Cardiovascular system, Flashcards
What is HTN?
Chronic high blood pressure
Risk factors for HTN?
age
obesity
African America
Hispanic
oral contraceptive
sedentary lifestyle
family history
hyperlipidemia
smoking
over 60yr
postmenopausal
high sodium
high caffeine
alcohol
stress
S/S of HTN?
usually asymptomatic “silent killer”
Achy headache
Blurred vision
Chest pain
what can uncontrolled HTN cause?
stroke
MI
HF
renal failure
atherosclerosis
blindness
2 main classifications of HTN?
Primary
Secondary
Primary HTN?
HTN that is a result of no existing health problems
most common
from lifestyle
Secondary HTN?
HTN from disease or certain drugs
COPD, diabetes, pregnancy
smoking, oral contraceptive
Normal BP
120/80 or less
Elevated BP
120-129/80 or less
Stage 1 BP
130-139/80-89
Stage 2 BP
140/90 or more
HTN crisis BP
180/120 or more
Over 140…
…OH LORDY!
What is hypertensive urgency?
BP 180/120 or more
no organ damage occuring
What is hypertensive emergency?
180/120 or more
organ damage
Treatment for elevated BP?
lifestyle changes
reassess in 3-6mo
Treatment for stage 1 HTN?
lifestyle changes 1 BP med
Treatment for stage 2 HTN?
lifestyle changes 2 BP meds
(from different classifications)
HTN interventions?
lifestyle changes
(restrict sodium)
(alcohol cessation)
(no tobacco, caffeine)
(reduce weight)
(exercise)
(relaxation techniques)
DASH diet
Medications
What is the Dash diet?
Incr fruits/veggies
whole grains
lean meats
nuts & seeds
decr. dairy
limit fats/sweets
Antihypertensives?
ACE inhibitors
ARB’s
Beta Blockers
Calcium Channel Blockers
Digoxin
Diuretics
Labs for HTN?
BNP (100 & less)
Total cholesterol (200)
Triglycerides (150)
LDL (under 100)
HDL (0ver 40)
Diagnostic test for HTN?
Echocardiogram
ECG
BP measurements 3wk apart
What is an aneurysm?
permanent enlargement of an artery
Two main aneurysms?
AAA (abdominal aortic aneurysm)
TAA (Thoracic aortic aneurysm)
What happens if an aneurysm ruptures?
severe sudden pain
hypotension
rapid HR
hypovolemic shock
SOB
(TAA in chest region)
(AAA abdominal region)
What are the interventions for an aneurysm?
surgical (rupture= life threatening)
non-surgical (monitor growth, keep BP normal)
What is an Aortic dissection?
a tear in the aortic wall
EMERGENT SITUATION
Intervention for if a dissection occurs?
Insert large IV bore IV Cath.
0.9%NaCl and meds
treatment depends on location
If there is a mass, do we palpate?
NO, DO NOT PALPATE
What are the 2 main types of vascular disorders?
arterial disorders
venous disorders
What is an arterial disorder?
Atherosclerosis
thickening/hardening of artery wall
What is atherosclerosis?
build up of fat/plaque in the artery
Risk factors for atherosclerosis?
HTN
diabetes
smoking
dislipidemia
obesity
stress
lack of exercise
What are the 6 P’s of atherosclerosis?
P-pain (severe, shooting, burning)
P-pallor (light color)
P-pulselessness (no palpable pulse)
P-poikilothermia (cool temp to touch)
P-parathesia (numbness/tingling)
P-paralysis (immobility, tissue damage)
Labs for atherosclerosis?
Elevated lipid levels
Elevated LDL
Elevated triglycerides
Decreased HDL
Interventions for atherosclerosis?
Lifestyle changes (always first)
cholesterol lowering agents (statin)
Niacin
Omega 3
What is an example of venous disorders?
peripheral vascular disease
What causes peripheral vascular disease?
damaged vessels
smoking
diabetes
high cholesterol
hypertension
2 peripheral vascular diseases?
Peripheral venous disease
Peripheral arterial disease
What is the issue in PVD?
blood gets to extremity, but cannot make it back up to the heart
(pooling of blood in extremities)
Indicators of PVD?
achy, dull pain
hard to palpate pulse (edema)
edema present (blood is pooling)
warm temp (blood is warm)
stasis dermatitis (brown/yellow)
venous stasis ulcer, irregular shape
no gangrene (too much blood)
Treatment for PVD?
Elevate legs
Statin
Bypass
Angioplasty
What is the issue in PAD?
the blood cannot reach the extremities from the heart
Indicators of PAD?
Sharp pain
poor/absent pulse
no edema (no blood in extremities)
cool temp (no blood=cool leg)
pale, hairless, dry
regular wounds, round, punched out
gangrene present (no blood cells die)
Treatment of PAD?
dangle arteries
daily skincare
stop smoking
no tight clothes
no heating pads
vasodilators
antiplatelets
What are other examples of venous disorders?
venous insufficiency
venous thrombosis (deep vein thrombosis)
What is venous insufficiency?
vein are stretched out due to prolonged HTN (Valve damage)
2 results from venous insufficiency?
stasis dermatitis
stasis ulcers
Treatment for venous insufficiency?
compression stockings
What causes a venous thrombosis/DVT?
stasis of blood
vessel wall injury
hyper-coagulation
who is at risk for a DVT/venous thrombosis?
hip surgery
knee replacement
prostatic surgery
HF
Cancer
UC
Oral contraceptive
Immobility
smoking
past DVT/VTE
over 70yr
Venous thrombosis/DVT prevention measures?
documentation
SCD’s
plexus foot pump
compression socks
s/s
What are interventions for venous thrombosis/DVT?
rest
elevating legs
compression socks
heparin
warfarin
diet education
What is Heart Failure?
failure to pump blood forward
(heart can’t maintain adequate cardiac output)
What are the risk factors for HF?
