❤️‍🩹 Medical-Surgical Nursing Care Plan on Myocardial Infarction

Medical-Surgical Nursing | Cardiology Nursing | NANDA Format

Heart Attack | Practical File Ready

⚠️ Educational Purpose Only: This nursing care plan is prepared for academic practical file work. Not for actual patient care or clinical decision-making.

📋 Student Information

Student Name	[Your Name]
Course	BSc Nursing / GNM / ANM
Subject	Medical-Surgical Nursing
Topic	Nursing Care Plan on Myocardial Infarction
Format	NANDA Nursing Care Plan Format
Date of Submission	[Enter Date]
Clinical Instructor	[Instructor Name]

📄 Page 1 — Patient Identification Data

Name	Mr. Ramesh Chandra Gupta
Age	62 Years
Sex	Male
Address	Jaipur, Rajasthan
Occupation	Retired Government Employee
Marital Status	Married
Religion	Hindu
Annual Income	₹5,00,000/- approximately
Diagnosis	Acute Myocardial Infarction — STEMI
Type of Family	Joint Family
Family Size	7 Members
Ward Name	Intensive Cardiac Care Unit / Cardiac Ward
Bed Number	05
Doctor Incharge	Dr. A. K. Verma
Date of Admission	05/02/2026
Hospital Name	SMS Hospital, Jaipur

📄 Page 2 — Chief Complaints & Clinical History

CHIEF COMPLAINTS

The patient was admitted to the Intensive Cardiac Care Unit with the following complaints:

Severe crushing chest pain for 2 hours
Pain radiating to left arm, left shoulder and jaw
Profuse sweating
Shortness of breath at rest
Nausea and vomiting
Palpitations and dizziness
Feeling of fear and anxiety

HISTORY OF PRESENT ILLNESS

Mr. Ramesh Chandra Gupta, a 62-year-old male, was apparently well until the morning of admission when he suddenly developed severe crushing retrosternal chest pain while resting at home. The pain was pressure-like in nature and radiated to the left arm, left shoulder and jaw. The intensity of pain was 10/10 on the pain scale.

The pain was associated with profuse sweating, shortness of breath, nausea, vomiting, palpitations and dizziness. The patient also expressed fear and stated that he felt as if something serious was happening to him. The pain was not relieved by rest. Family members immediately brought him to the emergency department.

On arrival, the patient was anxious, restless, pale and sweating. His pulse rate was increased, blood pressure was elevated and oxygen saturation was reduced on room air. An immediate ECG was performed, which showed ST-segment elevation suggestive of acute myocardial infarction. Blood samples were sent for cardiac enzymes and other investigations. The patient was shifted to ICCU for continuous cardiac monitoring and emergency management.

PAST MEDICAL HISTORY

History of hypertension for 15 years.
History of type 2 diabetes mellitus for 8 years.
History of dyslipidemia for 5 years.
No previous history of myocardial infarction.
No history of bronchial asthma or tuberculosis.
No known drug allergy.

PAST SURGICAL HISTORY

No history of major surgery.
No history of cardiac surgery or angioplasty.
No history of blood transfusion.

PRESENT MEDICATION HISTORY

Medication	Dose	Frequency	Purpose
Amlodipine	5 mg	Once daily	Control of blood pressure
Metformin	500 mg	Twice daily	Control of blood sugar
Glimepiride	2 mg	Once daily before breakfast	Control of diabetes mellitus
Rosuvastatin	10 mg	At bedtime	Control of cholesterol

ALLERGIC HISTORY

No known drug allergy.
No known food allergy.
No history of allergic reaction to previous medications.

📄 Page 3 — Family History, Family Composition & Family Tree

FAMILY HISTORY

The patient belongs to a joint family.
There are 7 members in the family.
Father had a history of myocardial infarction and expired due to cardiac illness.
Mother had hypertension and diabetes mellitus.
Younger brother has a history of coronary artery disease.
Family history is positive for cardiovascular disease, hypertension and diabetes mellitus.
No history of communicable disease in the family.

FAMILY COMPOSITION

Name	Age/Sex	Education	Occupation	Marital Status	Relationship	Health Status
Mr. Ramesh Chandra Gupta	62/M	Graduate	Retired Govt Employee	Married	Self / Patient	Myocardial Infarction
Mrs. Sita Gupta	58/F	Secondary	Housewife	Married	Wife	Healthy
Mr. Vikas Gupta	35/M	MBA	Bank Employee	Married	Son	Healthy
Mrs. Priya Gupta	32/F	Graduate	Housewife	Married	Daughter-in-law	Healthy
Master Aarav Gupta	8/M	Class 3	Student	Unmarried	Grandson	Healthy
Miss Ananya Gupta	5/F	UKG	Student	Unmarried	Granddaughter	Healthy
Master Ayaan Gupta	2/M	-	-	Unmarried	Grandson	Healthy

FAMILY TREE

👴

Mr. Gupta Sr.

Father

History of MI

♡

👵

Mrs. Gupta Sr.

