Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Perfusion/HTN Fall19
Updated LPN Perfusion HTN Powerpoint Fall 2019
| Question | Answer |
|---|---|
| Categories of perfusion | Central perfusion and Tissue or Local perfusion |
| Central perfusion | Force of blood movement generated by cardiac output Requires adequate cardiac function, blood pressure, and blood volume Cardiac output (CO) = Stroke volume × Heart rate |
| Tissue or local perfusion | Volume of blood that flows to target tissue Requires patent vessels, adequate hydrostatic pressure, and capillary permeability |
| Cardiac output (CO) | Stroke volume × Heart rate |
| Impaired central perfusion | Cardiac output is inadequate Reduced cardiac output results in a reduction of oxygenated blood reaching the body tissues (systemic effect) If severe, associated with shock If untreated, leads to ischemia, cell injury, and cell death |
| Impaired tissue (local) perfusion | Associated with loss of vessel patency or permeability, or inadequate central perfusion Results in impaired blood flow to the affected body tissue (localized effect) Leads to ischemia and, ultimately, cell death if uncorrected |
| Populations at greatest risk with impaired perfusion | The populations at greatest risk are: Middle-aged and older adults Men African Americans |
| Assessment: Impaired Perfusion | History Baseline Problem-based Pain Dyspnea Edema Dizziness Examination Central perfusion Tissue perfusion |
| Common diagnostic tests Impaired Profusion | Laboratory tests, Electrocardiogram (EKG) Cardiac stress tests Exercise or pharmacological test Radiographic studies Chest x-ray, ultrasound, arteriogram |
| Laboratory tests | Creatine kinase, lactic dehydrogenase, natriuretic peptides, troponin, homocysteine, C-reactive protein, serum lipids, platelets, prothrombin time (PT), partial thromboplastin time (PTT), International Normalized Ratio (INR) |
| Primary Prevention Impaired Perfusion | Smoking and nicotine cessation Diet Exercise Weight control |
| Screening Impaired Perfusion | Screening Blood pressure screening Lipid screening |
| Collaborative interventions Impaired Perfusion | Treatment strategies depend on underlying condition The most common strategies include: Diet modification and smoking cessation Increased activity (conditioning) Pharmacotherapy |
| Collaborative interventions Impaired central perfusion** | Antihypertensives-lower bp Antiarrhythmics-correct cardiac rhythms Inotropics-increase contractility of heart muscle Antianginal agents-decrease chest pain related to heart Vasopressors-constrict vessels Vasodilators-dilate vessels |
| Impaired tissue (local) perfusion** Interventions | Anticoagulants-thib blood to prevent clots; Thrombolytics-break up clots ; Lipid-lowering agents-lower cholesterol to decrease plaque ;Vasodilators-dilate vessels ;Antiplatelet agents and platelet inhibitors-prevent platelets from sticking together and fo |
| Procedures and surgical interventions Central perfusion** | Pacemaker insertion-no MRI!! Electrical cardioversion Ablation therapy Intraaortic balloon pump Cardiac valve surgery Cardiac transplant |
| Procedures and surgical interventions : Tissue (local) perfusion | Bypass and/or graft surgery Stent or angioplasty Endarterectomy |
| Normal blood pressure | Systolic: <120 mm Hg; diastolic <80 mm Hg |
| Prehypertension | Systolic pressures between 120 and 139; diastolic pressures between 80 and 89 |
| Primary hypertension | 90% to 95% of all cases of hypertension Cause is unknown |
| Secondary hypertension | Caused by underlying factors, such as kidney disease, certain arterial conditions, some drugs, and occasionally pregnancy |
| Cardiac output | The volume of blood pumped by the heart in a specific period (usually 1 minute) Determined by strength, rate, and rhythm of the contraction of the left ventricle and the blood volume |
| Peripheral vascular resistance (systemic) | Force in the blood vessels that left ventricle must overcome to eject blood from the heart (afterload) |
| The most prominent characteristic of hypertension | Increased peripheral vascular resistance: |
| Resistance to blood flow determined by | Diameter of the blood vessels and blood viscosity (thickness) |
| Vasoconstrictors that cause blood vessels to constrict, making diameter smaller | Norepinephrine and epinephrine (catecholamines) |
| Norepinephrine increases peripheral vascular resistance and raises blood pressure | By constricting blood vessels |
