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CH 35 Card Mod IV-


Name drug therapy for cardiac events Cardiac glycosides, antianginals, antidysrhytmic, ACE inhibitors, diuretics, anticoagulants, antiplatelets, antifibrinolytics, Lipid Lowering, Analgesics
Generic and trade name for cardiac glycosides digoxin/lanoxin
antianginals end with: olol and remember nitroglycerin
ACE end with: pril
How does Cardiac glycosides work slows heart rate, increases force myocardial contraction = increase stroke volume and cardiac output (CO)
Cardiac Glycosides are used for what cardiac conditions 1) HF 2) a-fib 3) a flutter
Cardiac Glycosides interventions 1) obtain baseline vitals, ECG and electrolytes before admin of first dose 2) Apical 3) hold and notify physician if less than 60
What condition puts pts at risk for Glycoside toxicity? renal failure
Glycoside toxicity symptoms 1) dysrhythmias, 2)pulse < 60 3) anorexia, nausea, syncope, visual disturbance, abdominal pain
toxic Glycoside lvl > 2.0
name 3 types of Antianginals nitrates, beta-blockers, calcium channel blockers
nitrates are for? actual angina episodes and prevention of angina
long term drug therapy for angina beta and calcium
what did Mrs. Gorcyca say to do if pt at home is using nitrates 3x's and it does not relieve pain. call 911
Antianginals nursing interventions Assess BP and pulse before admin; apply on paper provided; apply to nonhairy skin, ROTATE sites, DO NOT TOUCH with skin (causes headaches)
Antianginals teaching sit or lie down at onset of angine; place tablet under tongue (tingling means its working), repeat q 5 mins for 3 times; if not relieved call 911; headache decrease with tolerance; take before sex or exercise
Mrs. Gorcyca says to keep glycoside tablets in container: what is the rationale? light and air decomposses drug so keep ORIGINAL container
why can't you sleep w/ a nitro patch? you build tolerance
Nadolol action/classification selective beta-blocker, used in hypetension, prophylactically for chronic stable angina
nadolol side effects hypotension if dc'ed abruptly ****Mrs. G emphasized another drug Propranol is a beta II and causes bronchospasms...DO NOT GIVE TO PT W/ RESPIRATORY Problems
nadolol pt teaching 1) hold meds and contact DR. if HF 2) monitor weight (report gain of 3-4lbs) 3) do not dc aburuptly= taper off 1-2 weeks
Atenolol action/classification beta blocker; treats angina and hypertension
Diltiazem (cardizem) action/classification calcium channel blockers, dilates coronary arteries, used in chronic stable angina, coronary artery spasm, HYPERTENSION
Review of Glycoside nursing considerations take apical, VS before admin, smoking contraindicated, ECG may be needed, know toxic symptoms
drug class that treat abnormal cardiac rhythm antidysrhythmics
antidysrhythmics action slows rate of impulse conduction, depressing automaticity, increase resistance to premature stimulation
amiodarone: points mentioned by Mrs. Gorcyca an antidysrhythmia; PHOTOPHOBIA, PHOTOSENSITIVITY, monitor pulse daily, observe thyroid dysfunction, tremors, insomnia;
What is the rationale Mrs. G gave for assessing thyroid dysfunction for Amiodarone Amiodarone has iodine in it. Iodine affects the thyroid (like Goiter etc).
used to prevent recurrent PVCs and V-tach disopiramide/norpace
disopiramide/norpace should be withheld if apical pusle is: apical pulse hold if < 60 > 120 (that is what the book says)...
disopiramide/norpace nursing considerations Monitory BP; I&O; weigh daily and observe for edema; change position slowly (severely brings down BP); photosensitivity
dilate arteries and decrease resistance to blood flow (reduce afterload) by working against the renin-angiotensin-aldosterone ACE inhibitors
what does ACE stand for angiotensin-converting enzyme
Ace inhibitors are prescribe for pts w/: HF, some HTN, and after MI.
Ace Inhibitors end in: pril
What did Mrs. G say was a side effect of ACE inhibitors dry cough
ACE inhibitors nusring considerations monitor blood cell count, report changes in urine output because ACE inhibitors cause less fluid retention
Why are diuretics given to pts w/ cardiac disorders? many pts w/ heart problems have fluid retention. Also more fluid in your blood causes hypertension. So Diuretics are also an antihypertensive drug
name the 3 most frequently types of diuretics and give a name of a med for each one loop diuretics (furosemide/Lasix), Thiazide (hydrochlorozid, Esidrix), Potassium Sparing (aldactone)
What conditions would diuretics be prescribed for other then those who have edema CHF, HTN
why is it called Loop diuretic? loop diuretics work on the kidneys. Remember anatomy that the Loop of Henle is part of the kidney and helps in excretion and reabsorption of sodium/potassium
DIURETICS: What did Mrs. G say were nursing considerations I&Os, weight, encourage POTASSIUM RICH FOODS for potassium wasting diuretics (Loop and Thiazide), INTERVENTIONS for possible hypotension (dangle feet, slowly get up, gait belt)
DIURETICS: what did Mrs. G say were side effects Hypokalemia, hypotension/orthostatic
drug the PREVENT clot formation by decreasing the ability of blood to prevent clots. Anticoagulant: it does NOT dissolve clots just prevents more clots from being made
name 3 types of Anticoagulatns heparin, LMWH, warfarin
Heparin is administered initially how? and how is it administered when stabilzed initially: continuous IV drip; STABILIZED: subq
what factor is taken into consideration when adjusting the dose of Heparin aPTT-activated partial thromboplastin time
why are pts hospitalized when taking heparin it is never given orally
Heparin is used in conjunction w/ what other type of drug Firbrinolytic agents
Derived from heparin that prevents clots and blocks formation of thrombin LMWH (low molecular weight heparin)
Example of LMWH Lovenox
LMWH advantages anticoagulant effect is more PREDICTABLE; SUBQ once or BID; NO NEED FOR CLOSE MONITORING OF aPTT
LMWH is recommeded for pts w/ what conditions DVT; unstable angina; AMI
What anticoagulant is can be given orally Warfarin/Coumadin
Heparin is regulated by what while Warfarin is regulated by what? Hep = aPTT; War = PT/INR
When Heparin and Coumadin are being used together, what did Mrs. G say is the usual routine. Warfarin taken away or Heparin is taken away after a time? Heparin: explanation on next card
What did Mrs. Gorcyca say is the rationale for giving both Hep and War together and why hep is taken away Heparin and Warfarin work on different factors of blood clotting. Heparin works quicker so is uesd for immediate purpose. Warfarin takes longer (days) to reach PT/INR therapeautic lvl. Once that is reached then Heparin is no longer needed.
