Running head: PART B: MYOCARDIAL ISCHEMIA

Part B: Myocardial Ischemia

Valentina M Ramirez NURS252
Humber College

PART B: MYOCARDIAL ISCHEMIA

2
Myocardial Ischemia

A fifty eight year old female has come into the walk in clinic with pain in her jaw and
lower back for the past twenty four hours. She has a history of hypertension and cholesterol and
she is currently faced with high demands from work. The signs and symptoms she is displaying
are the warning signs for myocardial infarction. Her increasing age, gender and health history
have also contributed to her prognosis. There are several pharmacological and nonpharmacological ways to treat her. In this case, it is important to establish a quick resolution for
her pain before it worsens.
The pathophysiological priorities versus the psychological priorities for myocardial
ischemia attack. Having her arteries subjected to a constant elevated pulse pressure causes the
endothelial cells of the artery wall to weaken and damage (Dart & Kingwell, 2001, p. 979).
Arthrosclerosis becomes eminent, and stiffening in the artery will occur; which will only worsen
the disease process and cause a lack of blood flow to the major organs (Dart & Kingwell, 2001,
p. 979). Arterial hypoxia to the cardiac muscle will trigger an increase in blood pressure and
reduce vascular conductance (Calbet, et al., 2014, p. 582). The dying tissues activate the
chemorereflexes to send pain signals along the nerves. Controlling her pain will help her vital
signs become more stable. When someone is in a state of pain their breathing, blood pressure,
and pulse increase. Once her pain level decreases her hyperventilation should subside, as
anticipated, from becoming more relaxed. Her high blood pressure, of 148/96, and increased
heart rate, of 100 beats per minute, should decrease once the pain reduces. This will allow for
the cardiac muscle to contract effectively without putting added strain onto the heart. To control
tachycardia and help coronary artery perfusion, her blood pressure must be managed by
removing the painful stimuli (Lewis, Heitkemper, & & Dirksen, 2006, p. 1980).

PART B: MYOCARDIAL ISCHEMIA

There are also psychological risk factors brought on by the negative effects of stress,
which may have led to her episode of myocardial ischemia. Stress can sometimes put the body in
a destructive state, especially when the person cannot tolerate added stress; stress overload
occurs. Some of the signs and symptoms that made it hard for her body to function properly
include: overwhelming emotions, disturbed sleeping patterns, and high level of activity. Since a
myocardial ischemia attack is a pathophysiologic alteration affecting her heart during this
moment, then the main goal would be to treat her physical threat now (i.e. acute pain), rather
than manage her chronic stress at this time.
The clinical manifestations for a myocardial ischemia attack. Her coronary arteries are
not providing enough oxygenated blood to the heart which is evidenced by her bodys response;
increased respirations of twenty breaths per minute and her decreased oxygen saturation, 90% on
room air (Erfanian, 2001, p. 33). The patients age will also play a role in her health. Women
who have reached the age of fifty to fifty five have an increased chance of having a myocardial
infarction (Erfanian, 2001, p. 33). This increase is due to the fact that their estrogen levels have
decreased; they are left vulnerable at this time (Erfanian, 2001, p. 33). Their natural protection is
gone, and their bodys ability to uphold vasodilatation in the coronary arteries and protect against
harmful cholesterol has diminished (Erfanian, 2001, p. 33). These women have a higher chance
of developing arthrosclerosis as more fatty deposits are made in the arteries (Erfanian, 2001, p.
33). The plaque increases the risk for blood clot formation as the arteries begin to narrow
(Erfanian, 2001, p. 33). Jaw pain and lower back pain may be a result of the lack of oxygen
supplied to the heart; due to narrowed arteries.
The nursing interventions for a myocardial ischemia attack. The very first action
would be to get this patient to sit down and relax. She is short of breath and this could cause her

PART B: MYOCARDIAL ISCHEMIA

to have a dizzy spell or faint, causing more bodily trauma. A resting electrocardiography test
should be recorded the minute she arrives on seen. This will discover any irregular patterns in the
heart and pin point whether it is in fact related to ischemia or myocardial infarction (O'Shea,
2010, p. 17). Exertion may be eliciting her pain, so less movement may do the opposite and
terminate her pain (O'Shea, 2010, p. 14). Analgesics such as such as aspirin and nitroglycerin
should be administered within the first five minutes of arrival (Weldon, 2016, p. 46). A chewable
aspirin (160mg) will keep a myocardial infarction from occurring and decrease pain within the
first fifteen to thirty minutes of taking it (Weldon, 2016, p. 46). A sublingual dose of 0.4mg
nitroglycerin spray should be administered to help dilate coronary arteries and recover the blood
flow to the heart; thus decreasing pain (Skidmore-Roth, 2014, p. 757). The sublingual dose may
be executed twice more times if pain persists, but they must be taken five minutes apart.
However, if the three sublingual nitroglycerin spray 0.4mg doses are ineffective, then the use of
morphine may be considered for pain control (Lewis, Heitkemper, & & Dirksen, 2006, p. 912).
Morphine has the ability to not only reduce cardiac workload, but also decrease feelings of fear
and anxiety (Lewis, Heitkemper, & & Dirksen, 2006, p. 915). Morphine should lower the blood
pressure and heart rate, which is why it is important to constantly monitor these vitals while a
patient is receiving it (Lewis, Heitkemper, & & Dirksen, 2006, p. 915). The patient should be
aware that they should not get up right away due to their increased risk for having an episode of
syncope occur once their blood pressure starts lowering.
The patients pain level should be monitored every five minutes and after every analgesic
dose administered utilizing the numeric pain intensity scale. It is estimated that the patients pain
level should go down to a more tolerable number once they have been given some form of
analgesics. If the pain worsens then the amount of doses should coordinate with it. One way of

PART B: MYOCARDIAL ISCHEMIA

not using pharmacological methods to help with pain is through the notion of distraction
techniques. This can work by just simply talking to the patient and finding out what they like (i.e.
grandchildren) or dislike so that you can focus the conversation on those specific topics. When
their mind is focused on something other than their pain, then their body is able to relax more. If
talking does not help them then music can be mentally stimulating as well.
Myocardial ischemia has shown how it can cause a person so much distress. Medical
history, gender, and age were all unwelcoming medical findings that increased this patients risk
for having a myocardial ischemia. Choosing to take care of her physical needs rather than her
psychological needs allows for her survival through a life threatening event. All of her vitals
were negatively affected by the level of her pain. Using relaxation techniques and
pharmacological methods such as aspirin helped address her pain appropriately. It was estimated
that her level of pain would have successfully decreased within fifteen minutes after the last dose
of the sublingual nitroglycerin 0.4mg spray.

PART B: MYOCARDIAL ISCHEMIA

6
Bibliography

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Erfanian, P. (2001). Patient with signs and symptoms of myocardial infarction, presenting to a
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