Thrombocytopenia S/S - Less than 150K; prolonged bleeding, bruising, petechiae, purpura, nosebleeds, heavy menstrual bldg, intrabdominal/GI bldg, intracranial bldg, Thrombocytopenia Interventions - No OTC meds with aspirin; monitor body fluids for bleeding, electric razors only, no contact sports, no tampons, pads only, monitor menstrual blds/count pads, soft toothbrush, no tattoos, no piercing, no alcohol based mouthwash, no waxing, bleeding precautions, no flossing, hold pres-sure at injection sites for 5-10 mins; prefer subQ injections; no IM injections; if runny nose, pat nose gently, don't blow forcefully, Thrombocytopenia Treatments - ITP: Bleeding issue, corticosteroids, rituximab, cyclosporine, splenectomy, platelet tx only if below 10K or before surgery or extensive bldg; TTP: Bleeding and clotting issue, plasmapheresis, determine the cause (meds, infx, etc), corticosteroids, IVIG (rituximab), cyclosporine, no platelet transfusion; HIT: Clotting issues, stop heparin!!!!, no more heparin ever, argatroban 1st and then when plt 150K, switch to warfarin, Dysrhythmias: Atrial Fibrillation/Flutter - Flutter: Sawtooth P waves aka pretty, atria beating 200-350 bpm; Fibrillation: Ugly P waves, uneven amount of P waves, controlled 60-100 bpm; rapid above 100 bpm; S/s: chest discomfort, lightheaded, palpitations, dizzy, confused, weak palpable pulses; Treatment: Beta blockers, calcium channel blockers, amiodarone, digoxin, anticoagulants (risk for clots so need to thin the blood), cardioversion if needed, Dysrhythmias: Sinus Tachycardia - HR about 100; s/s: dizzy, chest pain, hypotension, palpitations, dyspnea; If pain induced, treat pain; admin calcium channel blockers, beta blockers, or adenosine; can try vagal maneuver (instruct to bear down); synchronized cardioversion (shock the pt with 50-100J), Dysrhythmias: Sinus Bradycardia - HR less than 60; not all pts have symptoms; s/s: dizzy, syncopal episode, lightheaded, dyspnea, cool skin, pale, weak, confused: Treatment: Stop/hold med if med induced, Admin atropine 1st when symptomatic, admin epinephrine/dopamine infusion, temporary transcutaneous PM, if needed, permanent PM, Dysrhythmias: First Degree Heart Block - Prolonged PR interval; longer than 1 block; no treatment, just monitoring and notify provider, Heart Failure S/S - Right = rest of body; edema in legs, weight gain, nausea, ascites, tachycardia; Left = lung; shortness of breath, cough, crackles, confusion, orthopnea, anxiety, pulmonary edema, tachycardia, Heart Failure Teaching - Nutrition: reduce sodium; DASH diet, decrease saturated fats; healthy carbs/fiber; 30 mins exercise/day or as they tolerate activity; monitor for wt gain 2-3 lbs in one day/one week; elevate lower extremities to help with swelling; monitor for med side effcts; monitor for worsening symptoms (facial swelling, dizzy, dyspnea), take diuretics in AM; when to notify provider; monitor new cardiac symptoms (like CP); monitor for edema, Heart Failure Interventions - Monitor BNP* (normal is <100); monitor troponin and BMP as well; need EKG; monitor intake/output; monitor cholesterol levels; daily weights; assess breath sounds and decreased edema; monitor urinary output; improved palpable pulses on extremities; pt states they feel better; place in high fowler's, Heart Failure Meds - Diuretics (furosemide-remove excess fluids); Beta blockers (metoprolol-decrease HR; ACE inhibitors (lisinopril-reduce afterload, protect ventricles, decrease BP); calcium channel blockers (amlodipine/diltiazem-decrease BP); Digoxin (reduce BP, HR, improve cardiac contractility, monitor for dig toxicity->2 = toxic), CAD/Chronic Stable Angina S/S - 4E's-emotions, exertion, eating, extreme temps; c/o chest pain, pain can radiate, dizzy, pale, shortness of breath, diaphoretic, CAD/Chronic Stable Angina Meds - Nitroglycerin (vasodilation), aspirin/plavix (thin blood, prevent platelet aggregation), ACE inhibitors (protect ventricles and vasodilate), beta blockers (decreases myocardial oxygen demand); calcium channel blockers; statins/hyperlipidemic (prevent cholesterol blockages), CAD/Chronic Stable Angina Teaching - Nutrition: DASH, no fried foods, low salt, low fat; Activity: educate about physical activity; NTG: sit down before taking; store away from light; take at onset of pain, wait 5 mins, take a 2nd and call 911, take a 3rd after 5 mins; no more than 3 dose; keep track of time; take acetaminophen for HA, CAD/Chronic Stable Angina Intervetions - Cardiac cath: done to look blockages and opens vessels; Before cardiac cath: need consent and asses for iodine/shellfish allergy; after cath: (got heparin during procedure), assess neurovascular (5P's), teach about aspirin/plavix, assess distal pulses, pressure should have been held at insertion site for min 30 mins PTA, must be supine for 4-6 hours, no lifting of leg for 4-6 hours; monitor resp status, monitor for dysrhythmias; monitor for hematoma; Monitor VS, need EKG, place cardiac monitor; monitor troponin levels (q4-6h lab draws),

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