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NUR-210 > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

What is hypertension?

A

Persistent elevated BP, chronic progressive disorder. to diagnosis, must need 3 high readings of BP

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2
Q

What are the systolic and diastolic number for prehypertension?

A

sys: 120-139 dia: 80-89

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3
Q

When do you begin treating hypertension with meds?

A

stage 1: sys greater than 139 or dia: greater than 89

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4
Q

what are Stage 1 vs stage 2 hypertension number?

A

stage 1= 140-159 systolic, 90-99 diastolic
stage 2= greater or equal to 160 systolic, greater or equal to 100 diastolic

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5
Q

Contributing factors to primary/essential hypertension

A

-hyperactivity of sympathetic nervous system
-hyperactivity of the renin-angiotensin system (increased aldosterone aka sodium and water which raises BP)
-endothelial dysfunction

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6
Q

Risk factors for primary hypertension

A

-genetics
-age: greater than 60 yrs
-obesity
-smoking
-diabetes
-hyperlipidemia
-high sodium diet?

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7
Q

Difference between secondary hypertension and primary hypertension?

A

secondary has an identifiable cause vs primary with no identifiable cause but has risk factors

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8
Q

What are the identifiable causes for secondary hypertension?

A
  • Renal disease
    -Coronary artery disease
    -Toxemia of pregnancy
    -Drug therapy: oral -contraceptive therapy
    -Sleep apnea
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9
Q

short term effects of hypertension

A

majority of clients asymptomatic

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10
Q

long term effects of hypertension

A

-MI
-Heart failure
-Kidney disease
-Stroke
-Peripheral artery disease
-Retinopathy

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11
Q

what is the objective of hypertensive therapy

A

Treat hypertension
to reduce
morbidity and mortality
without
decreasing
the quality of life
with the drugs
employed

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12
Q

primary determinants of arterial blood pressure

A

arterial pressure= cardiac output x peripheral resistance

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13
Q

what is cardiac output determined by?

A

heart rate
contractility
blood volume
venous return
4-8 L/ min is the normal

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14
Q

what is peripheral resistance determined by?

A

arteriolar constriction

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15
Q

What is preload?

A

cardiac output
heart rate (ANS)
stroke volume

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16
Q

what is afterload?

A

peripheral resistance
2.5-4 l/min

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17
Q

what is stroke volume determined by?

A

preload
afterload
contractility

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18
Q

what life styles effect afterload?

A

low cholesterol diet
caffeine restriction
alcohol restriction
smoking cessation
(exercise, stress reduction are both)

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19
Q

what life styles have an effect on preload?

A

weight loss
sodium restriction
(exercise, stress reduction are both)

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20
Q

How do you promote compliance with medications

A

patient education
self-monitoring
minimize ADRs
simplify regimen
keep cost down

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21
Q

which type of drugs are beta blockers ending in (-olol)

A

antihypertensive drugs

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22
Q

what is the action of antihypertensive drugs (-olol)

A

blocks beta receptors in the heart
-decreases heart rate
-decreases conduction of system
-decreases force of contraction

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23
Q

what are ADRs for antihypertensive drugs (-olol)

A

hypotension
bradycardia
bronchial constriction
drowsiness/depression

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24
Q

What do diuretics do?

A

-promote renal excretion of water and lytes
-increase urinary output

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25
Q

therapeutic uses for diuretics

A

-hypertension
-removal of edematous fluid

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26
Q

what are the site of action for diuretics?

A

thiazide
high ceiling loop diuretics
potassium sparing diuretics

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27
Q

Diuretics- mechanism of action

A

-blockade: sodium/ chloride reabsorption
-site of action
-ADR: hypovolemia, electrolyte imbalance

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28
Q

Nursing implications for diuretics

A

-daily weights: same time and place
-monitor BP
-administer early in the day
-prevent orthostatic hypotension

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29
Q

what is the action for the antihypertensive drug- thiazide diuretics

A

action : distal convoluted tubule
- reduction of blood volume
-reduction of arterial resistance

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30
Q

What are the ADRs for the antihypertensive drug- thiazide diuretics

A

-Hypokalemia
-Dehydration
-Hyperglycemia
-Hyperuricemia
-Hyperlipidemia

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31
Q

high-ceiling (loop) diuretics

A

-furosemide (lasix)- ascending loop of henle
-rapid onset

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32
Q

What are the ADRs for high-ceiling (loop) diuretics (lasix)

A

Hypotension - Hypokalemia
Hyponatremia - Ototoxicity
Hyperglycemia - Hyperuricemia
Hyperlipidemia

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33
Q

What are potassium-sparing diuretics?

