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
Risk for Decreased Cardiac Output
- Risk for Decreased Cardiac Output
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.
- 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.
|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:|
||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 may be associated with myocardial ischemia, ventricular stiffening, and pulmonary or systemic hypertension.|
||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.|
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 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