2 Myocardial Infarction Nursing Care Management and Study Guide

9/13/2020 Myocardial Infarction: Nursing Care Management and Study Guide
Myocardial Infarction
By Marianne Belleza, R.N. - Last Updated on September 26, 2017
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A patient was rushed to the emergency room because he was found in the men’s public
toilet sprawled on the oor, unconscious. ECG results show an inverted T wave, an
abnormal Q wave, and ST segment elevation. Upon waking up, the patient narrated that he
fell unconscious because of the unexplainable pain in the chest that he felt. ER doctors
diagnosed him with myocardial infarction.
1. Description
2. Pathophysiology
3. Statistics and Epidemiology
4. Causes
5. Clinical Manifestations
6. Prevention
7. Assessment and Diagnostic Findings
8. Medical Management
8.1. Pharmacologic Therapy
8.2. Emergent Percutaneous Coronary Intervention
9. Nursing Management
9.1. Nursing Assessment
9.2. Diagnosis
9.3. Planning & Goals
9.4. Nursing Priorities
9.5. Nursing Interventions
9.6. Evaluation
9.7. Discharge and Home Care Guidelines
9.8. Documentation Guidelines
https://nurseslabs.com/myocardial-infarction/ 1/13
10. See Also
Description
Myocardial infarction (MI), is used synonymously with coronary occlusion and heart
attack, yet MI is the most preferred term as myocardial ischemia causes acute coronary
syndrome (ACS) that can result in myocardial death.
In an MI, an area of the myocardium is permanently destroyed because plaque

rupture and subsequent thrombus formation result in complete occlusion of the
artery.
The spectrum of ACS includes unstable angina, non-ST-segment elevation MI, and
ST-segment elevation MI.
Pathophysiology
In each case of MI, a profound imbalance exists between myocardial oxygen supply and
demand.
Unstable angina. There is reduced blood ow in a coronary artery, often due to

rupture of an atherosclerotic plaque, but the artery is not completely occluded.
Development of infarction. As the cells are deprived of oxygen, ischemia develops,

cellular injury occurs, and lack of oxygen leads to infarction or death of the cells.
Schematic Diagram of Myocardial Infarction via Scribd
Myocardial Infarction by Osmosis
Watch the video below for a simpli ed pathophysiology of Myocardial Infarction by

Osmosis. Let’s support them to make more great content by becoming a patron.
Statistics and Epidemiology

“Time is muscle”; this is the re ection of the urgency of appropriate treatments to improve
patient outcome.
Each year in the United States, nearly 1 million people have acute MIs.
One fourth of the people with the disease die of MI.
Half of the people who die with acute MI never reach the hospital.
Causes
The causes of MI primarily stems from the vascular system.
Vasospasm. This is the sudden constriction or narrowing of the coronary artery.
Decreased oxygen supply. The decrease in oxygen supply occurs from acute blood
loss, anemia, or low blood pressure.
Increased demand for oxygen. A rapid heart rate, thyrotoxicosis, or ingestion of

cocaine causes an increase in the demand for oxygen.
Clinical Manifestations
Some of the patients have prodromal symptoms or a previous diagnosis of CAD, but about
half report no previous symptoms.
Chest pain. This is the cardinal symptom of MI. Persistent and crushing substernal pain
that may radiate to the left arm, jaw, neck, or shoulder blades. Pain is usually described
as heavy, squeezing, or crushing and may persist for 12 hours or more.
Shortness of breath. Because of increased oxygen demand and a decrease in the

supply of oxygen, shortness of breath occurs.
Indigestion. Indigestion is present as a result of the stimulation of the sympathetic

nervous system.
Tachycardia and tachypnea. To compensate for the decreased oxygen supply, the
heart rate and respiratory rate speed up.
Catecholamine responses. The patient may experience such as coolness in extremities,

perspiration, anxiety, and restlessness.
Fever. Unusually occurs at the onset of MI, but a low-grade temperature elevation may
develop during the next few days.
Prevention
A healthy lifestyle could help prevent the development of MI.
Exercise. Exercising at least thrice a week could help lower cholesterol levels that
cause vasoconstriction of the blood vessels.
Balanced diet. Fruits, vegetables, meat and sh should be incorporated in the patient’s
daily diet to ensure that he or she gets the right amount of nutrients he or she needs.
Smoking cessation. Nicotine causes vasoconstriction which can increase the pressure
of the blood and result in MI.
Assessment and Diagnostic Findings

