7 Myocardial Infarction (Heart Attack) Nursing Care Plans

February 27, 2014

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):

Acute Pain

Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with anticipated or predictable end and a duration of <6 months.

Nursing Diagnosis

Pain, acute

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:
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.

Activity Intolerance

Activity Intolerance: Insufficient physiologic or physiological energy to endure or complete required or desired activity.

Nursing Diagnosis

Activity intolerance

May be related to

Imbalance between myocardial oxygen supply and demand
Presence of ischemic/necrotic myocardial tissues
Cardiac depressant effects of certain drugs (beta-blockers, antiarrhythmics)

Possibly evidenced by

Alterations in heart rate and BP with activity
Development of dysrhythmias
Changes in skin color/moisture
Exertional angina
Generalized weakness

Desired Outcomes

Demonstrate measurable/progressive increase in tolerance for activity with heart rate/rhythm and BP within patient’s normal limits and skin warm, pink, dry.
Report absence of angina with activity.

Nursing Interventions	Rationale
Document heart rate and rhythm and changes in BP before, during, and after activity. Correlate with reports of chest pain or shortness of breath.	Trends determine patient’s response to activity and may indicate myocardial oxygen deprivation that may require decrease in activity level and/or return to bedrest, changes in medication regimen, or use of supplemental oxygen.
Encourage rest initially. Thereafter, limit activity on basis of pain and/or adverse cardiac response. Provide nonstress diversional activities.	Reduces myocardial workload and oxygen consumption, reducing risk of complications.
Instruct patient to avoid increasing abdominal pressure (straining during defecation).	Activities that require holding the breath and bearing down (Valsalva maneuver) can result in bradycardia (temporarily reduced cardiac output) and rebound tachycardia with elevated BP.
Explain pattern of graded increase of activity level: getting up to commode or sitting in chair, progressive ambulation, and resting after meals.	Progressive activity provides a controlled demand on the heart, increasing strength and preventing overexertion.
Review signs and symptoms reflecting intolerance of present activity level or requiring notification of nurse or physician.	Palpitations, pulse irregularities, development of chest pain, or dyspnea may indicate need for changes in exercise regimen or medication.
Refer to cardiac rehabilitation program.	Provides continued support and/or additional supervision and participation in recovery and wellness process.

Fear/Anxiety

Anxiety: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response.
Fear: Response to perceived threat that is consciously recognized as a danger.

May be related to

Threat to or change in health and socioeconomic status
Threat of loss/death
Unconscious conflict about essential values, beliefs, and goals of life
Interpersonal transmission/contagion

Possibly evidenced by

Fearful attitude
Apprehension, increased tension, restlessness, facial tension
Uncertainty, feelings of inadequacy
Somatic complaints/sympathetic stimulation
Focus on self, expressions of concern about current and future events
Fight (e.g., belligerent attitude) or flight behavior

Desired Outcomes

Recognize feelings.
Identify causes, contributing factors.
Verbalize reduction of anxiety/fear.
Demonstrate positive problem-solving skills.
Identify/use resources appropriately.

