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Adult Health Nursing II

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1 Adult Health Nursing II
Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

2 Cardiovascular Pharmacology
A Good Resource: Block 7.0 Module 2.1

3 Concept Map: Selected Topics in Cardiovascular Nursing
ASSESSMENT Physical Assessment Inspection Palpation Percussion Auscultation Cardiac Monitoring Lab Monitoring PHARMACOLOGY Cardiac Glycosides ACE Inhibitors Beta Blockers Antiarrhythmics Catecholamines Anticoagulants PATHOPHYSIOLOGY Myocardial Infarction Acute Coronary Syndrome Valvular Heart Disease Pacemakers CABG Abdominal Aortic Aneurysm Pericarditis Peripheral Vasc Disease (PVD) Fem-Pop Bypass Graft Shock / Fluid Deficit Raynaud’s Phenomenon Arrhythmias / Dysrhythmias Care Planning Plan for client adl’s, Monitoring, med admin., Patient education, more… Nursing Interventions & Evaluation Execute the care plan, evaluate for Efficacy, revise as necessary Block 7.0 Module 2.1

4 Potassium – Sparing / Combination Diuretics
Cardiovascular Pharmacology Alpha Blockers Beta Blockers Anti-Arrhythmics ACE Inhibitors Anti-Hypertensives Anti-Anginals Digitalis Glycosides Calcium Channel Blockers Anti-Lipemics Loop Diuretics Potassium – Sparing / Combination Diuretics Platelet Aggregation Inhibitors Thiazide / Related Diuretics Block 7.0 Module 2.1

5 -pril------------------------------- ACE Inhibitor
-lol or –olol Beta Blocker -pine  Ca Channel Blocker -statin  anti-lipemic -nitr  nitrates -zosin  alpha blockers -pine -olol -nitr -statin -lol -pril -zosin Block 7.0 Module 2.1

6 Alpha Blockers Beta Blockers Ca Channel Blockers ACE Inhibitors
atenolol (Tenormin ®) carvedilol (Coreg ®) metoprolol (Toprol XL ®, LoPressor ®) propranolol HCl (Inderal ®) Alpha Blockers Beta Blockers Ca Channel Blockers ACE Inhibitors Anti-Lipemic Nitrates -olol -pril -pine -statin -nitr- -zosin -lol benazepril HCl (Lotensin ®) captopril (Capoten®) enalapril maleate (Vasotec®) lisinopril (Prinivil ®, Zestril®) amlodipine besylate (Norvasc ®) diltiazem HCl (Cardizem ®, Dilacor ®) nifedipine (Adalat ®, Procardia XL ®) Verapamil HCl (Calan ®, Isoptim ®, Covera ®) atorvastatin calcium (Lipitor ®) lovastatin ( Mevacor ®) pravastatin (Pravachol ®) rosuvastatin calcium (Crestor ®) simvastatin (Zocor ®) isosorbide dinitrate (Isordil ®) isosorbide mononitrate (Ismo®) Nitroglycerin doxazosin mesylate (Cardura®) prazosin HCl (Minipress®) Block 7.0 Module 2.1

7 -pril ACE Inhibitors benazepril HCl (Lotensin ®) captopril (Capoten®)
enalapril maleate (Vasotec®) lisinopril (Prinivil ®, Zestril®) hypertension CHF Diabetic Neuropathy Left Ventricular Dysfunction After MI ACUTE M.I. “The Multi-Purpose Group !” Block 7.0 Module 2.1

8 Prototype: captopril ACE Inhibitors produce desired effect by blocking production of angiotensin II, resulting in arteriolar vasodilation, excretion of sodium and retention of potassium Indications: Heart failure, HTN, MI (reduce mortality, reduce heart failure), diabetic & non-diabetic nephropathy. Nursing Implications: orthostatic hypotension, cough, potential hyperkalemia Block 7.0 Module 2.1

