NSG-318 EXAM 3 REVIEWED
SUMMARY
Agranulocytosis
severely low levels of neutrophils
Thrombocytopenia
low platelet count in the blood
acute HF
-heart muscle weakens and enlarges
-loses ability to pump blood adequately
-compensatory mechanisms fail
-lungs/periphery become congested
R sided heart failure
blood backs up in periphery
-peripheral edema & weight gain
L sided heart failure
blood backs up into lungs
-pulmonary edema, shortness of breath, dyspnea, cough
cardiomegaly is common with
heart failure
heart failure nonpharmacologic tx
-limit salt and saturated fat intake (limit to 2g/1tsp/day)
-limit/avoid alcohol intake (avoid/1 drink/day)
-stop smoking
-perform mild exercise
-fluid intake (may be dec)
Digoxin class
cardiac glycoside
e.g. Lanoxin
,digoxin use
HF, a-fib (oral/IV admin)
digoxin action
inhibits Na/K+ ATPase; inc cardiac contractility, CO and
tissue perfusion
digoxin side effects/adverse effects
hypokalemia, blurred/yellow vision, green/yellow halos w
toxicity
Digoxin contraindications
V-fib, hypokalemia
caution w/ acute MI, AV block, HTN, older adults
digoxin drug interactions
-Diuretics and cortisone: inc risk for toxicity (diuretics may
cause hypokalemia)
-Antacids: dec digoxin absorption
digoxin CAM interactions
-Ginseng: inc digitalis levels
-St. John's wort and psyllium: dec absorption
-Hawthorn: inc effects
-Licorice, aloe, ephedra: inc risk of toxicity
digoxin interventions
-assess apical pulse before administering; DON'T
ADMINISTER IF HR <60bpm
-advise client to eat foods high in K+
Antidote for digoxin toxicity
digoxin immune FAB
digoxin therapeutic serum level
0.5-1ng/mL
digoxin effects on heart muscle
-inc. myocardial contractility and CO
-dec. HR and conduction
,angina
acute cardiac pain caused by inadequate blood flow to
myocardium
antianginal drugs
-nitrates
-beta blockers
-Ca channel blockers
nitroglycerin class
antianginal (Nitrate)
e.g. Nitrostat
nitroglycerin uses
control angina, acute MI and HF
nitroglycerin action
dec myocardial demand for O2 consumption (vasodilator)
Nitroglycerin Contraindications
inc intracranial pressure; heat and light dec potency of
drug. keep in dark bottle
nitroglycerin routes of administration
-SL spray: 1-3min onset. space out over 5mins and call
911 before taking 2nd dose
-Topical cream: wipe off old cream 1st (4-8hr duration)
-Transdermal: leave off for 12hrs to give break
nitroglycerin side effects/adverse effects
CNS effects, syncope, tolerance, GI distress, circulatory
collapse
nitroglycerin drug interactions
-alcohol, beta blockers, Ca channel blockers,
antihypertensives, Aspirin, benzos, vasodilators: inc effect
-heparin: dec effect
nitroglycerin CAM interactions
-Hawthorn: inc. levels
, nitroglycerin interventions
-for SL spray, call 911 if 1st dose doesn't work
-proper storage of tabs
-administer SL tab if chest pain occurs
Atenolol class
beta 1 adrenergic blocker
e.g. Tenormin
atenolol use
tx of hypertension, prophylaxis, and acute MI
atenolol action
blocks beta 1 adrenergic receptor sites (NE and
Epinephrine), depress SNS, suppress RAAS, dec
workload and O2 demands of heart
what ethnicity may beta blockers not work for
African Americans (unless paired with diuretics)
Atenolol contraindications
sinus bradycardia, heart block, pulm edema,
bronchospasm, pregnancy
atenolol drug interactions
-Atropine/anticholinergics: inc absorption
-NSAIDs: dec effects
-Insulin and sulfonylureas: inc risk of hypoglycemia
Atenolol side effects/adverse effects
ED, CNS effects, GI distress, cool extremities,
hypotension, bradycardia, dyspnea, bronchospasm,
thrombocytopenia
atenolol interventions
-teach pt to not stop taking abruptly to avoid rebound HTN
(wean off 1-2 weeks)
-warn male clients of dose related ED
-assist with ambulation (ortho hypotension)
