passpoint cardiac

Ezetimibe (Zetia)

lowers cholesterol

A client is taking spironolactone to control hypertension. The client's serum potassium level is [6 mEq/L (56mmol/L)]. For this client, the nurse's priority should be to assess their

Although changes in all these findings are seen in hyperkalemia, ECG results should take priority because changes can indicate potentially lethal arrhythmias such as ventricular fibrillation. It wouldn't be appropriate to assess the client's neuromuscular function, bowel sounds, or respiratory rate for effects of hyperkalemia.

When performing external chest compressions on an adult during cardiopulmonary resuscitation, how deep should the rescuer depress the sternum?

An adult's sternum must be depressed 2 inches (5 cm) with each compression to ensure adequate heart compression.

sulfadiazine

Antibiotics It can treats UTIs, malaria, ear infections, and toxoplasmosis. It can also help prevent rheumatic fever and meningitis.

valsartan

Antihypertensive drug It can treat high blood pressure and heart failure. It can also lower the risk of death after a heart attack.

risperidone

Antipsychotic (Atypical) - schizophrenia, bi polar, + irritability caused by autism

Oligohydramnios

amniotic fluid volume that is less than the minimum expected for gestational age. - fetal distress, rupture, post date preg?

dabigatran

an anticoagulant used to treat and prevent blood clots and to prevent stroke in people with atrial fibrillation.

lithium

0.6-1.2 - drug interaction with diuretics (hydrochlorothiazide), NSAIDS, and antidepressants - might increase BG levels

Serum Creatinine

0.6-1.2 provides estimation of glomerular filtration rate (GFR), *and is an indicator of kidney function.

inr

0.8-1.1 healthy INR should be close to 1 warfarin INR 2-3

mg

1.7-2.2

bun

10-20 mg/dL

Promthrombin time (PT)

11-16 seconds

Platelets

150-400K

WBC

5-10k

Ca

8.6-10.3

Pink frothy sputum indicates

Congestive Heart Failure AND *Pulmonary Edema* (life-threatening)

The nurse on the previous night shift documented that the lungs of a client with lung cancer were CTA (clear to auscultation) in all fields. While doing the shift assessment, the day shift nurse noticed decreased breath sounds, especially in the right lower lobe. Which action is the nurse's best choice?

Pleural effusion is a common complication of lung cancer. Fluid accumulates in the pleural space, impairing transmission of normal breath sounds. Because of the acoustic mismatch, breath sounds are diminished.

complications of MS

Typical complications of multiple sclerosis include contractures (Stiff fingers), decubitus ulcers, and respiratory infections. Nursing care should be directed toward the goal of preventing these complications.

vasopressor drugs

drugs used to increase blood pressure

preeclampsia

hypertension, edema, and proteinuria 300mg/24h during pregnancy also pitting pedal edema, blurry vision are common manifestations

anuria

failure of kidneys to produce urine

greatest potential to increase lithium concentration

thiazide diuretics

Bumetanide (Bumex)

Loop diuretic TXN: Acute pulmonary edema Hypercalcemia Maintenance in CHF

How long after oral administration should a nurse expect to see digoxin's peak effect?

peak digoxin is 2 to 6 hours therapeutic range is 0.5-2

Elevated BNP

(> 100) primary DX for CHF

NSAIDS in the heart

(eg, naproxen, ibuprofen, celecoxib) increase the risk of thrombotic events (eg, myocardial infarction [MI], stroke), especially in clients with cardiovascular disease (eg, coronary artery disease). The nurse should investigate why a client with a history of cardiovascular disease is taking an NSAID and alert the health care provider of its use

Dystonia

- extrapyramidal side effect of antipsychotic a disorder characterized by involuntary muscle contractions that cause slow repetitive movements or abnormal postures. The movements may be painful, and some individuals with dystonia may have a tremor or other neurological symptoms.

Atropine

-Muscarinic antagonist -Used in bradycardia and for ophthalmic applications -Actions include increase pupil dilation, cycloplegia, decreased airway secretions, decreased acid secretions, decreased gut motility, decreased bladder urgency in cystitis -Toxicity: increased body temp (due to decreased sweating), rapid pulse, dry mouth, dry and flushed skin, cycloplegia, constipation, disorientation; -Can cause acute angle-closure glaucoma in elderly (due to mydriasis), urinary retention in men with prostatic hyperplasia, and hyperthermia in infants - atropine also dries out secretions it it's accepted for use during prep for abdominal surgery & pts with diarrhea

severe hyperkalemia

>7 mEq/L administer 50% IV dextrose with 10 units of regular insulin for most effective/quick tx - dextrose prevents hypoglycemia as the insulin increases in the body and pushes K into the cell

A physician orders several drugs for a client with hemorrhagic stroke. Which drug order should the nurse question?

Administering heparin, an anticoagulant, could increase the bleeding associated with hemorrhagic stroke. Therefore, the nurse should question this order to prevent additional hemorrhage in the brain. In a client with hemorrhagic stroke, the physician may use dexamethasone to decrease cerebral edema and pressure; methyldopa, to reduce blood pressure; and phenytoin, to prevent seizures.

