Exam #2 (Cardiovascular/Respiratory)

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What are the two ways drugs can bind?
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What do most Cholinergic drugs effect?-GI -Bladder -EyeWhat is the Agrenergic receptor function of Alpha-1?-Ocular--> Mydriasis -Blood Vessels--> VasoconstrictionWhat is the Agrenergic receptor function of Alpha-2?-Inhibits the release of NorepinephrineWhat is the Agrenergic receptor function of Beta-1?-Heart= Increase in contraction, HR, and conductivity -Kidney= Stimulate the release of ReninWhat is the Agrenergic receptor function of Beta-2?Arterioles in the heart, lungs, and skeletal muscles-->VasodilationWhat is the function of Dopamine receptors?-Dilation of renal arteries, which enhances renal perfusionWhat are the two functions of the circulatory system?-Delivery of oxygen -Removal of Carbon dioxideWhat are the components of the circulatory system?Arteries Arterioles Capillaries Venules Veins Chambers of the heartWhat makes blood return to the RIGHT side of the heart?-Negative pressure -Venous valves -Muscle contractionHow is cardiac output calculated?stroke volume x heart rateWhat is Stroke Volume?Amount of blood ejected by the heart with each contractionWhat is Preload?Amount of tension applied to the muscle before each contractionWhat is Afterload?Load against which the heart must contract to eject bloodHow is arterial pressure regulated?-Autonomic nervous system -Renin-angiotensin system -KidneysWhat is the Baroreceptor reflex?-Constriction of nearly all arterioles -Constriction of veins -Acceleration of heart rateWhat are some risk factors for PRIMARY hypertension?-Age -Cigarette smoking -Diabetes mellitus -Family history -EthnicityWhat is secondary hypertension?There is an underlying identifiable cause causing the hypertensionWhat peptide is Obesity HTN linked to?LeptinWhat occurs when there's an altered Renin-Angiotensin mechanism?High plasma renin activityWhat are some consequences of HTN?-HF -Stroke -End organ damageWhat are some diagnostic tests for HTN?-Urine analysis -Echocardiogram -BUNWhat are some lifestyle modifications for HTN?-Sodium retention -DASH diet -Alcohol restriction -Aerobic exercise -Smoking cessationHow is arterial pressure calculated?cardiac output x systemic vascular resistanceWhat are the classes of antihypertensive drugs?-Diuretics -Sympatholytics (antiadrenergic drugs)What is a hypertensive crisis?-Sever increase in BP where the diastolic exceeds 120What are some clinical manifestations of hypertensive crisis?Hypertensive emergency= evidence of acute End Organ DamageWhat are some drugs for hypertensive crisis?-Sodium nitroprusside (Nipride) -Labetalol (Trandate)What is Heart Failure?-An abnormal condition involving impaired cardiac pumping and/or filling -It's a SYNDROMEHow is HF characterized?-Left ventricular dysfunction -Reduced exercise tolerance -Diminished quality of life -Shortened life expectancyIs HF a disease or a syndrome?SyndromeWhat is HF associated with?-Long standing HTN -Coronary Artery Disease (CAD) -Myocardial Infarction (MI)What is the PRIMARY risk factors of HF?-Coronary artery disease (CAD)What is the CONTRIBUTING risk factor of HF?-HTN -Diabetes -Tobacco use -ObesityWhat is a hallmark finding with systolic failure?Decrease in left ventricular ejection fraction (EF)What is the main issue with compensatory mechanisms?Over time, they are detrimental as they, increase the workload of the failing myocardium and need for oxygenWhat are the two types of HF?-Systolic OR HFrEF (Heart Failure w/ Reduced Ejection Fraction) -Diastolic OR HFpEF (Heart Failure w/ Preserved Ejection FractionWhat is HFrEF?-Enlarged LV chamber with an "ineffective "squeeze" -Reduced left ventricular ejection fraction (LVEF)What do Natriuretic peptides do?