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NR202 oxygenation pharm test (Nurisng)


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What are some indications for the thrombolytics Streptokinase Activase (tpa) and TNK (tenecteplase)
1. It's for those who have had a Myocardial Infarction.
2. Activase is for those who have had a Cerebral Vascular accident.
3. It's for those who have a central venous line that has clotted off.
4. It's for those who had a massive Pulmonary embolism
Action of thrombolytics:
Lysis of thrombi or pulmonary emboli
Side efects of thrombolytics
Bleeding in the GI tract or cerebral vascular area, Allergic reaction (streptokinase only)
Nursing implications for thrombolytics
Avoid invasive procedures, monitor ECG and VS. Monitor PTT and ACT. Monitor for bleeding and hemoccult stools. Maintain 2 IV sites. Do not give if active bleeding, BP > 180/110, recent OR, CVA, or trauma
Expected outcomes for those receiving thrombolytics
Relief of symptoms related to the clot
Patient teaching for those receiving thrombolytics
Report bleeding of gums, bruising, bright red or black tarry feces, hematuria, hematemesis
Name 3 anticoagulants
Heparin, Lovenox, Coumadin
What is Heparin and Lovenox indicated for?
They are indicated for those who have had an MI, DVT, PE, and it's for the prevention of clots in bedfast patients
What is the action of Heparin or Lovenox
Prevents conversion of fibrinogen to fibrin
What are the side effects to Anticoagulants
Bleeding, bruising,
thrombocytopenia, anemia
What are the nursing implications for Heparin and lovenox
Monitor the lab test which is called aPTT. The normal lab values is 25-35 sec. The therapeutic value is 1.5-2.5 x control. The antidote for heparin is protamine sulfate. If converting to coumadin the pt. will need 2-3 days on both meds. SQ-do not aspirate or rub site after injection
What are the expected outcomes for anticoagulants
No new clot development. Lab values therapeutic
What could you teach a patient receiving Heparin or Lovenox
Use electric razor & soft toothbrush. MedicAlert tag. Inform dentist/MDs. Report bleeding of gums, bruising, bright red or black tarry feces, hematuria, hematemisis
What is Coumadin indicated for?
Prevention of clot formation in high risk patients (A-fib, prosthetic heart valve, previous clot).
Nursing implications for Coumadin
Monitor the lab tests: aPTT and INR
The normal lab INR values 2.0-3.0
Therapeutic 2x normal
Antidote vitamin K
Requires 3-5 days to be therapeutic. Give at 1700 every day or same time every day.
What could you teach a patient receiving coumadin
Maintain consistent intake of Vitamin K: eat yellow and dark green vegetables. Routinely draw lab.
Name some antiplatelet aggregation drugs
Aspirin, Ticlid, Plavix, ReoPro, Integrillin
What are antiplatet aggregation drugs indicatied for
For the prevention of clot formation, for people going to have a heart cath or stent placement, and for those who have acute coronary syndrome
What is an action for antiplatelet aggregation drugs
They supress platelet aggregation
What are the side effects for antiplatelet aggregation drugs
Bruising, GI bleed (wth high dose ASA), ASA toxicity: N/V, rash, tinnitus
Give a po antiplatelet med with what?
What is an expected outcome for someone who is taking antiplatelet aggregation
No new clot development
What would you teach a patient who is taking antiplatelet aggregation drugs
PO-Give with food, Chest pain not relieved with nitro, chew one ASA and call EMS
Name 2 Inotropic vasopressors
Dopamine, Dobutrex
What are the indications for inotropic vasopressors
For those with low blood pressure, low urine output (<30 cc/hr) Heart failure
Actions for those taking inotropic vasopressors
1-4 mcg/kg/min. Raise in renal perfusion. 5-10 mcg/kg/min, raises cardiac output and blood pressure
Side effects to Inotropic vasopressors
Infiltration causes tissue necrosis-treat with regitine
Nursing implications for those taking inotropic vasopressors
Infuse via IV pump through CVL. Avoid discontinuing abruptly. Monitor BP closely (frequently titrated by RN) and I and O hourly
Expected outcome for those taking inotropic vasopressors
output > 30 cc/hr, raise in BP
what could a nurse teach a patient about taking inotropic vasopressors
Notify RN of chest pain, dyspnea, numbness, tingling or pain at infusion site
What is an Adrenergic Sympathomimetic
What is Epinephrine for
It is for Low BP, Low urine output (<30 cc/hr) bronchospasm
What does epinephrine do (Actions?)