The diagnosis of MI is generally based on the presenting symptoms.
Patient history. The patient history includes the description of the presenting
symptoms, the history of previous cardiac and other illnesses, and the family history of
heart diseases.
ECG. ST elevation signifying ischemia; peaked upright or inverted T wave indicating

injury; development of Q waves signifying prolonged ischemia or necrosis.
Cardiac enzymes and isoenzymes. CPK-MB (isoenzyme in cardiac muscle): Elevates

within 4–8 hr, peaks in 12–20 hr, returns to normal in 48–72 hr.
LDH. Elevates within 8–24 hr, peaks within 72–144 hr, and may take as long as 14 days
to return to normal. An LDH1 greater than LDH2 ( ipped ratio) helps con rm/diagnose
MI if not detected in acute phase.
Troponins. Troponin I (cTnI) and troponin T (cTnT): Levels are elevated at 4–6 hr, peak
at 14–18 hr, and return to baseline over 6–7 days. These enzymes have increased
speci city for necrosis and are therefore useful in diagnosing postoperative MI when
MB-CPK may be elevated related to skeletal trauma.
Myoglobin. A heme protein of small molecular weight that is more rapidly released
from damaged muscle tissue with elevation within 2 hr after an acute MI, and peak
levels occurring in 3–15 hr.
Electrolytes. Imbalances of sodium and potassium can alter conduction and

compromise contractility.
WBC. Leukocytosis (10,000–20,000) usually appears on the second day after MI because

of the in ammatory process.
ESR. Rises on second or third day after MI, indicating in ammatory response.
Chemistry pro les. May be abnormal, depending on acute/chronic abnormal organ

function/perfusion.
ABGs/pulse oximetry. May indicate hypoxia or acute/chronic lung disease processes.
Lipids (total lipids, HDL, LDL, VLDL, total cholesterol, triglycerides,

phospholipids). Elevations may re ect arteriosclerosis as a cause for coronary
narrowing or spasm.
Chest x-ray. May be normal or show an enlarged cardiac shadow suggestive of HF or

ventricular aneurysm.
Two-dimensional echocardiogram. May be done to determine dimensions of

chambers, septal/ventricular wall motion, ejection fraction (blood ow), and valve
con guration/function.
Nuclear imaging studies: Persantine or Thallium. Evaluates myocardial blood ow

and status of myocardial cells, e.g., location/extent of acute/previous MI.
Cardiac blood imaging/MUGA. Evaluates speci c and general ventricular performance,

regional wall motion, and ejection fraction.
Technetium. Accumulates in ischemic cells, outlining necrotic area(s).
Coronary angiography. Visualizes narrowing/occlusion of coronary arteries and is

usually done in conjunction with measurements of chamber pressures and assessment
of left ventricular function (ejection fraction). Procedure is not usually done in acute
phase of MI unless angioplasty or emergency heart surgery is imminent.
Digital subtraction angiography (DSA). Technique used to visualize status of arterial

bypass grafts and to detect peripheral artery disease.
Magnetic resonance imaging (MRI). Allows visualization of blood ow, cardiac

chambers or intraventricular septum, valves, vascular lesions, plaque formations, areas
of necrosis/infarction, and blood clots.
Exercise stress test. Determines cardiovascular response to activity (often done in

conjunction with thallium imaging in the recovery phase).
Medical Management
The goals of medical management are to minimize myocardial damage, preserve
myocardial function, and prevent complications.
Mnemonics for Myocardial Infarction
Pharmacologic Therapy
Morphine administered in IV boluses is used for MI to reduce pain and anxiety.
ACE Inhibitors. ACE inhibitors prevent the conversion of angiotensin I to angiotensin II

to decrease blood pressure and for the kidneys to secrete sodium and uid, decreasing
the oxygen demand of the heart.
Thrombolytics. Thrombolytics dissolve the thrombus in the coronary artery,allowing

