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NUR 210 > NUR 210 Exam 4 > Flashcards

NUR 210 Exam 4 Flashcards

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1
Q

What are some triggers of clot formation?

A

Intravascular (ASHD), Extravascular ( trauma ex. hitting your head, falling down, slamming your finger, cut yourself), hemostasis, Virchow’s Triad,

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2
Q

What are the three parts of Virchow’s Triad?

A

Venous Statsis - not moving
Hypercoagulability- genetic predisposition to making you clot faster
Endothelial damage

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3
Q

What is a thromboembolic event:?

A

​​A thromboembolic event means that a blood clot has formed and then “embolized” or moved from where it started to another area and causes damage

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4
Q

What factors are link to increase risk of thromboembolic event?

A

Decreased Circulation
* Reduced Mobility
* Disease or Disability
* Obesity
* Obstruction of venous flow
* Medications

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5
Q

What are examples of injectable heparins?

A

Heparin & LMWH ( Low molecular weight heparin shots)

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6
Q

What are examples of oral anticoagulants?

A

Coumadin & Pradaxa

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7
Q

What is an example of antiplatlet drugs?

A

ASA

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8
Q

What are examples of thrombolytic drugs?

A

: tPa & Urokinase & Streptokinase ( Only by IV)

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9
Q

What is Heparin?

A

Rapid Acting Anticoagulant
Heparin does not prevent clots, it keeps them from getting bigger
Give it prevently or someone who has DVT or Pulmonary embolism

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10
Q

What are some indications of Heparin?

A

– DVT – deep vein thrombosis
– PE- pulmonary embolism
– CVA
– MI
– Pregnancy ( does not cross placental barrier)

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11
Q

What is the mechanism of action of heparin?

A

Parenterally only ( IV mostly, can be given IM but can give bruises)
– Not absorbed in GI tract
– Very acid solution ( Can’t give other Iv or medication or same site)
– Large molecule
– Rapid acting ( short half life)

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12
Q

True or False: Heparin is metabolized in the liver

A

True

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13
Q

True or False: Heparin is eliminated via liver

A

FALSE: Heparin is eliminated via the KIDNEY

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14
Q

True or false: the less heparin that is bound the less its working

A

FALSE: Heparin is highy protein bound, which means the more you have bound the less it is working

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15
Q

What are the ADRs of Heparin?

A

Hemorrhage
– Osteoporosis ( concerned with pregnant population)
– HIT( heparin induced thrombocytopenia)

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16
Q

LIst some nursing implications for Heparin

A

Intravenous injection: Continuous, Intermittent
– Do not mix with other IV medications
– Check daily dose changes with another RN
– Use an infusion pump
– Subcutaneous injection - abdomen ) ONLY PLACE) SubQ tissue , Heparin & Lovenex
– Rotate sites
– No aspiration - can’t aspirate and give heparin & lovenox
– Do not massage
-change needle before giving because it you don’t change it will cause more bruising

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17
Q

Nursing Implications for Heparin

A

Has to be on a infusion pump, be extremely accurate
– Monitor aPTT :activated partial thromboplastin time
– Normal value for aPTT is 40 seconds
– Therapeutic level between 1.5 to 2 times the control
– Usually 60 to 80 seconds
– Monitor for bleeding
– Bruising, petechiae
– Smokey urine
– Antidote : Protamine sulfate

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18
Q

What is the antidote for Heparin?

A

Protamine Sulfate

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19
Q

What is an example of low molecular weight heparin?

A

enoxaparin (Lovenex), dalteparin (Fragmin),

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20
Q

What is LMWH?

A

Fragments of unfractionated heparin

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21
Q

What is the bioavailability of giving heparin subs injection?

