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Case Study:

Mr Gulyas is a 49-year-old Hungarian man who presents to the emergency department with central chest pain. He has no personal history of coronary artery disease or myocardial infarction, and no known family history of artherosclerotic (deposits in the arteries) heart disease. Mr Gulyas states he has associated symtoms of nausea, diaphoresis (perspiration), and pain radiating to both shoulders and down his left arm. When asked to rate his pain, he states his pain score is 10 out of 10. When questioned about his social history, he states he smokes cigarettes (15 per day), works as a computer programmer in an office, and does very little exercise.

Mr Gulyas is pale and clammy. He is afebrile, with a blood pressure of 106/62 mm Hg, a regular pulse of 68 bpm, a respiratory rate of 18 breaths/min, and an oxygen saturation of 96% while breathing room air. An ECG reveals an acute ST elevation myocardial infarction (STEMI). His Troponin 1 result is 2.4. The plan for Mr Gulyas is to admit him to the cardiac ward for monitoring and thrombolysis/clots. Mr Gulyas is anxious and feels guilty about his lifestyle that he considers has contributed to his admission today.

1. Risk Factors and Health Promotion
What are the factors that may have contributed to Mr Gulyas’s myocardial infarction? Outline how you would approach Mr Gulyas regarding these and what health promotion information and referral you would provide to him. (approx. 500 words).

2. Activities of Living.
Consider the twelve (12) activities of living in the Roper Logan & Tierney Model of Nursing and specifically discuss which of these activities of living may be influenced or altered for Mr Gulyas during his admission/hospital stay (choose four only). These could be culturally related as Mr Gulyas is of Hungarian origin, however he does speak English. Outline how the registered nurse could assist the patient to manage them. (approx. 500 words).

3. Nursing and Care.
Outline and justify the nursing care required for Mr Gulyas with his presenting symptoms, placing this nursing care in order of clinical priority (A= airway, B= breathing, C= circulation, D= disability, E= exposure, F= fluids, G= glucose, H= Health promotion). (approx. 600 words).

4. Pathophysiology
Briefly describe the pathophysiology behind both a STEMI in your own words (in the way you would explain it to a family member) and identify how it differs from a non-STEMI. (approx. 400 words).

5. Homeostatic Mechanisms
Outline the homeostatic mechanisms that result in the following symptoms Mr Gulyas is displaying on your nursing assessment:
– radiation of pain to shoulders and left arm
– pallor
– clamminess
(approx. 500)

* Important to note – Your should incorporate current research to support your discussion – using academic references that are less than ten (10) years old – texts/ journal articles and text books etc.

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