Nursing Care Plan for Myocardial Infarction (MI)
Myocardial infarction is the destruction of a segment of the myocardium as a result of an occlusion in a coronary artery causing a change in blood flow.
Nursing Diagnosis: Pain related to physical factor of myocardial ischemia resulting in hypoxia as coronary blood flow is reduced.
Expected Outcomes: Pain reduced and controlled, evidenced by less frequent need for analgesic, absence of restlessness, grimacing, verbalization that pain is relieved.
Intervention and Rationale:
1. Severity of pain, radiation to arms, jaw or neck, duration of five minutes or longer , what precipitates or relieves pain. Characteristic symptoms of reduced blood flow to myocardium resulting in lactic acid release, which irritates heart muscle.
2. Nonverbal expression such as clutching at chest, pallor, restlessness, dyspnea, diaphoresis. Associated symptoms and signs of infarction.
Blood pressure and pulse changes. Increased as result of pain or unrelieved pain.
Monitor, Describe, Record:
1. Pulse, respirations, and characteristics every two to four hours. May increase with pain or response mechanisms.
2. Blood pressure every two to four hours. May increase with pain or decrease with medications.
3. ECG status. Detection of arrhythmias as result of unrelieved pain.
1. Analgesic (morphine) before pain becomes severe. Drug of choice for pain reduction in MI; acts by inhibiting pain pathways in CNS.
2. Vasodilator (nitroglycerin). Acts as coronary vasodilator which increases blood flow to myocardium and reduces pain.
Perform of Provide:
1. Comfortable, quiet environment. Minimum stimuli reduce pain and enhance effect of drug.
2. Stay with patient until pain relieved, maintain calm attitude. Provides support and reassurance to decrease fear and anxiety.
Teach Patient or Family:
1. Report pain at onset. Pain that become extreme increases workload of heart.
2. Report any recurrence of pain before, during, or after therapy. May indicate extension of infarction with decreasing ventricular function.
3. Notify physician if pain is unrelieved by nitroglycerin and continues longer than 20 minutes. May indicated MI rather than angina.
Other possible Diagnoses:
1. Decreased cardiac output related to alteration in conduction resulting in decreased contractility and stroke volume and arrhythmias.
2. Altered cardiopulmonary tissue perfusion related to interruption of arterial flow to myocardial tissue resulting in reduced blood supply, cardiac output and hemodynamic changes.
3. Hyperthermia related to myocardial tissue necrosis resulting in inflammation.
4. Altered nutrition: Less than body requirements related to inability to ingest and digest food (nausea and vomiting) as result of vagal stimulation.
5. Activity intolerance related to bedrest, imbalance between oxygen supply and demand resulting in generalized weakness.
6. Impaired physical mobility related to decreased strength and endurance, intolerance to activity resulting in decreased muscle strength and mass.
7. Anxiety related to threat of death, change in health status resulting in inability to manage stress, uncertainty about future.