Nursing Interventions	Rationale
Identify and acknowledge patient’s perception of threat and situation. Encourage expressions of, and do not deny feelings of, anger, grief, sadness, fear.	Coping with the pain and emotional trauma of an MI is difficult. Patient may fear death and/or be anxious about immediate environment. Ongoing anxiety (related to concerns about impact of heart attack on future lifestyle, matters left unattended or unresolved, and effects of illness on family) may be present in varying degrees for some time and may be manifested by symptoms of depression.
Note presence of hostility, withdrawal, and/or denial (inappropriate affect or refusal to comply with medical regimen).	Research into survival rates between type A and type B individuals and the impact of denial has been ambiguous; however, studies show some correlation between degree or expression of anger or hostility and an increased risk for MI.
Maintain confident manner (without false reassurance).	Patient and SO can be affected by the anxiety/uneasiness displayed by health team members. Honest explanations can alleviate anxiety.
Observe for verbal and nonverbal signs of anxiety (restlessness, changes in vital signs), and stay with patient. Intervene if patient displays destructive behavior.	Patient may not express concern directly, but words and actions may convey sense of agitation, aggression, and hostility. Intervention can help patient regain control of own behavior.
Accept but do not reinforce use of denial. Avoid confrontations.	Denial can be beneficial in decreasing anxiety but can postpone dealing with the reality of the current situation. Confrontation can promote anger and increase use of denial, reducing cooperation and possibly impeding recovery.
Orient patient and/or SO to routine procedures and expected activities. Promote participation when possible.	Predictability and information can decrease anxiety for patient.
Answer all questions factually. Provide consistent information; repeat as indicated.	Accurate information about the situation reduces fear, strengthens nurse-patient relationship, and assists patient and SO to deal realistically with situation. Attention span may be short, and repetition of information helps with retention.
Encourage patient and SO to communicate with one another, sharing questions and concerns.	Sharing information elicits support and comfort and can relieve tension of unexpressed worries.
Provide privacy for patient and SO.	Allows needed time for personal expression of feelings; may enhance mutual support and promote more adaptive behaviors.
Provide rest periods and/or uninterrupted sleep time, quiet surroundings, with patient controlling type, amount of external stimuli.	Conserves energy and enhances coping abilities.
Support normality of grieving process, including time necessary for resolution.	Can provide reassurance that feelings are normal response to situation and/or perceived changes.
Encourage independence, self-care, and decision making within accepted treatment plan.	Increased independence from staff promotes self-confidence and reduces feelings of abandonment that can accompany transfer from coronary unit and/or discharge from hospital.
Encourage discussion about postdischarge expectations.	Helps patient and/or SO identify realistic goals, thereby reducing risk of discouragement in face of the reality of limitations of condition and/or pace of recuperation.
Administer anti anxiety and hypnotics as indicated: alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), flurazepam (Dalmane).	Promotes relaxation and rest and reduces feelings of anxiety.

Risk for Decreased Cardiac Output

Risk for Decreased Cardiac Output: At risk for inadequate blood pumped by the heart to meet metabolic demands of the body.

Risk factors may include

Changes in rate, rhythm, electrical conduction
Reduced preload/increased SVR
Infarcted/dyskinetic muscle, structural defects, e.g., ventricular aneurysm, septal defects

Possibly evidenced by

Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.

Desired Outcomes

Maintain hemodynamic stability, e.g., BP, cardiac output within normal range, adequate urinary output, decreased frequency/absence of dysrhythmias.
Report decreased episodes of dyspnea, angina.
Demonstrate an increase in activity tolerance.

