1. Management & Nursing Care of Patient with Coronary Artery Diseases Myocardial Infarction)) Dr. Walaa Nasr Lecturer of Adult Nursing Second year Second year

2. Myocardial infarction outlines Definition Definition Etiology and pathophysiology Etiology and pathophysiology Clinical manifestations Clinical manifestations Diagnostic evaluation Diagnostic evaluation Medical management Medical management Nursing process Nursing process

3. Myocardial infarction Definition Other names: coronary occlusion- heart attack Myocardial infarction refers to the process by which myocardial tissue is destroyed in regions of the heart that are deprived of an adequate blood supply because of a reduced coronary blood flow (a prolonged lack of myocardial oxygenation leading to necrosis of a portion of the heart muscle). Myocardial infarction refers to the process by which myocardial tissue is destroyed in regions of the heart that are deprived of an adequate blood supply because of a reduced coronary blood flow (a prolonged lack of myocardial oxygenation leading to necrosis of a portion of the heart muscle).

4. Myocardial infarction Etiology and pathopysiology *Causes of reduced blood flow: Narrowing of a coronary artery owing to atherosclerosis Narrowing of a coronary artery owing to atherosclerosis A complete occlusion of an artery owing to embolus or a thrombus A complete occlusion of an artery owing to embolus or a thrombus Myocardial necrosis caused by acute occlusion of a coronary artery due to plaque rupture or erosion with imposed thrombosis) Myocardial necrosis caused by acute occlusion of a coronary artery due to plaque rupture or erosion with imposed thrombosis)

5. Myocardial infarction Clinical manifestations Symptoms Pain is the cardinal symptom of an MI Pain is the cardinal symptom of an MI Anxiety and fear of impending death Anxiety and fear of impending death Nausea and vomiting Nausea and vomiting Breathlessness Breathlessness Collapse/syncope Collapse/syncope

6. Myocardial infarction Clinical manifestations (cont … ) Physical signs Signs of sympathetic activation: pallor, sweating, tachycardia Signs of sympathetic activation: pallor, sweating, tachycardia Signs of vagal activation: nausea,vomiting, bradycardia Signs of vagal activation: nausea,vomiting, bradycardia Signs of impaired myocardial function: hypotension, oligurea, cold peripheries Signs of impaired myocardial function: hypotension, oligurea, cold peripheries Signs of complications: e.g. mitral regurgitation, pericarditis Signs of complications: e.g. mitral regurgitation, pericarditis

7. Myocardial infarction Diagnostic evaluation Electrocardiogram (ECG) Electrocardiogram (ECG) Blood test (Cardiac enzymes) Blood test (Cardiac enzymes) Echocardiogram Echocardiogram Nuclear scan Nuclear scan Chest radiographs Chest radiographs Coronary angiography Coronary angiography Exercise stress test. Exercise stress test. Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI). Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI).

8. Myocardial infarction Medical management Immediate management: the first 12 hours Immediate management: the first 12 hours Analgesic (morphin sulphate) & antiemetic Analgesic (morphin sulphate) & antiemetic Antithrombotic therapy (Antiplatlet therapy, anticoagulants) Antithrombotic therapy (Antiplatlet therapy, anticoagulants) Anti-anginal therapy Anti-anginal therapy Surgical therapy Surgical therapy

9. Myocardial infarction Nursing process Assessment A careful history A careful history Description of symptoms ( chest pain, palpitation, dyspnea, syncope or sweating). Each symptoms must be evaluated with regard to time, duration, precipitating & relieving factors. In addition complete physical assessment for: Description of symptoms ( chest pain, palpitation, dyspnea, syncope or sweating). Each symptoms must be evaluated with regard to time, duration, precipitating & relieving factors. In addition complete physical assessment for: *level of consciousness *level of consciousness

10. *Heart sounds *Heart sounds *Peripheral pulses *Peripheral pulses *Lung sound *Lung sound Nursing process (cont … )

11. Nursing diagnosis Chest pain related to reduced coronary blood flow. High risk for breathing pattern ineffective related to fluid overload Anxiety related to fear from death High risk for tissue perfusion alteration related to decreased cardiac output Health maintenance alteration related to no adherence to therapeutic regimen Nursing process (cont … )

12. Patient's goals Report that pain is decreased Report that pain is decreased Breath effectively Breath effectively Experience less anxiety level Experience less anxiety level Have improved tissue perfusion Have improved tissue perfusion Adhere to the self care program Adhere to the self care program

13. Nursing process (cont … ) Nursing intervention Nursing intervention Relief or control of chest pain Relief or control of chest pain Alleviate respiratory difficulties Alleviate respiratory difficulties Reduce the anxiety level Reduce the anxiety level Maintain adequate tissue perfusion Maintain adequate tissue perfusion Help the patient to adhere to the self care program Help the patient to adhere to the self care program