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TL Cardiovascular

Nursing of the adult with cardiovascular disorders (HESI)

QuestionAnswer
How is cardiac function related to kidney function? the kidneys normally filter 1 liter of blood per minute resulting in urine production. Decreased urine production could be a sign of poor cardiac output.
What rate of urine production is considered minimally adequate to perfuse vital organs? 0.5 ml of urine production per kg of body weight or average of 30mL/hour
Define angina. myocardial oxygen demand exceeds supply resulting in pain/discomfort
Since angina is a problem of supply and demand name some common causes of angina. Athersclerotic heart disease, hypertension, coronary artery spasm, hypertrophic cardiomyopathy
How is the quality of angina pain often described? Mild to moderate burning, pressing, squeezing, heavy, choking, aching and feeling of apprehension
Where is angina pain located? substernal radiating to left arm/shoulder, jaw, or right shoulder
What is the usual onset and duration of angina pain? can be transient or prolonged, with gradual or sudden onset; typically short duration
What types of things precipitate angina pain? exposure to cold, heavy meal, exercise, mental tension, sexual intercourse
What kinds of things relieve angina pain? rest, nitroglycerin
What symptoms other than pain may accompany angina? dyspnea, tachycardia, palpitations, nausea, vomiting, fatigue, diaphoresis, pallor, weakness, syncope, dysrhythmias
What ECG anomalies characterize an angina attack? ST depression and T wave inversion
What are the results of an exercise stress test likely to show for a person with angina? ST depression and hypotension
What will a stress echocardiogram show for a person with angina? changes in wall motion
What is the difference between an exercise stress test and stress echocardiogram? Echocardiogram uses ultrasound
What test could help diagnose if a person has angina by detecting coronary artery spasms? coronary angiogram
Define coronary angiography procedure using contrast dye and x-ray to see how blood flows through the heart
What kind of test can detect arterial blockage? Cardiac Catheterization
What are the nonmodifiable risk factors for angina? age, ethnicity > risk for African Americans, Heredity, Gender – women at greater risk until menopause then equal with men,
What are the modifiable risk factors for angina? hyperlipidemia, cholesterol level above 300mg/dL (4 x risk for CAD), high LDL, Low HDL, Sedentary, Obesity, Smoking, Hypertension, Diabetes, Stress
What are a couple applicable nursing diagnoses for a client with angina? Pain related to; Anxiety related to
What does the client with angina need to know? how to take medications, how to avoid precipitating factors, risk factors, what to do during an attack, diet modifications (low fat/salt)
What does the client with angina need to know about physical activity and sex? Good to start exercise, avoid isometric, sex okay when 2 flights of stairs does not cause physical exertion, Nitroglycerin can be taken prophylactically before sex
What are the medical interventions for angina? Percutaneous Transluminal Coronary Angioplasty (PTCA), Arthrectomy, Coronary Artery Bypass Graft, Coronary laser therapy, Coronary artery stent
What should a person do during an angina attack? rest, sit by the phone, take no more than 3 nitorglycerin tablets 5 minutes apart, seek emergency treatment if no relief after taking nitroglycerin
Define Myocardial Infarction myocardial tissue death due to insufficient coronary artery blood supply
Name two common causes of MI Thrombus or clotting; Shock or hemorrhage
Describe the location of the pain associated with MI sudden onset of pain in the lower sternal region
Describe the onset, location, quality and duration of MI pain. sudden onset in the lower substernal region that increases in intensity as to be nearly unbearable, heavy and vise like, radiates to shoulders and down arms, may persist for hours/days
Define Silent MI MI without pain -clients with diabetic neuropathy especially at risk
How is MI pain different from angina pain? sudden onset, not relieved by rest, not relieved by nitroglycerine
What symptoms other than pain might a patient with MI have? Rapid, irregular, feeble pulse; decreased LOC ; heart shift to left sometimes post MI; dysrhythmias; cardiogenic shock, fluid retention; absent or high pitched bowel sounds; HF/wet lung sounds; ECG changes as early as 2 hr post MI or late as 72 hr post MI
Name three drug classes used to treat or prevent angina. Nitrates, Beta Blockers, and Calcium Channel Blockers
What kind of drugs are Isordil and Imdur? Nitrates– Isosorbide Nitrate and Isosorbide mononitrate
Name the adverse reactions associated with nitrates. Headache, hypotension, flushing, dizziness, weakness, nausea
What are the nurse’s responsibilities when her patient has required administration of a nitrate? Monitor effectiveness and vital signs; have the client rest.
What are the storage and replacement requirements for nitroglycerine tablets? store in original container in cool, dry place. Replace after 3-5 months
Name three Beta Blockers. Propranolol (Inderal), Atenolol (Tenormin), Nadolol (Corgard)
How do beta blockers work to prevent angina? They decrease oxygen demand.
What are the adverse effects associated with beta blockers? FLIBB HHH -Fatigue, Lethargy, Impotence, Bradycardia, Bronchospasm/bronchoconstriction, Hypotension, Hallucinations, HF
What teaching goes with the administration of Beta Blockers? Don’t stop abrubtly, change position slowly; report dizziness, weakness, fainting, Diabetics – signs of hypoglycemia masked
What are the nursing responsibilities for the patient on Beta Blockers? monitor apical heart rate, assess bp (hold for systolic pressure less than 90mm Hg), masks signs of hypoglycemia, exercise caution for HF, COPD, bronchitis, asthma, hepatic/renal trouble
Name three Calcium Channel blockers. Verapamil (Calan), Nifedipine (Procardia), Diltiazem (Cardizem, Norvasc)
How do calcium channel blockers prevent angina? They decrease contractility and conductivity of the heart thereby reducing the heart’s oxygen demand
What is the most frequent effect associated with calcium channel blockers? peripheral edema
What are the adverse effects of calcium channel blockers (ABCD PEHH)? hypotension, headache, Bradycardia, peripheral edema, dysrhythmias, may precipitate AV heart block, constipation, nausea
What are some nursing responsibilities associated with Calcium channel blockers? Monitor for low BP; weigh client and report weight gain or edema; monitor renal and liver function studies
What are some teaching points for the client on calcium channel blockers (CCCC)? Change position slowly, Can't have grapefruit; Can't stop taking abruptly, Constipation fixes - exercise, fluid, and fiber
Which clients are at increased risk for adverse effects with Calcium Channel Blockers? Elderly and clients with HF
Give four possible nursing diagnoses for a patient with MI Ineffective tissue perfusion; Decreased cardiac output; Activity intolerance; Pain
What drug is given for MI for pain and to increase O2 perfusion? How does it work to increase perfusion? IV Morphine Sulfate – Acts as a vasodilator and decreases venous return
Other than morphine, what other drug classes are often prescribed for MI patients? Nitrates; Beta Blockers, Calcium Channel Blockers, Aspirin, Antiplatelet Aggregates, Thrombolytics
What assessments and labs will the nurse with a MI patient monitor? Vital signs including ECG rhythm strip per agency policy, cardiac enzymes, breath sounds for rales, monitor fluid balance – I&Os
What are the nursing responsibilities to the client with MI in regards to positioning, environment, activity level, IV, and O2? Administer O2 at 2 – 6 L/minute nasal cannula as prescribed; provide quiet restful environment; Maintain patent IV line for administration of emergency meds; Semi-folwer to assist with breathing; bedrest for 24 hours; gradual return to activity
What should the nurse discuss with the client with MI? encourage verbalization of fears; Provide information about the disease process and cardiac rehabilitation; Possible medical interventions like thrombolytics in the first 4 hours or invasive procedures like intraaortic balloon pump
Name 3 bile acid sequestrants. Colestipol (Colestid), Colesevelam (Welchol), Cholestryramine (Questran)
What are the indications for bile acid sequestrants? Hyperlipidemia and hypercholesterolemia when diet fails
How do bile acid sequestrants work? They are ion exchange resins. They trade anions for bile acids so that the bile acids are combined with the drug and excreted with feces. Bile acids are synthesized from cholesterol so keeping them from being reabsorbed lowers cholesterol.