blood to ow through the coronary artery again, minimizing the size of the infarction
and preserving ventricular function.
Emergent Percutaneous Coronary Intervention
The procedure is used to open the occluded coronary artery and promote reperfusion
to the area that has been deprived of oxygen.
PCI may also be indicated in patients with unstable angina and NSTEMI for patients who
are at high risk due to persistent ischemia.
Nursing Management
The nursing management involved in MI is critical and systematic, and e ciency is needed
to implement the care for a patient with MI.
Nursing Assessment
One of the most important aspects of care of the patient with MI is the assessment.
Assess for chest pain not relieved by rest or medications.
Monitor vital signs, especially the blood pressure and pulse rate.
Assess for presence of shortness of breath, dyspnea, tachypnea, and crackles.
Assess for nausea and vomiting.
Assess for decreased urinary output.
Assess for the history of illnesses.
Perform a precise and complete physical assessment to detect complications and

changes in the patient’s status.
Assess IV sites frequently.
Diagnosis
Based on the clinical manifestations, history, and diagnostic assessment data, major
nursing diagnoses may include.
Ine ective cardiac tissue perfusion related to reduced coronary blood ow.
Risk for ine ective peripheral tissue perfusion related to decreased cardiac output
from left ventricular dysfunction.
De cient knowledge related to post-MI self-care.
Planning & Goals
Main Article: 7 Myocardial Infarction (Heart Attack) Nursing Care Plans
To establish a plan of care, the focus should be on the following:
Relief of pain or ischemic signs and symptoms.
Prevention of myocardial damage.
Absence of respiratory dysfunction.
Maintenance or attainment of adequate tissue perfusion.
Reduced anxiety.
Absence or early detection of complications.
Chest pain absent/controlled.
Heart rate/rhythm su cient to sustain adequate cardiac output/tissue perfusion.
Achievement of activity level su cient for basic self-care.
Anxiety reduced/managed.
Disease process, treatment plan, and prognosis understood.
Plan in place to meet needs after discharge.
Nursing Priorities
1. Relieve pain, anxiety.
2. Reduce myocardial workload.
3. Prevent/detect and assist in treatment of life-threatening dysrhythmias or

complications.
4. Promote cardiac health, self-care.
Nursing Interventions
Nursing interventions should be anchored on the goals in the nursing care plan.
Administer oxygen along with medication therapy to assist with relief of symptoms.
Encourage bed rest with the back rest elevated to help decrease chest discomfort and
dyspnea.
Encourage changing of positions frequently to help keep uid from pooling in the bases
of the lungs.
Check skin temperature and peripheral pulses frequently to monitor tissue perfusion.
Provide information in an honest and supportive manner.
Monitor the patient closely for changes in cardiac rate and rhythm, heart sounds, blood
pressure, chest pain, respiratory status, urinary output, changes in skin color, and
laboratory values.
Evaluation
After the implementation of the interventions within the time speci ed, the nurse should
check if:
There is an absence of pain or ischemic signs and symptoms.
Myocardial damage is prevented.
Absence of respiratory dysfunction.
Adequate tissue perfusion maintained.
Anxiety is reduced.
Discharge and Home Care Guidelines
The most e ective way to increase the probability that the patient will implement a self-
care regimen after discharge is to identify the patient’s priorities.
Education. This is one of the priorities that the nurse must teach the patient about
heart-healthy living.
Home care. The home care nurse assists the patient with scheduling and keeping up
with the follow-up appointments and with adhering to the prescribed cardiac
rehabilitation management.
Follow-up monitoring. The patient may need reminders about follow-up monitoring
including periodic laboratory testing and ECGs, as well as general health screening.
Adherence. The nurse should also monitor the patient’s adherence to dietary
restrictions and prescribed medications.
Documentation Guidelines
To ensure that every action documented is an action done, documentation must be

secured. The following should be documented:
Individual ndings.
Vital signs, cardiac rhythm, presence of dysrhythmias.
Plan of care and those involved in planning.
Teaching plan.
Response to interventions, teaching, and actions performed.
Attainment or progress towards desired outcomes.
Modi cations to plan of care.
Practice Quiz: Myocardial Infarction

