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Category Archives: Cardiac Pharmacology

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NCLEX Review Notes:

NCLEX Review on Cardiac Diseases: Heart Failure

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– It is an insufficiency and the inability of the pumping ability of the heart.

LEFT SIDED HEART

– Failure of the left side of the heart to pump enough blood to meet the metabolic demands of the body.

  • THERE IS AN IMPAIRED OXYGENATION AND A DECREASE IN MYOCARDIAL WORKLOAD IN THE HEART.

ASSESSMENT FINDINGS in patients with Left Sided heart failure.

  • CRACKLES
  • DYSPNEA
  • GALLOP RHYTHM: S3, S4

NCLEX Review on Heart Failure Cont.

What we would usually find in patient with left sided heart failure  is that there is an INCREASE IN PULMONARY CONGESTION and there would be a left ventricular hypertrophy.
MANAGEMENT

  • LOW SODIUM DIET
  • SEMI FOWLERS POSITION ON PT.
  • WEIGHT PATIENT DAILY
  • ADMINISTER IV, OXYGEN AND MEDS AS ORDERED.
  • MONITOR VITALS, I/O

RIGHT SIDED FAILURE

– Failure of the right side of the heart to pump enough blood to meet the metabolic demands of the body.
Causes:

  • LEFT SIDED HEART FAILURE
  • COPD
  • ATHEROSCLEROSIS
  • PULMONARY HYPERTENSION

Assessment:

  • JUGULAR VEIN DISTENTION
  • DEPENDENT EDEMA
  • WEIGHT EDEMA

Diagnostic Procedures:

  • B- Type Natriuretic Peptide (BNP)  Levels= Elevated
  • ABG’s indicates hyposemia and hypercapnia.
  • Hemodynamic Monitor= Increase CVP

TREATMENT:

  • Oxygen Therapy
  • Paracentesis
  • Thoracentesis

Drug Therapy:

  • Cardiac Glycoside (Digoxin) Lanoxin
  • Inotropic Agents (Dopamine, Dobutamine)
  • Diuretics: Furosemide (Lasix)
  • Human BNP: (Nesiritide (Natrecor)

Interventions:

  • Keep Ct. in semi- fowlers position to increase chest expansion
  • Assess cardiovascular status and vital signs
  • Weigh the client daily: A weight gain of 1 to 2 lbs. indicates fluid gain.
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NCLEX Review of the Urinary System

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   Show Notes:

An NCLEX Review of the Urinary System: We will go over the major diseases that you most likely encounter in the NCLEX Exam.

The Urinary System

– is a vital system in the body that enables us to produce, store and eliminate urine.

MAINLY COMPOSED OF:
– the Kidneys
– the Prostate
– the Ureters
– the Bladder
– the Urethra

Although it is not necessary to have the physiology of each anatomy committed to your memory, it is very important to understand the concept and function of each.

DIAGNOSTIC TESTS WITH THE URINARY SYSTEM:

URINANALYSIS  

Very important to remember these values for the NCLEX.

BUN Level            10-20 mg/dl
Creatinine Level            0.5- 1.5 mg/dl
Calcium                 9- 11 mg/ dl
Urine Specific Gravity        1.003- 1.030

ELECTROLYTE IMBALANCE

Hyponatremia (decreased sodium)
Muscle weaknes, Headaches
Fatigue, confusion, vomiting, coma

Hpernatremia (increased sodium)
Tachycardia, dry mucus membrane
decreased urinary output

Hypokalemia (decreased pottasium)
Anorexia, nausea, vomiting
abdominal distention

Hyperkalemia (increased pottasium)
Irritability, nausea and vomiting
diarrhea

Hypokalcemia (decreased calcium)
osteoporosis, fractures, muscle spasms
tetany, n & v, vomiting.

Hypercalcemia (increased calcium)
Renal calculi, coma, arrythmias, decreased reflex

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POLYCYSTIC KIDNEY DISEASE

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NEPHROTIC SYNDROME

GLOMERULONEPHRITIS/ PYELONEPHRITIS

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Urinary Calculi/ Ur0lithiasis

CHRONIC RENAL FAILURE

STAGES OF CHRONIC RENAL FAILURE

Stage 1 Diminished Renal Reserve

  • – renal function is reduced, but no accumulation of metablic wastes occurs.
    – the healthier kidney compensates for the diseased kidney
    – The ability to concentrate urine is decreased
  •   ♦ Results in nocturia and polyuria

– Stage 2 Renal Insufficiency

  • – metabolic waste begin to accumulate in the blood, because affected nephrons can no
    longer compensate.
    – responsiveness to diuretics is decreased, resulting in Oliguria and edema

Stage 3 End Stage Renal Disease.

