Day II Flashcards
(59 cards)
1
Q
define HTN
A
- Defined as a systolic pressure at or greater than 140 mmHg or diastolic pressure at or greater than 90 mmHg for 2 or more assessments of blood pressure
- For those over 60, blood pressure should be less than 150/90
- Prolonged, untreated, or poorly controlled HTN can cause peripheral vascular dz that primarily affects the heart, brain, eyes, and kidneys
- Hypertrophy of the left ventricle can develop as the heart pumps against resistance caused by the HTN
2
Q
essential HTN vs. secondary HTN
A
- Essential HTN: AKA primary HTN
- Most common
- No known cause
- Secondary HTN: caused by dz states, like kidney dz, or as an ADR of some meds
- Tx: occurs by removing the cause (adrenal tumor, medication)
3
Q
prehypertension
A
- client’s with a SBP of 120-139 mmHg or a DBP of 80-89 mmHg
- Lifestyle changes are necessary for these clients to help prevent cardiovascular disease
4
Q
health promotion and dz prevention of HTN
A
- Maintain body mass index of less than 30
- Clients who have DM should keep blood glucose w/in a recommended reference range
- Limit caffeine and alcohol intake
- Use stress management techniques during times of stress
- Stop smoking: nicotine patches or engaging in a smoking cessation class are potential strategies
- Engage in exercise that provides aerobic benefits at least 3 times a week
- Limit sodium and fat intake
5
Q
explain the 4 mechanisms that regulate BP
A
-
Arterial baroreceptors:
- Baroreceptors are located in the carotid sinus, aorta, and left ventricle
- They control BP by altering the heart rate. They also cause vasoconstriction or vasodilation.
- Regulation of body fluid volume: properly functioning kidneys retain fluid when a client is hypotensive and excrete fluid when a client is hypertensive
- RAAS: renin is converted into Ang II, which causes vasoconstriction and controls aldosterone release, causing the kidneys to reabsorb sodium and inhibit fluid loss
- Vascular autoregulation: maintains consistent levels of tissue perfusion
6
Q
risk factors of essential HTN
A
- Positive family hx
- Excessive sodium intake
- Physical inactivity
- Obesity
- High alcohol consumption
- African American
- Smoking
- Hyperlipidemia
- Stress
- Age greater than 60 or postmenopausal
7
Q
risk factors of secondary HTN
A
- Kidney disease
- Cushing’s disease (excessive glucocorticoid secretion)
- Primary aldosteronism (causes HTN and hypokalemia)
- Pheochromocytoma (excessive catecholamine release)
- Brain tumors, encephalitis
- Meds like estrogen, steroids, and sympathomimetics
- Pregnancy
8
Q
expected finidngs in clients who have HTN
A
- Clients who have HTN can experience few or no manifestations. Monitor for the following.
- HAs, particularly in the morning
- Facial flushing
- Dizziness
- Fainting
- Retinal changes, visual disturbances
- Nocturia
9
Q
stages of HTN
A
- When a BP reading is elevated, take it in both arms and w/ the client sitting and standing
- There are levels of HTN:
- preHTN: 120-139/80-89
- Stage I HTN: 140-159/90-99
- Stage II HTN: greater than or equal to 160/greater than or equal to 100
10
Q
lab tests for HTN
A
- no lab tests can diagnose, but several can identify the causes of secondary HTN
- BUN, creatinine: elevation is indicative of kidney dz
- Elevated serum corticoids: detects Cushing’s dz
- Blood glucose and cholesterol studies: identify contributing factors related to blood vessel changes
11
Q
diagnostic procedures for HTN
A
- ECG: evaluates cardiac functions
- Tall R waves: often seen with left ventricular hypertrophy
- CXR: shows cardiomegaly
12
Q
meds for HTN
A
- used when HTN is not responsive to lifestyle changes alone
- Diuretics are first line, but many ppl require a combination of meds
- Client edu: instruct clients to change positions slowly, and to be careful when getting out of bed, driving, and climbing stairs until the med’s effects are fully known
- classes of HTN meds:
- diuretics
- CCBs
- ACE Inhibitors
- ARBs
- Aldosterone receptor antagonists
- beta blockers
- central alpha 2 agonists
- alpha adrenergic antagonists
13
Q
what are the types of diuretics used to tx HTN and how do they work?
