Understanding the Impact of Myocardial Infarction Using Orem's Self-Care Theory

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CHAPTER I
THE PROBLEM AND ITS SCOPE
INTRODUCTION
Rationale of the Study
Myocardial infarction is a common presentation of ischemic
heart disease. Defined as death or necrosis of myocardial cells,
It is a diagnosis at the end of the spectrum of myocardial
ischemia or acute coronary syndromes. Myocardial infarction
occurs when myocardial ischemia exceeds a critical threshold
and overwhelms myocardial cellular repair mechanisms designed
to maintain normal operating function and hemostasis. Ischemia
at this critical threshold level for an extended period results in
irreversible myocardial cell damage or death.
(www.clevelandclinic.com)
World Health Organization estimated that in 2002, 12.6
percent of deaths worldwide were from ischemic heart disease.
Ischemic heart disease is the leading cause of death in
developed countries, but third to AIDS and lower respiratory
infections in developing countries. According to the Centers for
Disease Control and Prevention (CDC), annual mortality rates in
the United States from all causes in the pediatric population

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range from 22 deaths per 100,000 population in children aged 5-
14 years to 756 deaths per 100,000 population in infants
younger than 1 year. (Compare this to 90 deaths per 100,000 in
persons aged 15-24 y and 2,538 deaths 100,000 in individuals
aged 65-74 y.2) The CDC also reports that the mortality rate
from acute myocardial infarction is 0.2 deaths per 100,000
population in persons aged 15-24 years and fewer than 0.2
deaths per 100,000 in infants younger than 1 year. (Compare
this to 1.4 deaths per 100,000 population in persons aged 25-34
y and 262 deaths per 100,000 population in individuals aged 65-
74 y.2) (www.emedicine.medscape.com)
Every hour, nine Filipinos die of cardiovascular or heart
diseases. In fact, cardiovascular diseases remain the No. 1 cause
of death in the Philippines. About one out of four deaths in the
country are traced to cardiovascular diseases, according to the
Department of Health. The DOH is promoting a massive
information and education campaign to increase awareness of
cardiovascular diseases. Surveys made by the DOH show that
Central Luzon had the highest cases of cardiovascular diseases
(225 per 100,000 population). Metro Manila registered the
highest mortality rate (99 per 100,000) while the lowest was in
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Central Mindanao (16 per 100,000). One out of 20 adults (40
years and older) suffers from coronary/ischemic heart disease.
And one out of 10 adults (15 years and older) suffers from
hypertension, or high blood pressure. Five out of 100 adults
suffer from coronary artery disease (www.philstar.com).
The researcher is a graduate of Bachelor of Nursing
Degree. She has been assigned to many different hospitals while
she was a student nurse and previously worked as a volunteer
nurse for 3 months at Cebu Peuriculture and Maternity House
Inc. She has been exposed in obstetric ward, labor and delivery
room, assisting obstetricians during delivery and labor watch,
and operating room assisting the surgeon in minor and major
operations. Presently the researcher is a Clinical Instructor at
Southwestern University College of Nursing where she is
assigned at Medical Surgical Ward and Emergency Room.
The interest of the researcher in conducting the study was
due to the death of a close relative from myocardial infarction.
The researcher, have acquired learning on Orem’s Self-Care
Theory and on the disease process of Myocardial Infarction. The
researcher is aware of the scope of this disease and its impact
on the patient and his family. Having such knowledge matched

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with skills on rendering health care, the researcher conduct this
study with an aim of assessing a case of Myocardial Infarction,
planning, implementing and at the same time, evaluating
nursing care plans for a patient with Myocardial Infarction using
Orem’s Self-care Theory as its bases.
Theoretical Background
This study was anchored on Dorothea Orem’s Self-Care
Theory. Orem developed the Self-Care Deficit Theory of Nursing
(her general theory), which is composed of three interrelated

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theories: (1) the theory of self-care, (2) the theory of self-care
deficit, and (3) the theory of nursing systems.
One of the most important contributions of Orem’s work is
her redefinition of the role of nurses in society. First and
foremost, because she sees individuals as capable of guiding
their own self-care, she does not promote the notion of
submitting to someone else’s care but rather engaging in a
partnership, or even a contractual relationship in order to receive
the assistance that one requires. In this philosophy, Orem views
people as having ‘health-associated limitations’ and having the
need for assistance in order to promote their self-care agency. In
this notion, nurses provide assistance relative to the person’s
needs at the time. This could be education and support (physical
and/or psychological), teaching and guiding or directing self-
care. Nurses have the ultimate role of facilitating and increasing
a person’s abilities to engage in their own self-care.
In many ways, Orem views nurses as agents of self-
empowerment. They are not meant to take over for someone’s
ability to provide their own self-care but to facilitate one’s ability
to perform this function. Thus, nursing is not so much about
caring for people but rather empowering and guiding people to

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understand how they can best care for themselves. According to
Marjorie A. Isenberg (2005), This does not imply that nurses do
not provide care, but rather a far different model of care and
what that means in a practical sense. (www.nursingplanet.com)
This study seeks to come up with effective nursing care
that will be beneficial for the client in performing self-care
activities while maintaining as much independence as possible.
The outcome of this study may help the researcher in coming up
with a proposed self-care guide for clients with Myocardial
Infarction. This would serve as a basis in client health teaching.
She states her general theory as follows: the condition
validates the existence of a requirement for nursing in an adult
is the health-associated absence of the ability to maintain
continuously that amount and quality of self-care that is
therapeutic in sustaining life and health, in recovering from
disease or injury, or in coping with their effects. With children,
the condition is the inability of the parent (or guardian)
associated with the child’s health state to maintain continuously
for the child the amount and quality of care that is therapeutic
(George, 2008)
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The self-care theory is based on the four concepts: self-
care, self-care agency, self-care requisites and therapeutic self-
care demand. (Kozier et al, 2004). Orem defined self-care as
“the practice of activities that individuals initiate and perform on
their own behalf in maintaining life, health and well being”
(Udan, 2004).
Self-care agency is the human’s acquired ability or power
to engage in self-care. This ability is affected by basic
conditioning factors. These basic conditioning factors age,
gender, development state, sociocultural factors , health care
system factors (i.e, diagnostic and treatment modalities), family
system factors, pattern of living (e.g., activities regularly
engaged in), environmental factors, and resource adequancy and
availability. It consists of two agents: a self-care agent (an
individual who performs self-care independently) and a
dependent care agent (a person other than the individual who
provides care) (Kozier et al, 2004).
Self-care is human endeavor, learned behavior that has
the characteristics of deliberate actions. Self-care is produced as
individual engage in action to care for themselves by influencing
internal and external factors to regulate their own internal

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functioning and development. Self-care has a purpose. It is an
action that has a pattern and sequences and when it is
effectively performed contributes in specific ways to human
structural integrity, human functioning, and human
development. The purposes to be attained through the kinds of
action termed self-care are named self-care requisites. Self-care
requisites must be known before they can serve as the purpose
of self-care (www.nursing.gr).
Three types of self care requites are identified: Universal
self-care requisites are associated with life processes, the
maintenance of the integrity of human structure and functioning,
and with general well-being. A common term for these requisites
is the activities of daily living (George, 2008). The eight self-care
requisites common in men, women and children are as follows:
the maintenance of a sufficient intake of air, the maintenance of
a sufficient intake of water, the maintenance of sufficient intake
of food, the provision of care associated with elimination
processes and excrements, the maintenance of a balance
between activity and rest , the maintenance of a balance
between solitude and social interaction, the prevention of
hazards to human life, human functioning and human well-being

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and the propmotion of human functioning and development
(Octaviano and Balita, 2008).
Developmental self-care requisites are associated with
human development processes and with conditions and events
occurring during those various stages of the life cycle (e.g.,
prematurity, pregnancy) and events that can adversely affect
development. Examples would be adjusting to a new job or
adjusting to body changes such as a facial lines or hair loss.
Health-deviation self-care requisites are associated with genetic
and constitutional defects and human structural and functional
deviations (George, 2008). The following are actions to be
undertaken that will provide developmental growth: provisions of
conditions that promote development, engagement in self-
development and prevention of the effects of human condition
that threatens life (Octaviano and Balita, 2008).
When these three types of requisites are effectively met,
they are productive of human and environmental conditions that
(1) support life processes, (2) maintain human structure and
human functioning within a normal range, (3) support
development in accord with the human potential, (4) prevent
injury and pathological states, (5) contribute to the regulation or

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control of the effects of injury and pathology, (6) contribute to
the cure or regulation of pathological processes, and (7) promote
general well-being (www.nursing.gr). The therapeutic self-care
demand refers to all self-care activities required to meet existing
self-care requisites, or in other words, actions to maintain health
and well-being (Kozier et al, 2004).
The theory of self-care deficit is the basic element of
Orem’s general theory because it delineates when nursing is
needed. Nursing is required when adults (or in the case of a
dependent, the parent or guardian) are incapable of or limited in
their ability to provide continuous effective self-care. This theory
explains not only when nursing is needed but also how people
can be assisted through five methods of helping: Acting or doing
for, guiding and directing, supporting, providing and maintaining
an environment that support personal development and teaching
(George, 2008).
In Orem’s third theory of nursing systems, she outlines
how the patient’s self-care needs will be met by the nurse, the
patient or both. She has identified three classifications of nursing
systems to meet the self-care requisites of the patient (George,
2008).
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The Compensatory system is when the nurse provides total
care for the patient. This patient cannot do anything for
themselves but they are not limited to activities of daily living
and ambulation. This patient is totally dependent of the nurse for
survival, such as an acute stroke patient. The second of Orem’s
system is the Partial Compensatory. The nurse must assist in the
care of the patient but the patient and family can assist as well.
A pneumonia patient, who is very short of breath, may require
the nurse to monitor the vital signs, oxygen saturations, assist in
ADL’s and ambulation. The patient will be able to resume their
own care when they are better but need the assistance and
education a nurse can provide at this time (George, 2008).
The third of Orem’s system is the Educative-Development
system. The patient has primary control over his health; the
nurse assist with education and promoting safe health practices.
The patient who has high cholesterol may fit into this category,
diet, exercise regimen and medication are considered important
education for this patient. The nurse should teach the patient
how to properly maintain good health practices
(www.bellaonline.com)
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According to Orem, human beings are very much different
from other living things in terms of their capacity. Humans can
reflect upon events, themselves and their environment. They can
symbolize experiences that they have been through by using
words or ideas. Such symbols could be used creatively in guiding
and communicating in their efforts towards the attainment of
something beneficial to them. She believes the attainment of
something beneficial to them. She believes that individuals have
the potential to be developed and learned (Octaviano and Balita,
2008).
Orem’s theory emphasizes the importance of a patient’s
reflection to self-care. For this, it is fundamental to understand
the patient’s reflection and development habits, his perceptions
and attitudes towards others, feelings and emotions
demonstrated in the most diverse situations. The nursing
process offers the adaptation of interventions to the patient’s
individual needs. Its use associated with a theory may result in a
more effective assistance, with conditions for the patient to
participate in the care planning (Octaviano and Balita, 2008).
Another theory that supports this study is Lydia Eloise
Hall’s Care, Core, and Cure Theory. One of the major concepts of
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her theory is self-awareness which refers to the state of being
that nurses endeavor to help their patients achieve. The more
self-awareness persons have their feelings, the more control
they have over their behavior (Tomey and Alligood, 2004).
Nursing circles of Care, Core, and Cure are the central
concept of Hall’s Theory. Care alludes to the “hands-on”,
intimate bodily care of the patient and implies a comforting,
nurturing relationship. While intimate physical care is provided,
the nurse and patient develop a close relationship representing
the teaching-learning aspects of nursing. Core involves the
therapeutic use of self in communicating with the patient. The
nurse, through the use of reflective technique, helps the patient
clarify motives and goals, facilitating the process of increasing
the patient’s self awareness. Cure is the aspect of nursing
involved with administration of medications and treatment. The
nurse functions in this role as investigator and potential cause of
pain related to skills such as injections and dressing changes
(Tomey and Alligood, 2004).
From Hall’s perspective, patient achieve their maximal
potential through a learning process; therefore, the chief therapy
they need is teaching. Rehabilitation is a process of learning to

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live within limitations. Physical and mental skills must be
learned, but a prerequisite is learning about oneself as a person,
becoming aware of feelings and behaviors, and clarifying
motivations (Tomey and Alligood, 2004).
Nola Pender’s Health Promotion Model (HPM) also supports
this study. Pender’s model integrates nursing and behavioral
science with factors that influence people’s ability to engage in
and/or change health behaviors. This model has been used to
guide the exploration of biopsychosocial processes that influence
one’s decisions to engage in health behaviors and as a
framework to predict health-promoting lifestyle as well. There
are many assumptions within the context of the HPM. For the
purpose of this study, there are three applicable assumptions: 1)
Persons have the capacity for reflective self-awareness, including
assessment of their own competencies, 2) individuals seek to
actively regulate their own behavior, and 3) Health professionals
constitute a part of the interpersonal environment, which exerts
influence on persons throughout their lifespan (www.nursing
.arizona.edu).
The Health Promotion Model uses a wellness orientation in
order to explain health-promoting behavior. There are two

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phases that comprises it. These phases are the decision making
phase and action phase. The decision phase involves seven
cognitive or perceptual elements that constitute motivational
mechanisms for acquiring and maintaining health-promoting
behavior as well as five modifying circumstances that indirectly
influence patterns of health behavior. The action phase involves
obstacles and prompts to action which stimulates activity in
health promoting behavior (Polit and Beck, 2004).
This theory relates to this study because this model
portrays the multifaceted nature of persons interacting with their
interpersonal and physical environment. Obviously, the
individuals participating in this study had undertaken a course of
action that they believe will improve their overall health and
functioning. There are many ramifications to their decision. Not
to be forgotten is the influence of family and environment on
arriving at health related decisions (Polit and Beck, 2004).
Anatomy and Physiology of Myocardial Infarction. The
promotion of self-care in Myocardial Infarction patient has
increasingly attracted attention due to increasing incidence of
such disease. Worldwide, cardiovascular disease is estimated to
be the leading cause of death and loss of disability-adjusted life

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years. Although age-adjusted cardiovascular death rates have
declined in several developed countries in past decades, rates of
cardiovascular disease have risen greatly in low-income and
middle-income countries, with about 80% of the burden now
occurring in these countries. Effective prevention needs a global
strategy based on knowledge of the importance of risk factors
for cardiovascular disease in different geographic regions and
among various ethnic groups. (www.medicinageriatrica.com.ar)
Myocardial infarction (MI or AMI for acute myocardial
infarction), commonly known as a heart attack, occurs when the
blood supply to part of the heart is interrupted causing some
heart cells to die. This is most commonly due to occlusion
(blockage) of a coronary artery following the rupture of a
vulnerable atherosclerotic plaque, which is an unstable collection
of lipids (like cholesterol) and white blood cells (especially
macrophages) in the wall of an artery. The resulting ischemia
(restriction in blood supply) and oxygen shortage, if left
untreated for a sufficient period of time, can cause damage
and/or death (infarction) of heart muscle tissue (myocardium).
(www.wikipedia.com)
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Myocardial Infarction are caused by a disruption in the
vascular endothelium associated with an unstable atherosclerotic
plaque that stimulates the formation of an intracoronary
thrombus, which results in coronary artery blood flow occlusion.
If such an occlusion persists long enough (20 to 40 minutes),
irreversible myocardial cell damage and cell death will occur.
The development of atherosclerotic plaque occurs over a
period of years to decades. The initial vascular lesion leading to
the development of atherosclerotic plaque is not known with
certainty. The two primary characteristics of the clinically
symptomatic atherosclerotic plaque are a fibromuscular cap and
an underlying lipid-rich core. Plaque erosion may occur because
of the actions of metalloproteases and the release of other
collagenases and proteases in the plaque, which result in
thinning of the overlying fibromuscular cap. The action of
proteases, in addition to hemodynamic forces applied to the
arterial segment, can lead to a disruption of the endothelium and
fissuring or rupture of the fibromuscular cap. The degree of
disruption of the overlying endothelium can range from minor
erosion to extensive fissuring, which results in an ulceration of
the plaque. The loss of structural stability of a plaque often

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occurs at the juncture of the fibromuscular cap and the vessel
wall, a site otherwise known as the plaque's “shoulder region.”
Disruption of the endothelial surface can cause the formation of
thrombus via platelet-mediated activation of the coagulation
cascade. If a thrombus is large enough to occlude coronary
blood flow completely for a sufficient period, MI can result.
(www.eMedicine.com)
The onset of symptoms in myocardial infarction (MI) is
usually gradual, over several minutes, and rarely instantaneous.
Chest pain is the most common symptom of acute myocardial
infarction and is often described as a sensation of tightness,
pressure, or squeezing. Chest pain due to ischemia (a lack of
blood and hence oxygen supply) of the heart muscle is termed
angina pectoris. Pain radiates most often to the left arm, but
may also radiate to the lower jaw, neck, right arm, back, and
epigastrium, where it may mimic heartburn. Levine's sign, in
which the patient localizes the chest pain by clenching their fist
over the sternum, has classically been thought to be predictive
of cardiac chest pain, although a prospective observational study
showed that it had a poor positive predictive value.

