Diabetes Management and Complications, Exams of Nursing

Download Diabetes Management and Complications and more Exams Nursing in PDF only on Docsity! 1 | P a g e NURS 215 EXAM 1 (ARIZONA COLLEGE OF NURSING) 2024-2025 WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS |FREQUENTLY TESTED QUESTIONS AND SOLUTIONS |ALREADY GRADED A+|NEWEST|LATEST UPDATE |GUARANTEED PASS Protective Isolation is for clients with a) a local infection b) with a systemic infection c) with TB d) if the client is immuno-compromised d) if the client is immuno-compromised During a clinic visit, the nurse is seeing a sexually active 20-year-old college student. The first intervention is a) Measure vital signs b) Encourage HIV screening c) Determine risk factors d) Instruct the client to use condoms c) Determine risk factors The nurse is reviewing the immunization record, this is which level of prevention? a) Primary b) Secondary c) Tertiary d) Quaternary a) Primary 2 | P a g e According to Maslow's hierarchy of needs, which of these needs would the patient seek to meet first? A) Self-actualization b) Self-esteem c) Shelter d) Love & belonging The nurse is discussing routine screening tests for different types of cancer. What is the level of prevention? a) Primary b) Secondary c) Tertiary d) Quaternary b) Secondary You will use the concept of primary prevention when instructing a patient to: a) get a flu shot every year. b) take a blood pressure reading every day. c) explore hiring a patient with a known disability. d) undergo physical therapy following a cerebrovascular accident. a) get a flu shot every year. The client presents with linear clusters of fluid-containing vesicles with some crusting. This is a) Allergic reaction b) Ringworm c) Systemic Lupus Erythematosus d) Herpes Zoster d) Herpes Zoster The client has a draining abdominal wound that has become infected. In caring for the client, the nurse will implement a) No precautions b) Contact precautions c) Droplet precautions d) Airborned precautions b) Contact precautions Which of the following changes in the older adult places them at higher risk of infection? a) Increased vascularity b) Thickening of skin c) Decreased cough d) Increased doctor visits c) Decreased cough 5 | P a g e a)A client with a new medication b)A client scheduled for a chest x-ray c)A client with asthma who requested a breathing treatment d)A client requiring daily dressing change c)A client with asthma who requested a breathing treatment What is it called when the nurse develops a plan? a)Assessment b)Diagnosis c)Planning d)Implementation c)Planning All are aspects of prioritization EXCEPT a)Which client should I see first ? b)What am I going to do? c)What interventions should be performed first? b)Which tasks appropriate to delegate ? b)What am I going to do? Which comes first when prioritizing care? a)Breathing b)Circulation c)Airway d)Temperature c)Airway (Airway, Breathing, Circulation) Which is a physiologic need based on Maslow's Hierarchy of Needs? a)Freedom b)Health c)Family d)Clothing d) Clothing What is self-actualization? a)Desire to become the most you can be! b)Desire to become the strongest you can be! 6 | P a g e c)Desire to become the best you can be! d)Desire to become the smartest you can be! a)Desire to become the most you can be! In a nursing process priority setting, the nurse should always remember to do which of the following? a)Develop a plan of care b)Assess the client c)Identify the main nursing priority problem d)Implement nursing interventions b)Assess the client For a client who is confused, disoriented & has been getting out of bed, what is the less restrictive intervention to use? a)A Wrist restraint only b)Bed alarm c)mattress pad bedside bed d)Mild sedative b)Bed alarm What is health? a)The absence of disease or infirmity b)Optimal physical and mental functioning. c)A state of complete physical, mental, and social well-being d)Being up to date on all vaccinations c)A state of complete physical, mental, and social well-being Which level of prevention focuses on the early detection of disease? a)Primary b)Secondary c)Tertiary d)Quadernary b)Secondary Is Health promotion the process of enabling people to increase control over and to improve their health. True False True Which level of prevention prevents the initial occurrence of disease? 