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Objectives activity aids
activity
1 1 mts Introduction: Explaining Listening
One ceiling fan Spin it suddenly stopped the
movement the first reason was the electric barrier or
maybe a pitch in the current
Myocardial infarction (MI), is used synonymously with
coronary occlusion and heart attack, yet MI is the most
preferred term as myocardial ischemia causes acute
coronary syndrome (ACS) that can result in myocardial
death.
2 2 mts Define the term Definition Explaining Listening Model Define the term
of Myocardial  MI is defined as a diseased condition which is Myocardial
Infarction caused by reduced blood flow in a coronary artery Infarction?
due to atherosclerosis and occlusion of an embolus
or thrombus
 MI or heart attack is the irreversible damage of
myocardial tissue caused by prolonged ischemia &
hypoxia LCD
3 1 mts Students will be Statistics and Epidemiology
able to know the “Time is muscle”; this is the reflection of the
Statistics urgency of appropriate treatments to improve patient
outcome.
• Each year in the United States, nearly 1 million
people have acute MIs.
• One fourth of the people with the disease die of MI.
• Half of the people who die with acute MI never
reach the hospital.
4 2 mts Describe The Causes Explaining Listening Chart Can you able to
Causes The causes of MI primarily stems from the vascular tell about the
system. causes?
 Vasospasm. This is the sudden constriction or
narrowing of the coronary artery.
 Decreased oxygen supply. The decrease in
oxygen supply occurs from acute blood
loss, anaemia, or low blood pressure.
 Increased demand for oxygen. A rapid heart rate,
thyrotoxicosis, or ingestion of cocaine causes an
increase in the demand for oxygen Can you able to
5 3 mts Enumerate the Pathophysiology Explaining Listening Handout enumerate the
Pathophysiology  Leukocytes Infiltrate the area Pathophysiology?
 Dead cardiac cells released enzymes
 4th day proteolytic enzymes of the neutrophils and
macrophages begin
 The development of collateral circulation
 Catecholamine – mediated lipolysis and
glycogenolysis occur
 At 10 to 14 days after MI the new scar tissue to still
weak. The myocardium to vulnerable to increased
stress during this time
 6 wks. after scar tissue has replaced necrotic tissue
and the injured area in considered weaken
 Uncoordinated wall motion, ventricular
dysfunction, or heart failure
 In attempt to compensation for the damage muscles
the normal myocardium
 Ventricular remodelling
6 3 mts Listdown the Clinical Manifestations Explaining Listening Handout Can you able to
Clinical  Chest pain. This is the cardinal symptom of MI. tell about the
Manifestation Persistent and crushing sub sternal pain that may Clinical
radiate to the left arm, jaw, neck, or shoulder Manifestation?
blades. Pain is usually described as heavy,
squeezing, or crushing and may persist for 12 hours
or more.
 Shortness of breath. Because of increased oxygen
demand and a decrease in the supply of oxygen,
shortness of breath occurs.
 Indigestion. Indigestion is present as a result of the
stimulation of the sympathetic nervous system.
 Tachycardia and tachypnea. To compensate for
the decreased oxygen supply, the heart rate and
respiratory rate speed up.
 Catecholamine responses. The patient may
experience such as coolness in extremities,
perspiration, anxiety, and restlessness.
 Fever. Unusually occurs at the onset of MI, but a
low-grade temperature elevation may develop
during the next few days.
7 2 mts Describe the Prevention Explaining Listening LCD How to prevent
Preventive A healthy lifestyle could help prevent the development of the MI?
Measures MI.
 Exercise. Exercising at least thrice a week could
help lower cholesterol levels that cause
vasoconstriction of the blood vessels.
 Balanced diet. Fruits, vegetables, meat and fish
should be incorporated in the patient’s daily diet to
ensure that he or she gets the right amount of
nutrients he or she needs.
  Smoking cessation. Nicotine
causes vasoconstriction which can increase the
pressure of the blood and result in MI.
8 3 mts Students will be Assessment and Diagnostic Findings Explaining Listening Pamphlet How to identify
able to known The diagnosis of MI is generally based on the presenting the Condition?
about the symptoms.
Diagnostic  Patient history. The patient history includes the
Findings description of the presenting symptoms, the history
of previous cardiac and other illnesses, and the
family history of heart diseases.
 ECG. ST elevation signifying ischemia; peaked
upright or inverted T wave indicating injury;
development of Q waves signifying prolonged
ischemia or necrosis.
