PERFUSION (EXAM 2) Flashcards
what are the contributing factors in perfusion
Heart
veins
arteries
what is the normal range for MAP
60 mmHg or greater
what is the main consequence of hypertension
there will be alot of perfusion issues
what are negative outcomes of bad perfusion
necrosis
loss of tactile function
fainting
confusion
DVT
decrease in organ function
ischemic pain
Normal BP
systolic <120
diastolic <80
Elevated BP
systolic 120-129
diastolic <80
Stage 1 high BP
systolic= 130-139
diastolic=80-89
stage 2 high BP
systolic= 140 or higher
diastolic= 90 or higher
Hypertensive crisis
systolic=higher than 190
diastolic=higher than 120
what is hypotension the most important risk factor for?
stroke
HF
Essential hypertension
the specific cause is unknown
Additive factors to contribute to essential hypertension
Genetics
behavioral
environmental factors
obesity
hyperlipidemia
African American
Secondary hypertension
it is the result of another disease
related to other issues
Example of secondary hypertension
renal artery disease
endocrine
cns disorders
sleep apnea
what happens when the cause of the hypertension is eliminated
hypertension goes away
BP return to normal
what can happen when hypertension is left untreated
cause end stage organ damage
GOAL of hypertension
reduce cardiovascular and renal morbidity and mortality
goal of hypertension
reduce cardiovascular and renal morbidity and mortality
Autoregulation
-the body tissues regulate their own blood flow to preserve 02
-think automatic
Parasympathetic N.S
little to no effect on vessels
dilates to blood vessels
Sympathetic N.S
Contraction of blood vessels to maintain BP
Maintain renin-angiotensin-aldosterone system (RAAS) in the kidneys
what factors affect blood flow
atherosclerosis
thrombus
embolus
what is the first action with a patient who has hypertension
non pharmological interventions
what is the BP goal
systolic less than 120
diastolic less than 80
name some lifestyle modifications
weight
Na intake
regular physical activity
moderate alcohol
no smoking
lifestyle management
exercise 30 minutes/day at least 4 times a week
what lab test should you take
liver
BUN
creatinine
Name some manifestations of hypertension
headache
blurry vision
nausea
vomiting
symptoms reflect target organ damage
angina
MI
HF
stroke
renal disease
categories of medications with hypertension do what
decrease BP
decrease peripheral vascular resistance
what is peripheral vascular resistance
resistance that the blood encounters as it circulates through the body
where do these drugs work
Heart
veins
what do alpha blockers do
they block vasoconstriction
they open the veins and decrease vasoconstriction
vasodilation of veins
what is clonidine and what does it do
it is an alpha blocker
lowers BP
how does clonidine decrease BP
relaxing the arteries (vasodilation) and increasing the blood supply to the heart
what kind of alpha blocker is clonidine
alpha 2 agonist
what do clonidine do
-decrease sympathetic response
-stimulate the alpha 2 receptor
-reduce peripheral vascular resistance and increase vasodilation
what the main action of clonidine
reduce the peripheral vascular resistance which increases vasodilation
what happens when peripheral vascular resistance is decreased
there is vasodilation
what are some side effects of alpha 2 agonist
Remember it vasodilates
-drowsiness
-drymouth
dizziness
-bradycardia
why does alpha 2 agonist cause drowsiness
when the blood pressure decrease from vasodilation the brain will not get enough blood causing that drowsiness
alpha 2 agonist interventions
-monitor serum liver enzyme
-do not stop abruptly
-take as prescribed
-may cause sodium and water retention
why must alpha 1 agonist do not stop abruptly
they might cause hypertensive crisis
what should be ordered with alpha 2 agonist
-A diuretic
-there is a chance of sodium and water retention which causes that peripheral edema
who should avoid clonidine
those who are pregnant
how do you administer clonidine
oral
transdermal patch
how do you take a patient off clonidine
gradually
worst case scenario hold the medication and do assessment
What must be administered with clonidine
a diuretic
clonidine is known to cause a lot of peripheral edema from the sodium and water retention
side effects/adverse effects of clonidine
Rebound hypertension if stopped abruptly
drowsiness
dizziness
fatigue
orthostatic hypertension
administration for clonidine with patients with hypertension
oral
transdermal patch
when should clonidine be given and why
at bedtime
because they cause drowsiness
how often should the patch be changed
every 7 days
before administering new patch what should you do
remove the old patch
don’t place the new one at the same spot
what is the most important pt teaching with clonidine
taper off
DO NOT STOP ABRUPTLY
REBOUND HYPERTENSION!!!!
What is the function of an ACE
it is a vasoconstrictor
what does an ace inhibitor do?
decreases vasoconstriction
Captopril is an example of a what
ace inhibitor
MOA of captopril
decrease effects of renin angiotensin
crease vasoconstriction
captopril is medication of choice for who
patients with HTN and HF
what else does captopril do
decrease retention of sodium and water
Captopril is a first line drug for who
why?
patients with diabetes
slow the progression of renal impairment
primary effect of ACE inhibitor
cardiovascular effects
decrease morbidity and mortality in those with HF
SE/AE of ACE inhibitors
dry non productive cough
angioedema
hypokalemia
what is the most common effect of ACE inhibitors
hyperkalemia
Interventions with ACE inhibitors
GO LOW AND SLOW!!!!!
do not give with potassium sparing diuretics or salt subsitutes that contain potassium
monitor dry cough, angiedema,BP,potassium
most important thing to note with ACE inhibitors
START LOW AND GO SLOW!!!!!
what should you not give ACE inhibitor with
-potassium sparing diuretics=spironolactone
-salt substitutes that contain potassium
TOO MUCH POTASSIUM
what should you do before administering ACE inhibitors
take BP
what are some S/S of hyperkalemia that you should educate your patient to look out for
muscle twitching
palpitations
weakness
paresthesia
what else should you teach your patient
-report dry hacking cough
-assess bp, hr, respiratory status
-report swelling around the face, mouth and throat
-refrain from taking potassium supplements
how do you know if a patient has angioedema
swelling in face
mouth
throat
can you give ACE inhibitors to a preg lady
NOOOO!!!!
what does ARBs stand for
angiotensin 2 receptor blockers
why is it better to give ARBs than ACE inhibitors
ARBs is less likely to cause hyperkalemia and dry cough
most ACE inhibitors end with?
PRIL
most ARBs end with
SARTAN
MOA of valsartan
they block the effects of angiotensin 2
SE/AE of ARBs
erectile dysfunction
orthostatic hypotension
NEUTROPENIA
what is neutropenia
what should you do to monitor
low WBC count
CBC
Interventions teaching with ARBs
treat angioedema
monitor and report CNS effects
Monitor BP and apical pulse
hypotension
fluid volume
nursing intervention with potassium high or low
monitor cardiac
EKG
ARBs administration
oral with or without food
what should you do if ARBs is being taken with a diuretic or pt have liver failure
reduce the dose
what can ARBs be used with
diuretics if treating HTN or HF