Decreases platelet aggregation (prevents platelets from sticking together) Prolongs bleeding time Antiplatelet
uses of antiplatelets used after AMI, prevents futher AMI events and strokes
Plavix considerations monitor bleeding time, CBC w/ differential, platelet count. AVOID OTC w/ aspirin or NSAIDs
Plavix pt. teaching report bleeding; keep appt for bloodwork
Destroys clots Firbrinolytics
Main example of Firbrinolytic mentioned by Mrs. G Streptokinase
when are firbonolytics best used as sooon as there is evidence of clot formation
how are fibronilytics administered IV
Uses: Fibrinolytics occlusive stroke and AMI happing right now
Inhibits cholesterol lvls from elevating by affecting LDL, HDL, and triglycerides Lipid Lowering agents
Lipid lowering Agents: overall teaching adhere to diet and exercise; quit smoking; may need to take w/ meal
many lipid lowering agents end w/ ____. Mrs. G says this "ending" is a substance that damages what organ Statin; liver (most work in liver or gut)
what tests are done for lipid lowering agents lipid profile/liver function (serial lab tests)
When a pt has an AMI w/ severe chest pain what is given first Analgesic (Nitroglycerin)
What did Mrs. G say about Side effects of nitroglycerin regarding BP and pulse? What is the intervention? Lowering BP, rising pulse; lie down
What did Mrs. G say to remember about Nitro topicals. take a break
When nitroglycerin does not relieve chest pain what is given? What does it do? morphine = reduces workload of heart, reduce anxiety
what is an alternative to morphine demorol/meperdine
Morphine and Meperdine are most effect by what route? IV
Mrs. G said when giving Morphine to hold if resperations are below 12
When you have extra Morphine left over, what are the appropriate actions? Have a witness, flush, put in sharps
Cholesterol intake should be __mg/day. Sodium __g/day. 200; 2
When fluid retention accompanies heart problems what is restricted sodium
when chest pain is unrelieved by nitro what is administered Oxgyen per NC or face mask
This device restores the regular rhythm and improve CO and perfusion. Pacemakers
name two types of pacemakers temp and perm
name 3 types of temporary pacemakers and describe each transq = impluse sent thru skin; transvenous = threaded through a vein into the right side of the heart; epicardial = impulse into epicardial wall during cardiac surgery
Permanent pacemakers is placed subq through an artery: T or false False: it is subq but through a vein not artery
Temp pacemakers are used for elective and ___ situations emergency
T or F: pacemakers increase heart rate beyond set point False
Permanent pacemaker battery life is 9-10: true or false false: 8-10
For Permanent pacemaker procedure, pts rest for how long after the procedure? What intervention follows rest? 24hrs; ambulation and encourage to resume activities
Pt. teaching for permanent pacemakers how to take pulse, and proper rest
After insertion of temp pacemaker what interventions follow? microshock precautions; portable ECG when transporting pt; a nurse must be in attendance
name 3 major problems that occur w/ pacemakers 1) failure to pace; 2) failure to capture 3) failure to sense
pacemaker did not initiate electrical stimulus is called: failure to pace
what are causes of failure to pace battery failure; lead wire displacement
how can you recognize that failure to pace occurs on an ECG lack of pacer spike
Electrical impulse from pacemaker occurs but doesn't result in contraction is called: failure to capture
causes of failure to capture dislodged of the lead or pacemaker output setting is too low
how is failure to capture recognized presence of spike w/o ECG activity following the spike= meaning it spikes then there is no P wave or QRS complex
pacemaker initiates impulse when not needed failure to sense
cause of failure to sense displacement of the electrode
how can you regonize failure to sense spikes that fall too close to pt's rhythm
Delivery of a sync shock to terminate atrial or ventricular tachy (abnormal rapid heart rhythms) Cardioversion
In cardioversion the shock is synced w/ which wave? Why R to avoid shocking during the vulnerable T. Means that T waves is when ventricles are at rest. If shock is delivered you can cause V Fib
during cardioversion what did Mrs. G say we need to have at the bedside emergency equipment
If pt is receiving digoxin during a cardioversion, what is done? drug is held for 24 hours
what emergency drug is made available for a cardioversion procedure in pts who took digoxin digiband (thanks Bryce)
During cardioversion the electrodes are placed where? right = sternum just below clavicle; left = apex of heart
After a cardioversion (the pt was given a sedative) the pt recovered very quickly from the sedative but doesn't remember the event. The nurse see's this as abnormal or normal Normal: in cardiversions pts usually recover quickly from sedatives and do not remember the event
Created by: Jgar2007