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NUR 155 med surg > Hypertension & heart failure > Flashcards

Hypertension & heart failure Flashcards

1
Q

Causes of hypertension

A
  • adrenal disorders
  • chronic kidney disease
  • coarctation of the aorta
  • Cushing syndrome/ steroid therapy
  • drug induced
  • obstructive urinary disorder
  • para thyroid/ thyroid disease
  • renal stenosis
  • sleep apnea
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2
Q

Lifestyle changes to reduce blood pressure

A
  • smoke free
  • less alcohol
  • less salt
  • healthy weight
  • exercise more
  • healthy diet
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3
Q

Normal blood pressure

A

120/80

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4
Q

Elevated blood pressure

A

Systolic 120-129
And
Diastolic < 80

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5
Q

Hypertension stage 1

A

Systolic 130-139
Or
Diastolic 80-89

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6
Q

Hypertension stage 2

A

Systolic <140
Or
Diastolic at least 90

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7
Q

Hypertensive crisis

A

Systolic over 180
Diastolic over 120

A sudden increase in blood pressure

With patient requiring medication changes

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8
Q

Assessments for hypertension risk

A

Body mass index

Waist circumference

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9
Q

Body mass index risk for hypertension

A
  • BMI 18.5-24.9 healthy
  • Overweight 25-29.9
  • obesity 30 or 30 pounds or more overweight
  • extreme obesity BMI of 40 or greater
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10
Q

Minimize modifiable risk factors

A
  • maintain healthy weight (follow DASH diet)
  • restrict sodium to less than 1500 mg/day
  • increase potassium intake to 3500 mg/day
  • increase physical activity to a min of 30 mins of exercise three times per week
  • limit alcohol intake to tow drinks or less per day for men, and one or less or women
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11
Q

Goal for antihypertensive therapy

A

To lower the systolic blood pressure to normal levels

Thought is when when SBP is lowered, DBP will normalize as well

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12
Q

Complexity of pharmacological treatment for hypertension

A

Rarely will management of hypertension be achieved with monotherapy

A combination of different classes of medication is necessary

To manage hypertension well these medication must focus on to driving forces of hypertension:

  • fluid management
  • vasoconstriction
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13
Q

Therapy guidelines for the different stages of hypertension

A
  • High risk/ Disease free= lifestyle modification
  • Elevated = lifestyle modification
  • Stage 1 = Thiazide Diuretic
  • Stage 2=
    • Combo of Thiazide w/ Beta Blocker
    • ACE inhibitors
    • Calcium channel blocker
    • Angiotensin blockers
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14
Q

Primary medication therapy for hypertension

A
  • Thiazide Diuretic
    • Hydrochlorothiazide
  • Loop Diuretic
    • Furosemide, Torsemide
  • Potassium Sparing Diuretic
    • Spironolactone

GOAL= Decrease intravascular FLUID volume

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15
Q

Secondary medication therapies for hypertension

A
  • Beta Blockers
    • metoprolol, antenolol
  • ACE inhibitors
    • enalapril, captopril
  • Calcium channel blocker
    • amtodipine, ditiazem
  • Alpha Blocker
    • doxazasin, prazosin
  • Aldosterone receptor blockers
    • eplerenone, spironolactone
  • Angiotensin ll antagonist
    • lasartan
  • Direct vasodilator
    • hydralazine

GOAL= increase VASODILATION, decrease venous pressure

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16
Q

Angiotensin converting enzyme
(ACE)

  • Prils
A
  • help body produce less angiotensin which helps blood vessels relax and open up

⬇️ blood pressure

Can develop a cough***

17
Q

Diuretic

A

help body get ride if excess sodium and water
⬇️ BP
often used in combination with additional prescription therapy

  • Thiazide: hydrochlorothiazide
  • Potassium Sparing:spironolactone
  • Potassium Wasting:furosemide
18
Q

Beta Adrenergic Blockers

  • lol
A

Inhibit affects of epinephrine on the sympathetic nervous system to..

