MYOCARDIAL INFARCTION

GROUP 2 :

1. SERLY FITRIA DEWI LISIANA (21115055)

2. RESVI ADRIZA (21115075)

3. SANTI MARLINA (21115095)

PROGRAM STUDI ILMU KEPERAWATAN

SEKOLAH TINGGI ILMU KESEHATAN MUHAMMADIYAH

PALEMBANG

TAHUN AJARAN 2016/2017

 NURSING CARE PLAN

NO. Nursing Diagnose NOC NIC

1. Acute pain After do nursing Pain management :

associated with examination for 2x24
1. Perform a
agents of hours expected problem
comprehensive
biological injury. resolved, with the result
assessment of pain
criteria :
Sign : include location,
Pain control : characteristics,
- The patient
has a onset/duration,
- Recognizes pain
sweat. frequency, quality,
- The patient onset.
intensity or severity of
has a often
hold the - Describes causal pain, and precipitating
chest. factors. factors.
Symptoms :
- The patient - Reports changes in 2. Administer
complains
pain symptoms to medication as
of pain
chest health professional. prescribed.
- The patient
complains Pain level : 3. Use therapeutic
of fatique communication
- The patient - Report pain.
complains strategies to
of dipsnea - Facial expressions of acknowledge the
pain. experience or pain and
convecy acceptance of
- Duration of pain.
the patients response
to pain.

2. Activity After do nursing Energy management :

intolerance examination for 2x24
1. Review physiological
associated with hours expected problem
status of patient that
imbalance between resolved, with the result
cause fatigue in
supply and the criteria :
accordance with the
 need for oxygen. Activity tolerance : age and development
context.
Sign : - Oxygen saturation
with activity. 2. Monitor location and
- The patient
has a source
- Respiratory rate
malaise inconvenience/pain
- The patient with activity.
experienced patient
has a
nausea - Ability to speak during activity.
Symptoms : with physical
- The patient 3. Reduce the
activity.
complains inconvenience
of pain
Psychomotor energy : physical experienced
after do
activity patient that can affect
- Exhibits affect that
- The patient cognitive function,
complains fits situation
self monitoring and
of
dizziness if - Complies with setting patient activity.
moving medication regimen.

- Exhibits stable
energy level.

3. Anxiety associated After do nursing Activity therapy :

with change in examination for 2x24
1. Monitor emotional,
health status. hours expected problem
physical, social, and
resolved, with the result
Sign : spiritual response to
criteria :
activity.
- The patient
has a Anxiety level : 2. Assist patient to
restless
- The patient - Distress decreased. develop self-
has a motivation and
nausea - Restlessness
reinforcement.
Symptoms : - Verbalized
3. Collaborate with
apprehension.
- The patient occupational, physical,
complains Anxiety self control : and recreational
of anxiety
 - The patient - Monitors intensity therapists in planning
complains of anxiety. and monitoring an
of
activity program, as
dizziness - Plans coping
appropriate.
strategies for
stressful situation.

- Seeks information to
reduce anxiety.

DAFTAR PUSTAKA

Internasional, NANDA. 2015. Diagnosis Keperawatan Definisi dan Klasifikasi

2015-2017 edisi 10. Jakarta: EGC.
Johnson, M., et all. 2016. Nursing Outcomes Classification (NOC) fourth Edition.
New Jersey: Upper Saddle River.

Mc Closkey, C.J., et all. 2006. Nursing Interventions Classification (NIC) fourth

Edition. New Jersey: Upper Saddle River.