NURS 308 - Exam 2

arteries

carries oxygenated blood from the heart

veins

returns deoxygenated blood to the heart

superior & inferior vena cava → right atrium → tricuspid valve → right ventricle → pulmonary semilunar valve → pulmonary trunk → left & right pulmonary arteries → lungs → left & right pulmonary veins → left atrium → bicuspid valve → left ventricle → aortic semilunar valve → aorta → systemic tissues

path of blood flow through the heart:

systole

contraction of the heart muscle, results in ejection of blood from the ventricles

diastole

relaxation of the heart muscle, allows for filling of the ventricles

stroke volume

the amount of blood ejected from the ventricle with each heartbeat

cardiac output

the amount of blood pumped by each ventricle in one minute

cardiac output = stroke volume x heart rate

equation for cardiac output:

4 to 8 L/min

for the normal adult at rest, cardiac output is maintained in the range of:

systemic vascular resistance

the force opposing the movement of blood; the pressure in the arteries that the heart has to pump against to maintain cardiac output

preload

the volume of blood stretching the ventricles at the end of diastole, before the next contraction (how stretched out the cardiac muscles are in the ventricles before contraction)

afterload

the peripheral resistance against which the left ventricle must pump (the force that the left ventricle has to overcome to actually send blood out)

baroreceptors

receptors that are sensitive to stretch or pressure within the arterial system (i.e., detects blood pressure)

decreased heart rate and peripheral vasodilation (to decrease blood pressue)

stimulation of baroreceptors (i.e., volume overload) results in:

chemoreceptors

receptors that detects changes in carbon dioxide, oxygen, and pH, causing a change in blood pressure and respiratory rate

systolic blood pressure

the peak pressure exerted against the arteries when the heart contracts

diastolic blood pressure

the residual pressure in the arterial system during ventricular relaxation or filling

mean arterial pressure (MAP)

the average pressure within the arterial system

MAP = ( SBP + 2 (DBP) ) ÷ 3

equation to calculate the mean arterial pressure (MAP):

ischemic

when the MAP is low for a period of time, vital organs become:

pulse pressure

the difference between the systolic blood pressure and diastolic blood pressure

pulse pressure = SBP - DBP

equation for pulse pressure:

age

family history

obesity

diet

vitamin D deficiency

tobacco

diabetes

high cholesterol

sedentary lifestyle

stress

metabolic syndrome

cardiovascular disease risk factors:

narrows the arteries which increases blood pressure and forms blood clots that can go to the heart, causing a heart attack

how does high cholesterol (increased plasma lipids) increase the risk for cardiovascular disease?

metabolic syndrome

a cluster of conditions that increase the risk of heart disease, stroke, and diabetes; include increased blood pressure, increased blood sugar, excess body fat around the waist, abnormal cholesterol

right-sided heart failure (fluid volume overload)

possible etiology of jugular venous distention:

prolonged O2 deficiency (chronic hypoxia)

possible etiology of clubbing of nail beds:

pale with elevation, rubor with dependency

describe possible color changes in extremities with postural changes for a patient with cardiovascular disease:

incompetent valves in veins

possible etiology of varicose veins:

venous thromboembolism, varicose veins, lymphedema (a blockage obstructing blood flow)

possible etiology of asymmetry in extremities:

dysrhythmias

possible etiology of irregular pulses:

atherosclerosis (hardening)

possible etiology of rigidity of veins:

S3

extra heart sound that signals excess fluid returning to the heart due to fluid volume overload

S4

extra heart sounds that signals stiff ventricles due to damage of the heart muscle

SBP < 120 mmHg and DBP < 80 mmHg

normal blood pressure

SBP 120-129 mmHg and DBP < 80 mmHg

elevated blood pressure

SBP 130-139 mmHg or DBP 80-89 mmHg

stage 1 hypertension blood pressure

SBP > 140 mmHg or DBP > 90 mmHg

stage 2 hypertension blood pressure

normal blood pressure

identify the blood pressure classification: 118/74

stage 2 hypertension

* based on whichever parameter meets the higher classification

identify the blood pressure classification: 136/92

elevated blood pressure

identify the blood pressure classification: 118/82

stage 1 hypertension

* based on whichever parameter meets the higher classification

identify the blood pressure classification: 136/78

stage 1 hypertension

* based on whichever parameter meets the higher classification

identify the blood pressure classification: 125/85

systolic blood pressure ≥ 130 mmHg

diastolic blood pressure ≥ 120 mmHg

current use of antihypertensive medication

one is diagnosed with hypertension if they have any one of the following:

