Nursing Diagnoses for a Patient with Chest Pain and Myocardial Infarction

QUESTION

On admission to the Emergency Department (ED), David is diaphoretic and pale. He is alert and orientated but anxious with central chest pain. The doctor examines him and orders a stat dose of IV morphine. David’s ECG is attended and shows ischaemic injury (ST elevation) in the anterior leads. As ST elevation indicates a coronary artery blockage, treatment is aimed at unblocking the vessel.

The doctor asks David if he has any history of head injuries, malignancies, stroke or gastric bleeding to ensure there are no contraindications for thrombolytic treatment. No risk factors are identified, and David is given thrombolytic therapy.

Admission observations

Temperature = 36.8 ℃

Pulse Rate = 108 beats/min

Respiratory Rate = 24 breaths/min

Blood Pressure = 150/90 mmHg

Sp02 = 95% on room air

BGL = 14.1 mmol/L

Pain score = 8

GCS = 15

Co-morbidities

Osteoarthritis

Hypertension

Hyperlipidaemia

Type 2 diabetes mellitus

Based on your interpretation of the assessment findings, explain two (2) nursing diagnoses for the person in the scenario

ANSWER

Nursing Diagnoses for a Patient with Chest Pain and Myocardial Infarction

In the given scenario, David, a patient experiencing central chest pain with ST elevation on his ECG, is admitted to the Emergency Department. The following nursing diagnoses are pertinent to his condition:

Acute Pain related to myocardial infarction and ischemic injury.

Rationale
David’s central chest pain, radiating down his left arm, and the ST elevation on his ECG are indicative of a myocardial infarction (MI). MI is a medical emergency, and the associated ischemic injury to the heart muscle results in severe chest pain. The patient rates his pain as 8 out of 10, indicating significant discomfort. As a nurse, addressing his pain is a priority not only to relieve suffering but also to decrease cardiac workload and oxygen consumption, thus minimizing the extent of the infarction. Effective pain management can also reduce anxiety, which is essential in MI cases. As David’s advocate, the nurse should assess pain characteristics, administer pain relief interventions such as sublingual nitroglycerin and IV morphine, and monitor pain relief effectiveness to maintain a pain score of 0-2.

Anxiety related to acute coronary syndrome and therapeutic interventions

Rationale
David presents with anxiety, which is a common response to experiencing chest pain and the fear associated with acute coronary syndrome. Anxiety can exacerbate his condition by increasing sympathetic nervous system activity, leading to vasoconstriction, increased heart rate, and blood pressure. To address this nursing diagnosis, the nurse should establish rapport, provide psychological support, and offer thorough explanations of the diagnostic and therapeutic procedures. Communication and reassurance can help reduce David’s anxiety levels and promote a sense of control. Implementing relaxation techniques and diversional activities can also aid in anxiety reduction.

In conclusion, when caring for a patient like David, who presents with chest pain and an ST-elevation MI, nursing diagnoses related to pain management and anxiety are essential for providing holistic and effective care. Through assessment, intervention, and patient education, the nurse plays a crucial role in addressing David’s immediate needs while preparing him for further therapeutic interventions and the recovery process.