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Emergency mgt of mi

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Emergency mgt of mi

  1. 1. Nursing Management Myocardial Infarction patient in Emergency Room Harmeet Kaur Kang M.Sc Cardiological / CTVS Nursing Associate Professor
  2. 3. Myocardial Infarction <ul><li>Myocardial Infarction occurs as a result of thrombotic occlusion of the coronary artery and cause irreversible injury and necrosis. </li></ul>
  3. 5. Clinical Manifestations <ul><li>Chest pain </li></ul><ul><li>Severe and prolonged and may be described as crushing, constricting, or oppressive. </li></ul><ul><li>Radiation of pain to ulner aspect of left arm, neck, jaw and Interscapular region. </li></ul>
  4. 6. Clinical Manifestations Contd…. <ul><li>Indigestion </li></ul><ul><li>Nausea </li></ul><ul><li>Vomiting </li></ul><ul><li>Diaphoresis </li></ul><ul><li>Palpitations </li></ul><ul><li>Dyspnea </li></ul>
  5. 7. Nursing Assessment in Emergency Room <ul><li>History Taking. </li></ul><ul><li>Physical Examination </li></ul><ul><li>Vital parameters </li></ul><ul><li>12 lead ECG monitoring. </li></ul><ul><li>Measure oxygen saturation. </li></ul><ul><li>Obtain initial serum cardiac markers. </li></ul>
  6. 9. <ul><li>Inferior wall MI: right coronary artery </li></ul><ul><li>lead II, III & AVF </li></ul><ul><li>Lateral wall MI : Lt circumflex artery </li></ul><ul><li>lead I, AVL, V5 & V6 </li></ul><ul><li>Anterior MI : Lt anterior descending </li></ul><ul><li>lead V1 to V6 </li></ul><ul><li>Posterior Wall MI:Rt coronary artery </li></ul>
  7. 10. Immediate General Management <ul><li>Oxygen at 4 l/min. </li></ul><ul><li>Aspirin 160-325mg. </li></ul><ul><li>Nitroglycerine SL or spray. </li></ul><ul><li>Morphine IV </li></ul><ul><li>Memory Aid: ‘MONA’ </li></ul>
  8. 11. Nursing management Plan <ul><li>Chest discomfort R/T imbalance between myocardial oxygen supply and demand </li></ul>
  9. 12. <ul><li>Goals: </li></ul><ul><li>To detect chest discomfort and associated ECG and hemodynamic changes early. </li></ul><ul><li>To reduce or eliminate chest discomfort </li></ul>
  10. 13. Interventions <ul><li>Assess and document the chest pain. </li></ul><ul><li>Assess vital parameters. </li></ul><ul><li>Obtain 12 lead ECG. </li></ul><ul><li>Assess cardiac marker values. </li></ul><ul><li>Report the findings of assessment to physician. </li></ul>
  11. 14. <ul><li>Administer oxygen, morphine sulfate, nitroglycerine or other medications as ordered. </li></ul><ul><li>Provide the restful environment and promote the patient’s comfort. </li></ul><ul><li>Provide care in calm, competent manner. </li></ul>
  12. 15. <ul><li>Decreased myocardial tissue perfusion R/T an imbalanced oxygen supply and demand. </li></ul>
  13. 16. <ul><li>Assessment </li></ul><ul><li>MONA </li></ul><ul><li>Start two IV lines. </li></ul><ul><li>Early reperfusion: </li></ul>
  14. 17. <ul><li>Administer adjunctive medications: </li></ul><ul><li>Beta blockers. </li></ul><ul><li>Nitroglycerine IV. </li></ul><ul><li>Heparin IV </li></ul>
  15. 18. No Reperfusion Delay NOTE:
  16. 19. 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
  17. 20. <ul><li>Administer thrombolytic therapy as prescribed. </li></ul><ul><li>Streptokinase </li></ul><ul><li>Urokinase </li></ul><ul><li>tPA </li></ul><ul><li>Door to drugs: <30min. </li></ul>
  18. 21. <ul><li>Prepare for Primary PCI as prescribed. </li></ul><ul><li>Door to balloon 90 + 30 min. </li></ul>
  19. 22. <ul><li>Fear/ anxiety related to diagnosis, treatment and prognosis acute MI </li></ul><ul><li>Provide individualized nursing care in calm and competent manner. </li></ul><ul><li>Listen, reflect, guide. </li></ul>
  20. 23. THANKS

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