Myocardial infarction⇨⇨ nursing assessment and care

introduction

To establish a plan of care, the focus should be on the following:

•  Relief of pain or ischemic signs and symptoms.

•  Prevention of myocardial damage.

•  Absence of respiratory dysfunction.

•  Maintenance or attainment of adequate tissue perfusion.

•  Reduced anxiety.

•  Absence or early detection of complications.

• Chest pain absent/controlled.

• Heart rate/rhythm sufficient to sustain adequate cardiac output/tissue perfusion.

•  Achievement of activity level sufficient for basic self-care.  

• Anxiety reduced/managed.

• Disease process, treatment plan, and prognosis understood. 

• Plan in place to meet needs after discharge.

Nursing Assessment:

👉One of the most important aspects of care of the patient with MI is the assessment:

•  Assess for chest pain not relieved by rest or medications.

•  Monitor vital signs, especially the blood pressure and pulse rate.

•  Assess for presence of shortness of breath, dyspnea, tachypnea, and crackles.

•  Assess for nausea and vomiting.

•  Assess for decreased urinary output.

•  Assess for the history of illnesses.

• Perform a precise and complete physical assessment to detect complications and changes in the patient's status.

•  Assess IV sites frequently.

Nursing Priorities:

• Relieve pain, anxiety.

• Reduce myocardial workload.

• Prevent/detect and assist in treatment of life-threatening dysrhythmias or complications.

• Promote cardiac health, self-care.

Nursing Interventions:

Nursing interventions should be anchored on the goals in the nursing care plan.

•  Administer oxygen along with medication therapy to assist with relief of symptoms.

• Encourage bed rest with the back rest elevated to help decrease chest discomfort and dyspnea.

• Encourage changing of positions frequently to help keep fluid from pooling in the bases of the lungs.

• Check skin temperature and peripheral pulses frequently to monitor tissue perfusion.

• Provide information in an honest and supportive manner.

• Monitor the patient closely for changes in cardiac rate and rhythm, heart sounds, blood pressure, chest pain, respiratory status, urinary output, changes in skin color, and laboratory values.

*After the implementation of the interventions within the time specified, the nurse should check if:

•  There is an absence of pain or ischemic signs and symptoms.

•  Myocardial damage is prevented.

•  Absence of respiratory dysfunction.

•  Adequate tissue perfusion maintained.   

• Anxiety is reduced

Home Care Guidelines:

⇒The most effective way to increase the probability that the patient will implement a self-care regimen after discharge is to identify the patient's priorities:

1. /  Education. This is one of the priorities that the nurse must teach the patient about heart-healthy living.
   
2. /  Home care. The home care nurse assists the patient with scheduling and keeping up with the follow-up appointments and with adhering to the prescribed cardiac rehabilitation management.
   
3. /  Follow-up monitoring. The patient may need reminders about follow-up monitoring including periodic laboratory testing and ECGs, as well as general health screening.
4. /  Adherence. The nurse should also monitor the patient's adherence to dietary restrictions and prescribed medications