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218 exam 5

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This 30 page Study Guide was uploaded by Ti-ishia Notetaker on Tuesday August 16, 2016. The Study Guide belongs to 218 at 1 MDSS-SGSLM-Langley AFB Advanced Education in General Dentistry 12 Months taught by in Fall 2016. Since its upload, it has received 15 views. For similar materials see pharmacology in NURSING at 1 MDSS-SGSLM-Langley AFB Advanced Education in General Dentistry 12 Months.


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Date Created: 08/16/16
30,34, 35.,36,41,42,43,44,45,46,47,48,49,50,52,52,53,55,56 (19) Chapter 30 1. Identify the characteristics and pathophysiology of migraine headache. Make sure pt understands which medication is taken and when. Neurovascular disorder involving dilation and inflammation of intracranial blood vessels 2. Define abortive therapy for migraine headache. Treatment: drugs are used to abort an attack: beta blockers tricyclic antidepressants antiepileptic drugs other drugs are used to treat the pain: aspirin-like drugs specific antimigraine drugs 3. Complete the table of this prototype drug. Drug Pharmacolo Mechanism of Therapeutic Adverse Effects gic Class Action Uses (Indications) Sumatriptan serotine relieves pain migraine chest pressure, avoid (Imitrex) receptor by constricting headache during pregnancy agonists intracranial Available in rapid- blood vessels acting formulations: and Subcutaneous, nasal suppressing spray, needle-free inflammation device Ergotamine ergot complex/unkn second-line Chemo receptors alkaloids own: drug for cause N/V stopping an ongoing migraine attack 4. Define preventive therapy for migraine and list drug classes that are used for this purpose. 5. Identify nursing implications for the drugs discussed in the chapter. 6. Define preventive therapy for migraine and list drug classes that are used for this purpose. 7. Identify nursing implications for the drugs discussed in the chapter. N 218 Pharmacotherapeutics Study Guide Exam # 5 Summer 2016 Chapter 34 1. Discuss side effects of benzodiazepines. Drugs that depress CNS function Used for anxiety (anxiolytic) Sleep (hypnotics) 2. Complete the table of these prototype drugs. Drug Pharmacolo Mechanism of Therapeutic Adverse Effects gic Class Action Uses (Indications) Triazolam benzodiaz depress insomnia CNS depression, (Halcion) epine activity in hypotension brainstem and anterograde amnesia limbic system, sleep-related increase the behaviors action of (scheduled, GABA controlled substance ) Zolpidem Sedative- acts on GABA to treat Somnambulation (Ambien) hypnotic, to enhance insomnia Schedule IV, ataxia, non- amnesia benzodiaz epine 3. Identify nursing implications for the drugs discussed in the chapter. Chapter 35 4. Define generalized anxiety disorder. Uncontrolled worrying for more than 6 months. Non drug therapy, counseling, therapy, relaxation are recommended. Unpleasant state of mind: fear and dread. 5. Complete the table of these prototype drugs. Drug Pharmacolo Mechanism of Therapeutic Adverse Effects gic Class Action Uses (Indications) Diazepam sedative- bind to insomnia, CNS depression (Valium) hypnotic, gamma- anxiety, (drowsiness, anxiolytic, aminobutyric seizures lightheadedness) anesthetic acid (GABA) Antidote for adjunct overdose: receptor Flumazenil (Romazicon)retrogra de amnesia Buspirone anxiolytic unknown, may Anxiety dizziness, nausea (BuSpar) be agonist at (take on a receptors for schedule because it takes a while serotonin and dopamine to have effect, does not interact with other depressants) 6. Identify nursing implications for the drugs discussed in the chapter. Can have withdrawal symptoms. Do not combine with alcohol or any CNS depressants. Chapter 36 7. Define Attention-Deficit/Hyperactivity Disorder (ADHD). Attention deficit/hyperactivity disorder (ADHD): characterized by inattention and hyperactivity. First diagnosed in children, boys more likely than girls, diagnosed around school age of 7. Children and adults When symptoms last at least 6 months and occur in two separate settings (home and school) Drug therapy includes both stimulants and nonstimulants 8. Complete the table of these prototype drugs. Drug Pharmaco Mechanism of Therapeutic Adverse Effects logic Action Uses Class (Indications) Amphetamine CNS work in the CNS stimulation, stimulant CNS and