-Promote vein AND artery vasodilation, which reduces preload AND afterload -Enhances diuresis -Blocks effects of RAASWhat does Nitric oxide (NO) do?Relaxes arterial smooth muscle, resulting in vasodilation and decreased preloadHow does vasodilation decreases pre and afterload?Vasodilation causes BP to decreases which causes afterload to decrease because it's easier to pump blood forward so your ejection fraction (EF) increasesWhat is Left-Sided HF?Left-sided HF (most common) from left ventricular dysfunction (e.g., MI hypertension, CAD, cardiomyopathy) Backup of blood into the left atrium and pulmonary veins Pulmonary congestion EdemaWhat is the result of Right-Sided HF?Backup of blood into the right atrium and venous systemic circulation leading to peripheral edemaWhat is JVD?Jugular vein distentionWhat are some EARLY signs of pulmonary edema?-Increase in RR -Decrease in PaCO2What are some LATE signs of pulmonary edema?-Tachypnea -Respiratory acidosisWhat are some clinical manifestation of Acute Decompensated HF?-Use of accessory muscles -Cyanosis -Cool and clay skin -Pink, blood-tinged sputumIf a patient is still perfusing, will their skin be warm and dry or wet and cold?Warm and dryIs a patient is no longer perfusing, will their skin be warm and dry or wet and cold?Wet and coldWhat are some clinical manifestations of Chronic HF?-Fatigue -Persistent, dry cough -Dependent edema -Nocturia -Dusky, cool, and damp skin -Chest pain -Weight changesWhy would a patient with Chronic HF be fatigued?A low delivery of oxygen to the brainWhat are some complications of HF?-Pleural effusion -Atrial fibrilation -Renal insufficiency/failureWhat are some cardiac markers?-When BNP levels are below 100= NO HF -When BNP levels are above 900= Sever HFWhat medications manage ADHF when decreasing intravascular volume?Loop diuretics (furosemide)What medications manage ADHF when decreasing venous return (preload)IV NitroglycerinWhat is the pharmacological management of ADHF?Decrease preloadWhat is the best position for a patient with ADHF?Sitting up because they can't breatheWhat are your Inotropic therapies when managing ADHF?-Digitalis -B-Adrenergic agonists (dopamine)What are the main treatment goals for Chronic HF?-Treat underlying cause -Maximize CO -Improve ventricular function -Improve quality of life -Preserve target organ functionWhat is the NEW drug for HF?Sacubitril/Valsartan (Entresto)What are some ways to manage Chronic HF?-Oxygen administration -Physical and emotional restWhat are the therapeutic goals of Chronic HF?-Correction of sodium and water retention and volume overload -Reduction of cardiac workloadWhat drugs can be used for Chronic HF?-ACE inhibitors -Angiotensin II receptor blockers -B-Adrenergic blockersWhat population is BiDil approved for?BiDilA patient diagnosed with heart failure has a history of diabetes and asthma. Which medication, if ordered by the health care provider, should the nurse question? A. Angiotensin-converting enzyme inhibitor B. Calcium channel blocker C. Thiazide diuretic D. Beta blockerD. Beta blockerWhat is the most POTENT angiotensin?Angiotensin IIWhat are the actions of Aldosterone?Regulation of blood volume and BPHow is Angiotensin II formed?It is formed from angiotensin I by angiotensin-converting enzyme (ACE)What do ACE inhibitors do?Block conversion of angiotensin I to angiotensin IIWhat are the therapeutic uses of ACE inhibitors?-Hypertension (HTN) -Heart failure (HF) -Myocardial infarction (MI) -Diabetic and nondiabetic nephropathyWhat are the adverse effects of ACE inhibitors?-Hypotension -Dry cough -Hyperkalemia -Renal failure -Dysgeusia and rashWhat are some drug interactions with ACE inhibitors?-Diuretics -Drugs that increase levels of K+ -LithiumWhat two drugs CANNOT be given with meals?Captopril and MoexprilWhat are the mechanisms of action of Angiotensin II Receptor Blockers (ARBs)?-Block access of angiotensin II -Causes dilation of arteries AND veins -Increase renal excretion of Na+ and H2OWhat is a patient less likely to complain of with ARBs?CoughWhat are the therapeutic uses of ARBs?-Hypertension -Heart failure -Diabetic nephropathy -MI -Stroke prevention -May prevent development of Diabetic retinopathyWhat are the adverse effects of ARBs?