HTN HF SG. TEST 4- DONE Flashcards
- Diuretics and nutrition
- increase potassium for potassium wasting (furosemide, Bumetamide)
>bananas, strawberries
>leafy greens
>oranges
>raisins
-watch salt & salt substitutes for potassium sparring (spironolactone)
>no mrs. dash
>avoid potassium-rich foods
- Diuretics nursing K,H,K (LOOP)
Loop Diuretics
EG: Furosomide, Bumetamide
Distractor isosorbide (not diuretic)
-most powerful diuretics
Suffix -ide
Use: HF, HTN, ASCITES (fluid in the abdomen)
-hypokalemia > Signs & symptoms : “low/slow” bradycardia, fatigue, muscle weakness
*Increase potassium rich foods (bananas, strawberries, dark leafy veggies, raisins)
*Monitor potassium labs NORMAL RANGE: 3-5
-toxicity>Signs & symptoms: tinnitus, dizziness, hearing changes
*Monitor symptoms
-hyperglycemia> signs & symptoms: high blood sugar on labs,
*Monitor blood sugars
- photosensitivity
*Avoid sun, wear sunscreen
-increased urine output
-take MED in the AM
- Diuretics nursing K,H,K (potassium sparring)
Weakest diuretics
EG:Spirolactone
Often used w/thiazide diuretic. Usually never prescribed alone
Use: HF, HTN, EDEMA
-Hyperkalemia>Signs & Symptoms: Tall T waves on EKG, dysrhythmias, increased blood sugars, muscle cramps, numbness & tingling in extremities
*Hook pt up to a 12 lead ECG
*Avoid potassium foods including salt substitutes
-Gynecomastia(excessive breast tissue growth in men)
-Menstrual Problems
-Sexual dysfunction
-avoid tasks that require alertness until effects of med is known.
- Categories of HTN (pp slide 4)
Normal: <120/80
Elevated: 120-129/80
Stage 1: 130-139/80-89
Stage 2: >or equal to 140/>or equal to 90
Common complications of HTN (pp slide 10)
-stroke (cava)
-renal disease/failure
-cardiac failure/ MI/ CAD
HTN management (pp slide 12)
-weight reduction
-decreased sodium intake
-moderate exercise
-reduce smoking & alcohol use
- Beta blockers nursing considerations K,H,K
*worry about the 4 B’s**
-Bradycardia
-Bottom out BP (hypotensive, low bP)
-Bronchi Restriction
-Blood Sugars (can mask hypoglycemia symptoms)
-Take vital signs, hold med if heart rate less than 60.
Caution in:
COPD, ASTHMA, DIABETIC patients
- HTN and nutrition (pg.357)
-limit sodium intake & salt substitutes
> pickles, green olives, sauerkraut, mustard, ketchup, bbq sauce, pizza sauce, canned soup & packaged mixes
-use fresh vegetables
-avoid consumption of processed meats
-use seasonings such as lemon, garlic & onion powder vs salt substitutes
-consume low fat foods, whole grains
- ACE inhibitors nursing K,H,K
Use: Hypertension, HF
Suffix-“pril”
-decrease blood pressure. Works on the kidneys & gets rid of water & sodium. Keeps potassium.
-Doesn’t affect heart rate.
-Affects blood pressure
Adverse Effects:
-electrolyte imbalance: look at labs, ekg (monitor heart rate) you will see tall T waves
Hyperkalemia
-Angio edema: swelling of lips, tongue, respiratory compromise(difficulty breathing)
*watch food: do not add salt substitute (mrs.dash), low sodium diet, watch potassium high foods
Expected effect: dry cough
Considerations:
-risk for falls, dizzy, keep call light in reach
-monitor vital signs
-hypotensive
- Thiazide nursing K,H,K
-1st line for HTN treatment
Use: HF, HTN, EDEMA
EG: HCTZ, Hydrochlorathiazide
-Hypokalemia > Signs & symptoms: “low/slow” bradycardia, fatigue, muscle twitching
*Increase potassium-rich foods (bananas, strawberries, dark leafy veggies, raisins)
*Monitor potassium labs NORMAL RANGE: 3-5
-chemically structured& similar to sulfonamides(antibiotics) . Watch & ask about allergies
- Digoxin nursing K,H,K
Use: HF, AFIB, A FLUTTER
ANTIDOTE: Digiband
-toxicity> signs & symptoms: nausea, vomiting, vision changes(halo fuzzy), fatigue, weakness, decrease appetite.
*Check apical pulse for a minute, hold med if less than 60
Check Lab digoxin level: Therapeutic Range : 0.8-2. If greater than 2 toxicity
-The older the client the higher the risk of toxicity
-risk of toxicity w/clients on loop/thiazide diuretics (because it decreases potassium)
-St. Johns worth contraindication
-early sign of toxicity: anorexia, nausea, vomiting
- Manifestations of left sided heart failure (pp slide 11)
-exertion dyspnea
-hypoxemia
-paroxysmal nocturnal dyspnea (sleep w/several pillows in bed or in a chair) wakes you up in the middle of the night w/SOB
-orthopnea
- moist crackles
-pulse rapid or irregular
-elevated BP
-Cough w/pink, frothy sputum
-hemoptysis
-urine output diminished
Acute left-sided HF
>pulmonary edema, hypoxia, restlessness & confusion
- Manifestations of right sided heart failure (pp slide 12)
-dependent pitting edema/ peripheral edema
-ascites
-gradual unexplained weight gain
-hepatomegaly
-enlarged abdominal organs
-Arrhythmias
-jugular vein distention
-fluid retention (rings, shoes or clothing become tight)
-accumulation of blood in abdominal organs (may cause anorexia, nausea & flatulence)
- Heart failure nursing assessment and actions (pp slide 17&20)
Goal: - Goal: reduce the heart’s workload, improve cardiac output
Assessment:
BNP: beta-type natriuretic peptide will be elevated
-question if they sleep w/several pillows or in a chair (signs of left-sided HF)
Nursing Actions:
-high fowlers
-lifestyle changes> gradual exercise/ ROM, weight loss
-Dietary modifications > low sodium 2gm, fluid restriction, cholesterol levels
-daily weights > call PCP if gain 2-3lbs in a day
-report sudden swelling
Risks for heart failure (pp slide 8)
-uncontrolled HTN
-MI/CAD/cardiomyopathy/High LDL
-heavy alcohol use
-sedentary lifestyle
-Cocaine or other drugs
-smoking
-advanced age
