Weber State Nursing 2100 Unit 10 Cardiovascular – Flashcards
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What are 5 non-pharmacologic interventions for cardiovascular disease?
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-Decrease alcohol -Decrease high-fat, high cholesterol foods -Keep lipid labs w/in normal range -Keep blood glucose w/in normal range -Exercise regularly -Maintain healthy weight -Don't use tobacco
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True/False: Meds replace healthy lifestyle changes.
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False - Meds DO NOT replace healthy lifestyle changes
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Vasoconstriction, fluid overload, edema, SOB are all characteristics of what disease?
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Congestive Heart Failure
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What are characteristics of Left Sided Heart Failure?
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Difficulty breathing, SOB, fatigue, gas exchange is inhibited by fluid build up in lungs, orthopnea, wet sounds in lungs, congestion
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What are characteristics of Right Sided Heart Failure?
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fluid build up in liver and lower extremities (peripheral edema), swelling in lower extremities, jugular vein distention, pedal edema
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What body systems are implemented to increase HR, contractility, cardiac output?
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RAAS (Angiotensin II) and sympathetic nervous system
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Cardiac output is too low to meet the body's need
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Pump Failure
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What side of the heart does CHF mostly refer to?
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Left sided heart failure
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What is cardiac remodeling?
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Scar Tissue where damage to the heart occurs
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Classic S/S of heart failure include:
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Dyspnea, fatigue, palpitations, angina; Right HF - JVD and pedal edema; Left HF - pulmonary edema, cough, orthopnea
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Stage of HF where no symptoms are present during activity.
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Stage 1
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Stage of HF where there are slight limitations during activity.
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Stage 2
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Stage of HF where marked limitations occur during activity.
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Stage 3
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Stage of HF where patient is unable to do any activity and has symptoms at rest.
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Stage 4
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What are the goals for treating heart failure?
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Decrease preload (amount of fluid coming into heart), decrease afterload (decrease systemic vascular resistance), Inhibit RAAS and SNS (prevent cardiac remodeling)
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What meds are used to treat mild to moderate HF? (3 meds)
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ACE Inhibitors, ARBs, Diuretics
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What meds are used to treat severe HF? (3 meds)
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Beta Blockers, Vasodilators, Cardiac Glycosides - Digoxin
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What is the mechanism of action for Cardiac Glycosides? (Digoxin)
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Inhibits Na/K pump in heat muscle cells which increases calcium concentration, ultimately increasing heart muscle contractions
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What direct actions do Cardiac Glycosides have on the heart's electrical conduction system?
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Positive inotropic effect (stronger force of contraction) Negative chronotropic effect (decreases speed/ HR) Decreases SNS, Increases PNS activity
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True/False: It is unknown how Digoxin decreases SNS and increses PNS activity.
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True
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Contraindications of Digoxin
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2nd or 3rd degree heart block, dysrhythmias, hypokalemia
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Side affects of Digoxin
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Blurred vision, halo vision, photophobia, color perception (green/yellow tint), bradycardia (All signs of toxicity)
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Life Threatening events of Digoxin
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Dystrhythmias, AV block, severe bradycardia
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What causes hypokalemia?
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Potassium wasting diuretics
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What is the dangers related to hypokalemia and digoxin?
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Hypokalemia increases Pt risk of developing toxic levels of digoxin
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What are nursing condierations of Digoxin?
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Monitor blood levels (draw 6-12h after last oral dose, 24h after last maintenance dose) Monitor s/s of toxicity (CAN develop signs at lower/higher blood levels Take apical pulse for 1 minute (ensure at least 60bpm) Teach to eat potassium rich foods (thiazide and loop diuretics are potassium wasters) Monitor K, Ca++, magnesium levels (replace electrolytes if low) ECGs DO NOT administer med IM
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What is the normal therapeutic range for Digoxin?
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0.5-2.0 mg/mL
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What range is considered toxic for Digoxin?
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>2.0 is considered toxic
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What are S/S of Digoxin toxicity?
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Adults: bradycardia, dysrhythmias, PVCs, blurred vision, halos of white/green/yellow, confusion, delierium Kids: cardiac dysrhythmias
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What is the antidote for Digoxin toxicity?
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digoxin immune FAB (Digibind) given IV
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What antidote should be used if Digoxin is taken orally?
