Test 5

Front 1

diuretics

Back 1

drugs that increase renal excretion of water, sodium and other electrolytes, increasing urine formation

Front 2

purpose of diuretics

Back 2

manage edema, heart failure, hypertension

Front 3

goal of diuretics

Back 3

reduce extracellulare fluid volume & reverse abnormal fluid retention in the body.

Front 4

where do diuretics act

Back 4

on the kidneys

Front 5

where sodium goes

Back 5

water flows

Front 6

what are the mose effective diuretics

Back 6

loop diuretics - high ceiling.

lasix

Front 7

lasix

Back 7

furosemide - increase urine output even though there is a decrease in blood flow to the kidneys

Front 8

where do loop diuretics work

Back 8

on the ascending loop of henle, to prevent sodium and chloride re-absorbtion.

Front 9

when is the maximum effect of loop diuretics

Back 9

1-2 hours after oral med, 2-10 min after iv med

Front 10

what are some complications of loop diuretics

Back 10

dehydration, electrolyte imbalance, potassium depletion, can lead to dysrhythmia

Front 11

when do you use loop diuretics

Back 11

moderate to severe fluid retention

Front 12

what is the most accurate measurement of fluid retention

Back 12

daily weight

Front 13

thiazide diuretics

Back 13

benzothiadiazides - block sodium and chloride reabsorbtion in distal tuble.

Front 14

what is the most common thiazide diuretic?

Back 14

hydrochlorothiazide

Front 15

what is a thiazide diuretic used for ?

Back 15

long term mngmt of heart failure and hypertension. pt must have adequate urine flow.

Front 16

when do you use thiazide diuretics cautiously

Back 16

allergy to sulfa drugs
pregnancy
pt taking digoxin
diabetics

Front 17

what is the goal of Potassium - sparing diuretics

Back 17

to promote diuresis and maintain normal serum _______ levels.

Front 18

where do K-sparing diuretics work

Back 18

on the distal renal tublule to retain potassium and excrete sodium

Front 19

hypertension

Back 19

a disease characterized by a systolic bp of >140 or diastolic of > 90

Front 20

arterial bp

Back 20

the force exerted on artery walls by blood flow

Front 21

primary hypertension

Back 21

90-95% of all cases of hypertension - the cause is unkown, it is incurable, but controllable. It increases with age

Front 22

secondary hypertension

Back 22

hypertension with a cause - Caused by : renal, endocrine, or CNS disorders.
drugs that stimulate the CNS
drugs that cause Na+ and H2O

Front 23

Per-hypertension

Back 23

120-139systolic or
80-89 diastolic

Front 24

stage 1 hypertension

Back 24

systolic 140-159 or
diastolic 90-99

Front 25

stage 2 hypertension

Back 25

systolic> 160 or diastolic 100 or >

Front 26

goal of hypertension mngmt

Back 26

maintain bp 140 /90
if the pt has diabetes, heart failure, or renal disease below 130/80

Front 27

HTN effects

Back 27

-increased workload of the heart can cause heart failure
-arterial lumen narrows which leads to a decreased blood supply to tissues.
-increased risk of thrombosis
-organ damage
-arteries may rupture @necrotic areas.

Front 28

hypertensive emergencies symptoms

Back 28

severe headache, nausea, vomiting, visual disturbances, neurological disturbances, disoriaentation, decreased level of consciousness

Front 29

what is the goal when trying to manage bp with meds

Back 29

maintain bp lower than 140/90, 130/80 for diabetics

Front 30

HTN effects

Back 30

increased workload of the heart
arterial lumen narrows leading to decreased blood supply to tissues
increase risk of thrombosis
organ damage

Front 31

hypertensive emergencies ss

Back 31

severe headach, nv, visual disturbances, disorientation

Front 32

beta adrenergic blocking agents - beta blockers

Back 32

occupy beta adrenergic receptor sites to prevent response to sympathetic nerve impulses

Front 33

beta 1 blockade

Back 33

affects heart,
HR, Cardiac output and renin release is decreased - BP is lowered

Front 34

what are the advantages of beta blockers

Back 34

mminimal hypotension, little effect on sexual function, little to no slowing of cns

Front 35

when are beta blockers less effective

Back 35

african american pts

Front 36

when do you avoid use of beta blockers

Back 36

pts with asthma, type 1 diabetes, heart failure, peripheral vascular disease.

Front 37

example of a beta blocker

Back 37

propanolol - usually end in olol

Front 38

ace inhibitors

Back 38

block the enzyme that converts angiotension 1 to angiotensin 2

Front 39

what is the result of a ace inhibitor

Back 39

vasodilation, decrease aldosterone

Front 40

what do ace inhibitors end with

Back 40

pril

Front 41

where are ace inhibitors recommended

Back 41

diabetic pts

Front 42

what may happen at the start of using ace inhibitor

Back 42

hypotension

Front 43

what is the black box warning of ace inhibitors

Back 43

pregnant women.

