Section 1
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What causes primary HTN?
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Last updated
6 years ago
Date created
Mar 1, 2020
Cards (52)
Section 1
(50 cards)
What causes primary HTN?
trick question! we don't know we do know that 95% of HTN is primary
MEDS: Statin
INDICATION: previous MI, hyperlipidemia MOA: Increase Hepatic LDL receptors not increase HMG-CoA reductase inhibitors lower cholesterol in the blood and reduce its production in the liver by blocking the enzyme that produces it SIDE EFFECTS: headache, muscle pain NURSING: NO GRAPEFRUIT!
ASSESSMENT AND INTERVENTIONS - PVD
ASSESSMENTS: limbs are warmer; pain worse with legs dependent; dependent edema; brown, scaly skin (hemociterous); wetter/redder/weepy ulcers with no definition INTERVENTIONS: encourage pt to elevate leg throughout the day; good skin and foot care; manage BP; dietary and exercise changes; discourage smoking;
Renin
hormone secreted by the kidney; it raises blood pressure by influencing vasoconstriction (narrowing of blood vessels)
HTN emergency
>180/120 with end organ damage Treat with IV nitroprusside, labetalol, Clonidine, Cardene
What causes decreased NA+ secretion (shift in natriuresis-pressure relationship)
endothelial dysfunction increased RAAS genetics increased SNS decreased K, Mg, and CA in diet (EASY FIX!!) Increased Na in diet (EASY FIX!) obesity insulin resistance renal glomerular and tubular inflammation
MEDS: Asparin
INDICATION: Thrombosis prevention in: *Ischemic stroke *TIA's *Chronic stable angina *Unstable angina *Coronary stenting MI - acute, previous and prevention ACTION: Suppresses platelet aggregation *Irreversible suppression of cyclooxygenase COX - for the life of the platelet 7 - 10 days SIDE EFFECTS: *GI Bleeding *Hemorrhagic stroke *Contraindications: recent GI bleed 6 wks, CVA within 2 years, thrombocytopenia, aneurysm, intracranial neoplasm NURSING: Dose: may use 325mg po initially in acute event, then 81 mg/day. Enteric coating may not prevent GI bleeding.
how to calculate PPY
number of years smoking x pack per day
ABI findings
Normal - 1.0-1.4 PAD < 0.9 >1.4 = PVD and venous pooling
Aldosterone
"salt-retaining hormone" which promotes the retention of Na+ by the kidneys. na+ retention promotes water retention, which promotes a higher blood volume and pressure
MEDS: Plavix (Clopidogrel)
INDICATION: Used as prophylaxis for: atherosclerotic events in patients post- myocardial infarction (MI) or stroke; patients who are at risk for MI or stroke; patients who have undergone coronary artery bypass grafting (CABG) or angioplasty ACTION: *Inhibit platelet aggregation by a different mechanism than aspirin *Causes irreversible inactivation of platelet aggregation SIDE EFFECT: *Hemorrhage GI distress NURSING: Can be used in combination with 81mg aspirin therapy for prophylaxis Must be discontinued 7 days before surgery to prevent excessive bleeding Take with food
Angiotensinogen
a plasma protein produced by the liver; Converted to angiotensin I by renin
MEDS: Calcium Channel Blockers
INDICATION: HTN, stable and variant angina ACTION: dilation of arteries by blocking calcium entry into smooth muscle; increases coronary perfusion SIDE EFFECTS: bradycardia, AV block, HF, hypotension NURSING: Assess HR and BP prior to administration; Prolongs PRl; Increased risk
Total cholesterol levels
<200 mg/dL
Causes of endothelial injury
smoking turbulent flow shearing forces HTN
s3 is heard when
Left-to-right shunt (VSD, PDA, ASD), mitral regurgitation, LV failure (CHF)
Formula for MAP
(SBP + 2DBP)/3
MEDS: Nitroglycerine
INDICATION: Stable and variant angina; unstable angina/MI ACTION: Extracellular nitrate binds with intracellulsar nitrate → converts into nitric acid → VSM relaxation → vasodilation → reduced preload → ↓ cardiac oxygen demand SIDE EFFECTS: Headache; Orthostatic hypotension; Reflex tachycardia secondary to ↓ BP Drug-drug interactions: MANY SEVERE NURSING: Assess: HR, BP prior to administration. Routes: SL: Acute angina: Tabs between cheek/lip & gum, Don't swallow, 1 tab q 5 min x 3, Call 911 if chest pain continues, NO ALCOHOL!, Creams and patches: Tolerance will develop if "drug holiday" is not provided - 12 hours on/12 hours off.
