ACUTE

MYOCARDIAL
INFARCTION

Nama :
Anisa Nurul Hikmah
Astrie Merlinda
Diah Ayu Prabandini
Nila Nurfadillah
Sri Wulandari
Yulia Indrianisa
Acute Myocardial Infarction (AMI)

disorder of blood flow to the heart that causes

the heart muscle cells to experience hypoxia.
coronary blood vessels are blocked so that the
blood flow to the heart muscle stops, except for a
small amount of Colateral flow from the
surrounding blood vessels.

Muscle areas that have no blood flow or very

little flow so that can not maintain the function
of heart muscle, said to have infarction
Etiology

 Acute myocardial infarction is caused by

atherosclerosis or total or partial blockage by
embolism and / or thrombus.
Classification

1. NSTEMI (Non ST-segment Elevation of

Miocard Infarction)

2. STEMI (ST-segment Elevation of Myocardial

Infarction)
Clinical Manifestations

Retrosternal chest pain

Pain may spread to the arm (generally left),
shoulders, neck, jaw even to the back and
epigastrium.
The pain lasts longer than angina pectoris and is
unresponsive to nitroglycerin. Sometimes,
especially in diabetic patients and the elderly, no
pain is found at all.
Pain can be accompanied by feelings of nausea,
vomiting, spasms, dizziness, cold sweat,
pounding or syncope.
Abnormalities on physical examination are not
specific and can be normal. BJ can be found ie
the broken S2, paradoxical and gallop rhythms.
Tachycardia, pale skin, coldness and
hypotension are found in relatively more severe
cases, occasionally found diskinetic pulsations
that appear or are in the chest wall of the inferior
IMA.
 Risk Factor

1. Age
2. Gender
3. Race
4. Family History
5. Hypertension
6. Diabetes Melitus
7. Dyslipidemia
8. Smoking History
9. Overweight and Obesity
10. Psychosocial Factors
11. Physical Activity
12. Lifestyle
Complications

• Expansion of infarct and post-infarction

ischemia
• Arrhythmias
• Cardiac muscle dysfunction (failure of left
janttung, hypotension and shock)
• Right ventricular infarction
• Mechanical defect
• Miocard rupture
• Anurisma
• Pericarditis
 Investigations

1. EKG (Electrocardiogram)
2. Blood Test
- LDH (Lactate Dehydrogenation)
- Troponin T & I
3. Cardiac enzyme
- CPK-MB / CPK
- LDH / HBDH
- AST / SGOT
4. Oronary Angiography
Management

Medical management
Several therapies that can be given include:
1. Vasodilatator
2. Anticoagulants
3. Thrombolytics
4. Analogic
 Prevention

