#1
Myocardial Infarction’s (MI) pathogenesis When blood supply to a portion of the heart muscle is blocked, tissue ischemia and necrosis result, which is known as myocardial infarction (MI). The most frequent cause is atherosclerosis, a condition in which the coronary arteries develop a plaque accumulation made of fatty deposits, cholesterol, and other materials. The formation of a thrombus, or blood clot, following a plaque rupture impedes blood flow to the myocardium. Within 20 to 30 minutes, the cardiac muscle cells suffer irreversible damage from this oxygen deprivation, which results in infarction. MI damage can cause cardiac function to be compromised, which can end in heart failure, arrhythmias, and, in extreme situations, death.
Cultural, Financial, and Environmental Implications
Cultural
A patient’s perspective of health, sickness, and treatment may be influenced by cultural customs and beliefs. For instance, stoicism may cause people in some cultures to put off getting medical help even when they are ill. As a former military officer, Leslie Collins could exhibit stoicism and minimize symptoms like chest pain, which could prolong his illness and make it worse. Furthermore, military members may put duty before their own health and are frequently subjected to high stress levels.
Financial
MI therapy involves hospital stays, diagnostic tests, medication, and continuous rehabilitation, it can be expensive. Leslie’s capacity to pay for these therapies will depend on his financial situation, which includes his eligibility for healthcare coverage as a former military officer. VA benefits may be available to veterans, which can help with their financial burden, but there might be restrictions based on their eligibility or ability to receive specialist care.
Environmental
The management and prevention of MI are influenced by environmental variables, including the availability of nutritious diet, safe places to exercise, and access to healthcare facilities. Leslie’s recuperation will be impacted by his ability to receive emergency care and rehabilitation. Furthermore, he might have been subjected to work risks including stress, restless nights, or chemical exposure as a soldier, all of which could raise his risk of cardiovascular disease.
Priority Nursing Interventions in the Emergency Department
Administer Oxygen Therapy– Supplemental oxygen should be given to maintain oxygen saturation and prevent further ischemia.
Administer Nitroglycerin and Aspirin – Nitroglycerin helps dilate blood vessels, improving blood flow to the heart, while aspirin prevents further clot formation.
Monitor Vital Signs and EKG Continuously – Monitoring allows the nurse to detect changes in heart rhythm and other signs of deterioration.
Administer Pain Relief (e.g., Morphine)– Pain control is essential, as chest pain increases sympathetic activity, which can further increase myocardial oxygen demand.
Prepare for Cardiac Catheterization or Thrombolytic Therapy – The nurse should prepare the patient for immediate interventions to restore blood flow, such as angioplasty or thrombolysis.
Labs and Diagnostic Testing
1. Troponin Levels – Troponin is a key marker of myocardial injury. Elevated troponin levels indicate myocardial cell damage and are critical in diagnosing MI
Creatine Kinase-MB (CK-MB) – Another enzyme that rises in response to myocardial damage, CK-MB is often used alongside troponin levels to confirm an MI diagnosis.
Electrocardiogram (EKG) – An essential diagnostic tool to identify the location and extent of the myocardial infarction, changes in the ST segment, T wave, and Q waves indicate areas of ischemia or infarction.
Complete Blood Count (CBC) – To assess hemoglobin levels, platelets, and potential signs of infection or anemia, which could exacerbate ischemic events.
Lipid Panel– Given Leslie’s history of high cholesterol, assessing his current lipid levels will provide insight into risk factors and guide future cholesterol-lowering therapy.
Members of the Interdisciplinary Team
Cardiologist – For expert evaluation and management of the myocardial infarction, including performing procedures like cardiac catheterization and long-term care planning. 2. Physical Therapist– To support recovery by assisting with physical activity and rehabilitation, which is key to preventing future cardiac events.
Pharmacist – To manage and adjust medications such as antiplatelets, statins, and beta-blockers, ensuring that Leslie receives optimal pharmacotherapy post-MI.
