HTN & HLD

Hyperlipidemia (Dyslipidemia)

Elevated number of lipids (cholesterol, triglycerides, and phospholipids​

Characterized as primary or secondary​

Primary: gene mutation ​

Secondary: lifestyle (high cholesterol, and fat diet, excessive alcohol consumption, smoking, sedentary lifestyle), obesity, comorbidities​ (DM, hypothyroidism, liver and renal diseases)

Asymptomatic until it develops into other diseases: atherosclerosis, CAD, stroke, PVD, HTN​

Which of the following is a risk factor for developing hyperlipidemia?​

A:Low body mass index (BMI) ​

B:Sedentary lifestyle ​

C:High-fiber diet ​

D:Regular physical activity​

B: Sedentary Lifestyle- leads to obesity, does not promote decrease of lipids

Management of Hyperlipidemia

Goal is to normalize lipid level and prevent complications​

Primary Screening: Lipid panel: LDL, HDL, cholesterol, and triglycerides​

Prevention Strategies: lifestyle modifications​-active, dieting, non-saturated foods

Pharmacological measures​

Supplements: Omega-3 fatty acids (fish oil)​- layer for cardiovascular protection, lowers risk for mortality

Lifestyle modification: low cholesterol, low fat high fiber foods, routine exercise, moderate alcohol consumption, weight reduction, tobacco cessation

A client's lipid profile reveals elevated levels of LDL cholesterol. Which lifestyle modification is most appropriate to recommend?​

A:Increase intake of saturated fats​

B:Decrease consumption of dietary fiber ​

C:Engage in regular aerobic exercise ​

D:Reduce intake of omega-3 fatty acids​

C:Engage in regular aerobic exercise ​

Lipid Panel

A common blood test used to measure and monitor risk for cardiovascular disease​

Patient should FAST for 8-12 hours prior to collecting sample!​

A Lipid Panel/Profile measures​

Total Cholesterol (normal <200 mg/dL)​

Low-Density Lipoprotein (LDL) (normal <100 mg/dL)​

High-Density Lipoprotein (HDL) (normal >60 mg/dL)​

Triglycerides (normal <150 mg/dL)​

​

Pharmacological Management

Statins: Primary choice, inhibits the biosynthesis of cholesterol

Bile acid binding agents: Depletes the hepatic pool of cholesterol available

Fibrates: Reduces triglyceride rich lipoproteins from the plasma

Cholesterol absorption inhibitors: Prevents absorption and reabsorption of cholesterol within the GI tract

Which medication is commonly prescribed to lower LDL cholesterol levels? ​

A:Aspirin ​

B:Furosemide ​

C:Atorvastatin ​

D:Metoprolol​

C:Atorvastatin ​

Factors Affecting BP

BP=COxSVR (Systemic Vascular Resistance)

CO= HR X SV​

Regulation- Body works to maintain homeostasis by changing CO and SVR​

Hypertension (HTN)

Classified as: ​

Systolic BP >130mmHg ​

Diastolic BP >80mmHg ​

Essential (primary) HTN- no known cause​

Secondary HTN- caused by diseases (comorbidities)​

Ex: kidney disease​

Bp has to be elevated for 2 or more readings when taken 2 weeks apart to confirm htn diagnosis​

Risk Factors for essential HTN

Genetics​

Excessive Na+ ​

Physical inactivity​

BMI >25​

High alcohol consumption​

African American​

Smoking​

Hyperlipidemia​

Diabetes​

Stress​

Age greater than 60 or postmenopausal​

The nurse is discharging a client with a new diagnosis of hypertension. When educating the client, which risk factors will the nurse include as modifiable for the client?​

A: Genetics

B: Excess of Na+ intake

C: Smoking

D: Advanced age

E: High alcohol consumption

B,C,E

Risk Factors for Secondary HTN

Kidney’s disease: properly functioning kidneys will retain fluid when hypotensive and excrete when hypertensive​

