Patient teaching:

Mr. Miller and his MI

BY:
DANA JOLLY
JENN VAN METER


SARAH BISHOP
MARGARET FORD
Assessment Findings:
(Focus: Perfusion and Circulation)
Patient presents to hospital with an MI and no previous history of heart disease, but several risk factors that
may have caused it. He is overweight, has high cholesterol, hypertension, and has developed Diabetes type
II and sleep apnea. Patient has deficient knowledge of how the heart works and how to keep it healthy. He
was unaware he had so many conditions that could lead to his heart attack. He knew he was unhealthy and
wanted to try to start eating better and being healthier, but he has been very busy and stressed with
financial and family problems. He reports that he eats out about 4-5 times a week and it is rare for him to
exercise. He has been taught about his type of diabetes before and has been prescribed medications for his
diabetes, hyperlipidemia, and his HTN, and was somewhat compliant with taking them. He has been
noncompliant with maintaining a healthy diet and regular exercise, and reports he isnt diligent about
taking measures to control his blood sugar. He says he gets about 5-8 hours of sleep a night but always
wakes up tired and feels drowsy throughout the day. Patient will greatly benefit from education of the risk
factors he has that may have contributed to his MI, and also more teaching about the heart and how
important it is to keep it healthy. He could also use some tips on what he can do to decrease his risks of
future heart-related health problems. It is important he be taught regular blood sugar checks and
controlling his blood sugar, and also sticking to a strict cardiac diet. Patient could also benefit from more
teaching of his medications that he has taken and will be taking, and the importance of compliance with all
these things.
Specify how you will teach
First assess the clients understanding. We would also
ask the client how he believes he learns best. Then try it
his way and have him teach it back to the nursing staff
to ensure comprehension.
Objective:
Have the patient be able to demonstrate tactics of self-care to the
nursing staff and allow him to ask questions and verbalize concerns.
Understand what a cardiac diet is, how to shop and cook for one.
Understand what activities to use in order to increase activity.
Understand how to loose weight. The patient should work with his
PCP on this goal
Understand how and when to take medications.
Goals for Patient
Goals, would be to help the client come up with his personal list or plan of commitments to lifestyle
change. We would want the client to make this list on his own accord with some help from the
nursing staff; as his probability of compliance rises when he makes it himself.
Take your prescription medication as directed
Eat a healthy cardiac diet- Lower salt, lower read meat, lower fats, higher fiber intake.
Exercise more- work your way up to 30 min of moderate exercise most days
Reduce stress- find a relaxing hobby, something that helps you find your center.
disease process
Our goal would be to have the patient since he is a middle-aged, adult male, be able to explain
to the nurse:
Contributing factors he can control
Diet, lifestyle, diabetes (manage it well), hypertension, sleep apnea (manage it well)
Factors he cannot control
Family history, genetics
His personal action plan to manage and prevent another MI
Assessing patient learning
This will be a constant thing through out Mr. Millers hospital stay.
We will begin educating this patient within the first day.
We will teach him about each medicine as we give it every day
At discharge we will assess what he has learned by having him tell us what his
meds are, when to take them, and what exercise he needs when he is home.
At that time we will fill in the missing or incorrect information.
Our goal with assessing the patients learning would be to have the patient
fully verbalize and demonstrate his new skills and understanding. Also, we
would have him teach it to his family to ensure his comprehension.
How does the heart work?
The heart muscle is pear shaped and is
the size of your fist. It is the strongest
muscle in the body. The heart pumps
oxygenated blood and nutrients to the
entire body.
Coronary Arteries:
The heart receives
oxygenated blood through
the coronary arteries located
on the surface of the heart.
Lack of blood flow to the heart
Causes a Heart Attack
Blood flow is Reduced by:
Blood Clots: Occlusion of the vessel
Plague build-up: Narrows and blocks
blood supply to the heart
Result: Cardiac cells die without oxygen

How do you know if your having a
Heart Attack?
Risk Factors for MI:
Diabetes II
High Blood Pressure
Hyperlipidemia
Obstructive Sleep Apnea
Weight Gain
Diabetes Type II: Insulin Resistance
After you eat a meal, glucose enters your blood stream.
Glucose is the #1 source of energy for body cells. A
hormone called insulin is secreted from the pancreas and
allows glucose to enter body cells. Insulin resistance
causes glucose to stay in the blood. Over time, high blood
glucose damages body organs and increases fatty
deposits inside the vasculature and restricts blood flow to
the heart.
Hypertension: What is it?
Blood pressure is the force of blood pushing up
against the blood vessel walls. The higher the
pressure, the harder the heart has to pump.
Hypertension is defined as BP >140/90.