1) decrease heart rate
2) increase vasodilation

  • parameters must be check (hold for HR <60, SBP <100)
  • are not typically used in African American males bc they are less responsive to BB and are better managed with other drugs like calcium channel blockers
19
Q

Non selective beta blockers

A

Affect both the heart and lungs
- propranolol

  • not safe for patients with asthma or other respiratory difficulties
  • use cautiously in diabetics - mask symptoms
20
Q

Selective beta blockers

A

Beta 1 blocker:
-Affect cardiac tissue only, -causing decrease in HR, BP
Safe for patient with respiratory disorders
- metaprolol

Beta 2 blocker

  • affect lung tissue only, causing broncodilation
  • most often inhaler/ nebulizer
  • some may induce anxiety or tachycardia
  • albuterol
21
Q

Angiotensin ll receptor blockers (ARBs)

  • sartans
A

Block effect of angiotensin

Blood vessels stay open
⬇️ blood pressure

22
Q

Calcium channel blockers

  • pines
A

Prevent calcium from entering the smooth muscle cells of the heart and arteries

⬇️ HR and ⬇️ BP!!!

23
Q

Alpha adenergic blockers

  • azosin
A

Reduce arteries resistance, relaxing the muscle tone of vascular walls resulting in vasodilation

⬇️ BP

  • doxazosin
24
Q

Alpha 2 receptor agonists

A

By reducing adrenaline heart rate and blood pressure are also reduced
⬇️ HR & BP

Methyldopa- is considered a first line antihypertensive during pregnancy because adverse effects are in frequent for pregnant women or the developing fetus

25
Q

Vasodilator

A

Can cause the muscle in the walls of the blood vessels to relax allowing the vessel to dilate
⬇️ blood pressure

  • Hydralazine
26
Q

Cholesterol levels

A
  • LDL: less than 100
  • HDL: greater than 60
  • Triglyceride: less than 150
  • Total cholesterol: less than 200
27
Q

Cholesterol

A
  • low density lipoprotein
    • bad
    • animal fat
  • high density lipoprotein
    • good
    • plant fat ( berry, avocado, veggie oil, nuts, coconut)
  • triglycerides
    • use for energy
  • total cholesterol
    • total amount in body of all three
28
Q

Alter blood pressure

A

1) life style change:
- diet, lower sodium, caffeine and fat
- exercise
- no smoking
- decrease stress

2) fluid
- use diuretic to decrease pressure in lumen

3) antihypertensive
- beta blocker, calcium channel blocker, ACE Inhibitors)
- increase vasodilation
- decrease pressure in muscle of vessel to allow them to relax and open up

29
Q

Blood clots form when

A

1) vascular injury
- bruise, contusion, laceration, bug bit scratched

2) decreased blood flow
- legs crossed

3) hypercoagulation
- dehydration

  • this is called the VIRCHOWS TRIAD
30
Q

What happens in heart failure

A

Muscles lose elasticity-> “pump fails” article and ventricle can’t open and close fully

31
Q

Left heart failure

A

Fluid in lungs (crackles) can lead to pulmonary edema
- back up of fluid in lungs

  • pink foam coming out mouth ( no way to exchange fluid)
  • sit them up!
  • need diuretic
  • medical emergency!
32
Q

Right heart failure

A

Build up of fluid in vessels “vessel overload”

  • peripheral edema, JVD, ascites, spenomegally (spleen filter blood and takes out bacteria and viruses so don’t want it to rupture)
33
Q

CHF

A

Whole heart stops working

Stroke and heart attack

34
Q

What tells the hearts chambers to contract

A

Baroreceptors

When it gets full it presses on receptors and they close the chambers to contract to let blood out

35
Q

What is used to treat heart failure

A

Beta blockers and diuretic

36
Q

Can lose / gain volume by

A

1) ⬇️⬆️ cells
2) ⬆️⬇️ fluid
3) total blood loss

37
Q

BNP for heart failure

A

NORMAL- 100 and less

MILD- 300+

MODERATE- 600+

SEVERE- 900+

38
Q

Most important chamber of the heart

A

Left ventricle

NUR 155 med surg (15 decks)

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