Chapter 16

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Chapter 16
2015-02-18 17:25:31
alternations in blood pressure
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  1. What is arterial blood pressure?
    the pressure differences between the L and R sides of the heart that produce gradient allowing systemic movement of the blood
  2. How is arterial bp produced?
    it is produced by the force of left ventricular contraction overcoming the resistance of the aorta to open the aortic valve
  3. Determinants of systemic BP?
    What is the equation?
    What is the preload and afterload?
    • CO = SV (stroke volume) X HR (heart rate) 
    • End-diastolic volume is preload
    • systemic vascular resistant is the afterload
  4. How is systemic vascular resistance determined?
    the afterload is determined by radius of arteries and degree of vessel compliance
  5. Components of BP
    • systolic bp
    • diastolic bp
    • SV (stroke volume) - primary influences systolic pressure
    • SVR (systemic vascular resistance) - for diastolic pressure
  6. mean arterial pressure
    • avg pressure within circulatory system thru-out cardiac cycle 
    • MAP =
  7. where is the catheter commonly placed?
    radial artery
  8. direct measurement of bp
    intraarterial catheter to transduce arterial fluid pulsations into electrical signals/waveforms
  9. indirect measurement of bp
    • via brachial artery using stethoscope and sphygmomanometer or automated oscillometric system 
    • Korotkoff sounds
  10. What affects bp regulation
    by neural, humoral, and renal factors
  11. short term regulation of systemic bp
    • changes in bp mediated thru activation of sympathetic nervous system 
    • -results in release of nt: epinephrine & norepinephrine 
    • -vasomotor center indirectly activated via baroreceptor
  12. which baroreceptors activates what?
    • α1 receptors in smooth muscle of arterioles 
    • βreceptors of the heart
  13. long term regulation of systemic bp
    • ^ in extracellular fluid vol. = ^ CO and SVR = elevated BP 
    • -^ serum sodium level = ^ osmolality = ^ ADH secretion 
    • -RAAS: renin-angiotensin-aldosterone system are important regulator of bp

    • angiotensin II produces ^ in SVR
    • -Atrial natriuretic peptides (ANP) cause kidneys to ^ sodium and water excretion by ^ glomerular filtrate rate 
    • -intrarenal arteriolar constriction leads to ^ tubular reabsorption of sodium and water
  14. normal fluctuations in systemic bp
    • suprachiasmatic nuclei in brain govern daily variations in bodily functions 
    • neural and hormonal regulation and lifestyle influences
  15. hypertension
    • primary diagnosis 
    • -^morbidity and mortality associated w/ heart disease, kidney disease, peripheral vascular disease, and stroke
  16. prehypertension
    a range of pressures between normal and stage 1 hyptertension in an effort to initiate interventions early enough to prevent/deter progression of disease process
  17. normal - S/D
    • <120 / <80
    • 120-139 / 80-89
  18. primary hypertension
    • idiopathic disorder 
    • common form of hypertension
  19. outcomes of primary hypertension
    • end organ damage,
    • -^ myocardial work results in HF 
    • -glomerular damage results in kidney failure 
    • -affects microcirculation of eyes 
    • -^ pressure in cerebral vasculature can result in hemorrhage
  20. secondary hypertension
    • attributed to specific identifiable pathology/condition 
    • -common form in children <10 yrs of age
  21. hypertensive emergency
    • sudden ^ in either or both systolic or diastolic bp with evidence of end-organ damage
    • -use of parenteral antihypertensive agents under close monitoring
  22. hypertensive urgency
    • similar bp elevation without evidence of end-organ damage 
    • -oral medications
  23. low bp
    • orthostatic (postural) hypotension is a decrease in systolic bp when moving to an upright position 
    • -excessive ^ in heart rate (by 15-20 beats/minute) may also be diagnostic
  24. result of low bp
    • -prob. w/ vasomotor/baroreceptor response 
    • -adverse effect of drug therapy 
    • -arterial stiffness 
    • -vol. depletion 
    • -secondary disease process
  25. treatment of low bp
    • medication history,
    • -slow positional changes,
    • -avoid hot environments,
    • -hydrate,
    • -avoid large/carbohydrate-heavy meals
    • -when symptoms begin, squatting/bending forward or crossing legs may reduce effects