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Shortness of breath (dyspnea) occurs when the damage to
the heart limits the output of the left ventricle, causing left
ventricular failure and consequent pulmonary edema. Other
symptoms include diaphoresis (an excessive form of sweating),
weakness, light-headedness, nausea, vomiting, and palpitations.
These symptoms are likely induced by a massive surge of
catecholamines from the sympathetic nervous system which
occurs in response to pain and the hemodynamic abnormalities
that result from cardiac dysfunction. Loss of consciousness (due
to inadequate cerebral perfusion and cardiogenic shock) and
even sudden death (frequently due to the development of
ventricular fibrillation) can occur in myocardial infarctions.
Women and older patients experience atypical symptoms
more frequently than their male and younger counterparts.
Women also have more symptoms compared to men (2.6 on
average vs 1.8 symptoms in men). The most common symptoms
of MI in women include dyspnea, weakness, and fatigue.
Fatigue, sleep disturbances, and dyspnea have been reported as
frequently occurring symptoms which may manifest as long as
one month before the actual clinically manifested ischemic

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event. In women, chest pain may be less predictive of coronary
ischemia than in men.
Approximately half of all Myocardial Infarction patients
have experienced warning symptoms such as chest pain prior to
the infarction. Approximately one fourth of all myocardial
infarctions are silent, without chest pain or other symptoms.
These cases can be discovered later on electrocardiograms or at
autopsy without a prior history of related complaints. A silent
course is more common in the elderly, in patients with diabetes
mellitus and after heart transplantation, probably because the
donor heart is not connected to nerves of the host. In diabetics,
differences in pain threshold, autonomic neuropathy, and
psychological factors have been cited as possible explanations
for the lack of symptoms.
Any group of symptoms compatible with a sudden
interruption of the blood flow to the heart is called an acute
coronary syndrome. The differential diagnosis includes other
catastrophic causes of chest pain, such as pulmonary embolism,
aortic dissection, pericardial effusion causing cardiac tamponade,
tension pneumothorax, and esophageal rupture.
(www.wikipedia.com)
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The Patient with suspected acute myocardial infarction
needs immediate treatment which includes oxygen receives
nitroglycerin, beta-adrenergic blocking agents, calcium channel
blockers, and antiplatelet agents, with the possible additions of
thrombolytics, analgesics, and angiotensin-converting enzyme
(ACE) inhibitors. Patients should receive a beta-blocker initially,
throughout the hospitalization, and prescription to continue its
use after hospital discharge. (Black and Hawk 2005)
A comprehensive study for reduction of mortality and
morbidity from Myocardial Infarction must include prevention
strategies, earlier detection, and adequate treatment. For
optimal control, a long-term commitment to lifestyle modification
and pharmacological therapy is required. Repeat in-depth patient
education and counseling not only improve compliance with
medical therapy but also reduce cardiovascular risk factors.
Therefore, health care professionals should also promote a
healthy lifestyle and preventive strategies to decrease the
prevalence of Cardiovascular Disease in the general population
(www.emedicine.com). For this disease, lifestyle changes are the
first line of prevention and treatment, which means one has to

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keep a tight rein of the major risk factors which include high
blood pressure, tobacco use, consumption of food high in
saturated fat, elevated blood cholesterol, lack of physical
activity, obesity, and diabetes.
The foundation of this case study which is anchored on the
interrelated concepts of the three theories given by Dorothea
Orem will definitely benefit a patient with myocardial infarction
since this patient has a certain degree of self care deficit and is
in definite need of the nurse’s care and attention. The principles
of the theory will also be able to address efficiency the needs of
the patient.
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THE PROBLEM
Statement of the Problem:
This study determined the effectiveness of nursing care
utilizing Orem’s theory to a patient with Myocardial Infarction.
The outcomes of the study served as bases for a proposed health
teaching care guide.
1. What are the needs of the patient in terms of following self-
care requisites:
1.1 universal;
1.2 developmental ; and
1.3 health deviation?
1. What nursing diagnosis and desired outcomes are identified
and formulated?
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2. How effective is the nursing care plan formulated and
implemented utilizing Orem’s theory.
3. What health teaching guide for self care can be proposed
based on the findings?
Significance of the Study
Death from heart disease ranks first as cause of death in
the Philippines. Cardiovascular Diseases, mainly heart attack and
stroke, kill more than 16 million people worldwide, while
disabling hundreds of millions more often individuals in the
prime of their lives. This will impact not only these individuals
but their families as well. With almost one in three adults
diagnosed with the disease, this is almost guaranteed that every
family will be affected by this disease. Thus, the researcher felt
the need to conduct this study to address these concerns. In
turn, this study will benefit the following:
Patients. This study will make the patients aware of the
nature of their condition and the importance of compliance to

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self-care measures. The patient can enhance their self-care
activities to certain measures pertinent to his condition. The
result of this study will serve as a good motivation for them to
assume the task of being actively involved in carrying out
specific care practices geared towards control of myocardial
infarction and prevention of complications.
Significant others. They are the patient’s significant
provider of emotional, physical, and psychological support. The
family can help the patient develop healthy life style and
behavior pattern which eventually will result to higher levels of
health not only to the patient but also the family members.
Through this study, the family of the patient’s will be able to
acknowledge the appropriate measures on how to care for their
Myocardial Infarction member.
Community. Awareness of the facts discovered in this
study would make the general public understand that myocardial
infarction control be achieved solely by the efforts of the health
team. Management of the condition demands much participation
from the patient and family. This research would make everyone
cognizant of the relevance of health education in the practice of
desirable self-care skills for promotion of health.

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Student Nurses. Student Nurses awareness of nursing
management on Myocardial Infarction will enable them to
provide appropriate interventions and health teachings to their
future clients. They will also develop a positive attitude towards
rendering health care in various clinical settings.
Health Care Providers. Knowing that patient’s
cooperation and participation on self-care measures are
essential, health care providers will have to focus more on giving
social support during the entire regimen. Necessary assessment
and follow-up on the patient’s compliance should be done from
time to time.
Clinical Instructors. Having the knowledge about the
importance of maintaining self-care principles in the care of
Myocardial Infarction patients, the Clinical Instructors will be
able to share this learning to their students, thus, effective care
management will be achieved.
Hospital Administrators. This study will serve as a guide
for hospital administrators to come up with effective staffing
patterns and standardized health teachings and interventions to
be done in handling patients with Myocardial Infarction.

27
Researcher. This study will be a guide for the researcher
to further enhance their competencies in handling patients with
Myocardial infarction using Orem’s Self-Care Theory.
Future Researchers. It will serve as an added reference
for future researchers in developing their research problems and
in designing their research study using the same variable or
research locale.
RESEARCH METHODOLOGY
Research Design
The study utilized the case study method to determine the
effectiveness of Dorothea Orem’s Self-Care Theory in the care of
a Myocardial Infarction patient.
Research Environment
The study was conducted at Sacred Heart Hospital, a 150
total bed capacity. It is a tertiary health care institution located
at Urjello St., Cebu City. The hospital offers a variety of health
services. These include various wards and private rooms,
operating room, emergency services, intensive care unit,
diagnostic laboratories, hemodialysis unit, diabetes clinic, public-

28
private mixed directly observed treatment short course
chemotherapy (DOTS) clinic as well as a reproductive health
clinic. The medical ward wherein the case study was conducted
receives an average of 15-20 patients/day.
Research Subject
The research subject of this study was a 79 year old, male,
who was diagnosed of Myocardial Infarction. Patient’s
developmental stage and maturational crisis presumes lack of
knowledge about his situation.
Situational Appraisal:
A case of Mr. I. T. V. of Bulacao Cebu City, 79 years old,
male, widower, Filipino, Roman Catholic, admitted for the first
time at Sacred Heart Hospital last August 03, 2009 due to mild
myocardial infarction.
Chief Complaints:
“I have difficulty in breathing when I carry heavy objects”,
as verbalized by the patient.
History of Present Illness:
Five months prior to admission patient noted difficulty in
breathing when carrying heavy objects. According to the patient,
3 days prior to admission he was able to manage doing things at

29
home like watering his plants. The Patient experienced chest
pain at around 12:30 in the afternoon, condition was tolerated
until condition worsened and the patient decided to seek
consultation at 1:18 pm and was advised for admission.
Research Instruments
A researcher-made tool was used for data collection and
assessment, as well as a thorough physical assessment utilizing
the IPPAO method and the Gordon’s Functional Health Patterns
in obtaining a comprehensive health history based on Dorothea
Orem’s model. The assessment tools were also translated to
vernacular for the patient’s convenience.
Research Procedure
Data Gathering
Before the actual data gathering, a transmittal letter was
sent to the Dean of the Graduate School asking permission to
conduct a case study method research at Sacred Heart Hospital.
Another letter asking permission to conduct a study was sent to
the Chief of Hospital of Sacred Heart Hospital, and the Chief
Nurse. The researcher then started conducting the case study.
The researcher asked permission from the patient,
explained the purpose and emphasized the significance of the

30
study and benefits he can have. A consent form was signed by
the patient and by a witness, stating that the former is informed
and has agreed to participate in the study and assured of utmost
confidentiality.
Definition of Terms
To fully understand the terms used in this study, the
following words are defined operationally:
Developmental Self-Care Requisites are maintaining
conditions to support life and development or to provide
preventive care for adverse conditions that affect development
of the patient with myocardial infarction.
Health Deviation Self-Care Requisites is the care needed
by individuals who are ill or injured; may result from medical
measures required to correct illness or injury.
Myocardial Infarction refers to a medical condition that
affects the human heart of the patient. In this cardiac disorders,

31
inadequate amount of oxygenated blood reach the cardiac
muscles thereby causing pain in the chest and weakening of the
pumping action of the heart. This condition is commonly know as
heart attack.
Partially Compensatory Nursing System is a situation in
which both nurse and patient perform care measures or other
actions involving manipulative tasks or ambulation. This system
is designed for individuals who are unable to perform some, but
not all, self-care activities.
Self-Care is the practice of activities that the patient with
myocardial infarction personally initiate and perform on their
own behalf to maintain life, health and well-being. It refers to
the personal and medical care performed by the patient, usually
in collaboration with and after instruction by a health
professional.
Self-Care Deficit is the inability of the patient with
myocardial infarction to carry out all necessary self-care
activities. It identifies when and how much a nurse is needed in
the care of the patient. Nursing care is needed if there is a
problem that prevents a person from reaching their optimal
health.
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Self-Care Requisites, also called self-care needs, are
measures or actions taken to provide self-care.
Therapeutic Self-Care Demand is the sum or total of self-
actions needed, during some period, to meet self-care requisites.
Universal Self-Care Requisites are those requisites
common to all throughout life, associated with life processes and
the integrity of human structure and function.
Wholly Compensatory Nursing System is a situation in
which the patient has no active role in the performance of self-
care. This system is required for individuals who are unable to
control and monitor their environment and process information.

33
CHAPTER II
RESULTS AND DISCUSSION
This chapter discussed about the needs of a Myocardial
Infarction patient based on Orem’s Self-Care requisites in terms
of following self-care requisites: universal; developmental ; and
health deviation.
I. Needs of the patient
Universal Self-Care Requisites Assessment
• Patient’s 24 hour Diet Recall
➢ Before Admission:
Meal Time Food Beverage
06:00 AM 3 pieces of bread, 1 banana 1 cup of coffee approx.

34
240 cc
12:00 noon 2 pieces of bread, 1 pack of 1 cup of coffee approx.

crackers 240 cc
07:00 PM 1 cup of rice, 1 piece fried fish 1 glass of water

approx. 240 cc
➢ During Admission
05:00 AM 1 cup rice, chicken soup, Water 250 ml

and 1 banana
10:00 AM 2 pieces bread and 1 pack Water 250 ml

crackers
12:00 noon 1 cup of rice, 1 piece fried Water 250 ml

fish
6:00 PM 1 cup rice, 1 cup bowl of Water 250 ml

vegetables with soup
• Patient’s food preferences: When patient wakes up
early in the morning he likes to eat bread with coffee or
juice. He likes to eat vegetables like during meal time and
eat any leftover bread for his snacks.
• Food preparation: Their food at home is prepared by her
daughter. The foods prepared are different for each
member of the family. The family utilizes a stove fueled by
an LPG (liquid petroleum gas) tank in cooking. Their
primary food storage is in the refrigerator.
• Food supplements: The patient is not taking any food
supplements.
35
• Factors that influence patient’s dietary
modifications: Since they are an extended family, their
table is too small to accommodate them all that’s why they
do not usually eat together. The patient eats first because
he has a different meal than the others. The family does
not have any food restrictions with regards to their cultural
or religious beliefs.
• Usual elimination pattern in terms of frequency,
amount and usual habits: Patient defecates once a day.
As to color, it is yellow to brown but he ca not account as
to how much. He urinates 3-5 times in a day with pale
yellow color about 50 cc per episode.
• Utilization of other aids to facilitate elimination:
Patient’s daughter buys laxative like Dulcolax or Docusate
from a pharmacy in front of their house to help facilitate
his elimination.
• Usual activity patterns: Patient likes to watch television
and read the newspaper. When he gets bored he goes out
of their house and walks around their compound or chat

36
with friends. He is also fun of planting vegetables and fruit
trees in their backyard.
• Adherence to a regular exercise regimen: Patient do
not have a regular exercise regimen. His only means of
exercise is when he walks around their compound. During
patient’s hospital admission and course of illness, he
prefers to stay in bed as he experience body weakness and
shortness of breath.
• Time and duration of patient’s usual sleep pattern:
Patient usually sleeps around 9 in the evening and wakes
up at around 4 in the morning. He takes his usual
afternoon nap around 1-2 pm.
• Attitude towards self and others: Patient said he is a
very hardworking and responsible father. He is a very fun
loving and energetic person. He believes that things
happen for a reason and he can surpass it all. His children
and grandchildren are his source of inspiration. Patient
has also mentioned feeling of sadness and loss whenever
he thinks of his wife who passed away. He has good
relationship with his children, grandchildren, neighbors and

37
has not had any conflicts with them. He enjoys having
chats with their neighbors and friends.
• Patient’s lifestyle: He was an alcoholic and smoker for
48 years. Due to his 1st hospitalization last 2003 at Miller
Hospital due to epistaxis and elevated BP of 150/90 he
decided to stop all his vices. Now for the last 6 years till
present the patient doesn’t adhere to any vices. He neither
drinks nor smokes.
• Environmental factors: Patient lives in a healthy
environment that is pollution-free, has clean surroundings
and proper waste disposal. His daughter said that they
have not encountered any conflicts with their neighbors.
• Health practices: Patient regularly takes a bath and
changes into clean clothes every day. He maintains good
health by eating nutritious food like fruits and vegetables.
He does not have much exercise since he gets tired easily.
He takes his medicine every day. He also said that his
daughter would prepare fresh calamansi juice for him
whenever he has cough or colds.
• Nursing Diagnosis
38
 Sedentary lifestyle related to lack of interest in
accomplishing a physical exercise regimen.
 Activity intolerance related to imbalanced oxygen
supply and demand as evidenced by verbal reports of
fatigue and shortness of breath.
 Deficient diversional activity related to physical
limitations as evidenced by verbal reports of fatigue
shortness of breath.
Developmental Self-Care Requisites
• Role in the family and community: Patient used to be
the breadwinner of the family when he was still working as
a carpenter. Now he just stays at home and sometimes
watches the house while his children are at work.
• Perception and satisfaction on the said role: Patient is
happy and contented with the responsibilities he is
carrying and does his best to fulfill his duties as well.
• Problems with relationship to others: None

