Module 7: The Complex Heart Flashcards
Used to control HEART RATE, management of hypertension, given post MI
- blocks the receptors that normally would accept epinephrine and norepinephrine which slows heart rate and blood pressure
Beta Blocker
; Metoprolol
Prevents the conversion of angiotensin I to angiotensin II which results in vasodilation and increases excretion of sodium and water
- often used to treat heart failure and are also helpful to manage hypertension
ACE Inhibitor
; Lisinopril
Classification: Antihyperlipidemic
Action: Inhibits HMG-CoA reductase
Why Take It: To lower lipids and decrease cholesterol production
Overexpression: Muscle cramps/aches; myalgia
Administration: If missed dose do not double up, but take as soon as realized if within 12 hours, if outside of 12 hours just take next scheduled dose
Follow Up: Are your lab values showing decreased LDL and decreased cholesterol?
Education: Teach patients about myalgia, avoid grapefruit juice
Atorvastatin
Classification: Beta Blocker
Action: Blocks receptors that normally bind with NE and E, slowing HR
Why Take It: Lower HR, manage HTN and heart failure
Overexpression: If finds Beta 2 receptors interferes with lungs and causes bronchoconstriction (bad for COPD and asthma)
Administration: High doses can cause bronchoconstriction, keep in mind baseline HR and BP, 100/60 = STOP/THINK
Follow Up: Increase in activity tolerance? Decreased BP/HR?
Education: Teach patient how to take own HR, signs of low heart rate
Metoprolol
Classification: ACE Inhibitor (‘pril’)
Action: Prevents conversion of Angio I to Angio II which results in vasodilation and increases secretion of sodium and water
Why Take It: Heart failure, decreases heart rate
Overexpression: Edema, INTOLERABLE COUGH (converted in lungs=cough), hyperkalemia (ACE blocks aldosterone which would normally increase the secretion of potassium)
Administration: Blood pressure in mind when giving**
Follow Up: decrease in BP?
Education: May cause drowsiness, advise to tell HCP about cough
Lisinopril
ACE Inhibitor
Classification: Calcium Channel Blocker
Action: blocks Calcium from entering the myocardium which decreases BP and HR
Why Take It: To slow HR/BP and decrease work of heart, manage heart failure
Overexpression: bradycardia, hypotension + associated sx, cardiac arrhythmias (b/c of affect on AV node)
Administration: check BP and HR
Follow Up: Heart rate decreased, less work of heart, more activity tolerance
Education: how to check HR
Diltiazem
Classification: Loop diuretic
Action: works at loop of Henle to decrease the reabsorption of sodium and chloride, therefore producing large amounts of sodium-rich urine
Why Take It: Hypertension, heart failure, hypervolemia
Overexpression: hypotension, dehydration, hyponatremia, hypokalemia
Administration: take in morning/4pm, mobility concerns?
Follow Up: Dizzy? Urination pattern
Education: take early in day, and not too late at night, eat potassium rich foods, change position slowly, may experience dizziness
Furosemide
Classification: Cardiac glycoside
Action: allows more calcium to enter myocardial cells which increases contractility and decreases HR
Why Take It: heart failure, cardiac arrythmias, a. fibb
Overexpression: bradycardia, fatigue, digoxin toxicity (nausea, visual disturbances- halo around lights, seeing double)
Administration: Check apical pulse before first dose full 60 sec then radial pulse check before each admin
-therapeutic window= 0.8-2.0ng/mL
Follow Up: signs of toxicity
Education:
any pulse rate under 60 stop and think, sx of dig toxicity
Digoxin
Classification: Nitrate
Action: works as a major vasodilator in both venodilation (slows blood being brought to the heart) and arteriodilation (decreases BP)
Why Take It: chest pain, angina, more blood is brought to myocardium
Overexpression: hypotension, intense headache because of massive vasodilation
Administration: three sprays if ordered, each 5 minutes apart; check blood pressure and HR after each spray; as long as reporting pain continue to admin
Follow Up: is pain at 0/10? blood pressure?
Education:
- any viagra?
- don’t take patch off while admin sprays
- use urinal or bedpan while experiencing chest pain
- sit down while taking it
- sometimes take prophylactically (ie. before sexual intercourse/walk)
- no harm in taking nitro if unsure
Nitroglycerin
Classification: Angiotensin Receptor Blocker (ARB) “SARBTANS”
Action: blocks the receptors for Angio II which results in vasodilation and increases excretion of sodium and water
Why Take It: heart failure, hypertension
Overexpression: edema, hyperkalemia
Administration: blood pressure in mind
Follow Up: urination patterns?
Education:
-same as ACE inhibitor but without cough
Losartan
- initiated with decreased volume and BP (hypovolemia = low fluid volumes)
- kidneys produce renin
- renin starts the conversion from AI to AII
- Angio II causes vasoconstriction and the release of aldosterone (function is fluid balance)
- vasoconstriction causes blood pressure to drive back up
- aldosterone helps to retain sodium and water which increases fluid volume and creates balance
RAAS
Classification: Anticoagulant
Action: interferes with clotting process to prolong time it takes to form a clot (Heparin IV=intrinsic, Warfarin PO=extrinsic pathway)
Why Take It: reduced mobility, surgery, hx of stroke, clots, DVT
Overexpression: hemorrhage
Administration:
Follow Up: Blood pressure?
