Heparin
415, 394-395
Class: Anticoagulant
Action: Used to prevent Thrombosis, by inhibiting the conversion of prothrombin to thrombin.
Example: Heparin Sodium
Implications:
- Can be given Sub-Q to prevent thrombosis, not IM, if given IM patient may experience pain/hematoma
- Monitor Partial Thromboplastin Time (heparin anti-factor Xa) 1.5-2 times control.
- Monitor Platelet Count for Decrease, can indicate “Heparin Induced Thrombocytopenia)
- Monitor for bleeding, and teach PT to report bleeding!
- Antidote (Protamine Sulfate)
Nitroglycerin
406-407, 416
Refer to box 24.1 (409)
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
- Document onset, type, radiation, location, and duration of chest pain
- Monitor apical pulse and BP
- Explain to PT that headache will occur when drug therapy begins, but will resolve with time aspirin may also be given.
- Tell PT to change positions slowly to avoid orthostatic hypotension and fall risk
Safety
- After 1 tablet and 5 minutes of unrelieved or worsened pain call 911, take 2 more doses as needed while waiting.
- Where gloves to protect yourself from hypotension from the ointment or patch medication.
- Always remove previous ointment or patch before applying a new one to prevent overdose.
- Never give sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), These dilate blood vessels and cause extreme BP drop when used with Nitrates!
Lasix
365
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:
- Contraindicated if allergic to sulfonamides
- Monitor potassium for hypokalemia
- Take with food or milk to prevent GI upset
- Use sunscreen to prevent photosensitivity.
Propanolol SATA
365
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.
Captopril
366
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
ACE Inhibitors
409
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!
Aneurysms
425-428
Signs & Symptoms:
- Back pain
- Flank pain
- Abdominal fullness
- Nausea
- Pulsating mass in abdomen
- Severe sudden backpain with rupture
Dx Tests:
- Ultrasound
- CT
- Aortography
Therapeutic Measures:
- Observe for aneurysm growth
- Maintain BP
- Surgical repair & graph
Complications
- Rupture
- Shock
- Hemorrhage
Priority Nursing Dx:
- Acute Pain
- Risk for deficient fluid volume
- Risk for ineffective tissue perfusion
Bumex
Class: Loop Diuretic
Generic name: bumetanide
Action: Decreases Fluid Overload
Nursing Implications:
- Check BP and pulse before giving
- Monitor electrolyte levels (especially potassium and those on digitalis), and fluid status (daily weight, I&O’s, thirst, dry mouth, oliguria) throughout therapy.
Potassium
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!
Modifiable vs Nonmodifiable Risks
363
Modifiable
- Lifestyle
- Blood Glucose Levels
- Activity Level
- Smoking
- Salt Intake
- Alcohol Intake
- Insufficient sleep
Nonmodifiable
- Family History
- Age
- Ethnicity
Aneurysms
Bulging Balloon, or dilation of weakened arterial walls,
Risk Factors: Antheroschlerosis, hypertension, smoking, trauma, congenital abnormalities, heredity.
Types of Aneurysm
- Fusiform: Dilation of circumference artery (360)
- Saccular Aneurysms: When it bulges to 1 side
- Dissecting Aneurysm: when cavity formed from a tear in the artery wall (Blood can pump into tear causing rupture).
Signs & Symptoms
- Back pain
- Flank pain
- Abdominal Fullness
- Nausea
- Pulsating mass in the abdomen
- Severe sudden back pain with rupture
Dx Tests
- Ultrasound
- CT scan
- Aortograpy
Therapeutic Measures
- Observe for growth of aneurysms
- Maintain BP
- Surgical repair and graft
Complications
- Rupture
- Shock
- Hemmorphage
Varicose Veins
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
