Ch 26-32 Quiz
Coagulation cascade
complex series of steps by which blood flow stops
heart failure (HF)
condition in which there is an inability of the heart to pump enough blood through the body to supply the tissues and organs with nutrients and oxygen
Conduction system
purpose is to regulate beat and maintain cardiac output
hypovolemic shock
shock resulting from blood or fluid loss
Clotting factors
substances contributing to the process of blood hemostasis
Nitroglycerin (Nitrostat) T&P
t: antianginal drug p: organic nitrate, vasodilator
Preload
the degree of stretch of the cardiac muscle fibers at the end of diastole, just prior to contraction
folic acid
vitamin supplement for anemia
Left-sided Heart Failure
• Blood accumulates in left ventricle • Left ventricle thickens and enlarges: hypertrophy • Cardiac remodeling • Blood backs up into lungs • Cough and shortness of breath result
Right-sided Heart Failure
• Blood backs up into veins • Causes peripheral edema and organ engorgement • Less common than left-sided HF
Diseases Associated with Heart Failure
• Coronary artery disease (CAD) • Mitral stenosis • Myocardial infarction (MI) • Chronic HTN • Diabetes mellitus • No cure, only prevention and slowing of progression
What is hypertension
Consistent elevation of systemic arterial blood pressure - High blood pressure - "Normal" B/P varies with age; abnormal as we age
norepinephrine
Levophed
The patient receives hydrochlorothiazide (Microzide). He tells the nurse he is urinating a lot and questions how this drug affects his blood pressure. What is the best response by the nurse?
"Hydrochlorothiazide (Microzide) decreases the fluid in your bloodstream and this lowers your blood pressure."
What is the pharmacologic class of Normal Serum Albumin?
- Blood product, colloid
What are fluid replacement for?
- It is used if the patient has lost a lot of blood or body fluids
What drug is in fluid replacement category?
- Normal Serum Albumin (Albuminar, Plasbumin)
What is the therapeutic class of Normal Serum Albumin?
- fluid replacement therapy
Nitroglycerin (Nitrostat) MOA
- taken while an acute angina episode is in progress or just prior to physical activity - oldest and most widely used - comes in sublingual, PO, intravenous (IV), transmucosal, transdermal, topical, and extended-release PO forms - sublingual = takes 2-4 mins... if it doesn't work within 10-15 mins, this may indicate MI and emergency medical services could be contacted - transdermal and oral extended-release forms are for prophylaxis only because they have a slow onset of action
Regulation of Hematopoesis- Hematopoietic growth factors
-Messages from hormones -Recombinant DNA technology -Used pharmacologically to stimulate production of erythrocytes, leukocytes, platelets -used to assist in what the body can't produce -can give protection if under chemotherapy bc this radiation harms cells and suppressed immune system and you need to be brought up to a good protective levels of WBCs -Adverse effects of these drugs: low platelets (thrombocytopenia-REMEMBER THIS MANY DRUGS CAUSE IT bc can't form clots and therefore bleed more)
Hematopoiesis
-Process of blood-cell formation -Begins with stem cell in bone marrow -Homeostatic control maintained by hormones and growth factors -200 million new blood cells formed every day -starts in stem cells in bone marrow -when formed, it meets bodys demands, if need RBC, make RBC same for WBC if have infection
classifications of shock
-Underlying pathological condition -Organ system causing the disease Hypovolemic, neurogenic, cardiogenic, septic, and anaphylactic
demands of the body affect hematopoiesis. explain
-WBCs can increase concentration up to ten times normal to combat infection -RBCs can increase concentration up to five times in presence of blood loss or hypoxia
Demands of the body affecting hematopoiesis
-White blood cells (WBCs) can increase concentration up to ten times normal to combat infection or injury -Red blood cells (RBCs) can increase concentration up to five times in presence of blood loss or hypoxia bc need more RBCs to carry oxygen
The client receives epoetin alfa (Epogen) subcutaneously, and says to the nurse, "My doctor said I have anemia. Are there little red blood cells in that shot?" What are the best responses by the nurse? Select all that apply. 1. "Your kidney makes more erythropoietin if it doesn't get enough oxygen." 2. "Erythropoietin also helps your body make hemoglobin." 3. "This stimulates your kidney to make more red blood cells." 4. "It is similar to a kidney hormone, erythropoietin, and helps your body make more red blood cells." 5. "Your kidney makes more erythropoietin when you have too much fluid in your body."
