Hypertension - EXAM 4 Flashcards
What are sodium restricted diets?
Sodium resitricted diets are important in managing not only problems affecting the heart and blood vessels but also problems affecting the kidneys and liver. Often times fat-restricted diets and sodium-restricted diets are ordered together, although can be separate.
How much does the American Heart Association recommend limiting sodium intake to?
2,400 mg/day
Where does sodium come from in our diet?
Processed foods have the most sodium, unprocessed foods have the least
Dairy products like cheese
Sodium bicarbonate
Sodiium saccharin
Monosodium glutamate
What is a DASH diet?
A diet rich in fruit, vegetables, low fat dairy products, reduced amounts of red meat, and reduced amounts of sweets and sugar significantly lower SBP and DBP even when sodium is not restricted
What are some ways to decrease salt intake?
- Remove the salt shaker from the table
- Do not add salt during cooking
- Prepare foods with sodium free spices: basil, bay leaves, curry, garlic, ginger, lemon, mint, oregano, pepper, rosemary, thyme
- Read labels to determine salt/sodium content. Consider alternatives for the visually impaired
- Eat high salt foods in moderation and use low salt or salt free products regularly
- Use these foods sparingly:
- Foods prepared in brine (pickles, olives, sauerkraut)
- Salty, cured, or smoked meats and fish
- Potato chips, pretzels, salted popcorn, salted nuts, salted crackers
- Bouillon cubes, seasoned salts, soy, worcestershire and BBQ sauces, prepared horseradish, catsup, and mustard
- Cheeses, especially processed types
- Canned and instant soups and sauces
What is important to note about salt substitutes?
They often contain potassium and would be contraindicated on a potassium restricted diet. Caution must be used if the patient is taking a potassium-sparing diuertic or ACE inhibitor
hydrochlorothiazide (HCTZ, Hydrodiuril)
Classification: Thiazide Diuretic, Potassium wasting
Mechanism of Action: Interferes with Na absorption in distal tubule of npehron. Decreases blood volume. Decreases Na in serum and increase Ca in serum.
Use: HTN, CHF
Side/adverse effects: Postural hypotension, dehydration, hypokalemia, weakness
Nursing Implications:
- Monitor serum electrolytes
- BUN
- I/O
- BP
- Edema
lisinopril (Prinivil, Zestril)
Classification: ACE Inhibitor
Mechanism of Action: Interrupts renin/angiotensin sequence blocking formation of angiotensin II. Promotes vasodilation by prevention vasoconstriction. Decreases preload and afterload.
Side/Adverse Effects: Dry cough, rash, hyperkalemia, angioedema, neutropenia
Nursing Implications:
- Monitor BP
- Monitor renal function
- Monitor K levels
- Take on empty stomach 1 hour before or 2 hours after
- Increase risk of lithium toxicity for patients taking lithium
- Notify provider promptly of any indication of infection
losartan potassium (cozaar)
Classification: Angiotensin II receptor antagonist also called Angiotensin Receptor Blockers (ARB)
Mechanism of Action: Blocks angiotensin II receptor found in vascular. Produces vasodilation. Activates alpha receptors, myocardial contraction, decreases afterload
Use: HTN
Side/Adverse Effects: dizziness, HA, orthostatic changes with diuertic use or other anti HTN agents, increased potassium levels
Nursing Implications:
- Monitor BP
- Monitor CBC
- Monitor Electrolytes
- LFT
- Full effect on BP may not be seen for 3-6 weeks
- Monitor for hyperkalemia
- Monitor for increase in BUN and Cr in long term use
amlodipine (Norvasc)
Classification: Calcium channel blocker
Mechanism of Action: blocks calcium influx across cell membranes of vascular and cardiac smooth muscle, thus causing vasodilation and decreased SVR
Use: HTN, vasospasm (coronary), angina, vasodilates everything
Side/Adverse Effects: peripheral or facial edema, postural hypotension, palpitations, tachy/bradycardia
Nursing Implications:
- Monitor HR
- Monitor BP
- Monitor weight
- Monitor for postural changes especially when combined with other anti HTN meds and diuretics
- Avoid grapefruit juice due to food/drug interaction
metoprolol (Lopressor)
Classification: Beta-adrenergic antagonist, primarily beta1
Mechanism of Action: Decreases HR and CO, Lowers BP, slows sinus conduction, decreases myocardial automaticity, antihypertension action may be due to antagonism of catecholamines
Use: Mild-severe HTN, long term treatment of angina, decreased mortality after AMI
Side/Adverse Effects: Bradycardia, orthostatic hypotension, complete heart block, bronchospasm
Nursing Implications:
- Check HR and BP prior to administration
- Monitor I/O
- Daily weights
- Patient to change position slowly
- Cautious use in patients with COPD and asthma
- Avoid sudden withdrawal of medication
What are the risk factoes of HTN?
- Age over 50
- More than 1 oz of alcohol per day
- Smoking
- Diabetes
- Elevated serum lipid levels (elevated cholesterol and/or triglycerides)
- Excessive sodium intake
- Male less than 55 or female over 55
- Family history of HTN or CVD
- Obesity
- BMI
11.
Why is it important to have adequate blood volume?
Blood volume in the circulatory system depends on a blood volume that is sufficient to fill the blood vessels and a pressure difference across the system that provides force to move blood forward. The total blood volume is a function of age a body weight, ranging from 85-90 mL/kg in the neonate and from 70-75mL/kg in the adult
What is the importance of the ability of the heart to effectively pump?
The circulatory system is divided into two parts: the low-pressure pulmonary circulation, linking circulation and gas exchange in the lungs AND the high pressure system circulation, providing oxygen and nutrients to the tissues
Blood flows down a pressure gradient from the high-pressure arterial circulation to the low-pressure venous circulation
What is the importance of vascular tone?
Ability of blood vessels to vasodilate and vasoconstrict in respoinse to changing hemodynamic states under the influence of the autonomic nervous system and RAAS
What is blood pressure?
The force exerted by the blood against the walls of the blood vessels
BP = Cardiac Output (CO) X Systemic Vascular Resistance (SVR)
If HR increases, what happens to CO?
Increases in HR or force of a contraction leads to an increase in CO
What will increase CO?
Factors that increase preload will increase CO