MYOCARDIAL INFARCTION

PATHOPHYSIOLOGY

RISK FACTORS

MALE 40 years of age with arterial HPN FEMALE taking oral contraceptives smoking

CLINICAL MANIFESTATION

CHEST PAIN occurs suddenly continuous unabated lower sternal region upper abdomen  steadily in severity until it becomes unbearable heavy, “viselike” pain

radiate to shoulders down the arms (Left) jaw and neck begins spontaneously persists for hours or days C:\WINDOWS\hinhem.scr

relieve neither by rest nor by nitroglycerin accompanied by SOB, pallor, diaphoresis, dizziness, lightheadedness, N/V C:\WINDOWS\hinhem.scr

DIAGNOSTIC EVAULATIONS

1. PATIENT HISTORY history of present illness diagnosis of MI subjective history of present illness and family health history risk factors

2. ECG electrophysiology of heart monitor evolution and resolution of MI determine location and relative size of infarction

NORMAL ECGECG in MI

3. ECHOCARDIOGRAM evaluate cardiac fnx (ventricular) ejection fraction

4. SERUM ENZYMES AND ISOENZYMES CREATINE KINASE MB  when there has been damage cardiac-specific enzyme LACTIC DEHYDROGENASE LDH 1 and LDH 2 

ASSESSMENT

1. LEVEL OF CONSCIOUSNESS Orientation Time Place Person Slurred speech Deepening of snoring sounds

2. CHEST PAIN pain rating intensity 3. HEART RATE rate unexplained  or 

4. HEART SOUNDS S1 apex; systole (lub) S2 base; diastole (dub)

ABNORMAL HEART SOUNDS S3 ventricular gallop S1- S2- S3 (ken-tucck-y) S4 atrial or presystolic gallop S4- S1- S2 (ten-nes-see) heart murmur friction rub

5. BLOOD PRESSURE vasodilator  BP 6. PERIPHERAL PULSES blood flow to extremities 7. IV SITES patency signs of inflammation

8. SKIN COLOR AND TEMPERATURE pink, warm skin blue to purple nail beds, oral mucosa, ear lobes cool, moist skin

9. LUNGS  or  rate of respiration labored breathing shortness of breath dry, hacking cough wheezes, crackles

10. GI FUNCTION N/V abdomen Tenderness Bowel sounds occluded Mesentric Artery 11. FLUID VOLUME STATUS U/O Edema

POSSIBLE NURSING DIAGNOSES

1. Chest Pain 2. Decreased cardiac output 3. Ineffective cardiopulmonary tissue perfusion 4. Potential impaired gas exchange 5. Potential altered peripheral tissue perfusion 6. Risk for activity intolerance 7. Anxiety 8. Deficient knowledge

PLANNING

1. Relief of pain or ischemic signs and symptoms 2. Prevention of further myocardial damage 3. Absence of respiratory dysfunction 4. Maintenance or attainment of adequate tissue perfusion by increasing heart’s workload

5. Reduce anxiety 6. Adherence to self-care program 7. Absence or early recognition of complications

INTERVENTIONS

1. Relieve chest pain VASODILATORS IV Nitroglycerine ANTI-COAGULANTS Heparin THROMBOLYTICS Streptokinase Tissue Type Plasminogen Activator Anistreplase OXYGEN THERAPY ANALGESIC Morphine Sulfate

2. Improve respiratory function DBE POSITIONING 3. Promote adequate tissue perfusion OXYGEN THERAPY

4. Reduce anxiety TRUSTING and CARING RELATIONSHIP 5. Patient education and home care considerations

EVALUATION

After nursing interventions, goal was met. The client was able to: 1. verbalize relief of pain 2. appear comfortable 3. demonstrate no signs of respiratory distress

4.maintain adequate cardiac output as evidenced by: strong peripheral pulses normal blood pressure clear breath sounds adequate urine output 5. verbalize reduce fear 6. tolerate progressive activity 7. verbalize realistic expectations for progressive activity 8. verbalize understanding of condition and adhere to self-care program