As far as possible reduce the factors that cause the

occurrence of coronary artery disease, especially
that can be changed by the patient:
1. Stop smoking
2. Lose weight and maintain ideal body weight
3. Controlling blood pressure
4. Lower blood cholesterol levels with diet or with
drugs
5. Doing sports regularly
Nursing care
Sample case:
Tn.S came to the emergency room with chest pain
on the left, and felt shortness of breath, the client
seemed to wince to hold back pain and hold the
pain area. After the assessment, the client said the
left chest pain was stabbed with a pain scale of 5,
chest pain was felt for 3 days and disappeared, the
client said earlier feeling breathless and tired
easily. The client has a history of active smokers
ASSESSMENT
1. Identity
a. Patient identity
Name : Tn. S
Age : 65 years old
religion : Islam
gender : Male
Status : Married
Education : SMP
Address : Kutabumi Rt 08/02,
Tangerang
MRS Date : March 10, 2018
Review Date : March 10, 2018
Medical diagnosis : Acute Myocardial Infarction
Main complaints : Chest pain
b. Identity of Responsible Person
Name : Ny. K
Age : 60 years
relationship with patien : Wife
Occupation : Housewife
Address : Kutabumi Rt 08/02,
Tangerang
 Health Status
a. Current health status
1. The main complaint (when the MRS and
current)
During MRS : Patients complain of left chest
pain
Current : The patient feels asphyxiated
2. Reasons for hospital admission and travel now:
Because Patients complain of left chest pain,
Patients complain of shortness of breath.
3. Efforts made to overcome them
Self-made efforts "Patients say if you feel pain,
patients will rest"
Efforts made by others "The patient said if it feels
pain, the family will encourage the patient to rest"
b. Past health status
1. Diseases that have been experienced:
"Patient said earlier had experienced shortness of
breath." Never treated:
"The patient said he had been treated previously,
treated with a Nebulizer tool because he felt short
of breath"
2. Allergies:
"Patient says do not have any"
3. Habit (smoking / coffee / alcohol etc):
"Patients say have an active smoking habit and
drink coffee every day"
c. Family disease history (depict genogram)
Patients say in the family no one has a hereditary
disease.
3. Pattern of basic needs (Data Bio-psycho-socio-
cultural-spiritual)
a. Pattern of Perception and Health Management
• Before illness: Patients say that in their daily
lives an active smoking, patients say they know
about the disease but do not want to stop
smoking.
• When sick: Patients say that when they get sick
eating patients will immediately rest and
patients do not want to take any medication.
b. Pattern of Nutrition-Metabolic
• Before illness: - Food intake: Patients say at the
time before the usual eating habits, good
appetite, rice, vegetables and side dishes.
Frequency of eating 3x / day. Intake fluid:
Patients 5-7 glasses a day, water, and coffee.
• When sick: - Food intake: Patients say since sick
appetite decreased not even want to eat, eat only
porridge only and can only spend ½ portion of
food only. How to eat it must be fed. So his
weight decreased. Liquid intake: Patients only
drink 3-4 cups / day, water
c. Patterns of Activity and Exercise
1) Activity
• Before illness
Patients say before the illness daily activities do
not experience difficulties
• When sick
Patients say when the illness of daily activities is
disrupted, it is unusual and unable to perform
due activity feel pain in chest left side and feel
tightness when breathe. Patient's ability
decreases so much need help to carry out daily
activities of patient assisted by family member
2) Exercise

