Cardiovascular pt 1 Flashcards
HTN:
Blood Pressure Categories
NORMAL: LESS THAN 120/80 MM HG;
PREHYPERTENSION: SYSTOLIC BETWEEN 120-139 AND DIASTOLIC 80-89;
STAGE 1: SYSTOLIC BETWEEN 140-159 OR DIASTOLIC 90-99;
STAGE 2: SYSTOLIC >160 OR DIASTOLIC >100 MM HG;
HYPERTENSIVE CRISIS: SYSTOLIC OVER 180 AND/OR DIASTOLIC OVER 110,
occurs with patients with a history of hypertension who have not complied with their medication regimen or are undermedicated.
HTN:
Primary Hypertension
an elevated BP without an identified cause and accounts for 90-95% of all cases of hypertension.
essential or idiopathic: Unknown
Abnormalities of glucose, insulin, and lipoprotein metabolism are common in primary HTN.
Etiology - Contributing Factors:
a. SNS activity
b. Na+ intake &/or retaining hormones and vasoconstrictors
c. Diabetes Mellitus
d. Excess alcohol intake
e. > Ideal body weight
f. Smoking
HTN:
Secondary Hypertension
This is a BP that can be attributed to a specific cause and accounts for 5-10% of all hypertension in adults.
Etiology
a. Coarctaction of aorta (HTN in upper extremities only)
b. Renal disease (RAS, glomerulonephritis, renal stenosis)
c. Endocrine disorders
d. Neurological disorders (brain tumors, Traumatic brain injury)
e. Cirrhosis (also leads to portal HTN)
f. Sleep anpnea
HTN:
What are two subtypes of Hypertension?
- Isolated systolic hypertension
(more common with older adults)
Control this to reduce the incidence of stroke, heart failure, cardiovascular mortality, and total mortality - Pseudohypertension – occurs with advanced arteriosclerosis
HTN:
Clinical symptoms of hypertension are?
Asymptomatic -“silent killer”;
Most symptoms are a result of target organ disease or damage
HTN Complications:
1. HEART hypertensive heart disease, Coronary Artery Disease, hypertrophy cardiomyopathy, heart failure
- PERIPHERAL VASCULAR SYSTEMS –
Pulmonary Vascular Disease,
intermittent claudication - KIDNEYS –
chronic kidney disease (CKD),
Renal Failure, Nephrosclerosis (damage to the blood vessels leads to damage to the Nephrons/tubules which lead to chronic renal failure if not reversed. - BRAIN –
stroke,
TIA
5. EYES – blurred vision, retinal hemorrhage, vision loss. Do not overlook the hemorrhages can indicate prolonged HTN.
HTN:
Basic Pharmacology for common HTN meds:
Cardiac output and Systemic Vascular resistance
Cardiac output: 1. Heart rate – think beta-adrenergic inhibition (beta blockers) Metoprolol (B1 selective) 2. Systemic volume – think diuretics Furosemide, Aldactone (watch K+)
Systemic Vascular Resistance – think vasodilators (ACE, ARB, CCB)
ACE – lisinopril
ARB – losartan
CCB – amylodipine (think Very Nice Drugs)
Now, go back and review these med classes and become familiar with the class, action, metabolism, adverse effects, contraindications, side effects, and interactions of these meds.
HTN:
Nursing Management of HTN
- First complete a H2T assessment
YOU WANT TO GET A THOROUGH HISTORY AND PHYSICAL EXAM!
INSPECT - Look for edema, shortness of breath, and other signs
PALPATE
AUSCULTATE - not only the heart but carotid, renals, aortic, iliac, and femoral too.
PERCUSS - to assess for enlargement or other organ damage (heart) - Screen
ACCURATE BP MEASUREMENTS
a. Monitor initial and follow up labs and diagnostics
b. ORTHOSTATIC HYPOTENSION (or postural changes)
This should be measured in older adults, in people taking antihypertensive drugs, and in clients complaining of light-headedness, dizziness, syncope. - Identify
- Educate
Treatment compliance:
a. Empathy increases patient trust, motivations, and adherence to therapy
b. Consider cultural beliefs and individual attitudes when formulating treatment goals
c. Side effects and adverse effects of HTN meds may be so severe, or undesirable, that the client does not comply. Assess for this and develop a teaching method for coping.
