cardiovascular system

chemoreceptors

-causes changes in respiratory rate and BP in response to increased arterial CO2 pressure

arterial blood pressure, systolic, diastolic

-measure of the force exerted by blood against the walls of the arterial system

-peak pressure

-residual pressure

mean arterial pressure (MAP)

-average pressure within the arterial system

-map = (SBP +2 DBP) / 3

gerontologic assessment differences (cardiovascular system)- kyphosis

-altered chest landmarks for palpations, percussion, and auscultation, distant heart sounds

gerontologic assessment differences (cardiovascular system)

-myocardial hypertrophy

-increased collagen and scaring

-decreased elastin, (CO, HR, SV (in response to exercise or stress))

-sclerosis, fibrosis, impending complete closure of valves

what anticancer agents (daunorubicin, doxorubicin) do to the heart

-dysrhythmias, cardiomyopathy

what antipsychotics (chlorpromazine, haloperidol) do to the heart

-dysrhythmias, orthostatic hypotension

what antirheumatics (hydroxychloroquine) does to the heart

-dysrhythmias, cardiomyopathy, heart block, prolonged QT interval

what corticosteroids (cortisone, prednisone) do to the heart

-hypertension, edema, potassium depletion

what hormone therapy and oral contraceptives (estrogen, progestin (prempro) does to the heart

-MY, thromboembolism, stroke, hypertension

what NSAIDS (celecoxib (celebrex), diclofenac, ibuprofen,) does to the heart

-MI, stroke, hypertension, HF

what psychostimulants (amphetamines, cocaine) does to the heart

-tachycardia, angina, MI, hypertension, dysrhythmias

what TCAs (amitriptyline, doxepin (silenor)) does to the heart

-dysrhythmias, orthostatic hypotension

central cyanosis

-inadequate O2 saturation of arterial blood because of pulmonary or cardiac disorders

clubbing of the nails

-endocarditis, congenital defects, prolonged O2 deficiency

chronic changes in extremities with postural change

-chronic decreased arterial perfusion

jugular venous distention (JVD)

-increased right atrial pressure, right sided HF

peripheral cyanosis

decreased blood flow from HF, vasoconstriction, cold environment

splinter hemorrhages

infective endocarditis

ulcers

-poor venous return, varicose veins, incompetent venous valves

asymmetry in limb circumference

-venous thromboembolism, varicose veins, lymphedema

cold extremities

-peripheral arterial disease, decreased CO, severe anemia

delayed capillary refill

-decreased perfusion, anemia

pitting edema of lower extremities or sacral area

-interruption of venous return to heart, right sided HF

unusually warm extremities

-thyrotoxicosis

3rd heart sound (S3)

-left ventricular heart failure, volume overload, mitral, aortic, or tricuspid regurgitation, hypertension

4th heart sound (S4)

-forceful atrial contraction from resistance to ventricular filling (left ventricular hypertrophy, aortic stenosis, hypertension, coronary artery disease)

arterial bruit

-arterial obstruction or aneurysm

heart murmurs

-heart valve disorder, abnormal blood flow patters

pericardial friction rub

-pericarditis

pulse deficit

-dysrhythmias, most often atrial fibrillation/ flutter or premature ventricular contractions

heaves

-sustained lifts of the chest wall

hemodynamic monitoring

-measurement of pressure, flow, and oxygenation within the cardiovascular system

arterial pressure-based cardiac output (APCO)

-measurement to determine continuous CO (CCO)/continuous CI (CCI)

common indications for pulmonary artery catheterization

-assessment of response to therapy in mixed types of shock

-cardiogenic shock

-differential diagnosis and response to therapy in pulmonary hypertension

-MI with complaints

-potentially reversible systolic HF

-severe chronic HF requiring vasoactive drug therapy

-transplantation workup

contraindications for pulmonary artery catheterization

-coagulopathy

-endocardial pacemaker

-endocarditis

-mechanical tricuspid or pulmonic valve

-right heart mass

what can increase the risk for ventricular dysrhythmia during catheter insertion

-hypokalemia, hypomagnesemia, hypoxemia, or acidosis ( can make the heart more irritable)

what can a rise in troponin levels indicate

-MI or injury

c-reactive protein

-made by liver during periods of acute inflammation

-elevated levels are linked with atherosclerosis and the firs occurrence of a heart event

positioning the zero reference stopcock

-mar the location of the phlebostatic axis on the patient’s chest with permanent marker

