Microsoft Word   Oxygenation Handouts 2007 Nclex
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Microsoft Word Oxygenation Handouts 2007 Nclex Document Transcript

  • 1. CV, RESPI, BLOOD DISORDERS REVIEW MATERIALS SUPPLEMENTAL MI Implementation for MI Chest pain radiating to arms, jaw, • neck (which is unrelieved by rest or Thrombolytic therapy-streptokinase, t-PA • nitroglycerin) Bedrest • Dyspnea Beta-blockers, morphine sulfate, dysrhythmics, • • Indigestion anticoagulants • Apprehension Do not force fluids (will give heart more to work • • with) Low grade fever • Elevated WBC (5-10, ESR, CK-MB, • LDH) ANGINA Stable Unstable Variant Intractable Triggered by a Triggered by an Triggered by coronary Chronic and predictable amount unpredictable amount of artery spasm; the attacks incapacitating and is of effort or emotion. exertion or emotion and may tend to occur early in the refractory to medical occur at night; the attacks day and at rest. therapy. increase in number, duration, and severity over time. Defibrillation Cardioversion • Start CPR first • Elective procedure, Informed Consent • 1st attempt – 200 joules • Valium IV • 2nd attempt – 200 to 300 joules • Synchronizer on • 3rd attempt – 360 joules • 25-360 joules • Check monitor between shocks for rhythm • Check monitor between rhythm • PULSE PRESENT = NO DEFIBRILLATION Left-Side CHF Right-Side CHF • Dyspnea, orthopnea • Dependent edema • Cough • Liver enlargement • Pulmonary edema • Abdominal pain/Nausea/Bloating • Weakness/Changes in mental status • Coolness of extremities CHF Implementations • Administer digoxin, diuretics • Low-sodium, low-calorie, low-residue diet • Oxygen therapy • Daily weight • Teach about medications and diet CVP: measures blood volume and efficiency of cardiac work; tells us right side of heart able to manage fluid • “0” on mamometer at level of right atrium at midaxilliary line • Measure with patient flat in bed • Open stopcock and fill manometer to 18-20 cm • Turn stopcock, fluid goes to patient • Level of fluid fluctuates with respirations • Measure at highest level of fluctuation • After insertion o Dry, sterile dressing o Change dressing, IV fluids, manometer, tubing q24 hours o Instruct patient to hold breath when inserted, withdrawn, tubing changed 1 nionoveno@hotmail.com
  • 2. CV, RESPI, BLOOD DISORDERS REVIEW MATERIALS SUPPLEMENTAL o Check and secure all connections • Normal reading—3-11 cm water • Elevated >11, indicates hypervolemia or poor cardiac contractility (slow down IV, notify physician) • Lowered <3, hypovolemia • Chest tray at bedside Arterial Peripheral Vascular Disease Assessments Venous Peripheral Vascular Disease • Rubor Assessments • Cool shiny skin • Cool, brown skin • Ulcers • Edema • Gangrene • Normal or decreased pulses • Intermittent Claudication (pain with • Positive Homan’s sign exercise/walking relieved with rest) • Impaired sensation • Decreased peripheral pulses Venous Peripheral Vascular Disease Arterial Peripheral Vascular Disease Implementations Implementations • Monitor peripheral pulses • Monitor Peripheral pulses • Elastic stockings • Good foot care • Medications—anticoagulants • Stop smoking • Elevate legs • Regular exercise • Warm, moist packs • Medications—vasodilators, anticoagulants • Bedrest 4-7 days (acute phase) Autologous Transfusion: ABO BLOOD TYPE COMPATIBILITY Blood Can Receive Can donate • Collected 4-6 weeks before surgery Type from: to: • Contraindicated—infection, chronic disease, O O O,A,B,AB cerebrovascular or cardiovascular A A,O A,AB disease B B,O B,AB AB O,A,B,AB AB Anaphylaxis o May repeat in 15-20 min. Delayed Allergic Reaction • Symptoms o Hives • Symptoms: o Rash o Rash, Hives, Swollen Joints o Difficulty breathing (first sign) • Nursing Care o Diaphoresis o Discontinue medication • Nursing care o Topical Antihistamines o Epinephrine 0.3 ml of 1:1000 solution o Corticosteroids SQ o Comfort measures o Massage site o Anemia Assessments (reduction in hemoglobin Anemia Implementations amount/erythrocytes) • Identify cause • Palpitations • Frequent rest periods • Dyspnea • High protein, high iron, high vitamin diet • Diaphoresis • Protect from infection • Chronic fatigue • Sensitivity to cold 2 nionoveno@hotmail.com
  • 3. CV, RESPI, BLOOD DISORDERS REVIEW MATERIALS SUPPLEMENTAL Iron Deficiency Anemia Assessments Iron Deficiency Anemia Implementations • Fatigue • Increase iron-rich foods (liver, green leafy vegetables) • Glossitis • Iron supplements (stains teeth) • Spoon fingernails • Impaired cognition Pernicious Anemia Assessments (gastric mucosa Pernicious Anemia Assessments fail to secrete enough intrinsic factor for stomach to • Vitamin B12—IM absorb) • Rest of life can’t be absorbed PO • Schilling’s Test • Fatigue, Paresthesia in hands and feet • Sore, red tongue Sickle Cell Anemia Assessments Sickle Cell Anemia Implementations • Pain /Swelling/Fever • Check for signs of infection (prevent crisis) • Scleral jaundiced • Check joint areas for pain and swelling • Cardiac murmurs • Encourage fluids • Tachycardia • Provide analgesics with PCA pump c crisis Hemophilia Assessments (female to male Hemophilia Implementations gene transmission) • Administer plasma or factor VIII • Easy bruising • Analgesics • Joint pain • Cryoprecipitated antihemophilic factor (AHF) • Prolonged bleeding • Teach about lifestyle changes • Non contact sports Leukemia Assessments Leukemia Implementations • Ulcerations of mouth • Monitor for signs of bleeding: petechiae, ecchymosis, thrombocytopenia • Anemia • Infections • Fatigue • Neutropenia (private room/limit # people, wbc • Weakness done daily, no fruit, no flowers/plotted plants, • Pallor clean toothbrush with weak bleach solution • Good mouth care • High calorie, high Vitamin diet (avoid salads/raw fruit/pepper/don’t reuse cup/don’t change litter box/digging in garden Acyanotic Congenital Heart Anomalies Cyanotic Congenital Heart Anomalies Assessments Assessments • Cyanosis • Normal Color • Clubbing of fingers • Possible exercise intolerance • Seizures • Small stature • Marked exercise intolerance • Failure to thrive • Difficulty eating • Heart murmur • Squat to decrease respiratory distress • Frequent respiratory Infections • Small stature • Failure to thrive • Characteristic murmur • Frequent respiratory infections 3 nionoveno@hotmail.com
  • 4. CV, RESPI, BLOOD DISORDERS REVIEW MATERIALS SUPPLEMENTAL Acyanotic Congenital Heart Anomalies Types: • Ventricular Septal Defect (VSD)—abnormal opening between right/left ventricles; hole size of pinhole or absence of septum; hear a loud harsh murmur, at age of 3 hole may close otherwise surgery such as purse-string suture Atrial Septal Defect (ASD)—abnormal opening between the two atria; audible murmur (if • defect is severe closure is done later in childhood) Patent Ductus Arteriosis (PDA)—failure of fetal structure to close after birth; ductus • areteriosis in the fetus connects the pulmonary artery to aorta to shunt oxygenenated blood from the placenta to systemic circulation (which bypasses the lungs). Once the child is born that structure should close because it is no longer needed because blood passes through to lungs; vascular congestion, right ventricular hypertrophy; murmur, bounding pulse, tachycardia; surgical to divide or ligate the vessel. Coarctation of the Aorta—narrow of aorta; high blood pressure and bounding pulse in areas • that receive blood proximal to the defect. Weak and absent blood distal to aorta. Surgical end- to-end anastomosis. Pulomonic Stenosis—narrowing at entrance to pulmonary artery; causes resistance to blood • flow and right ventricular hypertrophy; surgery Aortic Stenosis—narrowing of aortic valve; causes decrease cardiac output; surgery • Congenital Heart Anomalies Compensatory Mechanisms • Tachycardia • Polycythemia (increase formation of RBC’s) • Posturing—squatting, knee-chest position Cyanotic Congenital Heart Anomalies Types: • Tetralogy of Fallot—VSD, pulmonic stenosis, overriding aorta, right ventricular hypertrophy; squats/knee chest position to help breath; surgery needed Transposition of great vessels—pulmonary artery leaves left ventricle and aorta leaves right ventricle; • oxygenated blood not going into systemic circulation Truncus arteriosus—failure of normal septation and embryonic division of the pulmonary artery and • aorta; rather than two distinctly different vessels there is a single vessel that overrides both ventricles and gives rise to both pulmonary and systemic circulation; blood enters from both common artery and either goes to the lungs or to the body; cyanosis, murmur, difficult intolerance Total anomalous venous return—absence of direct communication between pulmonary veins and left • atria; pulmonary veins attach directly to right atria or drains to right atria Congenital Heart Anomalies Compensatory Medications—digoxin, iron, diuretics, • Mechanisms potassium • Tachycardia Change feeding pattern • • Polycythemia (increase formation of RBC’s) • Posturing—squatting, knee-chest position Congenital Heart Anomalies Implementations • Prevention • Recognize early symptoms • Monitor vital signs and heart rhythms 4 nionoveno@hotmail.com
  • 5. CV, RESPI, BLOOD DISORDERS REVIEW MATERIALS SUPPLEMENTAL i. second right ii. intercostal space - aortic area iii. second left intercostal space - pulmonic area iv. third left intercostal space - Erb's point v. fourth left intercostal space - tricuspid area vi. fifth left intercostal space - mitral (apical) area vii. epigastric area at tip of sternum Range of Normal Blood Pressure i. child under age two weighing at least 2700g: use flush technique,30-60mg Hg ii. child over age two: 85-95/50-65 mm Hg iii. school age: 100-110/50-65 mm Hg iv. adolescent: 110-120/65-85 mm Hg v. adult: <130 mm Hg Systolic / <85 mm Hg diastolic Normal Range of Peripheral Pulses infants: 120 to 160 beats/minutes • toddlers: 90 to 140 beats/minutes • preschool/school-age: 75 to 110 beats/ minute • adolescent/adult: 60 to 100 beats/minute • Normal Rates of Respirations newborn: 35 to 40 breaths/minute • infant: 30 to 50 breaths/minute • toddler: 25 to 35 breaths/minute • school age: 20 to 30 breaths/minute • adolescent/adult: 14 to 20 breaths/minute • adult: 12 to 20 breaths/minute • 5 nionoveno@hotmail.com
