title: Pain in the client experiencing myocardial ischaemia--nursing assessment and management. Part 1--neurophysiology and clinical manifestations of myocardial ischaemia pain.
abstract: Effective nursing management of the client experiencing myocardial ischaemia requires the nurse to integrate skills of clinical assessment (incorporating physiological and psychological domains), knowledge of myocardial oxygen supply and demand, knowledge of pain pathways and autonomic nervous system responses and appropriate nursing and pharmacological therapeutics. Part 1 of this article aims to describe cardiac pain pathways and the subsequent autonomic nervous system responses. This is necessary for the nurse to fully understand the clinical signs and symptoms found on clinical assessment of a client experiencing myocardial ischaemia. This myocardial ischaemia may manifest as pain. The concept of silent ischaemia will also be discussed as the critical care nurse must also be skilled in assessing a client experiencing myocardial ischaemia in the absence of pain. Part 2 in the next issue will provide a systematic framework for the nursing assessment of the client and discuss appropriate nursing and pharmacological therapeutics to reduce myocardial ischaemia.
authors.forename: R
authors.initials: R
authors.lastname: Beetson
mesh_terms: D000787:Angina Pectoris / Q000451:nursing* / Q000503:physiopathology; D003422:Critical Care; D006801:Humans; D009482:Neurophysiology; D009730:Nursing Assessment; D010147:Pain Measurement