Related Circulatory Stressors/Test 2 Flashcards Preview

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Flashcards in Related Circulatory Stressors/Test 2 Deck (71):
1

Hypertension defined as

*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

2

A HTN heart is _____ and has _____ ventricles

bigger and thickening

3

Optimal b/p is

<80

4

Normal b/p is

<85

5

High normal b/p is

130-139 and 85-89

6

HTN Stage I b/p is

140-159 and 90-99

7

HTN Stage II b/p is

160-179 and 100-109

8

HTN Stage III b/p is

>180 or >110

9

Hypertension etiology- Primary (essential) hypertension

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

10

Hypertension etiology- Secondary hypertension

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)

11

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

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

12

Modifiable HTN risk factors

*Excessive alcohol ETOH intake
*Smoking
*Uncontrolled DM
*increased serum lipids
*Excess dietary Na+
*Obesity
*Sedentary lifestyle
*Stress

13

Non-modifiable risk factors HTN

*Socioeconomic status
*Family history
*Ethnicity
*Gender
*Age

14

Controls of Blood Pressure

-SNS- sympathetic nervous system
-RAAS- renin angiotensin aldosterone system
-CO and SVR

15

Order of controls of b/p

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

16

Treatment of HTN

*weight reduction
*DASH eating plan
*Na++ reduction
*ETOH
*Exercise
*Smoking
*Stress

17

Treatment of HTN 2 main actions:

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

18

Treatment of HTN, stepped are approach

Go low and slow
*diuretics 1st med to be used- usually thiazide
*Beta blockers
*Calcium channel blockers

19

If b/p goes up stay on

diuretics and change to ace inhibitors
-angiotensin II receptors antagonists
-alpha blockers, central
-alpha blockers, peripheral
-alpha, adrenergic blockers
-vasodilators

20

Pharmacological approach

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

21

Side effects of medications

*impotence
*syncope
*dizziness
*orthostatic hypotension (sit on side of bed)

22

NSG Interventions for meds

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

23

Symptoms and interventions

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

24

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

*Low sodium foods
*Potassium rich foods
*3 servings of fish/week

25

Evaluations of complications

*End organ damage
1. renal failure
2. retinal damage
3. CVA
4. MI, CHF
*Hypertension crisis
1. Definition
2. Treatment

26

Definition of CHF

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

27

CHF Pathophysiology

*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!

28

What happens in CHF

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

29

Stages of CHF

Compensation and decompensation

30

Compensatory Mechanisms:

*Ventricular dilation
*Ventricular hypertrophy
*increased SNS stimulation
*Neurohormonal responses

31

Types of CHF

*left sided failure
*right sided failure

32

Manifestations of CHF- Left sided

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

33

Manifestations of CHF- Right sided

*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

CHF...you can get

JVD

35

Diagnostics for CHF

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

Brain natriuretic Peptide (BNP)

*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

Other CHF diagnostics

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

CHF collaborative care

*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

CHF drug therapy

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

40

CHF Drug Therapy...goal of medication is to

reduce workload of the heart

41

Diuretics

reduce volume

42

Inotropes

Improves contractility

43

Vasodilators

reduce preload and oxygen demand

44

Anti-Anxietals

reduce oxygen demand

45

Name Loop Diuretics:

*furosemide (Lasix)
*torsemide (Demadex)
*bumetanide (Bumex)

46

Name Thiazides

*metolazone (Zaroxolyn) (30 b/f lasix sometimes) empty foley before giving lasix
*hydrochlorathiazide (HCTZ)

47

Name Potassium Sparing

*triamterene (Dyrenium)

48

Name Aldosterone Receptor Blockers

spironolactone (Aldactone)

49

Name Vasodilators

*nitroprusside (Nipride)
*nitrates (Nitroglycerin)(Imdur)
*nesiritide (Natrecor)

50

Natrecor (nesiritide) IV

*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

Name Ace Inhibitors

*lisinopril (Zestril)
*captopril (Capoten)
*enalapril (Vasotec)

52

Name ARB's

*losartan (Cozaar)
*valsartan (Diovan)
*ibesartan (Avapro)

53

Name Beta-Blockers

*metoprolol (Lopressor)
*atenolol (Tenormin)
*nadolol (Corgard)

54

Name a & b Blockers

*carvedilol (Coreg)
*labetalol (Normodyne)

55

Name Positive Inotropes

*Digoxin
*Dobutamine
*Dopamine

56

Action of Digoxin is

digitalization

57

Digitalis Effects:

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

Nursing diagnosis of CHF

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

59

Overall goals of CHF

*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

Outcomes of CHF

*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

Nursing Interventions: respiratory management

*Assess breath sounds
*Trend breath sounds
*Assess cough
*Trend pulse ox

62

Nursing Interventions: fluid management

*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

Nursing Interventions: nutrition

*low sodium diet
*List inappropriate foods
*K+ sparing diuretics- avoid
*K+ wasting diuretics- Eat

64

Nursing Interventions: circulation

*Cardiac- telemetry assess for S3 and S4
*Peripheral- TEDS, Heparin SC

65

Nursing Interventions: anxiety

*Rest
*Environment
*Positioning
*Room placement
*Medications- ativan, morphine

66

Nursing Interventions: in general

*Environment: cool with fan
*Positioning
*Relief of anxiety
*Emotional support
*Skin care
*Elimination

67

Patient Home teaching tips:

*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

Heart failure complication:

Pulmonary edema
* precipitating causes:
-afib
-pneumonia or any physical stressor
-volume overload
-missed medications
-MI
-Severe valve disease

69

Complications of CHF: Manifestations

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

70

Complications of CHF: Immediate actions

*Position upright
*stop the cause, if possible
*give oxygen
*assess, report

71

Collaborative Interventions for Pulmonary Edema

Medications:
*Morphine
*Diuretics
*Vasodilators
*Digoxin
*Dopamine