Test 3 NSG 307 Flashcards

1
Q

How is Lovenox given?

A

Lovenox (enoxaparin) is a low molecular weight heparin. It is given subcutaneously, most often from pre filled syringes). Most common site is the abdomen. Stay at least 2” from belly button, do not aspirate before inject, NEVER massage site afterwards.

Never give with heparin, do this by preforming a double check.

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2
Q

What labs go with things - Like what labs go with heparin? What labs go with Coumadin?

A
  • Heparin= PTT: (Partial thromboplastin time) test that looks at how long it takes for blood to clot.
  • Coumadin=*PT: (Prothrombin time) measures amount of time it takes for plasma in blood to clot.
  • INR= (international normalized ratio) standardizes results of PT tests
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3
Q

Heart failure patient education

A
  • recording daily weight & reporting gains of > 2 lbs a day
  • -Notify provider if you experience SOB, Edema, chest pain, syncope, dizziness, blurred vision, or unexplained rapid weight gain (i.e. 2lbs in a day)
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4
Q

What are the adverse effects of ace inhibitors?

A
  • Hypotension, dizziness, dry cough, fatigue, angioedema, hyperkalemia, first dose HTN
  • A characteristic adverse effect that occurs is a dry, nonproductive cough BUT is reversible with discontinuation of the therapy.
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5
Q

what do ace inhibitors do?

A

These are drugs that inhibit angiotensin converting enzyme which converts angiotensin I to angiotensin II. Their effects are primarily cardiovascular and renal. This reduces BP by decreasing systematic vascular resistance, and prevents sodium and water reabsorption by reducing aldosterone secretion.

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6
Q

indications for ace inhibitors?

A

first line drugs for CHF and hypertension. They are drugs of choice for diabetic clients with cardiovascular disease.

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7
Q

What is Plavix for?

A
  • Plavix is used to prevent blood clots, and in people with certain disorders of the heart or blood vessels.
  • -Indications: Reducing the risk of stroke, MI, vascular death, peripheral arterial disease in high-risk patients, acute coronary syndrome, transient ischemic attack (TIA), unstable angina.
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8
Q

what is plavix?

A
  • Also known as Clopidogrel,

- – it is an antiplatelet (like aspirin)

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9
Q

What are the adverse effects of the anticoagulants?

A
  • –Risk of excessive bleeding (hemorrhages) is primary
  • –Blood in urine, black feces, severe bruising, nosebleeds, blood in vomit, coughing blood, unusual headaches, difficulty breathing.
  • The most serious adverse reactions are hemorrhage, agranulocytosis, leukopenia, eosinophilia, and thrombocytopenia, depending on the specific product.
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10
Q

Montelukast (Singular): (Pt teaching).

A

Take at night (to combat morning secretions)

  • Do not take if you are going to start Rafampin, or phenobarbital as these drugs will increase singulars concentrations.
  • do not use if you have a lactose allergy
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11
Q

Xanthine Derivative: indications and adverse effects.

A
  • Not commonly used.
  • Indications: Theophylline is the most commonly used and is given IV to pts who have Status Asthmaticus and do not respond to fast acting beta agonist such as ephedrine. as well as adults 12 and older as a prophylaxis and long term treatment of asthma.
  • Adverse effects include: liver dysfunction, and common (N/V, dizziness, insomnia, headache)
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12
Q

What would you give to thin secretions?

A

-An Expectorant such as Guaifenesin (Mucinex)

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13
Q

Thrush is a side effect if what is inhaled?

A
  • Inhaled Corticosteroid
  • You should instruct the client to rinse mouth thoroughly with water and spit it out. (This will remove excess steroid and reduce the risk to contract Thrush/ Candidas)
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14
Q

Emphysema – know & understand what emphysema is.

A
  • Type of COPD.
  • Can’t exhale (no cough or sputum). The surface area that gas exchange takes place is reduced because enzymes that are released from Leukocytes in response to inflammation in the alveolar have destroyed lung tissue.
    • Caused by smoking.
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15
Q

What is an asthma attack?

A

An asthma attack is a sudden worsening of asthma symptoms caused by the tightening of muscles around your airways (bronchospasm

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16
Q

what happens during and asthma attack?

A

-lining of the airways also becomes swollen or inflamed and thicker mucus
– more than normal – is produced.
All of these factors – bronchospasm, inflammation, and mucus production
– cause symptoms of an asthma attack such as difficulty breathing, wheezing, coughing, shortness of breath, and difficulty performing normal daily activities. Most are short, and normal breathing is subsequently recovered. However, an asthma attack may be prolonged and may not respond to a typical drug therapy

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17
Q

What role antihistamines have in allergies?

