Perfusion B Flashcards
MAP
mean artial pressure
SBP+2(DBP)/3
Hypertension
“silent killer”
can never be healed
Normal BP
120/80
Prehypertension
120-139/80-89
Hypertension Stage 1
140-159/90-99
Hypertension Stage 2
160/100
what medication will you use first to treat HTN?
Diuretics
How will you treat HTN first?
lifestyle changes for at least 3 months
Essential HTN
most common not caused by an existing health problem
Secondary HTN
specific disease states (renal, endocrine, cardiovascular, pregnancy, estrogen) and drugs (cocaine)
treatment is eliminating cause
Risk factors for essential HTN
age >60/postmenopausal family hx African American, hispanics, and American Indians ethnicity smoking alcohol obesity DM Elevated serum lipids >200 sodium and caffeine sedentary lifestyle socioeconomic status excessive stress electrolytes (K, Ca, Mg, Na)
risk factors for secondary HTN
Kidney disease (most common) Primary aldosteronism cushings disease brain tumors pregnancy drugs (estrogen, glucocorticoids)
> 140/>90
160/100
Isolated Systolic Hypertension
can lead to CVA or MI
older adults/elderly
SBP >139
DBP <90
clinical manifestations of HTN
May not have symptoms until BP has increased
Fatigue Dizziness Blurred vision Palpitations Angina Dyspnea Facial flushing
How will the nurse intervene with a pt who has
HTN crisis?
- Place pt in semi fowlers
- give o2
- start IV with NS
- IV beta blocker or Nicardipine as prescribed over 2-6H slowly
- Monitor BP Q15min
- observe for seizures, organ damage
- MAP 60-80
- Pulse Pressure 30-40
Lifestyle changes
Sodium restriction Weight reduction Reduce alcohol intake Exercise 30-40 mins 3-4x weekly Decrease stress levels Avoid smoking Complementary and alternative therapy Healthy People 2020, Table 36-2, pp.722
Effects of HTN
Heart (hypertensive heart disease) Brain (CVA) Peripheral vasculature (PVD) Kidney (Nephrosclerosis and renal insufficiency) Eye (papilledema)
Hypertensive Urgency
BP >180/120 mm Hg
No signs of target organ damage
**Usually caused by non-compliance with medication therapy
Hypertensive Emergency BP
> 180/120 mm Hg
+Signs of target organ damage
HTN urgency/emergency assessment
severe headache seizure decrease UO ShoB dizziness blurred vision CP unresponsiveness
MONA for CP/HTN anxiety
Morphine
Oxygen
Nitro
Aspirin
What medication will you give an African American?
Calcium Channel blockers
PINE, ZEM, AMIL
Hypertension in children
Diet control
Lifestyle changes
TX for HTN
**Lifestyle modifications are always the first treatment (preferred)
Monitor BP for several months before starting medications
If medications are required, patient knowledge and compliance is essential
goals for teaching with HTN
take drugs as ordered once started will be lifelong good BP goal less than 140/90 -if stop meds rebound htn can occur
Dietary Approach to Stop Hypertension (DASH) diet
**sodium restriction 1.5-2g daily maintain healthy weight BMI moderation of alcohol (1xdaily woman 2xdaily men) restrict cholesterol and saturated fats adequate K intake increase physical activity manage stress smoking cessation
Focused assessment for HTN
health hx medication hx (OTC?) family hx VS and BP evaluation both arms focused cardiac assessment health patterns lab (serum electrolytes, BUN CRT, BG, Cholesterol, CBC)
Pt Goals for HTN
- Maintain desired BP/tissue perfusion
- Understand accept and implement the therapeutic plan
- Experience minimal unpleasant side effects
PT education for HTN meds
- orthostatic hypotension
- sexual dysfunction
- dry mouth (diuretics)
- nocturia (diuretics need to take in AM)
- electrolyte imbalance
- hyper/hypokalemia
- adherence to medication
- weight control/balanced nutrition
explanation of HTN?
high cholesterol can be a factor to cause development of essential hypertension
often asymptomatic
Infant Normal BP
80/40
Preschool Normal BP
90/50
Adolescent Normal BP
100/60-70
When do kids need to start checking BP?
children need to start having b/p checked by age 3 then annually
Normal bp for kids
less then 90% up to 89%
risk factors for children to have HTN?
Families poor, African American , Hispanic females, American Indians, more likely to develop
younger than 10 causes for HTN
brain tumor, heart defects, sleep apnea, renal disorders
what can reduced the incidence of developing HTN?
breast feeding
risk factors for HTN in children
Family History of: Hyperlipidemia (<170 LDL <110 HDL >40) Hypertension Diabetes Smoking Obesity Sedentary lifestyle High sodium/high fat diet High stress
decreases risk for children to develop HTN
1H a day of after school activity
no fast food
Normal BP for kids
less than 90%
Prehypertensive kids
90-94th %
Hypertensive kids
95th %
Hypertensive stage 1
95-98th %
Hypertensive stage 2
> 99th %
Managing Obesity for kids
- Start a weight-management program
- Change eating habits (eat slowly, develop a routine)
- Plan meals and make better food selections (eat less fatty foods, avoid junk and fast foods)
- Control portions and consume less calories
- Increase physical activity (especially walking) and have a more active lifestyle
- Know what your child eats at school
- Eat meals as a family instead of while watching television or at the computer
- Do not use food as a reward
- Attend a support group
can kids have skim milk?
after age 2
how to reward kids?
with activity not food
should you give low calorie foods to kids?
never recommended until over age 2
what is the first choice for kids with HTN?
lifestyle management is always the first choice!!!
