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NURS2500 Patho/Pharma > Week 7: Vascular Perfusion: Bleeding/Clotting, Anemia Hypertension > Flashcards

Week 7: Vascular Perfusion: Bleeding/Clotting, Anemia Hypertension Flashcards

1
Q

what is the difference between homeostasis and allostasis?

A

homeostasis: think BALANCE or stability of the systems that maintain life

pH
con. of different ions in the ECF (Na, Ca)
osmolality of ECF
glucose levels
arterial O2 tension

Allostasis -under stress defence mechanisms

adaptation to changing external and internal environment
arterial BP
HR
body core temp
con of circulating hormones
sleep-wake cycle
energy metabolism

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2
Q

what does hemodynamics consist of?

A

systemic circulation:
arteries supply tissues with nutrients and O2 rich blood
veins return blood to pulmonary circulation
Left atrium and left ventricle to aorta = back to right atrium and right ventricle

pulmonary circulation:
right atrium and right ventricle pulmonary artery to lungs - pulmonary veins to Left atrium and left ventricle

re O2 and returned to systemic circulation

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3
Q

what is CO = HR x SV?

A

cardiac output = heart rate times stroke volume
ex. 60 bpm x o.1 L/beat = 6 L/minute

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4
Q

what is cardiac preload?

A

this is when the volume of blood returned to the heart pre systole - which exerts pressure on the ventricle walls

description: filling force applied to the heart
when the heart stretches it generates more force to effectively pump the increased load - Frank Starling mechanism (has limits)

increased preload - increased O2 demand of the myocardium, but is more O2 efficient than increasing HR

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5
Q

what is cardiac after load?

A

description: the pressure the ventricle must overcome to eject blood into the arteries

when contraction - LV must generate more pressure than aortic diastolic pressure

pressure must be great enough to overcome peripheral resistance

reduced after load with vasodilators is a useful therapy for failing heart
increased after load can decrease stroke volume

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6
Q

what does perfusion connect to?

A

pain
cognition
elimination
gas exchange
mobility
nutrition
patient education
inflammation
intracranial regulation
stress and coping

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7
Q

true or false regarding how the body clots:

Perfusion is needed to sustain life, supply oxygen and nutrients to tissues.

When we have an injury, the body must a way stop losing blood while still maintaining perfusion to the tissues. This is a controlled process called hemostasis.

In order to form clots we only need platelets in the blood to work together to form the mature and functional fibrin clot

Platelets (thrombocytes) are blood cells made in the bone marrow and stored in the spleen.

The liver does not make most of the clotting factors.

A

false; third one - clotting factors as well

last one: the liver does

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8
Q

where does stem cells originate from?

A

bone marrow

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9
Q

what falls under stem cell?

A

erythroblast, myeloblast, mono blast, lymphoblast, megakaryoblast

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10
Q

what does megakaryoblast develop into?

A

megakaryoblast - megakaryocytes - thrombocytes (platelets)

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11
Q

what are the two pathways that fall under clotting cascade?

A

intrinsic and extrinsic

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12
Q

explain extrinsic pathway?

A

External cellular injury (trauma, laceration)
Collagen exposed in the vessels activates clotting.
Bacteria or inflammation can also trigger clotting
Generally Protective

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13
Q

explain intrinsic pathway?

A

No trauma: Internal conditions trigger clotting.
Venous stasis, lack of blood flow, plaques in vessels, too many clotting factors
Less protective, often problematic

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14
Q

what are some labs used to measure blood clotting?

A

Activated partial thromboplastin time (aPTT)

International normalized ratio (INR)

Prothrombin time (PT)

Platelet count

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15
Q

what is Activated partial thromboplastin time (aPTT)?

A

purpose:
Assessment of intrinsic coagulation by measuring factors I, II, V, VIII, IX, X, XI, XII

normal values:
25-35 sec

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16
Q

explain International normalized ratio (INR)

A

purpose:
Standardized way of reporting PT- compares PT with a control value

normal values
0.8-1.2

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17
Q

prothrombin time (PT)

A

purpose
Assessment of extrinsic coagulation(blood going from solid to semi solid) by measurement of factors I, II, V, VII and X

normal values
11-16 sec

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18
Q

platelet count

A

purpose
Count of number of circulating platelets

normal values
150X109/L to 400x109/L

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19
Q

what falls under problem clots: Virchow’s Triad

A

Blood Stasis
Hypercoagulability
Endothelial injury
- risk factors clot formation are associated with these parts of the triad.