When monitoring a client who is receiving tissue plasminogen activator (t-PA), the nurse should assess the client for which changes?

Cardiac arrhythmias are commonly observed with administration of t-PA. Cardiac arrhythmias are associated with reperfusion of the cardiac tissue. Hypotension is commonly observed with administration of t-PA. Seizures and hypothermia are not generally associated with reperfusion of the cardiac tissue.

A client in the emergency department reports squeezing substernal pain that radiates to the left shoulder and jaw. The client also reports nausea, diaphoresis, and shortness of breath. What is the nurse's priority action?

Cardiac chest pain is caused by myocardial ischemia. Therefore the nurse should administer supplemental oxygen to increase the myocardial oxygen supply, attach a cardiac monitor to help detect life-threatening arrhythmias, and take vital signs to ensure that the client isn't hypotensive before giving sublingual nitroglycerin for chest pain

A client has sudden, severe pain in the back and chest, accompanied by shortness of breath. The client describes the pain as a "tearing" sensation. The health care provider suspects the client is experiencing a dissecting aortic aneurysm. The nurse should assess the client for which potential complication of a dissecting aneurysm?

Cardiac tamponade is a life-threatening complication of a dissecting thoracic aneurysm. The sudden, painful "tearing" sensation is typically associated with the sudden release of blood, and the client may experience cardiac arrest.

first degree heart block

Characterized by PR interval that is too long (>0.20 seconds/>5 boxes) P wave normal QRS wave normal "If the Qs are far from Ps, then you have a first degree"

Carbidopa/Levodopa side effects

Clients on carbidopa-levodopa are likely to experience side effects of dyskinesia, especially if they have been on this medication for more than 5-10 years. Dyskinesia includes actions such as facial tics, head bobbing, and pill rolling

prolonged PR interval

First-degree heart block. The signal from the SA node to the AV node is delayed longer than normal - no tx needed unless delay is prolonged

Kayexelate does what?

Gets rid of K+ slow and late K-exits-late exchanges sodium for potassium in the GI tract Sodium serum goes up leading to dehydration so push fluids Also called sodium polystyrene sulfonate

Metclopramide (Reglan)

It can treat gastroesophageal reflux disease (GERD) N/V. It can also treat gastroparesis in patients with diabetes.

Heart failure main characteristics

JVD + dependent edema

An older adult is admitted to the telemetry unit for placement of a permanent pacemaker because of sinus bradycardia. What is a priority goal for the client within 24 hours after insertion of a permanent pacemaker?

Maintaining cardiac conduction stability to prevent arrhythmias is a priority immediately after artificial pacemaker implantation. The client should have continuous electrocardiographic monitoring until proper pacemaker functioning is verified.

Troponin after an MI

Most regarded to diagnose MI OVER 0.5 = MI - after an MI CK-MB is also elevated for 1-2 days

STEMI

ST elevation MI, real-time ongoing death of heart tissue due to ischemia - when one of the coronary arteries is completely occluded - Prompt treatment (eg, percutaneous coronary intervention, thrombolytics) is needed to restore myocardial oxygen supply and limit myocardial damage

Aminoglycosides

a class of antibiotics used to treat serious infections caused by bacteria that either multiply very quickly or are difficult to treat Gentamycin, Kanamycin sulfate, Neomycin sulate, Steptomycin Sulfate OTOTOXICITY KIDNEY DAMAGE

Ménière's disease

a rare chronic disorder in which the amount of fluid in the inner ear increases intermittently, producing attacks of vertigo, a fluctuating hearing loss (usually in one ear/unilateral), and tinnitus

cardiac tamponade

acute compression of the heart that lowers cardiac output - narrowed pulse pressure (sys-dias=<40), JVD, and hypotension indicates the development of cardiac tamponade - other sx: muffled heart sounds, pulses paradoxes (lowered BP with inspiration), dyspnea, tachypnea, tachycardia - emergency pericardiocentesis needed

Amphorectin B

antifungal medication used to treat systemic fungal infections. It is commonly associated with severe adverse effects, including hypotension, fever, chills, and nephrotoxicity - monitor creatinine

Sumatriptan (Imitrex)

antimigraine Sumatriptan relieves migraine headaches by constricting, not dilating, cerebral arterial vessels. vasoconstriction = betablkcker is an vasodilator that decreases BP, ACE inhibitors also vasodilator but cx headaches/dry mouth SO to prevent headaches, we'd use a vasoconstrictor like sumatriptan/imitrex

placental abruption

when placenta prematurely detaches from the uterine wall - frequent contactions, abdominal pain, dark red vaginal bleeding, uterine tenderness, elevated uterine resting tone - need continues FH monitoring - palpation ob abdomen/uterus - assessment of material vitals

tPA (Thrombolytic)

works by dissolving blood clots that block blood flow to the brain. - given -3 hours after stroke to dissolve clot that cx the stroke in brain - might cx hypotension and cardiac arrhythmia due to repercussion of the cardiac tissue

mitral valve regurgitation does what?

