Unit 9 - Perfusion Flashcards
CO =
mL/min
heart rate x stroke volume
heart rate is measured in
bpm
stroke volume is measured in
mL put out/beat of heart
Blood Pressure =
CO x Peripheral resistance
if you increase CO or Peripheral Resistance you ____ BP
increases
The Hose Analogy (increase pressure)
- turn up flow (CO)
2. increase peripheral resistance by putting thumb on end (peripheral resistance)
chronic systemic BP readings of 140/90 or higher
hypertension
150/90 for people > 60 (s comorbid conditions)
primary htn
- cause unknown
secondary htn
- there’s an underlying cause (renal, endocrine, meds)
Interesting facts about different meds that we use:
1. ace-inhibitors & ARBs & beta-blockers are (less/more) effective in African Americans…choice of meds are __________
less, thiazidediuretics & Ca+ channel blockers
Interesting facts about different meds that we use:
2. asians are twice as sensitive to _________ & _________
beta blockers & other hypertensives
Interesting facts about different meds that we use:
- America-Indians have (decreased/increased) responses to beta blockers
decreased
T/F: Htn can go years without being noticed because it has no s/s
T
one of the main goals for htn treatment
decrease the damage that occurs in organs & tissues
3 main goals/objective of treatment of htn
- lower BP
- reduce risk factors
- prevent htn related diseases
- initial drug of choice for htn
- now recommendations for htn (4 main drugs used for htn)
- thiazidediuretics
- thiazidediuretics, ace-inhibitor, ARB, Ca+ Channel Blocker
angiotensin-converting enzyme inhibitors (ACE)
lisinopril (prinivil, zestril)
prototype for ace-inhibitors
lisinopril
ace-inhibitors generally end in ____
“pril”
adverse effects of lisinopril
*cough
Nursing Considerations of Lisinopril
- get baseline of LFTs & KFTs
- teach to avoid OTC NSAIDs = reduce affectiveness
T/F: ace-inhibitors & ARBs can reverse cardiac remodeling
T
Ca+ Channel Blockers are often used in combinations with ____
thiazodiuretics
medication that typically works best with African American clients
Calcium Channel Blockers
2 types of calcium channel blockers
dihydropyridines & nondihydropyridines
what do dihydropyridines work on
arterial smooth mucles
what do nondihydropyridines work on
arterial smooth muscle AND cardiac muscle
What drug:
inhibition of calcium ion movement across cardiac and arterial muscle cell membranes; slow amount of calcium that’s going across the membranes of the muscle cells; act directly on calcium required to make muscle contraction
calcium channel blockers
T/F: not all calcium channel blockers affect heart muscle
T, just the nondihydropyridines do
T/F: you can use calcium channel blockers with people who have a heart blockage
FALSE! You don’t want to make it worse by slowing the conduction through their AV node
4 ways nonselective calcium channel blockers work
- slows conduction through AV node
- prolonged effective refractory phase (how long it takes for electrical impulses to regenerate themselves)
- depressed myocardial contractility (heart doesn’t contract as strong as it normally would)
- dilation of coronary arteries and peripheral arterioles
what doe calcium channel blockers do
- decrease oxygen demand
- decrease cardiac effort
- increase oxygen to myocardium
prototype for dihydropyridine calcium channel blocker
nifedipine
prototype for nondihydropyridine calcium channel blocker
verapamil
becoming drug of choice for preterm labor contractions
nifedipine
What drug:
Prevents angiotensin II from being formed, decreases blood pressure, treats heart failure, improves heart function post MI
Lisinopril
What drug:
Prevents angiotensin II from acting on target organs, decreased BP, CVA prophylaxis, tx of heart failure; helps dilate coronary arteries
Losartan
adverse effects of Nifedipine
- peripheral edema
- affect on heart by increasing HR (tachycardia)
nursing considerations for Nifedipine
- not as helpful in geriatrics (increase risk for toxicity)
- stop med if develop pulmonary edema (SOB, auscultate)
- hepatic impairment
- parameters: take BP before administering (systolic 90 or less = hold med & notify doc)
T/F: it is known for people to get tachycardia from Verapamil
F, tachycardia is not common in Verapamil like Nifedipine
What drug:
Dilates vascular smooth muscle, decreasing blood pressure, decreasing workload of the heart, dilates coronary arteries; ***slows conduction through AV node = slows HR
Verapamil
Nursing Considerations for Verapamil
- take P & BP prior to administration
- if Systolic is < 90 or P < 60 = HOLD!
