Exam 2 Patho/Pharm #2

Perfusion

Perfusion

a. the passage of oxygenated capillary blood through the body tissues

b. Adequate perfusion depends on the normal functioning of both the respiratory and cardiac systems.

Cardiac Output

the amount of blood pumped from the left ventricle per minute

SA node

natural pacemaker of the heart; if not functioning, dysrhythmia

Atrial Kick

fills up with blood to “kick off” or push blood to the ventricle

Atrial Fibrillation

a conduction problem with the AV node

Depolarization

discharge of energy that transfers electrical charges across the cell membrane

Repolarization

return of electrical charges to their original state

AST/ALT

liver enzymes

Osmosis

the movement of water only through a semipermeable membrane to achieve an equilibrium of osmolarity

Osmolarity

number of milliosmoles in a kilogram of solution.

Pathophysiology of perfusion

• Heart Mechanical Activity

• Heart Electrical Activity

  • cardiac output-ventricle contraction

  • Hyperkalemia is the main problem of perfusion

cardiac output formula

Heart rate x stroke volume

symptoms of inadequate Cardiac Output

• Change of mental status

• Syncope

• Dizziness/weakness

• Shortness of breath

• Diaphoresis

• Cool, clammy skin

• Cyanosis

• Hypotension

• Chest pain

P-wave

• atrial depolarization

• depolarization

• repolarization

• isoelectric

PR interval

the time between atrial depolarization and the beginning of ventricular depolarization 

QRS complex

ventricular depolarization

ST-segment

the time between the end of the ventricular repolarization

T-wave

ventricular repolarization (recharge)

Patho found in the Atrium

• SA Node (generates electrical impulse)

  • P wave (EKG strip)

  • Natural rate 60-100bpm

• The SA node lives at the top

Patho of Internodal Pathway

• Junction

• Atrial tissue

AV node

• PR interval (EKG strip)

• “Atrial Kick”

  • located at the base of the atrium

• allows blood to fill the atrium to pump into the ventricle

Patho of the ventricle

• bundle of His

• right and left bundle branches

• purkinje

  • QRS complex (EKG strip)

  • ST-segment (EKG strip)

  • T-wave (EKG strip)

  • QT interval (EKG strip)

T-waves

• Represents ventricular repolarization or relaxation

• Commonly seen at the first upward or positive deflection following the QRS complex.

  • Indicator of electrolyte imbalance

  •  Hyperkalemia

  • Hypokalemia

Elevated T-wave

potassium level is high 

Depressed T-wave

potassium level is low

hypernatremia

Water deficit hypertonic

Hyponatremia

water excess

fluid and electrolytes of perfusion

• Hypernatremia

• Hyponatremia

• Hyperkalemia

  • Hypokalemia

Solute

• electrolytes

• ions

body fluid

extracellular (ECF)

Intracellular (ICF)

can cause cerebral edema and confusion 

hypo/hypernatremia

Pharmacology/Drug Therapy for cardiac problems

• hypertension

• heart failure

• coronary artery disease

• chest pain

  • coagulation

Heart Failure Medications

Ace Inhibitors 

ARBS (Angiotensin II receptor blockers)

Beta-Blockers

Centrally Acting Alpha 2 agonists

Thiazide Diuretics

Loop Diuretics

Potassium-Sparing Diuretics

Cardiac Glycosides (Digoxin)

Mechanism of Action for ACE inhibitors

Lowers blood pressure by blocking angiotensin II production, relaxing vessels effectively

Common Side effects of ACE inhibitors

• dry cough 

• hyperkalemia–check potassium levels

  • very common

serious reactions and precautions of ACE inhibitors

• Rare angioedema reactions

• Assess kidney function (BUN/creatinine) before administering medication

Therapeutic benefits of ACE Inhibitors

•  Protect the kidneys and heart

• Very beneficial for diabetics or heart failure patients

Mechanism of Action of ARBS (Angiotensin II receptor blockers)

Prevent vasocontraction and reduce blood pressure.

Clinical Uses of ARBS (angiotensin II receptor blockers)

• manage hypertension, heart failure, and chronic kidney disease

• Alternatives to ACE inhibitors

Nursing considerations of ARBS 

• Monitor patients for

  • Hypotension

  • Hyperkalemia

• Avoid during pregnancy due to fetal risk

Mechanism of Action of Beta-Blockers

• Reduce blood pressure by slowing the heart rate

• Decreases cardiac output through beta-adrenergic receptor blockage

Clinical uses of Beta Blockers

• Hypertension

• Angina

• Heart failure–manage cardio conditions effectively

Nursing Considerations for Beta Blockers

Monitor heart rate

Caution is for asthma and COPD patients–bronchospasm

Patient education for Beta Blockers

Fatigue

Cold extremities

Recommend gradual tapering to prevent rebound hypertension

Mechanism of Action for Centrally Acting Alpha 2 agonists

Reduce the sympathetic nervous system activity

Lowers heart rate

Vasodilation

Clinical use Centrally Acting Alpha 2 agonists

Resistant hypertension when others fail

Careful patient monitoring and adherence

Nursing Considerations for Centrally Acting Alpha 2 agonists

• Warn patients about:

  • Drowsiness

  • Dry mouth

  • Gradual tapering is needed to avoid rebound hypertension

Mechanism of Action for Thiazide Diuretics

Reduce fluid volume by increasing urine output to lower blood pressure/ease the heart workload.

