A: UNDERSTANDING HEART ATTACKS...HEART ATTACKS ©1998-2014 May be copied for use within each physical location that purchases this inservice. We hope you enjoy this inservice, prepared

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UNDERSTANDINGA Disease Process Module:

HEART ATTACKS©1998-2014

May be copied for use within each physicallocation that purchases this inservice.

We hope you enjoy this

inservice, prepared by

registered nurses

especially

for nursing assistants

like you!

After finishing this inservice, you will be

able to:

Explain the warning signs of a heart attack.

Name the three risk factors that can’t be changed or

controlled.

Describe the four risk factors that can be changed or

controlled.

Explain the relationship between life style and the

prevention of a heart attack.

Discuss at least six ways you can help your clients who have had heart attacks.

If you are studying the inservice on your own, please do the following:

Read through all the material. You may find it useful to have a highlighting marker nearby as you read. Highlight any information that is new to you or that you feel is especially important.

If you have questions about anything you read, please ask _________________________.

Take the quiz. Think about each statement and pick the best answer.

Check with your supervisor for the right answers. You need 8 correct to pass!

Print your name, write in the date, and then sign your name.

Keep the inservice information for yourself and turn in the quiz page to _____________________________ no later than _______________. Show your Inservice Club Membership Card to ___________________ so that it can be initialed.

Email In the Know at [email protected] with your comments and/or suggestions for improving this inservice.

THANK YOU!

Instructions for the Learner

A Disease Process Module:

UNDERSTANDING HEART ATTACKS

Developing Top-Notch CNAs, One Inservice at a Time

A Disease Process Module: Understanding Heart Attacks

”IT’S JUST A TOUCH OF THE FLU”

Inside This Inservice:

© 201 In the Know, Inc. www.knowingmore.com

May be copied for use within each physical location that

purchases this inservice from In the Know. All other

copying or distribution is strictly prohibited.


Douglas, a 60 year old man who lives alone was feeling poorly for two weeks. He said he felt like he had “a touch of the flu.” As his symptoms worsened, he became weak and looked pale.

At the end of the second week, his symptoms became life-threatening. He developed a crushing, vice–like pressure in his chest. The pain shot down his left arm and through to his back. He could barely talk or breathe and couldn't even lift an arm to pick up a phone to call 9-1-1.

Douglas didn't want to go to the hospital by ambulance and didn't want to disturb his friends. He convinced himself that if he took two aspirin and went to bed, he would feel better in the morning.

When the pain was still there in the morning, Douglas called a friend for help.

By the time Douglas reached the hospital, precious time was lost. The heart muscle was dying. An ECG and blood work confirmed Douglas was having a heart attack.

A heart attack happens when oxygen can’t get to one part of the heart because of a blockage. The heart muscle gets so “starved” for oxygen that it becomes damaged or even dies.

Just like Douglas, many heart attack victims describe the “discomfort” as:

A vice-like pressure in the chest.

A feeling of weakness.

A feeling of indigestion.

Having a touch of the flu.

And, like Douglas, many people delay treatment because they think the symptoms are minor problems

such as heartburn or the “flu”.

In fact, denial is a common symptom of a heart attack. And, denial can be deadly. The most successful treatment for a heart attack is that which is done within the first hour of having symptoms.

Keep reading to find out more about heart attacks

and how they can affect your clients. You may be surprised by what you learn!

Anatomy of a Heart Attack

2

Risk Factors 3

Warning Signs 4

Diagnosing and Stopping a Heart Attack

5

Recovering from a Heart Attack

6

Emotions and Behaviors After a Heart Attack

7

How You Can Help! 8-10

ANATOMY OF A HEART ATTACK

A Disease Process Module: Understanding Heart Attacks © 201 In the Know, Inc. Page 2

Grab your favorite highlighter! As you read through this inservice, highlight five things you learn that you didn’t know before. Share this new information with your supervisor and co-workers!

WHAT’S REALLY HAPPENING DURING A HEART ATTACK?

SOME TERMS YOU SHOULD KNOW

CORONARY ARTERIES: Blood vessels attached to the heart muscle that supply the heart with oxygenated blood.

ATHEROSCLEROSIS: A build-up of waxy plaque in an area of a blood vessel that causes hardening and can even block off blood flow completely.

CHOLESTEROL: A soft, waxy substance produced in the liver and found in animal fats. Too much cholesterol can lead to heart disease.

