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Mr. Jack Belfield, OBJECTIVE, SUBJECTIVE - Coggle Diagram

- - - - Anxiety Reduced / Managed
      - Chest pain controlled
      - Relieved Pain
      - NURSING INTERVENTIONS
        
        Provide patient information honestly - Giving a myocardial infarction patient accurate information is essential for making well-informed decisions, fostering trust, controlling expectations, promoting treatment compliance, providing psychological support, upholding legal and ethical duties, and enhancing the patient's overall quality of life. Transparent communication allows patients to actively participate in their care and make decisions to improve their health. (Ziebland et al., 2014)
        
        Administer antidysrhythmic medication as PRN with onset angina - Nitroglycerin is still the first choice to treat acute myocardial infarction and angina pectoris. By producing nitric oxide, which induces vasodilation and improves blood flow to the myocardial, nitroglycerin has beneficial effects. However, nitroglycerin tolerance is brought on by continual administration, which restricts the drug's use. (Ferreira and Mochly-Rosen, 2012)
        
        Assess capillary refill, skin temperature and color - Color of skin to measure perfusion. Check for pallor or cyanosis on the hands, lips, and cheeks. A bluish darkening of the skin, lips, and nail beds, known as cyanosis, is a sign of reduced oxygenation and perfusion. Pallor is the loss of pigmentation, or paleness, in the skin or mucous membranes caused by decreased oxygenation, blood flow, or red blood cell count. Pink is the appropriate hue for patients with light skin tones. Check for pallor on the inner aspect of the lower lip, palms, or conjunctiva in people with darker skin tones. (Rn), Ernstmeyer and Christman, 2021)
        
        Encourage Bed Rest & changing positions frequently - After a myocardial infarction (MI), bed rest and immobility may cause functional impairment that may not disappear after hospitalization. Early mobilization is linked to positive functional and clinical results in critical care, medical, and surgical settings. - (Munir, Fromowitz and Goldfarb, 2020)
        
        Assess Lung sounds every shift - It can predict cardiac failure in acute myocardial infarction patients. (Cabral et al., 2020) Left heart failure is first indicated by the third heart sound, linked to severe mitral regurgitation, low ejection fraction, restrictive diastolic filling, functionally severe heart failure, and cardiovascular mortality. (Mori et al., 2020)
        
        Administer O2 with Medication therapy - It may increase ischemic cardiac tissue oxygenation and reduce pain, infarct size, morbidity, and mortality. (Cabello et al., 2016)
        
        Monitor constant ECG's rate and rhythm - New arrhythmias may follow acute myocardial infarction. Myocardial infarction can cause ventricular tachyarrhythmias or atrial fibrillation. Frequent, prolonged electrocardiogram (ECG) monitoring can avert dire results from cardiac arrhythmias. (Kwun et al., 2021)
        
        Monitor Vital signs - In escalation procedures, vital signs are checked at intervals of many hours, typically starting with a monitoring frequency of every 12 hours. This practice, however, may allow for undetected deterioration to occur between readings. The use of continuous monitoring can identify these deteriorations.(Loft et al., 2022)
        
        Assess BP comparing both arms and obtain lying & standing - It shows that the more significant the difference in blood pressure between arms, the greater the cardiovascular risk; hence, measuring both arms is essential to identify high-risk patients. (McManus, 2021)
        
        Monitor O2 saturation - MI causes ischemia and cellular death in the myocardium due to mismatched blood oxygen supply and demand. Therefore, MI patients are regularly treated with supplementary oxygen to enhance oxygen supply to the ischemic myocardium. (Yu et al., 2020)
        
        Check temperature - Exposure to cold increased the chance of acute MI, and exposure to heat increased the risk of dying following an acute MI. (Madrigano et al., 2013)
        
        Check heart rate - Heart rate monitoring is crucial to assess cardiac function, detect arrythmias, monitor response to medications, identify ischemia, and monitor for other complications. (Weng et al., 2021)
        
