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NUR-210 > Exam 4 > Flashcards

Exam 4 Flashcards

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1
Q

What is hypertension?

A

Persistent elevated BP, chronic progressive disorder. to diagnosis, must need 3 high readings of BP

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2
Q

What are the systolic and diastolic number for prehypertension?

A

sys: 120-139 dia: 80-89

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3
Q

When do you begin treating hypertension with meds?

A

stage 1: sys greater than 139 or dia: greater than 89

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4
Q

what are Stage 1 vs stage 2 hypertension number?

A

stage 1= 140-159 systolic, 90-99 diastolic
stage 2= greater or equal to 160 systolic, greater or equal to 100 diastolic

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5
Q

Contributing factors to primary/essential hypertension

A

-hyperactivity of sympathetic nervous system
-hyperactivity of the renin-angiotensin system (increased aldosterone aka sodium and water which raises BP)
-endothelial dysfunction

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6
Q

Risk factors for primary hypertension

A

-genetics
-age: greater than 60 yrs
-obesity
-smoking
-diabetes
-hyperlipidemia
-high sodium diet?

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7
Q

Difference between secondary hypertension and primary hypertension?

A

secondary has an identifiable cause vs primary with no identifiable cause but has risk factors

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8
Q

What are the identifiable causes for secondary hypertension?

A
  • Renal disease
    -Coronary artery disease
    -Toxemia of pregnancy
    -Drug therapy: oral -contraceptive therapy
    -Sleep apnea
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9
Q

short term effects of hypertension

A

majority of clients asymptomatic

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10
Q

long term effects of hypertension

A

-MI
-Heart failure
-Kidney disease
-Stroke
-Peripheral artery disease
-Retinopathy

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11
Q

what is the objective of hypertensive therapy

A

Treat hypertension
to reduce
morbidity and mortality
without
decreasing
the quality of life
with the drugs
employed

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12
Q

primary determinants of arterial blood pressure

A

arterial pressure= cardiac output x peripheral resistance

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13
Q

what is cardiac output determined by?

A

heart rate
contractility
blood volume
venous return
4-8 L/ min is the normal

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14
Q

what is peripheral resistance determined by?

A

arteriolar constriction

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15
Q

What is preload?

A

cardiac output
heart rate (ANS)
stroke volume

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16
Q

what is afterload?

A

peripheral resistance
2.5-4 l/min

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17
Q

what is stroke volume determined by?

A

preload
afterload
contractility

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18
Q

what life styles effect afterload?

A

low cholesterol diet
caffeine restriction
alcohol restriction
smoking cessation
(exercise, stress reduction are both)

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19
Q

what life styles have an effect on preload?

A

weight loss
sodium restriction
(exercise, stress reduction are both)

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20
Q

How do you promote compliance with medications

A

patient education
self-monitoring
minimize ADRs
simplify regimen
keep cost down

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21
Q

which type of drugs are beta blockers ending in (-olol)

A

antihypertensive drugs

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22
Q

what is the action of antihypertensive drugs (-olol)

A

blocks beta receptors in the heart
-decreases heart rate
-decreases conduction of system
-decreases force of contraction

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23
Q

what are ADRs for antihypertensive drugs (-olol)

A

hypotension
bradycardia
bronchial constriction
drowsiness/depression

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24
Q

What do diuretics do?

