Transcript
Nursing Management Myocardial Infarction patient in Emergency Room
Harmeet Kaur KangM.Sc Cardiological / CTVS Nursing
Associate Professor
Myocardial Infarction
Myocardial Infarction occurs as a result of thrombotic occlusion of the coronary artery and cause irreversible injury and necrosis.
Clinical Manifestations
Chest pain Severe and prolonged and may be
described as crushing, constricting, or oppressive.
Radiation of pain to ulner aspect of left arm, neck, jaw and Interscapular region.
Clinical Manifestations Contd….
Indigestion Nausea Vomiting Diaphoresis Palpitations Dyspnea
Nursing Assessment in Emergency Room History Taking. Physical Examination Vital parameters 12 lead ECG monitoring. Measure oxygen saturation. Obtain initial serum cardiac markers.
Inferior wall MI: right coronary artery
lead II, III & AVF Lateral wall MI : Lt circumflex artery
lead I, AVL, V5 & V6 Anterior MI : Lt anterior descending
lead V1 to V6 Posterior Wall MI:Rt coronary artery
Immediate General Management Oxygen at 4 l/min. Aspirin 160-325mg. Nitroglycerine SL or spray. Morphine IV
Memory Aid: ‘MONA’
Nursing management Plan
Chest discomfort R/T imbalance between myocardial oxygen supply and demand
Goals: To detect chest discomfort and
associated ECG and hemodynamic changes early.
To reduce or eliminate chest discomfort
Interventions Assess and document the chest
pain. Assess vital parameters. Obtain 12 lead ECG. Assess cardiac marker values. Report the findings of assessment to
physician.
Administer oxygen, morphine sulfate, nitroglycerine or other medications as ordered.
Provide the restful environment and promote the patient’s comfort.
Provide care in calm, competent manner.
Decreased myocardial tissue perfusion R/T an imbalanced oxygen supply and demand.
Assessment MONA Start two IV lines. Early reperfusion:
Administer adjunctive medications: Beta blockers. Nitroglycerine IV. Heparin IV
No Reperfusion
Delay
NOTE:
Time duration
Eligible for thrombolytic therapy
Thrombolytic therapy contra-indicated
Not suitable for PTCA
Persistent symptoms
Thrombolysis PTCA
Other medical therapy
No Yes
Reperfusion
>12 hrs<12hrs
Administer thrombolytic therapy as prescribed.
Streptokinase Urokinase tPADoor to drugs: <30min.
Prepare for Primary PCI as prescribed.
Door to balloon 90+ 30 min.
Fear/ anxiety related to diagnosis, treatment and prognosis acute MI
Provide individualized nursing care in calm and competent manner.
Listen, reflect, guide.
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