1. "Your kidney makes more erythropoietin if it doesn't get enough oxygen." 2. "Erythropoietin also helps your body make hemoglobin." 4. "It is similar to a kidney hormone, erythropoietin, and helps your body make more red blood cells."
For the last 3 months, the nurse has been working with a group of patients who have been using nonpharmacological methods to try to manage their hypertension. The nurse anticipates that which patients will require the addition of a pharmacological intervention?
2. A 61-year-old man whose blood pressure is 144/90 mmHg who also has type 2 diabetes. 5. A 61-year-old woman whose blood pressure is 153/92 mmHg who is otherwise healthy.
The nurse is conducting the initial group education session for patients who have hypertension. What is the most important information to include?
2. The aorta has sensors that help regulate blood pressure. 3. Anger can result in hypertension.
What are the 4 steps of Hemostasis?
4 Steps: 1) Blood vessel injury causes vessel spasm (constriction) 2) Platelets are attracted to and adhere to injured area 3) Aggregation of platelets forms plug 4) Formation of insoluble fibrin strand and coagulation (coagulation cascade) * Normal clotting occurs in 6 minutes*
The client receives chemotherapy as therapy for cancer. The physician orders epoetin alfa (Procrit) subcutaneously. The client asks the nurse if this drug is also chemotherapy. What is the best response by the nurse? 1. "No, but it works with your chemotherapy to make it more effective." 2. "No, this drug helps to counteract the nausea and vomiting caused by your chemotherapy." 3. "No, it will stimulate your immune system to help you battle the cancer." 4. "No, this drug will help prevent anemia that can be caused by your chemotherapy."
4. "No, this drug will help prevent anemia that can be caused by your chemotherapy."
The nurse is teaching a class on how red blood cell formation is regulated by the body to a group of clients who have AIDS. The nurse evaluates that learning has occurred when the clients make which statements? Select all that apply. 1. "Red blood cell formation is regulated through chemicals called colony-stimulating factors that come from white blood cells." 2. "Red blood cell formation is regulated through messages from the hormone, secretin, which is located in the kidney." 3. "Red blood cell formation is regulated through specific liver enzymes and a process called hemochromatosis." 4. "Red blood cell formation is regulated through messages from the hormone erythropoietin." 5. "Red blood cell formation is regulated through specific transporter proteins called apolipoprotein A and B."
4. "Red blood cell formation is regulated through messages from the hormone erythropoietin."
Stop the heparin drip
A patient is receiving IV heparin therapy. The aPTT is 90; the laboratory control is 30 seconds. Which nursing intervention is most accurate?
"Heparin does not dissolve blood clots but neutralizes clotting factors, preventing extension of the clot and the possibility of it traveling elsewhere in your body."
A patient receiving IV heparin therapy for a deep vein thrombosis (DVT) in his right calf asks why his calf remains painful, edematous, and warm to touch after 2 days of anticoagulant therapy. Which response by the nurse is most accurate?
Protamine sulfate
A trauma patient arrives in the emergency department via EMS. He is bleeding profusely. A medical alert bracelet indicates that he is on heparin therapy. The nurse will most likely administer which medication that counteracts the action of heparin?
Types of Dysrhythmias
A/V tachycardia A/V flutter A/V fibrillation Heart block Premature A/V contractions Sinus bradycardia
what type of drug is lisinopril
ACE inhibitor (ends in -pril)
-pril
ACE inhibitors
The nurse teaches the client that the major difference between angina and pain associated with myocardial infarction (MI) is that: a. Angina is relieved with nitroglycerin and rest. b. Angina can be fatal. c. Myocardial infarction pain always radiates to the left arm or jaw. d. Both types of pain are treated the same.
