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NURSING ASSESSMENTSub sternal chest pain/pressure radiating to the left arm.Pain or discomfort in jaw, back or shoulder, or abdomenOccurring without cause, usually in the morning Relieved only by opioidsLasting 30 min or moreFrequent associated symptoms:nausea/vomitingDiaphoresisDyspneaFeeling of fear or anxietyDysrhythmiasFatiguePalpitationsEpigastric distressAnxietyDizzinessDisorientation/acute confusionFeeling “short of breath” DIAGNOSTICSTroponins T and I, creatine kinase-MB (CK-MB), and myoglobin. ECG’s, Thallium scans, contrast-enhanced cardiovascular magnetic resonance. Cardiac catherization, MANAGEMENTOxygen, vital signs, ensure an IV access, morphine sulfate, nitroglycerin, aspirin,antiplatelet drugs, MONA-morphine,oxygen,nitrogen, aspirin, Glycoproteinf (GP) inhibitors, Beta-blockers,angiotension coveritng enzyme inhibitors or angiotensin receptor blockers, calcium channel blockers, thrombolytic therapy, primary percutaneous transluminal coronary angioplasty, increasing activity tolerance, cardiac rehabilitation, teach effective coping mechanisms, decrease cardiac ouput , ETIOLOGYDecreased oxygenation to myocardial tissue.Approximately 50% of all myocardial infarctions in the United States occur in people younger than 65 yearsNursing DX #2 Decreased tissue perfusion related to decreased cardiac output as evidence chest pain, change in v/s, dyspnea, dysrhythmiasIdentify 5 or more Nursing Interventions: assess oxygenation, assess v/s, review laboratory data, monitor effectiveness of medications, monitor cardiac rhythmNursing DX #3 Acute Pain related to poor tissue perfusion as evidence by chest pain, dyspnea, palpitations.Identify 5 or more Nursing Interventions: assess s/s pain, administer pain medication, assess for pain relief, assess v/s, assess oxygenation, PathophysiologyPresence of Risk FactorsCoronary atherosclerosis, coronary embolismMyocardial ischemia Myocardial cell damageCatecholamine's release(Increase Heart rate, increase pain)Chest Pain Nursing DX #4 Activity intolerance related to decreased oxygenation as evidenced by fatigue and dyspnea Identify 5 or more Nursing Interventions: Identify precipitating factors, provide supplemental oxygen, note clients reports of weakness, fatigue, provide rest periods, monitor v/sNursing DX #5 Risk for Electrolyte imbalance related to pharmacological interventions as evidence by dysrhythmias, and palpitations.