Posted: July 17th, 2022

Myocardial Infarction in nursing

INSTRUCTIONS:
Mr. T., a 45-year-old black man employed as a midlevel corporate manager, came to the doctor’s office seeking a physical examination. He appeared somewhat overweight. He denied taking any medications or smoking, but admitted drinking alcohol. His father and older brother have hypertension (HTN) and his paternal grandfather experienced a myocardial infarction (MI) and a CVA at a young age. Mr. T. stated, “A year ago at a health fair my cholesterol was tested. I was told later by mail that my cholesterol was 250 and I had to recheck my blood pressure.” His Bp at the time of his examination was 159/94, HR 96, weight 275, height 5’11 in.
• Explain the progressive pathophysiologic relationship between an MI and the development of left ventricular (LV) failure. What factors affect the severity of LV failure?
Next, visit http://www.cdc.gov/ncbddd/dvt/facts.html (Links to an external site.) and access resources about deep vein thrombosis.
• Document the manifestations and management of clients with deep vein thrombosis.
• Submit a summary of some of the things you learned from this video.
Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.

EXAMPLE POST:
Mr. T., a 45-year-old black man employed as a midlevel corporate manager, came to the doctor’s office seeking a physical examination. He appeared somewhat overweight. He denied taking any medications or smoking but admitted drinking alcohol. His father and older brother have hypertension (HTN) and his paternal grandfather experienced a myocardial infarction (MI) and a CVA at a young age. Mr. T. stated, “A year ago at a health fair my cholesterol was tested. I was told later by mail that my cholesterol was 250 and I had to recheck my blood pressure.” His Bp at the time of his examination was 159/94, HR 96, weight 275, height 5’11 in.
Pathophysiologic Relationship Between MI and the Development of LVF
The pathophysiology of left heart failure or left ventricular failure is characterized by hemodynamic abnormalities resulting in an imbalance and neurohormonal activation in the autonomic nervous system. A modification in receptor activation causes an autonomic imbalance with increased sympathetic activity and reduced vagal activity, these two may have an extreme effect on cardiac function and structure (Kırali, Özer, & Özgür, 2017).
Due to the presence of damage in the heart muscle from myocardial infarction (MI), the left ventricle, which mainly has the most powerful force for pumping blood, is weakened. Temporary compensatory mechanism may develop but will eventually lead to more dysfunction and failure.
The development of left ventricular failure may be traced back to the presence of left ventricular dysfunction, where ventricular efficiency to pump out blood from the heart back to the systemic circulation is reduced. One of the causes of this dysfunction is myocardial infarction which affects a part of the heart muscle to become damaged due to decreased oxygen supply. With the presence of heart muscle damage, the heart pumping function is affected thereby, causing the left ventricle to compensate. Its compensatory mechanism happens when ventricular expansion occurs in order to temporarily improve cardiac output. Over time, continuous ventricular dilation can also increase ventricular volume and internal load. As a way of responding to this increasing demand, muscle cells increase, and ventricular walls thicken leading to ventricular hypertrophy. When ventricular walls become too stiff, compensatory increase may be limited and end up with congestion and heart failure.
Left ventricular failure may become severe due to underlying health problems such as coronary artery disease or past MI or cardiomyopathy. Unhealthy lifestyle practices also affect its severity including cocaine and tobacco use, heavy alcohol consumption. These are major factors for vasoconstriction and hypertension which are risk factors for left ventricular failure. High blood pressure, diabetes, obesity and sleep apnea may also contribute to its progression.
The Manifestations and Management of Clients with Deep Vein Thrombosis
DVT is a manifestation of venous thromboembolism. This typically happens after a fracture, severe muscle injury or following major surgery. Typically, about half of the people exhibiting DVT will have no symptoms at all. The most common symptoms will be swelling, pain, tenderness, warmth, and redness of the skin (CDC, 2020).
Managing clients with DVT can be done by using compression stockings and using anticoagulants such as Heparin, Warfarin, Dalteparin, Fondapainux, Rivaroxaban, and Apixabam. If the DVT is severe enough, surgery is warranted.
Summary of Findings from The Videos
Some of the most significant finding I remembered from watching the videos are:
• Cancer and some of its treatments can increase a person’s risk for blood clots. It is also the leading cause of death among people with cancer, and the risk is typically the first few months after diagnosis (CDC, 2020).
• Mothers are at risk for blood clots during pregnancy, childbirth & up to 3 months after the baby is born. This is mostly due to the Mothers inability to move around as much, family history or C-Section delivery (CDC, 2020).
• About half of all blood clots occur during or within three months of a hospital stay or surgery. They occur most often in the legs. 900,00 people in the U.S. are affected by blood clots each year, and 100,000 deaths will occur each year, which is more than the number of lives lost to AIDS, breast cancer, and motor vehicle crashes combined (CDC, 2020).
• On average, 1 person dies every 6 minutes due to a blood clot. Trauma, cancer, birth control, and hormone replacement therapy, pregnancy, overweight & genetic risk factors are the highest risk factors. Signs and symptoms of a blood clot in the lungs include: Difficulty breathing, chest pain that worsens with deep breaths, coughing (coughing up blood), and faster than normal or irregular heartbeats (CDC, 2020).
• CDC states general risk factors include the following: Older age (>40 increases), obesity, recent surgery, hospitalization, trauma, previous clot, estrogen use, pregnancy, postpartum, thrombophilia, active cancer, cancer treatment, serious medical illness, limited mobility, and a central venous catheter (CDC, 2020).

EXAMPLE POST:
“Left ventricular dysfunction will cause the progression of heart failure, and left ventricular fibrosis and dysfunction provide an arrhythmic substrate” (Struthers A. D. 2015).” When blood circulation to heart is slowed down, or stops an MI occurs, that can lead to cellular death and necrosis. The region of necrosis is immediately surrounded by an area of hypoxic injury and an outer zone of ischemia. Inflammation begins immediately. The destroyed cells in the zone of necrosis are damaged and replaced with scar tissue. In the zone of necrosis, the myofibrils no longer function, leading to an area of hypokinesis in the myocardial wall. In the zone of hypoxic injury and zone of ischemia, the injured myofibrils are oxygen deprived. This area can be treated, but will not work the same, rather this leads to an area that cannot contract or contracts in a dysfunctional manner. Which then causes the heart to stop, causing a heart attack, also known as a Myocardial Infarction.
DVT S&S
Deep vein thrombosis (DVT’s) are manifested when blood clots form in the vein. The most common symptoms of DVTs are swelling in the area where the DVT is present. Pain, tenderness, and sometimes redness around the area are signs of a DVT (CDC 2020). If caught early, DVTs are easy to manage, with blood thinners. To prevent it is important for patients to eat healthy, exercise, if at higher risk like pregnant women or post-op patients compression stockings may be advised.
SUMMARY
I was surprised to learn that one person dies every six min. due to blood clots. I feel that is high, being that it is something that can be fixed, it is something patients need more education on (CDC 2020) I was also surprised to know that even after birth, mothers are at risk for blood clots, I always knew they were at risk during pregnancy, but not afterwards (CDC 2020). I was also very surprised to find out that DVT’s do not cause a stroke or heart attack.

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