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What is Acute myocardial infarction and Its Assessment:Nursing Case Study

Thursday, 20 March 2014

An acute myocardial infarction (MI) occurs when reduced blood flow through one or more coronary arteries causes myocardial ischemia and necrosis. The infarction site depends on the vessels involved. Symptoms may differ between women and men.

Pathophysiology
With an acute MI, one or more coronary arteries become occluded. If coronary occlusion causes ischemia lasting longer than 30 to 45 minutes, irreversible myocardial cell damage and muscle death occur. Every MI has a central area of necrosis surrounded by an area of hypoxic injury; this injured tissue is potentially viable and may be salvaged if circulation is restored, or it may progress to necrosis.

Complications
■ Arrhythmias
■ Cardiogenic shock
■ Heart failure
■ Papillary muscle rupture
■ Pericarditis
■ Thromboembolism

Assessment
Health perception and management

■ Sudden onset of severe chest pain or tightness, arm, jaw, or back pain; extreme fatigue (women); feeling of impending doom
■ History of previous cardiac disease, diabetes mellitus, hypertension, acute MI, or cardiac surgery
■ Coronary artery disease risk factors
■ Family history of death from acute MI (especially before age 50)

Nutrition and metabolism
■ Indigestion, nausea, or vomiting
■ Poor dietary habits (high fat)

Elimination
■ Feeling of fullness or bowel movement coinciding with onset of chest pain

Activity and exercise
■ Shortness of breath
■ Sedentary lifestyle

Cognition and perception
■ History of recurrent chest pain

Sleep and rest
■ Sleep disturbances

Self-perception and self-concept
■ Concern about work

Roles and relationships
■ Concern about ability to maintain role in family

Coping and stress management
■ Anxiety, tension, type A personality (aggressive, competitive, impatient)
■ Fear of death or of the unknown

Values and beliefs
■ Denied need for medical attention

Physical examination
Mental status and behavior
■ Restlessness
■ Anxiety
■ Irritability
■ Confusion

Integumentary
■ Diaphoresis
■ Cool, clammy skin
■ Variable skin color (may be normal, pale, ashen, or cyanotic)

Respiratory
■ Crackles (if heart failure is present)
■ Dyspnea

Cardiovascular
■ Hypotension or hypertension
■ Tachycardia
■ Cardiac arrhythmias
■ Third (S3) or fourth (S4) heart sound
■ Slowed capillary refill time (in shock)

Gastrointestinal

■ Anorexia
■ Vomiting
■ Abdominal distention

Neurologic
■ Altered level of consciousness (shock)

Musculoskeletal
■ Pained or anxious facial expression
■ Tense posture

Diagnostic studies
■ Cardiac isoenzymes show characteristic trends, particularly elevated CK-MB.
■ Troponin I levels are positive.
■ Myoglobin levels are increased.
■ 12‑lead electrocardiogram (ECG) with transmural infarction shows elevated ST segment and upright T waves in hyperacute phase, progressing to deeply inverted T waves and pathologic Q waves in leads overlooking the infarcted area; with subendocardial infarction, depressed ST segment and inverted T waves.
■ Myocardial imaging (radionuclide) studies demonstrate areas of poor or absent perfusion, wall motion abnormalities, and reduced ejection fraction.
■ Echocardiography illustrates structural or functional cardiac abnormalities.

Teaching: Disease process; Teaching: Prescribed diet; Teaching: Prescribed medication; Teaching: Procedure/treatment

Teaching checklist

■ Disease process and treatment plan
■ Risk factor reduction
■ Medications
■ Dietary modifications
■ Activity restrictions
■ Rehabilitation programs
■ Follow-up care
■ Community agencies and support groups
■ Common emotional changes


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