Let’s reinforce what you’ve learned with this 5-item NCLEX practice quiz about Myocardial
Infarction.
 EXAM MODE
In Exam Mode: All questions are shown but the results, answers, and rationales (if
any) will only be given after you’ve nished the quiz.
Start
 PRACTICE MODE
Practice Mode: This is an interactive version of the Text Mode. All questions are

given in a single page and correct answers, rationales or explanations (if any) are
immediately shown after you have selected an answer. No time limit for this exam.
Start
 TEXT MODE
1. Which of the following is the most common symptom of myocardial

infarction (MI)?
A. Chest pain
B. Dyspnea
C. Edema
D. Palpitations
2. An intravenous analgesic frequently administered to relieve chest pain

associated with MI is:
A. Meperidine hydrochloride
B. Hydromorphone hydrochloride
C. Morphine sulfate
D. Codeine sulfate
3. The classic ECG changes that occur with an MI include all of the following
except:
A. An absent P wave
B. An abnormal Q wave
C. T-wave inversion
D. ST segment elevation
4. Which of the following statements about myocardial infarction pain is

incorrect?
A. It is relieved by rest and inactivity.

B. It is substernal in location.
C. It is sudden in onset and prolonged in duration.
D. It is viselike and radiates to the shoulders and arms.
5. Myocardial cell damage can be re ected by high levels of cardiac enzymes.

The cardiac-speci c isoenzyme is:
A. Alkaline phosphatase
B. Creatine kinase (CK-MB)
C. Myoglobin
D. Troponin
1. Answer: A. Chest pain
A: The most common symptom of an MI is chest pain, resulting from deprivation

of oxygen to the heart.
B: Dyspnea is the second most common symptom, related to an increase in the

metabolic needs of the body during an MI.
C: Edema is a later sign of heart failure, often seen after an MI.
D: Palpitations may result from reduced cardiac output, producing arrhythmias.
2. Answer: C. Morphine sulfate
C: Morphine administered in IV boluses is used for MI to reduce pain and anxiety.
A: Meperidine hydrochloride is not the analgesic of choice for MI.
B: Hydromorphone hydrochloride is not the analgesic of choice for MI.
D: Codeine sulfate is not the analgesic of choice for MI.
3. Answer: A. An absent P wave
A: An absent P wave is not part of the classic changes seen in an ECG result.
B: An abnormal Q wave is an indication of MI.
C: T-wave inversion is a classic ECG change in a patient with MI.
D: ST segment elevation is an indication of MI.
4. Answer: A. It is relieved by rest and inactivity.
A: MI pain continues despite rest and medications.
B: The pain occurs substernally or at the chest area.
C: MI pain occurs suddenly and is prolonged in duration.
D: The pain grips the patient like a vise and radiates towards the arms or the
shoulders.
5. Answer: B. Creatine kinase (CK-MB)
B: CK-MB is the isoenzyme for the heart muscle and the cardiac-speci c enzyme.
A: Alkaline phosphatase is not part of the creatine kinase isoenzymes.
C: Myoglobin is a heme protein that helps transport oxygen.
D: Troponin regulates the myocardial contractile process.
See Also
Posts related to Myocardial Infarction:
7 Myocardial Infarction (Heart Attack) Nursing Care Plans
Myocardial Infarction and Heart Failure NCLEX Practice Quiz (70 Items)
Heart Failure
Cardiovascular Care Nursing Mnemonics and Tips
Marianne Belleza, R.N.