narcolepsy, weight loss( not peripherally; ADHD, weight something that you release loss can stay on forever) norepinephrin e and dopamine Methylphenid ADHD activates the ADHD, anxiety, insomnia ate (Ritalin) drug, RAS narcolepsy, Take stimulants CNS depression early in the morning, stimulant last dose usually around 12. We worry about children’s growth so measure and weigh them. Monitor chest pain, palpitation, avoid simulants like caffeine. Schedule II ( often abused) Caffeine CNS not really sure treatment of dose-dependent stimulant narcolepsy lower doses: and shift-work alertness, keeps you sleep awake disorder, higher doses: heart given to palpitations, tremors, newborns to insomnia stimulant caffeine is also respiration added to alcohol which keeps you awake and allows you to drink more which can lead to alcohol poisoning. 9. Identify nursing implications for the drugs discussed in the chapter. Chapter 41 1. Identify how diuretics work. Drugs that increase the urine output. The drugs affect the kidneys. The kidneys have 3 basic functions: Cleaning, maintenance of volume and composition of extracellular fluid Acid-base balance of body fluids Excretion of wastes and foreign substances Electrolytes – potassium to low/high affects hrt and hrt rhythm Hypokalemia: potassium less than 3.5 mEq/L Hyperkalemia: potassium greater than 5 mEq/L 2. Complete the table of these prototype drugs. Drug Pharmacolo Mechanism of Therapeutic Adverse Effects gic Class Action Uses (Indications) Furosemide diuretic Prevents the to remove low potassium levels (Lasix) (loop type) reabsorption large amounts (hypokalemia) Oral, IM or of Na and of fluid dehydration IV()5 mins) water in the ( increase excess urine(we want …usually loop of Henle urine output this) accompanie d by because salt can cause cramps or follow water) fatigue if electrolytes potassium are to low (stopped) Hydrochlorot thiazide diuresis when hypertension, electrolyte hiazide diuretic renal function heart failure imbalance, (TAKE IN THE is not hypokalemia MORNING) impaired prevent reabsorption of water Spironolacto potassium blocks the mild dehydration, ne sparing action of hypertension hyperkalemia (Aldactone) diuretic, aldosterone aldosteron and promotes e sodium and antagonist water excretion and spares K+ 3. Identify nursing implications for the drug discussed in the chapter. Weigh pt who receives furosemide (Lasix), monitor potassium level, check vitals frequently ….given rapidly IV can cause damage to the ears and cause deafness… causes ototoxicity…no more than 4mg/min pushed IV. Diuretics should be taken in the morning so urine output doesn’t interfere with sleep. spirolactone (Aldactone) ppl with hypertension are taught to reduce salt intake… no salt substitutes that are often high in potassium. Avoid foods high in potassium. Chapter 42 4. Identify the normal serum potassium level. Hyperkalemia greater than 5 mEq/L cause: high consumption of K+ rich foods Hypokalemia less than 3.5 mEq/L cause: diuretics Both hyper- and hypokalemia are associated with fatal dysrhythmias ( hrt affected in such a pt that it cannot function as a pump) and serious neuromuscular disorders…peanut butter, bananas, broccoli, green leaf veggies are all high in potassium 5. Complete the table of this prototype drug. Drug Pharmacolo Mechanism of Therapeutic Adverse Effects gic Class Action Uses (Indications) Potassium Electrolyte intracellular, treatment/prev N/V/D , required ention of potassium for nerve hypokalemia supplemen impulses t 6. Identify nursing implications for the drug discussed in the chapter. (oral forms ) can also cause peptic ulcers and stomach upset. (Put in lots of liquid, diluted, take with food, and make sure they are upright to reduce stomach upset and Gerd) IV for infuse slowly no more than 10 meq/hr if given too fast it will cause burning NEVER PUSH IV POTASSIUM IT WILL STOP THE HRT! Chapter 43 Hemodynamics= The study of the movement of blood throughout the circulatory system along with the regulatory mechanisms and driving forces involved 7. Define the following components of the circulatory system. Heart Blood vessels Arteries Transport blood under high pressure to tissues…very muscular and do not stretch a lot. Arterioles Valves that regulate blood flow. Capillarie Sights of exchange of oxygen, carbon dioxide, nutrients, hormones s and waste. Venules Collect the blood from the capillaries. Veins Transport blood back to the heart. They expand. Major reservoir of the blood in our bodies. 