Nursing Care Plan Diagnosis for Myocardial Infarction (MI): A Comprehensive Guide

Myocardial infarction (MI), commonly known as a heart attack, is a critical condition arising from insufficient blood supply to the heart muscle (myocardium). This ischemia occurs due to a partial or complete blockage of blood flow, depriving the heart of essential oxygen. The primary culprit behind most heart attacks is coronary artery disease.

When oxygen supply to the heart cells diminishes, ischemia sets in rapidly. This imbalance between myocardial oxygen supply and demand can lead to MI, resulting in cardiac tissue death if not promptly addressed.

While coronary artery disease is the leading cause, other factors can trigger MI, including:

• Vasospasm: Sudden constriction or narrowing of a coronary artery, restricting blood flow.
• Blood clots: Formation of thrombi that obstruct coronary arteries.
• Electrolyte imbalances: Disruptions in electrolyte levels can affect heart function and blood flow.
• Trauma to the coronary arteries: Physical injury to these vessels can impede blood supply.

The hallmark symptom of prolonged oxygen deprivation in the heart is chest pain, often described as pressure, tightness, or discomfort. This pain may radiate to the neck, jaw, shoulder, or arm. Diagnostic evaluations, including laboratory tests and electrocardiogram (ECG) changes, are crucial to confirm heart damage.

STEMI vs. NSTEMI: Understanding the Difference

Myocardial infarctions are broadly classified into two types: STEMI (ST-elevation myocardial infarction) and NSTEMI (non-ST-elevation myocardial infarction). The distinction lies in the ECG findings.

STEMI: Characterized by a complete blockage of a coronary artery, leading to ST-segment elevation on the ECG. This signifies significant and acute myocardial injury.

NSTEMI: Involves a partial blockage of a coronary artery. Crucially, NSTEMI does not present with ST-segment elevation on the ECG. However, patients still experience heart attack symptoms and require immediate medical attention. The ECG changes in NSTEMI might include ST-segment depression or T-wave inversion.

The Nursing Process for Myocardial Infarction

In emergency situations, prompt nursing assessment and intervention are paramount. The initial nursing priority is to differentiate between chest pain (angina) and myocardial infarction (MI), as MI necessitates immediate action to preserve cardiac tissue.

Upon arrival at the emergency department, the immediate goals for a patient with acute MI are:

• Reduce ischemia: Restore blood flow to the heart muscle.
• Relieve pain: Manage chest pain and associated discomfort.
• Prevent circulatory collapse and shock: Stabilize hemodynamics and prevent complications.

The MONA regimen (Morphine, Oxygen, Nitrates, Aspirin) is often initiated in the acute phase. Continuous cardiac monitoring is essential, and intravenous (IV) access is established for fluid and medication administration. Further diagnostic tests and procedures, such as cardiac catheterization or coronary artery bypass graft (CABG) surgery, may be necessary depending on the patient’s condition.

Post-acute phase, nursing care focuses on patient education and support for long-term management. This includes:

• Medication adherence: Ensuring patients understand and follow their prescribed medication regimen.
• Diet and weight management: Guiding patients on heart-healthy dietary choices and weight control.
• Risk factor modification: Educating patients on lifestyle changes to reduce future cardiac events.
• Cardiac rehabilitation: Recommending and facilitating participation in cardiac rehabilitation programs for comprehensive recovery.

Comprehensive Nursing Assessment for Myocardial Infarction

The nursing assessment is the cornerstone of effective care. It involves gathering comprehensive data encompassing physical, psychosocial, emotional, and diagnostic aspects.

Review of Health History: Subjective Data Collection

1. General Symptom Inquiry: Elicit information about general symptoms, such as:

• Chest, back, shoulder, or jaw pain: Characterize the location, intensity, quality, and radiation of pain.
• Palpitations: Assess for irregular heartbeats or fluttering sensations.
• Shortness of breath (dyspnea): Determine if it occurs at rest or during exertion.
• Fatigue: Evaluate the level and impact of fatigue on daily activities.
• Sweating (diaphoresis): Note the presence and severity of sweating.
• Nausea and vomiting: Inquire about gastrointestinal distress.
• Fainting (syncope) and dizziness: Assess for episodes of lightheadedness or loss of consciousness.

