MYOCARDIAL INFARCTION

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

PATHOPHYSIOLOGY

RISK FACTORS

MALE

40 years of age

with arterial HPN

FEMALE

taking oral contraceptives

smoking

CLINICAL MANIFESTATION

CHEST PAIN

occurs suddenly

continuous unabated

lower sternal region

upper abdomen

steadily in severity

until it becomes unbearable

heavy, “viselike” pain

radiate to shoulders

down the arms (Left)

jaw and neck

begins spontaneously

persists for hours or days

relieve neither by rest nor by nitroglycerin

accompanied by SOB,

pallor, diaphoresis, dizziness, lightheadedness, N/V

DIAGNOSTIC EVAULATIONS

1. PATIENT HISTORY

history of present illnessdiagnosis of MI

subjective

history of present illness and family health history

risk factors

2. ECG

electrophysiology of heart

monitor evolution and resolution of MI

determine location and relative size of infarction

NORMAL ECG ECG in MI

3. ECHOCARDIOGRAM

evaluate cardiac fnx (ventricular)

ejection fraction

4. SERUM ENZYMES AND ISOENZYMES

CREATINE KINASE MB

when there has been damage

cardiac-specific enzyme

LACTIC DEHYDROGENASE

LDH1 and LDH2

ASSESSMENT

1. LEVEL OF CONSCIOUSNESS

Orientation

Time

Place

Person 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 skin

blue to purple nail beds, oral mucosa, ear lobes

cool, moist skin

9. LUNGS

or rate of respiration

labored breathing

shortness of breath

dry, hacking cough

wheezes, 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

5. Reduce anxiety6. Adherence to self-care

program7. Absence or early recognition

of complications

INTERVENTIONS

1. Relieve chest painVASODILATORS

IV NitroglycerineANTI-COAGULANTS

HeparinTHROMBOLYTICS

Streptokinase Tissue Type Plasminogen ActivatorAnistreplase

OXYGEN THERAPYANALGESIC

Morphine Sulfate

2. Improve respiratory functionDBEPOSITIONING

3. Promote adequate tissue perfusionOXYGEN THERAPY

4. Reduce anxietyTRUSTING and CARING RELATIONSHIP

5. Patient education and home care considerations

EVALUATION

After nursing interventions,

goal was met.

The client was able to:1. verbalize relief of pain

2. appear comfortable

3. demonstrate no signs of respiratory distress

4. maintain adequate cardiac output as evidenced by:

strong peripheral pulsesnormal blood pressureclear breath soundsadequate urine output

5. verbalize reduce fear6. tolerate progressive activity7. verbalize realistic expectations for

progressive activity 8. verbalize understanding of condition

and adhere to self-care program