Exam 2- SYSTEMS Flashcards
hypertension
the force exerted by the blood against the walls of the blood pressure
cardiac output
the total blood flow through the systemic or pulmonic circulation per minute
stroke volume
amount of blood put out by the left ventricle of the heart in one contraction; 70 ml/minute
how do you find cardiac output?
CO= SV * HR
systemic vascular resistance
amount of force that the left atrium and ventricle need to overcome to push the blood out; force opposing the movement of blood within blood vessels
what’s affected from SVR?
radius of arteries and arterioles
sympathetic nervous system activity
vasodilation
arteries DIALATE, resistance to blood flow DECREASES
vasoconstriction
blood vessels NARROW, resistance to blood flow INCREASES
normal blood pressure
<120/
<80
elevated
120-129/
<80
stage I blood pressure
130-139/
80-89
stage II blood pressure
> 140/
90
hypertensive crisis
> 180/
120`
what factors from cardiac output contribute to blood pressure?
heart rate
contractility
conductivity
renal fluid volume control
what factors from SVR contribute to blood pressure?
sympathetic nervous system
vasodilators
vasoconstrictor
what medications help the heat contract and work harder?
digoxin
positive isotropic
where and how fast does the SA node work?
right atrium; 60-100 BPM
where and how fast does the AV node work?
between atria and ventricle (backup); 40-60 BPM
where and how fast does the bundle of HIS work?
aorta; 20-40 BPM
where and how fast does the punkinje fibers work?
left ventricle; 20-0 BPM
which populations are most affected for hypertension?
african americans: less response to renin inhibiting meds, better with calcium channel blockers and diuretics
hispanics: less likely receive treatment, lack of awareness
women: increased chances due to oral contraceptives, preeclampsia, and after menopause
what are the risk factors for primary hypertension?
unknown cause
what are the risk factors from secondary hypertension?
specific cause
what are some clinical manifestations for hypertension?
silent killer, fatigue, dizziness, palpations, angina, and dyspnea
what are hypertension patients at risk for?
myocardial infraction, heart failure, stroke, renal disease, retinopathy, death, peripheral vascular disease (aortic aneurysm, aortic dissection)
what are hypertension patients at risk for in the cardiovascular system?
coronary artery disease, atherosclerosis, left ventricular hypertrophy (left ventricle trying to overcome SVR), heart failure
what are hypertension patients at risk for in the brain?
cerebrovascular disease, hypertensive encephalopathy, changes in auto regulation
what are hypertension patients at risk for in the kidney?
nephrosclerosis leads to chronic kidney disease
what are hypertension patients at risk for in the eyes?
damaged retinal vessels indicate concurrent damage to vessels in heart, brain, and kidney
what are diagnostic studies you can do?
take BP wherever; teach the patient; cardiac and peripheral pulses assessment; echo; ambulatory BP monitoring (consistent BP randomly for 24 hours)
what are the overall goals for hypertension
achieve and maintain goal Bp; lifestyle modifications
what are the AHA’s life’s simple 7?
- manage and monitor BP
- control cholesterol- dec choles and saturated fats
- reduce blood sugar
- get active
- eat better- restrict salt, eat potassium and calcium
- lose weight
- stop smoking
what are some lifestyle modification for patients diagnosed with hypertension
weight reduction; dietary approaches; dietary sodium reduction; dash diet; moderations of alcohol; physical activity; avoid tobacco products; management of risk factors
what is the drug therapy for patients diagnosed with hypertension?
primary actions- decrease circulating blood volume and reduce SVR; centrally acting alpha-agonist hypotensive agents; alpha adrenergic blocker; beta adrenergic blocker; diuretics
centrally acting alpha-agonist hypotensive agent
hypertension; decreases heart rate and relaxes blood vessels so that blood can flow more easily through the body
side effects: dry mouth
alpha adrenergic blocker
hypertension; relaxes blood vessels so blood can flow more easily
side effects: orthostatic hypotension
beta adrenergic blocker
blocks the action of certain natural chemicals in the body such as epinephrine, on the heart and blood vessels. this effect lowers the heart rate, BP, and strain on the heart
side effects: dizziness, lightheadedness, tiredness
diuretics
hypertension; help rid the body of sodium and water. the sodium takes with it water from your blood, decreasing the amount of fluid flowing through veins and arteries
side effects: dizziness, headaches, frequent voiding, loss of potassium, orthostatic hypotension
what is one important piece of information for patient and caregiver education?
need to continue adherence to therapy. Don’t double skip or stop abruptly. Know the patient’s medications
what are common side effects for those diagnosed with hypertension?
orthostatic hypotension, frequent voiding, hypotension
what is resistant hypertension?
failure to reach goal blood pressure which increases the risk of stroke or myocardial infraction
what are the causes of resistant hypertension?
improper BP measurement; volume overload; inadequate or inappropriate drug dose/therapy; poor adherence; white coat syndrome; secondary hypertension
what are priority problems with those diagnosed with hypertension?
altered BP; ineffective tissue perfusion; impaired sexual function; stroke; MI
what are gerontologic consideration for those diagnosed with hypertension?
increased incidence with age; more likely to have white coat syndrome; age-related physical changes; altered drug absorption, metabolism, and excretion; often a wide auscultatory gap
what are the age-related physical changes for the older population with hypertension?
