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57 Cards in this Set

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ARTERIOSCLEROSIS
hardening of the arteries; loss of elasticity (smaller system with same volume= increased pressure)
ATHEROSCLEROSIS
narrowing of the arteries; plaque formation on the endothelium causes a narrowing of the lumen.
CAD
Coronary artery disease: atherosclerosis of the coronary arteries (heart)
CVD
Cerebrovascular disease: atherosclerosis of the cerebrovascular arteries (brain-stroke)
PVD
Peripheral vascular disease: atherosclerosis of the peripheral arteries (leg)
True or False? Atherosclerosis is a type of arteriosclerosis
True
What is the suspected developmental process of atherosclerosis?
Fatty streak develops on the endothelium. Fibrous tissue then lays down on the fatty streak developing into plaque which then calcifies.
What is the platelet aggregation theory?
injury to the endothelium (possibly by HTN) cause platelets to adhere in an atempt to repair the area. Then smooth muscle can proliferate in the area and develop into plague
What is the Lipid theory?
Fats (cholesterol and triglycerides) accumulate over an area of injury and narrow the vessel.
What are some factors that affect development of plaque formation?
Gender (males >45, females >55), family hx, cigarette smoking, HTN, and inceased lipid levels.
Why is cigarette smoking a risk factor for atherosclerosis?
tars/nicotine damage and inflame the intima, it lowers HDL levels, increases catecholamine release which increases BP and it increases platelet adhesion.
What is LDL and what is a normal level?
Low density lipoprotein: BAD cholesterol because it deposits cholesterol and triglycerides into the arterial wall. Normal level is <100
What is HDL and what is a normal level?
High density lipoprotein: GOOD cholesterol because it carries cholesterol and triglycerides away from cells. Normal levels are: males 35-60 and females 35-85
What types of things can a pt. do to lower their LDL levels and increase their HDL levels?
Exercise: 30 min. 3-4X wk is a good goal. Individualize it to the pt. depending on their abilities. Also medication therapy
How do Bile acid sequestrants work in lowering cholesterol?
They bind bile acids (which have a lot of cholesterol in them) in the intestines and are then excreted in the stool. Then as a response the liver will develop more LDL receptors thus reducing the circulating LDL levels.
What are some of the side effects of bile acid sequestrants?
nausea, vomiting, diarrhea or constipation, bloating, fullness, and reduced absorption of vitamins and minerals.
What are fibric acid derivatives?
classification of drugs that increases HDL and sometimes would lower LDL but are rarely used anymore.
What are nicotinic acids?
Classification of drugs containing niacin and is used to lower LDL and increase HDL. Used with someone who doesn't have high levels of lipids.
What are some of the side effects of nicotinic acids?
Can cause a lot of GI side effects, pruritis, flushing, hot flashes, hepatotoxia, and hyperglycemia in diabetics.
How do Statins work in lowering cholesterol levels?
They inhibit the enzyme that helps with the production of cholesterol thus lowering LDL and raising HDL.
Of the drug classifications that lower cholesterol levels which is used as the first line of defense?
The Statins
What are some of the side effects of Statins?
Nausea, vomiting, diarrhea, abdominal cramping, upset stomach, etc. May also get Myopathy.
What is hypertension?
Systolic BP >140 and/or diastolic BP >90 for a sustained period of time.
True or False? Anything that affects cardiac output, heart rate, or stroke volume can increase or decrease blood pressure.
True
True or False? The parapsympathetic nervous system causes vasoconstrition and the sympathetic nervous system causes vasodialation.
False the Sympathetic NS causes vasoconstriction and the Parasympathetic NS causes vasodialation.
True or False? When our arteries vasodialation (via parasympathetic NS) with the same volume of blood are blood pressure will raise.
False, our blood pressure is lowered with vasodialation and the same volume of blood.
What types of things can cause hypertension?
anything affecting cardiac output, heart rate or stroke vol., fluid balance and fluid volume, and RAAS (Renin-angiotensin-aldosterone system)
How does ones fluid volume/balance affect BP?
If a person's vascular system is the same size, but has an increase in fluid volume it will increase pressure.
What can cause an increase in fluid volume?
sodium retension: kidney problems, too much sodium in diet, not excreting enough sodium, etc.
How does RAAS affect BP?
Renin activates an enzyme that causes conversion of angiotensin I to angiotensin II which is a potent vasoconstrictor. THEN, angioII attaches to recpetors in the adrenal glands which causes a release of aldosterone which causes the kidneys to retain fluids. So you end up with an increase of fluid in a smaller system.
What is essential (primary) HTN?
HTN with no known cause, but may have risk factors such as: sodium intake, diet, family hx, physical inactivity, smoking, stress.
