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NUR102 Unit 6 Cardiology > Circulatory Problems > Flashcards

Circulatory Problems Flashcards

1
Q

HTN epidemic in US

A

70M Americans have high BP, 30% are pre HTN, “silent killer”, inc risk for heart disease, stroke, and kidney disease

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2
Q

Which race will more often experience HTN?

A

African Americans. More common that whites and hispanics

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3
Q

Criteria for dx of HTN (> and < age 60)

A

age >60 BP 150/90
age <60 BP 140/90
those with DM or renal failure goal is <140/90 at any age

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4
Q

5 types of HTN

A

primary (essential) HTN, secondary HTN, “white coat” HTN, isolated systolic HTN (ISH), malignant HTN

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5
Q

“equations” for vascular regulatory system

A 
CO = SVxHR
BP = CO+PVR
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6
Q

CO

A

cardiac output

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7
Q

SV

A

stroke volume

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8
Q

HR

A

heart rate

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9
Q

PVR

A

peripheral vascular resistance

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10
Q

alterations of the vascular regulatory system (what happens if factors inc/dec?)

A

inc PVR, HR, or SV = inc BP

dec PVR, HR, or SV = dec BP and can cause dec perfusion to body tissues

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11
Q

location and function of baroreceptors

A

(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

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12
Q

function of the kidney’s in maintaining body’s homeostasis

A

regulate body fluid volume by regulating Na+ and H2O, Na+ retention by renin- angiotensin system

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13
Q

vascular autoregulation

A

keeps perfusion to the tissues constant

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14
Q

cause and risk factors of primary HTN

A 
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
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15
Q

cause of secondary HTN

A 
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)
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16
Q

“white coat” HTN

A

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

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17
Q

definition of isolated systolic HTN

A

Diastolic number less than 90 millimeters of mercury (mm Hg) and a systolic number greater than 140 mm Hg

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18
Q

complications of isolated systolic HTN

A

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

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19
Q

goal of tx of isolated systolic HTN

A

systolic <140 and diastolic no lower than 70

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20
Q

definition of malignant HTN

A

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

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21
Q

sx of malignant HTN

A

morning HA, blurred vision, dyspnea, uremia (waste products in the blood)

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22
Q

complications of malignant HTN

A

May cause stroke, renal failure, left ventricular failure

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23
Q

HTN crisis (urgency)

A

ACE inhibitors, adrenergic inhibitors, Ca antagonists. BP 180/110 but no target end organs effected, able to adjust meds w/o signs/sx

24
Q

HTN crisis (emergency)

A

Vasodilators, adrenergic inhibitors. BP >180/120 and target organs effected

25
Q

HTN crisis (malignant HTN)

A

persistent severe HTN causing organ damage

26
Q

Goal for treatment of pt’s in HTN crisis

A

reduce MAP (normal: 70-100) *measures adequate coronary blood flow

27
Q

common signs/sx of manifesting HTN

A 
Headache 
Epistaxis 
Dizziness 
Fainting
Flushed
Fatigue
Blurred vision
Palpitations
28
Q

HTN non- modifiable risk factors

A

family history
gender
age
ethnic profile

29
Q

HTN modifiable risk factors

A 
Stress profile
personality characteristics
genetic factors
Occupation
socioeconomic factors
Dietary factors
lifestyle habits
30
Q

consequences of elevated arterial pressure due to HTN

A 
Cerebral perfusion Reduced 
Cerebral oxygen supply reduced 
myocardial workload increases
oxygen consumption decreased
kidney blood flow reduced
*dec supply and inc demand
31
Q

complications of HTN

A 
Atherosclerotic disease
Left ventricular failure
Cerebrovascular insufficiency (stroke) 
Retinal hemorrhage (blindness)
Renal failure (30 ml/ hr)
32
Q

A patient with atherosclerosis and type 2 diabetes mellitus has these lab results. Which one is the most concern for this patient?

A

LDL level of 98 mg/dl (should be <70 for this pt)

33
Q

Key features of PE of pt with HTN

A

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)

34
Q

Nursing assessment of pt with HTN

A

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

35
Q

pharmacologic tx of HTN in non- african am, including DM

A

thiazide diuretic, Ca channel blocker, ACEi or ARB

36
Q

pharmacologic tx of HTN in african am, including DM

A

thiazide diuretic, Ca channel blocker, *ACE and ARB not as effective on this population

37
Q

A “normal” adult blood pressure would be

A

Less than 120 systolic and less than 80 diastolic

38
Q

thiazide (diuretic)

A

prevent sodium and water reabsorption in the distal tubules (HCTZ, hydrodiuril)

39
Q

lasix (diuretic)

A

Loop-depress sodium reabsorption in the loop of Henle

40
Q

aldactone (diuretic)

A

Potassium-sparing- act on the distal tubule and retain potassium

41
Q

patients taking diuretics should eat foods high in which vitamin?

A

K (b/c will be excreted)

42
Q

2 main precautions for patients taking diuretics to follow

A

Rise slowly and maintain fluid intake

Take 6 hr prior to bed at latest

43
Q

Angiotensin-Converting Enzyme Inhibitors (ACEi) *vasodilator

A

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

44
Q

Angiotensin II Receptor Antagonists

ARBs *drugs that end in -sartan

A

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

45
Q

Calcium Channel Blocking Agents

A

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

46
Q

Aldosterone Receptor Antagonists

A 
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
47
Q

Beta-Adrenergic Blockers *end in -olol

A

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

48
Q

Central Alpha Agonists

A

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

49
Q

Renin Inhibitors

A

Tekturna
Inhibits renin production which leads to vasodilitation
Rare SE: cough, diarrhea and respiratory distress

50
Q

lifestyle modifications for pts with HTN

A 
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)
51
Q

other associated therapy for HTN

A

ASA 81 mg “baby aspirin” for patients 50-80 with HTN
Statins for treatment of hyperlipidemia
Smoking cessation medications if needed

52
Q

general considerations for HTN

A 
Diminished compliance of the arterial wall
Decreased cardiac output, heart rate
Increased peripheral resistance
At risk: concomitant disease
stiffer vessels
complications greater
53
Q

what race has lowest prevalence of HTN?

A

mexican americans and native americans

54
Q

what race has highest prevalence of HTN?

A

african americans

*less responsive to beta blockers and ACEi which will alter other meds

55
Q

goal BP of HTN DM, african am, CV disease, and renal disease

A

140/90

56
Q

Which type of antihypertensive drug is considered the drug of choice for hypertensive patients who also have ischemic heart disease?

A

Beta blockers bc also dec BP and HR (dec workload of heart)

57
Q

What type of diet should HTN patients be taught?

A

DASH

NUR102 Unit 6 Cardiology (4 decks)

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