Circulatory Problems Flashcards
HTN epidemic in US
70M Americans have high BP, 30% are pre HTN, “silent killer”, inc risk for heart disease, stroke, and kidney disease
Which race will more often experience HTN?
African Americans. More common that whites and hispanics
Criteria for dx of HTN (> and < age 60)
age >60 BP 150/90
age <60 BP 140/90
those with DM or renal failure goal is <140/90 at any age
5 types of HTN
primary (essential) HTN, secondary HTN, “white coat” HTN, isolated systolic HTN (ISH), malignant HTN
“equations” for vascular regulatory system
CO = SVxHR BP = CO+PVR
CO
cardiac output
SV
stroke volume
HR
heart rate
PVR
peripheral vascular resistance
alterations of the vascular regulatory system (what happens if factors inc/dec?)
inc PVR, HR, or SV = inc BP
dec PVR, HR, or SV = dec BP and can cause dec perfusion to body tissues
location and function of baroreceptors
(w/n carotid sinus) monitor arterial pressure and counteracts rise through vagal response which dec HR and is also vasodilator, can also inc BP when it falls
function of the kidney’s in maintaining body’s homeostasis
regulate body fluid volume by regulating Na+ and H2O, Na+ retention by renin- angiotensin system
vascular autoregulation
keeps perfusion to the tissues constant
cause and risk factors of primary HTN
no known cause Age > 60 Family history of HTN High sodium intake Physical inactivity Excessive alcohol intake Low potassium, magnesium, calcium intake Smoking, Stress, Obesity Hyperlipidemia
cause of secondary HTN
Certain diseases increase susceptibility to hypertension=secondary *anything that regulates BP Renal vascular and renal parenchymal disease Primary aldosteronism Cushing’s disease Coarctation of the aorta Brain tumors Encephalitis Pregnancy Some medications (estrogen, steroids)
“white coat” HTN
with presence of Dr pt’s BP may rise up to 20 pts, but will dec to near normal w/n 10 mins as comfort level inc, retake BP before client leaves
definition of isolated systolic HTN
Diastolic number less than 90 millimeters of mercury (mm Hg) and a systolic number greater than 140 mm Hg
complications of isolated systolic HTN
can lead to serious health problems, such as stroke, heart disease, chronic kidney disease and dementia, and should be treated in the same way as regular high blood pressure
goal of tx of isolated systolic HTN
systolic <140 and diastolic no lower than 70
definition of malignant HTN
Severe form of elevated BP that rapidly progresses
SBP >200 mm HG, DBP >150
or DBP >130 with other complications *need to act quickly on sx
sx of malignant HTN
morning HA, blurred vision, dyspnea, uremia (waste products in the blood)
complications of malignant HTN
May cause stroke, renal failure, left ventricular failure
HTN crisis (urgency)
ACE inhibitors, adrenergic inhibitors, Ca antagonists. BP 180/110 but no target end organs effected, able to adjust meds w/o signs/sx
HTN crisis (emergency)
Vasodilators, adrenergic inhibitors. BP >180/120 and target organs effected
HTN crisis (malignant HTN)
persistent severe HTN causing organ damage
Goal for treatment of pt’s in HTN crisis
reduce MAP (normal: 70-100) *measures adequate coronary blood flow
common signs/sx of manifesting HTN
Headache Epistaxis Dizziness Fainting Flushed Fatigue Blurred vision Palpitations
HTN non- modifiable risk factors
family history
gender
age
ethnic profile
HTN modifiable risk factors
Stress profile personality characteristics genetic factors Occupation socioeconomic factors Dietary factors lifestyle habits
consequences of elevated arterial pressure due to HTN
Cerebral perfusion Reduced Cerebral oxygen supply reduced myocardial workload increases oxygen consumption decreased kidney blood flow reduced *dec supply and inc demand
complications of HTN
Atherosclerotic disease Left ventricular failure Cerebrovascular insufficiency (stroke) Retinal hemorrhage (blindness) Renal failure (30 ml/ hr)
A patient with atherosclerosis and type 2 diabetes mellitus has these lab results. Which one is the most concern for this patient?
