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ATI MedSurge Cardiac
Terms in this set (155)
Cardiac enzyme expected Range: <.2ng/L
Elevated indicates myocardial injury, detectable within 3-5hrs for 14-21 days. Most specific marker for MI.
Cardiac enzyme expected Range: <0.03ng/L
Elevated indicates myocardial injury, detectable within 3hrs for 7-10 days.
Cardiac enzyme expected Range: <90 mcg/L
Elevated level indicates myocardial injury. Detected earliest at 2 hours for 24 hours.
Creatine kinase MB
Cardiac enzyme expected Range: 30-170 units/L
Elevated levels indicate myocardial injury. Detectable by 4-6hrs for 3 days.
Screens for heart disease
Expected reference range: < 200mg/dL
"Good Cholesterol" produced by liver
Males: 35-65 mg/dL
< 130 mg/dL
Evaluation test for atherosclerosis
Males: 40-160 mg/dL
Females: 35-135 mg/dL
Elderly (65+): 55-22mg/dL
Ultrasound. Non invasive (up to 1 hour) heart test where patient lays on left side & remains still used to:
Diagnose valve disorders & cardiomyopathy. Used when signs of cardiomypathy, heart failure, angina, MI exist.
Test gives insight on the workload of heart by client walking on a treadmill until heart rate reaches a certain rate. Used on patients with: angina, heart failure, MI, dysrhythmia. Pt. is monitored with 12 lead EKG & with frequent BP checks.
Pharmacological Stress Testing
Stress test used when patient cannot complete a physical stress test and medication is given instead to stress & test the heart. Adenosine (Adenocard) & dobutamine (Dobutrex) is given. Pt. is monitored with 12 lead EKG & with frequent BP checks.
Prior to Stress Testing patient should avoid:
Before test avoid:
Eating for 2-4 hours prior
Caffeine, Tobacco, Alcohol
Use of special indwelling catheters obtain info on pt.:
Blood volume/ Cardiac Output
Heart functioning status
Arterial lines for hemodynamic monitoring are placed in the radial (most common), brachial or femoral artery. What should you Monitor for?
Monitor circulation in the limb with the arterial line. Such as capillary refill, temperature, color.
Arterial lines are NOT used for IV fluid administration, they provide continuous data on blood pressure changes, allow withdrawal of arterial blood for samples.
The pulmonary artery (PA) catheter is inserted into a large vein (internal jugular, femoral, subclavian, brachial) and threaded through the right atria and ventricles into a branch of the pulmonary artery. PA catheters have multiple lumens, ports and components that:
allow for various hemodynamic measurements, blood sampling and infusion of IV fluids.
Proximal (CVP) lumen of PA= hemodynamic monitoring & IV fluid administration.
Distal lumen of PA = hemodynamic monitoring & collection of blood samples. NOT used for fluid administration!
CVP (Central venous pressure) in Right atria expected reference range
pulmonary artery systolic (PAS) expected reference range
pulmonary artery diastolic (PAS) expected reference range
pulmonary artery wedge pressure (PAWP) expected range
expected range for cardiac output
Mixed venous oxygen saturation (SvO2)
What patient should a nurse anticipate lower hemodynamic values in?
Elderly, especially if dehydrated.
What position should the patient be in when inserting a pulmonary arterial line/catheter for hemodynamic monitoring?
Trendelenburg or supine
Hemodynamic Monitoring System includes:
Pressure transducer (placed @ plebostatic axis -4th ICS/midaxillary line) which corresponds to R atria
Pressure bag & flush device
Air needs to be purged from system & sterility of connections is needed. Zero system with atomospheric pressure, so it reads zero at atmospheric pressure. Should have pt. with HOB at 45 degree during reading.