Nursing Interventions	Rationale
Auscultate BP. Compare both arms and obtain lying, sitting, and standing pressures when able.	Hypotension may occur related to ventricular dysfunction, hypoperfusion of the myocardium, and vagal stimulation. However, hypertension is also a common phenomenon, possibly related to pain, anxiety, catecholamine release, and/or preexisting vascular problems. Orthostatic (postural) hypotension may be associated with complications of infarct (heart failure).
Evaluate quality of pulses on both pulse points.	Decreased cardiac output results in diminished weak or thready pulses. Irregularities suggest dysrhythmias, which may require further evaluation and monitoring.
Auscultate heart sounds:
Note development of S3	S3 is usually associated with HF, but it may also be noted with the mitral insufficiency (regurgitation) and left ventricular overload that can accompany severe infarction.
S4	S4 may be associated with myocardial ischemia, ventricular stiffening, and pulmonary or systemic hypertension.
Presence of murmurs or friction rubs.	Indicates disturbances of normal blood flow within the heart: incompetent valve, septal defect, or vibration of papillary muscle and/or chordae tendineae (complication of MI). Presence of rub with an infarction is also associated with inflammation: pericardial effusion and pericarditis.
Auscultate breath sounds.	Crackles reflecting pulmonary congestion may develop because of depressed myocardial function.
Monitor heart rate and rhythm. Document dysrhythmias via telemetry.	Heart rate and rhythm respond to medication, activity, and developing complications. Dysrhythmias (especially premature ventricular contractions or progressive heart blocks) can compromise cardiac function or increase ischemic damage. Acute or chronic atrial flutter may be seen with coronary artery or valvular involvement and may or may not be pathological.
Note response to activity and promote rest appropriately.	Overexertion increases oxygen consumption and demand and can compromise myocardial function.
Provide small and easily digested meals. Limit caffeine intake and caffeine-containing products.	Large meals may increase myocardial workload and cause vagal stimulation, resulting in bradycardia or ectopic beats. Caffeine is a direct cardiac stimulant that can increase heart rate. Note: New guidelines suggest no need to restrict caffeine in regular coffee drinkers.
Have emergency equipment and/or medications available.	Sudden coronary occlusion, lethal dysrhythmias, extension of infarct, and unrelenting pain are situations that may precipitate cardiac arrest, requiring immediate life-saving therapies and/or transfer to CCU.
Administer supplemental oxygen, as indicated.	Increases amount of oxygen available for myocardial uptake, reducing ischemia and resultant cellular irritation and/or dysrhythmias.
Measure cardiac output and other functional parameters as appropriate.	Cardiac index, preload, afterload, contractility, and cardiac work can be measured noninvasively with thoracic electrical bioimpedance (TEB) technique. Useful in evaluating response to therapeutic interventions and identifying need for more aggressive and/or emergency care.
Maintain IV or Hep-Lock access as indicated.	Patent line is important for administration of emergency drugs in presence of persistent lethal dysrhythmias or chest pain.
Review serial ECGs.	Provides information regarding progression or resolution of infarction, status of ventricular function, electrolyte balance, and effects of drug therapies.
Review chest x-ray.	May reflect pulmonary edema related to ventricular dysfunction.
Monitor laboratory data: cardiac enzymes, ABGs, electrolytes.	Enzymes monitor resolution or extension of infarction. Presence of hypoxia indicates need for supplemental oxygen. Electrolyte imbalances: hypokalemia or hyperkalemia, adversely affects cardiac rhythm and contractility.
Administer antidysrhythmic drugs as indicated.	Dysrhythmias are usually treated symptomatically, except for PVCs, which are often treated prophylactically. Early inclusion of ACE inhibitor therapy (especially in presence of large anterior MI, ventricular aneurysm, or HF) enhances ventricular output, increases survival, and may slow progression of HF. Note: Use of routine lidocaine is no longer recommended.
Assist with insertion and maintenance of pacemaker, when used.	Pacing may be a temporary support measure during acute phase or may be needed permanently if infarction severely damages conduction system, impairing systolic function. Evaluation is based on echocardiography or radionuclide ventriculography.

Risk for Ineffective Tissue Perfusion

Risk for Ineffective Tissue Perfusion: At risk for decreased in the oxygen resulting in the failure to nourish the tissues at the capillary level.

Nursing Diagnosis

Risk for Ineffective Tissue Perfusion

Risk factors may include

Reduction/interruption of blood flow, e.g., vasoconstriction, hypovolemia/shunting, and thromboembolic formation

Possibly evidenced by

Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.

Desired Outcomes

Demonstrate adequate perfusion as individually appropriate, e.g., skin warm and dry, peripheral pulses present/strong, vital signs within patient’s normal range, patient alert/oriented, balanced I&O, absence of edema, free of pain/discomfort.