39
• Patient’s consciousness and awareness of his own
health: Patient is aware of his own health and strictly
follows his diet. He no longer eat what is bad for him or
what is restricted for him to eat. Patient is conscious about
what is happening to his body and tells his daughter
whenever he feels something unusual. He is mindful is
mindful of his prescribed medication and takes it on time.
He claimed that he is particular when it comes to
cleanliness in their home and surroundings. Patient always
observes proper hygiene practices such as taking a bath
everyday and changing into clean clothes. He is aware of
the importance of health care practices.
• Knowledge of the importance of self-examination:
Patient does not have knowledge on taking one’s blood
pressure, pulse and temperature measurements.
• Experienced any of the following for the past 6
months:
√ loss of family member (nephew)
× loss of possessions or occupation

40
× change of residency into an unfamiliar
environment
× any hazardous accident or health threat
√ CAP MR and Hypocalemia
NURSING DIAGNOSIS:
 Ineffective Family Coping: risk for compromised related
to prolonged disease/disability progression that
exhausts the supportive capacity of family members.
 Ineffective coping related to situational crisis.
HEALTH DEVIATION SELF-CARE REQUISITES
 Patients vital signs (upon assessment)
Temperature: 37.0 °C Respiratory Rate: 35 cpm
Pulse Rate: 62 bpm Blood Pressure: 130/90
 Heredo familial disease present in both parent’s
family:
 Hypertension and diabetes are present on both sides
of the patient’s family
 Current laboratory results or diagnostic tests
findings
41
 ECG Date performed: is a transthoracic interpretation
of the electrical activity of the heart over time
captured and externally recorded by skin electrodes.
It is a noninvasive recording produced by an
electrocardiographic device.
• August 03, 2009
AF MVR Acute Ant MR CRBB
Complete Blood Count: A complete blood count (CBC) is a
series of tests used to evaluate the composition and
concentration of the cellular components of blood. It consists of
the following tests: red blood cell (RBC) count, white blood cell
(WBC) count, and platelet count; measurement of hemoglobin
and mean red cell volume; classification of white blood cells
(WBC differential); and calculation of hematocrit and red blood
cell indices.
42
Date Laboratory
Result Normal Value Significance
Taken Procedure
August 5.49 Normal
WBC 4.4/11.0
03, 2009
RBC 5.28 4.50/5.10 Normal
HGB 15.6 11.0/18.0 Normal
HCT 46.3 35.0/54.0 Normal
MCV 87.6 80/90 Normal
MCH 29.9 26.0/34.0 Normal
MCHC 33.7 33.4/35.5 Normal
RDW 15.1 10.0/16.0 Normal
PLT 176 150/450 Normal
MPV 7.92 6.0/9.9 Normal
.906 25.0/50.0 Normal
LYM%
1.00/4.80
.548 0.0/0.7 Normal
MON%
0.10/1.00
.225 37.0/80.0 Normal
NEU%
2.00/8.00
.225 0.0/0.7 Normal
EOS%
0.00/0.40
.067 0.0/2.5 Normal
BAS%
0.00/0.20
Serum Enzyme: This test measures the amount of an enzyme

called angiotensin-converting enzyme in blood.
Date Laboratory
Result Normal Value Significance
Taken Procedure
Normal
August Na+ 140.6 135-145 mEq/L
03,
Normal
2009 K+ 3.16 3.5-5.0 mEq/L
Creatinine 1.1 0.6-1.36mg/dl Normal

CK-MB 9.48 0 – 18 u/L
Normal
Troponin T (Quantitative )
It is used to help diagnose a heart attack, to detect and evaluate

mild to severe heart injury, and to distinguish chest pain that
43
may be due to other causes. In patients who experience heart-

related chest pain, discomfort, or other symptoms and do not
seek medical attention for a day or more, the troponin test will
still be positive if the symptoms are due to heart damage.
➢ 0.05 ng/ml
August 03, 2009

Interpretation of Results Rationale
1. < 0.03 ng/ml Low Cardiac Risk
2. Between 0.03 ng/ml & Medium Cardiac Risk (Possible
0.1 ng/ml Myocardial damage)
3. Between 0.1 ng/ml & High Risk (Myocardial damage
3.0 ng/ml detected)
4. > 2.0 ng/ml Massive Myocardial damage
has been detected
COAGULATION: It is a complex process by which blood forms

clots. It is an important part of hemostasis (the cessation of
blood loss from a damaged vessel), wherein a damaged blood
vessel wall is covered by a platelet and fibrin-containing clot to
stop bleeding and begin repair of the damaged vessel. Disorders
of coagulation can lead to an increased risk of bleeding
(hemorrhage) or clotting (thrombosis).
Date Laboratory Normal

Result Significance
Taken Procedure Value
August PT 10.3 10-14 Normal

03, sec.
2009
% activity 126.2% 67-142% Normal
INR 0.79 0.82-1.2 Bleeding time
URINE ANALYSIS: Urinalysis is a diagnostic physical, chemical,
and microscopic examination of a urine sample (specimen).

44
Specimens can be obtained by normal emptying of the bladder
(voiding) or by a hospital procedure called catheterization.
(August 03, 2009)

➢ Macroscopic Exam:
Color: Yellow Transparency: clear

Volume: 60 ml Specific Gravity: 1.025
➢ Chemical Exam:
Albumin: +1 Blood: +1
PH: 6.0 Glucose: Negative
Ketone: Negative
➢ Microscopic Exam:
WBC: 1.2 RBC: 1.2
Fasting Blood Sugar Lipid Profile: A fasting blood test is a

blood sample taken from a person who has not eaten for 9 to 12
hours. Usually, the blood sample is taken early in the morning.
Date Laboratory Normal
Result Significance
Taken Procedure Value
August Glucose 63 mg/dL 74 – 106 Hypoglycemia
04, 2009 Uric Acid 2.5 – 6.2 Hyperuricemia,
Cholesterol 176 mg/dL 0 – 200 normal

Triglycerides 173 mg/dL 0 – 150 Atherosclerosis
Direct HGL 28 mg/dl 40 – 60 increased
LDL 113.4 mg/dL 60 – 180 normal
VDRL 34.6 mg/dL 25 – 50 normal
 Adhere to the prescribed treatment : Currently adhering to
the appropriately to his prescribed medications
Nursing Diagnoses:
 Risk for decreased cardiac output related to increased after
load secondary to Myocardial Infarction.

45
 Ineffective breathing pattern related to fatigue as
evidenced by client’s verbalization of feelings of
breathlessness.
 Knowledge Deficient regarding therapeutic regimen,
present condition and potential complications of illness
related to lack of information.
 Readiness for enhanced therapeutic regimen related to
minimal knowledge regarding disease process 2°
Myocardial Infarction.
II. LIST OF NURSING DAIGNOSES WITH DESIRED

OUTCOMES
Nursing Diagnosis: Alteration in comfort: acute pain related to
increased cerebrovascular pressure 2 ° to myocardial infarction.
Expected Scientific Basis
Outcome
After 4-6 hours of Pain has been defined as “an unpleasant sensory
rendering and emotional experience associated with actual
appropriate or potential tissue damage and mediated by
nursing specific nerve fibers to the brain where its
interventions, conscious appreciation may be modified by

46
the patient will various factors.” Pain follows the bumps and
be verbalize bruises encountered in daily life, and all persons
decrease in pain have experienced unpleasant but innocent
from 8 to 5 (in a headaches, sore throats, and muscle stitches. In
given scale of 0- contrast, pain that seems to originate in the
10, 0-no pain and chest generates far greater concern because it
may announce the presence of severe,
10-severe pain).
occasionally life-threatening disease. The new
onset of chest pain and what it may connote
provokes anxiety and fright; consequently, it is
one of the symptoms most likely to cause the
victim to seek prompt medical attention.
The pain of myocardial ischemia is described

first because of its clinical importance, both
in terms of its frequency and in terms of its
diagnostic and therapeutic implications.
Even though the receptors, chemical
transmitters, and sensory pathways that
mediate cardiac pain are not well
understood, the message being sent by the
oxygen-deprived heart is clear and needs to
be listened to.
(http://www.nlhep.org)
Nursing Diagnosis: Ineffective breathing pattern related to
fatigue as evidenced by verbalization of feelings of
breathlessness 2 ° to Myocardial Infarction.
Expected Outcome Scientific Basis
After 4-6 hours of Shortness of breath can stem directly

rendering appropriate and indirectly from many sources.
nursing interventions, Present time problems such as heart
47
the patient will be attacks, lung disease, asthma, and

able to establish a suffocation are comparatively easy to
normal & effective observe. Learning edge health
respiratory pattern as practitioners realize there may be many
evidenced by the aspects to shortness of breath that may
absence of tachpnea, not be considered by much of Western
will be able to initiate Medical Science. Poor physical
the needed lifestyle conditioning, recurrent lung infections,
changes as poor posture, over-tight clothing, obesity,
evidenced by junk food, stress, unresolved emotional
adhering to an issues, toxic environment, recent
appropriate diet and surgery, prescription drug side effects,
be able to and even pictures of people we do not
demonstrate like, whom you are afraid of, or find
appropriate coping extremely exciting can as well take our
behaviors in case of breath away cause , or exacerbate
possible recurrence. shortness of breath. SOB is largely a
matter of degree and individual
susceptibility.
(http://www.breathing.com)
Nursing Diagnosis: Risk for decreased cardiac output related

to decreased after load as evidenced by blood pressure
elevation 2 ° to Myocardial Infarction.
Expected Scientific Basis
Outcome
After 3-4 hours of Inadequate blood pumped by the heart to
meet the metabolic demands of the body.
rendering
48
appropriate Common causes of reduced cardiac output

include myocardial infarction, hypertension,
nursing
valvular heart disease, congenital heart
interventions
disease, cardiomyopathy, pulmonary
patient will be disease, arrhythmias, drug effects, fluid
overload, decreased fluid volume, and
able to
electrolyte imbalance. Geriatric patients are
demonstrate
especially at risk because the aging process
ways to control causes reduced compliance of the
ventricles, which further reduces
blood pressure
contractility and cardiac output. Patients
and be able to do
may have acute, temporary problems or
Activities of daily experience chronic, debilitating effects of
decreased cardiac output. Patients may be
living (ADLs).
managed in an acute, ambulatory care, or
home care setting. This care plan focuses on
the acute management.
(http://nursingcareplan.blogspot.com)
Nursing Diagnosis: Alteration in thermoregulation: Hyperthermia

related to increased metabolic rate 2 ° to Myocardial Infarction.
After 4-6 hours of Hyperthermia is an elevated body

temperature due to failed
rendering appropriate thermoregulation. Hyperthermia occurs
when the body produces or absorbs more
nursing intervention, heat than it can dissipate. When the
49
the patient’s elevated body temperatures are sufficiently

high, hyperthermia is a medical emergency
temperature will and requires immediate treatment to
prevent disability and death.
decrease from 38.8 ˚C Hyperthermia is generally diagnosed in the
presence of an unexpectedly high body
to 37.5 ˚C. temperature and a history that suggests
hyperthermia instead of a fever.[2] Most
commonly this means that the elevated
temperature has appeared in a person that
was working in a hot, humid environment
(heat stroke) or that was taking a drug for
which hyperthermia is a known side effect
(drug-induced hyperthermia). The presence
of other signs and symptoms related to
hyperthermia syndromes, such as the
extrapyramidal symptoms that are
characteristic of neuroleptic malginant
syndrome, and the absence of signs and
symptoms more commonly related to
infection-related fevers, are also
considered in making the diagnosis.
If fever-reducing drugs lower the body
temperature, even if the temperature does
not return entirely to normal, then
hyperthermia is excluded.
(http://www.wikepedia.com/Hyperthermia.)
Nursing Diagnosis: Risk for fluid volume excess related to excess in

fluid intake 2 ° to Myocardial Infarction.
After 3-4 hours of Heart failure is the result of poor cardiac

rendering appropriate function and is reflected by a decreased
nursing interventions volume of blood pumped out by the heart,
patient will be able called cardiac output. Heart failure can be
response to caused by weakness of the heart muscle,
interventions and which pumps blood out through the arteries
teaching and actions to the entire body, or by dysfunction of the
performed.
50
heart valves, which regulate the flow of

blood between the chambers of the heart.
The diminished volume of blood pumped
out by the heart (decreased cardiac output)
is responsible for a decreased flow of blood
to the kidneys. As a result, the kidneys
sense that there is a reduction of the blood
volume in the body. To counter the
seeming loss of fluid, the kidneys retain salt
and water. In this instance, the kidneys are
fooled into thinking that the body needs to
retain more fluid volume when, in fact, the
body already is holding too much fluid.
This fluid increase ultimately results in the
buildup of fluid within the lungs, which
causes shortness of breath. Because of the
decreased volume of blood pumped out by
the heart (decreased cardiac output), the
volume of blood in the arteries is also
decreased, despite the actual increase in
the body's total fluid volume. An associated
increase in the amount of fluid in the blood
vessels of the lungs causes shortness of
breath because the excess fluid from the
lungs' blood vessels leaks into the
airspaces (alveoli) and interstitium in the
lungs. This accumulation of fluid in the lung
is called pulmonary edema. At the same
time, accumulation of fluid in the legs
causes pitting edema. This edema occurs
because the build-up of blood in the veins
of the legs causes leakage of fluid from the
legs' capillaries (tiny blood vessels) into the
interstitial spaces (http://www.
Medicine.net).
Nursing Diagnosis: Anxiety related to change in health and

socioeconomic status 2 ° to Myocardial Infarction.
After 3-4 hours of Anxiety is a multisystem response to a

administering perceived threat or danger. It reflects a
appropriate nursing combination of biochemical changes in
interventions, patient the body, the patient's personal history
51
will be able to and memory, and the social situation.

verbalized reduction As far as we know, anxiety is a uniquely
of anxiety and human experience. Other animals
identified causes and clearly know fear, but human anxiety
contributing factors. involves an ability, to use memory and
imagination to move backward and
forward in time, that animals do not
appear to have. The anxiety that occurs
in post-traumatic syndromes indicates
that human memory is a much more
complicated mental function than
animal memory. Moreover, a large
portion of human anxiety is produced
by anticipation of future events.
Without a sense of personal continuity
over time, people would not have the
"raw materials" of anxiety
(http://www.answer.com).
NURSING CARE PLANS
Day 1
Nursing Diagnosis: Alteration in comfort: acute pain related to increased

cerebrovascular pressure 2 ° to myocardial infarction.
Defining Characteristics
Subjective Cues: “ Sakit man akong dughan.”, as verbalized by the patient.
52
Objective Cues: facial grimace noted, restlessness, shows guarding or

distraction behaviors, restricts movement, pain related at scale from 1-10 is 8,
with the following vital signs:T – 36.4 ˚C, R – 36 cpm, P – 65 bpm, BP – 130/60
mmHg
Interventions Rationale
1. Evaluate pain regularly 1. Provides information about need for or
noting characteristics, location effectiveness of interventions.(Doenges,
& intensity on a 0-10 scale. Marilynn, Mary Frances Moorhouse, Alice
Geissler-Murr (2000). Nursing Care Plans.
Philadelphia:F.A. Davis Company)
2. review history of previous
MI pain 2. May differentiate current pain from
preexisting patters as well as identify
complications.(Doenges, Marilynn, Mary Frances
Moorhouse, Alice Geissler-Murr (2000). Nursing
Care Plans. Philadelphia:F.A. Davis Company)
3. Instruct patient to report 3. Delay in reporting of pain hinders pain relief.

pain immediately. (Doenges, Marilynn, Mary Frances Moorhouse,
Alice Geissler-Murr (2000). Nursing Care
Plans. Philadelphia:F.A. Davis Company)
4. Schedule adequate rest 4. Prevents fatigue and conserves energy for

periods. healing.(Doenges, Marilynn, Mary Frances
Moorhouse, Alice Geissler-Murr (2000). Nursing
Care Plans. Philadelphia:F.A. Davis Company)
5. Provide quiet environment, 5. Decrease external stimuli which may

calm activities, and discomfort aggravate anxiety and cardiac strain.(Doenges,
measures. Marilynn, Mary Frances Moorhouse, Alice
6. Assist in relaxation 6. Helpful in decreasing perception to pain.

