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NSG 2202 > Related Circulatory Stressors/Test 2 > Flashcards

Related Circulatory Stressors/Test 2 Flashcards

1
Q

Hypertension defined as

A
  • sustained elevation of b/p
  • diagnosis requires that increased readings be present on more than one occasion during several weeks
  • HTN makes the heart work harder, putting both the heart and vessels under strain, and contributing to other disorders
  • considered a “silent” disease
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2
Q

A HTN heart is _____ and has _____ ventricles

A

bigger and thickening

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3
Q

Optimal b/p is

A

<80

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4
Q

Normal b/p is

A

<85

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5
Q

High normal b/p is

A

130-139 and 85-89

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6
Q

HTN Stage I b/p is

A

140-159 and 90-99

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7
Q

HTN Stage II b/p is

A

160-179 and 100-109

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8
Q

HTN Stage III b/p is

A

> 180 or >110

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9
Q

Hypertension etiology- Primary (essential) hypertension

A

no identifiable cause; accounts for 90%-95% of all cases

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10
Q

Hypertension etiology- Secondary hypertension

A

a specific cause can be identified and corrected, like:
*Renal disease *sleep apnea
*Endocrine disorders *Aorta narrowing
*Brain tumors *Pregnancy-induced
*SNS stimulants
(cocaine, MAO inhibitors, oral contraceptives, NSAIDS, estrogen replacemen therapy)

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11
Q

Manifestations of hypertension
What are it’s early symptoms?
Second symptoms may include:

A 
No early symptoms
Second symptom:
*Fatigue
*decreased activity intolerance
*Dizziness
*palpitations
*Angina
*Dspnea
If extremely high- HA, blurred vision, nosebleeds
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12
Q

Modifiable HTN risk factors

A
  • Excessive alcohol ETOH intake
  • Smoking
  • Uncontrolled DM
  • increased serum lipids
  • Excess dietary Na+
  • Obesity
  • Sedentary lifestyle
  • Stress
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13
Q

Non-modifiable risk factors HTN

A
  • Socioeconomic status
  • Family history
  • Ethnicity
  • Gender
  • Age
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14
Q

Controls of Blood Pressure

A
  • SNS- sympathetic nervous system
  • RAAS- renin angiotensin aldosterone system
  • CO and SVR
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15
Q

Order of controls of b/p

A

Heart+increased salt intake= High b/p

Heart-renin, angiotensinogen I,(andgiotensin converting enzyme), angiotensinogen II, = high b/p or from angiotensinogen II back to heart to aldosterone to high b/p

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16
Q

Treatment of HTN

A
  • weight reduction
  • DASH eating plan
  • Na++ reduction
  • ETOH
  • Exercise
  • Smoking
  • Stress
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17
Q

Treatment of HTN 2 main actions:

A
  1. decrease circulating voluem- thiazide diuretics and loop diuretics
  2. Reduce SVR (stroke volume rate)- adrenergic SNS inhibitors, andiotensin inhibitors, direct vasodilators
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18
Q

Treatment of HTN, stepped are approach

A

Go low and slow

  • diuretics 1st med to be used- usually thiazide
  • Beta blockers
  • Calcium channel blockers
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19
Q

If b/p goes up stay on

A

diuretics and change to ace inhibitors

  • angiotensin II receptors antagonists
  • alpha blockers, central
  • alpha blockers, peripheral
  • alpha, adrenergic blockers
  • vasodilators
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20
Q

Pharmacological approach

A
  1. diuretics- thiazides-HCTZ, potassium sparing-triamterene, loops-lasix, aldosterone receptor blockers-aldactone, combination-dyazide-HCTZ/triamterene
  2. Beta blockers- metoprolol (lopressor) or atenolol (Tenormin)
  3. Calcium channel blockers- cardiazem
    - ace inhibitors-zestril
    - ace receptor blockers- valsartan
    - non-nitrate vasodilators-hydralazine, hyperstat
    - central blockers- clonidine, catapress
    - combination-lisinopril+HCTZ-Zestoretic
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21
Q

Side effects of medications

A
  • impotence
  • syncope
  • dizziness
  • orthostatic hypotension (sit on side of bed)
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22
Q

NSG Interventions for meds

A

avoid standing in hot showers, rise slowly from sitting or laying. avoid long standing

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23
Q

Symptoms and interventions

A
  • Synergistic effects of medications
  • Symptoms of syncope, fatigue- leading to falls
  • Self-checks
  • Diuresis
  • Lo Na diet
  • Hypokalemia
  • K+ replacements
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24
Q

Diet- teach the benefits of DASH (Dietary approaches to stop HTN)

