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46 Cards in this Set
- Front
- Back
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Perfusion
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Adequate blood flow to organs
Adequately functioning cardiovascular system |
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Mean Arterial Pressure (MAP)
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Average Pressure throughout the cardiac cycle
Diastole is longer than systole Need a MAP of 90 to perfuse vital organs MAP=DBP + 1/3 pulse pressure |
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Pulse Pressure
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Difference between SBP & DBP
Increased pulse pressure - exercise or people with atherosclerosis of larger arteries (increased SBP) Decreased pulse pressure - cardiac failure or hypovolemia (decreased SBP) |
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Perfusion Disorders
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Impediment to blood flow
Lack of adequate O2 and nutrients Heart, blood vessels (CV disease) Hypertension Peripheral Vascular Disease Aneurysm Anemia, Leukemia, Lymphoma |
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Cardiovascular Disease
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Most common cause of death in older adults in North America
Most common is CAD secondary to atherosclerosis Difficult to separate normal aging changes from pathophysiologic changes of atherosclerosis Some of normal changes of aging promote atherosclerosis, HTN, and cardiac failure |
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Age Related Changes in CV System
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Heart-increased collagen/scarring, decreased elastin
Calcification/sclerosis/fibrosis of valves and conduction system Blood vessels-arterial stiffening secondary to decreased elastin in walls, thickening of intima, and fibrosis of media Table 31-12 |
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PERFUSION DISORDERS: Assessment
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CVD risk factors (HTN & CVA)
Physical Assessment Vital Signs Palpation Inspection Auscultation |
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Physical Assessment
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Vital Signs-B/P, HR, RR, Sats, EKG
Palpation-pulses, temperature of extremities, liver enlargement, displaced PMI (point of maximal intensity) Inspection-dyspnea, edema, distended neck veins(sign of right-sided heart failure), cyanosis, color changes to extremities, stasis ulcers, cap refill, varicose veins Auscultation-lung, heart, arterial bruit(turbulent blood flow) |
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Alteration in Perfusion: Hypertension
Definition-B/P |
The force exerted by the blood against the walls of the blood vessel
Must be adequate to maintain tissue perfusion during activity and rest A function of cardiac output and systemic vascular resistance Arterial BP=CO x SVR |
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Normal regulation of BP
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Sympathetic Nervous System
-Increases BP by increasing CO and SVR (alpha and B-adrenergic receptors) -Baroreceptors - aortic arch and carotid sinus- sensitive to stretch and pressure-info to vasomotor centers in the brain to stimulate sympathetic or parasympathetic Chemoreceptors - aortic arch and carotid body - initiate changes in HR and arterial pressure in response to decreased PaO2, increased PCO2, and decreased arterial pH, also stimulates vasomotor center to increase cardiac activity Release of epinephrine and norepinephrine stimulate alpha and beta adrenergic receptors (increase heart rate and vasoconstriction) |
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Normal regulation of BP
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Vascular Endothelium
-has ability to produce vasoactive substances and growth factor (vasodilatory effects & inhibit platelet aggregation) Alpha-adrenergic receptors in vascular smooth muscle-Increased stimulation leads to vasoconstriction, Decreased stimulation leads to vasodilation |
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Normal regulation of BP
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Endocrine System
-Stim of SNS = release of epi & norepi by the Adrenal Medulla Release of aldosterone by adrenal cortex (kidneys retain NA and water - B/P increases) ADH released from posterior pituitary in response to increased sodium osmolarity level - reabsorption of H2O in distal renal tubules |
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Normal Regulation of BP - Renal System
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*Fluid volume & NA regulation
Renin-angiotensin system-renin is secreted by juxtaglomerular apparatus in the kidney Renin converts angiotensinogen to angiotensin I Angiotensin-converting enzyme (ACE) converts angiotensin I to angiotensin II Angiotensin II is a potent vasoconstrictor (increases B/P) Angiotensin II stimulates the adrenal cortex to secrete aldosterone, which leads to NA and water retention by the kidneys (increasing B/P) **ACE inhibitors block enzyme which in turn lowers B/P** |
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Hypertension (HTN)
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Sustained elevation of BP
-Elevated readings on at least three occasions during several weeks -Exists when: SBP is equal to or greater than 140 mm Hg DBP is equal to or greater than 90 mm Hg |
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Classifications of Blood Pressure: Normal
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Systolic <120
Diastolic <80 |
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Classifications of Blood Pressure: Pre HTN
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Systolic 120-139
Diastolic 80-89 |
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Classifications of Blood Pressure: Stage 1 HTN
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Systolic 140-159
Diastolic 90-99 |
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Classifications of Blood Pressure: Stage 2 HTN
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Systolic greater than or = 160
Diastolic greater than or = 100 |
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Classification of HTN
Primary HTN |
Onset between 30-50 years old
Accounts for 95% of all HTN Contributing factors: *Increased SNS activity *Increased Na retaining hormones and vasoconstrictors *Increased Na intake *Weight gain *DM *ETOH use |
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Classification of HTN
Secondary HTN |
-Elevated B/P due to a specific cause that can be detected and treated
-Accounts for less than 5% of all HTN -Contributing factors: *congenital *renal disease *endocrine disorders *neurologic disorders *sleep apnea *medications/drugs *pregnancy |
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Risk Factors: Primary HTN
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Age
Sex Race Family History Obesity Cigarette smoking Increased homocysteine (homecysteine damages endothelium of vessels) Increased C-reactive Protein Excessive dietary Na Elevated serum lipids ETOH Sedentary lifestyle DM Socioeconomic status Stress |
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Pathophysiology
