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Myocardial infarction (MI or AMI for acute myocardial infarction), commonly known as a heart attack, occurs when the blood supply to part of the heart is interrupted.
RISK FACTORS: Hyperlipidemia Diabetes Mellitus Hypertension Tobacco Use Male Gender Family History
Two types of heart attacks: 1. Transmural myocardial infarction. 2. Nontransmural myocardial infarction
TERMINOLOGIES
LEARNING ISSUES
1. What are the signs and symptoms of acute myocardial infarction? 2. What are the risk factors for acute myocardial infarction? 3. What could be the possible risk factors for the patient to experience having cardiomegaly? 4. What is the normal value of CPK? 5. What is the relationship of CPK in the patients condition? 6. Is the value of CPK an indicator that made it clear that the patients prognosis was extremely grim? 7. Among all the procedures done in the patient. What could be the possible indicator that could affect the rose of CPK?
LEARNING ISSUES
8. What is the normal value of troponin I? 9. What is the purpose of troponin I in the patients condition? 10. What does ST elevation indicates? 11. What is the purpose of PTCA in the patients condition? 12. Why does PTCA failed to re-open the right coronary artery of the patient? 13. Why is a transcutaneous pacemaker placed in the patient? 14. Why the paramedics did gave atropine to the patient when they found out he was cool, clammy, bradyardic and hypotensive?
LEARNING ISSUES
15. Why is the patient experiencing expiratory wheezes but does not have signs of pulmonary edema? 16. Why did the patient display a decrease in pulse oximeter blood oxygen saturation and cyanosis despite the addition of supplementary oxygen? 17. Why is there a need for the patient to be intubated? 18. Why is aspirin given to the patient in the case that he is experiencing hypotension? 19. What is the action of dopamine in the patients body? 20. What is the purpose of giving morphine to the patient?
Atheroma
Atherosclerotic plaque
Ischemia
Blood supply
Hypoxia
Myocardial cell death Release of intracellular enzymes Aerobic to anaerobic metabolism Lactic acid production
Ventricular function
Pain
Cardiac output
Cool clammy
Chest pain
Cardiomegaly
bradycardic
NURSING DIAGNOSIS
Activity intolerance Acute pain related to related to Impaired gas inadequate flow imbalance exchange of blood to the between related to myocardial tissue of the altered blood oxygen supply heart as flow as evidenced by evidenced by and demand bradypnea, facial Grimace, as evidence nasal flaring, by generalized cool and cool, clammy clammy skin, weakness, skin, cyanosis, hypotension restlessness hypotension and a and hypoxemia. and inability to pain scale of stand and 8/10 walk.
Ineffective cardiac tissue perfusion related to reduced coronary blood flow as evidence by dyspnea, bradypnea, and hypoxemia
Decrease cardiac output related to altered contractility as evidenced by cool, clammy skin, cyanosis and hypotension.
DRUGS
LABORATORY RESULT
ANALYTE RESULT NORMAL RANGE
LABORATORY RESULT
CPK-MB
89 IU/L-4422 IU/L
5-100 IU/L
TROPONIN I
<0.4 ng/mL
0 - 0.1 ng/ml (onset: 4-6 hrs, peak: 1224 hrs, return to normal: 4-7 days)
Cardiomegaly
Atropine Aspirin
Morpine
Concept Map
Treated with
IABP
PTCA
Electrocardiogram
Diagnosed with:
X-ray
Cigarette smoking
Obesity
Diabetes Mellitus
LDL cholesterol
Best Case Scenario Threat the acute attack of acute myocardial infarction If the treatment worked the progression of the disease will stabilize. Prevention of further tissue injury and limitation of infarction size
Worst Case Scenario: Potential complications Acute pulmonary edema Heart failure Cardiogenic shock Dysrhythmias and cardiac arrest Pericardial effusion and cardiac tamponade Myocardial rupture
THANK YOU!
REFERENCES: Nurses pocket guide, edition11 by Marilyn E. Doenges et.al Nursing Diagnosis reference manual, 6th edition by Shiela Sparks Ralph et.al Nursing care plan guidelines for individualizing patient care, 6th edition, Marilyn E. Doenges Medical-Surgical Nursing, vol.2 by Suzanne C. Smeltzer et.al Essentials of Pathophysiology, 2nd edition, by Carol Mattson Porth Fundamentals of Anatomy and Physiology, 2nd editon, by Gilliam, S. (2006) Springhouse Nurses Drug Guide (7th Ed.), Lewis, s. Heithkemper, m. and Dirksen, S. (2007) Medical-Surgical Nursing: Assessment and Management of Clinical Problems (7th Ed.) St. Louis: Mosby. Donald C. Ritzo Brunner, L, Bare, B., Hinkle, J., Cheever, K. (2010) Brunner and Suddarth Textbook of Medical-Surgical Nursing (12 Ed.), Philadelphia: Lippincott Williams and Wilkins.