Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
NP2 Safety Meds Circ
Unit 1 Safety in Meds - Circulation (Dehouske)
| Question | Answer |
|---|---|
| The term for "chest pain" | Angina |
| Angina Pectoris | Chest pain secondary to myocardial ischemia. |
| Myocardial ischemia | Reduced blood flow to the heart muscle. |
| Drug treatment for angina pectoris includes what three types of drugs? | Nitrates, beta blockers, calcium channel blockers |
| What causes myocardial ischemia? | Usually either atherosclerosis, in which plaque builds up in the blood vessels, narrowing the lumen, or a blood clot. |
| Which form of angina is predictable? | Stable Angina |
| What is meant by "predictable" in reference to stable angina? | We can predict what activities and/or circumstances will cause the pain to occur. For example, exertion, exercise, emotional/mental stress. |
| How is stable angina treated? | Rest, nitroglycerin, or both. |
| Unstable angina | Chest pain is unexpected and often occurs even when patient is at rest. |
| Which is typically more severe - stable angina or unstable angina? | Unstable angina. |
| What is the treatment for unstable angina? | Evaluation in the ER or on a heart unit. |
| What is heart failure? | The heart is unable to pump adequate amount of blood through the body. There is a decreased blood flow, and decreased venous return. |
| What causes contribute to the edema seen in heart failure? | Decreased blood flow and decreased venous return. Blood isn't effectively reaching kidneys, so there is decreased ability of the kidneys to regulate NA and H2O, making edema worse. |
| What are causes of heart failure? | Hypertension, myocardial infarction, atherosclerosis |
| What is the treatment for heart failure? | Rest, diet & lifestyle changes, medication. |
| What medications are used to treat heart failure? | ACE-inhibitors, beta blockers, digoxin, diuretics |
| What BP is considered to be "prehypertensive"? | 140/90 |
| What does MAP stand for, and what is it? | Mean arterial pressure It gives an idea of the average perfusion pressure, or how well blood is reaching vital organs and tissues. |
| What is the formula for mean arterial pressure? | Systolic + 2(Diastolic) ______________________ 3 |
| What is the normal range for MAP? | 70 - 110. |
| What happens if MAP drops below 60 for a length of time? | Organs experience reduced blood flow and become ischemic. |
| T or F - Normal ranges for mean arterial pressure are the same for all ages. | False. For kids, the normal range for MAP is different. |
| T or F - MAP is synonymous with perfusion pressure. | True. MAP is an indicator of the average perfusion pressure over the entire body. |
| Preload | Degree to which muscle fibers of the ventricle are stretched by the volume of blood in ventricles at the end of diastole. (End diastolic pressure) Volume of blood returned to heart through vena cava and in the heart before it beats. |
| What is the importance of preload? | The length of the ventricular muscle fibers (how stretched they are) directly affects the strength (force) of contraction. |
| What factors influence preload? | Total blood volume, venous return. |
| Afterload | Resistance against which the heart must pump to eject the blood from the ventricles. Pressure of the ventricle contraction must exceed the pressure within the arteries in order to eject the blood. |
| Under what circumstances is afterload increased? | Hypertension, vasoconstriction |
| What is the implication of afterload for the heart? | With a higher afterload, the heart has an increased workload. |
| What three things affect heart function? | Preload, afterload, and contractility. |
| Contractility | Forcefulness with which the heart contracts |
| What are the four ways in which cardiovascular medications decrease blood pressure? | Decrease intravascular volume Decrease venous return (preload) Decrease afterload Improve cardiac function |
| What does the "ACE" in ACE inhibitor stand for? | Angiotensin-converting enzyme |
| What do ACE inhibitors do? | Prevents conversion of angiotensin I to angiotensin II, which is a potent vasoconstrictor |
