Hypertension Flashcards
What is stroke volume?
Volume of blood ejected from LV with each contraction
What are the factors that influence cardiac output ?
Heart rate
Force of contraction
Blood volume venous return to the heart
What are the systems that control blood pressure?
ANS
Renin angiotensin aldosterone system
Endocrine
What is the blood pressure for prehypertension And what kind of step care approach is applied to these patients with prehypertension ?
120-139 over 80-89
Life style changes, reducing weight, dietary changes, limiting alcohol, smoking, exercise, reduce stress
*medication therapy if risk factors are present as well like: diabetes, older age, heart failure
Stage one blood pressure and treatment ?
140-159 over 90-99
Life style changes ^
Drug therapy:
Usually single drug therapy
(First start with beta blocker or diuretic
Stage two blood pressure and therapy?
> 160/100
Life style changes
Usually drug combination drug therapy
Hypertensive crisis blood pressure?
> 210/120
What are the Goals for stepped Care Approach ?
Reduce morbidity & mortality associated with chronic HTN
Reduce risk of CV disease
What is the Thiazide Diuretic prototype drug?
And use/moa?
Hydrochlorothiazide/hydrodiuril
Use: HTN and edema
MOA: blocks Na and Cl in distal tubule
»> dependent on adequate kidney function
Side effects and nursing implications of thiazides diuretics ?
S/E: Electrolyte imbalance (Na,K,Cl)
- hypercalcemia
- Dehydration
- hyperglycemia (careful with diabetics)
- muscle weakness,orthostatic hypotension
NI: monitor bun & creat, I&O, hydrate
Will not work with bad renal function
Usually administered in the morning
Teaching: (orthostatic)-safety & pos. changing
Assess hypercalcemia: fatigue&weakness
Loop diuretics
Prototype drug?
Use?
MOA?
Furosemide, Lasix
Use: decrease peripheral edema, associated with CHF, pulm edema, & HTN
MOA: inhibits Na&Cl in loop of henle
-do not need good renal function to work
Side effects & nursing implications of Lasix ?
Side effects: fluid loss, orthostatic hypotension, electrolyte imbalance (Na,Cl,K,Mg,Ca,)
Ototoxicity (cn 8) tinnitus-first sign
Hyperglycemia - watch diabetics
Hyperuricemia: increased uric acid (increased risk for gout)
Increased LDL (total cholesterol)
Nursing implications:
Assess bp
K Supplements
IV: works within 5 minutes, lasts up to 2 hrs
–dose (20-40mg over 2 min)
PO: works in 1 hour, lasts up to 8 hours
Careful with other drugs that are ototixic and bp meds
Potassium sparing diuretics
Prototype
Use
MOA
Aldactone,spironolactone
Use: adjunct therapy for HTN, edema associated with CHF, cirrhosis
MOA: blocks the action of aldosterone in distal tubules:
- aldosterone antagonist(aldosterone saves Na) so it’s decreases Na
- increases Na and water loss
- decreases Ca & Cl
- promotes retention of K & Mg
Side effects & nursing implications of aldactone
Side effects: Hyperkalemia Electrolyte imbalance (Na,Cl,Ca,) Promotes retention of K&Mg Weakness,vomiting,nausea Menstrual irregularities,impotence,gynecomastia
Nursing: Assess K Assess cardiac arrhythmias Limit foods high in K(bananas) Avoid K supplements Patient teaching Onset: 24-48 hrs Drug interactions DOC for Ascites Can be used for thiazides and loops
Osmotic diuretic
Prototype
Use
MOA
Mannitol
Use: (increased cranial pressure)
MOA: increased osmolarity of plasma
Mannitol
Side effects & nursing
NV Fluid/electrolyte imbalance Headache Careful with IV-tissue necrosis Can cause rebound inter cranial pressure
Nursing: Vitals Assess fluid& electrolyte Assess for decrease ICP may be used in the ED
What electrolyte is blocked in order for diuresis to occur?
Na
Identify the electrolytes lossed that most likely occurs with loop diuretics
Na Cl K Mg
The patient is present with blood pressure of 120/80 with a history of angina and CAD. The most likely therapy would be:
A. Beta blocker
B. Thiazide diuretics & life style changes
C. Life style
D. Alpha 1 blocker
B thiazide diuretic and lifestyle changes
Which of the following occur with thiazide diuretics? (Select all)
A. Hypotension B. Hyperkalemia C. Hyperglycemia D. Muscle cramps E. Hypernatremia
A hypotension
C hyperglycemia
D muscle cramps
The patient is prescribed aldactone, and asks what is the best choice for breakfast ?
Low Na and low K
ACE inhibitors
(Angiotensin Converting Enzyme)
Prototype Drug
MOA
Use
Catopril, vasotec (pril drugs)
MOA: prevent conversion of angiotensin 1 to angiotensin 2 by blocking ACE
USE: HTN and CHF
Side effects & nursing implications of ace inhibitors
Hypotension, dry cough, increased potassium
NI: good for pts to maintain kidneys and good for diabetics
Less orthostatic hypotension
used with asthma pts
Give on empty stomach
Caution with other drugs that cause bp to decrease
What is cardiac output
The amount of blood ejected from the LV into the aorta per minute