What are the adverse effects of bile sequestrants? GI trouble – pain, NV, distention, gas, constipation; reduced absorption of fat soluble vitamins; reduced absorption of other oral medications
How should we teach the client to take powdered forms of bile sequestrants? Why? In liquid or applesauce to prevent inhalation and esophageal distress
What lab value needs to be monitored when the patient is taking a bile sequestrant? PTT
What are some possible complications the nurse should monitor for due to reduced fat soluble vitamin absorption with bile sequestrants? visual changes and rickets
When should other medications be administered in relation to bile sequestrants? 1 hour before or 6 hours after
Name 5 statins. Atorvastatin (Lipitor), Fluvastatin (Lescol), Pravastatin (Pravachol), Simvastatin (Zocor), Lovastatin (Mevacor)
How do statins work to lower cholesterol? They inhibit HMG-CoA which is an enzyme responsible for early synthesis of cholesterol.
What are the adverse effects of statins? GI upset – Gas, cramps, constipation, diarrhea,heartburn; Rash; Rhabdomyolysis; Hypersensitivity reactions like angioneurotic edema; may elevate liver enzymes; Hepatitis or pancreatitis
What lab values need to be monitored for a client on statins? liver enzymes (baseline and q 6 months), CPK levels
What does CPK level tell us about? CPK is an enzyme found in heart, brain, and skeletal muscle. Elevated level may indicate damage in these areas.
What does the client taking statins need to know about taking the drug? Take as directed – no doubling up for missed doses; Report muscle tenderness/weakness; Avoid grapefruit juice
Name 3 Fibric Acid Derivatives. Gemfibrate (Lopid), Fenofibrate (Tricor), Clofibrate (Claripex)
What are fibric acid derivatives used for? with diet to lower cholesterol/triglycerides
How do fibric acid derivatives work? They prevent the synthesis of triglycerides
What are the side effects of fibric acid derivatives (PEW FRoGG)? GI upset – pain, diarrhea, gas, N/V, heartburn; Gallstones, weakness, fatigue, rhabdomyolysis, pulmonary embolism
What labs need to be monitored with fibric acid derivatives and at what frequency? baseline and q 3-6 months: CBC, Liver Function, Electrolytes, CPK
What is the administration time for Lopid and Tricor in relation to meals? Lopid 30 minutes before breakfast and dinner, Tricor with meals
What are the indications for Niacin and Nicotinic Acid ? decrease lipoprotein and triglyceride synthesis and increase HDL
What are the side effects of Niacin Nicotinic Acid(FP OHHHHUG)? Flushing, pruritis, HA, Orthostatic Hypotension, Hepatotoxicity (Extended release), Hyperglycemia, Hyperuricemia, Upper GI distress
What instructions should the nurse give the client taking Niacin or Nicotinic Acid? take with milk or food to avoid GI irritation; change position slowly; If taking ER form report dark urine, light stool, anorexia, severe stomach pain, or yellowing of eyes or skin
Define Hypertension Persistent seated BP > 140/90
What is the cause of essential hypertension? No known cause
What is the terminology for hypertension that develops in response to an identified mechanism? Secondary hypertension
What are the two main factors that influence blood pressure? cardiac output and vascular resistance
What assessment finding would indicate postural hypotension? a difference of more than 10mmHg between lying, sitting, and standing BP readings (check both arms)
Name 4 non-modifiable risk factors for hypertension. heredity – positive family history, Age – risk increases with age, Gender – Men higher risk than women, Ethnicity – African Americans at greater risk than whites
Name 5 modifiable risk factors for hypertension. alchohol, tabbacco, caffeine; sedentary/obesity; high salt/fat diet; oral contraceptive/estrogens; stress
Name some medical conditions associated with hypertension. renal failure; respiratory problems – especially COPD; cardiac disorders – especially valvular disorders
Name two drugs that can cause hypertension. Steroids and estrogen
What kind of symptoms might the nurse find on assessment of a person with hypertension? Headache, edema, nocturia, nosebleeds, vision changes, may be asymptomatic
What personality type is most likely to have hypertension? Type A
What are three possible nursing diagnoses for a person with hypertension? insufficient knowledge; noncompliance; ineffective tissue perfusion
What can the nurse teach the client with hypertension about the disease process? Risk factors, causes, long-term complications, lifestyle modifications, how treatment prevents complications
What can the nurse teach the client with hypertension about treatment? How to take BP; Reason for each med; how to take meds; need for consistency with meds& ongoing assessments; check BUN, Creatinine, and electrolytes Q 90-120 days; BP & pulse weekly
What is the number one cause of CVA in hypertensive clients? Noncompliance
Why is noncompliance the number one cause of CVA in hypertensive clients? Side effects of the medications compared to the effects of an often symptomless disorder make clients feel that they don’t need their medication
How can a nurse help prevent noncompliance? Teach the client about the medication. Studies show the more clients know about taking their medications the more likely they are to take them. Ask about side effects like insomnia, impotence.