SUMMARY
Agranulocytosis
severely low levels of neutrophils
Thrombocytopenia
low platelet count in the blood
acute HF
-heart muscle weakens and enlarges
-loses ability to pump blood adequately
-compensatory mechanisms fail
-lungs/periphery become congested
R sided heart failure
blood backs up in periphery
-peripheral edema & weight gain
L sided heart failure
blood backs up into lungs
-pulmonary edema, shortness of breath, dyspnea, cough
cardiomegaly is common with
heart failure
heart failure nonpharmacologic tx
-limit salt and saturated fat intake (limit to 2g/1tsp/day)
-limit/avoid alcohol intake (avoid/1 drink/day)
-stop smoking
-perform mild exercise
-fluid intake (may be dec)
Digoxin class
cardiac glycoside
e.g. Lanoxin
,digoxin use
HF, a-fib (oral/IV admin)
digoxin action
inhibits Na/K+ ATPase; inc cardiac contractility, CO and
tissue perfusion
digoxin side effects/adverse effects
hypokalemia, blurred/yellow vision, green/yellow halos w
toxicity
Digoxin contraindications
V-fib, hypokalemia
caution w/ acute MI, AV block, HTN, older adults
digoxin drug interactions
-Diuretics and cortisone: inc risk for toxicity (diuretics may
cause hypokalemia)
-Antacids: dec digoxin absorption
digoxin CAM interactions
-Ginseng: inc digitalis levels
-St. John's wort and psyllium: dec absorption
-Hawthorn: inc effects
-Licorice, aloe, ephedra: inc risk of toxicity
digoxin interventions
-assess apical pulse before administering; DON'T
ADMINISTER IF HR <60bpm
-advise client to eat foods high in K+
Antidote for digoxin toxicity
digoxin immune FAB
digoxin therapeutic serum level
0.5-1ng/mL
digoxin effects on heart muscle
-inc. myocardial contractility and CO
-dec. HR and conduction
,angina
acute cardiac pain caused by inadequate blood flow to
myocardium
antianginal drugs
-nitrates
-beta blockers
-Ca channel blockers
nitroglycerin class
antianginal (Nitrate)
e.g. Nitrostat
nitroglycerin uses
control angina, acute MI and HF
nitroglycerin action
dec myocardial demand for O2 consumption (vasodilator)
Nitroglycerin Contraindications
inc intracranial pressure; heat and light dec potency of
drug. keep in dark bottle
nitroglycerin routes of administration
-SL spray: 1-3min onset. space out over 5mins and call
911 before taking 2nd dose
-Topical cream: wipe off old cream 1st (4-8hr duration)
-Transdermal: leave off for 12hrs to give break
nitroglycerin side effects/adverse effects
CNS effects, syncope, tolerance, GI distress, circulatory
collapse
nitroglycerin drug interactions
-alcohol, beta blockers, Ca channel blockers,
antihypertensives, Aspirin, benzos, vasodilators: inc effect
-heparin: dec effect
nitroglycerin CAM interactions
-Hawthorn: inc. levels
, nitroglycerin interventions
-for SL spray, call 911 if 1st dose doesn't work
-proper storage of tabs
-administer SL tab if chest pain occurs
Atenolol class
beta 1 adrenergic blocker
e.g. Tenormin
atenolol use
tx of hypertension, prophylaxis, and acute MI
atenolol action
blocks beta 1 adrenergic receptor sites (NE and
Epinephrine), depress SNS, suppress RAAS, dec
workload and O2 demands of heart
what ethnicity may beta blockers not work for
African Americans (unless paired with diuretics)
Atenolol contraindications
sinus bradycardia, heart block, pulm edema,
bronchospasm, pregnancy
atenolol drug interactions
-Atropine/anticholinergics: inc absorption
-NSAIDs: dec effects
-Insulin and sulfonylureas: inc risk of hypoglycemia
Atenolol side effects/adverse effects
ED, CNS effects, GI distress, cool extremities,
hypotension, bradycardia, dyspnea, bronchospasm,
thrombocytopenia
atenolol interventions
-teach pt to not stop taking abruptly to avoid rebound HTN
(wean off 1-2 weeks)
-warn male clients of dose related ED
-assist with ambulation (ortho hypotension)
