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NUR 210 > NUR 210 Exam 4 > Flashcards

NUR 210 Exam 4 Flashcards

1
Q

What are some triggers of clot formation?

A

Intravascular (ASHD), Extravascular ( trauma ex. hitting your head, falling down, slamming your finger, cut yourself), hemostasis, Virchow’s Triad,

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2
Q

What are the three parts of Virchow’s Triad?

A

Venous Statsis - not moving
Hypercoagulability- genetic predisposition to making you clot faster
Endothelial damage

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3
Q

What is a thromboembolic event:?

A

​​A thromboembolic event means that a blood clot has formed and then “embolized” or moved from where it started to another area and causes damage

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4
Q

What factors are link to increase risk of thromboembolic event?

A

Decreased Circulation
* Reduced Mobility
* Disease or Disability
* Obesity
* Obstruction of venous flow
* Medications

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5
Q

What are examples of injectable heparins?

A

Heparin & LMWH ( Low molecular weight heparin shots)

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6
Q

What are examples of oral anticoagulants?

A

Coumadin & Pradaxa

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7
Q

What is an example of antiplatlet drugs?

A

ASA

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8
Q

What are examples of thrombolytic drugs?

A

: tPa & Urokinase & Streptokinase ( Only by IV)

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9
Q

What is Heparin?

A

Rapid Acting Anticoagulant
Heparin does not prevent clots, it keeps them from getting bigger
Give it prevently or someone who has DVT or Pulmonary embolism

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10
Q

What are some indications of Heparin?

A

– DVT – deep vein thrombosis
– PE- pulmonary embolism
– CVA
– MI
– Pregnancy ( does not cross placental barrier)

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11
Q

What is the mechanism of action of heparin?

A

Parenterally only ( IV mostly, can be given IM but can give bruises)
– Not absorbed in GI tract
– Very acid solution ( Can’t give other Iv or medication or same site)
– Large molecule
– Rapid acting ( short half life)

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12
Q

True or False: Heparin is metabolized in the liver

A

True

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13
Q

True or False: Heparin is eliminated via liver

A

FALSE: Heparin is eliminated via the KIDNEY

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14
Q

True or false: the less heparin that is bound the less its working

A

FALSE: Heparin is highy protein bound, which means the more you have bound the less it is working

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15
Q

What are the ADRs of Heparin?

A

Hemorrhage
– Osteoporosis ( concerned with pregnant population)
– HIT( heparin induced thrombocytopenia)

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16
Q

LIst some nursing implications for Heparin

A

Intravenous injection: Continuous, Intermittent
– Do not mix with other IV medications
– Check daily dose changes with another RN
– Use an infusion pump
– Subcutaneous injection - abdomen ) ONLY PLACE) SubQ tissue , Heparin & Lovenex
– Rotate sites
– No aspiration - can’t aspirate and give heparin & lovenox
– Do not massage
-change needle before giving because it you don’t change it will cause more bruising

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17
Q

Nursing Implications for Heparin

A

Has to be on a infusion pump, be extremely accurate
– Monitor aPTT :activated partial thromboplastin time
– Normal value for aPTT is 40 seconds
– Therapeutic level between 1.5 to 2 times the control
– Usually 60 to 80 seconds
– Monitor for bleeding
– Bruising, petechiae
– Smokey urine
– Antidote : Protamine sulfate

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18
Q

What is the antidote for Heparin?

A

Protamine Sulfate

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19
Q

What is an example of low molecular weight heparin?

A

enoxaparin (Lovenex), dalteparin (Fragmin),

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20
Q

What is LMWH?

A

Fragments of unfractionated heparin

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21
Q

What is the bioavailability of giving heparin subs injection?

A

100%

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22
Q

True of False: The half life of LMWH is 6 times longer than heparin

A

True

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23
Q

True or False? LMWH is very highly protein binding

A

FALSE, LMWH is minimal protein binding, it doesn’t interact with other proteins

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24
Q

A mechanism of heparin is renal clearance

A

True

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25
Q

What are the nursing implications of for LMWH?

A

Obtain baseline:
– aPTT, PT, CBC, creatine
– Administered
– subcutaneously every 12 - 24 hours

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26
Q

What is an important education tip when educating your patients about heparin?

A

Nurses must and teach patients if you have to draw up heparin from a vial or a lovenox, the needle must be changed sterilly from what you drew it up with,
MUST CHANGE THE NEEDLE

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27
Q

What type of drug is warfarin ( Coumadin) ?