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20
Q

true of false: A clot of this type is called a thrombus. A thrombus will trigger inflammation. A piece of the clot that breaks off and travels around the body is called an embolus.

A

true

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21
Q

true or false: deep vein thrombosis is a problem clots

A

true

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22
Q

select all that is true about DVT:
Thrombus forms in the deep veins
May be asymptomatic
Common symptoms include:
Calf or groin pain on affected side
Sudden onset unilateral edema Increased warmth
Redness (rubour) to affected limb

A

all true

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23
Q

how do you diagnosis for DVT?

A

Physical assessment, confirm with venous duplex ultrasonography

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24
Q

what is superficial vein thrombosis?

A

Usually superficial leg veins- close to the skin surface
* Tenderness, rubour, warmth, pain, inflammation and induration along the vein
* Vein appears as a palpable cord
* Edema rarely occurs
* If left untreated, DVT can occur

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25
Q

true or false: DVT is a risk for pulmonary embolism - clot breaks off and blocks blood flow in lungs: emergency

A

TRUE

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26
Q

what is a life threatening complication of VTE?

A

pulmonary embolism!!!

Blockage of pulmonary artery by air, fat, tumor tissue or a thrombus
Lodges in blood vessel obstructs perfusion of alveoli
30% mortality in untreated clients
Diagnosis plus anticoagulant therapy mortality rate is 6-8%

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27
Q

what could be possibly happening in the life threatening complication of VTE : pulmonary embolism ?

A

cutting the circulation into your lungs causes to have difficulty breathing, and short of breath

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28
Q

Anemia Critical Values : Hgb often looked at clinically
how much is the value in men and women?

A

<135 in men, <120 in women

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29
Q

Anemia Critical Values L
Do men and women share the same general signs and symptoms?

A

yes they do share the same general signs and symptoms

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30
Q

True or False. With Anemia Critical Values : S & S influenced by severity more than etiology.

A

true

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31
Q

Do we look at age, and underlying health in when we are looking at anemia critical values.

A

yes we do.

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32
Q

is this true, in terms of hematocrit M 42- 52 % , F 37-47% , is this the correct value ?

A

yes it is the correct value

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33
Q

Define the signs and symptoms within the value

Hct > 30- 35%
Hct 25-30%
Hct 20-25%
Hct 15-20%
Hct < 15 %

A

no symptoms
fatigue, malaise
SOBOE, dyspnea
light- headed, confusion
death, MI, etc.

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34
Q

what is the normal range of hgb for male and female ?

A

M 140 - 180
F 120- 160

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35
Q

what are the two types of anemia we covered in class ?

A

anemia due to decreased production of RBC
anemia due to blood loss ( acute and chronic )

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36
Q

what are the characteristics of anemia due to decreased production of RBC

and what are the characteristics of anemia due to blood loss ( acute & chronic )

A

anemia due to decreased production of RBC
1. Iron deficiency anemia
2. Vitamin B12 deficiency anemia
3. Folic Acid deficiency anemia

Anemia due to blood loss ( acute & chronic )
1. bleeding

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37
Q

what does iron essential for?

A

involved in the procces of making hemoglobin

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38
Q

when we don’t have enough iron/ we have iron deficiency anemia what do we call that ?

A

microcytic

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39
Q

where is iron store in our body ?

A

liver and muscle tissue

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40
Q

define if this is a TRUE or FALSE statement regarding iron the body

  • we do not recycle the vast majority of the iron in our body
  • red blood cells live for 220 days and when they are they open up
A

false, we do recycle the vast majority of the iron in our body

false, red blood cells live for 120 days and when they are broken down ( not open up)

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41
Q

What do we keep and reuse in the body

A

iron

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42
Q

true or false. We excrete only 1 mg iron/day ?

