Nursing Management Myocardial Infarction patient in Emergency Room

Harmeet Kaur KangM.Sc Cardiological / CTVS Nursing

Associate Professor

Myocardial Infarction

Myocardial Infarction occurs as a result of thrombotic occlusion of the coronary artery and cause irreversible injury and necrosis.

Clinical Manifestations

Chest pain Severe and prolonged and may be

described as crushing, constricting, or oppressive.

Radiation of pain to ulner aspect of left arm, neck, jaw and Interscapular region.

Clinical Manifestations Contd….

Indigestion Nausea Vomiting Diaphoresis Palpitations Dyspnea

Nursing Assessment in Emergency Room History Taking. Physical Examination Vital parameters 12 lead ECG monitoring. Measure oxygen saturation. Obtain initial serum cardiac markers.

Inferior wall MI: right coronary artery

lead II, III & AVF Lateral wall MI : Lt circumflex artery

lead I, AVL, V5 & V6 Anterior MI : Lt anterior descending

lead V1 to V6 Posterior Wall MI:Rt coronary artery

Immediate General Management Oxygen at 4 l/min. Aspirin 160-325mg. Nitroglycerine SL or spray. Morphine IV

Memory Aid: ‘MONA’

Nursing management Plan

Chest discomfort R/T imbalance between myocardial oxygen supply and demand

Goals: To detect chest discomfort and

associated ECG and hemodynamic changes early.

To reduce or eliminate chest discomfort

Interventions Assess and document the chest

pain. Assess vital parameters. Obtain 12 lead ECG. Assess cardiac marker values. Report the findings of assessment to

physician.

Administer oxygen, morphine sulfate, nitroglycerine or other medications as ordered.

Provide the restful environment and promote the patient’s comfort.

Provide care in calm, competent manner.

Decreased myocardial tissue perfusion R/T an imbalanced oxygen supply and demand.

Assessment MONA Start two IV lines. Early reperfusion:

Administer adjunctive medications: Beta blockers. Nitroglycerine IV. Heparin IV

No Reperfusion

Delay

NOTE:

Time duration

Eligible for thrombolytic therapy

Thrombolytic therapy contra-indicated

Not suitable for PTCA

Persistent symptoms

Thrombolysis PTCA

Other medical therapy

No Yes

Reperfusion

>12 hrs<12hrs

Administer thrombolytic therapy as prescribed.

Streptokinase Urokinase tPADoor to drugs: <30min.

Prepare for Primary PCI as prescribed.

Door to balloon 90+ 30 min.

Fear/ anxiety related to diagnosis, treatment and prognosis acute MI

Provide individualized nursing care in calm and competent manner.

Listen, reflect, guide.