Study Guide!!!!

Question 1

Heparin

415, 394-395

Answer 1

Class: Anticoagulant

Action: Used to prevent Thrombosis, by inhibiting the conversion of prothrombin to thrombin.

Example: Heparin Sodium

Implications:

1. Can be given Sub-Q to prevent thrombosis, not IM, if given IM patient may experience pain/hematoma
2. Monitor Partial Thromboplastin Time (heparin anti-factor Xa) 1.5-2 times control.
3. Monitor Platelet Count for Decrease, can indicate “Heparin Induced Thrombocytopenia)
4. Monitor for bleeding, and teach PT to report bleeding!
5. Antidote (Protamine Sulfate)

Question 2

Nitroglycerin
406-407, 416
Refer to box 24.1 (409)

Answer 2

Class: Nitrate #1 Acute Anginal attacks

Action: Dilate peripheral vessels to increase oxygen, and vasodilates so the heart does not have to work so hard by reducing preload & afterload.

Nursing Implications

1. Document onset, type, radiation, location, and duration of chest pain
2. Monitor apical pulse and BP
3. Explain to PT that headache will occur when drug therapy begins, but will resolve with time aspirin may also be given.
4. Tell PT to change positions slowly to avoid orthostatic hypotension and fall risk

Safety

1. After 1 tablet and 5 minutes of unrelieved or worsened pain call 911, take 2 more doses as needed while waiting.
2. Where gloves to protect yourself from hypotension from the ointment or patch medication.
3. Always remove previous ointment or patch before applying a new one to prevent overdose.
4. Never give sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), These dilate blood vessels and cause extreme BP drop when used with Nitrates!

Question 3

Lasix

365

Answer 3

Class: Loop Diuretic
Gebeneric Name: Furosimide

Action: Use the ascending loop of Henle to initiate sodium and water loss, which also causes a loss of magnesium, calcium, potassium.

Nursing Implications:

1. Contraindicated if allergic to sulfonamides
2. Monitor potassium for hypokalemia
3. Take with food or milk to prevent GI upset
4. Use sunscreen to prevent photosensitivity.

Question 4

Propanolol SATA

365

Answer 4

Class: Beta Blocker
Trade name: Inderal

Action: Decrease the sympathetic nervous system response, resulting in decreased BP, heart rate, contractility, cardiac output, and renin activity

Nursing Implications:
1. Check heart rate and BP before administration for bradycardia and orthostatic hypotension.
2. Check daily I&O and weight
3. Monitor for Bronchospasms
Teach
1. Rise slowly
2.Do not stop drugs abruptly could cause rebound hypertension, angina, or arrthymias.

Question 5

Captopril

366

Answer 5

Class: Angiotensin-Converting Enzyme (ACE) Inhibitor
Trade Name: Capoten

Action: Blocks the production of angiotensin II, a potent vasoconstrictor; reduces peripheral arterial resistance and BP.

Nursing Implications:
1. Monitor PT for edema with HF, decreased BP with hypertension, and new-onset cough.
Teach
1. Rise slowly
2. Report new onset cough
3. Use sunscreen to prevent photosensitivity
4. Understand angioedema which can occur anytime during therapy
5. Do not stop drug abruptly to avoid rebound hypertension, angina, or arrthymias

Question 6

ACE Inhibitors

409

Answer 6

Block production of angiotensin II, which is a potent vasoconstrictor. This reduces peripheral arteriole resistance vasodilation which lowers BP. May also cause potassium retention. Inform HCP if dry cough occurs!

Question 7

Aneurysms

425-428

Answer 7

Signs & Symptoms:

1. Back pain
2. Flank pain
3. Abdominal fullness
4. Nausea
5. Pulsating mass in abdomen
6. Severe sudden backpain with rupture

Dx Tests:

1. Ultrasound
2. CT
3. Aortography

Therapeutic Measures:

1. Observe for aneurysm growth
2. Maintain BP
3. Surgical repair & graph

Complications

1. Rupture
2. Shock
3. Hemorrhage

Priority Nursing Dx:

1. Acute Pain
2. Risk for deficient fluid volume
3. Risk for ineffective tissue perfusion

Question 8

Bumex

Answer 8

Class: Loop Diuretic
Generic name: bumetanide

Action: Decreases Fluid Overload

Nursing Implications:

1. Check BP and pulse before giving
2. Monitor electrolyte levels (especially potassium and those on digitalis), and fluid status (daily weight, I&O’s, thirst, dry mouth, oliguria) throughout therapy.

Question 9

Potassium

Answer 9

Normal Level: (3.5-5.3)

Hypokalemia (Low Potassium)- weak, irregular, thready pulse

Hyperkalemia (High Potassium)- Muscle twitches, cramps, muscular weakness, slow irregular heart rate, weak pulse, reduced BP

Arrhythmias are also are a potential threat, all dangerous potassium levels should be reported to HCP!

Question 10

Modifiable vs Nonmodifiable Risks

363

Answer 10

Modifiable

1. Lifestyle
2. Blood Glucose Levels
3. Activity Level
4. Smoking
5. Salt Intake
6. Alcohol Intake
7. Insufficient sleep

Nonmodifiable

1. Family History
2. Age
3. Ethnicity

Question 11

Aneurysms

Answer 11

Bulging Balloon, or dilation of weakened arterial walls,

Risk Factors: Antheroschlerosis, hypertension, smoking, trauma, congenital abnormalities, heredity.

Types of Aneurysm

1. Fusiform: Dilation of circumference artery (360)
2. Saccular Aneurysms: When it bulges to 1 side
3. Dissecting Aneurysm: when cavity formed from a tear in the artery wall (Blood can pump into tear causing rupture).

Signs & Symptoms

1. Back pain
2. Flank pain
3. Abdominal Fullness
4. Nausea
5. Pulsating mass in the abdomen
6. Severe sudden back pain with rupture

Dx Tests

1. Ultrasound
2. CT scan
3. Aortograpy

Therapeutic Measures

1. Observe for growth of aneurysms
2. Maintain BP
3. Surgical repair and graft

Complications

1. Rupture
2. Shock
3. Hemmorphage

Question 12

Varicose Veins

Answer 12

Elongated, tortuous, dilated veins, caused by structural defects in vessel walls. With defect vessels, dilation can occur which leads to venous valves. This can cause valve reflux