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NUR 143
Cardiovascular
| Term | Definition |
|---|---|
| Right side HF | blood back up in the vena cava, causing cor pulmonale, hepatomegaly, Splenomegaly, decrease GI blood flow, nausea, vomiting, abdominal pain, and edema in legs/feet |
| Left side HF | blood backs up in the lungs causing a pulmonary congestion, pulmonary edema, hemoptysis, rales, wheezing, low oxygenation, S3 heart sound "lub-dub-see" |
| CHF (congestive heart failure) | blood backs up into the lung's tissues, Usually begins w left side heart failure, Progresses w right side heart failure |
| Heart congestion | heart is unable to pump blood in sufficient amounts, from ventricles to meet body's metabolic needs. |
| Diastolic dysfunction | inadequate ventricular filling during ventricular relaxation (diastole) |
| Systolic Dysfunction | inadequate ventricular contraction systole |
| LS Failure (signs/symptoms) | restlessness, confusion, orthopnea, tachycardia , exertional dyspnea Cyanosis Late Sign, pulmonary congestion, cough, wheezes, hemoptysis. |
| HF causes | cardiac defet: MI, valve deficiency, congenital heart defects. Defects outside the heart: Coronary artery disease, Pulmonary HTN, Diabetes |
| ACE inhibitors (PRILS) | Inhibits aldosterone secretion Prevents water and Na+ reabsorption Decreases Diuresis PRELOAD Decreases l Ventricular end-volume Decreases heart work Good for HTN, cardiac patients |
| Beta blockers (OLOL) | Reduces heart rate & delays AV node conduction Reduces myocardial contractility and decreases automaticity MONITOR hR if <60 BETAS are the **stars** Reduces SNS and heart's conduction system |
| ARBS (SARTAN) | potent vasodilators, decreases systemic vascular resistance (after load), NO diuretic effect, Good vascular effect |
| Digoxin (lanoxin) | Increases stroke volume increases contractility reduces heart size during diastole decreases venous BP & Vein engorgement Increases coronary circulation Promotes diuresis to improve blood circulation Hold if HR >100, HOLD if HR <40 |
| Digoxin AE (lanoxin) | Narrow therapeutic window Hypokalemia increases its toxicity Electrolyte levels must be monitor Cardiovascular dysrhythmia: bradycardia, tachycardia CNS headaches, fatigue, malaise, confusion, convulsion |
| Digoxin Indications | heart failure supra ventricular dysrhythmias Atrial fibrillation and atrial flutter |
| Digoxin Nursing (HALOS drug TOXICITY) | assess history, drug allergies, contraindications, assess clinical parameters (weight, I&O, ECG, BP, Apical pulse full minute. Breath sounds, Hold dose <60 or >100 MUST NOTIFY prescriber Serum labs K+, Na+, Mg, Ca, renal & liver fx Anorexia, nausea, |
| Digoxin Toxicity | HYPOKALEMIA (K+=3.5 -5.0) Use of Cardiac Pacemaker Hepatic dysfunction Hypercalcemia Dysrhythmias Hypothyroid, respiratory and renal diseases ANY CRITICAL lab value can be LIFE threatening KNOW YOUR VALUES |
| Anticoagulants | Atrial fibrillation, MI, Unstable angina, Indwelling devices (mechanical heart valves) Major orthopedic surgeries |
| AC AE (anticoagulants) | Bleeding Risk increases w increased dosages May be localized or systemic May Cause HEPARIN-INDUCED THROMBOCYTOPENIA (HIT) Nausea, vomiting, abdominal cramps, THROMBOCYTOPENIA |
| Heparin Antidote (Protamine Sulfate) | Monitor: activated partial thromboplastin time aPTIs aPTIs within range levels Pt may start Warfarin several days before discharge while in heparin injections User w caution due to Nephrotoxicity, rotate sites, Heparin given Sub Q in abdomen |
| Coagulation system (2 pathways) | Clot forming cascade Each activated factor serves a catalyst that amplifies the next reaction Result is fibrin, a clot-forming substance Intrinsic pathway (clot formed inside blood vessel) Extrinsic pathway (clot formed outside blood vessel) |
| AC (anticoagulants) | Heparin inhibits clotting factors from activating through certain pathways Warfarin (coumadin) helps a lot by blocking the activation of clotting factors |
| AC education | importance of regular laboratory testing signs of abnormal bleeding Measures to prevent bruising , bleeding or tissue injury Pt TEACHING on injury prevention most IMPORTANT! Bruising is very common |
| AC nursing | wear medical bracelet Monitor intake of foods high in vitamin K (dark leafy green vegetables, etc) Consult physician before taking other drugs or OTC, including herbals. Vitamin K interacts w Coumadin |
| Coagulation modifiers | Anticoagulants (HEPARIN) * Inhibit the action of formation of clotting factors * Prevent clot formation Antiplatelet drugs (ASPIRIN) or CLOPIDOGREL Plavix) * Inhibit platelet aggregation * Prevent platelet plugs |
| thrombocytopenia | deficiency of clotting cells, leads to a lack of platelet action |
| Warfarin Sodium (Coumadin, Vitamin K) | *PO Monitor prothrombin time and INR *"PT-INR" test Warfarin levels w/in range *Vitamin "K" ANTIDOTE to Warfarin toxicity *Patient needs several blood test per week until therapeutic level is reached. |
| Warfarin nursing | many herbal products w potential interactions increase bleeding: Capsicum pepper Garlic Ginger Ginkgo St. John's wort Feverfew |
| Antiplatelets | Anti-thrombotic effects Reduces risk of fatal and nonfatal strokes Acute unstable angina and MI Adverse effects Vary according to drug |
| thrombolytic AE | Bleeding Internal Intracranial Superficial Other effects Nausea, vomiting, hypotension, anaphylactoid reactions Cardiac dysrhythmias: can be dangerous |
| feberlitic (thrombolytic antidote) | Prevent lysis (breakdown) of fibrin Result in promoting clot formation used for prevention & tx of excessive bleeding resulting from hyperfibrinolysis or surgical complications Tx for hemophilia or von Willebrand's disease |
| Antianginals | Nitrates: treat & prevent attacks of angina; acute Tx Nitrates - nitroglycerin Beta adrenergic blockers - metoprolol Calcium Channel Blockers - dilitazem Calcium channel blockers & Beta blockers: prophylactic use for longer-term management |
| Heart Failure drugs | ACE Inhibitors lisinopril (Prinivil) ARB - valsartan (Dinovan) Aldosterone Antagonist - spironolactone Aldactone B-type Natriuretic peptide - nesiritide (Natrecor) Cardiac glycoside - digoxin (Lanoxin) Phosphodiasterase inhibitors primacor |
| Dysrrhytmia drugs | Dysrrhytmia I - lidocaine Dysrrhytmia II - propranolol (linderal) Dysrrhytmia III - amiodarone (Cordarone) Dysrrhtymia IV - diltiazem (Cardizem) |
| Coagulation Modifier | Antiplatelets - aspirin (repeat from pain module) Anticoagulant - heparin Thrombolytic - alteplase (Activase) Antifibrinolytic - aminocaproic acid (Amicar) |
Created by:
farinag
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