MYOCARDIAL - MYOCARDIAL INFARCTION Myocardial infarction(MI is caused by marked reduction/loss of blood flow through one or more of the coronary

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MYOCARDIAL INFARCTION Myocardial infarction (MI) is caused by marked reduction/loss of blood flow through one or more of the coronary arteries, resulting in cardiac muscle ischemia and necrosis. CARE SETTING Inpatient acute hospital, step-down, or medical unit. RELATED CONCERNS Angina Dysrhythmias Heart failure: chronic Psychosocial aspects of care Thrombophlebitis: deep vein thrombosis Patient Assessment Database ACTIVITY/REST May report: Weakness, fatigue, loss of sleep Sedentary lifestyle, sporadic exercise schedule May exhibit: Tachycardia, dyspnea with rest/activity CIRCULATION May report: History of previous MI, CAD, HF, hypertension, diabetes mellitus May exhibit: BP may be normal, increased, or decreased; postural changes may be noted from lying to sitting/standing Pulse may be normal, full/bounding, or have a weak/thready quality with delayed capillary refill; irregularities (dysrhythmias) may be present Heart sounds S 3 /S 4 may reflect a pathological condition (e.g., cardiac failure, decreased ventricular contractility or compliance) Murmurs may reflect valvular insufficiency or papillary muscle dysfunction Friction rub (suggests pericarditis) Heart rate regular or irregular; tachycardia/bradycardia may be present Edema: Jugular vein distention, peripheral/dependent edema, generalized edema Color: Pallor or cyanosis/mottling of skin, nailbeds, mucous membranes, and lips may be noted EGO INTEGRITY May report: Denial of significance of symptoms/presence of condition Fear of dying, feelings of impending doom Anger at inconvenience of illness/”unnecessary” hospitalization Worry about family, job, finances May exhibit: Denial, withdrawal, anxiety, lack of eye contact Irritability, anger, combative behavior Focus on self/pain ELIMINATION May exhibit: Normal or decreased bowel sounds FOOD/FLUID May report: Nausea, loss of appetite, belching, indigestion/heartburn May exhibit: Poor skin turgor; dry or diaphoretic skin Vomiting
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HYGIENE May report/exhibit: Difficulty in performing self-care tasks NEUROSENSORY May report: Dizziness, fainting spells in or out of bed (upright or at rest) May exhibit: Changes in mentation Weakness PAIN/DISCOMFORT May report: Sudden onset of chest pain unrelieved by rest or nitroglycerin (although most pain is deep and visceral, 20% of MIs are painless) Location: Typically anterior chest (substernal, precordium); may radiate to arms, jaw, face; may have atypical location such as epigastrium/abdomen; elbow, jaw, back, neck, between shoulder blades, severe sore throat; throat fullness (females) Quality: Crushing, constricting, viselike, squeezing, heavy, steady Intensity: Usually 10 on a scale of 0–10 or “worst pain ever experienced.” Note: Pain is sometimes absent in females, postoperative patients, those with prior stroke or heart failure, diabetes mellitus or hypertension, or the elderly. Studies indicate that up to one-third of persons experiencing MI do not have typical chest pain.
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This note was uploaded on 02/01/2011 for the course PNR 182 taught by Professor Toole during the Spring '10 term at Orangeburg-Calhoun Technical College.

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MYOCARDIAL - MYOCARDIAL INFARCTION Myocardial infarction(MI is caused by marked reduction/loss of blood flow through one or more of the coronary

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