techniques like deep (Doenges, Marilynn, Mary Frances Moorhouse,
breathing. Alice Geissler-Murr (2000). Nursing Care
Evaluation: The patient verbalized lessening of intensity level of pain from 8 as

severe to 6 as moderate; appeared to be relaxed, able to sleep and rest well.
Day 2
Nursing Diagnosis: Ineffective breathing pattern related to fatigue as evidenced

by verbalization of feelings of breathlessness 2 ° to Myocardial Infarction.
Subjective Cues: Kutasan ku dayun basta maglihok-lihok ko”, as verbalized by
the patient.
Objective Cues: received patient sitting on bed, awake, conscious & coherent;
nasal flaring noted; tachypnea noted; using of accessory muscles when breathing
53
noted, productive cough noted, with Oxygen @ 2L/min via nasal prong; with the
following vital signs: T – 36.5 ˚C, R -42 cpm, P – 60 bpm, BP – 140/90 mmHg
1. Assess, document & report to 1. Can be used as a guide for activity
the physician on abnormal prescription and a basis for patient health
breath sound and taught deep management. To help relieve difficulty in
breathing exercise. breathing. (Doenges, Marilynn, Mary Frances
Moorhouse, Alice Geissler-Murr (2000).
Nursing Care Plans. Philadelphia:F.A. Davis
Company)
2. Maintain the patency of 2. To provide oxygen needed by the

oxygenation therapy. physiologic need of the body.(Doenges,
Marilynn, Mary Frances Moorhouse, Alice
3. Inspect pallor, cyanosis, and 3. Systemic vasoconstriction resulting from

mottling, cool/clammy skin. diminished cardiac output may be evidenced by
Note strength of peripheral decreased skin perfusion and diminished
pulse. pulses.(Doenges, Marilynn, Mary Frances
Company)
5. Monitor respirations, note 5. Cardiac pump failure and/ or ischemic pain

work of breathing. may precipitate respiratory distress; however,
sudden/ continued dyspnea may indicate
thromboembolic pulmonary complications.
(Doenges, Marilynn, Mary Frances Moorhouse,
6. Cerebral perfusion is directly related to

6. Investigate sudden changes cardiac output and is also influenced by
or continued alterations in electrolyte/ acid-base variations, hypoxia, and
mentation e.g, anxiety, systemic emboli.(Doenges, Marilynn, Mary
confusion, lethargy, stupor. Frances Moorhouse, Alice Geissler-Murr (2000).
Company)
Evaluation: Patients RR has decreased from 42cpm to 35 cpm & verbalized
understanding of the importance of performing deep breathing exercise.
Day 3
Nursing Diagnosis: Risk for decreased cardiac output related to decreased after
load as evidenced by blood pressure elevation 2 ° to Myocardial Infarction.
Subjective Cues: “Nalipong-lipong ko”, as verbalized by the patient.
Objective Cues: received sitting on bed awake, conscious and coherent;
verbalized reports of headaches and dizziness; clammy skin noted; weakness
noted; with the following vital signs: T – 36.8 ˚C, R – 34 cpm, P – 63 bpm, BP –
150/90 mmHg
54
1. 1. Provide calm, restful 1. Help reduce sympathetic stimulation;
surroundings, minimize promotes relaxation.(Doenges, Marilynn, Mary
environmental Frances Moorhouse, Alice Geissler-Murr (2000).
Nursing Care Plans. Philadelphia:F.A. Davis Company)
activity/noise. Limit the
number of visitors and
length of stay.
2. Reduces physical stress and tension that
affect blood pressure and the course of
2. Maintain activity restrictions,
hypertension.(Doenges, Marilynn, Mary Frances
e.g. bedrest/chair rest; schedule Moorhouse, Alice Geissler-Murr (2000). Nursing Care
periods of uninterrupted rest; Plans. Philadelphia:F.A. Davis Company)
assist client with self-care
activities as needed.
3. Decreases discomfort and may reduce
3. Provide comfort measures, sympathetic stimulation.(Doenges, Marilynn, Mary
e.g. back and neck massage, Frances Moorhouse, Alice Geissler-Murr (2000).
elevation of head. Nursing Care Plans. Philadelphia:F.A. Davis Company)
4. Can reduce stressful stimuli, promotes

4. Instruct in relaxation relaxation.(Doenges, Marilynn, Mary Frances
techniques, guided imagery, Moorhouse, Alice Geissler-Murr (2000). Nursing Care
distractions.
5. Reduces physical stress and tension that
5. Maintain activity restrictions, affect blood pressure and the course of
e.g. bedrest/chair rest; schedule hypertension.(Doenges, Marilynn, Mary Frances
Moorhouse, Alice Geissler-Murr (2000). Nursing Care
periods of uninterrupted rest; Plans. Philadelphia:F.A. Davis Company)
assist client with self-care
Evaluation: Patient was able to demonstrate ways to control blood pressure like
following his diet low salt and low fat.
Day 4
Nursing Diagnosis: Alteration in thermoregulation: Hyperthermia related to

increased metabolic rate 2 ° to Myocardial Infarction.
Subjective Cues: “Init akong paminao”, as verbalized by the patient.
Objective Cues: received patient lying in bed ;skin warm to touch; flushed skin
noted; with the following vital signs: T – 38.8˚C, R – 35 cpm, P – 65 bpm, BP –
130/90 mmHg
55
1. Monitored vital signs 1. Have a baseline data and be alert for

especially temperature. sudden changes in the temperature. (Doenges,
Marilynn, Mary Frances Moorhouse, Alice
2. Encouraged adequate rest 2. Decreases discomfort and may reduce

periods. sympathetic stimulation. (Doenges, Marilynn,
Mary Frances Moorhouse, Alice Geissler-Murr
(2000). Nursing Care Plans.
3. Performed tepid sponge bath. 3. To facilitate heat loss through evaporation

and conduction. (Doenges, Marilynn, Mary
Frances Moorhouse, Alice Geissler-Murr
4. Demonstrated proper 4. To provide proper knowledge and to

performance of TSB. empower the SO in taking care of the –patient
to slow down the patient metabolism.
(Doenges, Marilynn, Mary Frances Moorhouse,
5. Instructed the significant 5. To prevent impairment of blood flow.

others not to let the client wear (Doenges, Marilynn, Mary Frances Moorhouse,
tight clothing. Alice Geissler-Murr (2000). Nursing Care
6. Instructed the SO to keep the 6. Aid in lowering down the temperature.

patient rested. (Doenges, Marilynn, Mary Frances Moorhouse,
Evaluation: Patient’s temperature has reduced from 38.8 to 37.7 ˚C and seen
sleeping comfortably.
Day 5
Nursing Diagnosis: Risk for fluid volume excess related to excess in fluid intake
2 ° to Myocardial Infarction.
Subjective Cues: “ki ohaw gyud ko, ganahan ko mu inom daghan tubig”, as
verbalized by the patient.
Objective Cues: received sitting on bed awake, conscious and coherent restless
noted; clammy skin noted; shortness of breath noted; anxiety noted; limit fluid to
1L/day as ordered ; with the following vital signs: T – 36.5˚C, R – 35 cpm, P – 65
bpm, BP – 130/90 mmHg
56
1. Measure I&O, noting decrease 1. DECREASED CARDIAC OUTPUT RESULTS IN IMPAIRED KIDNEY
in output, concentrated PERFUSION, SODIUM/WATER RETENTION, AND REDUCED URINE
appearance. Calculated fluid OUTPUT. (Doenges, Marilynn, Mary Frances Moorhouse,
balance. Alice Geissler-Murr (2000). Nursing Care Plans.
2. Maintain total fluid intake at 2. Meets normal adult body fluid requirements,
1000 mL/24 hr within but may require alteration/restriction in
cardiovascular tolerance. presence of cardiac decompensation. (Doenges,
Marilynn, Mary Frances Moorhouse, Alice Geissler-Murr
(2000). Nursing Care Plans. Philadelphia:F.A. Davis
Company)
3. Promote early mobilization. 3. Decreases discomfort and may reduce

sympathetic stimulation. (Doenges, Marilynn,
Mary Frances Moorhouse, Alice Geissler-Murr
4. Evaluate for any edematous 4. To promote wellness. (Doenges, Marilynn,

extremities. Mary Frances Moorhouse, Alice Geissler-Murr
5. Discuss the importance of 5. To prevent fluid excess and edematous on

fluid restrictions. extremities. (Doenges, Marilynn, Mary Frances
Company)
6. Stress the need mobility and 6. To prevent impairment of blood flow.

frequent position changes. (Doenges, Marilynn, Mary Frances Moorhouse,
Evaluation: Patient understood the importance of restricting fluid intake and
complied with doctor’s orders. Seen monitoring his intake to 1L/day only.
Day 6
Nursing Diagnosis: Anxiety related to change in health and socioeconomic

status 2 ° to Myocardial Infarction.
Subjective Cues: “maayu pakaha ko aning akong sakit?”, as verbalized by the
patient.
Objective Cues: received patient sitting on bed; passivity noted; lack of initiative
noted; restlessness noted; facial tension noted; expressions of concern about
current and future events; with the following vital signs: T – 36.5 °C, R – 42 cpm,
P – 60 bpm, BP – 140/90 mmHg
57
1. Encouraged client to express 1. One way of releasing tension and assessing the level of
feelings. anxiety. (Doenges, Marilynn, Mary Frances Moorhouse,
Alice Geissler-Murr (2000). Nursing Care Plans.
2. Listened attentively 2. To identify client’s problem regarding the situation.

concerning client’s feelings. (Doenges, Marilynn, Mary Frances Moorhouse, Alice
3. Diverted client’s attention 3. This will help client divert her attention for the time
through listening to a soothing being. (Doenges, Marilynn, Mary Frances Moorhouse,
music. Alice Geissler-Murr (2000). Nursing Care Plans.
4. Provided a less stressful 4. Decreases discomfort and may reduce sympathetic

environment. stimulation. (Doenges, Marilynn, Mary Frances
5. Instructed significant others 5. To prevent client from an environment that could

to schedule visiting others. trigger stress. (Doenges, Marilynn, Mary Frances
Evaluation: Patient appeared relaxed and reported anxiety is reduced to

manageable level as evidenced by talking to his daughter.
• Medication or therapy used
Brand Name Metoprolol

Generic Lopressor
Name
Classification Antihypertensives
Action A selective beta blocker that selectively blocks beta1 receptors;
decreases cardiac output , peripheral resistance, and cardiac
oxygen consumption; and depressed renin secretion
Pt. dosage
ordered by 50 mg 1 tab. BID
58
Physician
Indication Hypertension, initially 100 mg P.O. once daily; then up to 100 mg
to 450 mg daily divided in two or three doses.
Adverse CNS: fatigue, dizziness, depression. CV: hypotension,
reaction bradycardia, heart failure, AV block, edema. GI: nausea, diarrhea.
Respiratory: dyspnea. Skin: rashes
Nursing  Always check patient’s apical pulse
consideration rate before giving drug.
 Monitor blood pressure frequently.
 Beta blockers may mask
tachycardia caused by hyperthyroidism. In
patients with suspected thyrotoxicosis, taper off
beta blocker to avoid thyroid storm.
 When stopping therapy, taper dose
for 1-2 weeks.
 Beta selectively is lost at higher
doses. Watch for peripheral side effects.
 Take drugs exactly as prescribed
with meals.
 Avoid driving and other task
requiring mental alertness.
 Inform the Health provider before
procedures or surgery
 Alert, if have a shortness of breath
occurs
 Notify the prescriber, if you stop
taking medication.
Source Davis’s Drug Guide for Nurses 9th Edition 2005
Brand Name Simvastatin

Generic Zocor
Name
Classification Antilipemics
Action Inhibits HMG-CoA reductase, an early (and rate-limiting) step in
cholesterol biosynthesis.
Pt. dosage
ordered by 40 mg 1 tab. OD qHS
Physician
Indication  To reduce risk of death from CV
disease and CV events in patients at high-risk for
coronary events.
 To reduce total and LDL
cholesterol levels in patients with homo-zygous
familial hyper- cholesterolemia.
Adverse CNS: Asthenia, Headache. GI: Abdominal pain, Constipation,
reaction Diarrhea, Nausea.
Musculoskeletal: Myalgia. Respiratory: upper respiratory tract
infection
Nursing  Use drug only after diet and other non-drug therapies prove
consideration ineffective. Patient should follow a standard low-cholesterol diet
during therapy.
 Obtain liver function test results at start of therapy and then
periodically. A liver biopsy maybe performed if enzyme elevations
persist.
59
 40 mg daily significantly reduces risk of death from coronary

heart disease, non fatal MIs, stroke, and revascularization
procedures.
 take drug with meals
 proper dietary management of cholesterol and triglycerides
 inform patients, adverse reaction occur, particularly muscles
aches.
Brand Name Captopril

Generic Capoten
Name
Classification Antihypertensives
Action Inhibits ACE, preventing conversion of angiotensin I to angiotensin
II, a potent vasoconstrictor. Less angiotensin II decrease
peripheral arterial resistance, decreasing aldosterone secretion,
which reduces secretion, which reduces sodium and water
retention and lower blood pressure.
Pt. dosage
ordered by 25 mg 1 tab. OD
Physician
Indication  Left ventricular ventricular dysfunction after acute MI
Adverse CNS: dizziness, fainting, headache, malaise, fatigue, fever. CV:
reaction tachycardia, hypotension, angina pectoris Hematologic: abdominal
pain, anorexia, constipation, diarrhea, dry mouth, dysgeusia,
nausea, vomiting Metabolic: hyperkalemia Respiratory: dry,
persistent, nonproductive cough, dyspnea Skin: urticarial rash,
maculopapular rash, pruritis, alopecia Other: angioedema
Nursing Before:
consideration  Check pt. chart for the doctors order
 Take baseline V/S
 Explain the need for medication
Discuss the existing adverse reaction
During:
 Give the medication on its specific site of administration
 Ensure that the pt. take the medication
 Observe for any adverse reactions
 Assess the pt. if there is a result of some adverse
reactions
After:
 Instruct pt. to take drug 1 hour before meals;food in GI
tract may reduce absorption
 Inform pt. that lightheadedness is possible especially
during first few days therapy
 Advise pt. for signs and symptoms of infection such as
fever and sore throat
 Urge pt.to report swelling of the face, difficulty breathing
Source Nursing2008 Drug
Handbook by Lippincott,Williams, Wilkins
Brand Name Kalium Durules

Generic Potassium Chloride
Name
60
Classification Electrolytes and replacement solutions

Action Replace potassium and maintains potassium level.
Pt. dosage
ordered by 1 tab TID x 3days
Physician
Indication To prevent hypolealemia
Adverse CNS: paresthesla of limbs, listlessness, confusion, weakness or
reaction heaviness of limbs, flaccid paralysis.
CV: post infusion phlebitis, arrhythmias, heart block, cardiac
arrest, ECG changes, hypotension.
G.I.: nausea, vomiting abdominal pain,diarrhea.
Metabolic: Hyperkalemia
Respiratory:Respiratory paralysis
Nursing Before:
consideration  Make sure powders are completely dissolved
before giving.
 Drug is commonly use with potassium, wasting
diuretics to maintain potassium levels.
During:
 Monitor ECG and electrolyte levels during therapy.
 Many averse reactions may reflect hyperkalemia.
After:
 Teach patient signs and symptoms of
hyperkalemia, and tell patient to notify prescriber if they
occur.
 Tell patient to report discomfort at I.V. insertion
site.
Source Nursing 2008 Drug Handbook 28th Edition page: 885-886
Philadelphia Wolters Kluwer Health / Lippincott Williams & Wilkins
Brand Name Imdur

Generic Isosorbide Mononitrate (ISMN)
Name
Classification Anti-anginal Drug
Action The principal pharmacological action of isosorbide -5-
mononitrate, an active
metabolite of isosorbide dinitrate, is relaxation of vascular smooth
muscle produ
-cing vasodi -
latation of both arteries and veins, with the latter effect
predominating. The effect of the treatment is dependent on the
dose. Low plasma concen-
trations lead to venous dilata-tion, resulting in peripheral pooling
of blood, decreased venous return and reduction in left ventricular
end diastolic pressure (preload). High plasma concentrations also
dilate the arteries reducing systemic vascular resistance and
arterial pressure leading to a reduction in cardiac afterload.
Pt. dosage
ordered by 30 mg 1 tab OD
Physician
Indication Prophylactic treatment of angina pectoris. Treatment of post
myocardial infarction (MI) anginal attacks.
Adverse Autonomic Nervous System Disorders: dry mouth, hot flushes.
reaction Body as a Whole: asthenia, back pain, chest pain, edema, fatigue,
61
fever, flu-like symptoms, malaise, rigors.

