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117 Cards in this Set

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diuretics
drugs that increase renal excretion of water, sodium and other electrolytes, increasing urine formation
purpose of diuretics
manage edema, heart failure, hypertension
goal of diuretics
reduce extracellulare fluid volume & reverse abnormal fluid retention in the body.
where do diuretics act
on the kidneys
where sodium goes
water flows
what are the mose effective diuretics
loop diuretics - high ceiling.

lasix
lasix
furosemide - increase urine output even though there is a decrease in blood flow to the kidneys
where do loop diuretics work
on the ascending loop of henle, to prevent sodium and chloride re-absorbtion.
when is the maximum effect of loop diuretics
1-2 hours after oral med, 2-10 min after iv med
what are some complications of loop diuretics
dehydration, electrolyte imbalance, potassium depletion, can lead to dysrhythmia
when do you use loop diuretics
moderate to severe fluid retention
what is the most accurate measurement of fluid retention
daily weight
thiazide diuretics
benzothiadiazides - block sodium and chloride reabsorbtion in distal tuble.
what is the most common thiazide diuretic?
hydrochlorothiazide
what is a thiazide diuretic used for ?
long term mngmt of heart failure and hypertension. pt must have adequate urine flow.
when do you use thiazide diuretics cautiously
allergy to sulfa drugs
pregnancy
pt taking digoxin
diabetics
what is the goal of Potassium - sparing diuretics
to promote diuresis and maintain normal serum _______ levels.
where do K-sparing diuretics work
on the distal renal tublule to retain potassium and excrete sodium
hypertension
a disease characterized by a systolic bp of >140 or diastolic of > 90
arterial bp
the force exerted on artery walls by blood flow
primary hypertension
90-95% of all cases of hypertension - the cause is unkown, it is incurable, but controllable. It increases with age
secondary hypertension
hypertension with a cause - Caused by : renal, endocrine, or CNS disorders.
drugs that stimulate the CNS
drugs that cause Na+ and H2O
Per-hypertension
120-139systolic or
80-89 diastolic
stage 1 hypertension
systolic 140-159 or
diastolic 90-99
stage 2 hypertension
systolic> 160 or diastolic 100 or >
goal of hypertension mngmt
maintain bp 140 /90
if the pt has diabetes, heart failure, or renal disease below 130/80
HTN effects
-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.
hypertensive emergencies symptoms
severe headache, nausea, vomiting, visual disturbances, neurological disturbances, disoriaentation, decreased level of consciousness
what is the goal when trying to manage bp with meds
maintain bp lower than 140/90, 130/80 for diabetics
HTN effects
increased workload of the heart
arterial lumen narrows leading to decreased blood supply to tissues
increase risk of thrombosis
organ damage
hypertensive emergencies ss
severe headach, nv, visual disturbances, disorientation
beta adrenergic blocking agents - beta blockers
occupy beta adrenergic receptor sites to prevent response to sympathetic nerve impulses
beta 1 blockade
affects heart,
HR, Cardiac output and renin release is decreased - BP is lowered
what are the advantages of beta blockers
mminimal hypotension, little effect on sexual function, little to no slowing of cns
when are beta blockers less effective
african american pts
when do you avoid use of beta blockers
pts with asthma, type 1 diabetes, heart failure, peripheral vascular disease.
example of a beta blocker
propanolol - usually end in olol
ace inhibitors
block the enzyme that converts angiotension 1 to angiotensin 2
what is the result of a ace inhibitor
vasodilation, decrease aldosterone
what do ace inhibitors end with
pril
where are ace inhibitors recommended
diabetic pts
what may happen at the start of using ace inhibitor
hypotension
what is the black box warning of ace inhibitors
pregnant women.
angiotensis II receptor blockers
blocks the effects of angiotensin II - the potent vasoconstrictor from binding on sites in blood vessels, brain, heart, kidneys, and adrenal glands.
what are ABR's less likely to do then ACE inhibitors
cause hyperkalemia
what is the black box warning on ABR's
pregnant women
calcium ion antagonists action / result
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
what does the effect of calcium ion antagonist depend on
the severity of the disease.
what is a common direct vasodilator
hydralazine (apresoline)
what is the prefered rx of choice for children with htn
beta blockers
can you use ace inhibitors on children
6years or older - for htn with coexisting conditions - diabetes, renal disease
infiltrations
leaking of iv fluids out of vein
what happens during infiltration
skin becomes hard(induration) and firm
absencse of blood return
skin temp / swelling changed
painful, numbness, tingling
phlebitis
inflammation of only the vein,
preventable through close observation
cannula must be removed
hematoma and bruising
leakage of blood into surrounding tissue
extravasation
unintentional infaltration with vesicant medication. causing blisters with subsequent sloughing of tissue due to necrosis.
