Focus exam 2
The exam will be 50-60 questions. Most questions will be multiple choice. Also expect “select
all that apply”, possible fill in the blank, matching or short answer questions.
Test material will be material discussed in class, PowerPoint content, group presentations, case
studies and from readings. Questions will be mainly from the level of application and analysis.
When studying, ask yourself how you will prioritize care and anticipate complications for
patients with these conditions. Review assessment findings including; important labs, nursing
interventions, and evaluations.
 Math questions (2 questions)
 48 questions will cover the following:
Diastolic HF---Right HF---Peripheral edema
Systolic HF---Left HF---Pulmonary edema
CAD/ACS/MI
**Goal with chest pain..have good perfusion
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Risk factors: Modifiable and non-modifiable (know difference)
o Modifiable
 High cholesterol, hypertension, tobacco use, lack of exercise, obesity,
diabetes,
o Non-modifiable
 Age, gender, ethnicity, family history, genetics
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Clinical manifest
o CAD
 Coronary Artery Disease
 Most common type of cardiovascular disease
 Any disorder of the coronary arteries that affects their ability to deliver
blood to the myocardium. (fatty plaques, which lead to restriction of the
blood flow to the heart.)
 Diagnosis: EKG, stress test, heart cath, PCI
 Treatment: Medications-antiplatelets, aspirin (watch for bleeding). Not
for a pt with a recent MI or stent. Meds: statins, zetia (cholesterol), niacin,
asa, plavix
 Nursing interventions: educate on preventing progression of the disease,
on treatments, complications, modify lifestyles (no smoking, healthy diet,
lose weight, etc) Explain s/s and when to seek treatment and procedures.
 Risk factors: smoking, abdominal obesity, HTN, diabetes,
hyperlipidemia, psychosocial
 Clinical manifestations: angina pain, SOB, diaphoresis, pallor,
nausea/unusual back pain
 Coronary artery spasm: may occur in pt with or without artherosclerosis
 Risk factors: smoking and stress
o ACS
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Acute Coronary Syndrome
Treatment: Fibrinolytic therapy, coronary surgical revascularization. Bed
rest, MONA (Morphine, oxygen, nitrate, aspirin), PCI (Percutaneous
coronary intervention [coronary angioplasty]), CABG.
If PCI cannot be achieved within 120 minutes, thrombolytic therapy may
be given.
EKG changes=yes=STEMI
EKG changes=no cardiac markers elevated?
 If so, NSTEMI. If no elevated cardiac markers=unstable angina.
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o MI
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Result of abrupt stoppage of blood flow through a coronary artery with a
thrombus caused by platelet aggregation, causing irreversible myocardial
cell death. (Result of sustained ischemia >20 minutes)
Diagnosis: Unstable angina, elevated Troponin
Treatment: STEMI (emergency artery must be opened within 90 minutes,
with either PCI or thrombolytic), Cath lab, monitor markers,
Nursing interventions: 12-lead ECG, upright position, oxygen (keep O2
>93%), IV access, Nitro and Asa, morphine, statin. Educate on bed rest,
gradual increase in activity. Sexual activity-7-10 days, or when pt can
climb two flights of stairs.
Risk factors:
Clinical manifestations: Usually lasts for more than 20 minutes. Severe
chest pain not relieved by rest, position change, or nitrate administration.
Heaviness, pressure, tightness, burning, constriction, or crushing. Usually
in the substernal or epigastric area. May radiate to neck, lower jaw, arms,
or back. Often occurs in early morning, lasts greater than 20 minutes. No
pain if cardiac neuropathy (diabetes). Skin: ashen, clammy and/or cool to
touch.