What lifestyle changes can the nurse teach the client with hypertension about? stress reduction, weight loss, tobacco cessation, exercise
What kind of diet is recommended for hypertension? Low-salt, low-cholesterol, low-fat
Why isn’t Digoxin a good choice for angina pain? It increases the strength and contractility of the heart muscle leading to increased oxygen demand
Why is atropine an inapporopriate choice for angina pain? Increases the heart rate by blocking vagal stimulation which increases oxygen demand
When is propanolol (Inderal) considered appropriate for angina? Not good for an attack but good for long term management because it decreases vasoconstriction – more oxygen to heart
Name several Fibronolytic Agents. Streptokinase, Tenecteplase, Alteplase, Anisterplace, Reteplase, Urokinase
What are the indications for Steptokinase? DVT, pulmonary embolism, arterial thrombosis and embolism, coronary thrombosis, dissolving clots in ateriovenous cannula
What adverse reactions should we watch for with the administration of Streptokinase? Anaphylactic reactions like breathing difficulty, bronchospasm, periorbital swelling, angioedema; increased bleeding risk, hemorrhage at site of myocardial damage, reperfusion dysrhythmias
What assessments should be made when a patient receives Streptokinase? puncture site for bleeding – apply pressure to control bleeding, watch for allergic reactions and dysrhythmias, Monitor thrombin time – should be less than twice control before resuming heparin or oral anticoagulants
Describe care and activity level of a client after femoral coronary cannulation and perfusion with Streptokinase. keep leg immobile for 24 hours, assess pedal pulses for adequate perfusion
How is should Streptokinase be mixed if reconstitution is required? Do not shake. Roll and tilt vial to gently mix.
What are the indications for Tenecteplase and Reteplase? Acute management of coronary thrombosis
When would administration of tenecteplase or reteplase be contraindicated? History of uncontrolled hypertension
What are the adverse effects associated with tenecteplase and reteplase? can cause hypotension
What lab values are necessary with the administration of tenecteplase and reteplase? baseline PT, PTT, CBC, fibrinogen level, renal studies, and cardiac enzymes prior to administration
What are some signs of bleeding that would preclude the administration of tenecteplase or reteplase? abnormal pulse, nuero signs, skin lesions
What should we know about injections and tenecteplase or reteplase? avoid needle punctures due to possibililty of bleeding, Apply pressure to injection sites for 30 minutes then pressure dressing, Do not inject where pressure cannot be applied (jugular vein)
What complication should we be watchful for with the administration of tenecteplase for coronary thrombosis? Watch ECG - reperfusion arrhythmias are likely
What are the indications for Urokinase ( Abbokinase)? Pulmonary Embolism, Coronary Thrombosis, IV catheter clearance
What adverse reactions are associated with Urokinase (Abbokinase)? Same as Streptokinase except no danger of allergic reactions: increased risk of bleeding, Hemorrhage, reperfusion dysrhythmias
Urokinase is much more expensive than Streptokinase. Why would Urokinase be preferable to Streptokinase? Urokinase does not cause allergic reactions – it is nonantigenic
How is rethrombosis prevented after the administration of Urokinase? Administration of heparin or oral anticoagulant
When is Urokinase reconstituted? immediately before use
What are the indications for Alteplase and Anistreplace? DVT, Pulmonary Embolism, Coronary Thrombosis
What are the adverse effects of alteplase and anistreplace? Interacts with heparin, oral anticoagulants and anitplatelet drugs increasing the risk for bleeding
How are alteplase (Activase) and Anisteplace (Eminase) different from Streptokinase? Bleeding complications with Alteplase are reduced compared to Streptokinase because it works just on the clot not systemically. It is a human protein – less likely to cause anaphylaxis.
What is the half life of Alteplase? How soon should it be administered? 3-7 minutes, use immediately
Define PVD Peripheral Vascular Disease – circulatory problems originating from venous or arterial pathology
Why is careful assessment so important for PVD? The signs, symptoms, and treatment vary widely depending on the source of pathology
Name some predisposing factors for PVD. Aterial – Atherosclerosis (95% of cases), advanced age; Venous – History of DVT, Valvular incompetence
Name some disease associated with arterial PVD. Raynaud disease, Buerger disease, Diabetes, Acute Occlusion (emboli/thrombi)
Define Raynaud disease. A disorder in which vasospasm of small arteries decrease blood flow to extremities like fingers, toes, or nose – usually fingers- in response to cold or stress
Define Buerger disease. a progressive thrombosis and clotting of small arteries and veins decreasing blood flow to hands and feet, associated with smoking
Name some venous disorders associated with PVD. Varicose veins, Thrombophlebitis, Venous stasis ulcers
Define thrombophlebitis. Inflammation of a vein caused by a blood clot
What alterations might a nurse find during assessment of the patient’s skin and appendages if PVD is due to arterial insufficiency? smooth, shiney skin; loss of hair; thickened nails
What alterations in skin may be present in the skin if a patient has PVD of venous origin? Brown pigment around ankles
What color changes will be observed with elevation and dependent position when PVD is arterial in origin? Elevation – pallor; Dependent – Rubor
What color would dependent limbs be in PVD if the origin is venous? Cyanotic/blue
What will the nurse note about temperature of extremities when the source PVD is arterial? Venous? Arterial – cool; Venous – warm
What difference will the nurse note when assessing pulses of arterial PVD vs. venous PVD? arterial – decreased or absent; venous –normal
What type of pain is associated with PVD of arterial origin? Sharp pain that increases with walking and elevation; intermittent claudication; rest pain when extremities are horizontal – may be relieved by dependent position
Describe the pain associated with PVD of venous origin. What relieves this pain? Persistent, aching, full feeling, dull sensation; relieved when horizontal ( elevate and use elastic stockings)
Describe ulcers associated with PVD of arterial origin. very painful on lateral lower legs, toes, and heels; demarcated edges; necrotic; not edematous
Describe ulcers associated with PVD of venous origin. slightly painful, on medial legs and ankles, uneven edges, superficial, marked edema
Give several applicable nursing diagnoses for the patient with PVD. Ineffective tissue perfusion, impaired skin integrity, risk for infection, pain
What are some noninvasive treatments for arterial PVD? stop smoking, topical antibiotic, saline dressing, bed rest/immobilization, finbrinolytic agents if clots – not for Buerger or Raynaud
What are some noninvasive treatments for venous PVD? Systemic antibiotics, compression dressing, limb elevation, fibrinolytic agents and anticoagulants if thrombosis
Name 5 surgical interventions for arterial PVD. Embolectomy, Endarterectomy, Aterial bypass, Percutaneous transluminal angioplasty, Amputation
Name 3 surgical interventions for venous PVD. vein ligation, thrombectomy, debridement
A patient with PVD will need assessment of the affected extremities at regular intervals. What will the nurse check? Color, temperature, sensation, and pulse quality
Explain nursing care of the patient with PVD in regards to activity level, positioning, clothing, and promoting warmth of the extremity. Encourage rest at first sign of pain, schedule activities within tolerance level, encourage elevation of extremity if venous and frequent position change, avoid restrictive clothing and crossing legs, keep warm with extra clothing not heating pads
Why shouldn’t a patient with PVD use external heat sources such as a heating pad? Sensation in the extremity is diminished so that the patient could burn themselves without realizing it.
