Transcript myocardial infarction

MYOCARDIAL
INFARCTION
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 illness
diagnosis 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 SOUNDS
S3 ventricular gallop
S1- S2- S3 (ken-tucck-y)
S4 atrial or presystolic gallop
S4- S1- S2 (ten-nes-see)
heart murmur
friction rub
5. BLOOD
PRESSURE
vasodilator
BP
6. PERIPHERAL
PULSES
blood flow to
extremities
7. IV SITES
patency
signs 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 FUNCTION
N/V
abdomen
Tenderness
Bowel sounds
occluded Mesentric Artery
11. FLUID VOLUME STATUS
U/O
Edema
POSSIBLE
NURSING
DIAGNOSES
1.
2.
3.
4.
5.
6.
7.
8.
Chest Pain
Decreased cardiac output
Ineffective cardiopulmonary
tissue perfusion
Potential impaired gas exchange
Potential altered peripheral
tissue perfusion
Risk for activity intolerance
Anxiety
Deficient knowledge
PLANNING
1.
2.
3.
4.
Relief of pain or ischemic
signs and symptoms
Prevention of further
myocardial damage
Absence of respiratory
dysfunction
Maintenance or attainment of
adequate tissue perfusion by
increasing heart’s workload
5.
6.
7.
Reduce anxiety
Adherence to self-care
program
Absence or early recognition
of complications
INTERVENTIONS
1.
Relieve chest pain
VASODILATORS
IV Nitroglycerine
ANTI-COAGULANTS
Heparin
THROMBOLYTICS
Streptokinase
Tissue Type Plasminogen Activator
Anistreplase
OXYGEN THERAPY
ANALGESIC
Morphine Sulfate
2.
Improve respiratory
function
DBE
POSITIONING
3.
Promote adequate tissue
perfusion
OXYGEN THERAPY
4.
Reduce anxiety
TRUSTING and CARING RELATIONSHIP
5.
Patient education and
home care considerations
EVALUATION
After nursing interventions,
goal was met.
The client was able to:
verbalize relief of pain
2. appear comfortable
3. demonstrate no signs of
respiratory distress
1.
4. maintain adequate cardiac output as
evidenced by:
strong peripheral pulses
normal blood pressure
clear breath sounds
adequate urine output
5. verbalize reduce fear
6. tolerate progressive activity
7. verbalize realistic expectations for
progressive activity
8. verbalize understanding of condition
and adhere to self-care program