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84 Cards in this Set
- Front
- Back
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Normal cardiac output
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8-10 L/min
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Normal SVR
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800-1200
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What is the preload?
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amt of blood in ventricles at the end of diastole. heart is fililng up
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What is the afterload?
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Resistance against which the LV must pump. What are we pumping against? HTN affects this.
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What is contractility?
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The force of cardiac contraction.
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What is Starling's law?
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The more you stretch, the bigger contraction you will get (like a rubber band) but only so much it can take before it snaps.
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How is HTN diagnosed?
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140/90 on 2 or more successive measurements.
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Symptoms of HTN
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Maybe a headache. Known as the "Silent Killer"
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What does the sympathetic nervous system do?
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Increase HR, renin, contractility, vasoconstriction.
So, it increases the BP. |
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Risk factors for HTN
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Age
More than 1 drink/day Diabetes Hyperlipidemia Excess Na intake Family Hx Obesity - especially in apple shaped pts African American Low economic status Sedentary Smokers/Drinkers |
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What is nephrosclerosis?
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Associated with HTN. Kidney damage. Early sign is nocturia.
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What do retinal vessels look like in HTN pts?
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corkscrews.
Pt complains of blurry vision, loss of vision, retinal hemmorhages. |
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Dietary considerations for HTN
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Low Na and DASH diet
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What is the DASH diet?
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Several portions of fish weekly, increase fiber, reduce Na to <2g/day, fruits and veggies
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How often should we tell a person with HTN to excercise?
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30 min/day every day
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Weight's effect on BP
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Lose 10% of your body weight and lower your BP by 10mmHg
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K lab value
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3.5-5.1
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Ph lab level
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2.7-4.5
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Ca lab level
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8-10
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BUN lab level
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5-25
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Mg lab level
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1.6-2.6
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BNP significance
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released in response to atrial and venticular stretch. Serves as a marker for CHF.
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BNP lab level
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<100
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Name 3 Thiazide diuretics
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HCTZ, chlorothiazide, metalazone
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Name 2 loop diuretics
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furosemide (Lasix) and bumetanide (Bumex)
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Name 2 K-sparing diuretics
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Midamor and Dyrenium Watch for arrhthmias
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Name the Aldosterone receptor blocker
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Aldactone
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Considerations with diuretics
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Watch for orthostatic hypotension.
Take them in the am. Eat foods with K (except for with K sparing diuretics) Take with meals. |
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Labs to check before giving diuretics
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K, BUN, Creatinine
K-3.5-5.1 BUN - 5-25 Creatinine 0.5-1.5 |
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What do adrenergic blockers affect?
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Inhibits SNS
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Name 2 adrenergic blockers
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Catapres and Aldomet
SE: dizziness, orthostatic hypotension, dry mouth, restlessness, sexual dysfunction |
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What suffix do Ca channel blocker end in?
Name 2 other Ca channel blockers. |
-dipine
Cardizem and Calan |
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Side effects of Ca channel blockers
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bradycardia, orthostatic hypotension, 1st degree AV block, peripheral edema, dizziness
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#1 complaint for ACE's and ARB's
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Dry cough
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ARB's end in...
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-sartan
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ACE's end in...
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-pril
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What labs do you look at before giving ACE's and ARB's?
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BUN and Creatinine and K
BUN-5-25 Creatinine - 0.5-1.5 K-3.5-5.1 |
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Gerontologic Considerations for HTN
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Loss of tissue elasticity
Stiffer myocardium Increased PVR Decreased renal function More sensitive to BP changes so start on lower doses More prone to orthostatic hypotension - do a set of orthostatic VS |
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Difference b/w hypertensive emergency and hypertensive urgency
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Emergency develops over hrs to days from preeclampsia, pehochromocytoma, head injuries, illicit drug use. Evidence of end organ damage.
Urgency develops of days to weeks. No evidence of end organ damage. |
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Hypertensive emergency interventions
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Maintain airway
Monitor BP q 5 min HOB 45 degrees Assess for fluid overload Monitor urinary output b/c chance of renal failure. |
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How fast do you want to bring down BP in hypertensive crisis?
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25% within first hour and reduce to 160/100 over next 2-6 hours.