Cushing Disease: Too much cortisol, stress hormone, too much stress= Increase in BP, Excessive glucocorticoid secretion

Primary Aldosteronism: causes HTN and hypokalemia

Pheochromocytoma: excessive catecholamine release​

Brain tumor, encephalitis

Medications

Pregnancy

Manifestations of HTN

Headaches​

Facial flushing​

Dizziness​

Fainting​

Retinal changes/visual disturbances​

The nurse is assessing medication compliance with a client diagnosed with hypertension. Which statement indicates a need for further teaching?​

A. “I should take my blood pressure before I take my medication.” ​

B. “If I do not have any signs/symptoms it is okay to take my medication as needed.”​

C. “I should follow up with my provider if my blood pressure remains high.”​

D. “ I should adjust my diet as well as taking my medications as prescribed.”​

B. “If I do not have any signs/symptoms it is okay to take my medication as needed.”​

Laboratory and Diagnostic Testing

Lab tests can identify the cause of secondary HTN and target organ damage​

BUN/Creatinine: Measures kidney function

Elevated blood corticoids: Measures cortisol, Cushing disease

Blood Glucose/Cholesterol: identify contributing factors related to blood vessel changes, assess if diabetic

ECG: Evaluates cardiac function, Tall R-waves are often seen with left-ventricular hypertrophy​

Chest X-ray: Show cardiomegaly, enlarged heart

Medical management-Nutrition

Reduce alcohol consumption​

Low sodium intake​

DASH diet​

Smoking cessation​

Stress reduction​

Aerobic exercise 3x weekly​

​Consume less than 2.3g/day of sodium​

Consume a diet low in fat, saturated fat, and cholesterol​

Limit alcohol intake to 2 servings per day for men and 1 for women​

DASH diet is high in fruits, vegetables, and low-fat dairy foods​

Pharmacological Therapy-Diuretics

• Diuretics​

• Hydrochlorothiazide​

• Furosemide​

• Spironolactone​

*Monitor K+​

Pharm Therapy-ARBs

• ARB’s​

• Valsartan​

Losartan​

*Avoid K+​

*Monitor for angioedema- swelling of the lips or face​

Pharm Therapy-Calcium Channel Blockers

• Calcium-channel blockers​

• Verapamil​

Amlodipine​

Diltiazem​

*Avoid grape juice​

*Use w/ caution in clients w/ HF​

Pharm Therapy- Beta-blockers

• Beta-blockers​

• Metoprolol​

Atenolol​

*If stopped abruptly can cause rebound HTN​

Pharm-Therapy-ACE Inhibitors

• ACE inhibitors​

• Lisinopril​

Enalapril​

*Report a cough​

*Monitor for s/s of HF- edema​

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Client Education

Report manifestations of electrolyte imbalance: hyper/hypokalemia and hyponatremia​

Understand the importance of adhering to medication regimen even w/out manifestations​

Keep scheduled appointments​

Report findings of adverse effects​

Monitor BP at home​

Risk for elder clients: More likely to experience medication interactions and orthostatic hypotension​

Lifestyle changes​

SDOH: Ensure the client has the resources necessary to pay for and obtain prescribed medication​

Complications

• Hypertensive Crisis​

• Manifestations: severe headache, BP 180/120, blurred vision, dizziness, disorientation, epistaxis​

• Administer IV antihypertensives​

• Goal is to lower BP by 20-25%, but do not drop below 140/90​

• Monitor BP every 5-15 min, continuous ECG​

• Assess neuro status​

• PVD that affects heart, brain, eyes, and kidneys​

• Left ventricular hypertrophy as the heart pumps against resistance​

• Heart Failure​

• TIA​

• Stroke​

• MI​

A nurse in the emergency department is admitting a client who has a blood pressure of 266/147 mm Hg and reports severe headache and blurred vision. Which of the following actions should the nurse take first?​

A. Administer an analgesic​

B. Assess the client’s neurovascular status​

C. Obtain IV access​

D.Assess the client’s cardiac status​