  • 6. CV, RESPI, BLOOD DISORDERS REVIEW MATERIALS SUPPLEMENTAL AIR EMBOLISM POSITIONING: Place the client on the left side in the trendelenburg position. Lying on the left side may prevent air from flowing into the pulmonary veins. The trendelenburg position increases intrathoracic pressure, which decreases the amount of blood pulled into the vena cava during inspiration. Hypovolemic Cardiogenic Distributive Decreased in intravascular Decreased cardiac Problem with blood flow to volume output cells Shock Signs and Symptoms • Cool, clammy skin • Cyanosis • Decreased alertness • Tachycardia • Hypotension • Shallow, rapid respirations • Oliguria Implementation for shock • Monitor CVP: <3 inadequate fluid >11 too much fluid Electroencephalogram (EEG) Electroencephalogram (EEG) Preparation Post-test • Test brains waves; seizure disorders • Remove paste from hair • Tranquilizer and stimulant meds • Administer medications withheld before test withheld for 24-48 hours • Observe for seizure activity • Stimulants (caffeine, cigarettes) withheld • Seizure prodromal signs; epigastric distress, for 24 hours lights before the eyes • May be asked to hyperventilate during test • Meals not withheld • Kept awake night before test; want them to lie still 6 nionoveno@hotmail.com
  • 7. CV, RESPI, BLOOD DISORDERS REVIEW MATERIALS SUPPLEMENTAL Hyperkalemia on Electrocardiogram: Tall, peaked T waves; prolonged PR interval; widening QRS complex Hypokalemia on Electrocardiogram: ST segment depression; Flat T wave First-Degree Heart Block: Prolonged P-R interval Bundle Branch Block: Widened QRS complex Myocardial Necrosis in Area: Q waves present Ventricular Fibrillation: No visible P waves or QRS complexes, no measurable rate. Irregular, chaotic undulations of varying amplitudes. HypoCalcemia: Prolonged Q-T interval Myocardial Ischemia: ST segment elevation or depression Premature Ventricular Contractions: absence of P waves, wide and bizarre QRS complexes, and premature beats followed by a compensatory pause Ventricular Tachycardia: absence of P waves, wide QRS complexes, rate between 100 and 250 impulses per minute. Regular rhythm Atrial Fibrillation: no P waves; instead there are wavy lines, no PR interval. QRS duration is WNL and irregular ventricular rate can range from 60-160 beats/minute. Hypokalemia Assessments Hypokalemia Implementations • K+ < 3.5 mEq/L • Potassium Supplements • Muscle weakness • Don’t give > 40 mEq/L into peripheral IV or without cardiac monitor • Paresthesias • Increase dietary intake – oranges, apricots, • Dysrhythmias beans, potatoes, carrots, celery, raisins • Increased sensitivity to digitalis 7 nionoveno@hotmail.com
  • 8. CV, RESPI, BLOOD DISORDERS REVIEW MATERIALS SUPPLEMENTAL Hypercalcemia Assessments Hypercalcemia Implementations • Ca+> 5.2 mEq/L • 0.4% NaCl or 0.9% NaCl IV • Sedative effects on CNS • Encourage fluids (acidic drinks: cranberry juice) • Muscle weakness, lack of coordination • Diuretics • Constipation, abdominal pain • Calcitonin • Depressed deep tendon reflexes • Mobilize patient • Dysrhythmias • Surgery for hyperparathyroidism Hypomagnesemia Assessments Hypomagnesemia Implementations Mg+< 1.5 mEq/L Monitor cardiac rhythm and reflexes Neuromuscular irritability Test ability to swallow Tremors Seizure precautions Seizures Increase oral intake—green vegetables, nuts, bananas, oranges, peanut butter, chocolate Tetany Confusion Dysphagia Flail Chest Sucking Chest Wound Pneumothorax Implementation Affected side (Sucking Open Collapse of lung due to Monitor for shock goes down during Pneumothorax) alteration of air in intrapleural Humidified inspiration and space oxygen • Sucking sound up during Thoracentesis with respiration • Dyspnea expiration (aspiration of fluid • Pain • Pleuritic pain from pleural • Decreased • Restricted movement space) breath sounds on affected side Chest Tubes • Anxiety • Decreased/absent breath sounds • Cough • Hypotension COPD Assessments COPD Implementations • “Blue Bloaters” • Assess airway clearance • “Pink Puffers” • Listen to breath sounds • Weakness • Administer low-flow oxygen (1-2 L, not too much because your trying to prevent CO2 • Change in postured day and hs narcosis) (don’t sleep laying down, have to stay erect) • Encourage fluids • Use of accessory muscles of • Small frequent feedings breathing • Use metered dose inhalers (MDI) • Dyspnea • Cough 8 nionoveno@hotmail.com