Cardiovascular Disorders, General: cardiac failure, hypertension,
hypotension.
Central and Peripheral Nervous System Disorders: dizziness,
headache, hypoesthesia, migraine, neuritis, paresis, paresthesia,
vertigo.
Gastrointestinal System Disorders: abdominal pain, constipation,
diarrhea, dyspepsia, flatulence, gastric ulcer, gastritis, glossitis,
hemorrhagic gastric ulcer, hemorrhoids, loose stools, melena,
nausea, vomiting.
Hearing and Vestibular Disorders: earache, tinnitus, tympanic
membrane perforation.
Heart Rate and Rhythm Disorders: arrhythmia, arrhythmia atrial,
atrial fibrillation, bradycardia,
Nursing Before:
consideration  Assess condition of the patient.
 Store drug in a cool place, in a tightly close
container, & away from light.
 Explain the action and possible effects of the drug
 Observe 5 Rights
During:
 Stay with the patient
 Observe reaction of the patient
After:
 Monitor blood pressure & intensity & duration of
drug response
 Drug may cause headache, treat it with aspirin or
acetaminophen
 Advise patient not to stop taking drug abruptly, it
may cause spasm of coronary arteries
 Tell patient to minimize dizziness upon standing
up by changing to upright position slowly.
Brand Name Levox

Generic Levofloxacin
Name
Classification Quinolone
Action inhibit bacterial DNA gyrase (main target in gram -ve bacteria)
and topoisomerase IV (main target in gram +ve bacteria)although
this major mechanism of action requires cell division quinolones
also have other mechanisms of action which result in them being
active against bacteria that are not actively replicating
Pt. dosage
ordered by 500 mg 1 tab. OD
Physician
Indication  infection of the sinuses, skin, lungs, ears, airways,
bones, and joints caused by susceptible bacteria
 urinary tract infections
 prostatitis
Adverse Nausea, vomiting, diarrhea, abdominal pain, hives, anaphylaxis,
reaction seizure, tendonitis, myasthenia gravis
62
Nursing BEFORE:
consideration  Administer medication at least 2 hours before or 2
hours after taking any medications containing magnesium
or aluminum.
DURING:
 Encourage patient to drink plenty of fluids while
taking this medication.
 Observe patient for any adverse reactions to drug.
AFTER:
 Tell to take this medication until the full-prescribed
amount is finished even if symptoms disappear after a
few days.
 Refer any unusuality seen.
Brand Name Lilac

Generic Lactulose
Name
Classification Laxative
Action inhibits the diffusion of NH3 into the blood by causing the
conversion of NH3 to NH4+; also enhances the diffusion of NH3
from the blood into the gut where conversion to NH4+ occurs;
produces an osmotic effect in the colon with resultant distention
promoting peristalsis
Pt. dosage
ordered by 30cc OD
Physician
Indication  portal-systemic
 Encephalopathy
 treatment of chronic constipation
Adverse Flatulence, diarrhea, nausea, vomiting, cramping, hypokalemia
reaction
Nursing BEFORE:
consideration  Ask patient if he has a diabetes mellitus.
 To improve taste, drug may be given with fruit
juices or milk.
DURING:
 Monitor blood pressure.
 Monitor bowel movement patterns.
 Monitor fluid status.
 Observe patient for any adverse reactions.
AFTER:
 Record the intake and output data of the patient.
 Note for any adverse effects.
Brand Name Plavix, Platexan

Generic clopidogrel bisulfate
Name
Classification Cardiovascular System Drug
Action Inhibits the binding of adenosine diphospate (ADP) to its platelet
receptor, impeding ADP-mediated activation and subsequent
platelet aggregation. Clopidogrel irreversibly modifies the platelet
ADP receptor.
63
Pt. dosage
ordered by 75 mg OD, PC Lunch
Physician
Indication  to reduce thrombotic events in patients with
atherosclerosis documented by recent stroke, MI, or
peripheral arterial disease
 to reduce thrombotic events in patients with acute
coronary syndrome(unstable angina and non-Q-wave MI),
including those receiving drugs and those having
percutaneous coronary intervention(with or without stent)
or coronary artery bypass graft (CABG).
Adverse headache, dizziness,fatigue,edema,epistaxis,abdominal
reaction pain,hemorrhage,constipation,ulcers
Nursing BEFORE:
consideration  Assess patient for drug hypersensitivity.
 Check patients chart.
 Check for rights in medication administration.
 Check patient’s vital signs.
DURING:
 Advise patient it may take longer than usual to
stop bleeding.
 Tell patient to refrain from activities in which
trauma and bleeding may occur.
Instruct patient to notify prescriber if unusual bleeding or bruising
occurs.
 Tell patient to inform all health care providers,
including dentists, before undergoing procedures or
starting new drug therapy, that he is taking drug.
 Inform patient that drug may be taken without
regards to meal.
AFTER:
 Reassess patient’s vital signs.
 Record and document procedure and patient’s
reaction to medication.
 Refer for any unusualities.
64
PROPOSED HEALTH TEACHING GUIDE FOR

PATIENTS WITH MYOCARDIAL INFARCTION
Rationale
This health teaching guide is intended to guide patients
with myocardial infarction, those who are at risk and even those
who are not currently experiencing the said illness and to make
them aware on the proper measures to prevent, control or
minimize its ill effect.
Objectives:
This health teaching program would encourage patients
with myocardial infarction to:
1. Obtain a functional knowledge on myocardial infarction.
2. Gather information on the different risk factors that can
contribute or trigger the occurrence of myocardial

65
infarction, reason for avoiding them and measures on how
to avoid them.
3. Acquire practical measures to promote health and enjoy
life free from any further complications of myocardial
infarction.
Myocardial Infarction
Myocardial Infarction are caused by a disruption in the
vascular endothelium associated with an unstable atherosclerotic
plaque that stimulates the formation of an intracoronary
thrombus, which results in coronary artery blood flow occlusion.
If such an occlusion persists long enough (20 to 40 minutes),
irreversible myocardial cell damage and cell death will occur.
The development of atherosclerotic plaque occurs over a
period of years to decades. The initial vascular lesion leading to
the development of atherosclerotic plaque is not known with
certainty. The two primary characteristics of the clinically
symptomatic atherosclerotic plaque are a fibromuscular cap and
an underlying lipid-rich core. Plaque erosion may occur because
of the actions of metalloproteases and the release of other
collagenases and proteases in the plaque, which result in

66
thinning of the overlying fibromuscular cap. The action of
proteases, in addition to hemodynamic forces applied to the
arterial segment, can lead to a disruption of the endothelium and
fissuring or rupture of the fibromuscular cap. The degree of
disruption of the overlying endothelium can range from minor
erosion to extensive fissuring, which results in an ulceration of
the plaque. The loss of structural stability of a plaque often
occurs at the juncture of the fibromuscular cap and the vessel
wall, a site otherwise known as the plaque's “shoulder region.”
Disruption of the endothelial surface can cause the formation of
thrombus via platelet-mediated activation of the coagulation
cascade. If a thrombus is large enough to occlude coronary
blood flow completely for a sufficient period, MI can result.(
http://www.medicinageriatrica.com)
Risk Factors:
• Atherosclerosis with occlusive or partially occlusive
thrombus formation
• Nonmodifiable risk factors for atherosclerosis
○ Age
○ Sex
67
○ Family history of premature coronary heart disease
• Modifiable risk factors for atherosclerosis
○ Smoking or other tobacco use
○ Diabetes mellitus
○ Hypertension
○ Dyslipidemia
○ Obesity
• New and other risk factors for atherosclerosis
○ Elevated homocysteine levels
○ Male pattern baldness
○ Sedentary lifestyle and/or lack of exercise
○ Psychosocial stress
○ Presence of peripheral vascular disease
○ Poor oral hygiene
• Nonatherosclerotic causes
○ Vasculitis
○ Coronary emboli
68
○ Congenital coronary anomalies
○ Coronary trauma
○ Coronary spasm
○ Drug use (cocaine)
○ Factors that increase oxygen requirement, such as
heavy exertion, fever, or hyperthyroidism
○ Factors that decrease oxygen delivery, such as
hypoxemia of severe anemia
Lifestyle Modifications
○ Weight Reduction. If the patient’s body mass index
(BMI) is 25 or higher. Weight loss is encouraged.
Exercise is critical for successful weight loss, lowered
blood pressure and edurance. The Patient should
have moderate physical activity. A patient should
start with activity that lasts 3 minutes, such as
parking farther from a building to increase the
walking time. For sustained activity, patients should
begin with a 5-minute warm-up period to stretch to

69
prepare the body for exercise. They should end the
exercise with a 5-minute cool-down period in which
they gradually reduce the intensity of the activity to
prevent sudden decrease in the cardiac output. They
should also be taught to exercise to an intensity that
does not preclude their ability to talk; if they cannot
have a conversation, they should slow down and
switch to a less intensive activity. Stop any activity if
experiencing chest pain, unusual chest pain,
shortness of breath, dizziness, lightheadedness, or
nausea.
○ Moderate of Alcohol Intake. Patient’s are instructed
to stop or limit alcohol intake to no more than 1
ounce of ethanol ( 2 ounces of liquor, 8 ounces of
wine, or 24 ounces of beer) daily. Excessive alcohol
consumption may elevate arterial blood pressure and
can add “empty” calories.
○ Smoking Cessation. The inhalation of smoke can
increases the blood carbon monoxide level, causing
hemoglobin, the oxygen carrying component of
blood, to combine more readily with carbon

70
monoxide than with oxygen. A decreased amount of
available oxygen may decrease the heart’s ability to
pump. Nicotine acid in tobacco triggers the release
of catecholamines, which raise the heart rate and
blood pressure. The use of tobacco also causes a
detrimental vascular response and increase platelet
adhesion, leading to a higher probability of thrombus
formation. People who stop smoking reduce their risk
of heart disease by 30% to 50% within the first year,
and the risk continues to decline as long as they
refrain from smoking.
The Dietary Approaches to Stop Myocardial Infarction
➢ Encouraged the patient and instructed the significant
others to prepare foods that are:
○ Low calorie - Calorie restriction in individuals with
hypertension is recommended. Otherwise normal
individuals need the daily-recommended calorie
according to the age, sex and physical activity.
○ Low fat - It is advisable to reduce the fat
consumption since hypertension has greater risk of
arteriosclerosis. It is better to avoid high intake of

71
animal fat or hydrogenated oils, which contain
saturated fatty acids. The cholesterol rich foods such
as liver, meat, organ meat, egg yolk, lobster, crab
and prawns should be minimized in the diet. The
dietary fats should consist of vegetable oil like corn
oil, olive oil and sunflower oil.
○ High fiber- Not only does a high fiber diet aid in
healthy bowel movements but also research has
shown that it also lowers cholesterol. There are even
types of fiber that will help reduce the risk of colon
cancer.
○ High protein – Most high protein foods are
extremely low in carbohydrates and extremely low in
saturated fat. Therefore, by eating a high protein
diet loaded with high protein foods, at the same time
you'd end up eating low carbohydrates foods and low
saturated fat foods. And, if you didn't already know,
in order to lose weight and lose fat, eating low
carbohydrates and eating little or no saturated fat is
a must. Chicken, lean meats, beef and fish and egg
whites.
72
○ Low sodium and high potassium diet- Help to
lower high blood pressure. Moderate sodium
restriction 2- 3 gm per day decreases diastolic blood
pressure 6- 10 mmHg and enhances the blood
pressure lowering effect of diuretic therapy.
Potassium intake should be increased. Food sources
of potassium should be increased to patients who are
on diuretics. For example apricots, tomato,
watermelon, banana, leafy vegetables, and potato
should be included in the daily diet since they
contain low sodium and high potassium.
Hypertensive patients with kidney disease should
avoid a high intake of potassium as it puts an
excessive load on the kidney.
○ Instructed the significant others to avoid gastric
irritant foods, such as spicy products this is to
minimize gastrointestinal disorder, such as nausea
and vomiting, abdominal pain, CNS disorder like
dizziness, headache. (Lippincott Williams and
Wilkins, 2004)
73
CHAPTER III
SUMMARY OF FINDINGS, CONCLUSION AND
RECOMMENDATIONS
This chapter presents the summary of findings, conclusion, and
recommendation.
Summary of Findings
Using the researcher-made assessment tool guide that was
based on Orem’s Self-Care Theory, it was found out that the
patient has self-care requisite in the three categories of
Universal, Developmental and Health Deviation.

74
In the Universal Self-Care Requisite category, the patient
demonstrated no problems with regards to his nutritional intake
of foods high in fat and sodium and regular physical activity due
to his reports of weakness and shortness of breath. The patient
demonstrates an imbalance between his activity and rest
because he only performs minimal exercise and most of the time
engaged in a sedentary lifestyle.
In the Developmental Self-Care Requisite category, it was
found out that a possible factor of the onset of his illness was
due primarily to the loss of his wife and feeling of worthless
because of his illness. In the Health Deviation Self-Care
requisite, patient’s elevated blood pressure level was also caused
by potential hazards to his health related to a family history of
hypertension on both paternal and maternal sides. His laboratory
and diagnostic reports also showed Troponin T(Quantitative) of
0.05 ng/ml which were positive indicators Medium Cardiac Risk
Possible Myocardial damage.
The selected patient of this study was found out to have
the diagnosis of Myocardial Infarction due to the following
factors: heredo familial history of essential hypertension and
diabetic history on both sides of the patient’s family, patient’s

75
body mass index of 28 which falls in the category of overweight,
non-adherence to a particular physical exercise regimen, a
current diagnosis of HCVD, Acute Ant, MI Killip CRBB, AF MVR,
CHF III C, CAP-MR, Hypokalemia & high salt, high fat intake diet.
These findings imply the need to teach the patient to prevent
further complications.
Conclusion
It was concluded that Orem’s Self-Care Theory is effective
in the care of patient’s with Myocardial Infarction.
Recommendations
Based on the findings of the study, the following are suggested:
1. Utilization of Health teaching guide.
2. That anyone who has a great propensity of experiencing
heart attacks due to unmodified risk factors such as age &
a heredo familial history should be vigilant in adhering to
their repetitive health management.
3. That, in order to prevent and control the progression of the
disease, everyone is advised to relent to adhere to
appropriate lifestyle modifications.
4. That the proposed health teaching guide for patient with
myocardial infarction be handed out & implemented.

76
5. The future researchers will delve further into the following
related studies:
• An evaluation of the Effects of the Health Teaching Guide
on Selected Clients with Myocardial Infarction.
• Lifestyle Management Practices of Patients with Myocardial
Infarction.
• Risk Factors Affecting Compliance to Lifestyle Modification
of Patients with Myocardial Infarction.
BIBLIOGRAPHY
BOOKS
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Medical-Surgical Nursing. Philadelphia:Lippincott-Williams
& Wilkins
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Nurses. Pensylvania: F.A. Davis Company.
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Murr.I (2008)..
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Professional Nursing Practice. 5th edition. Singapore:
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Process and Practice. 7th edition. . Singapore: Pearson
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Wilkins.
Mosby’s Pocket Dictionary of Medicine, Nursing & Health

Professions(2006). 5th edition. Singapore: Elsevier Pte. Ltd.
Octaviano, Eufemia f. and Carlito E. Balita (2008). Theoretical

Foundations of Nursing: The Philippine Perspective . Metro
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edition. St. Louis: Mosby.
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Principles and Methods. 7th Ed. Philadelphia: Lippincott,
Williams & Wilkins.
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Suddarth’s Textbook of Medical- Surgical Nursing. 10th
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Tomey, Ann Marriner and Martha Raile Alligood (2004). Nursing

Theorists and Their Work. 5th edition. Singapore: Elsevier
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edition Philippines:Guiani Prints House.
JOURNALS AND PERIODICALS

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Amerena , Fulcher, Conner, and ( 2003 August) “ Prevention of

Cardiovascular disease: an evidence based clinical aid”.
The Medical Journal of Australia.
Arnolda, Leonard F. and Chalmers, John P. ( 2003 September) “

Lowering blood pressure in 2003”. The Medical Journal of
Australia Volume. 176, No. 6
Campbell, Duncan J. (2003 October) “ Heart failure: How can we

prevent epidemic?” The Medical Journal of Australia.
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Clark, Judith C. and Lan, Virginia M. et al (2004 August)” Heart

Failure Patient learning needs after hospital discharge”.
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Approach to Patient-Centered Care”. The Journal of
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Dehner, Gantt, Houck, Lethen, and Riggs (2005 July) “ Relation

of atmospheric pressure changes and the occurrence of
Acute Myocardial Infarction and Stroke”. The American
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Kaplan N.M.(2000) “ Evidence in Favor of Moderate Dietary

Sodium Reduction” American Journal of Hypertension.
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UNPUBLISHED THESES
Penales, Chulou H. (2008). “Dorothea Orem’s Theory on the

Client with Hemothorax”, Unpublished Master of Arts in
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Nursing thesis, Southwestern University, Cebu City,

Philippines.
INTERNET SOURCES
“Orem’s Theory” from

http://www.answer.com
(retrieved 10 June 2009)
“Dorothea Orem's Self-Care Requisites” from

http://www.bellaonline.com/articles/art57906.asp
“Hypertension” from
http://www.emedicine.com/med/TOPIC1106.HTM
“High Blood Pressure” from
http://www.medicinenet.com/high_blood_pressure/article.htm
“Optimal Breathing” from

http://www.breathing.com
“NCP Anorexia Nervosa” from

http://nursingcareplan.blogspot.com
“Dorothea Orem” from

http://www.philstar.com,ph/
“Hypertension” from
http://en.wikipedia.org/wiki/Hypertension
80
CURRICULUM VITAE
Personal Data
Name : Cherry Joy Hermoso Datan
Date of Birth : September 21, 1984
Place of Birth : Cebu City
Civil Status : Single
Religion : Roman Catholic
Profession : Nurse
Educational Background
Postgraduate : Master’s of Arts in Nursing: Medical

Surgical Nursing
Southwestern University
Villa Aznar, Urgello Street Cebu City
2007-present
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College : Bachelor of Science in Nursing

Southwestern University
Villa Aznar, Urgello Street Cebu City
2002-2006
Secondary : University of San Carlos – Girls High

School
P. del Rosario Street Cebu City
1998-2002
Intermediate : Guadalupe Elementary School

1997-1998
Bethany Christian School
1990-1997
Buena Hills Subd., Guadalupe, Cebu City
Work Experiences
Clinical Instructor : Southwestern University (SWU)

April 10, 2007- Present
Nurse Volunteer : Cebu Puericulture & Maternity House Inc.
November 15, 2006 – February 15, 2007
APPENDICES
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APPENDIX A
TRANSMITTAL LETTER
TO THE DEAN OF THE GRADUATE SCHOOL AND PEDAGOGY
SOUTHWESTERN UNIVERSITY
Dr. Rouel A. Longinos

Dean, Graduate School
Southwestern Uiniversity
Villa Aznar, Urjello St., Cebu City
Dear Dr. Longinos:
Greetings!
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I a student of Southwestern University enrolled in Masters of

Arts in Nursing. I am currently undertaking a research entitled:
Orem’s Self-Care Theory on Patient with Myocardial
Infarction.
In line with this, may I humbly ask permission from your good
office to allow me to conduct this study. Furthermore, may I ask
permission to go on duty in the Cebu City Medical Center at 8
hours per shift for 6 days (total of 48 hours) as part of this
study.
I look forward with great gratitude your kind approval of this

request.
Respectfully yours,
Cherry Joy H. Datan, R.N.

