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Adult Health I Test III > Day II > Flashcards

Day II Flashcards

1
Q

define HTN

A
  • Defined as a systolic pressure at or greater than 140 mmHg or diastolic pressure at or greater than 90 mmHg for 2 or more assessments of blood pressure
    • For those over 60, blood pressure should be less than 150/90
  • Prolonged, untreated, or poorly controlled HTN can cause peripheral vascular dz that primarily affects the heart, brain, eyes, and kidneys
  • Hypertrophy of the left ventricle can develop as the heart pumps against resistance caused by the HTN
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2
Q

essential HTN vs. secondary HTN

A
  • Essential HTN: AKA primary HTN
    • Most common
    • No known cause
  • Secondary HTN: caused by dz states, like kidney dz, or as an ADR of some meds
    • Tx: occurs by removing the cause (adrenal tumor, medication)
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3
Q

prehypertension

A
  • client’s with a SBP of 120-139 mmHg or a DBP of 80-89 mmHg
  • Lifestyle changes are necessary for these clients to help prevent cardiovascular disease
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4
Q

health promotion and dz prevention of HTN

A
  • Maintain body mass index of less than 30
  • Clients who have DM should keep blood glucose w/in a recommended reference range
  • Limit caffeine and alcohol intake
  • Use stress management techniques during times of stress
  • Stop smoking: nicotine patches or engaging in a smoking cessation class are potential strategies
  • Engage in exercise that provides aerobic benefits at least 3 times a week
  • Limit sodium and fat intake
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5
Q

explain the 4 mechanisms that regulate BP

A
  • Arterial baroreceptors:
    • Baroreceptors are located in the carotid sinus, aorta, and left ventricle
    • They control BP by altering the heart rate. They also cause vasoconstriction or vasodilation.
  • Regulation of body fluid volume: properly functioning kidneys retain fluid when a client is hypotensive and excrete fluid when a client is hypertensive
  • RAAS: renin is converted into Ang II, which causes vasoconstriction and controls aldosterone release, causing the kidneys to reabsorb sodium and inhibit fluid loss
  • Vascular autoregulation: maintains consistent levels of tissue perfusion
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6
Q

risk factors of essential HTN

A
  • Positive family hx
  • Excessive sodium intake
  • Physical inactivity
  • Obesity
  • High alcohol consumption
  • African American
  • Smoking
  • Hyperlipidemia
  • Stress
  • Age greater than 60 or postmenopausal
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7
Q

risk factors of secondary HTN

A
  • Kidney disease
  • Cushing’s disease (excessive glucocorticoid secretion)
  • Primary aldosteronism (causes HTN and hypokalemia)
  • Pheochromocytoma (excessive catecholamine release)
  • Brain tumors, encephalitis
  • Meds like estrogen, steroids, and sympathomimetics
  • Pregnancy
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8
Q

expected finidngs in clients who have HTN

A
  • Clients who have HTN can experience few or no manifestations. Monitor for the following.
    • HAs, particularly in the morning
    • Facial flushing
    • Dizziness
    • Fainting
    • Retinal changes, visual disturbances
    • Nocturia
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9
Q

stages of HTN

A
  • When a BP reading is elevated, take it in both arms and w/ the client sitting and standing
  • There are levels of HTN:
    • preHTN: 120-139/80-89
    • Stage I HTN: 140-159/90-99
    • Stage II HTN: greater than or equal to 160/greater than or equal to 100
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10
Q

lab tests for HTN

A
  • no lab tests can diagnose, but several can identify the causes of secondary HTN
    • BUN, creatinine: elevation is indicative of kidney dz
    • Elevated serum corticoids: detects Cushing’s dz
    • Blood glucose and cholesterol studies: identify contributing factors related to blood vessel changes
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11
Q

diagnostic procedures for HTN

A
  • ECG: evaluates cardiac functions
    • Tall R waves: often seen with left ventricular hypertrophy
  • CXR: shows cardiomegaly
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12
Q

meds for HTN

A
  • used when HTN is not responsive to lifestyle changes alone
  • Diuretics are first line, but many ppl require a combination of meds
  • Client edu: instruct clients to change positions slowly, and to be careful when getting out of bed, driving, and climbing stairs until the med’s effects are fully known
  • classes of HTN meds:
    • diuretics
    • CCBs
    • ACE Inhibitors
    • ARBs
    • Aldosterone receptor antagonists
    • beta blockers
    • central alpha 2 agonists
    • alpha adrenergic antagonists
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13
Q

what are the types of diuretics used to tx HTN and how do they work?

