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228 Cards in this Set

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Normal Sinus rhythm characteristics
- P, QRS, T wave present
- Regular heart rate
- Rate 60-100 BPM
- Normal PR, QRS, and QT intervals
Sinus tachycardia characteristics
- P, QRS, T wave
- Regular heart rate
- Rate >100 BPM
Sinus tachycardia causes
- Pain
- Fever
- Anxiety
- Activity
- Medications
Sinus tachycardia treatments
- May be none
- Treat underlying cause
Sinus Bradycardia characteristics
- P, QRS, T wave
- Regular heart rate
- Rate <60 BPM
Sinus Bradycardia causes
- Can be normal
- Drugs (B-blockers, dig, etc)
- Enhanced vagal tone
- Hypoxia
Sinus bradycardia treatments
Symptomatic
- Atropine
- Pacing
Asymptomatic
- Maybe none
- Adjust medication
Atrial fibrillation characteristics
- No P waves
- Irregular rhythm
- Fibrillatory (F) waves
Atrial fibrillation causes
- Sinus node is no longer in control of the heart
- Impulses are coming from everywhere in atria
- CHF, hypertension, MI, fluid overload, valve dx
- Emboli develop in quivering atria that can travel elsewhere
Atrial fibrillation treatment
- Rate control (CCB, B-blockers, amiodarone, dig)
- Rhythm control (ibutilide, amiodarone, cardioversion)
- RF abllation (go in, find the source of a fib and zap it out)
- Anticoagulation (heparin, warfarin)
Atrial flutter characteristics
- Regular flutter waves
- very fast but very regular
Atrial flutter causes
- Sinus node is no longer in control of the heart
- Impulses are coming from everywhere in atria
- CHF, hypertension, MI, fluid overload, valve dx
- Emboli develop in quivering atria that can travel elsewhere
Atrial flutter treatment
- Rate control (CCB, B-blockers, amiodarone, dig)
- Rhythm control (ibutilide, amiodarone, cardioversion)
- RF abllation (go in, find the source of a fib and zap it out)
- Anticoagulation (heparin, warfarin)
PVCs characteristics
- Wide bizarre QRS
- Premature complex
- Not associated with P waves
PVCs causes
- Ischemia/injury
- Drugs or electrolyte imbalances
- Invasive lines
PVCs treatments
- Watch for frequency
- Assess for cause and treat it
- Do not routinely give drugs to suppress
Ventricular fibrillation characteristics
- Chaotic quivering of ventricles
- Grossly irregular electrical activity
- Unable to recognize any waveforms
- No pulse
Ventricular fibrillation causes
- Drugs that increase QT
- Ischemia
- Electrolyte abnormalities
- Reduced EF
Ventricular fibrillation treatments
- Call code
- CPR
- Defibrillation
- Epinephrine or vasopressin
- Amiodarone
- Lidocaine
Ventricular tachycardia characteristics
- Wide QRS
- Rate > 100 BPM
- A.V dissociation
Ventricular tachycardia causes
- Electrolyte abnormalities (low potassium, low magnesium)
- Ischemia, acute MI
- Reduced EF, CHF
Ventricular tachycardia treatments
Pulse:
- EKG
- Vital sings
- Vagal maneuver
- Drug therapy
- Correct electrolytes
No Pulse:
- Call code
- CPR
- Defibrillation
- EPI or vasopressin
- Amiodarone
- Lidocaine
Torsades de pointes characteristics
- Twisting of VT around the baseline
- Rate > 250 BPM
Torsades de pointes cause
- Drugs that increase QT
- Electrolyte abnormalities
- Ischemia
Tosades de pointes treatment
- Defibrillation
- Magnesium
- Overdrive pacing
P wave
Atrial depolarization
QRS wave
Ventricular depolarization
T wave
Ventricular repolarization
Normal PR range
.12 - . 2
Normal QRS range
.04 - .11
Normal QT range
.36 - .44
Angina pathophysiology
Results when there is an imbalance between the heart's oxygen demand and supply
Angina precipitating factors
- Age
- Cigarette smoking
- Diabetes
- Hypertension
- Obesity
Angina Manifestations
- Chest discomfort (pressure, heaviness, tightness, squeezing, burning or choking sensation)