PLAQUE: A buildup of fatty substances, cholesterol, cellular waste products, calcium, and fibrin that can partially or completely block an artery.

ELECTROCARDIOGRAPH (ECG OR EKG): A machine that records the heart’s electrical impulses; used to diagnose heart damage by detecting abnormal electrical impulses.

HYPERTENSION: High blood pressure; occurs when the pressure of the blood circulating in the body is too great; high blood pressure can damage or burst a blood vessel.

1. When a person has atherosclerosis, coronary arteries (blood vessels in the heart) become hardened and brittle as plaque builds up inside the vessels’ walls.

2. Eventually, the force of blood (blood pressure) disrupts the plaque, leaving a wound on the inside of the blood vessel.

3. The blood vessel repairs itself by building a clot over the wound to heal it (like a scab on a cut). And, the blood vessel constricts (squeezes smaller) to help close the wound.

4. This clot combined with the squeezing blocks the flow of blood in the artery.

5. Without blood flow, the area of the heart supplied with oxygen by that vessel supplies dies. This is a heart attack.

Heart cells can only handle about 20 minutes without oxygen before they begin to die. That’s why immediate treatment is so important!

Coronary Arteries

Blockage

Area of Cell Damage

© 201 In the Know, Inc. Page 3 A Disease Process Module: Understanding Heart Attacks

A risk factor is a characteristic that increases a person’s chances of a heart attack. There are two types of risk factors—those that can’t be changed or controlled, and those that can be changed or controlled.

RISK FACTORS THAT CAN’T BE CHANGED:

Family history (heredity)—Heart attacks can run in families. The number of relatives and their ages when they had heart attacks determine how strong the risk is.

Age—Risk of a heart attack gets higher with age for both men and women.

Sex (being male)—Men have a higher chance of having a heart attack than women, they have attacks earlier in life and they have fatal heart attacks more often than women. However, heart disease is the leading cause of death for women.

RISK FACTORS THAT CAN BE CHANGED:

Exposure to Cigarette Smoke—Smoking is the most preventable cause of early death. Second-hand smoke should also be avoided.

High Blood Cholesterol—Eating high cholesterol foods increases the risk of getting clogged arteries. The higher the cholesterol level, the greater the chance of having a heart attack.

High Blood Pressure—This makes the heart work harder which causes it to get larger and weaker.

Lack of Exercise—Not being active is a risk factor, too. The heart needs even more oxygen when a person doesn’t lead an active lifestyle. Regular exercise helps keep the heart healthy.

ADDITIONAL RISK FACTORS INCLUDE:

Diabetes—Diabetes doubles the risk of a heart attack because it can damage the heart tissue and blood vessels which leads to heart failure.

Stress—Stress causes some people to overeat, to start smoking or to drink more which can make the other risk factors worse.

Obesity—People who are very overweight (especially in the waist area) are more likely to develop heart disease—even if this is the only risk factor. Extra weight causes a strain on the heart, raises blood pressure and increases cholesterol levels.

Oral Contraceptives—The early form of birth control pills had higher levels of hormones which increased the chances of heart disease. It’s still not clear how the newer low dose pills affect the heart.

RISK FACTORS THAT MAY LEAD TO A HEART ATTACK

Current research clearly connects lifestyle choices like smoking, overeating, and lack of exercise to heart disease.

Do you think health insurance companies should be allowed to charge more for (or even deny) coverage to people whose lifestyles put them at a greater risk for developing heart disease?

It’s a great idea but how would it work? Do you think people would be honest about smoking 3 packs of cigarettes a day or drinking a 6-pack of beer every night?

And, what about people who have high cholesterol or high blood pressure because of genetics, not lifestyle?

If you could write the rules on insurance coverage, what would you want to see happen?

“Except for the occasional heart attack, I’ve never felt better.”

~ Dick Cheney (Former Vice President)


COMMON WARNING SIGNS OF A HEART ATTACK INCLUDE:

Uncomfortable pressure, fullness, squeezing or pain in the center of the chest—the pain lasts more than a few minutes or may go away and come back.

Pain spreading to the shoulders, neck or arms.

Lightheadedness, fainting, sweating, nausea, or shortness of breath.

WHAT’S DIFFERENT FOR WOMEN?