A

Oral anticoagulant

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28
Q

What dos warfarin ( Coumadin)

A

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

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29
Q

What is the action of warfarin ( Coumadin)

A

long half life 42 hours
– highly protein bound 99.5%
– No effect on currently circulating clotting factors

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30
Q

What is the uses of warfarin ( Coumadin)

A

prevents thrombosis formation

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31
Q

What are the adverse drug reactions of warfarin ( Coumadin)

A

Multiple drug & food interactions
– Hemorrhage

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32
Q

what is the PT ( prothrombin time) of warfarin?

A

1.2-1.5 times control

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33
Q

What is the INR ( International normalized ratio) for warfarin?

A

2-3

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34
Q

What is the nursing implications for warfarin?

A

monitor, patient teachingg, monitor for bleeding, ID Band- medical braclet, check all new medications, diet recommendations

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35
Q

What is the antagonist for warfarin ( Coumadin)

A

vitamin K

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36
Q

What are examples of foods high ( >150) in vitamin K

A

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

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37
Q

what are foods moderate in vitamin k ( ,150)

A

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

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38
Q

what are foods low in vitamin K <30)

A

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

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39
Q

What are other examples of oral anticoagulants

A

Pradaxa
Xarelto
These medications don’t have an antidote and are 25% more expensive

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40
Q

What are some examples of antiplatlet drugs?

A

aspirin (ASA)
* ticlopidine (Ticlid)
* clopidogrel ( Plavix) ** SuperAspirin
* 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

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41
Q

What does aspirin do?

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

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42
Q

What is the name of the only drug that eats clots and gets rids of clots you have and is only given IV?

A

Thrombolytic drugs

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43
Q

examples of thrombolytic drugs?

A

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

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44
Q

what does thrombolytic drug do?

A

Binds plasminogen: dissolving of the clot

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45
Q

what are the uses of thrombolytic drugs?

A

all administered via IV within 6 hours
Stroke
– Myocardial infarction
– Deep vein thrombosis
– Massive pulmonary emboli

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46
Q

what are the adverse effects of aspirin?

A

Bleeding
– Hypotension
– Cardiac arrhythmias

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47
Q

What is CK-MB

A

Creatine Kinase MB
Specific to myocardial cells
*Rise 4-6 hours after MI, peaks in 15-20 hours
*Returns to normal 2-3 days
So if I have chest pain today and I don’t go to the hospital until Wednesday because I’m too busy, my CKMV may be normal
- cardiac marker

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48
Q

What is troponin

A

More specific and sensitive indicator than CK-MB
*Rises 2-6 hours after MI, peaks in 15-20 hours
*Returns to normal 5-7 days
( cardiac marker)

49
Q

what is myoglobin?*

A

*Rises 1-3 hours after MI, rapidly cleared in 1 day
Measure within 12 hours of onset s of onset
( cardiac marker)

50
Q

What are the cardiac labs?

A

Cardiac Natriuretic Peptide Markers (BNP): , and serum lipids

51
Q

what are examples of diagnostic studies?

A

ECG
ECHO
Exercise Stress
TEE
MUGA
MRI?CT
Angiogram

52
Q

How is hypertension diagnosied?

A

must have 3 BP readings above normal in 3 different settings & are more concerned with diastolic than systolic

53
Q

What is the range for prehypertension?

A

: 120-139 or 80-89

54
Q

When do you start treating BP with medication?

A

Stage 1: Systolic greater than 139 or
Diastolic greater than 89

55
Q

What is primary ( essential hypertension)

A

Essential hypertension—once considered “essential” to providing adequate perfusion and thought this was pressure that you had to have in your body to make your essentials organs function

56
Q

What are key things to remember about primary ( essential hypertension)

A

Ages 25- 74: Increased Occurance with age
* Chronic progressive disorder
* Contributing factors
– Hyperactivity of sympathetic nervous system
– Hyperactivity of the renin-angiotension system
– Endothelial dysfunction

57
Q

What are the risk factors for essential hypertension?

A

Genetics & Ethnic groups
* Age: > than 60 years
* Obesity: then it has to pump harder b/c theres more tissue
* Smoking
* Diabetes- harder to pump something thick than thin blood
* Hyperlipidemia- alot of fat in your body
* ? High sodium diet

58
Q

What is secondary hypertension?