Hyperlipidemia: High Cholesterol
Abnormal accumulation of lipids
in the blood can cause fatty
deposits (plague) inside arterial
walls.
Watch Video:
http://www.healthline.com/video/understanding-and-treating-
high-cholesterol
How to Lower your Cholesterol:
Read Food Labels: Reduce your intake of: butter, fried foods, baked goods
Limit intake of Red meat and dairy products
Increase your fiber intake: Lowers LDL Cholesterol
Statin Medication: Lowers LDL and triglycerides and raises HDL
Limit processed luncheon meat, hot dogs, bacon, sausage and egg yolk
Obstructive Sleep Apnea
Is a type of sleep disorder characterized by pauses in breathing
or instances of shallow or infrequent breathing during sleep. Each
pause in breathing, called an apnea can last for several seconds
to several minutes. S/S: fatigue, forgetfulness, mood change
Apnea increases C02 in the blood and affects the hearts ability to
pump oxygenated blood to body tissues.
Being inactive or overweight places
stress on your heart.
Being overweight increases insulin resistance.
(Exercise lowers blood glucose levels quickly and improves
your bodys ability to use insulin. )
Losing weight reduces your risk for heart disease, lowers
your cholesterol and blood pressure. Exercise strengthens
the heart and improves blood circulation.

Recovery from an MI
Nutrition
Eat small frequent meals, large meals make the heart work harder
Eliminate or reduce Caffeine: Stimulates the heart
3 cups of fresh fruits and veggies.
Avoid trans fats and saturated fats. (Increases LDL cholesterol)
Reduce sodium intake


Exercise strengthens the heart
Participate in Cardiac Rehab: Receive Support/Exercise Program
Avoid Strenuous Activity such as:
Lifting 20 pound weights
No heavy house work, mowing the lawn, scrubbing the floor
Avoid exercising in extreme heat or cold
**Stop what your doing and rest if chest pain occurs
Tips for Heart Health
Take your medicine as prescribed. Never stop taking your medicine
without your doctors consent. Inform your physician of any OTC drugs or
herbs that you might be taking.
Balance Rest and Activity:
Get 6-8 hours of sleep. (Rest promotes healing)
Weigh yourself every day: 1
st
thing in the morning before breakfast
Report a weight gain of 2 pounds in a day or 5 pounds in a week.
In-hospital medications
Goal would be to have this patient be able to verbalize the medication
indication and care considerations.

ASA 325mg once upon arrival then 81mg daily- helps thin the blood and helps with pain.
Plavix 600mg now then 75mg daily inhibits platelet aggregation.
Heparin bolus and gtt inhibits the bloods ability to clot.
NTG 0.4 mg SL x3 then gtt. Titrate to relieve pain- vasodilator allows the heart to not work so hard by reducing the resistance and increasing
oxygenation.
Toprolol xl 50mg daily- beta 1 blocker, blocks sympathetic stimulation to the heart arteries, allowing the heart to not work so hard by inhibiting
the vasoconstriction of the fight or flight response.
Lisinopril 5mg daily- ace inhibitor, systemic vasodilation- allows the heart to not work so hard by blocking the components that make up a
vasoconstrictor.
Metoprolol 5mg every5 hours x3 hold if HR <50 or SBP <90 beta 1 blocker, blocks sympathetic stimulation to the heart arteries, allowing the
heart to not work so hard by inhibiting the vasoconstriction of the fight or flight response..
Glyburide 5 mg antidiabetic, increases insulin production, increases insulin sensitivity, and may decrease glucose production by the liver
Blood Thinners
Aspirin: Anti-platelet
Side effects- dyspepsia, epigastric distress, nausea, vomiting, abdominal pain, anorexia, hepatotoxicity, GI
bleeding
Heparin
Side effects- Main adverse effect is bleeding (rash and thrombocytopenia)
1.Watch for signs of bleeding and Report: blood in urine or stool or excessive bruising.
2. Blood levels will need to be checked periodically to check for therapeutic levels.

Safety Precautions to prevent bleeding:
Use an electric razor, avoid contact sports, avoid walking bare foot and apply pressure if bleeding occurs.
Antiplatelet medication


Plavix:
Promotes blood circulation and prevents MI
Side effects- Bleeding, rash, headache, gastritis, cough, dizziness and fatigue
1. Take medicine without regards to food
2. Bleeding Precautions: may cause bruising
3. Do not double up on doses, if you miss a dose
4. Withhold Plavix for 5-7 days prior to surgical procedures.



Nitroglycerin
Is used to treat Angina, also known as chest pain. Chest pain occurs because the heart isnt getting
sufficient blood and oxygen. Nitrates dilate blood vessels and increase blood flow.
Side effects- dizziness, headache, nausea, flushing, syncope, weakness and blurred vision
1. If your feeling dizzy, avoid strenuous activities
2. Get up slowly from a lying or sitting position (Prevents Falls)
3. Do not expose nitroglycerin to heat and replace every 6 months
4. Learn to take your own pulse and blood pressure, report a pulse <55.

