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Nursing 2 Test 2
Cardiovascular & Respiratory
| Question | Answer |
|---|---|
| (CAD) Coronary Artery Disease : | Any Narrowing or Obstruction of lamina that interferes with Cardiac Perfusion. Resulting in Angina(Ischemia) or Necrosis(Infarction). CAD is effected by Triglycerides, LDL and HDL, as well as Total Cholesterol. |
| LDL level for Normal ____ LDL level for CAD___ | LDL < 100 mg/dL for average , or , LDL < 70mg/dL for CAD, Diabetes |
| HDL level ____ | HDL > 60 mg/dL to protect against heart disease |
| Triglycerides ____ | Triglycerides < 150 mg/dL |
| Cholesterol ____ | Cholesterol < 200 mg/dL |
| Carbohydrates should be ____ , Protein should be ____ , Total Fat ____ , ~Saturated Fat __ ~Monosaturated Fat ____ ~PolySaturated Fat _____ @ least ___ g of Soluble fiber a day. | Carbs: 50-60% Protein: 15% Total Fat: 25-35% ~Saturated Fat: < 7% ~Monosaturated Fat: 20% ~Polysaturated Fat: 10% 20-30 g of Soluble fiber |
| Statins (AKA): Do what? Examples? | Statins “Lipid-Lowering Agents” Block cholesterol synthesis, lower LDL & triglyceride levels, increase HDL Initial drugs tried Need to monitor liver function Lovastatin (Mevacor); Atorvastatin (Lipitor) |
| Nicotrinc Acids - Niacin | Decrease lipoprotein synthesis, lower LDL & triglyceride levels, increase HDL Side effects: GI upset, gout, flushing, warm feeling Monitor liver function |
| Fibrates : Do what? Examples? | Decrease synthesis of cholesterol, reduce triglyceride levels, increase HDL levels Also have the potential to increase LDL so they are used for pts with triglyceride levels above 400 Fenofibrate (Tricor) and Gemfibrozil (Lopid) |
| Resins (Bile Acid Sequestrants) | Bind cholesterol in the intestine, increase its breakdown, & lower LDL levels with minimal effect on HDL & no effect on triglycerides Side effects – constipation & gastric distention |
| Cholesterol absorption Inhibitor | Decreases LDL & TG Increases HDL Side Effects: back, joint & abdominal pain Example: Zetia |
| Angina Pectoris | A clinical syndrome characterized by episodes or paroxysms of pain or pressure in the anterior chest. Cause: Insufficient coronary blood flow Need for oxygen by the heart exceeds the supply |
| Nitrates | Main treatment for angina NTG reduces myocardial oxygen consumption, dilates veins & arteries, prevents vasospams, increases coronary artery blood flow Administered: IV, SL, topical, po, spray Isordil, Apresoline |
| Beta Adrenergic Blocking Agents: does What? Examples? | Reduce myocardial oxygen consumption by blocking sympathetic stimulation to the heart Slows heart rate, decreases BP, decreases contractility Propranolol (Inderal); Metoprolol (Lopressor); Atenolol (Tenormin) |
| Calcium Channel Blockers: Does What? Examples? | Decrease workload of the heart by decreasing heart rate & contractility Relax the blood vessels Amliodipine (Norvasc); Diltiazem (Cardizem) |
| Antiplatelet Medications: Does What? Examples? | Minimize platelet aggregation and danger of coronary occlusion Aspirin – Initial dose of 160-325 mg and then 81-325 mg daily Plavix, Ticlid Glycoprotein IIb/IIIa agents |
| Anticoagulants | Heparin – prevents blood clot formation Low Molecular weight heparin – Lovenox, Fragmin |
| Diuretics 3 types | Remove excess extracellular fluid from the body Thiazide (Zaroxolyn), loop(Lasix or Bumex), & Potassium sparing (Aldactone) |
| Digoxin | Increases force of myocardial contractility, improving left ventricular output Slows heart rate |
