OXYGENATION (CAD/HTN) Flashcards
is the product of the heart rate (HR) and the stroke volume (SV)
is the amount of blood ejected by the heart in 1 minute
cardiac output
is the amount of blood ejected by the heart per contraction.
stroke volume
what is the function of coronary artery
Gives oxygenated blood to heart to function normally
what artery is bigger? left or right
right
- Atrium are contracting and filling in the ventricle
is the force used to stretch the muscle fibers; filling of blood in the atria and ventricles
preload
- Is the force the heart must pump against high pressure to push blood out of left ventricle
afterload
stretch
preload
pump against high pressure
afterload
what happens during diastole
o AVV open | SLV close | s2 sound is heard
contraction of both atriums
▪ The ventricles are relaxed; while the atrium are filling the ventricles with blood.
▪ Atrioventricular valves are open for 0.5s while the Semilunar valves are close.
what happens in systole
AVV close | SLV open | s1 sound is heard
contraction of both ventricles |
right ventricle pushes unoxygenated blood going to the lungs
▪ QRS:
➢ Right ventricle pushes unoxygenated blood against the Pulmonary valve towards the lungs for oxygenation.
➢ Left ventricle pushed oxygenated blood against the Aortic valve towards the different systems of the body.
▪ Atrioventricular valves are close while the Semilunar valves open for 0.3s.
QRS are happening where ventricles are contracting
systole
give oxygenated blood to brain anteriorly
carotid artery
give oxygenated blood to brain posteriorly
vertebral artery
The blood vessels and coronary artery are obstructed with lipids, but the flow of blood is still good since it is still a partial obstruction.
atherosclerosis
major cause of Coronary Artery Disease
atherosclerosis
what coronary artery is more prone in lipids accumulation inside artery
left; smaller
When the lumens are constricted it causes high blood pressure; therefore, the amount of blood flow is minimal.
This causes the arteries to make new blood vessels.
collateral circulation
used to know what part of coronary arteries blocked with lipid
cardiac catheterization
if patient keeps on eating = obese, what will happen to the collateral circulation?
Lipids will accumulate - Arterial lumen narrowed - BP increase - Minimal amount of blood pasing
Compensatory mech:
* Gumawa bagong arteries
* Where blood will flow
risk factor can not do anything about it
non-modifiable
risk factor can change
modifiable
risk factor: AGE
NM
how can age be risk factor of CAD
as grow older, BP increases bc of elasticity
risk factor: gender
NM
how can gender be risk factor of CAD
male more affected on CAD
Male deal w/ stressors: smoke/drink
risk factor: Ethnicity
NM
risk factor: family history
NM
how can family be risk factor of CAD
minamana
essentially hypertension
risk factor: elevated serum lipids
M
how can elevated serum lipids be risk factor of CAD
a. High intake in red meats (beef)
- Red meats are high in urea; therefore, this should be avoided.
- If you have plenty of urea, you are increasing the workload of your kidneys.
ONLY EAT: chicken, fish
risk factor: HYPERTENSION
M
how can hypertension be risk factor of CAD
e) The Lumen in hypertensive patients becomes smaller.
a. Which causes the intimal layer of the artery to become smaller also.
b. If the intimal layer of the artery becomes smaller, the production of Nitric Oxide (NO) becomes less.
i. Nitric Oxide functions to dilate the vessels
Therefore, advise the patient to:
a. Stop smoking.
b. Stop eating high sodium.
c. Stop drinking alcoholic drinks, caffeinated drinks, and carbonated drinks.
d. Avoid stressors.
risk factor: diabetes
M
how can diabetes risk factor of CAD
must control intake
high glucose level
stop eating: donut/fries
4 factors lead to CAD
obese, smoker, hypertension runs in family, diabetes
HYPERTENSIVE level
140/90
if hypertensive, what happens to the lumen?