A
- Thiazide diuretics: like HCTZ, inhibits water reabsorption and increases potassium excretion
- Loop diuretics: like furosemide, dec Na reabsorption and inc K excretion
- Potassium sparing diuretics: like spironolactone, affect the DCT and prevent reabsorption of Na in exchange for K
14
Q
nursing considerations and client edu for diuretics used to tx HTN
A
- Nursing Considerations: monitor K levels and watch for muscle weakness, irregular pulse, and dehydration
- Thiazide and loop diuretics: can cause hypokalemia
- Potassium sparing: can cause hyperkalemia
- Client edu:
- Encourage client to keep all appts w/ provider to monitor efficacy of medications and possible electrolyte imbalance
- If taking K wasting diuretic, encourage consumption of K rich foods
15
Q
CCBs used to tx HTN
A
- verapamil, amlodipine, diltiazem
- After movement of calcium ions thru the cell membrane, vasodilation and lowered BP results
- Nursing considerations:
- Monitor BP and pulse and change client’s position slowly
- Use cautiously if pt has HF
- Client edu:
- Verapamil: constipation is common so inc fluids and inc fiber intake
- Dec or inc in HR and AV can occur
- Teach client to take pulse and call provider if irregular or lower than expected
- Avoid grapefruit juice
16
Q
ACE Inhibitors used to tx HTN
A
- lisinopril, enalapril
- Prevent conversion of Ang I to Ang II which prevents vasoconstriction
- Nursing considerations:
- Watch BP and pulse
- Watch for evidence of HF like edema
- Client edu:
- Teach client to report a cough (ADR)
- Report signs of HF
17
Q
ARBs used to tx HTN
A
- valsartan, losartan
- Good for clients who take ACE inhibitors but have a cough or have hyperkalemia
- Do not require a dosage adjustment for older adults
- Nursing considerations:
- Watch for signs of angioedema or HF
- Client edu:
- Change positions slowly
- Report signs of angioedema (swollen lips, face) or HF
- Avoid foods high in K and have serum K levels monitored b/c ARBs can cause hyperkalemia
18
Q
aldosterone receptor antagonists used to tx HTN: medication and action
A
- eplerenone
- Block aldosterone’s action which promotes the retention of K and excretion of Na and water
19
Q
aldosterone receptor antagonists used to tx HTN: nursing considerations
A
- Monitor kidney fcn, triglycerides, Na, and K
- Risk of adverse effects inc with deteriorating kidney fcn
- Risk inc as dose inc
- Monitor K levels every 2 weeks for first few months and every 2 months thereafter
- Avoid taking K supplements or K sparing diuretics
20
Q
aldosterone receptor antagonists used to tx HTN: client edu
A
- Teach client about food, med, herbal interactions like grapefruit juice and St. John’s wort can increase ADRs
- Instruct the client not to take salt substitutes with K or other foods rich in K
21
Q
beta blockers used to tx HTN
A
- metoprolol, atenolol
- For clients who have unstable angina or MI
- Decrease cardiac output and block the release of renin, subsequently decreasing vasoconstriction of the peripheral vasculature
- Nursing considerations:
- Monitor BP and pulse
- Meds mask hypoglycemia in clients who have DM
- Client edu:
- Teach the client that these meds can cause fatigue, weakness, depression, and sexual dysfunction
- Do not d/c abruptly
- Teach about S/S of hypoglycemia that do not include tachycardia, which beta blockers suppress
22
Q
central alpha 2 agonists used to tx HTN
A
- clonidine
