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Myocardial infarction (MI) or acute myocardial infarction (AMI) commonly known as heart attack happens when there is marked reduction or loss of blood flow through one or more of the coronary arteries, resulting in cardiac muscle ischemia and necrosis.
Myocardial infarction is a part of a broader category of disease known as acute coronary syndrome, results from prolonged myocardial ischemia due to reduced blood flow through one of the coronary arteries.
In cardiovascular diseases, the leading cause of death in the United States and western Europe usually results from the cardiac damage or complications of MI. Mortality is high when treatment is delayed and almost one-half of sudden deaths due to an MI occur before hospitalization, within one hour of the onset of symptoms. The prognosis improves if vigorous treatment begins immediately.
Nursing Care Plans
The goals of treatment for myocardial infarction are to relieve chest pain, stabilize heart rhythm, reduce cardiac workload, revascularize the coronary artery, and preserve myocardial tissue.
Here are seven (7) nursing diagnosis for myocardial infarction (heart attack) nursing care plans (NCP):
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- Acute Pain
- Activity Intolerance
- Fear/Anxiety
- Risk for Decreased Cardiac Output
- Risk for Ineffective Tissue Perfusion
- Risk for Excess Fluid Volume
- Deficient Knowledge
- Other possible nursing care plans
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Acute Pain
Nursing Diagnosis
May be related to
- Tissue ischemia (coronary artery occlusion)
Possibly evidenced by
- Reports of chest pain with/without radiation
- Facial grimacing
- Restlessness, changes in level of consciousness
- Changes in pulse, BP
Desired Outcomes
- Verbalize relief/control of chest pain within appropriate time frame for administered medications.
- Display reduced tension, relaxed manner, ease of movement.
- Demonstrate use of relaxation techniques.
| Nursing Interventions | Rationale |
|---|---|
| Monitor and document characteristic of pain, noting verbal reports, nonverbal cues (moaning, crying, grimacing, restlessness, diaphoresis, clutching of chest) and BP or heart rate changes. | Variation of appearance and behavior of patients in pain may present a challenge in assessment. Most patients with an acute MI appear ill, distracted, and focused on pain. Verbal history and deeper investigation of precipitating factors should be postponed until pain is relieved. Respirations may be increased as a result of pain and associated anxiety; release of stress-induced catecholamines increases heart rate and BP. |
| Obtain full description of pain from patient including location, intensity (using scale of 0–10), duration, characteristics (dull, crushing, described as “like an elephant in my chest”), and radiation. Assist patient to quantify pain by comparing it to other experiences. | Pain is a subjective experience and must be described by patient. Provides baseline for comparison to aid in determining effectiveness of therapy, resolution and progression of problem. |
| Review history of previous angina, anginal equivalent, or MI pain. Discuss family history if pertinent. | Delay in reporting pain hinders pain relief and may require increased dosage of medication to achieve relief. In addition, severe pain may induce shock by stimulating the sympathetic nervous system, thereby creating further damage and interfering with diagnostics and relief of pain. |
| Instruct patient to report pain immediately. Provide quiet environment, calm activities, and comfort measures. Approach patient calmly and confidently. | Decreases external stimuli, which may aggravate anxiety and cardiac strain, limit coping abilities and adjustment to current situation. |
| Instruct patient to do relaxation techniques: deep and slow breathing, distraction behaviors, visualization, guided imagery. Assist as needed. | Helpful in decreasing perception and response to pain. Provides a sense of having some control over the situation, increase in positive attitude. |
| Check vital signs before and after narcotic medication. | Hypotension and respiratory depression can occur as a result of narcotic administration. These problems may increase myocardial damage in presence of ventricular insufficiency. |
| Administer supplemental oxygen by means of nasal cannula or face mask, as indicated. | Increases amount of oxygen available for myocardial uptake and thereby may relieve discomfort associated with tissue ischemia. |
| Administer medications as indicated: | |
| Nitrates are useful for pain control by coronary vasodilating effects, which increase coronary blood flow and myocardial perfusion. Peripheral vasodilation effects reduce the volume of blood returning to the heart (preload), thereby decreasing myocardial workload and oxygen demand. |
| Important second-line agents for pain control through effect of blocking sympathetic stimulation, thereby reducing heart rate, systolic BP, and myocardial oxygen demand.May be given alone or with nitrates. Note: beta-blockers may be contraindicated if myocardial contractility is severely impaired, because negative inotropic properties can further reduce contractility. |
| Although intravenous (IV) morphine is the usual drug of choice, other injectable narcotics may be used in acute-phase and/or recurrent chest pain unrelieved by nitroglycerin to reduce severe pain, provide sedation, and decrease myocardial workload. IM injections should be avoided, if possible, because they can alter the CPK diagnostic indicator and are not well absorbed in underperfused tissue. |
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Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
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- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use. - Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively. - NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales. - Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates. - Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing. - Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans. - Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you. - Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023. - All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
See also
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch. - Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans for cardiovascular system disorders:
- Angina Pectoris (Coronary Artery Disease) | 4 Care Plans
- Cardiac Arrhythmia (Digitalis Toxicity) | 3 Care Plans
- Cardiac Catheterization | 4 Care Plans
- Cardiogenic Shock | 5 Care Plans
- Congenital Heart Disease | 5 Care Plans
- Heart Failure | 18 Care Plans
- Hypertension | 6 Care Plans
- Hypovolemic Shock | 4 Care Plans
- Myocardial Infarction | 7 Care Plans
- Pacemaker Therapy | 7 Care Plans
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Thanks.. it is helpful
Very educative and helpful! Thank you!
I cannot thank you enough…
I am very gratefull to the matt vera for such a great help for us.
Robin
Thanks a lot..