Healthcare Assignment: Myocardial Infarction Risk Factors and Nursing

This healthcare assignment delves into the complexities of myocardial infarction, starting with the identification of significant risk factors such as smoking and a sedentary lifestyle, particularly in the case of Mr. Papas. It then explores the pathophysiology of the condition, differentiating between STEMI and NSTEMI, and examining the impact on the heart's structure and function. The assignment also discusses the homeostatic mechanisms involved, including the experience of referred pain, pallor, and clamminess. Finally, it outlines crucial nursing approaches, such as percutaneous coronary intervention (PCI), aimed at managing and treating STEMI heart attacks, emphasizing the importance of timely intervention to minimize heart muscle damage. The report underscores the need for patient education, lifestyle modifications, and continuous monitoring in the comprehensive care of individuals with myocardial infarction.

Running head: HEALTHCARE ASSIGNMENT
HEALTHCARE ASSIGNMENT
Name of the student:
Name of the university:
Author note:

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Risk factors and health promotion:
One of the most important risk factor that leads to myocardial infarction is smoking or
tobacco. Mr. Papas was seen to smoke 15 cigarettes per day which had been one of the risk
factor that had made him vulnerable to the development of the disorder of myocardial infarction.
Myocardial infarction can be described as the cardiovascular disorder that occurs when blood
flow is seen to decrease or stop to a particular part of the heart which actually causes damage to
the heart muscle (Ibanez et al., 2017). Studies are of the opinion that chemicals in the cigarette
smoke is seen to cause swelling of the cells that line the blood vessels which in turn become
inflamed. This actually contributes in the narrowing of the blood vessels which in turn lead to
different types of cardiovascular conditions. Smoking can initiate plaque formation in the arteries
making them narrow as well as less flexible resulting in situations called atherosclerosis. The
opening inside the arteries is seen to become narrow and blood can no longer flow to various
parts of the body. Many of the studies have also stated that chemicals in the cigarette smoke can
make the blood become thicker and forms clots inside the veins and arteries. Blockage from the
clot can also lead to myocardial infarctions and this leads to heart attack and sudden death
(Anderson et al., 2017). Hence, Mr. Papas should be educated about how his smoking habits are
contributing to the disorder and that how he could stop them. Mr. Papas is also seen to undertake
very less physical activities and mostly lives a sedentary lifestyle because of his job role of an IT
professionals. The work load is mentally demanding which keeps him so busy and leaves him so
tired that he could not get any scopes of exercises. It might be also possible that he is not aware
of the importance of exercises (Ibanez et al., 2017). Studies opine that exercises help in keeping
the heart fitter by strengthening the heart muscles and lowering the blood pressure of the body
which otherwise becomes a chance of affecting the heart. Moreover, exercise also helps in

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maintaining a healthy body weight as obesity links with development of myocardial infractions.
It also helps in sleeping better. Hence, the healthcare professional should be teaching Mr. Papas
the need to stop smoking and the need to undertake exercises. They should be first analyzing the
heath literacy level of the patient and accordingly, they should educate him about the risk factors
and consequences of myocardial infarction. Following these, they should develop an exercise
regime for the patient (Thiele et al., 2017). They should also undertake motivational interviewing
themselves or may send Papas to a substance abuse disorder that can undertake cognitive
behavioral therapies and help him to change the negative behavior of smoking. They should also
refer him to agencies that help individuals in quitting smoking and would help him to develop
safer life. Moreover, Mr. Papas would be educated about the importance of regular screening
sessions and would be requested to visit the healthcare centers founded taking screening tests
every month to see whether he is safe from any dangers.
Pathophysiology:
Myocardial infarction results from an imbalance in the oxygen supply as well as its
demands and this is mainly developed as the cause of plaque rupture with the thrombus
formation taking place in the epicardial coronary artery. This mainly results in the acute
reduction of the supply of blood to a portion of the myocardium. Many of the studies are of the
opinion that although the clinical presentation of the patients is the key component in the overall
diagnosis and evaluation of the patient with MI, many of the events are found to be silent and
may not be recognized by patients, healthcare professionals or families (Hoffman et al., 2017).
The appearance of the cardiac biomarkers in the circulation can be seen to be the main indicating
factor for myocardial necrosis and is considered to be a useful adjunct for the diagnosis.
Myocardial infarction primarily takes place in the left ventricle (LV) but they can also extend to