  • 9. CV, RESPI, BLOOD DISORDERS REVIEW MATERIALS SUPPLEMENTAL Adventitious breath sounds • Pneumonia Pneumonia Implementations Assessments • Check breath sounds • Fever • Cough and deep breath q 2 hours • Leukocytosis • Chest physiotherapy • Productive • Antibiotics Cough (rust, • Incentive spirometer green, yellow) • Encourage fluids • Dyspnea • Suction PRN • Pleuritic pain • Provide oxygen • Tachycardia • Semi-Fowler’s position • Bedrest • Medications—mucolytics (Mucomyst), expectorants (Robitussin), Bronchodilators (Aminophylline), Antibiotics (Bacterim) Chest Tubes Chest Tube Removal: Complications of Chest Tubes: Implementations • Instruct patient to • Constant bubbling in water-seal • Use to utilize negative do valsalva chamber=air leak pressure in lungs maneuver • Tube becomes dislodged from • Fill water-seal chamber • Clamp chest tube patient, apply dressing tented on one with sterile water to 2 cm side • Remove quickly • Fill suction control • Tube becomes disconnected from • Occlusive dressing chamber with sterile water drainage system, cut off contaminated applied to 20 cm tip, insert sterile connector and reinsert • Maintain system below level of insertion • Tube becomes disconnected from drainage system, immerse end in 2 cm • Clamp only momentarily of sterile water to check for air leaks • Ok to milk tubing towards drainage • Observe for fluctuation in water-seal chamber • Encourage patient to change position frequently Chest Tubes Fill water-seal chamber with sterile water to 2 cm (middle chamber) Fill suction control chamber with sterile water to 20 cm (chamber all the way to the right) Air-leak if bubbling in water-seal chamber (middle chamber) Obstruction: “milk” tube in direction of drainage 9 nionoveno@hotmail.com
  • 10. CV, RESPI, BLOOD DISORDERS REVIEW MATERIALS SUPPLEMENTAL Removal o chest tube: pt. does valsalva maneuver, clamp chest tube, remove quickly, apply occlusive dressing Dislodged: apply tented dressing Tube becomes disconnected from drainage system, cut off contaminated tip, insert sterile connector and reinsert Tube becomes disconnected from drainage system, immerse in 2cm of water Tracheostomy Tube Cuff Purpose—prevents aspiration of fluids • Inflated • o During continuous mechanical ventilation o During and after eating o During and 1 hour after tube feeding o When patient cannot handle oral secretions Tracheostomy Tube Cuff Prevents aspiration of fluids/separates upper and lower airways Inflated during continuous mechanical ventilation Inflated during and after eating Inflated during and 1 hour after tube feeding Inflated when patient cannot handle oral secretions NCLEX-RN exam is a “here and now” test; take care of problem now to prevent • harm to client. Do not ask “why” on the licensure exam • Morphine Sulfate for pancreatitis causes spasms of the sphincter of Oddi; • Meperidine is drug of choice. Normal Intraocular Pressure is 10-21 mm Hg • Ecchymosis (faint discoloration) around the umbilicus or in either flank indicates • retroperitoneal bleeding Oxygen Administration: assess patency of nostril, apply jelly • Face mask: 5-10 l/min (40-60%) • Partial rebreather mask: 6-15 l/min (70-90%); keep reservoir bag 2/3 full during inspiration • Non-rebreather mask: (60-100%); keep reservoir bag 2/3 full during inspiration • Venturi mask: 4-10 l/min (20-50%); provides high humidity and fixed concentrations, keep tubing free of kinks • Tracheostomy collar or T-piece: (20-100%); assess for fine mist; empty condensation from tubing’ keep water container full • Croupette or oxygen tent: o Difficulty to measure amount of oxygen delivered o Provides cooled, humidified air o Check oxygen concentration with oxygen analyzer q4 hours 10 nionoveno@hotmail.com
  • 11. CV, RESPI, BLOOD DISORDERS REVIEW MATERIALS SUPPLEMENTAL o Clean humidity jar and fill with distilled water daily o Cover patient with light blanket and cap for head o Raise side rails completely o Change linen frequently o Monitor patient’s temperature Clear liquid Full liquid Low-fat cholesterol Sodium High Low-residue No jam restricted restricted roughage, No milk Minimize high fiber Can eat lean meat No intestinal No juice No fruit cheese activity No white with pulp No avocado, milk, No nuts bread bacon, egg yolks Buttered without fiber butter rice white processed food, no whole wheat corn bran High protein diet Renal Low-phenylalanine diet Restablish anabolism to raise albumin Keeps protein, Prevents brain damage from levels potassium and imbalance of amino acids sodium low Egg, roast beef sandwich, Fats, fruits, jams allowed No beans, no cereals, No junk food No meats eggs bread no citrus fruits Antiarrhythmics Antiarrhythmics Antiarrhythmics Action: Medications: Side effects: • Interfere with electrical excitability • Atropine • Lightheadedness of heart sulfate • Hypotension Used for: • Lidocaine • Urinary retention • Atrial fibrillation and flutter • Pronestyl Antiarrhythmics • Tachycardia Nursing Considerations: • Quinidine • PVCs • Monitor vital signs • Isuprel • Monitor cardiac rhythm Aminoglycosides Aminoglycosides Aminoglycosides (Antibiotics) (Antibiotics) (Antibiotics) Side effects: Action: Medications: • Ototoxicity and Nephrotoxicity • Inhibits protein • Gentamycin • Anorexia synthesis in gram- • Neomycin • Nausea negative bacteria • Streptomycin • Vomiting Used for: • Tobramycin • Diarrhea • Pseudomonas, E.Coli Aminoglycosides (Antibiotics) Nursing Considerations: 11 nionoveno@hotmail.com
