Care For M.I.

7/23/2019 Care For M.I.

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Myocardial

InfarctionERICKA JANE S. BARRIOS,

R.N.

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INTRODUCTION

ACUTE MYOCARDIAL INFARCTION (AMI orMI) commonly known as a HEARTATTACK , is a disas s!a! !"a! w"n!" #lood s$%%ly !o !" %ar! o& !" "ar!

is in!rr$%!d, rs$l!s in I'CEMIA orOY*EN 'ORTA*E lads !o dama+and %o!n!ial da!" o& "ar! !iss$

T" !rm MYOCARDIAL INFARCTION isdri-d &rom MYOCARDIUM ("ar!m$scl) and INARCTION (!iss$ da!"d$ !o o.y+n s!ar-a!ion)

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DEINITIONMI may # d/nd as a %rocss #y

w"ic" !" #lood s$%%ly !o !"myocardial clls is in!rr$%!d d$ !ooccl$sion o& a coronary ar!ry #y

a!"rosclro!ic %la0$, m#ol$s or!"rom#$s, lads !o isc"mia o& !"sclls and i& i! con!in$d &or a %rolon+d%riod !"n i! ca$ss %rmann! in1$ry!o !" clls (myocardi$m), $l!ima!lylads !o INFARCTION and is no! a#l !om! !" m!a#olic nds o& !" clls

MYOCARDIAL INFARCTION isIRRE2ER'I3LE 4ROCE''

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CORONARY ARTERIES O THEHEART

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ETIO!O"Y NON5MODIFIA3LE

RI'6 FACTOR'

Incrasin+ A+Family is!ory

*ndr

MODIFIA3LE RI'6FACTOR'

y%rli%idmiay%r!nsion

'mokin+

4"ysical Inac!i-i!yO#si!y

Dia#!s Mlli!$s

'!rss

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NON#MODIIAB!E RISK

ACTORSA*E7 mor !"an 89 yars old

FAMILY I'TORY7 MI can # in"ri!d &rom%arn!s !o c"ildrn

*ENDER7 MI is : !ims mor in mn

!"an womn

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MODIFIA3LERI'6 FACTOR'

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Hy$%rli$id%&ia

LDL is dan+ro$s #ca$s i! con!ains mor li%ids and "as ca%aci!y!o d%osi! &a! wi!"in !" ar!ris

'o, LDL l-l mor !"an ;<9m+=dl will %lac a %rson a! a risk o& MI

!I'IDS(!I'O'ROTEI

NS)

!O*DENSITY

!I'O'ROTEIN (!D!)

DAN"EROUS

HI"HDENSITY

!I'O'ROTEIN (HD!)

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y%r!nsion

3LOOD 4RE''URE is mor !"an ;89=>9

mm+ con!in$o$sly &or 85? yars

'$s!aind s!rss on ar!rial walls

In1$ry !o ndo!"lial linin+

ATERO'CLERO'I'

RISK O MI

Also sal! cons$m%!ion ? +ms=day

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'mokin+

Nico!in rlass ca!c"olamin(%in%"rin @ nor%in%"rin)

Incrass "ar! ra!@ #lood %rss$rincrass cardiac

load

CO dcrass Oa-aila#ili!y !omyocardi$m

INJURY TO

MYOCARDIUM

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4"ysical Inac!i-i!y

Im%ro%r li%id m!a#olism

LDL L-l incrass

'!ar!s acc$m$la!in+ in #lood -ssls

RISK OR MI

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O#si!y

Mor li%ids ar %rod$cd

LDL l-l incrass

ATERO'CLERO'I'

RISK OR MI

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Dia#!s Mlli!$s

*l$cos molc$ls may s!ick !o l$mn o&ar!y

3locka+ o& ar!ry

Ri+ of -ain/ MI

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'!rss

'N''!im$la!ion

Rlas o&ca!c"olamin

Incras "ar! ra! @ in!nsi&y !"&orc o& myocardial con!rac!ion

Incrass O

dmand

Cll da!"

Ri+ of MI

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'ATHO'HYSIO!O"Y

4rdis%osin+ Fac!ors

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Al!rdd%olariBa!ion

Al!rdr%olariBa!ion

MYOCARDIA!

Ncrosis

Rlas o&lysoBomalnBym

4rdis%osin+ Fac!ors

4rma!$r, Acclra!d A!"rosclrosis

4ro+rssi- narrowin+ o&#lood -ssls

Risk &or .cssi- #lood clo!&orma!ion

Isc"mia o& !" "ar!m$scl

T"rom#om#olism

y%o.ia

Aro#ic !o$naro#ic

m!a#olism

Lac!ic acid&orma!ion

C"s! %ain=M$scl s%asm

Dcrasdmyocardialcon!rac!ili!y

Dcrasd cardiaco$!%$!

