Cardiac Medications Flashcards
common site for ABG
Radial Artery
ABG type and size of syringe
10mL heparinized syringe
why do they use heparinized syringe in ABG analysis?
anticoagulant to prevent bleeding
What is done to assess collateral circulation of the hand?
Allen’s Test
Normal return to pinking color during ABG analysis?
6 seconds
ABG: Where to place specimen?
container with ice to prevent hemolysis or breakdown of RBC
How to do an ABG analysis?
- Occlude radial and ulnar artery
- Close and open hand until blanch
- Release ulnar artery
- Wait for 6s for the return of pinkish color
*Less than 6seconds indicates decrease collateral circulation of the hand
Interpret ABG
pH: 7.18
PaO2: 90
co2: 47
HCO3: 22
Respiratory Acidosis
Interpret ABG
pH: 7.25
PaO2: 94
co2: 38
HCO3: 20
Metabolic Acidosis
Interpret ABG
pH: 7.47
PaO2: 98
co2: 49
HCO3: 29
Partially Compensated Metabolic Alkalosis
Interpret ABG
pH: 7.48
PaO2: 93
co2: 21
HCO3: 20
Partially Compensated Respiratory Alkalosis
Primary Risk Factor of Respiratory Acidosis
COPD
Clinical Manifestations of Respiratory Acidosis
Headache
Hypercapnia
Warm and flush skin
Tachycardia
Blurry Vision
Irritability
Decrease level of consciousness
Late sign of respiratory Acidosis
Disorientation and Confusion
Management for Respiratory Acidosis
Maintain patent airway: 2-3 lpm (Venturi mask)
Give medications as prescribed
Administer o2 as ordered
Perform tracheal suctioning, postural drainage, coughing, and deep breathing
*Hyperoxygenate before and after
Interval for tracheal suctioning
15 minutes Max time
20-30 minutes before re-inserting
Chest physiotherapy nursing considerations
15 minutes
Upon awakening
Before meals
At bedtime
*After meals causes aspiration
most common cause of respiratory alkalosis
Panic Attack/ Anxiety
Manifestations of respiratory alkalosis
Tachypnea
Anxiety
Restleness
Lightheadedness
Paresthesia
Increase deep tendon reflex
(+) Trousseau and Chvostek sign
Convulsion and seizure
hyperventilation management
breathe into brown paper bag
hypoventilation management
pursed lip breathing
most common causes of metabolic acidosis
renal failure and diarrhea
metabolic acidosis manifestations
breathing is rapid and deep (Kussmaul’s breathing)
SOB or dyspnea
Headache
metabolic acidosis ECG reading
peaked T wave
Prolonged PR Interval & QRS duration
Initial signs of metabolic acidosis
paresthesia, high and fast > diarrhea
late sign of metabolic acidosis’’
muscle weakness
Management for metabolic acidosis
Na HCO3 per IV (alkalinizing solution)- to reduce the effects of the acidosis on cardiac function. Flush it with NSS
Management for metabolic acidosis esp. for renal failure
Dialysis
Metabolic Alkalosis is caused by
loss of H production due to excessive vomiting
commonly associated with the use of diuretics because of hydrogen ion loss from kidneys
manifestations of metabolic alkalosis
electrolyte imbalance
disorientation/ confusion
muscle twitching
paresthesia
headache
nausea/ vomiting
metabolic alkalosis late sign
tremor and convulsion
management for metabolic alkalosis
Adm. 02 as ordered
Seizure precautions
Maintain patent IV
Adm. diluted K solution w/ am infusion pump
Monitor I and O
Metabolic alkalosis drug management use to increase excretion of HC03
Diamox
What is the IV solution for the management for metabolic alkalosis. This solution is infused no faster than 1L over 4hrs.
Ammonium Chloride
*Don’t adm. to patients with hepatic or renal disease
Arterial Disorder
Reynaud’s Disease
Venous Disorder
Deep Vein Thrombosis
Pain; intermittent claudication aggravated by activity and exercise
Reynaud’s Disease
Reynaud’s Disease Manifestations
Thin, shiny skin in the legs
Loss of hair on the affected leg
Skin is cold to touch
Ulcers occur in toes
Gangrene may develop
DVT pathognomonic Manifestation
Homan’s sign > positive calf pain
DVT s/sx
pain is improved by activity and exercise
brown pigments around ankles
Redness of skin with edema
skin is warm to touch
ulcers occur in ankle
gangrene does not develop
*phlebitis
what triad is the cause of DVT
Virchow’s triad
- vessel wall injury
- venous stasis
- hypercoagulability of the blood
antidote for anticoagulant heparin
protamine sulfate
thrombolytics examples
streptokinase
urokinase
reteplase
tenecteplase
tissue plasminogen activator
anisolyted plasminogen streptokinase activater complex
thrombolytics adverse reactions
hypersensitivity reactions
bleeding
antidote for thrombolytic
Amicar/ aminocaproic acid
examples of anticoagulant
enoxaprin (lovenox)
heparin
tinzaparin (innohep)
daleparin (fragmin)
certoparin (sancloparin)
nadroparin (flaxiparin)
Route for anticoagulant
IV and SQ
*roate injection site
Anticoagulant can cause decrease in
platelet count causing pat prone to bleeding: reactal bleeding, gum bleeding, epistaxis, melena
Side effects of anticoagulant
hemorrhage
itching
burning
determine the effectivity of heparin
partial thromboplastin time
normal result for ptt
60-70s
more sensitive version of ptt
activated partial thromboplastin time
aptt normal normal range
30-40s