8. Define the following terms. Cardiac output Hrt rt times stroke volume normal is 5ml/min . the amount of blood pumped by each ventricle each minute Preload - filling The force of venous return. How much blood is in the hrt rt before it beats. the amount of blood that fills the heart just before systole Afterload – Arterial pressure that the left ventricle must overcome. How pressure the hrt hard does the lft ventricle have to squeeze to return blood to pumps against the left ventricle? the pressure in the aorta that must be overcome in order for the heart to eject blood Chapter 44 9. Briefly define the Renin-angiotensin-aldosterone system (RAAS). How our body regulates our blood pressure. Plays an important role in regulating blood pressure, blood volume, and fluid and electrolyte balance. 10.Define (include therapeutic uses) and give examples of an Angiotensin- Converting Enzyme (ACE) inhibitors. Angiotensin I is a precursor of angiotensin II Angiotensin-Converting Enzyme (ACE) Inhibitors captopril -prils 11.Define (include therapeutic uses) and give examples of an Angiotensin II Receptor Blockers (ARBs). Adrenal cortex on kidneys releases aldosterone helps raise bp. Angiotensin II Receptor Blockers (ARB) losartan -sartin All used for hypertension 13.Identify nursing implications for the drug discussed in the chapter. Prevention of MI/STROKE …we worry about lowering to much hypotension….orthostatic bp , falls risk, carefully monitor bp Chapter 45 14.Define (include therapeutic uses) and give examples of calcium channel blockers (CCBs). Lower bp Drugs that prevent calcium ions from entering cells Greatest effect on heart and blood vessels Calcium regulates contraction in vascular smooth muscle Nifedipine -ipine Verapamil & diltiazem Indications: hypertension, angina pectoris, and cardiac dysrhythmias 15.Identify nursing implications for the drug discussed in the chapter. Chapter 46 16.Define (include therapeutic uses) and give examples of vasodilators. Work directly on vessels mostly veins to make them bigger, we lower bp, preload, afterload. Vasodilation can be achieved with the use of many types of drugs Some dilate arterioles and some veins Indications: hypertension, heart failure, MI 2 main adverse effects: postural hypotension ( reation to making vessles bigger, this increases hrt rt ) reflex tachycardia Menoxydly –is an example also used for hair growth 17.Identify nursing implications for the drug discussed in the chapter. Chapter 47 18.Define hypertension. No one knows direct cause but contributing factors include: family members, aging, stress, smoking, alcohol, AA American. AA American males have the highest diagnoses. Occurs for many yrs and you won’t know that you have it. Contributes to heart attacks and strokes. Primary (Essential) hypertension: the most common by far no identifiable cause older people and African Americans are most at risk Secondary hypertension: brought on by an identifiable factor- adenal tumor, preclampsia, meds Consequences Heart disease (MI) Heart failure Angina Kidney disease Stroke The higher the pressure the greater the risk 19.List lifestyle modifications that may prevent hypertension or lower blood pressure for those who have hypertension. Restrict sodium Limit intake of alcohol DASH Eating Plan: Reduce the intake of saturated fat and cholesterol and increase consumption of fresh fruits and vegetables Aerobic exercise: can reduce BP by 10 mmHg Smoking cessation Weight loss 20.Complete the table of these prototype drugs. Drug Pharmacolo Mechanism of Therapeutic Adverse Effects gic Class Action Uses (Indications) Hydrochlorot thiazide diuresis when hypertension, electrolyte hiazide diuretic renal function heart failure imbalance, is not hypokalemia impaired prevent reabsorption of water Spironolacto potassium- blocks the hypertension Hyperkalemia ne sparing action of diuretic aldosterone and promotes sodium and water excretion and spares K+ Propranolol beta blocks beta hypertension, bradycardia, blocker receptors in angina, impotence sympathetic anxiety, system aggressive behavior Metoprolol beta blocks beta hypertension, bradycardia, blocker receptors in angina, heart impotence sympathetic failure, MI system Captopril ACE block the hypertension, first-dose (Capoten) Inhibitor production of