After an acute myocardial infarction of the left ventricle, a client has irreversible cellular necrosis of the myocardium. The nurse planning care determines that which nursing diagnosis would be the highest priority at this time?
1. Activity Intolerance
2. Infection, Risk for
3. Breathing Pattern, Ineffective
4. Cardiac Output, Decreased
Correct Answer: 4
Rationale 1: After a myocardial infarction of the left ventricle, a client might experience Activity Intolerance, but it is not the priority nursing diagnosis at this time.
Rationale 2: This client is not at high Risk for Infection at this time.
Rationale 3: Ineffective Breathing Pattern is associated with heart failure, and is not the priority at this time.
Rationale 4: Forward flow of blood could be impaired if a portion of the left ventricle myocardium is replaced with scar tissue. This will reduce stroke volume and cardiac output.
Global Rationale: Forward flow of blood could be impaired if a portion of the left ventricle myocardium is replaced with scar tissue. This will reduce stroke volume and cardiac output. After a myocardial infarction of the left ventricle, a client might experience Activity Intolerance, but it is not the priority nursing diagnosis at this time. This client is not at high Risk for Infection at this time. Ineffective Breathing Pattern is associated with heart failure, and is not the priority at this time.
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