A

100%

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22
Q

True of False: The half life of LMWH is 6 times longer than heparin

A

True

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23
Q

True or False? LMWH is very highly protein binding

A

FALSE, LMWH is minimal protein binding, it doesn’t interact with other proteins

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24
Q

A mechanism of heparin is renal clearance

A

True

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25
What are the nursing implications of for LMWH?
Obtain baseline: – aPTT, PT, CBC, creatine – Administered – subcutaneously every 12 - 24 hours
26
What is an important education tip when educating your patients about heparin?
Nurses must and teach patients if you have to draw up heparin from a vial or a lovenox, the needle must be changed sterilly from what you drew it up with, MUST CHANGE THE NEEDLE
27
What type of drug is warfarin ( Coumadin) ?
Oral anticoagulant
28
What dos warfarin ( Coumadin)
it inhibits liver synthesis of vitamin K and affects factors of VII, IX, X, and prothrombin
29
What is the action of warfarin ( Coumadin)
long half life 42 hours – highly protein bound 99.5% – No effect on currently circulating clotting factors
30
What is the uses of warfarin ( Coumadin)
prevents thrombosis formation
31
What are the adverse drug reactions of warfarin ( Coumadin)
Multiple drug & food interactions – Hemorrhage
32
what is the PT ( prothrombin time) of warfarin?
1.2-1.5 times control
33
What is the INR ( International normalized ratio) for warfarin?
2-3
34
What is the nursing implications for warfarin?
monitor, patient teachingg, monitor for bleeding, ID Band- medical braclet, check all new medications, diet recommendations
35
What is the antagonist for warfarin ( Coumadin)
vitamin K
36
What are examples of foods high ( >150) in vitamin K
Broccoli, cucumber, endive, kale, red lettuce, raw mint,turnips & parsley, spinach, Swiss chard, green tea, watercress, brussel spouts
37
what are foods moderate in vitamin k ( ,150)
Green beans, raw cabbage, canola oil, coleslaw, green lettuce, mayonnaise
38
what are foods low in vitamin K <30)
Apple, artichoke, cauliflower, celery, green pepper, tomato, onion
39
What are other examples of oral anticoagulants
Pradaxa Xarelto These medications don’t have an antidote and are 25% more expensive
40
What are some examples of antiplatlet drugs?
aspirin (ASA) * ticlopidine (Ticlid) * clopidogrel ( Plavix) ** SuperAspirin * 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
41
What does aspirin do?
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
42
What is the name of the only drug that eats clots and gets rids of clots you have and is only given IV?
Thrombolytic drugs
43
examples of thrombolytic drugs?
Streptokinase (Streptase), anistreplase (Eminase) , urokinase, alteplase (tPA), reteplase ( Retavase), tenecteplase, ( TNKase)
44
what does thrombolytic drug do?
Binds plasminogen: dissolving of the clot
45
what are the uses of thrombolytic drugs?
all administered via IV within 6 hours Stroke – Myocardial infarction – Deep vein thrombosis – Massive pulmonary emboli
46
what are the adverse effects of aspirin?
Bleeding – Hypotension – Cardiac arrhythmias
47
What is CK-MB
Creatine Kinase MB Specific to myocardial cells *Rise 4-6 hours after MI, peaks in 15-20 hours *Returns to normal 2-3 days So if I have chest pain today and I don't go to the hospital until Wednesday because I'm too busy, my CKMV may be normal - cardiac marker
48
What is troponin
More specific and sensitive indicator than CK-MB *Rises 2-6 hours after MI, peaks in 15-20 hours *Returns to normal 5-7 days ( cardiac marker)
49
what is myoglobin?*
*Rises 1-3 hours after MI, rapidly cleared in 1 day Measure within 12 hours of onset s of onset ( cardiac marker)
50
What are the cardiac labs?
Cardiac Natriuretic Peptide Markers (BNP): , and serum lipids
51
what are examples of diagnostic studies?
ECG ECHO Exercise Stress TEE MUGA MRI?CT Angiogram
52
How is hypertension diagnosied?
must have 3 BP readings above normal in 3 different settings & are more concerned with diastolic than systolic
53
What is the range for prehypertension?
: 120-139 or 80-89
54
When do you start treating BP with medication?
Stage 1: Systolic greater than 139 or Diastolic greater than 89
55
What is primary ( essential hypertension)