it's a vasopressor so it raises BP and force (+ inotrope), and rate(+ chronotrope) of myocardial contraction (raises Cardiac output), it's a bronchodilator
What are the side effects to epinephrine
tachycardia, nervousness, restlessness, tremor, angina, arrhythmias
What are the nursing implications for those receiving Epinephrine
Infiltration causes tissue necrosis-watch IV site. Monitr VS, q 5-15 minutes and output q 1 hr. Dosage frequently titrated
Expected outcomes and Pt teaching for those receiving epinephrine
Raised Blood pressure and tissue perfusion, Output > 30cc/hr.
May cause feelings of anxiety. Report palpitations or chest pain
Name an anti-arrhythmic
Wha is adenosine indicated for
SVT conversion to Normal sinus rhythm when vagal unsuccessful
Actions for adenosine:
Interrupts re-entrant pathways and slows conduction in the AV node
Possible side effects for those taking adenosine
Brief asystole followed by conversion, transient arrhythmias, facial flushing, SOA
Nursing implications for those taking adenosine
ECG monitoring during admission. Give over 1-2 seconds. Proximal IV port and follow with rapid normal saline flush
Expected outcomes for those taking adenosine
Restores Normal sinus rhythm

Change position slowly because the med lowers BP. Report facial flushing, SOA, dizziness
Diuretics: Name 4 kinds
Loop diuretic
Thiazide diuretic
Potassium sparing diuretic
Osmotic diuretic
What are the indications for those taking Loop, Thiazide, and Potassium sparing diuretics
for those with heart failure, edema, hypertension
Actions of Loop, thiazide and potassium sparing diuretics
Promotes excretion of sodium and water. Increases urine output riding the body of excess fluid (decreasing preload).
Nursing implications for those receiving Loop, thiazide, and potassium sparing diuretics
Monitor daily weight, I&O, vitals, skin turgor, edema for fluid volume status. Assess for volume depletion (dehydration): dizziness, orthostatic hypotension, tachycardia, and muscle cramping, thirst, rapid pulse. Monitor serum electrolytes and replace as indicated. Avoid night doses to decrease nocturia. Loop diuretics--Potassium increased in diet: fresh orange or tomato juice, bananas, raisins, dates, figs, prunes, apricots, spinach, cauliflower, potatoes, and salt substitutes
What are the expected outcomes for those taking loop, thiazide, and potassium sparing diuretics
urine output < 30 cc/hr, lowered BP, Lowered edema, Lowered crackles and lowered SOA.
For potassium sparing: maintaining potassium levels w/o taking in more potassium
Pt teaching for Loop and thiazide diuretics
Avoid sudden position changes. Foods raised in potassium. Sx of lowered potassium: N/V, anorexia, muscle cramps or weakness, arrhythmias
Names of Loops:
Names of Thiazide diuretics
Names of Potassium sparing diuretics
Loops: Lasix, bumex, demedex
thiazide: hydrochlorothiazide (diuril)
Potassium: sparing: Spironolactone (aldactone) triamterene
Side effects for thiazide and loop diuretics
Loop: Lowered potassium, dehydration, hypotension, jaundice, dark urine, bleeding, bruising.
Thiazide: Dizzy, drowsy, dehydration, alkalosis, N/V, hypotension, hypochloremic, hypokalemia, hypomagnesemia, hyponatremia, hypovoleia, hypophosphatemia, hepatitis, hyperglycemia, phototoxicity, lehargy, weakness, anorexia, rashes, elevated lipids, muscle cramps, pancreatitis
Side Effects: Potassium sparing diuretics
Monitor for raised potassium if also on ACE inhibitor or potassium. Monitor I &O, daily weights.
