Nurses Role in the Initial Assessment and Nursing Management

Nurses role in the initial assessment and nursing management of a patient with Acute Myocardial Infarction For the purpose of this essay, the author will investigate the role of a registered nurse in the initial assessment and management of a patient with acute Myocardial Infarction (MI).

This essay will further discuss the anatomy of the heart and how it functions; the pathophysiology and initial signs and symptoms of MI.To achieve this, the author has conducted literature review through using the following database: CINAHL, MEDLINE and INTERNURSE. These databases were chosen because they provide nursing journals and provide nurses with the best available and most recent clinical evidence. The first key word was acute myocardial infarction, second assessment and third management.

Combined together three hundred and twenty three results came up on the database which was too much.To limit the search and to ensure that only most current and relevant database came out the author added year limit 2007 to 2012 and age groups which was adult getting twenty seven articles. According to the code of professional conduct of nursing and Midwifery Council (NMC), registered nurses have a responsibility to deliver care based on current evidence, best practice, and where applicable-validated research where available (NMC 2010). Nursing research’s interest has grown up and nurses have been encouraged to provide evidence based practice.Nurses has personal responsibility to remain updated on current best practice which include ability to critically appraise new research ( Cutcliffe &Ward 2007) According to Gerrish & Lacey (2010) nursing research is essential as it develop knowledge, influence nursing decision making with an intention of improving patient care, health outcome and public health.

Nursing research is essential for the development of new knowledge and mostly it enables nurses to provide evidence based health care.Evidence based nursing (EBP) is defined as clinical or nursing judgement, interventions based on the best available current research in consideration of the needs and preferences of a patient (Parahoo 2006). LoBiondo-Wood (2006) defines EBP as collection, interpretation and integration of valid and applicable current research. A Systematic review of relevant research need to be carried out in order to draw an overall conclusion. Gerrish & Lacey 2010 states that when using EBP strategies, the first step is to identify problem or issue in practice.Diseases of heart and cardiovascular disease are the main cause of death in the United Kingdom (UK) and account for almost 191 000 death each year, one in three of all deaths.

It is also one of the main causes of premature deaths in the UK with 28% of premature deaths in men and 20% in women in 2008 (British Heart Foundation Statistics 2010). Accordingly, nurses play a major role in assessment and management of patients with acute myocardial infarction. Firstly the author will look at pathophysiology of acute myocardial infarction.Heart plays a major role in pumping blood around the body, caring nutrients oxygen and waste products.

It lies in the thoracic cavity of the body; it has four chambers two on the left side and two on the right side. Blood (oxygenated) is pumped from the strong left ventricle of the heart through arteries to peripheral tissues and returns to the right atrium of the heart through veins. It (de-oxygenated) then enters the right ventricle and is pumped through the pulmonary artery to the lungs and returns to the left atrium through the pulmonary veins.Blood then enters the left ventricle to be circulated again (British Heart Foundation ) Acute myocardial infarction occurred when there is shortage or interruption of blood supply of oxygenated blood to myocardial cells causing heart cells to be ischemic. This is commonly due to occlusion of coronary artery by atherosclerotic plaque and white blood cells.

The occlusion of the coronary artery stimulates sympathetic nervous system via stress. As a result adrenaline and noradrenaline are realised from adrenal cortex.Adrenaline increase heart rate and strength; increase blood pressure and cardiac output; increase blood glucose; dilation of bronchioles increasing rate of deep breath and stimulates renin – angiostensin system. All the effects of adrenaline increase chest pain and cause the skin to become cold and clammy. On the other hand noradrenaline cause smooth muscle in the blood vessels to constrict which improves venous return and increase blood pressure When acute myocardial infarction occurred, cardiac output falls and this endanger myocardial cell.Oxygen level fall in the myocardium as there is a change from anaerobic to anaerobic metabolism (check here it may be aerobic to anaerobic or vice versa).

Anaerobic glycolysis leads to accumulation of lactic acid. As the cell continued to be deprived of oxygen there is cellular membrane disruption leading to electrolyte imbalance. This changes the ionic concentration of potassium and sodium. Potassium then leaks to the intracellular space followed by water causing cellular oedema.

The initial ymptoms of MI can present severe or persistent chest pain caused by heart muscle not receiving the oxygen it required, the pain last for 2 to 15 minutes and the patient can sometimes describe it as heavy and crushing pain. The pain may radiate to the throat, jaw, neck, shoulder and arms. MI pain may also be accompanied by sweating, dyspnoea, pallor and anxiety. Ref says some patients may experience silent infarction which is more common in elderly patients with diabetes or hypertension.

These patients do not experience any pain. This is because diabetes can damage the nerves to the heart, these results in delaying MI diagnoses.The nurse’s role involves assessing the level of pain using assessment tools (British Heart Foundation 2007) The nurse’s role is to provide prompt assessment of patients presenting with chest pain in order to identify those with STEMI and to commence thrombolysis with 20 minutes of arrival in hospital. Whitlock & MacInnes 2010 identify ten things the nurses should focused on in assessment and investigation MI; vital signs, chest x-rays, 12 lead electrocardiograph (ECG), assessment of fluids status, Blood test, full physical examination, medical history and psychosocial assessment.

Resuscitation Council (2008) recommends assessment of patient using the ABCDE in order to establish the patient’s current priorities. A nurse’s role is to assess the patient’s airway, breathing, circulation, disability and exposure. Airway and breathing are assessed together. Respiration rate will increase as the body attempt to compensate for reduction in tissue perfusion.