- monitor for peripheral edema
T/F: It is important to use Bets-Adrenergic Blocking Agents that are selective rather than nonselective
T
what is a Beta-Adrenergic Blocking Agent
Sympatholytics
prototype for Beta-Adrenergic Blocking Agent
Metoprolol
Is Metoprolol selective or nonselective
selective (doesn’t affect Beta 2, does affect Beta 1: heart & artery muscle)
What drug:
Decreased BP, decreased heart rate, decreased cardiac output
Metoprolol
beta blockers usually end with ____
“olol”
Nursing consideration for Metoprolol
- monitor P & BP (systolic < 90, P < 60 = HOLD!)
- take apical P
What is an Alpha-Adrenergic Blocker
Sympatholytic (selective Alpha 1)
Prototype for Alpha-Adrenergic Blocker
Prazosin
T/F: Prazosin takes a while for therapeutic effects
T, about 4-6 weeks before sustained BP droppage
Prazosin has (short, long) half life
short, so people have to take ~3 times a day
What drug:
Dilation of peripheral blood vessels- decreased BP; treats raynaud’s disease
Prazosin
T/F: these medications have a high risk for first dose effect
T, their BP will get so low at first, so nurses need to encourage to take at night & teach about first dose effect…the effects will decrease the longer the pt is on them
Nursing Considerations for Prazosin
- monitor BP (systolic < 90 = HOLD!)
- take at night, have someone monitor pt
what is a Direct Acting Vasodilator
Sympatholytic
Prototype for Direct Acting Vasodilator
Hydralazine
drug used for hypertensive crisis
Hydralazine
What drug:
Potent antihypertensive-works on arterial muscle directly
Hydralazine
T/F: Hydralazine is used for typical hypertension
FALSE, used for hypertensive crisis & pregnancy, or last resort for htn
Nursing Consideration for Hydralazine
- directly affects muscle
- can give other med for side effects
Adverse effects of Hydralazine
- causes reflex tachycardia (due to dilation)
- edema
- lupus syndrome
Q: Which THREE of the following are therapeutic effects of lisinopril?
Multiple answers: You can select more than one option
A. vasodilation
B. decreased fluid retention
C. reverses the symptoms of a stroke
D. stabilization of cardiac remodeling
A. vasodilation
B. decreased fluid retention
D. stabilization of cardiac remodeling
Q: What is a potential adverse effect of nifedipine, a selective calcium channel blocker, due to its mechanism of action? A. rebound tachycardia B. hypertension C. skin blanching D. urinary retention
A. rebound tachycardia
Q: What two physiologic effects does verapamil have because it is non-selective?
A. decreased heart rate and vasodilation
B. increased heart rate and vasodilation
C. increased diuresis of fluid and vasodilation
D. decreased release of aldosterone and vasodilation
A. decreased heart rate and vasodilation
Q: A patient is due for their morning dose of metoprolol and their blood pressure is 82/66. What should the nurse do?
A. take the patient’s apical pulse and give the med if the pulse is above 60
B. hold the medication and notify the provider
C. wait until after the patient eats breakfast, and then give the medication
D. give the patient a dose of epinephrine to bring up the blood pressure
B. hold the medication and notify the provider
Q: What should the nurse watch out for with a patient’s first dose of prazosin?
A. an extreme drop in blood pressure
B. an allergic reaction, including hives and difficulty breathing
C. a sudden inability to see
D. a sharp increase in blood sugar
A. an extreme drop in blood pressure
First dose effect
Q. What is hydralazine used for? A. treatment of MI B. treatment of stroke C. hypertensive crisis D. extreme fluid retention
C. hypertensive crisis
Q: Which of the following is NOT an objective of treating hypertension?
a. reduce BP
b. reduce risk factors
c. prevent the client from ever having to see their care provider
c. prevent client from developing related diseases
c. prevent the client from ever having to see their care provider
Q: What helps determine the pharmacologic treatment of hypertension?