2. Detailed Chest Pain Assessment: Obtain a thorough description of chest pain:

• Quality: Tightness, squeezing, heaviness, burning, pressure.
• Location and Radiation: Arm, shoulder, jaw, back, abdomen.
• Onset and Duration: Sudden or gradual, intermittent or persistent, lasting more than 20 minutes.
• Provoking and Relieving Factors: Exertion, rest, stress, emotions, medications.
• Pain Scale: Quantify pain intensity using a standardized pain scale.

3. Risk Factor Identification:

• Non-modifiable Risk Factors:

  • Gender and Age: Men over 45 and women over 50 (or post-menopausal) are at higher risk.
  • Family history: Ischemic heart disease in a first-degree relative before age 55 increases risk.
  • Race/Ethnicity: Black individuals have a disproportionately higher risk of MI.

• Modifiable Risk Factors:

  • Hypertension: Uncontrolled high blood pressure strains the heart and arteries.
  • Hyperlipidemia/Hypercholesterolemia: Elevated LDL (“bad”) cholesterol and low HDL (“good”) cholesterol contribute to plaque formation.
  • Diabetes or Insulin Resistance: Impairs blood vessel health and increases blood viscosity.
  • Tobacco Use: Smoking and secondhand smoke significantly elevate MI risk.
  • Obesity: Increases workload on the heart and contributes to hypertension and other risk factors.
  • Physical Inactivity: Sedentary lifestyle promotes arterial stiffness and poor cardiovascular health.
  • Diet: High intake of trans and saturated fats promotes atherosclerosis.
  • Stress: Chronic stress elevates heart rate and blood pressure.
  • Alcohol Use: Excessive alcohol consumption damages the heart and increases sudden cardiac death risk.
  • Lack of Sleep: Insufficient sleep contributes to elevated blood pressure.

4. Medication Review: Document all current medications, including:

• Prescription medications
• Over-the-counter drugs
• Herbal supplements
• Recreational drugs: Be particularly alert to substances known to affect cardiovascular health, such as amphetamines, cocaine, and anabolic steroids.

Certain medications can have cardiovascular side effects, including:

• Anthracyclines
• Antipsychotic drugs
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Type 2 diabetes medications (thiazolidinediones and rosiglitazone)
• Recreational and street drugs (amphetamines, anabolic steroids, cocaine, nicotine)

5. Emotional and Psychological Factors: Assess for anginophobia (fear of chest pain) and underlying anxiety disorders, as these can mimic MI symptoms.

Physical Assessment: Objective Data Collection

1. Prioritize ABCs (Airway, Breathing, Circulation): In suspected MI, immediate stabilization of ABCs is paramount. If the patient is unresponsive and pulseless, initiate Cardiopulmonary Resuscitation (CPR) immediately and activate emergency medical services.

2. Systemic Physical Examination:

• Neck: Assess for jugular vein distention (JVD), indicating fluid overload or heart failure.
• Central Nervous System (CNS): Evaluate for anxiety, feelings of impending doom, syncope, dizziness, lightheadedness, and changes in mental status (confusion, disorientation).
• Cardiovascular System:
  • Auscultate heart sounds for murmurs.
  • Auscultate carotid arteries for bruits (abnormal sounds indicating turbulent blood flow).
  • Assess for arrhythmias (irregular heart rhythms).
  • Monitor blood pressure for hypertension or hypotension.
• Circulatory System: Palpate peripheral pulses (radial, femoral, dorsalis pedis) for strength and regularity; assess for thready pulse.
• Respiratory System: Observe respiratory rate and effort; assess for dyspnea at rest or with exertion.
• Gastrointestinal System: Inquire about nausea and vomiting.
• Musculoskeletal System: Assess for pain in the neck, arm, back, jaw, and upper extremities; evaluate for fatigue.
• Integumentary System: Observe skin color for cyanosis (bluish discoloration), pallor (pale skin), and diaphoresis (excessive sweating).

3. ASCVD Risk Score Calculation: Calculate the patient’s Atherosclerotic Cardiovascular Disease (ASCVD) risk score to estimate their 10-year risk of cardiovascular events. This score incorporates factors like:

• Age
• Gender
• Race
• Blood pressure
• Cholesterol levels
• Medication history
• Diabetes status
• Smoking history

A low ASCVD risk score is desirable.