| Causes blood pressure to rise by constricting blood vessels and increases the force of cardiac contraction | Epinephrine |
| Released when Vasoconstriction decreases blood flow to the kidneys | Renin |
| Renin leads to the formation, another potent vasoconstrictor | Angiotensin |
| Stimulates the adrenal cortex to secrete aldosterone, a hormone that promotes sodium & water retention , which results in increased blood volume | Angiotensin |
| True or False: Vasoconstriction, cardiac stimulation, and retention of fluid all contribute to hypertension | True |
| Reduce the elasticity of the arteries, causing decrease in cardiac output and increase in peripheral vascular resistance | Atherosclerotic changes |
| Pulse pressure | widens in response to a decreased ability of the aorta |
| Pulse pressure | The difference between the systolic and diastolic pressures |
| Risk Factors for Hypertension | Dyslipidemia-elevated cholesterol Atherosclerosis-reduced elasticity Diabetes mellitus Tobacco use Age >55 years for men or age >65 years for women Family history Father or brother with heart disease before age 55; mother or sister with heart dise |
| Signs of Hypertension | Occipital headaches that are more severe on arising Lightheadedness Epistaxis - nosebleeds If hypertension has damaged blood vessels in the heart, kidneys, eyes, or brain, patient may have symptoms of impaired function of those organs |
| Complications of Hypertension | Heart - Coronary Artery Disease) Kidneys Brain Eyes |
| Coronary artery disease with hypertension | 2-3 times more frequently than in people with normal blood pressures |
| Kidneys and Hypertension | Narrowing of the renal arteries may decrease renal function and lead to chronic renal failure |
| Brain Complication with Hypertension | Prolonged hypertension constricts and damages cerebral arteries, putting patient at risk for transient ischemic attacks and cerebrovascular accidents |
| Eyes Complication of Hypertension | Damage to eyes may include narrowing of the retinal arterioles, retinal hemorrhages, and papilledema; may lead to blindness |
| Diagnostic Tests and Procedures | Confirmed by repeated findings of average pressures equal to or greater than 140/90 Ambulatory blood pressure monitors Provider collects data about patient’s lifestyle, other cardiovascular risk factors, and other medical diagnoses Electrocardiogram |
| Lifestyle modifications with Hypertension | Weight reduction Smoking cessation Sodium and alcohol restriction Exercise Relaxation techniques |
| Pharmacologic therapy Hypertension | Diuretics Beta-adrenergic receptor blockers Calcium antagonists Angiotensin-converting enzyme (ACE) inhibitors (ACEIs) Angiotensin II receptor antagonists (ARBs) Central adrenergic blockers Alpha-adrenergic receptor blockers Direct vasodilator |
| Nursing Implications Hypertension | Administering the drugs to inpatients Monitoring for therapeutic and adverse effects Teaching patients about their drugs |
| Secondary hypertension | Has a specific known cause and is less common than primary hypertension |
| Causes of Secondary Hypertension | Renal disease Excess secretion of adrenal hormones Narrowing of the aorta Increased intracranial pressure Some drugs such as vasoconstrictors |
| Nursing Interventions | Diet therapy goals Maintain ideal body weight; Exercise Stress management Drug therapy Ineffective coping Sexual dysfunction |
| Exercise | Walking is highly recommended: increases cardiovascular functioning, burns calories, relieves stress, and promotes a sense of well-being |
| Stress management HTN | Help patients identify stressors in their lives and explore ways to reduce them |
| Drug therapy HTN | Review the name, dosage, purpose, and side effects of any prescribed medications |
| Risk for Injury (Nursing Interventions - HTN) | Orthostatic Hypotension and Sedation |
| Orthostatic HTN | Sudden drop in systolic pressure usually 20mm Hg, going from lying or sitting to a standing position Advise provider so an alternative medication or other intervention can be considered |
| Sedation (NUrsing Intervention _HTN) | Advise if drowsiness..likely.. activities requiring alertness can be avoided during times of peak drug effect Take meds at bedtime to promote sleep |
| Older Patients HTN | Response to drug therapy more difficult to predict; side effects are more common Atherosclerotic changes-plaque and reduced elasticity Valves become thick and stiff Decreased number of SA node cells Decreased contractility of heart muscle |