A

-weaker diuretics
-spironolactone (aldactone)

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34
Q

action of spironolactone (aldactone)

A

-blocks aldosterone in the distal nephron
-retention of potassium

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35
Q

ADRs for potassium- sparing diuretics

A

-hyperkalemia
-avoid with ACEs and ARBs since they also promote hyperkalemia

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36
Q

what do angiotensin-converting enzyme inhibitors (ACEs) end in

A

“pril”

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37
Q

What is the action of angiotensin-converting enzyme inhibitors (ACEs)

A

interrupts renin angiotensin-aldosterone system (RAAS)

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38
Q

ADRs for angiotensin-converting enzyme inhibitor

A

First–dose hypotension: decrease blood volume
Persistent cough: increased bradykinin
Hyperkalemia: potassium retention
Interaction with NSAIDS: fluid retention
Angioedema: rare increased capillary permeability
Fetal harm: renal failure

39
Q

What are angiotensin II receptor blockers (ARBs)

A

-losartan (cozaar)
-hypertension
-heart failure

40
Q

ADRs for angiotensin II receptor blockers (ARBs)

A

Dizziness
Birth defects
Newer ARB’s
Candesartan (Atacand)
Irbesartan (Avapro)
Telmisartan (Micardis)
Valsartan (Diovan)

41
Q

Action for cardiac glycoside= digoxin (Lanoxin)

A

-slows the transmission of cardiac impulses through the cardiac conduction system
-increase the force of cardiac contraction

42
Q

What are the cardiac glycoside-digoxin (lanoxin)ADR: low TI index

A

-anorexia, nausea
-bradycardia

43
Q

What are the nursing implications for digoxin

A

check apical pulse
monitor dig and K+ levels

44
Q

What is angina pectoris

A

-sudden pain beneath the sternum often radiating to the left shoulder and arm
-oxygen demand greater than oxygen supply

45
Q

types of angina pectoris

A

-Chronic Stable: Exertional
-Variant: any time even at rest
-Unstable: Medical emergency

46
Q

drugs for angina pectoris

A

nitrates-nitroglycerin

47
Q

What is the action of nitrates-nitroglycerin

A

-increases the blood flow to the coronary arteries
-dilate the peripheral arteries

48
Q

What is the administration for nitrates- nitroglycerin

A

-highly lipid soluble
-very short half-life (5-7 mins)

49
Q

What are the ADRs for nitrates-nitroglycerin

A

-orthostatic hypotension
-headache

50
Q

routes of administration for nitrates

A

sublingual
topical
oral sustained released
intravenous

51
Q

nitrates sublingual route directions

A

Tablets or spray
-Drink water before taking
-Do not swallow
-Should feel a tingling sensation
-If pain not relived in 5 minutes with initial dose call 911
-take 2nd dose in 5 minutes
-take 3rd dose 5 minutes later

52
Q

What are topical route of admin for nitrates?

A

transdermal delivery systems
-rotate sites and remove previous patch
-need to wear continuously during all daily activities

53
Q

cardiac diagnostics, creatine kinase MB ( CK-MB)

A

-specific to myocardial cells
- rise4-6 hrs after MI, peaks in 15-20 hrs
-returns to normal 2-3 days

54
Q

cardiac diagnostics,. troponin

A
  • more specific and sensitive indicator than CK-MB
    -rises 2-6 hrs after MI, peaks in 15-20 hrs
    -returns to normal 5-7 days
55
Q

cardiac diagnostics, myoglobin

A

-rises 1-3 hrs after MI, rapidly cleared in 1 day
- measure within 12 hrs of onset

56
Q

Cardiac diagnostic studies

A

ECG
ECHO
Exercise Stress
TEE
MUGA
MRI/CT
Angiogram

57
Q

Coagulation Pathways- Clot formation

A

triggers
hemostasis
virchows triad

58
Q

What are triggers for Intravascular pathways and extravascular coagulation pathways?

