Herzing University NSG 223 Med Surg II Exam #1 questions and answers

What is the Action of Atropine? blocks the effects of acetylcholine at muscarinic cholinergic receptors What classification is Atropine? Anticholinergic What does atropine treat? Cardiovascular effects such as bradycardia and syncope What are the side effects of an overdose of Atropine? - Decreased secretions - Increased HR - Decreased GI and Genitourinary tone What is the antidote for Atropine? Physostigmine at a slow rate of 1 mg/min What are the effects of rapid administration of Atropine? - Bradycardia - Hypersalivation - Seizures How long does it take for the peak effects of Atropine IV and IM to take effect? IV: The peak effect occurs in 2 to 4 minutes IM: 30 minutes Nurse assesses for what with Atropine? - HR for patients with bradycardia if Atropine administered - Diminished secretions in preoperative patients What are some adverse Effects from Atropine? - Urinary retention - Bowel Sounds- paralytic ileus - Photophobia, mydriasis, blurred vision, and increased intraocular pressure - Dry mouth - Increased temperature Elderly and children are prone to what when on Atropine? hyperpyrexia due to suppression of perspiration and heat loss What are some patient education for Atropine? - Avoid excessively high temperatures - Drink a lot of water - Rinse mouth frequently - Maintain good dental hygiene - Use hard candy before taking medication - Void before taking medication - Visit ophthalmologist regularly When patient is on Atropine what signs/symptoms should you notify the MD about? - If fluid intake is greater or less than urine output - Fever - Weakness becomes severe After IV heparin injection how long does it taking to act? immediatley After Sub Q heparin injection how long does it take to act? 20-30 minutes What does Heparin treat? - Prevents DVT and PE - Prevents further thrombus formation and embolization - A-Fib It is essential to take a what count before heparin therapy begins and every 2-3 days during heparin therapy? Platelet count If the platelet count falls below 100,000 or less than half the baseline, what do we do to the heparin therapy? discontinue the heparin What is the goal of heparin? prevent blood coagulation long enough for clotting factors to be replenished and thus control hemorrhage What is the action of Heparin? Combines with antithrombin III to inactivate clotting factors to prevent thrombus formation What are contraindications for Heparin? GI ulcerations, intracranial bleeding, dissecting aortic aneurysm, blood dyscrasias, severe kidney or liver disease What should be maintained at approximately 1.5-2.5 times the baseline value during heparin therapy? aPTT Normal control value for heparin is how many seconds? 25-35 seconds The theraputic range for heparin is what? 45-70 seconds if the rate is below 45 seconds for heparin what do we do? increase the rate if the rate is higher than 70 seconds for heparin what do we do? decrease/stop rate aPTT should be drawn approximately when before a dose of heparin is scheduled? 1 hour before For heparin assess patient for what? overt bleeding or HIT What drugs increase the effects of heparin? - Warfarin (if receiving both heparin and warfarin, draw blood for the PT at least 5 hours after the last IV heparin dose) What are the Adverse Effects of Heparin? -Hemorrhage is the major side effect of heparin therapy, hypersensitivity and local irritation with subcutaneous injections What is the life threatening side effect of Heparin? Heparin-induced thrombocytopenia: leading to a decrease in platelet count and detectable HIT antibodies. What is the antidote for Heparin and LMWHs? Protamine Sulfate Why do we give the antidote Protamine Sulfate? When hemorrhaging is present and bleeding that may not respond to withdrawing from heparin Patient Education for Heparin? - Low-fat and Low-cholesterol diet to lower cholesterol below 200 mg/dL - LDL cholesterol below 130 mg/dL What diet should you have while taking heparin? Avoid or maintain levels of broccoli, brussels sprouts, cabbage, cauliflower, leafy dark greens. What medication can you take for home management of venous thrombosis? Lovenox Unnecessary to monitor aPTT with low-dose standard heparin when Sub Q for prophylaxis of thromboembolism or with lovenox Education for Lovenox - wash hands and cleanse skin to prevent infection What areas on the body can you inject Sub Q Lovenox? - Around the navel - Upper thigh - Buttocks - Change site daily What is the classification of Warfarin? - Anticoagulant, Vitamin K Antagonist What is the antidote for warfarin? Vitamin K What should the patient on anticoagulation therapy must have checked regularly to determine proper dosage and adequacy of therapy? - INR Patient education while on Warfarin? - Avoid walking barefoot - Avoid contact spores - Use an electric razor - Avoid injections when possible - Carry an identification card or medic alert bracelet What is the action of Warfarin? Inhibits vitamin K-dependent clotting factors - II, VII, IX, X (produced in liver) What is warfarin used for? most useful in the long-term prevention or management of venous thromboembolic disorders, including DVT, pulmonary embolism, and embolization Warfarin contraindications - Hypersensitivity - Active bleeding - Hemorrhagic tendencies - Recent surgery of the eye, spinal cord, or brain. What Herbs and Foods that can Effect Warfarin? - Ginseng, St. John's wort, foods high in vitamin K (broccoli, brussels sprouts, cabbage, etc.) What classification is Digoxin? cardiac glycoside What is digoxin used to treat? congestive heart failure, atrial fibrillation What does digoxin do? - Improves the contractility and pumping ability of the heart by increasing the force of myocardial contractility - Also inhibits sodium, potassium, and adenosine Why would we need reduce Digoxin dosages? - decreased liver or kidney function - decreased body weight - Advanced cardiovascular disease - Impaired renal function - Increased risk of accumulation What are contraindications for Digoxin? severe myocarditis, VTach or Vfib What are symptoms of Digoxin Toxicity? - Vision changes with yellow-green halos and blurred vision - N/V, loss of appetite, Abd pain, Hyperkalemia and Hypercalcemia