Answer: a. Angina is relieved with nitroglycerin and rest. Rationale: Angina pain is uncomfortable, but it rarely is fatal. It usually is relieved immediately by nitroglycerin. Pain from a myocardial infarction does not always radiate to the jaw or arm. Angina pain is treated differently than MI pain.
Dysrhythmias
Abnormalities of electrical conduction or rhythm in heart
Dysrhythmias AKA arrhythmias
Abnormalities of electrical conduction or rhythm in heart across the myocardium Range from harmless to life-threatening
normal serum albumin (colloid)
Albuminar
Cardiac Output (CO)
Amount of blood pumped in 1 minute (~5 L)
When monitoring for therapeutic effect of any antidysrhythmic drug, the nurse would be sure to assess which essential parameter? 1. Pulse 2. Blood pressure 3. Drug level 4. Hourly urine output
Ans: 1 Rationale: In the absence of ECG monitoring, the nurse would assess the pulse for rate, regularity, quality, and volume, noting any changes. The nurse should also teach the patient to monitor the pulse for rate and regularity before sending the patient home. Options 2, 3, and 4 are incorrect. The nurse is monitoring for the therapeutic effects of antidysrhythmic therapy. Al- though BP and drug level may also be monitored, they do not evaluate the therapeutic effects of the drug. Urine output may change related to the type of drug given and any effects on cardiac output. However, frequent output monitoring is not indicated in routine antidysrhythmic therapy and will not assess for therapeutic drug effects.
The physician orders pentoxifylline (Trental) for the patient with peripheral vascular disease. The nurse has completed medication education and determines that learning has occurred when the patient makes which statement(s)? Select all that apply 1. "It makes my red blood cells (RBCs) squishy so they can go into the little blood vessels." 2. "It decreases my platelets so my blood is less likely to clot." 3. "It decreases the "stickiness" of my blood." 4. "It changes how my liver makes clotting factors." 5. "It destroys clotting factors."
Ans: 1,2,3 Rationale 1: Pentoxifylline (Trental) acts on red blood cells (RBCs) to reduce their viscosity and increase their flexibility to allow them to enter partially occluded vessels. Rationale 2: Pentoxifylline (Trental) also has antiplatelet action. Rationale 3: Pentoxifylline (Trental) decreases the viscosity or "stickiness" of blood. Rationale 4: Pentoxifylline (Trental) does not interfere with the manufacture of clotting factors in the liver. Rationale 5: Pentoxifylline (Trental) does not destroy clotting factors.
The client is admitted with a diagnosis of angina caused by coronary arteriospasms. The nurse recognizes that this type of angina is classified as: a. Stable angina. b. Classic angina. c. Vasospastic angina.
Answer: c. Vasospastic angina. Rationale: Angina that is fairly predictable is classic or stable angina. Intense, frequent episodes mark unstable angina. Vasospastic angina occurs when ischemia is present due to coronary arteriospasms.
The nurse is managing care for a patient with cirrhosis of the liver. The nurse teaches the patient about how to avoid injury that may result in bleeding. The patient asks the nurse why he is at risk to start bleeding. What is the best response by the nurse? 1. "Because your liver is injured and unable to manufacture platelets." 2. "Because your liver thickens your blood so it is less likely to clot." 3. "Because your liver is injured and cannot make clotting factors." 4. "Because your liver is breaking down your clotting factors too quickly.
Ans: 3 Rationale 1: The liver is not responsible for manufacturing platelets. Rationale 2: The liver is not responsible for making the blood thick. Rationale 3: The liver is responsible for the production of essential clotting factors necessary to prevent bleeding. Rationale 4: The liver is not responsible for breaking down clotting factors.
Verapamil (Calan, Covera-HS, Verelan) should be used with extra caution or is contraindicated in patients with which cardiovascular condition? 1. Hypertension 2. Tachycardia 3. Heart failure 4. Angina
Ans: 3 Rationale: CCBs such as verapamil (Calan) are used cautiously or are contraindicated in patients with HF because they may cause decreased contractility, which may precipitate or worsen HF. Options 1, 2, and 4 are incorrect. Verapamil and CCBs are often prescribed to treat HTN, tachycardia, and angina.
