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med surg > med surg lecture 5 > Flashcards

med surg lecture 5 Flashcards

1
Q

what is a normal blood pressure

A

below 120/80 mm Hg

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2
Q

average of two or more BP readings above elevated levels on different dates

A

hypertension

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3
Q

what blood pressure reading obtained determines the category of HTN

A

the highest one

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4
Q

having HTN puts the patient at risk for developing what

A

-cardiovascular disease
-stroke

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5
Q

how often should a person ages 18-39 with normal blood pressure have HTN screenings

A

every 3-5 years

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6
Q

how often should a person ages >39 or at an increased risk for developing htn have HTN screenings

A

yearly

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7
Q

who is at an increased risk for developing HTN

A

-those with elevated BP
-overweight
-African American
-Family history of HTN

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8
Q

why are african americans at an increased risk for HTN

A

increased renin activity from the RAAS systems, greater sodium and fluid retention

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9
Q

if the cause of htn is unknown what is it called

A

primary htn

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10
Q

what is primary htn also called

A

essential htn

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11
Q

If there is a known cause of htn what is it called

A

secondary htn

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12
Q

secondary htn is a sign of what

A

another problem within the body

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13
Q

modifiable risk factors for htn there are 8

A

-decreased activity level
-smoking/tobacco
-poor diet
-insufficient sleep
-elevated blood glucose level
-elevated weight
-poor stress management
-type 2 dm

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14
Q

non-modifiable risk factors for developing htn

A

-family history
-age
-race/ethnicity

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15
Q

a person cannot control being a type 1 diabetic but can control sugar levels what is an important thing to teach these patients regarding htn

A

glucose control education for prevention of htn

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16
Q

signs and symptoms of high blood pressure

A

-headache
-bloody nose
-severe anxiety
-dyspnea

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17
Q

how is htn diagnosed

A

-presence of risk factors
-presence of signs and symptoms
-history of kidney or heart disease
-evaluated home blood pressure readings

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18
Q

why would a doctor have a patient do home blood pressure readings

A

due to white coat syndrome, if patient gets nervous in drs office it can affect blood pressure readings

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19
Q

elevated blood pressure category readings

A

systolic - 120-129 AND
diastolic - <80

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20
Q

stage 1 htn category readings

A

systolic - 130-139 AND/OR
diastolic - 80-89

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21
Q

stage 2 htn category readings

A

systolic - >=140 AND/OR
diastolic - >= 90

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22
Q

hypertensive crisis category readings

A

systolic - higher than 180 AND/OR
diastolic - higher than 120

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23
Q

if systolic and diastolic are in two different categories how to categorize the type of htn

A

use the higher reading of the two

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24
Q

what are the two types of hypertensive crisis

A

urgency and emergency

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25
Q

what are the signs and symptoms of hypertensive crisis

A

-severe headaches
-nose bleeds
-severe anxiety

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26
Q

low risk or does not progress into organ disfunction or damage

A

hypertensive crisis - urgency

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27
Q

high risk or progression into organ dysfunction or damage

A

hypertensive crisis - ermergency

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28
Q

what can an emergency hypertensive crisis cause

A

-stroke
-heart attack
-heart failure
-kidney failure
-hemorrhage

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29
Q

what should you do for a patient if they are in a hypertensive crisis

A

intervene asap, keep them calm, dont stress them out and call the dr for further instructions

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30
Q

lifestyle modifications for htn

A

-weight reduction
-incorporate diet changes
-increase physical activity
-tobacco cessation
-psychosocial risk factors/reduce stress

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31
Q

what diet changes should be made for htn

A

-dash diet
-dietary sodium reduction
-eat more whole foods
-reduce added sugars

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32
Q

if lifestyle modifications dont lower bp what will need to be done?

