MYOCARDIAL INFARCTION

PREPARED BY:
1-Mohamed osama
2- Mohamed adel
3-Ahmed abohatab
4-Mohamed bakr
5-kareem mohamed
6-Momen mohamed
7-Noor habib
8-Eslam mohamed
9-Ammar Yasser
10-Nada hesaen

Supervised By:
DR:HANAA ABASS
DR:GEHAD
DR:ALSHIMAA RAGAB
 Pathophysiology
A.Acute
Marked
to: reduction or loss of blood flow through one or more of the coronary arteries, resulting in cardiac muscle ischemia,
Desired Outcomes/Evaluation Criteria— Pain Management: Acute NIC
and over a finite period, resulting in necrosis.
Client Will Independent :
1-Tissue ischemia Monitor and document characteristics of pain, noting verbal
reports, nonverbal cues, for example, moaning, crying,
Pain Level NOC : restlessness, diaphoresis, clutching chest, rapid breathing,
2-Increased
B. cardiac
Occurs most workload
often due toand
coronary artery disease (CAD). and hemodynamic response
oxygen consumption (BP and heart rate changes)
Verbalize relief or control of chest pain
within appropriate period for administered Obtain full description of pain from client, including
3-Decreased myocardial blood flow location, intensity (using 0 to 10 or similar scale), duration,
C. Cellular ischemia and necrosis can affect medi cations.rhythm, pumping action, and blood
the heart’s circulation.
characteristics (dull or crushing), and radiation. Assist client
to quantify pain by comparing it to other experiences
Possibly Evidenced By: Demonstrate relief of pain as evidenced by
stable vital signs and absence of muscle Note history of previous angina, anginal equivalent, or MI
D. Other prob lems
1-Verbal/coded may
reports also ensue, such astension
of pain heart and
failure, life- threatening arrhythmias,pain.
restlessness andDiscuss
death.family history if pertinent.

(such as moaning, crying, pacing, self- Instruct client to report pain immediately.
focus, or restlessness)
Observe for associated symptoms, such as dyspnea, nausea,
E. Delay in seeking treatment is the largest barrier to receiving therapy quickly. vomiting, dizziness, palpitations, and desire to urinate.
2-Diaphoresis; changes in blood
pressure, heart rate, respiratory rate, Monitor vital signs every 5 minutes during initial pain
pupillary dilation attack.
 Pathophysiology
A.Acute
Marked
to: reduction or loss of blood flow through one or more of the coronary arteries, resulting in cardiac muscle ischemia,
Desired Outcomes/Evaluation Criteria— Pain Management: Acute NIC
and over a finite period, resulting in necrosis.
Client Will Independent :
1-Tissue ischemia Monitor and document characteristics of pain, noting verbal
reports, nonverbal cues, for example, moaning, crying,
Pain Level NOC : restlessness, diaphoresis, clutching chest, rapid breathing,
2-Increased
B. cardiac
Occurs most workload
often due toand
coronary artery disease (CAD). and hemodynamic response
oxygen consumption (BP and heart rate changes)
Verbalize relief or control of chest pain
within appropriate period for administered Obtain full description of pain from client, including
3-Decreased myocardial blood flow location, intensity (using 0 to 10 or similar scale), duration,
C. Cellular ischemia and necrosis can affect medi cations.rhythm, pumping action, and blood
the heart’s circulation.
characteristics (dull or crushing), and radiation. Assist client
to quantify pain by comparing it to other experiences
Possibly Evidenced By: Demonstrate relief of pain as evidenced by
stable vital signs and absence of muscle Note history of previous angina, anginal equivalent, or MI
D. Other prob lems
1-Verbal/coded may
reports also ensue, such astension
of pain heart and
failure, life- threatening arrhythmias,pain.
restlessness andDiscuss
death.family history if pertinent.

(such as moaning, crying, pacing, self- Instruct client to report pain immediately.
focus, or restlessness)
Observe for associated symptoms, such as dyspnea, nausea,
E. Delay in seeking treatment is the largest barrier to receiving therapy quickly. vomiting, dizziness, palpitations, and desire to urinate.
2-Diaphoresis; changes in blood
pressure, heart rate, respiratory rate, Monitor vital signs every 5 minutes during initial pain
pupillary dilation attack.
acute Pain(sever chest pain):
1-tissue ischemia
2-Increased cardiac workload and
oxygen consumption
3-Decreased myocardial blood flow
Possibly Evidenced By:
1-Verbal/coded reports of pain
(such as moaning, crying, pacing, self-
focus, or restlessness)
2-Diaphoresis; changes in blood
pressure, heart rate, respiratory rate,
pupillary dilation
Desired Outcomes/Evaluation Criteria—
Client Will
Pain Level NOC :
Verbalize relief or control of chest pain
within appropriate period for administered
medi cations.
Demonstrate relief of pain as evidenced by
stable vital signs and absence of muscle
tension and restlessness
Pain Management: Acute NIC
1.Instruct the client to report pain immediately.
2. Provide a quiet environment, and calm activities, and
place the client in a position of comfort. Approach the client
calmly and confidently.
3. Instruct the client to do relaxation techniques such as
deep and slow breathing, distraction behaviors,
visualization, and guided imagery. Assist as needed.
4. Administer supplemental oxygen by means of a nasal
cannula or face mask, as indicated.
5. Administer medications as indicated.
5.1. Antianginals such as nitroglycerin, isosorbide dinitrate, •
and mononitrate
•
5.2. Beta-blockers such as atenolol, pindolol,
propranolol, nadolol, and metoprolol
5.3. Analgesics such as morphine and meperidine•
Risk for Decreased Activity Intolerance
Activity intolerance :
May be related to:
1-An imbalance between myocardial oxygen
supply and demand
2-Presence of ischemic/necrotic myocardial
tissues
3-Cardiac depressant effects of certain drugs
(beta-blockers, antiarrhythmics)
Possibly evidenced by
Alterations in heart rate and BP with activity
Development of dysrhythmias
Changes in skin color/moisture
Exertional angina
Generalized weakness
1-Assess and document heart rate and
rhythm and changes in BP before,
during, and after activity. Correlate
with reports of chest pain or shortness
of breath.
2. Review signs and symptoms
reflecting intolerance of present
activity level or requiring notification
of a nurse or healthcare provider.
1. Encourage rest initially. Thereafter, limit activity
on the basis of pain and/or adverse cardiac
response. Provide non-stress diversional
activities.
2. Instruct the client to avoid increasing
abdominal pressure (straining during defecation).
3. Provide a quiet environment and limit visitors.
Encourage stress management and diversional
activities as appropriate.
4. Explain the pattern of graded increase of
activity level: getting up to commode or sitting in
a chair, progressive ambulation, and resting after
meals.
5. Promote tolerable, light physical exercise as
indicated.
6. Refer to a cardiac rehabilitation program.
7. Assist in procedures for inserting ventricular
assist devices.

