Care Plan For Minor

Care Plan For Minur3125fal

Homework 2 Homework 2 Care plan for MI NUR3125 Fall 2017 This patient is presenting to the emergency with symptoms that indicate a Myocardial Infarction. The patient, who is a 48-year-old man, is stating a 3-day history of sub sternal chest pain that is radiating to his back. The symptoms started up while he was mowing his lawn. He stated the pain has eased up over time. He also reported mild trouble with breathing and some nausea but no vomiting.

He exercises daily, but does report that he eats a lot of fast food. His last total cholesterol was 232 mg/dL. He also has a 15-year history of tobacco use and family history of myocardial infarction (MI), specifically his father had an MI at age 54 and his grandfather at age 58. His current blood pressure is elevated at 158/98 and heartrate of 102 bpm, his respiratory rate is currently high at 26 breaths/min and noted mild use of accessory muscles upon examination. Lungs are noted to have slight inspiratory crackles at both lung bases.

Jugular venous distention is noted at less than 2cm bilaterally. His lab work reveals an elevated Troponin at 2.9 ng/ml, elevated Creatinine phosphokinase at 141 units/L, and an elevated CK-MB/CK isoenzyme at 2%. Elevated troponin indicates damage to the heart muscle, and the elevated Creatinine phosphokinase and CK-MB/CK isoenzyme along with all these other symptoms and labs indicate a heart attack. ECG is done and shows ST elevation and T wave inversion, also noted with premature ventricular contractions. The lab values and ST elevation point to a Myocardial Infarction and Transmural ischemia that will require immediate attention.

I have chosen three NANDA nursing diagnoses for this patient, with the first one being the priority. The three I choose are: · Decreased Cardiac Output related to altered heart rate and ischemia as evidenced by ECG showing an ST elevation, elevated Troponin, and patient stating he has had chest pain for three days. · Acute Pain related to tissue damage in the myocardium from inadequate blood supply as evidenced by elevated troponin labs and patient reporting chest pain that radiates to back for three days. · Ineffective Health Maintenance related to deficient knowledge about self-care and treatment as evidenced by patient stating he eats fast food often and has had elevated blood pressure and cholesterol at past appointments, and patient admitting to smoking ½ pack of cigarettes daily despite family history of MI.

Care Plan Diagnosis #1

Myocardial Infarction NANDA Diagnosis 1: Decreased Cardiac Output related to altered heart rate and ischemia as evidenced by ECG showing an ST elevation, elevated Troponin, and patient stating he has had chest pain for three days. NOC (Nursing Outcome Classification) Label: Tissue Perfusion Expected Client Outcomes: 1. Patient will demonstrate adequate cardiac output evidenced by blood pressure, heart rate, and heart rhythm within normal parameters by shift end tonight (7pm). 2. Patient will report resolution of chest pain by shift end tonight (7pm). 3. Patient’s respiratory rate will be within normal limits by shift end tonight (7pm).

NIC (Nursing Intervention Classification) Label: Cardiac Care Nursing Interventions/Strategies 1. Administer oxygen to the patient as needed and as ordered by the physician. 2. Administer aspirin to the patient as ordered by the physician. 3. Prepare the patient with intravenous access and education for cardiac catheterization and possible PCI in under 90 minutes door to balloon time for a STEMI. 4. Maintain the patient on bedrest as ordered by the physician. Scientific Rationales with Citations 1. Supplementing oxygen increases the oxygen availability to the myocardium (Ackley and Ladwig 2014). 2. Aspirin prevents platelet clumping and aggregation, thus preventing thrombus formation (Anderson et al,2011; Antman et al,2008). 3. A time of under 90 mins door to balloon has been associated with improved client outcomes (Anderson et al, 2011; Antman et al, 2008). 4. Anti-ischemic therapy would include reducing and minimizing oxygen demand by the myocardium in the early hospital phase (Anderson et al, 2011).

Additional Context on Cardiovascular and Hypertension Management

Hypertension, a common alteration of cardiovascular function, is characterized by a sustained increase in systemic arterial blood pressure, resulting from prolonged elevated peripheral resistance, increased circulating blood volume, or both. Primary hypertension accounts for the majority of cases, often linked to genetic, lifestyle, and environmental factors, including diet and stress. Effective management involves regular blood pressure monitoring, lifestyle modifications, and medication adherence to prevent complications such as stroke, heart failure, and renal failure.

Research indicates that proper training for healthcare staff, including nurses, on accurate blood pressure measurement and consistent tracking improves diagnosis and management of hypertension. For example, a 2012 study in the Wisconsin Medical Journal confirmed that retraining staff and ensuring accurate readings led to better control rates, which could be translated into hospital settings to improve patient outcomes (Wisconsin Medical Journal, 2012).

References

• Ackley, B. J., & Ladwig, G. B. (2014). Nursing diagnosis handbook: An evidence-based guide to planning care (10th ed.). Mosby Elsevier.
• Anderson, J. L., Adams, C. D., & Antman, E. M. (2011). 2011 ACCF/AHA Guideline for the Management of Patients With ST-Elevation Myocardial Infarction. Journal of the American College of Cardiology, 57(23), e78–e142.
• Huether, S. E., & McCance, K. L. (2017). Understanding Pathophysiology (6th ed.). Elsevier.
• Wisconsin Medical Journal. (2012). Office-based nursing staff management of hypertension in primary care. Retrieved from https://journals.lww.com/wismedjournal
• Antman, E. M., Anbe, D. T., & Armstrong, P. W. (2008). ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction. Journal of the American College of Cardiology, 52(24), e1–e142.
• Chobanian, A. V., Bakris, G. L., & Black, H. R. (2013). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JAMA, 289(19), 2560–2572.
• Whelton, P. K., Carey, R. M., & Aronow, W. S. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension, 71(6), e13–e115.
• Fryar, C. D., Gu-Q, G. T., & Ostchega, Y. (2016). Hypertension Prevalence and Control Among Adults: United States, 2015–2016. NCHS Data Brief No. 289. National Center for Health Statistics.
• Green, B. (2015). The impact of hypertension on public health. American Journal of Hypertension, 28(3), 369–370.
• Sharma, P., & Mookherjee, S. (2019). Epidemiology of hypertension: Current status and future prospects. Indian Journal of Medical Research, 149(4), 391–393.