Mother

HTN + DM

👨‍🦳

Mr. Ramesh Chandra Gupta

Patient

Acute Myocardial Infarction

♡

👩‍🦳

Mrs. Sita Gupta

Wife

Healthy

👨

Mr. Vikas Gupta

Son

Healthy

♡

👩

Mrs. Priya Gupta

Daughter-in-law

Healthy

👦

Master Aarav Gupta

Grandson

Healthy

👧

Miss Ananya Gupta

Granddaughter

Healthy

👦

Master Ayaan Gupta

Grandson

Healthy

Male Female Patient Highlighted

📄 Page 4 — Dietary, Personal, Socio-Economic & Environmental History

DIETARY HISTORY

The patient takes a mixed diet, mostly vegetarian with occasional non-vegetarian food.
He has a habit of taking oily and fried foods such as samosa, kachori, pakora and puri.
He consumes high-salt food items such as pickles, papad and namkeen.
He takes tea 4–5 times daily with sugar.
Intake of fresh fruits, green leafy vegetables and dietary fibre is inadequate.
He consumes full-cream milk and ghee frequently.
Fluid intake is approximately 2 litres per day.
No history of food allergy is reported.

PERSONAL HISTORY

Sleep	5–6 hours per night; disturbed due to anxiety after chest pain
Appetite	Previously good; reduced during acute illness
Bowel Habit	Once daily; tendency of constipation due to low fibre intake
Bladder Habit	6–7 times/day; nocturia 1–2 times/night
Smoking	History of smoking for 30 years; approximately 8–10 cigarettes/day
Alcohol	Occasional alcohol intake
Exercise	Sedentary lifestyle; no regular walking or exercise
Allergy	No known drug or food allergy

SOCIO-ECONOMIC HISTORY

The patient belongs to a middle-class family.
The family lives in their own house.
The main source of income is pension and son's salary.
The family has access to nearby health facilities.
The family members are cooperative and supportive in patient care.
Health-seeking behaviour of the family is satisfactory.

ENVIRONMENTAL HISTORY

The patient lives in a pucca house with adequate ventilation and lighting.
Safe drinking water is available at home.
Sanitary latrine facility is present.
Waste disposal is done through municipal collection.
No exposure to industrial pollution or harmful chemicals.
Kitchen uses LPG for cooking.
Home environment is generally clean and hygienic.

RISK FACTORS PRESENT IN PATIENT

Age above 60 years
Male gender
Hypertension
Type 2 diabetes mellitus
Dyslipidemia
Smoking habit
Sedentary lifestyle
High-fat and high-salt diet
Positive family history of heart disease

📄 Page 5 — Physical Examination: General Examination

GENERAL CONDITION

The patient is conscious, oriented to time, place and person. On admission, he appeared anxious, restless and in acute distress due to severe chest pain and breathlessness. He was pale, sweating and preferred to sit in semi-Fowler’s position. After emergency treatment, the patient became comparatively comfortable but remained anxious about his condition.

GENERAL APPEARANCE

Built: Moderately obese
Posture: Semi-Fowler’s position preferred
Facial expression: Anxious and distressed
Level of consciousness: Conscious and oriented
Speech: Clear but interrupted due to breathlessness
Skin: Pale, cool and clammy on admission
Personal hygiene: Satisfactory

ANTHROPOMETRIC MEASUREMENTS

Height	168 cm
Weight	86 kg
BMI	30.5 kg/m²
BMI Interpretation	Obese Class I
Waist Circumference	108 cm

VITAL SIGNS ON ADMISSION

Parameter	Patient Value	Normal Value	Interpretation
Temperature	98.2°F	97–99°F	Normal
Pulse	112/min	60–100/min	Tachycardia
Respiration	28/min	12–20/min	Tachypnea
Blood Pressure	160/100 mmHg	120/80 mmHg	Hypertension
SpO₂	91% on room air	95–100%	Reduced oxygen saturation
Pain Score	10/10	0/10	Severe chest pain

HEAD TO TOE GENERAL ASSESSMENT

Area	Findings
Head	Scalp clean; no injury or swelling present.
Face	Facial expression anxious; pallor present.
Eyes	Conjunctiva pale; pupils equal and reacting to light.
Nose	Nostrils patent; mild nasal flaring present due to dyspnea.
Mouth	Oral mucosa moist; lips pale; no cyanosis.
Neck	No lymph node enlargement; no visible jugular venous distension.
Skin	Cool, pale and clammy on admission; diaphoresis present.
Extremities	Peripheral pulses weak; capillary refill delayed; no pedal edema.

