Nursing management patient with Myocardial infraction

1. NURSING MANGEMENT CLIENT
WITH MYOCARDIAL INFARCTION
(MI) HEART ATTACK
ANILKUMAR BR
LECTURER
MEDICAL-SURGICAL NURSING

2. Introduction
• MI or Heart attack are terms used anonymously,
but the preferred term is MI.
• In an MI an area of the myocardium is
permanently destroyed.
• MI is usually caused by reduced or decreased
blood flow in a coronary artery due to rupture of
an atherosclerotic plaque and subsequent
occlusion of the artery by a thromus.

3. Etiopathophysilogy
• MI refers to the processes by which myocardial tissue is
destroyed in regions of the heart that are deprived of an
adequate blood supply because of reduced coronary artery
blood flow.
• Eighty percent to 90% of all acute MI are secondary to
thrombus formation.
• When thrombus develops , perfusion to the myocardium
distal to the occlusion is halted,resulting in necrosis.

4. Continue
• The acute MI process takes time. Cardiac cells can
withstand in ischaemic conditions for approximately
20 minutes before cellular death begins.
• The earliest tissue to become ischemic is the sub
endocardium (the innermost layer of tissue in the
cardiac muscle)
• If ischemia persists,it takes approximately 4 to 6
hours for the entire thickness if the heart muscle to
become necrosed.

5. Areas of the necrosis ( white arrow)

6. Continue....
• Infractions are usually described based on
location if damage ( anterior,inferior,posterior,or
lateral wall).
• Descriptions are used to further identify an
MI:the type of MI ( ST- segment elevation
myocardial infraction STEMI and non-segment-
elevation myocardial infraction NSTEMI

7. Clinical manifestations of MI
1) CARDIOVASCULAR
• Chest pain : chest pain occurs suddenly,severe immobilizing chest pain
that not relieved by rest ,position change,and medications.
• Increased jugular venous distention
• BP may be elevated because of sympathetic stimulation or decreased BP
because of decreased contractility, development if cariogenic shock
• Decrease pulse rate
• ST- segment and T-wave changes, ECG may show tachycardia,
bradycardia, or dysrhythmias.

8. Respiratory
• Shortness of breath (SOB)
• Dyspnea, tachypnea, and crackles if MI has
caused pulmonary congestion.
• Pulmonary edema

9. Gastrointestinal or GIT
• Nausea and vomiting

10. Genitourinary
Decreased urinary output may indicate
cariogenic Shock

11. Skin
• Cool.,clammy,diaphoretic, and pale
appearance on skin

12. Neurologic symptoms
• Anxiety,restlessness,and light headness

13. Psychological
• Fear with feeling of impending doom or
patient may deny that anything is worng

14. Complications
• Dysrhythmias ( the most common complications
after an MI in 80% of MI cases.
• Acute pulmonary edema
• Heart failure
• Cariogenic shock
• Papillary muscle dysfunction
• Pericarditis and cardiac tamponade

15. Assessment and diagnostic findings
• The diagnosis of MI is generally based on the
presenting symptoms, the ECG, and laboratory
test results (e.g serial cardiac biomarke valve)

16. Patient history
• The patient history has two parts: the
description of the presenting symptoms and
the history of previous illness and family
history of the cardiovascular disease.

17. Electrocardiogram or ECG

18. • The ECG provides information that assists in
diagnosing acute MI.
• It should be obtained within 10 minutes
from the patient a reports chest pain

19. Echocardiogram

20. Laboratory tests
• Laboratory tests called “CARDIAC BIOMARKERS”
are used to diagnose AMI.
• Creatine kinase –MB or CK-MB
• myoglobin
• Troponin T or I

21. Medical management
• The goal of medical management is to
1. Minmize myocardial damage
2. Preserve myocardial function and prevent
complications
*Minimizing myocardial damage is also
reducing myocardial oxygen demand and
increasing oxygen supply.

22. Pharmacologic therapy
• The patient with suspected MI given
• Aspirin
• Morphine sulphate
• Beta blockers

23. Thrombolytics
• Thrombolytics are usually administered IV,
although some may also be given directly into the
coronary artery in cardiac catheterization.
• The purpose of thrombolytics is to dissolve and
lyse thrombus in a coronary artery allowing blood
to flow through the coronary artery again
(reperfusion), minimising the size of the
infraction and preserving ventricular function.

24. Conti...
• Thrombolytics should not be used if the patient
is bleeding or has a bleeding disorders.
• To be effective,thrombolytics must be
administered as early as possible after the onset
of symptoms that indicate an acute MI, generally
within 3 to 6 hours.

25. Contraindications of thrombolytic therapy
• Previous hemorrhagic stroke
• Known intracranial tumour
• Active internal bleeding
• Severe uncontrolled hypertension
• Recent head injury
• current use of anticoagulants

26. Analgesics
• Morphine sulfate administered in IV boules to
reduce pain and anxiety
• The cardiovascular response to morphine is
monitored carefully particularly BP and
respiratory rate.

27. Angiotensin-converting enzyme inhibitors
(ACE inhibitors)

28. Emergent percutaneous coronary
intervention
• CABG
• PTCA

29. Cardiac rehabilitation
• Cardiac rehabilitation is a comprehensive
long term program that involves periodic
evaluation,prescribed exercise and
education and counseling about cardiac risk
factors modification.

30. Indications of cardiac rehabilitation
• Myocardial infarction
• Post CABG
• Angina pectoris
• Percutaneous coronary intervention
• Heart transplant
• Coronary artery disease

31. Aras of cardiac rehabilitation
• Smoking cessation
• Lipid management
• Weight control
• BP control
• Improve exercise tolerance
• Symptoms control
• Psychological well-being /strss management

32. Nursing management for a patient with acute
MI
• Achieving a balance between myocardial oxygen supply
and demand
• This are achieved via oxygen administration and
medication (Nitroglycerin)
• Prevention of complications
• Continuous monitoring of cardiac functions
• Continuous ECG monitoring
• Hemodynamic monitoring
• Monitor and record intake and urine output

33. Conti.
• Closely monitor and prevent complications
associated with MI particularly dysrhythmia and
cardiigenic shock
• Provide emotional and psychological support
• Explain and provide adequate information and
knowledge about disease cond and treatment
process

34. Risk factors modification
• Daily fat intake less than 309 % of total calories
• Maintenance of serum cholesterol level
• Maintain LDL levels less than 70 mg/dl
• Stop smoking and reduce daily salt intake
• Control Hypertension and diabetes
• Increase physical activity and reduce weight

35. Nursing diagnosis
• Ineffective cardiac tissue perfusion related to
reduced coronary blood flow from coronary
thrombus and atherosclerotic plaque
• Risk for imbalnved fluid
• Death of anxiety
• Deficient knowledge about post-MI and self care