Welcome NCLEX. How yielders is dr.
Z Shawn and I'm the host of NCLEX high-yield podcast where
we will be giving out daily content for your exam tips and
tricks that the board's up to ask and overall general
information on how to study what to study and complex topics
broken down for you. Whether your first time test
taker or even a repeat test taker, we have helped people
across the globe. Pastor NCLEX exam, so do not
give up and get motivated. Make sure you subscribe to our
podcast and also visit our Instagram at NCLEX high yield at
NCLEX high-yield where you can DMS questions, so we can answer
them on the podcast. Also, check out our website
www.dimplex.co.uk Calm, And subscribe to receive a link to
our weekly free Zoom session free.
Zoom session where I drop all types of content break down
complex topics and make them easy for you to understand every
Wednesday. 3:00 p.m. Pacific Standard Time, 6 p.m.
Eastern Standard Time. See you guys then?
Take care. All right, so coronary artery
disease. Where are the coronary arteries?
What did they do? Coronary arteries are going to
be the arteries that provide the heart blood.
So these are the arteries that give the heart its blood supply.
So, you can imagine how important they are.
So, what happens? Well, we've got some risk
factors that can cause coronary artery disease and that's where
we start. Let's start with the basics.
What can cause coronary artery disease?
How about high cholesterol? Of course, smoking absolutely.
smoking alcohol, diabetes diet No exercise.
So start by educating your patients About the risk factors.
Because if I am to talk to a patient, I'm going to tell you
and I'm a broken record when I say this, don't smoke.
Decrease alcohol, eat healthy and exercise.
Tell me anytime we say the opposite of those four
statements, you don't see it on the board, select all the play.
Choose it. It's gonna be right.
You're never gonna be like, yeah, you know what?
Today you can smoke a pack. We're okay, no, have a couple
burgers for lunch every single day we're good.
No, no, absolutely not risk factors for coronary artery
disease. So the first step Coronary
artery disease is get rid of the risk factors, educate them.
Why put them on any pharmacological intervention, or
do any type of invasive procedure?
If we can prevent this disease, remember in real life in real
life, we are now becoming preventative.
Why? Because doctors want to get paid
and insurance. Companies are not going to pay
them if they have these diseases.
If we don't screen them if we don't document them they'll yank
that contract right away. They don't want to pay.
For the long-term effects. So educate them early.
Alright, well, let's just say it's gotten a little bit past
this. And now are artery.
Has developed a plaque. So what type of a plaque is this
a thorough sclerotic plaque? Well, don't use memorize after
school or a big plaque? Know what it means.
The artery is narrowed because of a plaque.
I throw sclerotic plaque. Understand what's going on.
So what used to be a nice healthy open artery now has
diminished blood flow. If we have diminished blood flow
to the heart, We are now. Causing ischemia.
We are not providing the heart with the blood supply that it
needs. we have now in farted this area, how about?
The muscle of the heart is now, infarcted myocardial infarction.
Yeah, we don't have blood flow in that area.
So of course it's going to get infarcted.
Of course, it's going to get ischemic.
So now before we go, and I'm going to kind of go a little bit
more in-depth here because I want to I want you to see when
an MI occurs. 24 to 48 hours after What are we concerned
about? What are we going to monitor
them for will? Guess what?
In The myocardium? We've got cardiomyocytes.
What is a cardio myocyte? It's a cells in the muscle of
the heart cells in the muscle of the heart.
If you come to my EKG lectures or you're in the course, I tell
people what part of the heart. Is controlled by potassium.
The ventricles So, if potassium starts to leak out, leak out,
leak out, this electrolyte disturbance can cause one of the
most lethal cardiac dysrhythmias.
V-fib. So, because these sites have
died off. They've leaked potassium,
potassium can put us into v-fib. That's why in ask graph changes
in potassium are one of the eight things that we are
freaking out about. The next thing is, is that if
I'm in farting and causing this ischemia, In the heart.
Is it now going to be weekend? Absolutely do we not kill some
of it off, do we not compromise the structural Integrity of the
heart where it was infarcted? Yes.
So what can happen if this heart is beating and that wall is
compromised. Rupture that heart wall can
rupture. So, not only are we worried
about acutely, what's happening to the heart, because we've
blocked off the blood supply to it.
But now we're working 24 or 48 hours later to make sure that
there are no complications like, v-fib or rupture.
