WK 2: HTN and HLD Flashcards
Afterload
pressure ventricles must work against to open the semilunar valves to pump blood out of the heart to the lungs/body
Preload
amount the ventricles stretch at end of of diastole
-the relaxation / filling phase of ventricles
myocardial contractility
strength of cardiac cells to contract or shorten
cardiac output
the amount of blood that the heart pumps out in one minute
CO= HR x SV
it maintains tissue perfusion
Ejection fraction
What is it?
what is a normal ejecton fraction?
% of blood pumped out of the left ventricle with EACH contraction
NML= >50%
heart failure = <40%
infarction
blocking of blood flow to a certain area, causing tissue death
ischemia
tissue perfusion has decreased but is not totally cut off, resulting in hypoxia
stroke volume
amount of blood pumped by a ventricle with each beat
stroke volume is affected by: contractility, preload and afterload
pulsus alternans
an arterial pulse with alternating strong and weak beats
venous thromboembolism
obstruction of a blood vessel by a a clot that has been dislodged from another site
commonly starts in legs and moves to lungs (PE)
perfusion
passage of fluid through the circulatory system to tissue, oxygenating the tissue
perfusion
passage of fluid through the circulatory system to tissue, oxygenating the tissue
what is the formula for cardiac output ?
CO= HR x SV
What can alter a persons cardiac output?
HR
SV
myocardial contractility
EX. medications, Dz processes, activity
What is pulse pressure?
the difference between systolic and diastolic BP
NML= 1/3 of SBP
Ex: BP of 120/80
120-80= a pulse pressure of 40, this is normal
what is peripheral vascular resistance?
the amount of effort that the heart has to overcome in order to get the blood out of the heart and into the periphery
HTN
pressure in your arteries is higher than it should be
-causes adverse effects to arterial walls
-changes in arterial walls leads to PVR, leading to decreased peripheral perfusion over time
What is an elevated BP range
systolic: 120-129
Diastolic: less than 80
What is the range for stage 1 HTN
systolic: 130-139
diastolic: 80-89
what is the range for stage 2 HTN
systolic: 140 or higher
diastolic: 90 or higher
what is the range for a hypertensive crisis
systolic: higher than 180
diastolic: higher than 120
What are some modifiable factors that influence blood pressure?
DM, elevated lipid serum lipids, excess sodium intake, obesity, sedentary lifestyle, stress, tobacco use, alcohol use
what are some non-modifiable risk factors that influence blood pressure?
genetics, family hx, race/ethnicity, increasing age, gender, chronic kidney Dz, obstructive sleep apnea
complications of HTN
cardiovascular Dz
MI
HF
stroke
PVD
renal Dz
retinal Dz
nursing care of HTN
-determine risk factors and assist with changing
-promote heart healthy nutrition
-weight reduction if needed
-encourage balance of rest & activity
-smoking cessation
-medication management
-BP monitoring
-collaboration
-patient education
What symptoms indicate that you are having a hypertensive crisis and should see a physician ?
BP >180/110
severe HA
dyspnea or CP
Dizziness, numbness, and weakness
loss of vision
difficulty speaking
nosebleed/ epistaxis
severe anxiety
unresponsive
what is the difference between a hypertensive emergency and hypertensive crisis
HTN emergency: develops in hours-days, BP>220/140, targets organ diseases
HTN urgency: develops over days to weeks, BP>180/110, NO target organ disease.
EMERGENCY requires fast reversal wile URGENCY requires slow reversal
what are some causes of hypertensive crises?
medication non-compliance
drug abuse
head injury
preeclampsia/eclampsia
phenochromocytoma
Acute aortic dissection
lifestyle modifications of HTN
manage BP
control cholesterol
reduce BG if a diabetic
eat better (DASH diet)
loose weight
stop smoking
limit alcohol
stress modifications
What is hypotension?
why do we care if a patient is hypotensive?
systolic BP is less than 90
we care d/t concerns about the patients tissues getting perfused
-before reacting, check patients baseline BP and see if they are symptomatic
Sx of hypotension
pallor/ skin mottling/ clamminess
decreased brain perfusion -> LH/dizzy/syncope/confusion
burred vision
CP
increased HR
decreased urine output
N/V
nursing implementations of hypotension
monitor VS frequently
assess symptoms
treat cause
consider adding salt to diet
increased fluid intake
compression stockings
medications
what kind of patients typically get orthostatic hypotension?
elderly
bed rest pt
pregnant pt
pt w/o high blood volume
How do you diagnose someone with orthostatic hypotension?
-measure BP lying down/sitting/standing
-measurements done within 3 minutes of position change
SBP-decreases by 20
DBP- decreases by 10
nursing care for a patient with orthostatic hypotension
-slow position changes
-don’t cross legs
-early ambulation
-balance rest and activity
-isometric exercises before standing
-compression stockings
-don’t stand for long periods of time
-risk factor for falls
why do we care if a patient has high cholesterol levels?
it can lead to atherosclerosis which overtime can lead to poor perfusion, CAD, peripheral artery Dz and MI’s
When should a person get tested for HLD?
test at 20 y/o, then test evert 4-6 years
how long does a person need to fast prior to their cholesterol testing?
9-12 hours
What should a patients levels be for cholesterol?
overall cholesterol
LDL
HDL
cholesterol <200
LDL <130
HDL
males should be >45
females should be >55
HLD Nursing Care
-check, change, control
-maintain healthy weight
-be active
-limit smoking and alcohol
-dietary modifications
-lipid-lowering drug therapy
what diet modifications should be enacted for a patient with HLD?
-reduce saturated and trans fats
-increased complex carbs (whole grains, fruits, veggies)
-limit major sources of cholesterol (yolk, whole milk)
-limit alcohol and simple sugars
-eat fatty fish weekly
-eat foods high in omega 3 (soybean oils, canola, walnuts, flax seed)
what diet modifications should be enacted for a patient with HLD?
-reduce saturated and trans fats
-increased complex carbs (whole grains, fruits, veggies)
-limit major sources of cholesterol (yolk, whole milk)
-limit alcohol and simple sugars
-eat fatty fish weekly
-eat foods high in omega 3 (soybean oils, canola, walnuts, flax seed)
who is at risk for a venous thromboembolism
pt wit venous stasis (bed rest)
pt with hyper-coagulability(thick blood)
pt with endothelial damage
S/Sx of VTE (venous thromboembolism)
localized redness, tenderness, and swelling
warmth, tenderness, firmness over muscle calf
calf pain w/ ambulation
unilateral size of legs
how would one diagnose of VTE?
obtain Hx
physical assessment
vascular US
nursing care to prevent VTE
assess symptoms
measure calf
check for calf tenderness/phlebitis
early ambulation/ activity
TED stockings
SCD’s
calf pumping
VTE treatment
prevention is key
anticoagulation
thrombolytic
IVC filter
diagnostics related to cardiovascular system
- CBC
Hgb: iron containing pigment needed for O2 to travel
females should be 12-16, males should be 14-18
Hct: % of total volume of blood that is made up of RBC. women should be 37-47% men should be 42-52% - fasting lipid panel
LDL, HDL, triglycerides - CXR
- EKG: conduction of the heart
What are some cardiovascular nursing problems?
risk for unstable BP
activity intolerance
decreased cardiac output
ineffective tissue perfusion
fatigue
impaired gas exchange
ineffective airway clearance
fluid volume issues
risk for injury
S4
atrial gallop
“TEN-nes-see”
S3
ventricular gallop
“ken-TUCK-y”
