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94 Cards in this Set
- Front
- Back
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BP
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CO + PVR
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BP regulators
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ANS, kidneys, endocrine system
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BP is regulated by?
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the sympathetic and parasympathetic nervous sytem of the ANS
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What are parts of the ANS that regulate BP?
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baroreceptors, chemoreceptors, stretch receptors
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How does the renal system control BP
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When renal Blood flow decreases, the kidneys retain sodium and water and BP rises due to fluid retention and activation of the renin-angiotensin-aldosterone mechanism, also the release of ADH
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What are external factors that raise BP
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stress, excitement, pain, anger, high and low temperature
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How is general hypertension determined?
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by 2 separate readings
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What is normal BP?
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Systolic is less than 120 and diastolic less than 80
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What is prehypertension levels
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systolic 120-139 and diastolic 80 to 90
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What is stage 1 hypertension levels
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Systolic 140-159 and diastolic 90-99
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What is stage 2 hypertension levels
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systolic above 160 and diastolic above 100
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What will people with HTN likely develop later in life
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CHF
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What can lower BP?
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supporting a patients back relaxes the body on average of 8 SBP and DBP
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What can elevate BP
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obesity, caffeine ingesion, false narrow BP cuff
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What are MAJOR risk factors for hypertension/ heart disease
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smoking
hypertension dyslipidemia DM family history of premature CAD (women under 65 men under 55) Age (over 55 men and over 65 women) Obesity Physical inactivity Microalbuminuria or estimated GFR of below 60 mL/min |
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What are effects of high BP on the body?
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hardening of the arteries, stroke, heart attack, kidney damage, blindness
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How can you lower BP
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eat less sodium and salt
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How can you lower sodium?
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eat out less often, buy fresh, frozen, or unsalted canned foods, choose foods with less than 400 mg/serving, buy low sodium foods, use less salt
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What is a severe type of elevated BP that is rapidly progressive?
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malignant hypertension
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What are symptoms of malignant hypertension?
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morning headaches, blurred vision, dyspnea, and/or uremia
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Who can MH affect?
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30s, 40s, 50s
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What is the level for malignant hypertension?
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systolic over 200 and diastolic over 150 or over 130 if pre-existing conditions
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What may MH lead to?
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renal failure, left ventricular failure, stroke
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What are risk factors of essential hypertension
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over 60 y/o, family history, excessive calorie intake, physical inactivity, obesity, excessive alcohol, hyperlipidemia, African American, high intake of salt, caffeinie, reduced K, Ca, Mg, smoking, stress
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What is secondary hypertension caused by?
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underlying factors
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What are risk factors for secondary hypertension
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renal vascular or parenchymal disease, primary aldosteronism, pheochromobytoma, Cushing's disease, coarctation of the aorta, brain tumor, psychiatric disturbances, encephalitis, pregnancy, medication
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What are some lifestyle modifications for hypertension?
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diet (restrict sodium, lose weight), moderation in alcohol, exercise, smoking cessation, complimentary therapies (stress managment)
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What do you always do first?
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modify lifestyle
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what do you do w/ fruits and veggies in the dash diet?
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increase to 8 or more a day
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How much dairy do you have per day in the dash diet?
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3 servings of low fat and non-fat dairy produts a day
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How often do you have nuts, seeds, and dried benas in the dash diet?
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4-5 times/week
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How much meat, fish, or poultry per day?
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6 oz or less
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What should you eat more of with dash diet
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whole grain cereals and braids
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How much sodium should you have on the dash diet?
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less then 2400 mg or less than 2.5 g total
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Why should you not use some salt subs?
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have high K content
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How can you reduce sodium?
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avoid adding during cooking or at table, avoid seasonings that have salt, limit consumption of canned and processed foods
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When trying to reduce hypertension, what BMI do you want
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27 or less
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What should your total intake of fat be?
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less than 30%
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What should you total sat fat be?
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less than 10%
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What should you cholesterol be?
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less than 300 mg/day
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What should you alcohol be?
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2 oz. liquor or 8 oz. wine or 24 oz. beer per day
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What should your exercise be?
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30-45 minutes 3-5 days a week
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What are some things about teaching with HTN?
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weight reduction, alcohol intake, exercise, smoking cessation, complimentary therapies
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BP reduction with weight reduction
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5-20 per 10 kg weight
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BP reduction with DASH
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8-14
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BP reduction with sodium restriction
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2-8
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BP reduction with physical activity
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4-9
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BP reduction with moderate alcohol consumption
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2-8
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What are some meds for HTN?
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beta blockers, calcium channel blockers, ACE inhibitors, diurectis, vasodilators, ARBs
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What is the MOA of beta blockers?
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block beta receptor sites which are responsive to E and NE which then causes a decrease in HR, BP, and CO
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What may beta blockers cause?
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bronchoconstriction ( worry with asthma)
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What are some side effects of Beta blockers?
