 Welcome to Nursing School Explained and this video on the nursing considerations for a patient suffering myocardial infarction. If you haven't already done so, please watch my videos that are on myocardial infarction as well as coronary artery disease and acute coronary syndrome to get more of the background information. Once a myocardial infarction has been confirmed, this patient will be very sick with a potential to really suffer bad consequences or complications. So typically this patient will be a one-on-one. So there will be one nurse for one patient or you might even have two nurses for one patient depending on how sick the patient is, how severe the symptoms are. We want to make sure that we get this EKG within 10 minutes. This is the most important part because it will determine the course of action and what we need to do to get this patient treated. Certainly, whenever there is something going on with the heart and the patient has high risks for developing dysrhythmias or even cardiac arrest, we want to keep them on a continuous heart monitor. We also want to have the emergency equipment close by because you might need to use your defibrillator. You might need to use your pacing function of that defibrillator and or the patient might have to be intubated. So we need to have that emergency equipment close by and even put the pads on the patient to hook them up to the defibrillator so that all we have to do is switch the button and press shock in case we need that. We want to check their vital signs very frequently, mostly because they're in this very fragile state, but also we're going to be administer medications to hold the patient over until they can go to the cath lab for their angiogram. So these medications can have a severe impact on the patient's blood pressure and heart rate, so we need to keep an eye on that and check them at least every five minutes, sometimes maybe even a little bit more frequently if they are very labile. We want to elevate the head of the bed because that facilitates chest expansion and excursion and for them to draw in more oxygen. And we also want to assess the cardiovascular and respiratory systems frequently. So you might have to check the peripheral pulses, their central pulses, their skin signs, their lung sounds very frequently. This is not a Q1 shift thing. This might be every 15 minutes because we know that that heart muscle as it weakens because the area of low blood flow or low oxygen supply and the occlusion of the coronary artery, this can lead to heart muscle dysfunction and then it can affect the lung. So we really need to keep a very close eye on these patients. We also need to assess their pain frequently because many times they will be complaining of this excruciating crushing chest pain and the pain assessment is what will guide our treatment and the medications that we administer. So we will need to be very good in our PQRST and our old cards questions so that we can assess them frequently and then provide them pain relief as best as we can. And then medications we'll talk about here in a moment. We also want to manage their anxiety. So imagine you're in that bed and they are telling you're having a heart attack. You're having this excruciating chest pain. Of course the patient is going to be anxious and worried and all of that. So therapeutic communication goes a long way explaining what you're doing, explain what's happening, explain why there are so many people around, explain why you have that crash card and the defibrillator hooked up to the patient if they are lucid enough to understand what's going on. Certainly we want to make them NPO. This is not a patient that we want to give even like ice chips or anything because they're going to go to the cath lab. We have to anticipate that they might have to be intubated. So NPO is the name of the game. And then we have to be able to communicate with all the people involved that are going to get this patient better. Most likely the patients, the goal is to get them to the cath lab. So we have to connect with the cath lab. Are you there yet? Can I bring the patient? How soon can I bring them? We also have to communicate with the cardiologist or the electrophysiologist who is going to perform that angiogram to open up that occluded coronary artery. Now, this can be a very busy time. So you might not have time to take phone calls and talk to all these people, which is why you need to also communicate with the charge nurse or your mentor. People that have had this experience before that know who to call, they know what to say. They know how to get the important information from you to relate to others. So this communication is super, super important here. And then get help. If you are overwhelmed, if you need to hang three different drips at once and the patient is about to crash, ask for help. Say I need somebody else to help me take care of this patient so that I can provide the care that will get the patient to the cath lab so that they don't start coding right there in the bed where you're taking care of them. So please speak up for yourself, communicate and communicate and communicate again. Now, for medications, medications that we always talk about for myocardial infarction or acute coronary syndrome, for that matter, we use the acronym MONA, which stands for morphine, oxygen, nitroglycerin and aspirin. That is a very nice acronym. But many times we give them together kind of if we can. But if it comes for prioritization like a nursing school exams, typically it goes this way. We want to give the patient oxygen first because it's very easy and it can be quickly administered, plus it will give the patient extra supplemental oxygen to give to provide that coronary artery with that blood supply and that oxygen that is currently lacking from that occlusion. We want to give them nitroglycerin because it dilates the coronary artery. So if we have a complete or partial obstruction and we're only able to dilate that coronary artery a little bit, we might get a little bit of blood flow past that occlusion, which will definitely help the patient feel better and get that blood flow, prevent the muscle tissue from dying. Because the platelets aggregate to whenever there is an occlusion, we want to give aspirin, which is an anti-platelet agent. And that is typically the chewable aspirin because it works a little bit faster. It kicks a little bit in a little bit faster. It's easier digestible and easier available to work on those platelets. And then we also give morphine, which gives pain relief. We know it's a narcotic analgesic. It also helps to decrease heart rate and blood pressure because many times with that sympathetic nervous system response, those two will be elevated. The morphine will kind of dampen that and it also helps to relieve the patient's anxiety. So it's a very nice medication to use. Of course, with all these medications, we have to know the parameters on what to assess for because they all can affect the patient's blood pressure. They might affect their heart rate. And it depends on where the MI, where the location of the occlusion is, where in the heart muscle, certain medications might not be indicated. So check my separate video where I go into the cardiac medications in more detail. Other medications that might be used in addition to mona are other antiplatelet agents. Some cardiologists like to give the patient two different kind of antiplatelet agents because they work on the platelets in a different way and help prevent them from aggregation. So other ones that we use here commonly are plavix, also known as copridogrel and then agronox. Many times we use beta blockers, which reduce the workload of the heart. They reduce the heart rate and therefore reduce that oxygen demand that that heart muscle is currently having. They might need to be on a heparin drip to again anti-coagulate them and get a little bit of blood flow past that occlusion. Maybe an ACE inhibitor might be indicated or maybe if the patient is having dysrhythmias from the disturbances of the blood flow to that heart muscle then we might need to give them an anti-dysrhythmic which might be amiodarone, lidocaine or any of those other medications. So again, a patient with an MI is very sick, has a very high potential of sudden cardiac death. So these things are super important. Please always ask for help if you need them so that you can take care of the patient. You can get them to the cath lab or give them thromboletics if that is indicated. Know your medications well and get the help. Speak up so your patient can have the best possible outcome. Thanks so much for watching this video on nursing school explained. Please give me the thumbs up and I'll see you right back here very soon for the next video. Thanks for watching.