| Hypertensive Emergencies ***********not in Fall PPt | A life-threatening medical emergency Severe headache, blurred vision, nausea, restlessness, and confusion Elevated diastolic blood pressure (130 mm Hg or more); the heart and respiratory rates are increased May result from having stopped taking antih |
| Hypertensive Emergencies **********not in Fall PPt | Causes: malignant hypertension, hypertensive encephalopathy, eclampsia, pheochromocytoma (adrenal tumor), cerebrovascular accident Without treatment, the patient in hypertensive crisis may incur cardiac and renal damage Death may ensue as a result of |
| Medical Diagnosis Hypertensive Emergencies *********not in Fall PPt | Assessment in the ED reveals elevated blood pressure, pulse, and respiratory rate Retinal hemorrhage or papilledema, or both, observed in fundus (back, interior portion) of eye Physician may order blood drawn for arterial blood gases, CBC, electrolytes |
| Medical Treatment HTN Emergency**********not in Fall PPt | The goal of drug therapy is to rapidly reduce the pressure to a non–life-threatening level and then to bring it slowly within normal range |
| Medical Treatment HTN Emergency**********not in Fall PPt | Diuretics and potent vasodilators Fenoldopam Nitroglycerin Diazoxide Hydralazine Phentolamine Labetalol Nitroprusside |
| Medical Treatment HTN Emergency**********not in Fall PPt | An intravenous line is usually established because many drugs are given by that route Oral options for the management of hypertensive crisis include captopril, clonidine, and nifedipine |
| Assessment HTN Emergency**********not in Fall PPt | Frequently check blood pressure, pulse, respiration, and level of consciousness Some drugs are given in intravenous fluids, requiring continuous monitoring and adjustment Careful record of fluid intake and output Nausea and vomiting may indicate an |
| Interventions HTN Emergency**********not in Fall PPt | Administer prescribed drugs Vital signs before and after each dose Monitor cardiac and renal function Start and maintain intravenous therapy Administer oxygen as ordered Comfort the patient |
| Interventions HTN Emergency**********not in Fall PPt | Take appropriate safety measures if the patient shows signs of seizure activity or a decreasing level of consciousness Once patient’s condition improves, it is important to explain how to manage hypertension and prevent future crises |
| Anti-Hypertensive Medications | Diuretics; beta-adrenergic blocking agents ACE inhibitors; angiotensin II receptor blockers (ARBs) Direct renin inhibitors; aldosterone receptor antagonist Calcium channel blockers; alpha-1 adrenergic blocking agents Central-acting alpha-2 agonists; p |
| Diuretics | Cause volume depletion, sodium excretion, vasodilation of peripheral arterioles Most commonly prescribed Usually in combination with other HTN meds |
| Beta-Adrenergic Blocking Agents-beta blockers (end in –olol) | Inhibit cardiac response to sympathetic nerve stimulation Inhibit renin release from kidneys Uses Initial therapy for stage 1 and 2 hypertension |
| beta blockers | Common adverse effects Bradycardia, peripheral vasoconstriction (purple, mottled skin); heart failure; bronchospasm, wheezing; masks hypoglycemia in diabetic patients |
| beta blockers | Hold medication if systolic BP is less than 100 mm Hg or if heart rate is less than 60 bpm; contact prescriber ****Sudden discontinuation of therapy has resulted in worsening angina, MI; medication should be gradually reduced over 1-2 weeks |
| beta blockers | NSAIDs may inhibit effectiveness |
| ACE Inhibitors-Always end in -pril | Inhibit angiotensin I converting enzyme (ACE), disrupting the conversion of angiotensin I to angiotensin II; reduce blood pressure; preserve cardiac output; and increase renal blood flow Uses Single therapy for stage 1 or 2 hypertension Not as effectiv |
| ACE Inhibitors | Common adverse effects Nausea, fatigue, headache, diarrhea; orthostatic hypotension, about one-third of patients get a cough |
| ACE Inhibitors | Not as effective in African Americans unless combined with diuretic |
| ACE Inhibitors | Serious adverse effects include Angioedema Initial doses may cause hypotension with dizziness, tachycardia, and fainting (more likely with older adults) Neutropenia Hyperkalemia Nephrotoxicity May cause fetal harm May increase blood levels of dig |