Dietitian/Nutritionist – Given his history of high cholesterol, a dietitian can work with Leslie to develop a heart-healthy eating plan to reduce future risk factors.
Mental Health Counselor/Psychologist– Addressing stress, anxiety, and possible post-traumatic stress disorder (PTSD), which are prevalent in veterans and can affect recovery from MI
#2
A myocardial infarction also known as a “heart attack” occurs when there is a stop of blood flow to any part of the myocardium. At times a myocardial infarction can be so miniscule that it occurs without causing any obvious signs or symptoms. This obscure occurrence is often known as a silent heart attack and is most commonly detectable through an electrocardiogram or an EKG. Other occurrences are more severe and categorized as catastrophic leading to homeostatic deterioration and even death. Many heart attacks are attributed to coronary artery disease. Coronary artery disease is when the coronary arteries become blocked and cause a cessation of blood flow to the myocardium. This cessation of blood flow depletes the myocardium of oxygen and then leads to cell death of the myocardium (Ojha & Dhamoon, 2023).
Surprisingly considering other researches I have read regarding culture affecting health, when it came to the trends of a myocardial infarction based on cultures, trends have shown that over a 14 year span all cultures decreased in the percentage of myocardial infarctions resulting in that Hispanics and Asians showed less incidences of MI than their white counterparts. Though the blacks had decreased in incidences, they eventually saw a plateau. This trend shows definitely shows that culture has a direct relation to this disease process (Chi et al., 2020).
In a study involving both the United States and Finland people from a low socioeconomic status were at an increased risk for non-fatal MI’s and sudden death (Schultz et al., 2018). In another study taking environmental considerations, air pollution, green space ratio to a resident’s home and road traffic nose was found to have an effect on increasing or decreasing the risk of an MI (Poulsen et al., 2023).
My first nursing intervention is to ensure patient has a patent airway and that their breathing is compensating adequately to meet their body’s needs and if not supplementing with oxygen or an airway if necessary. This can be measured with a pulse ox. Ensuring patient safety would be my next nursing intervention. My third intervention would be communicating with the patient and family and providing appropriate immediate education for treatments and potential outcomes. Another nursing intervention would be administering appropriate ordered medications such as Nitro or aspirin to assist in cardiac perfusion.
When a patient comes into the emergency room for suspected MI the three labs that performed would be ordered are a troponin, BNP, and a Creatinine (MYTHILI & MALATHI, 2015). These are some of the biomarkers that would result in an elevation for this type of event. Though there are other biomarkers that could be tested, these are the most commonly ordered. Elevation of these studies would be expected. EKG would confirm an MI and the severity of. A chest x-ray would help us determine a widening mediastinum to determine the reason for pain.
Critical levels of these would be:
Troponin > 0.40 nanograms per milliliter can indicate a heart attack and should be considered critical
BNP a level of >400 pg/ml is elevated and indicated heart failure. A level of over 4000 pg/ml is dangerous (What Is a BNP Test? Results, Normal, High, and Levels, n.d.).
Creatinine >5.0 mg/dl in adults is critical
According to Batchelor et al. (2023), a study showed that member of the multidisciplinary team should include a core team consisting of Interventional imaging physician or an interventional cardiologist, who would be responsible for utilizing guided imagery to assist in catheterizations and to assist in treating vascular diseases, an interventional cardiologist, a cardiac surgeon could also be needed if open heart surgery was needed or any other cardiac surgery. More member of the multidisciplinary team, apart form the core team, would include a primary care physician to oversee the medical regiment overall, and nurses who would assist in closely hemodynamical monitoring the patient as well as administering medications.
In the inpatient arena a pharmacist would also be brought in to assist with proper medication coordination and monitoring of drug interactions and therapeutic levels. A dietician would also assist in recommending diet recommendations. A social worker would also benefit this patient for any home needs and or outpatient resources. With proper and timely collaboration off all members of this patients’ multidisciplinary team, this patient expected outcome would be maximal efficacy reached.
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