A 55-year-old client is admitted with an acute inferior-wall myocardial infarction. During the admission interview, he says he stopped taking his metoprolol (Lopressor) 5 days ago because he was feeling better. Which of the following nursing diagnoses takes priority for this client?
A. Anxiety
B. Ineffective tissue perfusion; cardiopulmonary
C. Acute pain
D. Ineffective therapeutic regimen management
Correct Answer: B. Ineffective tissue perfusion; cardiopulmonary
MI results from prolonged myocardial ischemia caused by reduced blood flow through the coronary arteries. Therefore, the priority nursing diagnosis for this client is Ineffective tissue perfusion (cardiopulmonary). Cerebral perfusion is directly related to cardiac output and is also influenced by electrolyte and/or acid-base variations, hypoxia, and systemic emboli.
Option A: Coping with the pain and emotional trauma of an MI is difficult. The patient may fear death and/or be anxious about the immediate environment. Ongoing anxiety (related to concerns about the impact of heart attack on future lifestyle, matters left unattended or unresolved, and effects of illness on family) may be present in varying degrees for some time and may be manifested by symptoms of depression.
Option C: Monitor and document characteristics of pain, noting verbal reports, nonverbal cues (moaning, crying, grimacing, restlessness, diaphoresis, clutching of chest), and BP or heart rate changes. Variation of appearance and behavior of patients in pain may present a challenge in assessment. Most patients with an acute MI appear ill, distracted and focused on pain.
Option D: Ineffective therapeutic regimen management is appropriate but doesn’t take priority. Stress the importance of follow-up care, and identify community resources and support groups. Reinforces that this is an ongoing and continuing health problem for which support and assistance are available after discharge.
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