A
  • Thiazide diuretics: like HCTZ, inhibits water reabsorption and increases potassium excretion
  • Loop diuretics: like furosemide, dec Na reabsorption and inc K excretion
  • Potassium sparing diuretics: like spironolactone, affect the DCT and prevent reabsorption of Na in exchange for K
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14
Q

nursing considerations and client edu for diuretics used to tx HTN

A
  • Nursing Considerations: monitor K levels and watch for muscle weakness, irregular pulse, and dehydration
    • Thiazide and loop diuretics: can cause hypokalemia
    • Potassium sparing: can cause hyperkalemia
  • Client edu:
    • Encourage client to keep all appts w/ provider to monitor efficacy of medications and possible electrolyte imbalance
    • If taking K wasting diuretic, encourage consumption of K rich foods
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15
Q

CCBs used to tx HTN

A
  • verapamil, amlodipine, diltiazem
    • After movement of calcium ions thru the cell membrane, vasodilation and lowered BP results
  • Nursing considerations:
    • Monitor BP and pulse and change client’s position slowly
    • Use cautiously if pt has HF
  • Client edu:
    • Verapamil: constipation is common so inc fluids and inc fiber intake
    • Dec or inc in HR and AV can occur
    • Teach client to take pulse and call provider if irregular or lower than expected
    • Avoid grapefruit juice
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16
Q

ACE Inhibitors used to tx HTN

A
  • lisinopril, enalapril
    • Prevent conversion of Ang I to Ang II which prevents vasoconstriction
  • Nursing considerations:
    • Watch BP and pulse
    • Watch for evidence of HF like edema
  • Client edu:
    • Teach client to report a cough (ADR)
    • Report signs of HF
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17
Q

ARBs used to tx HTN

A
  • valsartan, losartan
    • Good for clients who take ACE inhibitors but have a cough or have hyperkalemia
    • Do not require a dosage adjustment for older adults
  • Nursing considerations:
    • Watch for signs of angioedema or HF
  • Client edu:
    • Change positions slowly
    • Report signs of angioedema (swollen lips, face) or HF
    • Avoid foods high in K and have serum K levels monitored b/c ARBs can cause hyperkalemia
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18
Q

aldosterone receptor antagonists used to tx HTN: medication and action

A
  • eplerenone
    • Block aldosterone’s action which promotes the retention of K and excretion of Na and water
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19
Q

aldosterone receptor antagonists used to tx HTN: nursing considerations

A
  • Monitor kidney fcn, triglycerides, Na, and K
    • Risk of adverse effects inc with deteriorating kidney fcn
    • Risk inc as dose inc
  • Monitor K levels every 2 weeks for first few months and every 2 months thereafter
    • Avoid taking K supplements or K sparing diuretics
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20
Q

aldosterone receptor antagonists used to tx HTN: client edu

A
  • Teach client about food, med, herbal interactions like grapefruit juice and St. John’s wort can increase ADRs
  • Instruct the client not to take salt substitutes with K or other foods rich in K
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21
Q

beta blockers used to tx HTN

A
  • metoprolol, atenolol
    • For clients who have unstable angina or MI
    • Decrease cardiac output and block the release of renin, subsequently decreasing vasoconstriction of the peripheral vasculature
  • Nursing considerations:
    • Monitor BP and pulse
    • Meds mask hypoglycemia in clients who have DM
  • Client edu:
    • Teach the client that these meds can cause fatigue, weakness, depression, and sexual dysfunction
    • Do not d/c abruptly
    • Teach about S/S of hypoglycemia that do not include tachycardia, which beta blockers suppress
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22
Q

central alpha 2 agonists used to tx HTN

A
  • clonidine
    • Reduce peripheral vascular resistance and dec BP by inhibiting the reuptake of NE
  • Nursing considerations:
    • Monitor BP and pulse
    • Med is not for 1st line management of HTN
  • Client edu:
    • ADRs: sedation, orthostatic hypoTN, impotence
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23
Q

alpha adrenergic antagonists used to tx HTN

A
  • prazosin
    • Reduce BP by causing vasodilation
  • Nursing considerations:
    • Start tx w/ low dose of med and give at night
    • Monitor BP for 2 hours after starting tx
  • Client edu:
    • Rise slowly to prevent postural hypoTN
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24
Q