What is secondary HTN?
HTN caused by a specific disease process or medication such as: kidney problems, hyperfunction of the adrenal medulla, pheochromocytoma, coarctation of aorta, etc.
What is coarctation of the aorta and what are some of the signs and symptoms?
Congentital problem when aorta narrows at a point after the upper body vessels in the aortic arch. May see an increased BP and strong bounding pulses in upper part of body and a lower BP with thready weak pulses in lower part of body.
How does aging affect BP?
may have an effect on baroreceptors causing parasympathetic NS to not have the same effect, increased peripherovascular resistance, decreased renal perfusion, an effect from medications, etc.
What types of considerations should we make when assessing a pt for HTN?
risk factors:smoking, family hx, headaches, dizziness, fainting? BP on several checks, orthostatic BP, bruits, tachycardia? Are they diaphoretic? do they have retinal changes? How are their labs: sodium levels, potassium, serum, BUN, cholesterol, serum renin levels? EKG, 24 urine output, echocardiogram, tumors, etc?
What is pheochromocytoma?
Tumor of the adrenal medulla which can cause a release of excess catecholamines (hyperfunction of the adrenal medulla which can cause HTN)
What are catecholamines and how do they affect BP?
They are neurotransmitters such as epinephrine and norepinephrine which cause vasoconstriction.
How does the ANS lower BP?
Baroreceptors in the carotid sinus, aorta, and lf ventricle sensing a rising BP which triggers the parasympathetic NS to cause vasodilation and thus decrease BP.
What types of things can a pt. do to treat HTN?
diet changes: sodium restriction, fat reduction, cholesterol reduction, weight reduction, decreasing alcohol consumption, exercise, smoking cessation, medications, etc.
How do thiazide diuretics work in lowering HTN?
They reduce sodium resorption in the kidneys thus reducing water resorption. This will then lower circulating volume and thus lower BP.
What is a common side affect with all diuretics?
Hyperkalemia or Hypokalemia Therefore potassium levels should be monitored when on diuretics and pt. may need K+ supplements
What are some of the signs and symptoms of hypokalemia?
muscle weakness, irregular pulse, etc.
How do loop diuretics work to lower HTN?
Causes kidneys to make more urine thus decreases fluid vol and BP.
What are some of the side effects of loop diuretics?
hypokalemia, hypovolumia, hypotensive, ototoxicity (=hearing loss), dehydration, etc.
What nursing considerations would one take for a pt. on loop diuretics such as lasix?
monitor B/P for hypotension, potassium levels for hypokalemia, and pulse for tachycardia. Watch for dehydration: skin turgor, I/O, dry mucus membranes, increased thirst, etc.
What is a third classification of diuretics besides loop and thiazide?
potassium sparing diuretics
How do beta blockers work in lowering BP?
They decrease the heart rate which decreases BP (decreased force of contraction = decreased BP)
What are some nursing considerations for pts on beta blockers?
need to be careful with pts with heart failure and may be given other meds to balance negative effect. Also, dyspnea, wheezing and a reduction in bronchodilation can be a side effect so those with asthma or COPD may have exacerbated breathing problems
How do calcium channel blockers work in lowering BP?
They reduce (block) Ca+ from entering smooth muscle cells which causes the muscle to constrict less thus causing vasodialation.
What are some nursing considerations for pts on Ca+ channel blockers?
watch for pedal edema (blood pooling in peripheries), hypotension (careful when getting out of bed), and reflexive tachycardia.
How do ACE (angiotensin-coverting enzyme) inhibitors work in lowering BP?
inhibit coversion of angiotension I to angiotension II (which causes vasoconstriction and increased fluid vol)
What are some nursing consideration for pts on ACE inhibitors?
Severe hypotension: pts must use assistance with ambulation when first starting med. Monitor BP closely. Other side effects are dry cough and angioedema
How do ARBS (angiotension II receptor blockers) work in lowering BP?
They block angio II from attaching to angio II receptors in the vessels and adrenal glands thus preventing vasoconstriction and increased fluid vol.
How do aldosterone receptor blockers work in lowering BP?
block aldosterone from attaching to receptors in the kidneys thus reduces Na+ resorption and blood vol = less pressure.
True or False? Ca+ channel blockers can be either selective or nonselective.
True. Selective have only an effect on blood vessels while nonselective have an effect on the heart and vessels.
How do vasodilators work in lowering BP?
they reduce the tone of smooth muscle causing it to relax and vasodilate thus lowering BP.
What type of medication would be used for a pt in ICU who is in a hypertensive crisis?
An IV vasodilator such as nipride because it lowers BP immediately and has a short half life so if pt became hypotensive the med can be stopped and BP would increase.