Hey everyone its Sandra Turner sorry and calm and in this video I want to be going over part

two
of myocardial infarction in this video I'm going to be covering the nursing interventions and the
medications given in this condition now be sure to watch part 1 because that video built upon
this video where I cover the path oh the anatomy how it's diagnosed reading an EKG and things
like that and as always over here on the side Or in the description below you can access the quiz
the lecture notes and part one in other videos in the in kliks cardiac series so let's get started first
let's talk about nursing interventions what are you going to be doing for this patient as the nurse
remember time is muscle we talked about in part one those cells in the heart when they quit
receiving blood they die really fast and within 30 minutes it's irreversible we can't fix them and
once They're gone they are gone they cannot be replaced so as a nurse we want to make sure
we're assessing our patients and we're acting fast okay so we will assess our patients for chest
pain one times patients will tell you if they're having chest pain or if they're there for cardiac
issues you need to always assess them for chest pain because some patients may not tell you and
take steps to evaluate it hospitals have protocols what you do for whenever a patient has Chest
pain so typically what you're going to do is you're going to start assessing the cardiovascular
system you're going to get a 12-lead EKG per physicians order and your job as the nurse is to get
that EKG and to look at it in the previous video that's what I really want you to watch it I talked
about how to read these EKGs as a nurse what we need to know to do our job the different areas
it reflects on the heart and what you're looking for because You're looking for ST segment
elevation or depression you're looking at those t ways are they hyper - are they inverted and
you're looking for pathological Q waves so what's that video to figure out how to look at those
things another thing is you want to put them on continuous bedside monitoring because they are
at risk for going into life-threatening and just redness like v-fib v-tach things like that also just
with meals like Atrial arrhythmias or AV blocks you want to monitor their blood pressure their
heart rate and you look for those dysrhythmias place them on oxygen nasal cannula as ordered by
the physician it's usually two to four liters whatever the physician orders and have a working IV
make sure that you have and at least one for sure and if you can get multiple IVs typically you'll
probably you may be starting them on drips and you'll need another IV to give them other IV
push Medications so make sure you have working IV side monitor the respiratory sounds
because as we talked about in the previous video we talked about complications from an MI you
want to make sure that they're not having crackles or also called rails which could represent that
that we're having some heart failure problems we have some pump failure going on because that
heart muscle has died so that blood is backing up into those lungs fluid overload so Listen to that
strict bed rest I can tell you that is a for sure thing do not let your patients get up who are having
chest pain because getting up while having chest pain will increase that chest pain and make it
worse a lot of patients want to get up move paced the floor they're very anxious they're very
scared they may need to use the bathroom and you need to get mini journal or a bedside
commode for women because moving around is going to put extra stress on That heart and we
don't want to do that you're going to collect cardiac enzymes as ordered by the physician again
we talked about this usually that includes troponin levels for sure maybe some CK and B things
like that and the big part of our job is that we're going to be administering medications that the
doctor has ordered so as a nurse with medications is what you want to be familiar with whenever
we start going over this in the lecture the side Effects of the medications how the patients should
respond you need to evaluate as a patient responding appropriately is this what we want patient
education where you're going to educate the patient because a lot of times I'll be going home on
medications to manage of this condition how they work on the body and the typical medications
given for an mi so what medications are used to treat a patient experiencing a myocardial
Infarction to help you remember this remember this pneumonic to help you remember the
categories of drugs acute angina means nasty artery blockages and cardiac complications the first
stroke category is anticoagulants this will include anti from baudet and anti platelets first let's
talk about anti from bautex this will include lovenox and heparin these are one of the most
popular ones used in the hospital setting what how do they work they Prevent clot formation
because remember when we talked in part one about the patho of how these little coronary
arteries can become blocked remember and there was rupture of a plaque all those clotting
factors went there to form a thrombus and that actually caused more problems because it blocked
the blood spot even more to this heart muscle so this will prevent any further my cardio abortions
from happening solo van dogs this is usually given as a Sub-q injection as the nurse because it
decreases formation of clots you got to watch the patient for bleeding you'll want to assess their
gums make sure they don't have any bleeding on gums their stool is it dark and Tori are they
having a GI bleed and watch their urine is it turning light pink they may have be bleeding in the
kidneys or is there a drop in blood pressure and an increase of heart rate you don't see the
bleeding actively maybe it's inside the body Somewhere but a low blood pressure hypotension
and tachycardia represents that they're bleeding out another drug use is called heparin a lot of
times you will be starting a heparin drip or be given a subcu injection depending on whatever the
position once again you'll be monitor them for bleeding as well but as the nurse it's very
important that you are watching their platelet levels a lot of times CBC's will be ordered and
platelets will Be on there and you want make sure that they're not dropping because the patient
has been on heparin for several days you may notice a significant drop in platelets and I have
seen this happen so this really really does happen in patients develop this and it's known as
heparin induced thrombocytopenia also called a chai tea hip and what will happen is that you
will see those platelets draw less than 150000 typically if this happens heparin Will be
discontinued and the physician may switch them to aargh at Rabanne or NGO max those are
medications use for patients who have heparin induced thrombocytopenia now whenever a
patient is on heparin what's your role you're going to monitor for bleeding of course and you'll be
collecting or lab will be collecting phlebotomy will be collecting a PTT this is called a partial
thromboplastin time this is the amount of seconds it's taking for the patient To form a clot a
normal PTT is 25 to 35 seconds however whenever we have them on heparin we want to delay
that a little bit remember because that's the whole purpose of this is prevent clot formation so
depending on whatever facility lab is a therapeutic heparin PTT is generally 60 to 80 seconds
long the next a part of our mnemonic is anti platelet anti platelets work by decreasing platelet
aggregation and throwing this formation some popular Ones are aspirin and plavix aspirin how
does that work it's usually prescribed in a low dose and it decreases a clot from forming so hints
another Emma I just in case another plaque ruptured it would decrease those platelets from
aggregating at that site of injury however with this you have to watch out for GI bleeding
patients who've had a history of that are definitely at risk for developing again with aspirin
another thing is plavix a lot of page Times this is prescribed if the patient can't take us when they
can't tolerate it however with this as a nurse remember this they can develop a complication
known as thrombotic thrombocytopenic purpura we'll call it TTP and this is where clots form
and vessels little vessels and decreases the blood flow to the tiny a to vital organs so as the nurse
you may see decrease platelets the patient may all of a sudden have neuro changes renal failure
they may have a Fever anemia or bruising so it's very important that you educate the patient that
if you notice you start getting really confused you're having fever renal problems you can't pay
things like that they need to report that because they could be entering into this another thing
another part of education is if the patient is scheduled for a surgical procedure that they need to
let their surgeon know that they take platic because it takes a while for the body to Clear plavix
up to five to seven days so it's not something that you can just solve the day before surgery they
would have to stop at me place on something else okay another part of our new ma a.m.