I used to try and memorize this for my boards.
I say, oh, if they have an MI, then I got to worry about v-fib
and then I got to worry about well rupture, but I didn't
understand it. I didn't realize that the
cardiomyocytes had potassium in it and they were dying off
because we had ischemia. I didn't realize that all this
could happen 24 or 48 hours later.
So we were watching them. Like why are we watching them?
We aren't they already had the heart attack, but now I had to
go back and understand it in order for me to pass my boards.
So this is how I did it. I broke it down to a point where
I understood it. All right, so now we've got
these plaques well their cholesterol plaques.
How can we treat this? How are we going to treat
hyperlipidemia statins first? The question was, how do I treat
hyperlipidemia? So, remember when you're taking
your board exam, look at what they're really asking, that's
why I say, put it in your own words.
So statins simvastatin atorvastatin or rosuvastatin.
All statins. What are statins going to do?
Well, do can work on our lab values.
They're going to decrease our total cholesterol, they're going
to decrease our triglycerides. They're going to decrease our
lousy cholesterol or LDL. They're going to increase our
happy cholesterol or our HDL. The rule of 50s for a rough
estimate of where the normal values lie. 54 HDL. 104 LDL.
154, triglycerides and 204 total cholesterol.
But watch this. This is where students make
mistakes on the boards. if a patient's cholesterol, Went from
380 to 340, but normal is 200. Is this medication working?
But, but it's only it's at 3:40 and normal is 200.
That wasn't my question. My question was, is a the lab
value normal? My question was, is this
medication working? Yes, it is.
It dropped from 380 to 340 it. Did its job.
Have we reached our optimal results.
Not quite dose adjustment. So will increase it if we are
going to educate this patient about when to take this exam or
when to take example, what exams when to take this medication,
when are we gonna give it to them?
Okay, okay, okay. Okay.
See, I see different answers in here at night.
Time is wrong. I bet time is correct.
Look, I live in Vegas, bedtime here, varies.
People were graveyard shift. Nurses work, twelves.
So look for those little tricks. Look for the board's to trip you
up. The correct answer is I bedtime
because that's when we go into a fasting state when we're in a
fasting State, we release cholesterol.
When we release cholesterol, perfect time to try and attack
them. Prior to administering this
drug. Look at the word I used prior.
To those little words, change the hole.
Question, or the whole answer prior to giving his medication.
What are we going to check? Check your liver function tests.
Alt AST. I look Foss prior to does it's
no good if we check after takes away our Baseline.
There is a side effect that we're concerned about.
And the side effect that we are concerned, about is my APA thie.
Myopathy is muscle pathology. There's something wrong with my
muscles and the specific myopathy that were concerned
about Is rhabdo. Mayo.
Lysis. The rabbit emir's of my muscle
are being sliced or broken down. My muscle is breaking down.
Well, what is muscle made of protein?
Think about it. If I go to the gym and work out
and I want to get all buff, I'm gonna go and get what a protein
shake because I want to get big muscles.
Makes sense, right? Go.
Workout Core. Workout Core workout.
Would I need protein. I need my muscles.
So I can get all the hot ladies but if you break down your
muscles you're breaking down. What you're breaking out of
protein. Protein is going to get
dispersed and try to get excreted, and it's going to clog
our glomeruli. All this access breakdown is
going to clog our glomeruli and we will develop acute kidney
injury. And if we do not aggressively
Hydrate with IV fluids, this acute injury will lead to acute.
Renal failure. How's the patient going to come
in with Rhabdomyolysis? They're not going to walk in and
say nurse I think I got rhabdo. It would help us a lot but can't
do that. Yeah they're gonna come in with
some muscle pain, muscle tenderness muscle weakness.
If a person's on statins and they haven't done anything
extensively and they're complaining of muscle cramps,
muscle tenderness muscle pain. It should be a red flag.
What's going on? You were just fine.
Oh, it's presses on Statin. Let's get some blood work.
Let's check your kidney function.
And how do we check that be in creatinine?
You got it. Hey guys, dr.
Deshawn here. Thank you so much for joining us
on this podcast. Hope you guys enjoyed it.
If you guys, could, kindly subscribe, leave us some Stars,
whatever you think it's worth and leave us a review.
We always want to get better for you guys and want to keep
putting out this free content for you guys.
Hope you guys enjoyed have a good one.
See you, on the next podcast.