Researcher/Student
Noted by:
Jill Marie C. Hermogenes, R.N., M.A.N.
Adviser
APPENDIX B
TRANSMITTAL LETTER
TO THE MEDICAL DIRECTOR
SACRED HEART HOSPITAL
July 01, 2009
Dr. Vicente Gabriel Balbuena

Sacred Heart Hospital
Urjello St., Cebu City
Thru: Mrs. Kirsten A. Fermo

Chief Nurse
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As a graduate School student of Southwestern University taking

up Master of Arts n Nursing major in Medical-Surgical Nursing. I
am presently working a research entitled: Orem’s Self-Care
Theory on Patient with Myocardial Infarction.
In connection with this, may I humbly ask permission from your

good office to allow me to go on duty in the Medical Ward as a
part of my case study.
I hope that this letter merit your approval.

Thank you very much.
Respectfully yours,
CHERRY JOY H. DATAN, RN

Researcher/Student
Noted:
JILL MARIE C. HERMOGENES, RN, MAN

Adviser
ROUEL A. LONGINOS, Ed.D. Ph.D.

Dean, Graduate School
APPENDIX C-1
CONSENT TO SERVE AS A SUBJECT IN RESEARCH
To whom it may concern:
Be it known, that I, _____________________, _____
years of age, single/married/widowed, do hereby give my
consent without the influence of any person, to participate and
cooperate in the interventions done upon me by researcher as a

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subject in their research entitled: Care of a Patient with
Myocardial Infarction utilizing Orem’s Self-Care Theory. The
nature and general purpose of the research procedure have been
explained to me. The researcher is authorized to proceed on the
understanding that I may terminate my service as a subject in
this research at any time I so desire.
In witness thereof, I have herewith set my signature
this ____ day of _____, 2009.
Signature:
_______________________
(Patient, Guardian or Person
giving the consent or his
thumb mark)
Witness: ___________________
APPENDIX C-2
CONSENT TO SERVE AS A SUBJECT IN RESEARCH

(VERNACULAR)
Kung kinsa dapat mahibalo:
Mahibalo nga ako, si ____________________, ____ anyos
ang pangedarun, ulitawo/minyo/biyudo, naghatag sa akong
pagsugot, nga wala’y impluwensya ni bisang kinsa, na mu-apil
ug mu-hatag sa ako tabang sa ihayang pagbuhat sa mga

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pamaagi nga pag-atiman sa ako-a bahin sa ako-ang sakit, isip
usa ka subject para sa iyahang research na: Care of a Patient
with Myocardial Infarction utilizing Orem’s Self-Care Theory. Ang
mahitungod ani nga research kai gi-isplikar na kanako. Ang
estudyanteng researcher nasayud na nga pwede nako undangun
ang ako-a pagka-subject sa ilahang research bisan kanus-a nako
gusto.
Ako mi-pirma sa adlaw nga ___________, 2009.
Pirma: ______________________
(Pasyente, Taga-bantay o
ang taw nga naghatag ani
nga pagsugot o ang thumb
mark sa pasyent)
Witness: ___________________
APPENDIX D
GORDON’S FUNCTIONAL HEALTH PATTERN
I.Health Perception – Health Management Pattern
Patient defines health as “kanang walay sakit”. Patient related
health as 10, where 10 as very important and 1 as least
important. Patient verbalized that health is very important, for
when you are not healthy you can’t function well and can’t
perform your daily work. He maintains good health by eating

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nutritious foods and through regular exercise by just walking
around in their compound. Patient doesn’t take any medication
unless issued a prescription from his physician. He also claims
that he doesn’t take any vitamin supplements. Patients usually
seek consultation on health matters with a physician. Patient
verbalized that his daughter would prepare fresh calamansi juice
for him whenever he has cough or colds. Patient does not smoke
nor drinks alcohol. He considers the environment as a major risk
factor that influences his health practices. He claimed that he is
particular when it comes to cleanliness in their home and
surroundings. Patient always observes proper hygiene practices
such as taking a bath everyday and changing into clean clothes.
He is aware of the importance of health care practices. Patient
has no knowledge in performing self-examination such as: BP
taking, pulse and temperature measurements. Patient has not
undergone vaccination since during their time vaccines where
not yet available during their time. He has no known allergies to
food and drugs. Patient does not take herbal supplements or any
maintenance drugs.
Patient is admitted for the first time at Sacred Heart Hospital
due to Myocardial Infarction. During admission, patient is taking

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prescribed medications such as Metoprolol 50 mg 1 tab. BID,
Simvastatin 40 mg 1 tab. OD qHS, Captopril 25 mg 1 tab. OD,
Kalium Durules 1 tab TID x 3days, Imdur 30 mg 1 tab OD, Levox
500 mg 1 tab. OD, Lilac 30cc OD, and Plavix 75 mg OD PC
Lunch. He is very weak and doesn’t want to communicate with
the people around him.
Remark: Ineffective health maintenance related to inability to
take responsibility for meeting basic health practices during
hospitalization as evidenced by verbalization of body weakness
and shortness of breath.
II.Nutritional – Metabolic Pattern
Fluid:
Before admission, patient usually drinks around 6-7
glasses of water a day from a regular size of glass approximately
240 cc. He also drinks juice, soft drinks and hot drinks like
coffee.
During admission, patients’ oral fluids are limited to 1 liter
per day.
Food:
Before admission usually eats 3 times a day, breakfast,
lunch and dinner and he seldom take snacks. He usually eats the
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food prepared by his daughter. He eats together with his family.
He enlisted pork and roasted chicken as his favorite foods.
During admission, patient was on low salt, low fat, diet for
five days. He still eats three times a day (breakfast, lunch and
dinner). Patient has verbalized that he has decreased appetite
since he doesn’t like hospital foods.
Typical Dietary Intake

06:00 AM 3 pieces of bread, 1 1 cup of coffee approx.
banana 240 cc
12:00 noon 2 pieces of bread, 1 1 cup of coffee approx.

pack of crackers 240 cc
07:00 PM 1 cup of rice, 1 piece 1 glass of water approx.

fried fish 240 cc

05:00 AM 3 pieces of bread, 1 1 cup of coffee approx.
banana 240 cc
10:00 AM 2 pieces of bread, I pack 1 cup of coffee approx.
of crackers 240 cc
12:00 noon 1 cup of rice, 1 piece fried 1 glass of water approx.
fish 240 cc
6:00 PM 1 cup rice, 1 cup bowl of 1 glass of water approx.
vegetables with soup 240 cc
24-hour Diet Recall
Remark: Risk for altered nutrition, less than body requirement
related to decrease appetite for foods.
III.Nutritional – Metabolic Pattern

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Before admission, patient defecates once a day. But there
are times that he can’t defecate for 2 days. As to color, it is
yellow to brown and he can’t account as to how much.
Sometimes he experiences difficulty in defecating. When it
occurs, he just drinks water for relief or his daughter would buy
laxatives from a pharmacy near their house. He urinates 6-7
times in a day with pale yellow color about 120 cc per episode.
During admission, patient has lost his appetite. He only
defecates once during the first three days of admission with dark
hard stool. He voids 5-6 times in a day but he can’t account as
to how much.
Patient’s skin is intact and returns immediately when
pinched.
Remark: Risk for constipation related to poor eating habits as
evidenced by decrease frequency in defecation.
IV.Activity-Exercise Pattern
Before admission, patient usually starts his daily routine at
6 am. He takes a bath, eats breakfast and whiles the time by
watching television shows or reading the newspaper. 11 am is
the time when he usually eats his lunch with his family. He takes
his siesta at 1 pm and wakes up around 3 pm to take his snacks.

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Dinner is served at 7 pm wherein he eats together with his
family. After eating he resumes watching the television. He
retires to is bed around 10 pm. He prefers to sleep in a supine
position.
During admission, patient wakes up around 8 am to take
his breakfast & take his prescribed medications. He is unable to
perform his daily routine such as taking a bath, watching
television and chatting with his neighbors. He just lay in bed the
entire day. His activity according to him is limited during his
hospitalization because he feels weak and tired whenever he
attempts to stand up.
Remark: Activity intolerance related to generalized weakness
secondary to myocardial infarction
V. Sleep – Rest Pattern
Before admission, patient usually sleeps around 10 pm and
wakes up at 5 am. He takes his usual afternoon nap around 1-2
pm.
During admission, patient sleeps at 8 pm and doesn’t have
specific time in waking up. He said that he can’t sleep well
because he is not used to the hospital environment. He claimed

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that he is usually awakened during the medication
administration.
Remark: Disturbed sleep pattern related to treatment modalities
and environmental changes.
VI. Cognitive-Perceptual Pattern
Patients finished his education until grade 6. He is unable
to hear clearly but is oriented to time, person and place.
Directions and instructions are often repeated twice.
According to patient, he is able to follow instructions as
well as recall past events. At home, decisions are made by the
family members.
During admission, patient is still able to communicate and
understand instructions but still with difficulty in hearing.
Remark: Disturbed Sensory Perception related to neurological
dysfunction (sense of hearing).
VII. Self-Perception and Self-Concept Pattern
Patient said that he is a responsible husband and father.
According to the patient, he has always been a positive thinker
and is generally, a happy person. He said that whenever there is
a problem, there’s always a solution. Patient also mentioned that
his family has always been his source of strength.

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During admission, patient claimed that he is extremely
saddened with his condition. He is often bothered by the hospital
expenses and where to get the money to pay for the bill.
Remark: Powerlessness related to inability to perform role
responsibilities.
VIII. Role-Relationship Pattern
Patient values his family very much. He lives with his
married daughter and her family. He has a good relationship
with his family and has not experienced any major conflict with
anyone of them. Patient already stopped working due old age
and enjoys the company of his neighborhood residents.
During hospitalization, patient mentioned a feeling of
sadness because he misses his grandchildren.
Remark: Impaired Cooping related to condition
IX. Sexuality and Reproductive Pattern
The patient was circumcised at the age of eight. He has
been previously diagnosed with Essential Hypertension.
During admission, the patient claimed that he is not
currently experiencing any discomfort with regards to his
reproductive organ. He mentioned that at his age, he is no
longer sexually active.

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Remark: Effective sexuality and reproductive pattern.
X. Coping-Stress Tolerance Pattern
The patient considered his present condition as his source
of stress. He claimed that he already accepted that he has this
disease and not to dwell much time thinking about it. He kept
himself busy with activities such as reading newspaper &
watching television programs.
Patient said that he didn’t feel uncomfortable with his
present condition and asked for means as to how he could cope
up with his illness.
Remark: Readiness for enhanced coping
XI. Value Belief Pattern
The patient is a Roman Catholic and attends mass every
Saturday in their chapel. He shared that he has a strong faith in
God and that he never forgets to pray everyday.
During admission, patient said that he had lost interest in
praying.
Remark: Risk for impaired religiosity related to depression due to
wife’s death and present condition.

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APPENDIX E
SOAPIE
Day 1
 Universal Self-Care Requisite
S- “Wala kayo ko katulog ug tarung kay init”, as verbalized.

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O- received patient lying in bed awake, conscious and coherent
– With D5W 250cc @ KVO infusing well at Left arm
– With O2 @ 2L/min via nasal prong
– restless and irritability noted
– perspiration noted
– frequent yawning noted
– teary eye noted
– with the following vital signs:
T–36.4 ˚C R–36 cpm P–65 bpm BP–130/60 mmHg
A- Sleep pattern disturbance related to treatment modalities and
environmental changes.
P- After 4-6 hours of rendering appropriate nursing interventions, the
patient will be able to verbalize understanding of sleep disturbance.
I- Determine patient’s expectations of adequate sleep.
– Arranged schedule to provide adequate periods of rest & sleep
throughout the day
– Arranged care to provide for uninterrupted periods of sleep & rest.
– Explained necessity of disturbances for therapeutic monitoring.
– Provided and maintained a calm, quiet environment

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– Promoted client safety and comfort
E- Patient understood the reasons of sleep disturbances for therapeutic
monitoring.
 Development Self-Care Requisite
S – “ Nahadlok ko kai basin nya mu grabi ko” as verbalized
O – received patient sitting on chair, awake, conscious and coherent.
– sadness noted
– expressed negative feelings (e.g., emptiness)
– avoidance noted
A- Fear related to unfamiliarity with environmental experience.
P – After 4-6 hours of rendering appropriate nursing intervention, the
patient will be able to display appropriate range of feelings and
lessened fear.
I – Encouraged client verbalization of feelings about the situation.
– Utilized therapeutic communication skill of active listening.

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– Encourage patient to participate in divertional activity.
– Provided patient with comfort and safety measures.
– Provided information in verbal and written form.
– Provided opportunity for question and answer honestly.
– Encouraged patient’s involvement in usual activities, relaxation
exercise and socialization.
– Discussed with the patient healthy ways of dealing with
different situation.
E – Patient responded to treatment and verbalized understanding of
his condition.
 Health Deviation Self-Care Requisite
S- “mag sakit man akong dughan “As verbalized by the patient.
O- Received patient lying in bed awake, conscious and coherent.
– weakness noted
– restlessness noted
– breathlessness noted
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– grimaced face noted
– guarding of affected area noted
– teary eye noted
– related pain at scale of 8 in a given scale of 0-10, 0-no pain
and 10-severe pain
A- Alteration in comfort: acute pain related to increased
cerebrovascular pressure secondary to myocardial infarction.
patient will be verbalize decrease in pain from 8 to 5 (in a given scale
of 0-10, 0-no pain and 10-severe pain)
I- Assessed patient’s condition.
– Monitored vital signs frequently.
– Assisted patient in performing self care activities.
– Evaluated pain regularly noting characteristics, location &
intensity on a 0-10 scale.
– Positioned patient in bed in semi-fowler’s position.

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– Demonstrated and encouraged patient to do deep breathing
exercises.
– Provided patient a calm environment and adequate rest periods.
E- The patient verbalized lessening of intensity level of pain from 8 as
severe to 6 as moderate; appeared to be relaxed, able to sleep and
rest well.
Day 2
 Universal Self-Requisite
S- “Kapoy ako lawas dili ko ganahan maglihok-lihok kay
magpanglipong ko”, as verbalized.
O – received patient sitting on bed, awake, conscious and coherent
– weakness noted
– slowed movement noted
– decreased activity observed
T – 36.5 °C R – 42 cpm P – 60 bpm BP– 140/90 mmHg
A- Activity intolerance related to generalized body weakness 2°
P- After 4-6 hour of rendering appropriate nursing interventions, the
patient will be able to verbalize increase activity tolerance.

