c. In the majority of patients with AMI, chest pain is the major presenting
symptom. The pain is usually substernal and may radiate to the neck, shoulders, arms,
or epigastric area. The pain is described as heaviness, constriction, burning, or similar
to indigestion. It is important to remember, however, that there may be little or no pain
present at all. AMI can be very subtle, and often difficult to distinguish from angina. In
addition to chest pain, symptoms of MI include shortness of breath, diaphoresis,
weakness, fatigue, anxiety, nausea, vomiting, abnormal blood pressure, and abnormal
d. Pain, anxiety, and arrhythmias occur in the early stages of MI. Ventricular
fibrillation is the greatest threat to life in the first hours after MI. Medical management
includes ECG monitoring, bedrest to reduce the workload of the heart, and intravenous
therapy. Medications include morphine to reduce pain and relieve anxiety, vaso-
dialators, beta blocker, calcium channel blockers and lidocaine as antiarrhythmic
e. Nursing management of a patient with AMI is intensive in nature, requiring
close monitoring of the patient's status and progress, along with concurrent patient
education. The nursing staff works closely with the physician, physical therapist, and
dietician to develop an individualized rehabilitation plan for the patient. This post
myocardial infarction rehabilitation plan, often referred to as the "MI protocol," takes the
patient from complete bed rest during the first days of his MI to discharge from the
hospital several weeks later. The protocol is a plan of progressive, monitored "steps" of
increased activity and exercise, accompanied by intensive patient education. The
rehabilitation plan is implemented upon physician's orders once the patient's condition is
stable. Rehabilitation is advanced by the physician, who bases his decisions upon daily
review of the patient's status and the information recorded by the nursing staff.
Important information regarding patient tolerance and acceptance of the rehabilitation
process is obtained by the nursing staff and recorded in the patient's chart.
f. Nursing care is directed toward three major considerations: observation and
prevention of further myocardial damage and complications, promotion of an
environment that allows for maximum comfort and rest, and patient education to fully
prepare the patient for discharge.
Observation and prevention include the following nursing considerations:
(a) Frequent monitoring of the patient's vital signs and ECG.
(b) Observation for signs of impending heart failure by close monitoring
of intake and output, daily weight, breathe sounds, and serum enzymes.
(c) Careful assessment and documentation of each episode of chest
pain to include severity, duration, medication given, and relief obtained.