MYOCARDIAL INFARCTION

 

Acute myocardial infarction is a destructive process that produces irreversible tissue damage to regions of the heart muscle. It is caused by profound and sustained ischemia related to atherosclerotic narrowing of the coronary artery, spasm of the artery, thrombus formation, or any combination of these. The care plans focuses on the acute phase during hospitalization and after this patient is discharged or is not in an acute phase to prevent and treat complications and to provide emotional support and education.

 

 

NURSING INTERVENTIONS:

 

      Give psychological support to the patient and his/her family to get confidence and cooperation for better further recovering.

      Pipe a vein and start an IV infusion.

      Check the IV infusion

      Maintain a quiet, relaxed atmosphere.

      The patient must be in complete rest or maintain bed rest at least during periods of pain to reduce workload of the heart.

      Position patient comfortable preferably in Fowler's position which allows for full lung expansion by lowering the diaphragm.

      Monitor blood pressure every 1 or 2 hours or as prescribed.

      Evaluate pulse pressure for pulsus paradoxus alternants.

      Monitor temperature every 4 hours or as indicated.

      Record and document an EKG rhythm strip every 4 hours.

      Evaluate respiratory rate and breath sounds every 2 or 4 hours.

      Be alert for changes in level of consciousness, restlessness or confusion, admission-update-discharge.

      Administer medications prescribed by the doctor on time: Sedatives (to relax the patient and in this form he/she needs less oxygen), analgesics, diuretics, digitalics, beta blockers, and any other prescribed.

      Observe the patient carefully.

      Write all the observations on the patient's chart.

      Assess for changes in BP.

      Auscultate lungs for crackles.

      Assess respirations for dyspnea and tachypnea.

      Assess for restlessness, fatigue, and change in mental status.

      Assess level of fear. Note all signs and symptoms especially nonverbal communication.

      Allow patient to verbalze fears of dying. Reassure patients that most deaths occur prior to reaching hospital.

      Establish rest periods between cares and procedures to help patient relax and regain emotional balance.

      Provide diversional materials: Newspapers, magazines, music, and television, which can be relaxing and prevent feeling of isolation in private rooms.

      Instruct patient not to hold breath while exercising or moving about in bed.

      Provide light meals (progress to liquids to regular diets as appropriate)

      Maintain progression of activity as ordered by physician.

      Provide emotional support when increasing activity to reduce possible anxiety about "overexertion" of heart.

      Weight and measure diuresis daily to assess the evolution of edemas and renal function.

      Check the accomplishment of the adequate hyposodic diet.

      Control the quantity of liquids and food administered to the patient as well as his/her urine and feces.

      Assess knowledge of acute MI: Causes, treatment, early recovery process. Provide all necessary information about risk factors, recovery time in hospital (7 to 10 days), expected return to prior life -style ( 2 to 3 months)