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I- Assessed patient’s condition.
– Encouraged patient to increase exercise or activity level
gradually.
– Encouraged patient to verbalize feelings
– Assisted patient in performing range-of-motion (ROM) exercises.
– Encouraged patient to take adequate rest periods.
– Monitored patient’s vital signs.
E – Patient seen moving without any assistance and reading a
newspaper.
 Developmental Self-Care Requisite
S – “maayu pakaha ko aning akong sakit?” as verbalized.
O – received patient sitting on bed
– passivity noted
– lack of initiative noted
– facial tension noted
– expressions of concern about current and future events

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A- Anxiety related to fear of death.
P- After 3-4 hours of administering appropriate nursing interventions,
patient will be able to verbalized reduction of anxiety and identified
causes and contributing factors.
I- Monitored vital signs
- Encouraged change of scenery.
- Established therapeutic relationship showing positive regards for
client.
- Encouraged patient to verbalize and express feelings and
perceptions.
- Expressed hope to client.
- Encouraged patient to use coping mechanisms to divert attention.
- Provided a positive atmosphere for client to voice out concerns.
- Encouraged patient to maintain a positive attitude such as the use
of guided imagery as a relaxation technique.
E – Patient was able to have a sense of control over the current crisis.
S – “Kutasan ku dayun basta maglihok-lihok ko”, as verbalized.
O – received patient sitting on bed, awake, conscious & coherent
– nasal flaring noted
– tachypnea noted
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– using of accessory muscles when breathing noted
– with Oxygen @ 2L/min via nasal prong
A- Ineffective breathing pattern related to fatigue as evidenced by
verbalization of feelings of breathlessness 2° to Myocardial Infarction.
patient will be able to demonstrate appropriate coping behaviors and a
decreased in RR from 42 to 30 or at its normal range (16-20 cpm).
I – Assessed patient’s condition
– Assisted patient in sitting up in a chair, as appropriate.
– Encouraged patient to assume a comfortable position
– Demonstrated and encouraged client to follow pursed-lip
breathing technique
– Provided and maintained a calm environment for the client
– Encouraged patient to take adequate rest periods
– Encouraged deep breathing exercise
E – “ni arang-arang na akong paminaw”, as verbalized.
Patient’s RR decreased from 42-35 cpm.

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Day 3
S – “Kapoy paman akong lawas”, as verbalized
O – received patient sitting on chair, awake, conscious & coherent
– weakness noted
– decreased mobility
– disinterest in surroundings noted
A – Fatigue to confinement and health condition.
P – After 3-4 hours of rendering nursing interventions, the patient will
be able to improve sense of energy as evidenced by ability to perform
ADL at his acceptable level.
I – Assessed personal factors that may affect reports of fatigue level
– Instructed client methods on how to conserve energy (e.g., sitting
instead of standing during activities)
– Provided patient with comfort measures
– Encouraged patient to take adequate rest periods
– Planned care to allow individually adequate rest periods.
– Encouraged to do whatever possible and increase activity level as
tolerated.
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– Assisted in self-care needs and assisted in ambulation as needed.
– Provided divertional activities such as socializing with significant
others.
E – Patient showed an improved sense of energy as evidenced by
ability to perform ADL’s within his own limitations.
S – “ wala nai mu tabang naku, biyaan nya ku nila” as verbalized
– sadness noted
– avoidance noted
A- Ineffective Family Coping: risk for compromised related to
prolonged disease/disability progression that exhausts the supportive
capacity of family members
patient will be able to
– Utilized therapeutic communication skill of active listening.
– Encouraged patient to participate in diversional activity.

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– Provided patient with comfort and safety measures.
– Encouraged patient’s involvement in usual activities, relaxation
exercise and socialization.
– Discussed with the clients healthy ways of dealing with different
situation.
– Discussed underlying reasons for patient behaviors with family.
– Assisted family/patient to understand “who owns the problem”
and who is responsible for resolution. Avoid balance blame or
guilt.
– Involve family in information giving, problem solving and care of
patient as feasible. Identify other ways of demonstrating
support while maintaining patient’s independence
E –Patient and significant others had Involvement in the care and
enhanced feelings of control and self worth.
S – “Nalipong-lipong ko”, as verbalized by the patient.
O – received sitting on bed awake, conscious and coherent
– verbalized reports of headaches and dizziness
– clammy skin noted

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– weakness noted
A – Risk for decreased cardiac output related to increased after load 2
° to myocardial infarction.
P – After 3-4 hours of rendering appropriate nursing interventions
patient will be able to demonstrate ways to control blood pressure.
I – Assisted patient in doing simple exercises like walking.
– Instructed patient to eat diet that is low in both salt and fat like
fruits, fish, vegetables.
– Encouraged patient to be involved in diversional activities like
reading magazines/newspaper to prevent stress.
– Instructed patient to be involved in some complementary
modalities like massage.
– Provided calm, restful surroundings, minimize environmental
activity/noise. Limit the number of visitors and length of stay.
– Maintain activity restrictions, e.g. bedrest/chair rest; schedule
periods of uninterrupted rest; assist client with self-care
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– Provided comfort measures, e.g. back and neck massage,
elevation of head.
– Instructed in relaxation techniques, guided imagery, distractions
E – Patient was able to demonstrate ways to control blood pressure
like eating the proper foods with law salt and law fat.
Day 4
S – “Kapoy man ilakaw-lakaw”, as verbalized
O – received patient sitting on chair
– alert, awake, coherent
– slow movement noted
– decrease walking speed noted
T – 38.8˚C R – 35 cpm P – 65 bpm BP – 130/90 mmHg
A – Sedentary lifestyle related to lack of interest accomplishing a
physical exercise regimen.
P – After 3-4 hours of administering appropriate nursing interventions,
patient will be able to verbalize an interest in having an exercise
regimen and understand its importance.
I – Monitored vital signs

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– Discussed with the client the benefits of having exercise
– Encouraged change in scenery
– Involved patient and SO in making an exercise plan that fits the
client’s needs
– Introduced activities to client’s level of functioning such as
motivating the client to walk around the neighborhood for 15
minutes
– Encouraged patient to have ample time for exercise and rest
periods
– Discussed the importance of adequate fluid intake during hot
weather and with activity
– Provided a positive atmosphere for client to voice out concerns
– Encouraged client to maintain a positive attitude such as use of
guided imagery as a relaxation technique
– Encouraged SO to provide supervision during exercise
E – Patient was able to verbalize an understanding of the importance
of having exercise.
S – “ wala nai mu tabang naku, biyaan nya ku nila” as verbalized

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– sadness noted
– avoidance noted
T – 38.8˚C R – 35 cpm P – 65 bpm BP–130/90
mmHg
A- Ineffective coping related to situational crisis
patient will be able to
– Encouraged patient to talk about what is happening at this time
and what has occurred to precipitate feelings of helplessness
and anxiety.
– Allowed patient to be dependent in the beginning, with gradual
resumption of independence in ADLs. Self-care and other
activities. Make opportunities for patient to make simple
decisions about care/other activities when possible, accepting
choice not to do so.

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– Promoted safe and hopeful environment, as needed. Identify
positive aspects of this experience and assist patient to view it
as a learning opportunity.
– Provided for gradual implementation and continuation of
necessary behavior and lifestly changes. Reinforce positive
adaptation/ new coping behaviors.
E –Patient was ability to cope with current situation and plan for the
future.
S – no verbal cues
O – received patient lying in bed
– skin warm to touch
– flushed skin noted
T – 38.8˚C R – 35 cpm P – 65 bpm BP–130/90
mmHg
A- Alteration in thermoregulation: Hyperthermia related to increased
metabolic rate 2 ° to Myocardial Infarction.
P- After 4-6 hours of rendering appropriate nursing intervention, the
patient’s temperature will decrease from 38.8 ˚C to 37.5 ˚C.
I- Assessed the patient’s condition

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– Performed tepid sponge bath
– Monitored vital signs especially temperature
– Encouraged adequate rest periods
– Promoted patient’s safety
– Provided bedside care
E – Patient’s temperature has reduced to 37.7 ˚C.
Day 5
S – “ki ohaw gyud ko, ganahan ko mu inom daghan tubig”, as
verbalized
O – received sitting on bed awake, conscious and coherent
– restless noted
– clammy skin noted
– shortness of breath noted
– anxiety noted
– limit fluid to 1L/day as ordered

113
T – 36.5˚C R – 35 cpm P – 65 bpm BP–130/90
mmHg
A – Risk for fluid volume excess related to excess in fluid intake.
P – After 3-4 hours of rendering appropriate nursing interventions
patient will be able response to interventions and teaching and actions
performed.
I – Monitored and recorded input and output.
– Restricted sodium intake and fluid intake to 1L/day.
– Set an appropriate rate of fluid intake throughout 24 hour
period.
– Placed on semi-fowlers position as appropriate.
– Promoted early mobilization.
– Evaluated for any edematous extremities.
– Discussed the importance of fluid restrictions.
– Stressed the need mobility and frequent position changes.
E – Patient understood the importance of restricting fluid intake and
complied with the doctors orders.
S – no verbal cues
O – Received patient lying on bed, asleep

114
– Passivity noted
– Lack of initiative noted
– With the following vital signs:
T – 36.5˚C R – 35 cpm P – 65 bpm BP–130/90 mmHg
A- Hopelessness related to loss of belief in God.
patient will be able to recognize and verbalize feelings of hopelessness.
I- Monitored vital signs
– Encouraged change of scenery
– Established therapeutic relationship showing positive regards for
client.
– Encouraged patient to verbalize and express feelings and
perceptions.
– Expressed hope to client.
– Encouraged patient to use coping mechanisms to divert
attention.
– Provided a positive atmosphere for client to voice out concerns.
– Encouraged patient to maintain a positive attitude such as the
use of guided imagery as a relaxation technique.

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E – Patient understood why this crisis happened and had more faith in
God.
– “Dali ra ko kutasan basta maglihok-lihok ko”, as verbalized.
O – received patient sitting on bed, awake, conscious & coherent
– nasal flaring noted
– tachypnea noted
– using of accessory muscles when breathing noted
T – 36.5˚C R – 35 cpm P – 65 bpm BP–130/90 mmHg
A- Ineffective breathing pattern related to fatigue as evidenced by
verbalization of feelings of breathlessness.
patient will be able to demonstrate appropriate coping behaviors.
I – Assessed patient’s condition
– Assisted patient in sitting up in a chair, as appropriate.
– Encouraged patient to assume a comfortable position
– Demonstrated and encouraged client to follow pursed-lip
breathing technique.
– Provided and maintained a calm environment for the patient.

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– Encouraged patient to take adequate rest periods.
– Advised patient to have rest periods during activities.
E –Patients RR decreased from 35 to 29 and verbalized minimal relief.
Day 6
S – “Kapoy paman akong lawas, lay kai dri sa balay”, as verbalized
O – received patient sitting on chair, awake, conscious & coherent
– weakness noted
– decreased mobility
– slow movement noted
T – 36.5 °C R –27cpm P – 60 bpm BP – 1430/90 mmHg
A – Fatigue related to health condition.
P – After 3-4 hours of rendering nursing interventions, the patient will
be able to improve sense of energy as evidenced by ability to perform
ADL at his acceptable level.
I – Assessed personal factors that may affect reports of fatigue level
– Instructed client methods on how to conserve energy (e.g., sitting
instead of standing during activities)
– Provided client with comfort measures

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– Encouraged client to take adequate rest periods
– Encouraged patient to do diverstional activities such as watching
tv, socializing with neighbors, and going outside for fresh air.
E – Patient showed an improved sense of energy as evidenced by
ability to perform ADL’s within his own limitations.
S – “maayu pakaha ko aning akong sakit?” as verbalized.
– passivity noted
– lack of initiative noted
– facial tension noted
– expressions of concern about current and future events
A- Anxiety related to cheange in health and socioeconomic status 2 °
to Myocardial Infarction.
118
patient will be able to verbalized reduction of anxiety and identified
causes and contributing factors.
I- Encouraged patient to express feelings.
– Encouraged change of scenery.
– Established therapeutic relationship showing positive regards for
patient.
– Encouraged patient to verbalize and express feelings and
perceptions.
– Expressed hope to client.
– Encouraged patient to use coping mechanisms to divert
attention.
– Provided a positive atmosphere for client to voice out concerns.
– Encouraged patient to maintain a positive attitude such as the
use of guided imagery as a relaxation technique.
E – Patient verbalized feeling of relief and seen talking with his
daughters and eating their snacks.
S – “Unsa man akong buhaton para mu-ubos akong BP?” as verbalized
O – received client sitting on chair, awake, conscious & coherent

119
– expressed an interest in learning more about his illness
– behavior congruent with expressed knowledge noted
A – Readiness for enhanced knowledge related to illness 2° to
P – After 3-4 hours of rendering appropriate nursing interventions,
patient will be able to verbalize understanding of information gained.
I – Verified client’s level of knowledge regarding the illness
– Determined any challenge to client’s learning.
– Provided patient with health teachings on appropriate lifestyle
changes stressing the importance of diet and exercise
– Informed patient of available community sources.
– Encouraged patient to adhere to teachings given.
E – Patient volunteered to take a stroll around the neighborhood and
market it as his first step in his daily exercise regimen.
Discharge Plan
A case of Mr. Inocencio Tantiado Villaner of 735 Bulacao Cebu
City, 79 years old, male, widower, Filipino, Roman Catholic, admitted

120
for the first time at Sacred Heart Hospital last August 08, 2009 due to
mild myocardial infarction.
S – “Maka uli nadaw ko”, as verbalized by the patient
– Awake, alert, coherent
– Without Ivf
– Able to perform ADLs
– Seen packing things
– With doctors order of May Go Home
– Full billing done
– With the following vital signs:
T – 37 C R – 21 CPM P – 63 BPM BP–130/70 mmHg
A – Readiness for enhanced therapeutic regimen
P – After 3-4 hours of administering appropriate nursing
interventions, patient will be able to verbalized understanding of
the therapeutic regimen for illness or disease condition.
I -Promotes adherence measures by thoroughly explaining the
prescribed medication regimen and other treatment measures.
– Warn the patients together with relatives about adverse
reaction to drugs, and advise them to watch the sign and

121
symptoms of toxic (nausea, anorexia, vomiting, and yellow
vision)
– Organize patient care and activities to maximize periods of
uninterrupted rest.
– Don’t stress yourself, too much exercise. Enough, walk for
15 minutes.
– Encourage participation in a cardiac rehabilitation program.
– Encouraged patient to verbalize feelings and needs when
presence of chest pain, weakness, and prolonged headache,
this is to lessen the burden of the patient and for immediate
action as well as to minimize entertaining negative
thoughts.
– Watch for sign and symptoms of fluid retention (crackles,
cough, tachypnea, and edema), which may indicate
impending Heart Failure. Carefully monitor daily weight,
intake and output, respiration, serum enzyme level and
blood pressure.
– Instructed patient to return to OPD for follow-up check up.
– Review dietary restriction with the patient. A low sodium,
low fat, or low cholesterol diet and caffeine-free may be
ordered, provide a list of food that he should avoid. Provide
a clear liquid diet until nausea subsides. Ask dietitian to
speak to the patient’s family.

