.

In t h e m a j o r i t y of p a t i e n t s w i t h A M I , c h e s t p a i n is t h e m a j o r p r e s e n t i n g
s y m p t o m . The p a i n is u s u a l l y s u b s t e r n a l a n d may r a d i a t e to t h e n e c k , s h o u l d e r s , a r m s , or e p i g a s t r i c a r e a . The p a i n is d e s c r i b e d as h e a v i n e s s , c o n s t r i c t i o n , b u r n i n g , or s i m i l a r to i n d i g e s t i o n . It is i m p o r t a n t to r e m e m b e r , h o w e v e r , t h a t t h e r e may be l i t t l e or no p a i n p r e s e n t at a l l . AMI c a n be v e r y s u b t l e , a n d o f t e n d i f f i c u l t to d i s t i n g u i s h f r o m a n g i n a . In a d d i t i o n to c h e s t p a i n , s y m p t o m s of MI i n c l u d e s h o r t n e s s of b r e a t h , d i a p h o r e s i s , we a kne ss, fatigue, a nxie t y, n a u s e a , vomiting, a b no r ma l blood pressure, a n d a b no r ma l heart rate. d. P a i n , a n x i e t y , a n d a r r h y t h m i a s o c c u r in t h e e a r l y s t a g e s of MI. V e n t r i c u l a r f i b r i l l a t i o n is t h e g r e a t e s t t h r e a t to l i f e in t h e f i r s t h o u r s a f t e r MI. M e d i c a l m a n a g e m e n t i n c l u d e s E C G m o n i t o r i n g , b e d r e s t to r e d u c e t h e w o r k l o a d of t h e h e a r t , a n d i n t r a v e n o u s t h e r a p y . M e d i c a t i o n s i n c l u d e m o r p h i n e to r e d u c e p a i n a n d r e l i e v e a n x i e t y , v a s o d i a l a t o r s , b e t a b l o c k e r , c a l c i u m c h a n n e l b l o c k e r s a n d l i d o c a i n e as a n t i a r r h y t h m i c therapy. e. N u r s i n g m a n a g e m e n t of a p a t i e n t w i t h AMI is i n t e n s i v e in n a t u r e , r e q u i r i n g c l o s e m o n i t o r i n g of t h e p a t i e n t ' s s t a t u s a n d p r o g r e s s , a l o n g w i t h c o n c u r r e n t p a t i e n t e d u c a t i o n . The n u r s i n g s t a f f w o r k s c l o s e l y w i t h t h e p h y s i c i a n , p h y s i c a l t h e r a p i s t , a n d d i e t i c i a n to d e v e l o p an i n d i v i d u a l i z e d r e h a b i l i t a t i o n p l a n f o r t h e p a t i e n t . T h i s p o s t m y o c a r d i a l i n f a r c t i o n r e h a b i l i t a t i o n p l a n , o f t e n r e f e r r e d to as t h e "MI p r o t o c o l , " t a k e s t h e p a t i e n t f r o m c o m p l e t e b e d r e s t d u r i n g t h e f i r s t d a y s of h i s MI to d i s c h a r g e f r o m t h e h o s p i t a l s e v e r a l w e e k s l a t e r . The p r o t o c o l is a p l a n of p r o g r e s s i v e , m o n i t o r e d " s t e p s " of i n c r e a s e d a c t i v i t y a n d e x e r c i s e , a c c o m p a n i e d by i n t e n s i v e p a t i e n t e d u c a t i o n . The r e h a b i l i t a t i o n p l a n is i m p l e m e n t e d u p o n p h y s i c i a n ' s o r d e r s o n c e t h e p a t i e n t ' s c o n d i t i o n is s t a b l e . R e h a b i l i t a t i o n is a d v a n c e d by t h e p h y s i c i a n , who b a s e s h i s d e c i s i o n s u p o n d a i l y r e v i e w of t h e p a t i e n t ' s s t a t u s a n d t h e i n f o r m a t i o n r e c o r d e d by t h e n u r s i n g s t a f f . I m p o r t a n t i n f o r m a t i o n r e g a r d i n g p a t i e n t t o l e r a n c e a n d a c c e p t a n c e of t h e r e h a b i l i t a t i o n p r o c e s s is o b t a i n e d by t h e n u r s i n g s t a f f a n d r e c o r d e d in t h e p a t i e n t ' s c h a r t . f. N u r s i n g c a r e is d i r e c t e d t o w a r d t h r e e m a j o r c o n s i d e r a t i o n s : o b s e r v a t i o n a n d p r e v e n t i o n of f u r t h e r m y o c a r d i a l d a m a g e a n d c o m p l i c a t i o n s , p r o m o t i o n of an e n v i r o n m e n t t h a t a l l o w s f o r m a x i m u m c o m f o r t a n d r e s t , a n d p a t i e n t e d u c a t i o n to f u l l y prepare t h e patient f o r discharge. (1) O b s e r va t io n a n d p r e ve nt i o n i nc l ud e t h e follo wing n u r s i n g considerations O b s e r va t io n a n d p r e ve nt i o n i nc l ud e t h e follo wing n u r s i n g considerations: ( a ) F r e q u e n t m o n i t o r i n g of t h e p a t i e n t ' s v i t a l s i g n s a n d E C G . ( b ) O b s e r v a t i o n f o r s i g n s of i m p e n d i n g h e a r t f a i l u r e by c l o s e m o n i t o r i n g of i n t a k e a n d o u t p u t , d a i l y w e i g h t , b r e a t h e s o u n d s , a n d s e r u m e n z y m e s . ( c ) C a r e f u l a s s e s s m e n t a n d d o c u m e n t a t i o n of e a c h e p i s o d e of c h e s t p a i n to i n c l u d e s e v e r i t y , d u r a t i o n , m e d i c a t i o n g i v e n , a n d r e l i e f o b t a i n e d