mi and heart surgery

Management of Patients With Myocardial Infarction :

Management of Patients With Myocardial Infarction Karen Larson, MBA/TM, MSN, RN

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The most common symptom of myocardial ischemia is chest pain; however, some individuals may be asymptomatic or have atypical symptoms such as weakness, dyspnea, and nausea. Atypical symptoms are more common in women and in persons who are older, or who have a history of heart failure or diabetes. Treatment seeks to decrease myocardial oxygen demand and increase oxygen supply Medications Oxygen Reduce and control risk factors Reperfusion therapy may also be done Cardiac Ischemia

Medications for Cardiac Ischemia/Chest pain:

Medications for Cardiac Ischemia/Chest pain Nitroglycerin Beta-adrenergic blocking agents Calcium channel blocking agents Antiplatelet and anticoagulant medications Aspirin Clopidogrel (Plavix) and ticlopidine (Ticlid) Heparin Glycoprotein IIB/IIIa agents ReoPro Integrilin Aggrastat

Collaborative Problems:

Collaborative Problems Acute pulmonary edema Heart failure Cardiogenic shock Dysrhythmias and cardiac arrest Myocardial infarction

Myocardial Infarction:

Myocardial Infarction An area of the myocardium is permanently destroyed. Usually caused by reduced blood flow in a coronary artery due to rupture of an atherosclerotic plaque and subsequent occlusion of the artery by a thrombus. In unstable angina, the plaque ruptures but the artery is not completely occluded. Unstable angina and acute myocardial infarction are considered the same process but at different point on the continuum. The term acute coronary syndrome includes unstable angina and myocardial infarction.

Effects of Ischemia, Injury, and Infarction on ECG:

Effects of Ischemia, Injury, and Infarction on ECG

Clinical Manifestations and Diagnosis:

Clinical Manifestations and Diagnosis Chest pain, other symptoms ECG Laboratory tests—biomarkers CK-MB Myoglobin Troponin T or I

Treatment of Acute MI:

Treatment of Acute MI Obtain diagnostic tests including ECG within 10 minutes of admission to the ED Oxygen Aspirin, nitroglycerin, morphine, beta-blockers Angiotensin-converting enzyme inhibitor within 24 hours Evaluate for percutaneous coronary intervention or thrombolytic therapy As indicated; IV heparin or LMWH, clopidogrel or ticlopidine, glycoprotein IIb/IIIa inhibitor Bed rest Assessment A vital component of nursing care! Assess all symptoms carefully and compare to previous and baseline data to detect any changes or complications. Monitor ECG.

Collaborative Problems:

Collaborative Problems Acute pulmonary edema Heart failure Cardiogenic shock Dysrhythmias and cardiac arrest Pericardial effusion and cardiac tamponade

Nursing Process: The Care of the Patient with ACS—Planning:

Nursing Process: The Care of the Patient with ACS—Planning Goals include the relief of pain or ischemic signs and symptoms, prevention of further myocardial damage, absence of respiratory dysfunction, maintenance of or attainment of adequate tissues perfusion, reduced anxiety, adherence to the self-care program, and absence or early recognition of complications.

Percutaneous Coronary Intervention:

Percutaneous Coronary Intervention

Coronary Artery Bypass Grafts:

Coronary Artery Bypass Grafts

Greater and lesser saphenous veins are commonly used for bypass graft procedures.:

Greater and lesser saphenous veins are commonly used for bypass graft procedures.

Cardiopulmonary Bypass System:

Cardiopulmonary Bypass System

Postoperative Care of the Cardiac Surgical Patient:

Postoperative Care of the Cardiac Surgical Patient