LESSON PLAN ON MYOCARDIAL

INFARCTION
Name of the Lecturer: B.Beljin ajith

Designation: Student

Subject: Nursing education

Topic: Myocardial Infarction

Group: M.Sc(NURSING) I year

Venue: THASAIAH COLLEGE OF NURSING

Time:

No. of students:

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 Teacher,s & Learner,s AV AIDS Evaluation

Objective Activity
1. Introduce the 2mi Introduction:
concept of n Myocardial infarction (MI) is a
Myocardial process by which the myocardial
Infarction tissue is destroyed in regions of the
heart that are deprived of an
adequate blood supply because of
a reduced coronary blood flow. The
cause of the reduced blood flow is
either a critical narrowing of the
coronary artery due to
atherosclerosis or a complete

Teacher is asking the

question and students
are giving their point of
views

Teacher is introducing
the topic and students
are Black What is Coronary
listen carefully Board & PPT circulation?
4 2 occlusion of an artery due to
mins 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.
5 1
Define
min DEFINITION: What is
Myocardial Teacher is defining the Black board
Infarction Myocardial Infarction occurs when topic and students are And LCD Myocardial
there is ischemia (inadequate listen carefully Infarction?
blood flow) to a part of the heart
that results in death of the
6 5 myocardial cells. How many people
mins Black board
Estimate the Teacher is explaining the in the world are
Incidence of INCIDENCE: incidence of topic And LCD suffering from
Myocardial It is estimated that there are Myocardial
Infarction. 160,000 deaths with Myocardial Infarction?
infarction and 16,000 deaths occur
every year.
List the etiology
and risk factors ETIOLOGY\RISK FACTORS: Teacher is enumerating Black board, How are the risk
of Myocardial the etiology factors PPT And LCD factors classified?
Infarction. i. Non- Modifiable Risk Factors:
Age: The risk factor of MI increases
with age, doubling each decade
after 55 yrs of age.
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
6. Explain the 10 aggregation which can lead to Teacher is explaining the Black board What happens in
pathophysiolog mins thrombus formation. A high level of Pathophysiology of And LCD Myocardial
y of Myocardial glucose is seemed to cause damage myocardial infarction Infarction?
Infarction 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

Due to fatty streak deposition or

injury to the walls of the coronary
arteries

Attraction of the platelets to the

injured site

Development of thrombus

Narrowing of the lumen of the

blood vessel
Obstruction of the coronary blood
flow
 7. 4 Lack of oxygen supply to the Teacher is Black board What are the
8. mins tissues tissues enumerating the sign And LCD signs and
and symptoms of MI symptoms of
Infarction to Myocardial tissue Myocardial
Infarction?
Identify the CLINICAL MANIFESTATION
signs and
• Chest pain characterized by
symptoms of
heavy, vise like pain which
Myocardial
raduates to shoulders and
Infarction
down the arms, usually the left
arms
• Shortness of breath
• Pallor
3 • Cold clammy skin
mins • Diaphoresis Teacher is enumerating Black board
• Dizziness the diagnostic evaluation And LCD How will you
• Light headedness of MI Diagnose patients
• Nausea with Myocardial
• Vomiting Infarction ?
Mention the • fainting
diagnostic
evaluation of DIAGNOSTIC FINDINGS
Myocardial • History collection
Infarction • Physical Examination
• Cardio vascular Examination
• Electrocardiogram
• Echocardiogram
• Serum cardiac enzymes
• Complete blood count
• CT scan
• CT angiography
• MRI
9. Discuss the 10 • MR Angigraphy Teacher is enumerating Black board What is the
Management of mins • Positron Emission Tomography the Management of MI And LCD medical
Myocardial • Multigated nuclear scans management of
Infarction • Coronary Angiography Myocardial
Infarction?
MANAGEMENT
i. Drug Therapy:
Anti platelet drugs Clopidogrel,
Ecospirin
Thrombolytic therapy:
streptokinase, Urokinase,
Anistreplase
Calcium channel blockers:
Nimodip, amlong
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

10. Draw a nursing 10 arteries is established by using Teacher is explaining ,LCD , PPT Tell some nursing
11. care plan for a mins internal mammary artery or nursing management of diagnosis related
patient with sephaneous vein grafts. the MI to Myocardial
Myocardial Infarction ?
Infarction NURSING MANGEMENT:
• Chest pain related to reduced
coronary blood flow.
• Ineffective breathing pattern
related to decreased blood flow
to pulmonary capillaries
secondary to decreased
ventricular contractility.
• Impaired tissue perfusion
related to decreased cardiac
output..
• Anxiety related to fear of death. Teacher is describing the PPT What are the
Describe the 5 • Deficient self care related to phases of cardiac components of
phases of mins imposed bed rest. rehabilitation of the MI cardiac
cardiac • Deficient Knowledge regarding Rehabilitation
rehabilitation prognosis ad self care
management.

CARDIAC REHBILIAION:
Phase1: This phase occurs during
hospitalization. In this phase the
nurse assist the patient towards
the realization of his goal towards
independence.
Phase2: The nurse explains the
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
12.
13.
 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.

12 Teacher is 1 SUMMARY: Till now we have Teacher is LCD

summarize the min seen the definition, incidence, summarization to
topic etiology & risk factors, the topic of MI
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
• Define Myocardial the students
Infarction.
• Estimate the incidence of
Myocardial Infarction.
• List the etiology and risk
factors of Myocardial
Infarction.
• Explain the
pathophysiology 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”,