1. MYOCARDIAL INFARCTION

2. PATHOPHYSIOLOGY

6. RISK FACTORS

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

8. CLINICAL MANIFESTATION

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

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

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

12. DIAGNOSTIC EVAULATIONS

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

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

15. NORMAL ECGECG in MI

16. 3. ECHOCARDIOGRAM evaluate cardiac fnx (ventricular) ejection fraction

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

18. ASSESSMENT

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

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

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

22. 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

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

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

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

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

27. POSSIBLE NURSING DIAGNOSES

28. 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

29. PLANNING

30. 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

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

32. INTERVENTIONS

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

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

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

36. EVALUATION

37. 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

38. 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