EXAM 4 Flashcards
HTN is greater in
african americans
what is considered HTN
Systolic blood pressure ≥140 mm Hg OR Diastolic blood pressure ≥90 mm Hg OR Current use of antihypertensive medication(s)
pre HTN definition
Systolic BP: 120 to 139 mm Hg
OR
Diastolic BP: 80 to 89 mm Hg
STAGE 1 HTN
systolic: 140-159
diastolic: 90-99
STAGE 2 HTN
systolic: >160
diastolic: >100
5 factors that influence HTN
insulin resistance
Increased sympathetic nervous system activity
Increased reabsorption of sodium, chloride and water by the kidneys
Increased activity of the renin-angiotensin system
Decreased vasodilatation
5 symptoms of severe htn
Fatigue Dizziness Palpitations Angina Dyspnea
htn target organ disease
Heart Brain Peripheral vascular disease Kidney Eyes
serum creatinine
0.6-1.2
Noninvasive, fully automated system that measures BP at preset intervals over 24-hour period
Ambulatory blood pressure monitoring (ABPM)
Fruits, vegetables, fat-free or low-fat milk, whole grains, fish, poultry, beans, seeds, and nuts
dash eating plan
why are beta blockers a black box warning
due to bronchospasms and hyperactive airway
what to check before giving betablocker
bp and hr
tell the patient to report what 4 things if they are taking a HTN med
Orthostatic hypotension
Sexual dysfunction
Dry mouth
Frequent urination
Most common form of hypertension in individuals age >50
isolated systolic hypertension
hypertensive emergency
Occurs over hours to days
BP >220/140 with target organ disease
hypertensive urgency
Occurs over days to weeks
BP >180/110 with no clinical evidence of target organ disease
-pril
ace inhibitors
a syndrome whereby a patient’s feeling of anxiety in a medical environment results in an abnormally high reading when their blood pressure is measured.
white coat hypertension
bp goal for diabetes
130/80
can prevent adequate bp
NSAIDS
depolarization of the atria
p wave
depolarization of the ventricles
qrs
repolarization of the ventricles
t wave
if present may represent repolarization of the perkingie fibers
u wave
what equals blood pressure
systemic vascular resistance x cardiac output = blood pressure
relaxing and refilling
diastolic
contractions
systolic
blood pressure
measures arterial pressure
what to do for a person with white coat pnomenom
ambulatory blood pressure monitoring
first line treatment for hypertension
hydrochlorothiazide- diuretic
what teaching do we want to tell them about hydrochlorothiazide.
change positions slowly due to orthostatic hypotension; decreasing sodium
all diuretics cause
orthostatic hypotension
3 things to do before giving diuretics
check bp, creatinine, and electrolytes
nitroglycerin is given
for chest pain
sob
orthopnea
calcium channel blocker
can cause prolonged QT syndrome; slow conduction due to HR going down
slow heart rate =
slow conduction ; abnormal heart block
angina indicates
ischemia of the coronary artery
dyspnea on exertion/ sob is the first sign of
heart failure
why do you have shortness of breath
blood isnt moving like its suppose to and it backs up
if cuff is too big
bp will be low
If cuff is too small
bp will be high
bp with orthostatic hypotension
bp and pulse supine then sitting then standing, if they can tolerate to stand ; 1-2 minutes between position changes
what is considered positive orthostatic hypotension
↓ of 20 mm Hg or more in SBP, ↓10 mm Hg or more in DBP, or ↑ 20 beats/minute or more in heart rate
what helps with orthostatic hypotension
HYDRATION
Most common form of hypertension in individuals age >50
isolated systolic htn
postprandial hypotension
seen in older adults
hypertensive emergency
onset is hours to days
with target organ damage
hypertension urgency
onset is days to weeks
no target organ damage
htn and then rapidly drop their bp
blood dumps and the can cause damage
how is iv drug therapy managed
any meds a pt needs in a hypertensive crisis will get it through an iv. the meds are titrated (adjusting meds based on parameters) to MAP
what is blood pressure
cardiac output x peripheral resistance
risk factors of atherosclerosis
htn, tobacco use, diabetes, infections, toxins, hyperlipidemia, hyperhomocysteinemia
stable angina
they have the pain then it goes away, have it then goes
why does stable angina go away
because the plaque build up in the artery is stable
unstable angina
unstable lesion
pain not going away, increasing in intensity, increasing in severity; not relieved
lesion is complicated and is unstable
Thickening/hardening/narrowing or coronary arteries that result from risk factors like HTN
atherosclerosis
Arterial anastomoses (or connections) within the coronary circulation
collateral circulation
things you can change to improve your health
modifiable risk factors
chronic stress; chronic inflammation
CPR; NOT MODIFIABLE
CAD gender risk
younger men and older women
unsaturated fats
are good!! HDL ; protective for cardiovascular disease
gerontologic 2 risk factors
reducing their lipids and treating their blood pressure
clinical manifestation of ischemia
angina/chest pain
is ischemia reversible?
