m yocardial infarction

7/18/2019 M Yocardial Infarction

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Management & Nursing CareManagement & Nursing Care

of Patient with Coronary Arteryof Patient with Coronary ArteryDiseasesDiseases

Myocardial InfarctionMyocardial Infarction((((

Dr. Walaa NasrDr. Walaa Nasr

Lecturer of Adult NursingLecturer of Adult Nursing

Second yearSecond year



Myocardial infarctionMyocardial infarction

outlinesoutlinesDenitionDenition

!tiology and!tiology and"atho"hysiology"atho"hysiology

Clinical manifestationsClinical manifestations

Diagnostic e#aluationDiagnostic e#aluationMedical managementMedical management

Nursing "rocessNursing "rocess




DenitionDenition

$ther names% coronary occlusion heart$ther names% coronary occlusion heart

attac' attac'

Myocardial infarction refers to theMyocardial infarction refers to the

"rocess (y which"rocess (y which myocardial tissuemyocardial tissue isisdestroyed in regions of the heart thatdestroyed in regions of the heart that

areare de"ri#edde"ri#ed of an ade)uate (loodof an ade)uate (lood

su""ly (ecause of a reduced coronarysu""ly (ecause of a reduced coronary

(lood *ow +a "rolonged lac' of(lood *ow +a "rolonged lac' of

myocardial o,ygenation leading tomyocardial o,ygenation leading to

necrosisnecrosis of a "ortion of the heartof a "ortion of the heart

muscle-.muscle-.




!tiology and "atho"ysiology!tiology and "atho"ysiologyCauses of reduced (lood *ow%Causes of reduced (lood *ow%

Narrowing of a coronary artery owingNarrowing of a coronary artery owingto atherosclerosisto atherosclerosis

A com"lete occlusion of an arteryA com"lete occlusion of an arteryowing to em(olus or a throm(usowing to em(olus or a throm(us

Myocardial necrosis caused (y acuteMyocardial necrosis caused (y acuteocclusion of a coronary artery due toocclusion of a coronary artery due to"la)ue ru"ture or erosion with"la)ue ru"ture or erosion with

im"osed throm(osis-im"osed throm(osis-




Clinical manifestationsClinical manifestations

Sym"tomsSym"toms PainPain is the cardinal sym"tom of an MIis the cardinal sym"tom of an MI

An,ietyAn,iety and fear of im"ending deathand fear of im"ending death

NauseaNausea and #omitingand #omiting

/reath/reathlessnesslessness

Colla"seColla"se0synco"e0synco"e




Clinical manifestations +cont1-Clinical manifestations +cont1-

Physical signsPhysical signs

Signs ofSigns of sympathetic activationsympathetic activation: pallor,: pallor,

sweating, tachycardiasweating, tachycardia Signs ofSigns of vagal activationvagal activation::

nausea,vomiting, bradycardianausea,vomiting, bradycardia

Signs ofSigns of impaired myocardial functionimpaired myocardial function::hypotension, oligurea, cold peripherieshypotension, oligurea, cold peripheries

Signs ofSigns of complicationscomplications: e.g. mitral: e.g. mitral

regurgitation, pericarditisregurgitation, pericarditis




Diagnostic e#aluationDiagnostic e#aluation

!lectro!lectrocardiogram +!C2-cardiogram +!C2- /lood/lood testtest +Cardiac en3ymes-+Cardiac en3ymes-

!cho!chocardiogramcardiogram

NuclearNuclear scanscan

ChestChest radiogra"hsradiogra"hs

CoronaryCoronary angiogra"hyangiogra"hy

!,ercise!,ercise stress test.stress test.

CardiacCardiac com"uteri3ed tomogra"hycom"uteri3ed tomogra"hy

++C4C4) or) or magnetic resonance imagingmagnetic resonance imaging

++M5IM5I-.-.




Medical managementMedical management Immediate management% the rst 67 hoursImmediate management% the rst 67 hours

Analgesic +mor"hin sul"hate- & antiemeticAnalgesic +mor"hin sul"hate- & antiemetic

Antithrom(otic thera"y +Anti"latletAntithrom(otic thera"y +Anti"latletthera"y8 anticoagulants-thera"y8 anticoagulants-

Antianginal thera"yAntianginal thera"y

Surgical thera"ySurgical thera"y




Nursing "rocessNursing "rocess

Assessment Assessment A careful historyA careful history

Descri"tion of sym"toms + chestDescri"tion of sym"toms + chest"ain8 "al"itation8 dys"nea8 synco"e"ain8 "al"itation8 dys"nea8 synco"eor sweating-. !ach sym"toms mustor sweating-. !ach sym"toms must(e e#aluated with regard to time8(e e#aluated with regard to time8

duration8 "reci"itating & relie#ingduration8 "reci"itating & relie#ingfactors. In addition com"letefactors. In addition com"lete"hysical assessment for%"hysical assessment for%

le#el of consciousnessle#el of consciousness



9eart sounds9eart sounds

Peri"heral "ulsesPeri"heral "ulses

Lung soundLung sound

Nursing "rocess +cont1-Nursing "rocess +cont1-



Nursing diagnosis Chest "ain related to reduced coronary (lood

*ow.

9igh ris' for (reathing "attern ine:ecti#e

related to *uid o#erload

An,iety related to fear from death

9igh ris' for tissue "erfusion alterationrelated to decreased cardiac out"ut

9ealth maintenance alteration related to no

adherence to thera"eutic regimen





Patient's goalsPatient's goals 55e"ort that "ain is decreasede"ort that "ain is decreased

//reath e:ecti#elyreath e:ecti#ely

!!,"erience less an,iety le#el,"erience less an,iety le#el

99a#e im"ro#ed tissuea#e im"ro#ed tissue

"erfusion"erfusion AAdhere to the self caredhere to the self care

"rogram"rogram




Nursing interventionNursing interventionRelief or control of chest painRelief or control of chest pain

Alleviate respiratory dicultiesAlleviate respiratory dicultiesReduce the aniety levelReduce the aniety level!aintain ade"uate tissue!aintain ade"uate tissue

perfusionperfusion#elp the patient to adhere to#elp the patient to adhere to

the self care programthe self care program

m yocardial infarction

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