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51 Cards in this Set
- Front
- Back
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Psychosis
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Symptoms – Delusions, hallucinations, disorganized behavior, difficulty relating to other
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Diuretics: Furosemide (Lasix)
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1. Action: decreases circulating blood volume
2. Side effects: a. Hypotension, hypovolemia b. Dehydration/electrolyes imbalance (hypokalemia) i. Excrete Na+ and k, water follows c. oxotoxicity 3. Implementation: a. Monitor the blood pressure i. Monitor for signs/symptoms of dehydration: Changese in the level of consciousness, dizziness, fatique, dry mucous membranes b. Monitor serume electrolytes especially K c. Monitor hearing activity d. Instruct client on a low Na diet e. Instruct clien on foods high in K f. Instruct client to change position slowly |
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Calcium Channel Blockers: nifedipine (Procardia), diltazem (Cardizem), verapamil – treat hypertension
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1. Action: decresease movement of calcium causing decreases muscle contractions resulting in relaxation of aterioles and lowering of peripheral vascular resistance
2. Side effects a. Hyptension 3. Implementation: a. Monitor the blood pressure and heart rate b. Assess for signs of hypotension: changes in the level of consciousness, dizziness, postural hypotension c. Instruct client to change position slowly d. Instruct client to take the medication as prescribed, monitor blood pressure at home. |
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Angiotensin Converting Enzyme (ACE) inhibitors: enalapril (Vasotec), lisinopril (Zestril) – First Line (Less side effects)
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1. Action: Inhibits the action of angiotensin I converting enzymes
2. Side Effects: a. A persistant dry or tickling, nonproductive cough b. Postural hypotension 3. Implementation a. Monitor for the frist dose phenomenon of profound hypotension b. Instruct client to change position slowly c. Monitor for cough – may be given nebulizer d. Educate client to take the medication as prescribed; monitor blood pressure at home |
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Alpha1 – Antagonist
Alpha 2 – Antagonist Beta Blockers |
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Drugs for heart failure:
Cardioglycoside: digoxin (Lanoxin) |
1. Action:
a. Increases the force of myocardial contraction (positive inotropic) b. Slows the heart rate (negative chronitropic) 2. Side Effects: a. GI: Anorexia, Nausea, Vomiting b. CV: Bradycardia - >60 c. CNS: Visual Disturbances (halo vision) 3. Implementations a. Take apical heart rate for one full minute prior to the administration of the drug: withhold the drug if the heart rate is less that 60 beats/minute b. Assess/evaluate for na increase in the cardiac output c. Monitor the potassium level as a low level with digoxin administrations will potentiate the effects of digoxin d. Monitor serum Dig level (therapeutic level 0.8 -1.8 ng/ml) |
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Drugs for Dysrhytmias
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1. Actions
a. Sodium Channel Blockers b. Beta – adrenergic blockers c. Potassium channel blockers d. Calcium channel blockers 2. implementations a. monitor cardiac rate and rhythm b. monitor blood pressure c. investigate possible causes for dysrhythmias |
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Druges for Coagulation disorgers
Heparin – prolongs clotting time. |
1. Action: inhibits the conversion of prothrombin to thrombin
a. Onset Rapid (minutes) Duration Brief (Hours) 2. Side effects: Prolonged Bleeding 3. Implementation a. Asses/evaluate for bleeding b. Implement bleeding precautions c. Antidote:: protamine sulfate d. Dosages is regulated according to the partial thromboplastic time (PTT: normal 60-70 seconds), or activated partial thromboplastic time (APTT: normal 30-40 seconds); Therapeutic level: 1.5 to 2.5 times the clients baseline e. Administration route: subcutaneous or IV |
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Warfarin Sodium (Coumadin)
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1. Action: inhibits the hepatic synthesis of several coagulation factors – inhibits synthesis of vit. K dependant clotting factors.
2. Side effects: bleeding 3. Implementation a. Assess/evaluate for bleeding b. Implement bleeding precaution c. Instruct client to avoid a sudden dietary increase in the dark green leaft vegetables d. Antidote: vitamin k (aqua mephyton) e. Dosage is regulated according to the prothrombin time (PT: Normal 12-15 seconds) Therapeutic: 1.5- 2 times the client’s baseline or the INR value (2-3.5 are considered therapeutic) – go in daily until therapeurtic dose is achieved, then monthly. f. Administration: Oral |
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Antiplatelet Agents:
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1. ASA
2. ADP Inhibitors: clopidogrel (Plavix) a. Action: Alters the plasma membrane of the platelets preventing ability of platelets to receive signal to aggregate. b. Side effects: bleeding c. Implementation i. Assess/evaluate for bleeding ii. Implement bleeding precautions |
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Thrombolytics: streptikonase, TPA –dissolve clots (clot busters)
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1. Action: digest fibrin and break down fibrogen, prothrombin and other plasma proteins and clotting factors.