yes!
what to give a patient with angina
nitroglycerin to dilate arteries and oxygen. the pain goes away because the rbc are now getting oxygen
ischemia results from
narrowed and thick arteries
when do you get ischemia
when arteries are blocked 75% or more
you will get hypoxic within 10 seconds of occlusion
heart cells can stand HOW long without blood flow
20 minutes; after 20 minutes the blood vessels are irreversibly damaged
by product of anaerobic metabolism
lactic acid
what is the cardiac pain that patients feel
lactic acid build up
start when youre increasing demand for oxygen
chest pain that has a precipitating factor such as stress, activity, position changes
predictable
stable angina
5-15 minutes
stable angina
control with drugs; nitrates/oxygen
stable angina
ST segment depression and/or T-wave inversion
unstable and stable angina
unstable angina is more likely to progress to
an MI
nitroglycerin
acute nitrate so it works quickly and is why its given at the hospital
wont treat the chest pain
aspirin ; for platelets
nitroglycerin give sublingual why
It works faster; acute. dont chew or drink water ; short acting for people to take while at home
vasodilates
nitroglycerin
how many doses for how long -nitroglycerin
3 doses every 5 minutes and after the third dose if they are still having chest pain they need to call 911
if patient knows they are about to exert themselves in a certain activity what can they do
take nitroglycerin prophylactically 5-10 minutes before activity; sex
prevents the occurrences of angina
long acting nitrates
side effects of long acting nitrates
orthostatic hypotension, headache (to help w headache give acetaminophen )
oral long acting nitrate
isosorbide, -trates
1 reason to hold nitroglycerin
hypotension because its bringing down their bp
completed occluded
stemi
st elevation myocardial infarction
partial occlusion of a coronary artery
non stemi
complete occlusion of coronary artery
stemi
how to tell if its a stemi or non
ekg
complete occlusion means
reperfuse
mi symptoms in women
fatigue followed by abdominal pain
ask about chest pain that is likely myocardial
nausea, vomiting, sob, diaphoresis
initially for an MI HR and BP
go up
what do you expect to hr and bp after awhile with a mi
hr goes down patient is about to code
3 evidence to acute heart failure
crackles, jvd, abnormal heart sounds
fluid volume overload
s3 heart sound
troponin elevation
positive is 0.01
cardiac enzymes
troponin
CK-MB
myoglobin
most significant enzyme
troponin
what is morphine for
vasodilator and decreases oxygen consumption
why do you want to give someone a stool softener for acute coronary syndrome
avoid vasovagal stimulation which can lead to bradycardia which can lead to dysrhythmia
hallmark sign of pericarditis
pericardial friction rub
potassium wasting
hydrochlorohiazide
potassium sparing
Spironolactone
increased heart rate and is used for sinus brady patients
atropine
potassium wasting that is best for heart failure patients
lasix
what med treats a flutter and a fib
adenosine
increases cardiac out put
Dobutamine
normal ejection fraction
> 55%
SOB, crackles, orthopnea, dyspnea on exertion, paroxysmal nocturnal dyspnea, oliguria
left sided heart failure
JVD, peripheral edema, hepatomegaly, peripheral congestion, pitting edema, ascites
right sided heart failure