| What is the action of ACE inhibitors? | 1. ↓ peripheral vascular resistance 2. Secretion of aldosterone, resulting in lower Na and H2O retention |
| ACE inhibitors - Indications | 1. Mild to moderate hypertension Action: ↓ peripheral vascular resistance ↓ Na and water retention 2. Heart failure Action: ↓ systemic vascular resistance ("afterload") |
| What is the suffix for the names of ACE inhibitors? | -pril |
| Most common side effect of ACE inhibitors? | Non-productive cough |
| What is the danger of ACE-inhibitor use? | Angioedema |
| What is angioedema? | Swelling of dermis and mucous membranes, including airways. Dangerous. Requires immediate evaluation and discontinuation of ACE-I therapy. |
| What monitoring does a patient need who is beginning ACE-I therapy? | For patient with first few doses, watch for at least 1/2 hour, looking for signs of angioedema. |
| What assessments should the nurse complete for a patient on ACE inhibitors? | Monitor BP, pulse. Monitor daily weight, assess for resolution of fluid overload. Patient will probably lose weight. Monitor lab values for Na, K+, Creatinine, BUN. |
| What two lab tests discussed in this lecture measure kidney function? | Creatinine and BUN |
| What does BUN stand for? | Blood urea nitrogen |
| What is 1st dose phenomenon? | The first dose of ACE inhibitor can lower BP significantly within the first few hours, to the point they become symptomatic. |
| What should the nurse teach the patient about ACE inhibitor use? | Take at same time every day Don't stop abruptly Change positions slowly May cause dizziness Avoid drinking May cause alterations in taste Altered taste should resolve within 8-12 wks. Avoid salt substitutes Avoid potassium rich foods |
| What symptoms 0should prompt a pt. on ACE inhibitors to consult their MD? | Rash Hives Swelling of hands, face, or tongue Irregular heartbeat |
| Brand name for enalapril | Vasotec |
| Enalapril indications | Mgmt of HTN and CHF Reduction of death after MI Reduction of development of CHF after MI Slows progress of left ventricular dysfunction |
| What does CHF stand for? | Congestive heart failure |
| Enalapril side effects | *ANGIOEDEMA* *dry cough Hypotension Taste disturbance Proteinuria ↑ in creatinine and K+ levels |
| Assessment/Patient teaching for enalapril | Monitor BP and pulse Monitor daily weight and assess for resolution of fluid overload Don't stop abruptly Avoid salt substitutes Avoid potassium rich foods Change positions slowly |
| Discovery of medical benefit of nitrates | 1857 |
| What do nitrates do? | Relax vascular smooth muscle Generalized vasodilation in coronary arteries Relieve and prevent angina episodes First choice of treatment for acute angina |
| What is the first choice for treatment of acute angina? | Nitrates |
| Nitrates - Action | Relaxes arterial and venous smooth muscle Results in vasodilation Decreases preload Decreases blood volume in chambers, resulting in decrease in cardiac output Decreases afterload |
| Nitrates - Indications | Acute angina Chronic angina Acute MI CHF |
| For the following indications for nitrates, which routes would be used? Acute Angina Chronic Angina Acute MI CHF | Acute angina - sublingual, IV Chronic angina - oral, buccal, transdermal Acute MI - IV CHF - oral |
| Nitroglycerin action | Increased coronary blood flow by dilating coronary arteries and improving collateral flow |
| Nitroglycerin half-life | 1 - 4 minutes |
| Nitroglycerin side effects | Dizziness, headache, tachycardia, hypotension |
| Nitroglycerin nursing implications | Pain - assess location, duration, intensity, activity prior to onset Monitor BP and pulse before and after taking dose Teach how to use safely and effectively |
| Nitroglycerin patient teaching | Hold pill under tongue until dissolved Don't eat, drink, smoke until pill is totally dissolved Don't handle pills Change position slowly Treat headache with Tylenol or aspirin |
| Where are beta cells primarily located? | In the heart and lungs |
| Where are beta 1 cells primarily located? | In the heart |
| Where are beta 2 cells primarily located? | In the lungs (in bronchial and vascular smooth muscle). |