9 The –pril’s: ACE Inhibitors
Treatment of Hypertension captopril, enalapril, lisinopril—tx of HTN, CHF, decreased L ventricular function after MI Always check BP before administering—hold PRN (parameters) Teach patient to change positions slowly to avoid postural hypotension “cough” C.O. = HR x SV BP = C.O. x PVR Block 7.0 Module 2.1

10 -zosin Alpha Blockers doxazosin mesylate (Cardura®)
prazosin HCl (Minipress®) Block 7.0 Module 2.1

11 Prototype: prazosin Alpha blockers cause venous and arterial dilation, smooth muscle relaxation of prostate Indications: HTN Nursing Implications: monitor BP closely after initial dose; orthostatic hypotension Block 7.0 Module 2.1

12 The –zosin’s: Alpha Blockers sympatholytic
Uses: Nursing Implications Treatment of HTN BPH (doxazosin (Cardura®) Teach patient to avoid changing positions rapidly (postural hypotension) Check blood pressure prior to administration; hold med PRN (Parameters) C.O. = HR x SV BP = C.O. x PVR Block 7.0 Module 2.1

13 -nitr- Anti-Anginals isosorbide dinitrate (Isordil ®)
isosorbide mononitrate (Ismo®) Nitroglycerin Nitro-dur®, Transderm Nitro ® Nitrol ® Nitrostat ® Nitrotab ® Block 7.0 Module 2.1

14 Prototype: nitroglycerin
Vasodilation of coronary artries increases myocardial oxygen supply; decreases myocardial oxygen demand via vasodilation and reduction of preload Indications: angina treatment and/or prophylaxis; Nursing Implications: hypotension, orthostatic hypotension, cough, potential hyperkalemia Block 7.0 Module 2.1

15 The –”NITR’s” Anti-Anginals (effect: vasodilation)
nitroglycerin sl, nitropaste, nitroderm Chest pain regimen: 1 tab NTG sl, q5 min X 3 Isosorbide dinatrate (Isordil®) Treatment / Prophylaxis of angina, CHF C.O. = HR x SV BP = C.O. x PVR Block 7.0 Module 2.1

16 Anti-Arrhythmics ( Anti-Dysrhythmics )
amiodarone HCl (Cordarone ®, Pacerone® ) lidocaine HCl (Xylocaine ®) procainamide (Procanbid ®, Pronestyl ®) quinidine (Quinaglute ®) Block 7.0 Module 2.1

17 Prototype: lidocaine Class Ib antiarrhythmic; decreases electrical conduction, decreases automaticity, increases rate of repolarization Indications: short-term use for ventricular dysrhythmias; monitor respirations—respiratory arrest. Cardiac monitor—vital signs Nursing Implications: CNS effects—drowsiness, altered mental status, paresthesias, seizures Block 7.0 Module 2.1

18 A “Slight” Side-Effect of IV Amiodarone !
Block 7.0 Module 2.1

19 Lidocaine HCl—the old reliable; used for PVC’s, ventricular ectopy, ventricular tachycardia
Amiodarone –Management of life-threatening ventricular arrhythmias unresponsive to less toxic meds; assess for pulmonary toxicity Both of these: Infusion pumps, monitor v.s. frequently, cardiac monitor Block 7.0 Module 2.1

20 Anti-Hypertensives clonidine (Catapres ®, Catapres Patch ®, Catapres TTS ®) hydralazine HCl (Apresoline ®) hydroclorothiazide / lisinopril (Prinzide ®, Zestoretic ®) minoxidil (Loniten ®) Block 7.0 Module 2.1

21 Prototype: clonidine Sympatholytic—decreases HR causes decrease in C.O., peripheral vasodilation—decreases BP Indications: HTN, severe cancer pain Nursing Implications: hypotension, orthostatic hypotension, administer twice daily in divided dose Block 7.0 Module 2.1

22 Hydralazine—tx of essential hypertension
HCTZ/Lisinopril—combination drug –essential hypertension Always check BP prior to administration—hold PRN (Parameters) Postural hypotension precautions Block 7.0 Module 2.1

