Myocardial Infarction (Heart Attack) for Nursing & NCLEX

hey guys nurse Mike here and welcome to simple nursing calm before we get today's lectures started please remember to access your free quiz and preview our cool nifty new study guides not here on YouTube click the link right up here at any time during this video today we're wrapping up heart attack or mi that myocardial infarction so guy just think mi the heart muscles die like all heart muscles the heart needs oxygen to pump and during a heart attack there is a blockage and one or more of these oxygen tubes called the coronary arteries and so the heart muscle suffocates to death over 500 cells die per minute and if blocked over 45 minutes these cells can die forever called necrosis so guys minutes equals muscle now what causes this narrowing well fatty deposits called plaque develops on the walls of the coronary arteries narrowing the vessels which makes it harder for oxygen to get to the heart muscle so what causes this well just like hypertension we use the acronym soda s for stress this can cause momentary narrowing so anxiety cold temperatures even physical exercise like sex and stimulants like caffeine even in fetta means like meth and adderall also narrows the arteries momentarily but will really causes the most damage here our irritants found in smoking which scars the arteries and long-term obesity key term here guys a BMI over 25 but also diabetes and hypertension can cause stretching and tearing to the coronary arteries which severely damages them coupled with a bad diet high in cholesterol from animal fats like meats and dairies can cause fatty build-up getting stuck in the cracks and over time this growth makes the blood vessels stiff and hard something we call plaque this plaque causes hardening and narrowing in the arteries which is typically called atherosclerosis so just think arteriosclerosis hardening of the vessels from the scarring and plaque lastly heart disease is more common in african-american males and increased age over 50 and more common in men than women maybe women just handle stress better than men I don't know eventually too much plaque can turn into blockages and if one of these plaques ruptured usually from stress a blood clot can form in minutes and this blood cut can completely block all the oxygen to the heart muscle without oxygen heart cells die within minutes releasing proteins called troponin and guys this is the number one indicator of an MI but we're gonna cover that in the diagnostic section now narrowing is classified into three sections under the big umbrella of ischemic heart disease meaning a disease of lower oxygen to the heart and it comes in three sizes small medium and large kind of like a pizza so for small it's called coronary artery disease then stable angina the stress-induced angina or basically chest pain now medium is ACS the acute coronary syndrome which encompasses unstable angina and mi now unstable angina is our unsafe angina which is unrelieved with rest and totally unpredictable far worse because it means we're closer to the larger condition of an MI and then to death so typically more pain experienced means more tissue death is occurring now as far as signs and symptoms any complaint of chest pain guys is super serious exams use the classic key words of left substernal pain but guys now boards are getting way more advanced so key words like sudden or crushing pain even radiating or shooting and even key word here heavy pressure usually indicates a priority so we'll see words for pain like substernal chest pain everyone knows that one but here's a big tip jaw pain left arm pain even mid back or shoulder pain and even big one here heartburn or epigastric pain coupled with sob or shortness of breath dyspnea and even labored breathing now nausea and vomiting and abdominal pain not classic signs but big for MI also sweating cold diaphoresis and even pale cold skin known as dusky and even anxiety now here's a tricky thing diabetic patients can have something called a silent mi with no classic signs or symptoms guys they have dead nerves from diabetic neuropathy basically meaning they can't fill it and even women commonly tough it out thinking they're just tired or something so typically em eyes and diabetics and women often go unnoticed now as far as Diagnostics for MI both labs and imaging any new chest pain always requires an EKG first big NCLEX tip and no you don't need to know how to read a 12-lead EKG for the NCLEX or even the five other rhythms or views of an MI but you do need to know for the NCLEX ST elevation and ST depression so ST elevation usually means no o2 or it could mean hyperkalemia that high potassium so we always confirm with troponin labs so think if s T is high then the heart muscles have died and if s T is low we always think low o - now this is called ST depression or t-wave inversion again caused by that low - aka ischemia meaning only partial blockage or it could be from hypokalemia and typically ST segments will go back to normal when we get reperfusion so we confirm it with blood labs guys write this down troponin is our number one indicator for MI it's our gold standard so again write it down troponin over 0.5 indicates trauma to the heart as heart muscles die this protein leaks out into the blood along with potassium so patients will also have high potassium aka hyperkalemia but our other labs like CK ck-mb and even CRP these are important but guys they're not commonly tested on the NCLEX now a very common NCLEX question always shows an EKG with St elevation or gives you a positive troponin / 0.5 guys this always indicates an MI so we treat with drugs like Mona but we're gonna cover that in a moment but guys the goal is always to unclogged the oxygen tube within 45 minutes so patients are taken to the cath lab immediately