In Partial Fulfillment Of the Requirements in

RLE
(Related Learning Experience)

Presented to: Ms. Minda Alawaddin, R.N. (Clinical Instructor) Rotation 16 / WMMC ER

Presented by: Zaina O. Sanihin (BSN IV M) Nursing Student

March 16, 2012

MYOCARDIAL INFARCTION
DEFINITION Myocardial infarction (MI) refers to a dynamic process by which one or more regios of the heart muscle experience a severe or prolonged decrease in oxygen supply because of insufficient coronary blood flow; subsequently, necrosis or tissue death occurs. The onset of myocardial iinfarction process may be sudden or gradual, ad the progression of the event o completion takes approximately 3 to 6 hours. PATHOPHYSIOLOGY AND ETIOLOGY Acute coronary thrombosis (partial or total) associated with 90% of MIs. Severe coronary artery disease (greater than 70%) narrowing artery) precipitates thrombus formation Intramural hemorrhage into atheromatous plaques causes the lesion to enlarge and occlude the vessel; dissecting hemorrhage can also occur. The plaque rupture into the vessel lumen, and a thrombus forms on top of the ulcerated lesion with resulatnt vessel occlusion. Other etiologic factors include coronary artery spasm, coronary artery embolism, infectious diseases causing arterial inflammation, hypoxia, anemia, and severe exertion or stress on the heart in the presence of significant coronary artery disease (i.e. surgical procedures or shoveling snow). Different degress of damage occur in the heart muscle Zone of necrosis Zone of injury Zone of ischemia/ non Q) infarction According to the heart layers involved, Mis can be classified as: Transmural (Q wave) infarction

Subendocardial (nontransmural Location of MI is identified as the location of the damaged heart muscle within the left ventricle; inferior, anterior, lateral, and posterior or right ventricle. Left ventricle is the most common and dangerous location for an MI, because it is the main pumping chamber of the heart. Right ventricular infarctions commonly occur in conjuction with damage to the inferior and/ or posterior wall of the left ventricle. Region of the heart muscle muscle that becomes damaged determined by coronary artery that becomes obstructed.. The amount of heart muscle damage and the location of the MI determine prognosis.

CLINICAL MANIFESTATIONS Chest pain Severe, diffuese steady substernal pain of a crushing and squeezing nature Not relieved by rest or sublingual vasodilator therapy, but requires narcotics May radiate to the arm (commonly left), shoulders, neck, back, and/ or jaw Continues for more than 15 minutes May produce anxiety and fear, resulting in an increase heart rate, blood pressure, and respiratory rate. Dipahoresis, cool clammy skin, facial pallor Hypertension, hypotension Bradycardia, tachycardia Premature ventricular and/ or atrial beats Palpitations, severe anxiety, dyspnea Disorientation, confusion, restlessness Fainting, marked weakness Nausea, vomiting, hiccups Atypical symptoms; epigastric pain or abdominal distress, dull aching or tingling sensations, shortness of breath, extreme fatigue. DIAGNOSTIC EVALUATION ECG changes Elevation of Serum Ezymes ans Isoenzymes Elevated cardiac troponin Elevated myoglobin Elevated WBC count and sedimentatio rate MANAGEMENT

Therapy is aimed at the protection of ischemic and injured heart tissue to preserve muscle function, reduce the infarct size, and prevent death. Innovative modalities provide early restoration or coroary blood flow, and the use of pharmacologic agents inmporves oxygen supply and demand. Reduces and/ or prevents dysrhythmias, and inhibits the progression of coronary artery disease. Oxygen Therapy Pain Control Opiate analgesic therapy Morphine, Meperidine (Demerol) Vasodilator therapy Nitroglycerin (sublingual, IV, paste) Anxiolytic therapy Benzodiazepines Pharmacologic Therapy Thrombolytic agents streptokinase (Streptase), reteplase (Retavase) Anjunctive therapy eptifibatide (Integrilin), abciximab (ReoPro) Antocoagulation Therapy Beta adrenergic blockers Anti dysrhythmis therapy lidocaine (Xylocaine) Calcium channel blockers - Diltiazem Percutanous Transluminal Coronary Angioplasty Surgical Revascularization COMPLICATIONS Rhythm disturbances Cardiac failure Cardiac rupture Papillary muscle rupture Ventricular mural thrombus Thromboemboli Ventricular aneurysm Cardiac tamponade Pericarditis (2 to 3 days after MI) Psychiatric problems depression, personality changes NURSING DIAGNOSES The following are the possible nursing diagnoses to patients having myocardial infacrtion. Pain r/t an imbalance in oxygen supply and demand Anxiety r/t chest pain, fear of death, threatening environment