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Nursing management/interventions/priorities actions/assessment
Angina – know types and interventions
o S/S- SOB, diaphoresis, pallor, nausea/unusual back pain
o Inverted ST-means the heart has not received as much O2 as it should. Pain is due
to the accumulation of metabolites in muscle tissue.
o Stable- Temporary chest pain. Narrowing of the coronary arteries by
atherosclerosis. Referred pain in the left shoulder and arm is from transmission of
the pain message to the cardiac nerve root. Chest pain with activity, goes away
with rest, or if given nitro. Most pain is substernally, the sensation may occur in
jaw, neck, shoulders, and down the arm. Pain between shoulder blades can also
happen. Intermittent chest pain that occurs over a long period with the same
pattern of onset, duration, and intensity of symptoms. When questioned, some
patients may deny feeling pain, but will describe a pressure or ache in the chest. It
o
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is an unpleasant feeling, often described as a constrictive, squeezing, heavy,
choking, or suffocating sensation. Pain is usually 3-5 minutes.
 Interventions
 Drug therapy: goal is to decrease O2 demand and/or increase O2
supply, short-acting nitrates, long-acting nitrates, NTG ointment,
transdermal controlled-release NTG. Sublingual is first line of
therapy (short-acting nitrates).
Unstable- Pain during activity or rest, rupture of plaque. Overtime severity and
duration of pain get worse. Pain last more than 10-15 minutes. Monitor for 24
hours, every 2-8 hours draw blood and do EKG, then a stress test.
Variant angina- related to focal/diffuse coronary vasospasm usually occurs at
rest. Give Diltiazem (Cardizem)
Silent- usually with exercise. Associated with diabetic neuropathy..confirmed by
ECG changes.
Nursing interventions:
 Nitroglycerin- 3 doses, 5 minutes apart (under tongue)
 Take HR and BP before giving, check again after 5 minutes, .
before next dose.
 Aspirin- up to 325mg, can chew for faster absorption
 Morphine- to reduce preload of the heart
 Start 2 IV lines
 When did you start to have the chest pain?
 Troponin levels?
 Health history/physical exam
 Laboratory studies12-lead ECG (look for dysrhythmia)
 Chest x-ray
 Echocardiogram
 Exercise stress test
 PCI- percutaneous coronary intervention
 Angiography- through femoral or radial, to evaluate arteries and place
stent if needed
 CABG
 If more than 6 hours, treat with Heparin or TPA.
 Serum markers:
 CK-MB begins to rise about 6 hours after symptom onset, peaks in
about 18 hours, and returns to base line within 24-36 hours after
MI.
 Troponin is detectable within hours (average, 4-6 hours), peaks at
10 to 24 hours, and can be detected for up to 10 to 14 days. Should
be less than 0.1. MOST ACCURATE and MOST SPECIFIC
 Myoglobin begins to rise within 2 hours and peaks in 3 to 15
hours. Can be elevated due to heart damage or skeletal muscle
damage. Remain elevated for 24 hours and is NOT SPECIFIC TO
THE HEART.
*When ischemia is prolonged and is not immediately reversible, acute coronary syndrome (ACS)
develops.
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Collaborative interventions – PTCA
o Percutaneous transluminal coronary angioplasty
 Balloon catheter
 Stent intervention
 Need Consent
 Guided into the heart via a vein or artery used to measure blood flow in
the heart.
 Post-op care: Puncture site assessment (bleeding, hematoma, ecchymosis,
and infection) assess EKG for rhythm, output, neuromuscular (thrombus):
color, warmth, sensation, movement, and pulses.
 Education/Dietary/Exercise: Check with MD when to resume normal
activities, cardiac rehabilitation, and returning to work. Educate about
meds, including what the med is for, when and how to take it, and what
adverse effects to look for and report. Incision care and follow-up care.
Review lifestyle changes as needed (dietary adjustments, smoking
cessation, weight loss, cardiac diet.)
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Why is putting a patient on a monitor so important if they have acute coronary
syndrome?
o To act quickly if necessary. They need to know right away if they need to open up
an artery to stop damage to the heart. Seconds/minutes are vital.
