M yocardial infarction
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Transcript M yocardial infarction
Management & Nursing Care
of Patient with Coronary Artery
Diseases
)Myocardial Infarction)
Dr. Walaa Nasr
Lecturer of Adult Nursing
Second year
Myocardial infarction
outlines
Definition
Etiology
and pathophysiology
Clinical manifestations
Diagnostic evaluation
Medical management
Nursing process
Myocardial infarction
Definition
Other names: coronary occlusion- heart
attack
Myocardial
infarction refers to the
process by which myocardial tissue is
destroyed in regions of the heart that are
deprived of an adequate blood supply
because of a reduced coronary blood flow
(a
prolonged
lack
of
myocardial
oxygenation leading to necrosis of a
portion of the heart muscle).
Myocardial infarction
Etiology and pathopysiology
*Causes of reduced blood flow:
Narrowing of a coronary artery owing to
atherosclerosis
A complete occlusion of an artery owing to
embolus or a thrombus
Myocardial necrosis caused by acute
occlusion of a coronary artery due to
plaque
rupture or erosion with imposed
thrombosis)
Myocardial infarction
Clinical manifestations
Symptoms
Pain is the cardinal symptom of an MI
Anxiety and fear of impending death
Nausea and vomiting
Breathlessness
Collapse/syncope
Myocardial infarction
Clinical manifestations (cont…)
Physical signs
Signs
of sympathetic activation: pallor,
sweating, tachycardia
Signs of vagal activation: nausea,vomiting,
bradycardia
Signs
of impaired myocardial function:
hypotension, oligurea, cold peripheries
Signs
of
complications:
e.g.
mitral
regurgitation, pericarditis
Myocardial infarction
Diagnostic evaluation
Electrocardiogram (ECG)
Blood test (Cardiac enzymes)
Echocardiogram
Nuclear scan
Chest radiographs
Coronary angiography
Exercise stress test.
Cardiac computerized tomography (CT) or
magnetic resonance imaging (MRI).
Myocardial infarction
Medical management
Immediate management: the first 12 hours
Analgesic (morphin sulphate) & antiemetic
Antithrombotic therapy (Antiplatlet therapy,
anticoagulants)
Anti-anginal therapy
Surgical therapy
Myocardial infarction
Assessment
Nursing process
A careful history
Description of symptoms ( chest pain,
palpitation,
dyspnea,
syncope
or
sweating). Each symptoms must be
evaluated with regard to time, duration,
precipitating & relieving factors. In
addition complete physical assessment
for:
*level of consciousness
Nursing process (cont…)
*Heart sounds
*Peripheral pulses
*Lung sound
Nursing process (cont…)
Nursing diagnosis
Chest pain related to reduced coronary blood flow.
High risk for breathing pattern ineffective related to
fluid overload
Anxiety related to fear from death
High risk for tissue perfusion alteration related to
decreased cardiac output
Health maintenance alteration
adherence to therapeutic regimen
related
to
no
Nursing process (cont…)
Patient's goals
Report
that pain is decreased
Breath effectively
Experience less anxiety level
Have
improved
tissue
perfusion
Adhere
to the self care
program
Nursing process (cont…)
Nursing intervention
Relief
or control of chest pain
Alleviate respiratory difficulties
Reduce the anxiety level
Maintain
adequate
tissue
perfusion
Help the patient to adhere to the
self care program