Test #6 - Hypertension/CAD Flashcards Preview

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Flashcards in Test #6 - Hypertension/CAD Deck (90):
1

Who has the highest rates of hypertension?

Older adults

African Americans

Less educated

Lower socioeconomic groups

2

 

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

3

 

What is th definitin of normal BP and Hypertension?

Normal: 100-120/60-80

Hypertension: > 140/> 90

4

What is primary (essential or idopathic) hypertension?

No identifiable; multiple factors

Most cases of elevated SBP & DBP

5

What is secondary hypertension?

Identifiable Cause

Specific disease/problems cause elevated BP

Underlying cause needs to be identified because it may be correctable

6

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

7

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
(Past 50-55)

8

What is persistant severe hypertension (resistant or malignant)?

DBP >110

Usually results from untreated hypertension or hypertension that is unresponsive to tx

It becomes a severe emergency

9

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

10

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)

11

What are the 3 components that make up Blood pressure?

Heart (pump):
Rate (Chronotropic)
Strength/force (inotropic)
Volume (Stroke Volume)

Vascular Bed:
Size
Resistance (afterload)

Volume:
Blood Volume (preload)

12

What are the 4 control systems for hypertension?

Arterial Baroreceptors & Chemoreceptors

Regulation of body fluid volume (Kidneys)

Renin - Angiotensin System

Vascular Autoregulation

13

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

14

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

15

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

 

Chemoreceptors
-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

16

What is normal cardiac output (L)?

4-8L

17

What are some Non-modifiable risk factors for BP?

Genetics

Age

Gender

Ethnic Group

18

What are some Modifiable risk factors for BP?

Weight

Nutrients

Substances

Stress

Sedentary Lifestyle

19

What are some S&S of later stages of hypertension?

Headache

Fatigue

Dizziness

Fluttering in Chest

Facial Flushing

Vision Changes

Epistaxis (Nose Bleed)

20

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

21

What are some diagnostics for Hypertension (2)?

 

EKG
identifies electrical activity of the heart, including arrhythmias

CXR
May identify any structural changes to heart, lungs or major vessels

22

What are some common labs for hypertension?

Thyroid (TSH & T4)

Electrolytes (Na+, K+, Ca++, Cl-, Mg++)

BUN & Creatine

UA

23

What are some not so common labs for hypertension?

Antidiuretic hormone

Aldosterone

Renin

Angiotensin

24

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

DASH Diet

Stress Reduction &/or Relaxation Techniques

Exercise Program; Mod intensity for 30-45 min/day

Routine Follow-up

Medications as ordered

MANAGING HYPERTENSIVE CRISIS
Very  high BP-Puts @ risk for MI, CVA or Aneurysm

25

What are some interventions for Hypertensive Crisis?

BP Checked every 5 min

HIGH/STRONG meds

26

Diuretics are used for Hypertension, What does it do?

Promote water and electrolyt loss through kidney's , some types dilate renal arteries

27

Diuretics are used for Hypertension, What are some examples?

Thiazide
Hydrochlorothiazide (HCTZ)

Loop
Furosemide (Lasix)

Potassium-Sparing
Spironolactone (Aldactone)

28

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

29

ACE Inhibitors are used for Hypertension, What does it do?

Interrupts conversion of Angiotension I to Angiotenion II, leading to vasodilation

30

ACE Inhibitors are used for Hypertension, What are some exaamples?

Captopril (Capoten)

Enalapril (Vasotec)

31

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

32

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

33

Angiotensin II Receptor Blockers are used for Hypertension, What are some examples?

Irbesartan (Avapro)

Isoartan (Cozaar)

34

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

35

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)

36

Beta Blockers are used for Hypertension, What are some examples?

Stenolol (Tenormin)

Metaprolo (Lopressor)

37

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)

38

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

39

Calcium Channel Blockers are used for Hypertension, What are some examples?

Diltiazem (Cardizem)

Amlodipine (Norvasc)

Nifedipine (Procardia)

40

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

41

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

42

What are some spices with antihypertensive effects?

 

Basil

Black Pepper

Fennel

Tarragon

43

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

44

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

45

Intracoronary Stents is a surgical intervention for CAD, what is it?

Various types of stents are placed into an "opened" artery to prevent restenosis

46

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.

47

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

48

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

49

What are three types of medications used for CAD?

Lipid Lower Agents (Lopid, Zocor)

Antiplatelet Agents (Aspirin, Ticlid)

Vasodilators (Nitroglycerin, Persantine)

50

What are lipid lowering agents and what do you want to watch for?