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that of the right ventricle called the RV or the atria. Right ventricular infarction can result from a
dominant form of left circumflex artery or because of the obstruction of the right coronary artery.
This can be characterized by higher EV filling pressure that might take place along with severe
tricuspid regurgitation as well as reduced cardiac output (Levine et al., 2016). The second form is
called the inferio-posterior infarction that might take place due to some degrees of right
ventricular dysfunction in about half of the patients and this causes hemodynamic abnormality in
10 to 15%. RV dysfunction should be considered in those individuals who have infero-posterior
infarction and also have elevated jugular venous pressure along with that of the hypotension as
well a shock. When RV infarction causes complications to that of the LV infarction, it may result
in increase of the mortality risk. Studies have opined that anterior infarction tends to be highly
larger and this indeed results in a much worse prognosis than that of the previously discussed
infero-posterior infarcts (Cung et al., 2015). They occur mainly due to left coronary artery
obstruction mainly taking place in the anterior descending artery. On the other hand infero-
posterior artery is seen to reflect the dominant left circumflex artery obstruction as well as
reflecting the right coronary obstruction. Infarction might be both transmural as well as
nontransmural. Studies opine that transmural infarcts involve the whole thickness of that of the
myocardium starting from epicardium to endocardium. This is mainly characterized by abnormal
Q waves on that of the ECG image. Nontransmural infarcts are seen not to extend through that
of the ventricular wall and are seen to cause only ST-segment and T-wave (ST-T) abnormalities,
these infarcts also called the subendocardial are seen to involve only the one third part of the
myocardium where the wall tension is found to be highest and that the myocardial blood flow
would become highly vulnerable to the circulatory changes. These infarcts are seen to follow
prolonged hypotension (Bonaca et al., 2015).

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As transmural depth of the necrosis cannot be clinically determined, infarcts are thereby
classified as the STEMI or the non STEMI mainly by the presence as well as the absence of the
ST segment Elevation or Q waves on the electrocardiogram. Studies opine that the volume of
the myocardium that had been destroyed can be estimated roughly by the duration as well as the
extent of the CK elevation or by the peak levels of more commonly measured cardiac troponins
(Reed et al., 2017). ST segment evaluation of myocardial infarction mainly represents the
transmural myocardial infarction and is also called the STEMI which included myocardial
necrosis where the ECG changes show ST-segment elevation that cannot be immediately
reversed with the help of nitroglycerin. Moreover here, troponin I of troponin K and CK can be
found to be elevated. The subendocardial MI is also called the Non–ST-segment elevation
myocardial infarction NSTEMI. It mainly represents the myocardial necroses that do not include
ST-segment elevation. The changes in the ST that can be present are the ST-segment depression,
T-wave inversion or may be both (Han et al., 2015).
Homeostatic mechanisms:
Radiation of pain to shoulders as well as left arm:
During the time of heart attacks, pain is seen to begin in the chess and gradually spread to
the other areas even when there remains no chest pain as the initial symptoms. The signs of the
heart attack are mainly seen to include pain as well as discomfort in the left, right or both the
arms or even in shoulders, back, neck, elbow, stomach and lower jaw. Men are mostly seen to
have pain in the left arm whereas women are seen to experience it in both the arms. In the main
scenario, the heart is mainly seen to send the sensation of pain through the nerves to the brain or
to the spinal cord where many of the nerves are seen to follow the same pathway (Levine et al.,

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2016). The nerves of the arm might be absolutely fine but as the information coming from heart
travels via arms and shoulders, the brain might confuse the signals of the heart with that of the
nerve signals coming from arms and other past because of the nerve proximity. This is called
referred pain. This is often characterized to be a symptom of myocardial infarction showing they
heart muscle is not getting enough oxygen. In cases of Papas, it might be possible that he is
experiencing referred pain in arms and shoulders although the main nerve signals are sent by
heart and confused by brain to be coming from other parts (Waldo et al., 2015).
Pallor:
Paleness or pallor can be described as the unusual lightness of the skin color as compared with
that of the normal complex. Paleness may be developed because of the reduction of the blood
flow and that of the oxygen as well as by the decreased number of the red blood cells. This might
happen all over the skin or this might also remain localized (Smits et al., 2017). During the time
of myocardial infarction, blood cannot reach heart muscles ad so they cannot get oxygen to
function and those results in heart attack. As a result heart cannot continue the pumping
mechanism of the blood and hence, blood also cannot circulate to the different areas of the body
and also to skin. Hence, the skin as well as the other parts of the body stops receiving oxygen as
blood is not pumped effectively from heart for equal distribution (Puymirat et al., 2017). Lack of
oxygen in the organs result in development of paleness as red blood vessels cells carrying
oxygen gets prevented from reaching various regions of the body. This results in paleness and
pallor.

