test 2 Flashcards
Heart failure management
Digoxin side effects
Report fatigue, muscle weakness, confusion, loss of appetite
toxicity warnings and symptoms
Lack of appetite, nausea, vomiting, or diarrhea
Headache, confusion, anxiety, or hallucinations
Restlessness, weakness, or depression
Changes in vision such as blurred vision or seeing halos around bright objects
A fast, slow, or irregular heartbeat, or palpitations (fast, forceful heartbeats in an irregular rhythm)
digoxin patient education
Count pulse for 1 min before taking the medication. If the pulse rate is irregular or the pulse rate is outside of the limitations set by the provider (usually less than 60/min or greater than 100/min), hold the dose and contact the provider.
Take the digoxin dose at the same time each day.
Do not take digoxin at the same time as antacids. Separate the two medications by at least 2 hr.
Report manifestations of toxicity, including nausea, fatigue, muscle weakness, confusion, and loss of appetite.
Have blood digoxin and potassium levels checked regularly.
furosemide side effects (diuretic)
Dehydration
Hypokalemia
Hypomagnisemia
Hypovolemia
Metabolic Acidosis
furosemide patient education
Furosemide IV: no faster than 20mg/min
Teach: ingest foods/drinks high in potassium (if taking loop & thiazide)
heart failure classifications
class 1- no symptoms
class 2- mild symptoms, comfortable at rest, slight limits
class 3- moderate symptoms with less than normal physical activity, only comfortable at rest
class 4- severe symptoms- minimal physical activity even at rest
left sided heart failure symptoms
Dyspnea, orthopnea (shortness of breath while lying down), nocturnal dyspnea
Fatigue
Displaced apical pulse (hypertrophy)
S3 heart sound (gallop)
Pulmonary congestion (dyspnea, cough, bibasilar crackles)
Frothy sputum (can be blood-tinged)
Altered mental status
Manifestations of organ failure, such as oliguria (decrease in urine output)
Nocturia
Heart failure interventions
Monitor daily weight and I&O.
Assess for shortness of breath and dyspnea on exertion.
Administer oxygen as prescribed.
Monitor vital signs and hemodynamic pressures.
Position the client to maximize ventilation (high-Fowler’s).
Monitor diagnostic results to track progress.
Assess for manifestations of medication toxicity (digoxin toxicity).
Encourage bed rest until the client is stable.
Encourage energy conservation by assisting with care and ADLs.
Maintain dietary restrictions as prescribed (restricted fluid intake, restricted sodium intake).
Provide emotional support to the client and family.
right sided heart failure symtoms
Jugular vein distention
Ascending dependent edema (legs, ankles, sacrum)
Abdominal distention, ascites
Fatigue, weakness
Nausea and anorexia
Polyuria at rest (nocturnal)
Liver enlargement (hepatomegaly) and tenderness
Weight gain
American College of Cardiology and American Heart Association staging heart failure
A: High risk for developing heart failure
B: Cardiac structural abnormalities or remodeling but no manifestations of heart failure
C: Current or prior manifestations of heart failure
D: Refractory end-stage heart failure
Left-sided heart (ventricular) failure risk factors
Hypertension
Coronary artery disease, angina, MI
Valvular disease (mitral and aortic)
Smoking
Right-sided heart (ventricular) failure risk factors
Left-sided heart (ventricular) failure
Right ventricular MI
Pulmonary problems (COPD, pulmonary fibrosis)
heart failure dishcharge instructions
Take diuretics in the early morning and early afternoon.
Restrict fluid and sodium as instructed. Regulate potassium intake as instructed to prevent high or low potassium levels. A dietitian can help with menu planning.
Check weight daily at the same time, and notify the provider for a weight gain of 0.9 kg to 1.4 kg (2 to 3 lb) in 1 day or 2.3 kg (5 lb) in 1 week.
Schedule regular follow-up visits with the provider.
Obtain the pneumococcal and yearly influenza vaccines.
Initiate regular exercise as tolerated and prescribed.
Participate in cardiac rehabilitation program.