A

true

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43
Q

name characteristics about iron- deficiency anemia

A

most common worldwide
decrease iron impedes synthesis of Hgb –> less o2 transported

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44
Q

etiology of iron deficiency anemia

A

inadequate dietary intake of iron, especially during growth spurts or pregnancy

chronic blood loss from GI ulcer, hemorrhoids, cancer , or excessive menstrual flow = loss of iron from body as blood is lost ( not re-cycled ) - results in low iron stores

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45
Q

true or false. Etiology of iron deficiency anemia : impaired absorption of iron resulting from gastritis, chronic inflammatory bowel disease, or diarrhea can be a caused?

A

true

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46
Q

Signs & Symptoms of iron - deficiency anemia:

A

weakness
pallor
low exercise tolerance
Fatigue
fissures at corners of mouth
serum Hgb and HCt decreased
serum ferritin decreased
serum iron decreased

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47
Q

How is Iron deficiency anemia treated ?

A

change in diet- include iron-rich foods meat. fish, poultry, beans, peas, lentils, some fruits, and vegetables, iron fortified, flour, pasta, cereals

treat/heal GI tract if bleeding is cause

iron supplement (ferrous, coated, duodenum)

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48
Q

what is an example of iron supplement ?

A

ferrous sulfate

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49
Q

Iron is best absorbed as ferrous sulphate in what environment ?

A

acidic environment

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50
Q

Iron supplement : Ferrous suplhate can only be taken as an oral tablet

A

false, it can be taken as a liquid administration as well along with oral tablet

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51
Q

true or false. Ferrous sulfate is taken 3 hours prior to meals

A

false, it’s taken 1 hour before

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52
Q

What type of vitamin helps increase absorption of iron?

A

vitamin c

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53
Q

true or false .
Iron supplement : Ferrous Sulfate
undiluted liquid iron may stain teeth - give diluted through a straw

A

true

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54
Q

iron supplement : Ferrous Sulfate. Gastrointestinal side effects

A

heartburn, constipation, and diarrhea

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55
Q

select all that is true about VTE: Pulmonary Embolism:
Blockage of pulmonary artery by air, fat, tumor tissue or a thrombus
Lodges in blood vessel obstructs perfusion of alveoli
30% mortality in untreated clients
Diagnosis plus anticoagulant therapy mortality rate is 6-8%

A

all true

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56
Q

Makes red blood cells, but also had a place in neuro- numbness and tingiling with iron deficiency anemia ( this can lead into confusion and memory loss)

A

vitamin b12

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57
Q

what kind of embolism is this? rare cases surgery will be performed to remove the clot

A

saddle embolism

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58
Q

what are some pharmacological treatment of clotting disorders?

A

Anticoagulants: Heparin, enoxaparin, warfarin

Antiplatelet drugs: Aspirin, clopidogrel

Thrombolytics: Alteplase (tPA)

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59
Q

true or false: We can use three drug classes (anticoagulants, antiplatelet and thrombolytic) to treat clients who are at risk for blood clots, or clients who have formed blood clots.

A

true

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60
Q

DRUG CARD: Anticoagulants: Heparin

A

injection/ IV only
inactivates two major clotting factors in blood (Xa and Thrombin) - causes clot action to supress
rapid acting (works in minutes)
used to prevent formation of clots, OR extension of DVT or Pulmonary Embolus (PE) so that those clots do not enlarge or break off into emboli.
ADVERSE EFFECTS: risk of bleeding. possible hypersensitivity reactions

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61
Q

Deficiency causes impaired DNA formation- results in a larger than normal cell. These abnormalities target the cell for early destruction. What is this describing ?

A

Vitamin B 12 deficiency anemia ( cobalamin)

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62
Q

true or false: Anticoagulants: Heparin is rapid acting works within minutes?

A

true

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63
Q

does anticoagulants (Heparin) Needs close monitoring?

