vSIM Pharmacology Scenario-1 Junetta Cooper Highlights Latest Update, Exams of Nursing

Download vSIM Pharmacology Scenario-1 Junetta Cooper Highlights Latest Update and more Exams Nursing in PDF only on Docsity! 1 vSIM Pharmacology Scenario-1 Junetta Cooper Highlights Latest Update Patient Introduction The patient’s, Junetta Cooper’s, husband brought her to the emergency department this morning at 0815 because she was experiencing angina unrelieved by nitroglycerin. She has been evaluated in the emergency room, and she is now awaiting cardiac catheterization tomorrow to evaluate the extent of the coronary artery disease. pg. 1 2 Mrs. Cooper is a 75-year-old African American woman who has had primary hypertension since age 55 years. Her blood pressure pg. 2 5 • Usually begins as a benign disease, slowly progressing to an accelerated or malignant state • Two major types of hypertension o Essential hypertension—primary or idiopathic hypertension o Secondary hypertension—results from renal disease or another identifiable cause • Other forms of hypertension o White coat hypertension—elevated BP that occurs in nontreated individuals typically only during health care visits and not at other times; characterized by a systolic BP between 130 and 160 mm Hg ▪ May warrant screening with ambulatory or at- home BP monitoring ▪ May also warrant screening in adult patients who are on antihypertensive treatment and within 10 mm Hg of their systolic BP goal o Masked hypertension—characterized by BP readings that are consistently at 120 to 129 mm Hg (systolic) and 75 to 79 mm Hg (diastolic) ▪ Requires ambulatory or at-home BP monitoring ▪ Warrants having the patient look for elevations in BP throughout the day, which would signal the need for treatment o Hypertensive emergency—the most severe, fulminant form of hypertension characterized by end-organ dysfunction and an extremely high, rapidly developing BP that's typically greater than 180/120 mm Hg ▪ May arise from any type of hypertension and is considered a medical emergency ▪ Differs from hypertensive urgency (an extremely high blood pressure without end- organ dysfunction), which is treated differently pg. 5 Risk Factors Family history Black race Stress Obesity High-sodium, high-saturated fat diet Tobacco use Dyslipidemia Hormonal contraceptive use Excessive alcohol intake Sedentary lifestyle Age Diabetes Pregnancy or preeclampsia Renal artery stenosis Reduced nephron mass Depression and personality traits Hypovitaminosis Chronic nonsteroidal anti-inflammatory drug use Systemic corticosteroid use Antidepressant and atypical antipsychotic drug use Weight loss medication use Stimulant use (amphetamines and caffeine) Illicit drug use (methamphetamines and cocaine) Herbal supplement use (including ma huang) pg. 7 Following the DASH diet The DASH (Dietary Approaches to Stop Hypertension) diet is a healthy way of eating and was prevent osteoporosis, cancer, heart disease, stroke, and diabetes. The DASH diet focuses on: • vegetables • fruits • low-fat dairy products • whole grains • fish • poultry • lean meats • nuts. A low-sodium version of the DASH diet may be recommended when sodium restriction is pres Other recommendations include minimal alcohol consumption (two or fewer drinks per day fo More information on the DASH diet is available at h tt p : // ww w . h e a r t . o r g / H E A R T O R G / C o n dit io n s Blood-Pressure-with-a-Heart-Healthy- pg. 7 10 Dosages of Clopidogrel: Dosage Forms and Strengths Tablet • 75 mg • 300 mg Fondaparinux (Arixtra) is a synthetic anticoagulant based on the pentasaccharide sequence that makes up the minimal antithrombin (AT) binding region of heparin. Similar to low molecular weight heparins, it is an indirect inhibitor of factor Xa, but it does not inhibit thrombin at all.Aug 19, 2019 Pharmacological class: Anticoagulant pg. 10 Pain with angina pectoris usually subsides within 10 minutes. Chest pain with acute myocardial infarction lasts 30 minutes to 2 hours. Other symptoms could indicate either angina pectoris or acute myocardial infarction Women with coronary artery disease may experience typical chest pain (crushing chest pain that radiates down the arm or to jaw), but commonly experience atypical chest pain, vague chest pain, or a lack of chest pain such as upper back discomfort between the shoulder blades, nausea, or shortness of breath. The other answer choices do not meet the immediate need of this patient. Vasodilation causes blood to pool in the vessels, decreasing preload, while relaxation of vessels decreases afterload. Nitrates cause vasodilation of vessels. Nitrates do not lower the pressure in coronary arteries or increase the contractility of the heart. After a total of three doses, if the pain persists, the patient should go to an emergency room to ensure proper medical support should myocardial infarction occur. Nitroglycerin sublingual is placed under the tongue or in the buccal pouch and should not be swallowed. Sublingual dose may be repeated in 5 minutes if relief is not felt. A skin assessment is especially important if a patient is using the transdermal or topical form of nitroglycerin to prevent possible skin reactions and ensure adequate surface for application and absorption of transdermal or topical drug. Respiratory, fall risk, and neurological assessments are not specifically indicated for a patient receiving nitroglycerin transdermal. pg. 11 Regular polyvinyl chloride tubing can bind up to 80% of drug, making it necessary to infuse higher doses. A special nonabsorbent polyvinyl chloride tubing is available from the manufacturer. Intravenous nitroglycerin should be infused initially at 5 mcg/min, increasing as needed by 5 mcg/min every 3 to 5 minutes until response occurs. Concentrations should not exceed 400 mcg/mL. Filters are not indicated for intravenous nitroglycerin. Headaches caused by nitroglycerin may be treated with aspirin or acetaminophen. Headaches are a common side effect of nitroglycerin, especially at the beginning of therapy. Therapy should not be discontinued. Nitrites lower blood pressure; therefore, it is unlikely the patient is experiencing hypertensive crisis. Infusion of IV bolus is not indicated for headaches due to nitrate ingestion. pg. 12