Essential hypertension—once considered “essential” to providing adequate perfusion and thought this was pressure that you had to have in your body to make your essentials organs function
56
What are key things to remember about primary ( essential hypertension)
Ages 25- 74: Increased Occurance with age * Chronic progressive disorder * Contributing factors – Hyperactivity of sympathetic nervous system – Hyperactivity of the renin-angiotension system – Endothelial dysfunction
57
What are the risk factors for essential hypertension?
Genetics & Ethnic groups * Age: > than 60 years * Obesity: then it has to pump harder b/c theres more tissue * Smoking * Diabetes- harder to pump something thick than thin blood * Hyperlipidemia- alot of fat in your body * ? High sodium diet
58
What is secondary hypertension?
Hypertension with an identifiable cause – Renal disease – Coronary artery disease – Toxemia of pregnancy – Drug therapy: oral contraceptive therapy – Sleep apnea
59
What is the difference between short term and long term BP
Short Term : majority of clients asymptomatic * Long Term:MI ( myocardial infarction or heart attack) Heart Failure Kidney Disease Stroke Peripheral Artery Disease Retinopathy ( swelling of the retina) - the reason why most hypertensive patient are identfiied by eye doctors Diabetes
60
What is cardiac output?
Cardiac output is defined as the amount of blood pumped out of the body in a minute. It's usually somewhere between four to six liters of blood every minute gets pumped by your heart
61
What two things make up arterial pressure?
Cardiac output X Peripheral resistance
62
What is preload?
PRELOAD ( what we loaded the heart up with) = Cardiac output (Heart rate (ANS) + Stroke volume)
63
What is afterload?
AFTERLOAD ( what the heart has to pump against) = Peripheral resistance
64
Blood pressure increases when
cardiac output increases and/or · peripheral vascular resistance increase
65
does weight loss affect preload or afterload?
Preload
66
does exercise affect preload or afterload
afterload and a little bit of preload
67
does stress reduction affect preload or afterload?
Afterload and a little bit of preload
68
does smoking cessation affect preload or afterload?
afterload
69
does alcohol restriction affect preload or afterload
afterload
70
does caffeine restriction affect preload or afterload
afterload
71
does low cholesterol diet affect preload or afterload
afterload
72
does sodium restriction affecrt afterload or preload?
preload
73
How do you promote compliance with medications?
Patient education · Self-monitoring · Minimize ADRs · Simplify regimen · Keep cost down
74
What do beta blockers end in?
olol
75
What is the action of beta blockers?
Action : Blocks beta receptors in the heart – decreases heart rate – decreases conduction system – decreases force of contraction - work on cardiac output
76
What are the ADRs of beta blockers?
I'm giving it to you to lower your heart rate, lower your blood pressure, decrease the squeezing of your heart. – hypotension bradycardia – bronchial constriction – drowsiness/depression
77
What are the nursing implications of beta blockers?
–Assessment Know side effects
78
What are diuretics?
* Promote renal excretion of water & lytes * Increase urinary output
79
Why do you give tdiuretics herapeutics uses
Hypertension · Removal of edematous fluid
80
How are diuretics categorized?
by the site of action thiazide · high ceiling loop diuretics · potassium sparing diuretics
81
What is the number on problem with diuretics?
we pee out potassium, which makes us have electron imbalances. So there for people who are susceptible to that, we have potassium sparing diaretics.
82
What is the mechanism of actions
blockade- sodium/cholride reabsorption
83
What is the site of action of diuretics
they work by blocking sodium and chloride being re absorbed into the body.
84
What are the ADRs in diuretics?
I'm giving it to you because either you're hypertensive or you have too much fluid on your body. My side effects are gonna be hypotention and dehydration. – hypovolemia – electrolyte imbalance
85
What is the nursing implications for diuretics?
Daily weights – Monitor BP – Administer early in the day – Prevent orthostatic hypotension
86
What is the first choice of drugs that were going to give patients to control blood pressure
Thiazide drugs
87
What is action of thiazide drugs
distal convoluted tubule – Reduction of blood volume – Reduction of arterial resistance
88
What re the ADRsa of thiazide drugs
