ROY ADAPTATION MODEL-GUIDED NURSING MANAGEMENT OF STEMI COMPLICATED BY CARDIOGENIC SHOCK: A CASE REPORT

Abstract

Background: ST-Elevation Myocardial Infarction (STEMI) complicated by cardiogenic shock is a life- threatening cardiovascular emergency associated with high mortality despite advances in reperfusion therapy and intensive cardiovascular care. Comprehensive nursing management is essential not only for physiological stabilization but also for promoting adaptive responses during critical illness. Case Summary: A 62-year-old male patient presented with severe chest pain radiating to the left arm, progressive dyspnea, diaphoresis, hypotension, and signs of systemic hypoperfusion. The patient had a history of uncontrolled hypertension, type 2 diabetes mellitus, and long-term smoking. Physical examination revealed hemodynamic instability, respiratory distress, poor peripheral perfusion, and pulmonary congestion. Investigation and Diagnosis: Electrocardiography demonstrated ST-segment elevation in the anterior leads consistent with acute anterior STEMI. Laboratory findings showed elevated cardiac troponin and serum lactate levels, while chest radiography revealed cardiomegaly with pulmonary congestion. Echocardiography demonstrated reduced left ventricular systolic function. Based on clinical findings and diagnostic evaluation, the patient was diagnosed with STEMI complicated by cardiogenic shock and acute pulmonary edema. Management: Emergency cardiovascular management included oxygen therapy, continuous hemodynamic monitoring, dual antiplatelet therapy, anticoagulation, vasopressor and inotropic support, diuretic therapy, and primary percutaneous coronary intervention (PCI). Nursing management was implemented using Roy Adaptation Model focusing on physiological stabilization, psychological adaptation, therapeutic communication, and family-centered support. Outcome: The patient demonstrated gradual improvement in hemodynamic status, oxygenation, peripheral perfusion, pulmonary congestion, and adaptive responses following integrated cardiovascular management and Roy Adaptation Model-based nursing interventions. No major complications occurred during hospitalization. Conclusion: This case highlights the importance of rapid recognition, multidisciplinary cardiovascular management, and adaptation-focused nursing care in patients with STEMI complicated by cardiogenic shock. Roy Adaptation Model provided a comprehensive framework for addressing both physiological instability and psychosocial adaptation during critical cardiovascular emergencies.