Rnal isc"mia=Oli+$ria

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MI almos! always occ$r in !" l%ft %ntricl% d$ !ooccl$sion o& l%ft ant%rior d%+c%ndin/ art%ry(!ADA) and o&!n si+ni/can!ly d%rsss l&!

-n!ric$lar &$nc!ion (ant%rior 0all infarction)

Al!ra!ion in &$nc!ion d%nd on siB and loca!iono& an in&arc!

Con!rac!il &$nc!ion in !"ncro!ic ara cas%rmann!ly

alin+ r0$irs

&orma!ion o& scar !iss$s!"a! r%lac !" ncro!icmyocardial m$scl

'car !iss$ in"i#i!s

con!rac!ili!y

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C!ASSIICATION O

MI TRAN'MURAL INFARCT1.!nds &rom ndocardi$m !o %icardi$m

INTRAMURAL INFARCT1sn in %a!c"y aras o& !" myocardi$m0$ally associa!d wi!" an+ina %c!oris

'U3ENDOCARDIAL INFARCT1ac!s !" ndocardial m$scls

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2 AREAS *HICH DE3E!O'IN MI

ONE OF INFARCT1rcords %a!"olo+ic wa- in !" EC*

ONE OF INGURY1+i-s ris !o l-a!d 'T s+mn!

ONE OF I'CEMIA1%rod$cs in-rsion o& T wa-

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COM'!ICATIONS O

MI DY'RYTMIA'

CARDIO*ENIC 'OC6

4ERICARDITI'

RU4TURE OF MYOCARDIUM

2ENTRICULAR ANEURY'M

CRONIC EART FAILURE (CF)

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ASSESSMENTINDIN"S

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'AIN

AN4IETY 5A''REHENSION

Cardinal sym%!om o& MI7 %rsis!n!,

cr$s"in+ s$#s!rnal %ain !"a! mayradia! !o !" l&! arm, 1aw, nck, ands"o$ldr #lads

Unrli-d #y rs! or ni!ro+lycrin

Flin+ o& Hdoom, rs!lssnss

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O!I"URIA

E3ER

SHOCK 'ys!olic %rss$r JK9mm+, l!"ar+y,

cold clammy skin, dia%"orsis,%ri%"ral cyanosis, !ac"y=#radycardia,wak %$ls

Urin ow J:9mL="r

'li+"! !m%ra!$r l-a!ion wi!"in8"o$r @ .!nds :5days wi!"l$kocy!osis, l-a!d E'R

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INDE"ISTION

ACUTE 'U!MONARYEDEMA

H+as %ains aro$nd !" "ar!, na$sa @

-omi!in+

'ns o& s$oca!ion, dys%na,or!"o%na, +$r++lin+, #$##lin+rs%ira!ion

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MEDICA!MANA"EMENT

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IMMEDIATE ASSESSMENT

El-a!ion o& #d Loosn !i+"! clo!"in+ aro$nd nck Mas$r -i!al si+ns

Mas$r o.y+n sa!$ra!ion O#!ain I2 accss ; lad EC*

4r&orm #ri& "is!ory O#!ain ini!ial sr$m cardiac

markrs l-l

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ANA!"ESICANA!"ESICRli& o& %ainRli& o& %ain

T"is is a %riori!y #ca$s %ain may T"is is a %riori!y #ca$s %ain mayca$s s"ockca$s s"ock Adminis!r I2 Mor%"in s$l&a!, lidocainAdminis!r I2 Mor%"in s$l&a!, lidocain

or Ni!ro+lycrinor Ni!ro+lycrin

THROMBO!YTIC THERA'Y Disin!+ra! #lood clo! #y ac!i-a!in+

/#rinoly!ic %rocsss

'!r%!okinas, Urokinas, Tiss$%ladmino+n Ac!i-a!or (T4A)

Adminis!ra!ion is mos! cr$cial #!wn :5

<" a&!r ini!ial in&arc!ion "as occ$rrd

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D!c! &or occ$l! #ldin+ d$rin+ @ a&!r

!"rom#oly!ic !"ra%y

Assss n$rolo+ic s!a!$s c"an+s (mayindica! *I #ldin+ or cardiac

!am%onad)ANTICOA"U!ANT AND ANTI'!ATE!ETMEDICATIONS Adminis!rd a&!r !"rom#oly!ic !"ra%y

!o main!ain ar!rial %a!ncy

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DIA"NOSTICE3A!UATION

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El%ctrocardio/ra& (EC")

I! %ro-ids in&orma!ion !"a! assis!s india+nosin+ ac$! MI

T" classic EC* c"an+s ar7

T wa- in-rsion 'T s+mn! l-a!ion A#normal wa-

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Blood t%+t (CardiacEn6y&%+) Cardiac nByms ar rlasd &rom !"

