emergency mgt of mi
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Nursing Management Myocardial Infarction patient in Emergency Room
Harmeet Kaur KangM.Sc Cardiological / CTVS Nursing
Associate Professor
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Myocardial Infarction
Myocardial Infarction occurs as a result of thrombotic occlusion of the coronary artery and cause irreversible injury and necrosis.
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Clinical Manifestations
Chest pain Severe and prolonged and may be
described as crushing, constricting, or oppressive.
Radiation of pain to ulner aspect of left arm, neck, jaw and Interscapular region.
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Clinical Manifestations Contd….
Indigestion Nausea Vomiting Diaphoresis Palpitations Dyspnea
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Nursing Assessment in Emergency Room History Taking. Physical Examination Vital parameters 12 lead ECG monitoring. Measure oxygen saturation. Obtain initial serum cardiac markers.
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Inferior wall MI: right coronary artery
lead II, III & AVF Lateral wall MI : Lt circumflex artery
lead I, AVL, V5 & V6 Anterior MI : Lt anterior descending
lead V1 to V6 Posterior Wall MI:Rt coronary artery
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Immediate General Management Oxygen at 4 l/min. Aspirin 160-325mg. Nitroglycerine SL or spray. Morphine IV
Memory Aid: ‘MONA’
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Nursing management Plan
Chest discomfort R/T imbalance between myocardial oxygen supply and demand
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Goals: To detect chest discomfort and
associated ECG and hemodynamic changes early.
To reduce or eliminate chest discomfort
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Interventions Assess and document the chest
pain. Assess vital parameters. Obtain 12 lead ECG. Assess cardiac marker values. Report the findings of assessment to
physician.
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Administer oxygen, morphine sulfate, nitroglycerine or other medications as ordered.
Provide the restful environment and promote the patient’s comfort.
Provide care in calm, competent manner.
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Decreased myocardial tissue perfusion R/T an imbalanced oxygen supply and demand.
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Assessment MONA Start two IV lines. Early reperfusion:
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Administer adjunctive medications: Beta blockers. Nitroglycerine IV. Heparin IV
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No Reperfusion
Delay
NOTE:
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Time duration
Eligible for thrombolytic therapy
Thrombolytic therapy contra-indicated
Not suitable for PTCA
Persistent symptoms
Thrombolysis PTCA
Other medical therapy
No Yes
Reperfusion
>12 hrs<12hrs
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Administer thrombolytic therapy as prescribed.
Streptokinase Urokinase tPADoor to drugs: <30min.
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Prepare for Primary PCI as prescribed.
Door to balloon 90+ 30 min.
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Fear/ anxiety related to diagnosis, treatment and prognosis acute MI
Provide individualized nursing care in calm and competent manner.
Listen, reflect, guide.
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