Renal
What are the three classes of diuretics we discussed in class?
thiazide diuretics- K+ wasting
Loop diuretics- K+ wasting
K+ sparing diuretics like spironolactone
What is considered normal blood pressure?
What is considered HYPERTENSION?
Normal BP is UNDER 120/80
Elevated is 120-129/80
Stage 1 HTN 130-139/80-89
Stage 2 HTN greater than 140/90
What is a normal cholesterol level?
What is the ideal HDL?
What is the ideal LDL?
<200
>60
<100
Most common side effect of NTG?
Headache.
Can take tylenol.
If using the paste or a patch, the patient can develop tolerance to NTG and will need to have time without the medication so tolerance will not develop.
Erythropoietin
Prior to administering a loop diuretic the nurse knows she should check these two things?
1.) Blood pressure
2.) Potassium level
Drug class ending in "olol" that can treat hypertension by decreasing HR and cardiac contractility.
Beta-Blocker
Blocks the SNS response and therefore, decreases BP by decreasing blood pressure.
What is the most effective drug at controlling high cholesterol?
Statins
What are the nursing interventions when administering diuretics to a patient with heart failure?
1.) Monitor I&Os, daily weights and edema (peripheral or pulmonary).
2.) Administer medications as ordered and doing proper assessments prior to administration to ensure its safe such as potassium levels and blood pressure
What is the antidote to an antiplatelet medication?
There isn't an antidote. The patient will need a platelet transfusion to replace platelets that no longer "stick together".
What would happen if the nurse pushed the loop diuretic (Lasix) too fast?
Ototoxicity
A patient develops a cough while taking Lisinopril. What do you think the physician will order instead of the Lisinopril?
An ARB like Losartan.
SARTANS are ARBS.
PRILS are ACEI.
Statins decrease cholesterol synthesis by the liver and work better if taken at this time of the day?
Before bedtime.
How would you teach a patient to take NTG at home once discharged from the hospital with stable angina?
1.) take NTG at the first sign of chest pain or before an activity that is known to cause chest pain.
2.) If patient is unrelieved after 5 minutes after the first NTG, call 911.Do not drive to the hospital. Lay down and rest.
3.) Take another NTG. You can take up to 3 NTG, 5 minutes apart.
4.) Make sure NTG does not become expired and that it is kept in a dark bottle to prevent the drug from breaking down and becoming less effective.
Antidote for heparin?
Antidote for warfarin (Coumadin)?
Protamine Sulfate
Vitamin K
A patient has a potassium level of 2.8 and has an order for potassium replacement. The patient also has an order for a loop diuretic. The nurse wants to rush the potassium administration so she can give the lasix. What would happen if the nurse pushed the potassium instead of administering it using an IV infusion?
Patient could go into cardiac arrest.
On a general hospital floor, potassium must be given at a maximum rate of 10 mEq/hr.
A patient is started on lisinopril in the hospital to manage their hypertension. A few minutes after administration of the ACEI, the patient developed a swollen face, mouth and tongue. What adverse reaction did the patient have?
Angioedema. Complete contraindication to taking an ACEI.
Statins can cause this dangerous side effect that can result in kidney damage. Tell the patient to report any symptoms of this dangerous side effect.
Rhabdomyolysis.
Breaks down muscle tissue and releases heme which "clogs" the kidneys and causes kidney damage.
Statins are also hard on the liver and liver function tests should be checked periodically while the patient is on a statin.
Why would an ACEI be used for heart failure?
Decreases the workload on the heart. Prevents retention of fluid and causes vasodilation. Decreases blood pressure. Also, prevents remodeling.
Thrombolytics are medications that break-up clots but they are extremely dangerous drugs. What do these medications end in? What are some contraindications to use of these drugs?
"Ase" like alteplase.
enzyme that breaks down a clot.
Active bleeding, recent trauma
A patient takes both spironolactone and an ace-inhibitor for their hypertension. What would be incredibly important to monitor in this patient?
What teaching would be important?
Potassium. Both increase potassium.
Decrease potassium in the diet. Avoid salt substitutes.
What teaching is necessary for a patient that is prescribed a calcium channel blockers for management of high blood pressure?
CCB like amlodipine decreases calcium available in the muscle cells and prevents contract or decreases the force of contraction. This allows the blood vessel to be more relaxed and therefore, have decreased blood pressure. Some CCB also affect the contractility of the heart. This can mimic heart failure and lead to swelling of lower extremities. CCB can also decrease the HR. The patient will need to report any leg swelling or excessive weakness. If the patient has heart failure, it will be important to report that and likely, the patient will not receive a CCB.
List 3 foods you should avoid with high cholesterol and list 3 foods you should eat to lower cholesterol.
Avoid microwave popcorn, butter/margarine, hamburgers/fried foods, shellfish, cream cheese, ice cream, egg yolks, and red meat.
Eat salmon, sweet potatoes, whole grains, nuts, oatmeal, beans, apples, olives, avocados, oranges, Brussel sprouts and berries.
A nurse is getting ready to apply a NTG patch to a patient. What does the nurse need to do to complete this task correctly?
1.) Remove the old patch. WEAR GLOVES
2.) Ensure the patient has had a 8 hour break from nitroglycerin.
3.) Rotate sites and apply a new patch (WEAR GLOVES).
WHat happens if the nurse doesn't wear gloves to apply the patch? Vasodilation- headache or even hypotension.
3 Part Question:
1.) What lab is monitored with heparin?
2.) What lab is monitored with warfarin?
3.) What adverse reaction do we need to monitor for when administering heparin?
1.) aPTT
2.) PT/INR- normal INR is 1. On warfarin it is between 2 and 3.
3.) HIT- Heparin induced thrombocytopenia. Monitor platelet level in CBC.