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113 Cards in this Set
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The nurse is assigned to the care of a pt receiving digoxin. what adverse effects should the nurse assess for during the shift as part of routine care?
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N/V
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Serious adverse effects of digoxin include heart block, bradycardia, ventricular fibrillation, and other serious cardiac dysrhythmias, many of which can be more serious in the presence of elecrolyte imbalance. Other adverse effects include N/V, diarrhea, dizziness, visual distrubances, rash, hallucinations, confusion, dizziness, and delirium
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A pt with a new diagnosis of HF will begin drug therapy with digoxin. When explaining how this drug will help, the nurse would consider including which of the following points of information?
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Heart size is often decreased toward normal
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With digoxin, heart size is often decreased toward normal. Venous pressure falls, and the pulmonary and systemic congestion and their accomplanying s/sx are either diminishe or eliminated. coronary circulation is enhanced, myocardial oxygen demand is reduced, and the supply of oxygen and nutrients to the myocardium is improved.
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The nurse working on a cardiac unit is reviewing the results of lab studies drawn early in the morning. The nurse would do a further assessment on a pt that had which of the following digoxin levels?
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3.0 ng/ml
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Beneficial effects of digoxin are correlated with therapeutic serum levels of 0.8 to 2ng/ml. The pt with an elevated level should be assessed for toxicity manifestations.
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A nurse overhears a physician explain to a pt that he will be started on digoxin therapy using rapid digitalization to aid in improving new onset symptoms of heart failure. The nurse anticipates that the first dose of digoxin will be how many milligrams?
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0.5
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In the radip digitalization (loaading) method, which is reserved for pts who are in acute distress from HF, IV digoxin is given in divided doses in a 24-hr period for the pt who has not previously taken digoxin. A common protocol is to adm a total IV dose of 1 mg of digoxin. Digoxin may be prescribed as 0.5 mg IV now and 0.25 mg IV every 6 hrs for two doses (for a total of 1 mg).
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The nurse is working with an older adult pt taking digoxin. The nurse would monitor for development of which of the following, which is the earliest sign of digoxin toxicity?
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Anorexia
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Common dose-related adverse effects of the digoxin include anorexia, nausea, bradycardia, visual disturbances manifest by yellow vision, stomach pain, and dysrhythmias. A loss of appetite is usually the first sign of toxicity; N/V and abdominal distress usually occur several days after the anorexia. Confusion or changes in mental status can also be related to digoxin use, particularly in the older adult.
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The nurse would adm a scheduled dose of digoxin after noting which of the following safe potassium levels results from lab work drawn in early morning?
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4.5 mEq/L
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The normal k+ level is 3.5 - 5.1 mEq/L. A fall in k+ serum level enhances the effect of digoxin and the risk of digoxin toxicity. Excess k+ increases the risk of cardiac dysrhythmias. The nurse could safely adm the dose if the pt is free from either hypokalemia and hyperkalemia.
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The nurse would include which of the following points in a teaching plan for a pt being discharged to home on digoxin?
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Report a pulse rate of less than 60 or greater than 110 to the prescriber
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Pts need to take own pulse before each dose of med. The dose should be withheld and the prescriber notified if the pulse is below 60 or above 110 beats/min and /or is erratic or if he experiences anorexia, diarrhea, N/V, sudden weight gain, or apparent edema. Visual disturbances, such as blurred vision or green or yellow halos around objects, should also be reported to the prescriber. Pts should restrict Na intake to 2 g or less daily and report a weight gain of 2 lbs a day and should not take the oral preparation with meals that have high fiber content because this will reduce absorption.
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The HH nurse is caring for a pt diagnosed with CHF who has been prescribed the cardiac glycoside digoxin (Lanoxin) and the loop diuretic forosemide (Lasix). What statement by the pt indicates the meds are effective?
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"I am able to walk next door now without being short of breath."
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A sym of CHF is shortness of breath. The fact that the pt can ambulate without being short of breath is an improvement of symptoms, which shows that the meds are effective.
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The HCP's ofc is completing an assessment on a pt who has been prescribed the cardiac glycoside digoxin (Lanoxin) for CHF. What data indicates the med has been effective?
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The pt has clear breath sounds bilaterally.
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Clear lung sounds bilaterally indicate the tx is effective. The nurse assesses for the s/s of the disease for which the med is being adm. If the symptoms are resolving, then the med is effective.
