7 Myocardial Infarction (Heart Attack) Nursing Care Plans

By
Matt Vera, BSN, R.N.
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7 Myocardial Infarction (Heart Attack) Nursing Care Plans
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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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  1. Acute Pain
  2. Activity Intolerance
  3. Fear/Anxiety
  4. Risk for Decreased Cardiac Output
  5. Risk for Ineffective Tissue Perfusion
  6. Risk for Excess Fluid Volume
  7. Deficient Knowledge

1. Acute Pain

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Acute Pain

Nursing Diagnosis

  • Acute Pain

May be related to

  • Tissue ischemia (coronary artery occlusion)

Possibly evidenced by

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  • 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: 
  • Antianginals: nitroglycerin (Nitro-Bid, Nitrostat, Nitro-Dur), isosorbide dinitrate (Isordil), mononitrate (Imdur)
 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.
  • Beta-blockers: atenolol (Tenormin), pindolol(Visken), propranolol (Inderal), nadolol (Corgard), metoprolol (Lopressor)
 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.
  • Analgesics: morphine, meperidine (Demerol)
 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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1. Acute Pain

Other Possible Nursing Care Plans

Here are other nursing diagnoses you can use to make nursing care plans for myocardial infarction:

  1. Activity intolerance —imbalance between myocardial oxygen supply/demand.
  2. Grieving, anticipatory—perceived loss of general well-being, required changes in lifestyle, confronting mortality.
  3. Decisional Conflict (treatment)—multiple/divergent sources of information, perceived threat to value system, support system deficit.
  4. Family Processes, interrupted—situational transition and crisis.
  5. Home Management, impaired—altered ability to perform tasks, inadequate support systems, reluctance to request assistance.

See Also

You may also like the following posts and care plans:

Cardiac Care Plans

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Nursing care plans about the different diseases of the cardiovascular system:

Matt Vera, BSN, R.N.
Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.

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