Last updated on May 17th, 2022 at 08:42 am
NSTEMI Nursing Care Plans Diagnosis and Interventions
NSTEMI NCLEX Review and Nursing Care Plans
Myocardial infarction (MI), also generally referred to as a heart attack, is one of the numerous disorders known as acute coronary syndrome (ACS) that occur when the heart’s blood supply is unexpectedly restricted or blocked.
A non-ST-segment elevation myocardial infarction (NSTEMI) is a type of MI that may cause a partial blockage of blood flow. NSTEMI is a less severe heart attack and represents almost two-thirds of all cases.
STEMI versus NSTEMI
In comparison to the more prevalent type of heart attack known as ST-elevation myocardial infarction or STEMI, an NSTEMI is usually less detrimental to the heart.
Hence, an electrocardiogram (ECG), which captures the heart’s electrical activity, can help the healthcare team to differentiate STEMI from NSTEMI. An ECG will typically show a flat line among heartbeats known as the “ST segment,” which will be increased after a classic heart attack.
There will be no indication of ST-segment elevation with NSTEMI, but it is still considered a heart attack since it causes damage to the heart muscle. NSTEMI, on the other hand, has more similarities with unstable angina and usually has a favorable prognosis.
Moreover, individuals with diffuse coronary artery disease are more prone to have NSTEMI. This type of heart disease is characterized by a network of tiny blood arteries known as collateral vessels that only function on the heart occasionally.
STEMI, on the other hand, will encompass the primary coronary arteries. Lastly, even if NSTEMI is caused by a partial blockage of a major coronary artery, it can still lead to STEMI within hours, weeks, or months if not treated effectively.
Signs and Symptoms of NSTEMI
NSTEMI symptoms may include the following:
- breathing difficulty
- chest pressure, tightness, or discomfort
- discomfort or pain in the stomach, back, neck, and jaw
- vertigo
- dizziness
- nausea
- perspiration
If patients have these symptoms, they should promptly call the emergency services or 911. When it pertains to chest pain and other symptoms, it is always better to be prepared and seek medical attention.
If the symptoms are consistent, every minute of waiting for emergency help without assistance might worsen the damage to the heart.
Causes of NSTEMI
NSTEMI is a kind of acute coronary syndrome (ACS). ACS occurs when the heart requires more oxygen than it is receiving. Since blood transports oxygen to the heart, anything that restricts blood flow can cause an NSTEMI. Among these causes are:
- Plaque accumulation in the coronary arteries
- The coronary arteries or blood vessels that deliver oxygen to the heart are twitching uncontrollably.
- Inflammation of the cardiac arteries’ walls
- The cardiac rupture that causes bruising of the heart muscles
- The cardiac muscle is inflamed.
- Medications that are dangerous to the heart
- Hypertension or Hypotension
- A blood clot has formed in the lungs.
- Rapid heartbeat
- The constriction of the aortic valve opening
Risk Factors of NSTEMI
Several risk factors can increase the likelihood of suffering a heart attack. Some of these variables are controllable, while some are not.
These are some of the controllable risk factors examples:
- Tobacco consumption and smoking
- A diet containing salt, which may cause high blood pressure, sugar which may trigger diabetes; and fat intake, which may cause elevated cholesterol
- The level of physical activity
- Drug use for recreation especially stimulants and other medications that cause a fatal effect on the heart.
Uncontrollable factors are as follows:
- Age. Age influences the chances of developing cardiovascular disease. The older an individual is, the greater the chance of having NSTEMI.
- Gender. Men suffer myocardial infarction at a younger age than women. Men’s risk begins to rise at 45, while women’s risk rises at 50 or after a woman reaches menopause.
- Medical history in the family. If the patient’s father or brother is diagnosed with heart illness or a cardiac arrest before age 55, or a mother or sister is likewise diagnosed even before age 65, the risk increases.
- Congenital or existent at birth conditions. Several medical illnesses or disorders affecting the body’s other systems can also raise the chance of having a heart attack.