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The nurse is adm digoxin (Lanoxin), a cardiac glycoside, to a pt diagnosed with CHF. What interventions should the nurse implement?
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Check the pts current K+ level; Ask the pt if he or she is seeing a yellow haze around objects.
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The pts K+ level, as well as the digoxin level, is monitore because high levels of K+ impair therapeutic response to digoxin and low levels can cause toxicity. The most common cause of dysrhythmias in pts receiving digoxin is hypokalemia from diuretics that are usually given simultaneously. Yellow haze indicates the pt may have high serum digoxin levels. The therapeutic range for digoxin is relatively small 0.5 to 1.2, and levels of 2.0 or greater are considered toxic.
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The nurse is adm digoxin (Lanoxin) 0.25 mg IVP med to the pt. What interventions should the nurse implement?
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Insert the needle in the port closest to the pts IV site.
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Using the closest port ensures the least resistance to the flow of med into the pt and helps to control the rate at which the med reaches the pts bloodstream.
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The nurse is adm digoxin (Lanoxin) 0.25 mg IVP med to the pt. What intervention should the nurse implement?
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Check the pts K+ level.
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Hypokalemia may potentiate digoxin toxicity; therefore, the nurse should check the plts K+ level.
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The pt with CHF is taking digoxin (Lanoxin), a cardiac glycoside. What data indicates the med is ineffective?
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The pts lungs have crackles bilaterally.
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Signs or symptoms of CHF are crackles in the lungs, jugular vein distention, and pitting edema; therefore, the med is not effective. 421
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They increase the force of the cardiac contraction and have a positive inotropic effect
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Cardiac Glycoside Agents & Bipyridines
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Cardiac Glycoside Agents & Bipyridines
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______ slow the HR and have a negative chronotropic effect.
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Glycosides
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Cardiac Glycoside Agents & Bipyridines
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______ slow electrical impulse conduction through the AV node and have a negative dromotropic effect (delays or slows conduction)
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Glcosides
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Cardiac Glycoside Agents & Bipyridines
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______ & ______ are used to tx CHF
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Cardiac Glycosides Agents & bipyridines
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Cardiac Glycoside Agents & Bipyridines
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______ are used to tx certain supraventricular arrhythmias (An arrhythmia is an abnormality in the heart's rhythm, or heartbeat pattern. The heartbeat can be too slow, too fast, have extra beats, skip a beat, or otherwise beat irregularly.)
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Glycosides
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Cardiac Glycoside Agents & Bipyridines
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______ ______ (amt of blood pumpet from the heart in 1 min)
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Cardiac output
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Cardiovascular physiology
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______ ______ (the amt of blood ejected by the left ventricle with each contraction, or the stroke volume) X (the HR per min)
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Cardiac output
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Cardiovascular physiology
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Stroke volume is affected by ______ ______, preload and afterload (How good the heart contracts)
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myocardial contractility
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Cardiovascular physiology
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Usually ______ ______ to the rt atrium equals CO, but not always because of blood storage areas in circulation. This blood returning to the rt atrium determines how far the fibers of the left ventricle will stretch-preload.
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venous return
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Cardiovascular physiology
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______ is the load to which a muscle is subjected before shortening.
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Preload
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Cardiovascular physiology
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______ is the tension produced by heart muscle after contraction.
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Afterload
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Cardiovascular physiology
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______ increase myocontractility
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Glycosides
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Cardiac Glycosides Agents & Bipyridines
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Major parasympathetic nerve innervation of the heart
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Vagal
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Overview of the Cardiovascular System
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Abbreviation for adenosine triphosphatase (aden·o·sine/ (ah-den´o-sēn) A cardiac depressant and vasodilator used as an antiarrhythmic and as an adjunct in myocardial perfusion imaging in patients incapable of exercising adequately to undergo an exercise stress test.)
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ATP
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Overview of the Cardiovascular System
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Name of law pertaining to force of heart contraction
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Frank-Starling
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Overview of the Cardiovascular System
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Fibers that are part of conduction system of heart
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Purkinje (modified cardiac muscle fibers in the subendothelial tissue, concerned with conducting impulses through the heart.)
