Myocardial Infarction Care Plan

Myocardial Infarction Care Plan Myocardial infarction Etiology & Pathophysiology Risk Factors & Prevention Etiology: Risk Factors: Myocardial infarction happens usually from an imbalance in oxygen supply and demand. It is mostly caused by a plaque rupture with thrombus formation in an epicardial coronary artery, resulting in an acute reduction of blood supply to a portion of the myocardium (Zafari, 2019). Increasing age (older) Pathophysiology: The pathophysiology of acute myocardial infarction is a loss of viable myocardium impairs global cardiac function, which can lead to reduced cardiac output, and if damage is severe, to cardiogenic shock. Systolic and diastolic dysfunction are associated with ischemic myocardium (Klabunde, 2007). Male gender Heredity (including race) Tobacco smoke Signs and Symptoms Diagnosis & Treatment Chest pain or discomfort Nursing Diagnosis: Light-headedness, faint, and feelings of weakness Acute Pain Pain or discomfort in the jaw, neck or back Activity Intolerance Fear/Anxiety Risk for Decreased Cardiac Output High blood pressure Pain or discomfort in one or both arms and or shoulders High cholesterol Shortness of breath Risk for Ineffective Tissue Perfusion Physical inactivity Unusaly or unexplained tiredness, nausea and vomiting Risk for Excess Fluid Volume Obesity & being overweight (AHA, 2016). Prevention: Skin may be pale, cool and diaphoretic, peripheral or central cyanosis may be present. Deficient Knowledge TX: Stop smoking Prehospital: Oxygen, Aspirin, Nitrates Healthy diet/nutrition Drug TX: Lower blood pressure Antiplatelet drugs (Aspirin, clopidogrel), Lower bad cholesterol Be physically active Aim for a healthy weight Manage diabetes Reduce Stress (AHA, 2015). Antianginal drugs (nitroglycerin) Anticoagulants (Heparin or Bivalirudin) Beta-blockers, ACE inhibitor, Statins, morphine (pain) Pharmacology Initial treatment: aspirin 150300mg (antiplatelet with rapid effect) fibrinolytic therapy (streptokinase/TPA): given to dissolve thrombus in artery, allow for restore of flow; indication- symptoms for less than 12 hours with ECG of ST elevation or left bundle branch block; contraindication- cerebral event within 6 months, major trauma (surgery) within 1 month, bleeding peptic ulcer within 2 months, hypertension, noncompressible vascular puncture Heparin (antithrombin): 5000u bolus follow by 1000u per hour Ace inhibitors Beta blockers (reduce incidence of arrhythmias) https://www.nps.org.au/australia n-prescriber/articles/acutemyocardial-infarction-earlytreatment Assessment Check ECG levels, a stress test, an angiogram with coronary catheterization Diagnosis Risk of ineffective tissue perfusion r/t reduction of blood flow and vasoconstriction. Planning (Short & Long Term Goals) Short Term Goals: relieve chest pain, stabilize heart rhythm, reduce cardiac workload, revascularize the coronary artery, and preserve myocardial tissue. Long Term Goals: Eat healthy, exercise regularly Interventions & Implementation Observe any sudden changes or any alterations in mentation monitor respiration Assess GI function administer medication as ordered Evaluation Check the patient's pulse oximetry. Make sure patient’s vital is stable Anticipated Medications : Nitroglycerin Indications: Acute, and long term prophylactic management of angina pectoris. Adjunct treatment of HF and for treatment of acute MI Contraindications: Contraindicated in severe anemia, pericardial tamponade, constrictive pericarditis, alcohol intolerance, and concurrent use of PDE-5 inhibitors or riociguat. Use cautiously in head trauma or cerebral hemorrhage patients, glaucoma, severe liver impairment, hypovolemia, cardioversion patients. May compromise maternal/fetal circulation for pregnant women. Mechanism of action : Increases coronary blood flow by dilating coronary arteries and improving collateral flow to ischemic regions. Produces vasodilation (venous greater than arterial). Decreases left ventricular end-diastolic pressure and left ventricular end-diastolic volume (preload). Reduces myocardial oxygen consumption (Davis, 2017). Nurse considerations: Assess location, duration, intensity and precipitating factors of patients anginal pain. Nurse must monitor BP and pulse before and after administering Nitro. Patients receiving nitro via IV, continuous ECG and BP monitoring is required.