What are post procedure nursing interventions for hemodynamic monitoring
1. Obtain chest x-ray to confirm catheter placement
2. Continually monitor vitals
3. Compare noninvasive BP to arterial blood pressure
4. Observe/document waveforms, report changes in waveforms to MD (possible sign of catheter displacement)
5. Document catheter placement each shift and as needed
6. Place the patient in supine position prior to recording hemodynamic values ( HOB can be elevated 15° to 30°)
Complications of hemodynamic monitoring
Infection/Sepsis (look out for inc. WBC or temp)
Embolism- plaque/clot can be dislodged during procedure
Nurse should: Use NS to flush system
Pneumothorax risk with insertion of the line
Dysrhythmias with insertion/movement of line
Coronary angiography (cardiac catherization)
Invasive diagnostic test used to evaluate presence and degree of coronary artery blockage. Involves insertion of catheter in femoral or brachial vessel threaded into heart. Contrast media is injected to visualize locations of narrowing/occlusions under fluoroscopy.
Investigative tool for unstable angina, ECG changes (T wave inversion, ST elevation/depression).
Note: can also be done on lower extremities to determine blood flow and areas of blockage.
What are nursing actions preprocedure before an angiography?
1. Patient is NPO for at least eight hours before
2. Assess for iodine/shellfish allergy
3. Assess renal function (before contrast dye introduced)
4. Teach client that affected leg must remain straight post procedure. May feel flushed or warmth when contrast dye is inserted.
5. Administer meds as prescribed (ex. benedryl, methylprednisone)
6. Other usual stuff like ensure informed consent, etc
What are post procedure nursing interventions for an angiography ?
1. Assess vitals q 15 minutes for 1 hour, q 30 minutes for 1 hour, q hour for 4 hours and then every four hours
2. Assess site for bleeding, hematoma, and thrombosis (check pedal pulse, color temperature) with every vital sign check
3. Bed rest after with extremity straight for prescribed time
4. Monitor urine output & administer IV fluids for hydration (contrast media acts as an osmotic diuretic)
5.Administer antiplatelet as prescribed to prevent clot formation
Why does a pt. need to stay still post angiography?
Too much activity places pt. at higher risk for bleeding at insertion site.
How long do patients receive anticoagulation therapy that have stent placement?
What is cardiac tamponade?
Fluid accumulation in pericardial sac. A potential complication of angiography.
S/S of cardiac tamponade:
Muffled heart sounds
Paradoxical pulse (variance of 10mmHg or more in systolic pressure bw expiration & inspiration)
What are nursing actions for cardiac tamponade?
1. Notify MD immediately
2. Administer IV fluids to combat hypotension as prescribed
3. Obtain chest x-ray or echocardiogram to confirm diagnosis
4. Prepare client for pericardiocentesis
What is restenosis of blood vessel?
The recurrence of stenosis, a narrowing of a blood vessel, leading to restricted blood flow.
Bleeding into the abdominal cavity behind the peritoneum can occur due to femoral artery puncture (after an angiography)
What are nursing actions for retroperitoneal bleeding?
1. Assess for flank pain and hypotension
2. Notify MD immediately
3. Administer IV fluids and blood products as prescribed
What are central catheter's appropriate for?
Any fluids due to rapid hemodilution in the superior vena cava.
Nontunneled percutaneous central catheter
Short Term use only to administer blood, & meds
What is post procedure 'care' for a PICC line?
1. X-Ray to verify proper placement of central catheter
2. Initial dressing of gauze replaced with transparent dressing within 24 hours, after that q 7 days unless needed sooner
3. Assess site at least q 8 hours. Note redness, swelling, drainage, tenderness, & dressing condition
4. Change tube & positive pressure cap per facility protocol
5. Use 10mL or larger syringe to flush the line
6. Clean insertion port with alcohol for 3 seconds & allow to dry prior to accessing it
7. Perform flush for intermittent meds, usually 10mL of NS before, between and after med admin.
8. Obtain blood samples by withdrawing 10 mL of blood & discarding, take 2nd syringe & withdraw 10 mL of blood for sample, take 3rd syringe & flush with 10 mL of NS
9. Cannot immerse arm in water. Can shower but needs to cover dressing site to avoid water exposure.
10. Do not take BP on arm with PICC
What should you do if there's an occlusion in the access device that impedes flow?
