Cardiac...need to know

Secondary hypertension

(5-10%) High blood pressure caused by the effects of another disease (e.g., kidney disease)

Primary hypertension

(90-95%) High blood pressure, the *cause of which is unknown*

Normal BP range

*LESS THAN* 120/80 Systolic: Less than 120 Diastolic: Less than: 80

DASH diet

- Dietary Approaches to Stop Hypertension - Grains and grain products - Vegetables - Fruits - Low-fat or fat-free dairy foods - Meat, fish, and poultry - Nuts, seeds, and dry beans

OTC medications that are contraindicated with hypertension such as:

- High-sodium medications (Maalox, Alka-Seltzer, Rolaids) - Decongestants....some of these are unsafe with high blood pressure - Laxattives (Phospho soda is very high in sodium) - Diet pills are clearly contraindicated because most of them elevate b/p and heart rate....increase workload on the heart.

(Primary hypertension pathphysiology) Stress and increased SNS activity

- Produces increased vasoconstriction - Increased HR - Increased renin release

Over the years, manifestations of HTN include...

- Retinal and other eye changes - Renal damage - Cardiac hypertrophy - Peripheral Vascular Disease - Brain

Smoking and HTN

- increases HR - Constricts arterioles - Reduces heart's ability to eject blood

Diagnostic Assessment

-- posterior anterior and lateral CXR (decides if you need to go further with diagnostics) --Angiography (invasive, contrast media to see if there is a vaso-obstruction) --Arteriography

Hemodynamic Monitoring

---Invasive system provides quantitative information about vascular capacity, blood volume, pump effectiveness, tissue perfusion Pulmonary artery catheter Invasive artery catheter - most precise, mainly ICU Impedance cardiography

Cardiovascular Physical Assessment - Skin and Extremities

-6 p's (obstruction of arterial blood flow in extremities): pain, pallor, pulselessness, paresthesia, poikilothermic (coldness), and paralyses -bruising -peripheral edema (look at sacral area for pt on bedrest) -Prolonged capillary refill time (inadequate arterial perfusion) -Clubbing of fingers or toes (hemoglobin desaturation) -Hair loss, brittle nails, dry scaling skin, atrophy, color changes, ulcerations (chronically reduced oxygen)

Mean Arterial Pressure (MAP

-Average blood pressure in an individual during a single cardiac cycle -Must be at least 60mm Hg to maintain adequate blood flow through coronary arteries and perfuse major organs MAP = systolic BP + 2(diastolic BP) all divided by 3 Normal is between 60 and 70 mmHG Low blood volume makes MAP drop

infective endocarditis diagnosis

-Several lab finding may suggest BE: ---ECG changes ---elevated ESR ---elevated WBC -Sx: can be nonspecific such as anorexia, malaise, wt. loss, unexplained fever. May have new murmur, or change from existing.

rheumatic endocarditis teaching

-preventing a reoccurrence of rheumatic endocarditis is goal of notifying provider prior to invasive surgery or dental procedures -prophylactic antibiotics given prior to invasive/dental procedures d/t risk of streptococci

on an ECG each small square equals

.04 seconds.

With these 2 conditions a BP lower than 130/90 is recommended

1) Diabetes 2) Chronic Kidney disease

HTN is the most important modifiable factor for...

1. Coronary heart disease 2. Stroke 3. CHF, 4. Renal failure 5. peripheral vascular disease

Primary HTN risk factors

1. Genetic predisposition 2. Excess dietary salt intake 3. Adrenergic tone 4. racial pattern (HIGHEST : African Americans)

Potential causes of secondary HTN

1. Other conditions that affect the kidneys, arteries, heart, or endocrine system 2. Hyperaldosteronism (mineralcortico htn) 3. Sleep apnea, pheochromcytoma 4. NSAIDS, prediosone, epoetin alfa (epogen) 5. Pregnancy induced hypertension 6. coarction of the aorta

Major risk factors for HTN

1. Smoking 2. Obsity 3. HF 4. Physical inactivity 5. DM 6. Dyslipidemia

Near optimal LDL cholesterol level

100-129

elevated hypertension BP category range

120-129 AND <80

stage 1 hypertension BP range

130-139 OR 80-89

Sodium tabe 25-4

135-145 mEq/L Low or high serum sodium levels do not directly affect cardiac function Hypo: decreased sodium levels indicate fluid excess and can be caused by heart failure or administration of thiazide diuretics Hyper: increased sodium levels indicate fluid deficits and can result from decrease water intake or loss of water through excessive sweating or diarrhea

High for LDL cholesterol level

160-189

How long does it take for taste buds to adapt to decreased Na intake

2 - 3 months

How much salt should a person consume to improve BP

2 grams Sodium controls water distribution throughout the body. An increase in sodium causes an increase in water, thus increasing circulating blood volumes and more volume = more pressure

Recommended amount of antihypertensive medications to get BP less than 130/80

2 or more

patients without symptoms of aortic regurgitation usually have echocardiograms every_______.

