Now let's look at the long-term
prophylactic use of drugs.
Remember that word means
we're trying to prevent
an MI and death long term,
over a period of time.
So we talked about antiplatelets
We talked about antianginal, we're
against chest pain agents.
One or more of these long-acting
drugs like beta blockers,
calcium channel blockers, or
a long-acting nitrate.
Now go back up and see if what
we wrote there, one or more.
It is not going to be unusual
for your patient to be on
more than one of these options.
Beta blockers, a calcium channel blockers,
or long-acting nitrates,
or any combination that you find to work.
See, that's the cool part about being a nurse
and being part of the healthcare team.
We get to work with our patients
what unique combination actually
works for this particular patient.
Now remember, you always
have sublingual nitro.
That's what SL means.
if a patient has a period or an
exacerbation of chest pain.
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.
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.
Now, ACE inhibitors. Remember,
they end in "pril"
and we have another video for you
if you want to dig down into those.
But we also can put a patient on
an ACE inhibitor long term.
Research shows this is really
helpful and beneficial
to someone who's had an unstable
angina event or an MI.
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.
These are cholesterol-lowering drugs,
and I'll just give you a clue.
We have a video about these later,
but I want you to right underneath
these always give it night time.
Okay, so, make sure you make a note,
"Always give at night time."
This is a really unusual
factor with statins.
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.
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,
So these are going to involve
procedures or surgery,
breaking of the skin. This is way more
complicated than using just medications.
So I want to give you just kind of a
brief overview of this because, likely,
you'll experience patients who
need these procedures.
Okay, so revascularization therapy,
and we're just going to
reopen and establish the blood supply.
Now I've got a couple options,
coronary artery bypass graft,
CABG, C-A-B-G is usually what
we call the surgery.
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.
So they just kind of make this
little bridge with a clean artery.
It's an amazing surgery and if you
ever get the chance, as a student,
please get to see one of those.
It was one of the most exciting things
I did as a junior nursing student.
I had a surgical mask on but my eyes
were this big for the whole surgery.
And I was with a brilliant surgeon
who let me be right by them and
talk through the whole procedure.
I will never forget that experience.
It's amazing what they can do.
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.
But for PCI, they're just going
to go in through the leg
and feed that up through the body.
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.
They'll inflate that balloon, and that
will help to push back that plaque
and open or widen the artery.
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.
Now, we talked about encouraging
a patient to reduce their
cardiac risk factors, and you
see them here on the slide.
Now, just for fun, I want you to
think through each one
of these risk factors
and see how many of them you have.
Smoking, high cholesterol,
physical activity, inactivity,
or weight, being overweight.
So just put a small checkmark
by the ones that you have risk factors for.
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.
It's private, but just between
you and your notes.
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
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.
Listen, as someone who was incredibly
overweight about 5 years ago,
you didn't have to tell me I was overweight.
I was painfully aware
that I was overweight.
So, as a nurse, if you want to interact
with your patients and really help them
live better lives, get rid of the judgment.
Help them see that you don't have
to completely fix the problem.
You just need to take the next small step.
If you want more information, how to do that,
check out the resources on
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.
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.