- Pain in back, neck area, jaw, or shoulders (referred pain)
Angina Therapy
- Nitroglycerin (vasodilator)
- Beta blockers and calcium channel blockers (decreases the heart's workload)
Myocardial infarction pathophysiology
Most common triggering event is the disruption of atherosclerotic plaque in an epicardial coronary artery which leads to a clotting cascase
Myocardial infarction precipitating factors
- Age
- Gender
- Diabetes
- Hypertension
- smoking
- Obesity
Myocardial infarction manifestations
- Chest pain (tightness, pressure, or squeezing)
- Radiating pain to left arm, lower jaw, neck, right arm, back, and epigastrium
- Shortness of breath, weakness, sweating, nausea, vomiting, and palpitations
Myocardial infarction complications
- May occur immediately following the heart attack
- Heart failure
- Aneurysm or rupture of the myocardium
- Arrhythmias
Myocardial infarction therapy/management
- Oxygen
- Aspirin
- Nitroglycerin may be administered
Congestive heart failure pathophysiology
Causes by any condition which reduced the efficiency of the myocardium, or heart muscle, through damage or overloading
Congestive heart failure manifestations
Left-sided
- Tachypnea
- Increased work of breathing
- Rales or crackles
- Cyanosis
Right-sided
- Peripheral pitting edema
Congestive heart failure therapy/management
- Improving the symptoms and preventing the progression of the disease
- Re-establish adequate perfusion and oxygen delivery to end organs (ABC are adequate)
HCTZ (hydrochlorothiazide) use
Management of mild to moderate hypertension.
HCTZ (hydrochlorothiazide) therapeutic effects
- Lowing of blood pressure in hypertensive patients and diuresis with mobilization of edema.
HCTZ (hydrochlorothiazide) assess before
- Assess patients, especially if taking digoxin, for anorexia, nausea, vomiting, muscle cramps, paresthesia, and confusion
HCTZ (hydrochlorothiazide) NOTIFY CLINICIANS IF:
- If signs of electrolyte imbalance occur
- Patients taking digoxin are at risk of digoxin toxicity because of the potassium-depleting effect of the diuretic.
Metroprolol XL use
- Decreases blood pressure and heart rate
- Decreases frequency of attacks of angina pectoris
- Decreases rate of cardiovascular mortality and hospitalization in patients with heart failure
Metroprolol XL. To monitor
- Monitor intake and output ratios and daily weights
- Assess routinely for signs and symptoms of CHF (dyspnea, rales/crackles, weight gain, peripheral edema, jugular venous distention)
Metroprolol XL. To assess before
- Take apical pulse before administering.
- If <50 BPM or if arrhythmia occurs, withhold medication and notify health care professional
Enalapril uses
- Alone or with other agents in the management of hypertension
- Slows progression of left ventricular dysfunction into overt heart failure
Enalapril therapeutic effects
- Lowers blood pressure in hypertensive patients.
- Improves symptoms in patients with CHF
Enalapril Watch out for
- Warn patient not to discontinue ACE inhibitor therapy unless directed by health care professional
- Increase risk of hyperkalemia with concurrent use of potassium supplements, potassium-sparing diuretics, potassium-containing salt substitutes, or angiotensin II receptor antagonists
Losartan indications
- Alone or with other agents in the management of hypertension
- Treatment of diabetic nephropathy in patients with type 2 diabetes and hypertension
Losartan Therapeutic effects
- Lowers blood pressure
- Slows progression of diabetic nephropathy (ibesartan and losatran only)
- Reduces cardiovascular death and hospitalization due to CHF in patients with CHF
Losartan lab test considerations
- Monitor renal function and electrolyte levels periodically
- Serum potassium, BUM, and serum creatinine may be increased.
