CV TEST ONE: HYPERTENSION Flashcards
Hydrochlorothiazide
Diuretic HTN Med, potassium wasting (no potassium) potassium rich diet suggested
Peripheral resistance
Arteries’ resistance to blood flow, arteries constrict=increased resistance , arteries dilate= decreased resistance
Modifiable/non modifiable HTN factors
•Modifiable—diet, lifestyle, exercise
•non modifiable—race, gender, heredity, age, pre existing conditions
BP categories
*normal–less than 120/80 mmHg
*elevated–120-129/<80 mmHg
*stage 1–130-139/80-89 mmHg, poss. Med. intervention, lifestyle change
*stage 2–BP < 140/< or = 90 mmHg, meds (ANTIHYPERTENSIVES) lifestyle change
*urgent–180/120 or <, immediate reduction of BO to prevent organ damage, PT resting while 911 contacted
HTN diagnosis includes:
Confirmed >2 occasions of hypertensive measurements, risk factors, presence/absence of symptoms, history of heart/kidney disease, current meds used
HTN S/S
Headache, bloody nose, anxiety, SOB
Cardiac catheterization
•Studies heart’s anatomy/physiology, assesses pressure in coronary arteries/chambers/great vessels, assesses C.O./O2 saturation
•dye injected into catheter>inserted into femoral vein
Pre & post cardiac catheter
•pre– consent, assess for iodine/dye allergies, NPO/conscious sedation
•post–monitor for bleeding, pressure device at site, bedrest, no flexion of extremity for hrs, V.S. Taken, peripheral pulses taken
PTs radial pulse is different than their apical. What should nurse proceed to do and why
Report pulse deficit to doctor, could indicate arrhythmia/cardiac dysfunction
Trans esophageal Echocardiogram (TEE Test)
•Clearer picture, transducer probe in esophagus (doesn’t cross lung/rib tissue), sedation/local anesthetic in oropharynx, NPO 6 hrs pre-test
•complications—esophageal perforation, throat bleeding, hypoxia, dysthymias
Pre/Post TEE
•Pre TEE—assess allergy hx/sedation reactions/local & general anesthesia
•post TEE–asses VS, monitor bleeding, MONITOR GAG REFLEX!, keep suction & resuscitation equipment available
Pericardial rub
Heard in inflammatory processes (pericarditis), sounds like rubbing tissue papers, can be heard closely if PT sitting up & leaning forward
S3 & S4 sounds
•S3—ventricular gallop or LUBB DUBB DUBB
•S4— atrial gallop or LUBB LUBB DUBB
3 membranes of heart
•fibrous pericardium– outermost layer, forms sac around heart
•parietal pericardium–middle layer
•visceral pericardium aka epicardium– innermost layer
Where does blood start at in the heart ?
Superior and inferior vena cava
If a PT is struggling financially to pay for care costs they should be redirected to:
The financial dept within the clinical setting
The left ventricle pumps __x times more force because _____
5, accommodate systemic circulation
Cardiac pathway
AV node>SA node>Bundle of His>purkinje
SA node
Pacemaker of the heart, where cardiac impulse is first carried out, heartbeat initiation, located in R.A.’s wall, gives normal rhythm
Cardiac cycle
One heartbeat, 0.8 seconds
During cardiac cycle, both atrias and ventricles contract and relax, known as
•systole–contraction(emptying occurs)
•diastole–relaxation phase
Cardiac output
•amount of blood ejected from left ventricle in a minute
•calculation –stoke volume X heart rate
Too much or too little potassium can cause
Dysrhythmia
ANP (Atrial natriuetic) is secreted in response to
Vessels stretching from increased volume
Uretic
Sodium and water loss, BP increased
If there’s a different reading on the PTs arms go with
The higher reading for ongoing use
Complications of HTN
CAD, atherosclerosis, M.I., H.F., stroke, kidney damage, eye damage, L.V. hypertrophy
Meds to lower Bp (diuretics)
•K-sparing: Spironolactone (Aldactone)
•k-wasting: thiazide (hydrochlorothiazide) (chlorothiazide)
•Loop: furosemide (lasix), torsemide (demadex)
•oldest most studied antiHTN med
•PTs should swing legs on bed’s edge for some minute before standing to avoid syncope
most common heart disease manifestation
chest pain (angina)
Dyspnea may be a sign of
LV failure or transient CHF
Heart sounds produced by closing valves start at
the aortic
murmur
turbulent blood flow through heart/vessels, prolonged sound>narrowed valve closing
cardiac enzyme elevated values
CPK and troponin
C.O., blood viscosity, blood volume, PVR
factors determining BP
What is HTN? what could it cause?
Increase in blood pressure against vessel walls…
coronary heart disease, CHF, stroke, M.I., eye damage, LV hypertrophy
can a clot be caused by HTN
Yes due to blood being forced thru narrow vessels
Increased C.O., PVR, blood viscosity, blood volume, hormone imbalances, kidney dysfunction
pathophysiologic changes of HTN
Lifestyle mods. should be done ______ drug therapy unless PT is at high risk
before….
PTs at risk for urgent HTN
untreated HTN, non compliant with med, using nitroprusside as its a vasodilation
beta 1
beta 1 antagonist: iontropic, chronotropic effects
beta 1 blocker: decreased contractility, HR, decreased C.O.
BETA 2
agonist: bronchodilation
blocker: bronchoconstriction
alpha 1
agonist: vasoconstriction
blocker: vasodilation
secreted by adrenal medulla, sympathomimetic response
epinephrine
produced by adrenal cortex, regulates Na & K levels
aldosterone
ANP
secreted by atria, increases Na excretion