Deficient Knowledge
May be related to:
Lack of information/misunderstanding
of medical condition/therapy needs.
Unfamiliarity with information
resources.
Lack of recall.
Possibly evidenced by:
Questions; statement of
misconception.
Failure to improve on the previous
regimen.
Development of preventable
complications.
1-Assess the client or family member’s
level of knowledge and ability and
desire to learn.
2. Be alert to signs of avoidance
(changing the subject away from
information being presented or
extremes of behavior).
1-Encourage the client to enroll in smoking
cessation classes.
2. Promote a moderate consumption of alcoholic
beverages.
3. Warn against the isometric activity, Valsalva
maneuver, and activities requiring arms positioned
above the head.
4. Present information in varied learning formats:
programmed books, audiovisual tapes, question
and answer sessions, and group activities.
5. Reinforce explanations of risk factors, dietary
and/or activity restrictions, medications, and
symptoms requiring immediate medical attention.
6. Review programmed increases in levels of
activity. Educate the client regarding the gradual
resumption of activities, e.g., walking, work,
recreational and sexual activity. Provide guidelines
for gradually increasing activity and instruction
regarding target heart rate and pulse taking, as
appropriate.
7. Identify alternative activities for “bad weather”
days, such as measured walking in the house or
shopping mall.

8. Review signs and symptoms requiring a

reduction in activity and notification of healthcare
provider.

9. Differentiate between increased heart rate that

normally occurs during various activities and
worsening signs of cardiac stress (chest pain,
dyspnea, palpitations, increased heart rate lasting
more than 15 minutes after cessation of activity,
and excessive fatigue the following day).

10. Stress the importance of follow-up care, and

identify community resources and support groups.

11. Emphasize the importance of contacting the

healthcare provider if chest pain, change in anginal
pattern, or other symptoms recur.
12. Stress the importance of reporting the
development of fever in association with diffuse
and atypical chest pain (pleural, pericardial) and
joint pain.

13. Encourage the client and family members to

share concerns and feelings. Discuss signs of
pathological depression versus transient feelings
frequently associated with major life events.
Recommend seeking professional help if depressed
feelings persist.

14. Stress the importance of proper dietary intake.

Anxiety [specify level]
May Be Related To:
Situational crisis; environment Major
change (e.g., threat to or change in
health, economic status; threat of
death)
Possibly Evidenced By:
Fearful attitude Apprehension,
increased tension, restlessness, facial
tension Uncertainty, feelings of
inadequacy Reports concern due to
change in life events Focus on self,
worried
Desired Outcomes/Evaluation Criteria—
Client Will
Anxiety Self- Control NOC:
Recognize and verbalize feelings.
Identify causes and contributing factors.
Verbalize reduction of anxiety or fear.
Demonstrate positive problem- solving
skills.
Identify and use resources appropriately
Anxiety Reduction NIC:
Independent :
Identify and acknowledge client’s perception of threat or
situation. Encourage expressions of, and avoid denying
feelings of, anger grief, sadness, and fear.
Note presence of hostility, withdrawal, and denial—
inappropriate affect or refusal to comply with medical
regimen
Maintain confident manner, without false reassurance.
Orient client and SO to routine procedures and expected
activities. Promote participation when pos si ble.
Observe for verbal and nonverbal signs of anxiety, and
stay with client. Intervene if client displays destructive be
hav ior
Accept but do not reinforce use of denial. Avoid
confrontations
Answer all questions factually. Provide consistent
information; repeat as indicated
Encourage client and SO to communicate with one
another, sharing questions and concerns.

Provide privacy for client and SO.

Provide rest periods and uninterrupted sleep time

and quiet surroundings, with client controlling
type and number of external stimuli.

Support normality of grieving process, including

time necessary for resolution

Encourage independence, self- care, and decision

making within accepted treatment plan

Encourage discussion about postdischarge

expectations.

Collaborative Administer antianxiety or hypnotics,

as indicated, such as alprazolam (Xanax) and
lorazepam (Ativan)