THE CLIENT WITH A CARDIOVASCULAR ALTERATION:

ACUTE MYOCARDIAL INFARCTION

BSN IV Arellano, Liza G. Carandang, Dana Erica D. Fideli, Rachelle B. Opulencia, Melarnie G. Saldua, Ma.Shiela S.

Myocardial infarction (MI or AMI for acute myocardial infarction), commonly known as a heart attack, occurs when the blood supply to part of the heart is interrupted.

RISK FACTORS: Hyperlipidemia Diabetes Mellitus Hypertension Tobacco Use Male Gender Family History

Two types of heart attacks: 1. Transmural myocardial infarction. 2. Nontransmural myocardial infarction

TERMINOLOGIES

Hyperlipidemia CAD CPK PTCA IABP MB isoenzyme

LEARNING ISSUES
1. What are the signs and symptoms of acute myocardial infarction? 2. What are the risk factors for acute myocardial infarction? 3. What could be the possible risk factors for the patient to experience having cardiomegaly? 4. What is the normal value of CPK? 5. What is the relationship of CPK in the patients condition? 6. Is the value of CPK an indicator that made it clear that the patients prognosis was extremely grim? 7. Among all the procedures done in the patient. What could be the possible indicator that could affect the rose of CPK?

LEARNING ISSUES
8. What is the normal value of troponin I? 9. What is the purpose of troponin I in the patients condition? 10. What does ST elevation indicates? 11. What is the purpose of PTCA in the patients condition? 12. Why does PTCA failed to re-open the right coronary artery of the patient? 13. Why is a transcutaneous pacemaker placed in the patient? 14. Why the paramedics did gave atropine to the patient when they found out he was cool, clammy, bradyardic and hypotensive?

LEARNING ISSUES
15. Why is the patient experiencing expiratory wheezes but does not have signs of pulmonary edema? 16. Why did the patient display a decrease in pulse oximeter blood oxygen saturation and cyanosis despite the addition of supplementary oxygen? 17. Why is there a need for the patient to be intubated? 18. Why is aspirin given to the patient in the case that he is experiencing hypotension? 19. What is the action of dopamine in the patients body? 20. What is the purpose of giving morphine to the patient?

Atheroma

Atherosclerotic plaque

Builds up in the coronary artery

Blockage of the coronary artery

Narrowing of the coronary arteries

Ischemia

Blood supply

Hypoxia

Myocardial cell death Release of intracellular enzymes Aerobic to anaerobic metabolism Lactic acid production

Altered repolarization of myocardium myocardial contractility ST Segment

CPK MB (+) Troponin I

Ventricular function

Pain

Cardiac output

Cool clammy

Chest pain

Changes in acid base balance

Blood flow in the brain Hypotension Loss of Consciousness

Acidosis SOB dysrithmias

Cardiomegaly

bradycardic

NURSING DIAGNOSIS
Activity intolerance Acute pain related to related to Impaired gas inadequate flow imbalance exchange of blood to the between related to myocardial tissue of the altered blood oxygen supply heart as flow as evidenced by evidenced by and demand bradypnea, facial Grimace, as evidence nasal flaring, by generalized cool and cool, clammy clammy skin, weakness, skin, cyanosis, hypotension restlessness hypotension and a and hypoxemia. and inability to pain scale of stand and 8/10 walk.

Ineffective cardiac tissue perfusion related to reduced coronary blood flow as evidence by dyspnea, bradypnea, and hypoxemia

Decrease cardiac output related to altered contractility as evidenced by cool, clammy skin, cyanosis and hypotension.

DRUGS

Atropine sulfate Heparin Morphine Aspirin Dopamine drip

LABORATORY RESULT
ANALYTE RESULT NORMAL RANGE

LABORATORY RESULT

CPK-MB

89 IU/L-4422 IU/L

5-100 IU/L

TROPONIN I

<0.4 ng/mL

0 - 0.1 ng/ml (onset: 4-6 hrs, peak: 1224 hrs, return to normal: 4-7 days)

Cardiomegaly

Atropine Aspirin

Morpine

Concept Map
Treated with

IABP

PTCA
Electrocardiogram

Acute Myocardial Infarction

Diagnosed with:

X-ray

Cigarette smoking

Elavated risk from

Family History Cardiac Catheterization

Obesity

Diabetes Mellitus

LDL cholesterol

Best Case Scenario Threat the acute attack of acute myocardial infarction If the treatment worked the progression of the disease will stabilize. Prevention of further tissue injury and limitation of infarction size

Worst Case Scenario: Potential complications Acute pulmonary edema Heart failure Cardiogenic shock Dysrhythmias and cardiac arrest Pericardial effusion and cardiac tamponade Myocardial rupture

THANK YOU!
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