Test 1

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Author:
amber1026
ID:
32072
Filename:
Test 1
Updated:
2010-09-01 15:27:34
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Cardiac
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Description:
HTN
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  1. B/P =
    CO =
    • CO X PVR
    • HR X SV
  2. HTN result of change in
    PVR and CO
  3. HTN is most important modifiable risk factor for (5)
    coronary heart disease, stroke, CHF, PVD, ESRF
  4. import not only to identify and treat patients with HTN but also to promote________ and __________ to decrease to prevalence of HTN
    healthy life style, prevention strategy
  5. pre-hypertension
    120-139/80-89
  6. stage I HTN
    140-159/90-99
  7. Stage II HTN
    >160/>100
  8. symptoms of HTN
    - most
    - rarely
    • - Most are not aware they have HTN
    • - Rarely may have: headache, nose bleeds,fatigue, tinnitus
  9. uncontrolled HTN damages
    kidney, heart, large and small blood vessels
  10. Vital signs with HTN
    - BP should be measured how
    - assess
    - BP should be measured in
    - sig diff suggest
    • - supine, standing
    • - volume depletion
    • - both arms
    • - aortic dissection
  11. ENT observations with HTN
    Papilledema suggests
    • Presence of new retinal hemorrhages, exudates
    • HTN urgency
  12. Cardivascular considerations with HTN
    - elvaluate for presence of _________
    (what suggests this (4))
    • Heart Failure
    • - JVD, Crackle upon auscultation, peripheral edema, weight gain
  13. assess for what abdominal changes with HTN
    masses or bruits
  14. CNS changes with HTN
    LOC, Visual fields, Focal neurologic signs (vision, speech, vertigo, weakness)
  15. Risk factors for HTN (12)
    over weight, diabetes, age, race, family hx, high normal BP, diet high in sat fats, high salt diet, lack of exercise, ETOH, stress, smoking
  16. Assessment/Diagnostic regarding HTN
    • - H/P
    • - Retinal Exam
    • - Lab
    • - BUN, Cr, Electrolytes, Micro Albumin, Fasting glucose, cholesterol
    • - 12 lead EKG
  17. Medical Mgt
    - Goal is prevent _____ by _______
    - target range for ppl w/ diabetes, chronic renal disease
    • - death and complications by achieving and maintaing arterial bp of 140/90 or lower
    • - 130/80
  18. Lifestyle Modification to manage HTN
    - Weight reduction
    - Adopt DASH
    - Decrease dietarysodium
    - Physical activity
    - Modification ofalcohol consumption
    • - BMI 18.5 to 24.9
    • - rich fruit, vegetables, low fat dairy product
    • - sodium intake no more than 24g sodium or 6g sodium chloride
    • - reg aerobic physical activity at 30 min/day
    • - no more than 2 drinks
  19. DASH diet
    • Grains – grain products
    • Vegetables
    • Fruits
    • Low fat or fat-free diary foods
    • Meat, fish, and poultry
    • Nuts, seeds and drybeans
  20. Limiting Salt
    - Upper limit
    - preHTN or HTN
    - add what instead of salt
    - careful about
    • - 2400 mg daily
    • - 1500mg daily
    • - spices
    • - "no salt added" "sodium free" "low sodium" "very low sodium"
  21. to help get started on the DASH diet consider these strategies:
    - change
    - forgive itf
    - reward
    - add
    - get
    - remeber
    • - gradually
    • - you backslide
    • - success
    • - physical activity
    • - support if you need it
    • - healthy eating isn't an all or nothing proposition
  22. Assessment
    - HTN detected initially
    - HTN diagnosed
    - routinely
    - HTN treatment regimen
    • - careful monitoring BP at frequent intervals
    • - routinely scheduled intervals
    • - BP assessment to determine effectiveness of medications, changes in BP indicate needed changes
  23. H&P
    - assess symptoms indicate target
    - such as
    - check what with apical pulse
    • - organ dysfunction
    • - angina, SOB, dizziness, or nocturia
    • - rate, rhythm, character, check peripheral pulses
  24. Collaborative problems/potential complications from HTN include
    • - Left ventricular hypertrophy
    • - MI, CHF, TIAs, CVA
    • - Renal insufficiency and failure
    • - Retinal hemorrhage
  25. Major Goals for HTN tmt
    - understanding
    - participation in
    - absence of
    • - disease process, tmt
    • - self-care program
    • - complications
  26. Nursing Interventions
    - Obj of nursing care for HTN pt focus on...
    - support and teach
    - increasing
    - promote
    - teach
    - contiuing
    - monitor and manage
    • - lowering and controlling BP without adverse effects and without undue cost
    • - adherence
    • - knowledge
    • - home and community based care
    • - self care
    • - care
    • - potential complications
  27. Gerontology Consideration
    - compliance more difficult b/c
    - mono-therapy
    - able to..
    - include who
    - know when and who to
    - caution regarding
    • - hard to remember, expense can be a proble
    • - treatment with single agent may help with expense and remembering
    • - open container and get refills
    • - family member or support
    • - call if they have side effects of drugs
    • - use of herbal meds and OTC meds and their effects on HTN and HTN meds
  28. Evaluation - expected pt outcomes
    - maintain adequate...
    - demonstrate no symptoms of
    - stable...(labs)
    - palpable...
    • - tissue perfusion
    • - angina, palpitations or vision changes
    • - stable BUN, Cr
    • - peripheral pulses
  29. Expected pt outcomes - self care plan
    - adheres to
    - get regular
    - meds
    - abstain from
    - measure what routinely
    - keeps
    • - diet, reduce calories, sodium, fat intake, increase fruit, vegetable intake
    • - exercise
    • - take as prescribed/ reports SE
    • - tobacco, excessive ETOH intake
    • - BP
    • - follow up appointments
  30. Expected patient outcomes - no complications
    - reports no change in
    - exhibts no damage in..