A
  • Low sodium foods
  • Potassium rich foods
  • 3 servings of fish/week
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25
Q

Evaluations of complications

A
  • End organ damage
    1. renal failure
    2. retinal damage
    3. CVA
    4. MI, CHF
  • Hypertension crisis
    1. Definition
    2. Treatment
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26
Q

Definition of CHF

A

Not a disease but a group of responses r/t inadequate pump performance. Pump failure leads to hypoperfusion of tissue with pulmonary and venous congestion. The supply of oxygen will not equal demand due to pump failure

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27
Q

CHF Pathophysiology

A
  • CHF may be caused by any interference with the normal mechanisms regulating cardiac output
  • CO depends on: preload, afterload, myocardial contractility, and heart rate
  • Any alteration in any of these can lead to decreased ventricular function and the resulting manifestations of CHF
  • Remember, supply must equal demand!
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28
Q

What happens in CHF

A

Blood overflows to back into lungs. Heart overfills with blood. Limited ventricular squeezing capacity. Damaged heart muscle is weakened and stiff.

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29
Q

Stages of CHF

A

Compensation and decompensation

30
Q

Compensatory Mechanisms:

A
  • Ventricular dilation
  • Ventricular hypertrophy
  • increased SNS stimulation
  • Neurohormonal responses
31
Q

Types of CHF

A
  • left sided failure

* right sided failure

32
Q

Manifestations of CHF- Left sided

A
  • pulmonary edema *Dyspnea
  • orthopnea *PND
  • Fatigue *increased HR
  • Crackles (pulm edema) *S3, S4 heart sounds
  • Cheyne stokes respiration increased
33
Q

Manifestations of CHF- Right sided

A
  • Dependent and peripheral edema
  • JVD
  • More noticeable wt. gain
  • fatigue
  • increased HR
  • Ascites/hepatomegaly (fluid backs up into liver, abdomen, and spleen)
  • Rt sided pleural effusions
34
Q

CHF…you can get

A

JVD

35
Q

Diagnostics for CHF

A

Brain natriuretic peptide- also called B-type natriuretic peptide. BNP is a hormone that promotes vasodilation, is produced by the ventricles and it’s release is triggered by increased pressure there ( when they’re stretched).

The BNP assay is a blood test that has a very quick turn around time. (only 15 minutes)

36
Q

Brain natriuretic Peptide (BNP)

A
  • Normal level is 0-100; above 100 indicates CHF, but levels <400 mean difficult treatment.
  • Positive results can diagnose acute decompensated CHF
  • Often used to differentiate dyspnea caused by CHF as compared to dyspnea caused by pulmonary disease
37
Q

Other CHF diagnostics

A

The primary goal is diagnosis is to determine the underlying etiology of the heart failure and assess it, so treatment can begin.

  • Chest xray
  • 12 lead ECG
  • Echocardiogram or TEE
  • ABG’s
  • Serum studies
  • Nuclear imaging
  • Cardiac catherterization
  • Hemodynamic monitoring
38
Q

CHF collaborative care

A
  • Treatment of the underlying cause
  • High fowlers position
  • O2 by mask or nasal canula
  • Telemetry and pulse oximetry
  • Rest
  • Diet- low Na+, maybe fluid restriction
  • daily weights
  • I&O’s
  • Remember general rule of thumb is that for every 1000cc in excess fluid (imbalance between I&O) you can expect a weight gain of 1K (2.2 lbs)
  • So 1 L = 2.2 lbs
  • Drug therapy; overall goal is to increase CO
39
Q

CHF drug therapy

A
  • Diuretics: lasix, bumex, demadex
  • Inotropics: digoxin, dopamine, dobutrex (ventrical more effiecient
  • Vasodilators: Nipride, NTG
  • Anti-anxietals: Ativan, maybe morphine
40
Q

CHF Drug Therapy…goal of medication is to

A

reduce workload of the heart

41
Q

Diuretics

A

reduce volume

42
Q

Inotropes

A

Improves contractility

43
Q

Vasodilators

A

reduce preload and oxygen demand

44
Q

Anti-Anxietals

A

reduce oxygen demand

45
Q

Name Loop Diuretics:

A
  • furosemide (Lasix)
  • torsemide (Demadex)
  • bumetanide (Bumex)
46
Q

Name Thiazides

A
  • metolazone (Zaroxolyn) (30 b/f lasix sometimes) empty foley before giving lasix
  • hydrochlorathiazide (HCTZ)
47
Q

Name Potassium Sparing

A

*triamterene (Dyrenium)

48
Q

Name Aldosterone Receptor Blockers

A

spironolactone (Aldactone)

