Who has the highest rates of hypertension?
Lower socioeconomic groups
What are the limits for prehypertension, stage 1 and stage 2 hypertension?
Pre - 120-139/80-89
Stage 1: 140-159/90-99
Stage 2: > 160/>100
What is th definitin of normal BP and Hypertension?
Hypertension: > 140/> 90
What is primary (essential or idopathic) hypertension?
No identifiable; multiple factors
Most cases of elevated SBP & DBP
What is secondary hypertension?
Specific disease/problems cause elevated BP
Underlying cause needs to be identified because it may be correctable
What is White Coat Hypertension?
Normotensive except when their BP is checked by a health care professional
Intermittent vasovagal response is the cause for elevated BP
Must be properly diagnosed or could result in hypotension if treated or untreated hypertension
What is isolated systolic hypertension?
SBP >140 but DBP remains <90
May be due to Inc Cardiac output &/or atherosclerosis-induced changes in blood vessel compliance
Inc Risk with Inc Age
What is persistant severe hypertension (resistant or malignant)?
Usually results from untreated hypertension or hypertension that is unresponsive to tx
It becomes a severe emergency
What are some complications that can happen from hypertension?
EYES: Hemorrhage, Blindness
BRAIN: Hemorrhage, Infarctions, TIA (temp change in blood flow)
CARDIAC: Hypertrophy, Ventricular Failure, CHF, Angina, MI, Left-sided Ventricular hypertrophy
RENAL: Renal Failure
PERIPHERAL: Peripheral Arterial Disease
What is BP?
The amount of pressure exerted by the circulating blood on the walls of the circulatory system (heart, arteries, aterioles, capillaries, venules, and veins)
SBP=When the heart pumps
DBP=When the heart is "at rest" or refilling
(Vessels maintain pressure by elastic recoil)
What are the 3 components that make up Blood pressure?
Volume (Stroke Volume)
Blood Volume (preload)
What are the 4 control systems for hypertension?
Arterial Baroreceptors & Chemoreceptors
Regulation of body fluid volume (Kidneys)
Renin - Angiotensin System
What is Vascular Autoregulation?
Organs can regulate their own bloodflow by causing constriction or dilation of vessels - allows organs to maintain constant bloodflow to meet their metabolic needs despite changes in systematic arterial pressure
thermoregulation may also be an example:
Vasodilation to release heat
Vasoconstriction to retain heat
What is Regulation of body fluid volume (Kidneys)?
To Dec BP, Kidneys excrete Na+ and Water
To Inc BP; Kidneys reabsorb water (ADH from pituitary gland) or Aldosterone (from adrenal glands) causes Na+ & water to be reabsorbed and K+ to be excreted
What is Arterial baroreceptors and Chemoreceptors?
Baroreceptors (Stretch Receptors)
-Found in carotid sinus, aorta & left ventricular wall
-Counteract increased arterial pressure through vasodilation and dec heart rate via the vagus nerve
-Found in the medulla, aorta and carotids
-Detect changes in O2, CO2, and pH (hydroen ions)
-Dec O2=Inc in BP (primary respons)
-Dec pH=Inc in BP
-Inc CO2=Inc in BP
What is normal cardiac output (L)?
What are some Non-modifiable risk factors for BP?
What are some Modifiable risk factors for BP?
What are some S&S of later stages of hypertension?
Fluttering in Chest
Epistaxis (Nose Bleed)
What are some diagnosis interventions for BP?
Seated client allowed at least 5 min to rest
Two readings taken at least 2 min apart
Ave of readings is SBP >140 ad DBP >90
Follow-up visit to confirm unless BP is Stage 1 or Stage 2
Various tests to rule out any secondary causes
What are some diagnostics for Hypertension (2)?
identifies electrical activity of the heart, including arrhythmias
May identify any structural changes to heart, lungs or major vessels
What are some common labs for hypertension?
Thyroid (TSH & T4)
Electrolytes (Na+, K+, Ca++, Cl-, Mg++)
BUN & Creatine
What are some not so common labs for hypertension?
What are some interventions for Hypertension?
Health Screening (Catch the Problem)
Heath Teaching (Compliance is #1 prob, lifestyle changes)
-Weight reduction: Women(waist <35"), Men(Waist <40"), Gradual not rapid (1-2lbs/week)
-Smoking Cessation and limit alcohol & caffeine
Stress Reduction &/or Relaxation Techniques
Exercise Program; Mod intensity for 30-45 min/day
Medications as ordered
MANAGING HYPERTENSIVE CRISIS
Very high BP-Puts @ risk for MI, CVA or Aneurysm
What are some interventions for Hypertensive Crisis?