A

-intravascular- ASHD
-extravascular- trauma

59
Q

What makes us Virchow’s triad

A

-venous stasis
-hypercoagulability
-endothelial damage

60
Q

Factors linked to increased risk of thromboembolic event

A

decreased circulation
reduced mobility
disease or disability
obesity
obstruction of venous flow
medications

61
Q

Anticoagulants

A

-injectable anticoagulants: heparin& LMWH
-oral anticoagulants: Coumadin &Pradaxa

62
Q

antiplatelet drugs

A

ASA

63
Q

thrombolytic

A

tPa & Urokinase & Streptokinase

64
Q

Heparin: Rapid Acting Anticoagulant indications

A

DCT- deep vein thrombosis
PE- pulmonary embolism
CVA
MI
Pregnancy

65
Q

Heparin: Rapid acting anticoagulant mechanism of action

A

parenterally only
not absorbed in GI tract
very acid solution
large molecule
rapid acting

66
Q

heparin pharmacokinetics

A

metabolized in the liver
eliminated via kidney
short half life
highly protein bound

67
Q

heparin adverse drug reaction

A

hemorrhage
osteoporosis
HIT (heparin induced thrombocytopenia)

68
Q

nursing implications for heparin for IV injection

A

continuous, intermittent
-do not mix with other IV medications
-check daily dose changes with another RN
-use an infusion pump

69
Q

nursing implications for heparin for subcut injection

A

rotate sites
no aspiration
do not massage

70
Q

nursing implications for heparin for aPTT: activated partial thromboplastin time

A

normal value for aPTT is 40 secs
-therapeutic level between 1.5-2 times the control
-usually 60 to 80 secs

71
Q

nursing implications for heparin for monitor for bleeding

A

-bruising, petechiae
-smokey urine

72
Q

What is the antidote for heparin and low molecular weight heparin (LMWH)

A

protamine sulfate

73
Q

what is the mechanism of action for low molecular weight heparin (LMWH)

A

-Bioavailability 100% with subcutaneous injection
-Half life 6 times longer than heparin
-Minimal protein binding
-Renal clearance

74
Q

What is low molecular weight heparin

A

fragments of unfractionated heparin
ex: enoxaparin (lovenex), dalteparin (fragmin)

75
Q

for LMWH what baselines should you obtain as a nursing implications

A

aPTT
PT
CBC
creatine (Cr)

76
Q

how is LMWH administered

A

subcut every 12-24 hrs

77
Q

What does warfarin (coumadin) inhibit

A

liver synthesis of vitamin K
-affects factors VII, IX, X, and prothrombin

78
Q

what is the action of warfarin (coumadin)

A

long half life 42 hrs
highly protein bound 99.5%
no effect on currently circulating clotting factors

79
Q

what is the use of warfarin (coumadin)

A

prevents thrombosis formation

80
Q

ADRs for warfarin (coumadin)

A

multiple drug interactions
hemorrhage

81
Q

nursing implications for warfarin (coumadin)

A

-monitor PT (prothrombin time ) 1.2 -1.5 times control
-monitor INR (international normalized ratio) 2-3

82
Q

Patient teaching for warfarin (coumadin)

A

Monitor for bleeding
ID band
Check all new medications
Diet recommendations

83
Q

What is the antagonist for warfarin

A

vitamin K

84
Q

What content is high in vitamin K >150 ug

A

Broccoli, cucumber, endive, kale, red lettuce, raw mint,turnips & parsley, spinach, Swiss chard, green tea, watercress, brussel spouts

85
Q

What content is moderate in vitamin K <150 ug

A

Green beans, raw cabbage, canola oil, coleslaw, green lettuce, mayonnaise

86
Q

What content is low in vitamin K < 30 ug

A

Apple, artichoke, cauliflower, celery, green pepper, tomato, onion

87
Q

oral anticoagulants

A

pradaxa
xarelto

88
Q

antiplatetlet drugs

A

aspirin (ASA)
ticlopidine (Ticlid)
clopidogrel ( Plavix)
dipyridamole (Persantine) :only used with coumadin
pentoxifylline (Trental): intermittent claudication
anagrelide(Agrylin):oral treat essential thrombocytopenia
tirofiban (Aggrastat): IV in combination with heparin
abciximab (Reo Pro) : IV used during angioplasty
cilostazol (Pletal) : oral for intermittent claudication

89
Q

ASA (asprin)

A

inhibits prostagladin synthesis
inactivates cyclooxygenase activity
platelets do not respond to thrombin
100mg is sufficient to inhibit for 8 - 10 days
Dose: 81 - 325 mg per day
Adverse effects

90
Q

thrombolytic drugs

A

Streptokinase (Streptase), anistreplase (Eminase) , urokinase, alteplase (tPA), reteplase ( Retavase), tenecteplase, ( TNKase)

91
Q

What do thrombolytic drugs bind

A

binds plasminogen: dissolving of the clot

92
Q

uses for thrombolytic drugs

A

all administered via IV within 6 hrs
-Myocardial infarction
-Deep vein thrombosis
-Massive pulmonary emboli

93
Q

ADRs for thrombolytic drugs

A

bleeding
hypotension
cardiac arrhythmias

NUR-210 (5 decks)

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