N3: Exam 3

Week 5 material

CV System: Structures and Function — What is the mnemonic for remembering artery function?

"Arteries Going Away" (from the heart)

Blood Pressure — What is Systolic pressure the result of?

A contraction of the ventricles

Diastolic

The pressure when the ventricles are at rest

What is considered normal BP?

Less than 120/80 mmHg

BP should be taken

1. While Sitting.

2. At the same time each day

3. Feet lay flat on the floor

4. No crossing legs

DETERMINANTS OF BP

• Pumping action of the heart

• Peripheral Vascular Resistance

• Blood Volume

• Blood Viscosity

FACTORS AFFECTING BP

• Age: older adults

• Exercise

• Stress

• Race

• Gender

• Medications

• Obesity

• Medical conditions

• Thinking Nurse! Which of the following factor is modifiable?

HYPERTENSION: RISK FACTORS Modifiable Risk

Factors

Diet

• Excessive Sodium, Fat & Alcohol intake

• Tobacco use

• Sedentary lifestyle

• Obesity

• Stress

HYPERTENSION: RISK FACTORS Non-Modifiable Risk

Factors

Age

Gender

Family history

Ethnicity

Medical Conditions

Types of HTN — Elevated BP

120–129 / <80 mmHg check

Stage I hypertension

130–139 / 80–89 mmHg

Stage II hypertension

≥140 / ≥90 mmHg

Hypertension Crisis

>180 / >120 mmHg (requires immediate medical attention)

Thinking Nurse:

When/How the diagnosis of HTN can be made?

Primary HTN — Age of onset?

Age onset > 40 y/o

Primary HTN — What is known about its exact cause?

Exact causes unknown but has strong connection to family history

What perentage of ppl suffer from primary HTN

90 – 95% of all HTN

What percentage of ppl suffer from secondary HTN

5 – 10% of all HTN

Secondary HTN — Age of onset?

Age onset < 30 y/o

Secondary HTN due to specific causes

• GI (liver cirrhosis)

• Renal (renal artery stenosis, CKD, nephrotic)

• Endocrine (thyroid, Cushing, pheochromocytoma)

• Neuro (brain tumor, traumatic brain injury)

• Pregnancy

• Sleep apnea

• Medications and illicit drugs

HYPERTENSION Clinical manifestations

•Usually a__________  “Silent Killer”

•Fatigue, dizziness, palpitations, dyspnea

•Severe HA, N/V, seizure, confusion, coma

nosebleeds = Hypertensive encephalopathy

Thinking Nurse

Which information should the nurse include when teaching a patient with newly diagnosed hypertension?

a. Increasing physical activity will control blood pressure (BP) for most patients.

b. Most patients are able to control BP through dietary changes.

c. Annual BP checks are needed to monitor treatment effectiveness.

d. Hypertension is usually asymptomatic until target organ damage occurs

HYPERTENSION

Non-Pharmacological Therapy (“Lifestyle Modifications”)

• Weight reduction

• DASH and low sodium diet

• Moderate ETOH

• Physical activity

• Avoid tobacco

• Stress management

HYPERTENSION PHARMACOLOGICAL TREATMENT

• Diuretics

• Adrenergic Antagonists/Blockers

• RAAS Drugs

• Calcium Channel Blockers

RAAS DRUGS

ACE-Inhibitors

Angiotensin II Receptor Blockers

Direct Renin Inhibitor

Aldosterone Antagonist

RAAS DRUGS ACE-Inhibitors

Benazepril, Captopril, Enalapril, Lisinopril

RAAS DRUGS: Angiotensin II Receptor Blockers

Candesartan, Losartan, Olmesartan, Valsartan

RAAS DRUGS: Direct Renin Inhibitor

Aliskiren

RAAS DRUGS: Aldosterone Antagonist

Spironolactone, Eplerenone

ADRENERGIC ANTAGONISTS/BLOCKERS

Alpha Blockers

Beta Blockers

Alpha/Beta Blockers

Central Acting Alpha Blockers

Adrenergic Antagonists/Blockers — Name the Alpha Blockers

Doxazosin (Cardura), terazosin (Hytrin), prazosin

(Minipress)

ADRENERGIC ANTAGONISTS/BLOCKERS - Beta Blockers - Selective vs non-selective

 Selective beta1 = atenolol, bisoprolol, esmolol, metoprolol

 Non-selective (beta1 and beta2)= propranolol

ADRENERGIC ANTAGONISTS/BLOCKERS Alpha/Beta Blockers

carvedilol and labetalol

ADRENERGIC ANTAGONISTS/BLOCKERS Central Acting Alpha Blockers

 Clonidine

 Methyldopa (do not get confused with levadopa and

carbidopa used for….?)