• Before illness
Patients say that patients often exercise every
Sunday
• When sick
Patients say when sick can not exercise because
of her body condition is not possible
d. Sleep Patterns and Rest
• Before illness
Patient says sleeping night 7-8 hours, nap 1 hour
• When sick
Patients say it is difficult to start sleeping
because they feel uncomfortable with the
hospital environment. Patients only sleep about
5-6 hours a day
e. Pattern Elimination
1) Chapter
• Before illness:
Patients say before chapter normal as normal.
Usually chapter 1 x / day, at the time of day and
night, yellowish feces color and consistency of its
chapter soft
• When sick:
Patients say when the chapter is still normal as
usual
2) Urinate
• Before illness: Patients say before urinate illness
is only 4-5x / day. No difficulties experienced,
clear urine color and typical urine smell
• When sick: Patients say when the patient's
illness is only 2-3x / day urinate, yellow color
and typical urine smell
f. Pattern Roles and Responsibilities
• Before illness Patients say good family
relationships and communicate well with family,
patients can also play role as head of household.
• When sick The patient said he could not perform
his role as head of the household.
g. Pattern of Coupling and Stress Tolerance
• Before illness Patients say before sickness if
there is a problem always discussed with his
family, the absence of any other drug use before
the patient is sick
• When sick Patients when sick if there is a
problem of patients experiencing stress causing
chest pain often relapse
h. Cognitive Patterns and Perceptions
• Before illness
Patients assume no disturbance to the body, the
patient before the pain of understanding and
adaptability with the patient is very good, the
patient is very well understood about the illness,
but the patient has not willing to change his
perception from bad to good perception
• When sick
Patients say they want to change their behavior
so that the disease does not recur.
i. Self Concept Patterns
• Before illness
Before the patient's illness can illustrate the identity
of his role in the family
• When sick
Patients say when the illness continues to run on his
self-concept.
j. Sexual Reproduction Patterns
• Before illness
Patients said they were married, had 2 sons, and the
patient said there was no abnormality in the
reproductive organs
• When sick
Patients said they were married, had 2 sons, and the
patient said there was no abnormality in the
reproductive organs
k. Patterns of Values and Confidence
• Before illness
Patients always perform their duty as Muslims
(pray 5 time). The patient believes that his
illness can be cured by believing in God
• When sick
Patients perform prayers 3-4 times and always
pray to God about the pain he suffered
4. Physical Assessment
a. General situation: frail
Level of consciousness: Composmetis
GCS: Verbal: 6 , Psychomotor: 5, Eyes: 4
b. Vital sign :
pulse rate: 80x / min
Temperature: 36.3oC
TD: 170/90 mmHg
RR: 30x / min
c. Physical state
1) The state of hair and head
Inspection: simestris, no fall, flat hair
distribution, no lesions, oval head shape
Palpation: no lumps / swelling, bushy hair and
strong / not fragile
2) Face Preparation
Inspection: same color with other body parts,
not pale, simestris
Palpation: no tenderness and edema.
3) Eye examination
Inspection: left and right eye symmetry, left
eyeball symmetry right, isokor pupil.
4) Ear Examination
Inspection: symmetrical shape and position,
good skin integrity, same color with other
skin, no liquids
Palpation: no tenderness in the ear
5) Nose Check
Inspection: symmetrical nose shape, there is
still nasal hair, the use of the nostrils
6) Examination of the mouth and throat
Inspection: no enlarged tonsils, dry mouth
mucosa, tongue is not dirty, teeth are not
caries, and the ceiling is clean
7) Neck Examination
Inspection: no jugular venous distention
Palpation: no enlargement of the thyroid
gland
8) Examination of the Chest (lung, heart)
Development of right chest = left, fast and
shallow breathing frequency
9) Abdomen
Inspection: no stomach ascites, no lesions
Auscultation: Bowel sounds 12x / minute
Palpation: no tenderness in 4 quadrants
Percussion: sound of a tympanic sound
10) Upper extremities
Inspection: an infusion is installed on the
right hand and not cyanosis
Muscle strength: still good (able to withstand
the pressure given)
11) Lower limb
Inspection: fingernails clean, no toes, no
cyanosis
Muscle strength: still good (able to withstand
the pressure given)
12) Genetalia
- The state of the penis is clean, no lesions
 ANALISA DATA
No Data Focus Etiology Problem

DS: - Patient says shortness of breath

DO: - TD: 170/90 mmHG

N: 80 x/min
RR : 30 x/min
S: 36 ° C Decrease in
1. - Rapid and shallow breathing, nasal lobe breathing O2 Supply Respiratory pattern is ineffective

DS:
P: Patients say left pain
Q: Pain as stabbing
R: Patients say pain in the left chest area
S: Pain scale 5 O2 deficiency
Q: Pain disappears in coronary
2 DO: - The patient appears to be holding back pain arteries Pain (acute)
 Lanjutan...

DS: -
DO: - The patient does not seem to eat Inadequate Changes in nutrients are less than body
3. it intake needs

DS: -
DO: Daily needs of patients assisted by
nurses and families
-Patients seem limp Physical
4. - The patient is lying on the bed weakness Activity intolerance
Nursing Diagnosis
Nursing Diagnosis / Collaborative Issues by
Priority
1. Ineffective breathing patterns associated with
decreased oxygen supply.
2. Pain (acute) associated with lack of oxygen in
the coronary arteries
3. Nutrition imbalance is less than body needs
associated with inadequate intake.
4. Activity intolerance associated with physical
weakness.
Intervention
NOC:
 Inefficiency of breath pattern
After a nursing action for 1x24 hours is expected the patient can meet the
results criteria:
Indicator early target

