MI Nursing Situation

ANSWERS

Although the terms myocardial infarction (MI) and coronary occlusion (CO) are used interchangeably, MI is the preferred term because myocardial ischemia causes acute coronary syndrome (ACS), which can result in myocardial death.

An area of the myocardium is permanently destroyed during a MI due to plaque rupture and subsequent thrombus formation, which results in complete occlusion of the artery.
Unstable angina, non-ST-segment elevation MI, and ST-segment elevation MI are all part of the ACS spectrum.

Prevention

A healthy lifestyle may aid in the prevention of MI.

Exercise. Exercising at least three times per week may help lower cholesterol levels, which cause blood vessel constriction.
A well-balanced diet. Fruits, vegetables, meat, and fish should all be included in the patient’s daily diet to ensure they get the proper amount of nutrients.
Quitting smoking. Nicotine causes vasoconstriction, which can raise blood pressure and lead to MI.

Nursing Administration

Nursing management in MI is critical and systematic, and efficiency is required to implement care for a MI patient.

Nursing Evaluation
The assessment is one of the essential aspects of MI patient care.

Examine chest pain that is not relieved by rest or medication.
Keep an eye on your vital signs, especially your blood pressure and pulse rate.
Check for shortness of breath, dyspnea, tachypnea, and crackles.
Examine for nausea and vomiting.
Look for signs of decreased urinary output.
Examine the patient’s medical history.
Perform a thorough physical examination to detect complications and changes in the patient’s condition.
Regularly evaluate IV sites.
Diagnosis
Based on clinical manifestations, history, and diagnostic assessment data, primary nursing diagnoses may be made.

Inadequate cardiac tissue perfusion due to decreased coronary blood flow
There is a risk of ineffective peripheral tissue perfusion due to decreased cardiac output caused by left ventricular dysfunction.
Inadequate knowledge of post-MI self-care.

The following should be prioritized when developing a care plan:

Pain or ischemic signs and symptoms relief
Myocardial damage prevention.
There is no respiratory dysfunction.
Maintaining or achieving adequate tissue perfusion.
Anxiety was reduced.
Complications are not present or are detected early.
Chest pain is absent/under control.
Sufficient heart rate/rhythm to maintain adequate cardiac output/tissue perfusion
Attained a level of activity sufficient for essential self-care.
Anxiety has been reduced/managed.
The disease process, treatment plan, and prognosis are all well understood.
There is a plan in place to meet needs following discharge.
Priorities in Nursing
Pain and anxiety relief
Lower myocardial workload.
Prevent/detect and aid in treating potentially fatal dysrhythmias or complications.
Encourage cardiac health and self-care.

QUESTION

MI Nursing Situation

Patient Profile

F.M. is a 68-year-old white man who comes to the emergency department (ED) in the early afternoon with a 2-day history of severe chest pain. The pain started on wakening the previous day. The pain increased during the night, but his wife could not convince him to go to the hospital. He comes to the ED today because the pain is severe and no longer relieved by rest.

Subjective Data

• • Describes recurring chest pain for the past 6 months that was relieved by rest; the pain is a feeling of heaviness in chest with no radiating pain to arm or jaw or accompanying nausea or dizziness

• • Recently the chest pain has become severe and is no longer relieved by rest; is now slightly nauseated

• • His father died of a heart attack at age 62 years

• • Denies alcohol or drug use

• • Smokes one pack of cigarettes per day

• • Describes his lifestyle as sedentary

Objective Data

Physical Examination

• • Blood pressure 180/96, pulse 98, temperature 99.8°F, respirations 20

• • Height 5’11”, weight 210 lb, BMI 29.3 kg/m2

• • Alert and oriented to person, place, and time

• • Skin diaphoretic and clammy

• • Heart rhythm regular, no murmurs or extra heart sounds

• • Lungs are clear to auscultation

Diagnostic Studies

• • Hemoglobin 14 g/dL

• • Chemistry panel is normal

• • Cardiac markers – pending

• • Electrocardiogram showing changes that correlate with non–ST-segment–elevation myocardial infarction (NSTEMI)

Interprofessional Care

• • 0.9% NaCl infusing into IV catheter at 75 mL/hr.

• Nitroglycerin and morphine given with relief of pain

Questions

1. What are F.M.’s modifiable risk factors for coronary artery disease (CAD)? What are his nonmodifiable risk factors?

2.  What is the difference between chronic stable angina pain and pain associated with myocardial infarction (MI)?

3. What diagnostic studies are indicated for F.M.?

Case Study Progression

F.M. is diagnosed as having an MI.

4. What is the priority nursing care for F.M.?

5. What other interventions do you anticipate for F.M. at this time?

6. What are common complications after an MI?