122
– Encourages the family to seek out religious activities,
pertaining to spiritual issues.
E- Patient and significant others verbalized understanding with
the health teachings imparted.
APPENDIX F
IPPAO
GENERAL SURVEY:
A case of Mr. A case of Mr. I. T. V. of Bulacao Cebu City, 79
years old, male, widower, Filipino, Roman Catholic, admitted for the
first time at Sacred Heart Hospital last August 03, 2009 due to mild
Patient was seen lying ob bed, conscious and coherent with
ongoing D5W 250cc @ KVO infusing well at left arm; With O2 @
2L/min via nasal prong; is of medium built, has steady gait with
upright position. He has limited mobility, speaks in a low voice. Body
weakness noted. He has proper hygiene as evidenced by clean clothes
and well trimmed fingernails and toenails.
Patient is conscious, coherent, cooperative and ambulatory with
the following vital signs:
Temperature: 36.4 °C Pulse Rate: 65 bpm
Respiratory Rate: 36 cpm Blood Pressure: 130/60 mmHg
Height: 5”7 Weight: 220 pounds
I. Integumentary
a. Skin
Inspection
○ Skin is intact with brown complexion
123
○ Skin is warm to touch
Palpation
○ Skin surface is smooth and soft
○ Good skin turgor
○ Skin is warm which suggest normal circulation
b. Nails
Inspection
○ Nails are short and convex with an angle of less than 180
degrees, follows the normal curve of the finger
○ Nails are smooth and pinkish in color
○ No clubbing noted
Palpation
○ Nail beds are firm and non-tender
○ Capillary refill time was within 2-3 seconds
c. Hair and scalp

Inspection
○ Hair is black with hints of white at some areas; of
moderate thickness
○ Hair is evenly distributed
Palpation
○ No masses noted
II. Head and Neck

a. Skull
Inspection
124
○ Patient’s head is normocephalic with a measurement of

22 inches in circumference
○ Gently curved with prominences of the frontal and

parietal bones
○ Hair is evenly distributed
Palpation
○ No masses noted
b. Face
Inspection
○ Skin color is consistent with other parts
○ Patient was able to show different facial expressions
○ Symmetrical when at rest and upon movement
○ Facial hair evenly distributed
○ Absence of edema and involuntary facial movements
Palpation
○ No masses noted
c. Eyes and Ears

Inspection
○ Eyes are equally round and reactive to light
accommodation
○ Patient was able to open and close upper eyelids
○ Pupils are black and equal in size
○ Eyebrows and eyelashes are evenly distributed

125
○ Patient was able to read newsprint but with the use of

graded glasses
○ Ears are symmetrical and proportionate with head
○ No discharges noted
Palpation
○ No edema noted
d. Nose and Sinuses

Inspection
○ Nasal septum is intact
○ Nasal mucosa is moist and red in color
○ No nasal discharges noted
Palpation
○ No swelling noted
○ Sinuses are not painful when palpated
Olfaction
○ No foul odor noted
e. Mouth and Pharynx

Inspection
○ Patient is able to chew; able to distinguish sour, sweet
and salty substances
○ Lips are slightly dark and moist
○ Gums are pinkish and smooth

126
○ Tongue is in the middle and can move from right, left,

upward and downward
○ Tonsils are symmetrical and pinkish
○ Mucus membrane are pinkish in color and semi-

moist(almost dry)
○ Uvula is at the center
○ Teeth are incomplete and yellowish
○ Patient has dentures at the upper set of teeth
Palpation
○ No swelling noted
○ No masses noted
Olfaction
○ No foul odor noted
f. Neck
Inspection
○ Symmetrical with range of motion
○ No vein distention visible masses, lesions or swelling
Palpation
○ Lymph nodes are not palpable
○ No masses noted
III. Thorax and Lungs

a. Anterior
Inspection
127
○ Breathing patterns are irregular
○ Chest symmetrical upon respiration
Percussion
○ Symmetrical percussion sounds noted
○ Areas of dullness noted over the lungs
Auscultation
○ Wheezing breath sounds noted
b. Posterior
Palpation
○ No masses noted
Percussion
○ Dullness and some flatness noted over the lungs
Auscultation
○ Wheezing breath sounds noted
IV. Cardiovascular and Peripheral

a. Heart
Inspection of the neck of the pericardium
○ Absence of jugular vein distention & varicosities noted
○ No visible pulsations at the aorta
○ Absence of ulcerations noted
Palpation
○ Point of maximal impulse is seen at the 4th and 5th
intercostals space at the midclavicular line
128
○ No other pulsations noted
○ Pulses have regular rhythm and are equal and bilateral
Auscultation
○ Sound is heard as lub-dub. Lub Is the first heart sound
(S1) and dub is the second heart sound (S2)
○ Absence of murmurs or bruits
○ Distinct heart sound
○ Normal heart rate/rhythm
b. Peripheral Vascular System

Inspection
○ Warm and dry skin is noted
○ Absence of varicosities noted
○ No edema present
Palpation
○ Radial pulse rate of 120 bpm
○ Regular rhythm; weak, equal pulses bilaterally
V. Abdomen
Inspection
○ Umbilicus is centrally located; clean without presence of
dirt noted
○ Skin is lighter than exposed areas
Auscultation
129
○ Hyperactive bowel sound noted every 3 seconds over the

4 abdominal areas in a clockwise manner (upper right
quadrant, lower right quadrant, lower left quadrant and
upper left quadrant)
Percussion
○ Tympany sound over the stomach (upper left quadrant)
and dullness noted in the right upper quadrant and in
other areas
Palpation
○ Tenderness noted at the right of the epigastrium
VI. Breast and Axilla

Inspection
○ Presence of fine hair on axillae
○ No discharges noted
Palpation
○ No masses noted
VII. Reproduction
○ No data gathered since the patient does not want to
proceed with the physical assessment of this system
VIII. Musculoskeletal
“Wa man ko’y umoy primi, sige lang ko ug luya” as vernalized
Inspection
○ Weakness noted upon standing as evidence by need of
assistance in standing and walking
○ Decreased muscle strength on the extremities

130
Palpation
○ Muscle are non-tender
IX. Neurologic
○ Olfactory – equal and bilateral sense of smell
○ Optic – good visual acuity
○ Occulomotor, Trochlear and Abducens
– Patient uses graded glasses for clear

visualization
– Complete lid closure and simultaneous opening

of eyelids
– Coordinated movements of eyeballs/iris
○ Trigeminal – patient correctly identifies sharp, dull and

soft sensation
○ Facial – expressions are symmetrical
– Substances are correctly identified through the

sense of taste
○ Vestibulocochlear – patient is able to hear clearly

bilaterally
○ Glossopharyngeal – has good gag reflex
– Able to identify sweet, salty and sour

substances
○ Vagus – has good swallowing reflex

131
○ Spinal accessory – equal bilateral movement and strength

of the muscle of the shoulder
○ Hypoglossal – protrusion of the tongue is symmetrical
– Enables the cheek to have a puffed-out

appearance
SUMMARY OF SIGNIFICANT FINDINGS

III. Thorax and Lungs
a. Anterior
Inspection
○ Breathing patterns are irregular
V. Cardiovascular and Peripheral Vascular System

Auscultation
○ Distinct heart sound
VIII. Musculoskeletal
“Wa man koy umoy pirmi, sige lang ko ug luya” as verbalized
Inspection
○ Weakness noted upon standing as evidence by need of
assistance in standing and walking
○ Decreased muscle strength on extremities
IX. Neurologic
○ Occulomotor, Trochlear and Abducens – patient uses
graded eyeglasses for clear visualization
○ Vestibulocochlear – patient is unable to hear clearly

bilaterally
132
APPENDIX G
DAILY TIME RECORD

133
APPENDIX H
DOCUMENTATION
134
Home Visit
135
On the way to the patients house.
With his daughter Lilibeth.

136
APPENDIX I
TIMETABLE
Time Activities
Frame/Month
April 2009 • Submission of the proposed title for approval
with the Dean
• Coordination with the Adviser regarding the
plans, processes and theories for the study
• Start of the creation of Chapter 1 and
checking with the Adviser
May 2009 • Refinements to Chapter 1 and incorporation
of changes made by the Adviser
• Submission of manuscript for the Oral
Proposal Hearing
• Oral Proposal Hearing in the last week of May
June 2009 • Incorporations of the corrections made by the
panel during Oral Proposal Hearing
• Submission of the transmittal letters for
signing of the Dean
• Submission of the transmittal letters to the
Medical Directors
• Start of Actual Data Gathering
July 2009 • Continue Data Gathering at the specified
locale
August 2009 • Submission of the raw data to the Statistician
for computation
September 2009 • Creation of Chapter 2 and 3 and subsequent
refinement of the two chapters in
coordination with the Adviser
• Submission of manuscript for the Oral
Defense Hearing
October 2009 • Incorporation of the corrections made by the
panel during Oral Defense Hearing
• Submission to the Grammarian for proof-
reading
• Submission of soft copy as requirement for
graduation
137
APPENDIX J
Research Budget
A. Materials
Paper/Ink - P 2, 500.00
Folders/Ballpens - P 500.00
Photocopying - P 1, 000.00
B. Services
Encoding - P 300.00
Grammarian’s Fee - P 1, 500.00
Secretary’s Fee - P 500.00
C. Miscellaneous - P 2, 500.00
D. Oral Defense Fee - P 4, 200.00
Total - P 13, 000.00
Prepared by:
CHERRY JOY H. DATAN, RN

Researcher/Student
138
APPENDIX K-1
SAMPLE TOOL GUIDE
A. Patient’s profile in terms of:
 Name
 Date of birth, age
 Sex
 Height, weight
 Race
 Educational status
 Mental status
 Religion
 Occupation
 Date of admission
 Chief complaint
 Admitting diagnosis
 Number of years diagnosed with essential hypertension
 Attending physician
 Ward
 Bed number
139
A. Needs of the patient in terms of the following self-care
requisites:
1. Universal
 Patient’s 24 hour diet recall
 Patient’s food preference
 Food preparation
 Food supplement (e.g: vitamins, minerals)
 Factors that influence patient’s dietary modifications (e.g;
cultural, religious, medical)
 Usual elimination pattern in terms of frequency, amount
and usual habits (e.g:CFCAS)
 Utilization of other aids to facilitate elimination (e.g:
laxatives, fluids, etc.)
 Usual activity patterns
 Adherence to a regular exercise regimen
 Time and duration of patient’s usual sleeping pattern
 Attitude towards self and others
 Patient’s lifestyle (e.g: smoking, drinking alcohol)
 Environmental factors (e.g: exposure to smoke-belching
factory, improper waste sanitation, etc.)
 Health practices
140
1. Developmental
 Educational status
 Role in the family and community
 Perception and satisfaction on the said role
 Problems with relationship to others (e.g: family, friends)
 Patient’s consciousness and awareness of his own health
 Knowledge on the performance of self-examination (e.g:
breast examination, testicular examination, blood glucose
testing, blood pressure, pulse and temperature
measurements
 Experienced any of the following for the past 6 months:
✔ Loss of a family member, relative or friend
✔ Loss of possession or occupation
✔ Change of residency into an unfamiliar environment
✔ Any hazardous accident or health threat
✔ Any other disease or illness
1. Health Deviation
 Patient’s vital signs
 Heredo familial diseases present in both sides of the
patients family
 Current laboratory results or diagnostic tests findings

141
 Medications or therapy used
 Adhere to the prescribed treatment

142
APPENDIX K-2
SAMPLE TOOL GUIDE
(VERNACULAR)
A. Mga personal na impromasyon bahin sa pasyente sama sa:
 Pangalan
 Adlaw sa katawo, edad
 Sex
 Kabug-atun, katas-un
 Minyu, ulitawo o biyudo
 Relihiyon
 Trabaho
 Petsa sa pagka-admit
 Diagnosis sa pagka-admit
 Pila na ka tuig adunay hypertension
 Doctor nga nagkonsulta
 Ward
 Bed number
A. Mga kinahanglan sa pasyente bahin sa mga kuwang sa
paggam sa kaugalingun sama sa:
1. Universal
 Gikaon sa paseynte sulod sa milabay nga 24 oras
 Pagkaon nga gusto kaonon sa pasyente

143
 Pamaagi sa pag-preparar sa pagkaon sama sa bitamina,
minerals)
 Mga naka-impluwensya sa pagkaon sa pasyente
(pagtuo sa relihiyon)
 Oras sa pagkalibang
 Paggamit sa mga butang nga makatabang sa iyang
paglibang sama sa tambal o pagkaon
 Kasagarang buhaton sa pasyente sulod sa usa ka adlaw
 Pag-ehersisyo sa pasyente
 Oras sa ting katulog sa pasyente ug pila ka oras
kasagaran nga matulog
 Kina-iya sa pasyente ngadto sa iyang kaugalingon ug sa
uban pa
 Mga bisyo sama sa panigarilyo o pag-inom
 Mga butang sa palibut nga makadaot sa kalawasan
(sama sa mga itum nga aso sa tambutso sa sakyanan,
nagkalat nga basura)
 Mga kasagarang buluhaton sa pasyente bahin sa
pagatiman sa iyang kaugalingon
1. Developmental
 Iyahang natiwas sa pag-eskwela

144
 Iyang katungod sa pamilya ug sa komunidad
 Iyang opinion sa nahisgut nga kahitungod
 Mga problema sa pasyente sa karon mahitungod sa
iyang relasyon sa iyang pamilya ug sa iyang mga amigo
 Paglantaw bahin sa maayong panglawas
 Pagbuhat sa mga butang sama sa pagkuha ug blood
pressure, pagamit sa thermometer, magkuha ug blood
glucose
 Mga higayon nga naigahan sa pasyente sa milabay nga
6 ka bulan:
✔ Namatayn ug paryente, o suod nga higala
✔ Nawad-an ug trabaho o importanteng gamit
✔ Pagbilin sa laing lugar
✔ Mga pasakit o laing gipamati sa kalawasan
1. Health deviation
 Bag-ong vital signs sa pasyente
 Kaliwat nga mga sakit nga naa sa iyang pamilya
 Resulta sa iyang mga laboratory
 Laing gipaminaw nga sakit
 Gi-mintinar nga tambal sa nahisgutang sakit
 Pagsunod sa sakto nga pag-inum sa iyang tambal.

Understanding the Impact of Myocardial Infarction Using Orem's Self-Care Theory

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Understanding the Impact of Myocardial Infarction Using Orem's Self-Care Theory

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1

Rationale of the Study

Myocardial infarction is a common presentation of ischemic

heart disease. Defined as death or necrosis of myocardial cells,

It is a diagnosis at the end of the spectrum of myocardial

ischemia or acute coronary syndromes. Myocardial infarction

occurs when myocardial ischemia exceeds a critical threshold

and overwhelms myocardial cellular repair mechanisms designed

to maintain normal operating function and hemostasis. Ischemia

at this critical threshold level for an extended period results in

irreversible myocardial cell damage or death.

World Health Organization estimated that in 2002, 12.6

percent of deaths worldwide were from ischemic heart disease.

Ischemic heart disease is the leading cause of death in

developed countries, but third to AIDS and lower respiratory

infections in developing countries. According to the Centers for

Disease Control and Prevention (CDC), annual mortality rates in

the United States from all causes in the pediatric population

range from 22 deaths per 100,000 population in children aged 5-

14 years to 756 deaths per 100,000 population in infants

younger than 1 year. (Compare this to 90 deaths per 100,000 in

persons aged 15-24 y and 2,538 deaths 100,000 in individuals

from acute myocardial infarction is 0.2 deaths per 100,000

population in persons aged 15-24 years and fewer than 0.2

deaths per 100,000 in infants younger than 1 year. (Compare

this to 1.4 deaths per 100,000 population in persons aged 25-34

y and 262 deaths per 100,000 population in individuals aged 65-

Every hour, nine Filipinos die of cardiovascular or heart

diseases. In fact, cardiovascular diseases remain the No. 1 cause

of death in the Philippines. About one out of four deaths in the

country are traced to cardiovascular diseases, according to the

Department of Health. The DOH is promoting a massive

information and education campaign to increase awareness of

cardiovascular diseases. Surveys made by the DOH show that

Central Luzon had the highest cases of cardiovascular diseases

(225 per 100,000 population). Metro Manila registered the

Central Mindanao (16 per 100,000). One out of 20 adults (40

years and older) suffers from coronary/ischemic heart disease.

hypertension, or high blood pressure. Five out of 100 adults

suffer from coronary artery disease (www.philstar.com).

The researcher is a graduate of Bachelor of Nursing

Degree. She has been assigned to many different hospitals while

she was a student nurse and previously worked as a volunteer

nurse for 3 months at Cebu Peuriculture and Maternity House

room, assisting obstetricians during delivery and labor watch,

and operating room assisting the surgeon in minor and major

operations. Presently the researcher is a Clinical Instructor at

Southwestern University College of Nursing where she is

assigned at Medical Surgical Ward and Emergency Room.

The interest of the researcher in conducting the study was

due to the death of a close relative from myocardial infarction.

The researcher, have acquired learning on Orem’s Self-Care

Theory and on the disease process of Myocardial Infarction. The

researcher is aware of the scope of this disease and its impact

on the patient and his family. Having such knowledge matched

with skills on rendering health care, the researcher conduct this

study with an aim of assessing a case of Myocardial Infarction,

planning, implementing and at the same time, evaluating

nursing care plans for a patient with Myocardial Infarction using

Orem’s Self-care Theory as its bases.

This study was anchored on Dorothea Orem’s Self-Care

Theory. Orem developed the Self-Care Deficit Theory of Nursing