  • 12. CV, RESPI, BLOOD DISORDERS REVIEW MATERIALS SUPPLEMENTAL Harmful to liver and kidneys • Check 8th cranial nerve (hearing) • Check renal function • Take for 7-10 days • Encourage fluids • Check peak/trough level • Cephalosporins (Antibiotics) Cephalosporins Cephalosporins (Antibiotics) Action: (Antibiotics) Side effects: Medications: • Inhibits synthesis of • Bone marrow depression: caution • Ceclor bacterial cell wall with anemic, thrombocytopenic Used for: patients • Ancef • Tonsillitis, otitis media, • Superinfections • Keflex peri-operative prophylaxis • Rash • Rocephin • Meningitis Nursing Considerations: • Cefoxitin • Take with food • Cross allergy with PCN • Avoid alcohol • Obtain C&S before first dose: to make sure medication is effective against disease/bacteria • Can cause false-positive for proteinuria/glycosuria Fluoroquinolones Fluoroquinolones Fluroquinolones (Antibiotics) (Antibiotics) (Antibiotics) Action: Medications: Side effects: • Interferes with DNA • Cipro • Diarrhea replication in gram- • Decreased WBC and Hematocrit negative bacteria • Elevated liver enzymes (AST, Used for: ALT) • E.Coli, Pseudomonas, • Elevated alkaline phosphatase S. Aureus Nursing Considerations: • C&S before starting therapy • Encourage fluids • Take 1 hour ac or 2 hour pc (food slows absorption) • Don’t give with antacids or iron preparation • Maybe given with other medications (Probenicid: for gout) 12 nionoveno@hotmail.com
  • 13. CV, RESPI, BLOOD DISORDERS REVIEW MATERIALS SUPPLEMENTAL Macrolide Macrolide (Antibiotics) Macrolide (Antibiotics) (Antibiotics) Medications: Side effects: Action: • Erythromycin • Diarrhea • Binds to cell • Clindamycin • Confusion membrane and • Hepatotoxicity changes protein • Superinfections function Nursing Considerations: Used for: • Take 1hr ac or 2-3 hr pc • Acute infections • Monitor liver function • Acne • Take with water (no fruit juice) • URI • May increase effectiveness of: • Prophylaxis Coumadin and Theophylline before dental (bronchodilator) procedures if allergic to PCN Penicillin Penicillin Penicillin Action: Medications: Side effects: • Inhibits synthesis of cell • Amoxicillin • Stomatitis wall • Ampicillin • Diarrhea Used for: • Augmentin • Allergic reactions • Moderate to severe • Renal and Hepatic changes infections Nursing Considerations: • Syphilis • Check for hypersensitivity • Gonococcal infections • Give 1-2 hr ac or 2-3 hr pc • Lyme disease • Cross allergy with cephalosporins Sulfonamides (Antibiotics) Sulfonamides Sulfonamides (Antibiotics) Action: (Antibiotics) Side effects: Medications: • Antagonize essential • Peripheral Neuropathy • Gantrisin component of folic • Crystalluria acid synthesis • Bactrim • Photosensitivity Used for: • Septra • GI upset • Ulcerative colitis • Azulfidine • Stomatitis • Crohn’s disease Nursing Considerations: • Otitis media • Take with meals or foods • UTIs • Encourage fluids • Good mouth care • Antacids will interfere with absorption 13 nionoveno@hotmail.com
  • 14. CV, RESPI, BLOOD DISORDERS REVIEW MATERIALS SUPPLEMENTAL Tetracyclines TEtracyclines Tetracyclines (Antibiotics) (Antibiotics) (Antibiotics) Side effects: Action: Medications: • Discoloration of primary teeth • Inhibits protein • Vibramycin if taken during pregnancy or if sythesis child takes at young age • Panmycin Used for: • Glossitis • Infections • Rash • Acne • Phototoxic reactions • Prophylaxis for Nursing considerations: opthalmia • Take 1 hr ac or 2-3 hr pc neonatorum • Do not take with antacids, milk, iron • Note expiration date • Monitor renal function • Avoid sunlight Anticholinergics Anticholinergic Anticholinergic Action: Medications: Side Effects: • Inhibits action of • Pro-Banthine • Blurred vision acethylcholine and blocks • Atropine • Dry mouth parasympathetic nerves (affects • Scopolamine • Urinary retention heart, eyes, respiratory tract, GI • Chage in heart rate tract and the bladder) Nursing Consideration: • Dilates pupil, causes • Monitor output bronchodilation and decreased • Contraindicated with secretions glaucoma • Decrease GI motility • Give 30 min ac, hs, or secretions 2hr pc Used for: • Contraindicated: • Opthalmic exam paralytic ileus, BPH • Motion sickness • Pre-operative 14 nionoveno@hotmail.com
