Management & Nursing Care of Patient with Coronary Artery Diseases Myocardial Infarction

1. Management & Nursing Care of Patient with Coronary Artery DiseasesMyocardial Infarction Prepared By :MS.Sadia Farhan Khan MScN,PRN-BScN,RN

2. Myocardial infarction Objectives • Definition • Etiology and pathophysiology • Clinical manifestations • Diagnostic evaluation • Medical management • Nursing process

3. Myocardial infarctionDefinition Other names: coronary occlusion- heart attack • Myocardial infarction refers to the process by which myocardial tissue is destroyed in regions of the heart that are deprived of an adequate blood supply because of a reduced coronary blood flow (a prolonged lack of myocardial oxygenation leading to necrosis of a portion of the heart muscle).

4. Myocardial infarctionEtiology and pathopysiology *Causes of reduced blood flow: • Narrowing of a coronary artery owing to atherosclerosis • A complete occlusion of an artery owing to embolus or a thrombus • Myocardial necrosis caused by acute occlusion of a coronary artery due to plaque rupture or erosion with imposed thrombosis)

5. Myocardial infarctionClinical manifestations Symptoms • Pain is the cardinal symptom of an MI • Anxiety and fear of impending death • Nausea and vomiting • Breathlessness • Collapse/syncope

6. Myocardial infarctionClinical manifestations (cont…) Physical signs • Signs of sympathetic activation: pallor, sweating, tachycardia • Signs of vagal activation: nausea,vomiting, bradycardia • Signs of impaired myocardial function: hypotension, oligurea, cold peripheries • Signs of complications: e.g. mitral regurgitation, pericarditis

7. Myocardial infarctionDiagnostic evaluation • Electrocardiogram (ECG) • Blood test (Cardiac enzymes) • Echocardiogram • Nuclear scan • Chest radiographs • Coronary angiography • Exercise stress test. • Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI).

8. Myocardial infarctionMedical management • Immediate management: the first 12 hours • Analgesic (morphin sulphate) & antiemetic • Antithrombotic therapy (Antiplatlet therapy, anticoagulants) • Anti-anginal therapy • Surgical therapy

9. Myocardial infarctionNursing process Assessment • A careful history • Description of symptoms ( chest pain, palpitation, dyspnea, syncope or sweating). Each symptoms must be evaluated with regard to time, duration, precipitating & relieving factors. In addition complete physical assessment for: *level of consciousness

10. Nursing process (cont…) *Heart sounds *Peripheral pulses *Lung sound

11. Nursing process (cont…) Nursing diagnosis • Chest pain related to reduced coronary blood flow. • High risk for breathing pattern ineffective related to fluid overload • Anxiety related to fear from death • High risk for tissue perfusion alteration related to decreased cardiac output • Health maintenance alteration related to no adherence to therapeutic regimen

12. Nursing process (cont…) Patient's goals • Report that pain is decreased • Breath effectively • Experience less anxiety level • Have improved tissue perfusion • Adhere to the self care program

13. Nursing process (cont…) • Nursing intervention • Relief or control of chest pain • Alleviate respiratory difficulties • Reduce the anxiety level • Maintain adequate tissue perfusion • Help the patient to adhere to the self care program

14. References