        Input and output monitoring - Patients with heart failure frequently experience fluid overload or pulmonary/vascular congestion, which is linked to unfavorable outcomes. It has long been believed that keeping track of patients' fluid intake and output (I&O) is crucial to determining their hydration level. There is a known frequency of incongruence between I&O results and clinical indications and symptoms in clinical practice. We hypothesize that this discrepancy could result from either an imprecise or incomplete collection of fluid I&O or patients' and their families' insufficient understanding of the significance of I&O documentation. (Yang et al., 2019)
        
        Check daily weights - Weight monitoring is a crucial tool for determining liquid retention, thus health care practitioners should emphasize its importance in helping CHF patients cultivate WM attitudes through professional psychological guidance. (Lu et al., 2016)
        
        Provide Laxative PRN One of the most prevalent digestive problems, constipation, is linked to lifestyle variables like stress and irregular eating patterns. Therefore, constipation and CVD are strongly related. Numerous constipation reasons, including stress and aging, are also CVD risk factors. (Kubota, Iso and Tamakoshi, 2016)
        
        Monitor for stools - There is a link between constipation and cardiovascular problems. Constipation can alter the gut flora, leading to cardiovascular events, high blood pressure, and atherosclerosis. Age-related increases in constipation are standard, as are cardiovascular risk factors. Furthermore, strain at the stools raises blood pressure, which can result in cardiovascular problems such as aortic dissection, arrhythmia, acute coronary disease, and congestive heart failure. Several circumstances can cause the weakening of bowel movement and the hardness of feces. Patients with cardiovascular illness are often prescribed diuretics, which can induce constipation, and are advised to limit their water intake, particularly if their condition is exacerbated by heart failure. (Ishiyama et al., 2019)
        
        Monitor Blood results
        
        PTT - Prothrombin time (PTT), the international normalized ratio (INR), and activated partial thromboplastin time (APTT) are standard coagulation screening tests that are crucial components of essential laboratory examinations. One measure of intrinsic coagulation pathway activity is the APTT, and a short APTT is associated with higher thrombin production and a higher risk of thrombosis. In addition to helping manage acute coronary syndrome, APTT may be a helpful marker for screening individuals more likely to present with acute coronary syndrome. (Sotoudeh Anvari et al., 2018)
        
        H&H - After a myocardial infarction, it is critical to monitor hemoglobin (Hb) and hematocrit (Hct) levels in order to identify anemia, measure blood loss, assess oxygen-carrying capacity, verify hydration status, direct transfusions if needed, monitor changes in plasma volume, and evaluate kidney function. Healthcare providers can better control difficulties, optimize oxygen delivery, and guarantee their patients' general well-being by monitoring these metrics. (Alirhayim et al., 2012)
        
        Routine bloods: CBC and U&E - One of the most popular blood tests doctors order is the complete blood count (CBC), which assesses the overall quantity and quality of the blood's cell components. Numerous recent studies have revealed that CBC components may predict the risk of metabolic syndrome, arteriosclerosis, type 2 diabetes (T2DM), cancer, and cardiovascular disease (CVD). In order to evaluate kidney function, identify imbalances that may affect cardiac health, direct fluid, and medication management, and avoid consequences from electrolyte disturbances, patients with myocardial infarction must have regular electrolyte monitoring, including urea and electrolytes (U&E). (Seo and Lee, 2022)
        
        Platelet count - Platelet count monitoring is crucial in myocardial infarction patients to assess blood clotting risk, guide antiplatelet therapy, detect underlying health conditions affecting platelet count, and monitor potential complications. It helps healthcare providers determine the patient's risk of further clotting, optimize antiplatelet medication dosage, and detect thrombocytosis or thrombocytopenia. Abnormal platelet counts can indicate high or low platelet counts, affecting the ability to form clots. Monitoring platelet count also helps detect disseminated intravascular coagulation (DIC) and other clotting disorders early, enabling timely intervention. It plays a vital role in managing and preventing further cardiac events. (Amraotkar et al., 2016)
        