U/A lab values
Males: (2-8)
Female: (2-7.5)
U/A
Urinalysis can reveal disease that have gone unnoticed because they don't produce striking signs or symptoms
Calcium
8.5 - 10.5
Ionized Calcium
4-5
Chloride
95-107
Magnesium
1.5-2.5
Phosphate
2.5-4.5
Potassium
3.5 - 5
Sodium
136 - 145
BUN
10-20
Creatinine
.7- 1.5
Creatine phosphokinase
Male 25-90
Female 10-70
CPK means
CPK levels rise 4-8 hours after an acute MI< peaking at 16to 30 hours and returning to baseline within 4 days
Fasting glucose
65-110
Post prandial glucose
up to 140
Cholesterol
<200
HDL
> 40
LDL
1 - 129
triglycerides
45 - 155
Blood pressure measurement
Measurement of the force applied to the walls of your arteries as your heart pumps blood through your body
Chest x-ray
A noninvasive medical test that helps physicians diagnose and treat medical conditions.
ECG (electrocardiogram)
Used to monitor your heart. An EKG record electrical signs as they travel through your heart.
Nitroglycerin SL used for
- Acute and long-term prophylactic management of angina pectoris
- Increases coronary blood flow by dilating coronary arteries and improving collateral flow to ischemic regions.
- Reduces myocadial oxygen consumption
Nitroglycerin SL therapeutic effects
- Relieves or prevents anginal attacks
- Increases cardiac output
- Reduces blood pressure
Nitroglycerin SL TO DO
- First dose should be taken while in a sitting or reclining position, especially in geriatric patients
Nitroglycerin SL During Anginal attacks
- Advise patient to sit down and use medication at first sign of attack
- Relief usually occurs within 5 min
- Dose may be repeated if pain isn't relieved in 5-10 min.
- Call health care professional or go to nearest emergency room if anginal pain is not relieved by 3 tablets in 15 min.
ASA use
- Prophylaxis of transient ischemic attacks and MI
- Decreases platelet aggregation
ASA before hand
- Administer after meals or with food or an antacid to minimize gastric irritation
- Food slows but does not alter the total amount abosrbed
ASA do not
- Do not crush of chew enteric-coated tablets
- Do not take antacids within 1-2 hr of enteric-coated tablets.
- If MI is impending, have patient chew ASA to increase speed of absorption
Atorvastin uses
- Lowers total and LDL cholesterol and triglycerides
- Slightly increases HDL
- Slows the progression of coronary atherosclerosis with resultant decrease in CHD- related evented
Atorvastin lab considerations
- Evaluate serum cholesterol and triglyceride levels before initiating, after 4-6 weeks of therapy, and periodically thereafter
Atorvastin monitor
- Monitor liver function tests, including AST, before, at 12 wk after initiation of therapy or after dose elevation, and then q 6 mo.
- If AST levels rise to 3 times nomral, HMG- C reductase inhibitor therapy should be reduced or discontinued
Atorvastin STOP THERAPY if
- If patients develops muscle tenderness during therapy, monitor CK levels.
- If CK levels are >10 times the upper limit of normal or myopathy occurs, therapy should be discontinued
T-pa (tissue plasminogen activator) uses
- Acute myocardial infarction (MI)
Nitroglycerin SL TO DO
- First dose should be taken while in a sitting or reclining position, especially in geriatric patients
Nitroglycerin SL During Anginal attacks
- Advise patient to sit down and use medication at first sign of attack
- Relief usually occurs within 5 min
- Dose may be repeated if pain isn't relieved in 5-10 min.
- Call health care professional or go to nearest emergency room if anginal pain is not relieved by 3 tablets in 15 min.
ASA use
- Prophylaxis of transient ischemic attacks and MI
- Decreases platelet aggregation
ASA before hand
- Administer after meals or with food or an antacid to minimize gastric irritation
- Food slows but does not alter the total amount abosrbed
ASA do not
- Do not crush of chew enteric-coated tablets
- Do not take antacids within 1-2 hr of enteric-coated tablets.