smaller
if lumen of artery becomes smaller because of hypertensive, what does it affect or causes?
causes the intimal layer of the artery to become smaller
If the intimal layer of the artery becomes smaller, what happen?
the production of Nitric Oxide (NO) becomes less
Produced by intimal layer of artery
Role: dilate artery
nitric oxide
EXPLAIN:
The Lumen in hypertensive patients becomes smaller
Narrow Blood Vessel = slow blood flow - Increasing pressure, destroying intimal layer of artery – no NO - artery cannot dilate - result hypertension
attracted to lipids
WBC, RBC, Platelet
food intake high in NO
arugula
spinach
red beets
garlic
lettuce
basil
citrus fruits
watermelon
dark chocolates
hypertensive is genetic
idiopathic, primary, essential hypertension
causes of type 1hypertension
hyperactivity of:
a. SNS
b. RAAS
endothelial dysfunction
hyperactivity of SNS for Hypertension
trigger adrenal medulla producing norepinephrine that causes vasocontriction resulting increased Blood Pressure
hyperactivity of RAAS for Hypertension
low blood supply
bakit nagkaroon: internal bleeding related to aspirin therapy (ex)
endothelial dysfunction for Hypertension
destroy production of NO
Example of essential hypertension
excess intake of salt
abnormal arteries
increase blood volume
genetic disorder
stressful life
example of secondary hypertension
health condition certain medicine
decreational drugs
hormonal therapy
pregnancy
how can patient have ventricular hypertrophy
the patient’s blood pressure is 160/100, meaning to say the heart pushes against a high pressure which causes the heart muscles to become larger; and if the muscles become larger, the muscles will demand more blood. However, the coronary artery will not increase the amount of blood, instead it will give the same exact amount; therefore, the muscle contractility will become less causing the blood to accumulate in the left ventricle because of less elasticity which can result to left ventricular hypertrophy.
o If there is left ventricular hypertrophy, the apex will be change in position to 6th ICS LAAL
hypertension is caused by direct result of another problem or condition
secondary hypertension
stroke in secondary hypertension
In stroke there is a clotted blood. This clotted blood in our brain can increase the intracranial pressure (ICP).
Some clotted blood maybe caused by aneurysm.
aneurysm in secondary hypertension
swollen up ang artery
blown up: blood ooze, increase ICP kasi walang place on skull for the blood
High dose estrogen use for hypertension
Make women’s blood thick pssible to increase bp
Use as replacement on menstration
NURSING INTERVENTIONS FOR NOSE BLEEDING:
- keep px sit, lean forward with head tilted forward to keep blood from dripping down the throat or being aspirated in lungs
- apply direct pressure for atleast 15 mins to cause vasoconstriction to stop bleeding by pinching nostrils to help platelet to clot
- apply cold compress to the bridge of nose cause vasoconstriction
- keep px calm and quiet because anxiety tends to increase BP which could worsen nosebleed for it to stimulate SNS
- To prevent re-bleeding
- don’t prick / blow nose
- dont bend down
- keep head higher than level of heart
MEDICAL MANAGEMENTS FOR HYPERTENSION: 5 drugs
A - A - B - C - D
Diuretics
Beta-blockers
Alpha Blockers
ARBS
Calcium Channel Blockers
Beta-Blockers is also given to patients with Thyroid problem.
o Because in hyperthyroidism, the thyroid gland is giving out an extensive amount of T3 (Triiodothyronine) and T4 (Thyroxine); these hormones are responsible for metabolism of the body, however, if it’s giving out a huge amount then the metabolism of the patient will be accelerated, such as, very fast peristalsis, increased respiratory rate and etc.
This lessens the contractility of the heart.
