3611 Module I

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3611 Module I
2011-10-22 23:52:42
3611 Resp HTN CHF

Test one Chapters 13,29,30,32,37,38
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  1. prehypertension
    • 120-139
    • 80-89
  2. stage 1 hypertension
    • 140-159
    • 90-99
  3. stage 2 hypertension
    • >160
    • >100
  4. table 38-4 pg 797 *
  5. primary hypertension
    cause is unknown

    major risk factor is family histroy

    85-90% of pop with hypertension has primary
  6. secondary hypertension:

    disease states and meds that increase susceptibility
    Renal disease most common

    disfunction of the adrenal gland

    cushing disease - excess glucocorticoids

    RAS - renal stent treamtment
  7. secondary causes of secondary hypertension
    coarctation of aorta- twisting

    brain tumors

    encephalitis - brain inflammation

    psychiatric disturbances

  8. medications: causing secondary HTN
    estrogen - most common


    mineralocorticoids- fluorinef

    sympathomimetic- drugs that help with heart failure, dobutrex
  9. Important points with PT's with HTN
    prolonged B/P elevation damages blood vessels throughout the body

    consequences of uncontrolled HTN: stroke, renal damage

    Left ventricular enlargement: the "pump" ventricle in the heart
  10. B/P formula
    B/P = Cardiac output X peripheral resistance
  11. B/P effected by:
    increased sympathetic nervous system

    excess sodium intake

    kidney damage

    genetic alteration, obestiy, endothelial factors
  12. Assessment of a PT:

    history and risk factors associated with HTN


    family history

    average dietary intake of foods leading HTN: sodium, fat etc.

    alcohol intake

    exercise habits: coronaries

    smoking history

    • past or present history of renal and
    • cardiovascular disease: TIA, MI, etc.

    medications prescribed or illicit (cocaine)
  13. S/S of HTN
    Generally asymptomatic

    facial flusing can occur: check B/P bilat

    B/P elevated

    Abdominal Bruie


    Femoral pulses abscent
  14. Diagnostic testing HTN
    no test to tell

    secondary: lab tests looking a renal function

    increase in catacholamines in urine

    Echocardiogram: flow of blood through heart and valves

    Chest X-ray: shows enlargement

    EKG: shows hypertrophy, first signs of HTN
  15. Main diagnoses for HTN
    deficient knowledge

    risk for ineffective for therapuetic regimen

    pg 799
  16. Treatment of HTN
    goal is to prevent death by reducing and maintaing level of 140/90

    first attempt is lifestyle changes
  17. Nursing interventions for HTN
    main problem relates to knowledge deficit and noncompliance
  18. Nursing interventions for HTN
    educating:(s/s stroke and complications)

    increase knowledge

    monitoring and managing potential complications

    *involvement of the family members in care and treatment*
  19. Medical mgmt of HTN
    1st line: diuretics: thaizide

    • Need to have K levels checked
    • report pulse irregularities
    • encourage K intake (bananas, OJ)

    • 2nd line:
    • ACE inhibitors- 'pril drugs. often has nagging cough symptoms

    Calcium channel blockers

    Beta blockers- 'lol drugs
  20. Hypertensive Crisis

    BP needs to be brought down immediately or stroke will occur

    BP over 200

    PT reports extreme headache
  21. Interventions for Hypertensive Crises
    semi fowlers


    meds-vasodialators given IV

    cardine-straight IV

    nitroprussid-IV drip (concetration damaged by light)

    BP monitered q 15 min until BP lower than 90
  22. Malignant Hypertension
    morning headaches

    • systolic greater than 200
    • diastolic greater than 150

    may cause: renal failure, stroke, left ventricular failure
  23. Heart Failure
    inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients
  24. Major types of heart failure
    • left sided
    • right sided
    • high output
  25. patho of HF
    begins with failur of the left ventricle and progresses to failure of both ventricles
  26. conditions that lead to HF
    Damage or deterioration of myocardial tissue

    Dysrhthmia- most common atrial fibrillation


    decreased tissue perfusion

    coronary artery and valvular disease
  27. S/S of left sided cardiac failure
    blood backs up into the lung

    therefore creates respiratory related distress:

    • dyspnea
    • pallor
    • crackles
    • wheezing
    • pink tinged sputum
    • weak peripheral pulses, cool extremities
    • S3/S4 gallop indicating CHF
  28. S/S of right sided cardiac failure-backward failure

    dependent edema; fluid not getting back to heart

    hepatomegaly, splenomegaly

    weight gain due to fluid retention


    jugular vein distention

    distended abdomen
  29. lab studies for CHF





    *important for m. contractions

    • BUN (increased)
    • creatnine(increased)
    • urinalysis
    • protein
    • high specific gravity
    • HGB
    • HCT- excess volume in body HCT very dilute
    • anemia

    BNP- done to determine heart failure (increased in heart failure, normal 0-100)

    microalbumineria- shows up before BNP

    Imaging studies

    EKG shows dysrythmia

    pulmonary artery catheter test pressure
  30. medical mgmt for HF
    02 therapy above 90%

