Unit 1 Cardiac Nursing – MI


Definition of an MI
– Prolonged (>6 hrs.) 100% occlusion of coronary artery blood flow leading to myocardial tissue necrosis
– Patho/risk factors are the same as angina/CAD
• Atherosclerotic plaque ruptured/eroded
• Clot has formed
– Vessel 100% occluded

Damage of an MI
Determinants of damaging effects
• Size of damaged area- increased area = increased damage
• Location of infarct
• Collateral circulation
• Increased collateral circulation leads to decreased damage
• Can have 100% occlusion and no MI if a lot

Damage of an MI
• Associated S/S/Clinical manifestations
• Appears anxious
• Feeling of impending doom
• Denial
• “It’s just something I ate”
• Weak peripheral pulses
• Disorientation
• Clutches chest
• Muffled heart sounds, S4, S3 & crackles
• JVD (jugular vein distention) if has RV failure
• Mildly elevated temp (<101)

Diagnosis of an MI
Based on
•Pt. Hx.
•EKG — 12 lead
• Initially & Q8H X3 & PRN chest pain
• Changes remain even when pain is gone
•Cardiac markers
• CK-MB & troponin
• Increase in MI but not in angina
• Usu. ordered initially & Q8H X3

Diagnostic Tests Used for MI
– Echocardiogram- evaluates valves
– PT/PTT/INR – baseline values
– CBC- monitor infection and renal function
– Chemistries (CMP/BMP)- monitors infection and renal function
– Angiogram
• Angiogram Video
Later when pt. has recovered from MI:
– Thallium scan/thallium stress test

Complications of MI
– Dysrhythmias
– Structural damage
• Papillary muscle rupture
• Septal rupture
• Ventricular rupture
– Ventricular aneurysm
– Pericarditis
– CHF/cardiogenic shock

Management Goals for an MI
Prevent increase of infarct size & minimize cell death by early restoration of coronary blood flow to improve the balance between O2 supply & demand

Initial Drugs for an MI
“MONA greets each pt.”

M = Morphine IV
O = Oxygen
N = Nitroglycerin IV

Drug Purposes
-To decrease pain
-Decrease o2 demand

Oxygen – 2-4 LPM/NC

Nitroglycerin (NTG) – give SL gr. 1/150 or by spray x3 Q5 min

Nitroglycerin (NTG) IV gtt
-Increase the O2 supply

ASA – one adult (325 mg) or one baby (81 mg) decrease coagulation of platelets

Drug Purposes
Thrombolytics / fibrinolytics (clot busters) monitor for bleeding
– Nursing — bleeding precautions
• Minimize lab sticks
• No IM meds
• Hold all puncture sites by the clock
– Venous at least 5 min
– Arterial at least 10 min
• Watch for bleeding
– Stools, emesis, urine, bruising, epistaxis, bleeding gums, lab/IV sticks
– Abdominal/flank pain (retro peritoneal)

Watch neuro status/LOC
– May bleed inside head and have a stroke

Drug Purposes
– Heparin
– Administer/ Monitor PTT per protocol or orders
– May also be placed on Coumadin
– Monitor PT/INR
• Continue bleeding precautions
– Platelet inhibitors (IV/PO)
– Plavix – given PO

Drug Purposes
Beta blockers (olol)
– Atenolol, metoprolol
• Decreases O2 demand
• Watch for bradycardia & decreased BP

Drug Purposes
Angiotensin converting enzyme (ACE) inhibitors (pril)
– Enalapril, captopril, lisinopril
• Decreases cardiac workload
• Watch for orthostatic hypotension esp. in elderly

Drug Purposes
Ca++ channel blockers (Very Nice Drugs)
– Verapamil, Norvasc, Diltiazem (frequent in cardiac pts)
– Decreases cardiac workload
– Increases O2 supply

Drug Purposes
– Lasix IV in hospital OP when D/C to home
– Watch K+
– Decreases fluid volume/cardiac workload/O2 demand

Definitive procedures
•Cath lab – often used in combination with thrombolytics
-PTCA – often used in combination with stents


Nursing Care Plan for an MI
Nursing diagnosis (priority)
– Pain r/t imbalance of cardiac O2 supply & demand leading to ischemia AEB pt. report, facial grimace, Levine sign, restlessness, decreased LOC, changes in BP or pulse

• The pt. will verbalize freedom from pain (0/10)

Nursing Care Plan for an MI
Nursing diagnosis
– Risk for hemorrhage r/t receiving anticoagulants, antiplatlets and fibrinolytics

– Bleeding will be promptly managed and minimized

Nursing Care Plan for an MI
Nursing diagnosis
– Risk for decreased CO r/t changes in HR, rhythm, and electrical conduction, decreased contractility, and damaged myocardium and cardiac structures

– The pt. will
• Maintain adequate CO AEB VS within designated range, urine output 30 cc/h and decrease/absence of dysrhythmias
• Report decreased dyspnea and chest pain
• Demonstrate increase in activity tolerance

Nursing Care Plan for an MI
Nursing diagnosis
– Risk for altered tissue perfusion r/t vasoconstriction, fluid volume deficit, shock, and thromboemboli

– The pt. will
• Demonstrate adequate perfusion
– Skin warm, pink, & dry, strong peripheral pulses, CRT < 3 sec., VS within designated range, alert/oriented, urine output 30 cc/h, no edema, no chest pain

Nursing Care Plan for an MI
Nursing diagnosis
– Risk for FVE r/t decreased renal perfusion leading to low urine output and increased Na+ & H2O retention and increased hydrostatic pressure or decreased plasma proteins leading to edema