Patient teaching - dietary and exercise recommendations
Blood pressure: How to assess for end organ damage including labs
o Heart: BP, CAD, HF, Left ventricular hypertrophy
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o Brain: Check LOC and O2 sats, Stroke, TIA
o Peripheral vessels- Intermittent claudication, absent pulses
o Kidney- Kidney failure (serum creatine higher than 1.5) usually 1.0
 Look at this before contrast…iodine should not be given if creatine is
above 1.5**
o Eyes- Hemorrhages, narrowing of retina
**Intermittent claudication, elevated creatine, and microalbuminuria show target organ
damage.
o Labs: BUN, creatine, electrolytes, blood glucose, lipids, uric acid, ECG,
echocardiography, CBC, proteinuria
o Assessment:
 Repeated (usually 3 measurements) Elevated blood pressure above normal
levels (BP<120/90 mm Hg)
 Often asymptomatic until overt damage is imminent or has occurred.
 Even mild hypertension (BP>140/90mmHg) increases risk. Blood
pressure is age is age-dependent
Complications of MI including heart failure
o Dysrhythmias present in 80% of patients.
Signs/symptoms of HF, emergency treatment
o Pumping of the heart has diminished. Requires aggressive management.
Inadequate O2 and nutrients are supplied to the tissues because of severe LV
failure.
o HF is a chronic disease and can become an emergency because of pulmonary
edema. Common is left heart failure (systolic)
o Initial interventions: Establish IV, start O2, and administer sublingual NTG,
aspirin, or morphine sulfate Monitor vital signs and pulse oximetry.
o Emergent PCI is the first line of treatment for patients with confirmed MI. The
GOAL is to open the affected artery within 90 minutes of arrival to a facility
with an interventional cardia catherization lab.
o Left side failure manifestations: Pulmonary edema, fatigue, tachycardia
o Right side failure: Ascites, enlarged liver and spleen, distended jugular vein,
dependent edema
Heart Failure education: recognize s/s, diet, lifestyle, meds., f/u with providers,
vaccination
o GIVE ACE INHIBITOR!!
o PT should weigh themselves daily, no more than 3-5 pounds in a week!
o HF is failure to pump blood, affect cardiac output
o Can be acute or chronic dues to: HBP, MI pulm. HTN, heart disease, valvular
diseases, cardiomegaly, pericarditis, dysrhythmia.
o S/S: Initially subtle signs such as mild dyspnea, restlessness, agitation, or slight
tachycardia. Pulmonary congestion on chest x-ray, S3 or S4 heart sounds on
auscultation, crackles on auscultation of breath sounds, and jugular vein
distention.
o Left HF is the most common. Causes heart disease, valve problems (mitral and
aortic).
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o Right HF causes pulmonary HTN, thrombosis, sleep apnea
o Ejection fraction: >50-60%
o Goals: Improve SOB, edema, fatigue, reduce mortality, slow disease.
Lab: LDL, HDL, Triglycerides. Total Cholesterol. Troponin
o LDL: <100, <70
o HDL: F >45 M >55
o Triglycerides: F 35-135 M 40-160
o Total Cholesterol: <200
o Troponin: Troponin T-less than 0.1, Troponin I- less than 0.03. Rises 4-6 hours
after a MI. Stays elevated for 7-10 days.
o
Core Measures
**How to control HF: Ecocardiogram, to see how heart works and calculate Ejection
fraction..if less than 50, will give ACE inhibitor and Betablocker. Diet—low salt. Have pt
weigh themselves. No more than 1-2 pounds a day and 3-5 a week. Have them take their
pulse. BNP lab values!!
Pulmonary congestion: Lasix, monitor I and O’s, elevate HOB.