Doctors now know that women experience heart attack symptoms a little differently than men. While the most common symptom for both men and women is chest pain, women are more likely to experience:

Feeling out of breath

Pain along the neck, jaw, or upper back

Nausea, vomiting or indigestion

Unexplained sweating

Sudden or overwhelming fatigue

Dizziness

WHEN SYMPTOMS ARE VAGUE OR ABSENT:

Not everyone has all the warning signs or all of the symptoms of a heart attack. Sometimes there aren’t any symptoms—some heart attacks kill with no warning at all!

To make things even more difficult, the symptoms of a heart a heart attack aren’t always clear cut. People tend to brush them off as minor problems such as heartburn or the “flu”.

Denial is a common symptom of a heart attack. And, denial can be deadly. It prevents people from getting the help they need. (Remember...doctors can do the most good in the first hour .)

Knowing the warning signs of a heart attack—and paying attention to them—may just save a life!

It’s critical for a heart attack victim to get to the hospital within one hour of when the symptoms of a heart attack start.

Getting help early during a heart attack can prevent further damage to the heart tissue. The amount of heart tissue that dies during a heart attack determines the chances of surviving.

Also, if caught early, doctors can give certain medications that help stop a heart attack while it’s happening.

KNOW THE WARNING SIGNS

A FEW WORDS ABOUT CPR The latest research in CPR finds that chest compressions alone, without rescue breathing, can be just as effective or more effective in saving the life of a victim in cardiac arrest.

Here are some tips for doing CPR, with or without training:

If you're not trained in CPR, then just do chest compressions, about 100/minute, till paramedics arrive.

TIP: Sing the song, "Stayin’ Alive" in your head. Do chest compressions to the beat of the song to achieve about 100 per minute!

If you're well trained, and confident in your ability, then you can either alternate between 30 chest compressions and two rescue breaths or just do chest compressions.

If you are trained, but rusty, then just do chest compressions at about 100 per minute.

What steps would you take if you saw someone lying on the ground clutching his or her chest and left arm?

What actions are most effective in saving the person?

©201 In the Know, Inc. Page 5 A Disease Process Module: Understanding Heart Attacks

DIAGNOSING AND STOPPING A HEART ATTACK

When doctors suspect a heart attack, many tests will be done to find out what happened to the heart and why. Some routine tests you may have heard about, include:

EKG (electrocardiography)—This test lets doctors know when a heart attack has happened and if another heart attack is going to happen.

Blood tests—Lab tests check for certain chemicals in the blood that tell doctors how severe a heart attack was and how much damage it did.

Chest x-ray—This test is used to find out if the heart is enlarged or to check for fluid in the lungs.

Ultrasound—This routine test gives a clear picture of the heart’s size and its overall condition.

Other tests that may be used are pulse oximetry (measures blood oxygen), MRI (computerized pictures), and CT (pictures of the heart).

In addition, the doctor will do a complete physical exam which includes questions about family history, lifestyle, eating habits and smoking.

To stop a heart attack in progress or to minimize the damage, emergency doctors may do the following:

Place the client on oxygen and administer pain medications.

Administer a “clot buster” medication. Remember. . . most heart attacks are caused by a clot. If the doctor can administer a clot busting medication within one hour of the first symptoms, the clot can be dissolved and the heart attack can be stopped!

If more than one hour has passed, a clot busting drug may not work. In this case, surgery may be done. A small camera will be threaded through the blood vessels so the doctor can look at the actual blockage.

Once inside, the blood vessel can be opened with a balloon or a stent—or the decision to perform open heart surgery can be made.

Here are a few surgical procedures your clients with heart disease may have had:

Coronary Angioplasty (PTCA): A procedure that widens heart arteries by inserting a tube with a small balloon on the end.

Coronary Bypass (CABG): A major “open heart” surgery that creates a detour around the heart blockage by using a vein from the leg or groin.

Pacemaker: A small electronic device placed under the collarbone. (It can be temporary or permanent.) A pacemaker makes the heart beat strongly and regularly by giving it little electrical “shocks”.

Valve Replacement: The heart has valves that sometimes need to be replaced to keep the heart from “leaking”.

Think about a client you have cared for who had one of these procedures. What did you do differently to

care for this client? Did your client have to make any

lifestyle changes in addition to having the procedure? If so, what and why?

Talk about what you learned by working with this client. Ask your co-workers and supervisor what they know about caring for clients after these types of procedures.

©201 In the Know, Inc. Page 6 A Disease Process Module: Understanding Heart Attacks

Currently, there is no way for doctors to repair heart tissue after a heart attack. The heart does some repairs on its own, but there will always be a scar. The scar is strong—but just not able to contract and relax like healthy tissue. This makes the heart weaker.