– The pt. will
• Maintain BP within designated range
• Remain free of S/S of FVE ie edema, wt. gain, crackles

Nursing Care Plan for an MI
Nursing diagnosis
– Activity intolerance r/t imbalance between O2 supply & demand/damaged myocardium – decreased contractility – decreased CO/cardiac depressant effects of certain drugs (beta blockers, antidysrhythmics)
– AEB changes in HR & BP with activity, dysrhythmias, changes in skin color and moisture, angina, dyspnea, decreased pulse ox readings with activity

– The pt. will
• Demonstrate a progressive increase in activity tolerance with HR, rhythm, pulse ox., & BP remaining within designated limits, and skin warm, pink, & dry, no dyspnea
• Report absence of angina with activity

Nursing Care Plan for an MI
Nursing diagnosis
– Anxiety r/t possible death and loss of health, and concerns about lifestyle and economic status
– AEB fearful attitude, facial tension, restlessness, apprehension, expressions of concern, fight or flight behaviors

– The pt. Will:
• Recognize and verbalize feelings
• Identify causes of feelings
• Demonstrate problem solving skills
• Identify and use the resources available

Nursing Care Plan for an MI
Nursing diagnosis
– Knowledge deficit regarding cause and treatment of condition, self care, D/C meds r/t lack of or misunderstanding of information, unfamiliarity of resources, and lack of recall AEB
• Questions, statement of misconception
• Not following medical regimen
• Preventable complications

– The pt. will:
• Verbalize understanding of condition, potential complications, risk factors, treatment regimen, actions/side effects of meds

Interventions Initial for an MI
•Ongoing assessment/ documentation
– Pain
– Dyspnea
– Heart & lung sounds
•Instruct pt. to report pain immediately
•Relieve pain – highest priority
– VS & pulse ox. Q15min. until stable

Interventions Initial for an MI
•O2 2-4 LPM/NC to keep sat > 90%
•Cardiac monitor
– Urine output 30 cc/h
•Limit activity
– Usu. BR with BSC x 24 hrs

Interventions Initial for an MI
• Assist with ADLs
• No straining/valsalva ie BM, pushing self up in bed
• NPO until medical Rx. plan known
• Monitor labs

Interventions Initial for an MI
• Be aware of anticoagulants, anti-platelet medications, & fibrinolytics administered
– Bleeding precautions
• Planned rest
• Active ROM when stable/pain free to prevent DVT
• Ask for stool softener

Interventions Initial for an MI
• Decrease anxiety
– Give reassurance/here & now teaching
– Check frequently/answer call light promptly
– Provide privacy
– Maintain calm, restful environment
– Allow/encourage to express fears
• Fear of death/role changes
– Acknowledge grief & support need to grieve
– Often cope by using denial
– Meds ie Ativan, Xanax, Valium, or Versed

Interventions 24 hrs after a MI
• Small meals
– No caffeine
• Cardiac rehab
– Activity increased as tolerated
• Monitor tolerance
• Based on METs (metabolic equivalents)
– At rest average pt. needs 3.5 ml O2/kg/min. = 1 MET
• Light activity = 1-3 METs

Interventions 24 hrs after a MI
• Monitoring activity tolerance
– Check vital signs, heart rhythm & pulse ox before, during, & after activity
– May progress if
• Hr Increased < 20 BPM • No SBP decreased • No chest pain • Dyspnea • No severe fatigue • No dysrhythmias (irregular pulse)

Interventions 24 hrs after a MI
• Planned rest
• Avoid straining/valsalva
• Monitor pt. C/O fatigue & discomfort
• Observe for complications

Pt./Family Teaching r/t MI
Need both written & verbal
– Risk reduction esp. smoking
– Meds
– Check BP & pulse at home

– Low cholesterol
– Low caffeine
– Maybe low Na+

Pt./Family Teaching r/t MI
Importance of f/u
– When to seek help
• S/S to report
– Angina, medication side effects, complications

Stress reduction
– Encourage independence
– Refer to American Heart Association
– Continue cardiac rehab after D/C

Congestive Heart Failure (CHF) ……………… CHF Definition A chronic & progressive inability of the heart to pump sufficiently to meet the body’s metabolic needs WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE …

INFECTIOUS ENDOCARDITIS ……………………………. Definition of Infectious Endocarditis • Infection of the endocardial layer of the heart – Most commonly involves valve leaflets, chordae tendonae, & papillary muscles – May also invade the lining of the heart chambers & large vessels …

Angina ………………….. Angina Risk Factors Nonmodifiable Risk Factors •Age •Increase with age (55% pt. > 65 y/o) •Gender •Males > Females until menopause •At 70 y/o male = female •Females are twice as likely to die r/t: •Less likely to …

Pericarditis ……….. Definition of pericarditis Inflammation of the pericardium – Primary – Secondary – May or may not result in pericardial effusion WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE Write my …

Unit 1 Cardiac Nursing …………. Nursing Process -Assessment • Good History • Assessment of risk factors • Assessment of clinical manifestations • Subjective-What they tell us • Objective – What we see • Focused nursing assessment-focuses in on one area …

thiazide diuretics nursing implications monitor: vitals, electrolytes, weight, input and output loop diuretics nursing implications monitor: vitals, electrolytes, weight, I&O, orthostatics WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE Write my sample …

David from Healtheappointments:

Hi there, would you like to get such a paper? How about receiving a customized one? Check it out https://goo.gl/chNgQy