The nurse is managing care for a patient with a DVT (deep vein thrombosis) of the right calf. The patient receives heparin intravenously (IV). What is the priority outcome for this patient? 1. The patient will comply with dietary restrictions. 2. The patient will keep the right leg elevated on two pillows. 3. The patient will not disturb the intravenous infusion. 4. The patient will not experience bleeding.
Ans: 4 Rationale 1: Dietary restrictions are important but not the highest priority. Rationale 2: Elevation of the affected extremity is important but not the highest priority. Rationale 3: Disturbing the intravenous (IV) could relate to bleeding, but this does not directly correlate with heparin. Rationale 4: An absence of bleeding is a priority outcome for any patient receiving anticoagulant therapy.
The patient receives warfarin (Coumadin). The nurse notes that the patient's morning international normalized ratio (INR) is 7-. What are the priority nursing interventions at this time? 1. Hold the next dose of warfarin (Coumadin) and repeat the international normalized ratio (INR). 2. Administer protamine sulfate and hold the next dose of warfarin (Coumadin). 3. Hold the next dose of warfarin (Coumadin) and contact the physician. 4. Administer vitamin K and hold the next dose of warfarin (Coumadin).
Ans: 4 Rationale 1: Repeating the international normalized ratio (INR) is appropriate but not the highest priority. Rationale 2: Protamine sulfate is the antidote for heparin, not warfarin. Rationale 3: Consulting the physician is appropriate but not the highest priority. Rationale 4: Vitamin K is the antidote for warfarin (Coumadin) overdose, and its administration is warranted with an international normalized ratio (INR) of 7-.
A patient with type 1 diabetes on insulin therapy reports that he takes propranolol (Inderal) for hypertension. The nurse will teach the patient to check glucose levels more frequently because of what concern? 1. The propranolol can produce insulin resistance. 2. The two drugs used together will increase the risk of ketoacidosis. 3. Propranolol will increase insulin requirements by antagonizing the effects at the receptors. 4. The propranolol may mask symptoms of hypoglycemia. `
Ans: 4 Rationale: Beta blockers such as propranolol decrease the body's adrenergic "fight-or-flight" responses and may diminish or mask the symptoms and signals of hypoglycemia that a patient with diabetes normally perceives as blood glucose drops. Options 1, 2, and 3 are incorrect. Beta blockers may inhibit glycogenolysis, resulting in hypoglycemia, and have no effect on the development of insulin resistance.
29.1 The young client has a history of multiple allergies, and the physician prescribed epinephrine (EpiPen) for prevention of anaphylactic shock. The client's mother says to the nurse, "I thought shock was about heart failure." What is the best response by the nurse? 1. "There are many kinds of shock that also include infection, nervous system damage, and loss of blood." 2. "Heart failure is the most serious kind of shock; others include infection, kidney failure, and loss of blood." 3. "There are many kinds of shock: heart failure, nervous system damage, loss of blood, and respiratory failure." 4. "Allergic response is the most fatal type of shock; other types involve loss of blood, heart failure, and liver failure."
Answer: 1 "There are many kinds of shock that also include infection, nervous system damage, and loss of blood." Rationale: Obvious bleeding suggests hypovolemic shock, trauma to the brain or spinal cord suggests neurogenic shock, inadequate cardiac output would suggest cardiogenic shock, a recent infection may indicate septic shock, and a history of allergies with a sudden onset of symptoms may suggest anaphylactic shock. Kidney failure is not a type of shock. Respiratory failure is not a type of shock. Liver failure is not a type of shock.
29.3 The client comes to the emergency department with a severely infected pressure ulcer on the back. The client is in septic shock. The physician orders norepinephrine (Levophed) IV. Prioritize the nursing interventions for this client. 1. Connect the client to a cardiac monitor and pulse oximeter. 2. Assess the client's blood pressure. 3. Prepare for debridement of the pressure ulcer. 4. Administer oxygen. 5. Maintain a patient airway.