Nursing Interventions	Rationale
Investigate sudden changes or continued alterations in mentation (changes in LOC, mentation, stupor).	Cerebral perfusion is directly related to cardiac output and is also influenced by electrolyte and/or acid-base variations, hypoxia, and systemic emboli.
Inspect for pallor, cyanosis, mottling, cool and clammy skin. Note strength of peripheral pulses.	Systemic vasoconstriction resulting from diminished cardiac output may be evidenced by decreased skin perfusion and diminished pulses.
Monitor respirations, note work of breathing.	Cardiac pump failure and/or ischemic pain may precipitate respiratory distress; however, sudden or continued dyspnea may indicate thromboembolic pulmonary complications.
Monitor intake, note changes in urine output. Record urine specific gravity as indicated.	Decreased intake or persistent nausea may result in reduced circulating volume, which negatively affects perfusion and organ function. Specific gravity measurements reflect hydration status and renal function.
Assess GI function, noting anorexia, decreased or absent bowel sounds, nausea and vomiting, abdominal distension, constipation.	Reduced blood flow to mesentery can produce GI dysfunction, e.g., loss of peristalsis. Problems may be aggravated by use of analgesics, decreased activity, and dietary changes.
Encourage active or passive leg exercises, avoidance of isometric exercises.	Enhances venous return, reduces venous stasis, and decreases risk of thrombophlebitis; however, isometric exercises can adversely affect cardiac output by increasing myocardial work and oxygen consumption.
Assess for Homans’ sign (pain in calf on dorsiflexion), erythema, edema.	Indicators of deep vein thrombosis (DVT), although DVT can be present without a positive Homans’ sign.
Instruct patient in application or periodic removal of antiembolitic hose, when used.	Limits venous stasis, improves venous return, and reduces risk of thrombophlebitis in patient who is limited in activity.
Monitor laboratory data: ABGs, BUN, creatinine, electrolytes, coagulation studies (PT, aPTT, clotting times).	Indicators of organ perfusion and function. Abnormalities in coagulation may occur as a result of therapeutic measures.
Administer medications as indicated:
Antiplatelet agents: aspirin, abciximab (ReoPro), clopidogrel (Plavix);	Reduces mortality in MI patients, and is taken daily. Aspirin also reduces coronary reocclusion after percutaneous transluminal coronary angioplasty (PTCA). ReoPro is an IV drug used as an adjunct to PTCA for prevention of acute ischemic complications.
Anticoagulants: heparin or enoxaparin (Lovenox);	Low-dose heparin is given during PTCA and may be given prophylactically in high-risk patients (e.g., atrial fibrillation, obesity, ventricular aneurysm, or history of thrombophlebitis) to reduce risk of thrombophlebitis or mural thrombus formation.
Oral anticoagulants: anisindione (Miradon), warfarin (Coumadin);	Used for prophylaxis and treatment of thromboembolic complications associated with MI.
Cimetidine (Tagamet), ranitidine (Zantac), antacids;	Reduces or neutralizes gastric acid, preventing discomfort and gastric irritation, especially in presence of reduced mucosal circulation.
Assist with reperfusion therapy:
Administer thrombolytic agents, e.g., alteplase (Activase, rt-PA), reteplase (Retavase), streptokinase (Streptase), anistreplase (Eminase), urokinase, (Abbokinase);	Thrombolytic therapy is the treatment of choice (when initiated within 6 hr) to dissolve the clot (if that is the cause of the MI) and restore perfusion of the myocardium.This procedure is used to open partially blocked coronary arteries before they become totally blocked. The mechanism includes a combination of vessel stretching and plaque compression.
Prepare for PTCA (balloon angioplasty), with or without intracoronary stents;	Intracoronary stents may be placed at the time of PTCA to provide structural support within the coronary artery and improve the odds of long-term patency.
Transfer to critical care.	More intensive monitoring and aggressive interventions are necessary to promote optimum outcome.

Risk for Excess Fluid Volume

Risk for Excess Fluid Volume: At risk for increased isotonic fluid retention.

Risk factors may include

Decreased organ perfusion (renal)
Increased sodium/water retention
Increased hydrostatic pressure or decreased plasma proteins.

Possibly evidenced by

Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.

Desired Outcomes

Maintain fluid balance as evidenced by BP within patient’s normal limits.
Be free of peripheral/venous distension and dependent edema, with lungs clear and weight stable.

Nursing Interventions	Rationale
Auscultate breath sounds for presence of crackles.	May indicate pulmonary edema secondary to cardiac decompensation.
Note JVD, development of dependent edema.	Suggests developing congestive heart failure or fluid volume excess.
Measure I&O, noting decrease in output, concentrated appearance. Calculate fluid balance.	Decreased cardiac output results in impaired kidney perfusion, sodium and water retention, and reduced urine output.
Weigh daily.	Sudden changes in weight reflect alterations in fluid balance.
Maintain total fluid intake at 2000 mL/24 hr within cardiovascular tolerance.	Meets normal adult body fluid requirements, but may require alteration or restriction in presence of cardiac decompensation.
Provide low-sodium diet/beverages.	Sodium enhances fluid retention and should therefore be restricted during active MI phase and/or if heart failure is present.
Administer diuretics: furosemide (Lasix), spironolactone with hydrochlorothiazide (Aldactazide), hydralazine (Apresoline).	May be necessary to correct fluid overload. Drug choice is usually dependent on acute or chronic nature of symptoms.
Monitor potassium as indicated.	Hypokalemia can limit effectiveness of therapy and can occur with use of potassium-depleting diuretics.

