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Sunday, May 24, 2009

Myocardial Infarction (MI); Nursing Outcomes, Nursing Interventions, Patient Teaching And Home Health Care

Nursing outcomes for Myocardial Infarction (MI), Patients will

  • Perform activities of daily living without excessive fatigue or exhaustion.
  • Express feelings of comfort and decreased pain.
  • Verbalize strategies to reduce anxiety and stress.
  • Maintain adequate cardiac output.
  • Develop no complications of fluid volume excess.
  • Verbalize the importance of balancing activities, as tolerated, with adequate rest periods.
  • Achieve ideal weight.
  • Develop adequate coping skills.
  • The patient will recognize his acute condition and accept the lifestyle changes he needs to make.
  • Express feelings about changes in sexual patterns.
  • Maintain hemodynamic stability and develop no arrhythmias.

Nursing interventions for Myocardial Infarction (MI) ;

  • Nursing Care for patients who have suffered a Myocardial Infarction (MI), Most most of them receive treatment in the coronary care unit (CCU), where they're under constant observation for complications.
  • On admission to the CCU, monitor and record the patient's ECG readings, blood pressure, temperature, and heart and breath sounds.
  • Assess pain and give an analgesic as ordered.
  • Record the severity of pain, location, type, and duration of pain.
  • Check the patient's blood pressure before and after giving nitroglycerin, especially the first dose.
  • Frequently monitor ECG rhythm strips to detect rate changes and arrhythmias. if any new arrhythmias are documented, if chest pain occurs, or at least every shift change or according to facility protocol.
  • Obtain ECG readings and blood pressure and pulmonary artery catheter measurements, if applicable, to determine changes. During episodes of chest pain
  • Watch for crackles, cough, tachypnea, and edema, which may indicate impending left-sided heart failure.
  • Monitor daily weight, intake and output, respiratory rate, serum enzyme levels, ECG readings, and blood pressure.
  • Organize patient care and activities to maximize periods of uninterrupted rest.
  • Provide a clear liquid diet dietary until nausea subsides. A low-cholesterol, low-sodium diet, without caffeine-containing beverages, may be ordered.
  • Provide a stool softener to prevent straining during defecation, which causes vagal stimulation and may slow heart rate.
  • Allow the patient to use a bedside commode, and provide as much privacy as possible.
  • Assist with ROM exercises.
  • If the patient is immobilized by a severe Myocardial Infarction (MI), turn him often.
  • Give Antiembolism stockings to prevent venostasis and thrombophlebitis.
  • Provide emotional support, and help reduce stress and anxiety .
  • If the patient has undergone PTCA, sheath care is necessary. Keep the sheath line open with a heparin drip. Observe the patient for generalized and site bleeding. Keep the leg with the sheath insertion site immobile. Maintain strict bed rest. Check peripheral pulses in the affected leg frequently. Provide an analgesic for back pain if needed.
  • After thrombolytic therapy, administer continuous heparin as ordered. Monitor the partial thromboplastin time every 6 hours, and monitor the patient for evidence of bleeding.

Patient Teaching and Home Healthcare Guide for Patients with Myocardial Infarction (MI)
Explain procedures and answer questions for both the patient and family. Explain the CCU environment and routine. Remember that you may need to repeat explanations after the emergency situation has resolved.

  • To promote compliance with the prescribed medication regimen and other treatment measures, thoroughly explain dosages and therapy. Inform the patient of the drug's adverse reactions, and advise him to watch for and report signs and symptoms of toxicity (for example, anorexia, nausea, vomiting, mental depression, vertigo, blurred vision, and yellow vision, if the patient is receiving a cardiac glycoside).
  • Explain the need to treat recurrent chest pain or Myocardial Infarction (MI) discomfort with sublingual nitroglycerin every 5 minutes for three doses. If the pain persists for 20 minutes, teach the patient to seek medical attention. If the patient has severe pain or becomes short of breath with chest pain, teach the patient to take nitroglycerin and seek medical attention right away
  • Review dietary restrictions with the patient. If he must follow a low-sodium, low-fat, or low-cholesterol diet, provide a list of foods to avoid. Ask the dietitian to speak to the patient and family.
  • Explore mechanisms to implement diet control, an exercise program, and smoking cessation if appropriate.
  • Encourage the patient to participate in a cardiac rehabilitation exercise program. The physician and the exercise physiologist should determine the level of exercise and then discuss it with the patient and secure his agreement to a stepped-care program.
  • Counsel the patient to resume sexual activity progressively. He may need to take nitroglycerin before sexual intercourse to prevent chest pain from the increased activity.
  • Advise the patient about appropriate responses to new or recurrent symptoms.
  • Advise the patient to report typical or atypical chest pain. Post Myocardial Infarction (MI) syndrome may develop, producing chest pain that must be differentiated from a recurrent MI, pulmonary infarction, and heart failure .
  • Stress the need to stop smoking. If necessary, refer the patient to a support group.
  • Be sure the patient understands all the medications, including the dosage, route, action, and adverse effects.
  • Instruct the patient to keep the nitroglycerin bottle sealed and away from heat.
  • The medication may lose patients potency.


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