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 Ineffective Tissue Perfusion
- 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.
- 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.
|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:|
||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.|
||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.|
||Used for prophylaxis and treatment of thromboembolic complications associated with MI.|
||Reduces or neutralizes gastric acid, preventing discomfort and gastric irritation, especially in presence of reduced mucosal circulation.|
|Assist with reperfusion therapy:|
||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.|
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.
You may also like the following posts and care plans:
- 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