Myocardial Infarction Nursing Management

This assignment delves into the nursing care of a patient suffering from myocardial infarction. It requires students to analyze the patient's clinical presentation, including complications and symptoms, drawing upon relevant literature. The focus is on applying this knowledge to develop evidence-based nursing implications for managing the patient's condition effectively. The assignment emphasizes critical thinking, clinical reasoning, and the ability to synthesize information from empirical research.

Running head: SYNTHESIS PAPER
SYNTHESIS PAPER
Name of the Student
Name of the Author
Author Note

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PAPER TITLE: NURSING IMPLICATIONS ASSOCIATED WITH CARDIAC
DISEASES

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Executive Summary
This is synthesis report based on the case study of a patient named Renda Balley suffering from
cardiovascular diseases. She suffered from myocardial infarction, which causes several
symptoms and one of them being angina or cheat pain. Proper nursing implications involve
providing relief to patients suffering from chest pain. These are carried out by providing smooth
muscle relaxants like nitroglycerin, morphine, among others. If proper nursing implications are
not carried out, it can give rise to serious consequences including cardiac shock and death of the
patient. Moreover, preventive measures are to be carried out to prevent the risk of developing
critical health issues in the future like coronary artery diseases. One of the most effective
preventive measure is exercising, which can open up new perspectives in preventing high risk
medical conditions in the future.

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Table of Contents
Introduction......................................................................................................................................4
Description.......................................................................................................................................4
Literature Review............................................................................................................................5
Nursing implications........................................................................................................................6
Conclusion.......................................................................................................................................7
Reference List..................................................................................................................................9
Grading Rubric..............................................................................................................................11

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Introduction
The case study of the patient Renda Balley involved diagnosis of cardiovascular disease
with presence of hypertension, arrhythmia, dysarrthymia, myocardial infarction, among others.
She was a heavy smoker and had a history of cardiac abnormalities and underwent surgeries. She
underwent radiofrequency ablation in order to overcome cardiac arrhythmia.
The nursing implications or suggestions provided to her included: assessment of chest
pain, respiration, blood pressure, electrocardiogram, among others (Bandstein et al., 2014).
Moreover, the patient also suffered from dysrhythmias and as a result, hemodynamic regulations
were provided in the nursing care plan to determine pulse rate, ventricular contractions,
tachycardia, among others (Stouffer, 2017). These nursing interventions are highly relevant for
care of patients with cardiovascular diseases.
The purpose of the paper is to introduce the two nursing care plans: Nitroglycerin SL
administration and morphine administration that would have helped the patient to overcome the
chest pain associated with ostial stenosis.
Description
In the case study, the patient suffered from coronary artery disease. She had severe
stenosis or blockage of the coronary arteries, MLAD, ostial right coronary artery (RCA), middle
and distal RCA, proximal circumflex, left external iliac, left superficial femoral and the medial
branch. She had undergone surgical interventions like percutaneous coronary intervention in
order to open up the blocked coronary arteries. Stents were also used in order to improve the
luminal diameter of the coronary arteries. However, a previous XIENCE failure was reported.

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However, she was not administered any nitroglycerin SL or morphine to reduce her chest pain as
a result of blocked coronary arteries. Moreover, she was given a BIPAP, which can increase the
rate of myocardial infarction.
Literature Review
Angina or chest pain occurs as a result of poor supply of oxygen to the heart muscles or
myocardium. Angina feels like a squeezing or pressure on the heart (Chitra, Jegan & Ezhilarasu,
2017). This pain can move to the jaws, arms, back, among others. Angina is usually associated
with coronary artery disease. Coronary heart disease occurs as a result of plaque buildup on the
interior of the coronary arteries. Myocardial infarction is also associated with morbidity and
increased rates of mortality among the elderly people. One study depicts the role of opiods in
providing pain relief to patients suffering from myocardial infarction. Myocardial infarction
causes pain, breathlessness and anxiety in patients. The empirical research article aimed at
determining the clinical efficacy and outcomes associated with the morphine use in patients with
acute myocardial infarction. According to the study, pre-hospital use of morphine causes a
haemodynamic effect, which is beneficial in patients with acute myocardial infarction. It was
also not associated with any complications or side-effects. It causes a decreased heart rate
without affecting the systolic blood pressure. This makes it a favorable treatment method for
patients experiencing severe chest pain as a result of myocardial infarction (Puymirat et al.,
2015). Morphine provides relief from chest pain which cannot be treated by nitroglycerin.
Acute heart failure is a condition in which doctors, nurses and healthcare officials have to
provide rapid relief to the patients. Nursing interventions in this field involves acute monitoring
of patients to observe any symptoms that require immediate treatment and attention. Use of

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vasodialaters like nitroglycerin are required to control ventricular rate in patients with acute heart
failure. Morphine on the other hand can reduce the afterload, preload, relieve dyspnea and heart
rate (Mebazza et al., 2015).
Nitroglycerin is the first line treatment in association with angina or chest pain and
myocardial infarction. Nitroglycerin generates nitric oxide, which helps to cause vasodialation
and increases the amount of blood flow to the heart muscles or myocardium. Nitroglycerin helps
in creation of equilibrium between supply of nutrient and oxygen compared to the demand of the
ischemic heart. However, over usage of nitroglycerin can cause tolerance and give rise to
endothelial dysfunction, increased vasoconstrictor sensitivity and pro-oxidant effects (Ferreira &
Mochly-Rosen, 2012).
These nursing interventions are non-surgical methods that could have benefitted the
patient described in the case study prior to the surgical means like percutaneous coronary
interventions. These interventions could have helped the patient in getting relief from chest pain.
Nursing implications
Nitroglycerin has a relaxant effect on the smooth vascular muscles. In coronary artery
disease, the coronary arteries are blocked as a result of ostial stenosis (Strauss et al., 2015). As a
result, the heart muscles do not supply enough of both oxygen and blood, which can result in
severe chest pain or angina. Nitroglycerin helps to improve both the oxygen and blood supply to
the heart muscles or myocardium. This helps to dialate the peripheral veins, and when given in
higher doses can cause the peripheral arteries to dialate, thereby reducing both afterload and
preload and subsequent oxygen consumption of the myocardium.