-recheck the leveling of the stopcock

-transducers higher than the phlebosstatic axis will produce falsely low BP readings

-^lower will show false high readings

hypertension (blacks)

-have the highest prevalence

-more likely to have resistant hypertension

-develop hypertension at a younger age

-higher among in women

-have more nocturnal BP(increases risk for CVD)

-hypertension is more aggressive

-highest death rate from hypertension

hypertension (hispanics)

-less likely to receive treatment

-lowest rate for BP control

-

hypertension (men)

-before early middle age… more common

hypertension (women)

-more common if taking oral contraceptives

when a1 response when activated

-vasoconstriction, increased contractility

when a2 response when activated

-inhibition of norepinephrine release

when b1 response when activated

-vasoconstriction, increased contractility, increased heart rate, increased conduction, increased renin secretion

when b2 response when activated

-vasoconstriction

common causes of secondary hypertension

-cirrhosis

-sleep apnea

-renal disease

-neurologic problems

-endocrine problems

-pregnancy induced hypertension

risk factors for primary hypertension

-age

-alcohol

-diabetes

-ethnicity

-excess sodium intake

-family history

-gender

-increased serum lipids

-obesity

-sedentary lifestyle

-tobacco use

-stress

-socioeconomic status

secondary symptoms

-fatigue

-dizziness

-palpations

-angina

-dyspnea

what is the most common cause of cerebrovascular disease

atherosclerosis

who is at high risk for CVD

-reverse dippers

-increase in nighttime SBP

what is the salty 6

-food that you should reduce eating due to their increase in sodium

-bread products

-lunch meat

-cured meats

-pizza

-soup

-sandwiches

-poultry

doxazosin (cardura) drug alert

-best to give first dose at bedtime to reduce first dose BP drop

-syncope usually occurs 30-90 mins after first dose, too rapid increase in dose, or addition of another antihypertensive agent to therapy

-severe hypotension can occur if taking phosphodiesterase inhibitors (sildenafil (viagra) or tadalafil (cialis))

resistant hypertension

-if taking a diuretic in addition to 3- drug therapy regimen

-overactive renal nerves can be a cause

if both arms have different BPs which do you use

-the higher one

causes of pseudoresistant hypertension

-improper BP measurement

-inadequate drug doses

-inappropriate drug therapy

-poor adherence to drug regimen

-white coat syndrome

what are some possible findings in someone with hypertension

-abnormal serum electrolytes (especially potassium)

-increase BUN, creatinine, glucose, cholesterol, and triglycerides ect

hypertensive crisis (etiology)

-acute aortic dissection

-drug use (cocaine, amphetamines)

-exacerbation of chronic hypertension

-head injury

-MAOI taken with tyramine diet

-pheochromacytoma

-preeclampsia, eclampsia

-rebound hypertension (from abrupt withdrawal of antihypertensive drugs)

hypertensive crisis (assessment findings)

-systolic BP greater than 180 mm Hg and/ or diastolic BP greater than120 mm Hg

-blurred vision

-chest pain

-confusion

-dyspnea

-headache

-nausea and vomiting

-nosebleeds

-seizures

hypertensive crisis (interventions)

-obtain baseline vital signs, including O2

-start continuous BP and ECG monitoring

-auscultate heart and breath sounds

-insert IV

-administer IV antihypertensive medications

-obtain baseline blood work

-give O2 per agency protocol

hypertensive crisis (ongoing monitoring)

-titrate the drug according to MAP or SBP as ordered

-assess and record response to drugs

-measure urine output daily

-maintain the patient on bed rest

labetalol dug alert

-teach the patient to not stop the drug abruptly

^can lead to angina or HF

clonidine (catapres) drug alert

-teach patient to change positions slowly

-avoid hazardous activities(causes drowsiness)

-do not stop abruptly may cause a rebound increase in BP