-Angioedema -Fetal harm -Renal failureWhat is an Aldosterone Antagonist?Spironolactone (Aldactone)What is the mechanism of action of Spironolactone?Blocks aldosterone receptorsWhat are the therapeutic uses of Spironolactone?-Hypertension -Heart failureWhat is the adverse effect of Spironolactone?HyperkalemiaWhat are the stages of hemostasis?-Vascular spasm -Platelet plug formation -CoagulationWhat are the types of Thrombosis?-Coronary Artery Thrombus -Venous Thromboembolism in deep veinsWhat are the drug groups for Thromboembolic disorders?-Anticoagulants -Antiplatelets -ThrombolyticsWhat do anticoagulants do?Disrupts the coagulation cascade, thereby suppressing the production of fibrinWhat do antiplatelets do?inhibit platelet aggregationWhat do thombolytics do?Promote lysis of fibrin. causing dissolution of thrombiWhat drug affects Prothrombin?WarfarinWhat drug affects Thrombin?HeparinHow is Heparin administered?IV or SubQWhat are the therapeutic uses of Heparin?-Pulmonary embolism -Stroke evolving -Massive Deep Vein Thrombosis (DVT)What is the adverse effects of Heparin?-HemorrhageWhat are the contraindications of Heparin?-Thombocytopenia -Uncontrolled bleeding -During and immediately after surgery of the spinal cordWhat is the antidote for heparin?Protamine sulfateWhat is the normal aPTT?30-40 secondsWhat is the normal PTT?60-70 secondsWhat are the therapeutic uses of Low-Molecular Weight Heparin?-Prevention of DVT after surgery -Prevention of ischemic complicationWhat are some adverse effects of Low-Molecular Weight Heparin?-Bleeding -Severe neurologic injury from patients undergoing spinal puncture or spinal-epidural anesthesiaWhat is the ORAL anticoagulant?Warfarin (Coumadin)What is an antagonist for Warfarin?Vitamin KWhat are the therapeutic uses of Warfarin?-Not useful in emergencies because it has a delayed therapeutic effect of 5-7 daysWhat should you monitor for Warfarin?-International normalized ratio (INR) -Normal= 1.0What are the adverse effects of Warfarin?-HemorrhageWhat is the onset of Heparin?ImmediateWhat is the lab to be monitored for Heparin?aPTT and PTTWhat is the onset of Warfarin?SlowWhat is the lab to be monitored with Warfarin?PT and INRWhat is the prodrug for Direct Thrombin Inhibitors?DibigatranWhat is the advantage of Dibigatran?No labs are required for the monitoring of anticoagulationWhat are the therapeutic uses of Direct Thrombin Inhibitors?-Atrial Fibrillation -Pulmonary embolism -DVTWhat is the antidote for Direct Thrombin Inhibitors?idarucizumab (Praxbind)What is the main inhibitor for Direct Factor Xa?Rivaroxaban (Xarelto)What is the therapeutic uses of Rivaroxaban?-Prevention of DVT and PE after a total knee/hip replacement surgery -Prevention of a stroke in patients with A-FibWhat are the Antiplatelet drugs?-Aspirin (ASA) -Clopidogrel (Plavix)What are the adverse effects of Aspirin and Clopidogrel?Increase risk for GI bleedingWhat are the therapeutic uses of Aspirin?-Ischemic stroke -Acute MIWhat is the adverse effects of Aspirin?-BleedingWhat are the therapeutic uses of Clopidogrel?Prevents blockage of Coronary Artery stentsWhat is the adverse effects of Clopidogrel?-BleedingWhat are the most EFFECTIVE Antiplatelet drugs?-Glycoprotein IIb/IIa Receptor AntagonistsWhat are the therapeutics uses of Glycoprotein IIb/IIa Receptor Antagonists?Acute coronary syndrome (MI)What do Alteplase (tPA) convert Plasminogen molecules into?PlasminWhat does Plasmin do?Dissolves clotsWhat are the therapeutic uses of Alteplase (tPA)?-MI -Ischemic stroke -Massive PEWhat are the adverse effects of Alteplase (tPA)?-Bleeding -FeverHow can the nurse reduce the risk of bleeding?