Nursing Care of Patient with Myocardial Infarction

P. Revathy1,*, T. Jasmine Rajareegam Princely2, Mohanavalli3

1Emergency Ward Incharge, Kauvery Heartcity, Trichy, India

2Non Critical Ward Incharge, Kauvery Heartcity, Trichy, India

3Senior Staff Nurse, Kauvery Heartcity, Trichy, India.

*Correspondence: Tel No: +91 8508698000; nursing.heartcity@kauveryhospital.com

Background:

A 35-year-old male, with no history of Diabetes or Hypertenstion, came with complaints of chest pain since 12.30 pm.

On examination he was found conscious, oriented and irritable. He was hypotensive

ECG: Extensive Anterior Wall ST Elevation Infarction (STEMI)
Nursing-Care-of-Patient-with-Myocardial-Infarction-1

Lab Report: Total Cholesterol /HDL was abnormal

ECHO:

Nursing-Care-of-Patient-with-Myocardial-Infarction-2

Diagnosis: Coronary Artery Disease – Single Vessel Disease – Recanalyzed LAD.

Immediate care:

  1. After receiving the patient, we stabilized him with loading doses of Tab. Clopidogrel 300 mg, Tab. Ecosporin 325 mg, Tab. Atorvastatin 40 mg.
  2. As preventive measure Inj. Pantocid 40 mg IV stat and Inj. Emeset 4 mg IV stat was administered.
  3. Vital signs were assessed and pain score was found to be: 8/10, BP:80/?.2
  4. Immediately started IV Fluids and Inj. Noradrenaline infusion according to patient’s blood pressure.
  5. Duty doctor’s explained the condition of the patient to the attenders.
  6. A high-risk consent was obtained.
  7. Patient was taken up for Thrombolysis Inj. Streptokinase, 15 lakhs IV over 1hr was given because patient’s attenders were not willing for Primary PTCA.
  8. Patient was under continuous monitoring.
  9. No evidence of any active bleeding was found and patient was on observation for 2hrs in causality.
  10. Patient was shifted to CCU 1 for further management.

Nursing Management

  1. Patient was shifted to Critical Care Unit 1 with a duty doctor and continuous cardiac monitoring.
  2. Nurses maintained an every 15mits B.P chart. BP was stabilized with Inotropes and IV fluids.
  3. Nurses skilled in IV infusion and blood sampling techniques (Phlebotomy) obtained the samples for blood investigations like CBC, ESR, Sodium, Potassium, RFT, Blood grouping, Typing, Serology etc., with a sterile technique to prevent thrombophlebitis.
  4. Doctors explained the patient’s condition to the attenders. Nurses obtained consent for the clinical procedures after proper counseling.
  5. Nurses used AIDET technique (Acknowledge, Introduce, Duration, Explanation and Thank you) while communicating with patient and attenders to gain their confidence and improve the satisfaction level.
  6. Patient taken for Coronary Angiogram on (10.08.2022)
  7. The Coronary Angiogram report indicated: Left main coronary artery-Normal. Left Anterior Descending artery-Type -3 , proximal LAD has ectatic slow flow, terminal LAD has thrombotic occlusion.  Recanalyzed LAD.

Recommendation & Plan: Optimal medical treatment

  1. Patient was stabilized and shifted to ward on 11.08.2022 & drug orders followed as per doctor’s advice.
  2. Patient discharged on 12.08.2022.
  3. Discharged advised:
  4. Diet advice
  5. Medication advice
  6. Daily activity advice
  7. Review after 2 weeks

Outcome

On discharge patient was hemodynamically stable

Discussion

The patient received the most appropriate care for his symptomatic acute anterior wall myocardial infarction and got discharged by 12.08.2022.
P.-Revathy<

P. Revathy,

Emergency Ward Incharge

Jasmine-Rajareegam-Princely

Jasmine Rajareegam Princely,

Non Critical Ward Incharge

Mohanavalli

Mohanavalli

Senior Staff Nurse

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