**KNOW CORE MEASURES**
Pulmonary Embolism
 Signs, symptoms and etiology
o s/s: Restlessness, apprehension, wheezing, cyanosis, distended neck veins, feeling
of doom, shallow respirations, tachypnea, tachypnea, tachycardia, sudden SOB,
unusual chest pain, dyspnea, confuse, hypotension, pleural friction rub, sweating,
decrease O2 saturation
o Etiology
 Risk factors
o DVT, fat or amniotic emboli, right heart thrombus, A-Fib, valvular heart disease,
oral contraceptives, smoking, obesity, surgery, pregnancy, long bone fracture and
surgery, hip and knee anthroplasty.
 Assessments and diagnostic testing
o ABGs, D-dimer, WBC, Toponin, BNP, chest radiograph, CT, ECG, Doppler,
spiral CT scan (BEST OPTION)
 Nursing management/interventions
o Immediate assessment, call rapid response team if indicated
o Elevate HOB, turning, coughing, deep breathing, incentive spirometer, administer
O2, monitor vitals, prepare to administer heparin/warfarin immediately!!
Thrombolytic, Prevention begins with DVT prevention, Use intermittent
compressions stockings, early ambulation.
 Collaborative interventions and priorities
o Frequent blood draws on warfarin (INR 2-3), and heparin, risk of bleeding don’t
use aspirin, use a soft toothbrush
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Lab: d-dimer
o (<0.4) Results elevated can indicate blood clot/Coagulation therapy
Partial thromboplastin time (PTT)
Norma: 10-12 sec.
Therapeutic: 1.5-2.5 X the control value in seconds
INR
Normal:1-2
Therapeutic: 2-3, up to 3.5 for mechanical heart valves
Prothrombin tine (PT)
Normal: 11-12.5 sec.
Therapeutic: 1.5-2.5 X the control value
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Nursing considerations for patient going for CT scan/ spiral CT
o IV contrast dye: assess renal function, Stop Metformin prior
DVT
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DVT:
o Deep vein thrombosis (DVT) is caused by a blood clot in a deep vein and can be
life-threatening. Symptoms may include swelling, pain, and tenderness (often in
the legs).
Risk factors
o Immobility, hormone therapy, pregnancy, over 60, smoke, surgery w/in 3 months,
cancer.
Prevention
o Avoid sitting for long periods of time. Get up often to walk around in sitting long.
Make lifestyle changes, exercise. Smoking cessation.
Clinical manifestations/assessment
o Swelling in one or both legs, pain or tenderness in your leg, ankle, foot, or arm. It
might feel like a cramp or charley horse that you can’t get rid of. Leg and foot
pain might only happen when you stand or walk. Red or discolored skin on your
leg. Veins that are swollen, red, hard, or tender to the touch that you can see. D
dimers elevated.
Nursing management/interventions including patient teaching
o Encourage ambulation, don’t cross legs, SCD post-surgery (need to be on for 19
hours to be effective), smoking cessation.
Nursing considerations for CT: Consent, kidneys, pregnant?
Collaborative interventions
Pneumonia
Obstruction of bronchioles, decrease gas exchange, increase exudate
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Assessment findings, collaborative & nursing interventions
o Assessment findings: Cough, fever, chills, tachycardia, tachypnea, anxiety,
confusion from hypoxia is the most common manifestation in older adults,
dyspnea, pleural pain, malaise, respiratory distress, decrease breath sounds.
Yellow, blood streaked, rusty sputum=infection
Collaborative & nursing interventions
 CORE MEASURES: antibiotic within 60 min, Blood culture X 2 (different
locations) prior antibiotic administration,
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 Increase fluid intake (at least 2-3L/day), IV fluids
 Balance of activity and rest
 O2 therapy
 Physiotherapy
 VTE prophylaxis
 Appropriate antibiotic therapy
 Antipyretics
 Analgesics
 NSAIDs
Nursing implementation
 Aid in eating, drinking, and taking medication
 Elevate patient bed to 30 degrees (ATI high fowlers)
 Assess gag reflex
 Turning and moving patient (every 2 hrs) if immobile
 Encourage deep breathing
 Observe skin and pressure points for breakdown
 Treat comfort level of PAIN
 Encourage early ambulation
 Use of incentive spirometer
 ORAL Hygiene- she said this like 5Xs do this at least 2x a day
 Encourage fluids
 Avoid smoking/ alcohol
 Use cool mist
 Encourage influenza and pneumonia vaccination
 Explain a chest x-ray will be needed 6-8 weeks to see resolution of pneumonia
Prevention and risk factors.
