Myocardial Infarction Nursing Care Plans Diagnosis and Interventions
Myocardial Infarction NCLEX Review and Nursing Care Plans
Myocardial infarction (M.I.), also known as heart attack, is a serious medical emergency that occurs when the blood supply to the heart is suddenly cut off.
The blockage is usually caused by a clot. Prolonged lack of blood supply to the heart muscles can result in permanent damage and can be life-threatening.
Immediate medical intervention is necessary to prevent serious complications.
Myocardial infarction is the most common form of coronary heart disease and is highly associated with morbidity and mortality.
The most common cause of heart attacks is a clot built up from a ruptured plaque.
Plaques are fatty deposits on the walls of arteries that can trigger clot formation when they rupture.
The clot can partially or completely block an artery, which could then impede the flow of blood.
Signs and Symptoms of Myocardial Infarction
The signs and symptoms of myocardial infarction may vary from person to person.
Others may not have any symptoms at all, while some may have warning signs before the attack occurs.
The following are the signs and symptoms which may be noted in a person having a myocardial infarction:
- Chest pain – this is the most common symptom associated with M.I. The chest pain is often described as similar to the feeling of being squeezed or pressed by a heavy object on the chest. The pain may radiate to the jaw, neck, back, and arms.
- Shortness of breath
- Feeling weak, lightheaded, or both
- An overwhelming feeling of anxiety
In some cases, chest pain may not always be severe, particularly in women. It may even be mistaken for indigestion.
However, it should be noted that the severity of chest pain is not definitive and conclusive of myocardial infarction.
The chest pain should be assessed in combination of the other symptoms to determine a heart attack.
Causes of Myocardial Infarction
- Coronary artery disease (CAD). Coronary artery disease is a condition referring to the reduction in the blood flow to the heart muscles due to the build-up of plaques in the arteries of the heart. Plaques are fatty deposits including cholesterol, saturated fat, and trans fat.
- Spasm of the coronary artery. The coronary artery is the major artery that supplies blood to the heart muscles. The spasm of this artery can be caused by certain drugs and tobacco use.
The following are the risk factors that predispose an individual to develop myocardial infarction:
- Age – men aged 45 years and above and women aged 55 years and older are noted to have higher risks of having a myocardial infarction
- Tobacco use
- High blood pressure
- High blood cholesterol
- Metabolic syndrome
- Family history
- Lack of physical activity
- Drug use
- History of preeclampsia
- Autoimmune condition
Complications of Myocardial Infarction
- Arrhythmias. These are abnormal heart rhythms that can lead to death.
- Heart failure. Significant damage to the heart can cause strain to the remaining healthy heart muscles leading to heart failure.
- Cardiac arrest. While heart attack involves the lack of blood flow to the heart muscles, cardiac arrest refers to electrical disturbances in the heart rhythms, causing the heart to stop pumping.
Diagnosis of Myocardial Infarction
Immediate treatment is necessary to prevent permanent and serious damage when a heart attack is suspected.
A series of diagnostic tests may be performed to support the diagnosis and they will need to be performed as soon as possible so treatment can be started.
- Medical history and physical examination – A detailed history and thorough medical examination are helpful in the diagnosis of myocardial infarction. The assessment will focus on the presence of risk factors and signs and symptoms. Machines will be hooked to continuously monitor the heart tracing and vital signs.
- Electrocardiogram (ECG) – an ECG will be performed immediately to record the tracing of the heart.
- Partial blockage – non-ST elevation myocardial infarction (NSTEMI)
- Complete blockage – ST elevation myocardial infarction (STEMI)
- Blood tests – enzymes and protein markers such as troponin I and T and CKMB are often measured to identify muscle damage and wasting.
- Additional tests may also be performed to help treat the condition:
- Chest X-ray – chest x-ray will display the size of the heart and may identify the presence of fluid build-up in the lungs and other associated conditions.
- Echocardiogram – this test can help identify the area of the heart damaged by the infarction.
- Coronary catheterization – this procedure is done under fluoroscopy. A catheter is inserted thru an artery on the arms or the groin which will then thread to the coronary artery. Images are taken while a contrast agent is injected.
- Cardiac CT or MRI – these imaging techniques can help identify heart damage or associated heart problems.
Treatment of Myocardial Infarction
- Thrombolytics – these drugs can dissolve clots to improve flow.
- Antiplatelet agents – these drugs are given to prevent clots from getting worse and prevent future clot formation.
- Blood thinners – other forms of blood thinners are often given to make blood less viscous.
- Analgesic – pain killers may be given to help manage chest pain.
- Nitroglycerin – this drug is a common treatment for angina as it promotes the dilation of blood vessels and improves flow.
- Beta blockers – these drugs help the heart pump more effectively.
- ACE-inhibitors – these drugs help by lowering blood pressure and reducing the strain on the heart muscles.