Diagnosis of NSTEMI
The following tests may be used to diagnose NSTEMI:
- Electrocardiogram (ECG). Amongst the most significant ways to diagnose a heart attack is via an electrocardiogram. As previously said, this test measures cardiac electrical activity and displays it as a wave. Variations in the patterns caused by an NSTEMI can be interpreted and used to make a diagnosis by a trained cardiologist. An NSTEMI does not cause the ST section of the wave to be continuously higher as a STEMI does. Instead, the following alterations on an electrocardiogram may – but do not always – appear:
- Temporary ST-elevation. This alteration indicates that the ST section does grow higher, but only for a brief time.
- ST-depression. Under typical conditions, the ST segment is usually parallel to the wave’s total baseline. With an NSTEMI, meanwhile, the ST segment may dip below its standard baseline level.
- T-wave inversions. The T-wave is the final wave in the pattern, with the U-point signifying the conclusion of the T-wave, after which the pattern begins again towards the P-point of the next pulse. The term “new T-wave inversion” refers to the fact that if the T-waves generally bend upwards (like a hill), they now curve downwards (like a bowl).
- Laboratory testing. When any of the risk factors damages the cardiac muscle cells, they produce a distinctive substance called troponin. Since that substance may be detected with blood testing, such tests are one of the most efficient methods to diagnose any kind of myocardial infarction. However, because troponin levels could take longer to reach detectable amounts, a troponin test may need to be repeated within six hours.
- Imaging Tests. Imaging scans may also aid in diagnosing NSTEMI, mainly if the previous testing were inconclusive. A few of these tests may include physical activity to try to trigger symptoms that were not present while resting. The following are some of the most common imaging tests:
- Echocardiography. This test creates an image of the interior and outside of the heart using ultra-high-frequency sound waves. This test is frequently utilized in emergency departments since the equipment may be transported on a mobile cart and used at the patient’s bedside.
- CT (computed tomography) scan. This test utilizes X-rays to capture pictures, then assembled into a comprehensive three-dimensional representation by a computer. This diagnostic test could include an injectable material that appears on the scan, allowing healthcare experts to discover plaque or narrowing in the coronary arteries, which aids blood circulation to the cardiac muscle.
- Magnetic resonance imaging (MRI). This test creates accurate heart scans using enormously potent magnetic and computer processing.
Treatment for NSTEMI
The management of all types of heart attacks is time-sensitive, and the quicker the blood flow is restored, the better. If the blood oxygen levels are low, oxygen may help, but this depends on the person. Several alternative treatments and procedures are available, some of which can be used sequentially or concurrently. The following are some of the treatments used to manage NSTEMI:
- Percutaneous coronary intervention (PCI). Percutaneous coronary intervention is when a catheter device is inserted into a primary blood vessel somewhere within the body by an interventional cardiologist, commonly in the wrist or near the upper thigh. They then thread that device up to the heart and the affected arteries. Once inserted, they inflate a balloon at the device’s tip, which aids in the clearing of the obstruction. Stent implantation, which uses a scaffold-like structure to help keep the blood vessel intact, is also an option commonly used during PCI. PCI is more effective when conducted as soon as possible.
- Medications: NSTEMI patients can benefit from a variety of medicines. The following are some examples:
- Antiplatelet therapy. These medications prevent platelets from aggregating together and producing blood clots. This medication is significant because it prevents clot-based obstructions from worsening.
- Anticoagulant. This type of drug, like antiplatelet medicines, impedes clotting by interfering with the coagulation mechanism rather than the platelets.
- Angiotensin-converting enzyme inhibitors (ACE). These drugs disrupt the body’s normal protein breakdown that elevates blood pressure. By inhibiting that mechanism, blood pressure is reduced. If the patient has cardiovascular disease, hypertension, kidney difficulties, or diabetes, these medications are more typically recommended.
- Beta-blockers. These drugs cause the heart rate, enabling the heart to pump with much less pressure. Both effects are significant because they minimize the amount of oxygen the heart requires by reducing how hard it functions. If the patient has comorbidities such as hypotension, heart problems, or heart rhythm disorders, these drugs may not be a suitable treatment.
- Vasodilators. This class of drug induces blood arteries to dilate, increasing blood flow. This medication effectively controls chest discomfort caused by a lack of blood circulation.
- Inhibitors of HMG-CoA reductase. These drugs minimize the amount of cholesterol in the blood and prevent plaque from worsening in the coronary arteries.
