Nursing Care Plan for Myocardial Infarction
Definition
According to Brunner & Suddarth, 2002 myocardial infarction refers to the process of destruction of heart tissue due to inadequate blood supply so that coronary blood flow is reduced.
While understanding according Suyono 1999 acute myocardial infarction is myocardial necrosis due to blood flow to the heart muscle is interrupted.
Causes
According to Kasuari, 2002 there were some etiology / cause of acute myocardial infarction, namely:
1) The cause:
a) Reduced myocardial oxygen supply caused by three factors:
- Vascular factors: Atherosclerosis, spasm, arteritis.
- Circulation factors: hypotension, aortic stenosis, insufficiency.
- Blood factors: anemia, hypoxemia, polycythemia.
- Excessive activity.
- Eating too much.
- Emotions.
- Hyperthyroidism.
- Myocardial damage.
- Myocardial hypertrophy.
- Diastolic hypertension.
2) Predisposing factors
a) Biological risk factors that can not be changed:
- Age over 40 years.
- Gender: high incidence in men, whereas in women increases after menopause.
- Heredity.
- Race: the incidence is higher in blacks.
- Major: Hypertension, Hyperlipidemia, Obesity, Diabetes, Smoking, Diet: high in saturated fat, high in calories.
- Minor: Personality type A (aggressive, ambitious, emotional, competitive), excessive psychological stress, physical inactivity.
Signs and Symptoms of Myocardial Infarction
1 Pain :
- The main symptom is chest pain that occurs suddenly and constantly not subside, usually felt over the lower sternal region and upper abdomen.
- Increased severity of pain can persist until the pain becomes unbearable.
- Pain is very sick, like a punctured-pin that can spread to the shoulder and continues down to the arm (usually the left arm).
- The pain began spontaneously (not occur after activity or emotional disturbance), persist for several hours or days, and not relieved by rest or nitroglycerin assistance.
- The pain may spread to the direction of the jaw and neck.
- Pain is often accompanied by shortness of breath, pale, cold, severe diaphoresis, dizziness or head was floating, and nausea and vomiting.
- Patients with diabetes mellitus will not experience severe pain because of neuropathy that accompanies diabetes can interfere neuroreseptord.
2 Laboratory
Cardiac enzyme tests:
- CPK-MB / CPK, Isoenzymes were found in heart muscle increased between 4-6 hours, peaks within 12-24 hours, returning to normal within 36-48 hours.
- LDH / HBDH, Increased within 12-24 hours dam takes a long time to return to normal
- AST / SGOT, Increased (less real / special) occurs within 6-12 hours, peaking within 24 hours, returning to normal within 3 or 4 days.
3 ECG
- ECG changes that occurred in the early phase of high T waves and symmetrical. After this there is ST segment elevation. Change happens then is the wave Q / QS indicating the presence of necrosis.
Test and Diagnosis
- ECG. To determine the function of the heart. It will be found an inverted T wave, ST depression, pathological Q.
- Cardiac enzymes. CPKMB, LDH, AST.
- Electrolytes. Imbalance can affect conduction and contractility, such as hypokalemia, hyperkalemia.
- White blood cells. Leukocytes (10000-20000) usually appears on day 2 after AMI associated with inflammatory processes.
- Sedimentation velocity. Increased on day 2 and 3 after AMI, indicating inflammation.
- Chemistry. May be normal, depending on the function or organ perfusion abnormalities acute or chronic
- Blood gas analysis. Hypoksia or process can be demonstrated acute or chronic lung disease.
- Serum cholesterol or triglycerides. Increased, indicating arteriosclerosis as a cause of IMA.
- Chest x-ray. May be normal or show an enlarged heart is suspected CHF or ventricular aneurysm.
- Echocardiogram. Performed to determine the dimensions of the foyer, ventricular wall motion or valves and valve configurations or functionality.
- Nuclear imaging tests. a. Thallium: evaluating myocardial blood flow and myocardial cell status such as the location or extent of AMI. b. Technetium: collected in ischemic cells around the necrotic area.
- Blood imaging of the heart (MUGA). Evaluating appearance special and general ventricles, regional wall motion and ejection fraction (blood flow).
- Coronary angiography. Illustrates the narrowing or blockage of the coronary arteries. Usually done in conjunction with pressure measurements porch and assess left ventricular function (ejection fraction). The procedure is not always done in the phase of AMI, except approaching emergency heart surgery or angioplasty.
- Nuclear magnetic resonance (NMR), allows visualization of blood flow, cardiac or valve ventricular porch, lesivaskuler, plaque formation, areas of necrosis or infarction and blood clots.
- Exercise stress test, Determining the cardiovascular response to the activities or often done in conjunction with thallium imaging in the healing phase.
Acute Pain - Nursing Care Plan Myocardial Infarction
