Combined (PG) Institute of Medical Sciences & Research (CIMSR)

College of Nursing, Dehradun,UK

Lesson Plan

On

Myocardial Infarction (MI)

Subject-Medical Surgical Nursing

Submitted To Submitted By

Mohamad Dildar

M.Sc. (N) 1st Year

Submitted On:
Name of the Student: Mohamad Dildar

Subject: Medical Surgical Nursing

Unit: VII

Topic: Myocardial Infarction

Group: M.Sc.(N) I year

Venue: M.sc (N) 1ST year

Time: 11:00am

No. of students: 4

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.N. Specific Time Content Teacher’s & learners AV AIDS Evaluation
Objective Activity
To establish 1 INTRODUCTION ABOUT
1. report among min SELF
the students My Name is Mohamad Dildar.I
am student of M.Sc (N) 1st year
in CIMS, college of nursing
Dehradun.

2 To assess the 1 Question

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

Introduce the Introduction:

3 concept of 2 Myocardial infarction (MI) is a Teacher is introducing the Black What is Coronary
Myocardial mins process by which the myocardial topic and students are Board & PPT circulation?
Infarction tissue is destroyed in regions of the listen carefully
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
 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.

4 Define 2 DEFINITION:
Myocardial mins Myocardial Infarction occurs when Teacher is defining the Black board What is
Infarction there is ischemia (inadequate blood topic and students are And LCD Myocardial
flow) to a part of the heart that listen carefully Infarction?
results in death of the myocardial
cells.
How many people
5 Estimate the 1 INCIDENCE: Teacher is explaining the Black board in the world are
Incidence of min It is estimated that there are incidence of topic And LCD suffering from
Myocardial 160,000 deaths with Myocardial Myocardial
Infarction. infarction and 16,000 deaths occur Infarction?
every year.

6 List the etiology 5 ETIOLOGY\RISK FACTORS:

and risk factors mins Teacher is enumerating Black board, How are the risk
of Myocardial i. Non- Modifiable Risk Factors: the etiology factors PPT And LCD factors classified?
Infarction. 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
 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 characterize the
people like competitive striving for
achievement, exaggerated sense of
time, urgency, aggressiveness,
hostility are prone to coronary
atherosclerosis.

6. Explain the PATHOPHYSIOLOGY Teacher is explaining the Black board What happens in
pathophysiology 10 Pathophysiology of And LCD Myocardial
of Myocardial mins Due to fatty streak deposition or myocardial infarction Infarction?
Infarction 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
 Lack of oxygen supply to the
tissues tissues

Infarction to Myocardial tissue

What are the

7. Identify the CLINICAL MANIFESTATION Teacher is Black board signs and
signs and 4  Chest pain characterized by enumerating the sign And LCD symptoms of
symptoms of mins heavy, vise like pain which and symptoms of MI Myocardial
Myocardial raduates to shoulders and Infarction?
Infarction down the arms, usually the left
arms
 Shortness of breath
 Pallor
 Cold clammy skin
 Diaphoresis
 Dizziness
 Light headedness
 Nausea
 Vomiting
 fainting
8. Mention the 3 Teacher is enumerating Black board How will you
diagnostic mins DIAGNOSTIC FINDINGS the diagnostic And LCD Diagnose patients
evaluation of  History collection evaluation of MI with Myocardial
Myocardial  Physical Examination Infarction?
Infarction  Cardio vascular Examination
 Electrocardiogram
 Echocardiogram
 Serum cardiac enzymes
 Complete blood count
 CT scan
 CT angiography
 MRI
  MR Angigraphy
 Positron Emission Tomography
 Multigated nuclear scans
 Coronary Angiography

9. Discuss the MANAGEMENT Teacher is enumerating Black board What is the

Management of 10 i. Drug Therapy: the Management of MI And LCD medical
Myocardial mins Anti-platelet drugs management of
Infarction Clopidogrel, Ecospirin Myocardial
Thrombolytic therapy: Infarction?
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
 arteries is established by using
internal mammary artery or
sephaneous vein grafts.

10. Draw a nursing NURSING MANGEMENT:

care plan for a 10  Chest pain related to reduced Teacher is explaining ,LCD , PPT Tell some nursing
patient with mins coronary blood flow. nursing management of diagnosis related
Myocardial  Ineffective breathing pattern the MI to Myocardial
Infarction related to decreased blood flow Infarction?
to pulmonary capillaries
secondary to decreased
ventricular contractility.
 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.
11. Describe the CARDIAC REHBILIAION: Teacher is describing PPT What are the
phases of 5 Phase1: This phase occurs during the phases of cardiac components of
cardiac mins hospitalization. In this phase the rehabilitation of the MI cardiac
rehabilitation nurse assist the patient towards the Rehabilitation
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 mi seen the definition, incidence, summarization to
topic n etiology & risk factors, the topic of MI
pathophysiology, clinical
manifestation, diagnostic findings
and management of a patient with
Myocardial Infarction.
13 To recapitalize Recapitalization: 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 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”,
page number 1550-1567