Pharmacological Agents and Physiological Conditions, Exams of Advanced Education

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2023 NCLEX PN STUDY

ACE inhibitors - "PRIL" Captopril, Enalapril, Afosiopril Antihypertensive. Blocks ACE in lungs from converting angiotensin I to angiotensin II (powerful vasoconstrictor). Decreases BP, Decreased Aldosterone secretions, Sodium and fluid loss. Check BP before giving (hypotension) Dry cough *Orthostatic Hypotension ARBs - -sartan Inhibits vasoconstrictive properties of angiotension II --> Monitor BP, fluid levels, renal/liver status Calcium Channel Blockers - blocks heart calcium channels in the heart and blood vessels S.E: Constipation, dizziness, facial flushing, HA, edema in ankle/feet, decrease BP Beta Blockers - -lol ~decrease heart rate and dilate arteries by blocking beta receptors ~titrate off, Can mask the s/sx of hypoglycemia Venodilators (arterial) - relaxes arterial smooth muscle to promote dilation. arterial dilation decreases BP whitch increase CO ~S.E: Reflex tachycardia, hypotension, Venodilators (arterial and venous) - Venous dilation reduces venous return to heart, causing a decrease in ventricular contraction ~S.E: headache (expected), dizziness, flushing, orthostatic hypotension Atropine - - Anticholinergic

• Treats muscarinic effects ( sweating, diarrhea) ~S.E: blurry vison, uninary retention, dry mouth, constipation. sodium channel blocker - -Lidocaine
• used for dysthymias ~A.E: Diarrhea, hypotension, cardiosupression potassium channel blockers - Amiodarone, Ibutilide
• Dysrhythmias ~A.E: dizziness, tremors, ataxia, pulmonary fibrosis, bradycardia, heart block, blue/grey skin discoloration

Adenosine - Antiarrhythmic

• there is a period of asystole after administration. Rapid push! Digoxin toxicity - -Cholinergic—nausea, vomiting, diarrhea, blurry yellow vision (think van Gogh), arrhythmias, AV block. -Can lead to hyperkalemia, which indicates poor prognosis. GI effects (anorexia, n/v, abdominal pain), CNS effects (fatigue, weakness, diplopia, blurred vision, yellow-green or white halos around objects) Digoxin - Monitor potassium, apical pulse for 1 minute Monitor HR pulse is less that 60-- HOLD Digoxin antidote - digoxin immune FAB H1 antagonists - -ine ~S.E: monitor drowsiness, anticholinergic effects, possible paradoxical ~EDU: No alcohol, take at night and avoid driving, take with food to avoid GI side effects Glucocorticoids - inhaled- cause oral candidiasis, not for acute attacks Oral- long term use: hyperglycemia, PUD, growth suppression leukotriene receptor antagonist - -Montelukast (Singulair), Zafirlukast (Accolate)
• long term control. Cannot abort ongoing attacks. Can cause liver injury
• R.A.E: Neuropsychiatric effects, Churg-Strauss syndrome Monoclonal Antibodies - -Reduces the amount of IgE in the blood to limit their ability to trigger an inflammatory reaction. ~ SubQ injections ~R.A.E: CV problems/ Malignancy possible B2 adrenergic agonists - Class of drugs used to treat asthma and other pulmonary diseases by causing smooth muscle relaxation, resulting in dilation of bronchial passages ~S.E: tachycardia, angina, tremor Methylxanthines (Theophylline) - -relaxes smooth muscles of the bronchi -monitor serum levels -use only when other treatments are ineffective -toxicity (tachycardia, nausea, diarrhea) Anticholinergic drugs - blocks muscarinic receptors in bronchi, leading to decreased bronchoconstriction
• N.C: Can be used on ongoing attack. Monitor for anticholinergic side effects

decongestants - Drugs that reduce congestion or swelling, especially of the upper or lower respiratory tract. Antitussives - Agents that inhibit or suppress the act of coughing

• risk for physical dependence. Monitor for respiratory depression Expectorants - improve the ability to cough up mucus from the respiratory tract
• dont give with an antitussive Mucolytic - a drug that aids in the breakdown of mucus
• dont give with an antitussive ~R.A.E: bronchospasm smells like rotten eggs alpha adrenergic agonist - activates the alpha receptors of the SNS: FIGHT OR FLIGHT
• A.S.E: HTN, tachycardia, angina, hyperglycemia, Necrosis Beta-adrenergic agonists - Stimulate the beta-receptors in the sympathetic nervous system, increasing calcium flow into the myocardial cells, and causing increased contraction alpha adrenergic antagonists - blocks alpha receptors--> prevents vasoconstriction--> BP lowers ~A.S.E: Hypotension reflex tachycardia, nasel congestion --> take first dose at BEDTIME beta adrenergic antagonist - non selective - decrease the heart rate and myocardial contractility reduce cardiac output and workload ~A.S.E: Bradycardia, HF, Bronchoconstriction, hypoglycemia, rebound cardiac excitaion, depresstion beta adrenergic antagonist - selective - Stops FIGHT OR FLIGHT--> decrease HR, Force of contraction ~A.E: bradycardia, rebound cardiac excitation Cholinergic - Referring to cells that use acetylcholine as their synaptic transmitter. --> REST AND DIGEST
• Monitor for cholinergic side effects, bradycardia
• Take on an empty stomach Cholinergic side effects - Diaphoresis + diarrhea urination miosis bradycardia, bronchospasm emesis

lacrimation salivation Muscarine poisoning - -binds to muscarinic receptors -targets parasympathetic neuromuscular or neuroglandular junctions Symptoms: -salivation, nausea, vomiting, diarrhea, constriction of respiratory passages, low blood pressure, slow heart rate (bradycardia) Anticholinergics - reduce bronchospasm

• Increase IOP, uninary retention, bronchial plugging, constipation, Xerostomia, tachycardia Anti-Parkinson's - used to treat Parkinson's disease
• therapeutic response takes a few months to develop but wears off over time -S.E: nausea, vomiting, postural hypotension Cholinesterase inhibitors - -ase A class of drugs to treat people with dementia that help increase levels of acetylcholine in the brain.
• Cholinergic s.e., bronchoconstriction, CV effects Anticonvulsants - long term - stop the seizure generating neurons activity- while leaving healthy neurons alone
• S.E: gingival hyperplasia Anticonvulsant - administered to prevent seizures such as those associated with epilepsy
• monitor for respiratory depression
• ANTIDOTE: FLUMAZENIL Muscle relaxer - -suppresses hyperactive reflexes in spinal cord --> reduce spasms
• CNS S.E: drowsiness, dizziness, fatigue, weakness
• serious hypertension antiulcer - - dine -inhibits the secretion of acid by cells lining the stomach
• Monitor CBC and kidney function, given with meals
• Famotidine: peak absorption 2-3 hours Proton Pump Inhibitors (PPIs) - A group of drugs whose main action is a pronounced and long-lasting reduction of gastric acid production. They are the most potent inhibitors of acid secretion available today.
• administer 30-60 minutes before meal

• REPORT BLACK TARRY STOOL*

Mucosal Protectant - Sucralfate (Carafate) Used for duodenal ulcers. Reacts with stomach acid to form paste that cover ulcers Side effects: Constipation Want to give one hour before meals and at bedtime Antacids - neutralize the acids in the stomach

• constipation with aluminum and calcium antacids, diarrhea with magnesium antacids, hypophosphatemia laxatives - medications or foods given to stimulate bowel movements
• take with full glass of water or juice contraindicated in intestinal narrowing/obstruction Surfactant laxatives - Docusate sodium (Colace) Lower surface tension of stool to allow penetration of water
• administer with full glass of water , soft stool 1-3 hours after administration begins Stimulant laxatives - Bisacodyl (Dulcolax) Stimulates peristalsis Take 1 hour apart from milk or antacids discourage long term use Osmotic laxatives - draw water into the intestine to increase the mass of stool, stretching musculature
• works with 6-12 hours of administration
• encourage increased fluids antidiarrheal - slows down GI tract ( atropine, loperamide, Diphenoxylate)
• doses are small Antiemetics - Treat nausea and vomiting (Ondansetron, palonosetron, dolasetron) Administer slowly Dopamine antagonists - Blocks dopamine receptors in the area of the brain responsible for nausea S.E: extrapyramidal reactions, Anticholinergic effects, Hypotension, sedation+ respiratory depression TPN (total parenteral nutrition) - Hypertonic Solution Given via PICC line, tunneled catheter Prepared daily by pharmacy Use Sterile Asepsis for dressing change Check blood glucose every 4-6 hours Change bag every 24

Loop Diuretics - furosemide, bumetanide, torsemide non potassium sparing Think Lasix "L" for Loop= non potassium sparing

• Monitor potassium levels Thiazide diuretics - hydrochlorothiazide increase sodium in the filtrate causing an increased amount of water absorption --> increase urinary output
• A.E: Hyponatremia, chlormia, kalemia -- dehydration Potassium sparing diuretics - Spironolactone (Aldactone)
• Monitor potassium levels ( dont combine with drugs that increase k levels) steroids - suppress inflammation in the immune system, increase BG, cause of retention of water and sodium ( increase BP)
• Monitor for to many steroids (Buffalo hump, Cushing syndrome) -S.E: immunosuppression, hyperglycemia, delayed wound healing, Osteoporosis Thyroid hormone replacement - levothyroxine take everyday at the same time on an empty stomach. seperate from other medications Taper off Anti-thyroid - drug that reduces thyroid hormone action usually inhibiting hormone synthesis. monitor for s/sx of hypothyroidism posterior pituitary gland - vasopressin and desmopressin causes the body to retain water increasing the blood volume decreasing the UOP and increasing BP monitor BP and UOP Posterior pituitary gland hormone - - Oxytocin stimulates uterine smooth muscle causing it to contract monitor contractions/fetus, BP, HR, K, Glucose Insulin, rapid acting - insulin aspart, insulin lispro onset: 15 minutes Peak: Aspart: 1-3hr Lispro: 30-90 minutes duration: Aspart: 3-5hr, Lispro: 5 hr Insulin, short acting - Regular or Humulin R Lin is just a regular short person Onset: 30 mins - 1 hour Peak: 2-4 hours Duration: 5-7 hours (7 letters in regular) Give about thirty minutes prior to meal

Insulin, intermediate acting - NPH onset: 1-4 hr peak: 4-12 hr duration: 10-24+ hr Insulin, long acting - Glargine (Lantus) onset: 2-4 hr peak: none duration: 24 hr Heperin - prevents blood clotting

• Monitor for bleeding, bruising, hematuria
• heparin induced thrombocytopenia and thrombosis (5-10 days after exposure) -ANTIDOTE: PROTAMINE SULFATE Low Molecular Weight Heparin (LMWH) - Enoxaparin (Lovenox) stops thrombin from being activated, which prevents clots from forming
• N.C: give SC, dose is based on body size,
• Monitor platelets Warfarin - disrupts liver synthesis of vitamin k dependent clotting factors
• Monitor for bleeding, PT( norm. 10-12sec) and INR(norm. 0.9-1.2, therapeutic 2-3) Antiplatelet - reduces the tendency of platelets to stick together and form a clot -S.E: headache, vomiting, rash, diarrhea, dizziness Discontinue 5-7 days before surgery Fibrinolytics/Thrombolytics - medications that dissolve blood clots
• Must be given ASAP for good effects -A.E: Hemorrhage Blood Administration - Identification of patient with blood Filtering (filter comes with tubing)/ Y infusion set/normal saline (0.9%)/spike blood port Washed or Leukocyte depleted (packed RBCs without plasma) Warming of blood if transfusion needed rapidly (warmer provided) 18 or 20 gauge needle (large bore) Flush IV line with NORMAL SALINE before and after USE ONLY NORMAL SALINE with blood Average time to administer: 2 hours per unit (within 4 hours or else blood too warm) Run slowly for first 15 minutes, <2ml/min), then increase Baseline Vital Signs prior to transfusion Periodic measurement of Vital Signs during transfusion (every 15 - 30 mins) Assess patient for signs and symptoms of reaction BE VIGILANT during transfusion!

PATIENTS can have severe reactions to blood that is appropriately typed and matched to them! PENICILLIN Broad or Narrow Spectrum - Tetracycline - inhibits protein synthesis. bacteria dies

• can cause teeth staining, cause photosensitivity
• Avoid calcium, iron, magnesium food and medications Macrolids - inhibit protein synthesis
• Administer with meals to minimize GI discomfort
• can prolong QT interval Aminoglycosides - Treatment of serious infections ototoxicity, Renal toxicity, Can't take with PCN at all!
• gentamicin, neomycin, streptomycin Sulfonamides - Take with LOTS OF WATER regardless of whether you give it at mealtime or not -- Bactrim, Septra, Gantricin, ie, used to treat UTI
• dont administer to infants -Monitor CBC
• Hypersensitive reactions- cross sensitivity Fluoroquinolones - -Ciprofloxacin, norfloxacin, levofloxacin, ofloxacin, moxifloxacin, gemifloxacin, enoxacin. -Inhibit prokaryotic enzymes topoisomerase II (DNA gyrase) and topoisomerase IV. Bactericidal. Must not be taken with antacids. -Gram-negative rods of urinary and GI tracts (including Pseudomonas), Neisseria, some gram-positive organisms . Toxicity: GI upset, superinfections, skin rashes, headache, dizziness. Less commonly, can cause leg cramps and myalgias. -Contraindicated in pregnant women, nursing mothers, and children < 18 years old due to possible damage to cartilage. Some may prolong QT interval. May cause tendonitis or tendon rupture in people > 60 years old and in patients taking prednisone. . Vancomycin - Antibiotic; Treats MRSA, C diff; Ototoxic, nephrotoxic; Infuse slowly ( min) to avoid red man syndrome; CDC 12-step program Anti-Tuberculosis Agents - Treat the microbe Mycobacterium tuberculosis.

Drugs are used for long periods of time. -S.E: Hepatotoxicity, peripheral neuritis Rifampin - Give on empty stomach (anti-tuberculosis) remember Rifampin causes red urine Antiviral - acting to make a virus ineffective

• Cause gi upset (nausea, vomiting, diarrhea) give w/food
• may cause bone marrow suppression and warrant monitoring CBC Antifungals - kill fungi that infect the skin
• highly renal toxic --> give with 1L of saline, IV only -Azoles - - Antifungal
• Can be given PO and cause liver damage
• Monitor LFTs, dont give with acid reducers Justice - fairness; rightfulness Nonmaleficence - do no harm Beneficence - to do good Accountability - ability to answer for one's own actions fidelity - faithfulness; loyalty Autonomy - accepting the client as a unique person who has the right to have there own opinions, perspectives, values, and belief Veracity - truthfulness, honesty advanced directive - a legal document prepared by a living, competent adult to provide guidance to the health care team if the individual should become unable to make decisions regarding his or her medical care; may also be called a living will or durable power of attorney for health care living will - a document in which a person states his or her wishes about life support and other treatments medical power of attorney - A legal document signed by a person who is giving another individual the power to make health care decisions for the first person if he or she becomes incompetent, unconscious, or unable to make decisions for himself or herself. HIPPA - Health Insurance Portability and Accountability Act of 1996

American Disabilities Act - Law that prohibits employers from discriminating against people with physical disabilities Emergency medical treatment and active labor act (EMTALA) - requires anyone coming to an emergency department to be stabilized and treated regardless of their insurance status or ability to pay tort - a wrongful act or an infringement of a right (other than under contract) leading to civil legal liability. Negligence - failure to take proper care in doing something malpractice - Negligence by a professional person Assult - intentionally attempting or threatening to touch a person's body without the person's consent Battery - unconsented touching of another person False Imprisonment - unlawful restraint or restriction of a person's freedom of movement Othrodox Jews - kosher diet: no shellfish/Pork, dont combine meat/dairy products in the same meal

• prepare their own meal Islam - Halal: No alcohol, meat slaughtered religiously( no pork) Ramadan: fast during daylight hour Prayer: 5x a day Women need a female HCP Jehovah's Witness - No blood products should be used Seventh Day Adventist Church - No alcohol ● No caffeine ● Lacto-ovo vegetarians ○ Eggs and dairy products okay ○ No meat ● No pork Hinduism - - prefer a shower-- not bathtub
• lacto-vegetarians --> no eggs, meat ( dairy okay) Lorazepam - Anxiety, seizures, sleep
• Avoid alcohol, monitor respiratory depression ANTIDOTE: FLUMAZENIL

SSRIs - selective serotonin reuptake inhibitors; drugs administered to treat depression that may cause various sexual side effects, especially inhibited or delayed arousal or orgasm

• Monitor for serotonin syndrome, suicide precautions tricyclic antidepressants - block reuptake of serotonin and norepinephrine S.E: TCAS--> tachycardia, cardiac effects, anticholinergic effects, sedation/sexual dysfunction Monoamine Oxidase Inhibitors (MAOIs) - -class of antidepressant drugs sometimes used for treating depression
• Avoid food high in tyramine (Aged cheese, wine, pickled meat)
• S.E: hypertensive crisis Lithium - -Dont administer with NSAIDS
• Monitor drug levels --> therapeutic level: 0.6-1.2 mEq/L
• Adequate fluid intake
• S.E: seizures, arrhythmias, fatigue, confusion, nausea, anorexia, hypothyroidism, tremors Haloperidol - Antipsychotic Uses: schizophrenia, acute psychosis, Tourette's SE: neutropenia, high risk of EPS -tardive dyskinesia, Neuroleptic malignant syndrome, Prolong QT interval Diphenhydramine - antihistamine
• monitor for drowsiness, Anticholinergic effects Terbutaline - Beta 2 agonist used to suppress premature labor, but cardiac stimulatory effects may be hazardous to mother and fetus
• S.E: shakiness, jitteriness, dizziness, drowsiness, hyperglycemia, headache, nausea/vomiting, tachycardia, HTN
• Assess BP, HR, EKG, Blood glucose Magnesium Sulfate - electrolyte
• Monitor for Hypermagnesemia--> confusion, dizziness, decreased reflexes,
• GIVE IV SLOWLY Oxytocin - A hormone released by the posterior pituitary that stimulates uterine contractions during childbirth and milk ejection during breastfeeding.
• Monitor contractions/fetus, contractions will be more painful
• Monitor BP, HR, Glucose, K Misoprostol - - This med reduces gastric acid secretions so that ulcers can heal.

• Pt's taking this should avoid taking magnesium containing antacids as this will increase the risk of diarrhea.
• Misoprostol tends to cause diarrhea.
• This can induce uterine contractions, so women of childbearing age must r/o pregnancy.
• Given SL of Vaginally
• Closely monitor uterine contraction and the FHR in response to the contractions Dinoprostone - stimulates uterine contractions
• Closely monitor uterine contraction and the FHR in response to the contractions
• given as a vaginal gel or suppository Nitrous Oxide - Inhaled anesthetic, less likely to lower blood pressure than other agents, and has the smallest effect on respiration
• tasteless and odorless gas that is mixed with O2 through a mask inotropes - increase contractility vasopressors - act to increase blood pressure Epinephrine - - shock, cardiac arrest
• increase cardiac output -increase BP Norepinephrine - Shock, hypotension
• increase BP, CO Phenylephrine - second line defense for shock victims
• only vasoconstriction, no inotropy
• increased BP Dopamine - shock ,hypotension, trauma
• low dose used in kidney failure to increase renal flow(renal-dopa)
• low dose increase contractibility --> increase CO
• higher dose cause vasoconstriction --> increase SVR --> increase BP Vasopressin - (antidiuretic hormone) hormone released by posterior pituitary; raises blood pressure and enables kidneys to conserve water Milrinone - used with: Cardiogenic shock, decreased CO, Congenital/Acquired heart defects S.E: arrhythmias, hypofusion to extremities/kidneys/GI tract, Peripheral tissue necrosis, MI NEED TO BE ON CARDIAC MONITOR

Hypothalamus - Thyroid releasing hormone (TRH) Corticotropic releasing hormone (CRH) Pituitary Gland - Thyroid stimulating hormone (TSH) Follicle stimulating hormone (FSH) Luteinizing hormone (LH) oxytocin Antidiuretics hormone (ADH, Vasopressin) Parathyroid - parathyroid hormone (PTH) Adrenal glands - steroids': Glucocosteriods, Mineralocorticoids Pancreas - insulin, Glucagon Thyroid gland - T3, T Catecholamines - hormones secreted by the adrenal medulla that affect the sympathetic nervous system in stress response antidiuretic hormone (ADH) - Hormone produced by the neurosecretory cells in the hypothalamus that stimulates water reabsorption from kidney tubule cells into the blood and vasoconstriction of arterioles. Thyroid hormone - modulates activity of growth hormone, ensuring proper proportions

• controlled negative feedback loop
• thyroid stimulating hormone controls the release of T3 and T parathyroid hormone - A hormone of the parathyroid gland that regulates the metabolism of calcium and phosphorus in the body.
• causes calcium to be pulled out of the bones and into the blood
• cause an increase in serum calcium Calcitonin - decreases blood calcium levels
• inhibits osteoclast --> stops bones from releasing more calcium into bones, Opposes PTH, protects against hypercalcemia insulin - A protein hormone synthesized in the pancreas that regulates blood sugar levels by facilitating the uptake of glucose into tissues --> insulin decreases the blood glucose (Normal: 70-110) Glucagon - A hormone secreted by the pancreatic alpha cells that increases blood glucose concentration --> causes glycogenolysis in the liver Methylprednisolone - Corticosteroids

• Monitor for too much steroids' -S.E: immunosuppression, hyperglycemia, Osteoporosis, delayed wound healing levothyroxine - replacement T
• must be taken on an empty stomach -take same day everyday
• lifelong therapy Insulin storage - Keep away from heat and direct sunlight ● Never freeze insulin ● Store in the refrigerator until ready for use ● When actively using, keep at room temperature ● At room temperature: ○ NPH: good for one month ○ Glargine: good for 28 days ○ Rapid and short acting: good for 28 days mixing insulins - Patients whose blood glucose levels are well controlled on a mixed- insulin dose need to maintain their individual routine when preparing and administering their insulin. Do not mix insulin with any other medications or diluents unless approved by the prescriber. Never mix insulin glargine (Lantus) or insulin detemir (Levemir) with other types of insulin. Inject rapid-acting insulins mixed with NPH insulin within 15 minutes before a meal. Verify insulin doses with another nurse while preparing them if required by agency policy. Insulin Administration - injection areas: abdomen, thigh, and hips Rotate injection sites and 1.5 inches apart Don't rub site 45-90 degree angle and leave for 5 sec Glucagon - A protein hormone secreted by pancreatic endocrine cells that raises blood glucose levels; an antagonistic hormone to insulin.
• Administer IM, Monitor BG Metformin - lowers blood glucose
• monitor BG,BUN,Cr
• hold for 24 before and 48 hours after any study with IV contrast
• Take with food Addison's disease - A rare, chronic endocrine disorder in which the adrenal glands do not produce sufficient steroid hormones.
• Replace fluids: Prednisolone, Fludrocortisone TX: IV fluid, administration, increased sodium intake Cushing's disease - - excess of steriods

(Remember: UP, UP, UP, DOWN, UP)

• HYPERnatremia, HYPERtension, INCREASED blood volume, HYPOkalemia, HYPERglycemia
• TX: adrenalectomy, avoid infection Conn's disease - aka primary aldosteronism; a condition characterized by excretion of excessive amounts of aldosterone, the most influential of the mineralocorticoids, which causes the body to retain sodium and excrete extra potassium, leading to an increased volume of blood (hypervolemia) and hypertension
• TX: removal of tumor diabetes insipidus - antidiuretic hormone is not secreted adequately, or the kidney is resistant to its effect
• assessment: lack of concentration/memory/focus, dry mouth, excessive thirst, tachycardia
• TX: monitor neuro status, replace fluids, vasopressin SIADH (syndrome of inappropriate antidiuretic hormone) - - body making too much ADH --> kidneys hold onto the water
• body remains euvolemic
• Assessment: weight gain, nausea/vomiting, low sodium, seizures
• TX: Monitor serum sodium, seizure precaution, fluid restriction, hypertonic saline DI vs SIADH lab values - Hypothyroidism - condition of hyposecretion of the thyroid gland causing low thyroid levels in the blood that result in sluggishness, slow pulse, and often obesity -Symptoms: thinning hair, hair loss, puffy face, constipation, infertility, weight gain, poor memory, intolerance to cold, feeling of tiredness
• TX: Levothyroxine --> take on empty stomach. everyday same time. lifetime therapy hyperthyroidism/ grave's disease - abnormally high secretion of thyroid hormones causing increased appetite, weight loss, decreased attention -TX: Antithyroid (Methimazole), Iodine components (reduce thyroid gland), radioactive iodine therapy, thyroidectomy KEEP TRACH AT BEDSIDE Throid storm - -S/Sx: very high fever/heart rate, SOB, palpitations, chest pain
• Risk factors: untreated graves/hyperthyroidism, recent surgery, trauma to thyroid Hypoparathyroidism - hyposecretion of the parathyroid glands
• low serum calcium levels--> high phosphorus levels
• TX: fix electrolyte balance, calcium replacements, phosphorus binders

• Assessment: circumoral tingling, tetany, muscle cramps, irritability, +chvostek's sign, +trousseau's test, Hyperactive DTRs hyperparathyroidism - hypersecretion of the parathyroid glands, usually caused by a tumor
• high serum calcium levels--> low phosphorus levels Assessment: loss of appetite, fatigue, depression, bone/joint pains, kidney stones -TX: Partial parathyrectomy DM type1 - - Autoimmune disease--> body destroyed the beta cells of the pancreas that produce insulin --> No insulin in body, high glucose levels in blood stream Assessment: Frequent urination, fatigue, irritability, extreme hunger, weight loss, increased thirst, blurred vision Diabetic ketoacidosis - not enough insulin in body tissue to carry glucose to cells --> glucose builds up in cells --> break down protein/fat
• Metabolic acidosis
• 3ps: polyuria, polydipsia, polyphagia DM type 2 - Not enough insulin, bad insulin, resistance to insulin Risk for: obesity, elevated cholesterol levels, Htn Sx; blurred vision, fatigue, elevated appetite, frequent urination, thirst, (possibly symptom free) Tx: diet control, tiazamide, glimepiride, increase exercise levels, repaglidine/nateglinide, glycosylated hemoglobin, BUN/ECG, frequent blood sugar testing, acarbose, diabetic ulcer prevention Tests: Random blood glucose test, oral glucose tolerance test, fasting glucose test Monitor for: Neuropathy, CAD, increased cholesterol, retinopathy, PVD, Htn hypoglycemia - low blood sugar
• S/Sx: Tachycardia, Irritability, Restlessness, Excessive hunger, Diaphoresis -TX: 15-15-15 --> 15 grams, 15 minutes, 15 grams Chambers of the heart - Atria- Receives blood from veins, sends blood to ventricles Ventricles- receives blood from the aorta, sends blood to arteries Valves and their Direction - Atrioventricular valve (AV): one way flow of blood from the aorta to the ventricles. --Right = Tricuspid -- Left = bicuspid

Semilunar Valve: one way flow from the ventricles to either the pulmonary artery or to the aorta Blood flow through the heart - R. atrium (deoxygenated), R. ventricle, pulmonary arteries, lungs, pulmonary veins (now oxygenated), L. atrium, L ventricle, aorta, body Depolarization - contraction Repolarization - Return of the cell to resting state, caused by reentry of potassium into the cell while sodium exits the cell. autonomic nervous system - A subdivision of the peripheral nervous system. Controls involuntary activity of visceral muscles and internal organs and glands. parasympathetic nervous system - the division of the autonomic nervous system that calms the body, conserving its energy Hemodynamics - the forces involved in circulating blood throughout the body preload - Amount of blood returning to the right side of the heart Afterload - The force or resistance against which the heart pumps. compliance - how easily the heart muscle expands when filled with blood Ejection Fraction (EF) - calculation of how much blood a ventricle can eject with one contraction stroke volume - the volume of blood pumped out by a ventricle with each heartbeat causes of decreased CO - Bradycardia Arrhythmias: pulseless v tach, v-fib, asystole, SVT Hypotension MI Cardiac muscle disease causes of increased CO - ● Increased blood volume...sometimes ● Tachycardia...sometimes ● Medications ○ ACE Inhibitors ○ ARBS ○ Nitrates ● Inotropes Hemodynamics parameters -

Amlodipine - calcium channel blocker used to treat hypertension

• Avoid grapefruit, Monitor BP, Gingival hyperplasia Arterial dilators - Hydralazine, Minoxidil (more potent)
• Decreased BP, increase CO
• S.E: tachycardia, orthostatic hypotension, headache, nausea, Venodilators - nitroglycerin; decrease preload -S.E: headache, dizziness, flushing, orthostatic hypotension antiarrhythmic - Amiodarone--> a medication administered to control irregularities of the heartbeat -A.E: dizziness, tremors, ataxia, pulmonary fibrosis, bradycardia, heart block Inotropes - increase contractility of the heart --> dopamine, Dubutamine Vasopressors - drugs used to increase blood pressure --> Norepinephrine, Epinephrine, Vasopressin, Phenylephrine peripheral vascular disease (PVD) - a condition in which the legs, feet, arms, or hands do not have enough blood circulation
• elevate legs, focus on proper wound care hypertension (HTN) - elevated blood pressure persistently higher than 140/90 mm Hg deep vein thrombosis (DVT) - formation of a clot in a deep vein of the body, occurring most often in the femoral and iliac veins -Prevention: promote venous return -TX: Anticoagulant Superior vena cava syndrome - Tumor can compress SVC and cause swelling of face, JVD, and visible chest veins Atherosclerosis - condition in which fatty deposits called plaque build up on the inner walls of the arteries Aneurysms - an excessive localized enlargement of an artery caused by a weakening of the artery wall. embolus - A clot that breaks lose and travels through the bloodstream. --> At risk: pregnancy, AFIB, Long bone fracture air embolism - a bubble of air in the bloodstream
• L. lateral Trendelenburg --> trap bubble on R. side and grab it

Fat embolism - blood tinged sputum r/t inflammations. Increase ESR, respiratory alkalosis. Hypocalcemia, increased serum lipids. peripheral aterial disease (PAD) - disease of the arteries in the arms and legs, resulting in narrowing or complete obstruction of the artery

• Assessment: pallor, pulselessness, hairlessness -TX: dangle legs, Antiplatelet therapy coronary artery disease - disease of the arteries surrounding the heart
• Risk factors: Advanced age, HTN, smoking obesity --> blood flow decreased leads to decreased O2/Ischemia -> nitro - decrease workload of the heart unstable angina - chest pain that occurs while a person is at rest and not exerting himself--> not relieved by nitro myocardial infarction - the occlusion of one or more coronary arteries caused by plaque buildup (heart attack) Assessment: chest pain, Epigastric discomfort, fatigue, SOB, elevated troponin, vomiting TX: Cath lab percardial effusion - a collection of fluid between the pericardial sac and the myocardium Assessment: chest pain, muffled heart sound TX: Pericardiocentesis cardiac tamponade - Compression of the heart as the result of buildup of blood or other fluid in the pericardial sac, leading to decreased cardiac output. Assessment: chest pain, SOB, decreased CO, muffled/distant heart sounds, JVD, narrowed pulse pressure (<40) TX: Pericardiocentesis , surgery stenosis - narrowing, blocks blood flow regurgitation - backflow or ejecting of contents through an opening endocarditis - inflammation of the lining of the heart TX: antibiotics

heart failure (HF) - condition in which there is an inability of the heart to pump enough blood through the body to supply the tissues and organs with nutrients and oxygen Left sided heart failure - blood is backing up in lungs

1. Pnea, SOB
2. Crackles
3. Oliguria
4. Frothy Sputum
5. Displaced Apical Pulse (Hypertrophy) right sided heart failure - blood backs up in the body

• JVD, dependent edema, hepatomegaly, asities , weight gain, fatigue, anorexia central venous catheter - a blood-vessel access device usually inserted into the subclavian or jugular vein with the distal tip resting in the superior vena cava just above the right atrium; used for long-term intravenous therapy or parenteral nutrition arterial line - A catheter inserted into an artery, used most commonly to measure real- time blood pressure and obtain samples for arterial blood gas. thoracentesis - surgical puncture to remove fluid from the pleural space Risk: Pneumothorax , Mediastinal shift, infection Bronchoscopy - use to look at the airway structures or obtain a tissue sample
• NPO 4-8hrs prior
• Post-op: ensure gag reflex is intact Peak Inspiratory Pressure (PIP) - The highest pressure administered with each breath positive end-expiratory pressure (PEEP) - The amount of pressure in the alveoli at the end of expiration fraction of inspired oxygen (FiO2) - concentration of oxygen delivered (1.0 = 100% oxygen)
• 21-100% Tidal Volume (TV) - volume of air inhaled or exhaled in a normal breath end-tidal carbon dioxide - The amount of carbon dioxide present at the end of an exhaled breath. room air - air breathed during normal circumstances

volume controlled - There is a certain volume of air delivered to the patient with each breath pressure controlled - Lungs are inflated to a certain pressure CPAP (continuous positive airway pressure) - continuous positive airway pressure--> while the client controls the respiratory rate/volume BiPAP (bilevel positive airway pressure) - - pressure applied at two diff. pressure settings. one pressure is inhalation and a lower pressure on exhalation

• most often used for non obstructive sleep apnea Ventricular alarms -HIGH - - pressure in the circuit is to high --> client coughing, gagging, bronchospasm, fighting the ventilator, ETT occlusion, Kink in tubing, increased secretions, think screations Ventricular alarms - LOW - pressure in the circuit is too low --> tubing is disconnected, loose connections, leak, extubation, cuffed ETT or trach is inflated pulmonary care - -Bronchial drainage -Breathing technique -Cough facilitation -Postures to improve breathing -Relaxation Techniques -Bronchodilators -Ventilatory Assistance Devices wound drains - • closed drain: attached to a collection system, uses vacuum to draw drainage (JP, hemovac) expected drainage: first 24hrs: sanguinous, 24-72: serosanguinous, more than 72: serous
• open drain: deposits drainage on skin (Penrose) safety pin used, protect skin, if ordered pull drain outward 1-2 inches
• wound vacuum: computer controlled, requires a seal at wound site w/pressure wound packing, pt may be discharged with device chest tube - Catheter inserted through the thorax into the chest cavity for removing air or fluid; used after chest or heart surgery or pneumothorax. ileostomy - the surgical creation of an artificial excretory opening between the ileum, at the end of the small intestine, and the outside of the abdominal wall
• stools will be more liquidly and yellow in color

colostomy - redirects stool from the small intestine --> stools will form and be darker in color Urostomy - creation of an opening in the urinary tract, normally to divert urine flow away from a diseased bladder hemodialysis - A technique in which an artificial kidney machine removes waste products from the blood

• 3-4 times a week --> rapid fluid shift
• client must have fistula
• Complications: Disequilibrium, hypotension peritoneal dialysis - uses the peritoneal membrane as the filter instead of a machine --> Dialysate is infused into the peritoneal cavity, dwells for 6 hours, fluid is drained taking the toxins away with it --> drainage should be clear - turn side to side if decreased fluid return phototherapy - a therapy that involves repeated exposure to bright light --> helps breakdown bilirubin so it can be excreted in the feces --> Monitor the level and distance from the light if overhead therapy is being used pace makers - that's placed in the chest or abdomen to help control abnormal heart rhythms. This device uses electrical pulses to prompt the heart to beat at a normal rate Contractility - strength of contraction of heart muscle stroke volume - The amount of blood ejected from the heart in one contraction. cardiac output - The volume of blood ejected from the left side of the heart in one minute. Post-op care - 1. Assessment (ABCs, bleeding risk?, Infection?, Vitals?)

2. Pain management
3. Wound care/Dressing changes
4. Mobility (Early ambulation)
5. Respiratory care
6. Nutrition (Diet: High protein, Zinc, Iron, Vit. A,B,C,E,K)
7. Client advocacy ( Education, Emotional support)
8. Discharge planning Peripheral IV access - --> Allows for administration of medication, fluids and blood product IV --> Short term --> Changed every 72-96 hours or hospital policy Central IV access - --> Larger volume of fluid to be given

--> may draw blood specimens --> PICC, Nontunneled central venous cath., Tunneled Central Venous cath. TPN (total parenteral nutrition) - Highly concentrated, hypertonic lots of minerals less water Calories, fluids & nutrients Central venous access device required you have to have a central line not a peripheral line it would burn the tissue* also you will use a filter --> check blood glucose every 4-6 hours, daily weight --> Dont turn off suddenly Immunization schedule - Birth: Hep B 2 mos: Hep B, ROTAVIUS, DTaP, Hib, Pneumococcal, Poliovirus 4 mos: Rotavirus, DTaP, Hib, Pneum, Poliovirus 6 mos: Hep B, DTaP, Hib, Pneum, Poliovirus 12 mos: MMR, VAR, Hep A, Influenza, Hib 11-12 YEARS: Tdap, Meningococcal, HPV high risk behaviors - behaviors that expose a person to an unnecessarily high degree of physical or psychological jeopardy Ginkgo biloba - memory enhancement bleeding risk Ginseng - Mental performance bleeding risk Saw palmetto - Benign prostatic hyperplasia (BPH) bleeding risk St. John's Wort - Depression, Insomnia HTN, decrease effect of anticoagulants, Interacts w/antidepressants, steroids' and digoxin Licorice extract - Ulcers, Bronchitis Normal adult vital signs - Temperature: 96.8-99.1 oral BP: 120/80 Pulse rate: 60-100 BPM RR: 12-18 resp/min

Pulse: 60-100 bpm Normal pediatric vital signs - Head to toe assessment - A complete assessment of the patient, one that includes all systems Low fowlers - 15-30 degrees Semi fowlers - 30-45 degrees Fowlers - 45-60 degrees High-fowlers - 60-90 degrees Othrostatic hypotension - Dizziness due to sudden changes in posture (usually found in elderly), cause by slow nervous system response. When you suddenly get up from a resting position, your blood pressure drops. supine - lying on the back --> lookout for skin breakdown Prone - lying face down --> allows for full extension of the hip/knee joints Right lateral recumbent position - lying on the patient's right side; left knee may be drawn upward (also called right lateral decubitus position and right Sims position when knee is drawn upward) --> promote gastric emptying Left lateral recumbent - Recovery position, patient ends up on their left side, with their left arm folded under their head --> promotes an increase of blood flow to the placenta Trendelenburg position - A position in which the patient's feet and legs are higher than the head --> promotion of venous return( more blood back to the heart), postural drainage Reverse Trendelenburg - -entire bed is tilted with the foot of the bed lower than the head -position promotes gastric emptying and prevents esophageal reflux Sims - body position in which a person is lying on his left side with the upper knee flexed and raised toward the chest traction positioning - uses a pulling force to realign a bone

stages of pressure ulcers - ●Stage I - persistent redness; skin is intact with visible, non blanchable redness over a localized area, typically over bony prominence; changes in skin temperature, tissue consistency and sensation (pain, itching) ●Stage II - involves the dermis with partial thickness loss which presents as shallow open ulcer that can be shiny or dry; can also present as a blister that is intact or open/ruptured; wound bed is red pink color without slough or bruising ●Stage III - full thickness tissue loss with subcutaneous fat possibly visible; bone, tendon or muscle are not exposed or directly palpable ●Stage IV - full thickness tissue loss with bone, tendon, or muscle visible NG tube insertion - 1. check order, gather equipment, introduce yourself, identify Pt., provide privacy, explain procedure, hand hygiene, gloves.

2. solicit help & consider restraints prn
3. position child in fowler's position
4. (nasogastric)determine length of tube measure from the tip of the nose to the tragus of the ear to the xiphoid process & mark appropreately 5.(orogastric)determine length of tube measure from the mouth to the tragus of the ear to the xiphoid process & mark appropreately
5. apply lubricant to the tip of the tube
6. for orogastric tube insert tube into mouth with neck hyperextended & advance it toward the back of the throat, continue until mark is reached
7. nasogastric tube insert tube into nose with neck hyperextended & advance straight, if resistance is met increase pressure slightly or rotate tube, continue until mark is reached
8. use a syringe to aspirate a small amount of gastric content, test the PH of the contents using using the litmus paper ( a PH of 3 or less indicates gastric contents)
9. secure the tube with tape or other product to hold the tube in place NG tube placement - xray to confirm proper placement, monitor NG output (color and amt), monitor nasal skin around tube, monitor tubing for kinks & "plugs", continue to assess BS's and abdominal girth, pain, **aspirate contents & irrigate the tube w/ 30 mL of NS q 4 hrs or as ordered by hcp Enemas - The injection of liquid into the rectum through the anus for cleansing or stimulating bowel movement.