med surg lecture 5 Flashcards
(149 cards)
1
Q
what is a normal blood pressure
A
below 120/80 mm Hg
2
Q
average of two or more BP readings above elevated levels on different dates
A
hypertension
3
Q
what blood pressure reading obtained determines the category of HTN
A
the highest one
4
Q
having HTN puts the patient at risk for developing what
A
-cardiovascular disease
-stroke
5
Q
how often should a person ages 18-39 with normal blood pressure have HTN screenings
A
every 3-5 years
6
Q
how often should a person ages >39 or at an increased risk for developing htn have HTN screenings
A
yearly
7
Q
who is at an increased risk for developing HTN
A
-those with elevated BP
-overweight
-African American
-Family history of HTN
8
Q
why are african americans at an increased risk for HTN
A
increased renin activity from the RAAS systems, greater sodium and fluid retention
9
Q
if the cause of htn is unknown what is it called
A
primary htn
10
Q
what is primary htn also called
A
essential htn
11
Q
If there is a known cause of htn what is it called
A
secondary htn
12
Q
secondary htn is a sign of what
A
another problem within the body
13
Q
modifiable risk factors for htn there are 8
A
-decreased activity level
-smoking/tobacco
-poor diet
-insufficient sleep
-elevated blood glucose level
-elevated weight
-poor stress management
-type 2 dm
14
Q
non-modifiable risk factors for developing htn
A
-family history
-age
-race/ethnicity
15
Q
a person cannot control being a type 1 diabetic but can control sugar levels what is an important thing to teach these patients regarding htn
A
glucose control education for prevention of htn
16
Q
signs and symptoms of high blood pressure
A
-headache
-bloody nose
-severe anxiety
-dyspnea
17
Q
how is htn diagnosed
A
-presence of risk factors
-presence of signs and symptoms
-history of kidney or heart disease
-evaluated home blood pressure readings
18
Q
why would a doctor have a patient do home blood pressure readings
A
due to white coat syndrome, if patient gets nervous in drs office it can affect blood pressure readings
19
Q
elevated blood pressure category readings
A
systolic - 120-129 AND
diastolic - <80
20
Q
stage 1 htn category readings
A
systolic - 130-139 AND/OR
diastolic - 80-89
21
Q
stage 2 htn category readings
A
systolic - >=140 AND/OR
diastolic - >= 90
22
Q
hypertensive crisis category readings
A
systolic - higher than 180 AND/OR
diastolic - higher than 120
23
Q
if systolic and diastolic are in two different categories how to categorize the type of htn
A
use the higher reading of the two
24
Q
what are the two types of hypertensive crisis
A
urgency and emergency
25
what are the signs and symptoms of hypertensive crisis
-severe headaches
-nose bleeds
-severe anxiety
26
low risk or does not progress into organ disfunction or damage
hypertensive crisis - urgency
27
high risk or progression into organ dysfunction or damage
hypertensive crisis - ermergency
28
what can an emergency hypertensive crisis cause
-stroke
-heart attack
-heart failure
-kidney failure
-hemorrhage
29
what should you do for a patient if they are in a hypertensive crisis
intervene asap, keep them calm, dont stress them out and call the dr for further instructions
30
lifestyle modifications for htn
-weight reduction
-incorporate diet changes
-increase physical activity
-tobacco cessation
-psychosocial risk factors/reduce stress
31
what diet changes should be made for htn
-dash diet
-dietary sodium reduction
-eat more whole foods
-reduce added sugars
32
if lifestyle modifications dont lower bp what will need to be done?
