Nitroglycerin
Causes Vasodilation, Decreases BP, Must wear gloves when administering patch. Can give sublingual, patch, IV
Nitroglycerin
Can give a total of 3 times, 5 mins apart, if not effective call 911.
CAD Non Modifiable risk factors
Age, genetics, family history, ethnicity
CAD modifiable Risk factors
smoking, diet, exercise, high serum lipids, high BP, obesity, diabetes, metabolic syndrome.
Morphine
can be given for pain or vasodilation. Monitor for decrease in heart rate, BP.
Morphine in CAD
Decrease preload, decreases work of breathing, decreases anxiety.
High cholesterol =
Increased cholesterol plaque build up in arteries increasing cardiac risk.
Mitral valve prolapse
Leaky heart valve or an abnormality of mitral valve leaflets and papillary muscles or chordae that allow the leaflets to prolapse or buckle back into the left atrium during systole.
What to avoid with mitral valve prolapse
Be careful with any OTC stimulants, energy drinks/caffiene until healthcare provider approves. Check ingredients of other meds to ensure no stimulants due to palpitations.
What are the signs of PAD
Lower extremity coldness or discoloration, weak or absent pulses, thick toenails
PAD/PVD teaching
teach on smoking cessation and diet ( reduce sodium, follow DASH diet) ,Diabetes, lipid management, exercise.
Diagnostic test for PAD
Doppler studies for pulses
What to teach on for HTN
Make lifestyle changes such as diet and exercise, manage BP, cholesterol, blood sugar, lose weight, stop smoking
Caregiver teaching with HTN
Who cooks and shops so we can educate them on dietary mods. DASH diet ( low sodium)
Gestational HTN
Not pre-existing check BP every visit to get a baseline. S/S of swelling, vision changes, epigastric pain, convulsions ( worsening)
CHF S/S
Increased RR, increased effort to breathe, HTN, Tachycardia
Taking care of pt with CHF
Have pt sit up in bed high fowlers if showing signs of dyspnea. Record daily weights and I&O.
Monitoring pts on Digoxin
Monitor heart rate, pulse, BP if too low hold acall MD. Mointor esp in pt with decreased renal fucntion due to DIG TOX
( hypokalemia)
Range for Digoxin
Normal range 0.8-1.5
Propanolol monitoring
Check vitals before and medication administration, if heart rate is below 60 hold and call MD.
Bowel obstruction via mechanical obstruction
Surgical adhesions, hernia, CA, strictures from Crohn's, colorectal CA from diverticular dis.
Bowel obstruction via non mechanical obstructions
occurs with reduced or absent peristalsis such as parlytic ileus, pancreatitis, electrolyte imbalance etc..
Care for someone with suspected bowel obstruction
No enemas, no laxatives, NPO
Complete bowel obstruction surgical intervention
requires surgical removal or laparatomy, post op watch for drainage or hemorrhage, assess vitals esp for decrease in BP, wound , distention, and bowel sounds.
Divertiulosis sumptoms
no symptoms or abdominal pain, boating, gas, and changes in bowel habits, may need to medicate
Divertulitis symptoms
acute pain in left lower quad, distention, decreased or absetn bowel sounds, nausea, vomiting, systemic systems of infection, abodominal tenderness.
Diverticultis treatments
NPO, let colon rest, IV hydration, ABT
Neurogenic bladder teaching
teach pt how to self cath
Taking care of pt with neurogenic bladder
Ask about voiding pattern, do not take over care you need to involve the pt. what kind of home routine do they have.
DM type 1
Destruction of beta cells and complete lack of insulin believed to be auto immune.
DM type 1 symtpoms
Polyuria, polydipsia, polyphagia and weight loss may occur
DM type 2 manifestations
fatigue, recurrent infections, prolonged wound healing, vision problems.
Type 2 diabetes
Insulin is produced but cannot exert itself on cells bc of deficiency of insulin receptors on the cell membrane.
Type 2 diabetes treatment
use of metformin and monitor BUN, Creatine, GFR
Rapid acting insulin
Aspart, lispro ,
When should rapid acting insulin be given
with meals due to O=15 P= 60-90 D=3-4
When should you give short acting or regular insulin
( Humilin R, Novolin R)Give as sliding scale O=30-1 P = 2-3 D=3-6
Prednisone
is a corticosteroid that can effect the blood sugar, you may have to give insulin
Gestational diabetes test
Glucose challenge test, glucose tolerance test, and oral glucose test
Increased TSH production
Hypothyroidism
Medication given for hypothyroidism
Levothryoxine
If you have increased levels of T4 what should you do
Call MD to possibly adjust dose due to med not effective
What does low TSH indicate
Hyperthyroidism
What to avoid in hyperthyroidism
do not deeply palpate it could cause a thyroid storm
Hyerthyroidsim
normal to high vitals signs and thyroid storm causing hyperpyrexia and tachycardia
Hypothyroidism
Nomral to low vital signs and intolerance to cold
Throidectomy post op care
Support head and neck, raise bed to semi fowlers, assess for drainage under neck and shoulders and behind neck.
Throid storm complications
hyperpyrexia, tachycardia, agitated or confused, sick, change in LOC, High BP, jaundice