 Abdominal and chest surgery
 AGE>65
 Air pollution, altered conscious (alcohol, head injury, seizures, anesthesia, drug overdose,
stroke)
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Bed rest and prolong immobility
Chronic disease (lung, liver, diabetes, heart, cancer, CKD)
Immunosuppressive disease or therapy (corticosteroids, chemo, HIV, transplant)
Inhalation and gastric feeding
Drug IV use
Malnutrition
Recent antibiotic use
Smoking
Tracheal intubation
URI
Core Measures*****
o
 Prevention and risk factors.
 Abdominal and chest surgery
 AGE>65
 Air pollution, altered conscious (alcohol, head injury, seizures, anesthesia, drug overdose,
stroke)
 Bed rest and prolong immobility
 Chronic disease (lung, liver, diabetes, heart, cancer, CKD)
 Immunosuppressive disease or therapy (corticosteroids, chemo, HIV, transplant)
 Inhalation and gastric feeding
 Drug IV use
 Malnutrition
 Recent antibiotic use
 Smoking
 Tracheal intubation
o URI
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Labs & Diagnostic testing
o Sputum culture and sensitivity: obtain specimen BEFORE starting antibiotic
therapy. Obtain specimen by suctioning if not able to cough.
o Blood culture: to rule out organisms in the blood. Takes 72 hours for results.
o BCB: Elevated WBC count (might not be present in older adults)
o ABGs: Hypoxemia (decreased PaO2 less than 80 mm Hg)
o Serum electrolytes: To identify causes of dehydration
o Chest X-ray: Will show consolidation of lung tissue. May not indicate pneumonia
for a few days after manifestations.
o Pulse Oximetry: Clients who have pneumonia usually have oximetry levels less
than expected (<95%)
Core Measures
o Do a culture right away-Blood infection-two different areas, 20 minutes apart.
Within 60 minutes of dx
Aspiration pneumonia:
o causative substances entering the airway form either vomiting or impaired
swallowing. (GERD, vomiting, prominent dyspnea)
Risk:
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Decrease level of conscious
Difficult swallowing, (NG tube)
Gag and cough reflexes depressed
Neuromuscular disease patients
Assessment
 Gag reflex
 Neuro status
Prevention
 Elevate patient’s bed 30 degrees or higher!!!!
 Assess gag reflex before giving food or fluids (KEEP NPO till speech therapy evaluates)
*swallow eval
 Encourage movement and deep breathing at frequent intervals
 Involve Respiratory therapy
 Protect airway: high fowler’s position, suctioning, oxygen 100% non-rebreather mask,
call provider, reassess vitals, check IV patency
BED SIDE EVAL: Sit up, check symmetry of face, ask them to pretend to swallow, can
you push tongue against your cheek. Any drooling? No?..give a few CCs of water and see
if can tolerate.