-Minimize physical manipulation of patients -Avoid IM and SubQ injections -Minimize invasive procedures -Minimize concurrent use of antiplatelet and anticoagulant drugsA patient is receiving an intravenous infusion of heparin to treat a pulmonary embolism. What laboratory value will the nurse monitor to evaluate treatment with this medication? A. Activated partial thromboplastin time (aPTT) B. Prothrombin time (PT) C. Platelet count D. Hemoglobin and hematocritA. Activated partial thromboplastin time (aPTT)Which patient does the nurse identify as most likely needing an increased dose of Warfarin to have the same anticoagulant effect? A. Patient taking acetaminophen for back pain B. Patient taking cimetidine to prevent gastric ulcers C. Patient taking oral contraceptives to prevent pregnancy D. Patient taking prednisone for rheumatoid arthritisC. Patient taking oral contraceptives to prevent pregnancyDuring the administration of alteplase, the patient's IV site starts to ooze blood around the catheter. Which action by the nurse is most appropriate? A. Discontinue the infusion of alteplase B. Assess the patient's vital signs C. Apply direct pressure over the puncture site D. Administer aminocaproic acidC. Apply direct pressure over the puncture siteWhat drug is selective for vasodilation of arterioles?HydralazineWhat drug is selective for vasodilation of arterioles AND veins?NitroglycerinWhat are hemodynamic effects?-Drugs that can dilate resistance of vessels (arteries) and cause a decrease in cardiac afterload -Drugs that fillet capacitance vessels (veins) which reduce force with which blood is returned to the heart and thus reducing cardiac preloadWhat are some therapeutic uses of Vasodilators?-Essential HTN -Angina pectoris -MI -PheocyomocytomaWhat are the adverse effects of vasodilators?-Postural hypotension -Reflex tachycardia -Expansion of blood volume (Decrease preload and CO)What is the mechanism of action for Hydralazine?Selective dilate of arteriesWhat are the therapeutic uses of Hydralazine?-Essential HTN -Hypertensive crisis -HFWhat are the adverse effects of Hydralazine?-Reflex tachycardiaWhat are the interactions of Hydralazine?-Avoid excessive HypotensionWhat is the FASTEST acting antihypertensive agent?Sodium Nitroprusside (Nitropress)What does Sodium Nitroprusside (Nitropress) cause?-Artery AND vein dilationHow is Nipride administered?IV infusionWhat is the therapeutic uses of Nipride?-Hypertensive emergenciesWhat are the adverse effects of Nipride?-Excessive hypotension -Cyanide poisoningWhat pulmonary drugs are Smooth Muscle Relaxants?-Short Acting Beta Agonist (SABA) -Long Acting Beta Agonis (LABA) -Short Acting Muscurinic Antagonists (SAMA) -Long Acting Muscurinic Antagonists (LAMA)What Pulmonary drug inhibits constriction?LeukotrieneWhat pulmonary drugs are anti-inflammatory?SteroidsWhat is Dyspnea?-Difficulty breathing -Shortness of breathWhat is Orthopena?Difficulty breathing while lying downWhat is Paroxysmal Nocturnal Dyspnea?Sudden awakening from sleeping with shortness of breathWhat is Hypoventilation?Alveolar ventilation inadequate to meet the body's oxygen demand or to eliminate sufficient CO2What is Hyperventilation?Increased depth and rate of breathing that exceeds the body's need to remove CO2What is Hypocapnia?Low CO2 in the bloodWhat is Hypercapnia?High CO2 in the bloodHow is clubbing manifested?Chronic lung diseasesWhat is Hypoxemia?Low oxygen in the bloodWhat is Hypoxia?Deficiency in the amount of oxygen reaching the tissuesWhat is ventilation?Amount of gas reaching alveoliWhat is perfusion?Blood flow reaching alveoliWhat are some examples of a LOW V/Q?-Asthma -Pulmonary Edema -Pneumonia -AtelectasisWhat are some examples of a HIGH V/QPulmonary Embolism (PE)What are some common signs and symptoms of Obstructive Lung disorders>-Dyspnea -WheezingWhat are the major issues with asthma?-Smooth muscle constriction -Edema in the walls caused by Histamine -Increased mucous membranes, which decreases the size of the lumenHow is asthma diagnosed?When patients Forced Expiratory Volume (FEV) in 1 second increases by more than 12% OR 200 mL after administration of SABAWhat are the classification of asthma?-Intermittent -Mild persistent -Moderate persistent -Severe persistent -Sever AsthmaWhat is intermittent asthma?- </= 2 days/week - SABA ONLY - FEV*: > 80% predictedWhat is mild persistent asthma?- >2 days/week but not daily - SABA + Low Dose Corticosteroid - FEV= > 80% predictedWhat is moderate persistent asthma?