 Cardiac enzymes and is enzymes. CPK-MB (is
enzyme in cardiac muscle): Elevates within 4–8
hrs. peaks in 12–20 hrs., returns to normal in 48–
72 hr. Explaining Listening Pamphlet
 LDH. Elevates within 8–24 hrs. peaks within 72–
144 hrs., and may take as long as 14 days to return
to normal. An LDH1 greater than LDH2 (flipped
ratio) helps confirm/diagnose MI if not detected in
acute phase.
 Troponins. Troponin I (cTnI) and troponin T
(cTnT): Levels are elevated at 4–6 hrs. peak at 14–
18 hrs., and return to baseline over 6–7 days. These
enzymes have increased specificity for necrosis
and are therefore useful in diagnosing
postoperative MI when MB-CPK may be elevated
related to skeletal trauma.
 Myoglobin. A heme protein of small molecular
weight that is more rapidly released from
 damaged muscle tissue with elevation within 2 hr
after an acute MI, and peak levels occurring in 3– Explaining Listening Pamphlet
15 hr.
 Electrolytes. Imbalances
of sodium and potassium can alter conduction and
compromise contractility.
 WBC. Leukocytosis (10,000–20,000) usually
appears on the second day after MI because of the
inflammatory process.
Students will be  ESR. Rises on second or third day after MI, How to identify
able to known indicating inflammatory response. the Condition?
about the  Chemistry profiles. May be abnormal, depending
Diagnostic on acute/chronic abnormal organ
Findings function/perfusion.
 ABGs/pulse oxymetry. May indicate hypoxia or
acute/chronic lung disease processes.
 Lipids (total lipids, HDL, LDL, VLDL, total
cholesterol, triglycerides,
phospholipids). Elevations may reflect
arteriosclerosis as a cause for coronary narrowing
or spasm.
 Chest x-ray. May be normal or show an enlarged
cardiac shadow suggestive of HF or
Explaining Listening
ventricular aneurysm.
 Two-dimensional echocardiogram. May be done
to determine dimensions of chambers,
septal/ventricular wall motion, ejection fraction
(blood flow), and valve configuration/function.
 Nuclear imaging studies: Persantine or
Thallium. Evaluates myocardial blood flow and
status of myocardial cells, e.g., location/extent of
acute/previous MI.
  Cardiac blood imaging/MUGA. Evaluates
specific and general ventricular performance,
regional wall motion, and ejection fraction.
 Technetium. Accumulates in ischemic cells,
outlining necrotic area(s).
 Coronary angiography. Visualizes
narrowing/occlusion of coronary arteries and is
usually done in conjunction with measurements of
chamber pressures and assessment of left
ventricular function (ejection fraction). Procedure
is not usually done in acute phase of MI unless
angioplasty or emergency heart surgery is
Students will be imminent. How to identify
able to known  Digital subtraction angiography the Condition?
about the (DSA). Technique used to visualize status of
Diagnostic arterial bypass grafts and to detect peripheral artery
Findings disease.
 Magnetic resonance imaging (MRI). Allows
visualization of blood flow, cardiac chambers or
intraventricular septum, valves, vascular lesions,
plaque formations, areas of necrosis/infarction, and
blood clots.
 Exercise stress test. Determines cardiovascular
response to activity (often done in conjunction with
thallium imaging in the recovery phase).
9 3 mts Students will be Medical Management Explaining Listening OHP What are all the
able to Known emergency care
the Medical needed?
Management

Explaining Listening LCD

Pharmacologic Therapy
 Morphine administered in IV boluses is used for
MI to reduce pain and anxiety.
 ACE Inhibitors. ACE inhibitors prevent the
conversion of angiotensin I to angiotensin II to
decrease blood pressure and for the kidneys to
secrete sodium and fluid, decreasing the oxygen
demand of the heart.
  Thrombolytic. Thrombolytic dissolve
the thrombus in the coronary artery, allowing
blood to flow through the coronary artery again,
minimizing the size of the infarction and
preserving ventricular function.
10 1 mts students will be Emergent Percutaneous Coronary Intervention Explaining Listening LCD What you mean
able to know the by PCI?
PCI

 The procedure is used to open the

occluded coronary artery and promote reperfusion
to the area that has been deprived of oxygen.
 PCI may also be indicated in patients with
unstable angina and NSTEMI for patients who are
at high risk due to persistent ischemia.
Students Will be Nursing Management Explaining Listening LCD What are all the
able to know the The nursing management involved in MI is critical and nursing
Nursing systematic, and efficiency is needed to implement the care management?
Management for a patient with MI.
