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158 Cards in this Set
- Front
- Back
A normal serum Sodium level is
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135 - 145 mEq/L
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A normal serum Potassium level is
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3.5 - 5.0 mEq/L
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A normal serum Calcium level is
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9 - 11 mg/dl
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in Hyponatremia serum Sodium levels are
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< (less than) 135 mEq/L
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in Hypernatremia serum Sodium levels are
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> (greater than) 147mEq/L
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in Hypokalemia serum Potassium levels are
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< (less than) 3.5 mEq/L
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in Hyperkalemia serum Potassium levels are
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> (greater than) 5.1 mEq/L
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List 7 sources of Potassium
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1. Bananas, citrus fruit, melons
2. Raisins 3. Dark green leafy vegetables 4. Potatoes 5. All bran cereal 6. Salt-Substitutes 7. Dried beef (e.g. Jerky) |
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in Hypocalcemia serum Calcium levels are
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< (less than) 8.5 mg/dl
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in Hypercalcemia serum Calcium levels are
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> (greater than) 11mg/dl
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List 3 sources of Calcium
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1. Dairy Products
2. Fortified fruit juice 3. Dark green leafy vegetables |
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List 6 sources of Sodium
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1. Table salt, seasonings & spices
2. Processed food 3. Canned Soda 4. Potatoes & white vegetables 5. Sardines & Herring fish 6. Cold cuts |
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When recieving Thiazide or Loop Diuretics, consume foods
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high in potassium
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When recieving Potassium-sparing diuretics avoid foods
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high in potasium
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Thiazide Diuretics act by (2)
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1. Blocking Na+ absorption
2. Increasing K+ and H2O output. |
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Do not administer Atenolol (Tenormin) if pulse is
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1. less than 60 bpm
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Atenolol (Tenormin) can mask
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Tachycardia that occurs with hypoglycemia
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Atenolol (Tenormin) side effects (6)
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1. fatigue
2. Weakness 3. Bradycardia 4. Hypotension 5. Decreased sexual desire or ability 6. Increased cold sensitivity |
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Atenolol (Tenormin) acts by
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slowing HR & conduction
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Chlorothiazide (Diuril) should not be administered to
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lactating women
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Chlorothiazide (Diuril) absorption is increased when
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taken with food
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Chlorothiazide (Diuril) taken with caffeine
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increases diuresis
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Chlorothiazide (Diuril) taken with large amounts of licorice
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may increase hypokalemia effects
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Chlorothiazide (Diuril) decreases the effectiveness of
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antidiabetic drugs
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Chlorothiazide (Diuril) is contraindicated in patients with (2)
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1. Severe renal dysfunction
2. Anuria |
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Normal B/P
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<120/80
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Prehypertension
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120 - 139 / 80 - 89
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Stage 1 hypertension
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140 - 159 / 90 - 99
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Stage 2 hypertension
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>160 / > 100
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What kind of drugs are used for prehypertension?
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None. Lifestyle modifications are encouraged.
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What kinds of drugs are used for stage 1 hypertension?
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Thiazide type diuretics mostly
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Which kind of diuretics cause ototoxicity?
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Loop Diuretics
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Diuretics reduce the renal excretion of
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Lithium
*Lithium levels must be monitored as toxicity may occur |
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Hydrochlorothiazide is contraindicated in patients with (3 Things)
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1. Anuria
2. Prior sensitivity to thiazides 3. Prior sensitivity to sulfonamides |
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Hydrochlorothiazide should be taken with
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orange juice (promotes adequate potassium intake)
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Hydrochlorothiazide may increase serum levels of (6)
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1. glucose
2. triglycerides 3. Uric acid 4. BUN 5. Creatinine 6. Calcium *Watch patient for signs of metabolic imbalances |
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Hydrochlorothiazide may decrease serum levels of (3 things)
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1. Potassium
2. Sodium 3. Chloride *Watch patient for signs of metabolic imbalances. |
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Enalapril can produce "first dose phenomenon" of
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profound hypotension
*Ensure that the effect diminishes with continued therapy. |
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To avoid first dose phenomenon with Enalapril
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administer the first dose at bedtime
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patients on Enalapril should not consume (2)
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1. Electrolyte fortified nutritional snacks or sports drinks
2. salt sustitutes |
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The therapeutic advantage of potassium - sparing diuretics is that
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diuresis can be obtained without affecting blood K+ levels
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Spinorolactone (Aldactone) Potential Nursing Diagnosis
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Disturbed body image (gynecomastia in males, hirsutism in females), related to anti-estrogen effects of drug.
