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.
- Acute Pain
- Activity Intolerance
- Risk for Decreased Cardiac Output
- Risk for Ineffective Tissue Perfusion
- Risk for Excess Fluid Volume
- Deficient Knowledge
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
- Recognize feelings.
- Identify causes, contributing factors.
- Verbalize reduction of anxiety/fear.
- Demonstrate positive problem-solving skills.
- Identify/use resources appropriately.
|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.|
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.
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- Nursing Care Plan: The Ultimate Guide and Database – the ultimate database of nursing care plans for different diseases and conditions! Get the complete list!
- Nursing Diagnosis: The Complete Guide and List – archive of different nursing diagnoses with their definition, related factors, goals and nursing interventions with rationale.
Cardiac Care Plans
Nursing care plans about the different diseases of the cardiovascular system:
- 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 | 16+ Care Plans
- Hypertension | 6 Care Plans
- Hypovolemic Shock | 4 Care Plans
- Myocardial Infarction | 7 Care Plans
- Pacemaker Therapy | 7 Care Plans