Decreased Cardiac Output r/t impaired contractility Activity Intolerance r/t insufficient oxygenation to perfomr activities of daily living, deconditioning effects of bed rest Risk For Injury (bleeding) r/t dissolution of protective clots Altered Tissue Perfusion (myocardial) r/t coronary restenosis, extension of infarction Ineffective Individual Coping r/t threats to self esteem, disruption of sleep rest pattern, lack of significant support system, and loss of control

NURSING INTERVENTIONS Nursing Interventions focuses on the following: Reducing Pain Alleviating Anxiety Maintaining Hemodynamic Stability Increasing Activity Tolerance Preventing Bleeding Maintaining Tissue Perfusion Strengthening Coping Abilities

GRADES STUDENT ID: 2003-00175 STUDENT NAME: SANIHIN, ZAINA O.

School Year 2008-2009 ( First Semester ) Subject Code Description TFN THEORETICAL FOUNDATIONS IN NURSING ANA/PHYSIO ANATOMY & PHYSIOLOGY CHEM 101 GENERAL & INORGANIC CHEMISTRY School Year 2008-2009 ( Second Semester ) Subject Code Description SOC-ANTHRO SOCIO & ANTHROPOLOGY NCM 100 FUNDAMENTALS OF NURSING WITH SKILLS NCM 100B RELATED LEARNING EXPERIENCE CHEM 2 BIOCHEMISTRY PHYS 100 GENERAL PHYSICS School Year 2008-2009 ( Summer ) Subject Code Description HA HEALTH ASSESSMENT Grade 1.50 2.50 2.00

Grade 1.25 1.75 1.50 2.00 1.50

Grade 2.25

School Year 2009-2010 ( First Semester ) Subject Code Description CHN A COMMUNITY HEALTH NURSING BIOETHICS BIOETHICS CARE OF INDIVIDUALS AND FAMILY WITH NCM 101 A MATERNAL PHILO PHILOSOPHY OF MAN NCM 101B RELATED LEARNING EXPERIENCE CHN B RELATED LEARNING EXPERIENCE (102 HR MP MICROBIOLOGY & PARASITOLOGY School Year 2009-2010 ( Second Semester ) Subject Code Description NCM 102A NURSING CARE MANAGEMENT NCM 102B RELATED LEARNING EXPERIENCE PHARMA PHARMACOLOGY FOUNDATIONS IN NUTRITION AND DIET FN 101 THERAPHY PAGBASA AT PAGSULAT TUNGO SA FIL 2 PANANALIKSIK School Year 2009-2010 ( Summer ) Subject Code Description HealthEd. HEALTH EDUCATION IT NURSING INFORMATICS School Year 2010-2011 ( First Semester ) Subject Code Description CARE OF CLIENTS WITH PROBLEMS IN NCM 103 A* OXYGENATION, NCM 103 B* RELATED LEARNING EXPERIENCE (306 HRS) Biostat BIOSTATISTICS Humanities WORLD CIVILIZATION & LITERATURE School Year 2010-2011 ( Second Semester ) Subject Code Description ELECTIVE 1 EC-PARENT AND CHILD NURSING CARE OF CLIENTS WITH PROBLEMS IN NCM 104 A. INFLAMMATORY NCM 104 B. RELATED LEARNING EXPERIENCE (204 HOURS) CARE OF PATIENTS WITH MALADAPTIVE NCM 105 A. PATTERNS OF NRes 1 NURSING RESEARCH 1 (WITH RLE 51 HRS) NRES 1B RELATED LEARNING EXPERIENCE (51 HOURS) School Year 2010-2011 ( Summer )

Grade 1.50 2.00 1.75 1.75 1.50 1.50 1.75

Grade 2.00 1.50 2.00 1.00 1.75

Grade 1.75 1.25

Grade 2.00 1.50 1.25 1.25

Grade 2.00 2.00 1.75 2.25 1.50 1.50

Subject Code NCM 105 B

Description RELATED LEARNING EXPERIENCE (204 HRS.)

Grade 1.75

School Year 2011-2012 ( First Semester ) Subject Code Description CA 1 COMPETENCY APPRAISAL 1 NCM 106 B RELATED LEARNING EXPERIENCE (255 HOURS) CARE OF CLIENTS WITH PROBLEMS IN NCM 106 A CELLULAR ABB NRES 2 NR RLE (102 HOURS) ELECTIVE 2 ELECTIVE COURSE 2 NCM 107 A NURSING LEADERSHIP MANAGEMENT School Year 2011-2012 ( Second Semester ) Subject Code Description CA 2 COMPETENCY APPRAISAL 2 NCM 107 B RELATED LEARNING EXPERIENCE (153 HRS.) INTENSIVE NURSING PRACTICUM-RELATED INP LEARNING

Grade 1.50 1.50 2.25 .000 1.75 2.00

Grade .000 .000 .000

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