"ar! in!o !" #lood s!ram d$rin+myocardial dama+

I! can # $sd in !" dia+nosis o& an MI

7. TOTA! CREATINE KINASE!E3E! Riss wi!"in :" a&!r !" ons! o&

c"s! %ain

4aks wi!"in 8" a&!r dama+ andda!" o& cardiac !iss$

8. CK#MB I+o%n6y&% 4ak l-a!ion7 ;K58" a&!r ons! o&

c"s! %ain

2 TRO'ONIN !E3E!

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2. TRO'ONIN !E3E! Riss wi!"in :" Rmains l-a!d $% !o : wks

9. MYO"!OBIN Riss wi!"in ;" a&!r cll da!" 4aks in <"

R!$rns !o normal wi!"in 85:<" orlss:. !DH !%%l Riss 8" a&!r MI 4aks 8K5" Falls !o normal in days

;. *BC El-a!d 3C (;9,99959,999

clls=mm: ) on nd day &ollowin+ MI

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Ec-ocardio/ra&

I! is $s&$l !o assss !" a#ili!y o& "ar!m$scls !o con!rac! and rla.

I! is don !o -al$a! -n!ric$lar &$nc!ion

#y c"ckin+ 1c!ion ra!

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Cardiac Co&$<t%ri6%dTo&o/ra$-y (CT) or Ma/n%tic

R%+onanc% I&a/in/ (MRI) To d!c! si! and .!nd o& myocardial

clls

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An/io/ra$-y

To d!c!%rcn!a+#locka+ @ !y%o& MI

I! rmains !"mos! acc$ra! india+nosin+ !"%rcn!a+ o&#locka+ incoronary ar!ris

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C-%+t 4#ray

To d!c! cardiom+aly

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E=%rci+% Tol%ranc% T%+t orStr%++ T%+t Assss &or lc!rocardio+ra%"ic c"an+s

and isc"mia

E-al$a! &ormdical !"ra%y

Idn!i&y

%a!in!s w"omay ndin-asi-!"ra%y

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T-alli<& or N<cl%ar Scan

Assss isc"mia or ncro!ic m$scl !is$

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NURSIN"MANA"EMENT

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;NUR'IN* DIA*NO'I'7

ACUTE 4AIN R=T MYOCARDIAL I'CEMIARE'ULTIN* FROM CORONARY ARTERYOCCLU'ION, AN IM3ALANCE 3ETEENMYOCARDIAL OY*EN 'U44LY @ DEMAND

*OAL7 TO REDUCE OR ELIMINATE CE'TDI'COMFORT

INTER2ENTION'

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INTER2ENTION'7; A''E'' 4ATIENT' DE'CRI4TION OF CE'T

DI'COMFORT

A''E'' 3LOOD 4RE''URE, EART RATE @RYTM, AND RE'4IRATORY RATE

: A''E'' TE '6IN FOR TEM4ERATURE ANDMOI'TNE''

8 O3TAIN A ;5LEAD EC* DURIN* CE'TDI'COMFORT

? ADMINI'TER OY*EN, NT*, I2 MOR4INE, OR

OTER MEDICATION A' ORDERED< 4RO2IDE A RE'TFUL EN2IRONMENT7 3YELE2ATIN* EAD OF 3ED

4RO2IDE CARE IN CALM, UIET

EN2IRONMENT

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NUR'IN* DIA*NO'I'7

INEFFECTI2E TI''UE 4ERFU'ION RELATED TOAN IM3ALANCE 3ETEEN MYOCARDIALOY*EN 'U44LY @ DEMAND ANDMANIFE'TED 3Y CE'T DI'COMFORT,

DY'RYTMIA'

*OAL7 TO REDUCE OR ELIMINATE MANIFE'TATION'OF DECREA'ED MYOCARDIAL TI''UE4ERFU''ION

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INTER2ENTION'7

; 6EE4 TE 4ATIENT ON 3ED RE'T IT AUIET EN2IRONMENT

ADMINI'TER OY*EN AND ANTIRRYTMICAND OTER MEDICATION' A' ORDERED AND

CONTINUOU'LY E2ALUATIN* 4ATIENTCONDITION

: ADMINI'TER TROM3OLYTIC' OR 'END TE4ATIENT FOR AN*IO4LA'TY A' ORDERED

8 MONITOR 'T 'E*MENT'

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:NUR'IN* DIA*NO'I'7

DECREA'ED 'Y'TEMIC TI''UE 4ERFU''IONRELATED TO A DECREA'E IN CARDIACOUT4UT FROM ARRYTMIA' ANDCONDUCTI2E DI'TUR3ANCE'

*OAL7; TO REDUCE OR ELIMINATE MANIFE'TATION'