to locate and fix the blockages we call it the ABCs of mi surgery an angioplasty aka PCI is used to both visualize and move aside the blockages with either balloon or stent a bypass also called cabbage to go around more severe blockages using a piece of vein or artery from another part of the body usually the leg or we can just cut out the blockage calden and our dekhta me now we can also use thrombolytics AKA clot Buster's if surgery is not immediately available now these are called TPA or streptokinase but they're usually not routinely given as first-line therapy since they can cause massive bleeding and usually they have to be given within two to six hours of initial mi but we're gonna cover these treatments in the treatment section so now if your opponent comes back negative meaning no mi we commonly do a different test to diagnose the narrowing here this is called a stress test where we stress out the heart seeing how it responds with low oxygen it's all done to help pinpoint potential blockages so two types of stress tests are given either an exercise or treadmill stress test and non exercise called nuclear pharmacology so exercise or treadmill stress test we're looking for SG changes indicative of myocardial ischemia basically low oxygen in the heart so remember the 3 s's during a stress test we stop for chest pain or STDs guys big tests tip right there the NCLEX is gonna ask for which immediate action by the nurse is a first priority now the answer is always to stop the test for st changes or chest pain now as far as non exercise nuclear stress tests a radioactive dye tracer is injected into the vessels acting kind of like a highlighter tell pinpoint potential blockages now a big test tip before chemical stress test guys write this down huge NCLEX tips here since we're trying to diagnose narrowing we teach the patient to avoid the meds and stimulants that can alter the test now four big key terms always on select all that apply questions we avoid the C's and avoid the t's so 24 to 48 hours before we're always going to avoid cigarettes and caffeine including teas sodas and coffee guys not even decaf even decaf contains small amounts of trace caffeine and we're avoiding cardiac meds like and beta blockers these two can relax the heart too much and are gonna alter the test and lastly guys we're avoiding theophylline the respiratory drug this guy acts like a stimulant causing narrowing so write that down the affluent always comes up on exams here now one last tidbit here guys there's no eating or drinking for hours before and after the test we're not talking twelve here so just NPO four hours before and after now four mi treatments guys again think any acute chest pain we always have to think heart attack basically MI the heart dies regardless if it's only a bad burrito or maybe it's just heartburn the thing is we don't know until we get an EKG and troponin so guys always think the worst so right now we give drugs to open up those oxygen tubes next we remove the blockage and after we give the heart rest and prevent any future clots now you've heard the term Mona but for the NCLEX the correct sequence is oxygen for perfusion aspirin or antiplatelet congregate er to prevent platelets from sticking together and forming a bigger clot nitro opens those coronary oxygen tubes to provide more oxygen to the heart muscle and morphine helps the heart to relax decreasing the workload now all these drugs help get and conserve oxygen immediately so big test tips for nitro no viagra a fill ending drugs like a Zil denna fill remember a fill will kill since both are potent vasodilator z' it causes vascular collapse from low blood pressure now some other highly tested points here guys three doses a maximum of 5 minutes apart no swallowing always sublingual under the tongue and headache and orthostatic hypotension are common so guys we take this drug while sitting to prevent fall risk now a little side note for chronic angina patients at home we teach them to call nine one if there's pain five minutes after the first dose they again collects keator Amir guys pain five minutes after the first dose now test tips for morphine guys any chest pain after morphine indicates an mi even if it's only one or two out of ten NCLEX key word here is chess paid or unruly pain after morphine typically more pain equals more tissue death now we fixed the clot with cath lab and clot Buster's so for cath lab just think it clears the clot also called PCI percutaneous coronary intervention key terms that show up on exams are arterial or even angioplasty now angiography or even angiograms are images taken via x-rays to visualize the blockage and plasti means balloon or stent placement requiring more recovery time patients are usually awake not under general anesthesia so before we're NPO 6 to 12 hours meaning no eating or drinking and after patients will lie flat for several hours and are encouraged to drink to dilute that contrast dye which we'll be covering next now bypass also called open heart surgery requires more recovery time around 3 to 5 days in the hospital so words including bypass like coronary artery bypass graft or even midcab minimally invasive direct coronary artery bypass grafting usually a shorter recovery time because there's a smaller incision in between the ribs now post-operative general rules here we avoid lifting heavy objects and we protect incisions from infection so big no nose here guys no baths or soaking the wound but shower is okay if they avoid soaking the wound under water we want to prevent infection here so we monitor for redness warmth swelling and draining specifically at the incision site if there's any of these they were reported to the HCP immediately now test tips for cath lab guys always think contrast kills the kidneys usually used in procedures previously