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Med Surg Ch. 22

Understanding the CV System

What is a normal BP? Less than 120/80
How often should a pt with a normal BP follow up with their doctor? Every 2 years
What BP indicates pre-hypertension? 120-139/80-89
How often should a pt with pre-hypertension follow up with their doctor? Every year
What BP indicates stage 1 hypertension? 140-159/90-99
How often should a pt with stage 1 hypertension follow up with their doctor? Every 2 months
What drugs are prescribed for stage 1 hypertension? Thiazide-type diuretics. ACE inhibitors are considered
What BP indicates stage 2 hypertension? Over 160/100
How often should a patient with stage 2 hypertension follow up with their doctor? Every month
What drugs are prescribed for stage 2 hypertension? A two drug combination. Usually thiazide-type diuretics with an ACE inhibitor, ARD, BB or CCB
What determines BP? CO, PVR, viscosity of blood and amount of circulating blood volume
What processes influence BP? Nervous system regulation, aterial baroreceptors and chemorecceptors, the renin-angiotensin-aldosterone mechanism and the balance of body fluids
Cytomegalovirus may cause what? High BP
What is the cause of primary HTN? The cause is unknown
What is the cause of secondary HTN? A kidney abnormality, a tumor of the adrenal gland or congenital defect of the aorta
What is isolated systolic hypertension? A systolic pressure of 140 mm Hg or greater and diastolic pressure of 90 mm Hg or less
In what age group does isolated systolic hypertension occur most often? The elderly
How is isolated systolic hypertension treated? With lifestyle modifications. If that is not successful antihypertensives are used
Because HTN lacks symptoms it is refered to as...? The silent killer
What symptoms are occasionally seen with HTN? Headache, bloody nose, severe anxiety or shortness of breath
How is HTN diagnosed? By considering a pts risk factors, a previous diagnosis of HTN, presence of s&s. hx of kidney or heart disease and current meds
How many occasions must your BP be measured to be diagnosed with HTN? Two or more
What diagnostic tests are used to determine kidney damage? Urinalysis, electrolytes, uric acid, BUN, creatinine, blood glucose
What diagnostic tests are used to determine heart damage? ECG, CBC, lipid profile
What are modifiable risk factors for HTN? Blood glucose level, activity level, smoking, salt and alcohol intake, insufficient sleep (less than 5 hours/day)
What are nonmodifiable risk factors for HTN? Family history, age, ethnicity, diabetes mellitus
How much Na+ per day is allowed with the DASH diet? Less than 2,400mg
If a pt has severe HTN, increased risk factors or target organ disease what should their therapy begin with? Drug therapy and lifestyle modifications
If a pt has low risk of HTN what should their therapy begin with? Lifestyle modifications
What is the goal of therapeutic intervention of HTN? BP lower than 140/90 mm Hg; 130/80 mm Hg for pt with diabetes, chronic kidney disease or proteinuria
How long must hypertensive medications be continued usually? The rest of the pt's life
What side effect causes many men to become reluctant of taking their meds? Erectile dysfunction/impotence
What's the nursing dx for HTN? Deficient knowledge
What are common complications of HTN? Coronary artery disease, atherosclerosis, MI, HF, stroke and kidney or eye damage
What is target organ disease? When the BP increases dmaging the small vessels of the heart, brain, kidneys and retina
What patients are at higher risk for stroke, MI, HF, kidney failure and pulmonary and cerebral edema? Hypertensive
What is a hypertensive emergency/crisis? When the BP is greater than 180/120
Should pts with hypertensive crisis go to the hospital? Yes, they should be admitted to the critical care unit
What med may be given IV to decrease BP during crisis? Nipride (nitroprusside)
Are pts in crisis at risk for progressive target organ dysfunction? Yes
Are pts with hypertensive urgency at risk for progression of target organ dysfunction? No
What are symptoms of hypertensive urgency? Severe headaches, nosebleeds, shortness of breath and severe anxiety
How is hypertensive urgency treated? With combination oral meds and a follow up visit within several days
What is the most common cause of ESRD? Nephrosclerosis
What are the different thiazide diuretics? Hydrochlorothiazide (Hydrodiuril); Chlorothiazide (Diuril)
What are the different thiazide-like diuretics? Chlorthalidone(Hygroton); Indapamide (Lozol); Torsemide (Demadex)
What do thiazide diuretics do? Increases urine output by promoting Na+, Cl- and water excretion
What electrolytes are lost during thiazide diuretic use? Na+, K+ and Mg+
What are side effects of thiazide diuretics? Dizziness, fatigue, weakness, hypercalcemia, n&v, anorexia, hyperglycemia, photosensitivity
What drug should be given cautiously to pt on thiazide diuretics? Digoxin
What are the different loop diuretics? Bumetanide (Bumex); Furosemide (Lasix); Torsemide (Demadex)
What do loop diuretics do? They act on the ascending loop of henle to cause Na+ and water loss
What electrolytes are lost during loop diuretic use? K+, Mg+ and Ca+
What are side effects of loop diuretics? Nausea, hypoglycemia, tinnitus, increased uric acid levels, photosensitivity
In what pt are loop diuretics contraindicated? Pt allergic to sulfonamides
What are the different K+ sparing diuretics? Amiloride (Midamor); Spironolactone (Aldactone)
What do K+ sparing diuretics do? Promote Na+ and water excretion and K+ retention by the kidney
What are side effects of K+ sparing diuretics? Headache, n&v, anorexia, diarrhea
What foods should be avoided with K+ sparing diuretics? Food rich in K+; oranges, bananas, salt substitutes and dried fruits
What do beta blockers end in? -lol
What do beta blockers do? Decrease sympathetic nervous system response which decreases BP, HR, contractility, CO and renin activity
What are side effects of beta blockers? Ortho hypo, diarrhea, n&v, blood dyscrasias, HF
What beta blocker is not cardiac specific? Propanolol (Inderal)
To which pt should Inderal not be given? Asthmatic; causes bronchospasm=wheezing
What do ACE inhibitors end in? -pril
What do ACE inhibitors do? Blocks production of angiotensin II
What are side effects of ACE inhibitors? Hypotension, increased HR, dyspnea, cough, angioedema, photosensitivity
What do ARBs end in? -tan
What do ARBs do? Block angiotensin II receptors causing vasodilation and reduction in BP
What are side effects of ARBs? Dizziness, insomnia, diarrhea, cough, photosensitivity
What are the different Ca+ channel blockers? Amlodipine (Norvasc); Ditiazem (Cardizem); Felodipine (Plendil); Isradipine (DynaCirc); Nicardipine HCL (Cardene); Nifedipine (Procardia); Nisoldipine (Sular); Verapamil (Calan)
What do Ca+ channel blockers do? Prevent movement of extracellular Ca+ into the cell which vasodilates
What are side effects of Ca+ channel blockers? Dysrhythmias, edema, headache, fatigue, drowsiness, flushing
What drug may Ca+ channel blockers increase the level of? Digoxin
What are the different anticoagulants? Enoxaparin (Lovenox); Heparin; Warfarin (Coumadin)
What do anticoagulants do? Decrease the clotting ability of blood
What is the antidote for anticoagulants? Vitamin K
What are the different antiplatelets? Aspirin; Clopidogrel (Plavix)
What do antiplatelets do? Prevent blood platelets from sticking together so clots do not form
What are vasodilators? Nitrates
What do vasodilators do? Relax blood vessels and increase the supply of blood and oxygen to the heart while reducing the workload
What does Digoxin do? Increases the force of the heart's contractions
What do statins do? Lower LDL and triglycerides and raise HDL
Created by: maxxinekj