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Spinorolactone (Aldactone) is contraindicated in patients with (3)
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1. Anuria
2. Worsening decreased kidney function 3. Acute renal insufficiency |
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rules regarding weighing for patients on Spinorolactone (Aldactone) (List 4)
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1. weigh daily or weekly (depending on schedule recommended by healthcare provider)
2. same scale 3. same time 4. same amount of clothing |
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regarding weight results of patients on Spinorolactone (Aldactone), report changes of (2 things)
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>3lbs if weighing daily
>5lbs if weighing weekly |
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patients on Spinorolactone (Aldactone) must avoid foods high in
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potassium
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Spinorolactone (Aldactone) causes the following sexual changes (6)
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1. Decreased libido
2. Hirsutism in females 3. Gynecomastia in males 4. Impotence 5. Irregular menses, amenorrhea, post menopausal bleeding 6. Deepening of voice in females |
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Regarding pulse, patients on Cardiac Glycoside Therapy must (3 things)
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1. Count pulse for 1 full min
2. Record pulse with every dose. 3. Contact healthcare provider if pulse is less than 60 or greater than 100 bpm |
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Why should Lasix be used with caution in the elderly?
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They are more susceptible to dehydration & electrolyte imbalances from the drug.
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With Lasix, check weight
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Daily
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With Lasix, report weight changes that are
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greater or less that 2lbs in 24hrs.
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Lasix is contraindicated in patients with
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A history or hypersensitivity to the drug or sulfonimines.
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When on Lasix, patients can avoid dizziness by
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changing position slowly
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Lasix dose should be scheduled (2)
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1. In the morning
2. No later than 6pm if two- times-a-day dose is ordered. *Avoids Nocturia |
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Increased risk for Lasix toxicity occurs in patients with (List 3)
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1. Liver Disease
2. Cirrhosis 3. Ascities |
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Beta-blockers affect blood glucose levels by
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lowering them
*Finger-stick blood glucose levels should be checked regularly *Report signs of hypoglycemia |
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Beta-blockers affect cardiac output by
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lowering it
*exercise or exertion should be started slowly *Determine tolerance to increased activity |
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Patients on beta-blockers should report consistent fasting blood glucose levels below
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70mg/dl
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Target organs affected by untreated hypertension are
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1. Heart
2. Brain 3. Retina 4. Kidneys |
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Emotions that decrease B/P are
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1. Depression
2. Lethargy |
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Removal of excess fluid in the body results in (3 things)
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1. Decreased cardiac preload
2. Decreased cardiac output 3. Decreased total peripheral resistance |
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Side effects of Thiazide Diuretics are (5)
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1. Hypokalemia
2. Hyponatremia 3. Hyperglycemia 4. Hyperuricemia 5. Rash |
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Side effects of Loop Diuetics are (6)
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1. Hypotension
2. Hypokalemia 3. Fatigue 4. Hearing loss 5. Dehydration 6. Dry Mouth |
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ACE Inhibitors usually end in
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-pril
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Osmotic Diuretics are used to treat (2)
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1. Intra cranial pressure
2. Severe renal failure |
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An example of an Osmotic diuretic is
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Mannitol
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Beta-blockers often end in
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-lol
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Drug that can be used for hypertensive emergencies during labor and delivery
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Nitroprusside IV
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Is extremely light sensitive and only stable for 24hrs
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Nitroprusside IV
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The following occurs in Left-sided heart failure
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1. Blood accumulation in left ventricle.
2. Hypertrothy of left ventricle 3. Blood backs up into lungs 4. Cough and SOB results |
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The following occurs in Right-sided heart failure
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1. Blood backs up into veins
2. Peripheral edema & organ engorgement occurs. *Less common than L-sided failure |
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A positive Inotropic effect results in
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increased force of contraction
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A negative Inotropic effect results in
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decreased force of contractions
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A positive Chronotropic effect results in
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increased HR
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A negative Chronotropic effect results in
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decreased HR
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A positive dromotropic effect results in
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increased rate of electrical conduction
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A negative dromotropic effect results in
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decreased rate of electrical conduction
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ACE Inhibitors must not be administered if the following CBC result is seen
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Neutrophil count below 1000/mm3
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Digoxin will not work until
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therapetic dose is achieved
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Cardiac Glycoside toxicity can be treated with
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Digibind
*Neutralizes Digoxin |
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Max dose for Nifedipine is
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180mg/day
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Max dose for Enalapril is
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40mg/day
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Max dose for Doxazosin is
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16mg/day
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Max dose for Hydralzine is
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300mg/day
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The orthostatic hypotension caused by Chlorothiazide could result in the Potential Nursing Diagnosis
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Risk for falls
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Chlorothiazide when taken by patients with gout results in
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hyperuricemia without symptoms
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Chlorothiazide interferes with the excretion of
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Uric acid and may lead to hyperuricemia
*pay particular attention to patients who already have gout. |
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Chlorothiazide administered with amphotericin B or corticosteroids results in
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increased hypokalemic effects
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What kind of drug is Lisinopril (Prinivil) and what is it prescribed for?