CALCIUM CHANNEL BLOCKERS

DiHydroPyridines

Non-Dihydropyridines

DiHydroPyridines nemonic

“Doesn’t Hurt Pulse”

CALCIUM CHANNEL BLOCKERS

DiHydroPyridines

 amlodipine (Norvasc)

 felodipine (Plendil)

 nifedipine (Procardia, Adalat)

CALCIUM CHANNEL BLOCKERS: Non-Dihydropyridines

 verapramil (Calan)

 diltiazem (Cardizem)

CALCIUM CHANNEL BLOCKERS Both classes

Both Classes → arteriolar dilation → ↓BP

DIURETICS

•Thiazide and Thiazide-like diuretics

•Loop diuretics

•Potassium-Sparing diuretics

Thiazide and Thiazide-like diuretics

first line

– Hydrochlorothiazide

– Chlorothiazide

Loop diuretics

– Furosemide

– Torsemide

– bumetanide

Potassium-Sparing diuretics

Spironolactone

Thinking Nurse

The nurse is caring for an 80-year-old

patient who has just begun taking a thiazide

diuretic to treat hypertension. What is an

important aspect of care for this patient?

a. Encouraging increased fluid intake

b. Increasing activity and exercise

c. Initiating a fall risk protocol.

d. Providing a low potassium diet

HTN NURSING DIAGNOSIS

• ________ cardiac output

• ________ tissue perfusion

• ________ intolerance

• ________ knowledge

• Acute pain

• Disturbed sensory perception: vision

Remember! All nursing diagnosis has 3 parts- R/T and AEB

HTN NURSING INTERVENTION

• Education is the key

• Health care promotion HOW?

• Collaborative management

Registered dietician for ____________

Physical therapist for ____________

Pharmacist for ______________

HYPERLIPIDEMIA:

PATHOPHYSIOLOGY

• LDL ↑ risk of atherosclerosis

• HDL ↓ risk of atherosclerosis

LIPID PANEL

ANTI-LIPID DRUGS

HMG-CoA reductase inhibitors (Statins)

Simvastatin, Atorvastatin, Pravastatin, Lovastatin

ANTI-LIPID DRUGS

Nicotinic Acid (Vitamin B3)

 Niacor, Niaspan

ANTI-LIPID DRUGS

Bile acid sequestrants

Colesevelam, Cholestyramine, Colestipol

ANTI-LIPID DRUGS

Fibrates (BV)

Gemfibrozil (Lopid), Clofibrate, Fenofibratec

ANTI-LIPID DRUGS

Cholesterol Absorption Inhibitors

Ezetimibe

ANTI-LIPID DRUGS

Liver:

 HMG-CoA reductase inhibitors (Statins)

 Nicotinic Acid (Vitamin B3)

 Fibrates

ANTI-LIPID DRUGS

Intestines:

 Bile acid sequestrants

 Cholesterol Absorption Inhibitors (Ezetimibe)

What Herbal Products are associated with lipid management?

Garlic, Flaxseed, Omega-3

prior to starting anti-lipid drugs

***Always start with lifestyle modification (diet, exercise)

Statins work by

decreases total cholesterol and LDL

Increasing HDL and Triglycerides

Nicotinic Acid works by

Total Cholesterol, LDL, triglycerides decreased

increased HDL

Bile Acid Sequestrants works by

Decreases Total cholestrol and LDL

Fibrates works by

Decreased total cholesterol, LDL, Triglyceride

Increases HDL

Cholesterol Absorption Inhibitors works by

Decreased total cholesterol, LDL, Triglycerides

A t h e r o s c l e r o s i s a n d c a r d i o v a s c u l a r d i s e a s e risk factors

High fat diet

Alcohol consumption

Reduce stress

CRP = C Reactive Protien

Menopause

MEDICAL MANAGEMENT OF CAD

Coronary artery bypass grafting (CABG)

Percutaneous coronary intervention (PCI)

Coronary artery bypass graft

(CABG) surgery

A section of a vein is removed from the leg and anastomosed to a coronary artery to bypass an area of arteriosclerotic blockage.

An internal mammary artery is grafted to a coronary artery to bypass blockage.

PERCUTANEOUS CORONARY INTERVENTION (PCI) Includes

percutaneous transluminal coronary angioplasty (PTCA), stent placement, laser angioplasty, and atherectomy

THINKING NURSE

Which procedure involves insertion of a balloon-tipped catheter into a coronary artery?

a. Thrombolytic therapy

b. Coronary artery bypass grafting

c. Percutaneous coronary intervention.

d. Endarterectomy

COLLATERAL CIRCULATION

 Provides communication between the cornoray arteries and their branches.

 Important mechanism for________.