healthy people (HP)

sets goals and objectives to improve health and well-being every 10 years

primary (essential) hypertension

*most common

elevated blood pressure without an identified cause

secondary hypertension

elevated blood pressure with a specific cause

age

alcohol

cigarette smoking

diabetes mellitus

increased serum lipids (high cholesterol)

increased dietary sodium

stress

gender

family history

obesity

ethnicity

sedentary lifestyle

socioeconomic status

risk factors of primary hypertension:

cigarette smoking

one of the leading causes of hypertension and cardiovascular disease

narrows the arteries, increasing vascular resistance

how does increased serum lipids (high cholesterol) increase the risk of hypertension?

causes the body to hold onto more fluid, increasing cardiac output

*more blood is being pumped through the arteries

how does increased dietary sodium increase the risk of hypertension?

activates the fight or flight response, causing vasoconstriction

how does stress increase the risk of hypertension?

african-americans (especially males) because they produce less nitric oxide

(nitric oxide is produced in the lining of the arteries to help with vasodilation)

**health disparity

in which race is the risk for hypertension higher? why?

12 oz of regular beer, 8-9 fl oz malt liquor, 5 fl oz of table wine, 1.5 fl oz of liquor

1 serving of alcohol =

coarctation of the aorta (CoA) *narrowing of the aorta

renal disease

endocrine disorders

neurologic disorders

pre-eclampsia

obstructive sleep disorders (sleep apnea)

medications (corticosteroids, estrogen, amphetamines, NSAIDs)

causes of secondary hypertension:

*don't focus on this

↓ arterial elasticity

↓ receptor sensitivity

↓ renal function

↓ renin-Na-H2O function in the kidneys

↑ myocardial stiffness

↑ peripheral vascular resistance (stiffening of the arteries)

* decreased function of organs, stiffening of muscles & arteries

older adults have an increased incidence of hypertension due to:

impaired baroreceptors

fluid volume depletion *diminished thirst mechanism

chronic renal or hepatic diseases

why are older adults at increased risk of orthostatic hypotension? *safety concern

white coat hypertension

a common phenomenon of older adults in which patients exhibit elevated blood pressure in the hospital or doctor's office but not in their everyday lives *due to stress

fatigue

reduced activity intolerance

dyspnea

dizziness

palpitations

angina

* lack of oxygenation and perfusion to organs, heart must work harder

clinical manifestations of hypertension:

hypertensive heart disease

complication of hypertension: the heart muscle gets larger overtime due to having to pump against resistance. when the heart muscle gets larger, the chambers get smaller. therefore, the heart cannot carry as much blood, decreasing cardiac output

hypertensive heart disease

cerebral vascular disease *stroke

peripheral vascular disease *amputation

kidney disease

vision loss

* decreased oxygenation to specific organs decreases function of each organ

complications of hypertension:

hypertension, diabetes

what are the two leading causes of adult onset blindness?

weight reduction

restrict sodium (& increase potassium)

moderate alcohol intake

activity

tobacco cessation

manage psychosocial risk factors (stress, anxiety, social isolation)

* low sodium diet, limit alcohol, smoking cessation, exercise

what lifestyle changes are important for a patient with hypertension?

nicotine is a vasoconstrictor, which increases blood pressure

how does tobacco affect and worsen hypertension?

decrease sodium, increase potassium

the DASH diet is a diet used for patients with hypertension to decrease _____ and increase _____ intake, which helps to control hypertension

S4 heart sound

a sign of stiffness of the cardiac wall which can occur from hypertension

electrolytes (Na, K)

renal function

glucose

lipids (cholesterol)

albuminuria

what labs are important to monitor for hypertension?

declining renal function is a sign of target organ damage

why is it important to monitor the renal status of a patient with hypertension?

hypertension and diabetes go hand in hand

why is it important to monitor the glucose of a patient with hypertension?

