LESSON PLAN ON MYOCARDIAL INFARCTION

Subject: Medical Surgical Nursing

Topic: Myocardial Infarction

Previous Knowledge: Students are aware of anatomy and physiology of Cardio vascular system & coronary circulation

Method of Teaching: Lecture cum Discussion

Media of Instruction: Blackboard, Overhead projectors and charts & demonstration.

GENERAL OBJECTIVE:

At the end of the teaching the students are able to explain the definition, incidence, etiology, patho-physiology, clinical
manifestations, assessment, diagnostic findings and management of Myocardial Infarction and develop attitude and skills in providing
care to patients with Myocardial Infarction.

SPECIFIC OBJECTIVE:

At the end of the teaching, the students are able to

 Define Myocardial Infarction.

 Estimate the incidence of Myocardial Infarction.
 List the etiology and risk factors of Myocardial Infarction.
 Explain the patho-physiology of Myocardial Infarction.
 Identify the signs and symptoms of Myocardial Infarction.
 Mention the diagnostic evaluation of Myocardial Infarction.
 Describe the Medical Management of Myocardial Infarction.
 Discuss the surgical management of Myocardial Infarction
 Draw a Nursing care plan for patient with Myocardial Infarction.
 Describe the phases of cardiac rehabilitation.
S.No Specific Time Content Teachers & Learners AV AIDS Evaluation
Objective Activity
1. To establish 1 INTRODUCTION ABOUT
report among min SELF
the students My Name is Supriya Chaturvedi ,
Asst Professor , A.P.S College of
Nursing Malsian, Jalandhar

2 To assess the 1 Question

previous min 1. What do you mean by
knowledge of infarction ? Teacher is asking the
the group 2. How many chambers in the question and students are
heart? giving their point of
3. How will you explain blood views
circulation?

Introduction:
Introduce the Myocardial infarction (MI) is a
concept of process by which the myocardial
Myocardial 2 tissue is destroyed in regions of the
3 Infarction mins heart that are deprived of an Teacher is introducing Black What is Coronary
adequate blood supply because of a the topic and students are Board & PPT circulation?
reduced coronary blood flow. The listen carefully
cause of the reduced blood flow is
either a critical narrowing of the
coronary artery due to
atherosclerosis or a complete
occlusion of an artery due to
embolus or a thrombus. Decreased
coronary blood flow may also result
 from shock and hemorrhage. In
each case there is a profound
imbalance between myocardial
oxygen supply and demand.

DEFINITION:
Define Myocardial Infarction occurs when
Myocardial there is ischemia (inadequate blood
4 Infarction 2 flow) to a part of the heart that
mins results in death of the myocardial Teacher is defining the Black board What is
cells. topic and students are And LCD Myocardial
listen carefully Infarction?
INCIDENCE:
Estimate the It is estimated that there are
Incidence of 160,000 deaths with Myocardial How many people
5 Myocardial 1 infarction and 16,000 deaths occur Teacher is explaining the Black board in the world are
Infarction. min every year. incidence of topic And LCD suffering from
Myocardial
ETIOLOGY\RISK FACTORS: Infarction?
List the etiology
and risk factors i. Non- Modifiable Risk Factors:
6 of Myocardial 5 Age: The risk factor of MI
Infarction. mins increases with age, doubling each Teacher is enumerating Black board, How are the risk
decade after 55 yrs of age. the etiology factors PPT And LCD factors classified?
Gender: MI more commonly
occur in men than women and they
have the tendency to suffer with
stroke.
Race: MI is found mostly in
African Americans and southern
white men.
Family History: A family history
of MI increases the risk of MI in the
generation.
ii. Modifiable Risk Factors:
Cigarette Smoking: cigarette
smoking increases the blood carbon
monoxide (CO) levels. The
hemoglobin in the blood combines
more readily with CO than with
oxygen. Thus oxygen supply to the
heart is severely limited. The
nicotinic acid present in the smoke
releases catecholamines which
results in arterial constriction.
Moreover the smoke has the ability
to form adhesions leading to
thrombus formation.
Elevated blood pressure: An
elevated BP triggers a very high
pressure gradient against which the
left ventricle must pump.
Hyperlipidemia: lipids have the
property of being readily soluble in
solvents than in water. In the blood
the principal lipids are cholesterol
and triglycerides. The lipids are
attached with the proteins and form
lipoproteins. These lipoproteins are
believed to play a role in the
development of atherosclerosis.
Hyperglycemia: hyperglycemia
fosters increased platelet
aggregation which can lead to
thrombus formation. A high level of
glucose is seemed to cause damage
 in the smooth muscles lining the
blood vessels.
Behavior Patterns:
Behaviors that characterizes the
people like competitive striving for
achievement, exaggerated sense of
time, urgency, aggressiveness,
hostility are prone to coronary
atherosclerosis.

