Care for Acute Myocardial Infarction - Nursing Assessment Answer

Subject Name : Nursing

Care for Acute Myocardial Infarction
Acute myocardial Infarction is one of the most severe types of coronary heart disease that is mainly caused due to myocardial necrosis. Myocardial necrosis occurs due to severe and chronic myocardial ischemia due to rapid reduction in the supply of blood within the body. Several clinical manifestations are observed, and they include acute pain behind sternum, progressive changes in ECG, and increase in level of myocardial enzymes, arrhythmias and in severe conditions heart shock or heart failure. It is important that clinical diagnosis through progression in ECG should be done at early stage, along with that vitals of the person should be checked regularly in order to submit the person to proper nursing care and prevent the further progression of the chronic disorder (ACSQHC, 2011).
Osteoarthritis is one of the most common health problems in adults and in older population. Nearly, 1.9 million people across Australia are suffering from the diseases and in broader sense 1 in every 12 people across the country is suffering from the problem of osteoarthritis. Osteoarthritis is rarely symptomatic, and it causes chronic pain and the person loses the ability to move and thus loses his productivity. It is a disorder of synovial joint that occurs in whole joint comprising of bone, cartilage, synovial membrane. This lays impacts on both muscles and ligaments that are surrounding the joint. The damage in cartilage leads to recruitment of immune cells that causes rapid damage in joint. Hypertension is regarded as increase in blood pressure of the patient and it increases the risk of cardio vascular diseases in the patient.
High blood pressure is not life threatening in immediate sense, but it slowly damages the organs of the body due to inadequate supply of blood. The patients having hypertension should be undertaken through risk assessment program that would require medical history of the patient and would check the diabetes and cholesterol status of the person. Patients with increased level of fibrinogen, triglycerides, apolipoprotein B should be regarded at high risk of developing cardio vascular diseases. The patient is suffering from all of the above-mentioned health conditions therefore she requires a systematic nursing care plan for coping with these chronic problems (AIHW, 2011).
Early Assessment
The patient already suffering from hypertension has high risk of developing acute myocardial Infarction.
The patient should immediately receive 12 lead electro cardiogram and the results obtained should be immediately sent to the qualified clinician.
The comment obtained from the clinician should be referred before giving any emergency treatment. This assessment is crucial in early diagnosis and also ensures that the patient receives the correct treatment (Chew et al., 2013).
Prompt Reperfusion
The prompt clinical reperfusion is clinically appropriate for patient with acute segment elevation myocardial Infarction.
The patient should also be given with percutaneous coronary intervention or thrombolysis treatment in appropriate time frame as recommended by the concerned physician. It is done for the patient in whom the type of heart attack has been identified in which the artery responsible for providing blood to the cardiac muscles gets blocked completely.
The clinician later decides what treatment can help the patient to open the artery by looking at the medical history of the patient.
Immediate Management
If acute chest pain is persistent and other symptoms show occurrence of acute coronary syndrome then the patient should be treated with evidence based clinical practice.
The patient should be immediately referred to the emergency department where clinicians are supposed to give treatment
Nursing Practices
Psychological Care

Nursing Role Psychological Care Goal of Care Intervention Rationale
To provide a holistic environment to patient for mental wellness. The nursing staff should accompany the patient as long as the patient has severe chest pain and also allows the patient with space so that she can express her feelings.
The nursing staff should also be responsible for introducing the patient with general environment of the ward and the role of nurses working in it.
In case of acute myocardial infraction the cardiac load increases if the patient is not mentally stable. The nursing staff should tell the patient that any mental stress would increase myocardial oxygen consumption which will complicate her health condition therefore the patient should remain stress free.
The nursing staff can use the sedatives that are prescribed by the clinicians in order to make the patient rest (DE BLESER et al., 2006). This helps in checking the behaviour of the patient like irritability and moaning.
. It helps the patient to feel confident and it also makes her realize that good care will be taken of her.
It should be kept in mind that the patient should not be provided with information of her critical condition and should continuously be motivated that she will become healthy sooner.
Diet Management

