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Surgical Nursing Skills (AHS 263-263L ) Quick Notes Full

John Marsh
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California State Polytechnic University Pomona

Surgical Nursing Skills (AHS 263/263L )

Med Surg Quick Notes full

Med Surg Quick Notes
Page 8 of 638 Simplenursing.com 82% or Higher on Your Next Nursing Test
1 Cardiology I Exam Notes
1.1 Cardiology Terms & Introduction
 Preload: the 20% of blood remaining in the atria at end of diastole
 80% of ventricular filling occurs before atrial kick
 increase preload by inspiration or valsalva
 Afterload: the volume of blood in the ventricles after atrial contraction
 Cardiac output: volume of blood ejected from ventricles in one minute; normally 5 L
 increased by increasing HR, contractility, or blood volume (or decreasing resistance)
 Stroke volume: volume of blood ejected with each heartbeat
 Myocardial contractility: ability of cardiac muscle to shorten with a given load
 ejection fraction: a quantification of contractility; EF = SV/EDV
 Starling’s law: stroke volume increases as end diastolic volume increases due to greater stretch put on
walls of ventricles
 Stenosis: narrowing to forward flow
 Regurgitation (insufficiency): backward leakage while valve should
be closed
 Collaterals: normally nonfunctioning small vessels that interconnect coronary arteries
 function when blockage creates upstream pressure, forcing the collaterals open
 Heart sounds review
o S3 in CHF
o S4 in HTN
 Coronary vessel dominance: we want to identify which artery perfuses the posterior 1/3 of the
interventricular septum: is it the right coronary artery or the left circumflex (or both)?
 SA node typically supplied by the right coronary artery, but can also be left circumflex
 AV node supplied by whichever is dominant
 Coronary artery disease (CAD) (aka coronary heart disease CHD): narrowing of vessels supplying the
heart caused by atherosclerosis and/or hardening of the arteries
1.2 Pharmacology: Lipid Lowering Drugs
 Statins: act as analogues for liver cholesterol synthesis to inhibit the actions of HMG-CoA reductase →
liver upregulates LDL-R to try and draw cholesterol out of circulation
 First line medication for lower LDL!
 Can decrease LDL by 20-60%, decrease TG by 7-30%, and increase HDL by 5-15%
 doubling the does results in an additional lowering of LDL by ~6%, with HDL increase of ~10-15%
Med Surg Quick Notes
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Page 9 of 638
 Proven to decrease risk of major cardiovascular events and total mortality, including CAD, MI, stroke,
and peripheral vascular disease
 Administered at bedtime, when cholesterol synthesis peaks
 Kinds:
 atorvastatin: CYP3A4 metabolism
 lovastatin: CYP3A4 metabolism
 pravastatin: less interactions = good choice for someone on many meds, urinary excretion
 rosuvastatin: less interactions = good choice for someone on many meds, biliary excretion
 simvastatin: CYP3A4 metabolism
 Contraindications: pregnancy or potential pregnancy, active or chronic liver disease, concomitant use of
 Interactions: amiodarone, cyclosporine, macrolides, protease inhibitors, large amounts of grapefruit juice
 Side effects: elevated LFTs, myalgia (no change in CK), myopathy (CK increase), rhabdomyolysis (high
CK with organ damage)
 Monitor: LFTs (stop statin if increase to 3-5x upper limit of normal)
1.2.1 Drugs to Increase Lipoprotein Lipase Activity
 Fibric acid derivatives: stimulate PPARα, a transcription factor that promotes lipid metabolism →
increased oxidation of fatty acids and increased metabolism of fatty acids
 can reduce LDL by 5-10%, reduce TG by 20-50%, and increase HDL by 10-20%
 trials show decrease in major coronary events
 kinds:
o gemfibrozil:
o fenofibrate:
 contraindications: severe renal disease, severe hepatic disease
 side effects: dyspepsia, gallstones, myopathy
 Bile Acid Sequestrants: inhibit bile salt recycling → liver breaks down more cholesterol to make new bile
 Add to the LDL-lowering effects of statins
 reduces LDL by 15-30%, no effect on TG, mildly helps increase HDL
 Cons: requires several doses per day, concomitant drugs must be taken at a different time
 Good for persons needing only moderate LDL lowering or women considering pregnancy
 Kinds:
 cholestyramine:
 Contraindications: TG > 400 (could increase chance of pancreatitis)
 relative: TG > 200
 Side effects: constipation, GI upset, decreased absorption of other drugs
1.2.2 Drugs to Inhibit Cholesterol Absorption
Nicotinic acid (niacin): blocks the breakdown of fats needed for VLDL synthesis → shift in LDL composition
from small and dense to larger and more buoyant (less likely to deposit in arteries)
 typically used in combination with other lipid-lowering drugs
 lowers LDL by 5-25%, lowers TG by 20-50%, and increases HDL by 15-35%
 contraindications: chronic liver disease, gout
 relative: DM, hyperuricemia, PUD
 side effects: flushing (prevent with aspirin before), hyperglycemia, hyperuricemia, GI distreses,
Ezetimibe: inhibits cholesterol absorption at the brush border of the small intestine
 can be used alone to increase LDL by 15-20%, TG decrease by 5-10%, minimal increase of HDL =
similar to bile acid sequestrant, but better tolerated
 frequently used in combination with statins
 contraindications: active liver disease



Surgical Nursing Skills (AHS 263-263L ) Quick Notes Full

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