Pharmacology chapter 42(p-2)
Lecture Notes for 2nd year students
Heart Failure - Syndrome
Syndrome - requires 3 symptoms
HF - heart is unable to pump adequate or sufficient amt of blood to the tissues
Heart Failure - symptoms
SOB, fatigue, exercise intolerance, venus overload, peripheral and pulmonary edema, JVD
Venus overload
too much fluid in the veins heard by ausculation, fluid in the lungs, crackling
JVD
Jugular Venus distension - assess in semi-fowlers 45 degree angle
heart failure early stage
can't see w/o ECG, will see thickening of walls of atria and ventricals but asymptomatic
cardiac remodeling
response to stress put on it hypertrophy, more spherical shape, rounder
hypertrophy
thickening of heart walls
cardiac remodeling leads to
changing the left ventricular ejection fraction
electrical conduction altered leading to dysrhythmia
CHF
hyperreninimic state - elevated renin goes out to angie - the AI comess out
CHF - lab tests
atrial natriuretic peptide (ANP) brain natriuretic peptide (BNP)
ANP/BNP test
when there is heart damage and cells die and lyce... contents are released into blood and measurable
BNP
Most sensitive test, best indicator for HF
Digoxin - TI
A-Fib have a higher TI Ventricular rate tells how effective Digoxin is working
Digoxin - Function
positive inotropic action strengthens contraction make it work smarter not harder
negative chronotropic decrease HR
negative dromotropic decrease conduction of electrical stimulus
increased stroke volume affected by BP
Digoxin - drug interactions
Diuretics (furosimide)
potassium loss, Glucocorticoids promote hypokalemia inducing Digoxin toxicity - antacid, decrease
effectiveness by changing Ph in stomach - space out by at least one hour separation, herbs, Anise
(black licorice) increases effects of Digoxin causing toxicity
Digoxin - Toxicity Signs/Symptoms
halos, bradycardia
Nursing Intervention w/Digoxin
check apical pulse before giving, teach accurate radial pulse, demonstrate BP, potassium lvl 3.5-5.3
Digoxin - Toxicity antidote
Digibind - bind it up to be excreted via urine
other HF treatments
ACE inhibitors (Angiotensin Concerting Enzyme) ARBs (Angiotensin II receptor blockers) - sartans, BBs,
Vasodilators - pull extra fluid
Digoxin assessment
measure - baseline, daily weight, lung sounds, pulses, radial pulse, educate drug interactions, Toxicity
(NVD, halos) grapefruit interaction, stress relief - relax, stop smoking, constricts vessels making the
heart work harder
angina
heart hurts
nitrates
sublingual usual route
nitrate side effects
headaches, hypotension, reflex tachycardia
calcium channel blocker - side effect
BP decreased, hypotension, headache, peripheral edema
BB - side effects
vasodialator
Nitrate - MOA
Dilates large myocardial arteries, rapid decrease in BP
Nitrates - routes and times
oral hr 1 hr -- sublingual 30/60 minutes -- translingual 30/60 minutes -- IV Immediate -- Topical 1hr --
transmucosal, 30 minutes
Beta Blockers
vasodilation resulting in decreased heart rate, decreased contraction
BB side effects
bradycardia
B1 side effect
decreased chronotropic - HR, inotropic - strength
B2 side effect
peripheral edema, headache, hypotension, skin flushing, dizziness
lab tests for CCB
serum enzyme lvls
Client teaching - CCB
faintness - report
grapefruit increases
concentration levels
During an intravenous (IV) infusion of amphotericin B, a patient develops tingling and numbness in
his toes and fingers. What will the nurse do first?
Discontinue the infusion immediately.
If a patient is taking fluconazole (Diflucan) with an oral anticoagulant, the nurse will monitor for which
possible interaction?
Increased effects of oral anticoagulants
The nurse is preparing an infusion of amphotericin B for a patient who has a severe fungal infection.
Which intervention is appropriate regarding the potential adverse effects of amphotericin B?
Before beginning the infusion, administering an antipyretic and an antiemetic drug
The nurse is administering one of the lipid formulations of amphotericin B. When giving this drug,
which concept is important to remember?
The lipid formulations are associated with fewer adverse effects than the older drugs.
The nurse is reviewing instructions for vaginal antifungal drugs with a patient. Which statement by the
nurse is an appropriate instruction regarding these drugs?
"Abstain from sexual intercourse until the treatment has been completed and the infection has
resolved."
