Sunday, May 21, 2017

Special considerations in Patients with Myocardial infarction


With myocardial infarction (MI), also known as heart attack, reduced blood flow through one of the coronary arteries results in myocardial ischemia and necrosis. With cardiovascular disease, the leading cause of death in the United States and western Europe, death usually results from the cardiac damage or complications of an MI.

Mortality is high when treatment is delayed; almost half of all sudden deaths due to an MI occur before hospitalization, within 1 hour of the onset of symptoms. The prognosis improves if vigorous treatment begins immediately.
  • Care for patients who have suffered an MI is directed toward detecting complications, preventing further myocardial damage, and promoting comfort, rest, and emotional well-being. Most MI patients receive treatment in the coronary care unit (CCU), where they’re under constant observation for complications.
  • On admission to the CCU, record the patient’s blood pressure, temperature, and heart and breath sounds, and monitor them regularly. Also, obtain an ECG.
  • Assess and record the severity and duration of pain; administer an analgesic. Avoid I.M. injections; absorption from the muscle is unpredictable.
  • Check the patient’s blood pressure after giving nitroglycerin, especially the first dose.
  • Frequently monitor the ECG to detect rate changes or arrhythmias. Place rhythm strips in the patient’s chart periodically for evaluation.
  • During episodes of chest pain, obtain ECG, blood pressure, and pulmonary artery catheter measurements for changes.
  • Watch for signs and symptoms of fluid retention (crackles, cough, tachypnea, and edema), which may indicate impending heart failure. Carefully monitor daily weight, intake and output, respirations, serum enzyme levels, and blood pressure.
  • Auscultate for adventitious breath sounds periodically (patients on bed rest frequently have atelectatic crackles, which may disappear after coughing) and for third or fourth heart sounds.
  • Organize patient care and activities to maximize periods of uninterrupted rest.
  • Ask the dietary department to provide a clear liquid diet until nausea subsides. A low-cholesterol, low-sodium, caffeine-free diet may be ordered.
  • Provide a stool softener to prevent straining during defecation, which causes vagal stimulation and may slow the heart rate. Allow use of a bedside commode, and provide as much privacy as possible.
  • Assist with range-of-motion exercises. If the patient is completely immobilized by a severe MI, turn him often. Antiembolism stockings help prevent venostasis and thrombophlebitis.
  • Provide emotional support, and help reduce stress and anxiety; administer a tranquilizer, if needed.
  • Explain procedures, and answer questions. Explaining the CCU environment and routine can ease anxiety. Involve the patient’s family in his care as much as possible.
To prepare the patient for discharge:
  • Promote adherence measures by thoroughly explaining the prescribed medication regimen and other treatment measures.
  • Warn the patient about adverse reactions to drugs, and advise him to watch for and report signs and symptoms of toxic reaction (anorexia, nausea, vomiting, and yellow vision, for example, if the patient is receiving digoxin).
  • Review dietary restrictions with the patient. If he must follow a low-sodium or low-fat and low-cholesterol diet, provide a list of foods that he should avoid. Ask the dietitian to speak to the patient and his family.
  • Counsel the patient to resume sexual activity progressively.

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