Cardiovascular: HF and HTN

Biventricular failure

* Inability of both ventricles to pump effectively * Fluid build-up and venous engorgement * Decreased perfusion to vital organs

risk factors of HF

- CAD - HTN - DM - smoking - obesity - MI

complications for HTN

- CAD. stroke, hypertensive crisis, HF, renal failure, PVD, retinal damage

interventions from assessments

- VS - BS - HR - skin color, temp, pulses - daily weight - urine output - edema - activity - lab data

HTN nursing management

- high BP reading - silent killer

nursing management

- impaired O2 - decreased CO - ineffective peripheral perfusion

evaluation of HTN

- knowlege of disease - maange disease - no complications

teaching for HTN

- medication regimen - lifestyle changes - blood pressure taking - BP at home - signs and symptoms - stress management

interventions for HTN

- neurological assessment - blood pressure HR - urine output - palpation for edema and pulses - labs - BMI and waist circumference

treatment for HTN

- reduced BP and prevent extent of organ damage (death) - medications - lifestyle changes

evaluating care outcomes

- reduced dyspnea - absence of fatigue - activities of daily living - reduced hospitalizations

Left sided heart failure

- results from inability of LV to empty adequately during systole or fill adequately during diastole

medical managment for HF

- symptoms - medications - lifestyle changes - surgical

Abnormal EF

- systolic HF - less then 40% - weak contraction - diastolic HF - greater then 50% - inability to fill ventricles

Which topics would the nurse include in teaching for a client with a new diagnosis of hypertension? Select all that apply Reason for daily low dose aspirin use Use of a home blood pressure monitor Adverse effects of tobacco on blood pressure Avoidance of any alcohol consumption Benefits of moderate daily exercise

- use - adverse - benefits

signs and symptoms of HF

- weakened cardiac contraction - decreased cardiac output - back up of blood - poor peripheral perfusion - hydration status (hyper or hypo)

complications of HF

1. pleural effusion: fluid in lungs 2. dysrhythmias 3. left ventricular thrombus 4. *hepatomegaly: especially with RHF. liver becomes congested with venous blood.* -leads to impaired function; liver cells die, fibrosis occurs, & cirrhosis can occur 5. renal failure

normal EF

55-70%

white coat hypertension

A phenomenon in which patients exhibit elevated blood pressure in the hospital or doctor's office but not in their everyday lives.

treatment for HF

A. BED REST b. diurectics c. sodium restriction d. measures to improve myocardial contractile and correction of arrhythmias

Which is the best action for the nurse to take when a client with hypertension tells the nurse, "I took the blood pressure pills for a few weeks, but I didn't feel any different, so I decided I'd only take them when I feel sick"? Educate the client about the complications associated with high blood pressure Ask the client questions to determine the current understanding of high blood pressure Emphasize the importance of taking blood pressure medications now to continue to feel well Show the client the current blood pressure and compare that with normal blood pressure levels

Ask the client questions to determine the current understanding of high blood pressure

Which laboratory result will be important for the nurse to review when a client is admitted to the hospital with a long history of uncontrolled hypertension? Blood glucose level White blood cell count (WBC) Blood urea nitrogen (BUN) Lactic dehydrogenase

BUN

poor perfusion and low cardiac output

Decreased exercise tolerance Muscle wasting or weakness Anorexia or nausea Unexplained weight loss Lightheadedness or dizziness Unexplained confusion or altered mental status Resting tachycardia Daytime oliguria with recumbent nocturia Cool or vasoconstricted extremities Pallor or cyanosis

medications for HF

Diuretics Cardiac Glycoside: Digoxin Beta blockers ACE inhibitors Angiotensin receptor blockers (ARB) Milrinone Vasodilators

right sided heart failure

Right side of heart cannot empty all of blood received from venous circulation.

The nurse on a medical unit is caring for a client with heart failure. The client suddenly develops extreme dyspnea, tachycardia, and lung crackles. The nurse immediately asks another nurse to contact the provider and prepares to implement which priority interventions? Select all that apply a. Administer oxygen b. Insert an indwelling urinary catheter c. Administer furosemide IV d. Administer morphine sulfate IV e. Transport the client to the ICU f. Place the client in a side-lying position

a. Administer oxygen b. Insert an indwelling urinary catheter c. Administer furosemide IV d. Administer morphine sulfate IV

A client has been treated with a diuretic for fluid overload and shortness of breath. After voiding 960 mL clear yellow urine over an hour, the client says she feels funny. What should the nurse do next? a. Reassess oxygen saturation reading b. Administer an additional dose of the diuretic c. Assess the blood pressure d. Obtain a serum potassium level

c. assess the blood pressure

The nurse is administering medications on a medical-surgical unit. A client is ordered to receive 10 mg oral atenolol for the treatment of hypertension. Before administering the medication, the nurse should weigh the client. check the client's serum K level. check the client's heart rate. check the client's urine output.

check the clients HR

The nurse is to weigh the client in heart failure each morning. The nurse has an order to administer furosemide 40 mg IV for a weight gain greater than 2 kg. Today's weight is 243 lb; yesterday's weight 239 lb. How much furosemide should the nurse administer?

convert the weight from kg

120-129

elevated

Sustained hypertension

high BP in and out of office

HF

insufficient blood supply/ oxygen to tissues and organs which equals a decreased tissue perfusion

masked hypertension

low clinic blood pressure, but elevated ambulatory/home blood pressure

<120

normal

Ejection Fraction

percentage of blood ejected from ventrile with each contraction

Brain Natriuretic Peptide (BNP)

produced by ventricular muscle cells

signs of left HF are in the...

pulmonary system

130-139

stage 1 hypertension

140-159

stage 2 hypertension

greater or equal to 160

stage 2 hypertension

signs of right HF are in the...

systemic circulation

The nurse understands that an overall goal of hypertension management is that: the client maintains a normal blood pressure reading. there is no report of postural hypotension. there are no reports of sexual dysfunction. there is no indication of target organ damage.

there is no indication of organ damage