- If MI is impending, have patient chew ASA to increase speed of absorption
Atorvastin uses
- Lowers total and LDL cholesterol and triglycerides
- Slightly increases HDL
- Slows the progression of coronary atherosclerosis with resultant decrease in CHD- related evented
Atorvastin lab considerations
- Evaluate serum cholesterol and triglyceride levels before initiating, after 4-6 weeks of therapy, and periodically thereafter
Atorvastin monitor
- Monitor liver function tests, including AST, before, at 12 wk after initiation of therapy or after dose elevation, and then q 6 mo.
- If AST levels rise to 3 times nomral, HMG- C reductase inhibitor therapy should be reduced or discontinued
Atorvastin STOP THERAPY if
- If patients develops muscle tenderness during therapy, monitor CK levels.
- If CK levels are >10 times the upper limit of normal or myopathy occurs, therapy should be discontinued
T-pa (tissue plasminogen activator) uses
- Acute myocardial infarction (MI)
T-pa (tissue plasminogen activator) therapeutic effects
- Lysis of thrombi in coronary arteries, with preservation of ventricular function
- Improvement of ventricular function
- Increases risk of CHF or death
- Lysis of pulmonary emboli or deep vein thrombosis
- Lysis of trhombi causing ischemic stroke, drucing risk of neurologic problems
T-pa (tissue plasminogen activator) Watch for
- Assess patient carefully for bleeding every 15 min during the 1st hr of therapy, every 15-30 min during the next 8 hr, and at least ever 4 hour for the duration of therapy.
- If uncontrolled bleeding occurs, stop medication and notify physician immediately
Signs of internal bleeding
- Decreased neurologic status
- Abdominal pain with coffee- ground emesis
- Black, tarry stools
- Hematuria
- Joint pain
Troponin levels
Troponin I : less than 10 ug/L
Troponin T: 0 - 0.1 ug/L
Troponin shows
- These proteins are released when the heart muscle has been damaged
- The more damage to the heart, the greater the amount of troponin in the blood
Myoglobin values
0 - 85 ng/mL
Myoglobin shows
- When muscle is damaged, myoglobin is released into the bloodstream.
D- Dimer values
Around 500 ng/ml
D- dimer shows
- A fibrin degradation product, a small protein fragement present in the blood after a blood clot is degraded by fibrinolysis
WBC
4 - 11
PTT (partial thromboplastin) time
25 - 39 seconds

* If a person is taking blood thinners, clotting time takes up to 2 1/2 times longer
PTT test
A blood test that looks at how long it takes for blood to clot
PT (prothrombin time)
11 - 13. 5 seconds
PT test
A blood test that measures the time it takes for the liquid portion (plasma) of your blood to clot.
Bleeding Time
1 - 3 minutes
Bleeding time test
Looks at how fast small vessels in the skin close to stop bleeding
Thallium scan
- Examining the heart to obtain information about the blood supply to the heart muscle
- Thallium is injected in the blood to be used as a tracer
Cardiac catheterization
The insertion of a catheter into a chamber or vessel of the heart.
- X-ray opaque based contrast is injected to make the vessels show up
PTCA (percutaneous translumial coronary angioplasty)
- injecting a radio-opaque contrast agent into the blood vessel
Furosemide uses
- For edema due to heart failure, hepatic impairment or renal disease
Furosemide Therapeutic effects
- Diuresis and subsequent mobilization of excess fluid
- Decreases Blood pressure
Furosemide assess
- Assess fluid status
- Monior daily weight, intake and output ratios, amount & location of edema, lung sounds, skin turgor, and mucous membranes.

* Potassium supplements or potassium-sparing diuretics can be used to prevent hypokalemia*
Furosemide Notify physician if
- Thirst
- Dry mouth
- Lethargy
- Weakness
- Hypotension
- Oliguria
Morphine uses
Pain associated with MI
Morphine therapeutic effects
- Decreases severity of pain
Morphine HIGH ALERT
- Assess level of consciousness, blood pressure, pulse, and RR before and periodically during administration
* If RR is <10/min, assess level of sedation*
Digoxin uses
Treatment of CHF
Digoxin therapeutic effects
- Increases cardiac output
- Slows the heart rate
Digoxin monitor
- Monitor apical pulse for 1 full min before administration.