Diabetes Mellitus
Diabetes Mellitus –
Type 1
Type 2
Age
Young but can occur at any
age
Type of onset
Signs/ symptoms usually
abrupt
About 5% -10%
Viruses, toxins, often present
at onset, absent or minimal
insulin
More common in adults but
can occur at any age,
incidence increasing in
children
Gradual and might go
undiagnosed for years
Accounts for 90-95%
Obesity, lack of exercise,
Insulin resistance , decrease
insulin production
Prevalence
Environmental factors
Symptoms
Polydipsia, polyuria,
polyphagia, fatigue, weight
loss without trying
Insulin
Required
Nutrition
Thin, normal, or obese
Often none, fatigue, recurrent
infection, also the 3 Ps, poor
wound healing, vision
problems, recurrent vaginal
yeast infestion
Required for some. Disease
progressive and insulin
treatment may need to be
added to treatment
Often overweight
Assessment findings Lab & diagnostic tests (including prediabetes) : A1C – know normal value
and what constitutes DM, Glucose
Diagnostic assessment
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A1C of 6.5% or higher Goal: less than 6.5% to 7% (non-diabetic <6 diabetic
<7)
Fasting plasma glucose level of 126 mg/ dl (100-125, PPP)
2 hour plasma glucose level of 200mg/ dl (140-199,PPP)
Patient presented w/ classic symptoms of HYPERGLYCEMIA (3Ps)
Lipid profile
BUN and CREATINE
Electrolytes
Glycosylated hemoglobin: reflects glucose levels over past 2 to 3 months
Collaborative care/management & nursing interventions/management –
Nutrition, medications (insulins and metformin)
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Patient teaching
o Nutritional therapy
o Drug therapy
o Exercise
 Even walking 30minutes a day, just be active. (or swim)
 Need to be consistent
o Self-monitoring of blood glucose
o Foot care- Wash feet, dry between toes. Check for sores. Avoid bare feet, closed
toe shoes.
Diet, exercise, and weight loss may be sufficient for patients with type 2 diabetes
All patients with type 1 require insulin
Storage of insulin – don’t freeze/heat, unused vials left for 4 weeks, avoid direct sunlight,
Monitor rotate site
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Inject at 45 degrees
Know insulin (look at meds)– types and when to administer in terms of meals and when to
ASSESS for hypoglycemia
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Monitor after insulin administration
Symptoms and treatment of hypoglycemia
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Sweating, weakness, dizziness, confusion, headache, tachycardia, slurred speech
Untreated hypoglycemia can progress to loss of consciousness, seizures, coma, and death
Treatment
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Check blood glucose level
If less than 70 mg/dL, begin treatment
o Alert versus not alert?
Eat or drink 15 g of rapid-acting carbohydrates
Wait 15 minutes, check glucose
If less than 70 mg/dL, eat or drink another 15 grams of carbohydrates
If stable and meal more than 1 hour away or involved in activity; give carbohydrate and
protein
If glucose remains low after 2 to 3 times; call HCP or EMS
Acute care, unresponsive: IV D50 or IM glucagon 1mg push
Acute complications
o Hyperglcycemic hyperosmolar nonketotic coma (HHNC)
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Life threatening, occurs in type 2, have enough insulin for DKA but not
enough for hyperglycemia, common in the elderly, cardiac or renal
compromise
Causes: are urinary tract infections, pneumonia, sepsis, any acute illness,
and newly diagnosed type 2 diabetes.
usually a history of inadequate fluid intake, increasing mental depression,
and polyuria
>600 mg/dL
Treatment: immediate IV administration insulin and either 0.9% or 0.45%
NaCl
DKA (Diabetic ketoacidosis) – glucose higher than 250, PH lower 7.30, CO3 less than 16
Caused by profound deficiency of insulin…usually caused by severe dehydration
o Factors
 Illness, infection, not enough insulin, undiagnosed, poor self-management
o Manifestations
 Dehydration, lethargy weakness, sunken eyes, skin dry, N/V, kussumal
respirations, fruity breath, orthostatic hypotension, tachycardia, dry
mucous membranes ketones in urine
 Eyes, brain, heart, kidney, neuropathy *target organs*
o Priority treatment
o
o FLUID and K BEFORE INSULIN DRIP!********
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Ensure airway, admin oxygen, establish IV, begin fluid resuscitation.
NaCl, 0.45% or 0.9% or LR bolus
Insulin regular 0.1 unit/kg (max of 10 units) IV bolus. Infuse continuous
regular insulin drip, 0.1 U/kg/hr.