23 -statin Anti-Lipemics atorvastatin calcium (Lipitor ®)
colestipol (Colestid ®) gemfibrozol (Lopid ®) lovastatin ( Mevacor ®) Niacin ( Niacor ®, Niaspan ®) nicotinic acid (Slo-Niacin ®, Vitamin B) pravastatin (Pravachol ®) rosuvastatin calcium (Crestor ®) simvastatin (Zocor ®) Block 7.0 Module 2.1

24 Prototype: atorvastatin
Block 7.0 Module 2.1

25 -lol -olol Beta Blockers atenolol (Tenormin ®) carvedilol (Coreg ®)
metoprolol (Toprol XL ®, LoPressor ®) propranolol HCl (Inderal ®) Block 7.0 Module 2.1

26 Prototype: metoprolol
Remember that there are cardioselective and non-selective Beta blockers; Beta1 adrenergic blockage to reduce heart (- chronotrope) rate, decrease myocardial contractility (-inotrope), decrease rate of conduction through the AV node Indications: angina, HTN, dysrhythmias, MI, Heart failure, Nursing Implications: Apical pulse; monitor VS; Contraindicated in AV Block, SB. Block 7.0 Module 2.1

27 Used for tx of HTN, MI, angina prophylaxis, CHF
Cardioselective vs nonselective B-Blockers and Respiratory Nursing: Apical Pulse C.O. = HR x SV BP = C.O. x PVR Block 7.0 Module 2.1

28 Calcium Channel Blockers
-pine Calcium Channel Blockers amlodipine besylate (Norvasc ®) diltiazem HCl (Cardizem ®, Dilacor ®, Tiamate ®, Cardizem SR ®, Cardizem CD ® ) nifedipine (Adalat ®, Procardia XL ®) Verapamil HCl (Calan ®, Isoptim ®, Covera ®) Block 7.0 Module 2.1

29 Prototype: nifedipine
Vasodilation of peripheral arterioles; clocking of CA+ channels in heart causes decreased force of contraction, decreased heart rate, decreased pulse. (-inotrope, -chronotrope) Indications: HTN, angina, selected dysrhythmias Nursing Implications: hypotension, orthostatic hypotension, cardiac monitor, monitor pulse rate Contraindications: AV blocks, hypotension, bradycardia, aortic stenosis, severe heart failure Block 7.0 Module 2.1

30 Nursing: Check BP, hold PRN (Parameters)
Treatment of HTN, vasospastic angina, angina prophylaxis, Atrial Fibrillation (sometimes) , rapid atrial dysrhythmias Nursing: Check BP, hold PRN (Parameters) Postural Hypotension Precautions C.O. = HR x SV BP = C.O. x PVR Block 7.0 Module 2.1

31 Digitalis Glycosides digoxin (Lanoxin ®) (+) Inotrope, (-) Chronotrope
CHF, Atrial Tachy-arrhythmias (A-Fib, A-Flutter), Cardiogenic Shock Assess Apical Pulse Dig Toxicity—anorexia, fatigue, weakness, yellow-green halo’s around lights Role of K+ ! (Can be Dig Toxic with therapeutic Dig levels if K+ is low!) Therapeutic Level = ng/ml Low K+: Possible U Waves on EKG Block 7.0 Module 2.1

32 Prototype: digoxin (+) inotropic effect; (-) chronotropic effect; improves stroke volume and C.O. Indications: treatment of heart failure; treatment of atrial fibrillation Nursing Implications: AP, monitor dig levels, monitor K+ Contraindicated: Ventricular rhythm disturbances: VF, VT, 2nd -3rd degree AV block Block 7.0 Module 2.1

33 Loop Diuretics bumetanide (Bumex ®) furosemide (Lasix ®)
Monitor serum K+ 3.5 – 5.0 mEq/L Potassium rich foods Block 7.0 Module 2.1