- Coronary Artery Bypass Grafting (CABG). Heart surgery may be a preferable alternative to reestablish blood circulation when one or more heart or blood vessels are significantly narrowed or blocked. This process is called coronary artery bypass grafting (CABG). It is also known as bypass surgery or open-heart operation. During CABG, a surgeon removes a blood artery from other body parts, either in one of the legs or inside the chest wall. Surgeons then use that major artery to create a bypass around the clogged artery in the heart or arteries. This procedure permits blood to “bypass” the affected location.
Prevention of NSTEMI
There are various things a patient can take to avoid or delay a heart attack. The most important thing is to make an appointment with a cardiologist for a check-up or wellness visit.
Furthermore, many medical problems, such as diabetes and hypertension, do not manifest symptoms until they are somewhat advanced. However, even before symptoms develop, these disorders can cause continuing damage to the heart and coronary arteries, increasing the risk of suffering a heart attack significantly.
However, many problems can be detected early with the use of simple and non-invasive tests conducted during the yearly check-up. If the healthcare provider discovers any potential issues or health concerns, they can provide counseling and alternatives.
Some of the most important things to consider to avoid a heart attack are as follows:
- Eating a heart-healthy and well-balanced diet rich in fruits, vegetables, whole grains, and healthy fats
- Minimizing the consumption of saturated and trans fats
- Including at least 30 minutes of physical activity five times each week
- Using stress-reduction strategies such as meditation, taking deep breaths, or walking
- Smoking cessation
- Keep a healthy weight
Unfortunately, even if they follow all of these precautions, some people may still have a heart attack, especially if they are predisposed to heart attacks owing to a family medical history or another illness.
On the other hand, patients who observe the following preventive measures may be able to delay or lessen the severity of a heart attack. Good health facilitates healing and improves the general perspective following a heart attack.
NSTEMI Nursing Diagnosis
NSTEMI Nursing Care Plan 1
Acute Pain
Nursing Diagnosis: Acute Pain related to coronary artery occlusion secondary to NSTEMI as evidenced by complaints of chest pain in the presence or absence of radiation, facial grimace, alteration in pulse, blood pressure, and level of consciousness, and restlessness.
Desired Outcomes:
- The patient will provide verbal relief or control of chest discomfort once the medication is given.
- The patient will exhibit less tension, relaxed behavior, and increased mobility.
- The patient will exhibit the usage of relaxing techniques.
| NSTEMI Nursing Interventions | Rationale |
| Observe and record pain symptoms, including verbal reports and nonverbal indicators such as groaning, sobbing, frowning, agitation, excessive sweating, chest clutching, and blood pressure or heart rate changes. | The variability in appearance and demeanor of patients in pain can make assessment difficult. Most NSTEMI patients appear sick, preoccupied, and worried with pain. The patient’s history taking and further questioning regarding the symptoms should be delayed until the pain has been eased. Respiration may be increased drastically due to discomfort and worry; the release of stress-induced catecholamine raises heart rate and blood pressure. |
| Find a comprehensive description of the patient’s pain, including its location, intensity (on a scale of 0–10), frequency, features (dull, crushing, characterized as “like an elephant in my chest”), and radiation. | Help the patient in quantifying pain by correlating it to previous experiences. Pain is a subjective sensation that the patient must define. This intervention serves as a baseline for reference to measure treatment success, problem resolution, and advancement. |
| Examine any past angina, cardiac discomfort. If applicable, the patient should open up with his family and significant others about his health condition. | Postponement in disclosing discomfort impedes pain alleviation and may necessitate increased medication dosage to get relief. Furthermore, intense pain can cause a shock by triggering the sympathetic nervous system, causing massive damage, and compromising diagnostic testing and pain treatment. |
| Instruct the patient to report any pain as soon as possible. Make a peaceful setting available and soothing activities and comfort measures. Approach the patient with confidence and calmness. | This intervention reduces environmental forces, which can worsen anxiety and heart strain, limit coping capacities, and make it difficult to adapt to the present predicament. |
| Teach the patient relaxation strategies such as deep and slow breathing, distraction activities, meditation, and mental imagery. Assist the patient as necessary. | This intervention helps reduce pain perception and reaction and increases a good mindset by providing a sensation of having some control over the circumstance. |
| In between narcotic medication, monitor vital signs. | Narcotic administration can cause hypotension and respiratory distress. In the presence of ventricular dysfunction, these issues may exacerbate NSTEMI. |
| As directed, use a nasal cannula or a face mask to deliver oxygen therapy. | This approach increases the quantity of oxygen accessible for myocardial absorption, which may alleviate discomfort caused by tissue ischemia. |
NSTEMI Nursing Care Plan 2
Deficient Knowledge
Nursing Diagnosis: Deficient Knowledge related to inadequate information or misunderstanding of the medical condition and its therapy requirements, unawareness of available information, miscomprehension of information resources secondary to NSTEMI as evidenced by the statement of misunderstanding, inability to improve condition upon prior routine, and the emergence of avoidable complications.
