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CH 35 Card Mod IV-
CH 35 Cardiac MED THERAPY ETC
| Question | Answer |
|---|---|
| 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
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