A myocardial infarction, including the pathophysiology, signs/symptoms, labs, diagnosis, treatment, and nursing care associated with an MI. Percutaneous coronary intervention (PCI) and Coronary Artery Bypass Graft (CABG) procedures.
Our Medical-Surgical video tutorial series is taught by Cathy Parkes BSN, RN, CWCN, PHN and intended to help RN and PN nursing students study for their nursing school exams, including the ATI, HESI and NCLEX.
0:00 What to Expect with Myocardial Infarction 0:34 Myocardial Infarction 0:58 Signs and Symptoms of Myocardial Infarction 1:17 Diagnostics of Myocardial Infarction 1:50 Treatments of Myocardial Infarction 2:13 Surgical Intervantions 2:37 Nursing Care 3:13 PCI 3:34 Procedure 3:51 Nursing Care 4:25 CABG 4:46 Nursing Care 6:09 Quiz Time!
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Content
0.089 -> Hi, I'm Cathy with LevelUp RN.
2.34 -> In this video, we are going to talk about
a myocardial infarction as well as a PCI,
7.71 -> which is a percutaneous coronary intervention,
and then we'll also talk about CABG surgery.
13.99 -> So this is a coronary artery bypass graft.
17.61 -> At the end of the video, I'm going to provide
you guys a little quiz, a little knowledge
21.449 -> check, to test your understanding of some
of the key facts I'll be covering in this
24.93 -> video.
25.93 -> So definitely stay tuned for that.
27.36 -> And if you have our LevelUp RN medical surgical
nursing flashcards, definitely pull those
32.56 -> out so you can follow along with me.
34.93 -> A myocardial infarction is where we have a
sudden blockage of blood flow into the heart,
41.809 -> and the pathophysiology behind an MI is that
when a patient has atherosclerosis, so the
48.07 -> plaque on the coronary artery wall, this plaque
can rupture, causing a thrombus, and that
55.45 -> in turn occludes blood flow into the heart.
59.27 -> Signs and symptoms include chest pain and
discomfort, shortness of breath, diaphoresis,
65.539 -> as well as dizziness.
67.74 -> Women sometimes have different symptoms, which
may include nausea and vomiting, as well as
72.899 -> fatigue, pain in their back, shoulders or
jaw.
77.889 -> In terms of diagnostics, if we run labs, the
patient will have elevated cardiac enzymes,
83.88 -> and then their EKG may show abnormal ST elevation
or depression.
90.52 -> It may show T wave inversion or an abnormal
Q wave as well.
96.149 -> We can also do what's called a thallium scan,
which is a nuclear imaging test to see how
101.829 -> well blood flows into the heart.
104.929 -> And then a cardiac catheterization can also
be used as a diagnostic test.
110.649 -> Medications used in the treatment of an MI
can include aspirin, clopidogrel, as well
116.429 -> as thrombolytic anticoagulants, antihypertensive
agents such as beta blockers and ace inhibitors,
124.929 -> and statins.
126.149 -> And I go through all of these medications
in depth in my pharmacology playlist, so definitely
131.519 -> check that out if you need to.
133.68 -> In terms of surgical interventions, we have
a PCI, which is a percutaneous coronary intervention,
140.74 -> which we're going to talk more about here
in a minute.
142.93 -> We also have a CABG surgery, which is a coronary
artery bypass graft surgery.
149.569 -> And then an atherectomy can also be done which
is a surgery to remove the plaque from the
155.85 -> artery.
157.26 -> In terms of nursing care, we're going to administer
oxygen for an SpO2 that is below 90% per orders,
165.29 -> and then we're going to want to monitor the
patient for complications such as cardiogenic
169.92 -> shock and heart failure.
172.08 -> And just as a reminder about the signs and
symptoms of cardiogenic shock, those include
176.969 -> hypotension, tachycardia, tachypnea, as well
as weak pulses.
183.03 -> And then we're going to initiate cardiac rehabilitation
for the patient.
