MYOCARDIAL INFARCTION

RAMOS, Gemmalyn C.REALISAN, Joyce Ann R.RELANO, Rex Steve B.

PATHOPHYSIOLOGY

RISK FACTORS

MALE40 years of agewith arterial HPN

FEMALEtaking oral contraceptivessmoking

CLINICAL MANIFESTATION

CHEST PAINoccurs suddenlycontinuous unabatedlower sternal regionupper abdomen steadily in severityuntil it becomes unbearableheavy, “viselike” pain

radiate to shouldersdown the arms (Left)jaw and neckbegins spontaneouslypersists for hours or days

relieve neither by rest nor by nitroglycerinaccompanied by SOB, pallor, diaphoresis, dizziness, lightheadedness, N/V

DIAGNOSTIC EVAULATIONS

1. PATIENT HISTORYhistory of present illness

diagnosis of MIsubjective

history of present illness and family health history risk factors

2. ECGelectrophysiology of heartmonitor evolution and resolution of MIdetermine location and relative size of infarction

NORMAL ECG ECG in MI

3. ECHOCARDIOGRAMevaluate cardiac fnx (ventricular)ejection fraction

4. SERUM ENZYMES AND ISOENZYMES

CREATINE KINASE MB when there has been damagecardiac-specific enzyme

LACTIC DEHYDROGENASELDH1 and LDH2

ASSESSMENT

1. LEVEL OF CONSCIOUSNESS Orientation

TimePlacePerson

Slurred speech Deepening of snoring sounds

2. CHEST PAIN pain rating intensity

3. HEART RATE rate

unexplained or

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

ABNORMAL HEART SOUNDSS3 ventricular gallop S1- S2- S3 (ken-tucck-y)

S4 atrial or presystolic gallopS4- S1- S2 (ten-nes-see)

heart murmur

friction rub

5. BLOOD PRESSURE

vasodilatorBP

6. PERIPHERAL PULSES

blood flow to extremities

7. IV SITES patencysigns of inflammation

8. SKIN COLOR AND TEMPERATURE

pink, warm skinblue to purple nail beds, oral mucosa, ear lobescool, moist skin

9. LUNGS

or rate of respirationlabored breathingshortness of breathdry, hacking coughwheezes, crackles

10. GI FUNCTIONN/VabdomenTendernessBowel sounds

occluded Mesentric Artery

11. FLUID VOLUME STATUSU/OEdema

POSSIBLENURSINGDIAGNOSES

1. Chest Pain 2. Decreased cardiac output3. Ineffective cardiopulmonary

tissue perfusion4. Potential impaired gas exchange5. Potential altered peripheral

tissue perfusion6. Risk for activity intolerance7. Anxiety 8. Deficient knowledge

PLANNING

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

1. Reduce anxiety2. Adherence to self-care

program3. Absence or early recognition

of complications

INTERVENTIONS

1. Relieve chest painVASODILATORS

IV NitroglycerineANTI-COAGULANTS

HeparinTHROMBOLYTICS

Streptokinase Tissue Type Plasminogen ActivatorAnistreplase

OXYGEN THERAPYANALGESIC

Morphine Sulfate

1. Improve respiratory functionDBEPOSITIONING

4. Promote adequate tissue perfusionOXYGEN THERAPY

1. Reduce anxietyTRUSTING and CARING RELATIONSHIP

3. Patient education and home care considerations

EVALUATION

After nursing interventions,goal was met. The client was able to:

1. verbalize relief of pain2. appear comfortable3. demonstrate no signs of respiratory

distress

1. maintain adequate cardiac output as evidenced by:

strong peripheral pulsesnormal blood pressureclear breath soundsadequate urine output

2. verbalize reduce fear3. tolerate progressive activity4. verbalize realistic expectations for

progressive activity 5. verbalize understanding of condition

and adhere to self-care program