1. Flush line at least q 12 hours to maintain patency (3 mL for peripheral & 10 mL for central lines)
2. Administer urokinase to lyse obstructions per facility protocol
3. Flush implanted port after every use and at least once a month while implanted
What are nursing actions for a catheter thrombosis/emboli?
1. Flush line per facility protocol
2. Do NOT force fluid if resistance is encountered (may dislogde thrombosis)
3. Use a 10 mL or larger syringe to avoid excessive pressure
What is treatment for infiltration (leakage into surrounding subcutaneous tissue) and extravasation (infiltration of a medication that causes tissue damage)?
1. Remove using direct pressure with gauze sponge until bleeding stops
2. Apply cool compress
3. Elevation is optional
4. Avoid starting a new IV site in the same extremity
What are nursing interventions to prevent an air embolism in a vascular access device?
1. Leave central lines clamped when not in use
2. Have patient hold breath while the tubing is changed
3. If pt. has sudden SOB, place in Trendelenburg on left side, give oxygen & notify MD
What are nursing interventions to prevent accidental dislodgment of a catheter?
1. Cover extremity site with stretch netting
2. Wrap a washcloth folded into thirds around pt. arm before applying needed restraint
3. When removing the dressing, pull from distal to proximal
Abnormal enlargement of right side of heart as a result of disease of the lungs or the pulmonary blood vessels indicated by elevated hemodynamic levels.
What are medications/electrical management for bradycardia?
1. Atropine and isoproterenol (antiarrhythmic and bronchodilator)
*Only treat if pt. is symptomatic
What are medications/electrical management for a fib, SVT or VT with pulse?
1. Amiodarone, adenosine, verapamil (CCB)
2. Synchronized cardioversion
What are medications/electrical management for VT without a pulse or ventricular fibrillation
1. Amiodarone, lidocaine and epinephrine
What is cardioversion ?
Delivery of direct countershock to the heart synchronized to the QRS complex.
What is defibrillation?
Delivery of an unsynchronized, direct countershock to the heart. Stops all electrical activity of the heart, allowing the SA node to take over and reestablish a perfusing rhythm
Cardioversion requires activation of what prior to charging machine?
Synchronizer button. Allows shock to be in sync with pt. rhythm.
What is held 48 hours prior to elective cardioversion ?
Possible complications of Cardioversion:
Dislodge blood clots --> PE, CVA, or MI
Decreased CO & Heart failure (cardioverting may damage heart tissue, impairing heart function)
Pulmonary Embolism S/S include:
Dyspnea, chest pain, air hunger, decreased SaO2
CVA S/S include:
Decreased LOC, slurred speech, muscle weakness/paralysis
MI S/S include:
Chest pain, ST segment elevation/depression, Anxiety, Nausea, dizziness, pallor, cool clammy skin, tachycardia, heart palpitations, diaphoresis, vomiting, decreased LOC
Pt. is at risk for dysrhthmias if they have:
Kidney failure, liver or lung Dx
What is an arthrectomy?
(Hint: type of PCI=percutaneous coronary intervention)
Used to break up and remove plaques within cardiac vessels
What is a stent?