mentioned so contrast dye also called iodine is a thick dye highlighter used to find blockages and narrowing but it's really hard for the kidneys to wash out of the blood it's kind of like dumping cement into the washer machines of the body so think thick dye the kidneys will die now here are the top seven test questions that come up with cath lab just remember the ABCs a for allergy to iodine and yes warm flush is normal so guys allergies to shellfish is actually not used as a tool anymore to screen for iodine allergies according to the last NCLEX update B is for bleeding at the catheter site direct or manual pressure on or above the site for any potential bleed and patients will be lying flat hours after aka supine so NCLEX key terms here guys write these down we're not putting the patient in semi Fowler's and no crossing the legs also no blood thinners within a six-hour window this means no heparin no warfarin aspirin or even clopidogrel now C is for creatinine always indicating kidney function normally 0.92 1.2 so remember contrast kills the kidneys kind of like dumping that thick cement into a washing machine so creatinine over 1.3 usually means an injured kidney also called contrast nephropathy so we avoid renal failure patients and key word here guys write this down diabetics on metformin we stopped metformin 48 hours before and after the cath lab we want to prevent lactic acidosis and nephropathy and we can give mucus to protect the kidneys but it's not common on the NCLEX so remember iodine is like thick died the kidneys will die always a big NCLEX tip now the last C you can't palpate the pedo pulse after surgery guys we always call the doctor aka HCP healthcare provider remember this pulses equals perfusion normally we get diminished pulses but only four to 12 hours max not 1 to 2 days so NCLEX keywords here guys cold cool or remarkably cool legs absent pulses are non palpable or even just present with a Doppler ultrasound big no-no lack of perfusion now we can also give clot Buster's like TPA to dissolve the clot so let's review the top tested content right here from our DVT video now fibrinolytics aka clot Buster's which are not routine for DVT s but are still used these guys are like the atomic bomb their one-time push drugs so we give either teep or streptokinase well guy streptokinase has the most allergies associated with it and the big thing with these atomic bombs is the huge bleeding risk since it has an 8 hour or less duration this means we're most at risk to bleed during that 8 hour window so guys know injections at all no new IVs no sub q Steven for diabetics no IMS and definitely no ABG's these drugs can only be given through a compressible site like an IV so we never give these through a central line because we can't hold pressure on that central line only peripheral lines here ok now after the mi we want to prevent clots and give the heart some rest so heparin is used to stabilize unresolved clots and prevent the growth of current ones now big NCLEX key words here guys heparin does not dissolve clots only clot Buster's dissolve clots like TPA and to give the heart some rest we use BCD drugs beta blockers calcium channel blockers and dilators like nitro so here are the big NCLEX test tips for pharmacology again guys we took over 10,000 NCLEX questions here and here are the most tested keywords write these down again heparin prevents clots by thinning the blood so we have a huge bleed risk so the therapeutic range for coagulation therapy is to keep the PTT between the ranges guys write these down 46 to 70 always on the NCLEX typically a standard is three times max range now the antidote for heparin is protamine sulfate so our memory trick is hep it like a frog just think H for heparin is hep it for PTT and protamine sulfates now for all the NCLEX key words and memory tricks for beta blockers calcium channel blockers and dilators like nitro we include all that stuff in our pharmacology section so we'll leave a link right here for the membership site now for complications after an MI like a car crash the heart has some pretty serious damage specifically to the left ventricle which happens to be the main pump giving oxygen and blood pressure to the entire body so when this guy fails we end up with some deadly complications so three most deadliest complications here number one being cardiogenic shock we're talking BP solo it's on the flow so we watch for signs and symptoms of low cardiac output being low blood pressure agitation or confusion cool and clammy pale white skin with low urine output less than 30 miles per hour guys we need to increase that blood pressure fast with epi dopamine and nor happy now v-fib and v-tach occurs in around 90 percent of recovering mi patients yes that's correct guys ninety percent since the damaged heart sort of glitches or short circuits like a broken computer slipping into deadly rhythms like v-fib and v-tach so remember we always defibrillate if we don't have a pulse an always early defibrillation before CPR if given a choice big NCLEX tip we choose defib for v-fib and we also use cardioversion if you can count a pulse and always remember to synchronize lastly a heart failure is a big issue or pump failure we call it since we have a damaged pump it fails to pump blood forward and now it backs up into the lungs and our body eventually drowning the patient so remember HF and heart failure is HF for heavy fluid guys always report these key words rapid weight gain usually it means water gain worsening crackles can mean lung fluid and even sudden edema or JBD and even big key word here new s3 heart sounds or murmurs and collect key words like rapid worsening and sudden usually indicates a priority patient always the number-one intervention is pushing IV diuretics like furosemide guys they end in IED so think