LDL levels
less than 100 mg/dL is ideal
formula for BMI
weight (kg) / height (m^2)
HTN urgencies
SBP >220 or DBP>120 no other symptoms are apparent requires BP reduction within a few hours to days BP elevation in otherwise stable patients without acute or impending change in target organ damage or dysfunction
PVD v PAD
PAD: failure to perfuse tissues; decreased O2 delivery --> gangrene --> necrosis - Pain when walking - intermittent claudication - pain goes away with rest - you want this pt to exercise slightly past pain - b/c ischemia promotes angiogenesis (collateral blood flow) and dilates vessels - Pain worse when legs elevated, better when legs are dependent - PAD ulcers - pale wound bed, dry (not getting blood); defined borders - limbs will be cool to touch PVD: issue with blood return back to the heart - venous stasis -> blood pooling --> edema --> - elevation can hlep - Edema caused by increased hydrostatic pressure and blood pooling - lower calves can develop a deep red color b/c edema is plasma and some RBC -> hemoglobin will stay after edema and will cause hemociterous --> BROWN SCALY SKIN - PVD pain is worse when legs are dependent, better when elevated - PVD ulcers are wet, redder, with no sharp definition, weepy --> Edema compresses capillaries, decreases O2 and causing injury - limbs warm to touch
MEDS: Beta Blockers
END IN -OLOL Nonselective - propranolol Cardioselective (indicated for people with asthma, previous episodes of bronchospasm) - metoprolol INDICATION: dysrhythmias, HTN, Angina/Post-MI, HF ACTION: reduce automaticity in SA node; slow conduction in AV node; reduce contractibility in atria and ventricles; Reduces PVR; ↓ HR and contractibility *Neg. inotrope - ↓ force of contraction *Neg. chronotrope - ↓ HR *Neg. dromotrope - ↓ rate of electrical conduction Reduced MI oxygen demand, reduce cardiac remodeling SIDE EFFECTS: bradycardia, hypotension; bronchospasm in pt's with asthma NURSING: Assess apical BP and HR prior to adminstration - notify provider if less than 60bpm; nonselective (propranolol) not indicated for people with asthma, sinus bradycardia;
complications of an acute obstruction
stroke MI HF renal DZ PAD
what is the result of increased diastolic pressure
increased afterload increased diastolic forces he heart to work harder to contract during systole
_____________ are first line therapy for HF and HTN
diuretics
ASSESSMENT AND INTERVENTIONS - HTN
ASSESSMENTS: increased BP (duh); increased LDL, decreased HDL; obesity; INTERVENTIONS: DASH (Dietary approaches to stop HTN) + Low Sodium diet; encourage exercise; discourage cigarette smoking - determine methods used before, provide resources and support; created lifestyle modification plan for patient; assess weight, exercise, and diet; discourage processed foods; suggest HTN medication management - education pt; decrease alcohol intake
HDL levels
> 60 is GOOD 35 to 65 mg/dL for men, 35 to 80 mg/dL for women < 40 is pretty bad
MEDS: Digoxin
INDICATION: HF ACTION: vagal nerve stimulation - decreases HR - decreases condition in AV node; POS inotrope - increases force of contraction; increases intracellular CA+ SIDE EFFECTS: Bradycardia; GI upset NURSING: DIG TOXICITY; Assess potassium level; Assess for drug-drug interactions, many. Will potentiate bradycardic and hypokalemic effects of other medications. *Pre-admin - Assess Apical HR for 1 full min. prior to administration. Notify HCP for rate < 60 b/m.
