Myocardial Infarction (MI) NCLEX Review Part 2

This is an NCLEX review for myocardial infarction (heart attack or MI) part 2. Patients who have experienced a myocardial infarction are at risk for many complications. An MI is when there has been compromised blood flow to the myocardial tissue that leads to cell death.

In the previous review, I covered part 1 of myocardial infarction which was about the pathophysiology, causes, signs and symptoms, and tools used to diagnose MI.

When taking care of a patient who is experiencing an MI, it is very important the nurse knows how to recognize the typical signs and symptoms seen in this condition, how it is diagnosed, nursing interventions, and patient education.

Don’t forget to take the myocardial infarction quiz.

In this NCLEX review for myocardial infarction, you will learn the following:

• Nursing interventions for MI
• Medications used to treat an MI (with a mnemonic)

Lecture on Myocardial Infarction Part 2

Myocardial Infarction Nursing Interventions & Lecture

Nursing Interventions for Myocardial Infarction

• Monitoring & Assessing Cardiovascular system:
  • Obtain a 12-lead EKG, have continuous bedside cardiac monitoring
  • Monitoring blood pressure and heart rate
• Place on oxygen via nasal cannula per MD order 2-4 L
• Working IV access (multiple…may start drips and administer other IV medications)
• Monitor respiratory system: lung sounds “crackles”..represent heart failure
• Strict bedrest (activity puts strain on heart)
• Collect cardiac enzymes as ordered by the physician
• Administering medications per MD order:

Mnemonic: Acute Angina Means Nasty Artery Blockages And Cardiac Complications

Antithrombotic agents: prevent formation of clot

• Lovenox (subq injection) monitor for bleeding (assess gums of mouth, stool (dark tarry), drop in blood pressure and increase in heart rate, blood in urine)
• Heparin (drip usually or subq injection) monitor for bleeding just as with Lovenox, but watch platelet count which may start to decrease after several days while being on Heparin. This could represent Heparin-Induced Thrombocytopenia (<150,000 platelets)…. if this develops patient may be be switched to Argatroban or Angiomax
  • Monitor PTT (Partial thromboplastin time) normal 25-35 seconds
  • 60-80 therapeutic range (depends on facility)

Antiplatelets: decrease platelets aggregation and thrombus formation

• Aspirin: low dose (decrease the chances of a clot forming and decrease the chance of another heart attack). Watch for signs and symptoms of GI bleeding, especially if patient has a history.
• Plavix: taken if can’t take aspirin (may be prescribed short term for up to a year after the myocardial infarction)
  • Monitor for:
    • Thrombotic Thrombocytopenic Purpura (TTP): clotting disorder where clots form in blood vessels in the body which causes decreased blood flow to vital organs…low platelet count, neuro changes, bruising, anemia, renal failure, fever
    • **will need to discontinue medication for 5-7 days before a planned surgical procedure because of the increase chance of hemorrhage while taking this drug. Patients need to let their surgeon know they are taking Plavix because they will be switched to another antiplatelet prior to the surgery. Plavix takes a while to clear in the body’s system.

Morphine: for chest pain relief (may find that morphine only relieves the chest pain rather than nitro) hypotension, respiratory depression.

Nitrates: Nitroglycerin (ointment, sublingual, IV, patch, or oral “Imdur”): causes vasodilation and increases blood flow to the heart, hence better blood flow to the area experiencing ischemia

• Monitor blood pressure, assess patient’s chest pain, monitor EKG and BP continuously if on drip.
• Side effects: headache, flushing, dizzy

Ace Inhibitors: end in “pril” Lisinopril, Ramipril, Enalapril, Captopril

• ACEI work by allowing more blood to get to the heart muscle and this allows it to work easier. It does this by blocking the conversion of Angiotensin I or Angiotensin II (this causes vasodilation, lowers blood pressure, and allows kidneys to secrete sodium because it decreases aldosterone)
  • Side effects: dry, nagging cough and can increase potassium level (it does this by inhibiting angiotensin II which decreases aldosterone in the body which causes the body to retain more potassium and excrete sodium)

Beta blockers: “Coreg, Lopressor” decreases work load on the heart…slows heart rate and decreases blood pressure

• monitor for bradycardia, masking signs and symptoms of hypoglycemia in diabetics, breathing problems in asthmatics and COPD…educate patient not to take beta blockers with grapefruit juice because it slows the absorption of beta blockers

ARBS Angiotensin II receptor blockers:end in “sartan” like Losartan, Valsartan

• used in place of ACE inhibitors if patient can’t tolerate them
• ARBs work by blocking angiotensin II receptors which causes vasodilation. This lowers blood pressure and helps the kidneys to excrete sodium and water (due to the affects that blocking angiotensin II has on the kidneys…decreases aldosterone).
• Side effects: increases potassium levels….NO dry nagging cough

Cholesterol lowering medication such as Statins: “Lipitor, Crestor, Zocor” (goal: LDL less than 100 mg/dL) helps lower LDL, total cholesterol, lower triglycerides, and increase HDL.

• Educate not to replace diet and exercise
• Notify doctor if they develop muscle pain or tenderness
• Monitor CPK (creatine kinase) levels…. which if elevated it can cause muscle problems
• Monitor liver function because statins act on the liver to block it from producing too much cholesterol.

Calcium Channel Blockers: Norvasc, Cardizem

• This medications work by stopping the transport of calcium to the myocardium and into smooth muscle which causes vasodilation on the coronary arteries.
• Monitoring heart rate, orthostatic hypotension, educate about good oral hygiene due to gum enlargement.

More NCLEX Review

References