However, this is not that strong for hypertension
BLOOD CIRCULATION
“Unoxygenated blood from the upper extremities enters the Superior Vena Cava, while blood from the lower extremities enters the Inferior Vena Cava. This blood then flows into the Right Atrium and passes through the Tricuspid Valve to fill the Right Ventricle. The Right Ventricle propels the blood into the pulmonary artery and subsequently into the four Pulmonary Veins via the Pulmonary Valve. Once inside the lungs, the blood undergoes gas exchange, transforming it from unoxygenated to oxygenated blood. The oxygenated blood then travels to the Left Atrium and passes through the Bicuspid Valve to fill the Left Ventricle. The Left Ventricle forcefully pumps the blood into the aorta, passing through the Aortic Valve. Finally, the aorta distributes the oxygenated blood throughout the body.”
→ Atherosclerosis may lead to:
▪ Legs – Peripheral Arterial Disorder
▪ Heart – Myocardial Infarction (heart attack)
▪ Brain – Cerebrovascular Accident (stroke)
that supply oxygenated blood to
the brain.
Brain Vessels
❖ MEDICAL MANAGEMENT
→ ACE Inhibitor (pril)
▪ It inhibits the ace enzyme in converting
angiotensin I to angiotensin II, because it is a potent vasoconstrictor which can increase BP.
▪ Indicated for weak heart, enlarged heart, and hypertension.
❖ MEDICAL MANAGEMENT
→ ACE Inhibitor (pril)
NURSING INTERVENTION
➢ If coughing persists, inform the physician so that they can change the medication, commonly changed to ARBs.
➢ Progressively change px’s position because it can cause orthostatic hypotension.
➢ Warn patients not to abruptly discontinue the use of medication without notifying a health care provider because rebound hypertension could result.
❖ MEDICAL MANAGEMENT
→ Angiotensin II Receptor Blockers (sartan)
▪ Same action with ACE inhibitors but has
weaker effect to lower high blood pressure.
❖ MEDICAL MANAGEMENT
→ Adrenergic Blockers
▪ Beta-Blocker (olol)
➢ It is a vasodilator that enlarges the lumen of the blood vessels.
➢ It decreases the heart rate by allowing the atrioventricular valves to remain open for 0.5 seconds. This allows more blood to flow into the ventricles, improving cardiac output.
➢ It reduces heart contractility.
➢ It has a weak antihypertensive effect.
➢ Indicated for nervousness, thyroid problems, and young patients.
There is an excessive production of T3 and T4
hormones by the thyroid glands and they accelerate the metabolism resulting to fast eating, fast talking, fast peristalsis, sweating a lot, increases PR and RR
Hyperthyroidism
❖ MEDICAL MANAGEMENT
→ Adrenergic Blockers
▪ Beta-Blocker (olol)
NURSING INTERVENTION
Do not give the drug if patient’s cardiac rate is below 60 bpm.
❖ MEDICAL MANAGEMENT
→ Adrenergic Blockers
▪ Alpha Blockers
➢ It causes vasodilation of the peripheral vessels, and it causes edema.
▪ Common Adverse Effects: dizziness, bradycardia, hypotension, fatigue.
❖ MEDICAL MANAGEMENT
→ Calcium Channel Blocker (pine)
▪ It blocks the entrance of the calcium in the myocardium to prevent the contraction of the heart forcefully.
▪ It is a strong antihypertensive.
▪ Side Effect: Peripheral Edema
❖ MEDICAL MANAGEMENT
→ Diuretics
▪ It inhibits sodium reabsorption and water retention resulting to increased urine formation and excessive urination.
▪ This is the 1st line therapy got hypertension to eliminate excess salt and water
❖ MEDICAL MANAGEMENT
→ Diuretics
CLASSIFICATION
➢ Thiazide – (Hydrochlorothiazide: Diuzid, Betazide)
* also causes vasodilation
➢ Loop – (Flurosemide: Lasix)
* more potent than thiazide
* less effective as antihypertensive
❖ MEDICAL MANAGEMENT
→ Adrenergic Blockers
▪ Alpha Blockers
NURSING INTERVENTION
