Stressor: Myocardial Ischemia

Adaptation: Hypertension and chest pain.

NX DX: Myocardial infarction: High risk related to severe, prolonged myocardial ishemia as manifested by a past hx of MI, hx of hypertension, unstable angina and episodes of severe chest pain.

Goals:
STG: Pt. will experience a resolution of chest pain, upon occurrence within 15 minutes during the length of hospital stay starting 3/6/96

LTG Pt. will show no signs of cardiac arrhythmias as evidenced by AP at 60-100 bpm, systolic BP being less than 140 and EKG showing normal sinus rhythm by end of hopital stay on 3/7/96.

NX INTERVENTIONS:

NI #1: Nurse will assess pt. for chest pain noting the severity, duration, activity that brought pain on and how it was relieved PRN and each shift starting 3/6/96 .................... Anneliese Garrison,NS

Scientific Rationale: Any blockage of the coranary arterial circulation can be serious. According to my pt.'s chest x-ray, mild calcification of the aortic arch was present. This is giving rise to an impairment of blood flow to the heart causing him to have angina. Anginina is chest pain caused by fleeting, deficient blood delivery that may result from stress-induced spasms of the coronary arteries or increased physical demands on the heart. The myocardial cells are weakened by a temporary lack of oxygen, but they do not die. Far more serious is a prolonged coronary blockage resulting from an occluding blood clot or severe atherosclerosis. My pt. is putting himself at risk for developing artherosclerosis. His lab data showed a cholesterol level of 217 and a triglyceride level of 463. If this should continue, the ischemic cardiac cells will die, forming an infarct. The resulting myocardial infarction is commonly referred to as a heart attack or a coronary. Because the adult cardiac muscle is amitotic, any areas of cell death are repaired with noncontractile scar tissue. Thus decreasing the amount of oxygen delievered to the heart. So, whether or not a person survives a MI, depends on the extent of cell death and on the location of the damage.