patient will need medication
33
what does dash stand for
dietary approaches to stop hypertension
34
nursing responses to elevated bp
-identify patient's baseline
-ensure the bp reading is accurate
-observe for related symptoms
-review orders for antihypertensive treatment
-report and document
35
complications of unmanages htn
-atherosclerosis
-cardiovascular disease (CAD)
-myocardial infarction
-heart failure
-left ventricular hypertrophy
-stroke
-kidney disease
-retina damage
36
acute cardiac labs
troponin ckmb
37
kidney disease labs
bun
creatinine
egfr
38
long term cardiac labs
bnp
39
what type of stroke will htn cause
hemorrhagic more so than ischemic
40
self-care measures for htn control
decreasing stress
-lifestyle changes
-control modifiable risk factors
41
patient education when they are taking prescribed medications for htn
-stay on meds even if s/s are not present
-risk slowly and change positions slowly
-if you stop medications abruptly it could be dangerous
42
if htn medications are abruptly stopped dangerous situations may occur like
-rebound htn
-angina
-dysrhythmias
43
what are the medication classes that are used for htn
-statins
-diuretics
-angiotensin-converting enzyme inhibitor
-angiotensin II receptor blocker
-calcium channel blocker
-beta blockers
44
this medication treats HDL, does not directly treat htn
statins
45
what are the three types of diuretics
-loop diuretics
-thiazide diuretics and thiazide-like diuretics
-potassium-sparing diuretics
46
what does ACE inhibitor stand for
angiotensin-converting enzyme inhibitor
47
what medications are ACE inhibitors
prils
48
what does ARB stand for
angiotensin II receptor blocker
49
what medications are arbs
sartans
50
what does CCB stand for
calcium channel blocker
51
what medications are CCBs
pine or zem
52
what medications are beta blockers
lols
53
_____ may be caused secondary to hyperlipidemia
htn
54
statins are given to a patient with atherosclerosis and/or coronary artery disease to reduce _____ levels by reducing cholesterol ______
LDL
synthesis
55
does the nurse need to assess the blood pressure before and after administration of a statin
no they do not affect the blood pressure
56
common statins
-simvastatin (zocor)
-atorvastatin (lipitor)
-pravastatin (pravachol)
57
this type of medication is used to treat htn, chronic heart failure, edema, and pulmonary edema
diuretics
58
what labs must be monitored when a patient is on diuretics
electrolytes
59
diuretics usually get rid of which electrolyte
potassium
60
this diuretic acts on the loop of henle in the kidney to cause sodium and water loss
loop diuretics
61
what is an example of a loop diuretic
furosemide (lasix)
62
it is super important to monitor a patient for what condition when they are on lasix
hypokalemia
63
this diuretic increases urine output by promoting sodium, chloride and water excretion
thiazide and thiazide-like diuretics
64
what is an example of a thiazide diuretic
chlorothiazide (diuril)
65
a mild diuretic that promotes sodium and water excretion and potassium retention
potassium-sparing diuretics
66
what is an example of a potassium sparing diuretic
spironlocatone (aldactone)
67
what diuretic causes sodium and water loss
loop diuretic
68
what diuretic promotes sodium, chloride and water excretion
thiazides
69
what diuretic promotes sodium and water excretion and potassium retention
potassium sparing
70
what assessments will be done on a person taking diuretics
-blood pressure
-intake/output
-dehydration
-daily weights
-electrolytes
71
when someone is on diuretics when will you take their blood pressure
before and after administration
72
what should you make sure is within normal limits before administering diuretics
-blood pressure
-electrolytes
73
if a patient is on diuretics and electrolytes are out of normal range what should you do
hold medication and notify provider
74
a potent vasoconstrictor
angiotensin II
75
what do ace inhibitors do
blocks the production of angiotensin II
76
what do ARBs do
block angiotensin II receptors
77
what are some examples of ace inhibitors
-lisinopril
-enalapril
78
what are some examples of arbs
losartan
valsartan
79
what should you monitor for ace inhibitors and arbs
-assess bp before and after administration
-monitor for a new onset dry, irritating non-productive persistent cough
-monitor for angioedema
-dont stop abruptly
80
if you stop an ace inhibitor or arb abruptly what can it cause
rebound htn
81
these prevent movement of extracellular calcium into the cell and cause vasodilation
calcium channel blockers
82
common calcium channel blockers
amlodipine
nicardipine
nifedipine
diltiazem
83
what should you monitor when a patient is on calcium channel blockers
-pulse and bp before and after administration
-monitor for hypotension and bradycardia
-do not give if heartrate is less than 60 bpm
84
this decreases sympathetic nervous system respone
beta blockers
85
what does beta blockers decrease
-heartrate
-cardiac output
-workload of heart
-oxygen demand
-blood pressure
86
what should you monitor when a patient is on a beta blocker
-pulse and bp before and after administration
-hypotension and bradycardia
-do not give if hr is less than 60 bpm
-do not give if systolic bp is less than 100
87
cardiac specific beta blockers are called what
selective
88
what are examples of selective beta blockers
atenolol
metoprolol
89
beta blockers that are not cardiac specific are called
non selective
90
what is an example of a non-selective beta blockers
propranolol
91
what is a side effect of a non-selective beta blocker
bronchospasms
92
if a patient has these conditions you would not give them a non-selective beta blocker
copd
asthma
93
what should you know before giving a patient an antihypertensive medication
their bp and heart rate
94
how long before administration of anti hypertensive should you do vital signs
30 minutes to one hour
95
progressive inability of heart to pump enough blood throughout the body to meet bodys oxygen/nutrient needs
