Patient care management goal: to treat the underlying or precipitating factors and to reduce cardiac work load.

1. Provide oxygen to relieve ischemia at a flow rate based on institutional policy and the patient’s condition.
2. Assess and document continuous ECG rhythm, vital signs, mental status, heart and lung sounds, urine output, and any signs or symptoms indicating changes in these parameters.
3. Maintain activity restrictions based on the patient’s activity tolerance to reduce myocardial oxygen demands.
4. Administer I.V. morphine in small doses to decrease venous return, preload, myocardial oxygen consumption ,pain, and anxiety.
5. Begin diuretics to decrease preload and blood volume.
6. Start digitalis to increase contractility and decrease heart rate.
7. Consider vasopressors to increase contractility and support blood pressure.
8. Use nitrates to decrease preload and pulmonary and cardiac congestion.
9. Use afterload-reducing agents to decrease SVR and to aid ventricular ejection.
10. If a pulmonary artery catheter is in place ,assess and document PAP,PAWP, cardiac output, and SVR, as ordered
11. Provide patient education, and ensure that the patient can recognize signs and symptoms necessitating medical attention (e,g,, increased shortness of breath, weight gain, decreased activity tolerance, or change in pulse rate or rhythm) and that he or she understands dietary restrictions.
12. Refer the family to appropriate sources for CPR training.
13. Ensure that the family can activate the emergency medical system if any problems occur at home.