heart failure orthostatic ((made from the venom angiotensin II hypotension ( breaks down irritating cough - of snakes ) bradykinin prils which is a angioedema- potent swelling of throat vasodilator) Losartan ARB block hypertension, upper respiratory (Cozzar) pro vasoconstricti diabetic infections and drug- u give on and the neuropathy headache it and its not secretion of active until it aldosterone is metabolized by the body Verapamil Calcium block the angina, constipation, (Calan) channel calcium arrhythmia, dizziness blocker channels and and promote hypertension vasodilatation Nifedipine Calcium block the angina, constipation, (Procardia) channel calcium arrhythmia, dizziness ( works blocker channels and and better in AA) promotes hypertension (works on Reynolds vasodilatation phenonmenon.) 21.Identify nursing implications for the drug discussed in the chapter. Impotence is a big issue that may need addressing. Hold If beta blocker for hrt rt less than 60. Teach pt to take their own bp. AA American do not respond well, avoid during pregnancy Carefully monitor bp, advise compliance, no symptoms with hypertension Chapter 48 22.Define heart failure (HF). Pump failure. When the hrt cannot pump enough blood to meet the body’s needs. When the heart is unable to pump an adequate amount of blood to meet the body’s metabolic needs. Occurs with aging and can also be accelerated or caused by: Coronary artery disease (CAD) Mitral stenosis- mitral valve hardens so the hrt has to pump harder Myocardial infarction (MI)*- heart attack Chronic hypertension (HTN) * Diabetes mellitus (DM) Characterized by signs of inadequate tissue perfusion: (progressive, fatal) Fatigue Shortness of breath Exercise intolerance Also signs of volume overload: Peripheral edema Pulmonary edema Cardiac remodeling: ventricles dilate and hypertrophy. Changes in the cells. Stretching of vessels cause cardiac dysrhythmias. 23.List the classifications of drugs used for heart failure. Diuretics are first-line drugs Angiotensin-Converting Enzyme (ACE Inhibitors) Angiotensin II receptor blockers (ARBs) Beta adrenergic blockers Cardiac glycosides Vasodilators 24. Complete the table of this prototype drug. Drug Pharmacolo Mechanism of Therapeutic Adverse Effects gic Class Action Uses (Indications) Digoxin Cardiac affects ion heart failure Dysrhythmias (lanoxin) Glycoside, movement dysrhythmias inotropic across cell (atrial Toxicity: Anorexia, (narrow ( increases membranes fibrillation) N.V., they see white therapeutic range ) the causing a as yellow or green . contractio more forceful n strength, contraction makes hrt and slowing work heart rat harder, slows the ( makes hrt hrt rt ) work harder drug and slower) metoprolol (Lopressor)- see previous notes 24.Identify nursing implications for the drug discussed in the chapter. Always check hrt rt before giving. We want less edema, less SOB, normal hrt rt/ bp Hypokalemia Low potassium increases rt of toxicity Digoxin immune fab (Digibind): Used to treat digitalis toxicity Desired blood levels: 0.5-2.0 ng/mL Potassium levels (K+): 3.5 to 5.0 mEq/L Not used often. (Originated) Foxglove plant helped with peripheral edema. Implanted cardioverter-defibrillators Pacemakers to make sure the right and left sides of the heart are synchronized Exercise training Chapter 49 Dysrhythmia is defined as an abnormality in the rhythm of the heartbeat Concern is a decrease in cardiac output some produce no symptoms some are life threatening with not blood pumped at all 2 basic types: tachydysrhythmias bradydysrhythmias Some times called arrhythmia 25.Describe impulse conduction: pathways and timing. Flow and process Sinus node to AV node 26.Describe the basic components of the electrocardiogram. P wave- atrial defibrillation- dysrhythmia in the atrium QRS – represents ventricle T- They’re all lined up and ready to do it again. 