| Beta 1 Cells | Sites in the heart responsible for increasing heart rate, contractility, AV conduction |
| Beta 2 Cells | Cause relaxation and dilation of bronchioles. Can be selective or non-selective. |
| Considerations for the application of NTG patches and ointments | Apply to hairless sites - chest, abdomen, thighs. Avoid distal extremities Rotate sites Avoid massaging site Wear gloves during preparation and application Administer first doses with patient in sitting position (especially in geriatric patients) |
| Nitroglycerin storage | Keep in original container Avoid air, heat, and moisture Avoid handling, opening bottle excessively, and keeping bottle next to body (such as in a pocket). |
| Off-label uses for beta-blockers | Migraine Anxiety |
| Beta Blockers - Indications | Hypertension, angina, tachy-arrhythmias, MI prevention, CHF mgmt. |
| What is the suffix for the names of beta blockers? | OLOL |
| Beta Blockers - Action | Blocks beta receptors in the heart causing: ↓ Heart Rate ↓ Force of contraction ↓ Rate of AV conduction |
| Beta Blockers - Side Effects | Bradycardia, lethargy, GI disturbance, CHF, hypotension, depression |
| What is considered bradycardia for the purposes of beta blocker use, and what is generally considered bradycardia? | For beta blocker use - <50 bpm Generally - <60 bpm |
| Metoprolol trade name | Lopressor |
| Metoprolol action | Selective beta 1 Blocks stimulation of beta (myocardial) receptors Normally does not affect beta 2 receptors |
| Metoprolol side effects | fatigue, weakness, impotence, hypotension, depression, *bradycardia, *↓ myocardial contraction (may lead to CHF or pulmonary edema). |
| Metoprolol nursing implications | Assess apical pulse, if <50 bpm, withhold medication. Assess BP, fluid status (I&O, daily weight) |
| Metoprolol patient teaching | Take meds as directed Don't stop taking abruptly (may cause life-threatening arrhythmias) Change positions slowly Teach to take pulse |
| Diuretics have been available since ____ | the 16th century |
| Diuretics decrease _________ by increasing ______ production. | intravascular volume, urine |
| Diuretics - action | Decrease blood volume by increasing urine production. Reduced volume to right ventricle → reduced overload to left ventricle → heart contracts more efficiently and increases cardiac output |
| What is the most widely prescribed medication? | Diuretics |
| Furosemide trade name | Lasix |
| Furosemide indications | Edema due to heart failure, hepatic impairment, or renal disease. Hypertension |
| Furosemide onset for PO and IV | PO: 30-60 minutes IV: 5 minutes |
| Furosemide side effects | dehydration, loss of electrolytes (see below), metabolic acidosis, hypovolemia Hypochloremia Hypokalemia Hypomagnesemia Hyponatremia |
| Furosemide administration - nursing considerations | *OTOTOXIC!!!* *Check electrolyte levels B4 administration Assess fluid status B4 therapy Monitor BP and pulse (B4) Monitor renal, hepatic function and glucose levels Assess pt. receiving digoxin for N/V, muscle cramping - increased risk of dig. toxic |
| What is the relationship between potassium levels and digoxin toxicity? | Hypokalemia precipitates digoxin toxicity. Be careful when giving diuretics, which can cause hypokalemia and increase risk of dig. toxicity. |
| What is the danger of administering furosemide too quickly? | Damage to the 8th cranial nerve, resulting in loss of hearing. ("Ototoxic") |
| If a patient has lost 1 kg, how much fluid has been lost? (assume loss is fluid loss rather than fat or muscle loss) | 1 liter |
| Furosemide - patient teaching | Administer in the AM to prevent sleep disturbance from need to urinate. Take with food Change positions slowly Monitor weight Use sunscreen Report muscle weakness, cramps, nausea, vomiting, diarrhea, dizziness (can indicate electrolyte imbalance) |
| Hydrochlorothiazide - indication | CHF, mild to moderate hypertension |
| Hydrochlorothiazide - action | Inhibit Na and water retention at distal tubules |
| Which diuretic is more potent - hydrochlorothiazide or furosemide? | Furosemide |
| Hydrochlorothiazide - side effects | hypokalemia ↑ serum cholesterol, LDL & triglycerides Hyperuricemia (can cause gout and kidney stones) |