HTN
heart defects
arrhythmia
CAD
faulty heart valves
inflamed heart muscle
cardiomyopathy
What are the 2 main types of HF?
Left sided HF
Right sided HF
What occurs during R sided HF?
fluid backing up into venous system
(Right side= Rest of body)
What causes R sided HF?
Left sided HF
HTN
pulmonary HTN
s/s of R sided HF?
peripheral edema
JVD
abdominal growth
wt gain = water gain
What occurs during L sided HF?
fluid backing up into Lungs
(Left side= Lungs)
What causes L sided HF?
weak heart = weak pump
COPD
MI
low O2
s/s of L sided HF?
pulmonary edema
crackles
PINK FROTHY SPUTUM
orthopnea
What are the two types of L sided HF?
systolic HF
diastolic HF
What occurs with systolic HF?
weakened heart muscle
What happens with the ejection fraction in systolic HF?
the ejection fraction is reduced
What occurs with diastolic HF?
stiff non-compliant heart muscle
What happens with the ejection fraction in diastolic HF?
normal ejection fraction
Education for HF patients?
Daily wt
Fluid restrictions
decr sodium
decr fat
decr cholesterol
No OTC meds
Risk for fall
BP&BNP should not be incr
TED HOSE
Priority interventions for HF patients?
HOPE
H-HOB 45 degrees
O-oxygen
P-push furosemide and morphine
E-end sodium and fluids
What are the body’s compensatory mechanisms?
Sympathetic Nervous System
RAAS
What does the SNS do?
incr HR and BP and venous return
maintain BP (vasoconstriction)
incr tissue perfusion
What does the RAAS do?
Vasoconstriction
incr preload and afterload
Na retention
Water retention
Important Labs for HF?
serum electrolytes
BUN/Creatinine (decr)
microalbuminuia
ABG (hypoxia)
H&H (decr)
HF diagnostic tests?
Labs (BNP over 100)
echocardiogram (decr EF)
hemodynamic monitoring (over 8 not good)
HF medications?
ABCD
ACE inhibitors
ARB’s
Beta Blockers
CCB
Digoxin
Dilators
Diuretics
What is digoxin used for?
HF, dysrhythmia, A-fib or flutter
What is the action of digoxin?
increase the force of the heart contraction (since its failing )
s/s of dioxin toxicity?
GI symptoms
Visual symptoms
Neuro symptoms (headache)
cause of digoxin toxicity?
hypokalemia (dehydration)
injured kidneys
GFR decr (elderly)
How to give dioxin?
PO: with or without food
IV: push over 5 min
What to not take with dioxin?
Diuretics
St. Johns Wort
Jinseng
What are ACE inhibitors used for?
HTN
HF
What is the action of ACE inhibitors?
decreased blood pressure
(inhibits RAAS, dilated blood vessels)
Side effects of ACE inhibitors?
ACE
Angieoedema
Cough
Elevated K+
How to give ACE inhibitors?
can be taken by itself or with others, take 2-3 times daily
What not to take with ACE inhibitors?
NSAIDS
Lithium
What are ARBs used for?
ACE inhibitor replacement
What are the side effects of ARBS?
headache
angioedema
hyperkalemia
how to take ARB’s?
with or without food
What not to take with ARB’s?
foods high in potassium
NSAIDS
smoking
grapefruit juice
pregnant
drugs
What are Beta Blockers used for?
HF
HTN
what is the action of Beta Blockers?
decr HR and BP
what needs to be checked before Beta Blockers are administered?
HR and BP
hold if below 120 or 60
Side effects of Beta Blockers?
bradycardia
COPD exacerbation
fatigue
weakness
sexual dysfunction orthostatic hypotension
glucose control in diabetics
When to take Beta Blockers?
same time each day (atenolol before meals or at bedtime)
dont stop taking suddenly
What care CCB used for?
HTN
What is the action of CCB?
Lower BP and HR
What should you do before administering CCB?
take HR and BP
Side effects of CCB?
GI upset
hypotension
what to avoid taking with CCB?
grapefruit juice
what are statins used for?
high cholesterol
what is the action of Statins?
decr LDL
incr HDL
decr risk of cardiovascular disease
side effects of statins?
muscle cramps
abd pain
fatigue
jaundice
dark urine
what should you be careful with statins and muscle weakness/cramping?
rabdomylosis
what should be checked when taking statins?
lipid panel
liver enzymes
CK
What cannot be taken with statins?
pregnancy women
alcohol use disorder
grapefruit juice
warfarin
What is clopidogrel for?
prevents platelets sticking together
who is clopidogrel for?
stents
MI
a-fib
Side effects of clopidogrel?
GI upset
N/V/D
incr bleeding risk
thrombocytopenia
brusing
how to take clopidogrel?
without food
what not to take with clopidogrel?
NSAIDS
glucocorticoids
anticoagulants
What is Heparin used for?
formation of new clots (fast acting)
side effects for heparin?
incr bleeding risk
what should be assessed with heparin?
aPPT (47-70sec)
platelets
CBC
hematocrit
vitals HR BP
what is warfarin used for?
prevent coagulation (slow acting)
side effects of warfarin?
incr bleeding
importnat diet for warfarin?
dont change diet
warfarin drug interactions?
LOTS
what needs to be assessed with warfarin?
INR 2-3sec
Warfarin antidote?
vitamin K
heparin antidone?
protamine sulfate
digoxin antidote?
digibind or digital