27. Complete the table of these prototype drugs. Drug Pharmacolo Mechanism of Therapeutic Adverse Effects gic Class Action Uses (Indications) Quinidine 1A blocks sodium “broad diarrhea Antidysrhy channels and spectrum thmic slows impulse agent” used conduction for both supraventricul ar and ventricular dysrhythmias Also used for the treatment of Malaria Lidocaine 1B blocks sodium for the CNS such as Antidysrhy channels treatment of drowsiness (IV ) thmic only ventricular dysrhythmias Propranolol Class II blocks beta 1 Used in the Contraindications: (Inderal) antidysrhy receptors treatment of heart block thmic, fast heart Adverse effects: LOLO beta Beta- rates that hypotension, blocker Adrenergic come from bradycardia, heart Blocker the top part of failure, fatigue the heart Amiodarone Class III Prolong the Used for pulmonary toxicity, (Codarone) antidysrhy action treatment of bradycardia, visual thmic, potential and ventricular disturbances Potassium refractory tachycardia’s micro deposits in the Channel period of the (VT) & Atrial eyes can lead to Blocker cardiac cycle fibrillation blurry vision 75% have adverse effects Verapamil Class IV Depress Used in the swelling, dizziness (Calan) antidysrhy depolarization treatment of thmic, and decrease rapid heart Calcium oxygen rates in the Channel demand of the top part of the Blocker heart. heart (supraventricu lar) Adenosine cardiac slow impulse to treat facial flushing (Adenocard) agent, formation in supraventricul diagnostic SA node and ar aid slows tachycardia’s conduction (Wolff- through the Parkinson- AV node White syndrome- extra channels in hrt , causes really fat hrt bts , chemical pace maker… stops hrt and restarts it to reset hrt rt ) 27.Identify nursing implications for the drug discussed in the chapter. Chapter 50 28.Define atherosclerotic cardiovascular disease (ASCVD). Plack builds up in the arteries, this could lead to blood clots that are able to travel through the body. The is plaque cause a narrowing of large arteries. 29.Define the following terms: Very-low- density These eventually become LDL lipoproteins (VLDLs) Low-density Very low-density lipoprotein (VLDL) - transport from the tissue lipoproteins (LDL) to the organ where they are stored. High LDL’s contribute to many of the hrt diseases. High-density Good, high high reverse cholesterol transport- move lipoproteins cholesterol out of bodies to be excreted in stools. Raise with exercise, healthy eating not smoking. 30.List therapeutic lifestyle changes related to lowering LDL cholesterol. Eating healthy, exercising, not smoking. Should always be included in the treatment plan of a patient who needs to reduce blood lipid levels monitor blood levels regularly maintain weight at an optimum level exercise reduce intake of saturated fats increase fiber in diet reduce or eliminate tobacco use 31.Complete the table of these prototype drugs. Drug Pharmacolo Mechanism of Therapeutic Adverse Effects gic Class Action Uses (Indications) Lovastatin antihyperli inhibit HMG- reduce risk of diarrhea or pidemic, CoA reductase myocardial constipation, muscle First line HMG-CoA so the liver infarction and pain(Myopathy) reductase makes less stroke cholesterol rhabdomyolysis-a inhibitor, and lowers severe muscle side “statin” LDL levels effect. The muscle degenerates. The by products that are released damage the kidneys which leads to kidney failure… Their urine will be bright red. Colesevelam antihyperli binds with bile to lower (Welchol) pidemic, acids cholesterol bloating, gas Bile acid containing sequestra cholesterol (not absorbed nt works in GI to so it stays in Powder that is absorb the system ) mixed with fluid, cholesterol so juice. it doesn’t enter the blood stream…It is casts out through the stool. 32.Identify nursing implications for the drug discussed in the chapter. Statins: take with evening meal, avoid grapefruit juice Bile acid sequestrants: take before meals with plenty of fluids take other medications 2 hrs before or 4 hours after Encourage a healthy lifestyle Chapter 51 33. Define angina. Duration usually 5-10 mins Pain from the hrt due to the hrt not getting enough blood. Pain typically radiates to the left. Normal signs: Chest pain or discomfort Pain in arms, neck, jaw, shoulder, or back Nausea Fatigue Shortness of breath Sweating Dizziness 34.Define the three forms of angina: Chronic stable Most common. Angina that occurs with exertion. Initiated by angina increase demand (physical activity), relieved by stress. Cold exposure, exercising, heavy meals can cause. Treatment: reducing oxygen demand or increase supply. Beta blocker: reduce hrt rt and demand. Variant angina Angina that occurs due to a spasm of the coronary artery. (Prinzmetals or Unpredictable. Vessel spasms and get smaller which vasospastic reduces blood flow and causes pain. angina) Unstable angina Unpredictable. Gets worst over time. Can occur with rest or activity. Warning