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Overview of the Cardiovascular System
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Number of ventricles
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2
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Overview of the Cardiovascular System
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Abbreviation for calcium
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Ca
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Overview of the Cardiovascular System
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Term for speed
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Velocity
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Overview of the Cardiovascular System
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Term for when heart conduction (conveyance of energy, as of heat, sound, or electricity) does not occur
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Block
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Overview of the Cardiovascular System
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Term for the period of heart contraction
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Systole
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Overview of the Cardiovascular System
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Organ that pumps blood
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heart
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Overview of the Cardiovascular System
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Main cation affecting electrical stimulation of the heart
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Calcium
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Overview of the Cardiovascular System
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Stimulus that changes the resting membrane
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Threshold
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Overview of the Cardiovascular System
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Calcium, potassium, and sodium are examples
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Ions
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Overview of the Cardiovascular System
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Abbreviation for sodium
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Na
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Overview of the Cardiovascular System
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Top chambers of the heart
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Atria
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Overview of the Cardiovascular System
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Chambers that force blood to various parts of the body
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Ventricles
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Overview of the Cardiovascular System
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Term for cardiac contraction recovery, and is the return of the ions to their previous resting state, which corresponds with relaxation of the myocardial muscle
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Repolarization
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Overview of the Cardiovascular System
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Neurotransmitter that stimulates the vagus nerve
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Acetylcholine
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Overview of the Cardiovascular System
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Digoxin is an example of this classification
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Glycosides
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Overview of the Cardiovascular System
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Node that stimulates the heart to contract
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AV
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Overview of the Cardiovascular System
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Possible abbreviation for electrocardiogram
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EKG
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Overview of the Cardiovascular System
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Letters on graph depicting ventricular contraction
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QRS
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Overview of the Cardiovascular System
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Part of conduction system of heart
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HIS
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Overview of the Cardiovascular System
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Cardiac muscle conraction begins with a rapid change in the ______ ______ of the cell
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electrical charge
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Overview of the Cardiovascular System
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______ is the stage in which an electrical impulse results in contraction of the ventricular muscle; it is represented by the QRS complex on the electrocardiogram (ECG)
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Depolarization
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Overview of the Cardiovascular System
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The cells that possess the property of ______, the ability to initiate an impulse, are called pacemaker cells.
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automaticity
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Overview of the Cardiovascular System
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______ refers to the ability to transmit an action potential or nerve impulse from cell to cell
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Conductivity
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Overview of the Cardiovascular System
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Cardiac tissue is nonresponsive to stimulation during the initial phase of systole (contraction) and this phenomenon is know as ______.
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refractoriness
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Overview of the Cardiovascular System
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______ are graphic representations of electrical currents produced by the heart.
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Electrcardiograms (ECGs)
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Overview of the Cardiovascular System
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The rise in free ______ ion concentration is considered to be the primary event in excitation-contraction coupling that is responsible for increasing muscle tone and vasoconsriction.
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calcium
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Overview of the Cardiovascular System
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______ is the volume of blood expelled by the ventricles of the heart; it is equal to the ______ multiplied by the ______.
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Cardiac output (CO), stroke volume, HR
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Overview of the Cardiovascular System
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______ refers to the strength of the muscular contraction of cardiac tissue and can be adversely affected by a number of factors, including myocardial ischemia (A loss of oxygen to the heart muscle caused by blockage of the coronary arteries or their branches) or infarction (Gross necrosis of the myocardium, due to interruption of the blood supply to the area.).
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Contractility
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Overview of the Cardiovascular System
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______ is a term that refers to the amt of blood entering the ventricle before contraction and affects the stretching of the muscle fiber in the ventricle.
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Preload
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Overview of the Cardiovascular System
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______ is the pressure against which the ventricle is pumping blood and is primarily determined by peripheral vascular resistance (eg, BP)
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Afterload
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Overview of the Cardiovascular System
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_______ results in a decrease in CO - decreased myocardial contractility and increased preload and afterload.
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CHF
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Cardiac Glycoside Agents & Bipyridines
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The origin is the foxglove plant
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Cardiac glycosides
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Cardiac glycosides
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Cardiac glycosides have long ______ ______, and would need several days of therapy before achieving a therapeutic blood level, so a ______ or digitalizing dose is given, followed by ______ doses.
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half lives; loading; maintenance
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Cardiac glycosides
Pharmacokinetics |
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A dx not readministered is eliminated after ___ half lives, but regularly readministered reaches a constant total body amt or stteady state after about ___ half lives.
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5; 5
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Cardiac glycosides
Pharmacokinetics |
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______ ______ makes increased intracellular calcium available to the myocardium, thus an enhanced force of contraction.
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Cardiac glycosides
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Cardiac glycosides
Pharmacodynamics |
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______ stimulate the PNS, increasing vagal tone and slowing HR.