What can they do? What cant they do? what do they reduce? what kind of effect does is cause in the nervous system?

A
  • -They compete with histamine for H1 receptors (Histamine antagonists). Ex. Benadryl and Zyrtec (cetirizine). They prevent the adverse consequence of histamine. Vasodilation, increased GI and respiratory secretions, increased capillary permeability. For the immune system in response to an allergic reaction they bind to the receptors that the mast cells would usually bind to thus preventing inflammation
  • -They can’t knock off the histamine that has already been bound so taking it early works better.
  • –Benadryl is fast acting there as Zyrtec (cetirizine) needs to be taken before the allergy happens.
  • *Don’t give them to the elderly mostly Benadryl.** —If it makes you tired than take it at bedtime.
  • –More effective in preventing the actions then reversing them.
  • – For smooth muscles they reduce salivary, gastric, and respiratory secretions.
  • —Skin: reduces capillary permeability to stop itching. Has a anticholinergic effect: drying effect that reduces secretions (tears, nasal).
18
Q

what are the indications of antihistamines?

A

for the management of nasal allergies, seasonal or perennial allergic rhinitis, and some of the typical symptoms of the common cold.

19
Q

Adverse effects of antihistamines; contraindication.

A

Drying, difficulty urinating (BPH), constipation, blurry vision, drowsiness. *Can’t see, can’t pee, can’t spit, can’t shit (anticholinergic type effects)

20
Q

pt teaching: antihistamines

A

Pt. Teaching: report excessive sedation, confusion, or hypotension. Don’t take with other sedative OTC drugs. Avoid driving, drinking alcohol. If dry mouth use hard candy. Preform good oral care (pg. 577).

21
Q

Why would a doc prescribe intranasal/inhaled corticosteroids over oral corticosteroids?

A

Intranasal spray works locally without systemic adverse effects and works immediately. Flonase. Decreases the inflammation response in the nasal cavity. Less adverse effects. Can have rebound congestion

22
Q

What are the side effects of albuterol (sympathomimetic)

A

HTN, tachycardia, tremor, headache

23
Q

What are the levels of the stepwise asthma plan? (bronchodilator 1st & corticosteroid 2nd - understand the theory behind the steps

A

First use bronchodilator like albuterol to open up the alveoli then use the corticosteroid. This way your lungs will be super open and absorb lots of steroids

24
Q

What do bronchodilators actually do?

A

SABA (short acting beta agonist) Albuterol which is a rescue inhaler and Atrovent which is a preventive bronchodilator.
–They relax bronchial smooth muscle which caused dilation of the bronchi that are narrowed from inflammation or bronchospasm

25
Q

What do antihistamines do? indications

A

Relieve cold symptoms, nasal allergies, allergic rhinitis, allergic reactions, motion sickness, Parkinson disease, sleep aid, they dry up secretions

26
Q

What is the correct way to use a metered dose inhaler – how would you teach a pt to use it?

A

a. Inhale completely
b. Exhale completely
c. Put inhaler in mouth, press it, inhale completely
d. Then hold for about 5 seconds
e. Repeat for a second puff (wait between 2 to 5 minutes between puffs)
f. (need to press before beginning inhale)
g. Rinse mouth after each use (pg. 130)

27
Q

What is COPD?

A
  • -Lung disease that makes it hard to breathe. It is caused by damage to lungs over many years, usually from smoking.
  • -Usually a mix of two diseases:
  • *chronic bronchitis (airways that carry air to the lungs get inflamed and make a lot of mucus; this narrows/blocks airways making it harder to breathe) and
  • *emphysema (air sacs are damaged and lose their stretch, less air travels which makes you short of breath).
  • *Asthma also falls in this category when there is an obstruction present (pg. 589)
28
Q

What is asthma?

A

Usually caused by an irritant. Spasms in the bronchi of the lungs.

–Use Albuterol or epinephrine

29
Q

What are the side effects of Sudafed?

A

Dry mouth, HTN, nerviness

30
Q

What are the side effects of Atrovent

A
  • –Anticholinergic (prevents bronchoconstriction IS NOT a bronchodilator)
  • *Dry mouth, nasal congestion, stops all secretion and mobility….GI problems (pg. 594).
31
Q

What do you do when someone is having an asthma attack – what are the meds?

2..also know class and names for respiratory drugs

A

Epinephrine, Albuterol

–Treatment for an asthma attack requires the dilation of the airways and reduction of inflammation.