BP Checked every 5 min
Diuretics are used for Hypertension, What does it do?
Promote water and electrolyt loss through kidney's , some types dilate renal arteries
Diuretics are used for Hypertension, What are some examples?
Diuretics are used for Hypertension, What are some nursing interventions?
Watch for dehydration and electrolyte loss, esp K+
Give in am to minimize sleep disruption
ACE Inhibitors are used for Hypertension, What does it do?
Interrupts conversion of Angiotension I to Angiotenion II, leading to vasodilation
ACE Inhibitors are used for Hypertension, What are some exaamples?
ACE Inhibitors are used for Hypertension, What are some nursing interventions?
Watch for cough, agranuocytosis(Dec in WBC), kidney failure, HA and dizziness
Instruct how to avoid orthostatic hypotension
Angiotensin II Receptor Blockers are used for Hypertension, What does it do?
Blocks receptor sites on vascular smooth muscle and adrenal glands which leads to vasodilation
Angiotensin II Receptor Blockers are used for Hypertension, What are some examples?
Angiotensin II Receptor Blockers are used for Hypertension, What are some nursing interventions?
May take several weeks to see benefits
Observe for dizziness, HA and fatigue
Beta Blockers are used for Hypertension, What does it do?
Blocks stimulation of beta, (cardiac muscle) and beta2 (Bronchials); (some are beta1 selective); leads to dec rate and force of cardiac contraction (Some types also suppress renin activity)
Beta Blockers are used for Hypertension, What are some examples?
Beta Blockers are used for Hypertension, What are some nursing interventions?
Monitor for bradycardias/arhythmias... DEATH
May cause fatigue, weakness or drowsiness
May cause SOB and bronchospasm (if not beta1 selective)
Calcium Channel Blockers are used for Hypertension, What does it do?
Inhibits Ca++ transport into myocardial and vascular smooth muscle which leads to vasodilation and slowed cardiac conduction
Calcium Channel Blockers are used for Hypertension, What are some examples?
Calcium Channel Blockers are used for Hypertension, What are some nursing interventions?
Monitor for arrhythmias (bc of changing electrolytes)
May cause edema, HA, dizziness, heart block, or bradycardia
What are some Herbal Meds for hypertension?
Vasodilators: Bilberry, Hawthorne, Khella, Kudzu
Calcium Channel Blockers; Angelica
Dec HR and force of contraction: Chicory
Dec BP and Cholesterol: Bilberry, Hawthorne, Evening Primrose, Garlic & Flaxseed
Prevent Atherosclerosis: Garlic
What are some spices with antihypertensive effects?
What are do surgical interventions do for Coronary Artery Disease?
Re-opening occluded or narrowed arteries
All Involve inserting a catheter into a major artery and threading it retrograde into the affected Coronary artery
Percutaneous Transluminal Coronary Angioplasty is a surgical intervention for CAD, what is it?
Balloon-tipped catheter is inflated to reshape the arterial lumen by stretching it and flattening the plaque against the wall
Intracoronary Stents is a surgical intervention for CAD, what is it?
Various types of stents are placed into an "opened" artery to prevent restenosis
Directional Coronary Atherectomy is a surgical intervention for CAD, what is it?
Catheter with a rigid housing and a central rotating blade that shaves off the plaque and deposits it into it's nose cone.
Laser Ablation is a surgical intervention for CAD, what is it?
After PTCA, a brief burst of laser radiation is given to remove remaining plaque
Coronary Artery Bypass Graft is a type of surgical intervention for CAD, what is it?
Surgical transplantation or translocation of an artery or vein to bypass an occlusion and restore bloodflow to myocardium (Create an alternate pathway when other interventions don't work)
Traditionally, client's blood was diverted to a heart-lung mahine and heart was stopped during surgery; now there are other options
What are three types of medications used for CAD?
Lipid Lower Agents (Lopid, Zocor)
Antiplatelet Agents (Aspirin, Ticlid)
Vasodilators (Nitroglycerin, Persantine)
What are lipid lowering agents and what do you want to watch for?
Different types that disrupt lipid synthesis and often increase HDL production
Liver Function Tests
Muscle tissue damage
What are antiplatelet agents and what do you want to look for?
Inhibit platelet aggregation and thrombus formation
What are Vasodilators and what do you want to look for?