- whether the patient has other diseases such as kidney disease or diabetes
- race
Q: Which THREE of the following are therapeutic effects of lisinopril?
a. vasodilation
b. decreased fluid retention
c. reverse stroke
d. stabilization of cardiac remodeling
a. vasodilation
b. decreased fluid retention
d. stabilization of cardiac remodeling
Q: What is the mechanism of action of losartan?
it blocks angiotensin II from attaching to target cells
Satan blocks 2 angels from reaching their target goal
T/F: you can use lisinopril or losartan during pregnancy
FALSE! No pregnancy allowed!!
T/F: you should use non-selective beta blockers for clients with lung problems (ex. asthma)
FALSE! Selectives are used
does Hydralazine increase or decrease HR
increase due to it affecting the blood vessels & not the heart
Q: Which type of the following situations would required an increase in insuline or an additional insulin injection for an individual with TYpe 1 diabetes?
a. taking a nap
b. having acute appendicitis
c. running a marathon
d. eating a bag of halloween candy
b. having acute appendicitis
d. eating a bag of halloween candy
Q: A type 1 diabetic pt exhibits nervousness, pale skin, confusion, sweating, and increased pulse rate. Which of the following nursing actions is best?
a. pt is experiencing diabetic ketoacidosis, start and insulin drip
b. pt is hypoglycemic, check blood glucose level and administer carbohydrate if low
c. pt is hyperglycemic, check blood glucose level and administer sliding scale insulin as ordered by the physician
d. this is normal reaction for anyone with diabetes, monitor VS until symptoms pass.
b. pt is hypoglycemic, check blood glucose level and administer carbohydrate if low
Q: The portable or external insulin pumps are programmed by the client to deliver a basal insulin dose per hour and a bolus dose at meals as needed. Which type(s) os insulin can be used in insulin pumps?
a. NPH insulin
b. . insulin lispro (humalog)
c. insulin detemir (Levemir)
d. regular insulin (R)
b. . insulin lispro (humalog)
d. regular insulin (R)
Q: a nurse is caring for a type 1 diabetic pt. Pt is started on prednisone. Which of the following would the nurse expect to occur in relation to the pt’s new medi
amount of insulin will need to be increased
Q: in efforts to minimize adverse effects, which of the following strategies can be used in the prescribing of glucocorticoids?
a. use every other day
b. use the lowest dose possible
c. use localized meds
a. use every other day
b. use the lowest dose possible
c. use localized meds
Q: Nurse is caring for a 50-yr-old with moderate hypertension. Pt has no other comorbidities. Which of the following meds could be used as a first-line pharm treatment for Hypertension for this pt?
a. ace inhibitors
b. direct-acting vasodilators
c. calcium channel blockers
d. thiazide diuretics
a. ace inhibitors
c. calcium channel blockers
d. thiazide diuretics
Q: which of the following is a reason why a care provider might prescribe metoprolol, a selective beta blocker?
a. pt. has a history of gastric ulcers, and metoprolol has fewer GI effects
b. pt is a diabetic, and metoprolol has less of an effect on BS levels than non-selective beta blcokers
c. the pt. has COPD, and metoprolol will have minimal effects on lung function
c. the pt. has COPD, and metoprolol will have minimal effects on lung function
Q: which of the following is NOT a therapeutic effect of ace inhibitors and arbs?
a. decrease in cardiac muscle O2 consumption
b. decreased release of aldosterone
c. increased vasodilation
d. stabilization of cardiac remodeling
a. decrease in cardiac muscle O2 consumption
Q: the nurse should expect which of the following common side effects of nifedipine a calcium channel blocker?
a. paleness
b. bradycardia
c. headache
d. hypertension
headache
Q: which is an important pt teaching point to include for a pt receiving verapamil, a non-dyhydropyridine calcium channel blocker?
…
Q: When beta-adrenergic blocking drugs are administered, which condition might the person be at increased risk for?
a. hypotension
b. heart attack
c. tachycardia
d. stroke
a. hypotension
Q: a nurse is caring for a pt with Parkinson’s. Which drug groups that are used to control Parkinson’s would the nurse anticipate using for this pt?
a. anticholinergics
b. central acting smooth muscle relaxers
c. dopaminergics
d. indirect-acting cholineresterase inhibitors
a. anticholinergics
c. dopaminergics
