Hypertension Flashcards
Blood Pressure
BP is the force exerted by the blood against the walls of the blood vessel
BP is the function of…
Cardiac output (CO) & systemic vascular resistance (SVR)
What is the formula for CO?
Stroke volume (SV) x HR = CO
Erythrocyte
RBCs
Leukocyte
WBCs
Thrombocytes
Platelets
Anemia
- Deficiency in erythrocytes
- quality or quantity of hemoglobin
- Deficiency in the volume of packed RBCs (hematocrit)
Normocytic/normochromic
Normal in size & color
Microcytic/Hypochromic
Small, little color
Macrocytic/megablastic
Large in size
How is anemia diagnosed?
- CBC
- Blood smear
- Reticulocyte count
Causes of anemia
- Blood loss
- Decrease in RBC production
- Increase in RBC destruction
Tissue Hypoxia
Absence of enough oxygen in body tissues to sustain body function
Normal Hgb level for female/male
F: 12-16
M: 13.5-17.5
Mild/moderate/severe anemia Hgb levels
Mild: 10-12
Moderate - 6-10
Severe: <6
General Symptoms of Anemia
- Headaches
- Fatigue/weakness
- Yellowish skin/pallor
- Dizzy
- Numbness/tingling
- Cold hands/feet
- Pruritus
- Increased HR, angina, murmurs
- Dyspnea
Symptoms of Anemia in the Elderly
- Ataxia
- Confusion
- Fatigue
Cobalamin Deficiency
- Deficient in vitamin B12
- Megoblastic anemia
What kind of patients have Cobalamin Deficiency?
- GI issues/surgery (not absorbed well)
- Smokers/alcoholics
- Strict vegetarians
GI Symptoms of Cobalamin Deficiency
- Anorexia
- Nausea/vomit
- Abdominal pain
Neuromuscular Symptoms of Cobalamin Deficiency
- Weakness/muscle weakness
- Ataxia
- Paresthesia (pins/needles_
- Reduced position sense
- Impaired thought process
Treatment of Cobalamin Deficiency
- Parenteral Vitamin B12
- Intranasal Nascobal
- Education on diet
Aplastic Anemia
Lack of all blood cells
Pancytopenia
Levels of all blood cells are low
How does Aplastic Anemia work?
Bone marrow is damaged -> triggers an autoimmune response that destroys stem cells in bone marrow -> blood cells aren’t able to be produced
How is Aplastic Anemia diagnosed?
- CBC - Low RBCs, low hemaglobin
- Blood Smear - number of cells
- Bone Marrow Biopsy
Symptoms of Aplastic Anemia
- General symptoms of anemia
- Thrombocytopenia
- Increase risk of infection
- Sepsis
- Shock
- Death
Thrombocytopenia
Low platelet count leads to an increased risk of bleeding
Treatment for Aplastic Anemia
- Hematopoietic stem cell transplant (if younger and few blood transfusions)
- Immunosuppressive therapy
- Ongoing supportive blood transfusions
- If severe, prognosis is poor
Hemolytic Anemia
Destruction of RBCs that exceeds the rate of production
Intrinsic Factors Causing Hemolytic Anemia
- Hereditary
- Defects of RBCs themselves
Extrinsic Factors Causing Hemolytic Anemia
- Dialysis machine
- Bypass machine
- Parasites like Malaria
- Autoimmune disorders like Lupus
- Blood transfusion reactions
Symptoms of Hemolytic Anemia
- General symptoms of anemia
- Jaundice
- Splenomegaly
- Hepatomegaly
- Altered renal function
Splenomegaly/hepatomegaly
Enlarged spleen/liver
What causes renal dysfunction in hemolytic anemia?
Since so many RBCs are being destroyed, there is so much waste that the kidneys are working harder than normal to get rid of it and the tubules get clogged
Treatments for Hemolytic Anemia
- Supportive care such as blood transfusions or antibiotics/fungals to prevent infection
- Remove causative agent
- Aggressive hydration/electrolyte replacement may be needed for kidney injury
Nursing Management/Interventions for Anemia
- Remove causitive agent
- Acute Interventions
- Symptom management
- Education on dietary & lifestyle changes
What are acute interventions of anemia?
- Blood transfusions
- Drug therapy
- O2 therapy for hypoxia
Net Effect in BP
Increase in BP by increasing both the CO & SVR
Baroreceptors
Special nerve cells in the carotid arteries & aorta that sense changes in BP & help regulate BP by stimulating or inhibiting the SNS
Hypertension (HTN)
Force of blood pushing against the walls of the blood vessels
Primary Hypertension
- Unknown cause
- Many contributing factors both modifiable and nonmodifiable
Secondary Hypertension
- Elevated BP with a specific direct cause; sudden development
Examples of Secondary Hypertension
- Obstructive sleep apnea
- Kidney disease
- Thyroid issues
-Pre-e
Non-modifiable Risk Factors of Hypertension
- Age
- Gender (men younger, women menopause)
- Family History
- Ethnicity
- Socioeconomic status
- Chronic conditions
- Diabetes
Modifiable Risk Factors of Hypertension
- Alcohol use
- Tobacco use
- Obesity
- Sedentary lifestyle
- Stress
- Excess dietary sodium
BP Ranges - Normal/Elevated/Stage 1/Stage 2/Hypertensive Crisis
Normal: <120/<80
Elevated: 120-129/<80
Stage 1: 130-139/80-89
Stage 2: >140/>90
HTN Crisis: >160/>120
Symptoms of HTN
- Silent killer
- Fatigue
- Dizzy
- Palpitations
- Angina
- Dyspnea
- HTN crisis may also have headache & epistaxis
Nursing Management of HTN
- Past health history
- Life style factors
- Subjective date - what questions would you ask?
- Objective data - heart sounds, cuff size, test on both arms, cap refill, edema, skin color
Labs for HTN
- Identify or rule out secondary HTN (diabetes)
- Determine CV risk (cholesterol, stress, EKG, ECHO)
- Establish baselines before starting therapy
Goals of Care for HTN
- Lower & maintain BP
- Educate Patient
- Encourage lifestyle changes
Complications of HTN
- Heart failure, dysrhythmias
- Brain - stroke risk
- Kidneys - RAAS
- Eyes - Vessels burst -> blindness
- Vasculature
