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PNUR 122 Midterm
Study guide for exam 1
139
Nursing
Undergraduate 1
07/26/2009

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Term
In the clotting process, what happens when an injury occurs?
Definition
1. Cells lining the damaged blood vessel release chemicals that begin the clotting process.
2. The vessel immediately spasms or constricts to limit blood flow to the injured area.
3. Small blood componets, called platelets, become sticky, adhere to the injured area, and aggregate, or clump, to the injured area to plug the damaged vessel.
Term
What is the difference b/w anticoagulants and thromolytics?
Definition
Anticoagulants prevent the formation of clots whereas thrombolytics dissolve life threatening clots (EVERY clot).
Term
What are anticoagulants?
Definition
Drugs that prevent the formation of clots. They change the clotting factor. They do not do anything to change a clot once it has already been formed. They are the most commonly prescribed coagulation modifier. They inhibit the clotting action of platelets. Increase the time to form clots.
Term
What are thrombolytics?
Definition
Drugs that dissolve life threatening clots. They get rid of EVERY clot, so they increase the bleeding risk. They end en "-ase."
NO HERBALS!!
Term
What is warfarin"
Definition
It is the most prescribed anticoagulant drug.
Term
Warfarin lab values:
Definition
PT/INR:
PT 12-15 sec
INR 2-4.5
Term
What is a normal clotting time range (thromobolytic time -PT) ?
Definition
12-15 seconds
Term
Antidote to anticoagulants like warfarin?
Definition
Vitamin k
Term
What is another name for warfarin?
Definition
Coumadin
Term
Medications to avoid while on warfarin:
Definition
1. NSAIDs (they increase bleeding)
2. diuretics
3. SSRIs and other antidepressants
4. steroids
5 antibiotics (vaccines)
6. vitamin k
7. herbals like garlic, ginger, fever few (because they increase bleeding- anticoagulants effects)
Term
What are the factors that are responsible for blood pressure?
Definition
1. cardiac output- volume of blood pumped per minute
2. peripheral resistance- friction in the arteries
3. blood volume- total amount of blood in the vascular system
4. vasomotor center (in medulla oblongata)
5. baroreceptors in aorta and internal carotid arteries
6. emotions
7. hormones and other agents
8. lifestyle changes
Term
What is cardiac output?
Definition
volume of blood pumped per minute
Term
What is peripheral resistance?
Definition
friction in the arteries
Term
What is blood volume?
Definition
total amount of blood in the vascular system
Term
Where is the vasomotor center
Definition
in the medulla oblongata
Term
What are positive lifestyle changes that can be made in relation to the cardiovascular system?
Definition
1. stop using tobacco products
2. limit sodium intake
3. eat foods rich in potassium and magnesium such as bananas, beans, spinach, and tomatoes
4. limit alcohol consumption
5. implement a medically supervised excersize plan
6. reduce stress level by implementing coping strategies
7. limit caffeine consumption
8. reduce dietary saturated fats
9. keep weight at an optimum level
10. have hyperlipidemia treated
11. have hypertension treated
Term
What dietary changes can be made to reduce hyperlipidemia?
Definition
increase soluble fiber in the diet by eating foods such as oat bran, apples, beans, grapefruit, and broccoli
Term
What are diuretics?
Definition
Drugs that are effective at reducing fluid volume and relieving symptoms of heart failure.
Term
How do diuretics work to relieve heart failure?
Definition
1. reduce blood volume, edema, and congestion
2. the work load on the heart decreases, so cardiac output increases
3. often used in combination with other drugs to treat heart failure
Term
What should you watch for when using diuretics?
Definition
hyperkalemia, electrolyte imbalance, dehydration
Term
What are the risk factors for hypertention?
Definition
age
weight
heredity
males
African American
tobacco use
high fat diet
Term
What population has a decreased risk factor for hyper tension?
Definition
Mexican Americans
Term
What is heart failure?
Definition
HF is the inability of ventricles to pump enough blood to meet the body's metabolic needs.
Term
What are the risk factors for heart failure?
Definition
older adults
African American
male
high BP
myocardial infarction (5x greater risk)
Term
What are the treatment goals for heart failure?
