Nursing care plan Myocardial Infarction MI

MYOCARDIAL INFARCTION

I. Pathophysiology

a. Marked reduction or loss of blood flow through one or more
of the coronary arteries, resulting in cardiac muscle
ischemia, and over a finite period, resulting in necrosis
b. Occurs most often due to coronary artery disease (CAD)
c. Cellular ischemia and necrosis can affect the heart’s rhythm,
pumping action, and blood circulation.
d. Other problems may also ensue, such as heart failure, lifethreatening
arrhythmias, and death.
e. Delay in seeking treatment is the largest barrier to receiving
therapy quickly.

II. Classification

a. Type of myocardial infarction (MI) can be identified on the
electrocardiogram (ECG).
i. ST-segment elevation (also called STEMI)
ii. Non-ST elevation
b. Location of MI can be identified on the ECG.
i. Anterior wall of the ventricle
ii. Inferior wall of the ventricle
iii. Posterior wall of the ventricle
iv. Lateral wall of the ventricle
c. Infarcts are usually classified by size.
i. Microscopic (focal necrosis)
ii. Small (<10% of the left ventricle)
iii. Medium (10% to 30% of the left ventricle)
iv. Large (>30% of the left ventricle)
d. Point of time can be identified on the ECG by the Q wave
and the client’s history.
i. Acute or evolving infarction is characterized by the presence
of polymorphonuclear leukocytes unless the interval
between the onset of infarction and death is brief (e.g.,
6 hours), minimal, or no polymorphonuclear leukocytes
may be seen.
ii. Old or healed infarction is manifested as scar tissue
without cellular infiltration, a process usually requiring
5 to 6 weeks or more.

III. Etiology

a. CAD common cause with plaque formation narrowing
vessels and pieces of plaque breaking off, creating emboli
b. Severe spasm of a coronary artery is less common cause
c. Risk factors—age, being overweight or obese, smoking,
hyperlipidemia, family history
d. Greater risk in presence of kidney problems, peripheral
arterial disease, or prior MI
IV. Statistics (Centers for Disease Control and Prevention
[CDC],2007b; National Heart, Lung and Blood Institute
[NHLBI], 2007)
a. Morbidity: Approximately 1.1 million people in the United
States suffer from MI annually.
b. Mortality: almost 50% die, approximately 460,000 annually.
i. CAD is leading killer of both men and women in the
United States.
ii. Leading cause of death for American Indians, Alaskan
Natives, African Americans, Hispanics, and whites, and
second leading cause of death for Asians and Pacific
Islanders
c. Cost: Projected $258 billion spent for heart disease in 2006.

Care Setting

Myocardial infarctions are treated in the emergency room,
inpatient acute hospital, critical care unit (CCU), intensive
care unit (ICU), step-down unit, or medical unit.

Related Concerns

Angina,
Dysrhythmias,
Heart failure: chronic,
Psychosocial aspects of care,
Thrombophlebitis: deep vein thrombosis,

Nursing Priorities

1. Relieve pain and anxiety.
2. Reduce myocardial workload.
3. Prevent, detect, and assist in treatment of life-threatening
dysrhythmias or complications.
4. Promote cardiac health and self-care.

Discharge Goals

1. Chest pain absent or controlled.
2. Heart rate and rhythm sufficient to sustain adequate cardiac
output and tissue perfusion.
3. Achievement of activity level sufficient for basic selfcare.
4. Anxiety reduced and managed.
5. Disease process, treatment plan, and prognosis understood.
6. Plan in place to meet needs after discharge, including
follow-up appointments.

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