- Reduce peripheral vascular resistance and dec BP by inhibiting the reuptake of NE
- Nursing considerations:
- Monitor BP and pulse
- Med is not for 1st line management of HTN
- Client edu:
- ADRs: sedation, orthostatic hypoTN, impotence
23
Q
alpha adrenergic antagonists used to tx HTN
A
- prazosin
- Reduce BP by causing vasodilation
- Nursing considerations:
- Start tx w/ low dose of med and give at night
- Monitor BP for 2 hours after starting tx
- Client edu:
- Rise slowly to prevent postural hypoTN
24
Q
client education for HTN
A
- Report S/S of hyperkalemia, hypokalemia, and hyponatremia
- Adhere to medication regimen
- Ensure client has resources to pay for meds
- Teach how to manage BP at home
- Report ADRs
- Teach about how to make lifestyle changes
- nutrition education
- including weight reduction and maintenance
- smoking cessation
- stress reduction: yoga, massage, hypnosis
25
nutrition education for HTN
* Monitor for hyperkalemia and salt substitute use
* Consume less than 2.3 g/day of sodium
* Diet should be low in fat, saturated fat, cholesterol
* Limit alcohol intake to 2 servings/day for males and 1 serving/day for females
* DASH diet: high in fruits, veggies, low fat dairy foods
* Consume foods rich in Ca and Mg
* If not taking a K sparing medication, should inc K consumption
26
weight reduction and maintenance with HTN
* Begin slowly and gradually advance the program with the guidance of the provider and physical therapist
* Exercise at least 3 times a week in a manner that provides aerobic benefits
27
complication of HTN
* HTN crisis: often occurs when they don’t follow the medication regimen
* Nursing actions:
* S/S: severe HA, extremely high BP (usually over 240/120), blurred vision, dizziness, disorientation, epistaxis
* Administer IV anti HTN meds: nitroprusside, nicardipine, labetalol
* Monitor BP every 5-15 min
* Assess neuro status, such as pupils, LOC, muscle strength to monitor for cerebrovascular change
* Monitor ECG to assess cardiac status
28
what is acute coronary syndrome (ACS)?
* continuum from angina to MI
* symptoms due to an imbalance b/w myocardial O2 supply and demand
29
angina pectoris
* warning sign of impending MI
* Women and older adults do not always experience manifestations assoc with angina or MI
30
what improves outcomes following an MI?
clients treated w/ aspirin, beta blockers, and ACE inhibitors, or ARBs
31
what happens when blood flow the heart is compromised?
* When blood flow to the heart is compromised, ischemia causes chest pain
* Anginal pain often described as tight squeezing, heavy pressure, or constricting feeling in the chest
* Pain can radiate to jaw, neck, or arm
* Pain unrelieved by rest or nitroglycerin and lasting for more than 15 min differentiates an MI from angina
32
what does An abrupt interruption of O2 to the heart muscle produce?
* myocardial ischemia
* Ischemia can lead to tissue necrosis (infarction) if blood supply and O2 are not restored
* Ischemia is reversible
* Infarction results in permanent damage
* When cardiac muscle suffers ischemic injury, cardiac enzymes are released into the blood, providing specific markers of MI
33
health promotion and dz prevention for coronary artery disease
* Maintain exercise routine
* Have cholesterol level and BP checked
* Consume diet low in saturated fats and sodium
* Smoking cessation
34
what are the 3 types of angina?