loss of elasticity in arteries; stiffness in myocardium; increased PVR; decreased renal function
hypertension crisis
> 180/>120; target organ damage (kidney, brain, heart); requires hospitalization
hypertension urgency
no evidence of target organ disease
what are hypertension crisis clinical manifestations?
increase BP; hypertensive encephalopathy; renal insufficiency/failure; cardiac decompensation; aortic dissection
what are hypertension crisis interprofessional care actions?
hospitalization; monitor cardiac function; renal function; neurologic checks; bedrest if on IV drugs; determine cause; education to avoid crisis; hypertension urgency is outpatient
what is the primary purpose of the respiratory system?
transfer O2 and CO2 between atomsphere and blood
what is in the upper respiratory system?
nose, mouth, pharynx, epiglottis, larynx, and trachea
what is in the lower respiratory system?
bronchi, bronchioles, alveolar ducts, alveoli
how many lobes are in the right and left lung?
right has three
left has two
what is the structure of trachea and bronchi?
anatomic dead space; no gas exchange
what is the structure of the bronchioles?
smooth muscle that constricts and dilates
what is the structure of alveoli?
terminal part of the respiratory tract; gas exchange
alveoli
primary site for gas exchange with pulmonary capillaries
pores of kohn
interconnections between alveoli; allows air/bacteria to pass
surfactant
lipoprotein secreted by alveoli when stretched; reduces surface tension to make alveoli less likely to collapse
atelectasis
collapsed alveoli
what are the two blood supplies of the respiratory system?
pulmonary circulation and bronchial circulation
pulmonary circulation
artery: deoxygenated blood from right ventricle
capillaries: exchange gases at alveoli
veins: return oxygenated blood to left atrium
bronchial circulation
arteries: oxygen to bronchi and lung tissues
azygos vein: deoxygenated blood to superior vena cava
what are the parts of the chest wall?
ribs and sternum; mediastinum; pleura; diaphragm
oxygenation
O2 dissolved in plasma results in pressure of O2 in arterial blood (PaCO2); normal 80-100 mmHg
O2 bound to hemoglobin results in arterial O2 saturation (SaO2); normal >95%
diffusion
O2 and CO exchange at alveolar capillary membrane;
high to low concentration till equal
venitilation
inspiration and expiration occur due to intrathoracic pressure changes and muscle action
elastic recoil
lungs return to original size after expansion
compliance
measures ease of lung expansion and elastic recoil
decreased: hard to inflate
increased: hard to recoil
resistance
airflow impeded during inspiration and/or expiration; altered airway diameter
medulla
respiratory center in brainstem; responds to chemical and mechanical signals; sends impulses from spinal cord and phrenic nerve to respiratory muscles
chemoreceptors
respond to changes in PaCO2 and pH in surrounding fluid; in the medulla
mechanical recpetors
located conducting upper airways, chest wall, disphragm, and alveolar capillaries
what are the three types of stimuli mechanical receptors respond to?
irritant; stretch; j-receptors
what are the respiratory defense mechanisms?
protect lungs; filtration of air; mucociliary clearance; system-escalator; cough reflex; reflex bronchoconstriction; alveolar macrophages
what are the diagnostic studies of the respiratory system?
pulse oximetry; arterial blood gases; CO2 monitoring; mixed venous blood gases; sputum studies; skin tests; bronchoscopy; lung biopsy; thoracentesis; pulmonary function tests; radiology
what is the structure of the GI?
mucosal lining; submucosa connective tissue; muscle; serosa
autonomic nervous system
innervates and affects ENS
parasympathetic
excitatory
sympathetic
inhibitory
enteric nervous system
can work independently of CNS; regulates motility and secretion along entire GI tract
circulation of the GI system
celiac artery; superior mesenteric artery; inferior mesenteric artery
peritoneum
parietal layer lines the abdominal cavity wall
visceral layer covers abdominal organs
peritoneal cavity
potential space between 2 layers
function of GI system
supply nutrients to body cells through ingestion, digestion, and absorption
ingestion and propulsion of food
controlled by appetite center in hypothalamus and hormone ghrelin
mouth, pharynx, and esophagus
digestion and absorption
stomach
small intestine
physiology of digestion
gastric secretions
chief cells secrete pepsinogen; parietal cells secrete hydrochloric acid, water, and intrinsic factor
physiology of digestion
physical and chemical breakdown of food into absorbable substances; starts with saliva in mouth; protein is broken down by pepsin in the stomach; carbs, fats, and protein are broken down into the small intestine
absorption
transfer of the end products of digestion across the intestinal wall into circulation; most occurs in small intestine
digestion and absorption
small intestine- pylorus to ileocecal wall, duodenum, jejunum, ileum, villi, and microvilli
elimination
large intestine- cecum, colon, rectum, and anus
absorption of water and electrolytes; produces vitamin K and some B vitamins; forms and stores fecal mass; secretes mucus
liver
largest internal organ; contains right and left lobes; functional unit is the lobule (hepatocytes, kupffer cells, capillaries)
biliary tract
bile needed for fat emulsification
gallbladder
collects bile from lives and collects/ concentrates it
common bile duct
delivers bile to the duodenum at the ampulla of vater
pancreas
head, body, and tail; lobes and lobules; pancreatic duct enters the duodenum through the common bile duct at ampulla of vater; exocrine and endocrine functions
what are the diagnostic studies of the GI tract?
radiologic studies; endoscopy; liver biopsy; liver function studies