ACE inhibitors: enalapril, captopril
Angiotensin receptor II blockers: losartan
Calcium channel blockers: diltiazem, nifedipine
Phosphodiesterase-3 inhibitors: milrinone
teaching and interventions
ACE inhibitors: enalapril, captopril
Angiotensin receptor II blockers: losartan
Calcium channel blockers: diltiazem, nifedipine
Phosphodiesterase-3 inhibitors: milrinone
Nursing:
Monitor for hypotension, angioedema, decreased taste, skin rash, increased K+
Teach:
Can cause dry cough
Notify provider if above conditions develop
beta blockers- lol drugs teaching and side effects
Nursing:
Monitor blood pressure, pulse, activity tolerance, orthopnea(difficult breathing lying down)
Check orthostatic B/P
Teach:
Weigh, check B/P daily
nitro
Vasodilators: nitroglycerin and isosorbide mononitrate
side effects and client education
Treat angina, control B/P
Can cause orthostatic hypotension
Headache common adverse effect
Change positions slowly
nursing interventions to reduce fluid
give diuretics, low sodium, limit fluids, weigh daily
Pulmonary embolism lab tests
Laboratory tests
– Arterial Blood Gases
* PaCO2 low initially
– d/t initial hyperventilation
– Respiratory alkalosis
* Hypoxia progresses resp. acidosis
* Leads to metabolic acidosis as well
– Lactic acid buildup d/t tissue hypoxia
– D-dimer
* Elevated d/t clot formation and release
of products of fibrin degradation
digoxin toxicity symptoms
pulmonary embolism diagnostic test
multidetector-row computed tomography angiography (MDCTA)
* Standard for detecting PE
* Uses contrast
– V/Q scan- ventilation perfusion scale
* Used in clients allergic to contrast
– Pulmonary angiography
* Gold standard when not MDCTA
available
* Informed consent needed
it is costly and invasive- uses a catheter
pulmonary embolism medications
anticoagulants- heparin, enoxaparin, and warfarin
Thrombolytic therapy- Alteplase, reteplase, and tenecteplase are used to dissolve blood clots and restore pulmonary blood flow.
Direct thrombin inhibitor- Dabigatran acts as a direct inhibitor of thrombin.
Direct factor Xa inhibitor
Rivaroxaban, apixaban, and fondaparinux - inhibits thrombin production
nursing actions anticoagulants
Assess for contraindications (active bleeding, peptic ulcer disease, history of stroke, recent trauma).
Monitor bleeding times: Prothrombin time (PT) and international normalized ratio (INR) for warfarin, partial thromboplastin time (aPTT) for heparin, and complete blood count (CBC). QEBP
Monitor for adverse effects of anticoagulants (thrombocytopenia, anemia, hemorrhage).
pulmonary embolism management strategies
Administer oxygen therapy
Position the client to maximize ventilation (high-Fowler’s = 90°).
Initiate and maintain IV access.
Administer medications as prescribed.
Assess respiratory status at least every 30 min.
Auscultate lung sounds.
Measure rate, rhythm, and ease of respirations.
Inspect skin color and capillary refill.
Examine for position of trachea.
Assess cardiac status.
Compare blood pressure in both arms.
Palpate pulse quality.
Check for dysrhythmias on cardiac monitor.
Examine the neck for distended neck veins.
Inspect the thorax for petechiae.
Provide emotional support and comfort to control client anxiety.
Monitor changes in level of consciousness and mental status.
Lupus triggers
trauma, infection, certain medications, UV light exposure, stress
Lupus patient education
Small, frequent meals for anorexia
Limit salt intake
Avoid UV/prolonged sun exposure
Use sunscreen
Mild protein shampoo
Avoid harsh hair treatments
Steroid creams for skin rash
Report edema immediately
Avoid crowds and ill individuals
Clients of childbearing age – risks of pregnancy w/lupus and medications
Lupus nursing care
Pain, mobility, fatigue
Vital signs (BP)
Hypertension, edema, urine output (kidney involvement)
Diminished breath sounds (pleural effusion)
Sharp inspiratory chest pain, tachycardia (pericarditis)
Lupus expected findings
Fatigue/malaise
Alopecia
Blurred vision
Pleuritic pain
Anorexia/weight loss
Depression
Joint pain, swelling, tenderness
Weakness
Fever (also a major indication of exacerbation)
Anemia
Lymphadenopathy
Pericarditis (presence of a cardiac friction rub or pleural friction rub)
Raynaud’s phenomenon (arteriolar vasospasm in response to cold/stress)
Erythematous “butterfly” rash on the nose and cheeks (raised, dry, scaly)
Discoid: coin shaped lesions on body areas exposed to sun (face, scalp)
Oral lesions
lab tests- Lupus
Skin biopsy: Used to diagnose DLE by confirming the presence of lupus cells and cellular inflammation.
Antinuclear antibodies (ANAs): antibodies produced against one’s own DNA; positive titers in 95% of clients who have lupus
Serum complement (C3, C4): decreased
Erythrocyte sedimentation rate (ESR): elevated due to systemic inflammation
CBC lab test for lupus
pancytopenia
urinalysis- lupus
Positive for protein and RBCs (kidney involvement)
BUN and blood creatinine- lupus
Increased (with kidney involvement)
hypokalemia signs and symptoms
can be caused by vomiting, diuretics
heart palpitations, constipation, fatigue, tingling and numbness
severe- muscle cramps and twithching, arrhythmias, polyuria and polydipsia
Lupus meds
NSAIDS: reduce inflammation and arthritic pain
Immunosuppressant agents: suppress the immune response
Methotrexate and azathioprine
Corticosteroids: immunosuppression and reduction of inflammation
Antimalarial: suppression of synovitis, fever, fatigue
Hydroxychloroquine
