Nursing Diagnosis

I will be discussing 5 relevant nursing diagnoses related to a heart attack. I will then go into detail about possible nursing interventions related to one of the diagnoses.

1. Acute pain related to tissue ischemia. This can be evidenced by patient reports of chest pain, patient expressing facial grimaces, changes in level of consciousness, and changes in pulse or blood pressure.

2. Activity intolerance related to imbalance between myocardial oxygen supply and demand. This can be evidenced by changes in pulse and blood pressure on exertion, having irregular heartbeats, changes in skin color, feeling weak, and feeling chest pain on exertion.

3. Anxiety related to threat to change in health. This can be evidenced by increased tension and restlessness, feelings of uncertainty, and expressing concern about recent events.

4. Decreased cardiac output related to heart muscle damage. This can be evidenced by changes in heart rate and blood pressure, changes in skin color, chest pain on exertion.  

5. Risk for Ineffective tissue perfusion related to interrupted blood flow.  

(Myocardial Infarction: Heart Attack, 2015)

For decreased cardiac output related to heart muscle damage, outcomes and goals include patient having adequate cardiac output and tissue perfusion as demonstrated by maintain BP within normal limits, maintaining warm and dry skin, having regular cardiac rhythm, having clear lung sounds, and strong bilateral, equal peripheral pulses, having adequate urinary output and decreased frequency of angina (Myocardial Infarction: Heart Attack, 2015).

Nursing interventions include:

Assessing for signs of decreased cardiac output through heart rate, blood pressure, skin color, temperature, weakness and fatigue, crackles, cyanosis of skin.

Perform actions to reduce cardiac workload such as maintain appropriate levels of physical activity and creating a soothing environment. Restricting activity will reduce oxygen demands and prevent the heart from overworking itself.

Administer medications as ordered by the health care provider in order to maintain blood pressure, cholesterol, decrease heart rate and myocardial oxygen requirements, and reduce incidence of ventricular thrombus formation.

Educating the patient about the importance of maintaining the recommended diet from his healthcare provider and the positive effects this will have on his heart.

(Myocardial Infarction: Heart Attack, 2015)

Myocardial Infarction: Heart Attack – nurseslabs. (2015). Retrieved February 2/18/15. From http://nurseslabs.com/7-myocardial-infarction-heart-attack-nursing-care-plans/

Nursing Care for Individuals with Heart Attack

Whether a Heart Attack patient is recuperating at the hospital or in a home environment, there are several assessments, interventions, and educational measures that are important to involve in improving and maintaining good health.

        1. One important aspect of nursing care will be to manage pain related to the heart attack experienced. Because of the heart attack there may have been a cut off of oxygen to other organs.

It will be important to monitor and document (Myocardial Infarction: Heart Attack):

• Verbal reports of pain
•  Nonverbal cues: moaning, crying, grimacing, restlessness, clutching chest
• Changes in blood pressure (pain and stress may increase blood pressure)
•  Increase heart rate (can be caused by pain and stress) 
•   Respiration may increase due to pain and anxiety  

The patient should be encouraged to report pain immediately and be educated on certain relaxation techniques and exercises, as well as deep breathing exercises for distraction and to promote a soothing environment (Myocardial Infarction: Heart Attack, 2015).

      

  2. Another important aspect of nursing care is to administer medications as ordered by the healthcare professional. This is really important because the medications the patient is taking is helping their heart to not overwork itself. Medications will help regulate blood pressure, heart rate, and pain. Taking medications will help keep the heart happy(How is a heart attack treated, 2013).

 3. It is also important to encourage a gradual increase in activity. It is important to encourage to rest at first, and then limit the amount of exercise and activity based on pain and bad heart responses (Myocardial Infarction: Heart Attack, 2015).  

It will be important to monitor and document (Myocardial Infarction: Heart Attack, 2015):

• Heart rate and rhythm before, during, and after activity and exercise
• Blood pressure before, during, and after activity and exercise

The patient should be taught and encouraged to (Myocardial Infarction: Heart Attack, 2015):

• Avoid straining themselves while going “number 2”
•  Review signs and symptoms of overworking themselves (chest pain, shortness of breath)

How is a heart attack treated? – national Heart, lung, and Blood Institute. (2013, December). Retrieved February 2/14/15. From http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/treatment

Myocardial Infarction: Heart Attack – nurseslabs. (2015). Retrieved February 2/18/15. From http://nurseslabs.com/7-myocardial-infarction-heart-attack-nursing-care-plans/

Treatments

There are different treatment guidelines for before, during, and after a heart attack.

Initial stage:

The usual treatments that are started immediately when a possible heart attack is suspected even without confirmation are oxygen therapy, aspirin to prevent blood clotting, and nitroglycerin which lets the heart to not have to work so hard (How is a heart attack treated, 2013).

