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51 Cards in this Set

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Psychosis
Symptoms – Delusions, hallucinations, disorganized behavior, difficulty relating to other
Diuretics: Furosemide (Lasix)
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
Calcium Channel Blockers: nifedipine (Procardia), diltazem (Cardizem), verapamil – treat hypertension
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.
Angiotensin Converting Enzyme (ACE) inhibitors: enalapril (Vasotec), lisinopril (Zestril) – First Line (Less side effects)
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
Alpha1 – Antagonist
Alpha 2 – Antagonist
Beta Blockers
.
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)
Drugs for Dysrhytmias
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
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
Warfarin Sodium (Coumadin)
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
Antiplatelet Agents:
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
Thrombolytics: streptikonase, TPA –dissolve clots (clot busters)
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.
Drugs of Angina Pectoris (Angina: temporary sessation of blood to heart), myocardial infarction, and cerebrovascular accident
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
Beta Blockers
Calcium Channel Blockers
.
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
Zetia
.
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
Methylxanthines: theophylline – causes many side effects not widely used
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)
Glucocorticoids
– steroid inhalers, maintenance drug
Antitussives: opiods and non-opiods – will suppress cough reflex
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
Expectoratns and mucolytics – loosen secretions
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
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
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)
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
Anticholinergic agents: benztropinemesylate (Cogentin), trihexyphenidyl hydrochloride (Artane)

Alzheimers Disease: Acetycholinesterase inhibitors
.
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
Non opiod analgesics
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
Aspirin (ASA)
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
Acetominophen (Tylenol)
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
Psychosis
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.
Schizophrenia
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)
EXTRAPYRAMIDAL SIDE EFFECT (EPS) PREVENTION & TREATMENT
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
COMMON CARDIOVASCULAR DISORDERS
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
HYPERTENSION
Most common cardiovascular disease

Definition: BP of 140/90 or greater

Etiology: >90% unknown
ACTION OF DIURETICS
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
K wasting Diuretics - SIDE EFECTS AND INTERVENTIONS FOR DIURETICS
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
DEFINITION AND TREATMENT FOR ELEVATED BLOOD PRESSURE
PREHYPERTENSION

BP 120/80 – 139/89

Teach lifestyle changes


HYPERTENSION

BP 140/90 or greater

Teach lifestyle changes and start drug therapy
HEART FAILURE
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.
FACTORS IN HEMODYNAMICS
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
CONSEQUENCES OF HEART FAILURE
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
SYMPTOMS OF RIGHT-SIDED FAILURE
SYSTEMIC CONGESTION
Cardiomegaly (hypertrophy)
Dsyrhythmia
Peripheral edema (dependent)
Distended neck veins
Ascites
oliguria
SYMPTOMS OF LEFT-SIDED FAILURE
PULMONARY CONGESTION
Cardiomegaly
Dsyrhythmia
Dyspnea
Orthopnea
Cough & wheezing
INOTROPIC (Affecting cardiac contractility)
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
INCREASE IN CARDIAC OUTPUT
Decrease in heart rate
Improvement in heart rhythm
Diuresis
Absence of dyspnea
Decrease in edema (and weight)
Feeling of well-being
DIGOXIN LEVELS
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
DSYRHYTHMIA (disturbed rhythm) ARRHYTHMIA (absence of rhythm)
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
ANTICOAGULANTS - prolong clotting time
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)
IMPLEMENT BLEEDING PRECAUTIONS
Use soft toothbrush

Use electric razor

Avoid activities with a potential for injury
HYPERLIPIDEMIA - leads to Atherosclerosis
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.
DRUGS FOR LIPID DISORDERS (antihyperlipidemics)
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%
ASTHMA
RESCUE DRUGS
Dilate bronchioles during attack


MAINTENANCE DRUGS
STEROID INHALERS (Glucocorticoids)
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