Front 44

angiotensis II receptor blockers

Back 44

blocks the effects of angiotensin II - the potent vasoconstrictor from binding on sites in blood vessels, brain, heart, kidneys, and adrenal glands.

Front 45

what are ABR's less likely to do then ACE inhibitors

Back 45

cause hyperkalemia

Front 46

what is the black box warning on ABR's

Back 46

pregnant women

Front 47

calcium ion antagonists action / result

Back 47

move calcium ions across cell membrane resulting in fewer arrhythmias, slower contraction rate of heart, relaxation of smooth vessels, leading to vasodilation and decreased bp

Front 48

what does the effect of calcium ion antagonist depend on

Back 48

the severity of the disease.

Front 49

what is a common direct vasodilator

Back 49

hydralazine (apresoline)

Front 50

what is the prefered rx of choice for children with htn

Back 50

beta blockers

Front 51

can you use ace inhibitors on children

Back 51

6years or older - for htn with coexisting conditions - diabetes, renal disease

Front 52

infiltrations

Back 52

leaking of iv fluids out of vein

Front 53

what happens during infiltration

Back 53

skin becomes hard(induration) and firm
absencse of blood return
skin temp / swelling changed
painful, numbness, tingling

Front 54

phlebitis

Back 54

inflammation of only the vein,
preventable through close observation
cannula must be removed

Front 55

hematoma and bruising

Back 55

leakage of blood into surrounding tissue

Front 56

extravasation

Back 56

unintentional infaltration with vesicant medication. causing blisters with subsequent sloughing of tissue due to necrosis.

Front 57

vesicant meds and fluids

Back 57

TPN - 50% dextrose
Dextroxe 10% or greater then 10% of any IV fluid that is hypertonic
Potassium chloride (KCL)
Phenytoin (Dilantin)
Cytotoxic antineoplastic agents (chemotherapy)

Front 58

special precaution for KCL

Back 58

must always be diluted, never IV push

Front 59

who is at high risk for extravasation and why

Back 59

infants - size
elderly & CA pts - fragility
comatose & anesthetized pt
pt using high pressure infusion pumps
pts with peripheral or cv disease
pts who undergo cpr

Front 60

how do you get speed shock

Back 60

too rapid IV push, IV drip,
ss =irregular pulse, CA, sycope, headach, facial flushing, tighness of chest

Front 61

air embolism

Back 61

traveling embolism of air,

Front 62

how big does a air embolism need to be to kill someone

Back 62

9-15 cc of air

Front 63

what is treatment for an air embolism

Back 63

turn to the left side, trangellenberg position this will trap air in right atrium

Front 64

vasovagal reaction

Back 64

sudden complete colapse of the vein,,
stimulates nerve #10

Front 65

what to do for infiltration of phlebitis

Back 65

slow large volume infusions to KVO 6-10 ml/hr and STOP piggy back meds until iv team checks site
fill out iv communication form
chart
carrout out nursing intervention to relieve problem

Front 66

continuous IV

Back 66

one IV line used to infuse fluids

Front 67

keep open

Back 67

keeps vein open with slow infusion at 6-10 ml per hour- it is a type of primary infusion only the rate is consistently slow

Front 68

medication

Back 68

use mini bags to deliver medicine in various amounts attached to the primary line

Front 69

adapted sites

Back 69

converted angiocath used for intermittent delivery of medicines
called - converted angio, adapted angio, medicine/saline/heparin lock

Front 70

what are the 2 basic types of IV fluid replacements

Back 70

colloids and crystaloids

Front 71

colloids

Back 71

protiens or other large molecules remain in blood because they are too large to cross capillary membrane. Called plasma volume expanders bc they draw h2o from the cells into the plasma and increase plasma osmolality and osmotic pressure

Front 72

crystalloids

Back 72

IV solution that contains electrolytes that quickly diffuse across membrane leaving plasma and entering IFC and interstitial fluid. used to replace lost fluids.

Front 73

the infusion of crystaloids can be

Back 73

hypertonic, isotonic, or hypotonic

Front 74

hypertonic infusion of crystaloids

Back 74

cause h20 to be drawn from cells and tissues and expand plasma volume with osmolality higher then that of plasma

Front 75

what are the two indirect actions of IFN-gamma?

Back 75

1. stimulates macrophages to produce IL-12
2. stimulates TH1 cells to produce IL-2, IFN-gamma, and TNF-beta
pg 240 Parham

Front 76

hypotonic infusion of crystalloids

Back 76

causes h20 to move out of the plasma into the tissues and cells with osmolality lower then that of plasma

Front 77

isotonic iv solution used for

Back 77

used to restore blood volume bc same concentration as blood plasma

Front 78

isotonic iv solution examples

Back 78

0.9 % NaCL (NSS)
Lactated ringers
5% d5W
d51/4NSS

Front 79

Hypertonic IV solutions used for

Back 79

to draw fluid into the vein and increase blood volume

Front 80

who don't you administer hypertonic solutions to

Back 80

dehydrated pts or pts that have kidney or heart disease.