A patient is infected by invasive aspergillosis, and the medical history reveals that the patient has not
been able to tolerate several antifungal drugs. The nurse anticipates an order for which medication to
treat this infection?
Caspofungin (Cancidas)
. A patient with a severe fungal infection has orders for voriconazole (Vfend). The nurse is reviewing
the patient's medical record and would be concerned if which assessment finding is noted?
History of cardiac dysrhythmias
During therapy with amphotericin B, the nurse will monitor the patient for known adverse effects that
would be reflected by which laboratory result?
Serum potassium level of 2.7 mEq/L
A patient has received a prescription for a 2-week course of antifungal suppositories for a vaginal
yeast infection. She asks the nurse if there is an alternative to this medication, saying, "I don't want to
do this for 2 weeks!" Which is a possibility in this situation?
A single dose of a fluconazole (Diflucan) oral tablet
A patient is taking nystatin (Mycostatin) oral lozenges to treat an oral candidiasis infection resulting
from inhaled corticosteroid therapy for asthma. Which instruction by the nurse is appropriate?
Let the lozenge dissolve slowly and completely in your mouth without chewing it."
The nurse is administering an amphotericin B infusion. Which actions by the nurse are appropriate?
(Select all that apply.)
Discontinuing the drug immediately if the patient develops tingling and numbness in the
extremities, Using an infusion pump for IV therapy, Monitoring the IV site for signs of phlebitis and
infiltration, Administering premedication for fever and nausea
n which of the following situations would blood be most likely to be rapidly relocated from central
circulation to the lower extremities?
A client is helped out of bed and stands up
A nurse is assessing the vital signs of a client. The client inquires about the functions of the arteries.
What should the nurse include in the client education about the function of arteries?
To carry oxygenated blood to the body cells
When describing Starling's law of the heart, the instructor compares this to:
stretching of a rubber band
When describing circulation, which would a nurse include?
A closed system
Fluid moves into the arterial end of a capillary due to:
Hydrostatic pressure
After teaching a group of students about circulation, the instructor determines that the teaching was
successful when the students identify it as:
a high to low pressure system.
A patient has a diminished flow of deoxygenated blood from the lower extremities. Which chamber of
the heart receives deoxygenated blood from the lower extremities?
Right atrium
As part of their orientation to a cardiac care unit, a group of recent nursing graduates is receiving a
refresher in cardiac physiology from the unit educator. Which teaching point best captures a
component of cardiac function?
"The diastolic phase is characterized by relaxation of ventricles and their filling with blood."
Pathologic changes in the structure of the capillary and venular endothelium can result in the
accumulation of fluid in interstitial space. What term refers to this accumulation?
Edema
The nurse assists and educates clients about blood pressure regulation. Based on this information, the
nurse asks the client what the number 80 in the blood pressure 120/80 represents. Which response
by the client demonstrates correct understanding of the basic concepts of blood pressure?
Diastolic pressure
The nursing instructor is explaining cardiac function to the senior nursing class. The instructor explains
that blood is ejected into the circulation as the chambers of the heart become smaller. The instructor
categorizes this action of the heart as what?
Systole
Which enzyme is produced in the kidney?
Renin
After explaining an electrocardiogram to a patient, which statement indicates that the patient
understands this test?
"It will show how impulses are moving through my heart."
If the production of actin is disrupted, what component of the human body will be affected?
Muscles
A client has been diagnosed with a problem associated with the heart's right atrium. Which statement
indicates the client
The top chamber, responsible for receiving blood from my body's veins, is the problem.
When explaining blood supply to the heart muscle, the nurse explains that the left circumflex artery
supplies the:
left ventricle.
The electrical impulses flow in the following manner:
Sinoatrial node, the atrioventricular node, bundle of His, right and left bundle branches, and
Purkinje fibers.
An instructor is describing the venous system, which is distensible and flexible and able to hold a large
amount of blood. The instructor is describing:
capacitancy.
When considering vital signs, which assessment is focused on the functioning of the body's resistance
system
Blood pressure
What primary event has occurred when a client experiences an ectopic focus?
The location of the heart's functioning pacemaker is no longer the sinoatrial (SA) node
Which client diagnosis is related to left-sided heart failure?
Pulmonary edema
A nurse is measuring the BP of a client. The client asks what the BP measures. What is the best
response by the nurse about the measurement of BP?
Pressure of blood within the arteries
The nurse is reviewing a patient's electrocardiogram and notes that the P waves are saw-toothed in
shape and there are three P waves for every QRS complex. The nurse would interpret this as
suggesting:
Atrial flutter
A client is diagnosed with an atrial septal defect (ASD) that has caused a hole between the two upper
chambers of the heart. What is the direct result of such a defect?
