Nursing Care Plan for Myocardial Infarction | NRSNG

Pathophysiology

Cardiac muscle tissue death from lack of blood flow. The blood carries oxygen and nutrients to the cells. When this is decreased, cells die also called necrosis. Cardiac muscle cells dying is problematic as they do not regenerate (although there is some debate of this topic: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042154/ )

Narrowing or occlusion of the cardiac vessels that perfuse the heart. The plaque that causes this could be from poor diet, lack of exercise, or genetics. It can also be from a deep vein thrombosis (DVT) that has broken free (embolus) and landed in the heart.

Re-perfusion to cardiac muscle and return of cardiac muscle functionality, or as much as possible.

Morphine: given if aspirin and nitroglycerine do not relieve chest pain. Initial dose is 2-4 mg IV.

Oxygen: helps for you to remember to check oxygenation for chest pain- if under 94% or if patient is short of breath give 2L NC initially. Evidence based research has left the use of oxygenation and its helpfulness in these situations inconclusive. Oxygen can cause vasoconstriction thus worsening the situation and decreasing blood flow. Administer oxygen when clinically relevant.

Nitroglycerin: This is the initial medication given, along with aspirin. This medication dilates the blood vessels to help allow any blood flow that might be impeded. Give 0.4 mg sublingual tab, wait 5 minutes, if the chest pain is not relieved administer another dose. This can happen 3 times total. Monitor a patients blood pressure, hold for a systolic BP of less than 90 mmHg.

Aspirin: given to thin the blood. A total of 4 baby aspirin (81 mg each) can be given for a total of 324 mg.

Right sided 12 lead ECG shows the right side of the heart to assess for right ventricular ischemia. **Inferior MIs need to be treated differently!**

A patient may also go to the cath lab without having a STEMI, and they may still find a clot. Most NON-STEMIs are treated without catheterization.

Monitor aPTT or Anti-Xa Q6H to adjust and maintain therapeutic levels.

For STEMIBolus: 60 units/kg (max 4,000 units)Continuous infusion: 12 units/kg/hr-Adjust according to your organization's nomogram (Q6H- based on results of aPPT or Anti-Xa)

For N-STEMIBolus: 60-70 units/kg (max 5,000 units)Continuous Infusion: 12-15 units/kg/hr-Adjust according to your organization's nomogram (Q6H- based on results of aPPT or Anti-Xa)

Cardiac enzymes further serve to rule out Myocardial Infarction and can give an indication to the extent of myocardial damage.Troponin ICKCK-MBMyoglobin

Troponin I is an enzyme that helps the interaction of myosin and actin in the cardiac muscle. When necrosis of the myocyte happens, the contents of the cell eventually will be released into the bloodstream.

Troponin can become elevated 2-4 hours after in ischemic cardiac event and can stay elevated for up to 14 days.

Creatine Kinase MB: This enzyme is found in the cardiac muscle cells and catalyses the conversion of ATP into ADP giving your cells energy to contract. When the cardiac muscle cells are damaged the enzyme is eventually released into the bloodstream.

CKMB levels should be checked at admission, and then every 8 hours afterwards.

Date Published - May 16, 2017Date Modified - Oct 29, 2018

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Nursing Care Plan for Myocardial Infarction | NRSNG