morphine this is prescribed a lot of times in the acute situations when your patients having chest
pain a lot of times nitroglycerine you will find is not even relieving their pain nitro is not
working remember that was one of Those signs and symptoms that we talked about in part one
but the morphine helped this is usually given IV route however watch for hypotension lowering
that blood pressure and respiratory depression next in for nitrates this includes nitroglycerin a lot
of times this can be given as an ointment a sublingual tablet on IV like an ax drip or transdermal
with a patch and how this works is that bago dilates those coronary arteries and this causes
Increased blood flow to the heart so if you have some ischemia going on you give some nitro
open up those coronary arteries hopefully some blood can get to those myocytes that are being
deprived of nutrients however with this you've got to monitor their blood pressure this can cause
a massive drop in blood pressure and also assess their chest pain throw on a drip you'll need to
titrate the drip based on their chest pain and their vital signs watch their EK gee and half
continuous bedtime monitoring while they're on a drip side effects of this medication includes a
headache because you have vasodilation all that blood is just pumping to that head so teach a
patient that you'll probably get a headache also you may feel warm or flushing or dizzy next a for
ACE inhibitors which stands for angiotensin converting enzyme inhibitors and these typically
end Imperial P or IL one uses lisinopril and this works by blocking the conversion of angiotensin
1 to angiotensin 2 which causes vasodilation drops of blood pressure and decreases the workload
on the heart however a side effect from this medication is that the patient could develop a dry
nagging cough where literally they call every like five minutes and while there's then and they
may not be able to tolerate this also these drugs can increase the potassium Level so education
should educate your patient about watching how much potassium they take in through their diet
and how it does this is because this decreases aldosterone in the body which causes the body to
retain the tascam and excrete sodium so that's why you get hyperkalemia next be for beta
blockers some use like core reg lopressor that's the brand name the generic names engine Oh lol
and they work by decreasing the workload on the Heart you will get a slower heart rate and a
slower blood pressure lower blood pressure as a nurse you want to monitor their heart rate make
sure it's same within 60 to 100 and what you need to educate your patients especially if they're
diabetic these beta blockers can mask the symptoms of hypoglycemia which includes the
tachycardia hints with beta blockers you're not going to get tachycardia or the sweating so let
your diabetic patients know that they need to Monitor their blood sugar more closely also with
patients with COPD or asthma they may not be a candidate for beta blockers because they can
cause bronchospasms problems with that and not to take these beta blockers with grapefruit juice
because grapefruit decreases the absorption of the beta blocker next a for arms this stands for
angiotensin receptor blockers also they end in certain SAR t8n for instance like losartan these are
typically used in Place of ACE inhibitors if the patient can't tolerate the ACE inhibitors maybe
due to that nagging cough they'll be placed on this and it works by blocking angiotensin 2 so you
get vasodilation however side-effects of this is an increase potassium level just like the ACE
inhibitors however you don't get the dry Knight ink off next for the c-4 cholesterol-lowering
medications a lot of times patients have high cholesterol levels that's why they developed in my
Cardio infarction because they got a thorough scrotus Kotik and the plaque ruptured so they
maybe started on a statin to decrease the ADL level like lipitor so this works by lowering LDL
which is your bad cholesterol lowers your lower total cholesterol your triglycerides and helps to
increase your HDL which is your good cholesterol and educate the patient that this is not to
replace diet exercise just because they're taking a cholesterol medication And to notify the doctor
if they develop muscle pain because statins can cause muscle issues also as a nurse you'll be
monitoring if the doctor orders a CPK level to monitor if there is muscle damage because this
will increase if there is muscle injury due to a statin causing it also you'll be monitoring liver
function because this drug works by acting in the liver to decrease cholesterol level level so we
want to assure a liver is functioning good the Last see part of the mnemonic is calcium channel
blockers sometimes this is ordered and maybe norvasc heart is in one of the other calcium
channel blockers and this works by stopping transport of calcium to the my cardial muscle or and
smooth muscle so whenever this happens you get so dilation of those coronary arteries that set on
the heart that feed it blood supply so as a nurse you want to monitor for high hypotension
monitor their heart Rate and also educate the patient because you get more blood flow for some
reason this stroke causes a hyperplasia of the gums so you get enlargement of the gums so they'll
want to have good oral hygiene while taking a calcium channel blocker okay so that is part 2 of
myocardial infarction be chat be sure to check out part 1 and don't forget to take the quiz and
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