Myocardial Infarction Nursing Diagnosis & Care Plan

Myocardial infarction (MI), commonly known as a heart attack, is a life-threatening condition that occurs when blood flow to the heart is severely reduced or blocked.

Understanding Myocardial Infarction

Myocardial infarction happens when a coronary artery becomes blocked, usually due to the rupture of an atherosclerotic plaque.

This blockage prevents oxygen-rich blood from reaching a part of the heart muscle, leading to tissue damage or death.

The severity of MI depends on the affected area’s size and the blockage’s duration.

Common signs and symptoms of MI include:

1. Chest pain or discomfort (angina)
2. Shortness of breath
3. Nausea or vomiting
4. Sweating
5. Fatigue
6. Anxiety or feeling of impending doom
7. Pain radiating to the arm, jaw, or back

Nurses must recognize these symptoms promptly and initiate appropriate interventions to minimize heart damage and improve patient outcomes.

Nursing Assessment for Myocardial Infarction

A thorough nursing assessment is essential for identifying MI and developing an effective care plan. Key components of the evaluation include:

Patient History:

• Past medical history, including previous cardiac events
• Family history of heart disease
• Risk factors such as smoking, hypertension, diabetes, and high cholesterol
• Current medications

Physical Examination:

• Vital signs, including blood pressure, heart rate, and oxygen saturation
• Heart and lung sounds
• Skin color and temperature
• Presence of edema
• Level of consciousness

Diagnostic Tests:

• 12-lead ECG
• Cardiac enzymes (troponin, CK-MB)
• Chest X-ray
• Echocardiogram

Pain Assessment:

• Location, intensity, duration, and quality of chest pain
• Factors that aggravate or alleviate the pain

Nursing Diagnoses for Myocardial Infarction

Based on the assessment findings, nurses can formulate appropriate nursing diagnoses. The following are five common myocardial infarction nursing diagnosis for patients with along with their care plans:

Acute Pain related to myocardial ischemia

Nursing Diagnosis Statement: Acute Pain related to myocardial ischemia as evidenced by verbal reports of chest pain, grimacing, and restlessness.

Related factors/causes:

• Reduced blood flow to the heart muscle
• Tissue damage due to lack of oxygen
• Activation of pain receptors in the heart

Nursing Interventions and Rationales:

1. Assess pain characteristics (location, intensity, duration, quality) using a standardized pain scale.
   Rationale: Provides baseline data for evaluating the effectiveness of interventions.
2. Administer prescribed medications (e.g., nitroglycerin, morphine) as ordered.
   Rationale: Reduces pain and improves myocardial oxygen supply-demand balance.
3. Position the patient in a semi-Fowler’s position.
   Rationale: Promotes comfort and reduces cardiac workload.
4. Provide oxygen therapy as prescribed.
   Rationale: Improves myocardial oxygenation and reduces pain.
5. Teach relaxation techniques such as deep breathing.
   Rationale: It helps reduce anxiety and may decrease pain perception.

Desired Outcomes:

• Patient reports pain reduction (pain score ≤3 on a 0-10 scale) within 30 minutes of intervention.
• The patient demonstrates the use of non-pharmacological pain management techniques.
• The patient verbalizes understanding of the pain management plan.

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Decreased Cardiac Output related to impaired myocardial contractility

Nursing Diagnosis Statement: Decreased Cardiac Output related to impaired myocardial contractility as evidenced by tachycardia, hypotension, and decreased urine output.

Related factors/causes:

• Myocardial damage
• Altered contractility of heart muscle
• Dysrhythmias

Nursing Interventions and Rationales:

1. Monitor vital signs, especially blood pressure and heart rate, every 15 minutes or as ordered.
   Rationale: Early detection of changes in cardiac output allows for prompt intervention.
2. Assess peripheral pulses, capillary refill, and skin temperature.
   Rationale: Provides information about tissue perfusion and cardiac output.
3. Administer prescribed medications (e.g., inotropes, vasodilators) as ordered.
   Rationale: Improves cardiac contractility and reduces afterload, enhancing cardiac output.
4. Monitor fluid intake and output closely.
   Rationale: Helps assess fluid balance and kidney perfusion.
5. Position the patient in a semi-Fowler’s position unless contraindicated.
   Rationale: Reduces preload and improves ventilation.

Desired Outcomes:

• The patient maintains blood pressure within the target range.
• Urine output remains >30 mL/hour.
• Patient demonstrates improved peripheral perfusion (warm extremities, capillary refill <3 seconds).

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Anxiety related to acute health crisis and fear of death

Nursing Diagnosis Statement: Anxiety related to acute health crisis and fear of death as evidenced by verbalized concerns, restlessness, and increased heart rate.

Related factors/causes:

• Sudden onset of a life-threatening condition
• Uncertainty about prognosis
• Fear of death or disability

Nursing Interventions and Rationales:

1. Provide clear, concise information about the patient’s condition and treatment plan.
   Rationale: Reduces uncertainty and helps the patient feel more in control.
2. Encourage the patient to express feelings and concerns.
   Rationale: Allows for emotional ventilation and helps identify specific sources of anxiety.
3. Teach and practice relaxation techniques (e.g., deep breathing, progressive muscle relaxation).
   Rationale: Helps reduce physiological manifestations of anxiety.
4. Ensure a calm, quiet environment.
   Rationale: Minimizes external stimuli that may increase anxiety.
5. Administer anti-anxiety medications as prescribed.
   Rationale: Provides pharmacological support for anxiety reduction when necessary.

