse twice daily) resulted in a weight loss of 4.5 kg over 5 days. Although supine blood pressure remained low (~100 mmHg), an ACE inhibitor was introduced without difficulty and she experienced no postural symptoms. Renal function improved in response to the changes in therapy.
Discuss any 3 nursing issues associated with the discharge of this patient in relation to the nature of cardiovascular disease and its self-management due to aging.
• Case Study Two (Phil) – Cardiovascular health promotion and disease risk reduction for the elderly person following myocardial infarction.
A widowed 73-year-old man who had sustained previous inferior and anterior myocardial infarctions presented with gradually increasing fatigue and oedema despite increasing diuretic therapy. He was being treated with frusemide 80 mg three times daily, captopril 50 mg three times daily, aspirin 150 mg once daily, isosorbide mononitrate SR 60 mg once daily and amlodipine 10 mg once daily.
On examination he had dependent oedema to the mid-thigh and crepitations. He had a resting tachycardia of 105 beats/min in sinus rhythm. Mitral and tricuspid regurgitation were evident and the supine blood pressure was low at 95/48 mmHg. Laboratory investigation revealed a reduced serum sodium (125 mmol/L) with impaired renal function (urea 12.8 mmol/L; creatinine 189 ?mol/L). The chest radiograph showed minimal interstitial oedema, a right sided pleural effusion and marked cardiomegaly. A 24-h ECG showed repetitive ventricular tachycardia (4 episodes of 10–20 beats with rate >150 beats/min). Repeat echocardiography revealed poor left ventricular contractility with global impairment, marked dilatation and functional mitral regurgitation.
Multiple drug therapy involves the risk of patient confusion over the medicines and a failure of compliance. This is a neglected area in the care of patients with heart failure yet well known to be associated with poor clinical outcome in cardiac patients.
Develop a health promotion strategy for patients such as Phil to improve contact with varied health professionals concerned with cardiac care, social circumstances, promotion of drug compliance and psychological support.
• Case Study Three (Thelma) – Physical activity for aged people with cardiovascular disease: recommendations.
Thelma is an 88-year-old female admitted to hospital due to chest pain upon exertion which she has been experiencing for several months. She has a history of arterial hypertension, glucose intolerance, hypercholesterolemia, hypertriglyceridemia, family history of sudden death, and smoking cessation at the age of 51 years. On physical examination she had a heart rate of 60 bpm, blood pressure of 150/80 mmHg and heart, lung and abdomen examinations were normal. Her lower limbs showed no oedema and her pulses were symmetrical. ECG revealed sinus rhythm, an electrically inactive area in the inferior dorsal wall and ventricular repolarisation changes with inverted T waves. Thelma weighs 93 kg, her height is 165cm and she has not exercised in 2 years.
Non-pharmacological approaches such as increased exercise and training within limits has important and demonstrable physical as well as psychological effects. There are few instances where a supervised increase in physical exercise is not of benefit to the patient with cardiac syndromes.
Discuss the recommendations and evidence for improved health and quality of life due to adherence to a structured exercise program for the elderly with cardiovascular disease.