Why shouldn’t a patient with PVD smoke? Smoking causes vasoconstriction and spasm of arteries
What can we teach the patient with PVD to prevent further injury? Change position frequently; wear nonrestrictive clothing; avoid crossing legs; avoid keeping legs dependent; wear good shoes; proper foot and nail care
How is the affected extremity to be treated preoperatively for the patient with PVD? Maintain in a level position if venous, 15 degrees dependent if arterial; room temperature; protect from trauma
What complication does the nurse assess frequently for after surgical intervention for PVD? hemorrhage
What drug may be given post surgery for PVD? Why? Anticoagulant to prevent thrombosis
Name 4 thiazide diuretics. Chlorthalidone, Hydrochlorothiazide, Indapamide, Metolazone
What are the benefits of and indications for thiazide diuretics? inexpensive, effective, effective orally; to decrease fluid volume, for severe hypertension, to enhance other antihypertensives
What are the adverse reactions associated with thiazide diuretics? Hypokalemia, hyperuricemia, glucose intolerance, hypercholesterolemia, sexual dysfunction
What are the signs of hypokalemia? Dry mouth, thirst, drowsiness, weakness, lethargy, muscle aches, tachycardia
What are the nursing implications for thiazide diuretics? Observe for postural hypotension, Use caution for gout, renal failure, lithium; hypokalemia increases risk for digitalis toxicity; administer potassium supplements
What substances could potentiate postural hypotension in combination with a thiazide diuretic? alcohol, barbiturates, narcotics
Name 3 loop diuretics. furosemide (Lasix), Torsemide (Demadex), Bumetanide (Bumex)
Describe the action of loop diuretics and when they are used. Rapid action, cause volume depletion, potent for use when thiazide diuretics fail
What are the adverse effects of loop diuretics? Hypokalemia, Hyperuricemia, Glucose intolerance, hypercholesterolemia, hypertriglyceridemia, sexual dysfunction, weakness
What are the nursing implications for loop diuretics? know that volume depletion and electrolyte depletion is rapid, observe for postural hypotension, caution with renal failure, gout, lithium; Hypokalemia increases risk for digitalis toxicity, administer potassium supplements
Name two potassium sparing diuretics. spironolactone and amiloride
What are the indications for spironolactone (Aldactone) and amiloride (Midamor)? volume depletion without significant potassium loss
What are the adverse effects of potassium sparing diuretics? Hyperkalemia, Gynecomastia, Sexual dysfunction
When should spironolactone (Aldactone) or amiloride (Midamor) be given in relation to meals in order to avoid GI distress? after meals
What are the nursing implications for potassium sparing diuretics? watch for hyperkalemia and renal failure in those treated with ACE inhibitors or NSAIDs; Watch for increase in serum lithium levels
Name three combination loop and potassium sparing drugs. HCTZ and triamterene (Maxidex), HCTZ and Amiloride (Moduretic), HCTZ and Spironolactone (Aldactazide)
What is the purpose of combination loop and potassium sparing diuretics? decrease fluid volume while minimizing potassium loss
How are the side effects of combination diuretics altered? Side effects of individual drugs are offset or minimized by its partner
What are the nursing implications for a patient on a combination loop/potassium sparing diuretic? Caution clients previously taking loop or thiazide about excess potassium in diet due to potassium sparing component of new drug; follow dose schedule so that sleep is not disrupted to get up and pee
Name several drug classes used as antihypertensives (7). Alpha blockers, beta blockers, calcium channel blockers, central acting inhibitors, vasodilators, angiotensin II receptor agonists, ace inhibitors
Name 4 Alpha Andrenergic Blockers. Prazosin (Minipress), terazosin (Hytrin), Phentolamine mesylate (Regitine), doxazosin (cardura)
How do alpha andrenergic blockers work to lower BP? block alpha andrenergic receptors in peripheral blood vessels leading to vasodilation
What are the indications for Alpha andrenergic blockers? extreme hypertension, pheochromocytoma, BPH
What are the adverse reactions associated with alpha-andrenergic blockers? Orthostatic hypotension, Palpitations, Weakness
What are labetalol (Normodyne) and Carvedilol (Coreg) used for? to decrease BP without reflex tachycardia or bradycardia
What kind of drugs are labetalol (Normodyne) and Carvedilol (Coreg)? combined alpha/beta blockers
What adverse affects might a patient taking labetalol (Normodyne) or Carvedilol (Coreg) experience (vdbbohh)? HF, Ventricular dysrhythmias, Blood dyscrasias, Bronchospasm, Orthostatic Hypotension
Labetalol (Normodyne) and Carvedilol (Coreg) are contraindicated for patients with what conditions? HF, Heart Block, COPD
Name 7 Beta Blockers (ABMMNPT). Metoprolol (Lopressor), Nadolol (Corgard), Propanolol (Inderal), Timolol (Blocadren), Atenolol (Tenormin), Bisoprolol (Zebeta), Metropolol (Lopressor, Toprol)
Give 4 therapuetic actions of Beta blockers? They block sympathetic nervous system stimulation especially to the heart; slow heart rate; lower BP; reduce O2 consumption during myocardial contraction
What adverse reactions may a patient taking a beta blocker for hypertension experience(fbbiddhsd)? Bradycardia, fatigue, insomnia, bizarre dreams, sexual dysfunction, hypertriglyceridemia, decreased HDL , Depression
What are some things to teach patients about taking Beta Blocker medication? Don’t stop abruptly; Caution for bronchospasm/asthma; Masks signs of hypoglycemia; Check radial or apical pulse daily
Name 3 central acting Inhibitors. Clonidine (Catapress), Guanabenz acetate (Wytensin), Methyldopa (Aldomet)
How do central acting inhibitors work? They act on central (in the brain) alpha receptors reducing sympathetic nervous system activation
What adverse effects might our patient on central acting inhibitors for hypertension experience (DFDSD)? Drowsiness, Fatigue, Dry mouth, Sexual dysfunction
What could result if our patient abruptly stops taking central acting inhibitors like Catapress, Wytensin, or Aldomet? Rebound hypertension
What instructions should we give our patient on central acting inhibitors for hypertension? change position slowly; avoid standing still and taking hot baths and showers
Name 2 vasodilators that might be used to treat hypertension. Hydralazine (Apresoline), Minoxidil (Loniten)
How do vasodilators work to lower BP? decrease peripheral vascular resistance
What adverse effects might our patient taking vasodilators for hypertension experience (HHFT)? Headache, postural hypotension, fluid retention (HF, peripheral edema), tachycardia
What should we monitor, assess, observe for when our patient is taking vasodilators for hypertension? observe for peripheral edema, monitor I&O, weigh daily, monitor pulse and BP routinely
Name 3 angiotensin II Receptor Antagonists. Losartan (Cozaar), Valsartan (Diovan), Irbesartan (Avapro)
How do ARBs work to lower BP? Blocks the vasoconstricting and aldosterone releasing effects of angiotensin II on vascular smooth muscle and adrenal glands
What are the potential adverse effects of ARBs(FRHHH)? Hypotension, Fatigue, Hepatitis, Renal Failure, Hyperkalemia (rare)
Name 6 ace inhibitors that might be prescribed to treat hypertension. Captopril (Capoten); Enalapril (Vasotec); Lisinopril (Zestril); Ramipril (Altace); Benazapril (Lotensin); Quinapril (Accupril)