Desired Outcomes:

• The patient verbalizes decreased anxiety levels within 2 hours of intervention.
• The patient demonstrates the use of at least one relaxation technique.
• The patient’s vital signs return to baseline range.

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Risk for Decreased Tissue Perfusion related to reduced cardiac output

Nursing Diagnosis Statement: Risk for Decreased Tissue Perfusion related to reduced cardiac output.

Related factors/causes:

• Compromised blood flow due to myocardial damage
• Potential for arrhythmias
• Possible formation of thrombi

Nursing Interventions and Rationales:

1. Monitor peripheral pulses, capillary refill, and skin color every 2-4 hours.
   Rationale: Allows early detection of changes in tissue perfusion.
2. Assess mental status and level of consciousness regularly.
   Rationale: Changes in mental status may indicate cerebral hypoperfusion.
3. Elevate extremities if not contraindicated.
   Rationale: Promotes venous return and reduces edema.
4. Administer anticoagulants as prescribed.
   Rationale: Prevents formation of new thrombi and reduces risk of further tissue damage.
5. Monitor for signs of bleeding (e.g., bruising, blood in stool or urine).
   Rationale: Early detection of potential complications from anticoagulant therapy.

Desired Outcomes:

• Patient maintains adequate tissue perfusion as evidenced by warm extremities and capillary refill <3 Seconds.
• The patient remains alert and oriented.
• No signs of new thrombus formation or bleeding complications.

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Deficient Knowledge related to new diagnosis and self-care requirements

Nursing Diagnosis Statement: Deficient Knowledge related to new diagnosis and self-care requirements as evidenced by verbalized questions about the condition and treatment plan.

Related factors/causes:

• Lack of exposure to information about myocardial infarction
• Misinterpretation of information
• Cognitive limitations due to stress or medications

Nursing Interventions and Rationales:

1. Assess the patient’s current understanding of myocardial infarction and treatment.
   Rationale: Provides a baseline for education and identifies misconceptions.
2. Provide concise information about MI, its causes, and treatment options.
   Rationale: Increases patient’s knowledge base and promotes informed decision-making.
3. Teach about lifestyle modifications (e.g., diet, exercise, stress management).
   Rationale: Help the patient take an active role in recovery and prevent future events.
4. Instruct on medication regimen, including purpose, dosage, and potential side effects.
   Rationale: Promotes medication adherence and early recognition of adverse effects.
5. Provide written materials and resources for future reference.
   Rationale: Reinforces verbal teaching and allows for review after discharge.

Desired Outcomes:

• The patient verbalizes understanding of myocardial infarction and its treatment within 48 hours.
• The patient demonstrates the ability to self-administer medications correctly.
• The patient identifies at least three lifestyle modifications to reduce the risk of future cardiac events.

Additional Nursing Interventions for Myocardial Infarction

In addition to the specific interventions outlined in the nursing care plans, nurses should implement the following general interventions for patients with myocardial infarction:

1. Continuous cardiac monitoring: Observe for arrhythmias and ST-segment changes.
2. Oxygen therapy: Administer oxygen as prescribed to maintain saturation >94%.
3. Pain management: Provide both pharmacological and non-pharmacological pain relief measures.
4. Emotional support: Offer reassurance and encourage expression of feelings.
5. Activity restriction: Enforce bed rest during the acute phase to reduce cardiac workload.
6. Medication administration: Administer prescribed medications (e.g., antiplatelet agents, beta-blockers, ACE inhibitors) as ordered.
7. Fluid and electrolyte balance: Monitor intake and output and assess for signs of fluid overload.
8. Nutritional support: Provide a heart-healthy diet as tolerated.
9. Patient and family education: Teach about risk factors, lifestyle modifications, and follow-up care.
10. Discharge planning: Coordinate with the healthcare team to ensure a smooth transition to home or rehabilitation facility.

Conclusion

Effective nursing care for patients with myocardial infarction requires a comprehensive approach that addresses both physical and psychosocial needs.

Nurses can significantly improve patient outcomes and quality of life by implementing appropriate nursing diagnoses, interventions, and care plans.

Regular assessment, prompt intervention, and ongoing patient education are vital to successful MI management.

References

1. American Heart Association. (2022). Heart Attack (Myocardial Infarction). Retrieved from https://www.heart.org/en/health-topics/heart-attack
2. Aehlert, B. (2022). ECGs Made Easy. 7th Edition. Elsevier.
3. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales. 15th Edition. F.A. Davis Company.
4. Herdman, T. H., & Kamitsuru, S. (Eds.). (2021). NANDA International Nursing Diagnoses: Definitions and Classification 2021-2023. Thieme.
5. Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2020). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 10th Edition. Elsevier.
6. Lewis, S. L., Bucher, L., Heitkemper, M. M., & Harding, M. M. (2022). Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 11th Edition. Elsevier.
7. O’Gara, P. T., et al. (2013). 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. Circulation, 127(4), e362-e425.
8. Urden, L. D., Stacy, K. M., & Lough, M. E. (2022). Critical Care Nursing: Diagnosis and Management. 9th Edition. Elsevier.
9. World Health Organization. (2021). Cardiovascular diseases (CVDs). Retrieved from https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
10. Yancy, C. W., et al. (2013). 2013 ACCF/AHA Guideline for the Management of Heart Failure. Journal of the American College of Cardiology, 62(16), e147-e239.