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Glycosides
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Cardiac glycosides
Pharmacodynamics |
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______ ______ are used to treat CHF, atrial fibrillation/flutter and paroxysmal atrial tachycardia (PAT)
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Cardiac glycosides
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Cardiac glycosides
Pharmacotherapeutics |
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______ is a commonly used cardiac glycoside given PO or IV, not IM because it causes severe ______ at site with an increased ______ lab, complicating interpretation of enzyme levels.
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Digoxin (Lanoxin, Lanoxicaps); pain; CPK
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Cardiac glycosides
Pharmacotherapeutics |
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The therapeutic serum concentration of Digoxin is ___ to ___ ng/ml
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0.5 - 2
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Cardiac glycosides
Pharmacotherapeutics |
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______ is used rarely because of the long half-life, which prolongs duration of adverse effects, given PO
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Digitoxin (Crystodigin)
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Cardiac glycosides
Pharmacotherapeutics |
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The therapeutic range of Digitoxin is ___ to ___ ng/ml
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14 - 26
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Cardiac glycosides
Pharmacotherapeutics |
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Lower dosages may be necessary to reduce the potential for drug toxicity in ______ adults
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older
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Digoxin:
Special Consideration for older adults |
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Laxative, which are commonly taken by older adults, may ______ the absorption of digoxin. Do not adm these drugs concurrently.
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reduce
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Digoxin:
Special Consideration for older adults |
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Dietary ______ ______ may affect digoxin bioavailability; have pts take digoxin 1 hr before or 2 hrs after having ______.
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bran fiber; bran
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Digoxin:
Special Consideration for older adults |
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For ______ individualize dosing with very close monitoring. Be extremely careful in calculating digoxin doses; a placement error of one decimal point can increase the dose 10-fold. Double check all calculations with another HCP (nurse, pharmacist, or physician)
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children
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Digoxin:
Special Consideration for Children |
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______ has a narrow therapeutic range and may produce digitalis toxicity.
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Digoxin
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Digoxin:
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______ is the #1 condition that may predispose a pt to digoxin toxicity.
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Hypokalemia
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Digoxin toxicity
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Hypokalemia, hypomagnesemia, hypothyroidism, hypoxemia, and advanced nyocardial disease are conditions that may ______ a pt to digoxin toxicity.
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predispose
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Digoxin toxicity
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Observe pts, esp the very young and very old for early these signs of digitalis (digoxin) toxicity
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Visual changes (blue/green vision); reading difficulity; GI complaints: N/V, anorexia, diarrhea; bradycardiaa
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Digoxin
Geri & Pedi considerations |
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Treats life threatening digoxin toxicity. Binds rapidly with digoxin and meakes it inactive. Because of high cost only used in life threatening situation. Derived from antibodies in sheep, pt should under go skin testing for allergy
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Digibind
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Digoxin toxicity
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Digoxin drug interactions of corticosteroids:
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hypokalemia
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Digoxin drug interactions
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Digoxin drug interactions of antacids:
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Increased glycoside absorption
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Digoxin drug interactions
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Digoxin drug interactions of antiarrhythmic agents, cocaine, succinylcholine, sympathomimetics:
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Increased risk of arrhythmias
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Digoxin drug interactions
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Digoxin drug interactions of calcium channel blockers and beta blockers:
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Bradycardia
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Digoxin drug interactions
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Digoxin drug interactions of quinidine (antiarrhythmic):
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Increased glycoside serum level (synergestic effect)
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Digoxin drug interactions
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Digoxin drug interactions of spironolacone (potassium-sparing diuretic):
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Increased glycoside half-life
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Digoxin drug interactions
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______ effervescent pain reliever and antacid tabs have 0.5 g/tablet
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Alka-Seltzer
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Na content for OTC
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These high-sodium foods should be avoided in the diet:
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Meat, poultry, fish, and other meat substitutes; Cheese; Commercially preparred main entrees and canned foods; Cereals: instant hot, cold with 200 mg or more; Salted snack foods; Baked goods: cakes, cookies, pies etc.,; Grains with seasoning packets or sauces; Canned vegetables, commercially prepared bouillon, instant or dried soups; Sauces - soy, teriyaki, steak, barbecue, smoked, spaghetti, alfredo, chili, cocktail, tomato, etc.,; Food additives in quick-cooking cereals and processed cheeses; chocolate milks and ice creams; relish, salad dressing; skins of olives, fruits and vegetables; curing meats and sausages; breads and cakes; bleached fruits such as maraschino cherries and glazed or crystallized fruits to be artifically colored; dried prunes
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Tips for Sodium-Restricted Dining
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______ are rapid acting IV for short duration. After a bolus CO increases within 5 min. The half-life is 30-40 min.