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activated charcoal (to bind with med in GI to prevent from being absorbed)
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What meds are given if heart arrhythmias are not corrected with potassium replacement? (3 meds)
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Phenytoin, lidocaine, atropine
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The points for Digoxin listed below are part of what list ? -Teach to monitor pulse rate -Review pulse rate parameters (hold med if <60) -Don't d/c med or change brands -Avoid OTC antacids and cold/cough meds -Notify pcp about adverse effects -instruct to F/U on labs -Increase K in diet
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Patient Teaching for Digoxin
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What are nursing considerations for Digoxin?
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-Monitor pulse - take apical for 1 minute -Hold med if pulse <60 -Monitor I&Os -Asses renal function and electrolyte levels -monitor s/s of toxicity
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What two issues to anticoagulants attempt to adress?
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Thrombolytics disorder (has thrombus, clotting too much (DVT)) Coagulation disorder (trouble clotting, hemophilia)
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What is the therapeutic affect of Warfarin?
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Decreases hepatic synthesis of Vitamin K clotting factors
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What are side affects of Warfarin?
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purple toe syndrome, bleeding, osteoporosis
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What is purple toe syndrome?
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microscopic plaques released from vessel walls that cause microembolization due to clogging tiny capillaries
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True/False: Warfarin and Heparin are used to break down clots.
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False: they prevent future clots, as well as current clots from increasing in size
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Vitamin K, Vitamin C, oral contraceptives all have what effect on Warfarin?
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They decrease the effect
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What tests are used for Warfarin?
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PT/INR, LFTs
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What is the antidote for Warfarin? What can be used if this is not on hand?
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Vitamin K, freshly frozen plasma can be used
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Name 5 patient teachings for Warfarin.
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-Eat less vitamin K rich foods -Avoid Alcohol -Use soft toothbrush -Don't use straight razor -Report s/s of liver problems -Avoid pregnancy
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What foods are considered rich in Vitamin K?
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Dark green veggies, coffee, beef liver, green tea
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What are the only two routes of administration for Heparin?
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IV, Subcutaneous
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What is the therapeutic effect of Heparin?
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Inhibits thrombin, prevents conversion of fibrinogen to fibrin
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What are side effects of Heparin?
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itching, burning, ecchymosis, osteoporosis
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True/False: Heparin can be used in pregnancy.
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True - it doesn't cross the placenta
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What is the antidote for Heparin?
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Protamine Sulfate
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What labs are used for Heparin?
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PTT/aPTT, CBC
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Should pressure be applied to the injection site after adminstering Heparin? Should it be messaged?
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Yes - pressure, No - message
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Is Dabigatran similar to Heparin?
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It directly inhibits thrombin
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What are contraindications for Dabigatran?
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Mechanical heart valves, recent surgery, hemorrhage, ulcers, renal disease
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It there an antidote for Dabigatran?
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No, have to use dialysis to rid med from blood stream
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What is the therapeutic effect of Clopidogrel?
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Inhibits platelet aggregation, prevents arterial thromboembolism to reduce risk of MI or stroke
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What is the protocol for Clopidogrel related to surgery?
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The med should be stopped 5-7 days prior to surgery to allow for platelets to synthesize (reduce risk of hemorrhage)
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True/False: increased liver metabolism increased med effect
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True
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What meds should be avoided when taking Clopidogrel?
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PPIs (omeprazole), Aspirin, NSAIDs
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What are 3 non-pharmacological interventions for hyperlipidemia?
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-Reduce saturated fat and cholesterol intake -Aerobic exercise -Weight loss -Stop Smoking -Increase fiber intake -Red wine
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What is the therapeutic effect for Atorvastatin?
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Lowers LDLs and VLDLs cholesterols, and triglycerides; prevents MI and stroke
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What is the serious side affect of Atorvastatin?
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Rhabdomyolysis (myopathy)
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What are the s/s of rhabdomyolysis?
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Muscle pain, joint pain, weakness
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How does Atorvastatin affect Digoxin?
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It can increases the digoxin levels.
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What meds may increase the risk of rhabdomyolysis?
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Antibiotics
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True/False: Rhabdomyolysis (myopathy) can lead to renal failure?
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True, the cause is unknown however.
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What are the instructions for testing regarding lipid labs?
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Fast for 12 hours, some physicians order low fat diet for 72 hours prior to testing.
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How often should lipid labs be drawn?
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Every 6 weeks for new therapy, then every 3-6 months after therpy is stabilized
