A 40 year old patient is admitted with crushing chest pain and an Electrocardiogram (ECG) showing Acute Myocardial Infarction. He is pale, has Blood Pressure of 90/60 mm Hg, irregular pulse of 120 beats per minute, respiratory rate 28 / minute. The correct statement regarding nursing care plans is:

1. A

   Nursing Diagnosis: Acute Myocardial Infarction with Shock

2. B

   Nursing Diagnosis: Chest pain with complications, under evaluation

3. C

   Long Term Goal: ECG will be normal at the time of discharge

4. D

   Short Term Goal: Within 24 hours patient will state that pain has decreased

Appeared in: GMCH - 2016

Explanation

• The statement represents a correctly formulated short-term goal using the SMART (Specific, Measurable, Achievable, Relevant, Time-bound) criteria.
• The goal is Specific (patient states pain has decreased), Measurable (patient's verbal report), Achievable (pain reduction is a primary aim of MI treatment), Relevant (addresses the main symptom), and Time-bound (within 24 hours).
• In the acute phase of MI, the immediate priorities are managing life-threatening symptoms like pain and hemodynamic instability. This goal directly addresses the patient's most critical symptom.

Why Other Options Were Wrong

• Option A: This is a medical diagnosis, not a nursing diagnosis. Nursing diagnoses focus on the human response to a health problem.
• Option B: This statement is vague, uses non-standard language ('under evaluation'), and does not follow the structure of a formal nursing diagnosis (Problem + Etiology + Signs/Symptoms).
• Option C: This is an unrealistic long-term goal. Myocardial infarction often leads to permanent, irreversible changes in the heart muscle, which are reflected as persistent abnormalities on the ECG (e.g., pathological Q waves).

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Clinical Relevance

• Nursing practice connection: Use the key finding related to Formulation of nursing care plans, including nursing diagnoses and SMART goals for a patient with Acute Myocardial Infarction (AMI) to guide bedside assessment, documentation, and the next nursing action.
• Accurate care planning is critical for AMI patients. A well-defined, realistic goal guides all nursing interventions, from medication administration to patient monitoring, ensuring care is focused and effective.
• The patient's vital signs (BP 90/60, pulse 120) indicate cardiogenic shock, a life-threatening complication of MI. While pain control is important, the absolute priority is stabilizing hemodynamics. Nurses must recognize these signs and escalate care immediately.
• What if the patient's BP was 140/90 and pulse was 70? The short-term goal of pain relief would still be correct, but the urgency of addressing hemodynamic instability would be lower, allowing a more primary focus on pain and anxiety reduction.

How to Approach the Question

• First, analyze the patient's clinical presentation: a 40-year-old with an acute MI showing signs of shock (low BP, high pulse). This indicates a critical situation.
• Next, evaluate each option based on the fundamental principles of the nursing process.
• Option A and B are nursing diagnoses. Ask yourself: Is this a valid NANDA-I diagnosis? Does it describe a human response, or is it a medical condition? 'Acute Myocardial Infarction' is a medical diagnosis, and 'under evaluation' is vague.
• Option C and D are patient goals. Ask yourself: Is this goal SMART (Specific, Measurable, Achievable, Relevant, Time-bound)? Is it realistic for this patient's condition?
• Evaluate Option C: Is a 'normal ECG' an achievable goal after a heart attack? No, permanent changes are common.
• Evaluate Option D: Is decreasing pain within 24 hours specific, measurable, achievable, relevant, and time-bound? Yes, it meets all criteria for a good short-term goal.

Concept Tested & Keywords

• Concept Tested: Formulation of nursing care plans, including nursing diagnoses and SMART goals for a patient with Acute Myocardial Infarction (AMI).
• Stem keywords: Acute Myocardial Infarction, crushing chest pain, nursing care plans, Blood Pressure 90/60, irregular pulse 120
• Lead-in keywords: correct statement
• Clinical cues: Patient presents with signs of cardiogenic shock (hypotension, tachycardia, tachypnea) secondary to AMI, which guides the priority of nursing interventions.

Question ID

Q5zf80dPkqhvomy6E4SYet

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Reference Book

E6 PATHOLOGY QUICK REVIEWBased on Harsh Mohan Textbook of PATHOLOGY p. 196-198

E6 Medicine Harrison 22e Part 2 p. 21-23

E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 554-556