Nursing Dx for Anterior MI

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Specializes in Long Term Care.

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:uhoh3:. 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:confused: ??

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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:uhoh3:. 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:confused: ??

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)

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Specializes in Telemetry.

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?

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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.

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

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Specializes in Telemetry.

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?

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

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Specializes in Telemetry.

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?

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morphine for pain...

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Specializes in Telemetry.

Serial Troponins

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Specializes in med/surg, telemetry, IV therapy, mgmt.

everyone. . .the op also posted this very same thing (word for word) on the general nursing discussion forum. i did not see it until tonight and answered it for her.

"there is no way that anyone can answer your question for you. the selection of a nursing diagnosis is not necessarily dependent on the medical diagnosis. it is dependent on the symptoms that the patient is having, not upon their medical diagnosis. the medical diagnosis can only point you in the direct of possible nursing diagnoses that you could use. this saves you time in looking for nursing diagnoses to go with your patient's symptoms if you are not familiar with the definitions and symptoms of the various nursing diagnoses. however, the patient still has to have the symptoms that match with that nursing diagnosis. you haven't mentioned one symptom that your patient has so there is no way to evaluate whether or not your choice of nursing diagnoses is correct.

the first step in care planning is to make a thorough assessment of your patient and pull out the list of all your abnormal findings. those abnormal findings, or symptoms, become the basis that support any nursing diagnoses you choose. as a student, you need to use a nursing diagnosis book as a reference to do this. just like a medical diagnosis has a list of symptoms associated with it, each nursing diagnosis also has a list of symptoms associated with it. these will be listed in a nursing diagnosis book."

since this op is a nursing student, the point of any care plans that are done is that the steps of the nursing process are being followed. that said, it is impossible to answer the op because the information needed has not been supplied. you cannot tack a nursing diagnosis onto a patient based upon their medical diagnosis. without the proper supporting patient symptoms it's like trying to put a square peg in a round hole.

let me put it another way, no doctor is going to (medically) diagnose a patient without having first done a proper assessment and determination of the patient's symptoms. if he is going to ask a colleague which diagnosis to use for a patient, his colleague is going to want to know what the patient's symptoms are. make sense?

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