Myocardial Infarction Nursing Diagnosis

Early recognition and prompt action are critical in myocardial infarction. Here are the key assessment cues and priority nursing actions for a patient with an acute MI:

  • Key Signs of MI: Intense, persistent chest pain or pressure (often radiating to the left arm or jaw) that is not relieved by rest; shortness of breath; profuse sweating; and nausea/vomiting. On an ECG, ST segment changes (elevation or depression) indicate ischemia or infarction.

  • Immediate Priorities: Give aspirin immediately, provide oxygen if needed, administer nitroglycerin (if BP allows) and morphine for pain, obtain a 12-lead ECG, and prepare for reperfusion therapy (thrombolytics or urgent angioplasty) as directed.

By focusing on these essentials, the nurse stabilizes the patient and lays the groundwork for further treatment.

Nursing Care Plan #1: Acute Pain

Nursing Diagnosis: Acute Pain related to decreased myocardial oxygen supply (ischemia) as evidenced by patient’s report of severe chest pain and guarded behavior.

Related Factors: Reduced coronary blood flow due to a blocked artery.

Nursing Interventions and Rationales:

  1. Administer pain relief promptly: Give nitroglycerin (sublingual or IV) and administer morphine IV if pain persists (monitor blood pressure closely). Also provide oxygen therapy if needed.
    Rationale: Relieving pain is priority – nitroglycerin dilates coronary arteries to improve blood flow, and morphine alleviates pain and anxiety, which in turn reduces the heart’s oxygen demand. Oxygen, if the patient is hypoxic, increases supply to the myocardium.

  2. Encourage rest and minimal stimulation: Have the patient stop all activity and rest in a semi-Fowler’s position. Keep the environment quiet and stay with the patient during acute pain episodes.
    Rationale: Rest and a calm environment decrease the heart’s workload. Simply being present provides reassurance and may decrease the release of stress hormones that can worsen pain.

Desired Outcome: The patient will report pain relief (chest pain rating 0/10 or a tolerable level) after interventions, with stable vital signs and reduced anxiety.

Nursing Care Plan #2: Decreased Cardiac Output

Nursing Diagnosis: Decreased Cardiac Output related to impaired cardiac muscle function secondary to MI, as evidenced by hypotension, weak peripheral pulses, and reduced urine output.

Related Factors: Necrosis of heart muscle leading to weakened pumping ability and possible arrhythmias.

Nursing Interventions and Rationales:

  1. Frequent vital signs and rhythm monitoring: Check blood pressure, heart rate, and cardiac rhythm frequently. Watch for any arrhythmias on the cardiac monitor. Also track intake/output (monitor urine output).
    Rationale: Hypotension, tachycardia, or new dysrhythmias can signal that cardiac output is worsening. Urine output is a quick indicator of organ perfusion – if the heart isn’t pumping well, kidneys will produce less urine (<30 mL/hr).

  2. Position patient flat or in semi-Fowler’s depending on BP, and maintain rest: If blood pressure is low, keep patient flat with legs elevated slightly; if BP is stable, semi-Fowler’s (head elevated) can be used for breathing comfort. Strict bed rest initially.
    Rationale: Positioning can improve venous return or reduce workload on the heart as needed. Limiting activity prevents strain on the damaged heart, conserving energy for healing.

  3. Administer medications as prescribed to support cardiac output: This may include inotropes (to increase contractility) or vasopressors if blood pressure is very low.
    Rationale: Inotropic drugs strengthen heart contractions to improve circulation, and vasopressors raise blood pressure to perfuse vital organs. These interventions help stabilize circulation in the acute phase.

Desired Outcome: The patient maintains adequate perfusion as evidenced by blood pressure within acceptable range (e.g., systolic >90 mmHg), alert mental status, and urine output at least 30 mL/hr. Peripheral pulses remain palpable and strong.

Nursing Care Plan #3: Risk for Ineffective Tissue Perfusion (Cardiac)

Nursing Diagnosis: Risk for Ineffective Tissue Perfusion (Cardiac) related to interruption of coronary blood flow secondary to a thrombus.

Risk Factors: Complete or partial occlusion of a coronary artery; potential re-occlusion or extension of the clot; hypotension or bradycardia that could further reduce heart perfusion.

Nursing Interventions and Rationales:

  1. Monitor cardiac status continuously: Keep the patient on a cardiac monitor to detect dysrhythmias; obtain serial ECGs and lab tests (troponins) as ordered.
    Rationale: Monitoring allows early detection of signs that perfusion is worsening, such as ST changes on ECG or arrhythmias. Prompt detection means rapid intervention (e.g., preparing for revascularization procedures) to restore perfusion.

  2. Maintain IV access and administer prophylactic treatments per orders: This includes anticoagulants (like heparin infusions) or antiplatelet agents to prevent clot expansion.
    Rationale: Anticoagulant and antiplatelet medications help keep the coronary artery from getting more occluded and reduce the risk of new clots. Preventing the existing clot from growing and avoiding new clots protects myocardial perfusion.

Desired Outcome: The patient will remain free of signs of worsened cardiac ischemia: no recurrent chest pain, no new significant ECG changes, and stable cardiac enzyme trends. By discharge, the risk for further perfusion problems is reduced (clot stabilized or removed via intervention).

FAQ

Q1: What are the top priorities in the first hour of an MI?
A: Call for help (activate your emergency response), have the patient chew an aspirin immediately, put them on the cardiac monitor and obtain an ECG, give oxygen if needed, administer nitroglycerin (if BP allows) and morphine for pain. Essentially, think “MONA” (Morphine, Oxygen, Nitro, Aspirin – with aspirin first). Also be ready to assist with reperfusion decisions (thrombolytic drugs or urgent angioplasty in the cath lab). Making sure IV access is in place and labs (troponin) are drawn is part of this critical first-hour care.

Q2: After an acute MI, what patient education should nurses emphasize?
A: Important teaching points include: take medications exactly as prescribed (to prevent another heart attack), gradually increase activity (enroll in cardiac rehab and follow exercise advice), eat a heart-healthy diet (low sodium, low saturated fat) and quit smoking. Also, ensure the patient knows the warning signs (chest pain, shortness of breath, unusual fatigue) that warrant calling 911. This education helps the patient recover safely and confidently.

Internal Links (Anchor Text Suggestions)

  • Coronary Artery Disease Nursing Care Plan

  • Chest Pain Assessment and Management

  • Decreased Cardiac Output Nursing Diagnosis

  • Ineffective Tissue Perfusion related to Cardiac Issues

Peer-Reviewed References

  1. Carpenito, L. J. (2022). Handbook of Nursing Diagnosis (16th ed.). Wolters Kluwer.

  2. Lewis, S. L., Bucher, L., Heitkemper, M. M., & Harding, M. M. (2022). Medical-Surgical Nursing: Assessment and Management of Clinical Problems (11th ed.). Elsevier.

  3. Hinkle, J. L., & Cheever, K. H. (2022). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (15th ed.). Lippincott Williams & Wilkins.

  4. Herdman, T. H., & Kamitsuru, S. (Eds.). (2021). NANDA International Nursing Diagnoses: Definitions and Classification, 2021–2023. Thieme.

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