34 Prototype: furosemide
Block reabsorption of NA and Cl, prevent reabsorption of H2O, causing extensive diuresis; Indications: Pulmonary edema d/t Heart failure Nursing Implications: I&O, daily weights, hypotension, diuresis (foley?), orthostatic hypotension, monitor K+, RELATE THIS MED IN RELATION TO OTHER MEDS. Dietary counseling. Block 7.0 Module 2.1

35 Platelet Aggregation Inhibitors
clopidogrel bisulfate (Plavix ®) dipyridamole (Persantine ®) ticlopidine HCl (Ticlid ®) Prevention of TIA’s, CVA; combined with warfarin or ASA for heart valves, MI, bypass grafts, stents. Block 7.0 Module 2.1

36 Prototype: aspirin Prevent platelets from clumping or aggregating;
Indications: Primary prevention of MI; prevention of CVA (stroke); Nursing Implications: bleeding , GI Upset ; use cautiously in those with anticoagulants and NSAID’s (potentiates). Block 7.0 Module 2.1

37 Potassium Sparing / Combination Diuretics
hydrochlorothizide / triamterene (Dyazide ®, Maxzide ®) spironolactone (Aldactone ®) Treatment of edema and hypertension Avoid high K= foods (oranges, bananas, salt substitute, dried apricots, dates, Weigh Daily Block 7.0 Module 2.1

38 Prototype: spironolactone
Spironolactone is classified as a potassium-sparing diuretic. Indications:congestive heart failure, cirrhosis of the liver, and kidney disease. It can also be used in combination with other drugs to treat elevated blood pressure. Nursing Implications: Used with other diuretics; Give with meals; Avoid salt substitutes containing potassium; Monitor I and O Block 7.0 Module 2.1

39 Thiazides / Related Diuretics
chlorthalidone (Hygroton ®, Hylidone ®, Thalitone ® hydrochlorothiazide [hctz] (Hydrodiuril ®) indapamide (Lozol ®) metolazone (Zaroxylyn ®) Block 7.0 Module 2.1

40 Monitor for hypokalemia

41 Anti-Coagulants Heparin Enoxaparin Warfarin Antidotes:
Heparin = protamine sulfate Coumadin = vitamin K Digoxin = Digibind, Digifab, Block 7.0 Module 2.1

42 Prototype: heparin Inactivation of thrombin formation vis inhibition of fibrin formation, Indications: DIC, stroke, prophylaxis agains post-op DVT, Nursing Implications: bleeding (remember: internal & external bleeding) Heparin Induced Throbocytopenia (HIT)—stop if platelets <100,000; monitor aPTT (< 2 x baseline) Antidote: Protamine sulfate Block 7.0 Module 2.1

43 Thrombolytic Medications
Block 7.0 Module 2.1

44 Prototype: streptokinase
Act by dissolving clots. Indications: Acute MI; DVT; Pulmonary emboli, ischemic stroke (alteplase) Nursing Implications: MONITOR FOR BLEEDING; monitor VS; (see p. 310, ATI Pharm) Contraindications: prior intracranial hemorrhage, active internal bleeding, significant trauma within 3 months, acute pericarditis, brain tumors. Block 7.0 Module 2.1


46 Lidocaine (or amiodarone)
Oxygen Epinephrine Atropine Adenosine Lidocaine (or amiodarone) Block 7.0 Module 2.1

47 Block 7.0 Module 2.1

48 Oxygen 100 % ! (during resuscitation, for all clients, including those with chronic respiratory conditions, e.g., COPD) Block 7.0 Module 2.1

49 Epinephrine (Adrenaline) catecholamine
Pharmacologic action: vasoconstriction; increased heart rate (+ chronotrope); increased rate of conduction; increased BP; increased myocardial contractility. Indication: Cardiac arrest; ventricular fibrillation Administration: IV, IV push Dose: 1 mg IV push  q3-5min Nursing Implications: Monitor blood pressure, peripheral pulses, urinary output Use infusion pump Block 7.0 Module 2.1

