[TruDivaRN]

I had my clinical instructor review my careplan for my client who had an MI on the 25th. She told me that Ineffective Tissue Perfusion and Decreased Cardiac Output where the same Nursing Dx. Ineffective Tissue Perfusion is my primary Nursing Dx. I was thinking of replacing Decreased Cardiac Output with Impaired Gas Exchange. My question is should I make the Impaired Gas Exchange my primary ??

[SMK1]

Originally Posted by SOON_2_BE_RN

I had my clinical instructor review my careplan for my client who had an MI on the 25th. She told me that Ineffective Tissue Perfusion and Decreased Cardiac Output where the same Nursing Dx. Ineffective Tissue Perfusion is my primary Nursing Dx. I was thinking of replacing Decreased Cardiac Output with Impaired Gas Exchange. My question is should I make the Impaired Gas Exchange my primary ??

Do they have impaired gas exchange? If so then yes make it your priority diagnosis, personally I would use decreased cardiac output over ineffective tissue perfusion because it seems to relate more specifically to what would happen as a result of an MI. (the decreased CO causes the ineffective tissue perfusion)

[TachyBrady]

Gosh, it's been a long time since I worked with care plans even though I carry out the interventions frequently in my job. Ineffective tissue perfusion sounds like a good choice. You have an occluded coronary artery that is hindering cardiac tissue perfusion. Cardiac output may or maynot be significantly affected depending on the size of muscle tissue damage. Impaired gas exhange sounds more like a respiratory thing which also can ultimately result from an MI. But first, you want to help increase perfusion to the heart. What are some interventions you can do to accomplish that?

[SMK1]

I am assuming that the occlusion has caused the infarction so perfusion to the dead infarct tissue isn't the greatest concern, or they have stented and opened the occlusion and improved perfusion to areas that can be saved already so the main issue now is the damage to heart which affects the contractility. This is a good point though! is the op wanting to address a ndx for a current MI that is happening or address the issues that happen after the episode? The interventions would be different in these situations.

[EricEnfermero]

How did they treat the MI? Is the pt in any pain?

[TachyBrady]

How about we start a care plan regardless of where the pt is. They may be in the field being cared for by an medic, in the ER with docs and nurses, in the cath lab, or on the floor after the fact with nurses.

Basically, are we going to want to:

assess for chest pain ?
provide supplemental O2 ?
NTG?

What else?

[SMK1]

Get them on tele and and get an I.V. in, obtain an order for a 12 lead ECG. Possibly aspirin...

[TachyBrady]

Good job SM. Aspirin is a biggy. The doctor may also order Plavix and heparin or lovenox. If the pt is for a cath, I'm not sure if they would still get the heparin/lovenox (anyone know?).

Possibly a beta blocker to ease the work of the heart.

What else?

[SMK1]

morphine for pain...

[TachyBrady]

Serial Troponins