Definition
decrease peripheral resistance
slow it down
dialate blood vessels
Term
What is left-sided heart failure?
Definition
Left ventricle blood backs up into the lungs. S/sx are congestive heart failure, cough, shortness of breath, orthopenea, muscle damage to ventricle
Term
Orthopenea
Definition
Inability to breath when laying flat.
Term
What is right-sided heart failure?
Definition
right ventricle blood backs up into the peripheral veins causing swelling feet and ankles (peripheral edema). Affects the liver. Fills organs with fluid.
Term
Which heart failure s more common?
Definition
Left-sided.
Term
Drugs that help HF?
Definition
cardiac glycosides, ACE inhibitors, vasodialators, diuretics, phosphodiesterace inhibitors, beta blockers
Term
How do cardiac glycosides treat HF?
Definition
They help heart contract more forcefully and beat slower. Positive inotropic. The nave a NARROW margin of safety, because they can create dysrhythmias.
Term
What population should use non selecive adrenergic blockers with caution?
Definition
asthmatic patients
Term
How do ACE inhibitors treat HF?
Definition
1st line drug. They lower peripheral resistance and reduce blood volume. This DIMINISHES AFTERLOAD and increases cardiac output, dialates veins, returns blood to the heart. It decreases preload, and peripheral edema. Ex. Lisinopril. May increase potassium levels. Do NOT take salt substitutes. Take BP one hour before meals.
Term
How do vasodialators treat HF?
Definition
LAST RESORT due to many side effects. They relax blood vessels and lower BP.
Term
How do diuretics treat HF?
Definition
They are used in combination with other drugs. They decrease blood volume, edema, and congestion.
Term
How do phosphodiesterase inhibitors treat HF?
Definition
Short- term, acute heart failure. VERY TOXIC. Usually an IV and on a heart monitor. They increase force of contraction and cause vasodilation.
Term
How do beta-adrenergic blockers treat HF?
Definition
Usually used in combination with other drugs. They decrease cardiac workload by DECREASING the AFTERLOAD.
Term
What are dysrhythmias?
Definition
There is a defect in the formation or conduction of electrical impulses across the myocardium. Drug therapy SLOWS the impulse conduction.
Term
Why do digoxin levels need to be monitored?
Definition
They can cause serious dysrhythmias.
Term
What are some common direct-acting vasodialators?
Definition
hydralazine (Apresoline)
ososorbide denitrate (Isordel)
Term
What do beta blocker drugs end in?
Definition
"-olol"
Term
What is the difference b/w beta 1 and beta 2 antagonists and nonselective beta antagonists?
Definition
B1 -heart
B2 -lungs
nonselective- block both b1 and b2
Term
What are beta blockers used for?
Definition
They are used to treat a large number of cardiovascular diseases like hypertension, myocardial infarction, heart failure, and dysrhthmias.
Term
What are the actions of ACE inhibitors?
Definition
They block the enzyme that changes angiotensin I to angiotensin II. This means there is no constriction of arterioles which DECREASES peripheral resistance, and there is no secretion of aldosterone which DECREASES blood volume.
Term
What are ACE inhibitors used for?
Definition
hypertension, heart failure, and MI
Term
What are the three angina types?
Definition
stable, unstable, and vasospastic
Term
What is stable angina?
Definition
Predictable and subsides with rest
Term
What is unstable angina?
Definition
Unpredictable. More frequent and severe. Does not stop with rest.
Term
What is vasospastic (varient) angina?
Definition
spasm of the coronary artery (AKA Printzmetal's)
Term
What are some common drugs for angina?
Definition
nitrates (organic)
Term
How do angina drugs work?
Definition
They reduce myocardial demand for oxygen which:
slows the HR, REDUCES PRELOAD by dilating veins, reduces contractility, decreases BP REDUCING AFTERLOAD, relieves the symptoms only (not a cure).
Term
What are the types of organic nitrates?
Definition
Short-acting (nitroglycerin) and Long-acting (isosorbide denitrole)
Term
How do organic nitrates relieve angina?
Definition
They dilate veins and coronary arteries, relax both arterial and venous smooth muscle by vasodilation, reduce preload (less blood in chambers), reduce afterload (decrease cardiac output), treat variant angina by relaxing spasms.