A

Hypertension with an identifiable cause
– Renal disease
– Coronary artery disease
– Toxemia of pregnancy
– Drug therapy: oral contraceptive therapy
– Sleep apnea

59
Q

What is the difference between short term and long term BP

A

Short Term : majority of clients asymptomatic
* Long Term:MI ( myocardial infarction or heart attack)
Heart Failure
Kidney Disease
Stroke
Peripheral Artery Disease
Retinopathy ( swelling of the retina) - the reason why most hypertensive patient are identfiied by eye doctors
Diabetes

60
Q

What is cardiac output?

A

Cardiac output is defined as the amount of blood pumped out of the body in a minute. It’s usually somewhere between four to six liters of blood every minute gets pumped by your heart

61
Q

What two things make up arterial pressure?

A

Cardiac output X Peripheral resistance

62
Q

What is preload?

A

PRELOAD ( what we loaded the heart up with) = Cardiac output (Heart rate (ANS) + Stroke volume)

63
Q

What is afterload?

A

AFTERLOAD ( what the heart has to pump against) = Peripheral resistance

64
Q

Blood pressure increases when

A

cardiac output increases and/or
· peripheral vascular resistance increase

65
Q

does weight loss affect preload or afterload?

A

Preload

66
Q

does exercise affect preload or afterload

A

afterload and a little bit of preload

67
Q

does stress reduction affect preload or afterload?

A

Afterload and a little bit of preload

68
Q

does smoking cessation affect preload or afterload?

A

afterload

69
Q

does alcohol restriction affect preload or afterload

A

afterload

70
Q

does caffeine restriction affect preload or afterload

A

afterload

71
Q

does low cholesterol diet affect preload or afterload

A

afterload

72
Q

does sodium restriction affecrt afterload or preload?

A

preload

73
Q

How do you promote compliance with medications?

A

Patient education
· Self-monitoring
· Minimize ADRs
· Simplify regimen
· Keep cost down

74
Q

What do beta blockers end in?

A

olol

75
Q

What is the action of beta blockers?

A

Action : Blocks beta receptors in the heart
– decreases heart rate
– decreases conduction system
– decreases force of contraction
- work on cardiac output

76
Q

What are the ADRs of beta blockers?

A

I’m giving it to you to lower your heart rate, lower your blood pressure, decrease the squeezing of your heart.
– hypotension
bradycardia
– bronchial constriction
– drowsiness/depression

77
Q

What are the nursing implications of beta blockers?

A

–Assessment
Know side effects

78
Q

What are diuretics?

A
  • Promote renal excretion of water & lytes
  • Increase urinary output
79
Q

Why do you give tdiuretics herapeutics uses

A

Hypertension
· Removal of edematous fluid

80
Q

How are diuretics categorized?

A

by the site of action
thiazide
· high ceiling loop diuretics
· potassium sparing diuretics

81
Q

What is the number on problem with diuretics?

A

we pee out potassium, which makes us have electron imbalances. So there for people who are susceptible to that, we have potassium sparing diaretics.

82
Q

What is the mechanism of actions

A

blockade- sodium/cholride reabsorption

83
Q

What is the site of action of diuretics

A

they work by blocking sodium and chloride being re absorbed into the body.

84
Q

What are the ADRs in diuretics?

A

I’m giving it to you because either you’re hypertensive or you have too much fluid on your body. My side effects are gonna be hypotention and dehydration.
– hypovolemia
– electrolyte imbalance

85
Q

What is the nursing implications for diuretics?

A

Daily weights
– Monitor BP
– Administer early in the day
– Prevent orthostatic hypotension

86
Q

What is the first choice of drugs that were going to give patients to control blood pressure

A

Thiazide drugs

87
Q

What is action of thiazide drugs

A

distal convoluted tubule
– Reduction of blood volume
– Reduction of arterial resistance

88
Q

What re the ADRsa of thiazide drugs

A

Hypokalemia
– Dehydration
– Hyperglycemia- people start having elevated blood sugars b/c they think it b/c it inhibits how well insulin works
– Hyperuricemia- ncreased levels of uric acid caused gout. Gout is an inflammatory disease in small joints. OK? So uric acid causes gout. Too much uric acid, it’s gonna cause little nodules to form. And your small joints, like toes and fingers, those joints get inflamed.
– Hyperlipidemia- A lot of our diuretics stimulate the liver to make more fat, so we have hyperlimia

89
Q

What is the high-ceiling ( Loop) Diuretics ( Furosemide: Lasik)

A

Ascending loop of Henle & Rapid onset

90
Q

What is ADRs of high- ceiling diuretics

A

Hypotension - Hypokalemia
– Hyponatremia - Ototoxicity
– Hyperglycemia - Hyperuricemia
– Hyperlipidemia

91
Q

What are the nursing implications of loop diuretics

A

Loop diuretics are potassium wasting so they are hypo

92
Q

What is the potassium ( HYPER) sparing diuretics?

