Drugs HF and H 3 Flashcards
arthomia
have to sit up to breath
paroxymal nocturnal dyspnea
wake up in the middle of the night gasping for breath, sign of retaining fluid
for fluid overload check
the RIGHT jugular vein distension in the older patient
why check the RIGHT jugular vein distension in the older patient
The left inominate vein dumps into the left jugular; this vein may be compressed between an elongated and unfolded aortic arch and the back of the sternum; increased mechanical pressure of the inominate vein may lead to increased left jugular vein distention continuously.
if S3
Indicates an elevated left ventricular diastolic pressure- blood on top of blood that didn’t get emptied the last time; lower sodium and water retention so that s3 goes away
if pt seems very anxious
give pt touch of morphone bc it vasodilates, so it will chill out pt and well make them relax and breath better; so morphine, lasix and ACE inhibitor
FVE (fluid volume excess)
edema, increase bp, sob, decrease u/o, rales, crackles, infiltrates/pleural infusion
the weakling of diuretics
potassium sparing diuretics
Spironolactone inhibits the action of
aldosterone. Blocks sodium and water retention; conserves potassium; (also used for hirsutism in women);
potassium sparing diuretics examples
This group consists of spironolactone (Aldactone), eprelrenone (Inspra), amiloride, and triamterene.
side effects of potassium sparing diuretics
gynecomastia (increase in breast tissue) in men, hyperkalemia
hyperkalemia
when levels are higher than 3.5 - 5.0 mEq/L; • Ventricular dysrhythmias, peaked T waves (tall tented T waves), prolonged PR interval on EKG)
Disruption of electrical activity of heart:
asystole (occurs when levels reach 8-9 mEq/L)
S/S of hyperkalemia
• Confusion, anxiety, dyspnea, weaknes or heaviness of legs, numbness/tingling of hands, feet, lips, bradycardia, changes in bp
Treatment of Hyperkalemia ***
- Withold foods containing potassium and medications that promote potassium accumulation 2. Calcium gluconate IV to promote cardiac contraction 3. Infusion of glucose and insulin 4. Sodium bicarbonate 5. Sodium polystyrene sulfonate 6. Dialysis
Calcium gluconate IV to promote cardiac contraction
won’t decrease potassium but will protect heart and makes it contract
Infusion of glucose and insulin:
As insulin carries glucose into the cells, it also carries K+ from the serum into the cell
Sodium bicarbonate:
By making the blood more alkalotic (raising the pH), the cells take up more K+ from the blood
Sodium polystyrene sulfonate
Kayexalate: an exchange resin (exchanges Na for K, works in GT tract so then increase in stool) that exchanges sodium for potassium in the GI tract, causing K+ to be eliminated in the stool
dialysis
will give amp of dextrose 50% then administer IV insulin
so if bump up glucose then**
will pull glucose in cell and K
in and outside cell elements
outside cell more Na inside more K, Hydrogen in cell and when K leaves starts moving in Hydrogen moves out
when at risk for hyperkalemia then at risk
for metabolic acidases; ph goes down but hydrogen ion concentration will be high
so to correct acidassis
give sodium bicarbonate