Rehabilitation after a heart attack usually occurs in four phases. As the heart heals and gets a little stronger each day, activity and exercise slowly increase.

THE PHASES OF REHABILITATION ARE: PHASE 1: This is the time in the hospital, immediately after the

heart attack. Bed rest may be ordered for the first day or so; then the person progresses to ambulating in the hall. Special attention is placed on pain and anxiety management.

PHASE 2: The client is discharged to home or to a rehabilitation facility. Self care activities are encouraged and very low impact exercises may be started.

PHASE 3: The client and family are taught how to get back to a normal routine. A walking program is started where the client must walk a little further each day. A treadmill stress test is usually performed at about 8 weeks to determine how well the heart is healing.

PHASE 4: Physical fitness continues. The client resumes a normal routine but usually must take medication and make some lifestyle changes.

COMMON MEDICATIONS (AND THEIR SIDE EFFECTS) ARE: Aspirin therapy—helps prevent blood clots. Side effects:

bleeding and increased risk of stroke.

Blood pressure drugs—help protect against heart attack, stroke, and heart failure. Side effects: muscle cramps and weakness, poor appetite, swelling in the joints, cough, rash, headache, and fatigue.

Cholesterol-lowering drugs—help bring down cholesterol levels when diet alone can’t do it. Side effects: intestinal discomfort, diarrhea, constipation, nausea, vomiting, gas, flushing of skin, itching and skin rash.

Anticoagulant drugs—help prevent blood clots. (Also called blood thinners.) Side effects: excessive bleeding from cuts, easy bruising, bleeding gums, nose bleeds, red urine and red or black stool.

Arrhythmia Drugs—help keep the heartbeat steady. Side effects: nausea, vomiting, headache, loss of appetite and change in vision.

RECOVERING FROM A HEART ATTACK

CAN STEM CELLS REPAIR DAMAGED HEART TISSUE?

Researchers are having some success in using stem cells to replace damaged heart muscle cells.

This is a huge scientific breakthrough that could change the way doctors treat people with heart attacks - and will change the course of recovery and the long term prognosis for patients.

Remember . . . the heart can heal itself to a degree. But, there is always a scar. This would eliminate that scar and leave the heart just as strong as it was before the heart attack.

The stem cells that work best for this purpose come from umbilical cord blood and from amniotic fluid (the fluid that surrounds the baby in the womb). No humans are being harmed to harvest these stem cells.

The first week or two after a heart attack can be the hardest time for clients and their families. It’s common for people who’ve had heart attacks to feel a mix of emotions. Most people follow a predictable pattern of responses, which includes:

DENIAL—The client may have a history of ignoring health problems or minimizing the severity. You may see the client ignoring activity restrictions or refusing to discuss lifestyle changes.

ANGER—Most clients go through a phase of being angry about what happened to them. They may ask “Why me?”

ANXIETY AND FEAR—Clients may worry about many things like having another heart attack, pain, death or getting used to the changes in their lives.

DEPENDENCY—Some may become overly dependent on family members (or you!) because they are afraid to be by themselves or to do anything strenuous.

DEPRESSION—This may be the most difficult of the emotions. Clients may feel that “life is over”. This is when the client realizes the seriousness of the situation and begins to worry about the future.

ACCEPTANCE—Usually after some success is achieved though rehabilitation . . . the client begins to feel stronger and more normal. You will see the client become more optimistic about the future and more willing to accept making the necessary changes needed to recover.

A FEW THOUGHTS ABOUT DEPESSION:

Depression is normal and should be expected in heart attack survivors. It can be mild or serious and may last several months. But, if a client is depressed all the time, it can be hard on the heart. Watch your clients for the signs of depression and report any changes to your supervisor.

Signs of depression include:

Weight loss or weight gain.

Lack of energy.

Overwhelming feelings of sadness.

Anxiousness.

Sleeping more or less than usual.


EMOTIONS & BEHAVIORS AFTER A HEART ATTACK

Working with clients in the home requires coming up with creative solutions to common problems.

THE PROBLEM: You are caring for a 63 year old man who is recovering from a heart attack. He also suffers from diabetes, high blood pressure and he is overweight.

During a visit from the physical therapist, you learn that your client is supposed to walk everyday and do chair exercises to build strength.

After the PT leaves, your client turns to you and says, “Yeah, right.” He tells you there is no way he is doing those exercises.