LDL level of 98 mg/dl (should be <70 for this pt)
Key features of PE of pt with HTN
History (health, fam)
Vital signs (avg of 2 or more BP separated by 2 min)
Subjective symptoms (blurred, HA, dizz, palp, fatigue)
Diet (sodium intake)
Lifestyle (activity level)
Nursing assessment of pt with HTN
Risk factor profile (modifiable and non modifiable)
Associated complaints (HA, nose bleed, syncope)
Nursing history and med hx
Medications (ant and all including rx and OTC, including herbal/ supplement)
Vital signs (mult readings)
Cardiovascular changes
pharmacologic tx of HTN in non- african am, including DM
thiazide diuretic, Ca channel blocker, ACEi or ARB
pharmacologic tx of HTN in african am, including DM
thiazide diuretic, Ca channel blocker, *ACE and ARB not as effective on this population
A “normal” adult blood pressure would be
Less than 120 systolic and less than 80 diastolic
thiazide (diuretic)
prevent sodium and water reabsorption in the distal tubules (HCTZ, hydrodiuril)
lasix (diuretic)
Loop-depress sodium reabsorption in the loop of Henle
aldactone (diuretic)
Potassium-sparing- act on the distal tubule and retain potassium
patients taking diuretics should eat foods high in which vitamin?
K (b/c will be excreted)
2 main precautions for patients taking diuretics to follow
Rise slowly and maintain fluid intake
Take 6 hr prior to bed at latest
Angiotensin-Converting Enzyme Inhibitors (ACEi) *vasodilator
Enzyme converts angiotensin I to angiotensin II, a powerful vasoconstrictor. When inhibited prevents an increase in BP
ACEI include: Captopril, Enalapril (Vasotec), and Lisinopril
Use with CKD and diabetes
Do not use with an ARB
Education: slow movement, with persist dizz alert doc, notify freq persist cough, monitor BP esp with 1st dose
Angiotensin II Receptor Antagonists
ARBs *drugs that end in -sartan
Angiotensin II receptor blockers act by blocking the binding of angiotensin II in the tissues (vasodilation)
ARBs include: Atacand, Cozaar (losartan), and Diovan
Used clients that are intolerant to ACEi (cough)
Monitor for HoTN, avoid K+ bc hypoCa can occur
Calcium Channel Blocking Agents
Very effective in older adults and African Americans
Lower BP by interfering with the calcium at the cellular level resulting in vasodilation
Examples: Verapamil (Calan), Amlodipine (Norvasc), Diltiazem (Cardizem), Nicardipine (Cardene)
Also lower HR
Pt should avoid grapefruit juice
Aldosterone Receptor Antagonists
Works by blocking aldosterone Aldosterone increases sodium reabsorption by the kidney and contributes to HTN and heart disease Examples include: Inspra Used for severe CHF Can inc Na+ and can dec K+ Avoid grapefruit juice
Beta-Adrenergic Blockers *end in -olol
Block beta receptors in the heart and peripheral vessels, decreasing cardiac rate and cardiac output thereby decreasing BP and workload of the heart (dec HR and BP)
Drug of choice for hypertensive patients that also have heart disease
Examples include: Atenolol, Metoprolol, and Propranolol
Many side effects are well tolerated
Central Alpha Agonists
Act on the CNS preventing reuptake of norepinephrine which results in decreased peripheral vascular resistance and BP
Examples include: Clonidine (Catapres), Minipress, Reserpine
Clonidine available in weekly patch form
Renin Inhibitors
Tekturna
Inhibits renin production which leads to vasodilitation
Rare SE: cough, diarrhea and respiratory distress
lifestyle modifications for pts with HTN
Moderately low-sodium, low-fat diet with high intake of fruits and vegetables (DASH diet) Weight loss to lower BMI < 25 Decrease alcohol intake (women one drink, men two) Physical activity (30 minutes 5Xs/per week)
other associated therapy for HTN
ASA 81 mg “baby aspirin” for patients 50-80 with HTN
Statins for treatment of hyperlipidemia
Smoking cessation medications if needed
general considerations for HTN
Diminished compliance of the arterial wall Decreased cardiac output, heart rate Increased peripheral resistance At risk: concomitant disease stiffer vessels complications greater
what race has lowest prevalence of HTN?
mexican americans and native americans
what race has highest prevalence of HTN?
african americans
*less responsive to beta blockers and ACEi which will alter other meds
goal BP of HTN DM, african am, CV disease, and renal disease
140/90
Which type of antihypertensive drug is considered the drug of choice for hypertensive patients who also have ischemic heart disease?
Beta blockers bc also dec BP and HR (dec workload of heart)
What type of diet should HTN patients be taught?
DASH