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1. ACE Inhibitor
2. Hypertension & Heart Failure |
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ACE Inhibitors block Aldosterone secretion resulting in
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1. Sodium loss
2. Potassium retention |
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When caring for a client receiving triamterene (Dyrenium), the nurse places priority on which nursing intervention?
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Monitoring electrolytes for hyperkalemia
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Nitroglycerin relieves chest pain by
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Dilating arteries and veins
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The nurse recognizes that the ability of organic nitrates to dilate coronary arteries is most effective for treating
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Vasospastic or variant angina
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The nurse in the telemetry unit explains two nonpharmacological treatments such as ___________, or ___________, can be used to treat dysrhythmias.
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Cardioversion; defibrillation
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The nurse recognizes the action of beta blockers for treatment of dysrhythmias is
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Negative chronotropic effect
*meaning decreased HR |
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When planning care for a client receiving treatment for cardiac dysrhythmias, an appropriate client outcome would be
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The client will avoid use of caffeine during therapy.
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The nurse adjusts the care plan of a client of Asian descent who is receiving propranolol to include increased monitoring of
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Heart rate
*Studies show lack of drug-metabolizing enzyme (mephenytoin hydroxylase) causes Asians to metabolize propranolol more quickly than do Caucasians. The nurse should assess for high early buildup and overdose. |
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What type of drug is Nifedipine (Procardia) and what is it prescribed for?
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1. calcium channel blocker
2. Hypertension |
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What kind of drug is Enalapril (Vasotec) and what is it prescribed for?
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1. ACE inhibitor
2. Hypertension |
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What kind of drug is Doxazosin (Cardura) and what is it prescribed for?
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1. Adrenergic blocker
2. Hypertension and benign prostatic hyperplasia. |
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What kind of drug is Hydralazine (Apresoline) and what is it prescribed for?
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1. Direct-acting vasodilator
2. Hypertension |
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What kind of drug is isosorbide dinitrate (Isordil) and what is it prescribed for?
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1. Vasodilator
2. angina |
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What kind of drug is digoxin (Lanoxin) and what is it prescribed for?
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1. Cardiac glycoside
2, Used to increase the strength of cardiac contractions, thereby alleviating symptoms of heart failure. |
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What kind of drug is milrinone (Primacor) and what is it prescribed for?
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1. Phosphodiesterase inhibitor
2. heart failure |
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What kind of drug is Furosemide (Lasix) and what is it prescribed for?
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1. Loop diuretic
2. acute heart failure |
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What kind of drug is carvedilol (Coreg) and what is it prescribed for?
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1. Beta-adrenergic blocker
2. Used to treat heart failure by lowering heart rate and blood pressure. |
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What kind of drug is nitroglycerin (Nitrostat) and what is it prescribed for?
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1. organic nitrate
2. angina and MI |
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What kind of drug is atenolol (Tenormin) and what is it prescribed for?
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1. Beta-adrenergic blockers
2. used to treat angina and hypertension, and to prevent MI |
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What kind of drug is diltiazem (Cardizem) and what is it prescribed for?
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1. Calcium channel blocker
2. angina, dysrhythmia, and hypertension |
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What kind of drug is metoprolol (Lopressor) and what is it prescribed for?
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1. Beta-adrenergic blocker
2. MI, angina, and dysrhythmia |
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What kind of drug is reteplase (Retevase) and what is it prescribed for?
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1. Thrombolytic
2. used to dissolve blood clots, especially after an MI |
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What kind of drug is verapamil (Calan) and what is it prescribed for?
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1. Calcium channel blocker
2. dysrhythmia and angina |
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What kind of drug is propranolol (Inderal) and what is it prescribed for?
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1. Beta-adrenergic blocker
2. dysrhythmia, hypertension, angina, and migraine headaches |
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What kind of drug amiodarone (Cardarone) is and what is it prescribed for?
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1. Potassium channel blocker
2. atrial dysrhythmia and ventricular tachycardia |
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What kind of drug is quinidine (Quinidex) and what is it prescribed for?
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1. Sodium channel blockers
2. dysrhythmia |
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What kind of drug is norepinephrine (Levarterenol)and what is it prescribed for?
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1.Vasoconstrictor
2. used to increase blood pressure and cardiac output in acute shock and cardiac arrest |
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What kind of drug is epinephrine (Adrenalin) and what is it prescribed for?
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1. Vasoconstrictor
2. acute anaphylactic shock |
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What kind of drug is dopamine (Dopastat, Inotropin) and what is it prescribed for?
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1. cardiotonic agent
2. stimulates beta-adrenergic receptors used to treat shock |
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What kind of drug is normal serum albumin (Albuminar, Albutein, and others) and what is it prescribed for?
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1. Fluid replacement agent
2. colloid fluid replacement |
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What kind of drug is atorvastatin (Lipitor) and what is it prescribed for?