WHAT YOU KNOW: You know the exercises are important for recovery and for regaining strength. You also know it would improve his overall health.

GET CREATIVE: Think of 3 creative solutions you might suggest to get your client to do the exercises as ordered.

TALK ABOUT IT: Share your ideas with your co-workers and supervisor and find out how they would solve the problem.

Loss of interest in usual activities.

Lack of interest in bathing.

Tearfulness.

Thoughts of death and suicide.

Unable to concentrate, remember, or make decisions.


HELPING WITH MEDICATIONS:

Remind your clients to take their medications ON TIME! These medications are doing a very important job—helping the heart and blood vessels work better. If medications aren’t taken on schedule, they won’t work as well.

To help your clients remember when to take their medications, suggest that they use a watch or a pill box with an alarm.

Remind your clients to take their medications as directed by their doctor—no more or no less! There can be serious side effects if the doctor’s orders aren’t followed exactly.

If you notice that your client is skipping a dose or not taking the correct amount of medication, tell your supervisor right away!

Encourage your clients to carry a day’s worth of medicine with them at all times. They should never be without their medications.

If your clients are mixing their heart medications with other prescription or over-the-counter drugs, let your supervisor know about it immediately.

Encourage clients who manage their own medications to organize them in a pill organizer or some other labeled container. This can help them remember to take their medications on time and prevent medications from getting misplaced.

Suggest to clients who manage their own medications that they keep their medications in the same place every day so that they remember to take them and don’t lose them.

Watch your clients for any side effects from their medications. Report any changes to your supervisor.

Remind your clients not to share their medications with anyone! It can be very dangerous.

HELPING WITH EMOTIONS:

Be patient! Many heart attack survivors have feelings of anger and guilt. They may be irritable and cranky about their situation and may resent that other people are healthier than they are. Try to be understanding and do a little something extra to make them feel better, like telling them they are looking better every day or that they have a nice smile.

Be reassuring! Many clients worry about every little thing. They may be afraid of being alone or of doing any kind of exercise/activity at all.

TIPS FOR HELPING HEART ATTACK SURVIVORS

Are you prepared to call 911in an emergency? Sounds like a simple enough question . . . So, see if you can answer these questions:

Where are you? Without spending time to search—can you give the full address of where you are right now?

_______________________________

_______________________________

Could you describe how to get to this location using landmarks and street names?

_______________________________

_______________________________

What phone number are you calling from? The operator may need to call you back. Look for the phone closest to you right now. What’s the number for that phone?

_______________________________

If you can’t answer these questions you need a plan—especially if you work in client homes or you work in different locations all the time.

What can you do to make sure you always have this information in an emergency? Share your ideas with your co-workers and find out what they would do.


HELPING WITH NUTRITION/DIET:

Encourage your clients to eat properly! Eating a well-balance diet is very important for people who’ve had a heart attack.

Be supportive! Most people who recover from heart attacks have to change their eating habits—especially if they are overweight, have high cholesterol or high blood pressure.

Help your clients choose healthy foods. Most likely, they will be watching their fat, cholesterol, salt and calorie intake. Help them make the right choices by reading the nutrition fact labels on food cartons.

Be sure to check the fat content, especially for clients who have high cholesterol levels. According to the American Heart Association, total fat intake should make up 30 % or less of all the calories that people eat.

Keep in mind that you can lower the fat content in some foods by using substitutes. For example: use non-fat milk not whole milk; margarine not butter; two egg whites not one egg; and low-fat yogurt not sour cream.

Praise your overweight clients when they lose some weight. Extra weight is hard on the heart. Losing even a few pounds can be helpful to their overall health.

Help your clients watch their salt intake— especially if they have high blood pressure. A low-sodium diet (less than 2,000 milligrams of salt a day) helps lower the blood pressure. Since many foods already have some amount of salt in them, it’s a good idea not to add anymore. So, don’t pass the salt shaker!

HELPING WITH EXERCISE:

Check with your supervisor about encouraging exercise. Overall, physical activity is good for the heart, but your clients may need a special exercise program or have specific do’s and don’ts from their doctor.

Exercise should be enjoyable! Try exercising with your client. It’s more fun to do it with someone and it’s good for you, too. Take a walk around your client’s home, within your facility or even outside.

Remind your clients to pace themselves! Don’t let them do too much at once. Encourage them to start slow and to take it easy.

