Chapter 25 and 28 Flashcards
Coronary Artery Disease
Narrowing or occlusion of a coronary artery
Narrowing causes myocardial ischemia
atherosclerosis
Most common etiology of CAD
Caused by presence of plaque & inflammation
Nitrates
Potent vasodilators (coronary arteries) main treatment for angina
Nitrates action
relax arterial & venous smooth muscle
Reduces preload → decreases cardiac output and cardiac demand → myocardial oxygen demand
Nitrates adverse effects
Headache, dizziness, hypotension, flushing, rash
Avoid with nitrates
no alcohol
no viagra
Myocardial Infarction tx
Nitrates Beta-blockers Thrombolytics Asprin Statins for hyperlipidemia ACE inhibitors Platelet Aggregation Inhibitors Heparin drip
Hematopoiesis
Process of blood-cell formation
Where does hematopoiesis begin
Begins with stem cells in bone marrow
Where is hematopoiesis begin
Homeostatic control maintained by hormones and growth factors
Demands of body on WBC
White blood cells (WBCs) can increase concentration up to ten times normal
Demands of body on RBC
Red blood cells (RBCs) can increase up concentration up to five times normal
Epoetin alfa (Epogen, Procrit) category
Erythropoiesis-stimulating Agents
Epoetin alfa (Epogen, Procrit) action
Hormone that stimulates RBC production
Secreted inreduction in oxygen
Body experiences hypoxia or hemorrhage
Epoetin alfa (Epogen, Procrit) use
anemia due to CRF, HIV infection treated with AZT, some cancers
Epoetin alfa (Epogen, Procrit) adverse effects
Hemoglobin > 12 g/dL increased risk death, arterial & venous thromboembolic events, tumor progression
HTN, H/A, seizures, flu-like symptoms, N/V/D, rash
Black box warning
Darbepoetin alfa (Aranesp) category
Erythropoiesis-stimulating Agents
Darbepoetin alfa (Aranesp) duration
Longer duration of action than Epoetin alfa: administered 1x/week
Darbepoetin alfa (Aranesp) uses
anemia due to CRF & chemotherapy
erythropoiesis-stimulating agents (ESAs) FDA warning
not for use in PT’s w/ cancer or getting myelosuppressive therapy when the anticipated outcome is cure
Erythropoietin client teaching
Monitoring BP
correct injection technique
reporting side effects
Clients Receiving Epoetin Alfa what to monitor
BP seizure activity H+H signs of thrombosis dietary intake for essential nutrients
Granulocyte CSF (G-CSF) function
colony stimulating factor
increases production of neutrophils
Granulocyte/macrophage CSF (GM-CSF) function
colony stimulating factor
stimulates production of both neutrophils and macrophages
Colony-Stimulating Factors considerations
monitor for hypertension, bone pain, respiratory distress and ST-segment depression
Avoid Colony-Stimulating Factors with
clients with kidney and liver impairment
Colony-Stimulating Factors teaching
how to avoid infections and to report adverse symptoms
What to monitor in clients on Filgrastim (Neupogen)
VS S/Sx of infection CBC hepatic status bone pain
Platelet Enhancers cautions
use in caution in PT’s with cardiac disease
withhold 12 hours before and after radiation
avoid injury
What to monitor with Platelet Enhancers
Monitor clients with hx of edema
Report Edema; change in urinary output or body weight or Bleeding; difficulty breathing
Anemia
Blood has reduced capacity to carry oxygen
Anemia can cause
Hemorrhage
Excessive erythrocyte destruction
Insufficient erythrocyte synthesis
Anemia symptoms
Pallor Decreased exercise tolerance Fatigue, dizziness and fainting Increased RR and HR Heart failure
Antianemic Agents
Vitamins and minerals
Enhance oxygen-carrying capacity of blood
Antianemic Agents examples
Most common are cyanocobalamin (B12), folic acid, and ferrous sulfate
Intrinsic Factor
Protein secreted by stomach cells
Required for vitamin B12 metabolism
Pernicious Anemia
Vitamin B12 deficiency
Sx can be reversed but nervous system damage may be permanent
Pernicious Anemia treatment
cyanocobalamin
Pernicious Anemia causes
Chronic alcoholism, fad diets, absorption diseases
Folic acid deficiency in pregnancy
linked to neural-tube defects
Cause of Folic acid deficiency
lack of sufficient dietary intake
Folic acid anemia absorption
does not need intrinsic factor to be absorbed
linked to pernicious anemia (decreased B12 causes decreased folic acid)
Antianemic Agents—Vitamin B12 and Folic Acid considerations
assess cause of anemia
monitor RR and cardiac
monitor K+
report SOB and edema
Iron uses
Essential for metabolism and energy
Ferritin and hemosiderin
maintain iron inside cells
Transferrin
transports iron to other body sites
Free iron
toxic
binds to protein complexes
Iron Deficiency tx
iron supplements
Iron Deficiency cause
Acute or chronic blood loss, peptic ulcer
Heavy menstruation, pregnancy, intensive athletic training
Iron supplements teaching
Take iron with food
**Use straw to prevent staining teeth
Report signs of bleeding