    - maintains
    - reports
    - maintains urine output that matches
    - has what function in normal range
    - demonstrates no....defictis
    - reports no...
    • - vision
    • - retina on vision testing
    • - pulse rate, rhythm and respiratory rate withinnormal range
    • - on dyspnea or edema
    • - with intake
    • - renal function test results within normal range
    • - no motor, speech, or sensory deficits
    • - headache, dizziness, weakness, change ingait or falls
  31. Hypertensive emergencies
    - severe HTN with acute impairment of
    - BP should be lowered how?
    • - an organ system
    • - aggressively over minutes to hours
  32. Hypertensive urgency
    - severe elevation of BP, without
    - BP can be controlled over
    • - evidence of progressive target organ dysfunction
    • - several days to weeks
  33. Hypertension Emergency
    - need to lower BP
    - acute life threatening BP elevations require
    - have immediate action that is
    • - immediately to halt or prevent damage to target organs
    • - prompt treatment in an ICU
    • - short lived - minutes to 4 hrs
  34. Medications of choice for HTN emergency
    - those that have what effect
    • - immediate, IV vasodilators
    • - sodium nitroprusside (Nipride, Nitropress)
    • - nicardipiine HCL (Cardene)
    • - fenoldopam mesylate (corlopam)
    • - enalaprilat (vasotech IV)
    • - nitroglycerin (nitro-bid IV, tridil)
  35. Sodium Nitropursside (Nipride, Nirtopress)
    - usual dose rate
    - max dose should never last more than
    - diluted to proper strength of
    - any other drugs administered with Nitro ?
    - protect diluted solution from what and how
    - must use what with this drug
    - start at what and then...
    • - 0.5-10mcg/kg/min
    • - 10 min., not controlled DC
    • - infusion
    • - NO other drug to be admined with Nitro
    • - protect from light by using supplied opaque sleeve, foil. do not cover drip chamber or tubing
    • - infusion pump
    • - 0.3mcg/kg/min and titrate up as needed
  36. Nicardipine HCL, dihydrpyridene (cardene)
    - type
    - does not depress
    - does not affect
    - major limitation longer half-life so you can
    - acute HTN: initial dose; increased to
    - effects in...
    - titrate to...
    • - Ca channel blocker
    • - LV function
    • - ICP (stroke)
    • - rapidly titrate
    • - 5mg/hr; 15mg/hr max
    • - 15 min
    • - lowest dose need to maintain stable BP
  37. Fenoldopam mesylate (corlopam)
    - rapid acting....; increases
    - starting dose....titrate to max of
    • - vasodilator, renal blood flow
    • - 0.1-0.3mcg/kg/min; 1.6mcg/kg/min
  38. Enalaprilat (Vasotech I.V.)
    - works by
    - IVP over
    - Used to treat;
    • - blocking an enzyme in the body called angiotensin-converting enzyme (ACE).
    • - 5 minutes, dilutedused
    • - HTN, CHF
  39. Nitroglycerin (Nitro-Bid I.V., Tridil)
    - Works by
    - Given
    - dose based on
    - Drug is absorbed by
    - SE:
    - Drug/Drug
    • - dilating blood vessels and reducing workload of the heart
    • - IV
    • - BP, HF, CP
    • - plastics, use special tubing,use glass bottle
    • - HA, Dizziness, weakness
    • - impotence drugs, ACE Inhibitor, BetaBlockers
  40. Causes of HTN Urgency
    - Most common cause is
    - other causes
    • - rapid unexplained rise in BP in patient with chronic essential HTN
    • - Diet pills, BCP, Cocaine, Amphetamines, CNS trauma, Post op trauma/comp
  41. Hypertensive Urgency
    - Situation BP must be lowered within
    - Managed using oral dose of fast-acting agents such as
    • - a few hours
    • - loop diuretics, beta blockers, ace inhibitors, Ca antagonist
  42. severe post op HTN is
    HTN urgency
  43. Nursing considerations with Loop diuretics during HTN urgency
    - works
    - risk for
    - watch for
    - monitor other
    - cant be on
    - lasix IV can cause
    • - quickest
    • - decrease K, heart palpitations
    • - leg cramps, gout
    • - other meds
    • - digoxin or lithium at same time
    • - ottotoxicity (deafness)
  44. Beta blockers
    - works how
    - on first dose be cautious of
    • - lowering pulse
    • - bronchospasm
  45. ACE inhibitors
    - can cause (no. one SE)
    - alters
    - warn pt about taking
    • - cough
    • - taste
    • - K supplement and salt substitues
  46. Ca Channel Blocker
    - watch for
    - teach pt to
    - interacts with
    - causes
    • - peripheral edema
    • - weigh daily
    • - grapefruit juice
    • - constipation
  47. when BP decreases quickly on meds monitor
    urinary output (renal system)
  48. tubing to use with sodium nitropursside (nipride, nirtopress)
    protect from light, use supplied opaque sleeve, foil. do not need to cover drip chamber or tubing
  49. type of tubing to use with NTG
    glass
  50. S&S of HTN
    HA, nose bleed, ear ringing, vision changes, most are asymptomatic
  51. first organ to be affected by HTN
    kidneys
  52. complications from HTN
    • stroke
    • CVD
    • CHF
    • renal
    • vision problems
  53. - Angina (def)
    - occurs when
    • - chest pain
    • - defect of oxygen for the heart muscle
  54. angina can occur when:
    - blood or oxygen supply to heart is
    - heart is
    - or...
    • - impaired
    • - working harder than usual and needs more oxygen
    • - combination of these
  55. patterns of chest pain
    classic, exertion, variant

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