How do ACE inhibitors decrease BP? suppressing the conversion of angiotensin I into angiotensin II
ACE inhibitors are especially helpful for patients with what disorder? Diabetes
What side effects might a patient on ACE inhibitors experience? Proteinuria, Neutropenia, Skin Rash, Cough
What will we need to observe for and what tests should be routinely performed on the patient taking ACE inhibitors? Acute Renal Failure (reversible); Renal Function tests
What instructions should the patient receiving their first dose of an ACE inhibitor be given? Stay in bed 3 hours
Name 4 Calcium Channel Blockers that may be prescribed for hypertension. Diltiazem (Cardizem), Nifedipine (Procardia, Adalat), Verapamil (Calan, Isoptin), Nisoldipine (Sular)
How do Calcium Channel Blockers work for the patient with hypertension? Inhibits calcium influx during cardiac depolarization; Decreases SA/AV node conduction
What side effects might a patient experience with Calcium Channel Blockers(HHDENCTHD)? Headache, Hypotension, Dizziness, Edema, Nausea, Constipation, Tachycardia, HF, Dry cough
What instructions should the patient taking calcium channel blockers receive regarding meals and food interactions? take before meals, avoid grapefruit juice and high fat meals (increase serum levels of drug causing hypotension), limit caffeine consumption
What assessments should be made routinely if the patient is taking CCBs for hypertension? BP and pulse
Name 6 anticoagulants. Heparin, Warfarin (Coumadin), Antiplatelets - Ticlopidine (Ticlid), Dipyridamole (Persantine), Clopidogrel (Plavix), Low molecular weight heparin – Enoxaparin (Lovenox)
How does heparin work? It keeps thrombin from turning fibrinogen to fibrin – thrombin antagonists
How is heparin administered? Heparin is administered SQ or IV
What adverse reactions might a patient have with heparin? Hemorrhage, Agranulocytosis, Leukopenia, Hepatitis
What is the antidote for heparin? Protamine sulfate
What labs should be monitored for the patient on heparin? PTT, Hgb, Hct, platelets, stools for occult blood
What common nursing procedure should be avoided when the patient is on heparin? injection
How does warfarin work? Blocks the synthesis of prothrombin from vitamin K
What adverse effects might a patient taking warfarin (Coumadin) experience? Hemorrhage, Agranulocytosis, Leukopenia, Hepatitis
How is warfarin administered? Orally or IV
What labs should be assessed for a patient on warfarin? PT and INR, hepatic function, CBC, and stool for occult blood
What is the antidote for Warfarin (Coumadine)? Vitamin K
Name three antiplatelet drugs. Ticlopidine (Ticlid), Dipyridamole (Persantine), Clopidagrel (Plavix)
Define AAA (abdominal aortic aneurysm). dilatation of the abdominal aorta caused by an alteration in the integrity of its wall
What is the most common cause of AAA? Atherosclerosis
AAA is a late manifestation of what sexually transmitted disease? Syphilis
What is the end result of an untreated abdominal aortic aneurysm? Rupture/death
What are the most frequent symptoms associated with abdominal aortic aneurysm? Mostly asymptomatic; abdominal pain; low back pain; feeling one’s heart beating
Clients taking which type of drug are at increased risk for abdominal aortic aneurysm? Antihypertensives
The client is admitted complaining of chest pain and terrible tearing sensation in his chest. What condition might you suspect? Dissecting aortic aneurysm
What are the symptoms of a rupture of an aortic aneurysm? hypovolemic or cardiogenic shock with sudden, severe abdominal pain
Which assessments are necessary in the first few hours for the patient with a dissecting aortic aneurysm? Vital signs Q hour, Neurologic vital signs, respiratory status, urinary output, peripheral pulses
What is the nurse likely to find on assessment of a patient with an abdominal aortic aneurysm? bruit over the abdominal artery, pulsation in upper abdomen, patient report of abdominal or lower back pain,
What diagnostic tests could confirm the diagnosis of abdominal aortic aneurysm if the aneurysm is calcified? abdominal radiograph (aortogram, angiogram, abdominal ultrasound)
What are several applicable nursing diagnoses for the patient with AAA? Activity intolerance, Impaired skin integrity, anxiety
What nursing interventions are required for the patient with an aortic aneurysm (4 important assessments)? regular assessment of all peripheral pulses and vital signs; look for signs of occlusion after graft; watch for signs of kidney trouble; Observe for postoperative ileus
Name all the peripheral pulses that a nurse would regularly check for the patient with abdominal aortic aneurysm. Radial, femoral, popliteal, posterior tibial, dorsalis pedis
After the placement of an aortic graft the nurse should observe for signs of occlusion. What are the signs of occlusion? changes in pulses; severe pain; cool to touch below graft; white or blue extremities
The kidneys are at risk for damage during grafting of the Aorta because the large arteries are clamped off. What signs would alert the nurse to this potential complication? Output < 30ml/hr; Dark urine; Elevated BUN and Creatinine
How often should BUN and creatinine levels be checked post surgery for AAA? daily
What are the normal levels for BUN, creatinine, and the ratio of BUN to creatinine? BUN 10 to 20 mg/dl; creatinine 0.6 to 1.2 mg/dL; BUN:Creatinine = 20:1
What is the purpose of an NG tube for 1-2 days after surgical repair of AAA? prevent postoperative ileus
What assessment does the nurse perform to monitor for postoperative ileus? - At what frequency? bowel sounds every shift
Define Thrombophlebitis. Inflammation of the venous wall with the formation of a clot
What are some other names for thrombophlebitis? DVT, Phlebothrombosis, venous thrombosis
What might the nurse find on assessment of a patient with Thrombophlebitis? positive Homan sign, calf pain, functional impairment of the affected extremity, edema and warmth of the extremity, asymmetry, pain with gentle touch
How reliable is Homan sign? Only about 10% of patients with phlebitis manifest Homan sign and there are many false positives
What does a positive Homan sign indicate? What else could illicit a positive Homan sign? early thrombophlebitis; muscle inflammation
Why is it important not to perform the Homan sign if thrombosis has been confirmed? Can precipitate embolism
What assessments does the nurse make to check for asymmetry related to thrombophlebitis? Inspect legs from groin to feet; measure diameter of calves
What diagnostic tests could confirm an occlusion of a vein? Venogram, Dopplar ultrasound, Fibrinogen scanning
Give 8 risk factors for thrombophlebitis. Prolonged strict bed rest, general surgery, leg trauma, previous venous insufficiency, obesity, oral contraceptives, pregnancy, malignancy
Give a couple applicable nursing diagnoses for a patient with thrombophlebitis. Ineffective tissue perfusion; pain
Why is it so important not to cause tissue damage when giving heparin subQ? because the clotting mechanism is prolonged tissue damage could lead to bleeding
How should SubQ heparin be administered? No massaging or aspiration – give in the abdomen between the pelvic bones and 2 inches below umbilicus, rotate injection sites
What type of prescription would you anticipate for the patient with thrombophlebitis? Anticoagulant
What is the main side effect that the nurse should watch for when the patient is taking an anticoagulant? bleeding
Name 2 lab values that are important to determine the efficacy of heparin. PTT and APTT