Answer: 1, 2, 3, 4, 5
29.2 The client comes to the emergency department after suffering a bilateral traumatic amputation of his lower extremities. The physician orders normal serum albumin (Albuminar). The client goes into shock. What will the best nursing assessment of this client reveal? 1. B/P: 130/88 mm/Hg, P: 90, bounding, R: 32, and shallow. 2. B/P: 50/0 mm/Hg, P: 126, weak and thready, R: 14, and shallow. 3. B/P: 80/20 mm/Hg, P: 122, weak and thready, R: 28, and shallow. 4. B/P: 140/90 mm/Hg, P: 46, weak and irregular, R: 24, and shallow.
Answer: 3 B/P: 80/20 mm/Hg, P: 122, weak and thready, R: 28, and shallow. Rationale: The central problem with hypovolemic shock is the inability of the cardiovascular system to send sufficient blood to the vital organs, with the heart and brain being affected early in the progression of the disease. Assessing the client's cardiovascular status will result in a blood pressure that is low, a heart rate that may be rapid with a weak, thready pulse, and breathing that is rapid and shallow. A client in shock will have a low blood pressure and a rapid, weak, not bounding, pulse. A client in shock will have rapid respirations, a respiratory rate of 14 is considered normal. A client in shock will have a low blood pressure; the heart rate will be rapid, not slowed.
The teaching plan for a client being started on long-acting nitroglycerin includes the action of this drug. The nurse teaches that this drug relieves chest pain by which action? a. Dilating just the coronary arteries b. Decreasing the blood pressure c. Increasing contractility of the heart d. Dilating arteries and veins
Answer: d. Dilating arteries and veins Rationale: Organic nitrates relax both arterial and venous smooth muscle. This in turn decreases myocardial oxygen demand by decreasing heart rate, decreasing preload, decreasing contractility, and decreasing afterload. The blood pressure might decrease secondary to venous vasodilation, but this is not the primary way in which angina is relieved.
The nurse recognizes that the ability of organic nitrates to dilate coronary arteries is most effective for treating ________________________.
Answer: vasospastic Rationale: Dilation of coronary arteries is no longer considered the primary mechanism of nitrate action in stable angina. It is important in variant angina, in which chest pain is caused by coronary artery spasm. The drug can relax the spasms and terminate the pain.
What drugs are used for Coagulation Disorders?
Anticoagulants Antiplatelets Thrombolytics Hemostatics
How many deaths is hypertension associated with in the U.S. per year?
Associated with more than 348,000 deaths in U.S. per year
Location of dysrhythmias
Atria Ventricles
Types of dysrhythmias
Atrial or ventricular tachycardia Atrial or ventricular flutter Atrial or ventricular fibrillation Heart block Premature atrial or premature ventricular contractions (PVCs) Sinus bradycardia
Occurrence of dysrhythmia
Can occur in both healthy and diseased hearts Disrupt regulation of heart May decrease cardiac output Closely associated with certain conditoins (heart disease, MI)
What three factors are responsible for blood pressure?
Cardiac output Peripheral resistance Blood volume
Filgrastim (Granix, Neupogen)
Colony stimulating factor, granulocyte- CSF for hematopoietic disorders
What is Hemostasis?
Complex process involving multiple steps Involves large number of enzymes and clotting factors Final product is a fibrin clot that stops blood loss
dobutamine (alpha adrenergic agonist)
Dobutrex
Heparin Block Box
Don't use with epidural, spinal anesthesia, or lumbar puncture (can cause hematomas and paralysis)
Heparin Admin Alert
IV bolus or continuous infusion (immediate) or Sub Q (up to 1 hour) IV: dosed by weight, target PTT value, and clinical indication SUB Q: DO NOT drawback plunger to aspirate DO NOT massage site DO NOT give IM
Heart Failure (HF) is
Inability of ventricles to pump enough blood for body's needs • Weakening of heart muscle due to aging or disease
dopamine (alpha adrenergic agonist)
Intropin
Nitroglycerin trade name
Nitrostat, Nitro-Bid, Nitro-Dur
symptoms of shock
Pallor; cold, clammy skin Feeling of sickness and weakness Restlessness, anxiety, confusion, depression, apathy B/P low, heart rate may be rapid with weak pulse Breathing usually rapid and shallow Unconsciousness Thirst
Atrial or ventricular tachycardia
Rapid heartbeat greater than 100bpm in adults Ventricular tachycardia is more serious than atrial tachycardia
blocks sodium ion channels in myocardial cells. thus reducing automaticity and slowing conduction of the action potential across the myocardium, thus prolonging the refractory period
Sodium channel blocker - procainamide
referred to as a broad spectrum drug because it has the ability to correct many different types of atrial and ventricular dysrhythmias
Sodium channel blocker - procainamide
therapeutic serum drug level is 4-8 mcg/mL
Sodium channel blocker - procainamide
The classic presentation of angina pectoris
Steady, intense pain in the anterior chest, sometimes accompanied by a crushing or constricting sensation.