Desired Outcomes:
- The patient will verbally explain the diagnosis, potential problems, individual risk factors, and pacemaker function.
- The patient will verbalize the symptoms of pacemaker failure.
- The patient will explain his comprehension of the therapy regimen.
- The patient will list the desired action and any potential adverse side effects of drugs.
| NSTEMI Nursing Interventions | Rationale |
| Evaluate the patient’s or significant other’s understanding, aptitude, and eagerness to understand NSTEMI. | This intervention is required to develop an individual education plan and treatment regimen for NSTEMI. |
| Advise the patient against isometric exercise, the Valsalva maneuver, and activities that require arms above the head. | These practices and activities directly impact cardiovascular health and may hinder recovery and raise the likelihood of NSTEMI complications. |
| Examine the patient’s plan of increasing his activity levels. Instruct the patient on the importance of gradually resuming activities such as walking, employment, leisure, and sexual activity. If needed, provide instructions for progressively increasing exercise and teaching on desired heart rate and pulse taking. | These activities significantly increase cardiac strain and myocardial oxygen uptake, and they may harm myocardial function and output. |
| Distinguish between typical increases in heart rate throughout numerous activities and deteriorating indications of cardiac stress such as chest discomfort, breathlessness, arrhythmias, higher heart rate persisting more than 15 minutes after activity cessation, and excessive weariness the next day. | Excessive pulse rate, the emergence of chest discomfort, or breathlessness may necessitate adjustments in exercise and treatment regimen. |
| Explain to the patient the importance of consulting a doctor if chest discomfort, an alteration heart rhythm, or other symptoms reoccur. | Prompt examination and management may help to avoid complications. |
NSTEMI Nursing Care Plan 3
Risk for Decreased Cardiac Output
Nursing Diagnosis: Risk for Decreased Cardiac Output related to alterations in rate, rhythm, and electrical conduction, enhanced systemic vascular resistance or decreased preload, muscle infarction or dyskinesia, structural defects such as ventricular aneurysms, and septal deficiencies secondary to NSTEMI.
As a risk nursing diagnosis, the Risk for Decreased Cardiac Output is entirely unrelated to any signs and symptoms since it has not yet developed in the patient, and safety precautions will be initiated instead.
Desired Outcomes:
- The patient will have hemodynamic stability, such as blood pressure, cardiac output within normal limits, sufficient urine output, and a low frequency or absence of abnormal heart rhythms.
- The patient will have reduced occurrences of respiratory distress and angina are reported.
- The patient will exhibit an improvement in activity tolerance.
| NSTEMI Nursing Interventions | Rationale |
| When possible, make a comparison of both arms and obtain blood pressure through lying, sitting, and standing position. | Hypotension can happen due to ventricular dysfunction, cardiac muscle hypoperfusion, or vagal activation. On the other hand, hypertension is a regular phenomenon associated with distress, anxiety, catecholamine release, or previously existing vascular issues. Orthostatic (postural) hypotension may be linked to NSTEMI complications. |
| Listen for the patient’s breath sounds. | Crackling noises are indicative of pulmonary edema and may result in the development of an impaired myocardial function. |
| Keep an eye on the patient’s heart rate and rhythm. Telemetry is used to record cardiac dysfunction. | Medication, activity, and developing comorbidities all affect heart rate and breathing. Dysrhythmias, particularly premature involuntary ventricular spasms and gradual cardiac blockage, can impair cardiac function or exacerbate ischemic damage. Thus, acute and chronic atrial flutter with coronary artery or valvular involvement can be pathological. |
| Take note of the patient’s reaction to activity and encourage rest as needed. | Excessive exertion increases oxygen consumption and demand, which can impair myocardial function. |
| Serve small, easily digestible meals to the patient. Caffeine and caffeine-containing products should be avoided. | Large meals can significantly raise myocardial workload and stimulate the vagus nerve, which tends to result in bradycardia or ectopic beats. Caffeine acts as a powerful cardiac stimulant, increasing heart rate. |
NSTEMI Nursing Care Plan 4
Risk for Ineffective Tissue Perfusion
Nursing Diagnosis: Risk Ineffective Tissue Perfusion related to blood flow reduction or interruption, such as vascular constriction, hypovolemia or shunting, and venous thromboembolism emergence secondary to NSTEMI.
