Nursing 211

N211: Health Differences Across the Lifespan I Myocardial Infarction (MI) is death to myocardial muscle related to lack of oxygen from inadequate perfusion. There is a disruption or deficiency of coronary artery blood supply, resulting in necrosis of myocardial tissue. Causes include thrombus, shock or hemorrhage. Signs and Symptoms Signs and symptoms include crushing substernal pain that may radiate to the jaw, back, and arms. It last longer than anginal pain and is unrelieved by rest or nitroglycerin. Client may also be asymptomatic. Other findings include dyspnea, nausea and vomiting, anxiety, diaphoresis, pallor, arrhythmias. Pain may radiate to the shoulders and down the arms and/or the neck and jaw. The common locations for the pain are substernal, retrosternal or epigastric areas. Women may also present with shortness of breath or fatigue. Diagnostics On EKG an enlarged Q wave, elevated ST segment, T wave inversion. Serum cardiac markers: creatinine kinase (CK) intracellular enzymes that are released into circulation after an MI. CK level rises 3 to 12 hours after an MI; peaks in 24 hours and returns to normal within 2 to 3 days. CK-MB band is specific to myocardial cells and can help quantify myocardial damage. Cardiac specific troponin is a myocardial muscle protein released into circulation after MI injury with greater sensitivity and specificity for myocardial injury than CK-MB. Increase 3-12 hours after the onset of MI; peaks at 24 to 48 hours; returns to baseline over 5 to 14 days. Bowel sounds may be absent or high pitched, indicating possibility of mesenteric artery thrombosis, which acts as an intestinal obstruction. Ineffective tissue perfusion related to decreased cardiac output • Decreased cardiac output related to altered peripheral tissue perfusion • Anxiety related to pain, loss of control, and uncertainty of future • Acute pain related to decreased myocardial oxygenation Nursing Int rventions To treat pain, increase oxygen perfusion, IV morphine sulfate (acts as a peripheral vasodilator and decreases venous return). Other medications are Nitrates, Beta-blockers, Calcium channel blockers, aspirin and antiplatelet aggregates. Obtain vital signs. Administer oxygen at 2 to 6L per nasal cannula, obtain cardiac enzymes, provide a quiet, restful environment, assess breath sounds for rales (indicating pulmonary edema), maintain patent IV line for administration of emergency medications, monitor fluid balance, keep in semi-Fowler position to assist with breathing. Maintain bedrest for 24 hours. Encourage the client to resume activities gradually, encourage verbalization of fears, provide client with information about the disease process and cardiac rehabilitation. Nursing Diagnosis •

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