Indications: Osmotic diuretic
Edema of tissues, acute oliguric renal failure, raised ICP or intraocular pressure
Names: osmotic diuretic
Mannitol, Albumin
Action: osmotic diuretic
Mobilizes fluid from extravascular tissues back into the intrvascular space- relieves and reduces edema
Expected outcomes:osmotic diuretic
raise in output, lower in edema, lower ICP
Nursing Implications:osmotic diuretic
Monitor VS, urine output, PA pressures & edema. Often given prior to loop diuretics
Side Effects: osmotic diuretic
Fluid overload & transient volume expansion
Pt. teaching: osmotic diuretic
Report dyspnea, SOA, explain purpose
Opioid Analgesic:Name
Morphine Sulfate
Indications: Opioid Analgesic
Pulmonary edema & chest pain associated with MI or PE
Action: Opioid Analgesic
Alters perception & response to pain. Mild vasodilation
Side Effects: Opioid Analgesic
respiratory depression, confusion, sedation, decreased BP, constipation
Nursing Implications: Opioid Analgesic
Assess pain, narcotic check, If resp <10, decrease or hold dose. Assess VS, orthostatic decreased BP, bowel function. Antidote is Narcan Naloxone dose
Expected outcomes:Opioid Analgesic
Decreased or cessation of pain
Pt. teaching: Opioid Analgesic
Causes drowsiness or dizziness- help with activity. Prevent constipation. TCDB q2hrs
Name cardiac glycoside:
digoxin (lanoxin)
Indications: cardiac glycoside
Treatment of HF, Atrial fibrillation and atrial flutter
(slows ventricular rate)
Actions: cardiac glycoside
Increases the force of myocardial contraction (+ inotropic effect), Slows conduction through the SA and AV nodes. Slows heart rate (negative chronotropic effect). Increase filling time, Increased cardiac output
Side effects: cardiac glycoside
anorexia , N/V, weak, ABD. Pain, Diplopia, yellow-green halos, dysrhythmias , palpitations
Nursing implications: cardiac glycosides
hold dose and notify Dr. if HR is <60 or BP <100
Assess for Hypokalemia, hypomagnesemia, or hypercalcemia may causes digitalis toxicity. Norm levels 0.5–2 ng/ml. Antidote is digoxin immune Fab (Digibind OR Ovine)
Expected outcomes: cardiac glycosides
Decreased HR, change to NSR, increased urine output, decreased edema
Pt teaching: cardiac glycosides
Daily pulse monitoring-Hold if <60. Don’t take with antacids or laxatives, add potassium foods to diet
Nitrates: name
Isordil, nitroprusside, nitroglycerin
Nitrates: indications
Tx and prevent angina
nitrates actions:
Dilates arterial, venous, and vessels decreasing preload, afterload, cardiac workload, and o2 demand. Dilates coronary decreasing cardiac workload and increasing CO
Side effects: nitrates
Decreased bp, increased hr, dizziness, HA Do not use if pt is taking viagra.
Nursing implications: nitrates
Tx HA with cool compress & tylenol. IV nitro mixed in glass bottle & monitor BP q15min. topical applied on dry, hairless site over muscle (remove old patch) Monitor BP before giving-hold if SBP<100
Expected Outcome: Nitrates
Decreased chest pain, increase activity tolerance
Pt teaching: nitrates
Avoid ETOH, hot showers/tub
Name: Ace inhibitors
Captopril, Fosinopril,(pril’s)
Indications: Ace inhibitors
Tx Heart Failure, Hypertension
Actions: Ace inhibitors
Vasodilitation, decrease blood volume, Increased cardiac output & renal blood flow, decrease edema & pulmonary congestion, decrease ventricular remodeling
Side effects: Ace inhibitors
Persistent dry cough, WBC or Differential changes, Hypokalemia, increase in BUN or creatinine
Nursing implications: Ace inhibitors
Assess BP & WBC before first dose. Give PO 1 hour A.C. Report Side Effects
Expected outcomes: Ace inhibitors
Decreased BP, wt, SOA, & edema
Increase in urine output
Pt teaching: Ace inhibitors
Change position slowly. Do not take potassium supplements concurrently. Report peripheral edema, signs of infection, or SOB
Name some Beta blockers:
Atenolol, Metoprolol ("olol") as a suffix
Indications: beta blockers
Antianginal, antihypertensive, acute MI, heart failure, tachyarrhythmias
Actions: beta blockers
Decreases cardiac workload, decreases Heart rate (-chronotrope), Decreases contractility (-inotrope), decreases myocardial O2 consumption, and decreases BP
Side effects: beta blockers
Decreased HR, BP,
SOA, fatigue, bronchospasm, impotence, HF, sleep disturbances, triglyceride levels raised.