A

patient will need medication

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33
Q

what does dash stand for

A

dietary approaches to stop hypertension

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34
Q

nursing responses to elevated bp

A

-identify patient’s baseline
-ensure the bp reading is accurate
-observe for related symptoms
-review orders for antihypertensive treatment
-report and document

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35
Q

complications of unmanages htn

A

-atherosclerosis
-cardiovascular disease (CAD)
-myocardial infarction
-heart failure
-left ventricular hypertrophy
-stroke
-kidney disease
-retina damage

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36
Q

acute cardiac labs

A

troponin ckmb

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37
Q

kidney disease labs

A

bun
creatinine
egfr

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38
Q

long term cardiac labs

A

bnp

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39
Q

what type of stroke will htn cause

A

hemorrhagic more so than ischemic

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40
Q

self-care measures for htn control

A

decreasing stress
-lifestyle changes
-control modifiable risk factors

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41
Q

patient education when they are taking prescribed medications for htn

A

-stay on meds even if s/s are not present
-risk slowly and change positions slowly
-if you stop medications abruptly it could be dangerous

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42
Q

if htn medications are abruptly stopped dangerous situations may occur like

A

-rebound htn
-angina
-dysrhythmias

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43
Q

what are the medication classes that are used for htn

A

-statins
-diuretics
-angiotensin-converting enzyme inhibitor
-angiotensin II receptor blocker
-calcium channel blocker
-beta blockers

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44
Q

this medication treats HDL, does not directly treat htn

A

statins

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45
Q

what are the three types of diuretics

A

-loop diuretics
-thiazide diuretics and thiazide-like diuretics
-potassium-sparing diuretics

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46
Q

what does ACE inhibitor stand for

A

angiotensin-converting enzyme inhibitor

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47
Q

what medications are ACE inhibitors

A

prils

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48
Q

what does ARB stand for

A

angiotensin II receptor blocker

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49
Q

what medications are arbs

A

sartans

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50
Q

what does CCB stand for

A

calcium channel blocker

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51
Q

what medications are CCBs

A

pine or zem

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52
Q

what medications are beta blockers

A

lols

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53
Q

_____ may be caused secondary to hyperlipidemia

A

htn

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54
Q

statins are given to a patient with atherosclerosis and/or coronary artery disease to reduce _____ levels by reducing cholesterol ______

A

LDL
synthesis

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55
Q

does the nurse need to assess the blood pressure before and after administration of a statin

A

no they do not affect the blood pressure

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56
Q

common statins

A

-simvastatin (zocor)
-atorvastatin (lipitor)
-pravastatin (pravachol)

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57
Q

this type of medication is used to treat htn, chronic heart failure, edema, and pulmonary edema

A

diuretics

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58
Q

what labs must be monitored when a patient is on diuretics

A

electrolytes

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59
Q

diuretics usually get rid of which electrolyte

A

potassium

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60
Q

this diuretic acts on the loop of henle in the kidney to cause sodium and water loss

A

loop diuretics

61
Q

what is an example of a loop diuretic

A

furosemide (lasix)

62
Q

it is super important to monitor a patient for what condition when they are on lasix

A

hypokalemia

63
Q

this diuretic increases urine output by promoting sodium, chloride and water excretion

A

thiazide and thiazide-like diuretics

64
Q

what is an example of a thiazide diuretic

A

chlorothiazide (diuril)

65
Q

a mild diuretic that promotes sodium and water excretion and potassium retention

A

potassium-sparing diuretics

66
Q

what is an example of a potassium sparing diuretic

A

spironlocatone (aldactone)

67
Q

what diuretic causes sodium and water loss

A

loop diuretic

68
Q

what diuretic promotes sodium, chloride and water excretion

A

thiazides

69
Q

what diuretic promotes sodium and water excretion and potassium retention

A

potassium sparing

70
Q

what assessments will be done on a person taking diuretics

A

-blood pressure
-intake/output
-dehydration
-daily weights
-electrolytes

71
Q

when someone is on diuretics when will you take their blood pressure

A

before and after administration

72
Q

what should you make sure is within normal limits before administering diuretics

A

-blood pressure
-electrolytes

73
Q

if a patient is on diuretics and electrolytes are out of normal range what should you do

A

hold medication and notify provider

74
Q

a potent vasoconstrictor

A

angiotensin II

75
Q

what do ace inhibitors do

A

blocks the production of angiotensin II

76
Q

what do ARBs do

A

block angiotensin II receptors

77
Q

what are some examples of ace inhibitors

A

-lisinopril
-enalapril

78
Q

what are some examples of arbs

A

losartan
valsartan

79
Q

what should you monitor for ace inhibitors and arbs

A

-assess bp before and after administration
-monitor for a new onset dry, irritating non-productive persistent cough
-monitor for angioedema
-dont stop abruptly