(Hint: type of PCI=percutaneous coronary intervention)
Placement of a mesh-wire device to hold an artery open and prevent restenosis
Percutaneous transluminal coronary angioplasty (PTCA)
Hint: Type of PCI
Involves inflating a balloon to dilate the arterial lumen and the adhering plaque, therefore widening the arterial lumen
What is a PCI?
nonsurgical procedure performed to open coronary arteries by:
atherectomy, stent, angioplasty
Indications for PCI
Coronary artery dx if 50%+ occlusion of 1 or 2 coronary arteries & area of occulsion is confined (not scattered) & easy to access (proximal)
To reduce ishcemia (most effective w/i 90 min of angina)
alternative to coronary artery bypass graft
To prevent reocclusion & to dilate left main coronary artery
What are preprocedure nursing actions for a PCI (besides informed consent, typical preprocedure agenda)
1. NPO at least eight hours if possible
2. Assess renal function prior to introduction of contrast dye
3. Check for shellfish allergy (d/t contrast dye used)
4. Administer antiplatelet medications as prescribed
What are two medications that are administered during the intraprocedure for PCI?
Sedative= Versed & Analgesia= Fentanyl
What is post procedure nursing actions after a PCI?
1. Assess vitals every 15 minutes for one hour, every 30 minutes for one hour, every hour for four hours and then every four hours.
2. Assess the groin site at the same intervals for bleeding and hematoma formation
3. Assess for signs of thrombosis
4. Maintain bed rest in a supine position with the leg straight for 4 to 6 hours ( or prescribed time)
5. Monitor urine output & administer IV fluids for hydration (contrast dye acts as osmotic diuretic)
Perforation of an artery by the catheter may cause _______.
What are clinical manifestations of anaphylaxis?
What are two medications that might be prescribed in the event of anaphylaxis?
Diphenhydramine &/or epinephrine
Coronary Artery bypass grafting (CABG)
An invasive surgical procedure that aims to restore vascularization of the myocardium by bypassing an obstruction in one or more of the coronary arteries.
A coronary artery bypass graft is most effective when a patient has sufficient ventricular function such as an EF greater then:
40-50% ejection fraction
What are preprocedure medications for a CABG?
1. Anxiolytics: (ex. lorazepam and diazepam)
2. Prophylactic antibiotics
3. Anticholinergic (ex. scopolamine) to reduce secretions
What are some important preprocedure teachings for a patient that is going to undergo a CABG?
1. Endotracheal tube and mechanical ventilator for airway management for several hours following the surgery
2. Inability to talk while endotracheal tube is in place
3. Sternal incision and possible leg incision
4. 1 to 2 mediastinal chest tubes
5. Indwelling urinary catheter
6. Pacemaker wires
7. Hemodynamic monitoring devices
8. Instruct pt. to d/c: diuretics 2-3 days prior & anticoagulants 1 week before surgery
Post procedure: what should you do with the patient within two hours following extubation?
Dangle & turn client from side to side as tolerated
What should you do within 24 hours after CABG?
Assist the patient to a chair & ambulate the patient 25-100 feet by first postoperative day.
During CABG surgery & the cardiopulmonary bypass machine:
-Demand for oxygen is lowered with cardiopulmonary bypass machine (& metabolism lowered)
-Motion of heart temporarily ceases to allow for placement of graft
-Core body temp is lowered for procedure & rewarming occurs through heat exchanges on cardiopulmonary bypass machine.
-Blood flow to the heart is maintained by the action of cardiopulmonary bypass machine
Post CABG: Monitor chest tube patency and drainage. Measure drainage at least once an hour. Volume exceeding ________ could be a sign of possible hemorrhage and should be reported to the surgeon!
After CABG surgery patient activity should involve:
Stay home first week after surgery & resume normal activities slowly.
Week 2: Possible return to work part time
Week 3: lift up to 15lbs, avoid heavier lifting for 6-8wks
Treatment of cardiac tamponade after a CABG involves:
1. Volume expansion
2. Emergency sternotomy (Pericardiocentesis is avoided because blood may have clotted)
What is maximum potassium administration rate IV ?
10 to 20 mEq/hour
Peripheral Bypass Graft
Involves suturing of graft to veins proximal & distal to occluded area of an artery to improve blood flow supply to area normally served by blocked artery.
How long should a patient remain NPO before a peripheral bypass graft?
