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2 Myocardial Infarction Nursing Care Management and Study Guide PDF
2 Myocardial Infarction Nursing Care Management and Study Guide PDF
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
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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.
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.
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Each year in the United States, nearly 1 million people have acute MIs.
Half of the people who die with acute MI never reach the hospital.
Causes
The causes of MI primarily stems from the vascular system.
Decreased oxygen supply. The decrease in oxygen supply occurs from acute blood
loss, anemia, or low blood pressure.
Clinical Manifestations
Some of the patients have prodromal symptoms or a previous diagnosis of CAD, but about
half report no previous symptoms.
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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.
Tachycardia and tachypnea. To compensate for the decreased oxygen supply, the
heart rate and respiratory rate speed up.
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.
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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.
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.
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Medical Management
The goals of medical management are to minimize myocardial damage, preserve
myocardial function, and prevent complications.
Pharmacologic Therapy
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.
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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.
Monitor vital signs, especially the blood pressure and pulse rate.
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.
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Reduced anxiety.
Anxiety reduced/managed.
Nursing Priorities
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.
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:
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Anxiety is reduced.
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
Individual ndings.
Teaching plan.
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.
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Start
PRACTICE MODE
Start
TEXT MODE
A. Chest pain
B. Dyspnea
C. Edema
D. Palpitations
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
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A. Alkaline phosphatase
B. Creatine kinase (CK-MB)
C. Myoglobin
D. Troponin
A: An absent P wave is not part of the classic changes seen in an ECG result.
D: The pain grips the patient like a vise and radiates towards the arms or the
shoulders.
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B: CK-MB is the isoenzyme for the heart muscle and the cardiac-speci c enzyme.
See Also
Posts related to Myocardial Infarction:
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