| ARBs -Sartan sisters | Bind to angiotensin II receptor sites and block the vasoconstrictor from binding to receptor sites in target organs Uses Alone or in combination with other antihypertensives to reduce blood pressure |
| ARBs | African Americans may not respond well to therapy with an ARB only |
| ARBs | Common adverse effects of this group Dyspepsia, cramps, diarrhea; headache; orthostatic hypotension |
| ARBs | Serious adverse effects include Hyperkalemia, more common in patients with renal impairment or DM Monitor potassium levels Discourage potassium or dietary supplements Can cause birth defects |
| Calcium Channel Blockers | Inhibit movement of calcium ions across cell membranes Vasodilation Uses Ideal for first- or second-line drug therapy for hypertension Effective in African-American patients |
| Calcium Channel Blockers- Serious adverse effects | Hypotension and syncope Edema |
| Central-Acting Alpha-2 Agonists | Stimulate alpha-adrenergic receptors in the brainstem, reducing sympathetic outflow from CNS Uses Considered adjunctive therpy; used only in combination with other antihypertensives |
| Central-Acting Alpha-2 Agonists - Adverse effects | Common adverse effects of this group of meds includes Drowsiness, dry mouth, dizziness, altered urine color, altered rest results Serious adverse effects Depression; rash |
| Central-Acting Alpha-2 Agonists Why you can't stop abruptly - Clonidine | Could cause rebound effect with increased BP, nervousness, agitation, restlessness, etc. Use adhesive overlay to keep patch in place |
| Central-Acting Alpha-2 Agonists | Withdrawal symptoms of this medication could appear within a few hours, become severe in 8 to 24 hours Use adhesive overlay to keep patch in place |
| Direct Vasodilators | Relax arterial smooth muscle, reducing peripheral vascular resistance |
| Direct Vasodilators | Treatment of stage 2 hypertension, renal disease hypertension, toxemia of pregnancy |
| Direct Vasodilators | This medication causes Dizziness, numbness, tingling in legs; orthostatic hypotension, palpitations, tachycardia; nasal congestion; hair growth |
| Direct Vasodilators - serious adverse effects | Fever, chills, joint and muscle pain, skin eruptions; gynecomastia |
| Angioedema | swelling of the face, eyes, lips, and tongue; difficulty breathing |
| Diuretics | Most commonly prescribed antihypertensives In combination with other antihypertensive agents |
| Effects of Impaired central perfusion | If severe, associated with shock If untreated, leads to ischemia, cell injury, and cell death |
| Problems with Impaired tissue perfusion | Results in impaired blood flow to the affected body tissue (localized effect) and may lead to ischemia or cell death if not corrected |
| Cardiac output (CO) is the product of two variables | Stroke volume and heart beat |
| The formula for Cardiac Output | CO = SV x HR. |
| Stroke volume | The amount of blood circulated by the heart with each beat. |
| Ineffective Coping (NI HTN) | If depression is a side effect of an antihypertensive, consult provider to substitute another drug |
| Sexual dysfunction (NI - HTN) | Decreased libido, inability to achieve an erection, or delayed ejaculation Advise provider so an alternative medication or other intervention can be considered |
| Central-Acting Alpha-2 Agonists - Serious Adverse effects | Depression; rash |
| Cardiac Conduction system | Consists of movement of conduction impulses thru the heart which causes the heart to contract |
| Heart Conduction impulse begins in this node | the Sinoatrial (SA) node |
| Conduction impulse move from the the Sinoatrial (SA) node to this node | Travels to the Atrioventricular (AV) node |
| From the Atrioventricular (AV) node and impulse is transmitted to the ventricles to Bundle of His is composed of left and right bundle branches These branches extend down to the Purkinje fibers which results | The bundle of His |
| Composes the Bundle of His | Left and right bundle branches |
| These branches extend down to the Purkinje fibers which results in the ventricular contraction | Left and right bundle branches |
| Regulates the vasomotor center | Diameter of blood vessels |
| Tracts from the medulla extend down the spinal cord to the thoracic and abdominal regions | Sympathetic nervous system |
| Causes release of the hormones norepinephrine and epinephrine | Stimulation of sympathetic nervous system |
Created by:
TutorDavis17
Popular Nursing sets