Emotional problems (e.g., anxiety, depression, sleep disturbance, fear of another myocardial infarction [MI]) during convalescence can seriously hamper rehabilitation. The adaptation and convalescence are influenced by the multiple symbolic meanings of the heart, for example:

1. Seat of emotions (love, pride, fear, sadness).
2. Center of the body (one-of-a-kind organ).
3. Life itself (can no longer rely on the heart; failure of the heart means failure of life).

1. Assessment:
1. Attitude—overly cautious and restrictive; may result in boredom, weakness, insomnia, exaggerated dependency.
2. Acceptance of illness—use of denial may result in noncompliance.
3. Behavior—self-destructive.
4. Family conflicts—related to activity, diet.
5. Effects of MI on:
1. Changes in lifestyle—eating, smoking, drinking; activities, employment, sex.
2. Family members—may be anxious, overprotective.
3. Role in family—role reversal may result in loss of incentive for work.
4. Dependence-independence—issues related to family conflicts (especially restrictive attitudes about desirable activity and dietary regimen).
5. Job—social pressure to "slow down" may result in loss of job, reassignment, forced early retirement, "has-been" social status.
2. Nursing care plan/implementation:
1. Prevent "cardiac cripple" by shaping person's and family's attitude toward damaged organ.
1. Instill optimism.
2. Encourage productive living rather than inactivity.
2. Set up a physical and mental activity program with client and mate.
3. Provide anticipatory guidance regarding expected weakness, fear, uncertainty.
4. Health teaching: nature of coronary disease, interpretation of medical regimen, effect on sexual behavior.
3. Evaluation/outcome criteria:
1. Adheres to medical regimen.
2. Modifies lifestyle without becoming overly dependent on others.