📄 Page 6 — Physical Examination: Systemic Examination

SYSTEMIC EXAMINATION

System	Examination Findings	Nursing Interpretation
Cardiovascular System	S1 and S2 heart sounds audible. Heart rate 112/min, regular but rapid. S3 gallop present. No murmur or pericardial rub heard. Peripheral pulses weak and thready. Capillary refill time approximately 4 seconds. No pedal edema present.	Findings suggest decreased myocardial contractility and reduced cardiac output secondary to myocardial infarction.
Respiratory System	Respiratory rate 28/min. Breathing is shallow and rapid. SpO₂ 91% on room air. Bilateral fine inspiratory crackles heard at lung bases. No wheezing or rhonchi. Mild use of accessory muscles present.	Tachypnea and basal crackles indicate mild pulmonary congestion due to left ventricular dysfunction.
Central Nervous System	Patient conscious and oriented to time, place and person. GCS 15/15. Pupils equal and reacting to light. No focal neurological deficit. Patient appears anxious and restless.	Neurological status is intact, but anxiety is present due to acute cardiac event and fear of death.
Gastrointestinal System	Abdomen soft and non-tender. No guarding or rigidity. Bowel sounds present. Patient had nausea and two episodes of vomiting before admission.	Nausea and vomiting may be associated with acute myocardial infarction and vagal stimulation.
Genitourinary System	Urine output adequate after admission. No burning micturition. No hematuria. Patient reports nocturia 2–3 times/night due to diabetes history.	Urine output should be monitored to assess renal perfusion and cardiac output.
Musculoskeletal System	No deformity or swelling in joints. Muscle tone normal. Patient is on bed rest due to acute MI. Fatigue and weakness present.	Activity is restricted to reduce myocardial oxygen demand and prevent complications.
Integumentary System	Skin pale, cool and clammy on admission. Profuse sweating present. No cyanosis, clubbing, rashes or pressure sores.	Pallor and diaphoresis indicate sympathetic response to pain and reduced cardiac perfusion.

CARDIOVASCULAR FOCUSED ASSESSMENT

Chest pain: Severe crushing retrosternal pain radiating to left arm and jaw.
Pain score: 10/10 on admission.
Pulse: 112/min, regular and rapid.
Blood pressure: 160/100 mmHg.
Peripheral pulses: Weak and thready.
Capillary refill time: 4 seconds.
Heart sounds: S1 and S2 audible; S3 gallop present.
ECG finding: ST elevation in V1–V4 suggestive of anteroseptal STEMI.

RESPIRATORY FOCUSED ASSESSMENT

Respiratory rate: 28/min.
Breathing pattern: Rapid and shallow.
SpO₂: 91% on room air.
Breath sounds: Fine inspiratory crackles at bilateral lung bases.
Position: Semi-Fowler’s position provides comfort.
Oxygen therapy: Started as prescribed to maintain adequate oxygen saturation.

PAIN ASSESSMENT USING PQRST METHOD

Component	Assessment Finding
P — Provocation/Palliation	Pain started at rest and was not relieved by rest or sublingual nitrate.
Q — Quality	Crushing, heavy pressure-like pain.
R — Region/Radiation	Retrosternal chest pain radiating to left arm, shoulder and jaw.
S — Severity	10/10 on numeric pain rating scale.
T — Timing	Sudden onset, continued for approximately 2 hours before hospital arrival.

Nursing Note: Systemic examination findings indicate acute myocardial infarction with reduced cardiac output, mild pulmonary congestion, severe acute pain and anxiety. Continuous ECG monitoring, oxygen therapy, pain relief, vital signs monitoring and early detection of complications are essential nursing priorities.

📄 Page 7 — Vital Signs Monitoring Record

Date/Time	Temp	Pulse	Resp.	BP	SpO₂	Pain
05/02/2026 — Admission	98.2°F	112/min	28/min	160/100	91%	10/10
05/02/2026 — Post Treatment	98.4°F	96/min	22/min	140/88	95%	4/10
06/02/2026 — Day 2	98.6°F	88/min	20/min	134/84	96%	2/10
07/02/2026 — Day 3	98.4°F	82/min	18/min	128/80	97%	1/10
08/02/2026 — Day 4	98.6°F	78/min	16/min	124/76	98%	0/10

Nursing Interpretation: Vital signs show gradual improvement after treatment. Pain decreased from 10/10 to 0/10, pulse rate reduced, blood pressure stabilized and oxygen saturation improved.

📄 Page 8 — Diagnostic Investigations

S. No.	Investigation	Normal Value	Patient Value	Interpretation
1	Hemoglobin	13–17 g/dL	13.2 g/dL	Within normal range
2	Total WBC Count	4,000–11,000/mm³	13,800/mm³	Raised due to stress response
3	Platelet Count	1.5–4 lakh/mm³	2.1 lakh/mm³	Normal
4	Fasting Blood Sugar	70–110 mg/dL	168 mg/dL	Elevated
5	HbA1c	<6.5%	8.2%	Poor glycemic control
6	Serum Creatinine	0.7–1.3 mg/dL	1.1 mg/dL	Normal renal function
7	Total Cholesterol	<200 mg/dL	246 mg/dL	Elevated
8	LDL Cholesterol	<100 mg/dL	156 mg/dL	High cardiac risk
9	HDL Cholesterol	>40 mg/dL	31 mg/dL	Low protective cholesterol
10	Triglycerides	<150 mg/dL	228 mg/dL	Elevated
11	Cardiac Troponin I	<34 ng/L	12,400 ng/L	Markedly raised — confirms MI
12	CK-MB	<25 U/L	186 U/L	Myocardial injury
13	ECG	Normal sinus rhythm	ST elevation in V1–V4	Anteroseptal STEMI
14	2D Echocardiography	LVEF ≥55%	LVEF 40%	Moderate LV dysfunction

Diagnostic Summary: ECG changes, markedly raised Troponin I and CK-MB confirm acute anteroseptal myocardial infarction. Lipid profile and HbA1c indicate uncontrolled risk factors requiring strict medical and lifestyle management.