ACE
inhibitors
Lisinopril: Improves post MI survival
Decreases vasoconstriction and reduces the retention of sodium and water
Side effects- cough, weakness, fatigue, hypotension, nausea, vomiting, ED, impaired renal function,
hypokalemia
1. Watch for signs of renal dysfunction and angioedema
2. Get up slowly from a sitting or lying position
3. Take 1 hour before or 2 hours after meals
4. Monitor your BP at home.
Beta blockers
Metoprolol:
Blocks sympathetic stimulation to the heart arteries, allowing the heart to not work so hard by inhibiting
the vasoconstriction of the fight or flight response.

Side effects- weakness, anxiety, drowsiness, dizziness, blurred vision, dry mouth, hypotension, ED,
hyper/hypoglycemia, back and joint pain, bradycardia, HF, pulmonary edema, constipation, gastric
pain.
Nursing considerations- get up slowly from a lying or seated position, watch for SOB, consider a stool
softener to avoid straining.


Beta Blockers
Toprolol xl
Side effects- fatigue, weakness, anxiety, dizziness, drowsiness, blurred vision,
constipation, nausea, vomiting, rashes, ED, hyper/hypoglycemia, bradycardia,
HF and pulmonary edema.
Nursing considerations- get up slowly from a lying or sitting position, do not
operate motor vehicles or heavy machinery until you know how the medicine
works for you.
Diabetes Medication:
Glyburide

Side effects- The main adverse effect of Glyburide is hypoglycemia
Signs and Symptoms of hypoglycemia are- Confusion, Visual disturbances, Shakiness, Anxiety, Sweating,
Hunger
Patient Education:
1. Take Glyburide 30 minutes before breakfast
2. Check your blood glucose at least 4x daily, before each meal.
3. Do not skip meals or snacks, this increases your risk for hypoglycemia
4. If blood sugar <60 or if you experience S/S of hypoglycemia: Eat a carbohydrate or drink orange juice.


Metformin/Glucophage

Reduces production of glucose by the liver and increases the uptake of glucose

Side effects- abdominal bloating, diarrhea, nausea, vomiting, unpleasant metallic taste,
decreased vitamin B-12 levels, Lactic acidosis.
Check blood sugar before meals and at bedtime, or as directed by your doctor. Take
medicine 30 min before meals. Do not stop taking this medicine without talking to your
doctor.

*Check liver and kidney function before starting the medication

Lipid lowering agents
Zocor
Side effects- dizziness, headache, insomnia, weakness, rash, hyperglycemia, diarrhea,
Nursing considerations- watch for kidney, muscle, or liver damage.
Vitamins/ mineral supplements
FeSO4
Side effects- dark stools, constipation, nausea, vomiting, tooth discoloration,
urine discoloration
Nursing considerations- take with orange juice. suggest a stool softener as to
avoid straining with BM.

Anti-ulcer
medications
Prilosec: (Prevents and treats ulcers)
Blocks histamine, which stimulates the secretion of gastric acid
Side effects- dizziness, drowsiness, fatigue, headache, weakness, nausea, vomiting, itching,
constipation or diarrhea
Nursing considerations- get up slowly from a seated or lying position, if constipation is severe(
pseudomembranous colitis) contact your medical provider, suggest a stool softener as to avoid
straining with BM.

Go home medication list
Zocor to 20mg daily- lipid lowering agent, inhibits the production of cholesterol.
FeSO4 325 mg daily- iron supplement, used to treat iron deficiency anemia.
Prilosec 20 mg daily- anti-ulcer agent, reduces the amount of acid the stomach produces. This will reduce the risk of GI
bleeding.
Toporol XL 50 mg daily-daily- beta 1 blocker, blocks sympathetic stimulation to the heart arteries, allowing the heart to not work
so hard.
Lisinopril 5mg daily - ace inhibitor, systemic vasodilation- allows the heart to not work so hard.
NTG 4mg X3 one every 5 min, after the 3
rd
if pain is still not relieved then call 911
Glyburide (diabeta) 5 mg daily- antidiabetic, increases insulin production, increases insulin sensitivity, and may decrease
glucose production by the liver
Glucophage 500 mg daily- antidiabetic, decrease hepatic glucose production and intestinal absorption of glucose, increases
sensitivity to insulin,
When to Go to the ER or call 911! :
Have the patient with the help of his family or cohabitants write down an emergency
action plan with the nurses help.
If you have chest pain and you have rested (no relief) and taken your NTG (1 pill at a
time 5 min apart up to 3 , no relief) call 911!
If you are short of breath with out extra exercitation.