Add 5% to 10% dextrose when blood glucose level approaches 250 mg/dL
Potassium replacement as needed (before insulin IV or when the blood
glucose is back to almost normal).
Protect from cerebral edema (decrease glucose level by 50 to 100 points/hour
max.)
Monitor for fluid overload (lungs sounds, urine output, HR. Pt can receive 6-8
liters in short period of time). Monitor for arrhythmia : cardiac monitor
/telemetry. Anion gap monitoring-good=<16 (as per policy)
Give 30ml/kilo for fluid!!
-A good nurse can recover a pt in 12 hours…18 hours max
Long term complications (all) *TARGET ORGANS*
Teaching for DM
o Tests important for individuals with DM to have annually: BP, creatinine, eye
exams, microalbuminuria and why?
o Annual exam:
 Retinopathy, nephropathy, neuropathy (comprehensive foot exam),
cardiovascular risk factor assessment
 Eyes-blurry?spots?
 Brain-Stoke
 Heart-MI
 Artery-harden
 Kidneys-BP, be moderate with salt
 Skin/extremities-peripheral neuropathy (Anti-depressants/Neurontin)
EDUCATE: Wash feet daily, between toes, dry between toes!! Closed shoes,
not too tight. Trim toenails. Check water temperature. Ask them to tell you
how they care for these situations or what they know about it. Avoid bare feet.
 **Ask them to show you how to give themselves insulin
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Differentiate Type I & Type II
Assessment findings Lab & diagnostic tests (including prediabetes) : A1C – know normal
value and what constitutes DM, Glucose
Collaborative care/management & nursing interventions/management –
o Nutrition, medications (insulins and metformin)
o Know insulin – types and when to administer in terms of meals and when to
assess for hypoglycemia
o Symptoms and treatment of hypoglycemia
Acute complications
o Hyperglycemic hyperosmolar nonketotic coma (HHNC) and DKA (Diabetic
ketoacidosis)
 Priority treatment
Long term complications (all)
o Teaching for DM
o Tests important for individuals with DM to have annually : BP, creatinine, eye
exams, microalbuminuria and why?
Medications:
Focus on what meds are for, class of meds, adverse effects/contraindications and main nursing
interventions:
Atorvastatin (Lipitor) what time of day to take it and why? Adverse effects to teach patient?
Rhabdo..
Insulins
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how to give, what site is best, and why?
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long acting, NPH, Rapid and Short Acting Insulins – when is hypoglycemia likely
in each
TNK: Thrombolytic, giving IV to destroy clots (risk of bleeding is high so not used often)
Heparin - Nursing interventions and labs for therapeutic level
Nitroglycerin
Aspirin
Morphine
Prednisone/solumedrol
PTU
Metformin
Diltiazem/Cardiazen – various actions of this medication, adverse effects
Antihypertensive
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Calcium channel blockers
o Three primary effects: 1) Systemic vasodilation with
decreased SVR. 2) Decreased myocardial contractility, and
3) Coronary vasodilation
o Verapamil, Cardizem, Nifedipine
ACE Inhibitors
o Lisinopril
o Enalapril (most pril suffixes)
o Unique side effects
Angiotensin receptor blockers
o Losartan (most artan suffixes)
Beta blockers
o Metoprolol
o Propranolol (most lol suffixes)
Diuretics
o Furosemide
o Spironolactone
o Potassium sparing vs. potassium wasting
Medications:
Type/ Class
Adverse Effects
Nursing interventions
Statins –
Atorvastatin- “Lipitor”
 Lowers LDL &
cholesterol
 Given to patients w/
ACS & CAD