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headache, fatigue, lethargy, masked hypoglycermia, asthma
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When should you avoid beta blockers?
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diabetics
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What do you monitor w/ Beta blockers?
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heart rate, blood pressure, symptoms of CHF
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What are some Calcium Channel Blockers?
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Diltiazem, Nifedipine, Nicardipine, Verapamil, Amlodipine
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What do calcium channel blockers do?
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block calcium channels in the specialized tissue of muscle cells of the heart and in teh smooth muscle cells in the walls of blood vessels
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What do Calcium channel blockers do?
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decrease HR, BP, and CO
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What are side effects of calcium channel blockers?
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headache, flushing, peripheral edema, fatigue, hypotension
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What are some things to monitor with ca channel blockers?
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HR and BP
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What should you avoid when on Ca channel blockers
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grapefruit and grapefruit juice
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What do ACE inhibitors do?
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decrease the formation of angiotensin by blocking the ACE enzyme which converts angiotensin I to angiotensin II which is a vasoconstrictor. It also decreases the secretion of aldosterone, which decreases BP and improves CO
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What are examples of ACE inhibitors?
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end in -pril
Captopril, Lisinopril, Benazepril, etc. |
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What are side effects of ACE inhibitors?
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cough(annoying tickle), dizziness, headache, photosensitivity, abdominal pain, hyperkalema (due to inhibited aldosterone)
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What are some nursing implications for ACE inhibitors?
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monitor BP, monitor K+, monitor renal function
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What may decrease absorption of ACE inhibitors?
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antacids
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What do diuretics do?
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increase sodium and water excretion by the kidney
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Where do thiazide diuretics work?
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distal tubulre
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Where do loop diuretics work?
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loop of Henle and proximal and distal tubules
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What do diuretics do to preload
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decrease it
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What are some thiazide diuretics?
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chlorthalidone (Hygroton), hydrochlorothiazide (Hydrodiuril, Mircozide), Inadapamide (Lozol), metolazone (Zaroxolyn)
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What are some loop diuretics?
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bumetanide (Bumex), ethacrynic acid (edecrin), Furosemide (Lasix), and torsemide (demadex)
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What do you need to take with loop diuretics?
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potassium supplements
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What are some K+ sparing diuretics?
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spironolactone (aldactone), triamterene (Dyrenium), amiloride (Midamor)
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What are some side effects of thiazide diuretics?
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hypokalemia, hypomagnesemia, hyponatremia, hypercalcemia, hyperuricemia, hypercholesterolemia, hypertriglyceridemia, pancreatitis
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What are some nursing implications for thiazide diuretics
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monitor electrolyte levels, give K+ supplements
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What are some side effects of loop diuretics?
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dehydration, hypokalemia, hypomagnesemia, hyponatremia, hyperglycermia, hyperuricemia, metabolic alkalosis, potential for circulatory collapse
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What are some nursing implications for loop diuretics?
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monitor electrolyte levels, K+ supplements, potential for ototoxicity with Lasix
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Why should you give Lasix as a SLOW IV push
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can cause ototoxicity
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What are some side effects of potassium sparing diuretics?
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hyperkalemia, GI disturbances, rash
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What are some nursing implications for K+ sparing diuretics?
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monitor electrolyte levels
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What are teh 3 types of actions of vasodilators?
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alpha adrenergic blockers, central acting, direct acting
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What are alpha adrenergic blockers?
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block alpha receptors that mediate vasomotor tone
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What are central acting vasodilators?
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causes decreased production of epinephrine
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What are direct acting vasodilators?
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act on smooth muscle in teh walls of the blood vessesl to cause relaxation of the vessel wall
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What do alpha 1 blocking agents do?
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block alpha1 adrenergic receptors to produce arteriolar and venous vasodilation and decrease peripheral vascular resistance
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What are some alpha 1 blockers
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Minipres, Cardura
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What is the MOA of central acting alpha 2 agonists?
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act by stimulating the alpha adrenergic receptors in the brain stem reducing sympathetic outflow from CNS (decrease catecholamine release)
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What are some alpha 2 agonists?
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clonidine (catapres) methyldopa
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How do direct acting vasodilators work?
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directly relax smooth muscle in blood vessels, resulting in dilation and decreased peripheral vascular resistance: may see a reflex tachycardia
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What are some direct acting vasodilators?
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hydralazine (apresoline), mioxidil (Loniten), Sodium nitroprusside (Nipride)
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How do angiotensin II receptor antagonists work?
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act by competing the the natural vasoconstrictor angiotensin II for its receptors at various sites, therefore decreases BP and improves CO
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What are some angiotensin II receptor antagonists?
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cozaar (losarten), atacand (candesarten), diovan (valsartan)
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What are the side effects of angiotensin II receptor antagonists?
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cough, dizziness, headache, vertigo, abdominal pain, photosensitivity, hyperkalemia
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What are the nursing implications of angiotensin II receptor antagonists?
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monitor BP, K+, renal function
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