Myocardial infarction (MI or AMI for acute myocardial infarction) is the rapid development of myocardial necrosis (die of heart cells) caused by a critical imbalance between oxygen supply and demand of the myocardium.
This is serious medical condition that sometimes called as a heart attack or a coronary thrombosis. The medical team should be take quickly action to give treatment and Nursing Care to prevent complication or die.
With myocardial infarction, reduce blood flow in one of the coronary arteries leads to myocardial ischemia, injury and necrosis. From the ECG result, with a Q-wave MI it's mean that the tissue damage extends through all myocardial layers. Non-Q-wave MI, ussually only the innermost layer is damage.
Possible causes of Myocardial infarction (MI) are : Coronary artery occlusion, Coronary spasm and Coronary stenosis. There are some risk factors to develop of Myocardial infarction such as :
- Decrease serum HDL levels
- Diabetes Mellitus
- Drug use, specifically use of amphetamines or cocaine
- Elevated serum Triglyceride, LDL and Cholesterol levels
- Excessive intake of saturated fats, carbohydrates, or salt
- Family history of CAD
- Post menopausal women
- Sedentary lifestyle
Nursing Care Plan For Myocardial Infarction (MI):
Assessment findings on the patient with myocardial infarction are : Dyspnea, Diaphoresis, Arrhythmias, Tachicardia, Anxiety, Pallor, Hypotension, Nausea and vomiting, Elevated temperature. The specific complain from the patient is crushing substernal chest pain (may radiate to the jaw, back and arms) that unrelieved by rest or nitroglycerin (NGT) tablet.
Diagnostic evaluation patient with myocardial infarction:
- ECG show deep, wide @ wave ; elevated or depressed ST segment; and T wave inversion or cardiac arrythmias.
- Blood chemistry test result show increased creatine kinase (CK), lactate dehydrogenase (LD), lipid, and troponin T levels; increased WBC count; positive CK_MB fraction; and flipped LD1.
Nursing diagnoses for patient myocardial infarction (MI) are:
- Chest discomfort (pain) due to an inbalance Oxygen (O2) demand supply
- Potential Arrhythmias related to decrease cardiac output
- Respiratory difficulties (dyspnoea) due to decrease CO
- Anxiety & fear of death related to his condition
- Activity intolerance related to limitations imposed
- Potential for complications of thrombolytic therapy
- Discharge medications, follow up & Health teachings
Planing and goals of nursing care plan;
- The patient won't develop preventable complication
- The patient will understand the necessary treatment and lifestyle changes.
Nursing Intervention for myocardial infarction (MI):
- Monitor ECG result to detect ischemia, injury new or extended infarction, arrhythmia, and conduction defects
- Monitor, record vital signs and hemodynamic variables to monitor response to the therapy and detects complication
- Administer oxygen as prescribe to improve oxygen supply to the heart
- Obtain an ECG reading during acute pain to detect myocardial ischemia, injury or infarction
- Maintain the patient's prescribed diet to reduce fluid retention and cholesterol levels
- Provided postoperative care if necessary to avoid postoperative complications and help the patient achieve a full recovery
- Allay the patient's anxiety because the anxiety increase oxygen demands.
Nursing Evaluation for myocardial infarction (MI):
- The patient explains how and when to take medicine and state reportable adverse reaction
- The patient describes appropriate lifestyle changes to reduce the risk of future cardiac event
- The patient experiences no complication after heart attack (myocardial infarction)