Be watchful! Report any problems to your supervisor right away.

TIPS FOR HELPING HEART ATTACK SURVIVORS-CONTINUED

1. A heart attack happens when oxygen can’t get to one part of the heart because of a blockage.

2. Common symptoms of a heart attack include sweating, nausea, and shortness of breath with uncomfortable pressure, fullness, squeezing or pain in the center of the chest, that spreads to the shoulders, neck, arms or back.

3. It’s critical for a heart attack victim to get to the hospital within one hour of when the symptoms start. Getting help early during a heart attack can prevent further damage to the heart tissue.

4. Rehabilitation after a heart attack occurs in four phases. While everyone heals differently, most will have to exercise, take medication and make certain lifestyle changes.

5. Knowing the signs and symptoms of a heart attack and being prepared to respond in an emergency are critical. If you think someone is having a heart attack . . . call 911 immediately!


HELPING WITH LIFESTYLE CHANGES:

Smoking Cessation

Smoking increases a person’s chance of having a heart attack or a stroke. Nicotine, a chemical in cigarettes, increases heart rate and increases the heart’s need for oxygen. It raises blood pressure for a short time and can cause blood clots, too.

People who smoke have two times the risk of developing heart problems than non-smokers. And, did you know . . . more smokers die from heart disease than from lung cancer!

Encourage your clients—and their family members not to smoke! And, remember. . . a person is never too old to quit.

Of course, quitting isn’t easy. On average, smokers try to quit at least five times before they actually do it. There are a lot of products in the stores that can help—like nicotine patches, nicotine gum, nicotine nasal spray, and nicotine inhalers. Keep encouraging your clients to stop.

Alcohol Use or Abuse

Studies have shown that drinking small amounts of alcohol may decrease heart disease and heart attacks by 20-40%. Small to moderate amounts of alcohol may help the heart by thinning the blood so clots don’t form. (And, it may prevent the narrowing of arteries by lowering cholesterol levels.)

Wine—especially red wine— gives more protection than beer or hard liquor.

But, drinking too much alcohol can cause rapid and irregular heart beats and can affect the heart’s ability to pump, which are two of the biggest causes of death after having a heart attack.

Encourage your clients who drink more than 1-2 drinks a day to cut down or quit.

Replace time usually spent on drinking with healthy activities like exercise or socializing with friends and family.

Enlist the help of family members. Non-judgmental family support is critical when making an important lifestyle change like managing alcohol use.

Let your supervisor know if you suspect alcohol abuse problems with your client. A social worker or other counselor may be able to help.

TIPS FOR HELPING HEART ATTACK SURVIVORS-CONTINUED

Now that you‘ve read this inservice on heart attacks, take a moment to jot

down a couple of things you learned that you didn’t know before.

Are you “In the Know” about Heart Attacks? Circle the best choice or fill in your answer. Then check your answers with your supervisor!

1. True or False

Many people describe the feeling of having a heart attack as a “feeling of indigestion” or “a touch of the flu.”

2. True or False

A person with diabetes does not have to worry about having a heart attack because diabetes does not affect the heart.

3. True or False

It is critical to get to the hospital within one hour of having symptoms of a heart attack.

4. True or False A pacemaker is a major “open heart” surgery that creates a detour around the heart blockage by using a vein from the leg or groin

5. After a heart attack, your client will likely be on a diet that restricts:

A. Fat and cholesterol B. Salt C. Calories D. All of the Above

6. True or False

Most people are discouraged from exercising after a heart attack.

7. True or False

Depression is a common emotional response after having a heart attack.

8. True or False

Smokers have twice the risk of developing heart problems than non-smokers.

9. True or False

Side effects of blood thinners include excessive bleeding and easily bruising.

10. Fill in the Blanks

If you think someone is having a heart attack, call ________________

immediately!

Inservice Credit:

Self Study 1 hour

Group Study 1 hour

File completed test in employee’s personnel file.

EMPLOYEE NAME (Please print):

________________________

DATE: __________________

I understand the information presented in this inservice.

I have completed this inservice and answered at least eight of the test questions correctly.

EMPLOYEE SIGNATURE:

________________________

SUPERVISOR SIGNATURE:

________________________

A Disease Process Module: Understanding Heart Attacks


A: UNDERSTANDING HEART ATTACKS...HEART ATTACKS ©1998-2014 May be copied for use within each physical location that purchases this inservice. We hope you enjoy this inservice, prepared

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