MYOCARDIAL INFARCTION REFERENCE: Principles of Medical-Surgical Nursing, LeMone and Burke, Volume 2, 3rd ed.

, pp 982-991

DEFINITION AND RISK PATHOPHYSIOL MANIFESTATIONS DIAGNOSTIC TESTS MANAGEMENT

FACTORS OGY
MF: interruption of blood Occlusion 1. Chest Pain 1. Creatinine kinase (CK) PHARMACOLOGIC
supply to part of the heart, ↓  Sudden onset  Normal: 12-80 (M), 10-70 (F) 1. Aspirin – platelet aggregation
most commonly due to Blood clot  Not associated with activity  Elevation indicates cardiac 2. Nitroglycerin (0.4mg) - pain
occlusion causing myocardial formation  Mostly occurs in the early tissue damage 3. Morphine sulfate (DOC) – oxygen demand
cell necrosis, resulting to ↓ morning 2. CK-MB 4. Striptokinase – fibrinolytic
ischemia and oxygen shortage Impaired blood  Crushing, severe, pressure,  Normal: 0% to 3% of total CK 5. Verapamil/Esmolol – atrial fibrillation or other dysrhythmias
flow heavy, squeezing, tightness  Most sensitive indicator of MI 6. Propranolol, Atenolol, Metoprolol – decrease cardiac work
RF: ↓ or burning  Elevation of greater than 5% 7. ACE inhibitors – reduce risk of subsequent HF and
Non-modifiable: Ischemia  Begins substernally and indicates MI reinfarction
1. Pre-existing coronary heart ↓ may radiate to shoulder, 3. Cardiac-specific troponin T 8. Abciximab – maintain coronary patency
diseases, including a previous Necrosis neck, jaw, or arms (cTnT) 9. Heparin – prevent systemic or pulmonary embolism
heart attack, prior angioplasty ↓  Lasts more than 15 to 20  Normal: <0.2 mcg/L 10. Dopamine – improves renal perfusion, myocardial
or bypass surgery, or  Scar formation, minutes  Elevation indicates acute MI, contractility, CO and BP
angina O2, Glycogen  Not relieved by rest or unstable angina MEDICAL
2. Age and ATP nitroglycerin 4. Cardiac-specific troponin I 1. Bed rest for the first 12 hours to reduce cardiac workload
M >45, W>55 depletion 2. Anxiety; Sense of impending (cTnI) 2. Allow sitting at bedside after 12 hours
3. Gender – M>F ↓ doom  Normal: <3.1 mcg/L 3. Gradually increase activity as tolerated
4. Heredity: Family history of Anaerobic 3. Tachycardia  Elevation indicates acute MI, 4. Provide a quiet, calm environment
early heart disease metabolism 4. Cool, clammy, mottled skin, unstable angina 5. Limit visitors
Modifiable: ↓ diminished peripheral pulses 5. CBC (elevated WBC and ESR) 6. Administer O2 by NC at 2-5LPM
 Smoking Acidosis, due to vasoconstriction 6. ABG (blood O2 levels, and A-B 7. Liquid diet for the first 4 to 12 hours, followed by Low-fat,
 Alcoholism. electrolyte 5. Tachypnea, Dyspnea, SOB imbalance) Low-cholesterol, Low-sodium diet
 Stress. imbalances, due to blood chemistry 7. ECG (inverted T, elevated ST, 8. Small, frequent feeding
 High blood pressure. hormone changes stimulating the formation of Q) 9. Limit caffeine
 High blood release , ↓MC, respiratory center 8. Echocardiography (cardiac wall SURGICAL
cholesterol ↓SV, ↓CO, ↓BP, 6. Diaphoresis motion and left ventricular 1. Percutaneous Coronary Revascularization (e.g. angioplasty
 Overweight and ↓tissue 7. elevation of temperature function) and stent replacement) to restore blood flow to myocardium
obesity perfusion 8. N&V 9. Radionuclide imaging 2. Intra-aortic balloon pump to augment CO, used after cardiac
 Physical inactivity 9. Hypotension or hypertension (myocardial perfusion) surgery
10. Palpitations, dysrhythmias 3. Ventricular Assistive Devices which takes partial or complete
control of cardiac function

ALAGAO, Jerome, SN IV/BAUTISTA, Jesther Rowen, SN IV

ALAGAO, Jerome, SN IV/BAUTISTA, Jesther Rowen, SN IV