- Daily - LABA + ICS - FEV= < 60% but< 80% predictedWhat is severe asthma?Requires Step 4 or 5 (moderate or high dose ICS/LABA +/- add on) or remains uncontrolled despite this treatmentWhat is the number one patient teaching with asthma?Avoid triggersWhat are the goals of asthma treatment?-Reduce frequency of attacks -Reduce risk of reoccurrenceHow is medication administered with SABA?Inhaler AND a spacerWhat are the side effects of SABA?-Increased HR -NervousnessWhat should a patient do when taking an inhaled corticosteroid?Wash their mouth out to prevent ThrushWhat should you NOT do when taking an inhaled corticosteroid?Use as Monotherapy -NEVER take by itselfWhat are the side effects of Oral Systemic Corticosteroid?-Increased risk of infection -Weight gain -Increased blood glucoseWhat should you NEVER do with an oral systemic corticosteroid?Discontinue abruptlyWhat does a peak flow meter do?Measure the fastest rate of exhaled air the patient can forcefully exhaleWhat are some diagnostic tests for asthma?-Pulmonary function tests -ABGs -CXRA pO2 levels of less than _____ is defined as hypoxemia80What is the normal range of PaCO2?35-45 mmHgA PaCO2 greater than 45 is?HypercapniaA PaCO2 less than 35 is?HypocapniaWhat are some nursing interventions for patients with Acute Asthmatic Attacks?-Position the patient in high fowlers -Give the patient oxygen -Maintain a calm and reassuring demeanorWhat is asthma that causes cyanosis, confusion, and lethargy?Staus AsthmaticusAbsence of what is an ominous sign?Breath soundsTwo hours after arriving on the medical-surgical unit, the client develops dyspnea. SaO2 is 91%, and the client is exhibiting audible wheezing and use of accessory muscles. Which of the following medications should the nurse expect to administer? A. Antibiotic B. Beta-Blocker C. Antiviral D. Beta-2 AgonistD. Beta-2 AgonistA nurse is completing discharge teaching with a client who has a new prescription for prednisone for asthma. Which of the following client statements indicates a need for nursing teaching? A. "I will drink plenty of fluids while on this medication" B. "I will tell the doctor if I have black, tarry stools" C. "I will take my medication on an empty stomach" D. "I will monitor my mouth for cold sores"C. "I will take my medication on an empty stomach"Which of the following parameters indicate deterioration in the client's respiratory status? Select all that apply A. SaO2 95% B. Wheezing C. Retraction of sternal muscles D. Warm and pink extremities and mucous membranes E. Premature ventricular complexes (PVCs) F. Respiratory rate of 34/min G. LethargyC. Retraction of sternal muscles E. Premature ventricular complexes (PVCs) F. Respiratory rate of 34/min G. LethargyWhen discharging a client home who is on oxygen, which of the following is most important for the nurse to teach? A. Smoking cessation B. Equipment maintenance C. Incorporating rest into ADLs D. Anger managementA. Smoking cessationWhat are the different types of pneumonia?-Community-acquired pneumonia (CAP) -Hospital-Acquired pneumonia -Ventilator-Associated pneumonia -Healthcare-Associated Pneumonia (HAP).What is pneumonia?Inflammation of the lungsIs pneumonia bacterial or viral?BothWhat objective data would you expect to find in a patient with pneumonia?-Asymmetrical expansion of abdomen -Use of accessory muscles -Fever -MalaiseWhat is the cause of tissue hypoxia?-Increased HR -Increased RR -RestlessnessWhat lung sounds are heard in a patient with Pneumonia?-Crackles -Rhonchi -WheezesIs a cough with pneumonia productive or nonproductive?ProductiveCan mucous plugs form with pneumonia?YesWhat does a CXR show on a patient with pneumonia?Aveolar patchy infiltratesWhat are some treatment options for a patient with pneumonia?-Elevate HOB -Monitor O2 saturation -O2 therapy -Push fluids -Monitor ABGsHow can pneumonia be prevented?-Vaccinations -Avoid crowds -Hydrate -Smoking cessationWhat is an EARLY sign of pneumonia?Respiratory AlkalosisWhat is a LATE sign of pneumonia?Respiratory Acidosis