Peripheral Artery Dx (PAD) indication for peripheral bypass graft:
Numbness or burning pain to lower extremity with exercise, may stop with rest --> Intermittent claudication
Claudication at rest & night. Awakens client at night. Pain may be relieved by LOWERING extremity below level of heart.
Decreased or absent pulses to feet. Dry, hairless, shiny skin on calves. Muscle atrophy if advanced stage. Feet & toes may be mottled & dusky, toenails thick.
What are diagnostic tests for PAD?
Arteriography: involves arterial injection of contrast media to visualize blood flow.
Exercise tolerance test
Plethymography: decrease in pulse pressure in lower extremity indicate possible blockage.
Segmental systolic BP measurements using doppler probe
Teaching points for pt. with PAD:
Encourage exercise with gradual increases as tolerated to promote circulation
Avoid crossing of legs to avoid swelling
Don't elevate legs above level of heart
Discourage cold temps
Discourage smoking, & stress
What are nursing actions for arteriography?
1. Observe for bleeding and hemorrhage
2. Palpate pedal pulses to identify possible occlusions
What are two client teaching points for a peripheral bypass graft?
1. Advise the patient not to cross legs
2. Explain that pedal pulses will be checked frequently
What are post procedure nursing interventions for a peripheral bypass graft?
1. Assess vitals every 15 minutes for one hour and then every hour after the first hour
2. Administer anticoagulant therapy/antiplatelet therapy
3. Maintain bed rest for 18 to 24 hours. The leg should be kept straight during this time
The graft may occlude due to reduced blood flow and clot formation. This occurs primarily in the first _______.
24 hours post-op
What is the treatment for graft occlusion?
Thrombectomy or thrombolytic therapy
surgical procedures for PAD
Percutaneous transluminal angioplasty
Laser assisted angioplasty
peripheral bypass graft
What is compartment syndrome?
Pressure from tissue swelling or bleeding within a compartment or a restricted space causing reduced blood flow to the area. If untreated can lead to tissue necrosis.
What procedure is used for compartment syndrome?
A nurse is caring for a client who is 4 hr postop following peripheral bypass graft surgery of left lower extremity. Which finding pose an immediate concern?
A. Trace of bloody drainage on dressing
B. Capillary refill of affected limb of 6 seconds
C. Mottled appearance of limb
D. Throbbing pain of affected limb that is decreased following IV bolus analgesic
E. Pulse of 2+ in affected limb
All others are expected findings.
Mottled skin refers to blood vessel changes in the skin that cause a patchy appearance.
What are physical assessment findings for peripheral artery disease?
1. Bruit over femoral and aortic artery's
2. Decreased capillary refill of toes
3. Decreased or non-palpable pulses
4. Loss hair on lower calf, ankle and foot
5. Dry, scaly, mottled skin
6. Thick toenails
7. Cold/cyanotic extremity
8. Pallor of extremity with elevation
9. Dependent Rubor
10. Muscle atrophy
11. Ulcers and possible gangrene
Patient complains of chest pain. What does the patient's ECG with an ST depression or T wave inversion indicate?
Presence of ischemia
What does ST-segment elevation indicate?
An abnormal Q wave post MI indicates _________.
What is thallium scan used for?
To assess for ischemia or necrosis. Radioisotopes can't reach areas with decreased or absent perfusion, so these areas appear as cold spots on the scan.
What should the nurse advise the patient to avoid prior to thallium scan?
Avoid smoking & consumption of caffeine 4 hours before
MI vs. Angina
MI: Can occur without cause, chest pain last more than 30 min, with nausea, dyspnea, anxiety, diaphoresis.
Angina: Precipitated by exertion/stress, relieved by rest or nitroglycerin & pain lasts less than 15 minutes. Not associated with other MI s/s (nausea, dyspnea, etc.)
MONA for pt. with MI
Oxygen administration (2-4L/min unless c/i)
Vasodilator that prevents coronary artery vasospasms & reduces myocardial O2 demand.