11 2 mts Nursing Assessment
One of the most important aspects of care of the patient
with MI is the assessment.
 Assess for chest pain not relieved by rest or
medications.
 Monitor vital signs, especially the blood
pressure and pulse rate.
  Assess for presence of shortness of breath,
dyspnea, tachypnea, and crackles.
 Assess for nausea and vomiting.
 Assess for decreased urinary output.
 Assess for the history of illnesses.
 Perform a precise and complete physical
assessment to detect complications and changes in
the patient’s status.
 Assess IV sites frequently.
Diagnosis
12 1 mts Will be able to Based on the clinical manifestations, history, and Explaining Listening LCD Describe the
know the diagnostic assessment data, major nursing diagnoses may Diagnostic
Diagnosis and include. measures?
goals
 Ineffective cardiac tissue perfusion related to
reduced coronary blood flow.
 Risk for ineffective peripheral tissue
perfusion related to decreased cardiac output from
left ventricular dysfunction.
 Deficient knowledge related to post-MI self-care.
13 1 mts Planning & Goals Explaining Listening LCD
 Relief of pain or ischemic signs and symptoms.
 Prevention of myocardial damage.
 Absence of respiratory dysfunction.
 Maintenance or attainment of adequate tissue
perfusion.
 Reduced anxiety.
 Absence or early detection of complications.
 Chest pain absent/controlled.
 Heart rate/rhythm sufficient to sustain adequate
cardiac output/tissue perfusion.
  Achievement of activity level sufficient for basic
self-care.
 Anxiety reduced/managed.
 Disease process, treatment plan, and prognosis
understood.
 Plan in place to meet needs after discharge.
Nursing Priorities
• Relieve pain, anxiety.
• Reduce myocardial workload.
• Prevent/detect and assist in treatment of life-
threatening dysrhythmias or complications.
• Promote cardiac health, self-care.
14 2 mts Students will be Nursing Interventions Explaining Listening LCD How to provide
able to know the Nursing interventions should be anchored on the goals in the quality care?
Nursing the nursing care plan.
Intervention?  Administer oxygen along with medication therapy
to assist with relief of symptoms.
 Encourage bed rest with the back rest elevated to
help decrease chest discomfort and dyspnea.
 Encourage changing of positions frequently to help
keep fluid from pooling in the bases of the lungs.
 Check skin temperature and peripheral pulses
frequently to monitor tissue perfusion.
 Provide information in an honest and supportive
manner.
 Monitor the patient closely for changes in cardiac
rate and rhythm, heart sounds, blood
pressure, chest pain, respiratory status, urinary
output, changes in skin colour, and laboratory
values.
 Evaluation
After the implementation of the interventions within the
time specified, the nurse should check if:
 There is an absence of pain or ischemic signs and
symptoms.
 Myocardial damage is prevented.
 Absence of respiratory dysfunction.
 Adequate tissue perfusion maintained.
 Anxiety is reduced.
15 2 mts Students Will be Discharge and Home Care Guidelines Explaining Listening LCD Enumerate the
able to Know The most effective way to increase the probability that the home care
the Home Care patient will implement a self-care regimen after discharge methods?
Management is to identify the patient’s priorities.
 Education. This is one of the priorities that the
nurse must teach the patient about heart-healthy
living.
 Home care. The home care nurse assists the
patient with scheduling and keeping up with the
follow-up appointments and with adhering to the
prescribed cardiac rehabilitation management.
 Follow-up monitoring. The patient may need
reminders about follow-up monitoring including
periodic laboratory testing and ECGs, as well as
general health screening.
 Adherence. The nurse should also monitor the
patient’s adherence to dietary restrictions and
prescribed medications.
Documentation Guidelines
To ensure that every action documented is an action done,
documentation must be secured. The following should be
documented:
 Individual findings.
  Vital signs, cardiac rhythm, presence of
dysrhythmias.
 Plan of care and those involved in planning.
 Teaching plan.
 Response to interventions, teaching, and actions
performed.
 Attainment or progress towards desired outcomes.
 Modifications to plan of care.
Summary
 Description of myocardial infarction
 Pathophysiology
 Statistics and epidemiology
 Causes
 Clinical manifestation
 Prevention
 Assessment and diagnostic findings
 Medical management
 Pharmacological therapy
Conclusion
By taking this microteaching students have gained
adequate knowledge regarding various aspects of
myocardial infarction. Students will be able to apply
adequate knowledge on myocardial infarction
management in various health care setting. I think our
madam/sir for giving this great opportunity.