What is the goal PTT value for a patient on heparin? 1.5 to 2.5 the normal control value
What is the antidote for heparin? Protamine sulfate
What are the lab values that tell us if Coumadine is effective? PT and INR
What are the goal numbers for Coumadine effectiveness? PT - 1.5 -2.5 times normal control, INR – 2-3 seconds
What drug’s effectiveness is measured by PTT? Heparin
What drug’s effectiveness is measured by PT? Coumadine
When performing venipuncture on a patient with thrombophlebitis how do we minimize the possibility of hematoma formation? apply pressure to the venipuncture site
When the patient is receiving anticoagulant the nurse should report any signs of unusual bleeding. Name 6 possible sources of unusual bleeding. Vaginal bleeding, nosebleed, melena, hematuria, gums, hemoptysis
What advice and teaching should the patient on anticoagulants for thrombophlebitis receive? soft toothbrush/waxed floss; medical alert symbol, avoid alcoholic beverages/aspirin, use safety razor, wear antiembolic stocking and elevate extremities, strict bed rest if prescribed – no potty privileges, avoid straining, increased risk for future DVT
What are some things we watch for when our patient is being treated for thrombophlebitis? bleeding, decreasing symptomology (pain, edema), development of pulmonary embolism (chest pain, shortness of breath)
Define dysrhythmia. disturbance in the heart rate or rhythm
What is and what is not responsible for dysrhythmias? They are caused by disturbance in the electric conduction of the heart, not by abnormal heart structure.
Talk about the onset of symptoms of dysrhythmias. The client with dysrhythmias may be asymptomatic until cardiac output is altered.
Name 5 common causes of dysrhythmias. certain drugs, acid-base or electrolyte imbalance, marked thermal changes, disease and trauma, stress
Name 5 drugs that could cause dysrhythmias. Digoxin, quinidine, caffeine, nicotine, alcohol
Name 3 electrolytes that if out of balance could result in dysrhythmias. Potassium, calcium, and magnesium
What might the nurse find on assessment of the client with dysrhythmia? Change in pulse rate or rhythm; irregular ECG; client complaint of palpitation, syncope, pain, dyspnea; Diaphoresis; hypotension; electrolyte imbalance
Give a couple applicable nursing diagnoses for the patient with dysrhythmia. Ineffective tissue perfusion; activity intolerance
Define Atrial Fibrillation. What would you see on an ECG? Chaotic activity in the AV node, Irregular ventricular rhythm, no true P waves visible on ECG
Give three treatments for atrial fibrillation. anticoagulant therapy (increased risk for CVA), cardioversion, antiarrhytmic drugs
Describe atrial flutter. What would it look like on an ECG? fluttering in chest, ventricular rhythm stays regular, saw toothed waves between QRS spikes
How is atrial flutter treated? cardioversion, antiarrhytmic drugs, radiofrequency catheter ablation
How does ventricular tachycardia look on an ECG? Wide, bizarre QRS
What might a nurse find on assessment of a client with ventricular tachycardia? Altered pulse and impaired cardiac output
How is ventricular tachycardia treated? synchronized cardioversion, antiarrhythmic drugs
What kind of dysrhythmia results in no cardiac output/cardiac emergency? ventricular fibrillation
How is ventricular fibrillation treated? CPR, defibrillation ASAP, antiarrhythmic drugs
What does the nurse assess for the client with dysrhythmia (9)? Current medications, serum drug levels esp. digitalis, electrolyte levels esp. K+ and Mg++, Set up and monitor ECG – watch for premature ventricular contractions (PVCs), watch for medication side effects, monitor activity level and symptoms with activity
A holter monitor offers continuous observation of the client’s heart rate. In order to interpret the readings best what activities should we ask the client to record? Medication- time/dose, Chest pain – type/duration, valsalva maneuver, sexual activity, exercise
Give some examples of times a person would employ the valsalva maneuver. straining at stool, sneezing, coughing
When the client has been admitted for dysrrhythmia what emergency measures should the nurse be ready to employ? cardioversion and defibrillation
Define cardioversion. Cardioversion is the delivery of synchronized electrical shocks to the myocardium
What’s the difference between synchronous and asynchronous pacemakers? synchronous = on demand- only when the client’s heart rate falls below a certain level; Asynchronous = always on – fires at a constant rate
What is the attitude the nurse wants to display for the patient admitted with dysrhythmia? calm and reassuring
What does the nurse do for the client admitted with dysrhythmia other than assessment? monitor activity and observe for symptoms with activity; ensure proper administration of medications and observe for side effects; be ready to employ emergency measures; be prepared for pacemaker insertion
When is a temporary pacemaker employed? in emergency situations
Describe 2 ways in which a temporary pacemaker might be introduced. a pacing wire is threaded into the right ventricle through the superior vena cava or an epicardial wire is put in place (through the client’s incision) during cardiac surgery
Where is the pulse generator usually implanted in a permanent internal pacemaker? in the shoulder or abdomen
How are programmable pacemakers programmed? by placing a magnetic device over the generator
What instructions does the nurse give the client with a pacemaker? Report pulses below the set rate of the pacemaker; avoid leaning over an automobile with the engine running; stand 4-5 feet away from electromagnetic sources; Avoid MRI
Give a couple of examples of electromagnetic sources. microwave oven; radar detectors
Why might it be important to watch for PVCs when our patient has been admitted for dysrhythmia? PVCs tend to be precursors of ventricular tachycardia and ventricular fibrillation
Give several examples of ominous PVCs. Occurring more often than once in 10 heartbeats; occurring in groups of 2 or 3; occurring near the T wave; taking on multiple configurations
What findings might the nurse expect on a chest radiograph of a patient with heart failure? Enlarged ventricles
Define Heart Failure. Inability of the heart to pump sufficient blood to meet the oxygen demands of the tissues
What are some primary underlying conditions that lead to heart failure (5)? Ischemic heart disease, Valvular heart disease, MI, Cardiomyopathy, Hypertension
Define Left sided heart failure. pulmonary edema, left ventricular failure, pulmonary congestion due to the inability of the left ventricle to pump blood to the periphery
What findings would the nurse expect on the assessment of a patient with left sided heart failure (9)? Dyspnea, Orthopnea, Wet lung sounds, Cough, Fatigue, Confusion, Anxiety, Restlessness, Tachycardia
Define Right Sided Heart Failure. Peripheral edema, Right ventricular failure, Peripheral congestion due to inability of the right ventricle to pump blood to the lungs
Give two frequent causes of right sided heart failure. left sided heart failure or pulmonary disease
What symptoms might the nurse find on assessment of the client with right sided heart failure (6)? Peripheral edema, weight gain, distended neck veins, anorexia/nausea, nocturia, weakness
Why would sodium restriction be useful for right sided heart failure? Restricting sodium reduces salt and water retention, thereby reducing vascular volume and preload.
