MYOCARDIAL INFARCTION REFERENCE: Principles of Medical-Surgical Nursing, LeMone and Burke, Volume 2, 3rd ed.
, pp 982-991
DEFINITION AND RISK PATHOPHYSIOL MANIFESTATIONS DIAGNOSTIC TESTS MANAGEMENT
FACTORS OGY MF: interruption of blood Occlusion 1. Chest Pain 1. Creatinine kinase (CK) PHARMACOLOGIC supply to part of the heart, ↓ Sudden onset Normal: 12-80 (M), 10-70 (F) 1. Aspirin – platelet aggregation most commonly due to Blood clot Not associated with activity Elevation indicates cardiac 2. Nitroglycerin (0.4mg) - pain occlusion causing myocardial formation Mostly occurs in the early tissue damage 3. Morphine sulfate (DOC) – oxygen demand cell necrosis, resulting to ↓ morning 2. CK-MB 4. Striptokinase – fibrinolytic ischemia and oxygen shortage Impaired blood Crushing, severe, pressure, Normal: 0% to 3% of total CK 5. Verapamil/Esmolol – atrial fibrillation or other dysrhythmias flow heavy, squeezing, tightness Most sensitive indicator of MI 6. Propranolol, Atenolol, Metoprolol – decrease cardiac work RF: ↓ or burning Elevation of greater than 5% 7. ACE inhibitors – reduce risk of subsequent HF and Non-modifiable: Ischemia Begins substernally and indicates MI reinfarction 1. Pre-existing coronary heart ↓ may radiate to shoulder, 3. Cardiac-specific troponin T 8. Abciximab – maintain coronary patency diseases, including a previous Necrosis neck, jaw, or arms (cTnT) 9. Heparin – prevent systemic or pulmonary embolism heart attack, prior angioplasty ↓ Lasts more than 15 to 20 Normal: <0.2 mcg/L 10. Dopamine – improves renal perfusion, myocardial or bypass surgery, or Scar formation, minutes Elevation indicates acute MI, contractility, CO and BP angina O2, Glycogen Not relieved by rest or unstable angina MEDICAL 2. Age and ATP nitroglycerin 4. Cardiac-specific troponin I 1. Bed rest for the first 12 hours to reduce cardiac workload M >45, W>55 depletion 2. Anxiety; Sense of impending (cTnI) 2. Allow sitting at bedside after 12 hours 3. Gender – M>F ↓ doom Normal: <3.1 mcg/L 3. Gradually increase activity as tolerated 4. Heredity: Family history of Anaerobic 3. Tachycardia Elevation indicates acute MI, 4. Provide a quiet, calm environment early heart disease metabolism 4. Cool, clammy, mottled skin, unstable angina 5. Limit visitors Modifiable: ↓ diminished peripheral pulses 5. CBC (elevated WBC and ESR) 6. Administer O2 by NC at 2-5LPM Smoking Acidosis, due to vasoconstriction 6. ABG (blood O2 levels, and A-B 7. Liquid diet for the first 4 to 12 hours, followed by Low-fat, Alcoholism. electrolyte 5. Tachypnea, Dyspnea, SOB imbalance) Low-cholesterol, Low-sodium diet Stress. imbalances, due to blood chemistry 7. ECG (inverted T, elevated ST, 8. Small, frequent feeding High blood pressure. hormone changes stimulating the formation of Q) 9. Limit caffeine High blood release , ↓MC, respiratory center 8. Echocardiography (cardiac wall SURGICAL cholesterol ↓SV, ↓CO, ↓BP, 6. Diaphoresis motion and left ventricular 1. Percutaneous Coronary Revascularization (e.g. angioplasty Overweight and ↓tissue 7. elevation of temperature function) and stent replacement) to restore blood flow to myocardium obesity perfusion 8. N&V 9. Radionuclide imaging 2. Intra-aortic balloon pump to augment CO, used after cardiac Physical inactivity 9. Hypotension or hypertension (myocardial perfusion) surgery 10. Palpitations, dysrhythmias 3. Ventricular Assistive Devices which takes partial or complete control of cardiac function
ALAGAO, Jerome, SN IV/BAUTISTA, Jesther Rowen, SN IV
ALAGAO, Jerome, SN IV/BAUTISTA, Jesther Rowen, SN IV