Helps treat angina & help control BP.
What are nursing considerations when giving Nitrogylcerin?
Use cautiously with other antiHTN meds.
Vasodilators can cause orthostatic hypotension
Teaching points for pt. taking Nitroglycerin for chest pain.
Stop activity & rest
Place nitroglycerin tablet under tongue for quick absorption
If pain unrelieved w/in 5 min call 911 or be driven to Emergency dpt.
Can take 2 more doses at 5 minute intervals
Headache is common side effect
Opioid analgesic to treat pain. Acts on mu & kappa receptors to alleviate pain.
respiratory depression (if R<12, stop med & notify MD stat)
decrease GI motility.
Client is only person who should push med admin button.
Beta blockers for MI
Decrease infarct size & improve short & longterm survival rates. ex) Lopressor
AntiHTN & antidysrhtmic that slows down HR & reduces oxygen demand of heart.
Avoid if pt. has asthma.
Hold med if HR<60/min & notify MD
Thrombolytic agents for MI patient:
Used to break up blood clots. Ex: Streptase or Activase
For best results give within 6 hours of infarct.
similar side effects as antiplatelets
PREVENTs clotting from platelet aggregation & vasoconstriction
ex: Aspirin & or Plavix
Note: Tinnitus (ringing in ear can be sign of aspirin toxicity)
Anticoagulants for MI
Heparin & Lovenox
check aPTT daily- over 70 sec = high risk for bleeding
Antidote= protamine sulfate
Heparin Induced thrombocytopenia
platelet count < 150,000
PT & INR (2.0-3.0 is therapeutic)
Warfarin antidote: Vitamin K
Class I of heart failure
(based on NY Heart Association scale)
Exhibits no symptoms with activity
Class II heart failure
Symptoms with ordinary exertion
Class III heart failure
Symptoms with minimal exertion
Class IV heart failure
Symptoms at rest
Left sided Heart failure
Crackles, cough, dysnpea, noturnal dyspnea, fatigue, hypertrophy, S3 heart gallop, frothy sputum, altered mental status, organ failure signs (ex. oliguria)
Left= L = think lungs
Right sided Heart failure
JVD, weight gain, Edema, ascites, fatigue, polyuria at rest, hepatomegaly
Lab Tests for heart failure
BNP > 100 & dyspnea = heart failure
Increase contractility & Cardiac Output
Increases contractility & decreases HR
Do not take at same time with antacids (digoxin is an acidic drug, so antacid will cancel out effect), give 2 hour time difference
Used to treat acute heart failure by promoting loss of Na & vasodilation.
IV medication, not compatible with heparin, use separate IV.
Immunosupressant required post transplant to prevent rejection
Pulmonary Edema S/S
Cough & pink, frothy sputum (cardinal sign)
tachypnea, dyspnea, orthopnea
Reduced urine output
cyanosis (later stage)
Note: Acute pulmonary edema is life threatening emergency
Response to acute pulmonary edema should include:
Place pt. in high fowlers
Oxygen, positive airway pressure &/or intubation with mechanical ventilation
Weight gain of _______ or more in 1 day should be reported esp. if pt. suffers from heart failure or pulmonary edema.
or 5lbs in 1 week
Serious complication of pump failure common after MI or 40%+ left ventricle injury
S/S: tachycardia, hypotension, low urine output, altered LOC, respiratory distress (crackles & tachypnea), cool, clammy skin, decreased peripheral pulses, chest pain
lab to monitor kidney function
percutaneous baloon valvuloplasty
Procedure to open aortic or mitral valves affected by stenosis. Catheter inserted via femoral artery, advanced to heart where balloon is inflated at stenosis to open fused commissures & improve leaflet mobility. Usually indicated for elderly when s/s affect their ADLs.
What are risk factors for peripheral venous disease?