 Reduce risk of MI and
Stroke
Niacin
Headache, Confusion, Chest
pain, Constipation, Elevated
liver enzymes,
Hyperglycemia
Erectile dysfunction, Pruritis
Can cause flushing, pruritis,
GI symptoms, orthostatic
hypotension
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What time to take
Do not double up/
take as directed
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Assess liver function
test
Assess for muscle
pain
(rhabdomyolysis)

Avoid grape juice
Niacin – premedicate with
aspirin before (30 min)
Insulins – diabetes
Rapid acting “logs”
Lispro(humolog)
Aspart
Gluisine
**Give food within 15
minutes
Onset :10-30min
Peak: 30min-3hr
Duration: 3-5hr
Short acting
Humalin R
Novalin R
Onset: 30min-1hr
Peak: 2-5hr
Duration : 5-8hr
Intermediate
NPH
Long Acting
Glargine ( Lantus)
Given before meals
Goal: to achieve a nearnormal glucose level of 70 to
130 mg/dL before meals
Onset: 1.5-4hr
Peak : 4-12hr
Duration: 12-18hr
Onset : 0.8-4hr
Peak: NONE
Duration: 16-24hr
Metformin (Glucophage)
Diabetic med
Diarrhea, lactic acidosis
Taken with the biggest meal
of the day
Teach storage
Some cannot be mixed
Given subQ
Must be held for 1-2 days
before IV contrast media and
for 48hrs after
Monitor vitals, any bleeding,
neuro, monitor ECG
continuously
TNK
 Lysis of thrombi
Bleeding!!
Heparin
 Blood thinner
 VTE, PE, A-fib
prophylaxis
Rashes, urticaria, HIT,
anemia,
Assess for bleeding, monitor
aPTT and HCT prior to and
periodically
Aspirin
 pain relief and to
reduce fever
 reduces risk of MI &
stroke
 preventing blood clots
from forming
Gi irritation
Take with food, watch for
bleeding, bruising, black tarry
stools.
Morphine
 decrease pain
 reduce anxiety
Confusion, sedation,
dizziness, blurred vision,
respiratory depression
Monitor Respiratory
depression, safety
Prednisone/solumedrol
Levothyroxine
PTU

Beta blockers

slow heart rate and
lessen the force of
heart contraction
Fatigue, cold hands,
headache, erectile
dysfunction, dizziness,
constipation, hypotension


Metoprolol
Propranolol (most lol suffixes
Calcium channel blockers
Verapamil,
Cardizem,
Nifedipine
Hypotension, reduces HR,
contractibility and BP,
fatigue, dizziness, headaches
May mask
hypoglycemic
symptoms
Can trigger asthma
attacks
If heart rate lower
than 60 don’t give!
Can cause constipation and
digoxin toxicity
ACE Inhibitors
Lisinopril
Enalapril
(most pril
suffixes)
Unique side
effects
Dizziness , Headache ,
Drowsiness , Diarrhea, Low
blood pressure, Weakness,
Nonproductive, persistent
cough, Rash
Angiotensin receptor blockers hypotension , dizziness,
Losartan
fatigue, hyperkalemia,
(most artan
hypoglycemia
suffixes)


a potent
vasoconstrictor
used to
decrease blood
pressure
Diuretics
Furosemide
Spironolactone
Potassium sparing
vs. potassium
wasting
Other
Natrecor- for acute or severe
heart failure
Blurred vision, dizziness,
headache, hypotension, dry
mouth
• NSAIDs may increase the
effect of ACEIs
• ACEIs may increase
potassium levels
• If the patient takes lithium,
ACEIs may raise blood levels
of lithium
• ACEIs may cause
photosensitivity
Have blood pressure checked
regularly
Rise slowly from sitting
Avoid situations that reduce
blood pressure such as
dehydration, excessive
sweating Continue the
medication even though you
feel well - Refrain from
taking potassium supplements
unless ordered by the
provider
Monitor daily weight, lung
sounds, weakness, I&O
NEEDS EXTREME
MONITORING
,
Digoxin – For heart failure
Monitoring for vision
disturbances ( yellowing of
eye vision) can indicate
toxicity