2. Side effects: bleeding 3. Implementation a. Monitor vital signs – evaluate for bleeding b. Administration route: iv c. Window of opportunity: 3-4 hrs symptoms starting, can actually prevent damages. |
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Drugs of Angina Pectoris (Angina: temporary sessation of blood to heart), myocardial infarction, and cerebrovascular accident
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1. Action: Relaxes (relieves pain) arterial and venous smooth muscle resulting in dilation of the arteries and veins
2. Side Effects: a. Hypotension b. Headache, lightheadedness, fainting c. Flushing 3. Implementations a. –Sublingual- treat and help preven attacks i. Monitor blood pressure prior to administration ii. Instruct client to allow table to dissolve under tongue iii. Take one tablent every five minutes for chest pain for a total of 3 tables iv. 1-2 tablets make be taken prophylactically v. Supply should be replaces every 3- 6 months vi. Tablets should be stored in a dark colored bottle away from heat and light vii. Keep a record of attacks nad response ot the medication b. Topical ointment i. Rotate the sites for application ii. Do not massage or rub into the skin c. Topical disc i. Rotate sites |
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Beta Blockers
Calcium Channel Blockers |
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Druges for lipid disorders – Antihyperlipidemics
A. “Statins”: levostatin (mevacor), atorvastatin (lipitor), pravastatin (pravachol) simvastatin (zocor) |
a. Action: inhibits cholesterol biosynthesis
b. Side effects: i. GI discomfort ii. Heptatotoxicity c. Implementation i. Monitor liver function studies, monitor cholesterol, triglyceride levels ii. Instruct client on low cholesterol diet |
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Zetia
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Asthma
Beta2-Adrenergic agonists- used as a rescue drug |
1. Use: Treatment of acute bronchoconstriction
2. Action: Relax bronchial smooth muscles 3. Side effects: a. Inhaled drug, saliva may appear pink b. Tachycardia 4. Implementation a. Hold breat for 10 seconds after inhaling medication and wait 2 minutes before second inhalation; administer bronchodialor 15 minutes prior to a steroid – opens airways first to let steroid in. b. Instruct client to limit use of products that contain caffeine c. Report difficulty breathing, heart palpitation, tremors, vomiting, nervousness. d. Assess respiratoy status/auscultating lung sounds e. Take heart rate |
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Methylxanthines: theophylline – causes many side effects not widely used
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1. Action – relaxes smooth muscles of bronchus
2. Side effects: nausea, vomiting, CNS stimulation, tachycardia 3. implementation a. monitor vital signs; assess respiratory rate/breath sounds b. Administer with food or milk c. Monitor theophylline levels (10-20 mcg/dl) |
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Glucocorticoids
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– steroid inhalers, maintenance drug
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Antitussives: opiods and non-opiods – will suppress cough reflex
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1. Action: Acts by raising the cough thresholds in the CNS
2. Implementation a. Instruct client to avoid driving or performing hazardous activites while take opiod antitussives b. Instruct client to avoid alcohol, which causes increased CNS depression c. Instruct client to report: green or yellow tinges secretions; difficulty breathing excessive drowsiness, constipation, nausea/vomiting. Lower respiratory, pneumonia- we want them to cough |
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Expectoratns and mucolytics – loosen secretions
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1. Use: Control excess mucus production
2. Action: a. Expectorant: increase bronchial secretions by reducing the thiknness or viscosity of secretions b. Mucolytic: loosen thick, viscous bronchial secretions by breaking down the chemical structure of mucus molecules 3. Side effects: infrequent 4. Implementation: a. Maintain fluid intake at 8-12 8 oz. glasses daily b. Suggest the use of a humidifier |
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Drugs for psychosis
Phenothiazines: Chlorpromazine (Thorazine) |
1. Action: Prevent dopamine nad serotonin from occupying their receptor sites in certain regions of the brain
2. Side effects a. Extrapyramidal symptoms (EPS) i. Dystonia: sever muscle spasms especially of back, neck, tongue, face ii. Tardive Dyskinesias: potentially irreversible neurologic disorder (grimacing, blinking, lip smacking, rocking) iii. Akathisia: inability to relax or rest iv. Pseudo-parkinsonism: tremor, muscle rigidity, stooped posture, shuffling gait v. Anticholinergic effect vi. Adverse effect: neuroleptic malignant syndrome (NMS) (hyper thermia, dehydration, unstable blood pressure, profuse sweating, musle rigidity, incontinence) 3. Implementation a. Monitor for extrapyramidal effects b. Monitor client for more coherent thoughts c. Client education regarding avoidance of alcohol and other CNS depressants |
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Nonphenothiazine: haloperidol (Haldol) similar effects as phenothiazine
Atypical antipsychotics: clozapine (Clozaril), rispendone (Risperdal), olanzapam (Zyprexa) quitiapine (Seroquel) – newer drugs, less extrapyrimidal side effects |