- Witholhd dose and notify physician if < 60 BPM
- Observe for signs and symptoms of toxicity
Digoxin toxicity signs
- Abdominal pain
- Anorexia
- Nausea
- Vomiting
- Visual distubrances
- Brady
- Other arrhythmias

* Hypokalemia, hypomagnesemia, or hyper calcemia may make the patient more prone for toxicity*
pH
7.35 - 7.45
pCO2
35 - 45
pO22
70-100
HCO3
19-25
O2 sat%
90-95
CVP (central venous pressure)
- Pressure of blood in the thoracic vena cava.
- Reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the aterial system.
INR (international normalized ratio)
How long it takes blood to clot
Normal - 1
Anticoagulant : 2 - 3
Watch and monitor : 4 +
Doppler studies
A non- invasive test that can be used to measure your blood flow and blood pressure by bouncing high-frequency sound waves off circulatingRBC
Warfarin uses
- Prophylaxis and treatment of: Venous thrombosis, Pulmonary embolism, Atrial fibrillation with embolization
Warfarin therapeutic effects
- Prevent thromboembolic events
Warfarin ASSESS
- Assess patient for signs of bleeding and hemmorrhage
- Monitor PT, INR, and other clotting factors during therapy

ANTIDOTE : VITAMIN K
Plavix clopidogrel uses
- Inhibits platelet aggregation by irreversibly inhibiting the binding of ATP to platelet receptors
Plavix clopidogrel therapeutic effects
- Decreased occurrence of atherosclerotic events in patients at risk
Plavix clopidogrel Lab test considerations
- Monitor bleeding time
- Prolonged bleeding time is expected
- Advise patient t0 notify health care professional if fever, chills, sore throat, or unusual bleeding or bruising occurs
Heparin therapeutic effects
- Prevents thrombus formation
- Prevents extension of existing thrombi
Heparin Lab test considerations
- Monitor activated PTT and hematocrit prior to and periodically throughout therapy
Heparin toxicity and overdose
ANTIDOTE: Protamine sulfate
- Overdose can often be treated by withdrawing the drug
Systemic circulation
Carries oxygenated blood away from the heart to the body, and returns oxygenated blood back to the heart
Cardiac circulation
The circulation of blood in blood vessels of the heart muscle
Systole
- Increased ventricular pressure
- AV valves close
- Semilunar valves open
- Blood injected into pulmonary artery and aorta
- AV and PV close
Diastole
- Ventricles relax
- AV valves open
- Blood flows into atria/ventricles
- Atria contracts
Cardiac conduction system
SA Node, AV node, Bundle of his, Bundle branches, Purkinje fibers
Cardiac output
The volume of blood being pumped by the heart in the time interval of a minute
- HR x SV
Stroke Volume
The amount of blood pumped by each ventricle with each heart beat ( avg 80 in adults at rest)
Preload
- Describes the degree of stretch of the cardiac muscle fibers at the end of diastole
Afterload
The pressure the ventricular myocardium must overcome to eject blood during systole
Ejection fraction
% of the end-diastolic volume ejected with each contraction (60-70%)
Peripheral vascular occlusive disease
- Blockages in the vasculature of the extremities
Peripheral vascular occlusive disease symptoms
Claudication (pain, weakness, numbness, cramping)
Sores, wounds or ulcers heal slowly
Change in color or temperature
Diminished hair or nail growth
Peripheral vascular occlusive disease causes
- Smoking
- Diabetes
- Dyslipidemia
- Hypertension
Peripheral vascular occlusive disease diagnosis
When BP readings in ankles are lower then in the arms
CT scan
Peripheral vascular occlusive disease treatment
- Stop smoking
- Management of diabetes
- Mangement of hypertension & cholesterol
- Antiplatelet drugs
- regular exercise
Pulmonary emboli
A blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream
Pulmonary emboli symptoms
SOB
Rapid breathing
Chest pain
Cough/coughing up blood