client education for HTN

A
  • Report S/S of hyperkalemia, hypokalemia, and hyponatremia
  • Adhere to medication regimen
  • Ensure client has resources to pay for meds
  • Teach how to manage BP at home
  • Report ADRs
  • Teach about how to make lifestyle changes
  • nutrition education
    • including weight reduction and maintenance
  • smoking cessation
  • stress reduction: yoga, massage, hypnosis
25
Q

nutrition education for HTN

A
  • Monitor for hyperkalemia and salt substitute use
  • Consume less than 2.3 g/day of sodium
  • Diet should be low in fat, saturated fat, cholesterol
  • Limit alcohol intake to 2 servings/day for males and 1 serving/day for females
  • DASH diet: high in fruits, veggies, low fat dairy foods
  • Consume foods rich in Ca and Mg
  • If not taking a K sparing medication, should inc K consumption
26
Q

weight reduction and maintenance with HTN

A
  • Begin slowly and gradually advance the program with the guidance of the provider and physical therapist
  • Exercise at least 3 times a week in a manner that provides aerobic benefits
27
Q

complication of HTN

A
  • HTN crisis: often occurs when they don’t follow the medication regimen
  • Nursing actions:
    • S/S: severe HA, extremely high BP (usually over 240/120), blurred vision, dizziness, disorientation, epistaxis
    • Administer IV anti HTN meds: nitroprusside, nicardipine, labetalol
    • Monitor BP every 5-15 min
    • Assess neuro status, such as pupils, LOC, muscle strength to monitor for cerebrovascular change
    • Monitor ECG to assess cardiac status
28
Q

what is acute coronary syndrome (ACS)?

A
  • continuum from angina to MI
  • symptoms due to an imbalance b/w myocardial O2 supply and demand
29
Q

angina pectoris

A
  • warning sign of impending MI
    • Women and older adults do not always experience manifestations assoc with angina or MI
30
Q

what improves outcomes following an MI?

A

clients treated w/ aspirin, beta blockers, and ACE inhibitors, or ARBs

31
Q

what happens when blood flow the heart is compromised?

A
  • When blood flow to the heart is compromised, ischemia causes chest pain
    • Anginal pain often described as tight squeezing, heavy pressure, or constricting feeling in the chest
    • Pain can radiate to jaw, neck, or arm
    • Pain unrelieved by rest or nitroglycerin and lasting for more than 15 min differentiates an MI from angina
32
Q

what does An abrupt interruption of O2 to the heart muscle produce?

A
  • myocardial ischemia
    • Ischemia can lead to tissue necrosis (infarction) if blood supply and O2 are not restored
    • Ischemia is reversible
    • Infarction results in permanent damage
      • When cardiac muscle suffers ischemic injury, cardiac enzymes are released into the blood, providing specific markers of MI
33
Q

health promotion and dz prevention for coronary artery disease

A
  • Maintain exercise routine
  • Have cholesterol level and BP checked
  • Consume diet low in saturated fats and sodium
  • Smoking cessation
34
Q

what are the 3 types of angina?

A
  • Stable (exertional) angina: results from exercise or emotional stress
    • Relieved by rest or nitroglycerin
  • Unstable (preinfarction) angina: occurs with exercise or rest, but inc in occurrence, severity, and duration over time
  • Variant (Prinzmetal’s) angina: due to coronary artery spasm, often occurring during periods of rest
35
Q

risk factors for coronary artery disease

A
  • Male gender or postmenopausal women
  • Ethnic background
  • Sedentary lifestyle
  • HTN
  • Tobacco use
  • Hyperlipidemia
  • Obesity
  • Excessive alcohol consumption
  • Metabolic disorders: DM, hyperthyroidism
  • Methamphetamine or cocaine use
  • Stress
  • Older adults who are inactive, have 1 or more chronic dzs (HTN, HF, DM) or have lifestyle habits (smoking, diet) that contribute to atherosclerosis
  • Inc with age, esp in presence of HTN, DM, hypercholesterolemia, elevated homocysteine, highly sensitive CRP
36
Q

expected findings with coronary artery disease or an MI

A
  • Anxiety, feeling of impending doom
  • Chest pain: substernal or precordial
    • Can radiate down shoulder or arm, or present as jaw pain
    • Can be described as a crushing or aching pressure
  • Nausea
  • Dizziness
  • Physical assessment:
    • Pallor and cool, clammy skin
    • Tachycardia and heart palpitations
    • Tachypnea and SOB
    • Diaphoresis
    • Vomiting
    • Dec LOC
37
Q