Confirmation stage:

When a heart attack is confirmed, the most common treatments are putting the patient on medicines that bust clots, and performing a procedure to open up the blocked coronary arteries, called a coronary angioplasty (How is a heart attack treated, 2013). The clot buster medicines are best when given immediately. These clot busters work the best when they are given to the patient within a few hours from when the first heart attacks symptoms started (How is a heart attack treated, 2013). 

A coronary angioplasty is when a small tube that has a balloon inside is inserted through a blood vessel and is placed in the coronary artery that is being blocked (How is a heart attack treated, 2013). The balloon is then inflated which opens up the artery and blood flow increases through the heart.

Other medicines used to treat heart attack and symptoms:

Beta blockers – treats chest pain, decreases heart’s workload

ACE inhibitors – decrease blood pressure

Anticoagulants – prevent blood clots from forming

Anticlotting medicines – stop platelet formation     

(How is a heart attack treated, 2013).

Other medical procedures used to treat heart attack and symptoms:

A coronary artery bypass is another procedure used to treat heart attack. A vein from the body is used in the heart, which allows blood to flow through a new passage (How is a heart attack treated, 2013).

Post hospital:

Treatment may include the previous listed medications. Non-pharmacological treatment include more exercise, having a healthy diet, being active, maintaining a healthy weight, and not smoking (How is a heart attack treated, 2013). There is cardiac rehabilitation that can also help patients recover from a heart attack. During this rehabilitation there is exercise training and education, counseling, and training to understand the heart condition and ways to reduce risk for future problems (How is a heart attack treated, 2013).

How is a heart attack treated? – national Heart, lung, and Blood Institute. (2013, December). Retrieved February 2/14/15. From http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/treatment

How is a Heart Attack Treated – youtube.com. (2004, March. Retrieved February 14, 2015, from https://www.youtube.com/watch?v=ApJvxgjUOjc

Your guide to coronary bypass surgery - heart disease treatment - youtube.com. (2014, February). Retrieved February 14, 2015. from https://www.youtube.com/watch?v=8b1FQJcRE1k

Signs and Symptoms

Heart attack symptoms can vary. Pain may range from mild to severe; individuals may not exhibit any symptoms while others may have sudden cardiac arrest (Heart attack symptoms 2015). Warning signs such as chest pain triggered by exertion and relieved by rest may appear in advance, ranging from hours to weeks (Heart attack symptoms 2015).

The following are some common signs and symptoms (Heart attack symptoms 2015):

• Chest pain, tightness, aching or pressure that may spread to the neck, jaw or back
• Abdominal pain
• Nausea, heartburn, indigestion
•  Cold sweat
• Fatigue
•  Lightheadedness or sudden dizziness

Chest pain isn’t the only big indicator. Not all heart attacks are associated with chest pain. One-third of patients who have suffered from heart attacks did not have any chest pain symptoms (What are the symptoms of a heart attack, 2013).

Important facts to know (What are the symptoms of a heart attack, 2013):

• Heart attacks can start slow and only mild pain or discomfort will be felt
• Diabetic patients or those with high blood sugar may not have symptoms, or very severe symptoms
•   Chest pain or discomfort is the most common symptom in men and women

           Women can experience very different symptoms than men

•       Women are more likely to experience shortness of breath, nausea, vomiting, tiredness, pain the back, shoulders, and jaw 
• 
  

      It is important that if signs and symptoms of a heart attack develop, that you must immediately call for help – 911. Those who arrive by ambulance receive faster treatment at the hospital compared to those who don’t; also emergency medical services can start saving your life right away through quick intervention ((What are the symptoms of a heart attack, 2013).

Heart attack symptoms – Mayo Clinic. (2015, January 1). Retrieved February 7, 2015, from http://www.mayoclinic.org/diseases-conditions/heart-attack/basics/symptoms/con-20019520

What are the symptoms of a heart attack – National Heart, Lung, and Blood Institute. (2013, December). Retrieved  February 7, 2015. From http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/signs

Diagnosis

The diagnosis of a heart attack is based on symptoms and test results. Some main tests to diagnose a heart attack include an ECG, blood tests, echocardiography, and coronary catheterization (Heart Attack 2015). 

An ECG monitors heart rate and rhythm and is able to determine how much damage to the heart muscle has occurred (Heart Attack 2015). Blood can be drawn to measure cardiac enzyme levels which indicate heart muscle damage (Heart Attack 2015). These specific enzymes are released when heart muscle cells are injured, such as potassium (Heart Attack 2015). Troponin levels are also an important indicator; they are proteins released from heart cells when the cells are damaged due to poor blood circulation to the heart (Heart Attack 2015). 

Echocardiography can show images of the heart and damaged heart structures and what locations the heart is not able to pump normally (Heart Attack 2015). 

