Exam 1 (2/22) Flashcards
Review nursing assessments prior to administering an antihypertensive drug
Monitor Heart Rate
Monitor BP
May also need to monitor ECG?? This can show signs of the problem.
Know when it is contraindicated to administer an antihypertensive drug
HR less than 60
Hypotension
Allergy
Identify AE’s of clonidine (Catapres)
Hypotension, do not discontinue abruptly
Drowsiness, fatigue, lethargy, sedated state
Upper abdominal pain
Know patient education for antihypertensives
Once you start and antihypertensive drug you will be taking it for lifelong therapy (90% of cases)
unless they make a major lifestyle change
If they miss a dose, do not double up on doses (significant hypotension)
Teach patients to change positions really slowly
Monitor BP and HR before and after taking drug.
Metoprolol and atenolol: Monitor Blood glucose,
Review AE’s of losartan (Cozaar) including black box warnings
Chest pain Fatigue Hypoglycemia Diarrhea UTI Anemia Weakness Do not give to pts that are pregnant or lactating: black box warning Cautious use in older adults (if used start with lowest dose possible) and those with kidney failure (harder for them to break it down)
Review patient teaching for metoprolol (Lopressor)
Monitor BP and apical pulse for 1 minute before taking
If pulse is less than 60 do not take and contact provider
Monitor blood glucose in diabetic pts (beta blockers hide symptoms of hypoglycemia)
Know interactions for captopril (Capoten)
NSAIDs Other antihypertensives Diuretics Lithium Potassium supplements
Know the AE’s of hydralazine (Apresoline) specifically in older adults
Dizziness Headache Anxiety Tachycardia Edema Dyspnea N/V/D Hepatitis Rash
Identify patient teaching for doxazosin (Cardura)
This drug works really well, sometimes too well
Avoid interactions (alcohol, benzos, opioids, etc.) or it can cause additive CNS depression
Monitor HR & BP before taking
Take medication at night
Know patient teaching for antihypertensives
Instruct patient to stick with dosage schedule, even if feeling better.
Do not stop abruptly can cause rebound HTN: clonidine (Catapres)
Change positions slowly to minimize orthostatic hypotension
Monitor BP and HR- Nifedipine (Procardia)
Doxazosin (Cardura): Monitor BP and HR before and after taking med. Do not take with alcohol, benzos, or opiods, take at night.
Captopril (Capoten): Dry-nonproductive cough- may indicate they need to switch to another type of antihypertensive, teach them to get into touch with the provider and taper off and start a new one. Avoid potassium supplements.
Metoprolol (Lopressor) and atenolol (Tenormin): Monitor BP and apical pulse before taking, if below 60 hold off on taking.
Once you start an antihypertensive drug you will be taking it for lifelong therapy (90%) of cases.
Know AE’s of captopril (Capoten)
Dry, nonproductive cough Fatigue Dizziness Mood changes HA
Review assessments to perform prior to administering carvedilol (Coreg)
Monitor intake and output ratios and daily weight.
Assess patient routinely for evidence of fluid overload (peripheral edema, dyspnea, rales/crackles, fatigue, weight gain, jugular venous distention).
Know the order of steps for a patient taking sublingual nitroglycerin
Place tab under tongue when chest pain starts.
If NOT relieved in 5 minutes, call 911, than take a second tab
If there is no relief after 5 minutes, take a third tablet.
PATIENT SHOULD SIT OR LIE DOWN AFTER TAKING THE FIRST TABLET.
Review the therapeutic effects of antianginals
Treatment and prophylaxis of angina pectoris
Iv or sublingual: Rapid-acting forms Treating a sudden onset of acute angina attack, not for prevention.
Patch or ointment: Long-acting for prevention from occurring
Know the interactions for nitroglycerin
Antihypertensive drugs, alcohol, sildenafil (Viagra), beta blockers, calcium channel blockers.
Interactions with Antihypertensives and alcohol can increase the risk for hypotension.
Review patient teaching for the patient taking sublingual nitroglycerin
The same as the order in which we should take the tablets.
NO more than 3 tablets.
Tablets should not be chewed, crushed or swallowed.
Place under the tongue or between the cheek and gum.
Do not eat, drink, smoke, or use tobacco while tablet is dissolving
Comes in a glass container, which is should stay in
Keep it with patient at all times
Keep away from sunlight and children
Sit or lay down after taking first tablet
Males: if taking erectile dysfunction meds too they can cause hypotension
Know contraindications/cautions for the use of nitroglycerin
Contraindications: Allergy Severe anemia Closed-angle glaucoma Hypotension Severe head injury Biggest contraindications are allergy and hypotension. Avoid giving to patients with this.
Identify patient teaching for transdermal nitroglycerin
Apply transdermal patches to areas without hair, press hard to adhere.
If the patch becomes dislodged apply a new one.
Choose a different area each day
You can shower while wearing a nitroglycerin skin patch
Know common AE’s of all antidysrhythmics
All antidysrhythmics can cause dysrhythmias! Hypersensitivity reactions N/V/D Dizziness Headache Blurred vision Prolongation of the QT interval
Review assessments needed for a client taking amiodarone (Cordarone)
Thorough drug and medical history Baseline BP, HR, I/O, and cardiac rhythm Serum potassium levels before starting Contraindications Potential drug interactions During Therapy: Monitor cardiac rhythm, HR, BP, general well-being, skin color, temperature, and heart and lung sounds. Assess plasma drug levels as indicated Monitor for AE and toxic effects.
Identify indications for verapamil (Calan)
Convert supraventricular tachycardia to regular sinus rhythm, slow rate of atrial fibrillation and flutter
Antidysrhythmic: Know the indications for lidocaine (Xylocaine)
Controls ventricular dysrhythmias caused by MI, cardiac surgery or procedures, and digoxin toxicity.
Antidysrhythmic: Review the AE’s of verapamil (Calan)
Hypotension Bradycardia HF Peripheral edema of feet and legs Lightheadedness Dizziness
Know nursing interventions for administration of adenosine (Adenocard) IV
Make sure patient is being monitored on ECG, explain that it causes asystole for a few seconds (very scary) and then heart rate will go back to normal
