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Myocardial Infarction, References: Ignatavicius, D., Workman, L., Rebar,…
Myocardial Infarction
Patient Education
Educate patient on maintaining a exercise routine and remaining physically active
Consume a diet low in fats and sodium
Smoking cessation
Educate client on s/s of infection
avoid straining, strenuous exercise, or emotional stress when possible
Educate patients on meds they are taking (nitroglycerin is sublingual, take max of 3 tabs, wait 5 min between each)
teach patient when to seek medical assistance
tell them the importance of cardiac rehab
teach the patient about the different medications they are taking, and what are some risk factors for MIs that they could modify
Pathophysiology
An abrupt interruption of oxygen to the heart muscle causes ischemia
Risk factors:
atherosclerosis, male, sedentary lifestyle, hypertension, tobacco, hyperlipidemia, obesity, alcohol consumption, metabolic disorders, stress and older clients
myocardial tissue is abruptly and severely deprived of oxygen, leading to ischemia
ischemia then leads to injury and necrosis of myocardial tissue if blood flow is not restored
2 types
NSTEMI
causes: vasospasm, spontaneous dissection, sluggish blood flow due to narrowing of coronary artery
STEMI
ST elevation caused by rupture of fibrous atherosclerotic plaque leading to platelet aggregation and thrombus formation at rupture site
Assessment
s/s
anxiety, sense of impending doom, chest pain (that radiates, described as crushing, aching pressure), nausea, dizziness, females will have atypical angina (between the shoulders, ache in the jaw, or sensation of choking with exertion)
Physical assessment
pallor, cool, clammy skin
tachycardia and heart palpitations
tachypnea and SOB
diaphoresis, vomiting, and decreased LOC
pain relieved only by opioids, lasting 30 minutes or more, occurring without cause often in the morning
labs
myoglobin, creatine kinase-MB, Troponin
Diagnostics
EKG, stress test (exercise electrocardiography), thallium scan, cardiac catheterization (coronary angiogram), CMR (contrast enhanced cardiovascular magnetic resonance,
Monitor VS, ECG, and telemetry very carefully
Interventions
Have cholesterol and blood pressure checked regularly
Meds
vasodilators (nitroglycerin) - prevents coronary artery vasospasm and reduced preload and afterload, decreasing myocardial oxygen demand
analgesics (morphine) - treatment of moderate to severe pain
assess chest pain every 5-15 mins, watch for respiratory depression, monitor VS, asses for n/v
Beta blockers (metoprolol) - decrease imbalance between myocardial oxygen supply and demand by reducing afterload and slowing HR
thrombolytic agents (alteplase) - break up blood clots
antiplatelet agents (plavix, aspirin) - prevent platelets from forming together
anticoagulants (heparin and lovenox) - prevent clots from becoming larger or forming
glycoprotien IIB/IIIA inhibitors (eptifibatide) - prevent binding of fibrinogen to platelets
consult cardiac and nutrition
procedures
Percutaneous translumial coronary angioplasty
reopen clotted coronary artery and restore perfusion, goal is to perform this within 90 minutes of acute STEMI dx
bypass graft (CABG)
References:
Ignatavicius, D., Workman, L., Rebar, C., & Heimgartner, N. (2021). Medical-surgical nursing:
Patient-centered collaborative care.
Evolve
, (10th ed.). ISBN: 978-0-323-61242-5
Holman, H. C., Williams, D., Johnson, J., Ball, B. S., Wheless, L., Leehy, P., & Lemon, T. (2019). RN Adult medical surgical nursing: Review module. Assessment Technologies Institute