Desired Outcome: The patient will demonstrate adequate perfusion, as evidenced by skin warm skin, strong peripheral pulses, and normal vital signs, as well as other indicators such as the patient is alert or oriented, balanced input and output, absence of inflammation, and free from pain or distress.
| NSTEMI Nursing Interventions | Rationale |
| Evaluate any sudden or ongoing changes in mental function and changes in the level of consciousness. | Cerebral perfusion is directly proportional to cardiac function and is also profoundly affected by electrolyte or acid-base changes, lack of oxygen, and systemic thrombus formation. |
| Examine the skin for the pale complexion, cyanosis, and discoloration, and check if the skin is cool or sweating. Take note of the strength of the peripheral pulses. | Skin perfusion and pulses may be reduced due to systemic vascular constriction caused by insufficient cardiac output. |
| Keep track of the respirations and record the patient’s breathing | Respiratory distress may be precipitated by cardiovascular pump failure or ischemic distress; however, unexpected or persistent shortness of breath may strongly imply thromboembolic pulmonary complications. |
| Observe the patient’s intake and note any changes in the urine output. Take note of the urine-specific gravity as directed. | Diminished intake or prolonged nausea can lead to a decline in blood volume, which harms cardiac oxygenation and organ function. Measurement of specific gravity reveals information about hydration and kidney function. |
| Prevent isometric exercises and encourage passive or active leg exercises. | Isometric exercises improve vascular resistance, decrease venous return, and lower the risk of deep vein thrombosis; however, they can diminish cardiac output by increasing myocardial function and oxygen uptake. |
NSTEMI Nursing Care Plan 5
Activity Intolerance
Nursing Diagnosis: Activity Intolerance related to the existence of ischemic or necrotic myocardial tissues, as well as the cardiac depressant effects of certain drugs, imbalance in myocardial oxygen supply and demand secondary to NSTEMI as evidenced by alterations in heart rate and blood pressure with activity, the emergence of abnormal heart rhythms, changes in color or moisture of the skin, exertional chest pain, and generalized malaise.
Desired Outcomes:
- The patient will show a measurable/progressive increase in tolerance for activity, with heart rate or rhythm and blood pressure within the patient’s normal parameters and warm, pink, and fair skin.
- The patient will report a lack of chest pain in the presence of activity.
| NSTEMI Nursing Interventions | Rationale |
| Record patient’s heart rate and rhythm and changes in blood pressure before, during, and after activity. Directly relate the difficulty in breathing with angina reports. | Patterns determine the patient’s response to exercise and may imply myocardial oxygen starvation, which may necessitate a reduction in activity level or resume to bedrest, a modification in prescribed medications, or oxygen therapy. |
| Promote rest at first. Following that, limit activities based on pain or an adverse cardiovascular response. | Deliver stress-free recreational activities. This intervention diminishes cardiac workload and oxygen usage, thus decreasing the likelihood of complications. |
| Instruct the patient to avoid increasing his or her abdominal pressure, such as straining during defecation. | Activities requiring holding one’s breath and bearing down (Valsalva maneuver) can cause dysrhythmias (momentarily decreased cardiac output) and rebound palpitations with increased blood pressure. |
| Examine signs and symptoms that indicate intolerance to current activity level or necessitate notification of a nurse or health care professional. | Chest pains, irregular pulses, the emergence of breathing difficulties, or respiratory failure may indicate the need to modify exercise routine or medication. |
| Consult with a cardiac rehabilitation facility. | This intervention provides ongoing assistance or additional monitoring and involvement in the recovery and wellness procedure. |
Nursing References
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. (2018). 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
Disclaimer:
Please follow your facilities guidelines, policies, and procedures.
The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.
This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.