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)