A

Diuretics: Spironolactone ( Aldactone)

93
Q

What is the action of potassium sparing diuretics?

A

It blocks aldolsterone So that’s how it keeps your body from re absorbing sodium. It just has a little bit of a diuretic effect, but it keeps the person from having hypo colemia.
– Blocks aldosterone in the distal nephron
– Retention of potassium
* Weaker diuretic- where we have to look into risk benefits

94
Q

What is the ADRs of potassium sparing diuretics?

A

hyperkalemia & avoid with ARB”S since they also promote hyperkalemia

95
Q

What are the nursing implications of potassium sparing?

A

*Regulation of BP by the Renin Angiotensin System

96
Q

What do Angiotensin - Converting Enzyme Inhibitors ( ACE) end in?

A

pril

97
Q

What is the action of ACE

A

Interrupts renin angiotension-aldosterone system (RAAS)

98
Q

What are the adverse effects of ACE hinibitors–

A

– First–dose hypotension : decrease blood volume
– Persistent Cough: increased bradykinin
– Hyperkalemia: potassium retention

99
Q

What is the interaction with NSAIDS

A

fluid retention
Angioedema: rare increased capillary permeability
– Fetal harm: renal failure

100
Q

What are the nursing implications?

A

You wanna make sure of what your blood pressure is, what your electro light levels are, what side effects the person has, and teach them to be alert for other drug drug interactions.

101
Q

What is the angitension II receptor blockers?

A

ARBs

102
Q

What is the action of ARBs?

A

They don’t block the inactive from becoming active , they block the receptor sites that active drugs hits- so that’s how they blocked the reabsoprtion

103
Q

What is an example of ARBs

A

Losartan (Cozaar)

104
Q

Why do you give an ARB

A

*Hypertension
*Heart failure

105
Q

What are the ADRs of ARBS

A

–Dizziness
–Birth defects

106
Q

What are the examples of newer ARBS

A

Candesartan (Atacand)
–Irbesartan (Avapro)
–Telmisartan (Micardis)
–Valsartan (Diovan)

107
Q

What is an example of cardiac glycoside?

A

Digoxin ( Lanoxin)

108
Q

What is the action of digoxin?

A

slows the transmission of cardiac impulses through the cardiac conduction system
– increases the force of cardiac contraction

109
Q

What are the ADRs of digoxin?

A

anorexia, nausea
– bradycardia

110
Q

What are the nursing implication for digoxin?

A

– Check apical pulse
– Monitor dig and K+ levels
*Relation of Ventricular Diameter to Contractile Flow

111
Q

What is angina pectoris –

A

– Sudden pain beneath the sternum often radiating to left shoulder and arm
– Oxygen demand greater than oxygen supply

112
Q

What are the types of angina?

A

Chronic Stable: Extertional
– Variant: any time even at rest
– Unstable: Medical Emergency

113
Q

What is an example of nitrate

A

nitroglycerin

114
Q

What is the action of nitrates?

A

Increases the blood flow to the coronary arteries
– Dilates the peripheral arteries- by doing so it increases the blood supply, oxygen to the heart

115
Q

Key administration for nitrates

A

Highly lipid soluble
- Very short half-life ( 5-7 minutes)

116
Q

What are the ADRs of nitrates?

A

orthostatic hypotension
– headache

117
Q

What are the key things to remember for nitrates sublingual

A

tablets or spray
- Drink water before taking
- Do not swallow, - Should feel a tingling sensation
- If pain not relieved in 5 minutes with initial dose call 911
§ Take 2nd dose in 5 minutes
§ Take 3rd dose 5 minutes later

118
Q

What are key things to remember for topical nitrate administration

A

Topical: Transdermal delivery systems
- Rotate sites and remove previous patch
- Need to wear continuously during daily activi

NUR 210 (1 decks)

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