sign for MI. Not caused by spasm. If you are with someone who is having chest pain that lasts longer than a few minutes: Rest Nitroglycerin Call 911 Do not drive to hospital Chew an aspirin (absorbed quicker) Move quickly, “time is muscle”- few hrs to restore oxygen to hrt muscles or they die 35.Complete the table of these prototype drugs. Sublingual: rapid onset short duration Transmucosal: rapid onset long duration Sustained-release oral capsules: slow onset long duration Transdermal: slow onset long duration Topical ointment: slow onset long duration Intravenous: rapid onset Drug Pharmacolo Mechanism of Therapeutic Adverse Effects gic Class Action Uses (Indications) Nitroglycerin Organic dilates prevention/reli Headache- bp e & nitrate, coronary ef of angina dropped so brain isosorbide Nitrates=vas vasodilator arteries doesn’t get as much patches are blood flow, odilators taken off at nt orthostatic (tolerance is developed to reduce hypotension, reflex over time ) tolerance tachycardia, tolerance Interacts w/ sildenafil (Viagra) & alcohol Propranolol beta- blocks beta angina and hypotension, feeling &meteoprolo adrenergic receptors in hypertension cold l (beta blocker cardiac tissue blockers) Black Box Warning: do not stop suddenly Verapamil antiangina inhibits the angina, peripheral edema, l drug, transport of hypertension, dizziness Calcium calcium into dysrhythmias Channel Blocker myocardial cells 36.Identify nursing implications for the drug discussed in the chapter. Assess chest pain for: location, character, cause Reassess soon after giving medications Monitor BP, pulse Instruct patients how to use nitroglycerin: SL and transdermal Encourage a healthy lifestyle Assess for side effects Reduce anxiety Chapter 52 37.Briefly describe hemostasis. –Our bodies process of stopping bleeding. The physiologic process of how bleeding is stopped Occurs in 2 stages: formation of a platelet plug reinforcement of the platelet plug with fibrin Process begins with blood vessel injury the vessel spasms and constricts platelets become sticky platelet aggregation is increased by thrombin, etc. Coagulation fibrin production 38.Briefly describe thrombosis. A blood clot w/in a vessel in the hrt. Can occur in the arteries or veins. It grows and cans top blood flow to a specific area. Usually occurs at sites where blood flow is low. DVT= Holman’s sign. When it breaks away and travels it is called a embolus. 39.Complete the table of these prototype drugs. Drug Pharmacolo Mechanism of Therapeutic Adverse Effects gic Class Action Uses (Indications) Heparin anticoagul binds to DVT, PE Hemorrhage ant, antithrombin (pulmonary :Heparin-induced indirect III and embolism) , MI thrombocytopenia ( not in oral thrombin inactivates (HIT)platelets clot form, given inhibitor several and then they bleed subcute only at hospital ) clotting Reversal agent for Aptt normal factors heparin: protamine sulfate is 40 secs Normal for Given subcute in ab heparinin is q12 hrs. Avoid 2 1.5- 2 times inches from belly 60-80 q4- button. 6hrs Enoxaparin Low potentiates prevention of injection site bruising (Lovenox) molecular antithrombin post-op DVT (low weight III, inactivates molecular heparin, clotting factor weight heparin) anticoagul Xa ant, does (safer than not hep) change Into ab sides aPTT Warfarin anticoagul inhibits action Treatment of Bleeding (Coumadin) ant, of vitamin K venous Reversal: (requires a Vitamin K so clotting thrombosis Vitamin K lot of antagonist factors are Atrial (Mephyton) slow monitoring) diminished fibrillation reversal Prevention of Foods high in vit k MI, stroke also interfere and make u more likely to clot …fresh frozen plasma will reverse it quickly. Dabigatran thrombin direct reduce risk of dyspepsia inhibitor, thrombin stroke, (heartburn) anticoagul inhibitor embolism in ant atrial dark tarry stools fibrillation bleeding Aspirin analgesic, affects the many Contraindications: antiinflam cyclooxygenas history of bleeding matory, e pathway disorders, antipyretic , gastric ulcers Side effects: Reye antiplatele syndrome in children t 81 mg or 325 mg/day is antiplatelet dose Clopidogrel antiplatele inhibits often used flu-like symptoms, t drug, platelet after MI or bleeding ADP aggregation stroke to receptor by binding to prevent a 2nd blocker receptor event stents, prevention of DVT Alteplase fibrinolytic catalyzes the to remove Bleeding conversion