antidote for anticoagulant warfarin
vit k
what is the measurement for anticoagulant warfarin
Prothrombin Time
Internation Normal Ratio
measures the time it takes for the blood clotting to occur
Prothrombin Time
side effects of Coumadin
internal bleeding- petechiae
anorexia
diarrhea
rashes
n/ v
fever
abdominal cramps
stomatitis
nursing management
bed rest for 5-7 days
elevate legs: improves venous return
apply compression support stockings: anti-embolic stockings
avoid prolonged standing
check pulse distal to the site of thrombosis
assess presence edema
monitor calf pain
PT normal range
11-16s
PT therapeutic range
1.5-2 * N
aptt therapeutic range
therapeutic range: 2-2.5 * N
INR normal range
0.8-1.2s
INR therapeutic range
2-3s
furosemide common side effects
orthostaticc hypotension
ototoxicity
rashes
photo sensitivity
common electrolyte imbalance in furosemide
hypokalemia
furosemide nursing considerations
monitor I and O
assess blood pressure
if given in IV, expect urinalysis output to increase in 15-20minutes
Adm. it slowly to prevent ototoxicity
when to take furosemide
in the morning to prevent sleep pattern disturbances
furosemide management
arise slowly to prevent orthostatic hypotension
if given per orem, give with four to prevent go upset
magnesium normal range
1.5-2.5
phosphorus normal range
1.5-4.5
potassium normal range
3.5-4.5
calcium normal range
8.5-10
chloride normal range
98-110
sodium normal range
135-145
neutrophils normal level
2,500-6000
mild neutropenia
1000-1500
moderate neutropenia
500-1000
severe neutropenia
< 500
nephrotoxic drugs
acetaminophen
acyclovir
amino glycoside
amphotericin B
ciprofloxacin
rifampicin
sulfonamide
tetracycline
contrast medium
hepatotoxic drugs
acetaminophen
erythromycin
iron overdose
isoniazid
rifampicin
sulfonamide
drugs causing staining
macrodantin
iron
lug’s solution
loop diuretic
ototoxic drugs
aminoglycoside
aspirin
chloroquine
loop diuretic
teratogenic
fluoriquinolone
aminoglycoside
tetracycline
ACE inhibitors
lithium
orał hypoglycemic agents
not taken by 7years old and below
tetracycline
not given to pregnant mother
ACE inhibitor
anti-hypertensive drugs
ACE
ARBS
CCB
Cardiac glycoside
ACE Inhobitors
lisinopril
enalapril
ARBS
Losartan
telmisartan
irbesartan
CCB
Verapamil
diltiazem
nifedipine
nicardipine
side effects of ace
angioedema
dry cough
side effects of arbs and ace
avoid in pregnant
elevated K
increases heart contraction. thus decreasing BP and HR
CCB
what does ccb blocks
L-type calcium channels
cardiac myocyte function
Inc. contraction
cardiac nodal tissue
Inc. HR
Vascular smooth muscle
Narrows blood vessel
Inc BP
CCB Is not taken with?
grapefruit
most common side effect of ccb
headache
makes the stronger heart contractions
positive inotropic
increases heart rate
positive chronotropic
(+) inotropic
(+) chronotropic
Cardiac glycoside
digoxin toxicity
green halos
blurring of vision
n/v
dizziness
digoxin normal range
0.5-2ng/ mL
digoxin considerations in terms of apical pulse
< 60 (adult)
< 90 (children)
*do not adm.
Warfarin route
Oral and IV
heparin route
SQ and IV
beta 1 acts on the following:
cardiac myocyte
cardiac nodal tissue
kidney
beta 2 acts on the following:
GI system
vascular smooth muscle
skeletal muscle
ciliary body of the eye
selective beta blockers
metoprolol
atenolol
esmolol
nonselective beta blockers
propanolol
sotalol
tinolol
non-selective beta-blocker effects
Dec. IOP
Bronchoconstriction
Hypo/ Hyperglycemia
Peripheral Vasoconstriction
Dec. HR
Antilipidemics effects
Dec. LDL
HMG-Coa reductase inhibitors
Examples of Antilipidemics
atorvastatin
simvastatin
effects of atorvastatin
sore muscle
bile acid sequestrants
colestipol (Colestid)
cholestyramine (Question)
effects of antianginals
Dec. resistance, workload, and cardiac output
antianginals 4Bs
Bradycardia
Bad for patients with respiratory problems
Blood sugar masking
Bad for patients with heart failure
Nitrates effects
vasodilator BV
dilates
decrease BP
Decrease vascular resistance
Nitrate drug examples:
nitroglycerin, nitroprusside, hydralazine, isosurbide, minoxidil, sildenafil
Nitrates considerations:
No rinsing
Don’t eat/ drink after 5-10 minutes of adm.
tranlingual nitrates considerations
direct to oral mucosa via spray
spray 5-8
hold breath 5-10s
avoid inhaling the spray
sublingual nitrates considerations
offer sip of water
let med dissolve
under the tongue
don’t chew or swallow
transdermal patch
hairless area
don’t shave
remove patch after 12-14hrs
allow 10-12 hrs patch free
topical ointment
instruct patient to remove excess prior applying
rotate site of application
transmucosal
between upper lip and gum or in buccal area
between the cheek and gum
meds for hypotension and shock
adrenergic agonist
1. dopamine and dobutamine
2. Epinephrine
class I
Sodium channel blockers
Class II
Beta Blockers
Class III
Conduction Delayers
Class IV
Calcium Channel Blockers
Class I Meds
Quinidine
Procainamide
LIdocaine
Flecainide
Class II Meds
Acebutolol
Propranolol
Esmolol
Class III Meds
Bretylium
Amiodarone
Class IV Meds
Verapamil
Diltiazem
Nifedipine
