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EXAM 3 - MED SURG
HTN & HF
| Question | Answer |
|---|---|
| Why is hypertension called the silent killer? | Often patients do not exhibit any signs or symptoms for many years indicating the presence of hypertension. So, when they find out, and by the time symptoms develop, the damage has already been done to various organs and bodies structures. |
| Prehypertension | 120-139/80-89 |
| Stage I Hypertension | 140-159/90-99 |
| Stage II Hypertension | >160/>100 |
| Nursing Management for Hypertension | Frequent BP assessments, education, counseling while actively engaging the patient to promote adherence to the treatment plan. Also focuses on lowering and controlling BP without adverse effects or undue costs |
| Hypertension Urgency | Severe BP elevation >180/100 in stable patients without target organ damage |
| Hypertension Emergency | Severe BP elevation >220/140 with new or worsening target organ damage. The patient is admitted to the ICU |
| The relationship between hypertension and sleep apnea | A cause of secondary hypertension |
| Primary hypertension | Also called essential hypertension, and is diagnosed when there is no identifiable cause. Accounts for 90-95% of hypertension |
| Secondary hypertension | Hypertension that has an identifiable underlying cause. Counts for 5-10% of hypertension |
| Target Organ Damage Definition | Structural and functional impairment of major body organs due to an elevated BP |
| DASH Diet | Dietary approach to stop hypertension. Includes consumption of a diet rich in fruits, veggies, reduction of sodium (less than 2g/day), increased physical activity, and moderation of alcohol intake |
| Organs Effected by Hypertension Emergency | Heart, Brain, Peripheral Vascular Diseases, Kidneys, Eyes |
| Clinical Manifestations of Hypertensive Emergency | Symptoms of TOD such as chest pain, SOB, back pain, numbness and weakness, changes in vision, difficulty speaking. Along with a significantly elevated BP |
| Blood Pressure Technique | No food or drinks 30 mins prior, empty bladder, no talking. Arm resting at chest height, cuff on bare skin, back is supported, feet flat on ground, no crossed legs, avoid tensing muscles. |
| Lifestyle Modifications for Hypertension, Education & Motivation for Changes | Weight reduction (BMI 18.5-24.9 kg/m2), DASH diet, sodium reduction, physical activity, moderation of alcohol consumption, increase intake of fruits and veggies, avoid smoking |
| Modifiable Risk Factors for Hypertension | Stress, smoking, alcohol, hypertension, obesity, diabetes mellitus, salt intake, occupations, personality, coffee and tea |
| Non-Modifiable Risk Factors for Hypertension | Family history, ethnicity, race, age, gender |
| Conditions associate with Hypertensive Emergencies | Encephalopathy, ischemic stroke, MI, HF with pulmonary edema, Dissecting aortic aneurysm, and renal failure |
| Thiazide Diuretics | Decrease blood volume, renal blood flow, and cardiac output. Monitor K+ levels |
| Beta-Blockers | Block the SNS to produce a slower heart rate and a lower BP |
| Angiotensin Converting Enzyme (ACE) Inhibitors | Inhibits the conversion of angiotensin I to angiotensin II and lowers peripheral resistance leading to a decreased BP and afterload, and relieves signs and symptoms of heart failure. Monitor for angioedema, and renal function. Dry annoying cough is common |
| Angiotensin II Receptor Blockers (ARBs) | Increase HR, force of contraction, cardiac output, while dilating arterioles and veins, and increasing the renal excretion of sodium and water. |
| Calcium Channel Blockers (CCBs) | Dilate peripheral arteries and decreases peripheral vascular resistance by relaxing vascular smooth muscle. Avoid grapefruit juice and St. John's Wort Monitor LFTs. Special monitoring for constipation and abdominal pain as then the meds are effect their smooth muscles |
| First line of drug therapy for Hypertension | Beta-Blockers |
| Patent Education for all Antihypertensive Drugs | Cautious with moving positions quickly, orthostatic hypotension may occur. It is important to know that medication works best when combined with life-style changes such as diet and exercise |
| What is Heart Failure? | a physiologic state in which the heart cannot pump enough blood to meet the body’s metabolic needs following any structural or functional impairment of ventricular filling or ejection of blood. |
| Systolic Heart Failure | Alteration in ventricular contraction, which is characterized by a weakened heart muscle. Results in decreased blood ejected from the ventricle. |
