hey everyone it's Sarah with register nurse rn.com and in this video I'm going 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 one because that video builds upon this video where I cover the patho 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 and the other videos in the inlex 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 it's irreversible we can't fix them and once they're gone they 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 a lot of 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 Physician's order and your job as the nurse is to get that EKG and to look at it in the previous video that's why 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 that reflects in the heart and what you're looking for because you're looking for ST segment elevation or depression you're looking at those t- waves are they hyperacute are they inverted and you're looking for pathological Q waves so watch 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 lifethreatening um dysrhythmias like vfib vtac things like that also dis rythmia like atrial arhythmia or AV blocks you want to monitor their blood pressure their heart rate again like for those dysrhythmias place them on oxygen nasal panula as ordered by The Physician it's usually 2 to four lers whatever the physician orders um have a working IV make sure that you have um at least one for sure and if you can get multiple IVs typically um 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 site monitor the respiratory sounds because as we talked about in the previous video we talked about complication 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 Pace the floor they're very anxious they're very scared they may need to use the bathroom um you need to get men a urinal 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 uh you're going to collect cardiac enzymes as ordered by The Physician again we talked about those usually that includes troponin levels for sure maybe some ckmb things like that and a 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 this 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 patient should respond you need to evaluate is the patient responding propriately is this what we want patient education where you going to educate the patient on because a lot of times they'll be going home on these medications to manage this condition how they work on the body and the typical medic 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 drug category is anti-coagulants this will include anti-thrombotics and anti- platelets first let's talk about anti-thrombotics this will include loow ox and heprin these are one of the most popular ones used in the hospital setting what how did 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 um there was rupture of a plaque all those um 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 cardial infarctions from happening so Lenox this is usually given as a subq injection as the nurse because it um decreases formation of clots you got to watch the patient for bleeding you want to assess their gums make sure they don't have any bleeding on gums their stool is it dark and tarer they having a GI bleed um 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 tacac cardi represents that they're bleeding out another drug use is called heprin a lot of times you will be starting to heprin drip or be given a subq injection depending on whatever the physician wants again you'll be monitoring them for bleeding as well but as the nurse it's very important that you are watching their platelet levels a lot of times times um cbcs will be ordered and platelets will be on there and you want to make sure that they're not dropping because the patient has been on heprin for several days you may notice a significant drop in platelets and I have seen this happen so this really really does happen and patients develop this and it's known as Hein induced thrombocytopenia also called hi hip and what will happen is that you will see those platelets drop less than 150,000 typically if this happens will be discontinued and the physician may switch them to argatroban or angiomax those are medications used for patients who have Hein induced thrombocytopenia now whenever a patient is on heprin what's your role you're going to monitor for bleeding of course and you'll be collecting or lab will be collecting FL body will be collecting a PTT this is called a partial thromboplastin time this is um the amount of seconds it's taking for the patient to um form a cla a normal PTT is 25 to 35 seconds however whenever we have them on heon 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 and a therapeutic heprin PTT is generally 60 to 80 Seconds long the next a part of our pneumonic is antiplatelets antiplatelets work by decreasing platelet aggregation and thrombus formation some popular ones are aspirin and Plavix aspirin how does that work it's usually prescribed in a low dose and it decreases the clot from forming so hence another Mi just in case another plaque ruptured um it would decrease those platelets from aggregating at that s 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 pavics a lot of patient times this is prescribed if the patient can't take aspirin they can't tolerate it however with this as the nurse remember this they can develop a complication known as thrombotic thrombocytopenia Pera uh we'll call it TTP and this is where clots form in vessels little vessels and decreases the blood flow to the tiny to vital organs so as the nurse you may see decreased 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 pee 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 platics because it takes a while for the body to clear pavics up to 5 to seven days so it's not something that you can just stop the day before surgery they would have to stop it and be placed on something else okay another part of our pneumonic the M morphine this is prescribed a lot of times in the acute situations when your patients having chest pain a lot of times nitroglycerin 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 helps 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 underneath the tongue Ivy like in a drip or transdermal with a patch and how this works is it baso dilates those coronary arteries and this causes increased blood flow to the hard so if you have some esea going on you give some Nitro you open up those coronary arteries hopefully some blood can get to those myocytes that are being deprived of nutrients however with this you got to monitor their blood pressure this can cause a massive drop in blood pressure um also assess their chest pain if they're on a drip you'll need to titrate the drip based on their chest pain and their Vital Signs watch their EKG and have continuous bedside monitoring while they're on a drip side effects of this medication includes a headache because you have vasod dilation 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 in p r i l one uses linil and this works by blocking the conversion of angot tensin one to angot two which causes Vaso dilation drops the 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 cough every like five minutes it bothers them and they may not be able to tolerate this also these drugs can increase the potassium level so educate educate your patient about watching how much potassium they take in through their diet and how it does this is because this decre increases aldosterone in the body which causes the body to retain potassium and excrete sodium so that's why you get hyperemia next B for beta blockers some use like Coreg low pressor that's the brand name the generic names end in o l o and they work by decreasing the workload on the heart you will get a slower heart rate and a slower blood pressure lowerer blood pressure as a nurse you want to monitor their heart rate make sure it's staying Within 60 to 100 um what you need to educate your patients especially if they're diabetic these beta blockers can Mass the symptoms of hypoglycemia which includes the tacac cardia hence with beta blockers you're not going to get tacac cardia or the sweating so let your um diabetic patients know that because they need to monitor their blood sugar more closely also with patients with cop or asthma they may not be a candidate for beta blockers because they can cause um bronos spasms problems with that and not to take these beta blockers with grapefruit juice because grapefruit juice decreases the absorption of the beta blocker next a for arbs this stands for Angiotensin receptor blockers also they end in stin s a r t a n um for instance like Lo sartin these are typically used in place of ACE inhibitors if the patient can't tolerate the ACE inhibitors maybe due to that nag and cough they'll be placed on this and it works by blocking Angiotensin too so um you get Vaso dilation however side effects of this is an increased potassium level just like the ACE inhibitors however you don't get the dry nagging cough next for the C for cholesterol lowering medications a lot of times patients have high cholesterol levels that's why they developed a mardial infarction because they got AOS scerotic scerotic and the plaque ruptured so they may be started on a Statin to decrease the ADL level like Lipitor so this works by lowering LDL which is your bad cholesterol uh lowers your lower total cholesterol your triglycerides and helps to increase your HDL which is your good cholesterol um educate the patient that this is not to replace diet and exercise just because they're taking a um cholesterol medication and to notify the doctor if they develop muscle pain cuz stat can um cause muscle issues also as the nurse you'll be monitoring if the doctor orders a CPK level to um 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 Li liver function because this drug works by acting in the liver to decrease cholesterol level level so we want to make sure our liver is functioning good the last uh C part of the pneumonic is calcium channel channel blockers sometimes this is ordered um maybe noras cazum one of the other calcium channel blockers and this works by stopping transport of calcium to the mardial muscle or and smooth muscle so whenever this happens you get Vaso dilation of those coronary arteries that set on the heart that feed it blood supply so as a nurse you want to monitor for H hypotension monitor the heart rate and also educate the patient because you get more blood flow for some reason this drug causes um hyperplasia of the gum so you get enlargement of the gum so they'll want to have good oral hygiene while taking a calcium channel blocker okay so that is part two of my cardial infarction be check be sure to check out part one and don't forget to take the quiz and thank you so much for watching and please consider subscribing to this YouTube channel