Myocardial Infarction (MI) Case History and Initial Assessment

 

 

History Taking and Initial Care 👀 Pyelonephritis – Check for fever and urination pain and monitor body temperature rise 👀 FEMORAL FRACTURE – Check accident progress and pain area, check blood pressure and pain score 👀 Pulmonic embolism – Check for shortness of breath and oxygen saturation 👀 Pneumonia – Cough, phlegm color change, body temperature, respiratory rate check 👀 Congestion heart failure (CHF) – Check swelling and shortness of breath, monitor weight change 👀 Myocardial infarction (MI) – Check the location and duration of chest pain, check blood pressure and heart rate 👀 Stroke – Check the time and speech impairment of symptoms, observe blood pressure 👀 Diabetic ketoacidosis (DKA) – Check thirst and frequency of urination, check respiratory rate (Kussmaul breathing) 👀 Sepsis – Check fever, history of infection, monitor changes in body temperature and heart rate

 

 

 

 

 

 

 

 

 

Comprehensive Simulation Scenario for Nurse Training: Myocardial Infarction (MI) Case History and Initial Assessment

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Scenario Title: Structured Interview, Vital Signs Monitoring, and Diagnostic Preparation for Acute Myocardial Infarction

Setting: Emergency Department / Cardiac Observation Unit

Characters:

• Nurse (RN) – Responsible for the comprehensive assessment of the patient
• Mr. Hyunwoo Kim (Patient) – 58-year-old male with acute MI symptoms

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Phase 1: Patient Identification and Introduction

Nurse: Good morning, Mr. Kim. I’m the nurse assisting you today. Could you please confirm your full name and date of birth?

 

Patient: Good morning. My name is Hyunwoo Kim, and my date of birth is July 14, 1965.

 

Nurse: Thank you, Mr. Kim. I’ll ask you some questions to better understand your condition. Everything you share will remain confidential. Please let me know if you feel uncomfortable at any time.

 

 

 

 

 

 

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Phase 2: Chief Complaint (CC)

Nurse: What brings you to the hospital today?

 

Patient: I’ve been having severe chest pain and trouble breathing.

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Phase 3: History of Present Illness (HPI)

Nurse: When did the chest pain begin?

 

Patient: It started suddenly about two hours ago.

 

Nurse: On a scale from 0 to 10, how would you rate the intensity?

 

Patient: About 8.

 

Nurse: How would you describe the pain—sharp, burning, squeezing?

 

Patient: It feels like someone is squeezing my chest very tightly.

 

Nurse: Is the pain constant or intermittent?

 

Patient: It’s been constant since it began.

 

Nurse: Does the pain radiate anywhere?

 

Patient: Yes, it spreads to my left shoulder and down my arm.

 

Nurse: Is it worsened by movement or relieved by rest?

 

Patient: Moving makes it worse, and rest hasn’t helped.

 

Nurse: Any associated symptoms—nausea, sweating, dizziness?

 

Patient: Yes, I feel nauseous, and I’m sweating heavily.

 

 

 

 

 

 

 

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Phase 4: Past Medical History (PMH)

Nurse: Have you been diagnosed with heart disease before?

 

Patient: No, this is my first time experiencing anything like this.

 

Nurse: Have you had any surgeries or procedures related to the heart?

 

Patient: No.

 

Nurse: Do you have any other chronic conditions such as hypertension or diabetes?

 

Patient: I have high blood pressure.

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Phase 5: Family History (FH)

Nurse: Is there any family history of heart disease?

 

Patient: Yes, my father had a heart attack in his 50s, and my brother has coronary artery disease.

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Phase 6: Social History (SH)

Nurse: Do you smoke or drink alcohol?

 

Patient: I smoke half a pack a day and drink socially twice a week.

 

Nurse: What is your occupation, and does it involve stress?

 

Patient: I work in sales. It’s a high-stress job.

 

Nurse: Do you engage in regular physical activity?

 

Patient: No, I don’t have time to exercise.

 

 

 

 

 

 

 

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Phase 7: Medication History and Allergies

Nurse: Are you currently taking any medications?

 

Patient: I take medication for high blood pressure.

 

Nurse: Have you had any side effects or allergic reactions to medications?

 

Patient: No.

 

Nurse: Do you take any over-the-counter medications or supplements?

 

Patient: No.

 

Nurse: Any known allergies to medications, food, or environmental triggers?

 

Patient: None that I know of.

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Phase 8: Vital Signs Assessment

Nurse: Mr. Kim, I’ll now take your vital signs. Please let me know if you feel uncomfortable.

 

 

8.1 Temperature

 

Nurse: I’ll begin by taking your temperature with an ear thermometer.

(Performs hand hygiene, uses probe cover, and positions the device.)

 

Nurse: Your temperature is 37.4°C, within the normal range.

 

 

8.2 Blood Pressure

 

Nurse: Let’s check your blood pressure.

(Positions cuff and uses stethoscope for manual reading.)

 

Nurse: It’s 150/95 mmHg—elevated, likely due to pain and stress.

 

 

8.3 Pulse

 

Nurse: I’ll now check your pulse.

(Counts full minute to check for irregularities.)

 

Nurse: Your pulse is 105 beats per minute—elevated.

 

 

8.4 Respiratory Rate

 

Nurse: I’ll observe your breathing.

(Discreetly counts respirations.)

 

Nurse: 24 breaths per minute—elevated and consistent with shortness of breath.

 

 

 

 

 

 

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Phase 9: Diagnostic Workup Plan

 

Nurse: Based on your symptoms and vital signs, we suspect a myocardial infarction (heart attack). We’ll perform the following tests:

1. Electrocardiogram (ECG): To evaluate your heart’s rhythm and detect any damage.
2. Cardiac Enzymes: Blood tests for troponin levels to assess myocardial injury.
3. Chest X-ray: To evaluate your heart and lungs.

We’ll also provide supplemental oxygen and may initiate IV access for medication as prescribed.

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Phase 10: Patient Education and Support

Nurse: These tests are non-invasive and typically painless. If you feel any discomfort or anxiety, please let me know.

 

Patient: Will I need surgery or intervention?

 

Nurse: That depends on the results. If the artery is blocked, the cardiologist may recommend procedures like cardiac catheterization or angioplasty.

 

Patient: Okay, thank you for explaining everything.

 

Nurse: You’re very welcome, Mr. Kim. Please try to rest and breathe steadily while we begin the ECG. We’re here to take care of you.

 

 

 

 

 

 

 

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Learning Objectives for Nurse Trainees

• Identify acute MI symptoms through comprehensive patient history
• Recognize associated risk factors and family history
• Accurately assess vital signs linked to myocardial ischemia
• Communicate effectively and educate patients on tests and expectations
• Support patient comfort and reduce anxiety in urgent cardiac care settings

End of Scenario

 

 

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Myocardial Infarction (MI) Case History and Initial Assessment