Myocardial infarction (MI) is caused by marked reduction/loss of blood flow through one or more of the coronary arteries, resulting in cardiac muscle ischemia and necrosis.
Nursing Care Plan for Myocardial Infarction (MI)
Here is a Sample of Nursing Care Plan for Myocardial Infarction (MI).
Nursing Care Plan for Myocardial Infarction (MI): Nursing Priorities & Discharge Goals
Nursing Priorities | Nursing Care Plan for Myocardial Infarction (MI)
- Relieve pain, anxiety.
- Reduce myocardial workload.
- Prevent/detect and assist in treatment of life-threatening dysrhythmias or complications.
- Promote cardiac health, self-care.
Discharge Goals | Nursing Care Plan for Myocardial Infarction (MI)
- Chest pain absent/controlled.
- Heart rate/rhythm sufficient to sustain adequate cardiac output/tissue perfusion.
- Achievement of activity level sufficient for basic self-care.
- Anxiety reduced/managed.
- Disease process, treatment plan, and prognosis understood.
- Plan in place to meet needs after discharge.
Nursing Care Plan for Myocardial Infarction (MI): Nursing Diagnosis
Nursing Care Plan for Myocardial Infarction (MI) | Nursing Diagnosis of Myocardial Infarction
Nursing Diagnosis of Myocardial Infarction: Pain, acute May be related to Tissue ischemia (coronary artery occlusion)
Nursing Care Plan for Myocardial Infarction (MI): Nursing Intervention & Rationale
Nursing Interventions of Myocardial Infarction with Rationale
Pain Management (NIC)
Nursing Interventions of Myocardial Infarction with Rationale: Independent
- Monitor/document characteristics of pain, noting verbal reports, nonverbal cues (e.g., moaning, crying, restlessness, diaphoresis, clutching chest, rapid breathing), and hemodynamic response (BP/heart rate changes). Rationale: Variation of appearance and behavior of patients in pain may present a challenge in assessment. Most patients with an acute MI appear ill, distracted, and focused on pain. Verbal history and deeper investigation of precipitating factors should be postponed until pain is relieved. Respirations may be increased as a result of pain and associated anxiety; release of stress-induced catecholamines increases heart rate and BP.
- Obtain full description of pain from patient including location, intensity (0–10), duration, characteristics(dull/crushing), and radiation. Assist patient to quantify pain by comparing it to other experiences. Rationale: Pain is a subjective experience and must be described by patient. Provides baseline for comparison to aid in determining effectiveness of therapy, resolution/progression of problem.
- Review history of previous angina, anginal equivalent, or MI pain. Discuss family history if pertinent. Rationale: May differentiate current pain from preexisting patterns, as well as identify complications such as extension of infarction, pulmonary embolus, or pericarditis.
- Instruct patient to report pain immediately. Rationale: Delay in reporting pain hinders pain relief/may require increased dosage of medication to achieve relief. In addition, severe pain may induce shock by stimulating the sympathetic nervous system, thereby creating further damage and interfering with diagnostics and relief of pain.
- Provide quiet environment, calm activities, and comfort measures (e.g., dry/wrinkle-free linens, backrub). Approach patient calmly and confidently. Rationale: Decreases external stimuli, which may aggravate anxiety and cardiac strain, limit coping abilities and adjustment to current situation.
- Assist/instruct in relaxation techniques, e.g., deep/slow breathing, distraction behaviors, visualization, guided imagery. Rationale: Helpful in decreasing perception of/ response to pain. Provides a sense of having some control over the situation, increase in positive attitude.
- Check vital signs before and after narcotic medication. Rationale: Hypotension/respiratory depression can occur as a result of narcotic administration. These problems may increase myocardial damage in presence of ventricular insufficiency.
Nursing Care Plan for Myocardial Infarction
Nursing Interventions of Myocardial Infarction with Rationale: Collaborative
- Administer supplemental oxygen by means of nasal cannula or face mask, as indicated. Rationale: Increases amount of oxygen available for myocardial uptake and thereby may relieve discomfort associated with tissue ischemia.
- Administer medications as indicated:
- Antianginals, e.g., nitroglycerin (Nitro-Bid, Nitrostat, Nitro-Dur), isosorbide denitrate (Isordil), mononitrate (Imdur). Rationale: Nitrates are useful for pain control by coronary vasodilating effects, which increase coronary blood flow and myocardial perfusion. Peripheral vasodilation effects reduce the volume of blood returning to the heart (preload), thereby decreasing myocardial workload and oxygen demand.
- Beta-blockers, e.g., atenolol (Tenormin), pindolol(Visken), propranolol (Inderal), nadolol (Corgard), metoprolol (Lopressor). Rationale: Important second-line agents for pain control through effect of blocking sympathetic stimulation, thereby reducing heart rate, systolic BP, and myocardial oxygen demand. May be given alone or with nitrates. Note: beta-blockers may be contraindicated if myocardial contractility is severely impaired, because negative inotropic properties can further reduce contractility.
- Analgesics, e.g., morphine, meperidine (Demerol). Rationale: Although intravenous (IV) morphine is the usual drug of choice, other injectable narcotics may be used in acute-phase/recurrent chest pain unrelieved by nitroglycerin to reduce severe pain, provide sedation, and decrease myocardial workload. IM injections should be avoided, if possible, because they can alter the CPK diagnostic indicator and are not well absorbed in underperfused tissue.
Nursing Care Plan for Myocardial Infarction (MI): Overview; Nursing Care Plan for Myocardial Infarction: Nursing Priorities & Discharge Goals; Nursing Care Plan for Myocardial Infarction: Nursing Diagnosis; Nursing Care Plan for Myocardial Infarction: Nursing Intervention with Rationale. Nursing Care Plan for Myocardial Infarction (MI).