Education:
- Warfarin needs a couple days for therapeutic effect
- WARFARIN THER WINDOW: 2.0-3.0 or 2.5-3.5 for MV
- do not play rough sports on Warfarin (risk for bleed)
- watch for bleeding gums, hematuria, blood in stool
- DO NOT increase VIt. K in diet (Warfarin is trying to inhibit VK in clotting)
Heparin
Warfarin
A patient’s PT is 3.2, they do not have a mechanical valve. Why should the nurse hold the patient’s daily dose of Warfarin?
PT of 3.2 is a slow coagulation time, and this patient is at an increased risk for bleeding. Warfarin will only slow coagulation time more, so hold it.
Classification: Antiplatelet
Action: interferes with platelet aggregation to decrease risk of clots forming
Why Take It: have cardiac risk factors
Overexpression: bleeding, bruising
Administration:
-1/4 pill (81mg)= for clotting, not pain
Follow Up: experiencing any bleeding, bruising that is changing
Education:
- use soft toothbrush
- use electric razor
- do not aggressively brush/floss
- watch spreading bruises
- blood in urine/stool
Aspirin
You are teaching Mr. Murphy about Warfarin and Furosemide.
Is this reply from Mr. Murphy effective, ineffective, or unrelated?
“I should take my furosemide first thing in the morning”
Effective
You are teaching Mr. Murphy about Warfarin and Furosemide.
Is this reply from Mr. Murphy effective, ineffective, or unrelated?
“I will watch for bruising and especially bruises that I see getting bigger and report them.”
Effective
You are teaching Mr. Murphy about Warfarin and Furosemide.
Is this reply from Mr. Murphy effective, ineffective, or unrelated?
“I will take an extra dose of Furosemide if I notice increased voiding.”
Ineffective
You are teaching Mr. Murphy about Warfarin and Furosemide.
Is this reply from Mr. Murphy effective, ineffective, or unrelated?
“I understand that I will have regular blood work to help with proper dosages for my Warfarin.”
Effective
You are teaching Mr. Murphy about Warfarin and Furosemide.
Is this reply from Mr. Murphy effective, ineffective, or unrelated?
“I will learn how to take my HR so I can be sure it’s okay to take my Furosemide.”
Ineffective
; with Furosemide we are keeping BP in mind, to reduce risk of hypotension and dizziness
You are teaching Mr. Murphy about Warfarin and Furosemide.
Is this reply from Mr. Murphy effective, ineffective, or unrelated?
“I will be much more careful in watching my cholesterol intake.”
Unrelated
You are teaching Mr. Murphy about Warfarin and Furosemide.
Is this reply from Mr. Murphy effective, ineffective, or unrelated?
“I will go purchase a Medic Alert bracelet today.”
Effective
; risk for bleeding
You are teaching Mr. Murphy about Warfarin and Furosemide.
Is this reply from Mr. Murphy effective, ineffective, or unrelated?
“I will cut out potassium from my diet.”
Ineffective
; Furosemide is potassium-wasting, so we would want patient to have a potassium rich diet
You are teaching Mr. Murphy about Warfarin and Furosemide.
Is this reply from Mr. Murphy effective, ineffective, or unrelated?
“I will make sure I am careful when changing positions.”
Effective
; Furosemide can cause orthostatic hypotension and dizziness
You are teaching Mr. Murphy about Warfarin and Furosemide.
Is this reply from Mr. Murphy effective, ineffective, or unrelated?
“I understand that I should not increase my Vitamin K intake now.”
Effective
; Warfarin works to inhibit Vit K in the clotting pathway
ACE Inhibitors and ARBs retain what electrolyte?
Potassium
What are the symptoms of Digoxin Toxicity?
; Nausea, bradycardia, blurred vision (halo around lights)
Mr. Murphy is scheduled to receive Lisinopril. You are concerned about his ________ prior to administering this medication.
; blood pressure
As you prepare to give Mr. Murphy his Diltiazem (CHB), you check his _______ and _______.
; heart rate and blood pressure
Prevents conversion of Angio I to Angio II which results in vasodilation and increases excretion of sodium and water
Lisinopril (ACE Inhibitor)
Lower lipids and decrease cholesterol production
Atorvastatin (Antihyperlipidemic)
Blocks receptors that normally bind with NE and E, slowing HR
Metoprolol (Beta Blocker)
Which medications would we consider BLOOD PRESSURE when administering?
All of them
Which medications is it very important to consider HEART RATE when administering?
Digoxin and Metoprolol and Diltiazem
Cardiac Glycosides and Beta Blockers and Calcium Channel Blockers
What is the expected PT range for someone not on Warfarin?
0.8-1.2 seconds
Digoxin Therapeutic Window
0.8-2.0 ng/mL
Normal Serum Potassium
3.5 to 5.0 mEq/L