1. Action: Controls both positive and negative symptoms of schizophrenia, blockes dopamine and serotonin
2. Side effects 3. Less EPS; weight gain 4. Agranulocytosis (Clozaril) |
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Drugs for degenerative diseases of the nervous system – too much Ach no enough dopamine
Parkinsonism 1. Dopaminergic: levodope (L-Dopa) |
a. Action: Incresease dopamine levels in the corpus stiatum of the brain
b. Implementation i. Monitor vital signs ii. Ensure a safe environment (At risk for falls) iii. Monitor for changes in signs/symptoms of the disease iv. Instruct client to avoid taking medication with high protein foods or foods hign in vitamin B6; take medication on an empty stomach v. Monitor for improved functional status |
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Anticholinergic agents: benztropinemesylate (Cogentin), trihexyphenidyl hydrochloride (Artane)
Alzheimers Disease: Acetycholinesterase inhibitors |
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Drugs for the control of pain
Opiate analgesics (morphine, codeine) – narcotics |
1. Action: interacts with at least 6 different receptor sites
2. use: a. Analgesia (moderate-severe) b. Sedation c. Management of diarrhea and cough 3. Side effects a. Constipation b. Respiratory depression c. Hypotension d. Itching ( may be prescribed benedryl) e. Tolerance/dependency – look at pupils constricted pupils and still in pain developing a tolerance 4. Implementation a. Assess/evaluate effectiveness of pain relief using scale b. Monitor bowel pattern, increase fluids and roughage c. Monitor respiratory rate prior to administration of the drug d. Monitor blood pressure e. Observe/assess the client for tolerance and physical dependence f. Opiod antagonist: naloxene hydrochloride (Narcan) – antidote for too much narcotics g. Record use of the drug on the controlled substance form |
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Non opiod analgesics
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1. Nonsteroidal anti-inflammatory drugs (NSAID), ibuprofen (Motrin, Advil), naproxen (Naprosyn), Ketorolac (Toradol) indomethacin (Indocin); COX-2 inhibitors
a. Action: inhibits cyclo-oxygenase, an enzyme, responsible, for the synthesis of prostaglandin b. Side effects: i. GI: Nausea, abdominal pain, anorexia ii. Heaptic toxicity c. implementation i. Assess/evaluate level of pain ii. Administer with food to reduce incidence of gastric irritation iii. Monitor liver enzymes iv. Client taking an anticoagulaten should not use NSAIDS |
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Aspirin (ASA)
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1. Use:
a. Analgesic (pain relief) b. Anti-inflammatory (joint paint)(arthritis) c. Antipyretic (fever) d. Antiplatelet aggregation (risk for myocardial infarcation) 2. Side effects a. Gastric irritation (GI bleeding) b. Oxotocitiy) 3. implantation: a. Assess/evaluate effectiveness of pain relief b. Assess/evaluate effectiveness of temperature control c. Administer with food to reduce incidence of GI irritation d. Instruct client to inform physician if tinnitus occurs e. Client taking an anticoagulant should not receive/take aspirin f. Do not administer if under 20 years of age with a viral infection |
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Acetominophen (Tylenol)
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1. Use
a. Analgesic b. Antipyretic 2. Side effect a. Gastric irritation b. Hepatic toxicity 3. Implementatoin a. Assess.evalute effectiveness b. Administer with food c. Monitor liver enzymes d. Administer no more than 4000 mg in 24 hours |
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Psychosis
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Symptoms – delusions, hallucinations, disorganized behavior, difficulty relating to others
Schizophrenia – a type of psychosis Occurs in 1-2% of the population -Mental Health Condition -Normally can't function in society without medicine. |
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Schizophrenia
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POSITIVE SYMPTOMS
Exaggerated or distorted function (agitation, tension, delusions, hallucinations, incoherent speech) NEGATIVE SYMPTOMS Loss of or diminished function (emotional and social withdrawal, blunted affect, poverty of speech content, lack of initiative, motor retardation) |
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EXTRAPYRAMIDAL SIDE EFFECT (EPS) PREVENTION & TREATMENT
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USE MINIMUM EFFECTIVE DOSE
USE IN COMBINATION WITH SHORT-TERM USE OF ANTICHOLINERGIC AGENTS (COGENTIN) MONITOR CONSISTENTLY FOR THESE SYMPTOMS IF PRESENT – HOLD THE DRUG AND REPORT IMMEDIATELY |
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COMMON CARDIOVASCULAR DISORDERS
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Congestive heart failure (CHF)
Arrhythmias Hypertension Nursing responsibilities: Prevention – teach healthy life styles Teach cardinal signs Teach how to modify lifestyle in presence of existing disease |
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HYPERTENSION
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Most common cardiovascular disease
Definition: BP of 140/90 or greater Etiology: >90% unknown |
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ACTION OF DIURETICS