1. Venus thromboembolism associated with Virchow triad
2. Hip surgery, total knee replacement, open prostate surgery
3. Heart failure
6. Oral contraceptives
7. Family history
Patients with venous disease most often complain of limb pain described as:
Aching pain and feeling of fullness or heaviness in the legs after standing
What are signs of DVT and thrombophlebitis ?
Calf or groin pain, tenderness, sudden edema in extremity, warmth, induration & hardness over involved blood vessel,
SOB, chest pain (may indicate --> PE!)
What are signs of Venous insufficiency?
1. Stasis dermatitis is a brown discoloration on the ankles that extends at the calf relative to the level of insufficiency
3. Stasis ulcers ( typically found around ankles)
What are clinical manifestation of varicose veins?
1. Distended, superficial veins that are visible just below the skin and are torturous in nature
2. Patients often report muscle cramping and aches, pain after sitting and pruritus
What are laboratory tests for PVD?
D dimer test measures fibrin degradation products present in blood from fibrinolysis. A positive test indicates thrombus formation has possibly occurred.
What are diagnostic procedures for DVT and thrombophlebitis?
1. Venus duplex ultrasonography
2. Impedance plethysmography
3. If above tests are negative for DVT, but one is still suspected, a venogram with contrast material or MRI may be needed for accurate diagnosis
For varicose veins Trendelenburg test is used. What are the nursing actions for this test?
1. Place patient in supine with legs elevated
2. When patient sits up, veins will fill from the proximal end if varicosities are present
When patient has DVT or thrombophlebitis the nures should teach client to:
Elevate extremity above level of heart as prescribed
Not massage affected limb
apply thigh high compression stocks
If venous insufficiency client should:
Elevate legs several x day for 15-30 min at least
Elevate feet 6in at night
Avoid crossing legs
Wear elastic compression stockings after elevation of legs when legs are least swollen
How long does it take for warfarin to take affect?
Other warfarin nursing considerations:
PT- 11-12.5 sec
If excess bleeding use Antidote= Vitamin K.
Used to treat PAD by reducing viscosity of blood & increasing blood flow in extremities.
Note: Notable effects may take several weeks.
What are patient teachings for patients that have venous ulcers (diet and DVT prevention)?
1. Recommend a diet high in:
zinc, protein, iron and vitamins A & C
2. Instruct pt. on compression stockings use
What kind of juice should not be taken with CCB medications?
Grapefruit juice (increases effects of CCB - increasing risk for hypotension)
ACE inhibitors Teaching points
Report cough, esp. if persistent as sign should be discontinued & occasional relationship to angioedema (swelling of tissues in throat)
What are two side effects of ARBs?
Angioedema & hyperkalemia
Aldosterone receptor antagonists
Block aldosterone action = promote excretion of sodium and water, retain K+
side effect: Hypertriglyceridemia
Diabetes & HTN Medication considerations
Metoprolol (Lopressor) can mask the effects of hypoglycemia.
Central alpha agonists
clonidine (catapres) reduce vascular resistance & BP by inhibiting reuptake of norepiniphrine
BP greater than 240/120+
From embolus traveling from another part of the body to a cerebral artery cutting off blood to brain causing immediate neuro effects. May be reversed with rtPA (Retavase) thrombolytic therapy if given within 4.5 hours of initial symptoms.
Left cerebral hemisphere stroke symptoms include:
aphasia (expressive & receptive)
agnosia (inability to recognize familiar objects)
Alexia (reading difficulty)
agraphia (writing difficulty)
Rt. hemiplegia / hemiparesis
Slow cautious behavior
Note: Left brain responsible for language, analytical thinking & math
Right cerebral hemisphere stroke s/s:
Altered perception of deficits
Left sided neglect syndrome
Loss of depth perception
Poor impulse control & judgment
Left hemiplegia / hemiparesis
Note: Right brain responsible for visual, spatial awareness & proprioception
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