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Clamminess:
Clammy skin mainly refers to the skin which remains wet because of excessive sweating.
Many of the studies are seen to sate that cold sweat or clammy skin act as the symptom for heart
attack and this requires immediate attention. During myocardial infarction, the pumping ability
of the heart decreases as the heart is not getting enough oxygen that it requires for functioning. It
can be seen that when heart cannot pump blood to different parts of the body, the different body
parts become devoid of oxygen (Sahlen et al., 2016). Hence, the heart provided more effort to
pump. As the cardiac muscles tend to provide more effort to pump blood, more ATP gets burnt
as more energy is required. Therefore, the body heat increases and the body homeostasis try to
normalize the body heat. This makes the homeostasis system to reduce the body heat for which it
tend to sweat it down to release the body heat. Hence, clamminess as a result of evaporation of
sweat can be found on the skin of the patient (Ahmad et al., 2015).
Nursing approaches:
A STEMI heart attack is seen to take place when the blood clot suddenly forms that
completely blocks the artery in the heart. This can result in causing damage that covers a huge
part of the heart and this gradually spreads to the heart muscles. The main priority of the heart
would be to open the artery quickly so that it can save more heart muscles as much as possible.
Treatments options that the nurses need to undertake are the percutaneous coronary intervention
(PCI). This is the first choice that nurses undertake where the goal mainly remains in opening the
artery within 90 minutes of the patient first receiving the care by the emergency healthcare
professionals (Pickering et al., 2016). They would be mainly locating the clot in Mr. Papas and
would then be placing a stent for regaining the blood flow to the heart. If the hospital does not

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have PCI facility where they do not have cardiac medicalisation laboratory available for 24 hours
a day, clot bursting medication can be also provided which are also an effective treatment
options. These medications are mainly seen to include the fibrinolytics which can help by
opening the arteries by dissolving the clots. The main goal of the nursing professionals would be
to infuse the clot-busting medications within that of the 30 minutes of the arrival of the patient at
the hospital. This would help in restoring the blood flow of the heart preventing further damage
of the cardiac muscles. The nursing professional can also provide nitroglycerin. This is the initial
medication that needs to be given along with aspirin. This medication would be helping in
dilating the blood vessels for allowing any blood flow that could have been impeded. The nurse
should first give 0.4 mg sublingual tab and should wait for 5 minutes. If the chest pain is not
found to be relieving the pain, another dose can be administered. This can be done to a total of
three times (Goldberg et al., 2016). The nurse should continuously monitor the patient blood
pressure and should hold for the systolic BP of less than 90 mmHg. Aspirin should be mainly
given for thinning of the blood and the nurse can provide a total of about 4 baby aspirins with 81
mg each totally accounting for 324 mg. the nursing professionals should also insert large bore IV
as this would be found to be important in the administration of the medications and would help
in possible interventions f the angina worsens and any scan that might be required for ruling out
thrombosis. The nurse should continue to evaluate the condition of Mr. Papas by drawing out
cardiac enzymes. Cardiac enzymes can help the nurses to understand the extent of the
myocardial infarctions. Troponin 1, myoglobin, CK as well as CK-Mb can help nurses to
develop an idea about the heart condition of the patient. The nursing professional can also
administer the thienopyridines which are actually P2Y212 receptor antagonists (Farnier et al.,
2019). These medications need to be used for about 12 months regardless of the stent used

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during the time of the PCI. These medications would be helping in the prevention of the heart
attacks and strokes in the persons by reduction of the clotting tendency mainly be interfering
with the platelets or by blocking the production of clotting substances of the body. They can be
also used with aspirin for the treatment of worsening chest pain occurring during myocardial
infarction as that took place in Mr. Papas
Activities of Daily Living:
One of the activities of daily living that would be affected is breathing. Since, the heart
will be weak and the pumping mechanism would be also not as fast as that of a healthy heart,
circulation of blood would be not as fast and hence the different cells of the body might not be
getting enough oxygen to conduct respiration. The organs might feel devoid of oxygen for which
fatigue may be expressed. Hence, working ability would be affected and in this situation, the
nurse should advise the patient to remain at bed rest so that the body requires the least amount of
oxygen (Sahlen et al., 2016). Breathing would be also affected as the heart would not be able to
carry oxygenated blood from the lungs with that much efficiency like that of a healthy heart. As
the patient would be in bed rest and should not be taking work stress, hence he would not be able
to undertake washing specially. In such situation, a social care aide might be allocated for him.
However, he would not be having any issues in dressing as she could mobilize freely after the
treatment. He would not also have any issue of mobilization and in fact the nurse should be
helping him to undertake free hand exercises and brisk walking so that he feels fresh and not get
bored from bed rest entirely for the coming weeks. Mr. Papas should be very careful during the
times of heat waves may affect his controlling of the body temperature (Pickering et al., 2016).
People with heart disorders and these who take heart medications might feel affected in hot
weather. In hot weather, temperature rises and the body tries to balance the heat by increasing

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blood flow and also by sweating. These can lead to dehydration which can put more pressure on
the heart. Hence, the patient needs to be very careful.

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