the body is dried and a little side note not ice or serb ID that's a nitrate for chest pain lastly two other conditions are common pericarditis and mitral valve prolapse and pericarditis the inflammation to the SAC around the heart can lead to deadly pericardial effusions or cardiac tamponade this is where the heart is basically squished to death by its own blood sac causing the heart to stop beating very common on the NCLEX since it's very deadly so guys we always monitor for Beck's triad so remember BEC be for big jugular veins or jugular vein distension efore extremely low BP and c4 you can't hear the heart sounds also called muffled or distant heart sounds now with mitral valve prolapse the little cords holding the valves can suddenly snap loose from a dead heart muscle now the patients will have a heart murmur and even develop atrial fibrillation from blood backing up stretching out those atria now after an mi we teach the 2ds diet and lifestyle change and drugs or aka pharmacology now it's not that we're just teaching them about diet and exercise we're nursing a broken heart here now our goal here is to prevent heart failure so the heart needs a few weeks off with less pressure and less workload now we do this with low sodium and low fluid intake so we educate the patient about the acronym dress so say yes to the dress now D is for diet low and sodium and fluids so remember the two into two grams and two liters per day or less this will reduce blood pressure and prevent heart failure so we watch for heavy fluid so we educate patients to take their own pulse guys write that one down big key word there we also do daily weights nan for weekly but daily and guys any rapid weight gain or any new edema or worsening dis Nia also called orthopedic we call the doctor these are early signs of heart failure and finally we teach the avoidance of high sodium foods like chips dressings ketchup meats cheeses basically anything that comes in a package always remember here sodium swells the body and with heart failure we're preventing heavy fluid now ours for reducing stress alcohol caffeine and here's a big one low cholesterol from animal fats so avoid animal products like beef poultry and dairy products like cheese and creams we're avoiding any and all land animals but fish that's okay now a side note again the numbers you need to know for the NCLEX all land animals increased bad cholesterol like total cholesterol trike rides and LDLs the loser lipids high cholesterol means high clogging and these numbers love to show up on the NCLEX and exam so guys write these down all these numbers should be low except hdls the happy lipids the only ones that should be high over 40 so HDLs help get rid of the bad cholesterol and also eating fiber found in fruits and veggies can help clean out that cholesterol so listen to your mama and eat those veggies he is for exercise 30 minutes five days a week this not only increases HDL as those happy lipids but also strengthens the weak heart S is for smoking sensation big and clicks key term there guys it prevents scarring aka atherosclerosis and another key term here guys is s for sex that's correct sex it can only be resumed only after climbing two flights of stairs with no shortness of breath big key word right there now a little test tip about therapeutic communication after an mi most patients don't even see a need to change but it's your responsibility as the health care provider to assess their fears guys by asking questions and teaching so big keywords for the test avoid key words like accusing blaming and even asking why and speaking of things to avoid so we teach patients to avoid NSAIDs like key words here guys ibuprofen and naproxen those non-steroidal anti-inflammatory drugs these guys can cause an increased risk for thrombotic effects a.k.a risk for clots and this causes future m eyes now speaking of drugs we can always use the aces and ARBs to decrease the blood pressure now a lot of NCLEX questions come from pharmacology and we do a full video for both aces and ARBs and all the other cardiac drugs in the pharmacology section okay lastly we can give two very particular drugs that prevent future m eyes let's play that segment right here so think a c4 anti clogging of the arteries a is for anti platelets like aspirin and clopidogrel brand name plavix this guy prevents platelets from clumping together and forming clots and c4 cholesterol-lowering drugs guys these Endon statin like lovastatin so remember stay clean because it cleans out the arteries keeping them free from cholesterol now since statins prevent the production of cholesterol in the liver it is very liver toxic so guys don't give this to patients with liver problems like hepatitis or cirrhosis oh and also avoid grapefruit juice since it blocks statin drugs alright guys that wraps it up for em I don't forget to take your quiz in the practice area thanks for watching for our full video & new quiz Bank click right up here to access your free trial and please consider subscribing to our You Tube channel last but not least a big thanks to our team of experts helping us make these great videos alright guys see you next time [Music]

Channel: Simple Nursing

Views: 353,890

Rating: 4.8875709 out of 5

Keywords: Heart attack, MI, Myocardial infarction, Antihypertensives, beta blockers, blood pressure drugs, heart failure, HF, ACS, CAD, atherosclerosis, Ischemic heart disease STEMI, ST elevation, PCI, percutaneous coronary intervention, Cath lab, Bypass, CABG, Coronary artery bypass graft, coronary artery disease, angioplasty, angiogram, radioactive iodine, Registered nurse RN, RN, Osmosis, Pharmacology, NCLEX, ATI exit, HESI exit, Kaplan, student nurse, nursing student, simplenursing, simple nursing

Id: vu3hMgkwjZs

Length: 25min 14sec (1514 seconds)

Published: Wed Aug 21 2019