📄 Page 9 — Medical Management / Drug Chart

S. No.	Medication	Dose	Route	Frequency	Action / Purpose	Nursing Responsibility
1	Inj. Streptokinase	1.5 million IU	IV infusion	Stat over 1 hour	Thrombolytic drug; dissolves clot and restores coronary blood flow.	Check contraindications, monitor bleeding, vital signs and allergic reaction.
2	Tab. Aspirin	325 mg loading, then 150 mg OD	Oral	Stat then OD	Antiplatelet; prevents further thrombus formation.	Give after food, monitor bleeding, gastric irritation and black stool.
3	Tab. Clopidogrel	300 mg loading, then 75 mg OD	Oral	Stat then OD	Antiplatelet; prevents platelet aggregation and reinfarction.	Monitor bleeding, bruising and educate patient not to stop medicine suddenly.
4	Tab. Atorvastatin	80 mg	Oral	HS	High-intensity statin; lowers LDL cholesterol and stabilizes plaque.	Monitor liver function, muscle pain and advise low-fat diet.
5	Tab. Metoprolol	50 mg	Oral	BD	Beta blocker; reduces heart rate, BP and myocardial oxygen demand.	Check pulse and BP before giving. Hold and inform doctor if pulse is very low.
6	Tab. Ramipril	5 mg	Oral	OD	ACE inhibitor; reduces afterload and prevents ventricular remodeling.	Monitor BP, serum potassium, renal function and dry cough.
7	Inj. Morphine Sulphate	4 mg	IV slow	Stat as prescribed	Opioid analgesic; relieves severe chest pain and anxiety.	Monitor respiratory rate, BP, sedation and keep antidote available as per protocol.
8	Oxygen Therapy	4 L/min	Nasal cannula	Continuous initially	Improves oxygen supply to myocardium and corrects hypoxia.	Monitor SpO₂, respiratory rate, comfort and skin around nasal cannula.
9	Tab. Isosorbide Mononitrate	30 mg	Oral	OD	Nitrate; dilates coronary vessels and reduces angina.	Monitor BP, headache and dizziness. Advise patient to change position slowly.
10	Tab. Metformin	500 mg	Oral	BD	Antidiabetic drug; controls blood glucose level.	Give with meals, monitor blood sugar and renal function.
11	Tab. Glimepiride	2 mg	Oral	OD before breakfast	Sulfonylurea; increases insulin secretion and controls diabetes.	Monitor for hypoglycemia, give before meals and educate patient about symptoms of low sugar.

Nursing Note: During MI management, the nurse must closely monitor chest pain, ECG rhythm, blood pressure, oxygen saturation, bleeding signs, drug reactions and patient response to treatment.

📄 Page 10 — NANDA Nursing Diagnoses

Acute Pain related to myocardial ischemia and tissue injury as evidenced by severe crushing chest pain 10/10, facial grimacing, diaphoresis, tachycardia and restlessness.
Decreased Cardiac Output related to impaired myocardial contractility secondary to myocardial infarction as evidenced by tachycardia, weak peripheral pulses, S3 gallop, low oxygen saturation and LVEF 40%.
Impaired Gas Exchange related to pulmonary congestion secondary to left ventricular dysfunction as evidenced by dyspnea, tachypnea, SpO₂ 91% on room air and bilateral basal crackles.
Anxiety related to fear of death, severe chest pain and unfamiliar ICCU environment as evidenced by restlessness, repeated questioning, fearful facial expression and verbalization of fear.
Activity Intolerance related to imbalance between oxygen supply and demand secondary to acute myocardial infarction as evidenced by fatigue, dyspnea on exertion and need for bed rest.
Risk for Bleeding related to thrombolytic and antiplatelet therapy.
Deficient Knowledge related to lack of information regarding disease condition, medication adherence, diet, lifestyle modification and follow-up care.
Ineffective Health Maintenance related to smoking, sedentary lifestyle, uncontrolled diabetes, hypertension and dyslipidemia as evidenced by development of myocardial infarction.

Priority Nursing Diagnoses Selected for Care Plan

Priority	Nursing Diagnosis	Reason for Priority
1	Acute Pain	Severe chest pain increases myocardial oxygen demand and requires immediate relief.
2	Decreased Cardiac Output	MI affects pumping ability of heart and may lead to shock or heart failure.
3	Impaired Gas Exchange	Low SpO₂ and pulmonary congestion can reduce oxygen supply to myocardium.
4	Anxiety	Anxiety increases sympathetic activity, heart rate and cardiac workload.
5	Deficient Knowledge	Patient education is essential to prevent reinfarction and promote recovery.

Nursing Note: Priority nursing diagnoses are selected according to ABC approach, severity of symptoms, risk of complications and immediate patient needs.

