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Nursing Management

Myocardial Infarction patient in


Emergency Room

Harmeet Kaur Kang


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.

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