Nursing Role Diet Management Goal Of Care Intervention Rationale
To ensure that the patient develops no digestive disorder like bloating and blenching. The patient is kept on complete bed rest with no physical activities. Due to this it is possible that the patient would develop digestive disorder involving bloating or belching.
If the patient is bed ridden then she can also develop secret knot but it happens only in old patients.
Patient should be provided with light, low cholesterol, low fat, easily digestible, semi liquid diet that is rich in vitamins. The diet of the patient is needed to be kept specific in order to prevent her from developing such disorder.
The meals should not be heavy and in case if the patient feels hungry she should be provided with multiple meals in small portions. The salt intake should also be administered as per the level determined by the clinician.
Care for Urine and Excrement
Nursing Role Urine and Excrement Care Nursing Goal Intervention Rationale
To prevent the patient from developing digestive disorders and prevent the patient from force excretion. During the acute phase of myocardial infraction the person becomes bed ridden therefore special care should be given to urine and excrement, and it should not be compromised or obstructed. It is important in preventing the patient from developing digestive disorders like bloating and belching.
. In order to ease the constipation they can be given with luke warm honey water in the morning for maintaining the bowel movements. Adult patients are not habitual of defecating in bed therefore they find it difficult to do in bed. If the piss and excrement is not done properly or adequately then there are chances that patient would increase the stress on heart.
Osteoarthritis Care
Nursing Role Osteoarthritis Care Nursing Goal Intervention Rationale
To prevent the development of pain in joints due to osteoarthritis. It can cause persistent irritability that would increase load on the heart. To such patients, physiotherapy cannot be suggested because all the physical activities are restricted and controlled to conserve myocardial oxygen.
In this condition pain management therapy is done where the pain is treated by giving pain medications as suggested by the concerned physician to the patient.( Lorig, Ket al. 2006) Hypertension Care
Nursing Role Hypertension Care Nursing Goal Intervention Rationale
To regulate the blood pressure of the patient. To subject the patient to therapy like thrombolytic therapy it is important to control the blood pressure of the patient through anti hypersensitive medication. If the blood pressure is monitored then there are chances that the blood glucose level will remain in homeostasis as in case of bleeding the rise in blood glucose level would make the situation more complex.
Thrombolytic Care
Nursing Role Thrombolytic Care Nursing Goal Intervention Rationale
To ensure that the patient has proper vitals for thrombolysis treatment. The nursing staff should cooperate with the concerned clinician to subject the patient to either 18 lead or 12 lead electro cardiogram before doing thrombolysis therapy.
Liver function test and kidney function test are also to be performed the level of blood platelets is also checked.
The nursing staff should thoroughly go to the drug prescription and infuse the thrombolytic drugs. Special attention is to be given to the speed of infusion, observe and record the temperature.
The change in pulse, respiration and blood pressure of the patient should also be recorded during the course of treatment.
The degree of reduction in chest pain and patients remission time is also to be recorded. Changes in electro cardiogram and time of arrhythmias should be recorded as well.
During the treatment bleeding takes place and therefore haemoglobin level of the person should be checked so that if heavy bleeding happens the condition can be monitored easily. On the day of thrombolysis treatment, after the treatment process is over the electro cardiogram of the patient is to be done at every half an hour (Lorig amp Fries, 2009). This is done to monitor the progression changes in electro cardiogram, blood oxygen saturation, blood pressure.
In case of patients suffering with hypertension or hypotension special attention is to be given to this protocol.
. From the day of thrombolysis treatment the electro cardiogram should be done consecutively for 3 days. After the thrombolytic treatment the kidney function test, liver function test, urine, clotting time test is to be done routinely till the condition of the patient gets stable.
Post Treatment Care
Rehabilitation
The patient has no extended family and her apartment is one the third floor therefore it is important to make proper rehabilitation management program in order to speed up the physical as well as psychological recovery process. There are chances that the patient can develop acute myocardial Infarction for the second time due to improper recovery (Fronteraet. Al, 2018). The rehabilitation program ensures that the patient goes into a safe environment that is monitored professionally to take care of health needs of the patient. Formal rehabilitation aids the person to get back to her normal life slowly and gradually.
For instance, if a person goes to her apartment immediately after the discharge then she gets forced to perform her daily activities and therefore the patient doesnt get enough time to make physical and psychological recovery. Rehabilitation program also helps the patient to understand the diet routines that they have to follow once they get recovered properly. In a hospital setting even though they are provided with the controlled diet plan, it is difficult for them to understand it because of the acute pain in chest and other problems associated with it (OSullivan, Schmitz amp Fulk, 2019)
Physical Activity
The patient suffering from hypertension, osteoarthritis and cardio vascular disease should go through moderate level of physical training regularly (Dishman, 2018). The nursing staff should aid the patient in monitoring their vitals while doing physical exercises and make sure that the level of exercise should not bring imbalance to their vitals. Rigorous exercise can lead to loss of breath, increase in pulse and high blood pressure. The nursing staff should refer the patient to physiotherapy where they can be assisted with professional help and can work out to maintain their health conditions. (Thomas, 2018)
Diet and Weight Management
Rise in cholesterol and body fat level is one of the major causes of cardio vascular diseases. In order to reduce the risk of getting a second attack of acute myocardial Infarction the patient should monitor their weight through diet. The portions of the meals should be small and multiple meals should be taken at short intervals (Bray amp Siri-Tarino, 2016)
References
ACSQHC. (2011).National safety and quality health service standards(pp. 1-80). Sydney Australian Commission on Safety and Quality in Health Care.
AIHW. (2011).Monitoring acute coronary syndrome using national hospital data. Canberra Australian Institute of Health and Welfare.
Chew, D., French, J., Briffa, T., Hammett, C., Ellis, C., amp Ranasinghe, I. et al. (2013). Acute coronary syndrome care across Australia and New Zealand the SNAPSHOT ACS study.The Medical Journal Of Australia,199(3), 185-191. doi 10.5694/mja12.11854
DE BLESER, L., DEPREITERE, R., WAELE, K., VANHAECHT, K., VLAYEN, J., amp SERMEUS, W. (2006). Defining pathways.Journal Of Nursing Management,14(7), 553-563. doi 10.1111/j.1365-2934.2006.00702.x
Bray, G. A., amp Siri-Tarino, P. W. (2016). The role of macronutrient content in the diet for weight management.Endocrinology and Metabolism Clinics,45(3), 581-604.
Dishman, R. K., Heath, G. W., amp Lee, I. M. (2018).Physical activity epidemiology. Human Kinetics.
Frontera, W. R., Silver, J. K., amp Rizzo, T. D. (2018).Essentials of physical medicine and rehabilitation musculoskeletal disorders, pain, and rehabilitation. Elsevier Health Sciences.
Lorig, K., amp Fries, J. (2009).The arthritis helpbook. Cambridge, Mass. Da Capo Lifelong.
Thomas, J. R., Nelson, J. K., amp Silverman, S. J. (2018).Research methods in physical activity. Human kinetics.
OSullivan, S. B., Schmitz, T. J., amp Fulk, G. (2019).Physical rehabilitation. FA Davis.