Nitro dilates smooth muscle - Arterial & Venous
Persantine selectively dilates coronary arteries
Tablets are inactivated by light, heat, air, moisture
What are some nursing interventions for CAD?
Thorough assessment (Particularly Cardiac focused)
Administer appropriate meds with acute complications of CAD (O2, nitro, aspirin, and Morphine Sulfate for acute MI)
MONA to remember
Approach with calmness and confidence
Monitor closely for post-op complications (Hemorrhage)
What are some nursing teachings for CAD?
About the disease
About the Meds
About the tests/procedures
What is the RN responsible for when relating to CAD?
Assess and direct care for all clients experiencing acute S/S (Acute coronary syndromes)
Monitor lab, VS, and client responses
What can the LPN do when pertaining to CAD?
Provide care and medications for stable clients
Assist with ongoing client data collection
Reinforce client teaching
What can the CNA do when pertaining to CAD?
Gather VS, daily weight, and I/O data
Provide hygeine and elimination assistance for stable clients
What are some community and home care items for CAD?
Home health referral may be needed
Utilize community resources:
Medical equipment & oxygen supply
Meals on Wheels
What are some cultural and spirituality for CAD?
Because of diet and genetics, some cultures have greater incidence of CAD and it's complications
MI often has great psychological and spiritual impact on a person:
-May cause + or - lifestle and relationship changes
-Depression is common
-May struggle with their spiritual beliefs
What is the anatomy of the Arteries?
Smooth muscle - Able to constrict and dilate
Intima - Innermost
Media - Middle (muscle layer)
Adenticia or externa - Outermost
Carry oxygen rich and nutrient rich blood to tissues
What is the anatomy of coronary arteries?
Branch off from Aorta
Proide oxygen and nutrients to heart itself
Bloodflow occurs during diastole, when heart is relaxed
For adequate bloodflow, DBP must be at least 60
What is the pathophysiology of Atherosclerosis?
Primarily affects the intima (innermost layers)
Gradual build-up of plaque on the lining of the artery. (Consists of extracellular lipids, fibrous tissue, and calcium)
Causes gradual narrowing of lumen and stiffening of the artery
Plaque may eventually occlude artery or rupture
A complication of CAD is Angina, What is it?
Chest pain resulting from myocardial ischemia (hypoxia), represents a temporary imbalance between oxygen supply and demand of cardiac tissue
May be described as pressure, burning, tightness, heaviness, squeezing or indigestion
Usually relieved in <10min
Stable vs Unstable
A complication of CAD is Angina, What are some Signs and Symptoms?
Sensation: Squeezing, burning, pressure, choking
Severity: Mild or moderate
Radiation: To left shoulder
Duration: <10 min
Relief: With rest or nitroglycerin
Precipitating factors: Level of activity
Pattern: Stable, unstable or Varient
There are 3 kinds of Angina, What are the following:
Chest pain that occurs w/predictable level of activity. Goes away when you sit or have O2
Occurs w/ unpredictable activity. At risk for MI
Something caused artery to spasm and tighten, goes away when relaxes
Myocardial Infarction is a complication of CAD, What is it?
Myocardial tissue death resulting from a sustained absence of oxygen to cardiac tissue.
Myocardial Infarction is a complication of CAD, What are some S&S and what is it described as?
Severe, vice-like, crushing pressure
Often radiates to jaw, between shoulder blades, or to left arm/shoulder
Dysrhythmias are a complication of CAD, what is it?
Hypoxic cardiac tissue impairs electrical conduction and may also initiate ectopy
May or may not be perceived by person
May be temporary, or permanent if infarction occurs
Congestive Heart failure is a complication of CAD, What is it?
Inability of heart to circulate blood effectively
May be right sided = Peripheral edema, ascites, liver engorgement, JVD
May be left sided = Pulmonary edema
Congestive Heart failure is a complication of CAD, What are some signs and symptoms?
Cerebral Hypoxia S&S
What are some risk factors for CAD?
Family members, especially parents
Symptomatic CAD after 40
Roughly equal over the course of time
Men > at early age
Women who take oral birth control or who have an early menopause
African, Mexican, Native, Native Hawaiians
Obesity - especiallly fat around waist and abdomen
Nicotine, cocaine, and caffeine cause vasoconstriction
Nutrients(cholesterol) are a risk factor for CAD, What are some and how do they impact?
High cholesterol increases risk
Lipids bind with cholesterol, triglycerides, phopholipids, and proteins to form Lipoproteins:
-Very-low-density lipoproteins (VLDL)
-Low-Density lipoproteins (LDL)
-High density lipoproteins (HDL)
High levels of HDL's protect against CAD
Low fat, low chol diet and exercise lead to increased HDL's
Sedentary lifestyle is a risk factor for CAD, Exercise can lower risk by?