of thrombi that Make sure u know plasmin, with have already what type of stroke digests the formed in PE, pt is having if fibrin MI, stroke hemorrhagic this would not be advised network of clots 40.Identify nursing implications for the drug discussed in the chapter. Chapter 53 41.Define the following terms: Myocardial infarction Necrosis pf the myocardium (muscle) resulting from local (MI) ischemia which cause cell death. Cause is partial or complete blockage of one or multiple coronary arteries that decreases the flow to the hrt area. Heart attack” Underlying cause is partial or complete blockage of a coronary artery Symptoms are the same as angina: Pain or pressure in the center of the chest that lasts Shortness of breath Sweating Impending sense of doom Nausea and vomiting Management: Oxygen Aspirin Morphine- decreases pain and cause vasodilation Nitroglycerine- does reduce preload and workload but not mortality ST-elevation MI Most common cause of death, risk factors, age, smoking, (STEMI) diabetes. Complete disruption is referred to as an ST-elevation MI (STEMI) Non-ST-elevation MI (nonSTEMI)( cell death begins at 20 mins) Reperfusion therapy to restore blood flow through the blocked artery Can be accomplished with: drugs (fibrinolytic) percutaneous( through the skin) coronary intervention (PCI) within 90 minutes With PCI the patient should receive an anticoagulant with an antiplatelet Cardiac bypass=CABG Skip Chapter 54 Chapter 55 42.Complete the table of these prototype drugs. Anemia: a decrease in the number, size, or hemoglobin content of erythrocytes (red blood cells or RBCs) Causes: blood loss hemolysis bone marrow dysfunction Drug Pharmacolo Mechanism of Therapeutic Adverse Effects gic Class Action Uses (Indications) Ferrous antianemi replacement Iron deficiency nausea, severe sulfate (Iron) c drug, anemia, GI poisoning in OD iron bleeding, supplemen pregnancy and t menses Cyanocobala drug for B 12 is for vitamin B Uncommon min anemia, essential for 12 deficiency Oral effective only if vitamin actively the patient has supplemen growing and Intrinsic factor t dividing cells Folic acid megaloblastic nontoxic when anemia, used short- pregnancy term 43.Identify nursing implications for the drug discussed in the chapter. Chapter 56 44.Define hematopoiesis. The process of blood cell formation. Stem cell: capable of forming into any type of blood cell Complete the table of these prototype drugs. Drug Pharmacolo Mechanism of Therapeutic Adverse Effects gic Class Action Uses (Indications) Epoetin alfa erythropoi stimulates the anemia related hypertension, (Erythropoiet esis- production of to chronic cardiovascular in) stimulatin erythrocytes renal failure events g drug stimulates the production of hemoglobin Stimulates the production of rbc Filgrastim drug for stimulate the to help the bone pain increasing bone marrow patient fight neutrophil to produce infection production neutrophils Oprelvekin Thrombop increases used with fluid retention, oietic platelet those cardiac dysrhythmias growth production undergoing factor myelosuppress ive chemotherapy 45.Identify nursing implications for the drug discussed in the chapter. Lab objectives: 2inches above the risk…stay away from places with lots of nerve 46. List advantages and disadvantages of IV therapy.  Advantages:    fast absorption and onset   maintains constant blood levels   less irritation than IM, SQ  Disadvantages:    circulatory overload   cannot correct errors   irritation to the vein    infection and septicemia 47.  Describe preparation for IV therapy, insertion of catheter, dressing an IV site, and           discontinuing of an IV catheter.  Equipment:    correct size catheter   correct tubing   infusion pump, if  indicated   clean gloves   scissors or electric shaver for hair removal Check order Assess the patient 6 rights Wash hands Examine the solution Prime tubing Gloves Assess area Patient teaching Use a clean tourniquet or BP cuff Select vein Untie the tourniquet Clean the area(back and forth) Remove cover from catheter Anchor the vein Warn the patient Insert the catheter Look for flashback( small amount of blood in the catheter that tells you you’re in the vein) Lower the hub Advance just the catheter Stabilize the IV and release the tourniquet Apply pressure above the site( keeps blood from running out fast) Always wear gloves Remove the needle Maintain pressure Apply dressing Avoid covering the site with tape Regulate the IV rate Throw everything away 47. Recognize correct documentation of IV insertion Date and time of insertion Insertion site and appearance Catheter size Type of dressing IV fluid and rate Number of attempts Patient response 49.  