7 | P a g e a)Primary b)Secondary c)Tertiary d)Quaternary a)Primary Which level of prevention focuses on recovery after disease? a)Primary b)Secondary c)Tertiary d)Quaternary c)Tertiary Which example demonstrates the primary level of prevention? a)Cardiac Rehab b)Physical Therapy c)Mammogram screening d)Flu shot d)Flu shot Which example demonstrates the secondary level of prevention? a)MMR vaccine b)cardiac rehab c)occupational therapy d)bone density testing d)bone density testing Which example demonstrates the tertiary level of prevention? a)MMR vaccine b)mammogram c)physical therapy d)Flu shot classify each level of prevention a) prevention b)recovery c)screening a) prevention (primary level) b)recovery (tertiary Level) c)screening (secondary level) 10 | P a g e b)has a rapid onset & is short lasting A pandemic outbreak affects a large group of people in a geographic region. True False False A chronic infection a)has a rapid onset & is short lasting b)has a rapid onset & is long lasting c)develops slowly & is short lasting once ill d)develops slowly and may last months d)develops slowly and may last months Your first line of defense against infection is a)Good handwashing b)Intact skin c)Eating healthy d)Bathing daily b)Intact skin The most important action a nurse can take to prevent infection is a)Eating healthy b)Good handwashing c)Bathing daily d)Never wearing nailpolish b)Good handwashing A primary defense against infection is: a)Normal body flora b)Phagocytosis c)Inflammation d)Fever a)Normal body flora The body's initial response to local injury includes all EXCEPT a)Redness b)Warmth c)Swelling d)Exudate 11 | P a g e d)Exudate The laboratory value to evaluate as a sign of infection is the a)Hematocrit b)White blood cells c)Platelets d)Hemoglobin b) White blood cells A systemic infection is when pathogens invade the blood or lymph and spread throughout body. True False True The importance of obtaining a culture & sensitivity is to know a)what time to start the antibiotic b)what antibiotic will work c)to know why the patient has a fever d)to know what bacteria is causing the infection b) what antibiotic will work A white blood cell count of 20,000 means no infection is present. True False False Nurses must wash their hands with soap & water a)at all times b)only after gloves are removed c)if the patient has c. difficile d)before gloves are used c) if the patient has c. difficile When washing hands with soap & water, hands must be washed a)for 1 - 2 minutes b)for 15 - 30 seconds c)until hands feel clean d)until skin is red b) for 15 - 30 seconds Standard precautions are used 12 | P a g e a)all the time b)when the patient has an infection c)when the patient has a fever d)if ordered by the doctor a) all the time Standard precautions include all of the following EXCEPT a)Clean gloves are worn when touching anything that can contaminate the nurse b)Applies to all bodily fluids, non-intact skin, and mucous membranes c)Face masks at all times d)Wear masks, face shields, and gowns if splashing of bodily fluids is possible c) Face masks at all times ___________ is not warn for contact precautions. a) Surgical mask b) Gloves c) Gown a) surgical mask ___________ is not warn for droplet precautions. a) Surgical mask b) N-95 c) Gloves d) Gown b) N-95 ___________ is not warn for airborne precautions. a) Surgical Mask b) N-95 c) Gloves d) Gown a) Surgical Mask When is a face shield worn? a) In contact precautions b) In droplet precautions c) In airborne precautions d) whenever there is a risk of bodily fluid splash d) whenever there is a risk of bodily fluid splash 15 | P a g e c) dopamine Haldol brings down dopamine levels, which is how pts experience the extrapyramidal effects Several hours after receiving his medication, Brian complains of muscle spasms in his neck and jaw. What side effect of the medication should the nurse suspect? A) Akathisia B) Dystonia C) Tardive dyskinesia D) Parkinsonism b) dystonia Medication education and health education are types of A) psychoeducational groups B) insight-oriented groups C) support groups D) psychodrama a) psychoeducational groups A group participant frequently reminds others of the group's main purpose. What type of role is this person fulfilling? A) Maintenance B) Individual C) Task c) task A patient with type 1 diabetes calls the clinic with complaints of nausea, vomiting, and diarrhea. It is most important that the nurse advise the patient to a) Withhold the regular dose of insulin. b) Drink cool fluids with high glucose content. c) Check the blood glucose level every 2 to 4 hours. d) Use a less strenuous form of exercise than usual until the illness resolves. c) check BG level q 2-4 The nurse plans a class for patients who have newly diagnosed type 2 diabetes mellitus. Which goal is most appropriate? a. Make all patients responsible for the management of their disease. b. Involve the family and significant others in the care of these patients. 