Deoxygenated and oxygenated blood will mix
An electrocardiogram (ECG) is prescribed for a client experiencing signs and symptoms associated
with a cardiac dysfunction. Which function of the heart will this diagnostic tool help evaluate?
Ineffective pumping
A client has severe aortic valve disease. When educating the client about anatomy, what would the
nurse include?
The aortic valve separates the left ventricle and aorta.
Considering the phases of the action potential of the cardiac muscle cell, what is the characteristic
event associated with phase 1?
Sodium is present in equal amounts both inside and outside of the cell
The capillary fluid shift is regulated by the balance between hydrostatic forces on the arterial end of
the capillary and:
Oncotic pressure
Which property is related to the ability of the heart cells to transmit an action potential of electrical
impulse?
Conductivity
Which is released initially when blood flow to the kidneys is decreased?
Renin
A client is diagnosed with a dysfunctional syncytia. What assessment finding supports this diagnosis?
The pumping of the heart's chambers of are not properly coordinated
A nurse is explaining blood flow through the heart to a patient who has experienced a myocardial
infarction. How would the nurse explain flow from the lungs to the heart?
Oxygenated blood from the lungs enters the left atrium through the pulmonary veins.
It is determined that a client's cardiac rhythm is being originated in the sinoatrial (SA) node. What
mechanism is responsible for the triggering of this node?
Specialized cells within the node itself
What structure makes it possible for the heart to be harvested for transplantation when donated by a
client who is declared "brain dead"?
sinoatrial (SA) node
Which teaching point should the nurse convey to a client being educated on the ability of the heart to
generate an electrical impulse?
"There are many different parts of your heart that can initiate an electrical impulse."
The critical care nurse is caring for a client with bradycardia after cardiovascular surgery. The nurse
knows that the heart rate is determined by myocardial cells with the fastest depolarizing rate. Under
normal circumstances, where are these cells located?
SA Node
A cardiovascular clinical nurse specialist describes the dysfunctional endothelium in relation to
cardiovascular disease. What is the major factor in the development of the dysfunctional
endothelium?
Atherosclerosis
A client who has been diagnosed with blood pressure problems is eager to know more about the
condition. What should the nurse explain is one of the internal processes that attempt to maintain
blood pressure within normal limits?
Special sensory receptors in blood vessel walls called baroreceptors are stimulated.
A nurse is assessing the vital signs of a client. The client inquires about the functions of the arteries.
What should the nurse include in the client education about the function of arteries?
To carry oxygenated blood to the body cells
A client has been declared "brain dead". The family asks the nurse to explain why their loved one's
heart continues to beat in spite of the damage to the brain. The nurse should provide what
explanation to the family?
The heart beats in response to impulses that are generated by specialized cells located in the heart
not the brain.
Several nursing students are creating a poster on the mechanism of the heart. What structure would
they label as separating the right half of the heart from the left?
Septum
A nurse is caring for a neonate born with a congenital heart anomaly. To better help the parents
understand the impact of this disorder, the nurse begins by describing the usual flow of blood through
the heart which takes what course?
Oxygenated blood from the lungs enters the left atrium through the pulmonary veins
A patient is scheduled to have a pacemaker implanted. The nurse knows pacemakers can be inserted
to correct what problem?
Malfunction of the sinuatrial (SA) node
What description of an artery, made by the nurse, is accurate?
Rigid resistance tubes
A 54-year-old man has a myocardial infarction, resulting in left-sided heart failure. The nurse caring
for the man is most concerned that he will develop edema in what area of the body?
Pulmonary
A patient, diagnosed with heart failure, would like the nurse to explain what the diagnosis means.
How will the nurse explain heart failure?
The heart muscle cannot pump effectively causing a backup of blood.
A patient who is on a ventilator has been declared brain dead. A family member asks the nurse how
the heart can still function if his father's brain is dead. What statement is an appropriate response by
the nurse?
The heart is self-controlled and does not depend on the brain to beat
The nurse is caring for a patient in the ICU; hypotension may be anticipated when the patient's body
produces insufficient quantities of what hormone?
Antidiuretic hormone (ADH)
The nurse is caring for a patient whose blood pressure is 120/78. What is the pulse pressure?
42
A patient is admitted to the cardiac unit with a diagnosis of a myocardial infarction (MI). The nurse
notes that the patient is having regular premature ventricular contractions (PVCs). Why would the
nurse be concerned?