Nursing Considerations for Thiazide Diuretics

Hypokalemia

Dehydration

Electrolyte imbalances (sodium and potassium)

Patient Educations for Thiazide Diuretics

Hydration importance

Electrolyte imbalances

Muscle cramps and weakness

Combination therapy–Often used with antihypertensive drugs to effectively manage BP

Mechanism of Action for Loop Diuretics

Inhibit sodium and chloride reabsorption in the kidneys’ loop of Henle, causing increased urine output

Nursing Considerations of Loop Diuretics

Monitor electrolyte levels–POTASSIUM

Track fluid intake and output

Potential side effects of Loop Diuretics

Ototoxicity can occur with high doses or fast IV administration

Dehydration

Clinical Use and Education of Loop Diuretics

Treating heart failure

Pulmonary edema

Educate on dehydration and lab tests

Mechanism of Action of Potassium-Sparing Diuretics

inhibit sodium reabsorption

reduce potassium excretion in the kidneys’ distal tubules

Nursing Considerations of Potassium-Sparing Diuretics 

Hyperkalemia 

advise avoiding potassium-containing salt substitutes 

Combination therapy–Used alongside thiazide or loop diuretics to balance electrolyte levels and enhance therapeutic effects

Patient Education of Potassium-Sparing Diuretics

dietary potassium management

regular blood potassium monitoring

Mechanism of Action of Cardiac Glycosides (Digoxin)

Cardiac glycosides inhibit sodium-potassium ATPase

Increase intracellular calcium for stronger heart contractions

Therapeutic Uses of Cardiac Glycosides (Digoxin)

Treat heart failure

Atrial fibrillation

Improves heart muscle contractility and rhythm control

Nursing Considerations of Cardiac Glycosides (Digoxin)

Monitor digoxin levels and pulse rate (apical)

Withhold dose if heart rate is too low to prevent toxicity

Patients with low potassium levels are at risk for digoxin toxicity

Patient Education of Cardiac Glycosides (Digoxin)

Sign of toxicity (ototoxicity)

Importance of adhering to prescribed medication doses

Coronary Artery Disease & Cholesterol Medications

Statins (HMG-COA Reductase Inhibitors)

Mechanism of Action of Statins (HMG-COA Reductase Inhibitors)

 Inhibit the HMG–CoA reductase enzyme in the liver

Lowering cholesterol production effectively

Clinical use of Statins (HMG-COA Reductase Inhibitors)

Used to reduce cardio risk in CAD disease

 Lowering LDL cholesterol levels

Nursing Considerations of Statins (HMG-COA Reductase Inhibitors)

Monitor liver enzymes

Assess muscle pain to detect myopathy or rhabdomyolysis

Patient Education of Statins (HMG-COA Reductase Inhibitors)

Emphasize medication adherence/lifestyle changes

Report unusual muscle symptoms promptly

Chest Pain (angina) Medications

Nitrates

Vasodilators

Mechanism of Action of Nitrates

Dilate the coronary arteries and veins

Improve blood flow and reduce heart oxygen demand

Forms of Administration of Nitrates

sublingual tablets 

Patches 

Sprays 

all provide angina relief

Nursing Considerations of Nitrates

Orthostatic hypotension

Headaches

Avoid PDE5 inhibitors

Dosing adherence

If patients feel dizziness or faint, instruct them to sit down; patients need to use it to their activity level

Mechanism of Action of Vasodilators

relaxes blood vessels

reducing resistance and lowering blood pressure effectively

Clinical Uses of Vasodilators

manage angina and hypertension 

improve blood flow 

reduce cardiac workload 

Nursing Consideration of Vasodilators

monitor BP closely 

educate on dizziness and flushing 

Patient Safety on Vasodilators

Rise slowly to prevent falls due to orthostatic hypotension

Coagulation Modifiers Medications

Anti-platelet Medications

Antithrombotic & Thrombolytics (CLOT BUSTERS)

Mechanism of Action of Anti-platelet Medications

Anti-platelet drugs prevent clumping

Reducing thrombus formation risks in cardio patients

Clinical Uses of Anti-platelets Medications

manage cardio disease, stroke

used after stent placements to avoid complications of clots

Nursing considerations of Antiplatelet Medications

• Monitor for bleeding

  • Hemoglobin, hematocrit, platelet labs

• Advise soft toothbrush use

• Avoid concurrent anticoagulants

Patient Education of Anti-platelets Medications

• Recognize bleeding signs

  • Bruising and nosebleeds

  • Regular lab monitoring

Type of Medications for Antithrombotic & Thrombolytics (CLOT BUSTERS)

• Heparin

• Warfarin prevents clots

  • Thrombolytics dissolve existing clots

Nursing Considerations Antithrombotic & Thrombolytics (CLOT BUSTERS)

Bleeding

PT/INT and aPTT labs (labs to monitor for blood clots)

Avoid IM injections

Clinical Application of Antithrombotic & Thrombolytics (CLOT BUSTERS)

• Manage effectively

  • Deep vein thrombosis

  • Pulmonary embolism

  • MI

Patient Education and Safety of Antithrombotic & Thrombolytics (CLOT BUSTERS)

Adherence

Bleeding symptoms

 Lab monitoring

Emergency bleeding protocols