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1. HMG-CoA reductase inhibitor (Statin)
2. hyperlipidemia |
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What kind of drug is cholestyramine (Questran) and what is it prescribed for?
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1. Bile acid resin
2. hyperlipidemia |
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What kind of drug is gemfibrozil (Lopid) and what is it prescribed for?
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1. Fibric acid agent
2. hyperlipidemia |
|
What serum level of Digitalis indicates toxicity?
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above 2.0 ng
|
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How often should the nurse monitor vital signs for the patient that has just recieved Nitroprusside (Nitropress) for a blood pressure as high as 220/110
|
every 5-15 minutes
*Nitroprusside decreases blood pressure instantaneously. Vital signs must be monitored very closely |
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Nifedipine (Procardia) 30 mg p.o. is prescribed for a client. The nurse teaches the side effects, and instructs the client to immediately report:
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Increased shortness of breath and orthopnea
*reflect signs of congestive heart failure |
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risk for digitalis toxicity is increased by
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hypokalemia
|
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'digitalize' means to
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gradually increase Digoxin levels until heart tissue is saturated and symptoms of HF subside.
|
|
side effects of digitalis therapy include
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anorexia, nausea and vomiting
|
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The major action of cardiac glycosides is that
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they have a positive inotropic effect.
*HR & afterload decreases |
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cardiac glycosides are used in the treatment of
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atrial fibrillation
|
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Phosphodiesterase inhibitors act by
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increasing the force of
myocardial contraction *increase cardiac output |
|
Cardiac glycosides act by
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increasing the force of
myocardial contraction *increase cardiac output |
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Diuretics should be discontinued before the nurse initially administers
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ACE inhibitors
*prevents severe hypotension |
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metabolic symptoms of shock are (4)
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1. Low temperature
2. Low urine output 3. Acidosis 4. Thirst |
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Respiratory symptoms of shock are (2)
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1. Rapid breathing
2. Shallow respirations |
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Cardiovascular symptoms of shock are (4)
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1. Thready Pulse
2. Tachycardia 3. Low cardiac output 4. Low blood pressure |
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Neurologic symptoms of shock are (4)
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1. Restlessness
2. Confusion 3. Anxiety 4. Lethargy |
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anaphylactic shock results from
|
an acute allergic reaction
|
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hypovolemic shock results from
|
loss of blood volume
|
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cardiogenic shock results from
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failure of the heart to pump sufficient blood to tissues
|
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neurogenic shock results from
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vasodilation due to overstimulation of the parasympathetic or understimulation of the sympathetic nervous system.
|
|
septic shock results from
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multiple organ dysfunction due to pathogenic organisms in the blood.
|
|
Septic shock is often a precursor to (2)
|
1. acute respiratory distress syndrome (ARDS)
2. disseminated intravascular coagulation (DIC) |
|
shock generally results when
|
there is inadequate blood flow to meet body’s needs
|
|
Colloids act by
|
drawing molecules from body’s cells and tissues into blood vessels
*Oncotic pressure |
|
Crystalloids are
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intravenous solutions that contain electrolytes
|
|
Crystalloids act by (2)
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1. replacing lost fluids and electrolytes
2. increasing urine output |
|
Signs and Symptoms
specific to Anaphylaxis are |
1. Periorbital edema
2. Urticaria (Hives) 3. Wheezing 4. Difficult breathing |
|
Treatment of Anaphylaxis is as follows
|
1. Give oxygen immediately.
2. Antihistamine to prevent release of histamine. 3. Bronchodilator to relieve shortness of breath. 4. Corticosteroids to suppresses inflammation. |
|
Most common cause of Acute Renal Failure is
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hypoperfusion
|
|
An elevated blood level of homocysteine is a risk factor for
|
1. Heart disease
2. Stroke |
|
Patients on Heparin therapy should avoid all
|
contact sports
|
|
signals indicating bleeding in patients recieving anticoagulant therapy are
|
1. an increase in HR followed by low B/P or a subnormal temperature.
2. flu-like symptoms (dizziness, chills, weakness, paleness) 3. Excessive bruising |
|
Patients recieving Alteplase should have vital signs monitored every
|
15 mins during 1st hr of infusion, then every 30 mins during remainder of infusion.
|
|
Patients have increased risk of bleeding for 2-4 days after infusion of
|
Alteplase
|
|
Immediately discontinue Amniocaproic Acid (Amicar) therapy if
|
patient develops muscle weakness or reddish brown urine.
*indicates myopathy and myoglobinuria |
|
response to Epoetin Alfa is minimal if there are deficient blood levels of
|
iron, folic acid and vitamin B12
|
|
use of IV nitrates puts the patient at risk for
|
severe hypotension secondary to vasodilation
*a baseline B/P should be obtained prior to administration |