heart failure
96
each ventricle should pump _____ amount of blood
equal
97
if blood returned to the heart is more than either ventricle can handle what happens
the heart is no longer an effective pump
98
if the heart is no longer an effective pump what can happen
back up of blood through the system
99
failure of one side of the heart usually leads to what
failure of the other side
100
most common causes of heart failure
-coronary artery disease
-chronic htn
-myocardial infarction
-dysrhythmias (a-fib)
101
decreased oxygen delivery to cardiac muscle, heart is not an efficient pump is called what
coronary artery disease
102
increased resistance, heart must work harder to maintain cardiac output
chronic hypertension
103
area of the heart died due to a lack of oxygen, heart is no longer an efficient pump
myocardial infarction
104
decreased cardiac output from dysrhythmia causes heart to work harder to attempt to maintain cardiac output
dysrhythmias (a-fib)
105
left sided heart failure
-increased left ventricular workload
-left ventricle becomes inefficient pump
-left sided heart failure
-decreased blood pumped to body
-left ventricle unable to hold blood being pumped into it
-blood backs up into lungs
-pulmonary edema
106
what decreases with left sided heart failure
-tissue profusion
-oxygen delivery
107
the decrease in tissue profusion and o2 delivery causes what
pulmonary edema
108
pulmonary signs and symptoms of left sided heart failure (7)
-crackles and/or wheezing
-dry hacking cough
-pink frothy sputum - big indication of pulmonary edema
-tachypnea
-dyspnea on exertion
-orthopnea
-paroxysmal nocturnal dyspnea
109
what is orthopnea
sob when laying flat
110
what is paroxysmal nocturnal dyspnea
waking up short of breath
111
mental status signs and symptoms of left sided heart failure (3)
-restlessness
-confusion
-fatigue
112
systemic signs and symptoms of left-sided heart failure (3)
-cyanosis
-nocturia
-tachycardia
113
why is nocturia a sign or symptom of left sided heart failure
heart workload decreases so kidneys get more blood than they would during the day and have increases urination at night
114
what is a major cause of right sided heart failure
left sided heart failure
115
what does cor pulmonale mean
enlargement of the right side of the heart because it works harder so the muscle gets larger
116
as the right side of the heart fails, it cannot keep up with the demands of the blood entering the right ventricle causing what
blood to back up into the body
117
systemic signs and symptoms of right sided heart failure
-fatigue
-weakness
-nocturia
-tachycardia
118
fluid overload signs and symptoms of right sided heart failure
-weight gain
-dependent peripheral edema
-ascites
-gi upset
-jugular vein distension
119
many signs and symptoms of right sided heart failure are due to what
fluid overload or blood backing up into the body
120
what is ascites
fluid accumulation in the abdomen
121
why does someone get a GI upset with right sided heart failure
due to fluid stuck in abdominal cavity putting pressure on everything
122
diagnostic tests for heart failure
-labs
-chest xray
-echocardiography
-ekg
123
what labs are done for heart failure
-bnp
-troponin
124
if BNP is above ____ it indicates chronic heart failure
400
125
if BNP is in the _____ you need to intervene because it means an acute exacerbation is occuring
thousands
126
what will a chest xray show
-size of heart
-shows lungs to determine extent of pulmonary edema
127
what determines ejection fraction
echocardiography
128
an ejection fraction lower than ____ may indicate heart failure
40
129
what does an ekg show
heart rate and rhythm
130
if BNP is in the thousands itll cause acute heart _____ and _____
damage and tissue death
131
nursing actions for heart failure
-daily weights
-supplemental oxygen
-balance rest and activity
-positioning - high fowlers
-fluid restrictions
-medications/teaching
-low sodium diet
-education
-coping with disease
132
medications for heart failure
-ace inhibitors
-arbs
-diuretics
-beta blockers
-cardiac glycosides
133
what is the first line of medication management for heart failure and why
ace inhibitors because it prevents vasoconstriction
134
what helps decrease the hearts workload, improve cardiac function, and improve symptoms of chronic heart failure
ace inhibitors
135
what medication can be used for heart failure if ace inhibitors are contraindicated
arbs
136
what medication can be used for heart failure if fluid volume needs to reduced
diuretics
137
what medication for heart failure decreases SNS response and decreases cardiac workload
beta blockers
138
what medication for heart failure improves efficiency of cardiac contractions
cardiac glycosides
139
what medication is a cardiac glycoside
digoxin (lanoxin)
140
what does digoxin do in the body
increased the force and contraction of the myocardium and slows heart rate which increased cardiac output
141
what do you need to assess when administering digoxin
pulse before and after and after
bradycardia
serum digoxin levels
142
what is a normal serum digoxin level when on medication
0.8-2.0 ng/ml
143
do not give digoxin if heart rate is less than what
60
144
educate patient to take the medication at what
the same time everyday
145
digoxin toxicity symptoms
-bradycardia
-loss of appetite/anorexia
-nausea, vomiting, diarrhea
-abdominal discomfort
-vision changes
-fatigue
-confusion, decreased LOC
146
what symptoms is very specific to digoxin toxicity
vision changes
147
what vision changes occur with digoxin toxicity
-blurred vision
-yellow/green vision changes
-may see yellow/green halos
148
digoxin toxicity is caused by digoxin levels of what
greater than 2.4 ng/ml
149
the goals of therapeutic interventions for heart failure are to improve hearts pumping ability and decrease hearts oxygen demand by these 4 things
-identify and correct underlying cause
-increase strength of hearts contraction
-maintain optimum water and sodium balance
-decrease hearts workload