16 | P a g e c. Enable the patients to become active participants in the management of their disease. d. Provide the patients with as much information as soon as possible to prevent complications. c) enable the pts to become active participants in the mgmt of their disease A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmoL/L). Which statement by the nurse is best? a. "You will develop type 2 diabetes within 5 years." b. "You are at increased risk for developing DM." c. "The test is normal, and diabetes is not a problem." d. "The laboratory test result is positive for type 2 diabetes." b) "you are at an increased risk for developing DM" The nurse is caring for a patient with type 1 diabetes mellitus who is admitted for diabetic ketoacidosis. The nurse would expect which laboratory test result? a. Hypokalemia b. Fluid overload c. Hypoglycemia d. Hyperphosphatemia a) hypokalemia In planning care for a patient with type 2 Diabetes admitted to the hospital with pneumonia, the nurse recognizes the patient: a) Must receive insulin therapy to prevent the development of ketoacidosis. b) Has islet cell antibodies that have destroyed the ability of the pancreas to produce insulin. c) Has minimal or absent endogenous insulin secretion and requires daily insulin injections. d) May have sufficient endogenous insulin to prevent ketosis but is at risk for development of hyperosmolar hyperglycemic nonketotic coma. d) May have sufficient endogenous insulin to prevent ketosis but is at risk for development of hyperosmolar hyperglycemic nonketotic coma. In what phase of the cardiac cycle does blood flow to the coronary arteries? A. Systole B. Diastole C. Asystole D. Adiastole b) diastole The left coronary artery arises from the aorta and divides into 2 main branches: the left anterior descending artery and left circumflex artery. These arteries supply which parts of the heart? 17 | P a g e A. left atrium B. left ventricle C. interventricular septum D. part of the right ventricle E. all of the above e) all of the above What's a normal cardiac output per min? A. 1-4 L B. 2-6 L C. 4-8 L D. 6-10L c) 4-8 L What is the formula to calculate cardiac output (CO)? A. HR x BP B. HR x SV C. BPx CI D. BP x SV B. HR x SV What can increase preload? A. Hypovolemia B. Hypertension C. Rapid HR D. Hypotension B. Hypertension Cardiovascular disease is the leading cause of death among those over 65 years old. A) True B) False a) true Many physiologic changes in the cardiovascular system of older adults are a result of: A. Lifestyle B. Aging process C. Disease D. Environmental E. All of the above 20 | P a g e - community setting for pts with repeated hospitalizations, severe s/s, or inability to participate in traditional tx - works in homes, agencies, hospitals, or clinics - call team 24/7 support Assertive community treatment (ACT) - emergency, adult, & kid's services for those without access to private care - med admin, therapy, dual dx treatment, psychoeducational groups Community MH centers o Right to treatment o Right to refuse o Right to informed consent o Rights surrounding invol commitment & psychiatric advance directives o Rights regarding restraint & seclusion o Right to confidentiality MH patient rights - indicated when interfering w tx (psych) - requires physician order restraints civil wrong for which money damages may be collected by the injured party from the responsible party Tort law willful or intentional acts that violate another person's rights or property Intentional tort unintended acts against another that produce injury or harm Unintentional law · Provides standard language for all HCP's, health insurance companies, & pharma · Official guideline for dx psychiatric disorders DSM-5 ability to recover from or adjust successfully to trauma or change Resilience process whereby a person unconsciously & inappropriately displaces (transfers) patterns of behavior & emotional reactions toward another person that originated in r/t significant figures in childhood Transference nurse displaces feelings r/t people in their past onto the pt 21 | P a g e Countertransference Chronic multisystem disease characterized by hyperglycemia r/t abnormal insulin production, impaired insulin utilization, or both Diabetes Mellitus (DM) Name the 5 types of DM o Type 1 o Type 2 o Gestational o Other induced/subsequential types o Prediabetes Chronic hyperglycemia leads to.... damage/failure of eyes, kidneys, nerves, heart, & blood vessels What are the 4 tests used to dx DM & their levels? o Random BG > 200 mg/dL with symptoms, plus 2nd test to confirm on a different day to make dx o 2hr PP > 200 mg/dL o OGTT > 200 mg/dL after 2hrs with 75g CHO o HbA1C > 6.5% - involves an alteration in B cells with mild disease - pancreas still able to produce insulin - most pts asymptomatic pre-diabetes Dx: OGTT 140-199 mg/dL, HbA1C 5.7% - 6.4%, IFG 100-125 mg/dL - autoimmune disorder characterized by body's inability to produce insulin - antibodies against insulin and/or pancreatic B cells that produce insulin - genetic & idiopathic - S/S: polyuria, polydipsia, polyphagia, wt loss, prolonged wound healing, weakness, fatigue, malaise type 1 diabetes mellitus (T1DM) Tx: insulin therapy (maybe pump), nutrition planning - most prevalent type of DM - progressive disease - pancreas produces some insulin but not enough OR body doesn't use it effectively - may possible control with diet & exercise - S/S: fatigue, recurrent infections, prolonged wound healing, visual changes, wt gain, malaise, thirst, hunger, N/V, leukocytosis 22 | P a g e type 2 diabetes mellitus (T2DM) Tx: nutritional therapy - result of not having enough insulin in the body - most often effects T1DM - S/S: soft & sunken eyeballs, Kussmaul respirations, hypotension, weak & rapid pulse, vomiting, fruity breath diabetic ketoacidosis (DKA) - acute symptom onset - screening 24-28w gestational diabetes - results from injury to, interference with, or destruction of B cell function in the pancreas - can result from some meds & conditions other types of DM name some meds & conditions that could cause DM - Cushing syndrome, hyperthyroidism, pancreatitis, cystic fibrosis, hemochromatosis, TPN - corticosteroids, thiazides, phenytoin, atypical antipsychotics - syndrome marked by having 3+ medical conditions that increase their risk for DM - obesity, high triglycerides, decreased HDL, HTN, increased BG metabolic syndrome type of insulin management that acts over 24 hours a) basal dose b) nutritional dose c) corrective dose d) pre-medicated dose a) basal dose type of insulin management that covers a meal or prandial dose a) basal dose b) nutritional dose c) corrective dose d) pre-medicated dose b) nutritional dose type of insulin management that corrects an elevated BG level 25 | P a g e - used to prevent T2DM - contraindications: renal disease, liver disease, CV disease, excessive etoh intake biguanides i.e.) Metformin - increased insulin production from pancreas - hypoglycemia is a major side effect - DM medication sulfonylureas i.e.) Glucotrol, Glyname, Amaryl abnormal fat distribution Lipodystrophy - system of assigning a number to CHO foods according to how much each food will increase BG levels - designed to help their food choices glycemic index accumulation of SC fat in response to the adipogenic actions of insulin at a site of multiple injections lipohypertrophy what are the sick day rules? - check BG levels q4 - counterregulatory response can be triggered by an illness (hyperglycemia) - BG > 240, check urine for ketones True/False: insulin allows H2O & K to enter the cell along with insulin, which can lead to vascular volume depletion & hypokalemia a) true - always get serum K before starting - insulin lowers K levels; if pt is hypokalemic, insulin can make K level dangerously low - lab test indicating how much of that substance is in the blood - presence of the substance indicates the pancreas is making insulin c-peptide - used to dx DM with level of 126 mg/dL - fasting BG test fasting plasma glucose (FPG) - transient cognitive disorder caused by an underlying physiological disturbance - always secondary to another condition 26 | P a g e - medical emergency - S/S: altered LOC, disorientation, anxiety, agitation, poor memory, delusional thinking, hallucinations delirium cardinal symptoms - acute onset, reduced ability w attention, disorganized thinking, disturbed consciousness o Best tool for standardized evidence-based practice to recognize delirium quickly & accurately o 4 features to find the greatest ability to distinguish delirium from other types of cognitive impairment o Highly reliable CAM assessment what are the causes of delirium - post-op state - intoxicated - alcohol withdrawal - infections - metabolic disorders - prescribed drugs - neurological disorders - tumors (cerebral) - psychosocial stressors · Substance or medication-induced psychotic disorder · Can be r/t another medical condition · Delusional disorder · Caused by the overactivity of neurotransmitters psychosis Tx: traditional antipsychotics (i.e. Haldol) what are the 3 subtypes of delirium? - mixed (combo of both) - hyperactive (restless, pacing, agitation, rapid mood swings, hallucinations) - hypoactive (decreased motor activity, sluggishness, drowsiness, dazed - motor disorder caused by antipsychotics & other drugs - S/S: acute dyskinesia, dystonic reactions, tardive dyskinesia, parkinsonism, akinesia, akathisia, neuroleptic malignant syndrome (NPS) extrapyramidal symptoms (EPS) - life-threatening motor disorder caused by some antipsychotics - severe muscle rigidity, hyperpyrexia, altered LOC, stupor, labile HTN, tachycardia, diaphoresis, drooling - S/S: fever over 103, elevated CPK & WBC, VS instability, encephalopathy, rigidity 27 | P a g e neuroleptic malignant syndrome (NMS) morbid fear associated with extreme anxiety Phobia false belief that is firmly maintained, even though it's not shared by others & is contradicted by reality Delusion filling in memory gaps with situations or events that can't be remembered Confabulation abnormal condition that is often manifested by motor restlessness, such as the inability to sit still or by feeling the need to pace Akathisia neuro movement disorder characterized by involuntary muscle contractions, generally in the face, tongue, neck, & jaw Dystonia shuffling gait, drooling, tremors, muscle rigidity Parkinson's disease - neuro movement disorder characterized by involuntary muscle contractions - can be a side effect of some 1st gen antipsychotics - S/S: sticking out tongue, puckering lips, lip smacking, puffing cheeks, chewing mvmts Tardive dyskinesia Class: phenothiazine (antipsychotic) O: neuro C: hypersensitivity, cross-hypersensitivity to phenothiaines, angle-closure glaucoma, bone marrow depression, liver disease or CV disease, lacting S: sedation, hypotension, photosensitivity, blurry vision, dry eyes, constipation, dry mouth K: use sunscreen, no CNS depressants, don't take antacids or antidiarrheals within 2h of taking Chlorpromazine / Thorazine Phenothiazine (Antipsychotic) typical conventional, low potency Class: phenothiazine (antipsychotic) O: neuro 30 | P a g e Anhidrosis - decreased sensation - typically at the foot, 1st metatarsal - erythema, swelling, tender to foot or ane - non traumatic or minor trauma - Xrays show bone damage or periostits (regeneration of new bone due to previous injury) - no systemic features Neuropathic arthropathy (Charcot's foot) - used in DM nephropathy to prevent CKD & ESRD - target BP < 140/90 - avoid in pregnant women - review if K consistently > 6 mmol/L - sick day rules - may increase serum creatinine by 30% on start ACEI & ARB Class: (anticovulsant, mood stabilizer) O: neuro [psych] C: hypersensitivity S: confusion, depression, dizziness, drowsiness, ataxia K: don't take with opioids, watch for s/s SI, don't take within 2h of antacids Gabapentin / Neurontin (Anticonvulsants) (Mood stabilizers) Class: (analgesic, anticonvulsant) O: neuro [psych] C: hypersensitivity, myopathy, severe renal impairment, lactating S: dizziness, drowsiness, peripheral edema, dry mouth K: may cause edema, avoid etoh & CNS depressants Pregabalin / Lyrica Non-opioid analgesic Gamma aminobutyric acid gaba analogues (Analgesics) (Anticonvulsants) Class: (antiemetic) 31 | P a g e O: GI C: hypersensitivity, GI obx, perf, GI hemorrhage, seizures, phechromocytoma, tardive dyskinesia, parkinsonism S: drowsiness, extrapyramidal reactions, restlessness K: avoid etoh & CNS depressants, watch for NMS Metoclopramide / Reglan (Antiemetics) Class: glucagon-like peptide 1 glp 1 receptor agonist (antidiabetic) O: endocrine C: hypersensitivity, medullary thyroid carcinoma, multiple endocrine neoplasia syndrome, T1DM, DKA, using insulin, SI, lactating S: N/V/D, headache K: don't mix with insulin, carry form of sugar at all times Liraglutide / Saxenda Glucagon like peptide 1 glp 1 receptor agonists (Antidiabetics) Class: SGLT2 inhibitor (antidiabetic) O: endocrine C: hypersensitivity, severe renal or liver impairment, dialysis, T1DM, lactating S: female mycotic infections, decreased renal function, hypotension, hypoglycemia K: follow prescribed diet, may cause yeast infections Canagliflozin / Invokana Na glucose cotransporter 2 [SGLT2 inhibitors] (Antidiabetics) o Procedure done under general anesthesia where small electric currents are passed through the brain, intentionally triggering a brief seizure o Causes changes in brain chemistry that can reverse the severe s/s of certain mental illness (med resistant depression) o Indications - SI, HI, extreme agitation or stupor, life-threatening illness (refusing food/fluid), hx poor drug response or good ECT response, standard med tx has no effect o OP procedure, ranges 4-20 treatments but most only need 6-12, 3x weekly Electroconvulsive therapy (ECT) Aka. Shock therapy the use of strong magnets to briefly interrupt normal brain activity as a way to study brain regions 32 | P a g e transcranial magnetic stimulation (TMS) what are the typical non-verbal signs of a suicidal pt? - Giving away prized possessions - Writing farewell notes (50% don't) - Making out a will - Putting personal affairs in order - Failing to sleep or fall asleep for more than one night in a row (global insomnia) - Exhibiting sudden or unexpected improvement in mood after being depressed & withdrawn - Neglecting personal hygiene what are the s/s of a suicidal person? o Mood o Anhedonia o Anergia o Anxiety o Worthlessness o Guilt o Helplessness o Hopelessness o Anger o Irritability what types of meds contribute to SI? o Antihypertensives o Benzos o Calcium channel blockers o Corticosteroids & other steroids o Hormonal meds & pain killers o Black box warnings for SI - recurrent depressive episodes in a seasonal pattern - depression increases with changes in daylight Seasonal affective disorder (SAD) - Seen in children - Chronic, severe, persistent irritability with outbursts larger than expected for the child's age & situation Disruptive mood dysregulation disorder - Seen in the week before menses start - Gradually improves/remits after the start of menses Premenstrual dysphoric disorder Pathophysiological consequence of medical condition causing or contributing to depressive symptoms 35 | P a g e o Atypical antidepressant o Black box warning Norepinephrine-dopamine reuptake inhibitors (NDRIs) i.e.) bupropion (Wellbutrin) o Prevent breakdown of norepinephrine, serotonin, & dopamine o Antidepressant o Increased levels result in increased mood o Increased levels of tyramine lead to HTN, hypertensive crisis, CVA, & death o Inhibit breakdown of tyramine in the liver o Must restrict tyramine intake in their diet - ask about diet before giving med o Restricting tyramine o Common side effects - insomnia, N, confusion o Must taper to avoid discontinuation syndrome o Severe side effects - hypertensive crisis r/t interactions o SI risk & antidepressants, serotonin syndrome Monoamine oxidase inhibitors (MAOIs) i.e.) phenelzine (Nardil), tranylcypromine sulfate (Parnate) what does a pt taking MAOIs need to avoid to restrict their tyramine intake? - OTC meds (decongestants & cold meds) - Foods - cheese, wine, aged meat, pickles - caused by serotonin medications - s/s: shivering, HYPERreflexia, myoclonus, fever, VS instability, encephalopathy, restlessness, sweating serotonin syndrome a condition that can occur following the interruption, dose reduction, or discontinuation of antidepressant drugs discontinuation syndrome loss of ability to experience joy or pleasure Anhedonia lack of reduction of energy Anergia Class: SSRI (antidepressant) O: neuro [psych] C: hypersensitivity, using MAOIs, MAOI-like drugs, using pimozide, etoh intolerance 36 | P a g e S: increased sweating, N/D, dry mouth, sexual dysfunction, tremor, dizziness, drowsiness, fatigue K: avoid etoh & CNS depressants, wear sunscreen Sertraline / Zoloft Selective serotonin reuptake inhibitors [SSRIs] (Antidepressants) Class: tricyclic antidepressant O: neuro [psych] C: angle-closure glaucoma, QT interval prolongation, recent MI, HF, lactating S: blurry vision, dry eyes, dry mouth, hypotension, constipation, lethargy, sedation, increased appetite K: watch s/s orthostatic hypotension, sedation common at start, change positions slowly, avoid etoh & CNS depressants, watch wt gain Amitriptyline / Elavil Tricyclic antidepressants (Antidepressants) Class: SSNRI (antidepressant) O: neuro [psych] C: hypersensitivity, MAOIs, MAOI-like drugs, severe renal impairment, hepatic impairment, alcoholism S: increased sweating, decreased appetite, constipation, dry mouth, N/D, dysuria, fatigue, drowsiness, insomnia, NMS K: s/s serotonin syndrome, s/s NMS, change positions slowly Duloxetine / Cymbalta Selective serotonin & norepinephrine reuptake inhibitors [SSNRIs] (Antidepressants) Class: aminoketone, atypical antidepressant O: neuro [psych] C: hypersensitivity, MAOIs, MAOI-like drugs, ritonavir, seizures S: dry mouth, N/V, HTN, agitation, headache, tremor K: judgment impairment, watch SI Bupropion / Wellbutrin Aminoketones (Antidepressants) (Smoking deterrent) 37 | P a g e Class: MAOI (antidepressant) O: neuro [psych] C: hypersensitivity, liver disease, severe renal disease, pheochromocytoma, HF, surgery, lactating S: dizziness, drowsiness, fatigue, headache, hyperreflexia, insomnia, tremor, twitching, weakness, edema, orthostatic hypotension, constipation, dry mouth K: avoid etoh & CNS depressants, change positions slowly Phenelzine / Nardil Monamine oxidase inhibitors (Antidepressants) anecdote - IV phentolamine o 4 chamber organ about the size of a fist o 3 layers - endocardium (inner lining), myocardium (middle muscle), & epicardium (outer lining o R side heart - deoxygenated blood o L side heart - oxygenated blood heart o fibrous sac covering the heart o 2 layers - visceral (inner) & parietal (outer) Pericardium pacemaker of the heart SA node The SA node impulses at how many bpm? a) 60-100bpm b) 40-60bpm c) 20-40bpm d) 15-40bpm a) 60-100bpm The AV node impulses at how many bpm? a) 60-100bpm b) 40-60bpm c) 20-40bpm d) 15-40bpm b) 40-60bpm 40 | P a g e - type of angina - coronary artery vasospasm Prinzmetal's angina - type of angina - myocardial ischemia from microvascular disease affecting the small, distal branches of the coronary arteries Microvascular angina - type of angina - rupture of unstable plaque, exposing thrombogenic surface unstable angina what should you eat & avoid to lower your LDL cholesterol? o Decrease sat fats & cholesterol - butter, lard, cakes, biscuits, fatty meats, cheese, red meats, egg yolks, whole milk products o Increase complex carbs & fiber - whole grains, fruits, veggies o Cardiac med o Block synthesis of cholesterol o Side effects - increased liver enzymes, muscle breakdown (rhabdomyolysis) Statins i.e.) atorvastatin, pravastatin, rosuvastatin, simvastatin (Zocor) o Cardiac med o B3 vitamin, inhibits synthesis & secretion of LDL o Side effects - flushing & pruritus Niacin i.e.) niacin (Niaspan) o Cardiac med o Decrease hepatic synthesis & secretion of VLDL, decreases triglycerides o Side effects - GI problems, rash Fibric acid derivatives i.e.) fenofibrate, gemfibrozil (Lopid) o Cardiac med o Inhibits synthesis/secretion of triglycerides o Side effects - GI problems Bile-acid dequestrants i.e.) cholestyramine 41 | P a g e o Cardiac med o Inhibits the intestinal absorption of cholesterol o Side effects - headache, GI issues Cholesterol absorption inhibitor i.e.) ezetimibe o Cardiac med o Inhibits platelet aggregation, which can block arteries Antiplatelet agent i.e.) Aspirin, clopidogrel, ticagrelor o Cardiac med o Promotes peripheral & coronary artery vasodilation o May prevent coronary artery spasm Nitrates i.e.) nitroglycerin, dinitrate, mononitrate, isosorbide - signifies systemic inflammation - protein made by liver - normal: < 10 mg/dL C-reactive protein (CRP) - amino acid made during protein catabolism - determines risk of developing CVD homocysteine (Hcy) - cardiac enzyme - normal: < 0.2 ng/mL troponins - cardiac enzyme - tests for myocardial cell injury - normal: < 6% total CK level CKMB - lipid panel - normal: < 200 mg/dL total cholesterol - healthy cholesterol - normal: > 45 mg/dL (male); > 55 mg/dL (female) HDL cholesterol 42 | P a g e - bad cholesterol - normal: < 130 mg/dL LDL cholesterol - mixture of fatty acids - cholesterol measure - normal: 40-160 mg/dL (male), 35-135 mg/dL (female) triglycerides - determines heart function & position - prep skin before applying electrodes, lay supine, breathe normal ECG (electrocardiogram) - records sound waves bounced off the heart (4 positions) - left side laying - may be difficult to obtain for COPD pts ECHO - provides info on cardiac function & exercise tolerance - wear comfy clothes & shoes, report any SOB or CP exercise stress test - insertion of a catheter into the heart via artery or vein - contrast allergy, NPO 6-12h prior, give sedation - neurovascular checks, bedrest, IVF cardiac cath - nuclear injection given at max HE while on bike or treadmill - light meal before scan, no caffeine 12h prior nuclear stress test - finds calcium deposits within plaque in the coronary arteries - can confirm CAD coronary calcium (heart) scan relation of the myocardium diastole contraction of the myocardium Systole Class: salicylates (antiplatelet agent)