Give 5 applicable nursing diagnoses for HF. Decreased cardiac output, Impaired urinary elimination, Activity intolerance, Anxiety, Ineffective tissue perfusion
What should the nurse monitor and watch for when her patient has experienced HF? What assessments are required? Monitor vital signs Q 4 hrs for changes; Apical heart rate (esp. before digitalis - <60 hold); dysrhythmias; S3 and S4 sounds; Assess for hypoxia; auscultate for wet lung sounds, observe for signs of edema
What symptoms would indicate hypoxia? Restlessness, Angina, Tachycardia
How does the nurse assess for edema? Weigh daily, monitor I&O, abdominal girth, check ankles and fingers
What prescriptions might the nurse expect for the HF patient? What are the related nursing indications? Oxygen as needed; Diuretics – administer in the a.m., check electrolyte levels; Digoxin – apical heart rate first, hold if <60bpm
Discuss nursing of the HF patient in regards to rest and activity, positioning, and dietary restrictions. provide periods of rest after periods of activity, elevate head of bed for orthopnea, elevate extremities while seated, limit sodium
Define inflammatory and infectious heart disease. inflammatory and infectious process involving the endocardium and pericardium
Define endocarditis and its pathology. inflammatory disease involving the inner surface of the heart, including the valves. Organisms travels through the blood to the heart; adhere to valves or endocardium; potential to break off and become emboli
Give 7 causes of endocarditis(RCCDIII). Rheumatic fever, Congenital heart disease, Cardiac surgery, Dental procedures, Immunosuppression, Invasive procedures, IV drug abuse
Define pericarditis. inflammation of the outer lining of the heart
Name 7 causes of pericarditis (TMN CHII). Trauma, MI, Neoplasm, Connective tissue disease, Heart surgery, Idiopathic, Infections
What symptoms might the nurse find on assessment of a patient with endocarditis (8)? Fever, chills, malaise, night sweats, fatigue, symptoms of heart failure, atrial embolization, murmurs
What symptoms might the nurse find on assessment of a patient with Pericarditis(3)? Pain, Pericardial friction rub, fever
Describe the quality, location, and aggravating and alleviating factors associated with pain from Pericarditis. Sudden, Sharp, Severe; Substernal radiating to the back or arm; Aggravated by coughing, inhalation, and deep breathing; Relieved by leaning forward
Explain how the heart valves are damaged with endocarditis. by the growth of vegetative lesions
What risks are posed by vegetative lesions on valve leaflets? embolization; erosion or perforation of the valve leaflets; abscesses within adjacent myocardial tissues; valvular stenosis, requrgitation, insufficiency (most commonly of mitral valve – can lead to symptoms of left-or right-sided heart failure)
What is a defining symptom of pericarditis? Friction rub
What changes might be seen on a ECG if the patient has pericarditis? ST segment elevations and T wave inversion
Give a couple of applicable nursing diagnoses for inflammatory/infectious heart disease patients. Decreased cardiac output; Risk for injury: emboli
What do we need to monitor for our patient with endocarditis? Hemodynamic status including vital signs, level of consciousness, urinary output
Discuss the use of antibiotics as it relates to the patient with endocarditis. Administer antibiotics for 4-6 wks. AHA recommends erythromycin before dental or genitourinary procedures. Clients may be instructed in IV therapy for home health care.
What do we need to discuss with our client with endocarditis? Teach about anticoagulant therapy if prescribed. Encourage maintenance of good hygiene. Teach to alert dentist and other health care providers of history of endocarditis
How does the nurse care for the patient with pericarditis? Provide rest and position of comfort. Administer analgesics and anti-inflammatory drugs.
Define valvular heart disease. Heart valves that are unable to open fully (stenosis) or close fully (insufficiency or regurgitation)
Valvular dysfunction is more common on which side of the heart? Which valves are most commonly affected by valvular heart disease? Most valvular dysfunction takes place on the left side of the heart. The mitral valve is the most common followed by the aortic valve.
Describe what’s happening in mitral valve stenosis. Blood slips through the stenosed mitral valve back into the left atrium.
Describe the progression from asymptomatic to symptomatic in the patient with mitral valve stenosis. At first symptoms may be absent but as the condition worsens the patient will exhibit dyspnea w/exertion, orthopnea, cough, hemoptysis, or Pulmonary edema from back up to lungs and excessive fatigue from lack of oxygenated blood being pumped systemically
Name 5 common causes of valvular disease(SHERC). Rheumatic fever, Congenital heart disease, syphilis, endocarditis, hypertension
What does treating strep throat have to do with valvular heart disease? Streptococcus infections like strep throat and scarlet fever lead to rheumatic fever. Prevention of rheumatic fever would reduce the incidence of valvular heart disease.
What symptoms might the nurse find on assessment of a patient with valvular heart disease (8)? Fatigue, dyspnea, orthopnea, hemoptysis, pulmonary edema, murmurs, irregular cardiac rhythm, angina
Give several applicable nursing diagnoses for the patient with valvular heart disease. Decreased cardiac output, impaired gas exchange, activity intolerance
What complication should the nurse monitor the patient with valvular heart disease for? atrial fibrillation with thrombus formation
What things should the nurse discuss with the patient with valvular heart disease? Treatment: surgical repair or replacement of heart valves and need for lifelong anticoagulant therapy thereafter. Teach the need for prophylactic antibiotic therapy before any invasive procedures
Name 9 class I antiarrhythmic drugs(Q, DN, ME, LX, MM, TT, PD, PR, FT) Quinidine, Disopyramide phosphate (Norpace), Moricizine (Ethmozine), Lidocaine (Xylocaine), Mexiletine (Mexitil), Tocainide (Tonocard), Phenytoin (Dilantin), Propafenone (Rhythmol), Flecainide (Tambocor)
What are the indications for class I antiarrhythmic drugs (4)? Premature beats, atrial flutter/fibrillation, ventricular dysrhythmias, (unlabled use) Digitalis induced arrhythmias
When are class I antiarrhythmics contraindicated? Heart block
Define Cinchonism. a condition from excessive ingestion of cinchona bark or its alkaloid derivatives (quinine or quinidine). Symptoms are tinnitus and slight deafness, photophobia and other visual disturbances, mental dullness, depression, confusion, headache, and nausea.
