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57 Cards in this Set
- Front
- Back
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ARTERIOSCLEROSIS
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hardening of the arteries; loss of elasticity (smaller system with same volume= increased pressure)
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ATHEROSCLEROSIS
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narrowing of the arteries; plaque formation on the endothelium causes a narrowing of the lumen.
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CAD
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Coronary artery disease: atherosclerosis of the coronary arteries (heart)
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CVD
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Cerebrovascular disease: atherosclerosis of the cerebrovascular arteries (brain-stroke)
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PVD
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Peripheral vascular disease: atherosclerosis of the peripheral arteries (leg)
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True or False? Atherosclerosis is a type of arteriosclerosis
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True
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What is the suspected developmental process of atherosclerosis?
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Fatty streak develops on the endothelium. Fibrous tissue then lays down on the fatty streak developing into plaque which then calcifies.
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What is the platelet aggregation theory?
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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
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What is the Lipid theory?
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Fats (cholesterol and triglycerides) accumulate over an area of injury and narrow the vessel.
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What are some factors that affect development of plaque formation?
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Gender (males >45, females >55), family hx, cigarette smoking, HTN, and inceased lipid levels.
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Why is cigarette smoking a risk factor for atherosclerosis?
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tars/nicotine damage and inflame the intima, it lowers HDL levels, increases catecholamine release which increases BP and it increases platelet adhesion.
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What is LDL and what is a normal level?
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Low density lipoprotein: BAD cholesterol because it deposits cholesterol and triglycerides into the arterial wall. Normal level is <100
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What is HDL and what is a normal level?
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High density lipoprotein: GOOD cholesterol because it carries cholesterol and triglycerides away from cells. Normal levels are: males 35-60 and females 35-85
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What types of things can a pt. do to lower their LDL levels and increase their HDL levels?
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Exercise: 30 min. 3-4X wk is a good goal. Individualize it to the pt. depending on their abilities. Also medication therapy
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How do Bile acid sequestrants work in lowering cholesterol?
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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.
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What are some of the side effects of bile acid sequestrants?
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nausea, vomiting, diarrhea or constipation, bloating, fullness, and reduced absorption of vitamins and minerals.
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What are fibric acid derivatives?
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classification of drugs that increases HDL and sometimes would lower LDL but are rarely used anymore.
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What are nicotinic acids?
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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.
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What are some of the side effects of nicotinic acids?
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Can cause a lot of GI side effects, pruritis, flushing, hot flashes, hepatotoxia, and hyperglycemia in diabetics.
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How do Statins work in lowering cholesterol levels?
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They inhibit the enzyme that helps with the production of cholesterol thus lowering LDL and raising HDL.
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Of the drug classifications that lower cholesterol levels which is used as the first line of defense?
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The Statins
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What are some of the side effects of Statins?
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Nausea, vomiting, diarrhea, abdominal cramping, upset stomach, etc. May also get Myopathy.
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What is hypertension?
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Systolic BP >140 and/or diastolic BP >90 for a sustained period of time.
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True or False? Anything that affects cardiac output, heart rate, or stroke volume can increase or decrease blood pressure.
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True
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True or False? The parapsympathetic nervous system causes vasoconstrition and the sympathetic nervous system causes vasodialation.
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False the Sympathetic NS causes vasoconstriction and the Parasympathetic NS causes vasodialation.
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True or False? When our arteries vasodialation (via parasympathetic NS) with the same volume of blood are blood pressure will raise.
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False, our blood pressure is lowered with vasodialation and the same volume of blood.
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What types of things can cause hypertension?
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anything affecting cardiac output, heart rate or stroke vol., fluid balance and fluid volume, and RAAS (Renin-angiotensin-aldosterone system)
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How does ones fluid volume/balance affect BP?
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If a person's vascular system is the same size, but has an increase in fluid volume it will increase pressure.
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What can cause an increase in fluid volume?
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sodium retension: kidney problems, too much sodium in diet, not excreting enough sodium, etc.
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How does RAAS affect BP?
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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.
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What is essential (primary) HTN?
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HTN with no known cause, but may have risk factors such as: sodium intake, diet, family hx, physical inactivity, smoking, stress.
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What is secondary HTN?
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HTN caused by a specific disease process or medication such as: kidney problems, hyperfunction of the adrenal medulla, pheochromocytoma, coarctation of aorta, etc.
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What is coarctation of the aorta and what are some of the signs and symptoms?
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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.
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How does aging affect BP?
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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.
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What types of considerations should we make when assessing a pt for HTN?
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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?
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What is pheochromocytoma?
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Tumor of the adrenal medulla which can cause a release of excess catecholamines (hyperfunction of the adrenal medulla which can cause HTN)
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What are catecholamines and how do they affect BP?
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They are neurotransmitters such as epinephrine and norepinephrine which cause vasoconstriction.
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How does the ANS lower BP?
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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.
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What types of things can a pt. do to treat HTN?
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diet changes: sodium restriction, fat reduction, cholesterol reduction, weight reduction, decreasing alcohol consumption, exercise, smoking cessation, medications, etc.
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How do thiazide diuretics work in lowering HTN?
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They reduce sodium resorption in the kidneys thus reducing water resorption. This will then lower circulating volume and thus lower BP.
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What is a common side affect with all diuretics?
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Hyperkalemia or Hypokalemia Therefore potassium levels should be monitored when on diuretics and pt. may need K+ supplements
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What are some of the signs and symptoms of hypokalemia?
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muscle weakness, irregular pulse, etc.
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How do loop diuretics work to lower HTN?
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Causes kidneys to make more urine thus decreases fluid vol and BP.
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What are some of the side effects of loop diuretics?
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hypokalemia, hypovolumia, hypotensive, ototoxicity (=hearing loss), dehydration, etc.
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What nursing considerations would one take for a pt. on loop diuretics such as lasix?
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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.
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What is a third classification of diuretics besides loop and thiazide?
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potassium sparing diuretics
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How do beta blockers work in lowering BP?
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They decrease the heart rate which decreases BP (decreased force of contraction = decreased BP)
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What are some nursing considerations for pts on beta blockers?
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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
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How do calcium channel blockers work in lowering BP?
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They reduce (block) Ca+ from entering smooth muscle cells which causes the muscle to constrict less thus causing vasodialation.
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What are some nursing considerations for pts on Ca+ channel blockers?
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watch for pedal edema (blood pooling in peripheries), hypotension (careful when getting out of bed), and reflexive tachycardia.
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How do ACE (angiotensin-coverting enzyme) inhibitors work in lowering BP?
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inhibit coversion of angiotension I to angiotension II (which causes vasoconstriction and increased fluid vol)
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What are some nursing consideration for pts on ACE inhibitors?
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Severe hypotension: pts must use assistance with ambulation when first starting med. Monitor BP closely. Other side effects are dry cough and angioedema
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How do ARBS (angiotension II receptor blockers) work in lowering BP?
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They block angio II from attaching to angio II receptors in the vessels and adrenal glands thus preventing vasoconstriction and increased fluid vol.
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How do aldosterone receptor blockers work in lowering BP?
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block aldosterone from attaching to receptors in the kidneys thus reduces Na+ resorption and blood vol = less pressure.
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True or False? Ca+ channel blockers can be either selective or nonselective.
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True. Selective have only an effect on blood vessels while nonselective have an effect on the heart and vessels.
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How do vasodilators work in lowering BP?
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they reduce the tone of smooth muscle causing it to relax and vasodilate thus lowering BP.
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What type of medication would be used for a pt in ICU who is in a hypertensive crisis?
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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.
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