M.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 patients 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 NOTE:
No Reperfusion
Delay Time duration <12hrs >12 hrs
Eligible for Thrombolytic
thrombolytic therapy Not Persistent therapy contra- suitable symptoms indicated for PTCA
No Yes
Thrombolysis PTCA Reperfusion
Other medical therapy
Administer thrombolytic therapy as prescribed. Streptokinase Urokinase tPA
Door 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.