Lowering BP too fast can lead to CVA, MI, acute renal failure |
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Meds for Hypertensive crisis
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Nitroprusside, Vasotec, IV betablocker
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Biggest risk factor for heart failure
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HTN
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Hallmark of systolic failure in CHF
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Ejection fraction less than 35%
Normal 55-75% |
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Symptom of left sided heart failure
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Pulmonary edema
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Systolic failure is like a
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pair of baggy underwear.
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Diastolic failure is like
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a stiff tortilla
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EF in diastolic failure is
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normal
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Compensation for heart failure...SNS...
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Increses HR, SV and contractility
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Compensation for heart failure...neurohormonal response...
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ADH release and renin-angiotensin-aldosterone system
causes Na and H2O retention and vasodilation |
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How do the ventricles compensate for heart failure?
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Dilate and hypertrophy
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Intervention for acute decompensated heart failure
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O2, rebreather mask
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Symptoms of right sided failure
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dependent edema,acites, gi distress, JVD
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What does FACES stand for?
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Fatigue
limitation of Activites chest Congestion/Cough Edema SOB |
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How big should the heart be?
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1/3 the size of your chest wall
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What do we do about the pleural effusion with CHF?
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Thoracentesis
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Complications of heart failure
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thrombus due to pooled blood from not pumping all the blood out of the ventricles
dysrhythmias b/c electrical system is disturbed from the hypertrophic heart hepatomegaly b/c blood is backing up renal failure due to poor perfusion |
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Dietary considerations for CHF
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Na <2g/day, DASH diet
Fluids <1200ml/day |
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Daily weights? When to call the doc?
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Weight gain >3lb in one day
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What should always be given with Lasix?
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Potassium
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Nitro Interventions...
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Take BP q 5-10min
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What do we watch out for with captopril?
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Angioedema, hyperkalemia, hypotension
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What is nesiritide (Natrecor)?
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recombinant form of BNP
Monitor for hypotension |
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Why would we use morphine with CHF?
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decreases O2 demand by dilating blood vessels and decreasing CNS activity
reduces anxiety monitor respirations |
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What do we watch out for with digitalis?
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MONITOR SERUM K LEVELS
Therapeutic range is 0.8-2mcg/ml |
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When do we hold digoxin?
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apical pulse <60
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Digitalis toxicity symptoms
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anorexia, n/v, fatigue, mental status changes, YELLOW VISION
More common with K depleting diurectics Treat by withholding digoxin or using digibind IV in severe cases |
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Dopamine
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dilates renal blood vessels, enhances urine output and increases contractility and SVR
monitor IV site for extravasation and tissue necrosis high doses may produce dysrhythmias |
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Only approved beta blocker for CHF
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Coreg, obtain standing BP 1hr after dosing
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BiDil
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combination drug only used in blacks
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CHF interventions
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Prevent infection - flu and pneumonia vaccines
Pace activities Encourage daily excercise Avoid temp extremes Wait 1-2 hrs after eating for activity Daily weights Strict I&O |
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Positioning for heart failure
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High-fowler's to promote venous return b/c of pooling of blood in the extremities. Increases ventilation.
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What does Na free mean?
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<5mg/serving
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What does very low Na mean?
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35mg or less/serving
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What does low Na mean?
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<140mg/serving
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What does reduced Na mean?
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25% less salt than the regular
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What does light in Na mean?
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50% less salt than the regular
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Gerontologic Considerations in HF
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HF increases with age
Decreased CO Decreased cerebral perfusion Mental status changes Prone to dehydration with diuretics susceptible to dig toxicity due to decreased renal function |
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What is the big worry with dilated cardiomyopathy?
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Ventricular thrombi due to blood pooling in LV.
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What kills our young athletes?
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Hypertrophic cardiomyopathy
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Teaching with hypertrophic cardiomyopathy
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Pts should avoid strenuous activity and dehydration. Rest and elevate feet to imporve venous return and manage chest pain. AVOID NITROGLYCERIN
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Most important teaching for cardiomyopathy
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teach family members CPR
and avoid dehydration |
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What kind of prognosis do cardiomyopathies have?
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A poor one.
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What drugs do you not give in obstructed HCMP?
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vasodilators and cardiac glycosides
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