Acute Coronary Syndrome (ACS)
Myocardial Infarction (MI)
JoAnn Smith, 68 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
1. Fluid and Electrolyte Balance
2. Clinical Judgment
3. Communication
4. Collaboration
, Acute Coronary Syndrome/Acute MI
History of Present Problem:
JoAnn Smith is a 68-year-old woman who presents to the emergency department (ED) after having three days of
progressive weakness. She denies chest pain, but admits to shortness of breath (SOB) that increases with activity. She
also has epigastric pain with nausea that has been intermittent for 20-30 minutes over the last three days. She reports that
her epigastric pain has gotten worse and is now radiating into her neck. Her husband called 9-1-1 and she was transported
to the hospital by emergency medical services (EMS).
Personal/Social History:
JoAnn is a recently retired math teacher who continues to substitute teach part-time. She is physically active and lives
independently with her spouse in her own home. She has smoked 1 pack per day the past 40 years. JoAnn appears
anxious and immediately asks repeatedly for her husband upon arrival.
What data from the histories are RELEVANT and have clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
RELEVANT Data from Social History: Clinical Significance:
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medications treat which conditions? Draw lines to connect)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
Diabetes mellitus type II 1. Iron Sulfate 325 mg PO
Hypertension daily
Hyperlipidemia 2. Lisinopril 5 mg PO daily
Cerebral vascular accident 3. Simvastatin 20 mg PO daily
(CVA) with no residual 4. Aspirin 81 mg PO daily
deficits 5. Clopidogrel 75 mg PO daily
Gastro-esophageal reflux 6. Omeprazole 20 mg PO daily
disease (GERD) 7. Metformin 500 mg PO bid
Anemia-Iron deficiency
One disease process often influences the development of other illnesses. Based on your knowledge of
pathophysiology (if applicable), which disease likely developed FIRST that created a “domino effect” in her life?
Circle what PMH problem likely started FIRST
Underline what PMH problem(s) FOLLOWED as domino(s)
Myocardial Infarction (MI)
JoAnn Smith, 68 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
1. Fluid and Electrolyte Balance
2. Clinical Judgment
3. Communication
4. Collaboration
, Acute Coronary Syndrome/Acute MI
History of Present Problem:
JoAnn Smith is a 68-year-old woman who presents to the emergency department (ED) after having three days of
progressive weakness. She denies chest pain, but admits to shortness of breath (SOB) that increases with activity. She
also has epigastric pain with nausea that has been intermittent for 20-30 minutes over the last three days. She reports that
her epigastric pain has gotten worse and is now radiating into her neck. Her husband called 9-1-1 and she was transported
to the hospital by emergency medical services (EMS).
Personal/Social History:
JoAnn is a recently retired math teacher who continues to substitute teach part-time. She is physically active and lives
independently with her spouse in her own home. She has smoked 1 pack per day the past 40 years. JoAnn appears
anxious and immediately asks repeatedly for her husband upon arrival.
What data from the histories are RELEVANT and have clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
RELEVANT Data from Social History: Clinical Significance:
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medications treat which conditions? Draw lines to connect)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
Diabetes mellitus type II 1. Iron Sulfate 325 mg PO
Hypertension daily
Hyperlipidemia 2. Lisinopril 5 mg PO daily
Cerebral vascular accident 3. Simvastatin 20 mg PO daily
(CVA) with no residual 4. Aspirin 81 mg PO daily
deficits 5. Clopidogrel 75 mg PO daily
Gastro-esophageal reflux 6. Omeprazole 20 mg PO daily
disease (GERD) 7. Metformin 500 mg PO bid
Anemia-Iron deficiency
One disease process often influences the development of other illnesses. Based on your knowledge of
pathophysiology (if applicable), which disease likely developed FIRST that created a “domino effect” in her life?
Circle what PMH problem likely started FIRST
Underline what PMH problem(s) FOLLOWED as domino(s)