vesicant meds and fluids
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)
special precaution for KCL
must always be diluted, never IV push
who is at high risk for extravasation and why
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
how do you get speed shock
too rapid IV push, IV drip,
ss =irregular pulse, CA, sycope, headach, facial flushing, tighness of chest
air embolism
traveling embolism of air,
how big does a air embolism need to be to kill someone
9-15 cc of air
what is treatment for an air embolism
turn to the left side, trangellenberg position this will trap air in right atrium
vasovagal reaction
sudden complete colapse of the vein,,
stimulates nerve #10
what to do for infiltration of phlebitis
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
continuous IV
one IV line used to infuse fluids
keep open
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
medication
use mini bags to deliver medicine in various amounts attached to the primary line
adapted sites
converted angiocath used for intermittent delivery of medicines
called - converted angio, adapted angio, medicine/saline/heparin lock
what are the 2 basic types of IV fluid replacements
colloids and crystaloids
colloids
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
crystalloids
IV solution that contains electrolytes that quickly diffuse across membrane leaving plasma and entering IFC and interstitial fluid. used to replace lost fluids.
the infusion of crystaloids can be
hypertonic, isotonic, or hypotonic
hypertonic infusion of crystaloids
cause h20 to be drawn from cells and tissues and expand plasma volume with osmolality higher then that of plasma
what are the two indirect actions of IFN-gamma?
1. stimulates macrophages to produce IL-12
2. stimulates TH1 cells to produce IL-2, IFN-gamma, and TNF-beta
pg 240 Parham
hypotonic infusion of crystalloids
causes h20 to move out of the plasma into the tissues and cells with osmolality lower then that of plasma
isotonic iv solution used for
used to restore blood volume bc same concentration as blood plasma
isotonic iv solution examples
0.9 % NaCL (NSS)
Lactated ringers
5% d5W
d51/4NSS
Hypertonic IV solutions used for
to draw fluid into the vein and increase blood volume
who don't you administer hypertonic solutions to
dehydrated pts or pts that have kidney or heart disease.
examples of hypertonic solutions
d5nss
d51/2nss
d5lactated ringers
d10w (10% dextrose in H20)
3%NS
hypotonic iv solutions used for
lower concentration than blood plasma
draws fluid from blood into tissues to hydrate cells, reverse dehydration.
examples of hypotonic iv solutions
0.45%NS
0.33%NSS
2.5%DW
contraindications for hypotonic solution
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
iv solutions as a nutrient
useful in preventing ketosis and dehydration, but not enough calories to promote wound healing, weight gain, or normal growth
examples of iv solution as a nutrient
d5w
d5nss
170 calories/ liter
iv solutions as an electrolyte
contain varying amounts of sodium, chloride, potassium,
calcium and lactate.
examples of iv solutions as electrolyte
nss
lactated ringers
iv solutions as blood volume expanders
draw interstitial fluids into vessels to increase blood volume.
examples of blood volume expanders (colloids)
dextran
plasma
human serum albumin
angiocath veins
metacarpal, basilic and cephalic veins
what don't you use with an angiocath
do not infuse TPN or chemotherapy
how often do you change and angiocath
every 96 hours.
what are central venous access sites used for
long term iv therapy, parenteral nutrition, to administer iv meds that are irritating to peripheral veins
Where are central venous access sites inserted
subclavian or jugular vein, distal end of the cath in the superior vena cava.
what must guardrails be used with
iv postassium, blood products, intralipids, peripheral parenteral nutrition (PPN), TPN
factors affecting infusion rates
if the site is inflamed, painful, leaking, slow IV to ko rate, call iv team
-position of arm
-admin set
-height of infusion bag
what is blood coagulation and the clotting process called
hemostasis
what are the parts of blood coagulation
vasoconstriction
platelet aggregation / clumping
instinsic pathway
extrinsic pathway.
intrinsic pathway
inside the body - ends when prothrombin converts to thrombin
extrinsic pathway
seen on the outside the body
hageman factor
chemical substance that is found in the circulating blood and happens after platelet aggregation.
clot resolution and anticlotting process
plasminogen is made in liver and found in plasma
where does the conversion of plasminogen to plasmin begin
with the activation of Hageman factor
what does plasmin do to the clot resolution
keeps vessels open and funcional by dissolving fibrin threads and resolving the clot
what are the contraindications to anticoagulation therapy
active bleeding
history of heparin-induced thrombocytopenia
platelet count of <50,000
high risk for bleeding
active intacranial lesions
anticoagulants
given to prevent formation of new clots
does not disolve formed clots
injectable heparin
acts immediatley after iv injection and within 30 mins
-injected q8-12hr or via continuous infusion
what is the anticoagulant of choice for pregnant women
injectibale heparin
what are the side affects of heparin
hematoma, petechiae, bleeding gums, hematuria, fever, chills,
HIT
oral warfarin - coumadin
effects occur in 3-5 days.
acts in liver to prevent synthesis of vitamin K
cora
check vitals and PT
observe for bleeding
review protocol for antidote
avoid all asprin and asprin compounds
what is fresh frozen plasma used for
to treat rx bleeding disorders caused by deficiency in clotting factors
what is one unit of FFP equal to
200-250ml
what is platelets used for
people with platelet deficiency or bleeding disorder.
one unit of platelets equals
30-60ml
what is albumin used for
to treat hypovolemic shock and low albumin levels