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
- 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
- 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.
|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.
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