Myocardial Infarction And Nursing Intervention

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Ischemic Heart Disease

Definition: Syndromes causing an imbalance between myocardial oxygen demand and supply
– Ischemia: insufficient tissue oxygenation.
– Infarction: a zone of tissue deprived of blood supply.

Results of Ischemic Heart Disease

– Angina Pectoris
– Acute Myocardial Infarction
– Sudden Cardiac Death
– Chronic Ischemic Heart Disease

Definition

— Refers to the process by which myocardial tissue is destroyed because of reduced coronary blood flow due to Atherosclerosis or complete occlusion of an artery, embolus or thrombus.

Myocardial Infarction

Risk Factor
— smoking
— hyper lipidemia
— DM> Diabetes Mellitus
— HTN > Hypertension
— obesity
— stress.
Clinical Manifestations
– Chest pain : is the most common symptom of a heart
– Crushing chest pain radiate to the shoulder + down the arms [not after effort or emotional upset
– Diaphoresis, cool clammy skin, facial pallor
– Hypertension or hypotension
– Bradycardia or tachycardia
– Premature ventricular and/or atrial beats
– Palpitations, severe anxiety, dyspnea
– Disorientation, confusion, restlessness
Clinical Manifestations
– Nausea, vomiting, hiccups
– weakness at the left jaw , shoulder and arm
– Atypical symptoms: epigastric or abdominal distress, dull aching or tingling sensations, shortness of breath, extreme fatigue
Note : rate of MI greater in ♂ male than ♀ female

Diagnostic evaluation:
— A: History of present illness [duration, pain]
B: History of previous illness [↑ BP., D.M]
— ECG: enlarge Q wave, elevation or depressed ST segment and T wave inversion.
— CPK most sensitive + reliable indicator in case of MI, p 6hrs → return to normal in the 3rd day.
— WBC shows increase count.

Complications :
— CHF : congestive heart failure
— Myocardial rupture
— Life threatening arrythemia
— Pericarditis
— Cardiogenic shock

Management
— Bed rest to ↓ O2 demand.
— Relieving chest pain, analgesics [morphine sulfate].
— Vasodilators Nitroglycerine IV. [dilates both arteries + veins.
— Anticoagulant [ heparin].
— Thrombolytic [streptokinase] dissolving thrombus.
— O2 administration.
— ↓ anxiety
— Patient education.
— Medical management: MONA
M : MORPHINE
O : OXYGEN
N : NITROGLYCERINE (GTN)tab S\L
A: ASPIRIN (ASA)

Drug Therapy
— The drugs are: an aspirin, a beta-blocker, an ACE inhibitor, and a statin. These drugs improve your outlook (prognosis)
Why are drugs prescribed after a myocardial infarction? .
To reduce the chance of having another myocardial infarction (MI)
To help prevent heart disease from getting worse
The drugs are usually taken each day for life

Nursing Interventions

Reducing Pain
– Handle patient carefully while providing initial care, bed rest, starting IV infusion, obtaining baseline vital signs, and attaching electrodes for continuous ECG monitoring.
• oxygen by nasal cannula.
• Offer support and reassurance to patient that relief of pain is apriority.
• Administer sublingual nitroglycerin as directed; recheck blood pressure (BP), heart rate (HR), and respiratory rate

— Discuss with patient and family member the anticipate nursing and medical regimen.
a. Explain visiting hours and need to limit number of visitors at one time.
b. Offer family members preferred times to phone to check on patient’s status.
c. Observe for adverse effects of sedation such as lethargy, confusion, and/or increased agitation.

— Observe for autonomic signs of anxiety such as increases in heart rate, BP, respiratory rate.
— Administer antianxiety agents as prescribed.
a. Explain to patient the reason for sedation.
b. Assure patient that the goal of sedation is to promote comfort and decrease anxiety.

— Maintain consistency of care with one or two nurse regularly assisting patient, especially if severe anxiety is present.
— Offer back massage to promote relaxation, decrease muscle tension, and improve skin integrity.
— Use techniques such as guided imagery to relieve tension and anxiety.

Maintaining Hemodynamic Stability
— Monitor BP every 2 hours or as directed-hypertension increases afterload of the heart, elevating oxygen demand; hypotension causes reduced coronary an tissue perfusion.
— Monitor respirations every 2 to 4 hours .
— Auscultate for normal and abnormal breath sound (crackles may indicate left ventricular failure; diffuse crackles indicate pulmonary edema).

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