What symptoms would alert the nurse to possible toxicity if the client is taking class 1 anti-arrhythmic therapy? tinnitus and visual disturbance, confusion, drowsiness, slurred speech, seizures with lidocaine
What vital signs should be monitored when the client is taking class I anti-arrhythmic medications? Pulse rate and rhythm (teach the client how) and ECG
Name a class II anti-arrhythmic drug. Propranolol (Inderal)
What are the indications for Propranolol (Inderal) when used as a class II anti-arrhythmic drug? Supraventricular and ventricular tachydysrhythmia
What are the main side effects of propranolol (Inderal)? Hypotension, Bradycardia, Bronchospasm
What are the contraindications for propranolol (Inderal)? asthma, COPD
Name 5 Class III anti-arrhythmics. Bretylium tosylate (Bretylol), Amiodarone HCL (Cordarone), Milrinone (Primacor), Sotalol (Betapace)
What type of arrhythmias do Class III anti-arrhythmics treat? ventricular dysrhythmias
What are the side effects associated with class three anti-arrhythmics? Dysrhythmias, hyper- or hypotension, muscle weakness, tremors, photophobia
What special instructions will the client taking amiodarone (Cordarone) need? Wear sunglasses and sunscreen
What assessments does the nurse watch for her patient taking a class III anti-arrhythmic? Vital signs and ECG
Name a class IV drug. Verapamil (Isoptin, Calan)
What are the indications for Class IV drugs? supraventricular dysrhythmias
What are the main side effects of Verapamil? Hypotension, Bradycardia, Constipation
What drug class is verapamil (Isoptin, Calan)? Calcium Channel Blocker
What assessments are particularly important to monitor if our patient is taking Verapamil for a supraventricular dysrhythmia? BP and pulse
What instructions do we give the patient taking verapamil (Isoptin, Calan)? Change position slowly
Name 4 miscellaneous agents used to treat arrhythmias. Atropine sulfate (Atropisol), Digoxin (Lanoxin), Digitoxin (Crystodigin), Epinephrine (adrenaline)
Atropine is therapeutic for what type of dysrhythmia? Bradycardia
What are the main side effects of atropine (Atropisol)? Chest pain, Urinary Retention, Dry mouth
What eye condition would make you think twice about administering atropine (Atropisol)? glaucoma
What should we monitor and assess when our patient is taking Atropine (Atropisol) (3)? Heart rate/rhythm, assess for chest pain and urinary retention
What type of dysrhythmias are digoxin (Lanoxin) and Digitoxin (Crystodigin) used to treat? Supraventricular, and atrial fibrillation
What are the main side effects associated with digoxin (Lanoxin) and Digitoxin (Crystodigin)? Bradycardia, Dysrhythmias, Anorexia, nausea, vomiting, diarrhea, visual disturbances
What instructions do we give the patient taking digoxin (Lanoxin) or Digitoxin (Crystodigin)? Report signs of toxicity or weakness (early sign of hypokalemia)
What are the signs of Digoxin toxicity? nausea, vomiting, diarrhea, blurred or yellow vision
What assessments are especially important for the patient on Digoxin? pulse rate and rhythm
What condition greatly increases the risk for Digoxin toxicity? hypokalemia
What electrolyte imbalance is associated with taking digoxin (Lanoxin) or Digitoxin (Crystodigin)? Hypercalcemia
What drug is given for cardiac arrest? Epinephrine (adrenaline)
What are the main side effects associated with epinephrine (adrenaline)? tachycardia, hypertension
Why is it important to monitor creatinine and BUN with the administration of Epinephrine? Impaired renal function can cause toxicity
What does the nurse monitor for when the patient has been given epinephrine (adrenaline) for cardiac arrest? return of pulse, vital signs
Name a vasopressor that is used to promote cardiovascular perfusion in the failing heart. Norepinephrine (Levophed)
How does Norepinephrine (Levophed) work to improve perfusion for clients with heart failure or emergency hypotensive states? It dilates coronary arteries and causes peripheral vasoconstriction
What are the adverse reactions associated with Norepinephrine (Levophed)? Can cause severe tissue necrosis, sloughing, and gangrene with extravasation
Why is it so important to maintain IV patency with Norepinephrine (Levophed)? Because it is rapidly deactivated by many body enzymes
How often should the nurse check the patient’s BP while administering Norepinephrine (Levophed)? Q 2-5 minutes
What drug should be diluted per protocol and ready to treat extravasation when norepinephrine (Levophed) is administered? Regitine
What kind of vein should be used for administering norepinephrine? Why? a large vein to avoid complications of prolonged vasoconstriction
What is the primary sign of extravasation of Norepinephrine (Levophed)? Blanching along the vein pathway
What are the indications for Nesiritide (Natrecor)? acutyely decompensated HF in clients who have dyspnea at rest or with minimal activity
Describe the action of Nesiritide (Natrecor). reduces PCWP - reduces dyspnea
What is the primary side effect of nesiritide (Natrecor)? hypotension
What adverse reactions are possible with administration of nesiritide (Natrecor)? Hypotension, Arrhythmias, H/A, dizziness, insomnia, tremors, paresthesias, abdominal pain, N&V
Which population is at risk for overresponse to nesiritide (Natrecor)? the elderly
What are the pertinent assessments and lab values to monitor with administration of nesiritide (Natrecor)? BP, telemetry, electrolytes – especially K+
What should keep in mind about nesiritide (Natrecor) and other drugs? Many drug-drug interactions to watch out for
Name a platelet antiaggregate used to promote cardiovascular perfusion in the failing heart. Eptifibatide (Integrilin)
What are some drugs used in combination with Eptifibatide (Intergrilin)? heparin, aspirin, and selected situations, Ticlid and Plavix
What the most common adverse reaction associated with Eptifibatide (Integrilin)? Bleeding
What are the adverse reactions associated with Eptifibatide (Integrilin)? bleeding, hypotension, thrombocytopenia, acute toxicity
What are the symptoms of acute toxicity from Eptifibatide (Integrilin)? decreased muscle tone, dyspnea, loss of righting reflex
What is the righting reflex? ability to make postural adjustments in response to perturbations
What baseline information should be collected before eptifibatide (Intergrilin)? PT/aPTT, H&H, platelet count, drug-drug interactions
What should the nurse know about Eptifibatide (Integrilin) dosing and the elderly? Dosing adjusted by weight
What should the nurse know about emergency procedures and the longevity of Eptifibatide (Integrilin)? quickly reversible so emergency procedures may still be performed shortly after discontinuing the infusion