| Diastolic Heart Failure | A stiff and non-compliant heart muscle, making it difficult for ventricles to fill |
| Congestion in Heart Failure | Seen in left-sided heart failure. Occurs from the left ventricle being unable to effectively pump blood out of the ventricle and into the aorta and systemic circulation |
| Perfusion in Heart Failure | Seen in right sided heart failure. Occurs from the hearts inability to eject blood effectively and cannot accommodate all of the blood that normally returns it from the venous circulation |
| Diagnostics used to confirm heart failure | BNP, ECG, Chest X-Ray, Echo, Other Lab Studies (BUN, creatinine, LFTs, thyroid-stimulating hormone, serum electrolytes, CBC, urinalysis) |
| Echocardiogram | Determines the EF, identifies anatomic features such as the structural abnormalities and valve malfunction in HF |
| Chest X-Ray and ECG | Assists in the diagnosis of HF |
| Brain Natriuretic Peptide (BNP) | If it is high, heart failure is getting worse. Key diagnostic indicator for HF. High levels are a sign of high cardiac filling pressure and can aid in the diagnosis and management |
| Nursing Management of Heart Failure | Improvement of cardiac function with optimal pharmacological management. Reduction of symptoms and improvement of functional status. Stabilization of patient condition and lowering the risk of hospitalization. Delay the progression of HF and extension of life expectancy. Promotion of a lifestyle conductive to cardiac health |
| Patient Self-Management & Teaching in Heart Failure | Import to adhere to medication regimen. Restrict dietary sodium (no more than 2 g per day), avoid excessive fluid intake (no more than 2,000 mL/day), avoid smoking, excessive alcohol. Weight reduction if indicated, regular exercise. Patient should monitor weight gain and should report if 3lbs are gained in one day, or 5lbs are gained in one week. |
| Correct Jugular Vein Distention (JVD) Assessment | Patient should sit at a 45 degree angle. If the distention is greater than 4 cm above sternal angle it is considered abnormal and indicative of right ventricular heart failure |
| Clinical Manifestations of Acute Decompensated Heart Failure | Sudden or gradual onset of worsening symptoms of HF. Requires unplanned office visits, emergency visits, or hospitalization. Patient will develop dyspnea, generally associated with rapid accumulation of fluid within the lungs interstitial and alveolar spaces leading to pink frothy sputum |
| Treatment and Evaluation of Goals in a Heart Failure Patient | Short-Term goals include management directed toward relieving symptoms of SOB, decreased exercise tolerance, and lower extremity edema while improving functional quality of life. Long-Term Goals include decreasing mortality and slowing or reversing the underlying cardiac structural abnormalities |
| Nursing Management of Decompensated Heart Failure | Airway assessment, pulse ox, supplemental oxygen, vital signs, cardiac monitoring, diuretic therapy, vasodilator, and urine output monitoring |
| Therapeutic Communication for a Patient with Heart Failure | It is important to respectfully explain the cause, and severity of the patient's disease. The patient needs to be aware of the possible outcomes, risks, and complications of their disease. Ensure you do not come off as judgmental, but be open and honest with the patient. |
| Evaluating the Patient's Understanding of the Treatment for Heart Failure | When the patient recognizes that the diagnosis of HF can be successfully managed with lifestyle changes and medications, recurrences of acute HF lessen, unnecessary hospitalizations decrease, and life expectancy increases. |
| Digoxin MOA & Considerations | Increases the force of myocardial contraction and slows conduction through the AV node. Improves contractility, increasing left ventricular output, and decreases the signs and symptoms of HF. erum potassium levels should be monitored because the effects of the drug can be enhanced in the presence of hypokalemia. |
| Clinical Manifestations of Digoxin (Digitalis) Toxicity | VISUAL DISTURBANCES, BRADYCARDIA, nausea, confusion, anorexia. |
| Digoxin Therapeutic Level | 0.8 - 2.0 ng/mL |
| Right-Sided Heart Failure | RIGHT BACK TO BODY |
| Left-Sided Heart Failure | LEFT TO THE LUNGS |
| Treatment/Management of Hypertension Urgency | Want to gradually stabilize BP within 24-48 hours. |
| Treatment/Management of Hypertension Emergency | Want to quickly and immediately stabilize BP. IV |
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