A Letter to My Future Students

Dear students,

I want to take you on a little journey.  It is a journey that took me five weeks to complete but it has opened so many new opportunities for me to explore that I do not feel the adventure is over yet.  This journey began with the introduction to Informatics, a world of technology.  For many of you, technology and what it has to offer is probably not a new concept.  For me, technology included Google, YouTube and PowerPoint presentations-- that other people created, NOT me!  I had never blogged before in my entire life.  I knew about blogging, mind you, but it was not an avenue that I had previously envision utilizing for providing instruction to students.  I had also never used Skype before I began this journey.  Now I wonder how many of my friends and family use it.

 

 

I am sure there are going to be many times that you can teach me new and exciting ways to use technology in the classroom, and I welcome this!  I feel learning is a collaborative experience.  I have learned so much from Informatics, primarily that learning is never limited by technology, only by our imagination!  I have discovered a world that goes far beyond lectures and textbooks.  It involves avatars, animoto, and virtual field trips.  I feel that I am now better prepared to meeting your learning needs and in providing a creative and fun educational environment for us all. 

 

                             

 

I look forward to the opportunity to learn and grow with you!

God bless and happy learning!

 

With warm regards,

Jennifer Smalls, RN, BSN

Future nursing educator



Be Heart Healthy

Recoverying from an MI

Surviving a myocardial infarction (MI) is just the beginning.  Part of the recovery process involves cardiac rehabilitation.  A team of health professionals (doctors, registered nurses, dietician, physical therapist, occupational therapist, and counselor) develop a 12-week program to provide education and counseling to help participants manage their heart condition and return to normal activity.  A regular physical activity program is developed for cardio-strengthening.

What is Cardiac Rehab?

 

 

Lifestyle changes are also essential to the recovery of a cardiac event.  This includes smoking cessation, dietary changes, regular physical exercise and stress management.  Long-term medications may be necessary to achieve controlled blood pressure, cholesterol levels and blood sugar.  Reducing  these risk factors will not only aid in the restoration of heart health, but will greatly reduce the risk of repeated events.

 

Drug of the Week:  Statins

 



Angina or MI-- What's the Diff?

     Angina is a heart condition that occurs when plaque builds up along the inner walls of the coronary arteries, narrowing the artery lumen (opening) and reduces the blood flowing through the artery to the heart muscle.  This results in a decrease amount of oxygen being supplied to the myocardium and causes ischemia.  The ischemia causes chest pain.  Stable angina is when the pain is predictable and follows a pattern, such as after exertion.  It will resolve with rest or with medication, such as a nitrate.  Stable angina is not a myocardial infarction, but may indicate a potential MI in the future.  Unstable angina is chest pain that does not follow a pattern and does not resolve with rest or medication.  In fact, it could occur at rest.  This indicates a very serious problem that requires immediate attention.  If the ischemia is not reversed quickly, the result could be an MI.

                                               

    

     In diagnosing an MI, an electrocardiogram (EKG or ECG) is performed.  During angina, there may be ST segment depression and/or T-wave inversion, indicating ischemia.  With prolonged ischemia, the ST segment will become elevated, indicating injury to the muscle.   During an infarction, when the tissue becomes necrotic, pathological Q-waves will form. 

 

                                          

 

 

 

       Cardiac enzymes, or markers, can also be used to diagnose an infarction.  The most reliable are  troponin levels, which become elevated after injury to the cardiac muscle occurs.  Sometimes a creatinine kinase (CK) is drawn, but is not as reliable because unlike troponins, which is sensitive to the cardiac muscle, CK level can become elevated with any skeletal muscle injury.

 

      To correct an infarction, an angioplasty may be ordered to locate the blockage in the coronary artery.  A balloon is guided along a wire into the artery and inflated at the site of the blockage to crush the plaque and widen the artery.  Sometimes a stent is placed in the artery to keep it open.

 

 

 

      For severe blockages, a coronary artery bypass graft (CABG) may be necessary.  This is when a healthy artery or vein is connected to the blocked coronary artery so that the blood flows past, or bypasses, the blockage.

 

     Telling the difference between angina and a myocardial infarction can be difficult since the symptoms are similar.  It is always best to seek medical attention, to be on the safe side, since untreated or unresolved ischemia can lead to permanent heart muscle damage or worse-- death.



 

 

Drug of the Week:  Nitroglycerin

 



       

Not a Typical Heart Attack

There are two populations at high risk for myocardial infarctions, who often are delayed in receiving treatment-- women and the elderly.  This is because the symptoms displayed are often mistaken for the flu or indigestion.  They more frequently present with the atypical symptoms of MI, referred to as a "silent" heart attack.  The damage on the heart, however, is no less dangerous than a typical MI.  In fact, heart disease is the #1 cause of death in women!  After the age of 85, chest pain becomes a less likely symptom.  Recognizing and reporting these atypical symptoms becomes even more crutial to saving the lives of these two at-risk groups.

 

"Just a Little Heart Attack"

 

Atypical symptoms of MI:

• Pain that is not substernal or left-sided.  Instead the discomfort could be located between the shoulder blades, upper abdomen, shoulders, elbows, axillae, or ears.
• Discomfort that is described as numbness, tingling, pressure, pricking, stabbing or burning
• Fatigue
• Weakness
• Palpitations
• Indigestions
• Loss of appetite
• Confusion
• Feeling of impending doom

 

In an attempt to increase awareness for heart health in women, the American Heart Association has launched the Go Red For Women campaign. 

 

 

Drug of the Week:  Beta Blockers

 

 



Acute Myocardial Infarction

Myocardial infarction is a heart condition of sudden onset caused by an abrupt reduction of blood flow to the myocardium.  The deprivation of oxygen and nutrients to the cardiac muscle, if not reversed, eventually leads to ischemia and myocardial cell death.  Ischemia occurs within 10 seconds of coronary occlusion.  After several minutes the heart cells lose the ability to contract, leading to a decrease in cardiac output.  Cardiac cells remain viable for approximately 20 minutes under ischemic conditions.  An MI occurs when coronary occlusion persists beyond 20 minutes.  If blood flow is restored beforehand, cellular repair begins and contractility is restored.  Time is of the essence to preventing permanent cardiac muscle damage-- Time is Muscle!!

 

Pathophysiology of an MI

 

Typical symptoms include:

• Substernal or left-side chest pain or pressure
• Radiation of pain to the neck, jaw, back, shoulder or arm
• Shortness of breath
• Nausea
• Diaphoresis

According to the ACC/AHA guidelines, the treatment for MI include pharmalogical reperfusion of the myocardium using antiplatelet and antithrombolytic therapy.  Nitrates can be used to promote vasodilation and decrease cardiac workload.  Beta blockers also promote vasodilation and decrease oxygen demand on cardiac tissue.  Analgesics, like morphine, help relieve pain.

Drug of the Week:  aspirin