Long-Term Prophylactic Use of Drugs and Revascularization Therapy (Nursing)

00:01 Now let's look at the long-term prophylactic use of drugs.

00:05 Remember that word means we're trying to prevent an MI and death long term, over a period of time.

00:12 So we talked about antiplatelets like aspirin.

00:15 We talked about antianginal, we're against chest pain agents.

00:18 One or more of these long-acting drugs like beta blockers, calcium channel blockers, or a long-acting nitrate.

00:25 Now go back up and see if what we wrote there, one or more.

00:30 It is not going to be unusual for your patient to be on more than one of these options.

00:35 Beta blockers, a calcium channel blockers, or long-acting nitrates, or any combination that you find to work.

00:41 See, that's the cool part about being a nurse and being part of the healthcare team.

00:45 We get to work with our patients and identify what unique combination actually works for this particular patient.

00:52 Now remember, you always have sublingual nitro.

00:55 That's what SL means.

00:57 Sublingual nitro, if a patient has a period or an exacerbation of chest pain.

01:02 But long term, we want them to be on one or more of those long-acting drugs, and we want them to have, on hand, sublingual nitro with them everywhere they go, in case they have an episode of chest pain.

01:13 And remember the sublingual nitro? Translingual would also work, but sublingual comes in those little tiny brown glass bottles so light can't get to them.

01:23 Now, ACE inhibitors. Remember, they end in "pril" and we have another video for you if you want to dig down into those.

01:28 But we also can put a patient on an ACE inhibitor long term.

01:32 Research shows this is really helpful and beneficial to someone who's had an unstable angina event or an MI.

01:41 Then cholesterol-lowering drugs. Well, nobody likes really talking about this one, but they're called the statins, and they end in S-T-A-T-I-N.

01:51 These are cholesterol-lowering drugs, and I'll just give you a clue.

01:54 We have a video about these later, but I want you to right underneath these always give it night time.

02:00 Okay, so, make sure you make a note, "Always give at night time." This is a really unusual factor with statins.

02:09 Just because your liver that's so involved in cholesterol gets super busy at night time, that's why we have patients take statins at night.

02:17 Now, our goal is that we can control the chest pain and prevent a clot just by using medications. But if drug therapy isn't successful, then we're going to have to look at something much more invasive, revascularization interventions.

02:31 So these are going to involve procedures or surgery, breaking of the skin. This is way more complicated than using just medications.

02:39 So I want to give you just kind of a brief overview of this because, likely, you'll experience patients who need these procedures.

02:46 Okay, so revascularization therapy, and we're just going to reopen and establish the blood supply.

02:52 Now I've got a couple options, coronary artery bypass graft, CABG, C-A-B-G is usually what we call the surgery.

03:00 And what they do is they take a clear, healthy artery, graft, they take that from somewhere else in the body, and they use it to bypass the blocked artery.

03:10 So they just kind of make this little bridge with a clean artery.

03:13 It's an amazing surgery and if you ever get the chance, as a student, please get to see one of those.

03:19 It was one of the most exciting things I did as a junior nursing student.

03:22 I had a surgical mask on but my eyes were this big for the whole surgery.

03:27 And I was with a brilliant surgeon who let me be right by them and talk through the whole procedure.

03:33 I will never forget that experience. It's amazing what they can do.

03:38 Now a percutaneous coronary intervention doesn't require opening the chest. I mean, to do a CABG, they've got to split your sternum and chest. I mean, it's really traumatic to the body if you're watching it.

03:50 But for PCI, they're just going to go in through the leg and feed that up through the body.

03:56 So what they do there, as you can see, we have a picture that you can see they've threaded that catheter in in a balloon.

04:01 They'll inflate that balloon, and that will help to push back that plaque and open or widen the artery.

04:08 Now they leave in there a little stent and you can see that's some wire mesh, and that will stay in there, like a little soldier, to keep everything open and flowing. That's what we do in a PCI.

04:19 Now, we talked about encouraging a patient to reduce their cardiac risk factors, and you see them here on the slide.

04:27 Now, just for fun, I want you to think through each one of these risk factors and see how many of them you have.

04:34 Smoking, high cholesterol, hypertension, diabetes, physical activity, inactivity, or weight, being overweight.

04:46 So just put a small checkmark by the ones that you have risk factors for.

04:51 Now, think through what is just one thing you could do to take the next step toward moving towards better cardiovascular health for yourself? You don't have to tell anyone else.

05:03 It's private, but just between you and your notes.

05:07 But by any of those factors that you checked, I just want you to write down what would be the one next best step I could take to move towards better cardiovascular health? Okay, now see the difference in the approach? What if I'd come in and said, "Hey, take a look at these. You shouldn't smoke, change your diet, your cholesterol is too high, your blood pressure's too high, you're diabetic, you don't do very much, you need to go to the gym every day, and you're overweight." See, too often, we approach people in medicine like that.

05:43 Listen, as someone who was incredibly overweight about 5 years ago, you didn't have to tell me I was overweight.

05:51 I was painfully aware that I was overweight.

05:54 So, as a nurse, if you want to interact with your patients and really help them live better lives, get rid of the judgment.

06:03 Help them see that you don't have to completely fix the problem.

06:07 You just need to take the next small step.

06:10 If you want more information, how to do that, check out the resources on motivational interviewing.

06:15 That's where you help put the patient back in charge, help them understand the benefits to themselves in changing these risk factors because no one has radically changed these risk factors because we gave them a pamphlet.

06:27 So do what you can to help every 1 of your patients reach the next level of health because you are their nurse in how you intervened with them.