Myocardial Infarction (MI) (USLOs 1, 2, 3, 4)
Myocardial Infarction (MI) (USLOs 1, 2, 3, 4)
You are the nurse caring for 48-year-old Leslie Collins, a retired army officer for the United States military, He arrives at the emergency department after experiencing chest pain and shortness of breath. His EKG indicated he had a myocardial infarction (MI). He has a history of hypertension and high cholesterol. He states he used to smoke about 15 years ago, he has no other reported risk factors.
Based on this information, your prior knowledge of this client (refer to medical card from the Collins-Kim family tree interactive), and your knowledge of the pathophysiology of myocardial infarction (MI), respond to the following prompts:
Thoroughly explain the pathophysiology of myocardial infarction (MI). Use a scholarly or authoritative source to support your answer.
Examine each of the following three factors related to this disease process. Support all three with a scholarly source.
cultural
financial
environmental implications
Identify 3-5 priority nursing interventions for the client in the emergency department.
Describe labs and diagnostic testing you would want to include in the client’s plan of care and why. What are critical indicators? Support with a scholarly source.
What interdisciplinary team members need to be included for holistic patient-centered care? Provide a rationale and support with a scholarly source.
5 hours ago
Sample Solution
Pathophysiology of Myocardial Infarction (MI)
Myocardial infarction (MI), or heart attack, occurs when the blood supply to a portion of the heart muscle is interrupted, often due to a blockage in a coronary artery. This blockage prevents oxygen and nutrients from reaching the heart tissue, leading to cellular death.
Pathophysiological process:
- Atherosclerosis: Over time, cholesterol and other substances can build up in the coronary arteries, forming plaques.
- Plaque Rupture: These plaques can rupture, triggering blood clot formation.
- Thrombosis: The blood clot can block the coronary artery, preventing blood flow to the heart muscle.
- Ischemia: The lack of blood flow leads to ischemia, or oxygen deprivation, of the heart tissue.
- Necrosis: If the blockage is not resolved quickly, the affected heart tissue can die (necrosis).
Source: National Institutes of Health, National Heart, Lung, and Blood Institute. (2020). Heart Attack. https://www.nhlbi.nih.gov/resources/learn-what-heart-attack-feels-fact-sheet
Factors Related to Myocardial Infarction
Cultural Implications
- Cultural beliefs and practices: Different cultures may have varying beliefs about heart disease and its causes, which can influence health-seeking behaviors.
- Access to healthcare: Cultural factors can impact access to healthcare, including preventive care and emergency services.
- Dietary habits and lifestyle: Cultural influences on diet and lifestyle can increase or decrease the risk of heart disease.
Source: Centers for Disease Control and Prevention. (2023). Heart Disease.
Full Answer Section
Financial Implications
- Healthcare costs: MI can lead to significant financial burdens due to hospitalization, medications, and long-term care.
- Lost income: MI may result in time off work, which can impact earnings and financial stability.
- Insurance coverage: The availability and coverage of health insurance can influence access to care and treatment outcomes.
Source: American Heart Association. (2023). Heart Attack. https://www.heart.org/en/health-topics/heart-attack/understand-your-risks-to-prevent-a-heart-attack
Environmental Implications
- Exposure to pollutants: Exposure to air pollution, secondhand smoke, and other environmental toxins can increase the risk of heart disease.
- Stress and social factors: Environmental factors such as stress, social isolation, and limited access to healthy food can contribute to heart disease.
Source: World Health Organization. (2019). Cardiovascular Diseases. https://www.who.int/health-topics/cardiovascular-diseases
Priority Nursing Interventions in the Emergency Department
- Monitor vital signs: Continuously monitor heart rate, blood pressure, oxygen saturation, and respiratory rate.
- Administer medications: As ordered by the physician, administer medications such as aspirin, nitroglycerin, and beta-blockers to improve blood flow and reduce heart workload.
- Prepare for diagnostic testing: Assist with preparing the patient for diagnostic tests such as electrocardiogram (ECG), echocardiogram, and cardiac markers.
- Provide emotional support: Offer emotional support and reassurance to the patient and their family.
- Manage pain: Assess pain and administer analgesics as needed.
Labs and Diagnostic Testing
- ECG: To identify the location and extent of the MI.
- Cardiac markers: Troponin, CK-MB, and myoglobin levels to confirm a diagnosis of MI.
- Echocardiogram: To assess heart function and identify any structural abnormalities.
- Complete blood count (CBC): To evaluate blood cell counts and identify any underlying conditions.
- Basic metabolic panel (BMP): To assess kidney function and electrolyte balance.
Critical indicators:
- Decreasing blood pressure: Indicates worsening cardiac function or shock.
- Increasing heart rate: May indicate heart failure or other complications.
- Decreasing oxygen saturation: Suggests respiratory distress or inadequate oxygen delivery to the heart.
- Abnormal cardiac markers: Elevated levels of troponin, CK-MB, and myoglobin are indicative of MI.
Source: American College of Cardiology. (2023). Heart Attack. https://www.cdc.gov/heart-disease/about/heart-attack.html
Interdisciplinary Team Members
- Cardiologist: To provide specialized medical management and treatment.
- Cardiac surgeon: If surgical intervention is necessary, such as angioplasty or bypass surgery.
- Respiratory therapist: To manage respiratory symptoms and assist with oxygen therapy.
- Registered dietitian: To provide nutritional guidance and support.
- Social worker: To address social and emotional needs and assist with discharge planning.
- Physical therapist: To help with rehabilitation and improve functional capacity.
Source: American Heart Association. (2023). Heart Attack Treatment. https://www.heart.org/en/health-topics/heart-attack