| IV Medications for Heart Failure | Neseritide (Natrecor) BNP used for acute, decompensated heart failure Preload Afterload Stroke volume Milrinone (Primacor) Preload Afterload Cardiac workload Dobutamine (Dobutrex) Contractility |
| Hypertensive Emergency | situation in which BP must be lowered immediately to halt damage to organs BP > 180/120 S&S – severe headache, dizziness, blurred vision, disorientation Treated with IV anti-hypertensives |
| Hypertensive Urgency | a situation in which BP must be lowered within a few hours, but no evidence of target organ damage See nosebleeds, severe headaches |
| Normal | Systolic < 120 mm/Hg Diastolic < 80 mg/Hg |
| Prehypertension | Systolic 120-139 mm Hg Diastolic 80-89 mm Hg |
| Stage 1 HTN | Systolic 140-159 mm Hg Diastolic 90-99 mm Hg |
| Stage 2 HTN | Systolic > 160 mm Hg Diastolic > 100 mm Hg |
| Treatment of Intermittent claudication | Pentoxifylline (Trental) ~Increases erythrocyte flexibility & has antiplatelet effects; decreases blood viscosity Cilostazol (Pletal) ~Vasodilator that inhibits platelet aggregation *Contraindicated in CHF |
| Arterial Insufficiency | Intermittent claudication to sharp, unrelenting constant pain Diminished or absent pulses Ulcers: tip of toes, heel or pressure area; painful, circular, pale to black & drug gangrene Minimal leg edema |
| Venous Insufficiency | Aching, cramping pain Pulses present but difficult to palpate Ulcers: medial malleolus, pain varies; superficial Irregular border; granulation tissue – beefy red to yellow fibrinous in chronic long-term ulcer Edema – moderate to severe |
| Rheumatic Fever | Occurs most often in school-age children Prompt treatment of strep throat with antibiotics can prevent rheumatic fever 39% of persons with rheumatic fever develop rheumatic heart disease which can cause valvular insufficiency, heart failure, & death |
| Asthma | Chronic, inflammatory disease of the airways that causes hyper-responsiveness, edema, and mucus production Affects more than 22 million Americans Most common chronic disease of children Incidence, severity, & death rate are increasing |
| Extrinsic Asthma | Results from sensitivity to specific external allergens |
| Intrinsic Asthma | Symptoms aren’t associated with allergic reaction May be triggered by anxiety, fatigue, endocrine changes, temperature & humidity |
| 3 Causes of Airway Narrowing | 1) Inflammation & edema , 2) Contraction of bronchial smooth muscles (bronchospasms) 3) Increased mucus production |
| Step 1: Intermittent Asthma | Symptoms: < twice week Nighttime symptoms: < 2 times/month PEF or FEV is > 80% of predicted value No interference with normal activity Rescue inhaler (Short acting B-agonist) < 2 days a week |
| Step 2: Mild Persistent Asthma | Symptoms: more than twice a week, but not daily Nighttime symptoms: 3-4 times/month Episodes affect activity & sleep PEF or FEV is > 80% of predicted value Minor limitation on normal activity Use of SABA more than 2 days a week but not daily |
| Step 3 or 4: Moderate Persistent Asthma | Daily symptoms: episodes affect activity & sleep Nighttime symptoms: > 1 night/week but not nightly PEF or FEV is 60% to 80% of predicted value Interference with normal activity; some limitations SABA used daily |
| Step 5 or 6: Severe Persistent Asthma | Daily symptoms; frequent episodes with extremely limited activities Frequent nighttime symptoms PEF < 60% of expected value SABA for symptoms control: several times a day |
| Quick-Relief/Rescue Meds: ~Inhaled short acting Beta-adrenergic agonists (SABAs) | Relax bronchial smooth muscles Give via inhalation, oral, IV Examples: Albuterol (Proventil, Ventolin), Metaproterenol (Alupent), Pirbuterol (Maxair) Given via MDI – don’t take more than 3-4X/day Side effects: irritability, tremors, nervousness, insom |