Pulmonary emboli treatment
Anticoagulation
Thrombolysis
Deep vein thrombosis
A blood clot in a deep vein
Deep vein thrombosis symptoms
Pain & tenderness in the leg
Swelling
Warmth
Redness or discoloration
Distention of surface veins
Deep vein thrombosis Prevention
Surgery patients
- early ambulation
- mechanical prophylaxis
- low dose unfractioned heparin
Hospital patients
- anticoagulation
- mechanical prophylaxis
Travelers
- frequent walking
- calf exercises
- aisle seating in airplanes
Congestive heart failure
A cardiovascular condition in which the heart is unable to pump an adequate amount of blood to meet the metabolic needs of the body's tissues
Congestive heart failure compensatory mechanism
- Increase HR
- Increase SV
- Arterial vasoconstriction
- NA & H20 retention
- Myocardial hypertrophy
Overtime, compensatory mechanisms make it worse
Pulmonary edema
- Fluid accumulation in the air spaces and parenchyma of the lungs
- Leads to impaired gas exchange and may cause respiratory failure
Pulmonary edema symptoms
Difficulty breathing
Coughing up blood
Pale Skin
Excessive sweating
Metabolic syndrome
A combination of medical disorders that increase the risk of developing cardiovascular disease and diabetes
Metabolic syndrome signs
Fasting hyperglycemia
High blood pressure
Central obesity
Decreased HDL cholesterol
Elevated triglycerides
Respiration
- O2 concentration in blood with in the capillaries of the lungs is lower than in the alveoli
- Concentration gradient leads to O2 diffusion from alveoli to blood
- CO2 which has a high concentration in the blood than in the alveoli diffuses frmo the blood into the alveoli
Ventilation
Movement of air in and out of the airwayds
PaO2
80-100
PaCO2
34-45
Pneumonia assessment
Dull percussion sounds
Consolidated breath sounds
Pneumonia treatment
Medication
Hospital admission
Plenty of rest
Plenty of fluids
Pneumonia symptoms
Fever
Cough
SOB
sweating
shaking; chills
headache
fatigue
Pneumonia interventions
Maintain patent airway
Monitor I & O
Auscultate breath sounds every 4 hours at least
Monitor patients ABG levels
Pneumonia complications
Bacteria in bloodstream
Septic shock
Fluid accumulation around lungs
Lung abscess
Acute respiratory distress syndrome
Pneumothorax pathophysiology
- Partial or complete collapse of the lung due to positive pressure in the pleural space
- Occurs when air gets into pleural space
- May occur from trauma or spontaneously
Pneumothorax management
-Aspiraton
Putting a needle in the chest cavity to remove extra air
- Chest tube
Connected to a one-way valve system that allows air to escape but not re-enter the chest
- Pleurodesis & surgery
Obliterates the plerual space and attaches the lung to the chest wall
Pneumothorax symptoms
Chest pain
Mild breathlessness
Tension pneumothorax : increased HR, rapid breathing, respiratory distress
Cor pulmonale physiology
-Enlargement of the right ventricle of the heart as a response to increased resistance or high blood pressure in the lung
- Pulmonary vasoconstriction, increased blood viscosity, pulmonary hypertension
Cor pulmonale causes
COPD
Pulmonary hypertension
Asthma
Pulmonary embolism
Loss of lung tissue
Cor pulmonale symptoms
Shortness of breath
Wheezing
Chronic wet cough
Swelling of abdomen with fluid, ankles, and feet
Cor pulmonalecomplications
- Blood backs up into the sytemic venous system
- Congestion in the liver leads to hypoxia and fatty changes of the peripheral hepatocytes
Pleural effusion pathophysiology
Abnormal accumulation of fluid in the pleural space
Usually secondary to other diseases
Pleural effusion causes
Transudative : Left ventricular failure & cirrhosis
Exudative: Bacterial pneumonia, cancer, viral infection, & pulmonary embolism
Pleural effusion treatment
Intercostal drain
Pleural catheter