Identify potential complications of IV therapy.  List signs and symptoms and nursing actions          for each. Infiltration Seepage of the IV fluid out of the vein IV should have a blood return if it is in the vein If infiltration occurs, remove the catheter, elevate the extremity, and apply heat or cold Extravasation Infiltration with a medication that damages the tissues Treatment is the same as infiltration, stop the infusion but you may leave the catheter in place in  order to administer an antidote   Hematoma Collection of blood in the tissues Treatment: elevate the limb, apply pressure and ice Infection Redness, swelling, pain at site  From the entry of microorganisms May occur at the site or systemically Phlebitis and Thrombophlebitis Inflammation of the vein which can cause development of a clot Prevention: change the site every 72­48 hours Treatment: remove the catheter, restart in opposite arm, and apply warm compresses Treatment: discontinue the IV and start in the other arm Phlebitis and Thrombophlebitis Inflammation of the vein which can cause development of a clot Prevention: change the site every 72­48 hours Treatment: remove the catheter, restart in opposite arm, and apply warm compresses Fluid overload Circulatory Overload Prevention: identify at­risk patients                      use an infusion pump                      calculate rate carefully                      monitor for signs of overload Catheter embolus   Prevention: remove and insert catheter                         carefully                        inspect the catheter when removed Air embolism     Prevention: prime tubing                         secure connections                         change bags of fluid before they are                               totally empty     If suspected: clamp tubing, turn patient on the left side (traps air in rt side of the hrt), and place in Trendelenburg position If the tip has broken off, place a tourniquet as proximally as possible to the IV site on the  affected limb 50. List t the nursing actions related to the administration of a piggyback medication Wash hands Gloves may be necessary IV route: rapid onset for faster therapeutic level more dangerous  Systems now often needleless Check for allergy Assess IV site Compatibility (example diltin only with NS) Almost always administer medications by pump    When adding medication to a bag:   make sure the fluid is not infusing   verify which type of fluid to use  wipe the port of the IV bag with alcohol INFUSING – piggyback must be higher than the primary  Warm to room temperature if cold Prime the tubing:    Close the roller clamp and spike bag   Squeeze drip chamber, prime tubing  While priming do not waste the medication Wipe access port with alcohol Connect piggyback to upper port and set rate May use backpriming to flush the tubing   inject the medication   gently turn the bag to mix   label the bag   only add medication to a new bag   51. Compare and contrast PPN and TPN solutions. PPN ­Supplies nutrients via the veins Contain:     Carbohydrates (dextrose)    Proteins (amino acids)    Vitamins    Minerals    Electrolytes    Water    Medications (regular insulin and heparin) Central vein= greater than 10% Peripheral = usually 10 % Prevents the breakdown of subcutaneous fat and muscle protein for energy 52. Recognize nursing actions related to safe administration of TPN (total is given centrally)  (partial is given peripherally)    Central vein: TPN    greater than 10% glucose Peripheral vein: PPN   usually 10% glucose   may cause sclerosis­ hardening of veins , phlebitis­ irritation , swelling 53. Identify the complications that can occur when a patient receives TPN or PPN. Hypoglycemia: do not suddenly stop! Hyperglycemia Hypervolemia Infection due to high concentration of glucose    change bag and tubing every 12­24 hours Carefully check the bag with the order Do not administer anything else through PN IV line Store PN solutions in the refrigerator, remove 30 minutes to 1 hour before use  Do not add anything to the bag


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