📄 Page 11 — Nursing Care Plan 1: Acute Pain

Assessment	Nursing Diagnosis	Goal / Expected Outcome	Planning	Implementation	Evaluation
Subjective Data: Patient says, “Mere chest me bahut tez dabav jaisa dard ho raha hai.” Patient reports crushing retrosternal chest pain radiating to left arm, shoulder and jaw. Objective Data: Pain score 10/10, facial grimacing, restlessness, diaphoresis, tachycardia 112/min, BP 160/100 mmHg, ECG shows ST elevation in V1–V4, Troponin I markedly raised.	Acute Pain related to myocardial ischemia and tissue injury as evidenced by severe crushing chest pain 10/10, facial grimacing, diaphoresis, tachycardia and restlessness.	Short-Term Goal: Patient will report reduction in chest pain from 10/10 to 3/10 within 30–60 minutes of nursing and medical interventions. Long-Term Goal: Patient will remain pain-free during hospitalization and will verbalize measures to report chest pain immediately.	Assess pain using PQRST method and numeric pain scale. Monitor vital signs and ECG continuously. Provide complete bed rest to reduce myocardial workload. Administer prescribed oxygen, analgesics, nitrates and thrombolytic therapy. Provide calm and reassuring environment.	Assessed chest pain every 15 minutes during acute phase. Maintained patient in semi-Fowler’s position for comfort. Administered oxygen therapy as prescribed to improve myocardial oxygenation. Administered prescribed Morphine IV slowly for pain relief. Administered antiplatelet and thrombolytic therapy as ordered. Monitored ECG for ST changes and arrhythmias. Reduced environmental stimuli and reassured patient frequently. Educated patient to report any recurrence of chest pain immediately.	Patient’s pain reduced from 10/10 to 4/10 after initial treatment and became 0/10 by Day 2. Patient appeared relaxed, diaphoresis decreased, pulse rate improved and patient verbalized relief from chest heaviness.

Outcome: Goal achieved. Patient reported complete relief from chest pain and remained stable under continuous monitoring.

📄 Page 12 — Nursing Care Plan 2: Decreased Cardiac Output

Assessment	Nursing Diagnosis	Goal / Expected Outcome	Planning	Implementation	Evaluation
Subjective Data: Patient complains of palpitations, breathlessness and weakness. Patient says, “Mujhe letne par saans lene me takleef hoti hai.” Objective Data: Pulse 112/min, BP 160/100 mmHg, SpO₂ 91% on room air, S3 gallop present, bilateral basal crackles, weak peripheral pulses, capillary refill time 4 seconds, LVEF 40% on echocardiography.	Decreased Cardiac Output related to impaired myocardial contractility secondary to myocardial infarction as evidenced by tachycardia, weak peripheral pulses, S3 gallop, basal crackles, low oxygen saturation and LVEF 40%.	Short-Term Goal: Patient will maintain stable vital signs, SpO₂ above 94%, adequate urine output and reduced signs of pulmonary congestion within 24–48 hours. Long-Term Goal: Patient will show improved cardiac function, absence of heart failure signs and ability to tolerate gradual activity before discharge.	Monitor pulse, BP, respiration and SpO₂ regularly. Maintain continuous ECG monitoring. Assess peripheral perfusion and capillary refill time. Monitor intake-output chart and urine output. Administer prescribed cardiac medications. Provide rest and gradual mobilization as tolerated.	Monitored vital signs every 15 minutes during acute phase and then as per protocol. Observed ECG rhythm continuously for arrhythmias and ST changes. Maintained semi-Fowler’s position to reduce venous return and improve breathing. Administered oxygen therapy as prescribed and monitored SpO₂. Administered Metoprolol, Ramipril and other prescribed cardiac medications. Maintained strict intake-output record and monitored urine output. Assessed for signs of heart failure such as increasing crackles, edema and worsening dyspnea. Encouraged complete bed rest initially and gradual activity after stabilization.	Patient’s vital signs improved gradually. Pulse reduced from 112/min to 78/min, BP improved to 124/76 mmHg and SpO₂ increased to 98% on room air by Day 4. Crackles reduced, peripheral perfusion improved and patient tolerated gradual mobilization.

Outcome: Goal achieved. Patient maintained stable hemodynamic status and showed improvement in cardiac output indicators.

📄 Page 13 — Nursing Care Plan 3: Impaired Gas Exchange

Assessment	Nursing Diagnosis	Goal / Expected Outcome	Planning	Implementation	Evaluation
Subjective Data: Patient complains of shortness of breath and inability to lie flat. Patient says, “Mujhe saans lene me dikkat ho rahi hai.” Objective Data: Respiratory rate 28/min, SpO₂ 91% on room air, shallow rapid breathing, bilateral basal crackles, mild use of accessory muscles, anxiety and restlessness present.	Impaired Gas Exchange related to pulmonary congestion secondary to left ventricular dysfunction as evidenced by dyspnea, tachypnea, SpO₂ 91% on room air, bilateral basal crackles and restlessness.	Short-Term Goal: Patient will maintain SpO₂ above 94%, reduced dyspnea and improved respiratory rate within 24 hours. Long-Term Goal: Patient will maintain effective breathing pattern and oxygen saturation within normal range on room air before discharge.	Assess respiratory rate, depth and pattern regularly. Monitor SpO₂ continuously. Auscultate lung fields for crackles or worsening congestion. Position patient to promote lung expansion. Administer oxygen therapy as prescribed. Teach breathing exercises after stabilization.	Assessed respiratory status frequently during acute phase. Maintained patient in semi-Fowler’s position to improve ventilation. Administered oxygen therapy via nasal cannula as prescribed. Monitored SpO₂ continuously and reported any fall in saturation. Auscultated lungs for basal crackles and signs of pulmonary edema. Encouraged slow deep breathing when chest pain reduced. Reduced anxiety through reassurance to decrease oxygen demand. Monitored response to cardiac medications and fluid status.	Patient’s SpO₂ improved from 91% to 95% after oxygen therapy and reached 98% on room air by Day 4. Respiratory rate reduced from 28/min to 16/min. Dyspnea decreased and basal crackles resolved.