80
Q

if you stop an ace inhibitor or arb abruptly what can it cause

A

rebound htn

81
Q

these prevent movement of extracellular calcium into the cell and cause vasodilation

A

calcium channel blockers

82
Q

common calcium channel blockers

A

amlodipine
nicardipine
nifedipine
diltiazem

83
Q

what should you monitor when a patient is on calcium channel blockers

A

-pulse and bp before and after administration
-monitor for hypotension and bradycardia
-do not give if heartrate is less than 60 bpm

84
Q

this decreases sympathetic nervous system respone

A

beta blockers

85
Q

what does beta blockers decrease

A

-heartrate
-cardiac output
-workload of heart
-oxygen demand
-blood pressure

86
Q

what should you monitor when a patient is on a beta blocker

A

-pulse and bp before and after administration
-hypotension and bradycardia
-do not give if hr is less than 60 bpm
-do not give if systolic bp is less than 100

87
Q

cardiac specific beta blockers are called what

A

selective

88
Q

what are examples of selective beta blockers

A

atenolol
metoprolol

89
Q

beta blockers that are not cardiac specific are called

A

non selective

90
Q

what is an example of a non-selective beta blockers

A

propranolol

91
Q

what is a side effect of a non-selective beta blocker

A

bronchospasms

92
Q

if a patient has these conditions you would not give them a non-selective beta blocker

A

copd
asthma

93
Q

what should you know before giving a patient an antihypertensive medication

A

their bp and heart rate

94
Q

how long before administration of anti hypertensive should you do vital signs

A

30 minutes to one hour

95
Q

progressive inability of heart to pump enough blood throughout the body to meet bodys oxygen/nutrient needs

A

heart failure

96
Q

each ventricle should pump _____ amount of blood

A

equal

97
Q

if blood returned to the heart is more than either ventricle can handle what happens

A

the heart is no longer an effective pump

98
Q

if the heart is no longer an effective pump what can happen

A

back up of blood through the system

99
Q

failure of one side of the heart usually leads to what

A

failure of the other side

100
Q

most common causes of heart failure

A

-coronary artery disease
-chronic htn
-myocardial infarction
-dysrhythmias (a-fib)

101
Q

decreased oxygen delivery to cardiac muscle, heart is not an efficient pump is called what

A

coronary artery disease

102
Q

increased resistance, heart must work harder to maintain cardiac output

A

chronic hypertension

103
Q

area of the heart died due to a lack of oxygen, heart is no longer an efficient pump

A

myocardial infarction

104
Q

decreased cardiac output from dysrhythmia causes heart to work harder to attempt to maintain cardiac output

A

dysrhythmias (a-fib)

105
Q

left sided heart failure

A

-increased left ventricular workload
-left ventricle becomes inefficient pump
-left sided heart failure
-decreased blood pumped to body
-left ventricle unable to hold blood being pumped into it
-blood backs up into lungs
-pulmonary edema

106
Q

what decreases with left sided heart failure

A

-tissue profusion
-oxygen delivery

107
Q

the decrease in tissue profusion and o2 delivery causes what

A

pulmonary edema

108
Q

pulmonary signs and symptoms of left sided heart failure (7)

A

-crackles and/or wheezing
-dry hacking cough
-pink frothy sputum - big indication of pulmonary edema
-tachypnea
-dyspnea on exertion
-orthopnea
-paroxysmal nocturnal dyspnea

109
Q

what is orthopnea

A

sob when laying flat

110
Q

what is paroxysmal nocturnal dyspnea

A

waking up short of breath

111
Q

mental status signs and symptoms of left sided heart failure (3)

A

-restlessness
-confusion
-fatigue

112
Q

systemic signs and symptoms of left-sided heart failure (3)

A

-cyanosis
-nocturia
-tachycardia

113
Q

why is nocturia a sign or symptom of left sided heart failure

A

heart workload decreases so kidneys get more blood than they would during the day and have increases urination at night