        Troponin - When myocytes are damaged, cardiac troponins are released into the circulation. Since serum troponin is a highly sensitive marker of myocardial damage, it is crucial to diagnose MI. High-sensitivity troponin assays improve myocardial infarction diagnosis and speed. MI must be detected early for anti-thrombotic therapy to reduce myocardial damage and preserve heart function. In acute coronary syndrome, troponin is diagnostic and prognostic. If troponin levels rise without ACS, they should be investigated for a non-thrombotic reason and treated accordingly. (Daubert and Jeremias, 2010)
        
        CRP - (C -reactive protein) The hepatocytes release acute phase protein (RP) in response to an inflammatory stimulation. Besides being an indicator of inflammation, CRP promotes inflammation by inducing the production of inflammatory cells and adhesion molecules. Although CRP has been demonstrated to be elevated in individuals with unstable angina, its lack of sensitivity and specificity precludes its utility as a diagnostic tool. High CRP has also been linked to unfavorable outcomes as a prognostic indication. (MYTHILI and MALATHI, 2015)
        
        Lipid Profile - Myocardial infarction patients must have their lipid profile checked to determine their cholesterol levels, including "bad" LDL cholesterol. High LDL cholesterol increases the risk of heart disease, including myocardial infarction. Healthcare providers use the lipid profile to assess cardiovascular risk and recommend lifestyle changes and medications to decrease cholesterol and prevent cardiac events. All patients admitted for AMI must have a periodic lipid profile to understand the trend, start lifestyle changes to reach target lipid levels, and forecast cholesterol-lowering medication. (Kumar et al., 2019)
        
        Renal Profile - During the first 10–12 years after a MI, renal function is a powerful and independent long-term prognostic factor. Comparing estimated GFR to se-creatinine yields a more accurate assessment of renal function and has greater predictive power. Due to decreased blood flow, myocardial infarction can put strain on the kidneys, perhaps resulting in renal injury. Keeping an eye on renal indicators like blood urea nitrogen and creatinine enables medical professionals to identify any kidney impairment early. Regular renal profile tests are crucial for effectively managing patients with myocardial infarction, since proper kidney function is critical for medication metabolism, fluid balance, and overall patient well-being. (Kümler et al., 2011)
        
        PREVENTION & MANAGEMENT
        
        SMOKING CESSATION - The most cost-effective secondary MI prevention intervention. As a pro-thrombotic factor, smoking is linked to atherosclerosis and myocardial infarction. - (Ojha and Dhamoon, 2021)
        
        DIET, ALCOHOL AND WEIGHT CONTROL : A low-fat, whole-grain, vegetable, fruit, and fish diet is cardioprotective. (Ojha and Dhamoon, 2021)
        
        TREATMENT
        
        Nitrates. - Intravenous nitrates are more effective than sublingual nitrates with regard to symptom relief and regression of ST depression :silhouette:Ojha and Dhamoon (2021)
        
        Beta Blockers This set of medications lowers heart rate, blood pressure, and contractility to minimize myocardial oxygen use. They diminish catecholamine effects by blocking beta receptors, including the heart. Beta-blockers should not treat suspected coronary vasospasm.:silhouette:Ojha and Dhamoon (2021)
        
        Relief of Pain, Breathlessness, & Anxiety : The chest pain due to myocardial infarction is associated with sympathetic arousal, which causes vasoconstriction and increased workload for the ischemic heart. Intravenous opioids (e.g., morphine) are the analgesics most commonly used for pain relief Ojha and Dhamoon (2021)
        
        Platelet Inhibition Aspirin inhibits thromboxane A2 production throughout the lifespan of the platelet :silhouette:Ojha and Dhamoon (2021)
        
        Anticoagulants Anticoagulants only treat left ventricular thrombus or comorbidities such as atrial fibrillation or deep vein thrombosis. A cardiologist customizes co-prescriptions of antiplatelets and anticoagulants, which increase bleeding risk. :silhouette:(Isted, Williams and Oakeshott, 2018)
        
        Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers - If intolerant, up-titrate an ACEI (ramipril) or ARB (candesartan) to a maximum tolerated dose while monitoring renal function. All patients with systolic dysfunction (LV ejection fraction <40%) should have it forever. :silhouette: (Isted, Williams and Oakeshott, 2018)
      - Maintenance or attainment of adequate tissue perfusion
      - Absence of respiratory dysfunction
      - Achievement of activity level sufficient for basic self-care
      - Prevention of myocardial damage
      - Heart rate/ rhythm sufficient to sustain adequate cardiac output
      - PLan in place to meet needs after discharge
- - - - Excessive Alcohol consumption - too much alcohol affects blood pressure, heart, and liver and causes dehydration. The liver plays a major role in the metabolic process, too much alcohol in the liver damages the liver and leads to serious illness such as hepatitis, liver failure, and steatosis. Health Service Executive (2023)
      - Smoking - cigarettes affect the lungs, cause cancer, tuberculosis and addiction. HSE (2023) Smoking reduces life expectancy, carbon dioxide replaces oxygen in the blood, pressure on the heart and increases heart rate. Smith J.(2023)
      - Poor diet - Lack of fibres, vegetables and fruit intake in the diet, obesity. Salt causes water to be deposited into blood vessels, heart needs more pressure to pump blood and the pressure damages and stretches the heart. mediterranean diet is highly recommended based on the quality of different nutrients that it provides for the body. More fruits, vegetables, legumes, healthy fats and grains to be included because they are rich in fibers. It prevents the risk of cardiovascular disease and increases life expectancy. Tosti V. et al. (2018 )
      - Lack of Physical activity (sedentary lifestyle) - Physical activities strengthens muscles and allows heart to pump blood into lungs and throughout the body resulting in more flow into muscles and increase of oxygen, it allow also the blood vessels to widen.
    - - BMI - Adiposity -body mass index is the estimated body fat, stop in growth in adults causes increase in body fat and body mass due to less physical activity, recommended between 18-24. Modified factors contribute to an increase in BMI. Emel A.(2019)
      - Blood pressure (Hypertension) - blood pressure performs a principal role in the heart. Hypertension damages arteries by putting pressure on the heart resulting in cardiovascular disease. Blood pressure can be elevated because of salt consumption in a way that sodium retains excess water in the body causing the blood volume to increase and putting pressure on the heart to pump, arteries become stiff and not able to expand neither contract. Kidney plays a role by regulating the fluid balance and excess salt will not be excreted by the kidney if too much.Titze J. , Luft C. F. (2017)
      - Elevated level of cholesterol - Bad cholesterol cause fatty deposits to build up in blood vessels,
        process food and take aways are high in saturated and trans fats,
        sugar, salt for taste and conservation. They lack essentials nutrients and minerals.
      - Execessive salt, sodium, and potassium - Excessive salt, sodium and potassium intake raises hypertension,
        narrowing of blood vessels causing vasoconstriction, not enough oxygen in the blood and there is pressure on the heart to pump blood and increase of hear rate.
    - - Psychosocial Stress - stress hormone adrenaline causes the vessels to contract, heart to beat fast and put the body in flight and fight mode because of the stressor caused by anxiety, depression, loneliness resulting in hypertension. S.McEwen B. and Tucker P. ( 2011 )
      - Education - level of education may help prevent and avoid the risk factors of cardiovascular disease. People need to be empowered with knowledge, be aware and educated about the early signs, risk factors and how to prevent and not to be at risk of cardiovascular disease. Through education, people will be able to know the early signs and seek medical intervention to promote health, manage stress, have a good diet, be physically active and live a healthy lifestyle. Decandia D. (2022 )
      - Depression / loneliness - Many negative feelings, thoughts take place in isolation
- - - - Right Atrium
      - Left Atrium
    - - Right Ventricle
      - Left Ventricle
    - - Right side - deoxygenated blood
      - Left side - oxygenated blood
    - - Epicardium (outer connective tissue layer)
      - Myocardium (middle muscular layer)
      - Endocardium (inner lining)
    - - Semi - lunar
        
        Aortic
        
        Pulmonic
      - Atrioventricular
        
        Tricuspid
        
        Mitral