labs drawn for chest pain or an MI

A
  • Cardiac enzymes:
    • Myoglobin: earliest marker of injury to cardiac or skeletal muscle
      • Levels no longer evident after 24 hr
    • Creatinine kinase MB: peaks around 24 hr after onset of chest pain
      • Levels no longer evident after 3 days
    • Troponin I or T: any positive value indicates damage to cardiac tissue
      • I: no longer evident after 7-10 days
      • T: no longer evident after 10-14 days
38
Q

list the diagnostics for chest pain or an MI

A
  • ECG
  • stress test
  • thallium scan
  • cardiac cath
39
Q

explain use of an ECG for angina or an MI

A
  • recording of electrical activity over time
  • Nursing actions:
    • Assess for changes
    • Angina: ST depression and/or T wave inversion indicates ischemia
    • MI: T wave inversion indicates ischemia, ST segment elevation indicates injury, abnormal Q wave indicates necrosis
40
Q

explain use of a stress test for angina or MI

A
  • exercise electrocardiography
    • Client tolerance tested using a treadmill, bicycle, or medication to evaluate response to inc HR
41
Q

explain use of a coronary angiogram for angina or MI

A
  • Coronary angiogram: AKA cardiac cath
    • Invasive diagnostic procedure used to evaluate the presence and degree of coronary artery blockage
    • Involves the insertion of a catheter into a femoral vessel and threading into the right or left side of the heart
      • Can identify coronary A narrowing/occlusions by injection of contrast media
    • Nursing actions:
    • Informed consent
    • NPO 8 hour prior to surgery
    • Assess for iodine/shellfish allergy
42
Q

differentiate b/w angina and an MI

A
  • angina:
    • precipitated by exertion or stress
    • relieved by rest or nitroglycerin
    • symptoms last less than 15 min
    • not associated with nausea, epigastric distress, dyspnea, anxiety, or diaphoresis
  • MI:
    • can occur w/o cause, often in the morning after rest
    • relieved only by opioids
    • symptoms last more than 30 min
    • associated with nausea, epigastric distress, dyspnea, anxiety, and diaphoresis
43
Q

MI classification is based on:

A
  • Affected area of the heart: anterior, lateral, inferior, posterior
  • ECG changes produced: ST elevation MI vs non ST elevation MI
  • Time frame w/in progression of infarction: acute, evolving, old
44
Q

nursing care with angina or an MI

A
  • Monitor:
    • V/S Q5 min until stable, then Q hour
    • Serial ECG monitoring
    • PQRST of pain
    • Hourly urine output
    • Lab data: cardiac enzymes, electrolytes, ABGs
  • Administer O2 at 2-4 L/min
  • Obtain and maintain IV access
45
Q

what are the classes of meds used to tx angina and MI?

A
  • vasodilators
  • analgesics
  • beta blockers
  • thrombolytic agents
  • anticoagulants
  • glycoprotein IIB/IIIA inhibitors
46
Q

vasodilators for angina and MI

A
  • nitroglycerin
    • Prevents coronary artery vasospasm and reduces preload and afterload, dec myocardial O2 demand
  • Nursing considerations:
    • Used to tx angina and help control BP
    • Use cautiously with other antiHTN meds
    • Can cause orthostatic hypoTN
  • Client edu for chest pain:
    • Stop activity and rest
    • Place NG tablet under tongue
    • If pain is unrelieved in 5 min, call 911
    • Can take up to 2 more doses at 5 min intervals
    • HA is common SE
    • Sit and lie down slowly
47
Q

analgesics for angina and MI

A
  • morphine sulfate
    • Opioid analgesic used to tx moderate to severe pain
    • Act on mu and kappa receptors to alleviate pain
      • Can cause analgesia, respiratory depression, euphoria, sedation, dec in myocardial O2 consumption and GI motility
  • Use cautiously if client has asthma or emphysema due to risk of respiratory depression
  • Nursing considerations:
    • If have chest pain, assess pain Q5-15 min
    • Watch for manifestations of respiratory depression
    • If less than 12, then stop med and notify provider
    • Monitor V/S for hypoTN and dec respirations
    • Assess for n/v
  • Client edu:
    • If n/v persist, notify provider
    • Teach client to use PCA pump: only client should press button
48
Q