  • – excessive amount of metabolic wastes such as
    urea and creatinine accumulate in the blood.
    – kidney is unable to maintain homeostasis
    – treatment is by dialysis

Metabolic Changes
– Urea and Creatinine
– Sodium
– Pottasium
– Acid Base Balance
– Calcium and Phosporus

Cardiac Changes
– Hypertension
– Hyperlipidemia
– Heart Failure
– Uremic Pericarditis

INTERVENTIONS
– It is important to monitor renal, respiratory and cardiovascular status and the fluid balance.

REMEMBER FOR NCLEX
– Patient with Chronic Renal Failure would have

  • ♣ UREMIA, ANEMIA AND ACIDOSIS

DIALYSIS:

Peritoneal Dialysis:

♣ Complication: can include Peritonitis

Hemodialysis:

♠ Pt. may use external shunt or surgically constructed internal arterivnous fistula (long-term)

Most common cause of renal failure is *poorly controlled diabetes & Hypertension.

Dopamine= can enhance renal perfusion and elevate blood pressure.

♠ Ways to control monitor kidney function:

  • Monitor I and O
  • Monitor Lab Values
  • Specific Gravity
  • BUN and Serum

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NCLEX Pharmacology

A Quick Review on Pharmacology

♣ Show Notes

NCLEX Review on Pharmacology

The fact is that pharmacology will always be a big part in your NCLEX Exam, and can be a huge catalyst in whether you pass or fail your NCLEX Exam.  It is quite important for us to focus a lot on the content that pertains to medications, if we are reviewing for the NCLEX.  The NCSBN (who is responsible for developing the NCLEX Exam) defines the category of Pharmacological and Parenteral Therapies as a sub-category within the Physiological Integrity area (of the exam)  in which the nurse is basically providing care related to the administration of medications and parenteral therapies.

To be more specific, Pharmacological and Parenteral Therapy has contents that  includes but is not limited to:

  • Adverse Effects/Contraindications/Side Effects/Interactions
  • Expected Actions/Outcomes
  • Medication Administration
  • Blood and Blood Products
  • Parenteral/Intravenous Therapies
  • Central Venous Access Devices
  • Pharmacological Pain Management
  • Dosage Calculation

First, I want to take a step back and look at Pharmacology from a technical sense and look at it more in depth.

What is Pharmacology?

♠ PHARMACOLOGY

Pharmacokinetics– The study if how drugs are being absorbed, distribuited, metabolized and excreted by the body.
Pharmacodynamics– is the study of how drugs are being used by the body.
Pharmacotherapeutics– the study of how the client responds to the particular drugs.

What’s in a drug name?
Chemical Name:
This tells you the chemical makeup of the drug.
Generic Name
This name is given by the company that developed the drug.
Trade Name
This is the name given to the drug by the company in which the medication originated.

The Seven Rights of Administering Drugs

  • Right Client
  • Right Route
  • Right Drug
  • Right Dose
  • Right Amount
  • Right Time
  • Right Documentation
  • Right to refuse treatment

Any drug can have a CHEMICAL NAME, A GENERIC NAME AND A BRAND OR TRADE NAME.

  • The generic name of a drug is suggested by the manufacturer, and accepted by the international committee.
  • How the drug is being affected affects the body and the patient’s response is called the effect.
  • Efficacy refers to the degree to which a drug is able to induce it’s maximal effects.
  • Adverse Effect is any unexpected or unintended response to a therapeutic use of a drug, it is also called side effect.

During this review, I want to focus specifically towards the drugs that is mostly in patients with hypertension.

DRUGS USED WITHIN THE CARDIAC SYSTEM

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Cardiac Pharmacology

♣ Pharmacology Drugs for Hypertension:

DIURETICS

  • – Helps get rid of the sodium and fluid in the body.
  • – Used to lower the blood pressure.
    – Promotes the excretion of sodium and water
    – Diuretics interferes with the sodium absorption in the kidney.
    – Increases the urine output.  Decreases the preload and afterload..

If the patients blood pressure drop to low, it is important to give IV fluids to pt.