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Bipyridines
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Bipyridines
Pharmacokinetics |
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______ are for short term mgmt of CHF in pts who haven't responded well to digitalis. It produces positive inotropic effects, that is it relaxes smooth muscles and increases cardiac contractility
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Bipyridines
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Bipyridines
Pharmacotherapeutics Therapeutic: inotropics Pharmacologic: bipyridines |
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______ is for short-term drug tx of CHF unresponsive to digoxin. It is a pos inotropic and a vasodilator. It is given continuous IV onset 2-5 min peak 10 min infusion
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Amrinon (Inocor)
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Therapeutic: inotropics
Pharmacologic: bipyridines Therapeutic Effects: Increased cardiac output (inotropic effect). |
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______ is for short-term tx of CHF unresponsive to conventional therapy with digoxin. It is ordered mcq/kg of body wt.
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Primacor
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Therapeutic: inotropics
Therapeutic Effects: Increased cardiac output (inotropic effect). |
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Adverse effects of the bipyridines (Inocor, Primacor):
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N/V, abd pain, arrhythmias, decreased BP, thrombocytopenia
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Bipyridines
Adverse Reactions/Side Effects |
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Blood levels of ___ are elevated in hypervolemic states, such as CHF and hypertension
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BNP
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Bipyridines
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______ effects are to reduce preload and afterload which are beneficial in HF
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nesiritide (Natrecor)
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Bipyridines
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Some nursing diagnosis regarding use of cardiac glycoside agents & bipyridines:
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Impaired adjustment to changed lifestyle
Hyperthermia related to hypersensitivity reaction to cardiac glycoside or amrinone Activity intolerance related to adverse effect or poor effect of cardiac glycoside |
Glycoside agents & bipyridines:
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Take apical pulse before adm any ______ ______
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cardiac glycosides
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NI for clycoside agents
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Do not adm ______ ______ if the pulse if less than 60.
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cardiac glycosides
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NI for glycoside agents
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Monitor BP and HR during ______ ______ infusion.
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amrinone (Incor)
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NI for glycoside agents
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Do not give ______ IM
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digoxin
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NI for cardiac glycosides
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When monitoring digoxin levels draw blood at least ___ hrs after last orad dse and preferably immediately before ______ daily
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8; adm
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Cardiac glycosides
Daily monitoring |
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Monitor pts on digoxin for the following:
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BUN, K+ (because of greater chance of toxicity), and creatnine
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Cardiac glycosides
Daily monitoring |
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Evaluate serum electrolyte levels (especially potassium, magnesium, and calcium) and renal and hepatic functions periodically during therapy for this drug
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digoxin
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Cardiac glycosides
Monitoring |
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Notify HPC before giving dose of ______ if patient is hypokalemic. Hypokalemia, hypomagnesemia, or hypercalcemia may make the patient more susceptible to digitalis toxicity.
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digoxin
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Cardiac glycosides
Monitoring |
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Check the pts VS when adm ______.
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digoxin
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Cardiac glycosides
Daily monitoring |
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When adm ______, measure pts fluid I & O, and wt.
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digoxin
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Cardiac glycosides
Daily monitoring |
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Teach pt to take ______
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pulse
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Digoxin
Client teaching |
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Ensure that pt is familiar with symptoms that should be reported immediately, especially:
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Enema, SOB (rales, rhonchi, gurgling), N/V, visual disturbances
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Digoxin
Client teaching |
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Advise pt to prevent deterioration of inotropic agents by always storing med in a tightly fitting, ______ and ______ resistant container.
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light; moisture
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Digoxin
Client teaching |
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Instruct pt to check with physician before taking any ___ drug, such as an antacid
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OTC
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Digoxin
Client teaching |
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Do not give digoxin with high ______ meals, as it affects bioavailability.
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digoxin
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Digoxin
Client teaching |
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______ and ______ rate are within normal limits, without rales or signs
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Heart; respiratory
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Digoxin
Nursing Evaluations |
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Client is adapting well to ______ lifestyle
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altered
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Digoxin
Nursing Evaluations |
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Pt experiences improved activity ______.
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tolerance
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Digoxin
Nursing Evaluations |