* Stable (exertional) angina: results from exercise or emotional stress
* Relieved by rest or nitroglycerin
* Unstable (preinfarction) angina: occurs with exercise or rest, but inc in occurrence, severity, and duration over time
* Variant (Prinzmetal’s) angina: due to coronary artery spasm, often occurring during periods of rest
35
risk factors for coronary artery disease
* Male gender or postmenopausal women
* Ethnic background
* Sedentary lifestyle
* HTN
* Tobacco use
* Hyperlipidemia
* Obesity
* Excessive alcohol consumption
* Metabolic disorders: DM, hyperthyroidism
* Methamphetamine or cocaine use
* Stress
* Older adults who are inactive, have 1 or more chronic dzs (HTN, HF, DM) or have lifestyle habits (smoking, diet) that contribute to atherosclerosis
* Inc with age, esp in presence of HTN, DM, hypercholesterolemia, elevated homocysteine, highly sensitive CRP
36
expected findings with coronary artery disease or an MI
* Anxiety, feeling of impending doom
* Chest pain: substernal or precordial
* Can radiate down shoulder or arm, or present as jaw pain
* Can be described as a crushing or aching pressure
* Nausea
* Dizziness
* Physical assessment:
* Pallor and cool, clammy skin
* Tachycardia and heart palpitations
* Tachypnea and SOB
* Diaphoresis
* Vomiting
* Dec LOC
37
labs drawn for chest pain or an MI
* Cardiac enzymes:
* Myoglobin: earliest marker of injury to cardiac or skeletal muscle
* Levels no longer evident after 24 hr
* Creatinine kinase MB: peaks around 24 hr after onset of chest pain
* Levels no longer evident after 3 days
* Troponin I or T: any positive value indicates damage to cardiac tissue
* I: no longer evident after 7-10 days
* T: no longer evident after 10-14 days
38
list the diagnostics for chest pain or an MI
* ECG
* stress test
* thallium scan
* cardiac cath
39
explain use of an ECG for angina or an MI
* recording of electrical activity over time
* Nursing actions:
* Assess for changes
* Angina: ST depression and/or T wave inversion indicates ischemia
* MI: T wave inversion indicates ischemia, ST segment elevation indicates injury, abnormal Q wave indicates necrosis
40
explain use of a stress test for angina or MI
* exercise electrocardiography
* Client tolerance tested using a treadmill, bicycle, or medication to evaluate response to inc HR
41
explain use of a coronary angiogram for angina or MI
* Coronary angiogram: AKA cardiac cath
* Invasive diagnostic procedure used to evaluate the presence and degree of coronary artery blockage
* Involves the insertion of a catheter into a femoral vessel and threading into the right or left side of the heart
* Can identify coronary A narrowing/occlusions by injection of contrast media
* Nursing actions:
* Informed consent
* NPO 8 hour prior to surgery
* Assess for iodine/shellfish allergy
42
differentiate b/w angina and an MI
* _angina_:
* precipitated by exertion or stress
* relieved by rest or nitroglycerin
* symptoms last less than 15 min
* not associated with nausea, epigastric distress, dyspnea, anxiety, or diaphoresis
* _MI_:
* can occur w/o cause, often in the morning after rest
* relieved only by opioids
* symptoms last more than 30 min
* associated with nausea, epigastric distress, dyspnea, anxiety, and diaphoresis
43
MI classification is based on:
* Affected area of the heart: anterior, lateral, inferior, posterior
* ECG changes produced: ST elevation MI vs non ST elevation MI
* Time frame w/in progression of infarction: acute, evolving, old
44
nursing care with angina or an MI
* Monitor:
* V/S Q5 min until stable, then Q hour
* Serial ECG monitoring
* PQRST of pain
* Hourly urine output
* Lab data: cardiac enzymes, electrolytes, ABGs
* Administer O2 at 2-4 L/min
* Obtain and maintain IV access
45
what are the classes of meds used to tx angina and MI?
* vasodilators
* analgesics
* beta blockers
* thrombolytic agents
* anticoagulants
* glycoprotein IIB/IIIA inhibitors
46
vasodilators for angina and MI
* nitroglycerin
* Prevents coronary artery vasospasm and reduces preload and afterload, dec myocardial O2 demand
* Nursing considerations:
* Used to tx angina and help control BP
* Use cautiously with other antiHTN meds
* Can cause orthostatic hypoTN
* Client edu for chest pain:
* Stop activity and rest
* Place NG tablet under tongue
* If pain is unrelieved in 5 min, call 911
* Can take up to 2 more doses at 5 min intervals
* HA is common SE
* Sit and lie down slowly
47
analgesics for angina and MI
* morphine sulfate
* Opioid analgesic used to tx moderate to severe pain
