Adult Smoking Cessation Advice/Counseling
This element refers to AMI patients who have a history of smoking. In regard to the measure, individuals receive smoking cessation counseling during their hospital stay (“Adult smoking cessation advice/counseling,” 2010). A patient is considered eligible for this standard if he or she has smoked cigarettes at some point during the twelve months before hospitalization. The measure is highly important for AMI since quitting smoking can decrease morbidity and mortality in people. Individuals who attend at least brief smoking cessation sessions from their healthcare providers are more inclined to stop smoking. Unfortunately, it is noted that smoking cessation counseling is not provided to all patients with AMI (“Adult smoking cessation advice/counseling,” 2010).
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Median Time to Fibrinolysis
This measure involves the average time from arrival to the delivery of “fibrinolytic agent in patients with ST-segment elevation or left bundle branch block (LBBB) on the electrocardiogram (ECG) performed closest to hospital arrival time” (“Median time to fibrinolysis,” 2010). Median time to fibrinolysis is necessary for AMI since it serves as a strong predictor of patient outcomes. When fibrinolysis is delayed by an hour, the likelihood of death is 2 to 1000. According to national guidelines, the most relevant time to fibrinolysis is 30 minutes upon hospitalization (“Median time to fibrinolysis,” 2010). Despite recommendations, many elderly AMI patients do not receive fibrinolytic therapy on time.
Median Time to Primary Percutaneous Coronary Intervention (PCI)
This measure is defined as the average time from arrival to PCI in individuals hospitalized with ST-segment elevation or LBBB on the ECG. The significance of this standard is justified by the decrease in morbidity and mortality in patients who are given primary angioplasty right after hospitalization (“Median time to primary PCI,” 2010). The effectiveness of PCI is increased if it is applied early. According to national guidelines, the prompt initiation of PCI is recommended for patients indicating ST-elevation MI.
The Pathophysiology of Acute Myocardial Infarction and Nursing Interventions
Acute myocardial infarction is reflected in patients through ST-segment elevation. AMI is the outcome of erosion or rupture of an atherosclerotic plaque “with thrombotic occlusion of an epicardial coronary artery and transmural ischaemia” (Heusch & Gersh, 2017, p. 774). The size of the resulting infarction can vary depending on the following factors:
- the size of the ischemic area that is at risk;
- the period and frequency of coronary occlusion;
- the range of coronary microvascular dysfunction and the degree of residual collateral blood flow (Heusch & Gersh, 2017).
The progressive development of MI depends on the innate collateral circulation as well as resistance to myocardial ischemia. 30-50% of the risk area is possible to be affected and, as a result, saved by reperfusion after 4-6 hours from the onset of angina symptoms in the patient (Heusch & Gersh, 2017). Even upon 12 hours of coronary occlusion, there is still a possibility of interventional reperfusion which can eliminate the size of the infarct.
One of the most effective measures for AMI patients is PCI. Research indicates that patients receiving this intervention are more likely to develop hypertension, diabetes, or dyslipidemia but less likely to develop the peripheral vascular disease, chronic lung disease, or heart failure within two weeks (Wayangankar et al., 2016). Another productive approach is a secondary prevention intervention (Harbman, 2014). This nurse practitioner measure is reported to enhance the attainment of such objectives as blood pressure, smoking cessation, attendance at cardiac rehabilitation, physical activity, and other improvements (Harbman, 2014).
Adult smoking cessation advice/counseling. (2010). Web.
Harbman, P. (2014). The development and testing of a nurse practitioner secondary prevention intervention for patients after acute myocardial infarction: A prospective cohort study. International Journal of Nursing Studies, 51(12), 1542-1556.
Heusch, G., & Gersh, B. J. (2017). The pathophysiology of acute myocardial infarction and strategies of protection beyond reperfusion: A continual challenge. European Heart Journal, 38(11), 774-784.
Median time to fibrinolysis. (2010). Web.
Median time to primary PCI. (2010). Web.
Wayangankar, S. A., Bangalore, S., McCoy, L. A., Jneid, H., Latif, F., Karrowni, W., … Klein, A. (2016). Temporal trends and outcomes of patients undergoing percutaneous coronary interventions for cardiogenic shock in the setting of acute myocardial infarction: A report from the CathPCI Registry. JACC: Cardiovascular Interventions, 9(4), 341-351.