Drug Classification with examplesGinseng may falsely elevate digoxin levelsSt. John’s wort decreases absorption of dig.Metamucil may decrease absorption of dig.Hawthorn may increase the effects of dig.Goldenseal may decrease the effects of dig.Antianginals NitratesBeta Blockers Antidysrhythmic DrugsLoop Diuretics Potassium-SparingBeta-adrenergic BlockersCentral Alpha AgonistsCARDIOVASCULAR DRUG STUDY GUIDEComplete Blood Count (CBC)Coagulation StudiesBlood ChemistryCARDIAC – MI CASE STUDYBasic Characteristics of Different RhythmsNursing Care of Patients’ with ArrhythmiasSinus Rhythms – initiated by the SA node: Characteristics include:Rev 12/09 1 Lincoln Memorial University Caylor School of Nursing NURS 241 Spring 2010 TITLE: Nursing Strategies: Alterations in Cardiac Function DATES: See syllabus TIMES: See syllabus OBJECTIVES: Upon completion of this unit the student will be able to demonstrate in the clinical/campus laboratory setting, in individual and group conferences, and on written material, the ability to: 1. Define and use the glossary terms as listed in the assigned readings. 2. Using the four adaptive modes of Roy”s Adaptation Model (RAM), recognize human adaptive responses to behavior or stimuli that affect cardiovascular function. 3. Describe the patho, clinical manifestations, management and associated use of the RAM nursing process to provide care for adults with alterations of the cardiovascular and peripheral vascular system. 4. Describe cardiac anatomy and physiology of the circulatory system and conduction system of the heart in relationship to cardiovascular disorders. 5. Incorporate assessment of cardiac risk factors into the nursing history and physical assessment of the cardiac patients. 6. Identify the clinical significance and related nursing implications of laboratory and diagnostic tests and procedures used for assessment and evaluation of cardiovascular function. 7. Describe nursing measures associated with hemodynamic monitoring and state clinical significance and nursing responsibilities. 8. Incorporate assessment of cardiac and peripheral vascular risk factors into the nursing history and physical assessment of the cardiac patients. 9. Describe the different treatments, non-surgical and surgical, procedures commonly use for treatment of cardiac problems. 10. Discuss the preoperative and postoperative goals and nursing care for adults undergoing surgery for related peripheral vascular disorders. 11. Identify possible complications following vascular surgery, measures to prevent these complications and assessment parameters appropriate for their identification. 12. Utilize the RAM nursing process to provide care for the adult who is experiencing any of the following common disorders of the cardiovascular system: a. Hypertension b. Heart Failure c. Pulmonary Edema d. Pericarditis e. Rheumatic Endocarditis f. Myocarditis g. Infective Endocarditis h. Mitral Valve Prolapase i. Mitral Stenosis j. Mitral Insufficiency k. Aortic Valve Stenosis l. Aortic Insufficiency m. AtherosclerosisRev 12/09 2 n. Burger’s Disease o. Raynaud’s Disease p. Aneurysm q. Thrombophlebitis r. Varicose Veins s. Coronary artery disease t. Angina pectoris u. Myocardial infarction v. Arrhythmia w. Cardiogenic Shock 13. Specify anatomic and physiologic factors that affect peripheral blood flow and tissue oxygenation such as positioning and stress. 14. Define appropriate parameters for assessment of peripheral circulation including skin temperature, turgor, and capillary refill. 15. Describe appropriate nursing measures in evaluation of laboratory and diagnostic tests associated with peripheral vascular disorders. 16. Describe the "stepped care approach" to drug therapy for hypertension and the goals of health teaching for patients of all ages with hypertension. 17. Compare and contrast nursing assessment, care and evaluation of patients with coronary atherosclerosis, angina pectoris and myocardial infarction. 18. Differentiate adult symptoms of angina pectoris and myocardial infarction from those symptoms experienced by geriatric clients. 19. Identify the important steps of patient teaching and cardiac rehabilitation associated with cardiovascular disorders. 20. Discuss the preoperative and postoperative goals and nursing care for adults undergoing cardiac surgery. 21. Identify possible complications following cardiovascular surgery, measures to prevent these complications and assessment parameters appropriate for their identification. 22. Correlate the components of the ECG with physiologic events of the heart such as depolarization and repolarization. 23. Specify the clinical usefulness of ECG for patients with cardiovascular disorders, electrolyte imbalance and drug toxicity. 24 Identify important factors associated with identification, management and evaluation of commonly occurring cardiac dysrhythmias. 25. State the use of pacemakers, nursing implications and possible complications. 26. Discuss the appropriate techniques and pharmacologic management of cardiac arrest. 27. Identify the psychological problems characteristic of patients admitted or transferred to an intensive care setting. 28. Identify the medications on the drug list by generic name, classification, mechanism of action, clinically significant side effects, normal dosage and nursing implications and be able to correctly calculate IV, IM, and po dosages. 29. Correctly calculate and regulate IV flow rate for critical care medications such as dopamine, dobutamine or nitroglycerine.Rev 12/09 3 TOPICAL OUTLINE: I. Assessment of the Cardiovascular System Function A. Overview of Cardiac Structure and Function 1. Cardiac Anatomy and Physiology 2. Conduction System of Heart B. Health History C. Physical Assessment D. Diagnostic Tests and Procedures 1. Laboratory Tests a. CK, CK-MB, Troponin T or I, & Myoglobin b. Lipid Profile c. B-Type Natriuretic Peptide (BNP) d. C-Reactive Protein e. Homocysteine 2. ECG 3. Echocardiogram 4. Exercise Stress Test 5. Pharmacologic Stress Test 6. Cardiac Catheterization 7. Radionuclide Imaging 8. Hemodynamic Monitoring II. Assessment and Management of Patients with Cardiac Disorders A.