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Myocardial infarction is associated with pressure, tightness and squeezing pain, in chest.
The pain often migrates to the arms, back and jaws. Those who have chest pains, which are
nitrate resistant can use morphine instead. It helps to decrease heart rate, venous return, blood
pressure and can also stimulate locally mediated histamine regulated processes. This helps to
reduce the oxygen demand of the myocardium. Morphine helps to reduce pain associated with
ischemic tissue destruction. It also provides anxiolysis, which is helpful in case of patients with
acute myocardial infarction (Parodi et al., 2015).
The consequences of myocardial infarction because of poor nursing treatment results in
various complications. The complication types are ischemic, mechanical and arrhythmic (Kutty,
Jones & Moorjani, 2013). Ischemic includes angina, reinfarction and extension. Mechanical
involves heart failure, aneurysms, cardiac rupture and shock. Arrhythmias include
atrioventricular node or sinus dysfunction. Thus, proper nursing interventions are necessary to be
carried out in a timely manner in order to reduce mortality rate of patients and to provide pain
relief in individuals suffering from coronary artery disease.
Conclusion
This synthesis report focuses on the clinical issues that can occur because of poor nursing
care in association with the case study of Renda Balley. The patient Renda Balley was suffering
from cardiovascular diseases with symptoms like chest pain. However, her case study revealed
that the nursing implications did not involve the administration of any heart muscle relaxants that
would help her to get relief from chest pain. Moreover, she was provided with a BIPAP, which
can increase the severity of her myocardial infarction. Thus, proper nursing care plan was not
carried out which could have serious consequences on her health. Coronary artery diseases are

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usually associated with high cholesterol, high blood pressure, among others. Lack of a proper
diet and exercise usually causes such medical conditions. Therefore, new ideas are need that
would enable the general population to engage in physical activities. It is necessary for health
insurance companies and hospitals to provide rewards that would encourage individuals to carry
out daily physical activities. Moreover, assessment of physical fitness is also essential in order to
monitor the health of the general population as well as patients with cardiovascular diseases.
Maintaining a healthy lifestyle can prevent the occurrence of broader issues in the future
regarding health of individuals. Thus, it can be concluded that physical activity can prevent the
occurrence of various risk factors and long-term health issues that is slowly gripping the present
generation.

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Reference List
Bandstein, N., Ljung, R., Johansson, M., & Holzmann, M. J. (2014). Undetectable high-
sensitivity cardiac troponin T level in the emergency department and risk of myocardial
infarction. Journal of the American College of Cardiology, 63(23), 2569-2578.
Chitra, R., Jegan, C., & Ezhilarasu, R. (2017). Analysis of myocardial infarction risk factors in
heart disease data set. Biology & Medicine Case Report, 1(1).
Ferreira, J. C., & Mochly-Rosen, D. (2012). Nitroglycerin use in myocardial infarction
patients. Circulation Journal, 76(1), 15-21.
Kutty, R. S., Jones, N., & Moorjani, N. (2013). Mechanical complications of acute myocardial
infarction. Cardiology clinics, 31(4), 519-531.
Mebazaa, A., Yilmaz, M. B., Levy, P., Ponikowski, P., Peacock, W. F., Laribi, S.,& McDonagh,
T. (2015). Recommendations on pre‐hospital & early hospital management of acute heart
failure: a consensus paper from the Heart Failure Association of the European Society of
Cardiology, the European Society of Emergency Medicine and the Society of Academic
Emergency Medicine. European journal of heart failure, 17(6), 544-558.
Parodi, G., Bellandi, B., Xanthopoulou, I., Capranzano, P., Capodanno, D., Valenti, R., ... &
Alexopoulos, D. (2015). Morphine is associated with a delayed activity of oral
antiplatelet agents in patients with ST-elevation acute myocardial infarction undergoing
primary percutaneous coronary intervention. Circulation: Cardiovascular
Interventions, 8(1), e001593.

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Puymirat, E., Lamhaut, L., Bonnet, N., Aissaoui, N., Henry, P., Cayla, G., & Goldstein, P.
(2015). Correlates of pre-hospital morphine use in ST-elevation myocardial infarction
patients and its association with in-hospital outcomes and long-term mortality: the FAST-
MI (French Registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction)
programme. European heart journal, 37(13), 1063-1071.
Stouffer, G. (2017). Cardiovascular hemodynamics for the clinician. John Wiley & Sons.
Strauss, R. A., Johnson, A., Lampert, R. C., Aziz, S. R., & Wessel, J. (2015). BASIC LIFE
SUPPORT, ADVANCED CARDIAC LIFE SUPPORT, AND ADVANCED TRAUMA
LIFE SUPPORT. Oral and Maxillofacial Surgical Secrets-E-Book, 131.

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Grading Rubric
Student Names: Content Points Possible Points Earned
Introduction of Topic 4
Purpose Statement 3
Description of Patient Clinical Issue 12
Literature Review
Incorporate Patient Information
15
10
Nursing Implications
Incorporate Patient Information
15
10
Conclusion 12
APA Format 5
General Rules
 Correct spelling
 Correct sentence structure
 Correct use of language/grammar
 Correct use of punctuation
1
1
1
1
Paper Length
 Maximum 7 pages
7
References
 3 References
 1 Reference must be an Empirical Article
2
1
Total 100