Diagnostic Procedures for Myocardial Infarction

1. Electrocardiogram (ECG) Interpretation: Obtain and interpret a 12-lead ECG within 10 minutes of arrival in the emergency department. Key ECG findings in MI include:

• Pathological Q waves: Indicate previous myocardial infarction.
• ST-segment elevation (STEMI): Signifies acute, ongoing myocardial injury and complete artery blockage.
• ST-segment depression or T-wave inversion (NSTEMI): Suggests myocardial ischemia and partial artery blockage.

2. Cardiac Troponin Level Monitoring: Measure cardiac troponin levels in the blood. Troponins are highly sensitive and specific biomarkers released into the bloodstream when myocardial damage occurs. Elevated troponin levels are a hallmark of MI. Levels typically rise 4-9 hours after myocardial injury, peak at 12-24 hours, and can remain elevated for up to two weeks.

3. Echocardiogram: Perform an echocardiogram (ultrasound of the heart) within 24-48 hours of suspected MI. This assesses:

• Wall motion abnormalities: Areas of the heart muscle that are not contracting normally.
• Ejection fraction: The percentage of blood pumped out of the left ventricle with each beat, indicating heart function.
• Structural abnormalities: Valve problems or other cardiac issues.

A follow-up echocardiogram is often performed within three months to establish a post-infarction baseline.

4. Advanced Imaging (Further Investigation):

• Cardiac Computed Tomography (CT) Scan: Provides detailed images of the coronary arteries to identify blockages.
• CT Coronary Angiography: Uses intravenous contrast dye to enhance visualization of coronary arteries and assess for stenosis or occlusion.

Nursing Interventions for Myocardial Infarction: Restoring Perfusion, Relieving Pain, and Managing Symptoms

Nursing interventions are crucial for patient recovery and aim to restore blood flow, alleviate pain, manage symptoms, and prevent complications.

Restore Blood Perfusion: Time is Muscle

1. Reperfusion Therapy: Assist with and prepare patients for reperfusion therapies, which are essential to rapidly restore blood flow to the ischemic myocardium and limit infarct size.

• Primary Percutaneous Coronary Intervention (PCI): A catheter-based procedure to open blocked coronary arteries, ideally performed within 90 minutes of symptom onset (“door-to-balloon time”).
• Fibrinolytic Therapy (Thrombolytics): Medications (“clot busters”) to dissolve blood clots and restore blood flow, used when PCI is not immediately available, ideally within 30 minutes of hospital arrival (“door-to-needle time”).

2. Interventional Procedures:

• Coronary Angioplasty and Stent Placement: During PCI, a balloon-tipped catheter is inflated to widen the narrowed artery, and a stent is deployed to maintain artery patency.
• Coronary Artery Bypass Graft (CABG) Surgery: Creates new pathways for blood flow around blocked arteries using grafts from other blood vessels in the body.

3. Anti-ischemic Medications:

• Dual Antiplatelet Therapy (DAPT): Combination of aspirin and a P2Y12 inhibitor (e.g., clopidogrel, ticagrelor) to prevent platelet aggregation and thrombus formation.
• Anticoagulants: Medications like bivalirudin, enoxaparin, and unfractionated heparin to prevent blood clot formation and extension.

4. Blood Thinning Agents (Anticoagulants and Antiplatelets): Administer cautiously as ordered to prevent clot formation and reduce the risk of further MI.

• Anticoagulants: Interfere with the coagulation cascade to prolong clotting time (e.g., heparin, warfarin, enoxaparin).
• Antiplatelets: Inhibit platelet aggregation, preventing clot formation (e.g., aspirin, clopidogrel).

5. Thrombolytic/Fibrinolytic Medications (“Clot Busters”): Administer as ordered to dissolve existing blood clots obstructing coronary arteries. Prompt administration is critical to minimize myocardial damage and improve survival.

Relieve Pain: Addressing Angina

1. Pain Management: Administer analgesics as prescribed, typically intravenous opioids like morphine. Morphine reduces pain, decreases myocardial oxygen demand by reducing preload and afterload, and can alleviate anxiety.

2. Supplemental Oxygen: Administer oxygen to increase myocardial oxygenation and reduce ischemic pain. This can also help limit infarct size and improve cardiac function.

3. Vasodilators: Nitroglycerin remains a first-line treatment for acute MI. It promotes vasodilation, increasing blood flow to the myocardium and relieving chest pain.

