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Nursing JRRMCH Mighghg

The document discusses nursing care for myocardial infarction (MI), highlighting its causes, symptoms, and the critical role of nurses in assessment, intervention, and patient education. It emphasizes the importance of early identification, pain management, and continuous monitoring to prevent complications. Additionally, it covers discharge planning and the need for psychosocial support and a multidisciplinary approach in patient care.

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zamilahmad2022
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7 views16 pages

Nursing JRRMCH Mighghg

The document discusses nursing care for myocardial infarction (MI), highlighting its causes, symptoms, and the critical role of nurses in assessment, intervention, and patient education. It emphasizes the importance of early identification, pain management, and continuous monitoring to prevent complications. Additionally, it covers discharge planning and the need for psychosocial support and a multidisciplinary approach in patient care.

Uploaded by

zamilahmad2022
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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NURSING CARE IN

MYOCARDIAL INFARCTION & ISCHEMIA


DR. MAHFUZUL ISLAM CHOWDHURY
Associate Professor
Department of Anesthesia, Analgesia & Intensive Care Medicine
Jalalabad Ragib-Rabeya Medical College & Hospital

INTRODUCTION TO MYOCARDIAL INFARCTION


 Commonly known as a heart attack

 Occurs when blood flow to the heart muscle


is abruptly cut off

 Causes tissue necrosis due to ischemia

 Leading cause of death globally and in


Bangladesh
ETIOLOGY – OVERVIEW
 Atherosclerosis (plaque buildup)

 Thrombus (blood clot)

 Coronary artery spasm

 Embolism
 Other causes: trauma, vasculitis,
congenital anomalies

PATHOPHYSIOLOGY OF MI
 Plaque rupture or erosion → thrombus
forms

 Coronary vessel occlusion reduces


oxygen supply

 Cardiac muscle ischemia & necrosis


occur if not rapidly treated
CLASSIFICATION OF MI
RISK FACTORS
MODIFIABLE NON – MODIFIABLE

 Smoking  Age

 Hypertension  Male gender

 Diabetes mellitus  Family history

 Hyperlipidemia

 Obesity

 Physical inactivity

 Poor dietary patterns

SIGNS & SYMPTOMS – CHEST PAIN


 Severe, unrelenting substernal pain/pressure

 May radiate to left arm, jaw, back, or neck

 Not relieved by rest or nitroglycerin


SIGNS & SYMPTOMS – OTHER MANIFESTATIONS

 Shortness of breath (dyspnea)

 Diaphoresis (sweating)

 Nausea, vomiting

 Anxiety, a sense of impending doom

 Dizziness or syncope

 Women, elderly, diabetics may experience: Fatigue, Epigastric pain or


indigestion, Lightheadedness

ASYMPTOMATIC OR “SILENT” MI
 More frequent in diabetics and elderly

 No classic chest pain

 May present as breathlessness or confusion


SYSTEMIC RESPONSES TO MI
 Tachycardia

 Hypotension or hypertension

 Arrhythmias

 Cool, clammy skin


 Altered mental status (if severe)

IMMEDIATE ASSESSMENT
 Check responsiveness, ABCs (airway, breathing, circulation)

 Monitor vital signs and oxygen saturation

 Record 12-lead ECG

 Establish IV access
DIAGNOSTIC INVESTIGATIONS
 Cardiac enzymes (HS - Troponin I, CK-MB, LDH)

 ECG changes (ST elevation, Q waves)

 Chest X-ray (assess for heart failure, complications)

NURSING DIAGNOSIS – OVERVIEW


 Acute pain related to myocardial tissue ischemia

 Ineffective tissue perfusion

 Risk for decreased cardiac output

 Anxiety or fear
 Knowledge deficit regarding MI
NURSING DIAGNOSIS – PAIN
 “Chest pain related to decreased coronary perfusion”

 Verbal report or pain scale assessment

 Reluctance to move, facial grimacing

NURSING DIAGNOSIS – PERFUSION


 Weak pulse, hypotension

 Altered level of consciousness

 Hypotension, tachycardia

 Arrhythmias
 Oliguria

 Restlessness, fear, agitation


NURSING PROBLEM PRIORITIZATION
 Relieve chest pain first

 Restore and maintain tissue perfusion

 Prevent complications (arrhythmia, shock)

 Provide emotional support

NURSING INTERVENTION – RELIEVE PAIN


 Administer prescribed analgesics (usually IV morphine)

 Provide supplemental oxygen as ordered

 Monitor for effectiveness and adverse effects

 Maintain calm environment


NURSING INTERVENTION – IMPROVE OXYGENATION

 Ensure airway patency

 Administer oxygen per protocol

 Monitor SpO₂ and respiratory status

NURSING INTERVENTION – PROMOTE CIRCULATION

 Monitor vital signs, hemodynamics

 Observe for arrhythmias

 Prepare for rapid interventions (defibrillation, CPR) as needed


NURSING INTERVENTION – MEDICATION SUPPORT

• Administer anticoagulants/antiplatelets (as prescribed):


• Aspirin, Clopidogrel, Enoxaparin
• Streptokinase (Fibrinolytic for STEMI)
• Beta-blockers, nitrates, statins, ACE inhibitors as ordered
• Analgesics – morphine, pethidine
• Others – anti-emetics, laxatives, anti-ulcerants, anxiolytics

NURSING INTERVENTION – MONITOR LABS & ECG

 Serial cardiac enzyme testing – Troponin I, CK-MB, LDH

 Monitor ECG for evolving changes – ST elevation or depression

 Report abnormal findings promptly


 Hypercholesterolemia
NURSING INTERVENTION – REST & ACTIVITY RESTRICTION

 Provide bedrest in acute phase

 Restrict activity until stable

 Gradually increase as tolerated

NURSING INTERVENTION – ANXIETY REDUCTION &


CARDIAC REHABILITATION
 Offer reassurance, clear explanations

 Encourage expression of feelings

 Involve family for support

 Educate patient about cardiac rehab


 Encourage participation in physical activity as tolerated

 Stress management and counseling


PREVENTING COMPLICATIONS
• ARRHYTHMIAS
 Continuous cardiac monitoring
 Identify and treat abnormal rhythms promptly
• HEART FAILURE
 Monitor for signs: edema, crackles, jugular venous distension
 Administer prescribed diuretics, monitor fluid balance
• CARDIOGENIC SHOCK
 Watch for hypotension, tachycardia, decreased urine output
 Report promptly for team intervention

HEALTH EDUCATION FOR PATIENT & FAMILY


 Lifestyle modification: diet, exercise, smoking cessation

 Importance of medication adherence

 Recognition of warning signs


DISCHARGE PLANNING
 Medication instructions

 Follow-up appointments

 Home care and support resources

PSYCHOSOCIAL SUPPORT & MULTIDISCIPLINARY APPROACH

 Address depression, anxiety, post-MI psychological effects

 Refer to counseling or peer support groups

 Collaborate with cardiologists, physiotherapists, dietitians, social workers

 Ensure holistic patient care


NURSING ROLE IN MI PREVENTION
 Community education

 Screening for risk factors

 Early recognition and referral Education

KEY POINTS TO REMEMBER


 Early identification & intervention are lifesaving

 Pain management is a priority

 Continuous monitoring for complications is crucial

 Education and emotional support recovery


CONCLUSION & QUESTIONS

 MI remains a critical emergency in Bangladesh

 Nurses are pivotal in care and rehabilitation

 Encourage questions and discussion

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