    • meds
    • 1st- diuretic to remove fluid

    Digoxin (cardio glycosides)-improve contractility of heart

    vasodialators- nitroglycerine

    morphine- help pt relax, reduce preload and afterload
  31. interventions of CHF
    nutritional therapy- reduce sodium and water retention

    fluid restrictions

    weigh daily- use same scale before breakfast

    high fowlers position

    deep breathing and coughing (DB& C) q2h

    I&O's strict
  32. priority nursing diagnoses for CHF
    Impaired gas exchange related to ventilation/perfusion imbalance

    decreased cardiac output related to altered contractility, preload and afterload

    activity intolerance related to an imbalance between oxygen supply and demand

    pg 770
  33. potential for pulmonary edema
    treated the same as left sided heart failure
  34. indications of worsening HF
    rapid weight gain- 1 to 2 lbs overnight

    decrease in exercise tolerance

    cold symptoms

    execissive wakening at night to urinate

    worsening angina

    increased swelling in feet, ankles and hands
  35. theureputic level digoxin
    0.5- 2.0 ng/ml
  36. Capoten pt education
    signs of angioedema
  37. Lasix info included when explaining how it helps heart
    reduction of cardiac preload
  38. places pt digoxin at greatest risk of toxicity and associated dysrhythmias
  39. early indications of digitalis toxicity
    anorexia, n/v
  40. electrolyte closely monitered after treatment with digibind
  41. Oxyhemoglobin Dissociation

    Oxygen affinity is related to:


    Body Temp
  42. intefering factors with oxygenation
    coronary atery disease

    blood volume depletion

    inadequate blood flow

    diseases of the lungs


    toxic inhalants

    airway obstruction


    decrease chest wall motion
  43. Hyperventilation
    excessive ventilation (fever)
  44. Hypoventilation
    inadequate alveolar ventilation (atelectasis)
  45. Hypoxia
    inadequate tissue oxygenation (anemia)
  46. Hypoxia
    life threatening

    decreased HGB levels

    diminished inspired oxygen

    poor tissue perfusion

    impaired ventilation
  47. s/s of Hypoxia

    apprehension, anxiety


    decreased concentration

    decreased LOC


  48. Altered Respiration in Hypoxia
    increased pulse rate

    respiration rate and depth increased

    b/p elevated

    cardiac dysrrhythmias


  49. Maintaining Respiration
    Cough, turn, and deep breath with early ambulation (CTDB)

    incentive spirometer

    cutaneous oximetry

    positioning q 2 h

    adequate hydration

  50. Wheezing characteristics
    breathing sounds more musical in nature than normal sounds

    high or low pitched
  51. Wheezing indications and causes
    indicates the airway is narrowed

    most common causes are asthma and COPD (emphysema or chronic bronchitis)
  52. benefits of 02
    expands lungs

    mobilizes secretions

    maintains patent airway

    keeps tissue oxygenated
  53. Thoracentesis
    withdrawal of fluid from pleural cavity
  54. bronchoscopy
    provides direct visualization

    NPO 6hrs before

    peop med & airway anesthetized topically

    post op check for gag reflex
  55. Respiratory acidosis

    pH & PaC02
    pH less than 7.35

    PaC02 greater than 45 mm Hg
  56. Respiratory Acidosis causes and results from
    caused by an accumulation of C02 which combines with water in the body to produce carbonic acid, to lower the pH

    any condition that results in hypoventilation can cause respiratory acidosis:

    CNS depression from head injury, meds, anesthesia, neuro disease etc.
  57. Respiratory Alkalosis

    pH & PaC02
    pH greater than 7.45

    PaC02 less than 35 mmHG
  58. Respiratory Alkalosis results from
    any condition that causes hyperventilation such as:

    anxiety, fear, pain, fever, pregnancy, meds etc.
  59. Metabolic acidosis levels
    bicarbonate less than 22 mEq/L

    pH less than 7.35
  60. metabolic alkalosis levels
    bicarbonate level greater than 25 mEq/L

    pH greater than 7.45
  61. influenza table 29-1 558
  62. Inhaler peak flowmeter (what is "normal" peak flow?)
    measures peak expiratory volume

    normal peak flow: 300-700 L/min

    baseline values are needed for comparison
  63. COPD and diseases often associated
    long term, irreversible diseases making breathing difficult because air does not easily flow out of lungs.

    chronic bronchitis and emphysema (both caused by smoking tobacco)
  64. avg fluid amt intake and output
    2600 ml per day
  65. both fluid and ion move across membrane
  66. "normal" C02, pH, HC03
    35-45 pg 655


  67. bronchoscopy post op
    check for gag reflex
  68. thorocentisis
    pneumothorax, need informed consent because it's invasive
  69. most important nursing intervention post op
    airway!! respirations
  70. pt with thorocentisis with suspected pneumothorax
    pt may be tachy with signs of hypoxia
  71. pt having respiratory problems most important thing to ask
  72. s/s respiratory alkalosis



    severe pain
  73. s/s metebolic acidosis

    m. twitching

  74. hypervalemia
    increased and bounding pulse

    pale cool skin

    increased b/p
  75. sodium
  76. potassium
  77. Calcium
  78. phosphorus
  79. magnesium
  80. chloride
  81. causes of low Na
    excessive diaphoresis (sweating)


    wound drainage

    decreased secretion of aldosterone

    renal disease

    NPO, low Na diet

  82. s/s of hyponatremia
    rapid pulse

    nausea and diarrhea, hyperactive bowels

    seizures when below 120

    death below 115
  83. kayexalate
    drug of choice for treating hyperkalemia
  84. Acid-base balance
    • homeostasis of hydrogen ion concentration in body fluid.
    • Maintained by controlling the H ion concentration of body fluids, especially ECF
    • Concentration of H ions in body fluid is expressed as the pH
    • Lungs and kindeys are major regulators
    • Lungs compensate for respiratory distrubances
    • Kidneys compensate for metabolic disturbances
    • Buffer systems regulate acid base balance
  85. How do ABG levels help determine a patients acid-base balance
    evaluating pulmonary gas exchange efficiency

    Assessing the respiratory system

    Evaluating blood oxygenation

    Monitoring respiratory therapy effectiveness