Module 2B Flashcards by Stephanie Walker

Normal BP

<80

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What is prehypertension?

120-139/80-89

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What is stage 1 hypertension?

> 140-159/90-99

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What is stage 2 hypertension?

> 160/>100

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What is the diagnosis of hypertension?

140 or >/ 90 or >

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What are the risk factors of hypertension?

coronary, cerebral, renal, peripheral vascular disease, ISH( isolated systolic HTN)

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Why are the risk factors a silent killer?

They don’t know they have it until there is already organ damage

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What are the risk factors for essential or primary hypertension?

modifiable factors: 2g Na+, increased body weight, physical inactivity, diet, smoking, ETOH, genetics, age, ethnicity

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What are the risk for secondary hypertension?

disease process: renal disease, brain tumor, pregnancy, steroids, endocrine disorders

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Causes of 2nd HTN

coarctation of aorta, renal disease, endocrine disorders, neurologic disorders, medications

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What are the clinical manifestations of 2nd HTN?

asymptomatic= silent killer, headache, dizziness or fainting, nosebleeds, tachycardia, sweating, pallor

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What are compelling factors of 2nd HTN?

ischemic heart disease, heart failure, diabetic HTN, chronic kidney disease, cerebrovascular disease

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What are nursing interventions for 2nd HTN?

sodium restriction (2g Na+ daily), weight reduction, ETOH intake, exercise promoted, relaxation techniques, and tobacco avoidance

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What are the drug therapy for hypertension?

oral & written info, diuretics, adrenergic inhibitors, direct vasodilators, ganglionic blockers, angiotensin inhibitors, and calcium channel blockers

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What do you never do with hypertension medications?

DO NOT STOP ABRUPTLY

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What are the sign of pre-eclampsia?

develops after 20 weeks gestation, decreased placental perfusion, fetal growth retardation, fetal hypoxia = arteries not wide enough to carry oxygen to baby, BP beings to rise after 20 week gestation, loss of vasodilation

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What does the loss of vasodilation result in?

decreased placental perfusion, decreased maternal perfusion, pathology in other systems

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What are the clinical manifestations of SEVERE PRE-ECLAMPSIA?

may develop suddenly, generalized edema, BP >160/110, albuminuria, frontal headaches, blurred vision & spots before eyes, nausea & vomiting, epigastic pain, decreased urine output

What does HELLP syndrome stand for?

Hemolysis, Elevated Liver function test, Low Platelet count

What does the HELLP syndrome mean?

decreased maternal perfusion, RBC’s fragmented, multiple organ failure-> increased maternal &fetal morbidity & mortality, associated with SEVERE pre-eclampsia

What are the signs and symptoms of HELLP syndrome?

RUQ pain & epigastric pain

What are therapeutic nursing interventions for HELLP syndrome?

prenatal visits for detection, monitor BP weight edema urine and reflexes, diet education, daily weights

What are therapeutic nursing interventions for MILD HELLP syndrome?

hospitalization, monitoring: maternal & fetal, nonstress test & fetal monitoring, stimuli, medications, impending labor, emotional support and activities

What are therapeutic nursing interventions for Eclampsia?

patent airway, suction, crash cart

What do you assess when administering MgSO4?

weight, BP, RR, breath sounds, deep tendon reflexes (knee jerk), urinary output, LOC

What do you keep at the bedside when giving MgSO4?

calcium gluconate

What are the signs of recovery after giving MgSO4?

urinary output, decreased proteinuria, BP returns to normal

What is claudication?

cramp like ischemic pain/ burning in the extremities; what brings patient into the hospital

PAD: Pain

intermittent claudication, > lactic acid present in muscles, > 75% occluded, < pain with rest

PAD: Skin

cool, pale, rubor, cyanosis, hair loss, edema, ulcers, pallor when legs elevated

Therapeutic Nursing Interventions to increase arterial blood supply

exercise, walking -> gradually and increase slowly walking promotes blood flow & collateral circulation, pain as guide, positioning -> elevate feet don't encourage elevation above heart can put one leg on floor,

What are the "NO's" for increasing arterial blood supply

crossing legs, cold temperatures, constrictive clothing, smoking

What are drug therapies for increasing arterial blood supply

walking 30-40 minutes/day, claudication, trental= blood flow extremities, ACE inhibitors, antiplatelet, aspirin

What is Virchow's triad?

1. venous stasis -> not moving 2. endothelial damage -> vena puncture; clot? 3. hypercoagulability of blood -> increased RBC's

What are the signs and symptoms of VTE?

superficial, pain warmth redness tenderness swelling infection, DVT-> unilateral swelling slight temperature calf or groin pain increased circumference of limb warmth and edema

What labs do you check with VTE or PE?

platelet, bleeding time, PTT & INR

What are preventive measures for VTE?

pharmacologic agents -> aspirin & Coumadin = prevent venous statis; early ambulation; TEDS; intermittent compression devices -> prior to VTE; ROM on bedrest patients

What are surgical management for VTE?

thrombectomy -> removal of clots, only done no response to medical treatment; inferior vena cava interruption -> greenfield filters= like sink drain but with high infection rate

What are anticoagulant therapy for VTE?

delay clotting time, prevent formation, prevent extension, DOESNT DISSOLVE THROMBUS

What is thrombolytic therapy?

clot busters streptokinase TPA not VTE; MI or stroke; NOT ANTICOAGULANTS

What are nursing concerns for anticoagulant therapy?

check dosage to be administered, monitor for S/S of bleeding, monitor VS, have antidotes available, monitor aPTT, PT and INR, pressure to sites, patient teaching, injections sub q not IM

Key features of lower extremity ulcers ARTERIAL

peripheral pulses, capillary refill -> greater than 3 seconds, other assessment findings, collaborative care

Key features of lower extremity ulcers VENOUS

peripheral pulses -> difficult to palpate, capillary refill -> less than 3 seconds brisk, other assessment findings