50 Atropine sympathomimetics
Pharmacologic Action: Indication: SYMPTOMATIC BRADYCARDIA Administration: IV Nursing Considerations: weigh the risks to increased myocardial oxygen demand in CV patient 1 mg rapid IV. Repeat q3-5 minutes up to maximum total dose of 0.04 mg/kg. Block 7.0 Module 2.1

51 Adenosine class V antiarrhythmic
Pharmacologic Action: Class V anti-arrhythmic; causes transient heart block in the AV node Indication: SVT & WPW Administration: IV Bolus Nursing Considerations: after IV bolus, causes a transient asystole 6 mg rapid IV, followed by saline flush. If no response in 1-2 minutes give 12 mg rapid IV. May repeat in 1-2 minutes if needed. Block 7.0 Module 2.1

52 Lidocaine anti-arrhythmic
Indications: ventricular fibrillation, ventricular tachycardia Pharmacologic Actions: anti-arrhythmic Administration: IV Nursing Considerations: monitor the patient! If received bolus, needs to receive a continuous infusion afterwards; CNS effects—drowsiness, altered mental status, seizures 1 to 1.5 mg/kg q3-5min. Maximum total: 3 mg/kg. Block 7.0 Module 2.1

53 Amiodarone anti-arrhythmic
Indications: Pharmacologic Actions: Administration: Nursing Considerations: Block 7.0 Module 2.1

54 Matching C J S V A G D H K Y E L I M N O U B T F R X P Z W Q Column A
Column B Alpha Blocker Beta Blocker Calcium Channel Blocker Anti-Anginal Anti-Arrhythmic Anti-Hypertensive Anti-Lipemic Digitalis Glycosides Loop Diuretics Platelet Aggregation Inhibitors Potassium Sparing / Combination Diuretics Thiazide Diuretics A. isosorbide dinitrate (Isordil ®) B. digoxin (Lanoxin ® ) C. prazosin HCl (Minipres ®) D. amiodarone HCl (Cordarone®, Pacerone ® ) E. hydralazine HCl (Apresoline ®) F. dipyridamole (Persantine ®) G. nitroglycerin (Nitrostat ®) H. lidocaine HCl (Xylocaine ®) I. simvastatin (Zocor ®) J. doxazosin mesylate (Cardura®) K. quinidine (Quinaglute ®) L. clonidine (Catapres ®) M. atorvastatin calcium (Lipitor ®) N. gemfibrozol (Lopid ®) O. lovastatin ( Mevacor ®) P. spironolactone (Aldactone ®) Q. hydrochlorothiazide [hctz] (Hydrodiuril ®) R. clopidogrel bisulfate (Plavix ®) S. carvedilol (Coreg ®) T. furosemide (Lasix ®) U. colestipol (Colestid ®) V. propranolol HCl (Inderal ®) W. nifedipine (Adalat ®, Procardia XL ®) X. ticlopidine HCl (Ticlid®) Y. verapamil HCl (Calan ®) Z bumetanide (Bumex ®) ACE Inhibitors C J S V A G D H K Y E L I M N O U B T F R X P Z Block 7.0 Module 2.1 W Q

55 Appendix: Electrolytes & Imbalances related to: Cardiac Effects
Sodium (Na+) Effects: Normal level = 135 to 145 mEq/L (adult) Required in acid-base and osmotic pressure balance, nerve function and water equilibrium.  >Decreased  Hypotension, headache, nausea, vomiting, abdominal cramps, muscle tremors, twitching, fatigue, headache, nausea, vomiting, diarrhea, abdominal cramps, muscle tremors, twitching, weakness, confusion, seizures, and coma <Increased  Lethargy, irritability, muscle twitching, tremors, dry skin and mucous membranes, fever, hypotension, disorientation, delirium, cerebral hemorrhage, coma  Block 7.0 Module 2.1

