[SOLVED] Analyzing Nursing Care Plans for Myocardial Infarction

This assignment involves analyzing nursing care plans for myocardial infarction (heart attack) by examining research articles and online resources. The goal is to provide a comprehensive understanding of best practices for patient care in this context, including triage, emergency department management, and post-acute care considerations.

NURSING

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................3
TASK 1............................................................................................................................................3
TASK 2............................................................................................................................................6
TASK 3............................................................................................................................................7
TASK 4............................................................................................................................................8
TASK 5............................................................................................................................................8
CONCLUSION................................................................................................................................8
REFERENCES..............................................................................................................................10

INTRODUCTION
Nursing is a professional field in which learning person explored dins, caring and wellbeing
of patients and glossary of medicine. Nurses are the individual in hospital setting responsible for
managing holistic care needs to different patients with reference to health code of conduct and
ethics. The study will outline care plan, nursing assessments, 3 priority nursing diagnosis, and
team care of 77-year-old woman who have been admitted in Acute Myocardial Infraction.
TASK 1
Myocardial Infraction is heart attack which happens due to lack of blood flow through
coronary arteries. Miss Violet Paterson is 77-year-old woman presented in ward complaining for
Acute Myocardial infraction. With assessment it is determined that she has history of long-
standing osteoarthritis and primary hypertension. With the diagnoses it is identified that her
arthritic pain has increased since year and this pain and blood pressure is impacting her daily
living activities. Deriving appropriate care plan for service user is necessary for manage safe
care considering holistic need of Miss Violet Paterson. Holistic care plan for old woman is
presented below:
Nursing care plan
Assessment
Subjective data:
 Chest Squeezing\ pressure
 Chest pain
 Shortness of breath of old woman
 Pain assessment PQRST, where precipitating, palliating and provoking will be prior
focus. Further quality, radiate, symptoms and time will be another measure which will be
focused on the basis of history and present condition of service user.
 Further, it is important for the nurse to focus on anxiety because Miss Violet Paterson
will be vulnerable and anxious because she lives alone and history primary hypertension
and blood pressure.
Objective data:
 Decrease in oxygenation
 Elevated cardiac enzymes

 Further, seeing risks of Bradycardia when Miss Violet Paterson is in stable condition.
 ST elevation on ECG which is known as STEMI (Ibanez, Borja and et.al., 2017)
Diagnosis
 Acute pain related to osteoarthritis and ischemia tissue.
 Activity intolerance related to imbalance of myocardial oxygen, effect of cardiac
depressants or due to presence of ischemic tissue (7 Myocardial Infarction (Heart Attack)
Nursing Care Plan, 2019).
 Anxiety or fear due to threat of change in socio economic status or loss.
 Risk of decrease in cardiac output due to change in heart rate or rhythm, increased SVR.
 In effective tissue prefusion due to interruption in blood flow (Bonaca and et.al., 2015).
 Excess fluid volume due to decrease in organ perfusion, increase in water or sodium and
due to increase in hydrostatic pressure.
Inference
 Hypertension which can lead to high blood pressure. This can lead to pressure on arteries
carrying blood to heart and other tissues of body.
 Also, high blood pressure to service user can lead to emotion imbalance and anxiety
which an interrupt treatment.
 Acute pain due to osteoarthritis will also focused by nurse for managing holistic care plan
for Miss Violet Paterson
Planning
 Nurse will put 8 hours intervention focus on service user with the motive of
communicating with patient over knowledge of disease and treatment regimen.
 Nurse will aim at facial grimacing and record of change in pulses
 Health care workers will further focus on general weakness and alternations in heart rate.
Intervention
 Obtaining full description of pain from location to intensity with the help of scale which
helps in analysing pain from 0 to 10
 Documentation of heart rhythm and rate and change in blood pressure, after and before
any activity. In this nurse will correlate repots with chest pain.
 Acknowledging and identifying perception of Miss Violet Paterson over the situation like
sadness, fear, grief, etc.

 Encouraging Miss Violet Paterson to share questions and concerns.
 Auscultating BP and quality of pulses.
 Nurse will monitor respiration and will maintain note for breathing patterns.
 Maintaining intake of fluid as per cardiovascular tolerance.
 Monitoring of cardiac enzymes
Rationale
 Pain is count under subjective experience of patient and therefore nurse ill discuss will be
able to describe intensity of pain with the help of pain assessment scale.
 Documentation of heart rhythm and rate trends will help nurse in deriving response of
patient to activity and myocardial oxygen.
 Patient perception over health outcome and feeling is important to understand by nurse
because it helps in outlining coping of patient with trauma and pain. This helps in
meeting holistic care needs of service user which helps in managing improvement in
health outcome.
 Encouraging question with Miss Violet Paterson will helps nurse in managing
communication and relieving tension of unexpressed worries like she lives alone which
could be reason of her emotional imbalance and hypertension.
 Auscultating BP is done with the motive of managing pain and anxiety of service user
which can lead to hypertension.
 Monitoring respiration is necessary because it helps nurse in managing risk of cardiac
pump failure.
Evaluation
 Verbalize relief
 Reduce tension
 Progressive increase in tolerance of patient towards different activity
 Identification of contributing factors
 Reduction in fear and anxiety
 Normalize range of cardiac output