albuminuria

a very early sign of damage to the kidneys; signals hypertension related damage to the kidneys

sexual function in males is a produce of filling up of an arteries. if you have narrowed arteries due to hypertension, the artery won't be able to fill, leading to sexual dysfunction

why is impaired sexual function a possible clinical problem of a patient with hypertension?

medications indicated for hypertension (diuretics, ACE inhibitors, or ARBs) can affect potassium levels

why is risk for electrolyte imbalance a possible clinical problem of a patient with hypertension?

many hypertension medications have an adverse effect of orthostatic hypotension

why is risk for injury a possible clinical problem of a patient with hypertension?

if the patient is on diuretics to help with hypertension (too much of a good think can lead to fluid volume deficit)

why is risk for fluid volume deficit a possible clinical problem of a patient with hypertension?

many of the medications will alter electrolytes, especially potassium

why should you review the labs (specifically electrolytes) of a patient with hypertension prior to medication administration?

potassium

* many anti-hypertensive drugs will alter electrolytes, especially potassium

which specific lab value should you ensure to check before administering anti-hypertensive medications?

dysrhythmias

what is the biggest risk for patients with high or low potassium levels?

- hypotension, especially if symptomatic (SBP < 100 or DBP < 60) *look at trends

- abnormal labs, especially K+ or renal function

- adverse effects of the drug present

as a nurse, when should you hold an antihypertensive drug?

as you lower the head of the bed, SBP gets higher and DBP gets lower. as you raise the head of the bed, SBP gets lower and DBP gets higher

*always document patient position

how does patient position affect blood pressure?

- identify, report, and minimize side effects such as orthostatic hypotension, sexual dysfunction, dry mouth, frequent urination

- use caution with OTC drugs

- lifestyle & dietary modification

- no abrupt cessation of medications

- medications & therapy are not a cure for hypertension (just controls hypertension)

patient teaching for a patient with hypertension should include:

mean arterial pressure (MAP)

used to determine if cardiac output is sufficient enough to perfuse the vital organs

60

a minimum MAP of _____ is required for adequate perfusion to the organs

the vital organs are not being well perfused and they are in imminent damage of organ failure

*monitor for other s&s such as LOC and urine output

what does a MAP of less than 60 mean for the patient?

call the provider

*the vital organs are not sufficiently being perfused

what should you do if your patient's blood pressure is 92/36 and MAP is 95?

hold the medication if this is not within the patients trends

what should you do if your patient's blood pressure is 102/50 and MAP is 67?

atherosclerosis (stiffening of the arteries)

an increase of pulse pressure is a sign of:

heart failure and hypovolemia

an decrease of pulse pressure is a sign of:

not taking medication

the number one leading cause of hypertensive crisis

hypertensive urgency

blood pressure > 180/110, no s&s of target organ damage

oral antihypertensives, often outpatient

how is hypertensive urgency treated?

hypertensive emergency

severe elevation of blood pressure (often > 220/140), evidence of target organ damage → severe headache, nausea and vomiting, seizures, confusion, coma, chest pain, dyspnea, pulmonary edema

IV antihypertensives in the ICU (monitor with the MAP)

how is hypertensive emergency treated?

heart failure

a complex clinical syndrome that results in the inability of the heart to provide enough blood to meet the oxygen needs of tissues and organs

decreased tissue perfusion

impaired gas exchange

fluid volume imbalance

decreased functional ability

with heart failure, decreased cardiac output leads to:

the heart is unable to provide sufficient blood to meet the body's needs

when is heart failure diagnosed?

systolic heart failure

* ejection fraction disorder, pumping disorder

heart failure due to an inability of the heart to pump effectively

diastolic heart failure

* filling disorder

heart failure due to an inability of the heart to fill properly

coronary artery disease

dilated cardiomyopathy

hypertension

valvular heart disease

* conditions that make it harder for the heart to pump, leading to a thin and weak heart muscle

the most common causes of systolic heart failure:

hypertrophic cardiomyopathy

restrictive cardiomyopathy

hypertension (heart muscle grows thicker overtime)

* conditions that cause the heart muscle to thicken, leading to less room in the ventricles for blood to fill

the most common causes of diastolic heart failure:

ejection fraction

the effectiveness of ventricular contraction is measured by the: