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Medical-Surgical Nursing, 10th Ed., Ignatavicius & Workman, 2020 | Registered Nurse (RN) School Study Aid

High Blood Pressure Response

Atria Release Atrial Natriuretic Peptide

Vasodilation

Antagonizes Aldosterone

Na+ and Water Excreted

1 min

Blood Pressure Classification (JNC 7)

Normal

Systolic (<120)

Diastolic (< 80)

Prehypertension

Systolic +20 (120-139)

Diastolic +10 (80-89)

Stage 1 Hypertension

Systolic +20 (140-159)

Diastolic +10 (90-99)

Stage 2 Hypertension

Systolic + > 20 (160)

Diastolic + > 10 (100)

Hypertensive Crisis

Systolic > 180

Diastolic > 110

4 mins

Primary Hypertension Risk Factors

Excessive Alcohol Consumption

High Sodium Diet

Dyslipidemia

Obesity

People of African Descent

Advanced Age

Vitamin D Deficiency

Reduced Nephron Number

Diabetes

Lack of Physical Activity

2 mins

Hypertension Assessment

Essential Hypertension

Secondary Hypertension

Headache

Vision Changes

Nosebleed (Epistaxis)

Chest Pain

Syncope (Fainting)

Average 2 Sets, 2 Minutes Apart

After 2 or More Visits (within 1-4 weeks)

Take BP Both Arms

Common in African Americans

2 mins

Pheochromocytoma

Adrenal Medulla Tumor

Increased Catecholamines

Episodic Hypertension

Diaphoresis

Abdominal or Chest Pain

Surgery

Antihypertensives

Phenoxybenzamine

Metyrosine (Demser)

Do Not Palpate Abdomen

3 mins

Hypertension Intervention

Weight Reduction and Exercise

Diet Changes

Relaxation Techniques

Smoking Cessation

Medications

Encourage Self Monitoring

1 min

Hypertension Medications

Diuretics

ACE Inhibitors

Angiotensin Receptor Blockers (ARBs)

Beta Blockers

Dihydropyridine Calcium Channel Blockers

2 mins

Hydrochlorothiazide HCTZ

Inhibits Reabsorption NaCl and H₂O

Edema

Mild to Moderate Hypertension

Hypokalemia

Hyponatremia

Dehydration

Hyperglycemia

Gout

Sulfa Allergy

Pregnancy and Breastfeeding

1 min

Calcium Channel Blockers (Verapamil and Diltiazem)

Slows AV Conduction

Angina Pectoris

Arrhythmias

Essential Hypertension

Bradycardia

Hypotension

Constipation

Peripheral Edema

Gingival Hyperplasia

Medication Education

2 mins

Angiotensin-Converting Enzyme (ACE) Inhibitors

"-pril" Suffix

Block Renin Angiotensin-Aldosterone System (RAAS)

Hypertension

Heart Failure

Dry Non-productive Cough

Hypotension

Dizziness

Possible Hyperkalemia

Angioedema

Slowly Change Position

Do Not Stop Abruptly

2 mins

Angiotensin II Receptor Blockers (ARBs)

Ends in "-sartan"

Blocks Angiotensin II Receptor

Hypertension

Angioedema

Renal Artery Stenosis

Pregnancy

1 min

Beta Blockers

"-olol" suffix

Decreases Heart Rate and Contractility

Decreases Peripheral Vascular Resistance

Decreases Renin Release

Hypertension

Heart Failure

Angina Pectoris

Asthma and Heart Block Patients

Assess Blood Pressure and Heart Rate

Masking Signs of Hypoglycemia

Do Not Stop Abruptly

2 mins

Cardiovascular Effects of Beta-Blockers

Cardiac Myocytes and Vasculature

Decrease cAMP

Decreases SA and AV Node Conduction Velocity

Lower Blood Pressure

Decrease O2 Consumption

Decreases Mortality Post-MI

2 mins

Systemic Effects of Beta-Blockers

Respiratory

Bronchoconstriction

Metabolic

Decreased Insulin

Decreased Glycolysis and Lipolysis

Eye

Reduces Intraocular Pressure

1 min

Spironolactone (Aldactone)

Inhibition of Aldosterone

Potassium Retention

Hypertension

Edema

Heart Failure

Hyperkalemia

Endocrine Effects

Avoid Potassium Supplements

2 mins

Statins

Rhabdomyolysis

Hepatotoxicity

HMG-CoA reductase inhibitors

Decrease LDL

Decrease Triglycerides

Increase HDL

2 mins

Atorvastatin (Lipitor)

-statin Suffix

HMG-CoA Reductase Inhibitors

High Cholesterol

Hepatotoxicity

Rash

Rhabdomyolysis

Myopathy

Monitor Liver Enzymes

Administer at Bedtime

Avoid Grapefruit

2 mins

Ezetimibe

Hyperlipidemia

Cholesterol Absorption Blocker

Decreases LDL

Diarrhea

Increased LFT Values

1 min

Peripheral Artery Disease (PAD)

Atherosclerosis

Intermittent Claudication

Pain with Exercise

Paresthesias

Arterial Ulcers

Critical Limb Ischemia

Amputation

Ankle-Brachial Index (ABI)

2 mins

Arterial Ulcer Assessment

Absent or Decreased Pulses

Intermittent Claudication

Sharp Pain

Dependent Rubor

Well Defined Edges

Over Bony Areas

Smooth, Shiny Skin

Toes, Heels, Lateral Lower Legs

Cool

2 mins

Arterial Ulcer Interventions

Saline Dressing

Structured Exercise Programs

Fibrinolytics

Antiplatelet Medication

No Caffeine, Nicotine

Surgery

1 min

Aspirin (Acetylsalicylic Acid)