A

yes, We use aPTT to measure effectiveness of heparin (if IV every 6-8 hours)

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64
Q

Name characteristics about vitamin b 12 deficiency anemia ( coablamin )

A

can be rarely caused by dietary deficiency ( vegan diets, low protein diets ). Usually caused by conditions that affect the bowel such as chronic diarrhea, celiac disease or intestinal surgery

failure to absorb B12 from lack of intrinsic factor in gut needed to uptake the vitamin ( automimmune )

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65
Q

what is the antidote drug in case of overdose for anticoagulant heparin?

A

protamine Sulfate

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66
Q

DRUG CARD: Anticoagulants Enoxaparin

A
  • form of heparin chemically altered to have shorter molecule chain, makes a “low molecular weight” heparin
    Inactivates one important clotting factor (Xa)
    works well as heparin SAFER AND EASIER TO USE, highly predictable effects. Used to prevent and treat DVT and PE.

given injection, no monitoring of aPTT
can be administered at home
longer half life than heparin: lasts longer
Adverse effect: risk fo bleeding

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67
Q

Neuropathy occurs only with_______, as lack of B12 affects nerve function.

A

B12 deficiency

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68
Q

what is the overdose treatment for anticoagulant enoxaparin?

A

protamine sulfate (same as heparin bc they are similar)

69
Q

What are the signs and symptoms of Vitamin B12 deficiency anemia ?

A

Jaundice
Pallor
Glossitis ( red smooth beefy tongue )
Fatigue
Weight loss
Paresthesias of feet and hands
- Serum Hgb & Hct decreased
-Serum B12 decreased

70
Q

DRUG CARD: Anticoagulants: Wafarin

A

suppresses four clotting factors made using vitamin K. Warfin INHIBITS Vitamin K being activated in body, so clotting factor cant be made normal - decreased 30-50%

highly protein bound : takes a long time

long term prevention (DVT and PE) oral med

frequently monitored to ensure therapeutic levels: monitor INR (min is monthly)

adverse: drug interactions with many other drugs, risk of bleeding

Antidote for overdose: Vitamin K

71
Q

what drug inactivates only one clotting factor (Xa)?

A

Enoxaparin anticoagulants

72
Q

DRUG CARD: Antiplatelet: Aspirin (ASA)

A

surpasses platelets clumping together by inhibiting COX. platelets need COX to synthesize TXA - one factor that makes platelets aggregate together
oral
assess ASA use before procedures that cause bleeding (surgery)

used to reduce risk of clotting that cause stroke or myocardial infraction

side affect: increased risk of bleeding, GI bleeding, stomach ulcers

73
Q

Vitamin B12 ( Cyanocobalamin) ( name the characteristics )

A

purified form of b12

can be given orally, intranasally , or by injection

if diet is the cause nutritional education is required. May also treat underlying cause if malabsorption is the issue

74
Q

Vitamin B12
( cyanocobalamin )
if lack of intrinsic factor is the cause, will be treated with parenteral B12 given by injection ?

A

yes, this is indeed true

75
Q

Vitamin B12
( Cyanocobalamin ): when injected is usally start with maintenance dose an taper down to monthly for life

A

nope, nope, nope. LOADING dose

76
Q

what are the side or adverse effects of vitamin b12 (cyanocobalamin)?

A

rare

best if treated significant neuro symptoms - may not reverse

77
Q

DRUG CARD: Antiplatelet: Clopidogrel

A

stops platelets from aggregating by blocking receptors on surface or platelets

Irreversible binding like ASA, effects last the life of the platelet (7-10 days)

platelet aggregation reduced by 40-60%

oral, liver converts into active form

used to prevent clots - specific clots in heart’s arteries

adverse: abdominal cramping, heartburn, diarrhea. Risk for bleeding.

78
Q

what is a higher risk for cancer if long term used ?

A

folic acid

79
Q

which two drugs are irreversible when given to bound platelets (last the life of platelet 7-10 days)

A

antiplatelet Clopidogrel and Aspirin ASA

80
Q

Folic Acid deficiency anemia what are the signs and symptoms?