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Increases rate of urine formation (diuresis)
Results in a decrease in intravascular volume, and a decrease in interstitial fluid (within the tissues) -lower IT, treats edema |
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K wasting Diuretics - SIDE EFECTS AND INTERVENTIONS FOR DIURETICS
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Hypotension - Monitor blood pressure, instruct patient to change positions slowly
Dehydration - Monitor for S&S of dehydration Electrolyte imbalance - Monitor electrolytes, especially potassium. Instruct client on appropriate diet |
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DEFINITION AND TREATMENT FOR ELEVATED BLOOD PRESSURE
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PREHYPERTENSION
BP 120/80 – 139/89 Teach lifestyle changes HYPERTENSION BP 140/90 or greater Teach lifestyle changes and start drug therapy |
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HEART FAILURE
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The inability of the ventricles to pump enough blood to meet the bodies metabolic demands
MI and HTN - 2ND Leading cause of death, 500,000 deaths each year. 1/2 die before they reach the hospital, 1/2 wait 2 hrs before seeking help. |
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FACTORS IN HEMODYNAMICS
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CARDIAC OUTPUT (CO) – amount of blood ejected by the heart each minute
STROKE VOLUME (SV) – strength of myocardial contractility HEART RATE (HR) CO = HR X SV |
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CONSEQUENCES OF HEART FAILURE
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Initially:
1) sympathetic stimulation increases the heart rate, thereby helping to maintain cardiac output, and 2) cardiomegaly allows for an increase in the force of myocardial contraction Eventually: Decrease in CO >>>>> body fatigue and weakness |
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SYMPTOMS OF RIGHT-SIDED FAILURE
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SYSTEMIC CONGESTION
Cardiomegaly (hypertrophy) Dsyrhythmia Peripheral edema (dependent) Distended neck veins Ascites oliguria |
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SYMPTOMS OF LEFT-SIDED FAILURE
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PULMONARY CONGESTION
Cardiomegaly Dsyrhythmia Dyspnea Orthopnea Cough & wheezing |
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INOTROPIC (Affecting cardiac contractility)
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A drug with a + effect strengthens or increases the force of contraction
A drug with a – effect decreases or weakens the force of myocardial contraction |
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INCREASE IN CARDIAC OUTPUT
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Decrease in heart rate
Improvement in heart rhythm Diuresis Absence of dyspnea Decrease in edema (and weight) Feeling of well-being |
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DIGOXIN LEVELS
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Therapeutic level – 0.5 to 2.5 ng/ml
(not always reliable in determining therapeutic effect of toxicity) Therefore, also assess for: Absence of S&S of CHF (therapeutic effect), and Absence of S&S of toxicity |
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DSYRHYTHMIA (disturbed rhythm) ARRHYTHMIA (absence of rhythm)
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A cardiac dysrhythmia (arrhythmia) is defined as any deviation from the normal rate or pattern of the heartbeat
This includes: Rates too slow (bradycardia) Rates too fast (tachycardia) Irregular |
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ANTICOAGULANTS - prolong clotting time
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Agents that prevent or delay blood coagulation
Use: Prevent the extension of an already existing clot Prophylaxis to prevent clots from forming (these agents do not dissolve an already existing clot) |
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IMPLEMENT BLEEDING PRECAUTIONS
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Use soft toothbrush
Use electric razor Avoid activities with a potential for injury |
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HYPERLIPIDEMIA - leads to Atherosclerosis
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A metabolic disorder, in which the patient has increased concentrations of cholesterol and triglycerides
Consequence >>> atherosclerosis. A disorder in which lipids are deposited in the lining of blood vessels, eventually causing obstruction of blood flow. |
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DRUGS FOR LIPID DISORDERS (antihyperlipidemics)
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Used when hyperlipidemia cannot be controlled by diet and exercise alone
75-85% of serum cholesterol is endogenously (internally) derived Dietary modification alone will typically only lower cholesterol levels between 10-30% |
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ASTHMA
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RESCUE DRUGS
Dilate bronchioles during attack MAINTENANCE DRUGS |
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STEROID INHALERS (Glucocorticoids)
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Suppresses inflammation
Not a rescue drug Is a maintenance drug Administer 15 minutes after a bronchodilator RINSE MOUTH THOROUGHLY - can get thrush, painful mouth infection |