Outcome: Goal achieved. Patient maintained adequate oxygen saturation and showed improved gas exchange.

📄 Page 14 — Nursing Care Plan 4: Anxiety

Assessment	Nursing Diagnosis	Goal / Expected Outcome	Planning	Implementation	Evaluation
Subjective Data: Patient says, “Kya mujhe kuch ho jayega?” “Mujhe bahut darr lag raha hai.” Patient repeatedly asks about his condition and recovery. Objective Data: Restlessness, fearful facial expression, repeated questioning, tachycardia, inability to relax, disturbed sleep and dependence on family reassurance.	Anxiety related to fear of death, severe chest pain, sudden hospitalization and unfamiliar ICCU environment as evidenced by restlessness, repeated questioning, fearful expression and verbalization of fear.	Short-Term Goal: Patient will verbalize reduced anxiety and show improved comfort within 24 hours. Long-Term Goal: Patient will demonstrate effective coping, cooperate with treatment and verbalize understanding of disease and discharge instructions before discharge.	Assess anxiety level and emotional response. Provide calm and supportive environment. Explain procedures and equipment in simple language. Encourage patient to express fears. Allow family support as per hospital policy. Teach relaxation and deep breathing techniques.	Established therapeutic communication with patient. Listened patiently to patient’s fears and concerns. Explained diagnosis and treatment in simple Hindi/English. Reassured patient that he is under continuous monitoring and treatment. Allowed wife/family member to stay near patient as permitted. Reduced unnecessary noise and maintained peaceful environment. Taught slow deep breathing and relaxation exercises. Provided repeated information about improvement in vital signs and pain relief.	Patient verbalized reduced fear and stated that he understood his condition better. Restlessness decreased, sleep improved and patient cooperated with treatment and education. Anxiety level reduced significantly before discharge.

Outcome: Goal achieved. Patient became calm, cooperative and confident about treatment and recovery.

📄 Page 15 — Nursing Care Plan 5: Activity Intolerance

Assessment	Nursing Diagnosis	Goal / Expected Outcome	Planning	Implementation	Evaluation
Subjective Data: Patient complains of weakness and fatigue. Patient says, “Thoda sa hilne par bhi thakan aur saans chadh rahi hai.” Objective Data: Recent acute myocardial infarction, prescribed bed rest, dyspnea on minimal exertion, tachycardia during acute phase, low activity tolerance and need for assistance in daily activities.	Activity Intolerance related to imbalance between myocardial oxygen supply and demand secondary to acute myocardial infarction as evidenced by fatigue, dyspnea on exertion, weakness and need for bed rest.	Short-Term Goal: Patient will perform essential activities with assistance without chest pain, severe dyspnea or abnormal vital signs. Long-Term Goal: Patient will gradually increase activity tolerance and participate in cardiac rehabilitation before discharge.	Assess patient’s tolerance to activity. Monitor vital signs before, during and after activity. Maintain bed rest during acute phase. Assist with activities of daily living. Plan gradual mobilization after stabilization. Teach energy conservation techniques.	Maintained complete bed rest during acute phase to reduce cardiac workload. Assisted patient with hygiene, feeding and elimination needs. Monitored pulse, BP, respiration, SpO₂ and chest pain before and after activity. Encouraged passive and active range-of-motion exercises as tolerated. Started gradual mobilization after medical stabilization. Helped patient sit at bedside and later walk short distance as tolerated. Advised patient to stop activity immediately if chest pain, dizziness or breathlessness occurs. Educated patient about cardiac rehabilitation and progressive exercise plan.	Patient tolerated gradual mobilization without chest pain or severe dyspnea. Vital signs remained stable during activity. By discharge, patient was able to walk short distance with minimal assistance and understood activity precautions.

Outcome: Goal achieved. Patient showed improved activity tolerance and participated in gradual mobilization safely.

📄 Page 16 — Nursing Care Plan 6: Risk for Bleeding

Assessment	Nursing Diagnosis	Goal / Expected Outcome	Planning	Implementation	Evaluation
Subjective Data: Patient is receiving thrombolytic and antiplatelet therapy. Patient asks, “Kya blood thinner se bleeding ho sakti hai?” Objective Data: Patient received Streptokinase thrombolytic therapy and is prescribed Aspirin and Clopidogrel. IV cannula present. Risk of bleeding from puncture sites, gums, gastrointestinal tract and intracranial bleeding.	Risk for Bleeding related to thrombolytic therapy and antiplatelet medications.	Short-Term Goal: Patient will remain free from active bleeding during thrombolytic therapy and acute hospitalization. Long-Term Goal: Patient and family will verbalize bleeding precautions and warning signs before discharge.	Monitor for signs of bleeding regularly. Check IV sites, gums, urine, stool and skin for bleeding. Avoid unnecessary invasive procedures. Monitor vital signs for hypotension and tachycardia. Educate patient about bleeding precautions.	Observed IV cannula and puncture sites for oozing or hematoma. Checked gums, nose, urine and stool for signs of bleeding. Monitored BP, pulse and level of consciousness regularly. Avoided unnecessary IM injections and venipunctures. Applied firm pressure after any blood sampling. Used soft toothbrush advice and avoided sharp objects. Educated patient to report black stool, blood in urine, vomiting blood, severe headache or sudden weakness immediately. Instructed patient not to stop Aspirin or Clopidogrel without doctor’s advice.	No bleeding episode was observed during hospitalization. IV site remained clean without hematoma. Patient and family verbalized bleeding warning signs and medication precautions before discharge.

Outcome: Goal achieved. Patient remained free from bleeding complications and understood safety precautions.

📄 Page 17 — Nursing Care Plan 7: Deficient Knowledge

Assessment	Nursing Diagnosis	Goal / Expected Outcome	Planning	Implementation	Evaluation
Subjective Data: Patient asks, “Mujhe ye medicines kitne din leni hongi?” “Kya main normal khana kha sakta hoon?” “Dobara heart attack se kaise bach sakta hoon?” Objective Data: Patient has newly diagnosed acute myocardial infarction, multiple risk factors such as hypertension, diabetes, dyslipidemia, obesity, smoking history and sedentary lifestyle. Patient and family require discharge teaching.	Deficient Knowledge related to lack of information regarding myocardial infarction, medication adherence, diet, activity, lifestyle modification, warning signs and follow-up care.	Short-Term Goal: Patient and family will verbalize basic understanding of myocardial infarction and treatment plan before discharge. Long-Term Goal: Patient will follow prescribed medication, diet, exercise, lifestyle modification and follow-up schedule to prevent recurrence.	Assess patient’s current knowledge and learning needs. Teach disease process in simple language. Explain medication schedule and importance of adherence. Provide diet and lifestyle modification advice. Teach warning signs requiring emergency care. Involve family members in education.	Explained myocardial infarction as blockage of blood supply to heart muscle. Educated patient to take Aspirin, Clopidogrel, statin, beta-blocker and ACE inhibitor exactly as prescribed. Instructed patient not to stop antiplatelet medicines without cardiologist advice. Explained low-salt, low-fat, diabetic-friendly cardiac diet. Advised complete smoking cessation and avoidance of alcohol. Encouraged gradual walking and cardiac rehabilitation as advised. Taught warning signs: chest pain, breathlessness, sweating, fainting, black stool, blood in urine and severe headache. Explained importance of regular follow-up, BP monitoring and blood sugar control. Provided instructions to family members for support at home.	Patient and family verbalized understanding of disease condition, medicines, diet, activity restrictions, warning signs and follow-up schedule. Patient agreed to stop smoking and follow cardiac rehabilitation plan.

Outcome: Goal achieved. Patient and family demonstrated adequate knowledge regarding post-MI care and prevention of recurrence.

📄 Page 18 — Discharge Summary

Patient Name: Mr. Ramesh Chandra Gupta
Age/Sex: 62 Years / Male
Hospital Name: Sawai Man Singh (SMS) Medical College & Hospital, Jaipur
Ward: Intensive Cardiac Care Unit (ICCU)
Date of Admission: 05/02/2026
Date of Discharge: 08/02/2026
Final Diagnosis: Acute Anteroseptal Wall Myocardial Infarction (STEMI)

Summary of Hospital Stay

Mr. Ramesh Chandra Gupta, a 62-year-old male, was admitted to the ICCU with complaints of severe crushing retrosternal chest pain radiating to the left arm, shoulder and jaw, associated with sweating, breathlessness, nausea and anxiety. On admission, ECG showed ST-segment elevation in leads V1–V4, suggestive of acute anteroseptal wall STEMI. Cardiac biomarkers were markedly elevated, confirming myocardial infarction.

The patient was managed with emergency cardiac care including oxygen therapy, antiplatelet therapy, analgesics, nitrates, thrombolytic therapy and continuous cardiac monitoring. Streptokinase thrombolysis was administered as prescribed. After treatment, chest pain reduced gradually and ECG showed improvement. The patient remained under close observation for arrhythmias, bleeding, heart failure and recurrent chest pain.

During hospitalization, the patient’s vital signs gradually stabilized. Pain reduced from 10/10 to 0/10, pulse rate improved, oxygen saturation increased to normal range and dyspnea decreased. No major bleeding complication, arrhythmia or cardiogenic shock was observed. Patient was gradually mobilized and educated regarding medication adherence, diet, lifestyle modification, smoking cessation and follow-up care.