Term
What is nitroglycerin?
Definition
It is a short-acting organic nitrate. It works on acute angina already in progress. It can be taken sublingually, IV, or patch.
Term
What is isosorbide denitrole (Isordil)?
Definition
It is a long-acting angina med. It reduces s/sx of HF. It can be taken orally or as a patch.
Term
Ex. of Anaphylaxis shock?
Definition
From allergies. Sudden onset from food or insects.
Term
Ex. of Neurogenic shock?
Definition
Trauma to brain or spinal cord. Drug overdose (depressed CNS)
Term
Ex. of Cardiogenic shock?
Definition
Heart disease (left HF, MI, PE)
Term
Ex. of Septic shock?
Definition
Recent infection, widespread inflammation, infection.
Term
Tx. Anaphylaxis shock?
Definition
Drugs therapy for symptoms. Antihistimine (Benedryl) , Give oxygen immediately, Support cardiac system, use a bronchodialator to relieve shortness of breath (Ibuterol), Use corticosteriods (hydrocortisone) to suppress inflammatory response.
Term
What is the good chlosterol?
Definition
HDL (high density lipid protein)
Term
What is the bad cholesterol?
Definition
LDL (low density lipid proteins)
Term
What are the drugs of choice for tx. lipid profile?
Definition
Statins
Term
What are statins the drug of choice for reducing blood lipid levels?
Definition
Statins have multiple actions. They:
1. The liver produces less cholesterole.
2. Creates more LDL receptors on liver cells.
3. More LDL is removed from the blood.
Moreover, they interfere with the enzymes responsible for making/synthesizing cholesterol (increase HDL and decrease LDL and triglyserides.) They have LESS side effects than other meds.
Term
What are Antihyperlipidemic meds used for?
Definition
They help lower the risk of coronary artery disease.
Term
What is the purpose of vaccines?
Definition
Vaccines are biological drugs used to prevent illness.
Term
How to vaccines work?
Definition
They create an immune response when the body produces antibodies. memory B-cells store information. Antibodies are quickly produced if later exposed to microorganisms.
Term
Who should get the anthrax vaccine?
Definition
1. military
2. lab personnel
3. those that work with imported animal products
Term
What is a pt. at risk for with long-term cortisone tx?
Definition
Cortisone is a steroid. Long term use may cause a disease called Cushing Syndrome (fat moon face, buffalo hump, easily bruised, joint problems (joints may dissolve), fat abdomen.
Term
Afrin (oxymetazoline):
Definition
ACTIONS: Sympathomimetic. Works directly on alpha receptors of CNS (no effect on beta receptors).
ADVERSE REACTIONS: Can cause burning, sneezing, and rebound congestion.
TEACHING: Wash hands carefully, rubbing eyes can cause blurred vision, too much can cause systemic effects
Term
Lanoxin (digoxin) :
Definition
ACTIONS: cardiac glycoside, increases contractility, inotropic, effects impulse conduction, used for dysrhthmias, and HF
ADVERSE EFFECTS: dysrhthmias, hypokalemia
TEACHING: weight gain of 2+, must watch serum levels, and potassium levels, nausea, vomiting, blurred vision "HALO" effect
NURSING: Monitir pulse for 60 sec. If LESS than 60 bpm= HOLD; If blood dig level is GREATER than 1.8=HOLD and call MD
Term
furosemide (Lasix)
Definition
ACTIONS: loop diuretic, decreases workload in heart, CO increases
ADVERSE EFFECT: electrolyte imbalance, decreased potassium causing dysrhthmias
TEACH and NURSING: watch for hypokalemia, electrolyte imbalance, potassium levels, dehydration
Term
nitroglycerine (Nitrobid)
Definition
ACTIONS: short acting vasodilator
ADVERSE EFFECTS: headache, decreased BP, reflex tachycardia
TEACHING: can repeat every 5 minutes for a max of 3 doses in 15 minutes, keep med out of sun, throw out if expired, do NOT use with Viagra
Term
diphenhydramine (Benedryl)
Definition
ACTIONS: histamine blocker, temp relief of allergic reactions to motion sickness, blood infusions, Parkinson's Disease, allergies
ADVERSE EFFECTS: drowsiness, tachycardia, dry mouth
TEACHING: No alcohol use or CNS depressant. Increase fluid intake.