56 ! Potassium (K+) Effects: Normal level = 3.5 to 5 mEq/L (adult)
Major factor in carbohydrate metabolism, osmotic pressure balance, acid-base balance and normal muscle contraction.  > Decreased  Cardiac arrhythmia, depressed S-T segment, flattened/inverted T wave, U wave, confusion, lethargy, muscle weakness, paralysis, abdominal distention, constipation, paralytic ileus, thirst, frequent voiding < Increased  Muscle weakness, paralysis, numbness and tingling, ventricular fibrillation, cardiac arrest, tall tented T waves ! Block 7.0 Module 2.1

57 Effects Calcium (Ca++) Normal level = 8.5 to 10 mg/dL
>Decreased  Frequent hives, chronic fatigue, canker and cold sores, muscle cramps (Charlie Horses), and itchy skin dementia, depression, psychosis, tetany (Chvostek's and Trousseau's signs), laryngospasm, or generalized convulsions, cardiac arrhythmias with lengthened QT segments <Increased  Muscle weakness, bone fragility, kidney stones, loss of appetite, thirst, frequent urination, lethargy, fatigue, joint pains, memory loss, depression, constipation, anorexia, nausea and vomiting, abdominal pain, ileus, polyuria, nocturia, and polydipsia, emotional lability, confusion, delirium, psychosis, stupor, coma, cardiac arrhythmias with shortened QT segment Normal level = 8.5 to 10 mg/dL Involved in bone and tooth formation, blood coagulation, nerve function, muscle contraction.  Block 7.0 Module 2.1

58 Magnesium (Mg2+) Normal level = 1.3 to 2.1 mEq/L
Required for activation of an enzyme necessary for energy metabolism and bone formation.  >Decreased  Muscle weakness, fatigue, confusion, restlessness, hyperexcitability, vertigo, seizures, muscle tremors, nystagmus, tachycardia, hypotension, PAC, PVC, Toursades de Pointes arrhythmia, anorexia, nausea, vomiting, personality change, tetany (eg, positive Trousseau's or Chvostek's sign or spontaneous carpopedal spasm), and tremor and muscle fasciculations  <Increased Muscle weakness, drowsiness, lethargy, hypotension, paralysis, coma, cardiac and respiratory problems Block 7.0 Module 2.1

59 Blood Glucose Hypoglycemia Hyperglycemia
Diabetic Ketoacidosis · Fatigue · Flushed, dry skin· Dry mouth · Increased thirst · Increased urination· Blurry vision · Headache· Nausea and Vomiting· Dehydration· Weak, rapid pulse· Hypotension· High blood glucose levels (>240 mg/dL).· Ketones in urine· Increased thirst and urination · Nausea, vomiting, and/or stomach pain· Changes in or difficulty breathing (Kussmaul’s respirations)· Acid or fruity smell on breath (Acetone breath)· Flushing · Dehydration · Fatigue · Stupor and coma Restlessness· Irritability· Confusion· Trembling· Slurred speech · Headache · Tingling lips · Paresthesia· Diaphoresis (cool skin) · Pallor· Tachycardia· Shallow respirations· Hypertension· Weakness · Hunger · Coma · Tremors  Block 7.0 Module 2.1

60 Hypokalemia: ST depression, decreased or inverted T waves, U waves ²         Hyperkalemia: peaked T waves, decreased P waves, short QT, widened QRS, sine wave ²         Hypocalcemia: prolonged QT, flat or inverted T waves ²         Hypercalcemia: short or absent ST, decreased QTc interval ²         Hypomagnesemia: prolonged QT, flat T waves, prolonged PR, aFib, torsade ²         Hypermagnesemia: short PR, heart block, peaked T waves, widened QRS0 ²         Digitalis toxicity: ST depression (scoop), flat T waves ²         Quinidine: prolonged QT, widened QRS ²        Pericarditis: diffuse ST elevation with PR interval depression Hypomagnesemia: prolonged QT, flat T waves, prolonged PR, aFib, torsade ²         Hypermagnesemia: short PR, heart block, peaked T waves, widened QRS0 ²         Digitalis toxicity: ST depression (scoop), flat T waves Block 7.0 Module 2.1