TASK 2
Prioritizing nursing assessment is the crucial part of care plan because in this service
provider aim at focusing on specific medical condition of patient on the basis of present and pat
medical condition. In accordance with plan 3 nursing assessment which are priority for holistic
nursing care plan of Miss Violet Paterson are as follows:
1. Shortness of breath: This is related to heart rate and rhythm and therefore it is important
for the nurse to determine patient response to treatment and medication. This will be
nursing assessment priority because it will help in focusing on oxygen deprivation which
can decrease human activity. Further, it is related to activity in tolerance and therefore
helps in deriving use of supplement oxygen and changes in medical regimen and use of
supplement oxygen (Steinman and et.al., 2017). In addition, this assessment will also
help health care provider in administering supplement oxygen which is done with the
motive of reducing ischemia and cellular irritation. Thus, this is nursing assessment
priority because it will help health practitioner in managing oxygen consumption.
2. Anxiety: It is an unusual feel of discomfort to patient in which service user experiences
threat of changing in social economic status and changes in health condition which can be
disastrous (Sanders and DeVon, 2016). It is nursing assessment priority because in case
patient is old woman who lives alone and has prehistory of hypertension and arthritic
pain therefore it is important for health care workers to understand perception of Miss
Violet Paterson by regular communicating with her over her health outcomes and
medication. Communicating with patient about individual fearful attitude, expression,
increase tension, restlessness is the basic practice of holistic nursing care which help
acknowledging patient perception and managing symptoms of depression, hypertension
and high blood pressure.
3. Elevated cardiac enzymes: Monitoring cardiac enzymes is another priority nursing
assessment which will be focused in case of old woman presented in ward complaining
for Myocardial infraction. This will be focused on Troponin | Creatine Kinase-MB. The
enzyme helps in deriving interaction of actin and myosin in cardiac muscle (Li and et.al.,
2016). This assessment in focused critically because when necrosis of myocyte occurs,
content of cells is released into blood stream which ensure continuous flow of

oxygenated blood to heart muscles. Troponin become elevated in 2 to 4 hours after
ischemic cardiac and stays up for 14 days.
TASK 3
Nursing diagnosis are essential to e focused on as it helps in deriving critical area of focus
by health care worker to manage holistic care plan. In accordance with case and nursing case
plan 3 priory nursing diagnosis which needs to focused are as follow:
1. Acute pain related to ischemia tissue
It is related to emotional experience and unpleasant sensory to patient due to tissue damage. It is
necessary for the nurse to focus on this pain diagnosis because it goes slow to high intensity
which can lead to severe medical condition (Ryan and et.al., 2016). This can be recognised by
nurse through reports of chest pain, changes in blood pressure and pulses, restlessness, changing
level of consciousness and facial grimacing. This is nursing priority because this can lead to
increase in myocardial damage due to ventricular insufficiency.
2. Activity intolerance related to imbalance of myocardial oxygen
This is second nursing diagnosis priority which is evidenced by alternation in heart rate,
changes in skin colour, weakness, increase in blood pressure and development of dysrhythmias
(7 Myocardial Infarction (Heart Attack) Nursing Care Plan, 2019). This needs to focused by
health workers because aim at progression in activity and control on heart, reduction in
myocardial workload and risk of angina. Further, it is important to prioritize imbalance of
oxygen because risk of this condition for service user can be controlled by instructing patient to
avoid abdominal pressure (Carey, 2016). In addition, the diagnosis helps the nurse in focusing on
correlation of reports of shortness of breath and chest pain which can helps in establishing
control over pain assessment and determine use of supplement oxygen.
3. Risk of decrease in cardiac output
This is a risk for inadequate pumping of blood by heart to manage metabolic demand of body.
Decreased output is risky condition for Miss Violet Paterson as it can lead to infarcted muscle
like septal defects which can be life threatening at age of 77. This is another priority nursing
diagnosis as it related to historic medical condition of patient which is hypertension which is
related to pain, anxiety and pre-existing vascular problems (Tourangeau and et.al., 2016). Also, it
is important for the nurse to focus on cardiac output because decrease in output can cause
thready pulses.