Manage Symptoms and Hemodynamic Stability

1. Blood Pressure Management: Establish and maintain blood pressure within target ranges as determined by the healthcare provider.

2. Antihypertensive Medications: Administer medications to manage blood pressure in patients with MI:

• Beta-blockers: Reduce heart rate, blood pressure, and myocardial contractility, decreasing myocardial oxygen demand. Use with caution in suspected coronary vasospasm.
• ACE Inhibitors: Recommended for patients with systolic left ventricular dysfunction, heart failure, hypertension, or diabetes to improve hemodynamics and prevent remodeling.
• Intravenous Nitrates: Effective for symptom relief and ST-segment depression in NSTEMI.

3. Lipid Management: Administer statin medications to lower LDL cholesterol levels. Statins stabilize atherosclerotic plaques, reducing the risk of plaque rupture and subsequent events.

4. Blood Glucose Control: Monitor and manage blood glucose levels. Hyperglycemia is common in acute MI due to stress response. Glucose-lowering treatments may be necessary to normalize blood sugar.

Cardiac Rehabilitation: Promoting Long-Term Recovery

1. Cardiac Rehabilitation Program: Encourage and facilitate patient participation in a comprehensive cardiac rehabilitation program. This is crucial for recovery, especially after MI and surgical interventions.

2. Prevent Complications and Readmissions: Cardiac rehabilitation reduces the risk of complications, improves functional capacity, and decreases hospital readmission rates post-MI.

3. Continued Rehabilitation: Rehabilitation continues even after hospital discharge, typically for about three months, in outpatient or home-based settings.

4. Benefits of Cardiac Rehab: Educate patients about the benefits, including improved exercise tolerance, weight management, lipid profile improvement, psychological well-being, and overall quality of life.

Prevent Myocardial Infarction Complications and Recurrence

1. Regular Exercise: Encourage gradual resumption of exercise, starting with 15-20 minutes sessions and progressing as tolerated, under healthcare provider guidance.

2. Healthy Weight Maintenance: Emphasize the importance of weight management to reduce cardiac workload and blood pressure.

3. Patient Education and Teach-Back: Educate patients about their medications, treatment plan, follow-up appointments, and ongoing diagnostic testing. Use the teach-back method to verify understanding.

4. Stress Management Techniques: Promote stress-reduction strategies like yoga, relaxation techniques, guided imagery, deep breathing, and meditation.

5. Management of Underlying Conditions: Ensure optimal management of comorbidities like diabetes, hyperlipidemia, and hypertension.

6. Lifestyle Modifications: Reinforce the importance of long-term lifestyle changes:

• Regular exercise and physical activity
• Heart-healthy diet
• Smoking cessation
• Stress and anxiety management
• Moderate alcohol consumption (if any)

7. Regular Follow-up: Emphasize the need for regular follow-up appointments with their cardiologist or healthcare provider.

8. CPR Training for Family/Caregivers: Encourage CPR training for family members and caregivers to prepare for emergencies.

9. Action Plan for Attack Symptoms: Educate patients on recognizing MI symptoms and when to seek immediate medical attention (call emergency services, take nitroglycerin or aspirin as directed).

10. Addressing Concerns about Sexual Activity: Reassure patients that sexual activity is rarely a trigger for MI and can typically be resumed once they are physically capable.

11. Medical Alert Identification: Recommend wearing a medical alert bracelet or necklace to inform emergency responders about their cardiac history.

Nursing Care Plans for Myocardial Infarction: Addressing Key Nursing Diagnoses

Nursing care plans are essential tools for organizing and prioritizing care based on identified nursing diagnoses. For myocardial infarction, common nursing diagnoses and associated care plans include:

1. Acute Pain related to Myocardial Ischemia

Nursing Diagnosis: Acute Pain related to blockage of coronary arteries, as evidenced by verbal reports of chest pain, pressure, or tightness, clutching chest, restlessness, labored breathing, diaphoresis, and changes in vital signs.

Expected Outcomes:

• Patient will verbalize pain relief or control within acceptable parameters (pain score less than baseline).
• Patient will appear relaxed and able to rest comfortably.
• Patient will participate in activities of daily living without significant pain.