A

-promote renal excretion of water and lytes
-increase urinary output

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25
therapeutic uses for diuretics
-hypertension -removal of edematous fluid
26
what are the site of action for diuretics?
thiazide high ceiling loop diuretics potassium sparing diuretics
27
Diuretics- mechanism of action
-blockade: sodium/ chloride reabsorption -site of action -ADR: hypovolemia, electrolyte imbalance
28
Nursing implications for diuretics
-daily weights: same time and place -monitor BP -administer early in the day -prevent orthostatic hypotension
29
what is the action for the antihypertensive drug- thiazide diuretics
action : distal convoluted tubule - reduction of blood volume -reduction of arterial resistance
30
What are the ADRs for the antihypertensive drug- thiazide diuretics
-Hypokalemia -Dehydration -Hyperglycemia -Hyperuricemia -Hyperlipidemia
31
high-ceiling (loop) diuretics
-furosemide (lasix)- ascending loop of henle -rapid onset
32
What are the ADRs for high-ceiling (loop) diuretics (lasix)
Hypotension - Hypokalemia Hyponatremia - Ototoxicity Hyperglycemia - Hyperuricemia Hyperlipidemia
33
What are potassium-sparing diuretics?
-weaker diuretics -spironolactone (aldactone)
34
action of spironolactone (aldactone)
-blocks aldosterone in the distal nephron -retention of potassium
35
ADRs for potassium- sparing diuretics
-hyperkalemia -avoid with ACEs and ARBs since they also promote hyperkalemia
36
what do angiotensin-converting enzyme inhibitors (ACEs) end in
"pril"
37
What is the action of angiotensin-converting enzyme inhibitors (ACEs)
interrupts renin angiotensin-aldosterone system (RAAS)
38
ADRs for angiotensin-converting enzyme inhibitor
First–dose hypotension: decrease blood volume Persistent cough: increased bradykinin Hyperkalemia: potassium retention Interaction with NSAIDS: fluid retention Angioedema: rare increased capillary permeability Fetal harm: renal failure
39
What are angiotensin II receptor blockers (ARBs)
-losartan (cozaar) -hypertension -heart failure
40
ADRs for angiotensin II receptor blockers (ARBs)
Dizziness Birth defects Newer ARB’s Candesartan (Atacand) Irbesartan (Avapro) Telmisartan (Micardis) Valsartan (Diovan)
41
Action for cardiac glycoside= digoxin (Lanoxin)
-slows the transmission of cardiac impulses through the cardiac conduction system -increase the force of cardiac contraction
42
What are the cardiac glycoside-digoxin (lanoxin)ADR: low TI index
-anorexia, nausea -bradycardia
43
What are the nursing implications for digoxin
check apical pulse monitor dig and K+ levels
44
What is angina pectoris
-sudden pain beneath the sternum often radiating to the left shoulder and arm -oxygen demand greater than oxygen supply
45
types of angina pectoris
-Chronic Stable: Exertional -Variant: any time even at rest -Unstable: Medical emergency
46
drugs for angina pectoris
nitrates-nitroglycerin
47
What is the action of nitrates-nitroglycerin
-increases the blood flow to the coronary arteries -dilate the peripheral arteries
48
What is the administration for nitrates- nitroglycerin
-highly lipid soluble -very short half-life (5-7 mins)
49
What are the ADRs for nitrates-nitroglycerin
-orthostatic hypotension -headache
50
routes of administration for nitrates
sublingual topical oral sustained released intravenous
51
nitrates sublingual route directions
Tablets or spray -Drink water before taking -Do not swallow -Should feel a tingling sensation -If pain not relived in 5 minutes with initial dose call 911 -take 2nd dose in 5 minutes -take 3rd dose 5 minutes later
52
What are topical route of admin for nitrates?
transdermal delivery systems -rotate sites and remove previous patch -need to wear continuously during all daily activities
53
cardiac diagnostics, creatine kinase MB ( CK-MB)
-specific to myocardial cells - rise4-6 hrs after MI, peaks in 15-20 hrs -returns to normal 2-3 days
54
cardiac diagnostics,. troponin
- more specific and sensitive indicator than CK-MB -rises 2-6 hrs after MI, peaks in 15-20 hrs -returns to normal 5-7 days
55
cardiac diagnostics, myoglobin
-rises 1-3 hrs after MI, rapidly cleared in 1 day - measure within 12 hrs of onset
56
Cardiac diagnostic studies
ECG ECHO Exercise Stress TEE MUGA MRI/CT Angiogram
57
Coagulation Pathways- Clot formation
triggers hemostasis virchows triad
58
What are triggers for Intravascular pathways and extravascular coagulation pathways?