Hypokalemia – Dehydration – Hyperglycemia- people start having elevated blood sugars b/c they think it b/c it inhibits how well insulin works – Hyperuricemia- ncreased levels of uric acid caused gout. Gout is an inflammatory disease in small joints. OK? So uric acid causes gout. Too much uric acid, it's gonna cause little nodules to form. And your small joints, like toes and fingers, those joints get inflamed. – Hyperlipidemia- A lot of our diuretics stimulate the liver to make more fat, so we have hyperlimia
89
What is the high-ceiling ( Loop) Diuretics ( Furosemide: Lasik)
Ascending loop of Henle & Rapid onset
90
What is ADRs of high- ceiling diuretics
Hypotension - Hypokalemia – Hyponatremia - Ototoxicity – Hyperglycemia - Hyperuricemia – Hyperlipidemia
91
What are the nursing implications of loop diuretics
Loop diuretics are potassium wasting so they are hypo
92
What is the potassium ( HYPER) sparing diuretics?
Diuretics: Spironolactone ( Aldactone)
93
What is the action of potassium sparing diuretics?
It blocks aldolsterone So that's how it keeps your body from re absorbing sodium. It just has a little bit of a diuretic effect, but it keeps the person from having hypo colemia. – Blocks aldosterone in the distal nephron – Retention of potassium * Weaker diuretic- where we have to look into risk benefits
94
What is the ADRs of potassium sparing diuretics?
hyperkalemia & avoid with ARB”S since they also promote hyperkalemia
95
What are the nursing implications of potassium sparing?
*Regulation of BP by the Renin Angiotensin System
96
What do Angiotensin - Converting Enzyme Inhibitors ( ACE) end in?
pril
97
What is the action of ACE
Interrupts renin angiotension-aldosterone system (RAAS)
98
What are the adverse effects of ACE hinibitors–
– First–dose hypotension : decrease blood volume – Persistent Cough: increased bradykinin – Hyperkalemia: potassium retention
99
What is the interaction with NSAIDS
fluid retention Angioedema: rare increased capillary permeability – Fetal harm: renal failure
100
What are the nursing implications?
You wanna make sure of what your blood pressure is, what your electro light levels are, what side effects the person has, and teach them to be alert for other drug drug interactions.
101
What is the angitension II receptor blockers?
ARBs
102
What is the action of ARBs?
They don’t block the inactive from becoming active , they block the receptor sites that active drugs hits- so that’s how they blocked the reabsoprtion
103
What is an example of ARBs
Losartan (Cozaar)
104
Why do you give an ARB
*Hypertension *Heart failure
105
What are the ADRs of ARBS
–Dizziness –Birth defects
106
What are the examples of newer ARBS
Candesartan (Atacand) –Irbesartan (Avapro) –Telmisartan (Micardis) –Valsartan (Diovan)
107
What is an example of cardiac glycoside?
Digoxin ( Lanoxin)
108
What is the action of digoxin?
slows the transmission of cardiac impulses through the cardiac conduction system – increases the force of cardiac contraction
109
What are the ADRs of digoxin?
anorexia, nausea – bradycardia
110
What are the nursing implication for digoxin?
– Check apical pulse – Monitor dig and K+ levels *Relation of Ventricular Diameter to Contractile Flow
111
What is angina pectoris –
– Sudden pain beneath the sternum often radiating to left shoulder and arm – Oxygen demand greater than oxygen supply
112
What are the types of angina?
Chronic Stable: Extertional – Variant: any time even at rest – Unstable: Medical Emergency
113
What is an example of nitrate
nitroglycerin
114
What is the action of nitrates?
Increases the blood flow to the coronary arteries – Dilates the peripheral arteries- by doing so it increases the blood supply, oxygen to the heart
115
Key administration for nitrates
Highly lipid soluble - Very short half-life ( 5-7 minutes)
116
What are the ADRs of nitrates?
orthostatic hypotension – headache
117
What are the key things to remember for nitrates sublingual
tablets or spray - Drink water before taking - Do not swallow, - Should feel a tingling sensation - If pain not relieved in 5 minutes with initial dose call 911 § Take 2nd dose in 5 minutes § Take 3rd dose 5 minutes later
118
What are key things to remember for topical nitrate administration
Topical: Transdermal delivery systems - Rotate sites and remove previous patch - Need to wear continuously during daily activi

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