PATHOPHYSIOLOGY

Explain the Due to fatty streak deposition or

pathophysiology injury to the walls of the coronary
6. of Myocardial arteries Teacher is explaining the Black board What happens in
Infarction 10 Pathophysiology of And LCD Myocardial
mins Attraction of the platelets to the myocardial infarction Infarction?
injured site

Development of thrombus

Narrowing of the lumen of the

blood vessel

Obstruction of the coronary blood

flow

Lack of oxygen supply to the

tissues tissues

Infarction to Myocardial tissue

 CLINICAL MANIFESTATION
 Chest pain characterized by
Identify the heavy, vise like pain which
signs and raduates to shoulders and down What are the
7. symptoms of the arms, usually the left arms Teacher is enumerating Black board signs and
Myocardial 4  Shortness of breath the sign and symptoms And LCD symptoms of
Infarction mins  Pallor of MI Myocardial
 Cold clammy skin Infarction?
 Diaphoresis
 Dizziness
 Light headedness
 Nausea
 Vomiting
 fainting

DIAGNOSTIC FINDINGS
 History collection
Mention the  Physical Examination
diagnostic  Cardio vascular Examination
8. evaluation of 3  Electrocardiogram Teacher is enumerating Black board How will you
Myocardial mins  Echocardiogram the diagnostic evaluation And LCD Diagnose patients
Infarction  Serum cardiac enzymes of MI with Myocardial
 Complete blood count Infarction ?
 CT scan
 CT angiography
 MRI
 MR Angigraphy
 Positron Emission Tomography
 Multigated nuclear scans
 Coronary Angiography
 MANAGEMENT
i. Drug Therapy:
Discuss the Anti platelet drugs Clopidogrel,
Management of Ecospirin
9. Myocardial Thrombolytic therapy: Teacher is enumerating Black board What is the
Infarction 10 streptokinase, Urokinase, the Management of MI And LCD medical
mins Anistreplase management of
Calcium channel blockers: Myocardial
Nimodip, amlong Infarction?
Anti anginal drugs:
Nitroglycerin, Nitrocontin
ii. Maintain ABC’s of the patient
iii. Oxygen administration
iv. Artificial airway insertion
v. Endo tracheal Intubation &
Mechanical ventilation
vi. Adequate hydration
vii. Monitor intake output chart.
Per cutaneous coronary
Interventions
i. Per cutaneous coronary
angioplasty
ii. Trans myocardial
revascularization
Surgical Management:
Coronary artery Bypass
Grafting: It is a procedure in which
blood supply to the coronary
arteries is established by using
internal mammary artery or
sephaneous vein grafts.
 NURSING MANGEMENT:
Draw a nursing  Chest pain related to reduced
care plan for a coronary blood flow.
10. patient with  Ineffective breathing pattern
Myocardial 10 related to decreased blood flow Teacher is explaining ,LCD , PPT Tell some nursing
Infarction mins to pulmonary capillaries nursing management of diagnosis related
secondary to decreased the MI to Myocardial
ventricular contractility. Infarction ?
 Impaired tissue perfusion related
to decreased cardiac output..
 Anxiety related to fear of death.
 Deficient self care related to
imposed bed rest.
 Deficient Knowledge regarding
prognosis ad self care
management.

CARDIAC REHBILIAION:
Describe the Phase1: This phase occurs during
phases of hospitalization. In this phase the
11. cardiac nurse assist the patient towards the Teacher is describing PPT What are the
rehabilitation 5 realization of his goal towards the phases of cardiac components of
mins independence. rehabilitation of the MI cardiac
Phase2: The nurse explains the Rehabilitation
nurse about the disease and answers
questions honestly and reassures the
patients to do a useful economic life
and resuming his activities.
Phase 3: the goal of third phase is to
continue to restore the patient
activity levels that allow the person
to return to work or return to
 activities in which he participated
before the illness. This phase is
usually accomplished by enrolling
the patient in a formal rehabilitation
program that provides supervised
incremental increase in activities
and exercise.
Phase 4: this focuses on long term
conditioning and the maintenance
of cardiovascular stability. The
patient is usually very self directed
during this phase and does not
. require a supervised program.

SUMMARY: Till now we have

seen the definition, incidence,
etiology & risk factors,
pathophysiology, clinical
manifestation, diagnostic findings
and management of a patient with
Myocardial Infarction.
13 To recapitualize Recapitualization : Teacher is telling LCD
the topic the reference to the
 Define Myocardial students
Infarction.

 Estimate the incidence of

Myocardial Infarction.

 List the etiology and risk

factors of Myocardial
Infarction.

 Explain the patho-

physiology of Myocardial
Infarction.

 Identify the signs and

symptoms of Myocardial
Infarction.

 Mention the diagnostic

evaluation of Myocardial
Infarction.

 Describe the Medical

Management of Myocardial
Infarction.

 Discuss the surgical

management of Myocardial
 Infarction

 Draw a Nursing care plan

for patient with Myocardial
Infarction

REFERENCES
Lewis Hitkemper, (2009)
“Text book of Medical surgical
Nursing”, Mosby Publishers,
Pg.1563-1571.

Black. M.Joyce, (2007),

“Text book of Medical Surgical
Nursing”, W.B. Saunder’s,
Philadelphia, Pg. 1732-1742.

Brunner & suddarth (2009),

“Text book of Medical surgical
Nursing”,