Acute Myocardial Infarction - Essay Example

Acute Myocardial Infarction Nursing Case Order 187961 Total Price: $50 Messages: 0 total Topic: Formal Nursing Research Paper request nursing professional Instructions: 10/21/07 Formal Research Paper Each paper will cover a disease process. Select one disease process and complete a research paper on the disease chosen. There must be 6 references for the paper: - 3 of which must be professional journal articles - 2 from a web site - 1 from a text or nursing book. Be aware the references, unless a classic, must be current (5yrs or less). This paper counts as 15% of your final grade. Papers will not be accepted after November 15, 2007 by 1700. Guidelines - Computer generated with correct spelling, grammar, & punctuation - APA format - Title page with title, student name, institution name, this is page 1, the running head is introduced on the top of the title page, flush right - Reference page - The minimum number of written (introduction, body, and conclusion) is 10 pages; the maximum is 12 pages. - The care plan in concept map format does not count as one of the written pages. The care plan concept map should put into conceptual format the nursing care discussed in the body of the paper. Choose the 4 highest priority nursing diagnoses as discussed in the paper for completion of your care plan concept map. - Besides assessing content, the faculty will be assessing your ability to use reliable references, your ability to analyze, draw conclusions, and plan nursing care - Please note this is a nursing research paper and the majority of your grade relates to nursing care of the person experiencing this disease process. Contents Contents 3 Introduction 3 Pathophysiology of AMI 6 Nursing Care for the AMI Patient 8 Ensure compliance with prescribed medicines 8 Behavioral changes 10 Conclusion 12 Bibliography 13 Introduction Acute Myocardial Infarction (AMI) afflicts 1,200,000 people per year in the United States (AHA, 2007). Of those who have a first or recurrent heart attack, 40%, or 452,000, die from the AMI. I have chosen this syndrome, as it presents complex issues of diagnosis and treatment after an initial AMI. There is clear evidence, which will be covered in this paper, of the positive impact of nursing and patient care interventions post-AMI, and the effect of lowering morbidity and mortality. The etiology of the disease is many-sided. Patients at higher risk for AMI include: Obese or morbidly-obese patients Patients with a previous history of one or more AMI's Diabetic patients Patients with depression Patients with a low exercise level Patients with a high total cholesterol, or a high LDL/HDL ratio There are a number of potential causes for AMI. The most prevalent include the following: Vulnerable plaque, which is estimated to occur in 35% of patients. This may have its origin in a general higher level of inflammation in a patient. Some patients encounter vulnerable plaque due to Chlamydia or other infectious causes (Madjid, 2007). Thrombus formation: this may occur due to injury, smoking or excessive drinking, which can tend to create scars in the medial and epithelial layers of the major cardiac arteries. Thrombus formation in other parts of the body, including DVT (deep vein thrombosis) may result in migration to the heart, causing an AMI. Plaque formation: This may occur (as demonstrated above) due to high circulating cholesterol, particularly LDL. Depression: There is some debate whether depression accompanies AMI, or vice versa. Pathophysiology of AMI This list is far from all-inclusive. As an example, patients with diabetes are much more likely to have one or more AMI's (Sulfi, 2007). The etiology is complex, however. Those with diabetes tend to have higher levels of renal insufficiency, thrombus formation and plaque formation. In addition, the general narrowing of arteries in insulin-dependent diabetes mellitus patients tends to make them more vulnerable to thrombus-induced AMI. A similar argument can be made for cigarette smokers. Their increased rate of thrombus formation is due to vessel injury, but other effects are co-related. Plaque formation is also elevated amongst smokers, which may result in greater susceptibility to thrombus-induced AMI. High blood pressure is both a co-related variable and an individual cause of increased incidence of AMI (AHA, 2007) Clinical Manifestations The AHA diagnosis of AMI includes the following elements: 1. Elevated enzymes, particularly Myoglobin, CK-MB and Troponin (I or T). These enzymes vary in sensitivity and specificity as follows: a. Myoglobin levels increase fastest, but can be confounded with muscle injuries throughout the body. b. Troponin levels increase more slowly than myo, but are more closely associated with heart muscle damage. c. CK-MB levels are also elevated, but may be less specific to the AMI. The combination of these three levels indicates when the AMI occurred, and the level of the damage. Figure 1: interaction of three enzyme levels after AMI (Innotrac, 2007) Nursing Care for the AMI Patient The quality of nursing in a CICU (Cardiac Intensive Care Unit) and subsequent patient care makes a significant difference in the patient's likelihood of having a second AMI, particularly in the 'acute' period from day 0 to day 30 after the initial AMI. The primary nursing goals during the patient's relatively short stay in the CICU and the hospital are as follows: 1. Insure compliance with prescription medicines to reduce chances of recurrence 2. Educate the patient and his/her family (particularly the spouse) on the etiology and treatment of the disease. 