Term
What is an antiplatelet?
Definition
They prevent clot formation in the veins by preventing aggregation.
Term
What are examples of antiplatelet drugs?
Definition
Aspirin- inhibits thromboxane, used to prevent strokes and MI
ADP- receptor blocker "-same"
Glycoprotein- IIb/IIIa receptor blocker: inhibits enzyme, used to prevent stroke, MI, and PTCA
Term
What are hemostatics (antifibrinolytics)?
Definition
They shorten bleeding time. They prevent fibrin from dissolving clots, so they promote the FORMATION of clots. NO ESTROGEN or ORAL CONTR.
Term
How is heparin given?
Definition
SC or IV (in the hospital !)
Term
Lab tests/values for heparin?
Definition
APTT baseline values 25-40 sec. Maintence at 1.5-2 X baseline value. If APTT is GREATER than 80, decrease heparin. Monitor APTT every 4-6 hours during the first few days.
Term
What is the antidote for heparin?
Definition
Protamine Sulfate
Term
What is the test/lab values for warfarin?
Definition
PT/ INR - PT 12-15 sec; INR 2-4.5
Term
How is warfarin given?
Definition
Orally, can be taken at home.
Term
What is gingko biloba?
Definition
It is a natural anticoagulant. It can reduce chances of CVA by increasing blood flow to the brain, so its use must be monitored if taking other drugs.
Term
What is cardiogenic shock?
Definition
Failure of the heart to pump enough blood. Ex. MI, HF, pericardial infection
Term
What is hypovolemic shock?
Definition
Loss of blood or fluids
Term
Ex. of hypovolemic shock?
Definition
Burn, hemorrage, vomiting, diarrhea, excessive sweating
Term
What is neurogenic shock?
Definition
Overstimulation of the parasympathetic system or understimulation of the sympathetic nervous system. Ex. trauma to spinal cord or medulla, severe stress, CNS depressants
Term
norepinephrine (Levarterenol)
Definition
ACTIONS: sympathomimetic, vasoconstrictor, acts on alpha-adrenergic receptors in smooth muscle of blood vessels to raise BP.
ADVERSE REACTIONS: hypertention, reflex bradycardia
Term
epinepherine
Definition
ACTIONS: nonselective adrenergic activator. Stimulates both alpha and beta. OPENS AIRWAYS!, Increases cardiac output.
ADVERSE REACTIONS: hypertention, dysrhthmia
Term
dopamine
Definition
ACTIONS: sympathomimetric. It is the precursor to epinephrine.
USES: Shock by increasing blood flow to the heart, raises BP
ADVERSE REACTIONS: dysrhthmias, hypotension
Term
albumin (Albutein)
Definition
protein extracted from whole blood or plasma, maintains plasma pressure to carry substances through the blood.
ADVERSE REACTIONS: allergic reaction, chills, rash, dyspnea
Term
Lipid (cholesterol) levels
Definition
Normal - less than 200
Borderline - 200-239
High - greater than 239
Term
atorvastatin (Lipitor)
Definition
ACTIONS: slows the biosynthesis of cholesterol by blocking enzymes that create cholesterol.
ADVERSE EFFECTS: few, PREGNANCY X, liver damage (rare)
INTERACTIONS: digoxin, oral contraceptives
TEACHING: Max effects 4-8 weeks
Term
What does half-life mean?
Definition
The half life referres to the time it takes for one half of the medication to to be broken down and eliminated from your body.
Term
What is hemostatasis?
Definition
Keeps a moderate amount of clotting to keep us from bleeding to death.
Term
What is the major side effects of diuretics?
Definition
Dehydration
Term
What does "inotropic" mean?
Definition
Heart contracts with a specific force or strength (contractility) . Ex. Cardiac glycosides, Positive inotropic
Term
What does "chronotropic" mean?
Definition
Heart contracts ata certain beat per minute.
Term
T or F. The faster the heart works, the more effective it is.
Definition
False
Term
What is Ovine?
Definition
Antidote for Digoxin toxicity.
