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| HTN- Diabetes- blurred vision | Diabetes is the leading cause of blindness, and is a major contributing factor to heart disease, stroke, and hypertension
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| HTN- blurred vision | Hypertensive Emergencies affects the heart, brain, peripheral vascular, kidneys, and eyes -- BP is typically 220/140
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| Angiotensin Converting Enzyme (ACE) Inhibitors | Can slow the progression of heart failure. Also used in Hypertension treatment. Adverse effects include dry persistent cough (common), angioedema (STOP MED AND PROVIDE EMERGENCY CARE)
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| Angiotensin II Receptor Blockers (ARBs) | Increases HR, force of contraction, cardiac output, while dilating arterioles and veins. Increases renal excretion of sodium and water
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| Thiazide Diuretics | Decrease blood volume, renal blood flow, and cardiac output. Monitor potassium levels
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| Calcium Channel Blockers | Dilates peripheral arteries, and decreases peripheral vascular resistance by relaxing vascular smooth muscle. AVOID GRAPEFRUIT JUICE & ST. JOHNS WORT. Monitor LFTs, constipation, and abdominal pain.
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| Beta Blockers | FIRST LINE DRUG THERAPY FOR HYPERTENSION. Blocks the sympathetic nervous system to produce a slower HR and lower BP.
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| All Antihypertensive Medications | In general they decrease BP by decreasing cardiac output or peripheral vascular resistance. Can cause orthostatic hypotension. Always ask patients that arrive with high BP (previously diagnosed) if they have been taking their meds as prescribed. When BP is less than 140/90 mm Hg for at least 1 year, gradual reduction in meds is indicated.
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| Direct Renin Inhibitors | Aliskiren (Tekturna), is the only direct renin inhibitor to decrease plasma renin activity and inhibit the conversion of angiotensinogen to angiotensin I. it can be given alone or in combination. BUT SHOULD NEVER BE USED WITH AN ACE OR ARB. Except for the FIXED DOSE OF valsartan (Valturna)
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| Heart Failure - Fluid Retention | Occurs in right-sided heart failure where the right ventricle fails, congestion in the peripheral tissues, because the right side of the heart cannot eject blood effectively and cannot accommodate all of the blood that normally returns to it from the venous circulation.
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| Right-Sided Heart Failure Symptoms | Leads to increased venous pressure, jugular venous distention, and increased capillary hydrostatic pressure throughout the venous system. Clinical manifestations include edema (low extremities), hepatomegaly (liver enlargement), ascites (accumulation of fluid in the peritoneal cavity), and weight gain due to retention of fluid. A WEIGHT GAIN OF 3 LBS IN ONE DAY, OR 5 LBS IN A WEEK SHOULD BE REPORTED.
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| Ultrafiltration | Alternative intervention for severe fluid overload. Used for those with advanced HF who are resistant to diuretic therapy. A dual-lumen central IV is placed, and the patient's blood is circulated through a small bedside filtration machine. Liters of excess fluid and plasma are removed slowly from the intravascular circulating volume over a number of hours. The patients output and filtration fluid, BP, and hemoglobin are monitored for indicators of volume status.
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| Heart Failure - Fluid Volume | Follow a low sodium diet (no more than 2g/day) and avoiding excessive fluid intake is recommended. Restriction of sodium is to decrease the amount of circulating blood volume which decreases the myocardial work.
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| Diuretics used in Heart Failure | Loop, Thiazide, and Aldosterone-Blocking Diuretics may be prescribed. They can improve patient's symptoms. But should only be given when renal function is adequate.
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| Loop Diuretics in HF | Furosemide is an example. Inhibits sodium and chloride reabsorption mainly in the ascending loop of Henle. They are generally the first type tired. Administered through IV for exacerbations of HF when rapid diuresis is needed, such as in pulmonary edema. INCREASES potassium secretion. Monitor for hypokalemia. May be used with a thiazide diuretic if they are unresponsive to the solo treatment.
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| Thiazide Diuretics in HF | Metolazone is an example. Inhibit sodium and chloride reabsorption in the early distal tubules. INCREASES potassium secretion. Monitor for hypokalemia. May be used with a loop diuretic if they are unresponsive to the solo treatment.
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| Aldosterone Antagonist Diuretic | Also called potassium-sparing diuretics. An example is spironolactone. They block the effects of aldosterone in the distal tubule and collecting duct. Serum creatinine and potassium levels should be monitored. Should not be given to patients with an elevated serum creatinine.
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| Fe Supplement administration | Meds should be taken on an empty stomach. But can be taken with orange juice or other Vitamin C products to aid in absorption. Eat high-fiber foods to prevent constipation. Stool may become darker in color. Use straw for liquid meds to prevent staining of teeth
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| Pernicious anemia | Vitamin B12 Deficiency. Caused from a lack of intrinsic factor from the gastric parietal cells. Required for vitamin B12 absorption. Results in vitamin B12 deficiency. Early symptoms are nonspecific and vague
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| Clinical Manifestations of Pernicious Anemia | Smooth, sore, red, tongue, mild diarrhea, extremely pale (especially in mucous membranes), May be confused, experience paresthesia in extremities. Vitiligo (patchy loss of skin pigmentation) & graying of hair. Balance difficulties from damage to spinal cord, and loss of position sense (Proprioception). WHEN HEMOGLOBIN IS AT 7-8 G/DL weakness, fatigue, paresthesia, difficulty walking, abdominal pain, weight loss (risk factor), sore tongue, and neurological manifestations
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| Febrile Reaction in Blood Administration | chills, fever, headache, flushing, tachycardia, and increased anxiety
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| Allergic Reactions in Blood Administration | hives, pruritus, facial flushing. Severe is SOB, bronchospasms, anxiety
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| Hemolytic Transfusion Reactions in Blood Administration | low back pain, hypotension, tachycardia, fever and chills, chest pain, tachypnea, hemoglobinuria, may have immediate onset
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| SBAR - Initiate Process - Blood Administration | Assess patient's vital signs before, during, and after blood transfusion is complete to screen for any adverse reactions, however, the optimal frequency for assessing these vital signs during the transfusion is not well established.
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