61 Appendix: A Med-Surg Nurses description of cardiac care—things to think about with patient care
Monitor your patient's response to drug therapy by assessing his blood pressure, heart rate, heart sounds, ECG results, breath sounds, urine output, and weight. Also, assess him for peripheral edema. If the physician prescribes a digitalis glycoside, take your patient's apical pulse for a full minute before administering the drug. Withhold the drug if his apical pulse is less than 60 beats per minute. Block 7.0 Module 2.1

62 Begin digitalis glycoside therapy by administering a loading dose (AS ORDERED) to achieve a therapeutic level more quickly. Monitor your patient's serum digoxin level to ensure that it remains in the therapeutic range of 1 to 2 ng/ml. Also, assess him for signs and symptoms of digitalis toxicity. If he's also receiving a thiazide or loop diuretic, monitor his serum potassium level; a low potassium level can lead to digitalis toxicity. Block 7.0 Module 2.1

63 If your patient is receiving one of these drugs during digitalis glycoside therapy, monitor his heart rate and rhythm and assess for signs of digitalis toxicity, such as gastrointestinal, neurologic, or vision disturbances. If he shows evidence of toxicity, HOLD THE MEDICATION & NOTIFY THE PYSICIAN--the digitalis glycoside will most likely be on hold until his level returns to the therapeutic range. Other drugs that increase the risk of digitalis toxicity include beta-blockers, anticholinergics, quinidine, verapamil, nifedipine, amiodarone, and propafenone. Block 7.0 Module 2.1

64 After therapy, your patient may be referred to an occupational therapist to learn how to conserve oxygen and energy while performing daily activities. The therapist also may help your patient modify his environment to reduce cardiac workload. For ex­ample, the therapist may suggest moving bed­room furniture to the first floor and obtaining a bedside commode. During therapy, reduce your patient's cardiac workload by restricting his activity. Provide oxygen through a face mask or nasal cannula, as prescribed, to support his heart's oxygen demands Block 7.0 Module 2.1

65 Tell him to withhold the dose and call the physician if his pulse is lower than 60 beats per minute. Also, teach him the signs and symptoms of digitalis toxicity, such as nausea, vomiting, diarrhea, fatigue, vision changes, and an abnormally slow pulse rate; hypokalemia, such as weakness, fatigue, nausea, abdominal cramps, and diarrhea; and hyperkalemia, such as muscle tenderness, fatigue, and constipation. Teach your patient and his family about his prescribed drug therapy. If a digitalis glycoside has been prescribed, instruct him to take his pulse before taking the drug. Tell your patient that he may need potassium supplements with diuretic and digitalis glycoside therapy. Block 7.0 Module 2.1

66 Tell your patient that he may need potassium supplements with diuretic and digitalis glycoside therapy. If your patient is taking more than one drug, help him devise a dosage schedule that accommodates his lifestyle. For example, advise him to take twice-daily drugs before breakfast and dinner (if not contraindicated) to avoid forgetting to take them during a busy workday. Block 7.0 Module 2.1

67 Instruct the patient to follow a low-sodium diet
Instruct the patient to follow a low-sodium diet. If necessary, refer him to a dietitian. Tell him to record his daily weights in a log and to report a weight gain greater than 3 pounds over 2 days or less. Tell him to conserve his energy by resting frequently. Explain how to obtain and use supplemental oxygen, if prescribed. Block 7.0 Module 2.1

68 Most patients with heart failure benefit from a home care referral
Most patients with heart failure benefit from a home care referral. If your patient will have a home care nurse, tell him that the nurse will perform a complete assessment of his cardiac and respiratory status. And the nurse will answer questions about his drug regimen and monitor his compliance with the drug regimen and dietary restrictions. The home health nurse will also instruct him and his family about using home oxygen therapy, if prescribed. Block 7.0 Module 2.1

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