Nursing implications: beta blockers
Hold and call the doctor if BP is less than 100 or hear rate less than 50. Do not discontinue abruptly. Report slow, irregular pulse, swelling, weight gain, or difficulty breathing.
Expected Outcome: beta blockers
Lowered HR, Lowered BP, Lowered occurance of chest pain
Pt teaching: beta blockers
Keep fast acting nitrates on hand for acute attacks. Do not discontinue abruptly. Check BP and HR daily
Names of Calcium channel blockers:
Verapamil, Nifedipine (ipine’s)
Indications: calcium channel blockers
Antiangina, antihypertensive, antidysrhythmic
Actions Calcium channel blockers:
Decreases contractility (- inotrope), HR (-chronotrope), & conduction
causes Vasodilitation
Side effects
Calcium channel blockers:
Abnormal dreams, anxiety, confusion, dizzy/lightheaded, drowsy, HA, jittery, nervous, psych disturbance, weakness, blurred vision, Arrhythmias, CHF, bradycardia, chest pain, hypotension, cough, SOA, Abnormal liver function, nocturia, polyuria, Sex dysfunction, flushing, increased sweating, hyperglycemia, joint stiffness, muscle cramps.
Nursing implications
Calcium channel blockers:
hold dose and notify Dr. if HR is <50 or BP <100 Antidote is calcium
Expected outcome
Calcium channel blockers:
Decreased chest pain, HR, & BP
Pt teaching
Calcium channel blockers:
Keep fast-acting nitrates on hand for acute attacks. Check BP & HR daily
Anti-Arrhythmic names:
Lidocaine, Amiodarone, Atropine
Anti-Arrhythmics: Lidocaine and Amiodarone
Ventricular dysrhythmias – PVCs and V-tachy
Amiodarone PO-SVT
Prolong refractory period, lowers ventricular irritability and PVCs
Anti-Arrhythmics:Lidocaine and amiodarone
lowers BP, Lowers HR, anorexia, N/V, constipation,
Side Effects
Anti-Arrhythmics: lidocaine and amiodarone
Photosensitivity, ataxia, seizures
Nursing implications
Anti-Arrhythmics: Lidocaine and Amiodarone
Infuse via IV pump with an in-line filter. Correct Potassium & Magnesium levels before starting. Monitor ECG rhythms
Expected Outcome
Anti-Arrhythmics: Lidocaine and amiodarone
Cessation of life- threatening arrhythmias
Pt teaching
Anti-Arrhythmics: Lidocaine and Amiodarone
Monitor pulse daily, wear protective clothing and sunblock for photosensitivity.
Sympatomatic sinus bradycardia
Increase SA node automaticity & AV node conduction
Side Effects
Tachycardia, dry mouth, blurred vision, drowsiness, urinary hesitancy
Nursing Implications
Not effective in heart transplants. Assess ECG strips & VS. Monitor I&O, and bowel function. Provide oral care or lozenge for dry mouth
Expected Outcomes
Increased HR with relief of symptoms of brady
Pt teaching
Hard candy or gum will decrease dry mouth, prevent constipation with increased fluids and stool softeners
Anti-infectives (Antibiotics): Name all kinds
Penicillin: -icillin, Cephalosporin: Cef-, Aminoglycosides: -mycin, -micin, Amikacin, Fluoroquinolones: C,G,L -acin, Tetracyclines: -cycline, Macrolides: Er, AZ—mycin or –Er-ocin, Sulfonamides: Sulf-, Metronidazole (Flagyl)
Treatment or prophylaxis of bacterial infections
Kill or inhibit growth of susceptible bacteria. Not effective on viruses or fungi.