Drainage catheter
COPD pathophysiology
Disease state in which air flow is obstructed by emphysema, chronic bronchitis or both
COPD cause
Smoking
occupational exposures
Air pollution
Genetics
Autoimmune disease
COPD Management
Bronchodilators
B2 agonist
Anticholinergics
Corticosteroids
COPD symptoms
Dyspnea
Rhonchi
Airflow limitation
SOB
Emphysema pathophysiology
- Impaired gas exchange results form destruction of the walls of over distended alveoli
- Increases the work of breathing because the hyper inflated lungs cause the diaphragm to flatten
Emphysema causes
Smoking
Air pollution
Second-hang smoke
Chemicals and toxins
Emphysema management
Stop smoking
Avoid all exposure to smoke & lung irritans
Pulmonary rehab
Medications
Emphysema symptoms
Shortness of breath
barrel chest
Leaning forward to help breath
Chronic bronchitis pathophysiology
Excessive accumulation of mucous and secretions block the airway
Gas exchange is hindered
Mucous medium allows for frequent infections
Leads to decreased PaO2, Hypoxemia, Increased PaCO2, repsiratory acidosis
Chronic bronchitis symptoms
Cough
SOB
wheezing
Occasionally chest pains, fever, fatigue
Albuterol use
Bronchodilator to control and prevent reversible airway obstruction caused by asthma or COPD
Albuterol side effects
nervousness
restlessness
tremor
Albuterol assess
Assess lung sounds pulse and blood pressure before administration and during peak of medication

Not amount, color, and character of sputum produced
Atrovent use
maintenance therapy of reversible airway obstruction due to COPD including chronic bronchitis and emphysema
Atrovent side effects
Bronchospasm
Cough
hypotension
palpitations
Fluticasone to use
-Instruct patient in the proper use of the metered-dose inhaler
- Most inhalers require priming before first use
- Shake inhaler well
- Exhale completely, and then close lips firmly around mouthpiece
- While breathing in deeply and slowly, press down on canister
- Hold breath for as long as possible to ensure deep instillation of medicine
- Allow 1-2 min between inhalations
Vancomycin
Antibiotic.
Used for resistant bacteria
Vancomycin given
Given IV every 12 hours over 60-90 minutes
Vancomycin - Rapid IV infusion
- Rapid IV infusion leads to red neck syndrome with hypotension, flushing, erthematous rach on face and upper body
Vancomycin side effects
Ototoxicity
Nephrotoxicity
Vancomycin monitor
- blood levels to prevent toxicity
- Assess hearing : affects CN VIII
- Monitor I & O
Hematacrit
Male 41-50%
Female 36-44%
Pneumovax
Pneumonia vaccine
Isoniazid (INH) uses
Antituberculosis agent.
Given orally, daily
Isoniazid (INH) Side effects
Peripheral neuropathy
parathesias
hepatotoxicity
Isoniazid (INH) risks
ETOH increase risks
Take on an empty stomach
Vit B6 can decrease neuropathies
Isoniazid (INH) watch
Liver enzymes need to be monitors
Look for signs of liver toxicity: dark urine, jaundice, clay colored stool
Rifampin
Antituberculosis agent, antileprosy agent
Given orally QD
Rifampin side effects
GI distress
Elevated liver function tests
Rifampin how to take
Take on an empty stomach
Check liver enzymes periodically
Rifampin watch
Drug will cause body fluids to be red-orange
Decreases effectiveness of oral contraceptives
Ceftriaxone
Cepholosporin antibiotic
Used to treat lower respiratory tract infections
Ceftriaxone side effects
Diarrhea
Nausea
Vomiting
Cholelithasis
Ceftriaxone assess
-Assess for infection (vital signs, appearance of wound, sputum, urine, and stool, wbc)
- Obtain a history to determine previous use of and reactions to penicillins of cephalosporins
- persons with a negative history of penicillin sensitivity may still have an allergic response
Thoracentesis
An invasive procedure to remove fluid or air form the pleural space for diagnostic or therapeutic purposes