Perfusion Exemplar Hypertension

BP is Determined by

Force of blood on arterial walls

Pumping power of heart

Size and condition of the arteries

Ie. Cardiac Output and Systemic Vascular resistance

Impaired Perfusion and BP

Blood flow becomes restricted, body increased BP to improve perfusion. Decreased perfusion causes vasoconstriction to increased blood flow causing rise in BP.

Creates vicious cycle that leads to higher BP which can worsen condition of vessels which further impairs perfusion

Primary Hypertension

90% of people with this. No known cause, called essential or idiopathic hypertension, normally asymptomatic

Secondary Hypertension

Due to another disease process, normally asymptomatic

HTN Presents

Headaches, dizziness, nausea, nose bleeds, fatigue, difficulty sleeping, blurred vision

HTN Damage

Permanent thickening and remodeling of vessels, increased peripheral resistance and back up of pressure to certain organs (heart, brain, kidneys)

When resistance increases, BP increases

Disorders include thickening of myocardium, enlargement of ventricles, heart failure, MI, CVA, and kidney injury

Left Ventricular Hypertrophy

Heart works harder to pump against high pressure, causing the left ventricle to thicken

Heart Failure

Heart weakens and leads to reduced pumping ability

Coronary Artery Disease

High BP damages arterial walls, promoting plaque buildup and narrowing which increases the risk of angina, MI and death

Angina

Chest pain

Transient Ischemic Attach

Disruption of blood flow to the brain, can be caused by HTN

Cerebrovascular Accident

Brain does not get enough oxygen or nutrients, can be caused by HTN. Can cause permanent damage

Hypotension

Can progress to shock or even death as the cells are not able to get O2 and nutrients typically 90/60

Hypotension Causes

Dehydration

Medications

Heart Problems

Neurological

Orthostatic

Hormonal Imbalances

Infection

RAAS

Low BP to Renin to Angiotensinogen to Angiotensin 1 to ACE converting to Angiotensin II which causes the release of aldosterone and vasoconstriction.

Aldosterone retains sodium and water, excretes K

ACE Inhibitor

Block ACE which blocks the production of angiotensin II, vasodilation occurs, excretion of sodium and H2O

Have ot monitor potassium can cause hyperkalemia

Lisinopril

An ACE inhibitor that works to lower BP and can help in heart failure patients by maintaining CO. Along with Diabetic nephropathy and left ventricular Dysfunction after an MI

Adverse Effects of Lisinopril

Hypotension

Rash

Metallic Taste

Hyperkalemia

Neutropenia

Dry, non productive cough

Angioedema

Neutropenia

Low WBC

Angioedema

Swelling of lips and mouth

Nursing Responsibilities of ACE Inihibitors

Monitor BP, any other drug interactions?

Potassium Levels

Kidney functions, BUN and Creatinine, intake and output, edema, daily weights

Liver enzymes

Angioedema

Angiotensin II Receptor Blockers (ARBS)

Block angiotensin II receptions which result in arteriolar vasodilation, urinary excretion of sodium and water with retention of potassium

Less able to protect from cardiovascular events like MI, typically second choice for HTN

ARBS Indications

Hypertension, diabetic nephropathy, heart failure

Losartan, Irbesartan, Valsartan

Angiotensin II Receptor Blockers (ARBS)

Adverse Effects of ARBS

Hypotension

Hyperkalemia

Upset GI

Upper respiratory Infection

Headache

Dizziness

Angioedema (occurs less typically)

ARBS Nursing Interventions

Monitor BP and other drug interactions

Monitor K levels

Kidney functions

Liver Enzymes

Angioedema

ACE Inhibitor Education

Hypotension may occur in first few doses, lie supine until lighheadedness subsides

Report any side effects

Never stop abruptly as HTN can occur

Stop if angioedema

Refrain from K supplements

Report palpitations, twitching, weakness, parasthesia as can be sign of hyperkalemia

Report Infection

Teratogenic

Teratogenic

Can harm fetus or baby

Beta Blockers

Block Beta 1 receptors which cause a decrease in heart rate and contractility

Prevents SNS response

Decreases cardiac output and tachycardia

Block renal beta I receptors causing decrease in the release of renin which decreases RAAS

Beta Blocker Indications

HTN

Angina Pectoris

Dysrhythmias

Decrease Mortality following an MI

Treat Heart Failure

Atenolol, Metoprolol

Beta Blockers

Adverse Effects of Beta Blcokers

Bradycardia

Heart Failure

Stopping can cause anginal pain or an MI

if given with oral hypoglycemic agen can increase risk of hypoglycemia

Can mask signs of hypoglycemia

Beta Blocker Interventions

Monitor pulse, if under 60 BPM report to provider

Monitor BP, signs of heart failure

Do not crush meds if sustained release

Absorption of metoprolol is enhanced with food

Take atenolol before meals or at bedtime

Should never be stopped abruptly

Beta Blocker Education

Have pt take pulse before meds

Monitor BP

Don’t stop abruptly

Report signs of Angina

Monitor for signs of HF

Diuretics

Can be used to excrete sodium and water to lower HTN alone or with other drugs

Loop, Thiazide, Potassium sparing