Myocardial Infarction: Nursing Interventions and Medications

Introduction

• Part two of the myocardial infarction series by Sarah from register nurse rn.com.
• Focus on nursing interventions and medications.
• Part one covers pathophysiology, anatomy, diagnosis, and EKG reading.
• Access quizzes, lecture notes, and related videos for further study.

Nursing Interventions

• Time is Muscle: Heart cells die quickly without blood (irreversible in 30 minutes).
• Assess for Chest Pain: Regular assessment for chest pain is crucial.
• Hospital Protocols: Follow procedures for chest pain, including cardiovascular assessments and obtaining a 12-lead EKG.
• EKG Monitoring: Look for ST segment elevation, T wave abnormalities, and pathological Q waves.
• Continuous Bedside Monitoring: For life-threatening dysrhythmias like v-fib and v-tach.
• Blood Pressure and Heart Rate Monitoring: Watch for dysrhythmias and apply oxygen therapy as needed.
• IV Access: Ensure working IV for medications; consider multiple sites.
• Respiratory Sounds: Check for crackles/rails indicating heart failure and fluid overload.
• Strict Bed Rest: Prevent movement that could exacerbate chest pain.
• Cardiac Enzymes Collection: Typically includes troponin and possibly CKMB.

Medications Overview

• Patient Education and Evaluation: Understand side effects, educate patients, and assess response to medication.
• Pneumonic for Drug Categories: Acute angina means nasty artery blockages and cardiac complications.

Anticoagulants

1. Antithrombotics: Lovenox and Heparin.

   • Prevent clot formation.
   • Monitor for bleeding (gums, stool, urine).
   • Watch for Heparin-induced thrombocytopenia (HIT).
   • Monitor platelet levels and PTT (goal: 60-80 seconds).

2. Antiplatelets: Aspirin and Plavix.

   • Decrease platelet aggregation.
   • Monitor for GI bleeding and TTP (Plavix).
   • Caution with surgical procedures due to clearing time.

Morphine

• Used for acute chest pain unrelieved by nitroglycerin.
• Administer IV, monitor for hypotension and respiratory depression.

Nitrates

• Nitroglycerin: Given in various forms (ointment, sublingual, IV, transdermal).
  • Causes vasodilation and increased blood flow.
  • Monitor blood pressure and chest pain.
  • Side effects: headache, warmth, flushing, dizziness.

ACE Inhibitors

• Block conversion of angiotensin I to II causing vasodilation.
• Monitor for dry cough and hyperkalemia.

Beta Blockers

• Decrease heart workload, lower heart rate, and blood pressure.
• Monitor for hypoglycemia masking in diabetics and bronchospa in asthma/COPD patients.
• Avoid grapefruit juice.

ARBs

• Used if ACE inhibitors cause cough.
• Monitor for increased potassium levels.

Cholesterol-Lowering Medications

• Statins: Lower LDL and total cholesterol, increase HDL.
  • Continue diet and exercise.
  • Monitor for muscle pain, CPK levels, and liver function.

Calcium Channel Blockers

• Stop calcium transport, causing vasodilation.
• Monitor for hypotension, heart rate, and gum hyperplasia.

Conclusion

• Ensure to review part one for foundational information.
• Take quizzes for self-assessment.
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