OF DECREA'ED 'Y'TEMIC TI''UE4ERFU'ION

4RE2ENT MANIFE'TATION' OF DECREA'ED'Y'TEMIC TI''UE 4ERFU'ION

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INTER2ENTION'7

; DECREA'ED 4ATIENT 4Y'ICAL ACTI2ITY ADMINI'TER OY*EN AND ANTIRRYTMIC

AND OTER MEDICATION': A''E'' FOR 4ERI4ERAL 4ERFU'ION7 3Y

MONITORIN* '6IN FOR CYANO'I', 4ALLOR,COOLNE'', DIA4ORE'I' AND 4ERI4ERAL4UL'E'

8 CEC6 FOR CERE3RAL 4ERFU'ION7 3Y

CEC6IN* MENTAL 'TATU' (RE'TLE''NE'',DECREA'ED RE'4ON'I2ENE'')

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? AU'CULTATE FOR LUN* 'OUND'73Y MONITORIN* FOR CRAC6LE'

< AU'CULTATE FOR EART 'OUND'7NOTE TE 4RE'ENCE OF *ALLO4,MURMUR, AND INCREA'ED OR DECREA'ED

EART RATE CEC6 FOR RENAL 4ERFU'ION7DECREA'ED URINE OUT4UT

K MONITOR ARTERIAL 3LOOD *A' LE2EL'

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8NUR'IN* DIA*NO'I'7

IM4AIRED *A' ECAN*E RELATED TODECREA'ED CARDIAC OUT4UT A'E2IDENCED 3Y CYANO'I', IM4AIREDCA4ILLIARY REFILL TIME AND DY'4NEA

*OAL7 TO IM4RO2E *A' ECAN*E

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INTER2ENTION'7

; ADMINI'TER OY*EN A' ORDERED MAINTAIN A3*s A' ORDERED: CONTINUE TO A''E'' TE 4ATIENT' '6IN,

CA4ILLIARY REFILL, AND LE2EL OF

CON'CIOU'NE'' E2ERY TO 8 OUR'8 A''E'' RE'4IRATORY 'TATU' FOR DY'4NEA

AND CRAC6LE'? 4RE4ARE FOR INTU3ATION @ MECANICAL

2ENTILATION IF Y4OIA INCREA'E'

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?NUR'IN* DIA*NO'I'7

ANIETY AND FEAR RELATED TO DIA*NO'I', TREATMENT, AND 4RO*NO'I' OF AN*INAMANIFE'TED 3Y A3NORMAL RATE ANDRYTM OF 4UL'E AND RE'4IRATION,

ELE2ATED 3LOOD 4RE''URE

*OAL7 TO ALLAY ANIETY AND FEAR

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INTER2ENTION'7

; A''E'' AND DOCUMENT TE 4ATIENT' ANDFAMILY' LE2EL OF FEAR AND ANIETY ANDEFFECTI2ENE'' OF CO4IN* MECANI'M

4RO2IDE CONTINUITY OF CARE

: ALLO AND ENCOURA*E TE 4ATIENT ANDFAMILY TO A'6 UE'TION'

8 ALLO TE 4ATIENT AND FAMILY TO2ER3ALIE FEAR'

? 4RO2IDE A COMFORTA3LE, UIETEN2IRONMENT FOR TE 4ATIENT AND FAMILY

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<NUR'IN* DIA*NO'I'7

6NOLED*E DEFICIT RELATED TOMYOCARDIAL INFARCTION, TREATMENT,4RO*NO'I', AND RI'6 FACTOR'

*OAL7 TO *I2E ADEUATE 6NOLED*E A3OUT I'DI'EA'E 4ROCE''

INTER2ENTION'7

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INTER2ENTION'7

; DE2ELO4MENT OFA TEACIN* 4LAN

ENA3LE' TE NUR'E TO 4ROMOTE'TANDARDIED CONTENT TO EAC 4ATIENT

TEAC 4ATIENT TO DECREA'E 4Y'ICALACTI2ITY AND TA6E NT* A' 4RE'CRI3EDDURIN* 4ERIOD' OF AN*INA

: TEAC 4ATIENT TO 'EE6 MEDICALATTENTION IMMEDIATELY IF RELIEF OF CE'T

4AIN A' NOT OCCURRED ITIN :9mins

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8 4RO2IDE A CONCRETE INFORMATION A3OUTDIA*NO'TIC 4ROCEDURE' 4ERFORMED ON

4ATIENT AND TE RATIONALE 3EIND IT? TEAC 4ATIENT @ RELATI2E' A3OUT TEIM4ORTANCE OF CAN*IN* LIFE'TYLE4RO2IDE INFORMATION A3OUT

MODIFICATION OF RI'6 FACTOR'< TEAC 4ATIENT TO REDUCE 4RECI4ITATIN*

FACTOR'

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THEEND>

Care For M.I.

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