2 to 3 years

potassium table 25-4

3.5-5 mEq/L Potassium has a major role in cardiac Electrophysiologic function Hypo: decreased potassium due to administration of potassium-excreting diuretics can cause many forms of dysrhythmias, including v tach, or v fib, and predisposed pt taking digitalis preparations to digitalis toxicity Hyper: increased levels from increased potassium intake, decreased renal excretion, use of potassium0sparing diuretics, or use of ACE inhibitors that inhibit aldosterone function. complication indulge heart block, systole, and life threatening ventricular dysrhymias

What % of U.S. population have HTN

30%

Expected value for dietary potassium

3500-5000 mg/day

patients with symptoms of aortic regurgitation usually have echocardiograms every_______.

6 months

Goal for ideal body weight for hypertension treatment

<1 kg reduction

Normal BP category ranges

<120 AND <80

goal for people with hypertension

<130/80

Expected value for dietary sodium

<1500 mg/day or 1000 mg/day reduction

sodium restrictions for stage B-D

<3gm/day

expected ejection fraction for people with systolic heart failure

<40%

BP of hypertensive emergency

> 180/120

stage 2 hypertension BP range

>/= 140 OR >/= 90

High total cholesterol level

>200

A 35-year-old female patient has been diagnosed with hypertension. The patient is a stock broker, smokes daily, and is also a diabetic. During a follow-up appointment, the patient states that she finds it cumbersome and time consuming to visit the doctor regularly just to check her blood pressure (BP). As the nurse, which of the following aspects of patient teaching would you recommend? a) Purchasing a self-monitoring BP cuff b) Advising a smoking cessation c) Discussing methods for stress reduction d) Administering glycemic control

A

A 77-year-old client has newly diagnosed stage 2 hypertension for which the physician has prescribed a thiazide and an angio-converting enzyme inhibitor. The nurse is concerned about the client's risk for postural hypotension because of these medications, as well as for what other reason? a) Older adults have impaired cardiovascular reflexes. b) Older adults require large doses of these medications to control their blood pressure. c) Older adults have trouble remembering to measure their blood pressure at home. d) These medications often cause rebound hypertension.

A

A 77-year-old client has newly diagnosed stage 2 hypertension. The physician has prescribed a thiazide and an angio-converting enzyme inhibitor. About what is the nurse most concerned? a) Postural hypotension and resulting injury b) Postural hypertension and resulting injury c) Rebound hypertension d) Sexual dysfunction

A

A 77-year-old client has newly diagnosed stage 2 hypertension. The physician has prescribed the client a thiazide and an angio-converting enzyme inhibitor. The nurse is concerned about postural hypotension. Which of the following will the nurse be sure to include in education for this client? a) Change positions (lying or sitting to standing) slowly. b) Check blood pressure every day for signs of rebound hypertension. c) Eat plenty of salty food to prevent hypotension. d) Do not become dependent on canes, walkers, or handrails.

A

A nurse is educating a client about monitoring blood pressure readings at home. Which of the following will the nurse be sure to emphasise? a) "Sit quietly for 5 minutes prior to taking blood pressure." b) "Be sure the forearm is well supported above heart level while taking blood pressure." c) "Avoid smoking cigarettes for 8 hours prior to taking blood pressure." d) "Sit with legs crossed when taking your blood pressure."

A

A nurse is teaching an adult female patient about the risk factors for hypertension. What should the nurse explain as risk factors for primary hypertension? A)Obesity and high intake of sodium and saturated fat B)Diabetes and use of oral contraceptives C)Metabolic syndrome and smoking D)Renal disease and coarctation of the aorta

A

A nurse is teaching the Dietary Approaches To Stop Hypertension (DASH) diet to clients who have been newly diagnosed with hypertension. Which of the following information will the nurse include? a) Seven to eight whole grain products per day b) Seven to eight fruits per day c) Three to four regular dairy foods per day d) Four to five servings of meat, fish, or poultry per day

A

A nurse working in the clinic is seeing a client who has just been prescribed a new medication for hypertension. The client asks why hypertension is sometimes called the "silent killer." The nurse's correct response is which of the following? a) "Hypertension often causes no symptoms." b) "Hypertension often causes no pain." c) "Hypertension often kills early in the disease process." d) "Hypertension is difficult to diagnose."

A

A patient has been prescribed antihypertensives. After assessment and analysis, the nurse has identified a nursing diagnosis of risk for ineffective health maintenance related to nonadherence to therapeutic regimen. When planning this patient's care, what desired outcome should the nurse identify? A)Patient takes medication as prescribed and reports any adverse effects. B)Patient's BP remains consistently below 140/90 mm Hg. C)Patient denies signs and symptoms of hypertensive urgency. D)Patient is able to describe modifiable risk factors for hypertension.

