AH1 Exam 3 - HLD & HTN

What is HLD?

Elevated # of lipids (cholesterol, triglycerides, & phospholipids)

How can secondary HLD occur?

• By lifestyle/habits!!

• Sedentary, unsat fatty foods

• Smokers, heavy alc users

• Obesity, comorbidities

When does HLD become symptomatic?

Until it occluded vessels or develops into other diseases

• Atherosclerosis

• CAD - narrowing of coronary arteries

• Stroke

• PVD

• HTN

Goal for management w/ HLD

Normalize lipid level & prevent complications

Primary screening for HLD

• Lipid panel:

  • LDL

  • HDL (want higher)

  • Cholesterol

  • Triglycerides

Prevention strategies for HLD

Lifestyle modss

Supplement for HLD

Omega-3 fatty acids (fish oil) — protect CV system, prevent complications

What should a pt do before a lipid panel?

FAST 8-12 HRS PRIOR

Norm cholesterol levels

<200 mg/dL

Norm LDL level

<100 mg/dL

norm HDL levels

>60 mg/dL

Norm triglyceride levels

<150 mg/dL

Pharm management for HLD

• Statins

• Fibrates

• Bile acid binding agents

• Cholesterol absorption inhibitors

Statins for HLD management

• Primary choice (effective & cheap)

• Inhibits the biosynthesis of cholesterol

Fibrates for HLD management

Reduces triglyceride rich lipoproteins from the plasma

Bile acid binding agents for HLD management

Depletes the hepatic pool of cholesterol available

Cholesterol absorption inhibitors for HLD management

Prevents absorption & reabsorption of cholesterol w/in GI tract

Factors affecting BP

CO x SVR

What is htn classified as?

• Systolic BP >130mmHg

• Diastolic >80mmHg

• ***** BP has to be elevated for 2+ readings when taken at least 2 weeks apart to confirm dx ****

Primary & secondary cause of htn

• Primary - no known cause

• Secondary - caused by diseases (comorbidities) — kidney disease

Norm BP for adults

less then 120/80

Prehypertension for adults

• Sys 120-129

• Dia less than 80

Stage 1 hypertension for adults

• Sys 130-139

• Dia 80-89

Stage 2 hypertension for adults

• Sys 140+

• Dia 90+

Hypertensive crisis for adults

• Sys 180+

• Dia 120+

Risk factors for essential htn (11)

• Genetics

• Excessive Na+ (water follows salt - more water retention)

• Physical inactivity

• BMI >25

• High alc consumption

• African american

• Smoking

• HLD

• DM

• Stress

• Greater than 60 or postmenopausal

Risk factors for secondary htn (7)

• Kidney disease - trouble excreting water - retaining fluid

• Cushing disease - too much cortisol! (stress hormone)

• Primary aldosteronism (too much aldosterone)

• Pheochromocytoma - rare tumor of adrenal glands; severe release of catecholamine

• Brain tumor, encephalitis

• Meds - ADHD meds, street drugs (coke, fent)

• Pregnancy - increase circulating vol

Htn manifestations

• HA

• Facial flushes

  • Dizziness

  • Fainting

• Retinal changes/visual disturbances

  • Blurry/double vision

• make sure pt takes meds as prescribed - CONSISTENTLY*

Lab tests & dx for htn (5)

• BUN/creatinine - kidney disease

• Elevated blood corticoids - cushing

• Blood glucose/cholesterol - DM/HLD

• ECG changes

• Chest X-Ray - shows cardiomegaly, hypertrophies cuz working too hard

Client edu for htn (3)

• Reduce alc use

• Stop smoking

• Lower Na+ to 2.3/day

Nutrition management for htn (6)

• Reduce alc consumption

• Low sodium intake - 2.3 g or less

• DASH DIET - outer isle of grocery store; fresh fruits, veggies, lean proteins

• Stop smoking

• Reduce stress

• Aerobic exercise 3x/week

Pharm therapy for htn

• Diuretics

• CCB

• ACE-I

• ARB’s

• BB

  ****Check BP BEFORE admin for ALL****

Diuretics pharm therapy for htn

• Hydrochlorothiazide

• Furosemide

• Spironolactone

• Removes excess fluid

• Monitor K+***

CCB for pharm therapy for htn

• Verapamil

• Amlodipine

• Diltiazem

• **AVOID grapefruit juice

• **Use w/ caution in pts w/ HF

ACE inhibitors pharm therapy for htn

• Lisinopril

• Enalapril

• **Report a cough

• **Monitor for s/s of HF - edema

ARBs pharm therapy for htn

• Valsartan

• Losartan

• **AVOID K+

• **Monitor for angioedema - swelling of lips or face - PRIORITY

BB pharm therapy for htn

• Metoprolol

• Atenolol

• If stopped abruptly can cause rebound HTN

What electrolyte imbalances should be reported w/ htn?

• Hyper/hypokalemia

• Hyponatremia - NEURO

Client edu for htn (7)

• Understand importance of adhering to med regimen even w/out manifestations - if they feel ok still need to take med

• Keep scheduled appointments

• Report findings of adverse effects

• Monitor BP at home

• rx for elder clients: more likely for med interactions & orthostat hypoten (teach to get up slowly)

• Lifestyle changes

• SDOH: ensure pt has resources necessary

Complication of htn

Hypertensive crisis

Manifestations of hypertensive crisis (6)

• Severe HA

• BP 180/120 or greater

• Blurred vision

• Dizziness

• Disorientation

• Epistaxis - nosebleed, too much pressure, small vessels in nose & first to burst

Priority for hypertensive crisis

IV antihypertensives!!

Goal w/ hypertensive crisis

Lower BP by 20-25% BUT do NOT drop below 140/90 — can send pt into hypoperfusion - organs can shut down!! Kidneys first to fail

How often do we monitor BP for hypertensive crisis

Every 5-15 min, continuous ECG

ECG for hypertensive crisis

Peaked QRS!

R peak HIGHH

Depressed T-wave

Make sure to assess…for hypertensive crisis

NEURO STAT!

Hemorrhagic stroke — more pressure can lead to burst vessels

Complications cont for htn

• PVD that affects heart, brain, eyes, kidneys

• Left ventricular hypertrophy - heart pumps against resistance

• TIA

• Stroke

• MI