Chapter 25 and 28

Question 1

Coronary Artery Disease

Answer 1

Narrowing or occlusion of a coronary artery

Narrowing causes myocardial ischemia

Question 2

atherosclerosis

Answer 2

Most common etiology of CAD

Caused by presence of plaque & inflammation

Question 3

Nitrates

Answer 3

Potent vasodilators (coronary arteries)
main treatment for angina

Question 4

Nitrates action

Answer 4

relax arterial & venous smooth muscle

Reduces preload → decreases cardiac output and cardiac demand → myocardial oxygen demand

Question 5

Nitrates adverse effects

Answer 5

Headache, dizziness, hypotension, flushing, rash

Question 6

Avoid with nitrates

Answer 6

no alcohol

no viagra

Question 7

Myocardial Infarction tx

Answer 7

Nitrates
Beta-blockers
Thrombolytics
Asprin
Statins for hyperlipidemia
ACE inhibitors 
Platelet Aggregation Inhibitors
Heparin drip

Question 8

Hematopoiesis

Answer 8

Process of blood-cell formation

Question 9

Where does hematopoiesis begin

Answer 9

Begins with stem cells in bone marrow

Question 10

Where is hematopoiesis begin

Answer 10

Homeostatic control maintained by hormones and growth factors

Question 11

Demands of body on WBC

Answer 11

White blood cells (WBCs) can increase concentration up to ten times normal

Question 12

Demands of body on RBC

Answer 12

Red blood cells (RBCs) can increase up concentration up to five times normal

Question 13

Epoetin alfa (Epogen, Procrit) category

Answer 13

Erythropoiesis-stimulating Agents

Question 14

Epoetin alfa (Epogen, Procrit) action

Answer 14

Hormone that stimulates RBC production
Secreted inreduction in oxygen
Body experiences hypoxia or hemorrhage

Question 15

Epoetin alfa (Epogen, Procrit) use

Answer 15

anemia due to CRF, HIV infection treated with AZT, some cancers

Question 16

Epoetin alfa (Epogen, Procrit) adverse effects

Answer 16

Hemoglobin > 12 g/dL increased risk death, arterial & venous thromboembolic events, tumor progression
HTN, H/A, seizures, flu-like symptoms, N/V/D, rash
Black box warning

Question 17

Darbepoetin alfa (Aranesp) category

Answer 17

Erythropoiesis-stimulating Agents

Question 18

Darbepoetin alfa (Aranesp) duration

Answer 18

Longer duration of action than Epoetin alfa: administered 1x/week

Question 19

Darbepoetin alfa (Aranesp) uses

Answer 19

anemia due to CRF & chemotherapy

Question 20

erythropoiesis-stimulating agents (ESAs) FDA warning

Answer 20

not for use in PT’s w/ cancer or getting myelosuppressive therapy when the anticipated outcome is cure

Question 21

Erythropoietin client teaching

Answer 21

Monitoring BP
correct injection technique
reporting side effects

Question 22

Clients Receiving Epoetin Alfa what to monitor

Answer 22

BP
seizure activity
H+H
signs of thrombosis
dietary intake for essential nutrients

Question 23

Granulocyte CSF (G-CSF) function

Answer 23

colony stimulating factor

increases production of neutrophils

Question 24

Granulocyte/macrophage CSF (GM-CSF) function

Answer 24

colony stimulating factor

stimulates production of both neutrophils and macrophages

Question 25

Colony-Stimulating Factors considerations

Answer 25

monitor for hypertension, bone pain, respiratory distress and ST-segment depression

Question 26

Avoid Colony-Stimulating Factors with

Answer 26

clients with kidney and liver impairment

Question 27

Colony-Stimulating Factors teaching

Answer 27

how to avoid infections and to report adverse symptoms

Question 28

What to monitor in clients on Filgrastim (Neupogen)

Answer 28

``` VS S/Sx of infection CBC hepatic status bone pain ```

Question 29

Platelet Enhancers cautions

Answer 29

use in caution in PT's with cardiac disease withhold 12 hours before and after radiation avoid injury

Question 30

What to monitor with Platelet Enhancers

Answer 30

Monitor clients with hx of edema | Report Edema; change in urinary output or body weight or Bleeding; difficulty breathing

Question 31

Anemia

Answer 31

Blood has reduced capacity to carry oxygen

Question 32

Anemia can cause

Answer 32

Hemorrhage Excessive erythrocyte destruction Insufficient erythrocyte synthesis

Question 33

Anemia symptoms

Answer 33

``` Pallor Decreased exercise tolerance Fatigue, dizziness and fainting Increased RR and HR Heart failure ```

Question 34

Antianemic Agents

Answer 34

Vitamins and minerals | Enhance oxygen-carrying capacity of blood

Question 35

Antianemic Agents examples

Answer 35

Most common are cyanocobalamin (B12), folic acid, and ferrous sulfate

Question 36

Intrinsic Factor

Answer 36

Protein secreted by stomach cells | Required for vitamin B12 metabolism

Question 37

Pernicious Anemia

Answer 37

Vitamin B12 deficiency | Sx can be reversed but nervous system damage may be permanent

Question 38

Pernicious Anemia treatment

Answer 38

cyanocobalamin

Question 39

Pernicious Anemia causes

Answer 39

Chronic alcoholism, fad diets, absorption diseases

Question 40

Folic acid deficiency in pregnancy

Answer 40

linked to neural-tube defects

Question 41

Cause of Folic acid deficiency

Answer 41

lack of sufficient dietary intake

Question 42

Folic acid anemia absorption

Answer 42

does not need intrinsic factor to be absorbed | linked to pernicious anemia (decreased B12 causes decreased folic acid)

Question 43

Antianemic Agents—Vitamin B12 and Folic Acid considerations

Answer 43

assess cause of anemia monitor RR and cardiac monitor K+ report SOB and edema

Question 44

Iron uses

Answer 44

Essential for metabolism and energy

Question 45

Ferritin and hemosiderin

Answer 45

maintain iron inside cells

Question 46

Transferrin

Answer 46

transports iron to other body sites

Question 47

Free iron

Answer 47

toxic | binds to protein complexes

Question 48

Iron Deficiency tx

Answer 48

iron supplements

Question 49

Iron Deficiency cause

Answer 49

Acute or chronic blood loss, peptic ulcer | Heavy menstruation, pregnancy, intensive athletic training

Question 50

Iron supplements teaching

Answer 50

Take iron with food **Use straw to prevent staining teeth Report signs of bleeding