LETS GO OVER THE CATEGORIES OF DIURETICS ♠

♦ TYPES OF DIURETICS

♣ POTTASIUM SPARING DIURETICS

It promotes the excretion of soduium and water, while the retention of pottasium

Used for:

  • Hypertension
  • Edema
  • Hyperaldosteronism
  • Hypokalemia

Medication:

  • SPIRONOLACTON (ALDACTONE)
  • AMILORIDE (MIDAMOR)
  • TRIAMTERENE

Now lets go to the side effects:

First, of course the person can have too much potassium or HYPERKALEMIA:

Signs of HYPERKALEMIA

  • irregular heartbeat
  • nervousness
  • tingling in hands and feet
  • shortness of breath
  • tiredness or weakness

OTHER SIDE EFFECTS:

  1. Nausea and vomiting
  2. Cramping and diarrhea
  3. Dizziness & headache

Loop Diuretics

  • BUMETANIDE (BUMEX)
  • FUROSEMIDE (LASIX)

Osmotic Diuretics

MANNITOL

  • Thizade Diuretics

HYDROCHLOROTHIAZIDE (HYDRODIURIL)
CHLOROTHIAZIDE (DIURIL)
CAUSES THE DEPLETION OF SODIUM AND WATER.
♣ CAN INDUCE HYPERGLYCEMIA

Very Important for the NCLEX:

SIDE EFFECTS OF DIURETICS

  • Frequent urination
  • Electrolyte abnormalitie
  • Muscle cramps or weakness
  • Blurred vision
  • confusion
  • headache
  • increased perspiration (sweating)
  • restlessness

BETA (ADRENERGIC)  BLOCKERS

– Helps lower blood pressure, puls rate and cardiac output.
– Can be used to treat headaches.
– Can be used to treat glacauma and prevent myocardial infarctions.
– Acts on the system, by blocking the symathetic vasomotor response.

For the NCLEX, try to remember that the syllable for beta blockers is usally (olol).

SIDE EFFECTS:

  • Orthostatic hypotension
  • bradycardia
  • nausea and vomiting
  • diarrhea

NOTE: Some of the symptoms may MASK signs of Hypoglycemia

♠ HYPOGLYCEMIC SYMPTOMS

NURSING INTERVENTIONS FOR CLIENTS TAKING BETA BLOCKERS:

Make sure that you monitor the client’s blood pressure, heart rate and rhythm, before administering the beta blocker.  Monitor the client for signs of edema.  The nurse should also assess the lungs sounds for signs of rales and ronchi.  When patient are taking beta blockers, it is also very important to monitor the changes in lab values such as (protein, BUN and creatinine) which can indicate nephrotic syndrome.  Nursing teaching for the NCLEX would include: Teaching the Client to rise slowly (ORTHOSTATIC HYPOTENSION) * (A SAFETY ISSUE), report any signs of bradycardia, dizziness, confusion depression or fever.  It is also very important to taper off the medication properly.

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Cardiac Pharmacology

♣ Calcium Channel Blockers

  1. – PREVENTS THE MOVEMENT MECHANISM OF CALCIUM WITHIN THE CARDIAC SYSTEM.
  2. – THEREFORE DECREASING THE CARDIAC WORKLOAD, AND CARDIAC MUSCLE CONTRACTILIY.
  3. – MEDICATIONS INCLUDE THE “DIPINE” : DILITAZEM (CARDIZEM), AMLOPIDINE (NORVASC), NEFEDIPINE, NICARDIPINE.
  4. – USED TO TREAT ANGINA.
  • Remember:

– Blocks the calcium channels in the heart, causing a decrease in contractility.
Decreases the workload of the heart.

Used for:
Hypertension

Medications:

  • Nifedipine (Procardia)
  • Amplodipine (Norvasc)
  • Do not give Norvasc with grapefruit, causees increase in drug level.
  • Verapamil (Isoptin)
  • Diltiazem (Cardizem)

SIDE EFFECTS:

Constipation
Nausea
Headache
Rapid heartbeat (tachycardia)
Drowsiness

Remember:

  • Make sure to monitor the heart rate and the blood pressure.
  • Hold medication if HR is less than 60 or if BP is less than BP.

♠ ACE INHIBITOR

  1. – ACE INHIBITORS “BLOCKS” THE CONVERSION OF ANGIOTENSIN 1 TO ANGIOTENSIN 2.
  2. – ALTERS THE “BLOOD PRESSURE” MECHANISM THROUGH THE RENIN-ANGIOTENSIN SYSTEM.
  3. MEDICATIONS INCLUDES THE “PRIL” : CATOPRIL, ENALAPRIL, LISINOPRIL, RAMIPRIL.

SIDE EFFECTS:

  • COUGH
  • TACHYCARDIA
  • NAUSEA AND VOMITING.

Remember:
GIVE ON AN EMPTY STOMACH OR 2-3 HRS. AFTER A MEAL.

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