Nursing diagnosis of left ventricular failure in acute myocardial infarction

A new mode of therapy has recently been advocated for the treatment of left ventricular failure (LVF) due to acute myocardial infarction (AMI). This therapy involves the use of vasodilator drugs. Current literature places little emphasis on the clinical findings of the effects of vasodilators. This is especially true of nursing literature. Registered nurses (RN) in coronary care units (CCU) throughout the country are responsible for the monitoring and administration of vasodilator therapy. The majority of RNs use hemodynamic measurements as their only data to administer vasodilators. It is a well-known fact that electronic equipment utilized to obtain hemodynamic measurements can produce inaccurate data. Several medical studies exist which document the relationships between clinical findings and hemodynamic measurements during LVF due to AMI. Providing adequate care requires the RN to acquire appropriate skills and be capable of correlating these skills with all available data. The investigator theorized that a properly prepared RN could assess, diagnose and place patients, with LVF due to AMI, into clinical and hemodynamic subsets for purposes of management. A continuous measurement experimental design as described by Drew (1976) was utilized. The subject population consisted of 30 patients with AMI. The investigator utilized multiple assessments on each subject while providing a continuous measurement of the subjects'clinical progress throughout medical therapy. The majority of subjects (23) did not require hemodynamic monitoring. Correlation of clinical and hemodynamic subsets for those subjects who were monitored is not consistent. A significant percentage (26.6%,) of the subject population were less than 50 years of age. Therapeutic regimes could not be compared because of the physicians' reluctance to record appropriate data. Appropriately prepared RNs are capable of performing cardiovascular assessments while obtaining a sound clinical data base upon which to arrive at a nursing diagnosis. Utilizing the subset classification system, the RN could begin management of patients with LVF due to AMI on a regular basis. This may reduce the number of fatalities due to LVF.