Cardiac

• Digoxin


  Inotropic- increasing myocardial contractions/ lowers heart rate
• Digoxin


  • Enhances heart output
  • Decreases preload
  • Improves blood flow to peripheral and kidney
  • Decreases edema & promotes fluid excretion
• Digoxin Toxicity Therapeutic Serum Range

  0.5-1.0 ng/mL
• Causes of Dig toxicity


  • Overdose /accumulation
  • Most common trigger is hypokalemia
• Signs & Symptoms of Dig toxicity


  • GI: anorexia, nausea, vomiting
  • CV: bradycardia, pvc
  • Ophthalmic: visual disturbances -> yellow/green halos (precursor)
  • CNS: fatigue, weakness, confusion, delirium
• Nitroglycerin MOA


  Promotes rapid vascular & coronary vasodilation, which increases blood flow, decreases preload, afterload & afterload and reduces myocardial oxygen demand
• Nitroglycerin USES


  • Control angina
  • AMI
  • Hypertensive crisis
  • Pulmonary edema
  • Heart failure
• Nitroglycerin SE


  • CNS- headaches , dizziness
  • CV- hypotension
  • DERM: flushing
• Nitroglycerin Administration


  1. Sublingual high first pass effect

  2. 0.4 every 5 min, 3x times

  3. Still pain after 3 doses? Go to the hospital!!
• Nitroglycerin Routes


  • IV, Sublingual, ointment, patch, oral sprays
• Nitroglycerin Important Facts
• Patho of Unstable Angina


  • Acute cardiac pain caused by inadequate blood flow to the myocardium due to either plaque occlusion or spasms of the coronary arteries
  • Decreases blood flow causes decrease in oxygen to the myocardium, resulting in pain
• Angina attacks may lead to MI
• Antihypertensives


  • ACE Inhibitors / ARBS
  • Beta Blockers
  • Calcium Channel Blockers
  • Diuretics
• Angiotensin converting enzyme- ACE inhibitors MOA


  Inhibit the conversion of angiotensin I to angiotensin II by this enzyme
• Adverse Effects of ACE inhibitors


  • Angioedema
  • Persistent dry cough
  • Electrolyte imbalance - hypernatremia, hyperkalemia
• Other Adverse Effects of ACE inhibitors


  • N/V/D, Hypotensions, Tachycardia, Renal insufficiency, HA/ Fatigue/ Dizziness/ insomnia
• Nursing intervention for ACE inhibitors


  1. Baseline VS, check lab values (Serum protein albumin, BUN, CR, potassium and WBC)

  2. Monitor BP

  3. Report any bruising/petechiae

  4. DO not take OTC drugs

  5. DO NOT abruptly stop

  6. DO not use during pregnancy
• Beta- Adrenergic Blockers (Beta Blockers)


  This drug class reduces cardiac output by diminishing SNS response to basal sympathetic tone, so over time vascular resistance is diminished and BP lowers. Reduces HR, Contractility and renin releases
• Beta Blockers


  Brakes the HEART
• Beta Blockers Side Effect


  • Cardiac: hypotension, bradycardia
  • CNS: insomnia, nightmares, dizziness, fatigue
  • Psychiatric: depression
  • Endocrine: Sexual dysfunction, altered glucose levels
  • Respiratory: bronchospasm- nonselective
• Beta Blockers Cautions- 4 B's


  • Bradicardia 60 or less
  • Bottomed out BP (80/60)
  • Breathing Problems (COPD, Asthma)
  • Blood sugar masking (diabetics)
• Beta Blockers Nursing Interventions


  1. Obtains vital signs (HR needs to be 60 and in order to give)

  2. Monitor vitals

  3. Monitor lab results ( BUN, serum creatinine, AST, and LDH)

  4. DO NOT use for pt in heart block or bradycardia

  5. DO NOT abruptly stop or rebound HTN can occur

  6. Avoid OTC drugs without checking with HCP
• Calcium Channel Blockers MOA


  These drugs blocks the calcium channel in the vascular smooth and promotes vasodilation
• Calcium Channel Blockers


  Calms the heart (Low BP and Heart Rate)
• Calcium Channel Blockers Side Effects


  • Flushing
  • Headache/Dizziness
  • Peripheral Edema
  • Bradycardia, hypotension, AV block
• Diuretics MOA


  Increase urine output by inhibiting sodium and water retention from the kidney tubules
• Diuretics

  • Loop diuretics (furosemide)
  • Thiazides
  • Potassium-sparing diuretic
  • Osmotic
• Furosemide MOA

  • Inhibits reabsorption of sodium & chloride
  • Causes potassium to be excreted -> potassium wasting
• furosemide


  • Inhibits reabsorption of sodium & chloride
  • Causes potassium to be excreted -> potassium wasting
• furosemide SE


  Potassium wasting -> hypokalemia
• furosemide Nursing Intervention


  1. Monitoring potassium level

  2. Slow administration!!!
• Thiazides MOA


  Diuretic that promote sodium, chloride, potassium, magnesium and water excretion and promotes calcium reabsorption
• Thiazides SE


  • Electrolyte: hypokalemia, decrease calcium, decrease magnesium
  • CV: hypotension
  • CNS: Dizziness, HA, weakness
  • Endocrine: hyperglycemia
  • GI: N/V, constipation, hyperuricemia, hyperlipidemia
• Thiazides Nursing Intervention


  1. Monitor potassium level

  2. DO NOT give to pt w/ gout

  3. Sulfa allergy
• Spironolactone MOA


  • Blocks the effect of aldosterone
  • Potassium is NOT excreted!
• Spironolactone Patient Education


  1. Avoid high potassium food

  2. Avoid potassium supplements

  3. Avoid salt substitutes
• Osmotic MOA


  Increases the thickness of the filtrate = water can be reabsorbed into the bloodstream
• Osmotic USES


  Decreases swelling & pressure in the eyes/brain
• Osmotic Nursing interventions


  1. Only given IV

  2. Neuro check/assessment