- Statins – these drugs help manage blood cholesterol levels.
- Coronary angioplasty stenting – this procedure involves the insertion of a balloon stent guided by fluoroscopy or ultrasound. A stent is inserted through a small catheter inserted from an artery in the arm or groin into the narrowed coronary artery to keep the vessel open.
- Coronary artery bypass surgery – this procedure is more invasive, and it involves the cutting and sewing of arteries to bypass the blocked part.
- Lifestyle changes. Smoking cessation, committing to a low cholesterol, low sugar diet, and stress management can help prevent M.I. or reduce the risk of another episode in a person who had a previous heart attack. Foods rich in omega-3 fatty acids such as fish, soybeans, and flaxseeds are recommended. Regular taking of prescribed blood pressure medications also helps control hypertension. Increasing physical activity by doing at least 150 minutes of moderate aerobic exercises will help promote an active lifestyle.
Nursing Diagnosis for Myocardial Infarction
Nursing Care Plan for Myocardial Infarction 1
Nursing Diagnosis: Acute Pain related to coronary artery occlusion secondary to M.I. as evidenced by pain score of 10 out of 10, verbalization of pressure-like/ squeezing chest pain (angina), guarding sign on the chest, blood pressure level of 190/100, respiratory rate of 30 bpm, and restlessness
Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness.
|Nursing Interventions for Myocardial Infarction||Rationale|
|Administer prescribed medications that alleviate the symptoms of angina.||Nitrates may be given to relax the blood vessels. Pain killers may be given to help manage chest pain. Other medications that help treat angina include anti-cholesterol drugs (e.g. statins), beta blockers, and calcium channel blockers.|
|Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.||To monitor effectiveness of medical treatment for the relief of angina. The time of monitoring of vital signs may depend on the peak time of the drug administered.|
|Elevate the head of the bed if the patient is short of breath. Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.||To increase the oxygen level and achieve an SpO2 value within the target range.|
|Place the patient in complete bed rest during angina attacks. Educate patient on stress management, deep breathing exercises, and relaxation techniques.||Stress causes a persistent increase in cortisol levels, which has been linked to people with cardiac issues. The effects of stress are likely to increase myocardial workload.|
Nursing Care Plan for Myocardial Infarction 2
Nursing Diagnosis: Risk for Decreased Cardiac Output related to lack of blood supply to the heart secondary to myocardial infarction
Desired outcome: The patient will be able to maintain adequate cardiac output.
|Nursing Interventions for Myocardial Infarction||Rationales|
|Assess the patient’s vital signs and characteristics of heartbeat through attaching the patient to a continuous vital signs monitor. Assess breath sounds via auscultation. Observe for signs of decreasing peripheral tissue perfusion such as slow capillary refill, facial pallor, cyanosis, and cool, clammy skin.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. Breath sounds of crackles/rales are important signs of heart failure. The presence of signs of decreasing peripheral tissue perfusion indicate deterioration of the patient’s status which require immediate referral to the physician.|
|Administer the cardiac medications, and diuretics as prescribed.||To alleviate the symptoms of heart failure and to treat the underlying condition.|
|Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.||To increase the oxygen level and achieve an SpO2 value within the target range.|
|Educate patient on stress management, smoking cessation, proper diet, blood pressure and blood sugar control, exercise, deep breathing exercises, and relaxation techniques.||Smoking cessation, committing to a low cholesterol, low sugar diet, and stress management can help prevent M.I. or reduce the risk of another episode in a person who had a previous heart attack. Foods rich in omega-3 fatty acids such as fish, soybeans, and flaxseeds are recommended. Regular taking of prescribed blood pressure medications also helps control hypertension. Increasing physical activity by doing at least 150 minutes of moderate aerobic exercises will help promote an active lifestyle.|
Nursing Care Plan for Myocardial Infarction 3
Nursing Diagnosis: Activity intolerance related to myocardial imbalance between oxygen supply and demand secondary to M.I. as evidenced by fatigue, overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion
Desired Outcome: The patient will demonstrate active participation in necessary and desired activities and demonstrate increase in activity levels.
|Nursing Interventions for Myocardial Infarction||Rationales|
|Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.||To create a baseline of activity levels and mental status related to fatigue and activity intolerance.|
|Encourage progressive activity through self-care and exercise as tolerated. Alternate periods of physical activity with 60-90 minutes of undisturbed rest.||To gradually increase the patient’s tolerance to physical activity.|
|Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.||To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.|
|Refer the patient to physiotherapy / occupational therapy team as required.||To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.|
|Educate the patient on energy conservation techniques, which include:Working or moving at an even pacePushing rather than pullingSliding rather than pullingSitting to perform some tasksPositioning frequently used items within reach||Energy conservation techniques help reduce the body’s demand for oxygen, which allows the patient to accomplish more ADLs.|
More Nursing Diagnosis for Myocardial Infarction
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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