 Respiratory Status: (0415)

Respiratory Frequency 3 4
Breathing Rhythm 3 5
Depth of Inspiration 3 4

 Fatigue Level (0007)

Fatigue 3 5

Sleep Quality 2 4

Daily activities 4 5

Loss of Appetite 4 5
•Acute Pain
After a nursing action for 1x24 hours is expected the patient can meet the criteria
of the results with the indicator:

Indicator early target

 Pain control (1605)
Recognize when pain occurs 3 5
Use pain relief without analgesic 3 5
Use recommended analgesics 3 5
Reporting controlled pain 3 5
 Level of discomfort (2109)
Pain 2 4
Anxious 3 5
Wince 3 5
Out of breath 3 5
Can not move 3 5
 Pain level

Pain reported 4 5
Lanjutan...

The length of the episodes of pain 4 5

Expression of facial pain 3 5

Can not rest 3 5

 Vital signs (0802)

Respiratory rate 3 4

Systolic blood pressure 4 5

Diastolic blood pressure 3 4

Respiratory rhythms 4 5
NIC:
Inefficiency of Breath Pattern Road Breathing
Management:
1. Perform chest physiotherapy, with deep
breathing relaxation
2. Auscultation of breath sounds, note area
where ventilation is decreased or absent and
the presence of additional sound
3. Position semi fowler
Respiratory Monitor:
1. Monitor additional breath sounds
2. Monitor patient's respiratory secretions
3. Monitor patient's shortness of breath, including
activities that increase or worsen the shortness of
breath.
Monitor Vital Signs:
1. Monitor blood pressure, pulse,
temperature and respiratory status
appropriately
2. Monitor rhythm and heart pressure
3. Monitor rhythm and respiratory rates (eg,
depth and symmetry)
4. Monitor central and peripheral cyanosis 5.
Identify possible causes of vital sign change
• Acute Pain Pain Management
1. Conduct a comprehensive pain assessment
that includes location, characteristics, onset /
duration, frequency, quality, intensity or
severity of pain and trigger factors
2. Dig up client knowledge and trust about
pain
3. Teach the principles of pain management
4. Encourage the patient to monitor the pain
and handle the pain appropriately
5. Support adequate rest / sleep to help
decrease pain.
• Relaxation Therapy
1. Get behaviors that indicate the occurrence
of relaxation, such as deep breathing,
yawning, stomach breathing, or pleasant
shadows
2. Ask the client to relax and feel the
sensation that occurs
3. Show and practice relaxation techniques
on the client
4. Encourage the client to repeat the
relakation technique if possible
5. Encourage regular repetition of certain
practices
Implementation:
1. Position the semifowler patient to reduce pain
Response results: the patient says the pain is
reduced
2. Teach patient pain management techniques
Response results: the patient knows the technique
of reducing pain
3. Determine sleep patterns / patient activities
Response results: patients are willing to follow the
instructions
Lanjutan...
4. Ask the client to relax and feel the sensation that
occurs
Response results: patients are willing to follow what is
instructed
5. Monitor the location and source of discomfort /
pain experienced by the patient during the activity
Response results: patients are willing to say the pain
is happening
6. Monitor vital signs
Response results: patients are willing to check the
vital signs
Evaluasi
S : Patients say left chest pain is reduced
Patients say shortness of breath began to decrease
O: The patient is not grimacing
TTV:
TD: 140/90 mmHg N: 78x / min
S: 360 C RR: 20x / min
A: Partially resolved problem
P: Continue the next intervention
1. Position a semi-fowler patient sleep if the
patient feels tight, advise the patient to limit his
activity
2. Encourage the patient to perform pain
management when pain recurs.
3. Monitor vital signs
THANK YOU