3. Ensure that the patient is enrolled in follow-up programs to maintain compliance. Ensure compliance with prescribed medicines Physicians generally prescribe a series of medications to reduce the chances of further AMI's. The primary prescription routines include beta blockers (to restore heart rhythms), anti-thrombotics (generally dual anti-platelet therapies) and, in some cases, anti-depressants. For longer-term reduction in AMI risk, physicians will also prescribe primary AMI reduction medicines, particularly statins, and secondary risk factor reductions. The latter may include glucophage for diabetes patients, anti-inflammatories for patients with concerns for inflammation, and other such medicaments as needed. It is particularly important that the patients maintain their anti-platelet therapies. Those who have received a coronary stent and stop their dual anti-platelet therapies within 6 months risk a 7-fold increase in secondary myocardial infarction (Grimes, 2007). Statin therapies have a similar inverse effect: once stopped, patients increase their chances of a second inflammation- or hypercholesteremia-induced MI. In contrast to anti-platelet therapy, however, the beneficial effects of statins do not seem to appear until at least 6 months after the onset of therapy (Heeschen, 2002). The role of the cardiac care nurse is not only to ensure proper taking of medications, but to educate the patient and his/her closest home caregiver in the function of these medications. This includes side-effects, and the consequences of cutting medication dosages or skipping administration. As a nurse, one can not only directly educate the patient, but also connect him/her with community and out-patient seminars and care solutions. In particular, at-hospital education sessions and community group therapy can be helpful. Nurses should also be attentive to patient fears, and look out for signs of depression. According to significant clinical research articles1, depression is both a co-related and a causative agent for subsequent AMI and rehospitalization. While it is understandable that patients may be fearful and depressed about their heart attack, addressing their depression symptoms (and perhaps those of their significant other and family) can improve compliance and reduce additional signs of cardiac troubles. The nurse can play two key roles: alert the physician to the possible presence of depression, and assist the patient and family to understand the benefits of aerobic exercise (which can be a depression-reducer). Behavioral changes Behavioral changes start in the hospital, but must be reinforced with the AMI patient's spouse and family. Although the rates of change are relatively low, the nurse and community programs can play a role in reducing harmful behaviors. A recent study indicated that in-hospital, nurse-directed stop-smoking programs increased the number of patients who stopped smoking (Gies, 2007). Other areas where the in-hospital nurse can be effective are as follows: 1. Discuss the impact of high BMI on future heart disease. Refer the patient to out-patient services to monitor weight. 2. Discuss the impact of exercise on the primary and secondary sequelae of heart disease. 3. Discuss compliance with the patient's spouse. 4. Discuss symptoms and next steps for follow-on AMI. The above concept map illustrates several of the main elements of nursing care post-AMI. The nurse plays a key role in the few days that the patient is in the hospital, despite not having a continuing role in patient care beyond that initial exposure. His/her intervention, diagnosis and direction to the patient and his/her family helps to reduce the chances of subsequent AMI. Conclusion The nurse can play a key role in insuring the short- and long-term survival of AMI patients. His/her role in post-AMI care can address the patient's capabilities to care for him/herself during the hospital stay and after his/her reentry into the community. The nurse's role is to be alert to the psyche of the patient and his/her immediate family, and include them in the patient's care during and after the hospital experience. By educating the patient on risk factors and how to reduce the risk of future heart problems, the nurse plays a key role in reducing fear and giving the patient an improved chance of compliance. The nurse can also help the patient to connect to resources on an out-patient basis with the hospital's training programs (such as seminars on heart care) and community resources, from group counseling to post-heart attack Internet resources. By involving the patient in his/her after-hospital care, the nurse can help to assure that the patient will improve his/her chances of not having a subsequent cardiac event, and improving his/her symptoms. Bibliography AHA. (2007, October 22). Heart Attack and Angina Statistics. Retrieved October 22, 2007, from AHA: http://www.americanheart.org/presenter.jhtmlidentifier=4591 AHA. (2007). Statistical Fact Sheet - Populations. Retrieved October 22, 2007, from American Heart Association: http://www.americanheart.org/downloadable/heart/1168553375937HISP07.pdf Gies, C. B. (2007). Effect of an Inpatient Nurse-Directed Smoking Cessation Program. Western Journal of Nursing Research , n.p. Grimes, C. B. (2007). Prevention of Premature Discontinuation of Dual Antiplatelet Therapy in Patients With Coronary Artery Stents. Circulation , 813-818. Heeschen, C. H. (2002). Withdrawal of Statins Increases Event Rates in Patients With Acute Coronary Syndromes. Circulation , 1446-1452. Innotrac. (2007). Innotrac Aio! immunoassay system for cardiac markers. Retrieved October 22, 2007, from Innotrac: Innotrac Aio! immunoassay system for cardiac markers Lauzon, C. e. (2003). Depression and prognosis following hospital admission because of acute myocardial infarction. Journal of the Canadian Medical Association , 547-552. Madjid, M. V.-T. (2007). Systemic Infections Cause Exaggerated Local Inflammation in Atherosclerotic Coronary Arteries. Journal of the Texas Heart Institute , 11-18. Sulfi, S. a. (2007). Heart Failure Complicating Acute Myocardial Infarction in Patients with Diabetes: Pathophysiology and Management Strategies. British Journal of Diabetes and Vascular Disease , 191-196. Thombs, B. e. (2006). Prevalence of Depression in Survivors of Acute Myocardial Infarction. J Gen Intern Med , 30-38. Read More