Monitor BUN,& creatinine (renal). N/V, diarrhea, Allergic reactions: Itching red rash, SOA, wheezing, decreased BP
Nursing implications
Assess for allergies. Culture & sensitivity prior to starting med. Monitor VS & WBC. Encourage diet increase Vit. C, protein, & fluids
Expected Outcome
Resolution of symptoms of infections
Pt teaching
Take all medication to prevent reoccurrence. Report Sx of infection or allergic reactions.
Adrenergic Stimulants
Epinephrine, Isoproterenol (Isuprel) Metaproterenol (Alupent, Metaprel), Terbutaline, Albuterol, Salmeterol
Anticholinergic names
Ipratropium (Atrovent)
Adrenergic Stimulants
Inhaler: quick relief of acute bronchospasm
PO- long term
Adrenergic Stimulants
Smooth muscle relaxation and bronchodilation
Adrenergic Stimulants:
Tachycardia, nervousness, restlessness, tremor
Nursing Implications
Adrenergic Stimulants
Rescue inhaler for acute bronchospasm. Onset of action slightly quicker than anticholinergic inhalers. Assess respiratory status. Give PO with food
Expected Outcomes
Adrenergic Stimulants and Anticholinergics
Decreased SOA, breathing easier, clearing of lung sounds
Pt teaching
Adrenergic Stimulants and Anticholinergics
Use of inhalers⬝ shake well , use spacers, wait 1-2 mins between puffs, take adrenergic inhaler first then anticholinergic and steroid last. Hard candy or gum may decrease mouth dryness.
Indications, Actions, and S.E. for Anticholinergics
Indication: management of bronchospasm
Actions: Bronchodilation
Side Effects: Uncommon
Nursing Implications Anticholinergics:
Assess Respiratory status, rate, breath sounds, degree of dyspnea, pulse. Onset of action too slow for patients in acute distress
Mast Cell Stabilizers
Cromolyn (intal)
Prevention of exercise induced asthma
Side Effects
Mast Cell Stabilizers:
Irritation of nose or thrat, unpleasant taste
Mast Cell Stabilizers:
Prevents release of histamine from mast cells
Nursing Implications/
Pt teaching
Mast Cell Stabilizers:
Use prophylactically. Will not help in asthma attack
Gargling decreases throat irritation. Not tx for acute asthma attack. Several weeks may be required before beneficial effect.
Expected Outcome
Mast Cell Stabilizers:
Less frequent symptoms of asthma
Names of Methylxanthines:
Prevent nocturnal asthma in adult clients or control airway obstruction in COPD
Bronchodilation, slight vasodilation, Increase CO & urinary output
Side Effects
Tachycardia, N/V, anxiety
Nursing implications
IV therapeutic level: 8 to 12 µg/mL
Narrow margin of safety & high risk of toxicity- SX:anorexia, N/V, restlessness, insomania, seizures, dysrhythmias
Expected Outcome
Less frequent nocturnal asthma
Pt teaching
Avoid caffeine & smoke. Avoid OTC cough or cold meds, Minimun of 2000cc/day fluid intake
Names of Gluco-Corticoids:
Solu-Medrol, Prednisone, Beclamethasone
Inflammatory conditions of the airway. Reversible airway disease (asthma, COPD)
Supresses inflammation & normal immune response
Side Effects
Inhaled: thrush Systemic: increased BS, mood swings, anorexia, drecased wound healing, fluid retention, increased BP, osteoporosis
Nursing Implications
Monitor BS & WBC, I&O, daily WT. Give with food, Monitor closely for SX of infection.
Expected Outcomes
Decrease in presenting SX (SOA,wheexzing)
Pt teaching
Do not sotp taking med suddenly, it must be tapered off. Avoid contagious people. Rinse mouth after using inhaler to prevent thrush

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