Term
Lisinopril
Definition
Most common ACE inhibitor, potassium levels may increase, do NOT take potassium salt substitutes, take BP one hour before meals
Term
T or F: All drugs for dysrhthmais have a narrow usage?
Definition
True. Too much can make matters worse.
Term
What is the single most important breakthrough in the treatment of stroke? Why?
Definition
Thrombolytic drugs. If used within 3 hours of a CVA, brain function can be completely restored. They break and dissolve clots.
Term
Lifestyle changes to reduce chance of CVA (stroke)?
Definition
Stop smoking, limit alcohol, limit sodium, excercise, reduce stress, reduce dietary fat, keep weight at optimum level, treat hyperlipidemia and hypertension
Term
S/Sx of shock
Definition
pale, cold and clammy skin, lethargy, thirst, low bp, weak pulse, rapid shallow breath
Term
What should be the initial treatment for shock?
Definition
ABCs of life support. Airway, Breathing, Cardiac;
THEN ID the cause.
Term
What is the initial drug of choice used to treat shock? Why?
Definition
Vasoconstrictor agents like epinephrine/ norepinephrine, because they increase bp so oxygen moves throughout the body to the brain. Monitor for dysrhthmias and hypertension.
Term
Colloids
Definition
Large proteins called albumin. Used as a fluid replacement.
Term
What are some fluid replacement agents?
Definition
Water, blood, colloids, crystalloids
Term
T or F: Fluid output should always be > 50 mL/h
Definition
True.
Term
HDL should be?
Definition
>60
Term
LDL should be?
Definition
< 130
Term
VLDL (triglyserides) should be?
Definition
<150
Term
How to find the cholesterol ratio?
Definition
total cholesterol / HDL (or LDL) = ratio
Males 5.0
Females 4.5
Term
Three types of vaccines:
Definition
1. killed ex. polio
2. live but weakened ex. MMR
3. toxoids ex. tetnus
Term
How do dysrhthmics work?
Definition
slows things down
Term
How can you tell if digoxin is working?
Definition
Increased urine output.
Term
What is an INR?
Definition
International Normalized Ratio- Blood test for anticoagulants, should be between 2-4.5.
Term
Why should a pt. restrict nicotine and caffeine?
Definition
They would counteract the effects of certain meds since they are stimulants.
Term
Most commom side effect of nitroglycerine therapy?
Definition
severe headache
Term
A sudden occlusion of a coronary artery is called?
Definition
MI
Term
Three basic types of lipids?
Definition
1. triglycerides
2. phospholipids
3. steroids
Term
Lab tests for statins?
Definition
Lipid panel and Liver enzyme test
Term
Most common side effect of benedryl?
Definition
drowsiness
Term
Rebound congestion is the most common side effect of what class of meds?
Definition
sympathomimetics like Afrin
Term
Most common side effect of high-dose aspirin therapy?
Definition
GI upset
Term
The amount of blood pumped by each ventricle per minute is called?
Definition
Cardiac output
Term
What medication, used to treat dysrhythmias, is widely used as a local anesthetic?
Definition
lidocaine
Term
What medication, used to treat dysrhythmias, is widely used as a local anesthetic?
Definition
lidocaine
Term
Fibrin?
Definition
The solid, insoluble part of a blood clot.
Term
Fibrinolysis
Definition
Breaking up insoluble part of a blood clot
Term
Most common type of hypertension?
Definition
Primary (or essential)
Term
The most common group of drugs used to tx hypertension?
Definition
1. diuretics- 1st choice
2. calcium channel blockers- most common
Term
Heart failure develops when?
Definition
The heart muscle fails to pump effectively and sufficient blood does not circulate to the lungs and body tissue.
Term
Hypertension is defined as ?
Definition
Systolic bp >140 and Diagnostic >90
Term
Digoxin has the following action?
Definition
Increases cardiac contractility without elevating the oxygen requirement of the myocardium.
Term
The primary goal of agrenergic therapy for all forms of shock is to:
Definition
Increase blood flow through the coronary and cerebral vessels.
Term
What is the primary nursing concern when digoxin and Lasix are given simultaneously?
Definition
hypokalemia
Term
What must the nurse consider about the dosage of either digoxin or amiodarone when they are being administered together?
Definition
Amiodarone can increase the digoxin the in blood.
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