beta blockers for angina or MI

A
  • metoprolol
    • Has antidysrhythmic and anti HTN properties that dec the imbalance b/w myocardial O2 supply and demand by reducing afterload and slowing HR
    • In an acute MI, beta blockers dec infarct size and improve short and long term survival rates
  • Nursing considerations:
    • Bradycardia and hypoTN
    • Hold med if apical pulse <60
    • Do not give to clients with asthma, only administer if using a cardioselective beta blocker (metoprolol) b/c won’t affect respiratory system
    • Caution in pts with HF
    • Monitor for dec LOC, crackles of lungs, chest discomfort
  • Client edu:
    • Sit and lie down slowly
    • Report immediately if any SOB, edema, weight gain, cough
49
Q

thrombolytic agents for angina and an MI

A
  • alteplase, reteplase
    • Break up clots
    • Give w/in 6 hours of infarction
  • Nursing considerations:
    • Contraindications: active bleeding, PUD, hx of stroke, recent trauma
    • Monitor for signs of bleeding: mental status changes, hematuria
    • Monitor PT, aPTT, INR, fibrinogen levels, CBC
    • Monitor for: thrombocytopenia, anemia, hemorrhage
    • Administer streptokinase slowly to prevent hypoTN
  • Client edu: remind client of risk for bruising and bleeding
50
Q

antiplatelet agents for angina and an MI

A
  • aspirin, clopidogrel
    • Prevent platelets from forming together, which can produce arterial clotting
    • Aspirin: prevents vasoconstriction
      • Administer w/ NG at onset of chest pain
  • Nursing considerations:
    • Antiplatelet agents can cause GI upset
    • Caution in clients with hx of GI ulcers
    • Tinnitus: sign of aspiring toxicity
  • Client edu:
    • Risk for bruising/bleeding
    • Use aspirin with enteric coating and take with food
    • Report ringing in the ears
51
Q

anticoagulants for angina and an MI

A
  • heparin, enoxaparin
  • use to prevent clots from becoming larger
  • Nursing considerations:
    • Contraindications: active bleeding, PUD, hx of stroke, recent trauma
    • Monitor for signs of bleeding: mental status changes, hematuria
    • Monitor PT, aPTT, INR, fibrinogen levels, CBC
    • Monitor for: thrombocytopenia, anemia, hemorrhage
52
Q

therapeutic procedures used to tx angina and MI

A
  • Percutaneous transluminal coronary angioplasty (PTCA)
  • Bypass graft (CABG)
53
Q

client education involved with angina and MI care

A
  • Cardiac rehab should be consulted for exercise program related to heart
  • Monitor and report signs of infection
  • Avoid straining, strenuous exercise, emotional stress
  • Regarding response to chest pain: follow instructions on use of SL NG
  • Smoking cessation
  • Remain active
54
Q

complications of angina or MI

A
  • acute MI
  • HF/cardiogenic shock
  • ischemic mitral regurgitation
  • ventricular aneurysms/rupture
  • dysrhythmias
55
Q

explain acute MI as a complication of angina

A
  • complication of angina not relieved by NG or rest
    • Administer O2
    • Notify provider
56
Q

explain HF and cardiogenic shock as a complication of angina or MI and what are the manifestations

A
  • injury to left ventricle can lead to dec CO and HF
  • Progressive HF can lead to cardiogenic shock
  • Serious complication of pump failure
  • Manifestations:
    • Tachycardia
    • hypoTN
    • Inadequate urinary output
    • Altered LOC
    • Respiratory distress (Crackles and tachypnea)
    • Cool, clammy skin
    • Dec peripheral pulses
    • Chest pain
57
Q

nursing actions to help manage HF and cardiogenic shock as a complication of angina and MI

A
  • Administer O2
  • Administer IV morphine, diuretics, and/or NG to dec preload
    • Administer IV vasopressors and/or positive inotropes to inc CO and maintain organ perfusion
  • Maintain continuous hemodynamic monitoring
58
Q

explain ischemic mitral regurgitation as a complication of angina and MI

A
  • evidenced by development of new cardiac murmur
    • Administer O2
    • Notify provider
59
Q

explain ventricular aneurysms/rupture as a complication of angina and MI

A
  • can be due to necrosis from MI
  • Can be present as sudden chest pain, dysrhythmias, and severe hypoTN
    • Administer O2
    • Notify provider immediately

Adult Health I Test III (5 decks)

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