  • -Medications used are:
  • *bronchodilators (beta adrenergic agonists), **anticholinergic,
  • *xanthines,
  • *leukotriene receptor antagonists,
  • *corticosteroids.
  1. .
    - –The beta adrenergic agonists include Albuterol (SABA).
    - –The anticholinergics are Atrovent.
    - –The xanthine derivatives are theophylline.
    - –The leukotriene receptor antagonists are Singulair. —The corticosteroids are budesonide and fluticasone (flowvent).
    - –Epinephrine pens are used as emergency devices in the case of an asthma attack that causes anaphylaxis. They are very quick to affect the lungs. Albuterol is also a fairly quick effect on the lungs.
32
Q

What is high blood pressure? How does it tie into cardiovascular disease?

A

Cardio output x resistance = blood pressure. When these factors are high you get HTN.

  • -Some causes are: hyperlipidemia or high cholesterol, which causes more resistance in the blood vessels (decreases diameter and elasticity due to hardening and buildup).
  • -Fluid retention, kidney disease.
  • *If your heart is overloaded you are at risk for cardiovascular disease.
  • ***The risk factors for HTN are the same as for CVD. It is unknown which comes first.
33
Q

What is essential hypertension? What is the difference between essential hypertension & secondary HTN?

A
  • Essential HTN: unknown cause. Happening with age, being overweight, DM which increases your risk for CVD.
  • Secondary HTN: this has a cause and if you remove the cause then the HTN goes away like pregnancy, side effect of a drug, tumor, kidney disease.
34
Q

What risk factors for heart disease that can be addressed & changed?

A
  • -gender & age cannot be changed so they are not addressed. Smoking can be addressed because it can be addressed
  • -Smoking, high LDL cholesterol and low HDL cholesterol, uncontrolled hypertension, physical inactivity, obesity, uncontrolled diabetes, uncontrolled stress and anger.
35
Q

Nitroglycerine: what it does?

  1. .How it has to be in its little glass bottle, how does it have to be used?
  2. .How many minutes apart?
  3. .What is the expected effect?
  4. .What are the expected side effects?
A

Nitroglycerine is a nitrate, they dilate all blood vessels. Used to redistribute blood to previously ischemic myocardial tissue after MI. Due to vasodilation, they reduce venous return -> reduce L ventricular preload -> reduce L ventricular wall tension -> reduce myocardial oxygen demand.

  1. .Given sublingual to bypass the liver due to large first pass effect.
    - Store in original container – exposure to air and moisture can inactivate the drug.
    - Given IV only in the ICU setting for ischemic pain, MI, heart failure, pulmonary edema, HTN emergency. Given topically for slow absorption for angina prophylaxis.
  2. .Nitro protocol – 1 tab SL q 5 minutes until pain is relieved for a max. of 3 doses. If pain is not relieved after the 3rd dose, go to the ER!
  3. .Expected effect – cessation of chest pain.
  4. .Side effects: HEADACHE, reflex tachycardia, postural hypotension.
36
Q

What does TPA do?

A

Tissue plasminogen activator (TPA) is a thrombolytic. It destroys clots that have already formed. It activates the conversion of plasminogen to plasmin, the enzyme that breaks down a thrombus.

37
Q

Patients need to be tapered off β-blockers not stopped abruptly - what is the rationale for that?

A
  • Beta-blockers help to slow heart, lower BP, anxiety (metoprolol: Lopressor).
  • **By suddenly discontinuing use it increases the risk of a heart attack or other heart problems by giving a suddenly faster heart rate.
38
Q

What does digoxin do?

What is digoxin’s role in heart failure?

A
  • *Inhibits sodium potassium ATPase.

* *It helps the heart beat stronger and with more rhythm.

39
Q

Lasix ; indications, what patient findings might concern us that we would we want to address before giving Lasix?

A
  • *Indications: edema in people w/CHF, liver dz, kidney dz, and to tx HTN.
  • *Pt finding of concern: problems urinating, allergy to sulfa drugs, electrolyte imbalance, diabetes,
40
Q

What foods can interfere with Coumadin?

A
  • Garlic, ETOH and foods high in Vit K content (broccoli, sardines, leafy greens, tofu, oysters)
    We talked about Vitamin K. We talked about potassium-containing foods. Make sure you are comfortable with those types of foods that could be problematic for somebody.
41
Q

Atorvastatin – what’s it for?

A
  • Reduces levels of “bad” cholesterol (LDL’s) and triglycerides in blood, while increasing “good” -cholesterol (HDL)
  • Tx high cholesterol and lowers risk of stroke, heart attack, & other heart complications