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In order for HTN to occur there must be an increase in CO or SVR
Hemodynamic hallmark is a persistent increased SVR |
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Incidence
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More than 50% of US over 60 years old have HTN
Most common cardiovascular disorder in the US More common among men up to age 55 More common among women after age 55 Highest in African-American population |
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Primary Prevention: Lifestyle modifications
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Activity
ETOH Smoking Stress reduction |
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Primary Prevention: Dietary modifications
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Sodium and fat intake
Weight loss Higher intake of potassium and calcium & magnesium |
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Clinical Manifestations: Primary symptoms
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-Asymptomatic
-"Silent Killer" |
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Clinical Manifestations: Secondary symptoms
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-Fatigue
-Reduced activity tolerance -Dizziness -Palpitations -Angina -Dyspnea -H/A |
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Complications/Target Organ Disease
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Heart can no longer pump enough blood to meet the metabolic demands of the body
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Complications/Target Organ Disease
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Hypertensive Heart Disease
-CAD -LVH -Heart Failure Cerebrovascular Disease Peripheral Vascular Disease Nephrosclerois Retinal Damage (Look at changes in vessels in retina and determine HTN) |
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Manifestations on Major Organs
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Cardiac
-Aneurysm, hemorrhage, CHF, MI Cerebrovascular -TIA, CVA Peripheral Vascular -PVD Renal -Renal Failure Retinopathy -Blindness, Retinal Hemorrhage, Blurred Vision |
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Diagnosis
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History and Physical
Blood Pressure CXR EKG UA Complete Blood Work-Up |
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Management
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Lifestyle modifications
DASH diet Drug theraphy Goal-reduce overall cardiovascular risk factors and control BP by the least intrusive means |
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Lifestyle Modifications
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Weight reduction
Increase physical activity Limit ETOH, sodium, and fat intake (DASH diet) Maintain adequate potassium, calcium and magnesium intake Smoking cessation/chewing Stress reduction |
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DASH diet (Dietary Approaches to Stop Hypertension)
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Lower saturated fat, total fat, and cholesterol and increase fruits and vegetables
Includes 4-5 servings per week of nuts, seeds, and beans Several servings of fish each week Increase water intake Restrict Na in diet to <6 grams/day **Read food labels, OTC drugs, baking soda toothpaste |
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Drug Therapy: Goals
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B/P of <131/85 in young adult with mild HTN
<130/80 if client has DM, CV disease, renal disease Older adults <140/90 Two Main Actions to lower B/P 1. Decrease SVR 2. Decrease volume of circulating blood |
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Drug Therapy
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Diuretics
Adrenergic Blockers (sympathetic) Vasodilators Angiotensin Inhibitors (ACE, ARBS) Calcium Channel Blockers |
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Drug Therapy
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Initial therapy - Usually diuretics (thiazide) or beta blockers (Stage I)
ACE inhibitors, ARBS, and CA Channel Blockers may be used as 1st line drugs Direct acting vasodilators, x-adrenergic blockers, & peripheral acting adrenergic blockers are not recommended for single drug therapy secondary to side effects |
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Drug Therapy
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Initial monotherapy (Stage I)
If B/P is not controlled in a few months 1. The first drug can be increased 2. The first drug can be substituted with a different drug from a different class. 3. A second drug from a different class can be added to the first drug. *Stage 2 - initial therapy - thiazide plus a beta blocker or ACE, ARB, or CCB |
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Diuretics
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Thiazide Diuretics - promote Na and H20 excretion
Loop Diuretics - reduce plasma volume Potassium-Sparing Diuretics - reduces vascular response to catecholamines |
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Thiazide Diuretics
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Diuril
Hydrochlorothiazide (HCTZ) Side Effects - decreased K+, dizziness, decreased B/P, increased blood sugar, hyperuricemia, vertigo, impotence |
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Loop Diuretics
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Bumex
Lasix Side Effects - decreased potassium, increased BS, dizziness, decreased B/P, ototoxicity (IV Push too fast) Loop diuretics can be given to patients with renal disease |
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K+ Sparing Diuretics
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Aldactone
**NSAIDS** - can decrease the diuretic and B/P effect of ALL diuretics Side Effects - hyperkalemia, headache, leg cramps, dizziness *AVOID with renal disease |
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Adrenergic Blockers
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Beta Blockers
Alpha(x) Adrenergic Blockers Central Acting Adrenergic Neuron blockers Suppresses the influence of the SNS on the heart, blood vessels and other structures Produces vasodilation Reduces SVR Decreases HR |
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Beta Adrenergic Blockers
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Lopressor, Inderal, Atenolol
Action: blocks beta adrenergic effect - leads to decreased CO (decreased HR) and decreased renin release from the kidneys (vasodilation) Side Effects: bronchospasm, depression, weakness, heart block, bradycardia *Lopressor is B1 selective & is the drug of choice with a client with asthma |
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Alpha Adrenergic Blockers
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Cardura, Minipress, Hytrin
Action: blocks alpha adrenergic effect on vessels, leads to peripheral vasodilation and decreased SVR Side Effects: postural hypotension, Na/H20 retention, reflex tachycardia |
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Alpha/Beta Blockers
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Carvedilol, Labetalol
Action: blocks alpha effect which leads to dilation of arterioles, blocks beta effect which leads to decreased heart rate and contractility Side Effects: Bradycardia, heart block, exacerbation of asthma & postural hypotension |