  • 15. CV, RESPI, BLOOD DISORDERS REVIEW MATERIALS SUPPLEMENTAL Anticoagulants Anticoagulants Anticoagulants (Heparin) Action: Medications: Side Effects: • Blocks conversion of • Heparin • Hematuria prothrombin to • Tissue irritation thrombin Nursing Considerations: Used for: • Monitor clotting time or Partial • Pulmonary embolism Thromboplastin Time (PTT) • Venous thrombosis • Normal 20-45 sec • Prophylaxis after acute • Therapeutic level 1.5-2.5 times MI control • Antagonist—Protamine Sulfate • Give SC or IV Anticoagulant Anticoagulant Anticoagulant (Coumadin) Action: Medication: Side Effects: • Interferes with • Coumadin • Hemorrhage, Alopecia synthesis of vitamin K- Nursing Considerations: dependent clotting • Monitor Prothrombin Test (PT) factors • Normal 9-12 sec Used for: • Therapeutic level 1.5 times control • Pulmonary embolism • Antagonist—Vitamin K • Venous thrombosis (AquaMEPHYTON) • Prophylaxis after acute • Monitor for bleeding MI • Give PO Thrombolytics Thrombolytics Thrombolytics Action: Medications: Side Effects: • Dissolves or lyses blood clots • Streptokinase • Bleeding Used for: • Urokinase • Bradycardia • Acute Pulmonary Emboli • Tissue • Dysrhythmias • Thrombosis Plasminogen Nursing Considerations: Activator • MI • Monitor for bleeding • Contraindicated in: hemophilia, CVA, Trauma, not used in patients • Have Amino over 75 years old, not used in Caproic Acid patients taking anticoagulants Available • Check pulse, color, sensation of extremities • Monitor EKG 15 nionoveno@hotmail.com
  • 16. CV, RESPI, BLOOD DISORDERS REVIEW MATERIALS SUPPLEMENTAL Antiplatelet Agents Antiplatelet Agents Antiplatelet Agents Action: Medications: Side Effects: • Interferes with • Aspirin • Hemorrhage platelet aggregation • Persantine • Thrombocytopenia Used for: Nursing Considerations: • Venous thrombosis • Check for signs of bleeding • Pulmonary embolism • Give with food or milk Antihistamines Antihistamines Antihistamines Action: Medications: Side Effects: • Block effects of • Chlor- • Drowsiness histamine Trimeton • Dry mouth Used for: • Benadryl • Photosensitivity • Allergic rhinitis • Phenergan Nursing Considerations: • Allergic reactions to • Give with food blood • Use sunscreen • Avoid alcohol Antihyperlipidemic Antihyperlipidemic Antihyperlipidemic Agents Agents Agents Side Effects: Action: Medications: • Constipation • Inhibits • Questran • Fat-soluble vitamin deficiency cholesterol and • Lipid Nursing Considerations: triglyceride • Take at hs or 30 min ac synthesis • Administer 1hr before or 4-6 hr Used For: after other meds • Elevated cholesterol • Reduce incidence of cardiovascular disease Antihypertensives Antihypertensives Antihypertensives Types: ACE Inhibitors (ACE Inhibitors) (ACE Inhibitors) Action: Medications: Side Effects: • Blocks ACE in lungs • Capoten • GI upset Used for: • Vasotec • Orthostatic hypotension • Hypertension • Dizziness • CHF Nursing Considerations: • Give 1hr ac or 3hr pc • Change position slowly 16 nionoveno@hotmail.com
  • 17. CV, RESPI, BLOOD DISORDERS REVIEW MATERIALS SUPPLEMENTAL A1-adrenergic receptors: found in the peripheral arteries and veins and cause a powerful vasoconstriction when stimulated A2-adrenergic receptors: several tissues and contract smooth muscle, inhibit lipolysis, and promote platelet aggregation. B1: Found in the heart and cause an increase in heart rate, atrioventricular node conduction, and contractility. B2: Arterial and bronchial walls and cause vasodilation and bronchodilation. Antihypertensives Antihypertensives Antihypertensives Type: Beta-Adrenergic Blockers Type: Beta-Adrenergic Type: Beta-Adrenergic Action: Medications; Side Effects: • Blocks Beta-Adrenergic • Nadolol • Changes in heart rate Receptors • Propranolol • Hypotension • Decrease • Tenormin • Bronchospasm excitability/workload Nursing Considerations: • Timoptic of heart, oxygen • Masks signs of shock and consumption hypoglycemia • Decrease • Take with meals Used for: • Do not discontinue abruptly • Hypertension • Angina • SVT Antihypertensives Antihypertensives Antihypertensives Type: Calcium Channel Blockers Type: Calcium Channel Type: Calcium Channel Action: Blockers Blockers Medications: Side Effects: • Inhibits movement of calcium across cell membranes • Procardia • Hypotension • Slow impulse conduction and • Calan • Dizziness depresses myocardial contractility • Cardizem • GI distress • Causes dilation of coronary arteries Nursing Consideration: and decreases cardiac workload • Monitor vital signs and energy consumption • Do not chew or Used for: divide sustained- • Angina release tablets • Hypertension • Interstitial cystitis 17 nionoveno@hotmail.com
  • 18. CV, RESPI, BLOOD DISORDERS REVIEW MATERIALS SUPPLEMENTAL Antihypertensives Antihypertensives Antihypertensives Type: Centrally acting Type: Centrally acting alpha- Type: Centrally acting alpha-adrenergics Side Effects: alpha-adrenergics adrenergics Action: Medications: • Sedation • Stimulates alpha • Aldomet • Orthostatic Hypotension receptors in • Catapres Nursing Considerations: medulla which • Don’t discontinue abruptly causes a • Monitor for fluid retention reduction in • Change position slowly sympathetic in the heart Used for: • Hypertension Antihypertensives Antihypertensives Antihypertensives Type: Peripheral-acting alpha-adrenergic Medications: Side Effects: blockers • Reserpine • Depression Action: • Orthostatic Hypotension • Depletes stores of • Brachycardia norepinephrine in Nursing Considerations: sympathetic nerve endings • Give with meals or milk Used for: • Change position slowly • Hypertension Antipyretic Agents Antipyretic Agents Antipyretic Agents Action: Medications: Side Effects: • Antiprostaglandin • Tylenol • GI irritation activity in (Acetaminophen Nursing Considerations: hypothalamus ) • Monitor liver function Used for: • Aspirin contraindicated for • Fever younger than 21 years old due to risk of Reye’s syndrome Antihypertensives Antihypertensives Antihypertensives Type: Direct-acting Medications Side Effects: vasodilators • Hydralazine • Tachycardia Action: • Minoxidil • Increase in body hair • Relaxes smooth Nursing Considerations: muscle • Teach patient to check pulse Used for: • Hypertension 18 nionoveno@hotmail.com
