Definition:
An unpleasant sensory and emotional experience arising in an actual or potential tissue damage or describe the damage (International Association of Pain Study): a sudden attack or low in intensity from mild to severe which can be anticipated by the end of a predictable and with a duration less than 6 months .
A heart attack (also known as a myocardial infarction) is the death of heart muscle from the sudden blockage of a coronary artery by a blood clot. Coronary arteries are blood vessels that supply the heart muscle with blood and oxygen. Blockage of a coronary artery deprives the heart muscle of blood and oxygen,causing injury to the heart muscle. Injury to the heart muscle causes chest pain and chest pressure sensation. If blood flow is not restored to the heart muscle within 20 to 40 minutes, irreversible death of the heart muscle will begin to occur. Muscle continues to die for six to eight hours at which time the heart attack usually is "complete." The dead heart muscle is eventually replaced by scar tissue.
Approximately one million Americans suffer a heart attack each year. Four hundred thousand of them die as a result of their heart attack.(nursing-care-plan-for-myocardial)
Acute pain
related to tissue ischemia secondary to arterial blockage
characterized by:
- chest pain with / without deployment
- facial grimacing
- nervous
- delirium
- changes in pulse, blood pressure.
Goal:
- Pain decreased after treatment measures during the hospital
Results Criteria:
- Chest pain scale was reduced for example from 3 to 2, or from 2 to 1
- facial expression relaxed / calm, not tense
- not agitated
- Nadi: 60-100 times / minute,
- BP: 120/80 mmHg
Nursing Intervention Acute Pain for AMI (Acute Myocardial Infarction) :
- Observation of the characteristics, location, time, and travel the chest pain.
- Instruct the client to stop activity and rest during an attack.
- Help clients doing relaxation techniques, eg deep breathing, distraction behavior, visualization, or the guidance of imagination.
- Maintain Oxygenation
- Monitor vital signs (pulse & blood pressure) every two hours.
- Collaboration with the health team in the delivery of analgesics.