A

jaundice
pallor
fatigue
weight loss
serum Hgb & Hct decreased
Serum folate decreased

81
Q

Thrombolytic: Alteplase (tPA)

A

IV - short acting

used to treat life-threatening clots in brain (stroke) heart (myocardial infraction) or lungs (pulmonary embolus)

Tissue plasminogen activator: tPA. This is a substance normally in our body that is used to break down old clots that have done their job after healing has occurred. We give it here as a medication.

breaks down clotting factors, and the fibrin that holds thrombi together. Lyses clots that are already formed. Also called fibrinolytics and “Clot busters”

Side/adverse effects: Can cause severe bleeding. Cannot form new clots.

82
Q

Folic acid deficient anemia :folic acid is the natural vitamin while folate is the synthethic.

A

false, it’s the other way around.

83
Q

what are some signs of bleeding?

A

bruising, ecchymosis, petechiae

Hematuria

Vomiting blood

Retroperitoneal tenderness

Bleeding gums

Melena

Stiff/boardlike or painful abdomen

Low BP, high or low HR Sao2

fatigue

Epitaxis

Positive occult blood (fecal test)

Cullens sign (brusie around peri-umbilical region)

Decreased LOC, confusion

84
Q

Folic Acid deficiency anemia : like B12 deficiency , Folic Acid causes what ? which an result in what ?

A

impaired DNA formation, result in a larger than normal cell, these abnormalities target the cell for early destruction

85
Q

Folic acid deficiency anemia can be caused poor nutrition, especially diet, now name those ditet?

A

diet low in leafy vegetables, citrus , dried beans and nuts. Uncommon in US and Canada due to fortified foods.

86
Q

DRUG CARD: Anti-fibrinolytic: Aminocaproic acid

A

stops normal process of fibrin breakdown that usually occurs when clot has served its use

preserves a clot or stabilizes one

most useful for preventing reoccurring bleeding, not used to manage severe ongoing bleeding (denture surgeries for at risk clients)

IV or oral

Can be given to treat severe bleeding caused by alteplase (tPA).

87
Q

True or false. Folic acid deficiency can also be intestinal malabsorption caused by conditions that affect the gut such as Crohn’s disease.

A

true

88
Q

True or false. Medications CANNOT lead to folic acid deficiency ( especially oral contraceptives)

A

false, they can lead to folic acid deficiency

89
Q

What if the problem is bleeding itself?

A

patient have conditions that increase risk of bleeding and low platelet count known as thrombocytopenia.

90
Q

Folic acid should be used long term, and diet changes should be altered.

A

false, folic acid should be used short term, however diet changes should be altered that is correct.

91
Q

not enough platelets = ?

A

abnormal bleeding can occur

92
Q

Changes to diet are required or treatment of underlying condition to improve absorption of folate. When using Folic acid.

A

true.

93
Q

what are some assessment findings for thrombocytopenia (objective data)

A

general -
fever lethargy

integumentary-
petechiae, ecchymoses, purpura

gastro intestinal
splenomegaly, abdominal distension, guaiacpositive stools(blood in stool)

possible findings: decrease in hemoglobin and hematocrit

94
Q

folic acid is active when administered, activated in the body

A

false, inactive.

95
Q

Folic acid is taken orally as a supplement

A

yes this is true

96
Q

what are some signs of bleeding in skin?

A

petechiae, Purpura, Ecchymosis

97
Q

what are the side or adverse effects of folic acid.

A

long term use can increase risk of certain cancers

98
Q

Question: A client with a venous thrombo-embolism (VTE) is started on enoxaparin and warfarin. The client asks the nurse why two medications are necessary. Which of the following responses by the nurse is accurate?

  1. “Administration of two anticoagulants reduces the risk for recurrent venous thrombosis.”
  2. “Enoxaparin will start to dissolve the clot, and warfarin will prevent any more clots from occurring.”

3.“The enoxaparin will work immediately, but the warfarin takes several days to have an effect on coagulation.”

  1. “Because of the potential for a pulmonary embolism, it is important for you to have more than one anticoagulant.”
A

3.

99
Q

Anemia from blood loss
blood loss may be

A

acute ( develops quickly from an an active bleed )

chronic ( develops slowly as small amounts of blood are lost over a long period of time )

100
Q

Blood loss acute and chronic, what is under it ?