Nursing Assessments:

1. Differentiate Angina from MI Pain: Assess pain characteristics: onset (often spontaneous, early morning), location (substernal, crushing), radiation (jaw, back, left arm), duration (≥30 minutes), and response to rest or nitroglycerin (MI pain is typically unrelieved).
2. Pain History: Obtain detailed pain history: onset, precipitating factors (activity, emotion), relieving factors, and prior pain management measures.
3. ECG during Pain: Obtain a 12-lead ECG during chest pain to rapidly assess for ST-segment changes and arrhythmias.

Nursing Interventions:

1. Nitroglycerin Administration: Administer nitroglycerin sublingually or buccally as per protocol for acute chest pain.
2. Oxygen Therapy: Administer supplemental oxygen to improve myocardial oxygenation.
3. Morphine Administration: Administer morphine intravenously as prescribed for pain relief and to reduce myocardial oxygen demand.
4. Pain Assessment and Evaluation: Frequently assess pain intensity, characteristics, and effectiveness of pain management interventions.

2. Anxiety related to Threat of Death and Health Status

Nursing Diagnosis: Anxiety related to perceived threat of death, change in health status, and lifestyle modifications, as evidenced by increased tension, fearful attitude, apprehension, expressed concerns, restlessness, and dyspnea.

Expected Outcomes:

• Patient will verbalize causes of anxiety and fears related to MI.
• Patient will demonstrate understanding of necessary lifestyle changes.
• Patient will implement effective coping mechanisms to manage anxiety.
• Patient will exhibit reduced anxiety levels (calm demeanor, stable vital signs).

Nursing Assessments:

1. Assess Anxiety Levels: Observe for verbal and nonverbal cues of anxiety (restlessness, agitation, increased heart rate, rapid breathing).
2. Identify Subjective and Objective Anxiety Cues: Be alert to subtle signs of anxiety, such as chest guarding, even if patient does not verbally express pain or anxiety.
3. Coping Mechanisms: Assess patient’s usual coping strategies and their effectiveness in the current situation.

Nursing Interventions:

1. Acknowledge and Validate Anxiety: Recognize and validate the patient’s anxiety as a normal response to a serious health event. Encourage verbalization of feelings and concerns.
2. Provide Information and Education: Explain diagnostic tests, procedures, and treatment plan clearly and honestly. Answer questions thoroughly and address misconceptions.
3. Involve Patient in Care Planning: Engage the patient in care decisions to promote a sense of control and autonomy.
4. Stress Management Techniques: Teach and encourage stress-reduction techniques (deep breathing, relaxation exercises, mindfulness).
5. Anxiety Reduction Strategies: Collaborate with patient to identify and implement anxiety-reducing activities (music therapy, journaling, relaxation techniques, medications as prescribed).

3. Decreased Cardiac Output related to Altered Contractility and Ischemia

Nursing Diagnosis: Decreased Cardiac Output related to changes in heart rate and electrical conduction, reduced preload, reduced cardiovascular blood flow, and altered muscle contractility secondary to myocardial infarction, as evidenced by chest pain unrelieved by rest and medication, shortness of breath, nausea, vomiting, anxiety, cool, pale skin, tachycardia, tachypnea, fatigue, dizziness, confusion, and dysrhythmias.

Expected Outcomes:

• Patient will maintain blood pressure within acceptable limits.
• Patient will demonstrate absence or reduction of dyspnea, angina, and dysrhythmias.
• Patient will verbalize understanding of MI and its management.
• Patient will participate in activities that reduce cardiac workload.

Nursing Assessments:

1. Risk Factors for Decreased Cardiac Output: Assess medical history for pre-existing conditions (atherosclerosis, heart failure, prior MI) that increase risk.
2. Differentiate Angina from MI: Distinguish MI pain from stable angina based on onset, duration, and response to rest and medications.
3. Blood Pressure Monitoring: Closely monitor blood pressure, reporting systolic BP < 100 mmHg or a drop of ≥ 25 mmHg from baseline immediately.
4. ECG Monitoring: Continuously monitor ECG for dysrhythmias, ST-segment changes, and other abnormalities.
5. Signs of Poor Cardiac Output: Assess for cool, clammy skin, weak pulses, decreased urine output, altered mental status, and peripheral vasoconstriction.
6. Cardiac Enzyme Monitoring: Monitor serial cardiac enzyme levels (troponin, CK-MB) to assess myocardial damage.

