Management & Nursing CareManagement & Nursing Care of Patient with Coronary Artery of Patient with Coronary Artery

DiseasesDiseasesMyocardial InfarctionMyocardial Infarction))))

Dr. Walaa NasrDr. Walaa Nasr

Lecturer of Adult NursingLecturer of Adult Nursing

Second yearSecond year

Myocardial infarctionMyocardial infarction

outlinesoutlines Definition Definition Etiology and Etiology and pathophysiologypathophysiology

Clinical manifestationsClinical manifestations Diagnostic evaluationDiagnostic evaluation Medical managementMedical management Nursing processNursing process

Myocardial infarctionMyocardial infarction DefinitionDefinition

Other names: coronary occlusion- heart Other names: coronary occlusion- heart attackattack

Myocardial infarction refers to the Myocardial infarction refers to the process by which process by which myocardial tissuemyocardial tissue is is destroyed in regions of the heart that destroyed in regions of the heart that are are deprived deprived of an adequate blood of an adequate blood supply because of a reduced coronary supply because of a reduced coronary blood flow (a prolonged lack of blood flow (a prolonged lack of myocardial oxygenation leading to myocardial oxygenation leading to necrosisnecrosis of a portion of the heart of a portion of the heart muscle).muscle).

Myocardial infarctionMyocardial infarction Etiology and pathopysiologyEtiology and pathopysiology

*Causes of reduced blood flow:*Causes of reduced blood flow:

Narrowing of a coronary artery owing Narrowing of a coronary artery owing to atherosclerosisto atherosclerosis

A complete occlusion of an artery A complete occlusion of an artery owing to embolus or a thrombusowing to embolus or a thrombus

Myocardial necrosis caused by acute Myocardial necrosis caused by acute occlusion of a coronary artery due to occlusion of a coronary artery due to plaque rupture or erosion with plaque rupture or erosion with imposed thrombosis)imposed thrombosis)

Myocardial infarctionMyocardial infarction Clinical manifestationsClinical manifestations

SymptomsSymptoms PainPain is the cardinal symptom of an MI is the cardinal symptom of an MI

AnxietyAnxiety and fear of impending death and fear of impending death

NauseaNausea and vomiting and vomiting

BreathBreathlessnesslessness

CollapseCollapse/syncope/syncope

Myocardial infarctionMyocardial infarction Clinical manifestations (cont…)Clinical manifestations (cont…)

Physical signsPhysical signs Signs of Signs of sympathetic activationsympathetic activation: pallor, : pallor,

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

nausea,vomiting, bradycardianausea,vomiting, bradycardia Signs of Signs of impaired myocardial functionimpaired myocardial function: :

hypotension, oligurea, cold peripherieshypotension, oligurea, cold peripheries Signs of Signs of complicationscomplications: e.g. mitral : e.g. mitral

regurgitation, pericarditisregurgitation, pericarditis

Myocardial infarctionMyocardial infarction Diagnostic evaluationDiagnostic evaluation

ElectroElectrocardiogram (ECG) cardiogram (ECG) BloodBlood test test (Cardiac enzymes)(Cardiac enzymes)

EchoEchocardiogramcardiogram NuclearNuclear scan scan ChestChest radiographs radiographs Coronary Coronary angiography angiography ExerciseExercise stress test. stress test. CardiacCardiac computerized tomography computerized tomography

((CTCT) or ) or magnetic resonance imaging magnetic resonance imaging ((MRIMRI).).

Myocardial infarctionMyocardial infarction Medical managementMedical management

Immediate management: the first 12 hoursImmediate management: the first 12 hours

Analgesic (morphin sulphate) & antiemeticAnalgesic (morphin sulphate) & antiemetic

Antithrombotic therapy (Antiplatlet Antithrombotic therapy (Antiplatlet therapy, anticoagulants)therapy, anticoagulants)

Anti-anginal therapyAnti-anginal therapy

Surgical therapySurgical therapy

Myocardial infarctionMyocardial infarction Nursing processNursing process

AssessmentAssessment A careful historyA careful history

Description of symptoms ( chest Description of symptoms ( chest pain, palpitation, dyspnea, syncope pain, palpitation, dyspnea, syncope or sweating). Each symptoms must or sweating). Each symptoms must be evaluated with regard to time, be evaluated with regard to time, duration, precipitating & relieving duration, precipitating & relieving factors. In addition complete factors. In addition complete physical assessment for:physical assessment for:

*level of consciousness*level of consciousness

*Heart sounds*Heart sounds

*Peripheral pulses*Peripheral pulses

*Lung sound*Lung sound

Nursing process (cont…)Nursing process (cont…)

Nursing diagnosis Chest pain related to reduced coronary blood

flow.

High risk for breathing pattern ineffective related to fluid overload

Anxiety related to fear from death

High risk for tissue perfusion alteration related to decreased cardiac output

Health maintenance alteration related to no adherence to therapeutic regimen

Nursing process (cont…)Nursing process (cont…)

Nursing process (cont…)Nursing process (cont…)

Patient's goalsPatient's goals RReport that pain is eport that pain is

decreaseddecreased BBreath effectivelyreath effectively EExperience less anxiety levelxperience less anxiety level HHave improved tissue ave improved tissue

perfusionperfusion AAdhere to the self care dhere to the self care

programprogram

Nursing process (cont…)Nursing process (cont…) Nursing interventionNursing intervention Relief or control of chest painRelief or control of chest pain Alleviate respiratory difficultiesAlleviate respiratory difficulties Reduce the anxiety level Reduce the anxiety level Maintain adequate tissue Maintain adequate tissue

perfusionperfusion Help the patient to adhere to Help the patient to adhere to

the self care programthe self care program