A

Acute
- trauma
- blood vessel rupture

chronic
- gastritis
-menstrual flow
-hemorrhoids

101
Q

not enough O2 attached to RBC, not able to distribute enough to body - very detrimental?

A

true

102
Q

this is when internal bleed may go unnoticed - causing you to have abdominal pain, back pain, hidden in bowel

A

acute blood loss

103
Q

In acute blood loss: what can happen?

A

may first be noticed with low blood pressure and increase in heart rate ( can become tatcharydia)

rapid, acute blood loss, body cannot adjust if too much blood leaves vascular system

104
Q

this is when the body can adjust but may use up iron stores - appears as an iron deficiency anemia

A

chronic blood loss

105
Q

in chronic blood loss: what can happen?

A

heavy exercise menstrual periods can become a concern if too much blood is lost

bleeding from bowel, gastritis, ulcer may be slow and unnoticed ( FOBT ) fecal occult blood test

106
Q

Treatment of anemia from blood loss

A

if acute need to determine cause and treat it ( stop acute bleeding )

may replace blood or components of blood ( transfusion)

if chronic need to determine cause and treat it ( stop chronic bleeding )

107
Q

which one is the most in leukocytes?
basophils
monocytes
eosinophils
lymphocytes
neutrophils

A

neutrophils

108
Q

what does blood contain the most?
fibrinogen
globulin
prothrombin
albumin

A

albumin

109
Q

Treatment of anemia from blood loss

iron supplements are common treatment to replace lost iron and rebuild the body’s stores so that normal RBC production can resume in the bone marrow?

true or false

A

true

110
Q

what is one route of stem cell formation?

A

erythroblasts - normowblast - reticulocyte - erythrocytes (RBC’s)

111
Q

Treatment of anemia from blood loss

some other treatments might include hematopoetic agents ( what type of agent are we talking about )

A

erythropoetin

112
Q

whats an immature RBC?

A

Reticulocyte

113
Q

what is the lifespan of RBC

A

120 days

114
Q

what does CBC mean

A

complete blood count

115
Q

hematopoetic growth factors : Epoetin Alfa ( Erythropoetin )
what type of hormone is this ?

A

hormone that is normally made in the kidneys which stimulates RBC production in the bone marrow

116
Q

true or false: Hemoglobin and hematocrit amounts vary between genders
* A low hemoglobin/ hematocrit could signal anemia

A

true

117
Q

lab values for anemia:

A

hemoglobin (hg)

Hematocrit (Hit)

Reticulocytes

Serum iron

Ferritin

Transferin

Serum B12 - lab values show if there’s deficiency for RBC production

Folate - rbc production

118
Q

this is used to increase erythrocyte counts in clients which chronic anemia due to certain diseases ( cancer, kideny disease), or before a surgery or procedure where bleeding might occur

A

hematopoetic growth factors: epoetin alfa ( erythropoetin)

119
Q

hematopoetic growth factors: epoetin alfa ( erythropoetin) is administered orally ?

A

no intravenously

120
Q

what is transferrin ?

A

Iron is bound to a globulin protein called transferrin and carried to the bone marrow for incorporation into hemoglobin. Transferrin exists in relationship to the need for iron. When iron stores are low, transferrin levels increase, whereas transferrin is low when there is too much iron.

121
Q

Is this true or false. Small doses should be given to gradually raise erythrocyte levels. Levels that rise too quickly can lead to adverse effects that can be severe .

A

true

122
Q

What happens when we don’t have enough red blood cells (anemia)?

A

Blood cannot carry enough oxygen to cells.
* Without enough oxygen to part of the body these symptoms can occur

122
Q

what are the side/adverse effects of erythropoetin

A

can cause hypertension, can cause MI ( Myocardial infraction), clots and cardiac arrest if hemoglobin increases too much. Cannot given if hemoglobin is 110 g/ L or higher.