backflow of blood from the L ventricle to the mitral valve and into the L atrium. leading to dilation of L atrium and pulmonary edema (dyspnea, orthopnea) and decreased cardiac output (fatigue) and can lead to HF

Celecoxib (Celebrex)

NSAID

dx pulmonary embolism

Positive D-dimer + Positive VQ scan(lung ventilation)

Arterial steals syndrome

The AV fistula complication that occurs when the anastamosed/open connected vein 'steals' too much arterial blood, causing the distal extremity to have ischemia. Sx: skin pallor, poor cap refill without intervention, ischemia may lead to necrosis

The nurse is assessing a client who has a long history of uncontrolled hypertension. The nurse should assess the client for damage in which area of the eye?

The retina is especially susceptible to damage in a client with chronic hypertension. The arterioles supplying the retina are damaged. Such damage can lead to vision loss.

atrial fibrillation

characterized by an irregularly irregular rhythm with P waves replaced by fibrillatory waves, resulting in ineffective atrial contraction. Clients are at increased risk for clot formation (long-term), which can cause a stroke or pulmonary embolism

pericardial effusion

fluid pouring out into the tissue (pericardial sac) around the heart - narrowed pulse pressure (sys-dias=<40), hypotension, JVD indicates the development of cardiac tamponade

Peaked T waves

hyperkalemia - administer IV Calcium gluconate to prevent heart dysrhythmias

ACE inhibitors adverse effects

hypotension *angioedema: swelling of face, lips hyperkalemia (potassium sparing) adverse affect is cough (notify HCP)

akathisia

inability to sit still - extrapyramidal side effect of antipsychotic meds

Ezetimbe (Zetia)

inhibits cholesterol absorption

Congestive HF

myocardium of the heart is overwhelmed and cannot circulate blood S/S: tachycardia (1st) tachypnea, R sided =increased venous pressure and enlarged liver/spleen, EDEMA L sided = pulmonary congestion, orthopnea, dyspnea (SOB except sitting upright), cardiomegaly, CRACKLES, CAD, Tx: reduce workload of the heart, propranolol, captopril, diuretics, inotropics, vasodilators, #1 is digoxin-- ASSESS HR BEFORE GIVING, IF UNDER 100, HOLD DRUG, rest, O2, SEMI-FOWLERS HELPS TO LOWER ABDOMINAL CONTENTS AND ENLARGE THE THORACIC CAVITY. - no salt (fluid follows salt) - report 2/3 lbs increase w/in 1 day diuretics, loop diuretics, digoxin, etc.

hemiplegia

paralysis of one side of the body, or part of it, due to an injury in the motor area of the brain (stroke, trauma, increased ICP)

characteristics of patient during an MI

persistent crushing chest pain, diaphoresis, cool clammy skin

hematoma

pool of clotted blood, a bruise - means blood flow to that part of the body is compromise - slow IV, do exercises in that area to promote blood flow

Spironolactone (Aldactone)

potassium sparing diuretic - absorbing too much salt and keeps your potassium levels from getting too low. - monitor K and ECG bc hypokalemia as a s/e can cx ventricular fibrillation which is an emergency

A nurse assessing a client who underwent cardiac catheterization finds the client lying flat on the bed. The client's temperature is 99.8° F (37.7° C). Their blood pressure is 104/68 mm Hg. Their pulse rate is 76 beats/minute. The nurse assesses the limb and detects weak pulses in the leg distal to the puncture site. Skin on the leg is cool to the touch. The puncture site is dry, but swollen. What is the most appropriate action for the nurse to take?

The client is probably developing a hematoma at the puncture site. The decreased pulses, swelling, and cool temperature in the leg are all classic signs that blood flow to that extremity is compromised. The nurse should notify the physician immediately to preserve the blood flow in the client's leg. Documenting findings and checking the client again in 1 hour, slowing the I.V. fluid, and encouraging the client to perform isometric leg exercises aren't appropriate actions for the nurse to take at this time.

Lispro (Humalog) Aspart (Novolog) Glulisine (Apidra)

rapid acting insulin Rapid-acting insulins (eg, aspart, lispro) peak quickly, often within 30 minutes to 3 hours of administration

dexamethasone

steroid to tx inflammation causes hyponatremia INCREASES BG, & insulin sensitivity

Digoxin

strengthens muscle contractility, but causes bradycardia, so the apical pulse needs to be taken (<60) to administer therapeutic range: 0.8-2.0

Partial Thromboplastin Time (PTT)

test to determine coagulation defects, such as platelet disorders & clots 25-35

hydrochlorothiazide

thiazide diuretic tx HTN & fluid retention (edema) CONTRAINDICATED WITH LITHIUM

Elevated creatine Kinse (CK-MB)

used to indicated MI along with #1 troponin usually elevated 12/24h after MI