Increasing HDL Levels
Dec LDL, Cholesterol, triglyceride, and blood glucose
Inc Insulin sensitivity
Dec Blood Pressure
What are some diseases that put you at risk for CAD?
Diabetes - ^ risk by 2-8 times
Chronic inflammatory Diseases (Arthritis, lupus, AIDS) - Causes ^ in C Reactive Protein. CRP causes plaque to crack or break. Leads to a thrombus
Increased Homocysteine levels (amino acid produced by body) - ^ risk; unknown reason
Electrocardiogram is a test to diagnose CAD, what does it do?
Displays electrical activity of heart from 12 angles
Allows dr to identify areas of ischemia and/or infarction
Does not evaluate pump effectiveness
Usually consists of 10 electrodes applied to specific locations on chest/abdomen
An Exercise Stress Test is a diagnosis tool for CAD, what does it do?
Evaluates the body's response to measured increases in exercise (Biccle-arm, foor or both; treadmill)
Involves monitoring ECG, VS, and pt's preceived level of exertion
Helps evaluate presence, absence or severity of CAD
Thallium Stress Test is a diagnosis tool for CAD, what is it?
Siilar to above but client receives radioactive isotope for 1 min before peak of test. After test, images are made by a gamma camera that indicate what part of heart is or is not perfusing
Repeat injection of isotope and repeat images made ~3 hours
Results: Well perfused=high concentration of Thallium
Ischemic="cold" spots that fill in on delayed images
Infarcted or scarred=Cold spots that remain cold
Magnetic Resonance Imaging is a diagnosis test for CAD, what is it?
Uses strong magnets to provide images of heart size, chamber size, wall motion, valve function, and bloodflow through heart and major vessels.
Identifies normal vs abnormal tissues
Echocardiogram/Doppler studies are a diagnosis test to identify CAD, what does it do?
uses ultrasound waves to record motion and structure of heart
Can make a 2-D, continuous picture and record it on videotape
Can be done through chest wall or look at back of heart by means of an endoscope equipped with a transducer placed inside the esophagus
Coronary Angiography is a diagnosis test for CAD, what is it?
Involves injection of IV contrast dye into coronary arteries during a cardiac catherization.
X-Ray films are obtained to identify areas of reduced or no-flow in the coronary arteries.
What are the appropriate levels for HDL, LDL, Cholesterol, Triglycerides and Homocysteine?
HDL - >40mg/dl
LDL - <100 mg/dl
Triglycerides - < 150 mg/dl
homocysteine - Want WNL
Troponin I, CPK-MB, and LDH are cardiac enzymes and Isoenzymes we test for CAD, when would you see them?
Troponin I (Within 3 hrs of MI or cardiac damage)
CPK-MB (Within 6 hrs of MI & peak 18-24 hrs)
LDH (Within 12-24 hrs of MI and peak 2-5 days)
There are 4 types of surgical interventions that re-open occluded or narrow arteries, what are they?
Percutaneous Transluminal Coronary Angioplasty
Directional Coronary Atherectomy
What is Percutaneous Trnsluminal Coronary Angioplasty?
Balloon-tipped catheter is inflated to reshape the arterial lumen bby stretching it and flattening the plaque against the wall
What is Intracoronary stents?
Various types of stents are placed into an "opened" artery to prevent restenosis
What is directional coronary atherectomy?
Catheter with a rigid housing and a central rotating blade that shaves off the plaque and deposits it into its nose cone
What is laser ablation?
After PTCA, a brief burst of laser radiation is given to remove remaining plaque
What is a Coronary Artery Bypass Graft?
Surgical transplantation or translocation of an artery or vein to bypass an occlusion and restore bloodflow to myocardium
Traditionally, client's blood was diverted to a heart-lung machine and heart was stopped during sugery; now, other options exist
What is the process of the effects of low blood pressure on the kidney?
Causes release of Renin
Which changes angiotensinogin (a plasma protein from the liver) to angiotensin I
Converts to angiotensin II
Causes vasoconstriction and stimulates release of aldosterone from adrenal cortex
increased BP, Reabsorption of H2O, Na, increased blood volume and increased blood pressure
What is the DASH diet?
High in Whole Grains
High in Fruits/Vegetables
Moderate in Lean cut meats/dairy
Low in fats/simple sugars