Myocardial infarction, commonly known as a heart attack, is the irreversible necrosis of heart muscle secondary to prolonged ischemia. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (cholesterol and fatty acids) and white blood cells (especially macrophages) in the wall of an artery. The resulting ischemia (restriction in blood supply) and ensuing oxygen shortage, if left untreated for a sufficient period of time, can cause damage or death (infarction) of heart muscle tissue (myocardium).
Signs and symptoms of myocardial ischemia:
- Crushing pain on the chest (angina pectoris), behind the sternum, often radiating to the lower jaw or the left arm
- Fear of dying
- Nausea
- Shock (manifesting as paleness, low blood pressure, fast weak pulse) shock
- Rhythm disturbances (in particular, increasing prevalence of ventricular ectopia, ventricular tachycardia, AV bloc
ECG Manifestations of Acute Myocardial Ischaemia (in Absence of LVH and LBBB)are :
ST elevation
New ST elevation at the J-point in two contiguous leads with the cut-off points: ≥0.2 mV in men or ≥ 0.15 mV in women in leads V2–V3 and/or ≥ 0.1 mV in other leads.
ST depression and T-wave changes.
New horizontal or down-sloping ST depression >0.05 mV in two contiguous leads; and/or T inversion ≥0.1 mVin two contiguous leads with prominent R-wave or R/S ratio ≥ 1
Management
An MI requires immediate medical attention. Treatment attempts to salvage as much myocardium as possible and to prevent further complications, hence the phrase "time is muscle". Oxygen, aspirin, and nitroglycerin may be administered. Morphine was classically used if nitroglycerin was not effective; however, it may increase mortality in the setting of NSTEMI. A 2009 and 2010 review of high flow oxygen in myocardial infarction found increased mortality and infarct size, calling into question the recommendation about its routine use. Other analgesics such as nitrous oxide are of unknown benefit. Percutaneous coronary intervention (PCI) or fibrinolysis are recommended in those with an STEMI. (Wikipedia)
Nursing Diagnosis: Acute Pain
Objectives and Expected outcomes
Chest pain is lost or controlled
Expected outcomes:
- Able to demonstrate use of relaxation techniques.
- Showed reduced stress, relaxed and easy to move.
Intervention
1. Monitor or record the characteristics of the pain, noted the report verbal, nonverbal cues, and the haemodynamic response (grimacing, crying, anxiety, sweating, clutching his chest, rapid breathing, blood pressure / heart frequency change).
Rational:
Variations in appearance and behavior, because the pain occurs as the findings of the assessment. Most of the Acute Myocardial Infarction looks sick, distraction, and focus on the pain. History of verbal and deeper investigation of the precipitating factors should be delayed until the pain is gone. Breathing may increase senagai caused pain and is associated with anxiety, stress cause temporary loss of catecholamines would increase heart rate and blood pressure.
2. Take a complete picture of the patient's pain including location, intensity (0-10), duration, quality (shallow / spread), and distribution.
Rational:
Pain is a subjective experience and should be described by the client. Help clients to rate your pain by comparing it with the experience of others.
3. Observations over the previous history of angina, pain resembling angina, or pain Myocardial Infarction. Discuss family history.
Rational:
Can compare the pain is there from the previous pattern, according to the identification of complications such as widespread infarction, pulmonary embolism, or pericarditis.
4. Instruct patient to report pain immediately.
Rational:
Severe pain can cause a shock by stimulating the sympathetic nervous system, resulting in further damage and interfere with diagnostic and pain relief.
5. Provide a quiet, slow activity, and comfortable action (eg, bed linen, dry / not crossed, rubbing his back). Patient approach calmly and with confidence.
Rational:
Lowering external stimuli in which anxiety and heart strain and limited coping abilities and judgment of the current situation.
6. Aids relaxation techniques, eg, deep breathing / slow, behavioral distraction, visualization, imagination guidance.
Rasaional:
Assist in the reduction in the perception / response to pain. Giving control of the situation, increase positive behavior.
7. Check vital signs before and after narcotic drugs.
Rational:
Hypotension / respiratory depression can occur as a result of drug administration. This problem can increase the myocardial damage in the presence of ventricular failure.
Collaboration:
8. Give supplemental oxygen by nasal cannula or mask as indicated.
Rational:
Increasing the amount of oxygen available for myocardial usage and also reduce discomfort in relation to tissue ischemia.
9. Give medication as indicated