| Quick-Relief/Rescue Meds: ~Anticholinergics | Reduce intrinisic vagal tone of the airway Example: Ipratropium bromide (Atrovent) |
| Long-Acting Medications (Preventor Meds): ~Corticosteriods | Most potent & effective anti-inflammatory meds Initially use inhaled form, may use po or IV Use lowest dose possible & wean off adverse effects: osteoporosis, elevated BP, decreased immunity, may slow growth in children; check q 3-6 mos. |
| Examples of Corticosteroids | Systemic Methylprednisolone (medrol) Presnisone (Deltasone) Inhaled AeroBid – flunisolide Azmacort – triamcinolone acetonide Beconase – beclomethasone Flovent – fluticasone Pulmicort – budesonide QVAR – beclomethasone diproprionate |
| Long-Acting Medications (Preventor Meds): ~Long-Acting Beta2 Agonists (LABAs) | Serevent (Salmeterol) – (DPI) - long acting bronchodilator; used twice a day for long term prevention of S&S & EIA |
| Long-Acting Medications (Preventor Meds): ~Leukotriene Modifiers | Alternate to steroids; decrease bronchospasms & block inflammation Examples: zafirlukast (Accolate), montelukast (Singulair) Taken po for long-term control |
| Long-Acting Medications (Preventor Meds): ~Mast Cell Inhibitors | Decrease release of histamine from mast cells which inhibits airway narrowing - NSAID Inhaled; used twice a day Used for cold dry air, EIA Examples: Cromolyn Sodium (Intal), Nedocormil sodium (Tilade) |
| Long-Acting Medications (Preventor Meds): ~Combination Products | Anti-inflammatory + bronchodilator Examples Advair – fluticasone & salmeterol Symbicort – budesonide & formoterol |
| Long-Acting Medications (Preventor Meds): ~Immunomodulators | Prevent binding of IgE to mast cells & decreases mast cell mediator release from allergen exposure Administered by subcutaneous injection every 2-4 weeks Example: omalizumab (Xolair) |
| Long-Acting Medications (Preventor Meds): ~Methylxanthines – bronchodilators | Theophylline (Slo-Bid, Theo-Dur); not often used but given IV, IM, po Side effects: nausea, tachycardia, irritability, seizures Monitor serum levels (5-15 mcg/ml) toxic >20 |
| Croup Syndrome: | an infection of the larynx, trachea, & large bronchi Inflammatory process creates swelling of mucosa, secretions in airways, & muscle spasms Narrowed airway = obstruction |
| 3 Types of Croup: | 1)Epiglottitis 2)Laryngotracheobronchitis (LTB) 3)Spasmodic Laryngitis (Spasmodic Croup) |
| Progression of Symptoms in LTB Croup stage 1&2: | Stage I Fear, hoarseness, cough, inspiratory stridor Stage II Stridor, retractions, labored respirations, use of accessory muscles |
| Progression of Symptoms in LTB Croup stage 3&4: | Stage III Anoxia, CO2 retention, restlessness, anxiety, pallor, diaphoresis, tachypnea Stage IV Intermittent cyanosis, respiratory failure from respiratory acidosis |
| Spasmodic Croup (Acute Spasmodic Laryngitis) | Sudden attacks of laryngeal obstruction chiefly at night that affects children 1-3 yo “Midnight” or “Twilight” croup Barky cough, dyspnea, & stridor No fever Short lived (few hours) Often resolves on exposure to cold air |
| Epiglottitis (Croup) | Life threatening bacterial infection of the epiglottis causing swelling that can lead to complete airway obstruction ^ Ages 2-8 years Sudden onset & rapid progression to severe High fever Sore throat Dysphagia Drooling – painful swallowing Tripod p |
Created by:
rtwing87a
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