TASK 4
Sharing specific knowledge with Miss Violet Paterson will be beneficial to helps old woman
ins managing condition post discharge. Nurse will educate her about community care nurse who
can assist her fulltime with social inclusion and therapies to minimize risk of angina, high blood
pressure, hypertension and pain due to long-standing osteoarthritis. In accordance with condition
of patient it be suggested that it is important for the lady to stay at ground floor or hire fulltime
maid who can help her with management cat, medicine and daily activities (Aeyels and et.al.,
2018). Also, nurse will educate her about her medication and appropriate time about medicines
and with the risk of avoiding medication. Further, nurse will share information over realistic
goals which can help her reducing risk of cardiac output like intake of proper diet. Lastly, nurse
will educate old lady about measures to prevent reinfarction which comprise intake of aspirin
regularly, cholesterol lowering drugs, lifestyle modifications which includes diet, weight and
exercise.
TASK 5
Allied Health team members are the number of professional individuals involve in patient to
management improvement in health outcome. This is the group professional people focused on
incorporating individual knowledge for managing improvement in health condition of one
patient (O'Keefe-McCarthy and et.al., 2018). The group of individuals comprise, audiologists,
chiropractors, occupational therapists, dietitians, exercise physiologists, orthoptists, orthotists
and prosthetists, osteopaths, podiatrists, psychologists, sonographers, social workers, hospital
pharmacists, etc.
Multidisciplinary team for Miss Violet Paterson care comprises cardiologist, and physician
assistants, nurse practitioners, Electro cardiographer, Pharmacists and orthoptists (Gallaghe and
et.al., 2018). However, at the time of discharge Allied Health team members for patient comprise
cardiologist, and physician assistants, care workers and receptionist hospital care setting. This
individual plays a crucial role in managing care of patient in health care setting till discharge
(Levett – Jones, 2018).
CONCLUSION
The report summarized nursing care plan of 77-year-old woman who have been presented in
hospital for myocardial infraction. It outlined nursing plan which comprise subjective and
objective data on the basis of medical condition of patients and assessment and diagnosis which

need to be focused by nurse for managing holistic care. Further, it specified three priority
nursing assessment and diagnosis which will be specifically focused by nurse to manage acute
care of Miss Violet Paterson. Thus, it concluded with allied team members involved in patient
care and discharge of Miss Violet Paterson.

REFERENCES
Books and Journals
Aeyels, D and et.al., 2018. Better hospital context increases success of care pathway
implementation on achieving greater teamwork: a multicenter study on STEMI
care. International Journal for Quality in Health Care. DOI:
<https://www.ncbi.nlm.nih.gov/pubmed/30256962>
Bonaca, M.P and et.al., 2015. Long-term use of ticagrelor in patients with prior myocardial
infarction. New England Journal of Medicine. 372(19). pp.1791-1800. DOI: <
https://www.nejm.org/doi/full/10.1056/NEJMoa1500857>
Carey, M.G., 2016. Cardiac Arrhythmias, An Issue of Critical Care Nursing Clinics of North
America, E-Book (Vol. 28, No. 3). Elsevier Health Sciences. DOI: <
https://www.elsevier.com/books/cardiac-arrhythmias-an-issue-of-critical-care-nursing-
clinics-of-north-america/carey/978-0-323-46254-9 >
Gallagher, R and et.al.,2018. Perspectives of cardiac rehabilitation staff on strategies used to
assess, monitor and review–a descriptive qualitative study. Heart & Lung. 47(5). pp.471-
476. DOI: < https://www.sciencedirect.com/science/article/pii/S0147956317304740>
Ibanez, Borja and et.al., 2017. ESC Guidelines for the management of acute myocardial
infarction in patients presenting with ST-segment elevation: The Task Force for the
management of acute myocardial infarction in patients presenting with ST-segment
elevation of the European Society of Cardiology (ESC)." European heart journal 39. no. 2
(2017): 119-177. DOI: < https://academic.oup.com/eurheartj/article/39/2/119/4095042>
Li, W.Q and et.al.,2016. Epidemiological assessments of skin outcomes in the nurses’ health
studies. American journal of public health. 106(9). pp.1677-1683. DOI: <
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4981523/>
O'Keefe-McCarthy, S and et.al., 2018. The Predictive Value of Cardiac Prodromal Symptoms
on Major Adverse Cardiac Events: A Systematic Review Protocol. Canadian Journal of
Cardiovascular Nursing. 28(1). DOI: < https://www.ncbi.nlm.nih.gov/pubmed/25419940>
Ryan, K and et.al., 2016. Factors associated with triage assignment of emergency department
patients ultimately diagnosed with acute myocardial infarction. Australian Critical

Care. 29(1). pp.23-26. DOI: <
https://www.sciencedirect.com/science/article/abs/pii/S1036731415000454>
Sanders, S.F. and DeVon, H.A., 2016. Accuracy in ED triage for symptoms of acute myocardial
infarction. Journal of Emergency Nursing. 42(4). pp.331-337. DOI: <
https://www.sciencedirect.com/science/article/pii/S009917671600043X>
Steinman, M.A and et.al.,2017. Association of β-blockers with functional outcomes, death, and
rehospitalization in older nursing home residents after acute myocardial infarction. JAMA
internal medicine. 177(2). pp.254-262. DOI: <
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2592699>
Tourangeau, A.E and et.al., 2016. Nursing-related determinants of 30-day mortality for
hospitalized patients. Canadian Journal of Nursing Research Archive. 33(4). DOI: <
https://www.ncbi.nlm.nih.gov/pubmed/11998198>
Levett – Jones, 2018. Chapter 1, Clinical Reasoning; What it is and why it matters. pp 4 – 12
DOI: < https://link.springer.com/chapter/10.1007/978-3-030-05560-8_3>
Online
7 Myocardial Infarction (Heart Attack) Nursing Care Plan. 2019. [Online]. Available through: <
https://nurseslabs.com/7-myocardial-infarction-heart-attack-nursing-care-plans/>.