Heparin Action
Therapeutic Class: Anticoagulant Pharma Class: Indirect thrombin inhibitor (inhibits thrombin activity) binds to antithrombin III, inactivating several clotting factors
Prototype Drug Epoetin Alfa (Epogen, Procrit)
USE: erythropoiesis stimulating drug. treat disorders of RBC formation given to chronic renal failure, chemo, pre surgery, HIV patients AE: HTN, seizure BB: cardiovascular and thromboembolic events. renal failure patients- stroke, MI, ischemic attack lowest dose in cancer, bc can cause tumors and shorten life. CONTRA: blood cancers, HTN
Leave the needle in place for 10 seconds after injection.
Which is an accurate nursing action when administering subcutaneous enoxaparin, a low-molecular-weight heparin product?
Angina pectoris
acute chest pain caused by insufficient oxygen to a portion of the myocardium.
Heparin Use
anticoagulant. Prolongs coagulation time preventing excessive clotting within blood vessels, prevents the enlargement of existing clots, and the formation of new ones. NO ABILITY to dissolve existing clots prophylactic low dose before surgery, dialysis procedures, unstable angina or Acute stages of MI High dose to treat conditions where immediate anticoagulation is necessary: Confirmed DVT and pulmonary embolism
atherosclerosis
atherosclerosis The presence of plaque, a fatty, fibrous material within the walls of the coronary arteries.
-olol
beta blocker
what type of drug is digoxin
cardiac glycoside
Myocardial ischemia
deficiency of blood supply to the myocardium
Prothrombin activator
enzyme in the coagulation cascade that converts prothrombin to thrombin; also called prothrombinase
erythropoiesis stimulating factor drug example
epoitin alfa (epogen, procrit)
epoetin alfa (epogen, procrit)
erythropoiesis stimulating factor
Secreted when kidneys sense reduction in oxygen Body experiences hypoxia or hemorrhage
erythropoietin Synthetic Forms- Epoetin alfa (Epogen)
atherosclerosis
form of arteriosclerosis characterized by buildup of fatty plaques on the walls of arteries and arterioles
myocardial infarction (MI)
heart attack; death of myocardial tissue (infarction) caused by ischemia (loss of blood flow) as a result of an occlusion (plugging) of a coronary artery;
erythropoiesis stimulating factors
hemorrhage COPD anemia decreased o2 kidneys make erythropoietin bone marrow makes RBC
What is the most common form of cardiovascular disease?
hypertension
what are the side effects of lisinopril
hypotension, chronic cough, headache, dizziness, orthostatic hypotension, hyperkalemia, angio edema
what is the mechanism of action for lisinopril
inhibits the ACE enzyme (that converts angiotensin 1 into angiotensin 2) and therefore blocks the vasoconstriction caused by angiotensin 2. also blocks activation of aldosterone (increase water and Na+ at kidneys)
angina pectoris
insufficient blood flow to the heart, with resultant spasm of the cardiac muscle, causing chest pain
arrhythmia
irregular rhythm; i.e., irregular heart beat
what is the drug of choice for heart failure and hypertension
lisinopril
Coronary Artery Disease (CAD)
narrowing of the coronary arteries, resulting in an insufficient blood supply to the heart
Primary defining characteristic of coronary artery disease
narrowing or occlusion of a coronary artery
bone marrow/pluripotent stem cells
platelets agranulocytes RBC granulocytes
Coagulation
process of blood clotting