In order for systole to occur...
pressure of ventricles has to be higher than pressure outside
MEDS: Thiazide Diuretic
inexpensive, mild SE, and relatively effective - increases compliance. Thiazides are potassium wasting - can lead to hypokalemia --> glucose intolerance INDICATION: HTN, HF (to reduce edema) ACTION: Decrease reabsorption of NA+ in distal renal tubule SIDE EFFECTS: NURSING: Glucose levels, I/O BP. inform pt that effects don't start until 3-4 days an don't peak until 3-4 weeks - do not stop taking because you feel better; Check renal and potassium labs;
Angiotensin 1
formed by conversion of angiotensinogen by renin; causes vasoconstriction and in increase in blood pressure; is converted to angiotensin 2 in the lungs
Formula for ABI
ankle/brachial
MEDS: ACE Inhibitors
ENDS IN - PRIL INDICATION: HTN, HF, MI ACTION:Prevents the formation of angiotensin II-mediated vasoconstriction also blocking aldosterone-mediated volume expansion. Blocks angiotensin converting enzyme and therefore body cannot turn Angiotensin I --> 2 *Increases levels of bradykinin (by preventing breakdown) = dry cough SIDE EFFECTS: DRY COUGH NURSING: major risk of ace and arbs is angioedema - MUST go straight to ER and can never have again -therapeutic effects occur in 1 hr
MEDS: Angiotensin Receptor Blockers (ARBS)
ENDS IN -SARTAN INDICATION: Hypertension Heart failure *Myocardial infarction ACTION:*Blocks action of AT II from binding at receptor site in smooth muscle and adrenal glands SIDE EFFECTS: NURSING: *Assess BP prior to and after administration
peripheral vascular resistance
The force exerted against the blood flow and is determined by the diameter of the vessel. The lower the vascular resistance the less force is needed to eject the blood out of the heart during systole.
MEDS: Loop Diruetic
FUROSEMIDE - LASIX - loop diuretics produce the greatest diuretic effect, however, due to risk for K depletion and dehydration - they are not indicated for first line therapy INDICATION: HF, HTN ACTION: Reduces blood volume - decreases venous pressure, arterial pressure (afterload), pulmonary edema, peripheral edema and cardiac dilation. SIDE EFFECTS: Hypokalemia; Hypotension; Digoxin toxicity NURSING: Assess serum potassium level prior to and after administration. Do not administer if K+ level < 3.5 mEq/L; May need to provide K supplementation; Promotes rapid/profound diuresis
DASH diet
increase fruit, vegetables, and low fat dairy; k, mg, ca
What does LDL do?
delivers hepatic cholesterol to peripheral tissues BAD!!
Angiotensin II
increases blood pressure by stimulating kidneys to reabsorb more water and by releasing aldosterone POTENT VASOCONSTRICTOR
Foam cell
Engorged lipid-laden macrophages that are the major component of the fatty streak
Potassium sparing diuretics
Spironolactone (Aldactone) Produce the most modest diuresis. potassium sparing - however, this can lead to hyperkalemia and thus cardiac conduction abnormalities
causes of vascular remodeling
endothelial dysfunction angiotensin II (potent vasoconstrictor) catecholamines (from SNS) inflammation insulin resistance
s4 is heard when
Aortic stenosis, hypertrophic subaortic stenosis
metabolic syndrome - five signs
increased waist circumference (abdominal obesity) hyperglycemia insulin resistance hyperlipidemia hypertension
ASSESSMENT AND INTERVENTIONS - PAD
ASSESSMENTS: cold extremities; ABI <.9; gangrene and necrosis in serious situations; pain worse with leg elevation; dry, defined, pale wounds on lower legs; pain begins with exercise; weak pulses INTERVENTIONS: instruct pts to exercise slightly past the pain; dangle legs intermittently throughout the day; discourage smoking and encourage exercise and dietary changes; medication therapy (asparin or plavix); good foot and skin hygiene; in severe cases - angioplasty
RAAS system
Renin is produced by the kidneys in response to impaired blood flow & tissue perfusion, and converts angiotensinogen in the blood to angiotensin I; ACE converts angiotensin I to angiotensin II in the lungs. Angiotensin II then vasoconstricts and stimulates the release of aldosterone. Aldosterone then promotes Na and water retention as well as K excretion.
Risk factors for primary HTN:
family hx advanced age men more than women (until women go through menopause, then even) African american increased NA in diet (EASY FIX!) DM 2 heavy alcohol use obesity decreased Mg, K, and CA in diet (EASY FIX!)
appraoches to get an accurate BP
have pt avoid smoking, caffeine and exercise within 30 min empty bladder sit quietly for 5 minutes support limb correct cuff size don't take over clothes measure in both arms and use the higher reading
what happens to coronary artery perfusion when diastolic pressure is too low
it decreases, O2 supply decreases and lack of perfusion
Section 2
(2 cards)