49
Q

Name Vasodilators

A
  • nitroprusside (Nipride)
  • nitrates (Nitroglycerin)(Imdur)
  • nesiritide (Natrecor)
50
Q

Natrecor (nesiritide) IV

A
  • Dump a lot of fluid quickly,,,monitor b/p
  • Recombinant form of BNP
  • Dilates veins and arteries
  • Used to dramatically unload fluid
  • IV loading Bolus, then IV drip
  • Isolate the line
  • Used 24-48 hrs
  • Monitor B/P, hold if b/p below 90 systolic
51
Q

Name Ace Inhibitors

A
  • lisinopril (Zestril)
  • captopril (Capoten)
  • enalapril (Vasotec)
52
Q

Name ARB’s

A
  • losartan (Cozaar)
  • valsartan (Diovan)
  • ibesartan (Avapro)
53
Q

Name Beta-Blockers

A
  • metoprolol (Lopressor)
  • atenolol (Tenormin)
  • nadolol (Corgard)
54
Q

Name a & b Blockers

A
  • carvedilol (Coreg)

* labetalol (Normodyne)

55
Q

Name Positive Inotropes

A
  • Digoxin
  • Dobutamine
  • Dopamine
56
Q

Action of Digoxin is

A

digitalization

57
Q

Digitalis Effects:

A

beta blocker slow HR

  • therapeutic level 0.8-2.0 ng/ml
  • s/s of toxicity
  • -anorexia
  • -n/v
  • -decreased HR (bradycardia) dysrhythmias
  • -visual disturbances (halos)
  • -possible decrease in potassium
58
Q

Nursing diagnosis of CHF

A

*decreased cardiac output
*excess fluid volume
*impaired gas exchange
*anxiety
*activity intolerance
*PC: pulmonary edema
Pt. teaching is essential

59
Q

Overall goals of CHF

A
  • determine cause and effects- echos, EF
  • Improve LV function, cardiac function
  • Decrease intravascular volume
  • Decrease venous return
  • Decrease afterload
  • Improve oxygenation
  • Improve perfusion
  • Decrease anxiety
60
Q

Outcomes of CHF

A
  • Improved CO= HR, BP, UO
  • Balanced I&O, decreased edema, no crackles, wt. stable
  • Improved gas exchange
  • Able to do ADL’s without dyspnea
  • Feeling less fatigued, increasing activity
  • Compliant with Na restricted diet
  • knowledgeable about
  • s/s to report
  • measures for prevention
61
Q

Nursing Interventions: respiratory management

A
  • Assess breath sounds
  • Trend breath sounds
  • Assess cough
  • Trend pulse ox
62
Q

Nursing Interventions: fluid management

A
  • I&O compare, trend
  • Foley
  • Daily weights, compare, trend
  • Fluid restriction: 1000 ml, 1200, 1500, 2000
  • low sodium diet
  • oral care for dry mouth
  • Skin care for edematous tissues
63
Q

Nursing Interventions: nutrition

A
  • low sodium diet
  • List inappropriate foods
  • K+ sparing diuretics- avoid
  • K+ wasting diuretics- Eat
64
Q

Nursing Interventions: circulation

A
  • Cardiac- telemetry assess for S3 and S4

* Peripheral- TEDS, Heparin SC

65
Q

Nursing Interventions: anxiety

A
  • Rest
  • Environment
  • Positioning
  • Room placement
  • Medications- ativan, morphine
66
Q

Nursing Interventions: in general

A
  • Environment: cool with fan
  • Positioning
  • Relief of anxiety
  • Emotional support
  • Skin care
  • Elimination
67
Q

Patient Home teaching tips:

A
  • Management/self monitoring
  • Wt. gain of >2 lb
  • shortness of breath with activity
  • Increased orthopnea
  • Medication usage
  • ADL
  • Na restricted diet
  • Lifestyle
  • Other chronic conditions as DM
68
Q

Heart failure complication:

A

Pulmonary edema

  • precipitating causes:
  • afib
  • pneumonia or any physical stressor
  • volume overload
  • missed medications
  • MI
  • Severe valve disease
69
Q

Complications of CHF: Manifestations

A
  • sudden, acute dyspnea
  • Wet, moist lungs
  • Wet crackles throughout
  • Frothy sputum to pink tinged
  • Cyanosis, restlessness
  • hypoxia, O2 decreased
  • Cardiac rhythm?
70
Q

Complications of CHF: Immediate actions

A
  • Position upright
  • stop the cause, if possible
  • give oxygen
  • assess, report
71
Q

Collaborative Interventions for Pulmonary Edema

A

Medications:

  • Morphine
  • Diuretics
  • Vasodilators
  • Digoxin
  • Dopamine

NSG 2202 (22 decks)

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