Different types that disrupt lipid synthesis and often increase HDL production

Observe for:
Abdominal Pain
GI Complaints
Liver Function Tests
Muscle tissue damage

51

What are antiplatelet agents and what do you want to look for?

Inhibit platelet aggregation and thrombus formation

OBSERVE:
Epigastric discomfort
Bleeding Tendencies

52

What are Vasodilators and what do you want to look for?

Nitro dilates smooth muscle - Arterial & Venous

Persantine selectively dilates coronary arteries

OBSERVE:
Headache
Hypotension
Dizziness
Flushing

Tablets are inactivated by light, heat, air, moisture

53

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

Promote Rest

Approach with calmness and confidence

Monitor closely for post-op complications (Hemorrhage)

54

What are some nursing teachings for CAD?

About the disease

About the Meds

About the tests/procedures

Lifestyle Changes

55

What is the RN responsible for when relating to CAD?

Assess and direct care for all clients experiencing acute S/S (Acute coronary syndromes)

Titrate Medications

Monitor lab, VS, and client responses

Client teaching

56

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

57

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

58

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

59

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

60

What is the anatomy of the Arteries?

Smooth muscle - Able to constrict and dilate

Three Layers:
Intima - Innermost
Media - Middle (muscle layer)
Adenticia or externa - Outermost

Carry oxygen rich  and  nutrient rich blood to tissues

61

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

62

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

63

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

64

A complication of CAD is Angina, What are some Signs and Symptoms?

Sensation: Squeezing, burning, pressure, choking

Severity: Mild or moderate

Location: retrosternal

Radiation: To left shoulder

Duration: <10 min

Relief: With rest or nitroglycerin

Precipitating factors: Level of activity

Pattern: Stable, unstable or Varient

65

There are 3 kinds of Angina, What are the following:

Unstable

Stable

Variant (Vasospastic)

Stable:
Chest pain that occurs w/predictable level of activity. Goes away when you sit or have O2

Unstable:
Occurs w/ unpredictable activity.  At risk for MI

Variant (Vasospastic):
Something caused artery  to spasm and tighten, goes away when relaxes

66

Myocardial Infarction is a complication of CAD, What is it?

Myocardial tissue death resulting from a sustained absence of oxygen to cardiac tissue.

67

Myocardial Infarction is a complication of CAD, What are some S&S and what is it described as?

S&S:
Dyspnea
Diaphoresis
Weakness
N/V
Severe Anxiety

DESCRIBED AS:
Severe, vice-like, crushing pressure
Often radiates to jaw, between shoulder blades, or to left arm/shoulder
 

68

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

69

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

70

Congestive Heart failure is a complication of CAD, What are some signs and symptoms?

Dyspnea

Activity Intolerance

Weakness

Renal Failure

Othopnea

Edema

Fatigue

Cerebral Hypoxia S&S

71

What are some risk factors for CAD?

Genetics:
Family members, especially parents

Age:
Symptomatic CAD after 40

Gender:
Roughly equal over the course of time
Men > at early age
Women who take oral birth control or who have an early menopause

Ethnic Group:
African, Mexican, Native, Native Hawaiians

Weight:
Obesity - especiallly fat around waist and abdomen

Substances:
Nicotine, cocaine, and caffeine cause vasoconstriction

72

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

73

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

Dec Weight

74

What are some diseases that put you at risk for CAD?

Diabetes - ^ risk by 2-8 times

Hypertension

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

75

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

76

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

77

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

78

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

79

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

80

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. 

81

What are the appropriate levels for HDL, LDL, Cholesterol, Triglycerides and Homocysteine?

HDL - >40mg/dl
LDL - <100 mg/dl
Cholesterol- <130mg/dl
Triglycerides - < 150 mg/dl
homocysteine - Want WNL

82

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) 

83

There are 4 types of surgical interventions that re-open occluded or narrow arteries, what are they?

Percutaneous Transluminal Coronary Angioplasty

Intracoronary Stents

Directional Coronary Atherectomy

Laser Ablation

84

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

85

What is Intracoronary stents?

Various types of stents are placed into an "opened" artery to prevent restenosis

86

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

87

What is laser ablation?

After PTCA, a brief burst of laser radiation is given to remove remaining plaque

88

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

89

What is the process of the effects of low blood pressure on the kidney?

Stimulates Kidneys

=

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

90

What is the DASH diet?

High in Whole Grains

High in Fruits/Vegetables

Moderate in Lean cut meats/dairy

Low in fats/simple sugars