-intravascular- ASHD -extravascular- trauma
59
What makes us Virchow's triad
-venous stasis -hypercoagulability -endothelial damage
60
Factors linked to increased risk of thromboembolic event
decreased circulation reduced mobility disease or disability obesity obstruction of venous flow medications
61
Anticoagulants
-injectable anticoagulants: heparin& LMWH -oral anticoagulants: Coumadin &Pradaxa
62
antiplatelet drugs
ASA
63
thrombolytic
tPa & Urokinase & Streptokinase
64
Heparin: Rapid Acting Anticoagulant indications
DCT- deep vein thrombosis PE- pulmonary embolism CVA MI Pregnancy
65
Heparin: Rapid acting anticoagulant mechanism of action
parenterally only not absorbed in GI tract very acid solution large molecule rapid acting
66
heparin pharmacokinetics
metabolized in the liver eliminated via kidney short half life highly protein bound
67
heparin adverse drug reaction
hemorrhage osteoporosis HIT (heparin induced thrombocytopenia)
68
nursing implications for heparin for IV injection
continuous, intermittent -do not mix with other IV medications -check daily dose changes with another RN -use an infusion pump
69
nursing implications for heparin for subcut injection
rotate sites no aspiration do not massage
70
nursing implications for heparin for aPTT: activated partial thromboplastin time
normal value for aPTT is 40 secs -therapeutic level between 1.5-2 times the control -usually 60 to 80 secs
71
nursing implications for heparin for monitor for bleeding
-bruising, petechiae -smokey urine
72
What is the antidote for heparin and low molecular weight heparin (LMWH)
protamine sulfate
73
what is the mechanism of action for low molecular weight heparin (LMWH)
-Bioavailability 100% with subcutaneous injection -Half life 6 times longer than heparin -Minimal protein binding -Renal clearance
74
What is low molecular weight heparin
fragments of unfractionated heparin ex: enoxaparin (lovenex), dalteparin (fragmin)
75
for LMWH what baselines should you obtain as a nursing implications
aPTT PT CBC creatine (Cr)
76
how is LMWH administered
subcut every 12-24 hrs
77
What does warfarin (coumadin) inhibit
liver synthesis of vitamin K -affects factors VII, IX, X, and prothrombin
78
what is the action of warfarin (coumadin)
long half life 42 hrs highly protein bound 99.5% no effect on currently circulating clotting factors
79
what is the use of warfarin (coumadin)
prevents thrombosis formation
80
ADRs for warfarin (coumadin)
multiple drug interactions hemorrhage
81
nursing implications for warfarin (coumadin)
-monitor PT (prothrombin time ) 1.2 -1.5 times control -monitor INR (international normalized ratio) 2-3
82
Patient teaching for warfarin (coumadin)
Monitor for bleeding ID band Check all new medications Diet recommendations
83
What is the antagonist for warfarin
vitamin K
84
What content is high in vitamin K >150 ug
Broccoli, cucumber, endive, kale, red lettuce, raw mint,turnips & parsley, spinach, Swiss chard, green tea, watercress, brussel spouts
85
What content is moderate in vitamin K <150 ug
Green beans, raw cabbage, canola oil, coleslaw, green lettuce, mayonnaise
86
What content is low in vitamin K < 30 ug
Apple, artichoke, cauliflower, celery, green pepper, tomato, onion
87
oral anticoagulants
pradaxa xarelto
88
antiplatetlet drugs
aspirin (ASA) ticlopidine (Ticlid) clopidogrel ( Plavix) dipyridamole (Persantine) :only used with coumadin pentoxifylline (Trental): intermittent claudication anagrelide(Agrylin):oral treat essential thrombocytopenia tirofiban (Aggrastat): IV in combination with heparin abciximab (Reo Pro) : IV used during angioplasty cilostazol (Pletal) : oral for intermittent claudication
89
ASA (asprin)
inhibits prostagladin synthesis inactivates cyclooxygenase activity platelets do not respond to thrombin 100mg is sufficient to inhibit for 8 - 10 days Dose: 81 - 325 mg per day Adverse effects
90
thrombolytic drugs
Streptokinase (Streptase), anistreplase (Eminase) , urokinase, alteplase (tPA), reteplase ( Retavase), tenecteplase, ( TNKase)
91
What do thrombolytic drugs bind
binds plasminogen: dissolving of the clot
92
uses for thrombolytic drugs
all administered via IV within 6 hrs -Myocardial infarction -Deep vein thrombosis -Massive pulmonary emboli
93
ADRs for thrombolytic drugs
bleeding hypotension cardiac arrhythmias

NUR-210 (5 decks)

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