  • 19. CV, RESPI, BLOOD DISORDERS REVIEW MATERIALS SUPPLEMENTAL Antitubercular Agents Antitubercular Agents Antitubercular Agents Action: Medications: Side Effects: • Inhibits cell and • INH • Hepatitis protein synthesis • Ethambutol • Peripheral Neuritis Used for: Nursing Considerations: • Streptomycin • Tuberculosis • Check liver function tests • PAS • To prevent disease in • Vitamin B6 given for peripheral • PYZ person exposed to neuritis (Pyridoxine) organism • Used in combination Antivirals Antivirals Antivirals Action: Medications: Side Effects: • Inhibits DNA and • Zovirax • Headache RNA replication • AZT • Dizziness Used for: • Videx • GI symptoms • Recurrent HSV Nursing Considerations: • Famvir • HIV infection • Encourage fluids • Cytovene • Not a cure, but relieves symptoms Bronchodilators Bronchodilators Bronchodilators Action: Medications: Side Effects: • Decreases activity of • Aminophylline • Tachcyardia phosphodiesterase • Atrovent • Dysrhythmias Used for: • Brethine • Palpitations • COPD • Proventil • Anticholinergic effects • Preterm labor Nursing Considerations: • Primatene (Terbutaline) • Monitor BP and HR • When used with steroid inhaler, use bronchodilator first • May aggravate diabetes Cardiac Glycosides Cardiac Glycosides Cardiac Glycosides Action: Medication: Side Effects: • Increases force of • Lanoxin • Bradycardia myocardial (Digoxin) • Nausea contraction, slows • Vomiting rate • Visual disturbances Used for: Nursing Considerations: • Left-sided CHF • Take apical pulse • Notify physician if adult <60, 19 nionoveno@hotmail.com
  • 20. CV, RESPI, BLOOD DISORDERS REVIEW MATERIALS SUPPLEMENTAL child <90-110, <70 in older children Monitor potassium level • Dose: 0.5-1 milligram IV or PO • over 24 hr period Average: 0.25 mg • Diuretics Diuretics Diuretics Action: Medications: Side Effects: • Inhibits • HydroDIURIL • Dizziness reabsorption of • Diamox • Orthostatic Hypotension sodium and • Aldactone • Leukopenia water Nursing Considerations: • Lasix • Blocks effects • Take with food or milk • Hygroton of aldosterone • Take in a.m. Used for: • Monitor fluid and electrolytes • CHF • Renal disease Narcotics Narcotics Narcotics Action: Medications: Side Effects: • Acts on CNS • Morphine • Dizziness receptor cells Sulfate • Sedation Used for: • Codeine • Respiratory depression • Moderate to severe • Demerol • Hypotension pain • Dilaudid • Constipation • Preoperative • Percodan Nursing Considerations: • Postoperative • Safety precautions • Avoid alcohol • Monitor vital signs • Use narcotic antagonist if necessary (Narcan) Antianginals Antianginals Antianginals Action: Medications: Side Effects: • Relaxes smooth • Nitroglycerine • Hypotension muscle • Isosorbide • Tachycardia • Decreases venous • Headache return • Dizziness Used for: Nursing Considerations: • Angina • Check expiration date • Peri-operative • Teach when to take 20 nionoveno@hotmail.com
  • 21. CV, RESPI, BLOOD DISORDERS REVIEW MATERIALS SUPPLEMENTAL hypertension medication CHF May take Q5min x3 doses • • Wet with saliva and place • under tongue Herbs: Toxicities and Drug Interactions Chamomile Uses: Chamomile is often used in the form of a tea as a sedative. Reactions: Allergic reactions can occur, particularly in persons allergic to ragweed. Reported reactions include abdominal cramps, tongue thickness, tightness in the throat, swelling of the lips, throat and eyes, itching all over the body, hives, and blockage of the breathing passages. Close monitoring is recommended for patients who are taking medications to prevent blood clotting (anticoagulants) such as warfarin. Echinacea Uses: Largely because white blood cells in the laboratory can be stimulated to eat particles, Echinacea has been touted to be able to boost the body's ability to fight off infection. Reactions: The most common side effect is an unpleasant taste. Echinacea can cause liver toxicity. It should be avoided in combination with other medications that can affect the liver (such as ketaconazole, leflunomide (Arava), methotrexate (Rheumatrex), isoniazide (Nizoral). St. John's Wort Uses: St. John's Wort is popularly used as an herbal treatment for depression, anxiety, and sleep disorders. It is technically known as Hypericum perforatum. Chemically, it is composed of at least 10 different