Front 81

examples of hypertonic solutions

Back 81

d5nss
d51/2nss
d5lactated ringers
d10w (10% dextrose in H20)
3%NS

Front 82

hypotonic iv solutions used for

Back 82

lower concentration than blood plasma
draws fluid from blood into tissues to hydrate cells, reverse dehydration.

Front 83

examples of hypotonic iv solutions

Back 83

0.45%NS
0.33%NSS
2.5%DW

Front 84

contraindications for hypotonic solution

Back 84

it can cause fluid to be drawn into red blood cells causing them to swell and rupture - hemolysis.
do not give for a pt with intercranial pressure

Front 85

iv solutions as a nutrient

Back 85

useful in preventing ketosis and dehydration, but not enough calories to promote wound healing, weight gain, or normal growth

Front 86

examples of iv solution as a nutrient

Back 86

d5w
d5nss
170 calories/ liter

Front 87

iv solutions as an electrolyte

Back 87

contain varying amounts of sodium, chloride, potassium,
calcium and lactate.

Front 88

examples of iv solutions as electrolyte

Back 88

nss
lactated ringers

Front 89

iv solutions as blood volume expanders

Back 89

draw interstitial fluids into vessels to increase blood volume.

Front 90

examples of blood volume expanders (colloids)

Back 90

dextran
plasma
human serum albumin

Front 91

angiocath veins

Back 91

metacarpal, basilic and cephalic veins

Front 92

what don't you use with an angiocath

Back 92

do not infuse TPN or chemotherapy

Front 93

how often do you change and angiocath

Back 93

every 96 hours.

Front 94

what are central venous access sites used for

Back 94

long term iv therapy, parenteral nutrition, to administer iv meds that are irritating to peripheral veins

Front 95

Where are central venous access sites inserted

Back 95

subclavian or jugular vein, distal end of the cath in the superior vena cava.

Front 96

what must guardrails be used with

Back 96

iv postassium, blood products, intralipids, peripheral parenteral nutrition (PPN), TPN

Front 97

factors affecting infusion rates

Back 97

if the site is inflamed, painful, leaking, slow IV to ko rate, call iv team
-position of arm
-admin set
-height of infusion bag

Front 98

what is blood coagulation and the clotting process called

Back 98

hemostasis

Front 99

what are the parts of blood coagulation

Back 99

vasoconstriction
platelet aggregation / clumping
instinsic pathway
extrinsic pathway.

Front 100

intrinsic pathway

Back 100

inside the body - ends when prothrombin converts to thrombin

Front 101

extrinsic pathway

Back 101

seen on the outside the body

Front 102

hageman factor

Back 102

chemical substance that is found in the circulating blood and happens after platelet aggregation.

Front 103

clot resolution and anticlotting process

Back 103

plasminogen is made in liver and found in plasma

Front 104

where does the conversion of plasminogen to plasmin begin

Back 104

with the activation of Hageman factor

Front 105

what does plasmin do to the clot resolution

Back 105

keeps vessels open and funcional by dissolving fibrin threads and resolving the clot

Front 106

what are the contraindications to anticoagulation therapy

Back 106

active bleeding
history of heparin-induced thrombocytopenia
platelet count of <50,000
high risk for bleeding
active intacranial lesions

Front 107

anticoagulants

Back 107

given to prevent formation of new clots
does not disolve formed clots

Front 108

injectable heparin

Back 108

acts immediatley after iv injection and within 30 mins
-injected q8-12hr or via continuous infusion

Front 109

what is the anticoagulant of choice for pregnant women

Back 109

injectibale heparin

Front 110

what are the side affects of heparin

Back 110

hematoma, petechiae, bleeding gums, hematuria, fever, chills,
HIT

Front 111

oral warfarin - coumadin

Back 111

effects occur in 3-5 days.
acts in liver to prevent synthesis of vitamin K

Front 112

cora

Back 112

check vitals and PT
observe for bleeding
review protocol for antidote
avoid all asprin and asprin compounds

Front 113

what is fresh frozen plasma used for

Back 113

to treat rx bleeding disorders caused by deficiency in clotting factors

Front 114

what is one unit of FFP equal to

Back 114

200-250ml

Front 115

what is platelets used for

Back 115

people with platelet deficiency or bleeding disorder.

Front 116

one unit of platelets equals

Back 116

30-60ml

Front 117

what is albumin used for

Back 117

to treat hypovolemic shock and low albumin levels