Marianne is a sta nurse during the day and a Nurseslabs writer at night. She is a registered nurse since 2015
and is currently working in a regional tertiary hospital and is nishing her Master's in Nursing this June. As an
outpatient department nurse, she is a seasoned nurse in providing health teachings to her patients making her
also an excellent study guide writer for student nurses. Marianne is also a mom of a toddler going through the
terrible twos and her free time is spent on reading books!
About Nurseslabs 
Nurseslabs.com is an education and nursing lifestyle website geared towards helping student nurses and registered nurses
with knowledge for the progression and empowerment of their nursing careers. Since we started in 2010, Nurseslabs has
become one of the most trusted nursing sites helping thousands of aspiring nurses achieve their goals. Our ultimate goal is to
help address the nursing shortage by inspiring aspiring nurses that a career in nursing is an excellent choice, guiding students to
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10. See Also

In an MI, an area of the myocardium is permanently destroyed because plaque

Unstable angina. There is reduced blood ow in a coronary artery, often due to

Development of infarction. As the cells are deprived of oxygen, ischemia develops,

Schematic Diagram of Myocardial Infarction via Scribd

Myocardial Infarction by Osmosis

Watch the video below for a simpli ed pathophysiology of Myocardial Infarction by

Statistics and Epidemiology

One fourth of the people with the disease die of MI.

Vasospasm. This is the sudden constriction or narrowing of the coronary artery.

Increased demand for oxygen. A rapid heart rate, thyrotoxicosis, or ingestion of

Shortness of breath. Because of increased oxygen demand and a decrease in the

Indigestion. Indigestion is present as a result of the stimulation of the sympathetic

Catecholamine responses. The patient may experience such as coolness in extremities,

Assessment and Diagnostic Findings

ECG. ST elevation signifying ischemia; peaked upright or inverted T wave indicating

Cardiac enzymes and isoenzymes. CPK-MB (isoenzyme in cardiac muscle): Elevates

Electrolytes. Imbalances of sodium and potassium can alter conduction and

WBC. Leukocytosis (10,000–20,000) usually appears on the second day after MI because

ESR. Rises on second or third day after MI, indicating in ammatory response.

Chemistry pro les. May be abnormal, depending on acute/chronic abnormal organ

ABGs/pulse oximetry. May indicate hypoxia or acute/chronic lung disease processes.

Lipids (total lipids, HDL, LDL, VLDL, total cholesterol, triglycerides,

Chest x-ray. May be normal or show an enlarged cardiac shadow suggestive of HF or

Two-dimensional echocardiogram. May be done to determine dimensions of

Nuclear imaging studies: Persantine or Thallium. Evaluates myocardial blood ow

Cardiac blood imaging/MUGA. Evaluates speci c and general ventricular performance,

Technetium. Accumulates in ischemic cells, outlining necrotic area(s).

Coronary angiography. Visualizes narrowing/occlusion of coronary arteries and is

Digital subtraction angiography (DSA). Technique used to visualize status of arterial

Magnetic resonance imaging (MRI). Allows visualization of blood ow, cardiac

Exercise stress test. Determines cardiovascular response to activity (often done in

Mnemonics for Myocardial Infarction

Morphine administered in IV boluses is used for MI to reduce pain and anxiety.

ACE Inhibitors. ACE inhibitors prevent the conversion of angiotensin I to angiotensin II

Thrombolytics. Thrombolytics dissolve the thrombus in the coronary artery,allowing

Emergent Percutaneous Coronary Intervention

Assess for chest pain not relieved by rest or medications.

Assess for presence of shortness of breath, dyspnea, tachypnea, and crackles.

Assess for nausea and vomiting.

Assess for decreased urinary output.

Assess for the history of illnesses.

Perform a precise and complete physical assessment to detect complications and

Assess IV sites frequently.

De cient knowledge related to post-MI self-care.

Planning & Goals

Main Article: 7 Myocardial Infarction (Heart Attack) Nursing Care Plans

To establish a plan of care, the focus should be on the following:

Relief of pain or ischemic signs and symptoms.

Prevention of myocardial damage.

Absence of respiratory dysfunction.

Maintenance or attainment of adequate tissue perfusion.

Absence or early detection of complications.

Chest pain absent/controlled.

Heart rate/rhythm su cient to sustain adequate cardiac output/tissue perfusion.

Achievement of activity level su cient for basic self-care.

Disease process, treatment plan, and prognosis understood.

Plan in place to meet needs after discharge.

1. Relieve pain, anxiety.

2. Reduce myocardial workload.

3. Prevent/detect and assist in treatment of life-threatening dysrhythmias or

4. Promote cardiac health, self-care.

Provide information in an honest and supportive manner.