A coronary catheterization, also known as an angiogram, is when a dye is injected into the arteries of the heart through a thin tube; this allows the arteries to appear visible on an X-ray showing possible areas of blockage (Heart Attack – Mayo Clinic 2015). 

An exercise stress test can also be used to measure how the heart responds to exercise and exertion (Heart Attack – Mayo Clinic 2015). 

      

Heart attack – Mayo Clinic. (2015, January 1). Retrieved January 31, 2015, from http://www.mayoclinic.org/diseases-conditions/heart-attack/basics/tests-diagnosis/con-20019520

Heart Attack: Symptoms, Diagnosis, Treatment, and More - WebMD. (2015, January 1). Retrieved January 31, 2015, from http://www.webmd.com/heart-disease/guide/heart-disease-heart-attacks?page=2#3

The Widow Maker of Coronary Artery Disease – youtube.com. (2015, June). Retrieved January 31, 2015, from https://www.youtube.com/watch?v=bAvxVUpv-rs

Pathophysiology

The widowmaker is a partial or full blockage of the left anterior descending (LAD) artery of the heart. The LAD supplies blood to the left ventricle which pumps blood to the rest of the body (Conjecture Corporation, 2015). When this artery is occluded, the rest of the body, as well as the heart, are deprived of oxygen. Because the heart is not getting enough blood and is not pumping properly, a person suffers from a myocardial infarction, also known as a heart attack. Because the LAD is a major source for blood to the heart, blockage induces a massive heart attack, and those who suffer one often die, creating the nickname widowmaker (Conjecture Corporation, 2015).

https://www.youtube.com/watch?v=3uSmUagTtsA

(Lee Memorial Health System, 2015)

Heart attacks are most often caused by build-up of fat and cholesterol which form a plaque in the arteries; this plaque blocks blood flow and damages the heart muscle (Mayo 2015). The plaque can rupture and a blood clot forms, depending on the size of the clot it can completely block blood flow through the coronary arteries (Mayo 2015).

Risk factors (Mayo 2015).

• Tobacco use – smoking and long-term exposure to secondhand smoke
• High blood pressure – can damage arteries by speeding up narrowing of the arteries
• High blood cholesterol or triglyceride levels – high levels of LDL cholesterol can narrow arteries, high levels of HDL lowers risk of heart attack
• Diabetes – causes high blood sugar levels which increases risk for heart attack
• Family history if heart attack
• Lack of physical activity – contributes to obesity and high cholesterol levels
• Obesity – association with high blood pressure, diabetes, high cholesterol and triglyceride increases risk
• Stress
• Illegal drug use – can cause spasm of coronary arteries 

Conjecture corporation.What is a Widow Maker? (2003-2015).  Retrieved January 24, 2015, from http://www.wisegeek.org/what-is-a-widow-maker.htm#comments  

Lee Memorial Health System. Watching Out For the Widow Maker. (2014, March 7). Retrieved January 18, 2015, from https://www.youtube.com/watch?v=3uSmUagTtsA

Mayo Foundation for Medical Education and Research. Heart attack. (1998-2015).  Retrieved January 25, 2015, from http://www.mayoclinic.org/diseases-conditions/heart-attack/basics/definition/con-20019520 

Epidemiology

Heart disease is the leading cause of death in the United States (Heat Attack, 2013). There are many different types of conditions related to heart disease, all of which can lead to heart attack.  Coronary Artery Disease is both the most common type of heart disease and the main cause of heart attack (Heat Attack, 2013). Heart disease accounts for every 1 out of 4 deaths, which equals 600,000 people a year (Heat Attack, 2013).

Heart disease is the leading cause of death for most ethnicities, percentages as follows from 2008 (Heat Attack, 2013):

Race of Ethnic Group                         % of Deaths

African Americans                              24.5

American Indians or Alaska Natives  18.0

Asians or Pacific islanders                  23.2

Hispanics                                             20.8

Whites                                                 25.1

All                                                        25

 As shown in the graph, heart disease death rates are concentrated more in the southern states. In terms of gender, woman account for slightly over half of the death rates (Heart Disease Facts, (2015). The number of women who die from heart attacks is six times more than the number who dies from breast cancer (Heart Disease Facts, 2015).

In the United States 1.2 million people have a heart attack each year, of these roughly 785,000 people have an initial heart attack while nearly 500,000 experience recurring heart attacks (Heat Attack, 2013).  

In the United States, every 34 seconds someone has a heart attack, while every minute someone dies due to heart attack (Heat Attack, 2013). 4 out of 10 people suffering from a heart attack will die (cite). Both men and women share similar statistics on heart disease-related deaths (Heat Attack, 2013).

Heart Attack. (2013, March 12). Retrieved January 18, 2015, from http://www.cdc.gov/heartdisease/heart_attack.htm

Heart Disease Facts. (2015). Retrieved January 18, 2015, from http://www.theheartfoundation.org/heart-disease-facts/heart-disease-statistics/