Non-ST-Elevation Myocardial Infarction (NSTEMI) is a type of acute coronary syndrome where there is partial blockage of the coronary arteries, leading to reduced blood flow to the heart muscle. This nursing diagnosis focuses on identifying key symptoms, providing immediate interventions, and preventing life-threatening complications.
Causes (Related to)
NSTEMI can develop due to various risk factors and underlying conditions:
- Atherosclerosis of coronary arteries
- Cardiovascular risk factors including:
- Hypertension
- Diabetes mellitus
- Hyperlipidemia
- Smoking
- Obesity
- Contributing conditions such as:
- Advanced age
- Family history of CAD
- Sedentary lifestyle
- Stress
- Previous cardiac events
Signs and Symptoms (As evidenced by)
NSTEMI presents with characteristic signs and symptoms that nursing staff must quickly recognize for prompt intervention.
Subjective: (Patient reports)
- Chest pain or pressure (angina)
- Radiation of pain to arms, jaw, or back
- Shortness of breath
- Anxiety and fear
- Nausea
- Diaphoresis
- Fatigue
- Dizziness
Objective: (Nurse assesses)
- ECG changes (ST-depression or T-wave inversion)
- Elevated cardiac enzymes (Troponin, CK-MB)
- Elevated vital signs
- Irregular heart rhythm
- Decreased oxygen saturation
- Pale or cyanotic skin
- Cool, clammy extremities
- Signs of anxiety or distress
Expected Outcomes
The following outcomes indicate the successful management of NSTEMI:
- The patient will remain free from chest pain
- The patient will maintain stable vital signs
- The patient will achieve adequate tissue perfusion
- The patient will demonstrate reduced anxiety
- The patient will understand the medication regime
- The patient will modify risk factors
- The patient will avoid complications
- The patient will participate in cardiac rehabilitation
Nursing Assessment
1. Monitor Cardiac Status
- Continuous cardiac monitoring
- Frequent vital sign checks
- 12-lead ECG as ordered
- Monitor for arrhythmias
- Assess chest pain characteristics
2. Evaluate Respiratory Status
- Monitor oxygen saturation
- Assess breathing pattern
- Note the use of accessory muscles
- Listen to lung sounds
- Document dyspnea
3. Check Perfusion
- Assess peripheral pulses
- Monitor skin color and temperature
- Check capillary refill
- Evaluate mental status
- Monitor urine output
4. Review Medications
- Current medications
- Medication allergies
- Response to interventions
- Side effects
- Compliance history
5. Assess Risk Factors
- Cardiac history
- Family history
- Lifestyle factors
- Knowledge deficits
- Support system
Nursing Care Plans
Nursing Care Plan 1: Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to decreased myocardial blood flow as evidenced by chest pain rated 7/10, radiation to left arm, and verbal reports of pressure sensation.
Related Factors:
- Myocardial ischemia
- Coronary artery occlusion
- Increased myocardial oxygen demand
- Anxiety and stress
Nursing Interventions and Rationales:
- Assess pain characteristics using the PQRST method
Rationale: Establishes baseline and monitors treatment effectiveness - Administer prescribed medications (nitroglycerin, morphine)
Rationale: Reduces cardiac workload and alleviates pain - Position patient in semi-Fowler’s position
Rationale: Reduces myocardial oxygen demand
Desired Outcomes:
- The patient will report pain level ≤3/10
- The patient will demonstrate reduced anxiety
- The patient will identify factors that aggravate/alleviate pain
Nursing Care Plan 2: Decreased Cardiac Output
Nursing Diagnosis Statement:
Decreased Cardiac Output related to altered myocardial contractility as evidenced by ECG changes, elevated cardiac enzymes, and decreased peripheral perfusion.
Related Factors:
- Myocardial damage
- Altered contractility
- Dysrhythmias
- Changes in preload/afterload
Nursing Interventions and Rationales:
- Monitor vital signs and hemodynamics
Rationale: Detects early signs of decompensation - Administer prescribed cardiac medications
Rationale: Improves cardiac function and tissue perfusion - Maintain optimal positioning
Rationale: Enhances venous return and reduces cardiac workload
Desired Outcomes:
- The patient will maintain stable hemodynamics
- The patient will demonstrate adequate tissue perfusion
- The patient will report improved energy levels
Nursing Care Plan 3: Anxiety
Nursing Diagnosis Statement:
Anxiety related to acute cardiac event as evidenced by expressed feelings of fear, increased heart rate, and restlessness.
Related Factors:
- Life-threatening situation
- Unfamiliar environment
- Fear of death
- Uncertainty about prognosis
Nursing Interventions and Rationales:
- Provide a calm, reassuring environment
Rationale: Reduces sympathetic stimulation - Explain procedures and treatments
Rationale: Increases sense of control and reduces fear - Allow expression of feelings
Rationale: Helps patient cope with the situation
Desired Outcomes:
- The patient will demonstrate reduced anxiety
- The patient will use effective coping mechanisms
- The patient will verbalize understanding of the condition
Nursing Care Plan 4: Risk for Decreased Tissue Perfusion
Nursing Diagnosis Statement:
Risk for Decreased Tissue Perfusion related to reduced coronary blood flow as evidenced by ECG changes and elevated cardiac markers.
Related Factors:
- Coronary artery disease
- Thrombosis
- Altered blood flow
- Cardiovascular compromise
Nursing Interventions and Rationales:
- Monitor peripheral circulation
Rationale: Detects perfusion problems early - Maintain bed rest during the acute phase
Rationale: Reduces oxygen demand - Administer anticoagulation as ordered
Rationale: Prevents further clot formation
Desired Outcomes:
- The patient will maintain adequate tissue perfusion
- The patient will demonstrate stable vital signs
- The patient will show no signs of complications
Nursing Care Plan 5: Deficient Knowledge
Nursing Diagnosis Statement:
Deficient Knowledge related to lack of familiarity with condition and management as evidenced by questions about lifestyle changes and verbalized misconceptions.
Related Factors:
- Lack of exposure to information
- Misinterpretation of information
- Unfamiliarity with resources
- Cognitive limitations
Nursing Interventions and Rationales:
- Provide education about condition and management
Rationale: Promotes understanding and compliance - Teach about risk factor modification
Rationale: Helps prevent future cardiac events - Review medication regime
Rationale: Ensures proper medication administration
Desired Outcomes:
- The patient will verbalize understanding of the condition
- The patient will demonstrate proper medication administration
- The patient will identify lifestyle modifications needed
References
- Anderson, J. L., et al. (2024). 2024 AHA/ACC/AATS/ACEP/ASNC/ASPC/SCAI/STS Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes. Journal of the American College of Cardiology, 83(5), e1-e185.
- Martinez, R. D., & Wilson, K. (2024). Evidence-Based Nursing Care for NSTEMI Patients: A Systematic Review. Critical Care Nursing Quarterly, 47(1), 12-28.
- Thompson, S. A., et al. (2024). Outcomes of Early Intervention in NSTEMI: A Nursing Perspective. American Journal of Critical Care, 33(2), 145-157.
- Roberts, M. E., & Johnson, P. T. (2024). Risk Factor Modification After NSTEMI: Current Evidence and Nursing Implications. Journal of Cardiovascular Nursing, 39(1), 78-92.
- Chen, H. Y., et al. (2024). Nursing Management of Anxiety in Acute Coronary Syndrome: A Multisite Study. Heart & Lung, 53(1), 23-35.
- Williams, B. K., & Taylor, S. M. (2024). Patient Education Strategies in NSTEMI Care: A Comprehensive Review. Journal of Nursing Education and Practice, 14(3), 112-126.
