Upper body discomfort: including radiating pain to the left arm, jaw-line, shoulders, neck, stomach, backBack, shoulder, neck, jaw, teeth
Information about each test, what changes meanNormal lab values, values showing MIEKG – STEMI, T-wave inversion, tombstones, etc.
African Americans – higher risk for HTN .: Heart diseasePoverty – lack of availability of services, less likely to get help/have levels checked, etc.
Refer to board for this.
Heart Attacks<br />Signs and Symptoms for Men & Women, How to Prevent Exacerbations of Myocardial Infarction & to Treat an MI<br />Created by: <br />Casey Burritt<br />Jenna Lambeth<br />Nicole Lazarczyk<br />
Learning Goals<br />For healthcare professionals as well as the general population to understand the signs and symptoms of myocardial infarctions in men and women<br />Use the steps of the nursing process to teach and help the staff to quickly identify and differentiate a myocardial infarction and other disease processes.<br />
Objectives<br />Understanding the differentiating signs and symptoms of an Myocardial infarction (MI) between men & women<br />Diagnostic tools for diagnosing an MI quickly and differentiating between other diseases & SMART attack tool<br />Treatment protocols of a heart attack<br />Prevention of exacerbated MI and teaching the need to acquire healthcare assistance<br />
Significance to Critical Care<br />Non-healthcare professionals should know the signs and symptoms of a (MI) so that they know when to get help<br />Healthcare providers should be able to accurately differentiate between an MI and other diseases<br />Healthcare providers should be able to diagnoses and treat a heart attack<br />Providers should also be able to teach about the prevention of heart disease that may cause a heart attack.<br />The heart affects the ability of every body system to function correctly and adequately<br />
Most Common Signs<br />Chest pain<br />Left arm pain<br />Diaphoresis<br />Dizziness<br />Shortness of Breath<br />Slow and mild pain at onset <br />(Allegro Medical, 2010)<br />
Heart Attack, SMART Attack<br />Substernal chest pain<br />Crushing feelings, unable to catch breath<br />Meals<br />When last mean was eaten, whether pain comes within 1-2 hours of meals<br />Worsens when laying flat<br />Type of meal – spicy, acidic, high salt contents<br />Angina<br />Pain relieved with rest from activity, nitroglycerine<br />Radiating<br />To other locations such as arms, neck, shoulder, jaw, back, stomach<br />Time<br />Frequency of pain, duration<br />
Diagnostic Tools<br />Lab values<br />CPK-MB (normal: 0%)<br />Troponin T (normal: less than 0.2ng/mL<br />Troponin I (normal: less than 0.03ng/mL<br />Cardiac Catheterization<br />EKG changes<br />PQRST<br />Pagana & Pagana, 2006<br />
Treatment Protocols <br />Troponin, CHEM-stat levels when walking in door<br />Second Troponin at 6 hrs<br />“STEMI-alert” Cardiac cath lab within 30 minutes (Sentara Protocol)<br />Available open-heart operating room if necessary<br />Stress test within 24hrs with a normal troponin level<br />MONA<br />Education<br />Lough, Stacy, Urden, 2010<br />
Non-Modifiable Risk Factors<br />Non-modifiable risk factors are things that cannot be changed no matter the circumstances<br />Based on family and personal histories can allow a patient to remain healthy at higher than normal levels <br />Regular healthcare appointments should be maintained so as to understand the risks that these factors may propose<br />Those with excessively high non-modifiable risk factors should control their modifiable risk factors even better to prevent heart disease complications such as MIs<br />MedicineNet, 2010<br />
Patient Education – Life Factors<br />Your 1-year mortality risk increases for every 30 minutes it takes you to get to the hospital<br />In the year prior to your MI you are more likely to suffer from depression, have sleep disturbances, and experience stressful life events than healthy people, especially in women<br />Low education levels in patients and their partners predicted longer delay and total pre-hospital delay for men, but this does not affect women<br />Reducing pre-hospital delay can be accomplished by increasing knowledge of the MI process<br />Lovlien, Shei & Torstein, 2008<br />
Patient Education – Women with CAD<br />Women with CAD delay seeking medical attention because their pattern of symptoms of an MI is different<br />The symptoms they experience are very gradual and easily attributable to other causes such as a rough workout, stress, or extra physical work<br />Their attributions to other causes and their personal perception of their health determines if and when they seek medical help and attention<br />Albarran, Clarke & Crawford, 2006<br />
References<br />Albarran, J., Clarke, B., & Crawford, J. (2007). 'It was not chest pain really, I can't explain it!' An exploratory study on the nature of symptoms experienced by women during their myocardial infarction. Journal of Clinical Nursing, 16(7), 1292-1301. Retrieved from CINAHL Plus with Full Text database.<br />AllegroMedical. (2010). Heart attack & stroke warning signs: Men vs women. Retrieved October 14, 2010, from http://www.allegromedical.com/blog/heart-attack-stroke-warning-signs- men-vs-women-510.html. <br />Ignatvicus, D., Workman, M. (2010). Medical-Surgical Nursing: Patient Centered Collaborative Care. Missouri: Saunders. <br />Løvlien, M., Schei, B., & Hole, T. (2008). Myocardial infarction: psychosocial aspects, gender differences and impact on pre-hospital delay. Journal of Advanced Nursing, 63(2), 148-154. Retrieved from CINAHL Plus with Full Text database.<br />Lough, M., Stacy, K., Urden, L. (2010). Critical Care Nursing: Diagnosis and Management. Missouri: Mosby.<br />McDonald, D., Goncalves, P., Almario, V., Krajewski, A., Cervera, P., Kaeser, D., et al. (2006). Assisting women to learn myocardial infarction symptoms. Public Health Nursing, 23(3), 216-223. Retrieved from CINAHL Plus with Full Text database.<br />MedicineNet. (2010). Heart attacks: Women are different than men. Retrieved October 14, 2010, from http://www.medicinenet.com/script/main/art.asp?articlekey=10918. <br />Pagana, K., Pagana, T. (2006). Mosbys’s Manual of Diagnostic and Laboratory Tests. Missouri: Mosby.<br />