HTN:
Orthostatic hypotension
Defined as
- decrease if 20 mmHg or more in SBP,
- a decrease of 10 mmHg or more in DBP,
- and/or an increase of 20 beats/min in pulse from supine to standing
This should be measured in older adults, in people taking antihypertensive drugs, and in clients complaining of light-headedness, dizziness, syncope.
HTN:
What are gerontologic considerations?
ORTHOSTATIC PRESSURES
May be a result of
• impaired baroreceptor reflex mechanisms,
• volume depletion
(decreased thirst in older pts leads to dehydration)
• and chronic disease states (e.g. decreased renal and hepatic function, or electrolyte imbalance).
AUSCULTORY GAP
• Gap between Phase II and III (no known clinical significance) and subsequent Korotkoff sounds
• Make sure to inflate the cuff high enough to not miss hearing the first beat which is the systolic blood pressure.
HTN:
Hypertensive Crisis is?
Extremely high blood pressure
STARTS AT 180/110 MMHG,
GO UP TO/SEVERE INCREASE IN BP (>220/140 MMHG)
Classified as Hypertensive Urgency or Hypertensive Emergency
HTN:
Hypertensive Urgency Vs Hypertensive Emergency
HYPERTENSIVE URGENCY
a. Develops over hours to days
b. While the BP is elevated there is no clinical evidence of target organ damage
c. Often occurs with non-compliant clients
d. Usually do not require IV medications but can be managed with oral agents
e. If not hospitalized, follow up should be within 24 hours
HYPERTENSIVE EMERGENCY a. Evidence of acute target organ damage such as • renal failure (edema) • MI, • CHF with exacerbation, • hypertensive encephalopathy, • cerebral hemorrhage
Clinical Manifestations:
• HA, nausea, visual changes, seizures, coma. May have chest pain, aneurysm rupture, aortic dissection
• Chest or back pain can be a result of an aneurysm rupture
Requires hospitalization with intensive monitoring and IV med administration
1. Lower the BP slowly,
• lower MAP no more than 20-25%,
• if done too quickly may lead to stroke, MI, renal failure
2. Requires regular ongoing assessment (q15 mins)
• pulses,
• frequent neuro checks (looking for stroke)
• back pain (looking for aneurysm)
• cardiopulmonary respiratory status,
• check urine output/renal failure.
Med is often IV nicardipine (CCB)
CAD:
Coronary Artery Disease is the ____.
leading cause of death in the U.S.
Called several names • atherosclerotic heart disease, • cardiovascular heart disease, • ischemic heart disease, they are all the same mechanism • cardiovascular disease
CAD:
Coronary Artery disease is progressive. What contributes to its progression?
- Collateral circulation delays detection
2. Atherosclerosis is the major cause (called “hardening of the arteries”) • Fatty streak • Fibrous plaque formation • Plaque rupture • Cycle of inflammatory response
other contributing factors include:
• Diabetes
• Metabolic syndrome
• Elevated homocysteine levels (An amino acid found in the blood)
• Certain psychological states(e.g. stress, anger, depression)
CAD:
How is CAD diagnosed?
C-reactive protein
- Is a non-specific marker for inflammatory disease
- Increased in many clients with CAD
- Chronic exposure to CRP is associated with unstable plaques and oxidation of LDL cholesterol
Elevated serum lipid levels
1. High-density lipoprotein (HDL)
• This is the “good” one, they help “sweep” the arteries clean
• Levels can be increased with physical activity, moderate alcohol consumption, and estrogen administration
2. Low-Density lipoprotein (LDL) - Levels are closely correlated with increased incidence of atherosclerosis and CAD
CAD:
What are non-modifiable risk factors of CAD?
What are modifiable risk factors?
Non-modifiable
- Age
- Gender
- Ethicity
- Genetic Predisposition
Modifiable 1. Lipids 2. Blood Pressure 3. Glucose Management 4. Tobacco use 5. Alcohol 6. Obesity 7. Sedentary Lifestyle 8. METHODS FOR HEALTH PROMOTION Identification of high risk people (cardiovascular history/symptoms, environmental patterns, psychosocial history)
