Asthma/COPD
A patient with a history of asthma contacts the clinic after measuring their daily peak flow, and it measures 45%. What would you instruct the patient to do?
the patient is having a serious asthma complication and needs to be evaluated by a health care provider
Green zone: 80-100% of personal best
Yellow zone: 50-80%
Red zone: <50% of personal best
What is systolic vs diastolic HF?
Systolic: pumping problem; decreased CO & decreased EF
Diastolic: filling problem; heart is unable to relax
You have a patient that comes in with a blood pressure of 170/96. They are on lisinopril, propranolol, and furosemide. They state 'my blood pressure was starting to be normal, so I stopped taking my medications.' What would you teach them at this time?
Their blood pressure started to be within the normal range due to their medications; they need to continue medications even when their BP is within normal range
What class of medication will someone with atrial fibrillation be on?
a blood thinner --> ex coumadin
A patient just took their inhaled corticosteroid for asthma. What would you instruct them to do immediately after?
Rinse their mouth --> want to prevent oral candidas
What are risk factors for patients with COPD?
What are 3 risk factors of Heart failure?
smoking, obesity, hypertension, lung disease, sleep apnea, alcohol misuse
What is hypertensive urgency vs emergency?
Both: BP >180/120
Urgency: elevated BP w/ no target organ damage; still want to decrease BP
Emergency: target organ damage is present; need to get BP down quickly
A patient is doing their ADLs, and suddenly has chest pain. After they sit down, their chest pain goes away. Which type of chest pain is this?
stable angina
What do we need to do before administering digoxin?
assess the APICAL heart rate; if it's <60, hold
What are some signs and symptoms that might indicate a patient has COPD; name at least 5?
- three primary: chronic cough, sputum production, dyspnea
- weight loss, barrel chest, chronic fatigue, accessory muscles to breathe, clubbing of nails, extra lung sounds, tripod positioning, elevated PCO2, decreased O2
What is the difference between the SNS & RAAS system?
SNS (fight or flight): rapid compensatory system; increases heart rate, constricts blood vessels (HTN), and mobilizes energy stores; Eventually, our RAAS system will be activated by the SNS
RAAS: hormones (renin, angiotensin I, angiotensin II, and aldosterone) that leads to vasoconstriction and increased blood volume; Angiotensin II is directly responsible for vasoconstriction → most of our medications block this
What are 3 lifestyle modifications you would instruct for hypertension?
DASH diet, <1500 mg of sodium a day; moderate alcohol consumption, stop smoking, physical activity
A patient suddenly has chest pain. What medication would you want them to take, and how would you instruct them to take it?
nitroglycerin -->
Can give 3 times every 5 minutes for chest pain; if patient is still having chest pain after 3 doses, need to go to emergency department
You have a patient in the ED who is on lisinopril who is currently having angioedema. What are nursing priorities at this time, and what medication class would you might expect the physician to change to?
You want to ensure a patent airway; this patient might need intubation or a trach
These patients will want to switch to another medication that blocks the RAAS, probably an ARB, which ends in -artan?
What is the pathophysiology behind COPD?
airflow limitation is progressive, associated w/ abnormal inflammatory response to noxious particles or gas; chronic inflammation damages tissues; scar tissue results in narrowing; THINK THE AIRWAYS ARE NARROWING DUE TO INFLAMMATION & SCAR TISSUE
What are clinical manifestations of left sided heart failure vs right sided heart failure?
-Left sided= LUNGS; Blood backs up into the lungs, causing more respiratory issues; SOB, cough, decreased O2 sats, crackles in lungs, pallor, dizziness, tachycardia
-Right sided= body; Blood backs up into the body; JVD, edema, polyuria @ night, weight gain
What antihypertensive drugs works by blocking the conversion of angiotensin I to angiotensin II, leading to vasodilation and decreased blood pressure.
ACE inhibitors
What is the most concerning side effect of -statin therapy for CAD and what does it do?
lowers LDL & triglycerides --> biggest side effect is muscle pain, instruct them to contact provider for new muscle pain
You have a patient on furosemide who has a potassium of 2.9. What would you want to do at this time?
stop the furosemide or don't administer the drug, put them on a potassium drip, EKG; switch to spiranolactone
A patient is going into status asthmaticus. What signs and symptoms would we see, and what is the treatment?
S/s: RR >30; pulse >120; too dyspneic to speak, no wheezing
Treatment: IV fluids, potent systemic bronchodilator, steroids, epinephrine, oxygen; may need emergency intubation
What are the four factors that affect how our heart is functioning and give a brief explanation of each?
- Contractility: muscle's contraction, which affects how much blood is ejected with each beat.
- Preload: The amount of blood filling the ventricles before they contract → blood going into the heart
- Afterload: The resistance in the arteries that the ventricles must overcome to pump blood out of the heart → blood leaving the heart
- Heart rate: The speed at which the heart beats, often controlled by the nervous system, which signals the heart to beat faster during stress or slower during rest.
This type of hypertension has no identifiable cause and accounts for about 90–95% of all cases. It is often associated with risk factors such as obesity, smoking, high sodium intake, and family history.
Primary hypertension
-secondary has an identifiable cause
What is chest pain caused by?
the heart is not getting enough blood, which causes that part of the heart to start to die off. This is due to the thinning of the arteries from the plaque
You have a patient with COPD who was prescribed inhaled MDI fluticasone and albuterol. How would you instruct them to use an MDI, as well as what order would you take them in?
- Shake up the inhaler, press the button while inhaling in, hold for 5-10 seconds, and wait 1 minute before next hit; Spacer to help
- albuterol before fluticasone (bronchoDILATOR before the steroid)