Deficient Knowledge

Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.

May be related to

Lack of information/misunderstanding of medical condition/therapy needs
Unfamiliarity with information resources
Lack of recall

Possibly evidenced by

Questions; statement of misconception
Failure to improve on previous regimen
Development of preventable complications

Desired Outcomes

Verbalize understanding of condition, potential complications, individual risk factors, and function of pacemaker (if used).
Relate signs of pacemaker failure.
Verbalize understanding of therapeutic regimen.
List desired action and possible adverse side effects of medications.
Correctly perform necessary procedures and explain reasons for actions.

Nursing Interventions	Rationale
Assess patient or SO level of knowledge and ability and desire to learn.	Necessary for creation of individual instruction plan.
Be alert to signs of avoidance (changing subject away from information being presented or extremes of behavior).	Reinforces expectation that this will be a “learning experience.” Verbalization identifies misunderstandings and allows for clarification.
Present information in varied learning formats: programmed books, audiovisual tapes, question and answer sessions, group activities.	Natural defense mechanisms, such as anger or denial of significance of situation, can block learning, affecting patient’s response and ability to assimilate information. Changing to a less formal or structured style may be more effective until patient and SO is ready to accept or deal with current situation.
Reinforce explanations of risk factors, dietary and/or activity restrictions, medications, and symptoms requiring immediate medical attention.	Using multiple learning methods enhances retention of material.
Encourage identification and reduction of individual risk factors (smoking/alcohol consumption, obesity).	Provides opportunity for patient to retain information and to assume control and participate in rehabilitation program.
Warn against isometric activity, Valsalva maneuver, and activities requiring arms positioned above head.	These behaviors and chemicals have direct adverse effects on cardiovascular function and may impede recovery, increase risk for complications.
Review programmed increases in levels of activity. Educate patient regarding gradual resumption of activities, e.g., walking, work, recreational and sexual activity. Provide guidelines for gradually increasing activity and instruction regarding target heart rate and pulse taking, as appropriate.	These activities greatly increase cardiac workload and myocardial oxygen consumption and may adversely affect myocardial contractility and output.
Identify alternative activities for “bad weather” days, such as measured walking in house or shopping mall.	Gradual increase in activity increases strength and prevents overexertion, may enhance collateral circulation, and allows return to normal lifestyle. Note: Sexual activity can be safely resumed once patient can accomplish activity equivalent to climbing two flights of stairs without adverse cardiac effects.
Review signs and symptoms requiring reduction in activity and notification of healthcare provider.	Pulse elevations beyond established limits, development of chest pain, or dyspnea may require changes in exercise and medication regimen.
Differentiate between increased heart rate that normally occurs during various activities and worsening signs of cardiac stress (chest pain, dyspnea, palpitations, increased heart rate lasting more than 15 min after cessation of activity, excessive fatigue the following day).	Pulse elevations beyond established limits, development of chest pain, or dyspnea may require changes in exercise and medication regimen.
Stress importance of follow-up care, and identify community resources and support groups.	Reinforces that this is an ongoing and continuing health problem for which support and assistance is available after discharge. Note: After discharge, patients encounter limitations in physical functioning and often incur difficulty with emotional, social, and role functioning requiring ongoing support.
Emphasize importance of contacting physician if chest pain, change in anginal pattern, or other symptoms recur.	Timely evaluation and intervention may prevent complications.
Stress importance of reporting development of fever in association with diffuse and atypical chest pain (pleural, pericardial) and joint pain.	Post-MI complication of pericardial inflammation (Dressler’s syndrome) requires further medical evaluation and intervention.
Encourage patient and SO to share concern and feelings. Discuss signs of pathological depression versus transient feelings frequently associated with major life events. Recommend seeking professional help if depressed feelings persist.	Depressed patients have a greater risk of dying 6–18 mo following a heart attack. Timely intervention may be beneficial. Note: Selective serotonin reuptake inhibitors (SSRIs), paroxetine (Paxil), have been found to be as effective as tricyclic antidepressants but with significantly fewer adverse cardiac complications.

Other Possible Nursing Care Plans

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

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