114
Q

what is a major cause of right sided heart failure

A

left sided heart failure

115
Q

what does cor pulmonale mean

A

enlargement of the right side of the heart because it works harder so the muscle gets larger

116
Q

as the right side of the heart fails, it cannot keep up with the demands of the blood entering the right ventricle causing what

A

blood to back up into the body

117
Q

systemic signs and symptoms of right sided heart failure

A

-fatigue
-weakness
-nocturia
-tachycardia

118
Q

fluid overload signs and symptoms of right sided heart failure

A

-weight gain
-dependent peripheral edema
-ascites
-gi upset
-jugular vein distension

119
Q

many signs and symptoms of right sided heart failure are due to what

A

fluid overload or blood backing up into the body

120
Q

what is ascites

A

fluid accumulation in the abdomen

121
Q

why does someone get a GI upset with right sided heart failure

A

due to fluid stuck in abdominal cavity putting pressure on everything

122
Q

diagnostic tests for heart failure

A

-labs
-chest xray
-echocardiography
-ekg

123
Q

what labs are done for heart failure

A

-bnp
-troponin

124
Q

if BNP is above ____ it indicates chronic heart failure

A

400

125
Q

if BNP is in the _____ you need to intervene because it means an acute exacerbation is occuring

A

thousands

126
Q

what will a chest xray show

A

-size of heart
-shows lungs to determine extent of pulmonary edema

127
Q

what determines ejection fraction

A

echocardiography

128
Q

an ejection fraction lower than ____ may indicate heart failure

A

40

129
Q

what does an ekg show

A

heart rate and rhythm

130
Q

if BNP is in the thousands itll cause acute heart _____ and _____

A

damage and tissue death

131
Q

nursing actions for heart failure

A

-daily weights
-supplemental oxygen
-balance rest and activity
-positioning - high fowlers
-fluid restrictions
-medications/teaching
-low sodium diet
-education
-coping with disease

132
Q

medications for heart failure

A

-ace inhibitors
-arbs
-diuretics
-beta blockers
-cardiac glycosides

133
Q

what is the first line of medication management for heart failure and why

A

ace inhibitors because it prevents vasoconstriction

134
Q

what helps decrease the hearts workload, improve cardiac function, and improve symptoms of chronic heart failure

A

ace inhibitors

135
Q

what medication can be used for heart failure if ace inhibitors are contraindicated

A

arbs

136
Q

what medication can be used for heart failure if fluid volume needs to reduced

A

diuretics

137
Q

what medication for heart failure decreases SNS response and decreases cardiac workload

A

beta blockers

138
Q

what medication for heart failure improves efficiency of cardiac contractions

A

cardiac glycosides

139
Q

what medication is a cardiac glycoside

A

digoxin (lanoxin)

140
Q

what does digoxin do in the body

A

increased the force and contraction of the myocardium and slows heart rate which increased cardiac output

141
Q

what do you need to assess when administering digoxin

A

pulse before and after and after
bradycardia
serum digoxin levels

142
Q

what is a normal serum digoxin level when on medication

A

0.8-2.0 ng/ml

143
Q

do not give digoxin if heart rate is less than what

A

60

144
Q

educate patient to take the medication at what

A

the same time everyday

145
Q

digoxin toxicity symptoms

A

-bradycardia
-loss of appetite/anorexia
-nausea, vomiting, diarrhea
-abdominal discomfort
-vision changes
-fatigue
-confusion, decreased LOC

146
Q

what symptoms is very specific to digoxin toxicity

A

vision changes

147
Q

what vision changes occur with digoxin toxicity

A

-blurred vision
-yellow/green vision changes
-may see yellow/green halos

148
Q

digoxin toxicity is caused by digoxin levels of what

A

greater than 2.4 ng/ml

149
Q

the goals of therapeutic interventions for heart failure are to improve hearts pumping ability and decrease hearts oxygen demand by these 4 things

A

-identify and correct underlying cause
-increase strength of hearts contraction
-maintain optimum water and sodium balance
-decrease hearts workload

med surg (7 decks)

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