123
Q

signs and symptoms of anemia

A

skin: general pallor
cool to touch
patient cant tolerate cooler temperatures
chronic: nails are brittle and concaved

Cardio:
continuous rapid heartbeat and increases with meals and activity
severe-abnormal heart sounds
orthostatic hypertension

respiratory: breathless on extortion
decreased O2 sat levels

neurologic:
fatigue
increase need for sleep
reduced energy levels

124
Q

The nurse is caring for a client who is showing signs of anemia. Which question by the nurse is most appropriate ?

how many miles can you run before you are fatigued?
do you feel difficulty falling asleep at night?
do you ever feel short of breath ?
is your heart rate abnormally slow ?

A

do you ever fell short of breath ?

125
Q

How does the body respond to a blood pressure that is too low : Hypotension?

A

Sympathetic nervous sytsem reacts to low BP with increased HR and arterial vasoconstriction

126
Q

This happens when the blood pressure is too low ( hypotension)
the arteries get smallers ( trying to increase the blood pressure, in other words narrowing the sides to constrict ?)
true or false.

A

true

127
Q

which lab value assesses intrinsic coagulation? extrinsic coagulation?

A

intrinsic - aPTT
extrinsic - prothrombin time (PT)

128
Q

risk factors for impaired perfusion: Perfusion
Population risk factors :

A

black Canadians and people of South Asian descent hae increased rates of HTN and develop it at younger ages

indigenous adults have a higher prevalence of HTN than the overall Canadian population

HTN is more common in older women than older men

129
Q

Risk Factors for impaired perfusion: Modifiable risk factors

A

smoking : nicotine vasocontricts
elevated serum lipids
sedentary lifestyle
obesity
diabetes millitus
hypertension

130
Q

what are the unmodifiable risk factors

A

age : increases with age
gender: men > women
genetics : family history

131
Q

how is htn diagnosed ?

true or false. Nurses do not diagnose, but it is important to know that one high measurement alone does not mean hypertension

A

true

132
Q

the diagnosis of hypertension is complex ?

A

true it is complex

133
Q

When diagnosing hypertension, it is required more than one measure on more than one visit within a month.

This makes sure that outside factors like stress or exercise are not cause of the high blood pressure.
True or false?

A

true

134
Q

what is the high blood pressure considered ?

A

140/90 mmHg

135
Q

what are the two type of hypertension?

A

primary/ essential hypertension
secondary hypertension

136
Q

Name the characteristics under Primary/ Essential Hypertension

A

Most common type
cause is unknown
90 - 95% clients

137
Q

name the characteristics of secondary hypertension

A

less common
cause is usually an underlying disease or medication
5- 10 % adults with HTN
80 % children with HTN

138
Q

Clinical Manifestations of Hypertension

A

known as a silent disease. almost all clients are asymptomatic = this is why screening is so important

clients who are untreated may have end organ damage to kidney

139
Q

there are some symptoms that may occur with very SEVERE HTN : what are they ?

A

Fatigue
Dizziness
Palpitations
Angina
Dyspnea
Low exercise tolerance

140
Q

why do you feel dizziness when hypertension ( severe ) might be occurring ?

A

get too much pressure in the brain

141
Q

How do we treat hypertension?

A

First line : lifestyle changes including :
- weight loss if indicated
-dietary changes ( DASH diet : healthy foods, low sodium, low saturated fat, reduce alcohol)
-regular physical activity
- smoking cessation

142
Q

true or false. If after approx. 3 months lifestyle factors have not reduced BP, then pharmacotherapy will be initiated.

A

true

143
Q

Pharmacological treatment of hypertension ( many medications for hypertension). true or false.

A

true

144
Q

what are the 3 types of treatment for hypertension

A

diuretics :
thiazide diuretics (hydrochlorothiazide)

loop diuretics ( furosemide)

potassium sparing diuretics (spironolactone)

ACE inhibitors : captopril

Beta- Adrenergic Blockers : Metaprolol

145
Q

Diuretics
- decrease in the stroke volume - decrease in the blood pressure

what are the two things you want to know when taking a diuretics?

A

how strong it is ? and what is it doing to the potassium

146
Q

the closer to the nephron, the more effective the drug is at removing water and solutes from the system.