| Hydrochlorothiazide - patient teaching | Same as Lasix Admin. in the AM to avoid sleep disturbances Take with food Change positions slowly Monitor weight Use sunscreen Report: Muscle weakness, cramps, N/V, diarrhea, dizziness (can indicate electrolyte imbalance) |
| Calcium channel blockers - action | Block calcium entry into cells of vascular smooth muscle and myocardium, dilates coronary arteries Decreases AV conduction Systemic vasodilation, decrease BP |
| Diltiazem trade name | Cardizem |
| Diltiazem side effects | Arrhythmias, CHF, Stevens-Johnson syndrome, peripheral edema |
| Diltiazem nursing responsibilities | Monitor BP, pulse, I&O, daily weight Monitor ECG for bradycardia Monitor K+ level Assess for s/s's of digoxin tox. DO NOT crush time-release meds Change positions slowly |
| Cardiac glycosides action | Strengthens and slows heart Slows AV node conduction ↓ conduction through SA and AV node resulting in ↓ heart rate Strengthens force of contraction, ↑ cardiac output |
| Digoxin trade name | Lanoxin |
| Digoxin side effects | Fatigue, bradycardia, anorexia, N/V, arrhythmias |
| Common signs of digoxin toxicity | Nausea and vomiting |
| Digoxin nursing responsibilities | Loading dose administered over 12 - 24 hours Monitor apical pulse one full minute B4 administration Hold med if bpm <60, and notify MD Monitor K+, Mg, and Ca levels Monitor renal, hepatic function Monitor apical pulse one full minute B |
| Digoxin toxicity symptoms | Abdominal pain, N/V, visual disturbances, bradycardia, arrhythmias |
| Therapeutic level for digoxin | 0.5-2ng/mL |
| T or F - Digoxin has a long half-life | True. |
| What makes the risk for dig. toxicity high? | Often using drugs that affect electrolyte levels, particularly potassium Very long half-life Very narrow margin of safety with dosing |
| Loading dose | Higher dose given at first to obtain a therapeutic level. When it saturates the liver, patient is given a lower maintenance dose. |
| Anticoagulants | Prevent formation and extension of clots Prevention of DVT, pulmonary embolism, embolism secondary to atrial fibrillation, stroke, and MI |
| Anticoagulants are contraindicated in: | Patients with coagulation disorders, ulcer disease, malignancy, recent surgery, trauma or active bleeding |
| Heparin - action | Prevents conversion of prothrombin into thrombin |
| Why is a low dose of heparin given to patients on bed rest? What is the dose? | To prevent DVT, 5,000 U SQ q8-12 hours |
| What must be done when verifying proper dose for heparin? | Must have dose checked by another licensed nurse, two signatures required on MAR. |
| Heparin - side effects | Bleeding, anemia, thrombocytopenia |
| Heparin - RN responsibilities | Monitor PTT throughout therapy Monitor platelet count q 2-3 days Avoid venipunctures and IM injections Use abdomen for injections Verify dose with another nurse DO NOT rub the site, can cause bruising DO NOT aspirate, can cause tissue trauma |
| Heparin half-life | Short. 2-6 hours. |
| Heparin antidote | Protamine sulfate |
| Heparin patient teaching | Don't use toothbrush with hard bristles If they fall, can bruise easily |
| Warfarin trade name | Coumadin |
| Warfarin action | interferes with hepatic synthesis of Vitamin K dependent clotting factor |
| Warfarin half life | 0.5-3 days |
| Warfarin side effects | bleeding |
| Warfarin nursing considerations | Monitor PT, INR Need control value for PT, should be 3 times control if on anticoagulation INR - below 2.0 if NOT on anticoagulation 2-3 if ON anticoagulation |
| What do PT, PTT, and INR stand for? | PT - prothrombin time PTT - partial thromboplastin time INR - international normalized ratio |
| Warfarin antidote | Vitamin K, aquamephyton, whole blood |
| How long would PO warfarin take to reach effective levels? | 3-5 days |
| Warfarin dietary restrictions | Beans, broccoli, cabbage, milk, mustard greens. Eat normally, no drastic diet changes, MD will adjust dosage around normal diet. |
| Which anticoagulant is quicker, heparin or warfarin? | Heparin |
| Which anticoagulant is used for continuous therapy? | Warfarin |
Created by:
christyness
Popular Nursing sets