Inhibits Platelet Aggregation

NSAID

Thrombotic Event Prevention

General Pain

Inflammatory Conditions

Fever

Pancytopenia

GI Ulcers

Bleeding

Withhold Before Surgery 7-10 Days

Reye's Syndrome

2 mins

Clopidogrel (Plavix)

ADP Receptor Antagonist

Prevent Platelet Aggregation

Acute Coronary Syndrome (ACS)

Prevention of Thrombotic Events

Bleeding

Thrombotic Thrombocytopenic Purpura (TTP)

Pancytopenia

Abdominal Pain

Withhold Before Surgery

2 mins

Alteplase

Tissue Plasminogen Activator

Thrombosis

Bleeding

Intracranial Hemorrhage

Internal Hemorrhaging

Minimize Bleeding

Monitor for Shock

Aminocaproic Acid

2 mins

Abdominal Aortic Aneurysm (AAA) Assessment

Atherosclerosis

Bruit

Pulsation in Abdomen

Abdominal or Lower Back Pain

Tearing Pain

Ultrasound

Rupture

Shock

Surgical Repair

1 min

Compartment Syndrome Assessment

Trauma

Increased Pressure

Compressed Nerves and Blood Vessels

1 or more of 6 P's

Ankle-Brachial Index (ABI)

May take Days to develop

Early Detection

Ischemia

Damage often Irreversible

2 mins

Compartment Syndrome Interventions

Frequent Neurovascular Assessments

Evaluate Pain

Do Not Elevate Extremity

Remove or Loosen Restrictive Items

Fasciotomy

Amputation

Infection

Monitor Urine Output

2 mins

Superficial Thrombophlebitis

IV Catheter Irritation

Erythema

Cord-like Vein

Edema

Remove IV Catheter

Elevate

Warm Compress

Rotate Sites Q3 Days

Aseptic Technique

2 mins

Venous Thromboembolism (DVT) Assessment

Venous Wall Inflammation caused by Thrombus

Tenderness

Edema

Warmth

Asymmetry

Could be Asymptomatic

Monitor for Pulmonary Embolism

58 secs

Venous Thromboembolism (DVT) Interventions

Anticoagulants

Prevention Education

Frequent Ambulation

Leg Exercises

Compression Stockings or SCD's

Avoid Nicotine and Oral Contraceptives

Surgery

1 min

Heparin (Unfractionated)

Suppresses Coagulation

Deep Vein Thrombosis (DVT)

Pulmonary Embolism

Hemorrhage

Heparin-Induced Thrombocytopenia (HIT)

Monitor aPTT

Preferred (Safe) During Pregnancy

Protamine Sulfate

2 mins

PT/PTT Lab Values

Prothrombin Time (PT)

10-14 seconds

Activated Partial Thromboplastin Time (PTT or aPTT)

25-35 seconds

1 min

INR Lab Value

0.8-1.2 Normal Range

Warfarin

2.0-3.0

1 min

Heparin Induced Thrombocytopenia (HIT)

5-10 Days After Heparin Exposure

Heparin-Platelet Factor 4 Complex

Autoantibodies Form Against Complex

Heparin-Platelet Factor 4-Antibody Complex Binds Platelets

Platelet Aggregation

Procoagulant Release

Thrombocytopenia

Serotonin Release Assay (SRA)

Stop Heparin, Start Direct Thrombin Inhibitor

2 mins

Enoxaparin (Lovenox)

Inhibits Clotting Factors

Factor Xa

Clot Formation Prevention

Heparin Induced Thrombocytopenia (HIT)

Bleeding

Medication Education

Subcutaneous Injection

2 Inches from Umbilicus or Incisions

Protamine Sulfate

2 mins

Warfarin (Coumadin)

Inhibits Clotting Factors

Atrial Fibrillation

Venous Thrombosis

Pulmonary Embolism

PT/INR Levels

Observe for Bleeding

Pregnancy

Vitamin K and Fresh Frozen Plasma

Prolonged Therapeutic Onset

Maintain Same Diet

2 mins

Warfarin Antidotes

Vitamin K

Fresh Frozen Plasma

59 secs

Vitamin K1 (Phytonadione)

Synthesizes Clotting Factors II, VII, IX, X

Hypoprothrombinemia

Newborn Prophylaxis

Bleeding from Warfarin Overdose

Shock

Kernicterus

Cardiac Arrest

Bile Salts required for Intestinal Absorption

Increased Risks with IV Administration

2 mins

Chronic Venous Insufficiency (Venous Stasis Ulcer) Assessment

Venous Stasis Ulcer

Uneven Edges

Dull Persistent Pain

Medial Malleolus

Necrotic

Normal Pulses

Lower Leg Edema

Bronze-Brown Pigmentation

Warm

Pruritus

2 mins

Chronic Venous Insufficiency (Venous Stasis Ulcer) Interventions

Frequently Elevate Legs

Avoid Standing/Sitting for Long Periods of Time

Elastic Compression Stockings

Bilayer Artificial Skin

Daflon

Wound Dressings

Proper Foot and Leg Care

2 mins

Varicose Veins Assessment

Increased Venous Pressure

Incompetent Valves

Telangiectasias

Small Reticular Veins

Dilated and Tortuous Veins

1 min

Varicose Veins Interventions

Laser Therapy

Sclerotherapy

Removal of Saphenous Vein

Avoid Prolonged Standing

Elastic Compression Stockings

2 mins

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