A

diuretics

147
Q

Diuretics : Thiazides : hydrochlorothiazide

A

first line drug for hypertension in Canada

148
Q

true or false. Thiazide : hydrochlorothiazide is taken within during the bedtime and not taken during morning and lunch.

A

false, it is the opposite

149
Q

Diuretics : Thiazides : hyrochlorothiazidde work through two mechanism : what are those mechanisms ?

A

reduce blood volume and reduce arterial resistance

150
Q

This causes increased urination, take orally in the morning or lunch.

A

Thiaizdes : hydrochlorothiazide

151
Q

what are the side/adverse effects of Diuretics : Thiazides : hyrochlorothiazidde

A

causes hypokalemia
cause hypotension, hypovolemia

clients should be encouraged to eat potassium-rich foods like bananas, and citrus. May take potassium supplements or add a potassium- sparing diuretic like spironolactone

152
Q

Diuretics : Loop: furosemide

A

stronger diuretic because it works on the loop of henle where most of the sodium and chloride is reabsorbed

capable of producing profound diuresis : removes excess water quickly

153
Q

this is not commonly used to treat general hypertension because they are too strong but may be used in certain cases.

A

furosemide

154
Q

Can Furosemide be given orally, and intravenously? and given during the night ?

A

false, it can be given oraly and iv, however it is taken during the morning/da as it will cause frequent urination

155
Q

Furosemide= lower blood volume and promote vasoconstriction?

A

false, not constriction but dialation

156
Q

what are the side/ adverse effects of furosemide ?

A

causes hypokalemia ( may need supplements), hyponateremia ( low sodium ), dehydration, hypotension, hyperglycaemia, may lead to ototxocity and hearing loss.

157
Q

Potassium - Sparing: Spironolactone

A

causes a small degree diuresis to help manage hypertension. not effective enough at diuresis to be used alone to manage HTN.

used to help when other HTN therapy decreases potassium in the body ( furosemide, thiazides ).

conserves potassium causing potassium to be reabsorbed in the kidney

158
Q

what are the side effects or adverse effects of spironolactone

A

hyperkalemia, this can be very dangerous as it affects functioning of the heart. HAs endocrine effects. Can cause gynecomastia ( an overdevelopment or enlargement of the breast tissue in men or boys) , menstrual irregularities

159
Q

the characteristics of ACE INHIBITORS : captoril

A

inhibit the renin - angiotension - aldosterone system ( RAAS)

work by stopping conversion of angiotensin I to angiotensin II

dialte blood vessles decrease blood volume

less effective in african americans

160
Q

what are the side/ adverse effects of ace inhibitors ( captoril )

A

risk of first dose hypotension
with captopril

risk of hyperkalemia

may cause renal injury in patients with renal conditions

also prevent breakdown of bradykinin. by Ace. this can lead to side effects such as angioedma and dry cough

hypotension

161
Q

True or false. Ace inhibitors and ace kinase are physically the same thing?

A

yes

162
Q

beta Adrenergic Blockers : Metoprolol

A

Also called Beta- blockers , BB ( Beta antagonists ) Target SNS

163
Q

Beta Adrenergic Blockers : Metoprolol
Block beta 1 cardiac receptors :

A

this decreased heart-rate and contractility so cardiac output falls

suppresses reflect tachycardia caused by vasodilators

164
Q

Beta Adrenergic Blockers : Metoprolol : block beta 1 renal receptors : renin release is increased whic will decrease Bp via inhibition of the RAAS

A

false, it decreased , which will decrease the BP

165
Q

true or false. Beta Adrenergic Blockers : Metoprolol decreases systemic vascular resistance if taken long term ( MOA unknown)

A

true

166
Q

side/ adverse effects of Beta Adrenergic Blockers : Metoprolol

A

bradycardia, low cardiac output, hypotension, masks signs of hypoglycemia. May result in dizziness, lightheadness

167
Q

Was there a common side/adverse effect you noticed for the antihypertensive medications?

A
  • many drugs hypokalemia, especially if they work on the kidney.

-all antihypertensive therapy has the potential to cause hypotension, or a blood pressure that is too low.

NURS2500 Patho/Pharma (16 decks)

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