187.79 -> This is an outpatient program that focuses
on exercise and education for the patient.
193.939 -> A PCI, or percutaneous coronary intervention,
is a procedure used to open up the coronary
201.06 -> arteries, and it must be performed within
two hours of the onset of symptoms of an MI.
207.64 -> That's why if you or someone you love has
any symptoms of an MI, you should get immediate
212.519 -> attention.
214.06 -> So during this procedure, a catheter with
a balloon is threaded through a blood vessel,
219.579 -> usually at the femoral artery, up to the blocked
coronary artery.
224.76 -> And there the balloon is inflated and a stent
is placed to restore blood flow to the heart.
231.81 -> After the procedure, you should monitor the
insertion site for bleeding, and you definitely
237.03 -> need to check perfusion to the extremity that
is distal from that insertion site.
242.659 -> So check that extremity for pulses, color
and temperature.
247.26 -> You also want to monitor the patient for complications,
which can include an artery dissection, as
253.29 -> well as re-occlusion of the coronary artery.
257.81 -> So definitely be on the lookout for symptoms
such as shortness of breath, chest pain, tachypnea,
264.13 -> as well as tachycardia.
266.18 -> The coronary artery bypass graft procedure
bypasses one or more of the patient's coronary
272.669 -> arteries due to blockage or persistent ischemia,
and it typically uses the saphenous vein from
280.729 -> the patient's leg.
282.02 -> However, synthetic grafts can be used as well.
285.36 -> In terms of nursing care after the procedure,
we're going to want to closely monitor the
291.009 -> patient's blood pressure because if the patient
has hypertension that can cause bleeding from
296.38 -> the graft sites.
297.38 -> And if the patient has hypotension, that can
cause collapse of the graft.
302.78 -> So we're going to really monitor the blood
pressure and keep it in that narrow therapeutic
307.03 -> window.
308.17 -> We're also going to monitor the patient's
temperature because post-op hypothermia is
313.95 -> a potential complication.
316.05 -> If needed, we should use rewarming procedures
to help bring the patient's temperature back
321.15 -> up.
322.24 -> We're also going to monitor the patient for
bleeding so they will have a chest tube when
326.33 -> they come back from surgery, and you're going
to want to closely monitor the drainage in
331.139 -> that chest tube.
332.45 -> If it exceeds over 150 milliliters per hour,
you need to notify the provider.
338.31 -> You're also going to assess the patient's
level of consciousness, their fluid and electrolyte
343.66 -> balance, as well as their cardiac rhythm,
their pain level and the neurovascular status
350.729 -> of the donor site.
352.15 -> So we definitely don't want to neglect the
leg where we got that saphenous vein.
357.199 -> And then we're going to monitor the patient
for complications, which can include a cardiac
361.699 -> tamponade.
363.46 -> And if you need a reminder about the signs
and symptoms of that condition, definitely
367.22 -> watch my video on that topic.
369.479 -> All right, time for a quiz.
371.5 -> I have three questions for you.
373.659 -> First question.
375.539 -> Symptoms of a myocardial infarction will be
the same for men and women.
380.699 -> True or false?
384.099 -> The answer is false.
385.99 -> So women will often have symptoms such as
nausea and vomiting, fatigue and pain in their
391.919 -> back, shoulders, or jaw.
395.199 -> Question number two.
396.56 -> A percutaneous coronary intervention must
be performed within blank hours of the onset
403.629 -> of MI symptoms.
407.47 -> The answer is two.
409.819 -> Question number three.
411.31 -> What vein is often used to bypass the blocked
coronary artery during a CABG procedure?
421.19 -> The answer is the saphenous vein.
423.99 -> Okay, I hope you enjoyed that quiz, and I
hope this video was helpful.
427.9 -> Take care and good luck studying.
429.939 -> I invite you to subscribe to our channel and
share a link with your classmates and friends
434.97 -> in nursing school.
436.539 -> If you found value in this video, be sure
and hit the like button, and leave a comment
441.55 -> and let us know what you found particularly
helpful.