Nursing Interventions:

1. Oxygen Administration: Administer supplemental oxygen to improve tissue perfusion.
2. Thrombolytic Therapy Administration: Administer thrombolytics as prescribed if PCI is not immediately available. Monitor for bleeding complications.
3. Beta-Blocker Administration: Administer beta-blockers as prescribed to reduce myocardial workload and improve perfusion.
4. IV Access and Fluid Management: Establish and maintain IV access for medication and fluid administration.
5. Prepare for Cardiac Catheterization: Prepare patient for possible cardiac catheterization and PCI to restore coronary blood flow.
6. Rest and Activity Restriction: Promote bed rest and limit activity to reduce cardiac workload.
7. Cardiac Rehabilitation Referral: Refer patient to cardiac rehabilitation program for comprehensive recovery.

4. Ineffective Tissue Perfusion (Cardiopulmonary) related to Interrupted Arterial Blood Flow

Nursing Diagnosis: Ineffective Tissue Perfusion (Cardiopulmonary) related to obstructed arterial blood flow secondary to plaque formation, narrowed arteries, and vasospasm, as evidenced by diminished peripheral pulses, tachycardia, dysrhythmias, decreased oxygen saturation, angina, dyspnea, changes in level of consciousness, pallor, and prolonged capillary refill.

Expected Outcomes:

• Patient will demonstrate palpable peripheral pulses and capillary refill time within normal limits.
• Patient will exhibit warm, dry skin with normal color (absence of pallor or cyanosis).
• Patient will maintain alert and oriented level of consciousness.

Nursing Assessments:

1. ECG Monitoring: Obtain and monitor ECG for changes indicating ischemia or infarction.
2. Cardiovascular Status Assessment: Assess for signs of inadequate cardiac output and tissue perfusion related to coronary artery blockage.
3. Peripheral Perfusion Assessment: Assess skin color and temperature, capillary refill time, and peripheral pulses (strength, equality).

Nursing Interventions:

1. Initiate CPR if Necessary: Be prepared to initiate CPR if cardiac arrest occurs.
2. Reperfusion Therapy Implementation: Facilitate prompt reperfusion therapy (PCI or fibrinolysis) as indicated.
3. Surgical Procedure Preparation: Prepare patient for potential PCI or CABG surgery.
4. Fibrinolytic Administration: Administer fibrinolytics promptly if PCI is not immediately available.
5. Aspirin Administration: Administer aspirin as ordered to inhibit platelet aggregation.
6. Cardiac Rehabilitation Referral: Refer patient to cardiac rehabilitation for long-term management and risk reduction.

5. Risk for Unstable Blood Pressure related to Myocardial Ischemia and Altered Cardiac Function

Nursing Diagnosis: Risk for Unstable Blood Pressure related to ineffective heart muscle contraction, ischemia, constricted arteries, and increased workload exertion secondary to myocardial infarction.

Expected Outcomes:

• Patient will maintain blood pressure within normal limits for their age and condition.
• Patient will perform activities without significant blood pressure fluctuations.
• Patient will adhere to prescribed medication regimen for blood pressure control.

Nursing Assessments:

1. Blood Pressure Monitoring: Frequently monitor blood pressure for trends and fluctuations.
2. Cardiovascular Status Assessment: Assess for signs of cardiac complications (arrhythmias, heart failure, cardiogenic shock).
3. Signs and Symptoms of Blood Pressure Instability: Monitor for headache, chest pain, changes in mental status, diaphoresis, and dizziness that may indicate unstable blood pressure.
4. Risk Factor Assessment: Identify and assess modifiable and non-modifiable risk factors for unstable blood pressure.
5. Chest Pain Assessment: Thoroughly assess chest pain characteristics and associated symptoms.

Nursing Interventions:

1. Blood Pressure Stabilization: Administer medications (beta-blockers, ACE inhibitors, calcium channel blockers) as prescribed to stabilize blood pressure.
2. Vasodilator Administration: Administer vasodilators (nitroglycerin, nitrates) as prescribed to improve blood flow and reduce blood pressure.
3. Fluid Overload Management: Administer diuretics if fluid overload contributes to hypertension.
4. Patient Education on Blood Pressure Management: Educate patient on the importance of blood pressure control, medication adherence, and lifestyle modifications.

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