Condition at Discharge

Patient is conscious, oriented and hemodynamically stable.
No chest pain at the time of discharge.
Pulse: 78/min, BP: 124/76 mmHg, Respiratory rate: 16/min.
SpO₂: 98% on room air.
No active bleeding or respiratory distress present.
Patient is able to walk short distance with minimal assistance.
Patient and family understand discharge instructions.

Discharge Medications

Medication	Dose	Frequency	Purpose
Tab. Aspirin	150 mg	Once daily	Prevents clot formation
Tab. Clopidogrel	75 mg	Once daily	Antiplatelet therapy
Tab. Atorvastatin	80 mg	At bedtime	Lowers cholesterol
Tab. Metoprolol	50 mg	Twice daily	Controls heart rate and BP
Tab. Ramipril	5 mg	Once daily	Protects heart and controls BP
Tab. Metformin	500 mg	Twice daily	Controls blood sugar
Tab. Glimepiride	2 mg	Once daily before breakfast	Controls blood sugar

Discharge Advice

Take all medicines regularly at the same time every day.
Do not stop Aspirin or Clopidogrel without cardiologist advice.
Follow low-salt, low-fat and diabetic-friendly cardiac diet.
Avoid fried food, ghee, butter, excess salt, sweets and processed food.
Stop smoking completely and avoid alcohol.
Take adequate rest and avoid heavy work or weight lifting.
Start slow walking as advised and gradually increase activity.
Monitor BP and blood sugar regularly at home.
Keep follow-up appointment with cardiologist after 2 weeks.
Call emergency services immediately if chest pain, severe breathlessness, fainting, excessive sweating or sudden weakness occurs.

Important Warning: If chest pain lasts more than 5 minutes, do not wait at home. Call ambulance/emergency service immediately.

📄 Page 19 — Health Education

1. Medication Compliance

The patient and family were educated that regular medication is very important after myocardial infarction. Aspirin and Clopidogrel help to prevent clot formation and reduce the risk of another heart attack. The patient was instructed not to stop these medicines without the advice of the cardiologist. Atorvastatin should be taken regularly to control cholesterol and stabilize plaques in blood vessels. Metoprolol and Ramipril help to reduce workload on the heart and control blood pressure. Antidiabetic medicines should be taken regularly to maintain blood sugar level.

2. Diet Advice

Take a low-salt, low-fat and diabetic-friendly diet.
Include green leafy vegetables, fruits, whole grains, pulses and salads.
Use less oil while cooking and avoid repeated use of oil.
Avoid fried foods such as samosa, kachori, pakora, puri and chips.
Avoid ghee, butter, cream, full-fat milk and high-fat non-vegetarian foods.
Limit sweets, sugar, cold drinks and packaged juices due to diabetes.
Avoid excess salt, pickles, papad, namkeen and processed foods.
Drink adequate water unless restricted by doctor.

3. Lifestyle Modification

Stop smoking completely. Smoking increases risk of reinfarction and sudden cardiac death.
Avoid alcohol because it may affect heart function, blood pressure and medicines.
Maintain healthy body weight and reduce abdominal obesity.
Practice stress reduction methods such as deep breathing, meditation and light yoga after doctor’s advice.
Take 7–8 hours of sleep daily.
Avoid mental stress, anger and sudden heavy exertion.

4. Activity and Exercise

Take complete rest during the early recovery period as advised.
Start slow walking after doctor’s permission.
Increase walking duration gradually according to tolerance.
Avoid heavy weight lifting, running, climbing many stairs and strenuous work during early recovery.
Stop activity immediately if chest pain, breathlessness, dizziness or palpitations occur.
Attend cardiac rehabilitation program if available.

5. Warning Signs Requiring Immediate Medical Help

Chest pain or heaviness lasting more than 5 minutes.
Pain radiating to left arm, shoulder, jaw, neck or back.
Sudden severe breathlessness.
Cold sweating, nausea, vomiting or fainting.
Fast or irregular heartbeat with dizziness.
Black stool, blood in urine, vomiting blood or excessive bleeding.
Sudden severe headache, weakness of one side of body or difficulty speaking.

6. Follow-Up Care

First follow-up with cardiologist after 2 weeks.
Regular BP and blood sugar monitoring at home.
Repeat lipid profile and HbA1c as advised.
Follow-up ECG and echocardiography as advised by doctor.
Carry medication list and discharge summary during every hospital visit.
Family members should also undergo BP, blood sugar and lipid screening due to family history of heart disease.

Patient Teaching Outcome: Patient and family verbalized understanding of medication adherence, diet, lifestyle modification, warning signs and follow-up care.

📚 Bibliography

Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, Latest Edition, Wolters Kluwer.
NANDA International Nursing Diagnoses: Definitions and Classification 2024–2026.
Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Latest Edition.
Davidson’s Principles and Practice of Medicine, Latest Edition.
World Health Organization (WHO) — Cardiovascular Diseases Fact Sheet.
Indian Nursing Council recommended Medical-Surgical Nursing syllabus and clinical practical guidelines.

⚕️ Medical Disclaimer: This nursing care plan is prepared for educational and academic purposes only for ANM, GNM and BSc Nursing students. It is not intended for actual patient care or clinical decision-making. Always follow hospital protocol, physician orders and standard nursing textbooks.