* Act on mu and kappa receptors to alleviate pain
* Can cause analgesia, respiratory depression, euphoria, sedation, dec in myocardial O2 consumption and GI motility
* **Use cautiously if client has asthma or emphysema due to risk of respiratory depression**
* Nursing considerations:
* If have chest pain, assess pain Q5-15 min
* Watch for manifestations of respiratory depression
* If less than 12, then stop med and notify provider
* Monitor V/S for hypoTN and dec respirations
* Assess for n/v
* Client edu:
* If n/v persist, notify provider
* Teach client to use PCA pump: only client should press button
48
beta blockers for angina or MI
* metoprolol
* Has antidysrhythmic and anti HTN properties that dec the imbalance b/w myocardial O2 supply and demand by reducing afterload and slowing HR
* In an acute MI, beta blockers dec infarct size and improve short and long term survival rates
* Nursing considerations:
* Bradycardia and hypoTN
* Hold med if apical pulse \<60
* Do not give to clients with asthma, only administer if using a cardioselective beta blocker (metoprolol) b/c won’t affect respiratory system
* Caution in pts with HF
* Monitor for dec LOC, crackles of lungs, chest discomfort
* Client edu:
* Sit and lie down slowly
* Report immediately if any SOB, edema, weight gain, cough
49
thrombolytic agents for angina and an MI
* alteplase, reteplase
* Break up clots
* Give w/in 6 hours of infarction
* Nursing considerations:
* Contraindications: active bleeding, PUD, hx of stroke, recent trauma
* Monitor for signs of bleeding: mental status changes, hematuria
* Monitor PT, aPTT, INR, fibrinogen levels, CBC
* Monitor for: thrombocytopenia, anemia, hemorrhage
* Administer streptokinase slowly to prevent hypoTN
* Client edu: remind client of risk for bruising and bleeding
50
antiplatelet agents for angina and an MI
* aspirin, clopidogrel
* Prevent platelets from forming together, which can produce arterial clotting
* Aspirin: prevents vasoconstriction
* Administer w/ NG at onset of chest pain
* Nursing considerations:
* Antiplatelet agents can cause GI upset
* Caution in clients with hx of GI ulcers
* Tinnitus: sign of aspiring toxicity
* Client edu:
* Risk for bruising/bleeding
* Use aspirin with enteric coating and take with food
* Report ringing in the ears
51
anticoagulants for angina and an MI
* heparin, enoxaparin
* use to prevent clots from becoming larger
* Nursing considerations:
* Contraindications: active bleeding, PUD, hx of stroke, recent trauma
* Monitor for signs of bleeding: mental status changes, hematuria
* Monitor PT, aPTT, INR, fibrinogen levels, CBC
* Monitor for: thrombocytopenia, anemia, hemorrhage
52
therapeutic procedures used to tx angina and MI
* Percutaneous transluminal coronary angioplasty (PTCA)
* Bypass graft (CABG)
53
client education involved with angina and MI care
* Cardiac rehab should be consulted for exercise program related to heart
* Monitor and report signs of infection
* Avoid straining, strenuous exercise, emotional stress
* Regarding response to chest pain: follow instructions on use of SL NG
* Smoking cessation
* Remain active
54
complications of angina or MI
* acute MI
* HF/cardiogenic shock
* ischemic mitral regurgitation
* ventricular aneurysms/rupture
* dysrhythmias
55
explain acute MI as a complication of angina
* complication of angina not relieved by NG or rest
* Administer O2
* Notify provider
56
explain HF and cardiogenic shock as a complication of angina or MI and what are the manifestations
* injury to left ventricle can lead to dec CO and HF
* Progressive HF can lead to cardiogenic shock
* Serious complication of pump failure
* Manifestations:
* Tachycardia
* hypoTN
* Inadequate urinary output
* Altered LOC
* Respiratory distress (Crackles and tachypnea)
* Cool, clammy skin
* Dec peripheral pulses
* Chest pain
57
nursing actions to help manage HF and cardiogenic shock as a complication of angina and MI
* Administer O2
* Administer IV morphine, diuretics, and/or NG to dec preload
* Administer IV vasopressors and/or positive inotropes to inc CO and maintain organ perfusion
* Maintain continuous hemodynamic monitoring
58
explain ischemic mitral regurgitation as a complication of angina and MI
* evidenced by development of new cardiac murmur
* Administer O2
* Notify provider
59
explain ventricular aneurysms/rupture as a complication of angina and MI
* can be due to necrosis from MI
* Can be present as sudden chest pain, dysrhythmias, and severe hypoTN
* Administer O2
* Notify provider immediately