substances that may produce its effects. The ratios of these different substances varies from plant to plant (and manufacturer). Studies of its effectiveness by the National Institutes of Health are in progress. Reactions: The most common side effect has been sun sensitivity which causes burning of the skin. It is recommended that fair- skinned persons be particularly careful while in the sun. St. John's wort may also leave nerve changes in sunburned areas. This herb should be avoided in combination with other medications that can affect sun sensitivity (such as tetracycline/Achromycin, sulfa- containing medications, piroxicam (Feldend). St. John's wort can also cause headaches, dizziness, sweating, and agitation when used in combination with serotonin reuptake inhibitor medications such as fluoxetine (Prozac) and paroxetine (Paxil). Garlic 21 nionoveno@hotmail.com
  • 22. CV, RESPI, BLOOD DISORDERS REVIEW MATERIALS SUPPLEMENTAL Uses: Garlic has been used to lower blood pressure and cholesterol (Dr. Lucinda Miller notes that there is quot;...still insufficient evidence to recommend its routine use in clinical practice.quot;) Reactions: Allergic reactions, skin inflammation, and stomach upset have been reported. Bad breath is a notorious accompaniment. Studies in rats have shown decreases in male rats' ability to make sperm cells. Garlic may decrease normal blood clotting and should be used with caution in patients taking medications to prevent blood clotting (anticoagulants) such as warfarin /Coumadin. Feverfew Uses: Most commonly used for migraine headaches. Reactions: Feverfew can cause allergic reactions, especially in persons who are allergic to chamomile, ragweed, or yarrow. Nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen (Advil), naproxen (Aleve) or Motrin) can reduce the effect of feverfew. A condition called quot;postfeverfew syndromequot; features symptoms including headaches, nervousness, stiffness, joint pain, tiredness, and nervousness. Feverfew can impair the action of the normal blood clotting element (platelets). It should be avoided in patients taking medications to prevent blood clotting (anticoagulants) such as warfarin (Coumadin). Ginko Biloba Uses: This herb is very popular as a treatment for dementia (a progressive brain dysfunction) and to improve thinking. Reactions: Mild stomach upset and headache have been reported. Ginko seems to have blood thinning properties. Therefore, it is not recommended to be taken with aspirin, nonsteroidal anti-inflammatory drugs (Advil), naproxen (Aleve) or Motrin), or medications to prevent blood clotting (anticoagulants) such as warfarin (Coumadin). Ginko should be avoided in patients with epilepsy taking seizure medicines, such as phenytoin (Dilantin), carbamazepine (Tegretol), and phenobarbital. Ginseng Uses: Ginseng has been used to stimulate the adrenal gland, and thereby increase energy. It also may have some beneficial effect on reducing blood sugar .in patients with diabetes mellitus. (Dr. Miller emphasized that there is substantial variation in the chemical components of substances branded as quot;Ginseng.quot;) Reactions: Ginseng can cause elevation in blood pressure, headache, vomiting, insomnia, and nose bleeding. Ginseng can also cause falsely abnormal blood tests for digoxin level. It is unclear whether ginseng may affect female hormones. Its use in pregnancy is not 22 nionoveno@hotmail.com
  • 23. CV, RESPI, BLOOD DISORDERS REVIEW MATERIALS SUPPLEMENTAL recommended. Ginseng may affect the action of the normal blood clotting element (platelets). It should be avoided in patients taking aspirin, nonsteroidal antiinflammatory drugs (such as ibuprofen (Advil), naproxen (Aleve) or Motrin), or medications to prevent blood clotting (anticoagulants) such as warfarin (Coumadin). Ginseng may also cause headaches, tremors, nervousness, and sleeplessness. It should be avoided in persons with manic disorder and psychosis. Ginger Uses: Ginger has been used as a treatment for nausea and bowel spasms. Reactions: Ginger may lead to blood thinning. It is not recommended to be taken with medications that prevent blood clotting (anticoagulants) such as warfarin (Coumadin). Saw Palmetto Uses: Saw palmetto has been most commonly used for enlargement of the prostate gland. (Dr. Miller emphasized that studies verifying this assertion are necessary.) Saw palmetto has also been touted as a diuretic and urinary antiseptic to prevent bladder infections. Reactions: This herb may affect the action of the sex hormone testosterone, thereby reducing sexual drive or performance. Dr. Miller states that quot;While no drug-herb interactions have been documented to date, it would be prudent to avoid concomitant use with other hormonal therapies (e.g., estrogen replacement therapy and oral contraceptives...quot;) Black Cohosh Claims, Benefits: A natural way to treat menopausal symptoms. Bottom Line: Little is known about its benefits and its risks. 23 nionoveno@hotmail.com