Blood is not efficiently pumped from the heart with PVCs.
The nurse is caring for a patient whose damaged ventricle is reducing left ventricular filling and
causing a backup of blood into the left atrium. What valve is damaged in this patient?
Mitral
How would the nurse calculate the patient's pulse pressure?
The difference between the ejection and the resting pressures
The nurse takes the patient's pulse and finds a regular rate at 44 beats/min. What area of the heart is
controlling this patient's heart rate?
The sinuatrial (SA) node
The nurse is caring for a patient with severe coronary artery disease (CAD) who is experiencing chest
pain because the oxygen demand exceeds supply. What forces could potentially be lowered to reduce
oxygen consumption? (Select all that apply.)
B) Afterload
C)Stretch on the ventricles
D) Heart rate
E) Preload
The patient has edema resulting from heart failure (HF) in both ankles. The nurse interprets this to
mean the hydrostatic pressure is higher than what opposing pressure?
Oncotic pressure
The nurse is explaining the normal conduction pattern of the heart to an adolescent with a newly
diagnosed congenital heart anomaly. The nurse tells the patient that what serves as the pacemaker
for the heart?
The sinuatrial (SA) node
The nurse is caring for an older adult patient who is displaying alterations in the conduction of
impulses in the SA node which the nurse assesses as what?
Cardiac dysrhythmias
The nurse is caring for a patient with coronary artery disease and hypertension. The nurse explains to
the patient that coronary artery disease disables what process that controls blood pressure?
Ability of the arterioles to increase or decrease resistance
When a muscle acts as a pump what is a necessary property for the muscle to function efficiently?
Simultaneous contraction
The nurse is caring for a science professor with hypertension who asks for a more complete
explanation of blood pressure. The nurse begins by explaining that the phase when the ventricle
contracts and ejects blood out into the aorta is known as what?
Systole
When sodium gates open along the cell membrane and sodium rushes into the cell it results in the
membrane no longer having a positive or negative side but being electrically the same on both sides.
The nurse recognizes this period of the cardiac cycle as what?
Depolarized
The nurse explains the normal conduction pathway to the patient and evaluates the patient
understood when they provide what description of the conduction pathway in the heart?
SA node to AV node to bundle of His to Purkinje fibers
The patient has had a myocardial infarction. The nurse realizes the significance of this injury is
damage to what layer of the heart?
Myocardium
The nurse is caring for a patient in a state of shock. The family asks the nurse why the patient is so
sick. What is the nurse's best response?
Low blood pressure means inadequate supply of oxygen to the body's tissues.
The nurse is caring for a patient with chronic renal failure. The patient asks the nurse how his kidney
disease causes hypertension. What is the nurse's best response?
When blood flow to the kidney declines, cells in the kidney release renin.
The nurse is assigned to watch the cardiac monitors in the constant care unit and notes four different
patients displaying arrhythmias. Which arrhythmia is the nurse's highest immediate priority?
Ventricular fibrillation
How does the nurse describe the cardiac action potential to a new coworker?
The cycle of depolarization and repolarization
The nurse teaches a class on the systems that control blood pressure and includes what systems in
the discussion? (Select all that apply.)
B) Aldosteroneantidiuretic hormone (ADH)
D) Stimulus from the sympathetic system
E) Reflex control of blood volume
A patient presents at the clinic complaining of shortness of breath, fatigue, and difficulty performing
activities of daily living (ADLs). The nurse notes the bluish color around the patient's mouth and
fingernail beds. What would the nurse expect the patient has?
Heart failure
The nurse explains how the myocardium receives oxygen to the new graduate nurse beginning work
in the constant care unit; she tells the new nurse the coronary arteries receive blood when?
During diastole
The nurse explains that the reason the left ventricle is so much larger than the right ventricle is what?
The left ventricle needs to pump blood through the entire body.
The nurse is caring for a patient with hypertension and recognizes this will have what impact on
afterload?
Increased afterload
The patient's blood pressure is low due to shock and vasodilation of the blood vessels. The nurse
recognizes this will have what impact on preload?
Preload will increase.
The patient has a diagnosis of atherosclerosis. When a branch of the coronary artery becomes
completely blocked, what event will the nurse expect to occur?
Myocardial infarction
The patient has an excessive production of antidiuretic hormone (ADH). The nurse expects what
change in the patient's blood pressure?
Increase in blood volume will cause increase in blood pressure