A

A patient has come to the clinic for a follow-up assessment that will include a BP reading. To ensure an accurate reading, the nurse should confirm that the patient has done which of the following? A)Tried to rest quietly for 5 minutes before the reading is taken B)Refrained from smoking for at least 8 hours C)Drunk adequate fluids during the day prior D)Avoided drinking coffee for 12 hours before the visit

A

A patient with primary hypertension comes to the clinic complaining of a gradual onset of blurry vision and decreased visual acuity over the past several weeks. The nurse is aware that these symptoms could be indicative of what? A)Retinal blood vessel damage B)Glaucoma C)Cranial nerve damage D)Hypertensive emergency

A

Decreasing hypertension is the main focus of the medical cardiology practice where you practice nursing. Different goals apply to different age groups for managing and reducing blood pressures. Angie Dodd, a 54-year-old nurse, is beginning medical management of her recently diagnosed hypertension. What is considered the most important strategy in her treatment? a) Reducing her systolic pressure below 140 mmHg b) Reducing her systolic pressure below 130 mmHg c) Reducing her diastolic pressure below 80 mmHg d) Reducing her diastolic pressure below 90 mmHg

A

The nurse is caring for a client with essential hypertension. The nurse reviews labwork and assesses kidney function. Which action of the kidney would the nurse evaluate as the body's attempt to regulate high blood pressure? a) The kidney excretes sodium and water. b) The kidney retains sodium and excretes water. c) The kidney retains sodium and water. d) The kidney retains water and excretes sodium.

A

The nurse is caring for a client with hypertension. The nurse is correct to realize that a 24-hour urine is ordered to determine if the cause of hypertension is related to the dysfunction of which of the following? a) The adrenal gland b) The thymus c) The thyroid gland d) The pituitary gland

A

The nurse is developing a nursing care plan for a patient who is being treated for hypertension. What is a measurable patient outcome that the nurse should include? A)Patient will reduce Na+ intake to no more than 2.4 g daily. B)Patient will have a stable BUN and serum creatinine levels. C)Patient will abstain from fat intake and reduce calorie intake. D)Patient will maintain a normal body weight.

A

The nurse is developing a teaching plan for a patient diagnosed with hypertension. It would be important to emphasize which of the following as part of the plan of care? a) Limiting sodium intake in the diet b) Limiting cigarette smoking to 1 pack a week c) Limiting activity to prevent over exertion d) Limiting alcohol to a can of beer to four times a day to thin the blood

A

The nurse is teaching a patient diagnosed with hypertension about the DASH diet. How many servings of meat, fish, and poultry should a patient consume per day? a) 2 or fewer b) 7 or 8 c) 4 or 5 d) 2 or 3

A

The nurse teaches the patient which of the following guidelines regarding lifestyle modifications for hypertension? a) Maintain adequate dietary intake of potassium b) Stop alcohol intake c) Limit aerobic physical activity to 15 minutes, three times per week d) Reduce smoking to no more than four cigarettes per day

A

The nurse understands that patient education related to antihypertensive medication should include all of the following instructions EXCEPT which of the following? a) If a dosage of medication is missed, double up on the next one to catch up. b) Avoid over the counter (OTC) cold, weight reduction, and sinus medications. c) Avoid hot baths, exercise, and alcohol within 3 hours of taking vasodilators. d) Do not stop antihypertensive medication abruptly.

A

Which of the following is the nurse most correct to recognize as a direct effect of client hypertension? a) Renal dysfunction resulting from atherosclerosis b) Emphysema related to poor gas exchange c) Hyperglycemia resulting from insulin receptor resistance d) Anemia resulting from bone marrow suppression

A

Why is it important for the nurse to implement measures to relieve emotional stress for patients with hypertension? a) The reduction of stress decreases the production of neurotransmitters that constrict peripheral arterioles. b) The reduction of stress increases the blood volume and improves the potential for greater cardiac output. c) The reduction of stress increases the resistance that the heart must overcome to eject blood. d) The reduction of stress increases the production of neurotransmitters that constrict peripheral arterioles.

A

You're seeing a patient in a low-income clinic for the first time and have just checked her BP. You're entering her as prehypertensive because: a) Her diastolic blood pressure is between 80 and 89 mm Hg. b) Her systolic BP is above 180 mm Hg. c) Her diastolic blood pressure is at 100 mm Hg. d) Her systolic BP is between 120 and 130 mm Hg.

A

(Primary hypertension pathphysiology) H20 and Na+ retention

A high sodium intake may activate a number of pressor mechanisms and cause water retention

electrical route of heart

A normal cardiac impulse begins in the sinoatrial node (SA) in the upper right atrium. it spreads over the atrial myocardium via interatrial and intermodal pathways, causing atrial contraction. the impulse then travels to the atrioventricular (AV) node, through the bundle of His, down the left and right bundle branches. it ends in the Purkinje fibers, which transmit the impulse to the ventricles.

Ventricular Tachycardia

A run of THREE OR MORE PVCs defines ventricular tachycardia (VT). It occurs when an ectopic focus or foci fire repeatedly and the ventricle takes control as the pacemaker. Different forms of VT exist, depending on QRS configuration. Monomorphic VT has QRS complexes that are the same in shape, size, and direction. Polymorphic VT occurs when the QRS complexes gradually change back and forth from one shape, size, and direction to another over a series of beats.

Initial medication for HTN is...

A thiazide diuretic

Management of hypertension includes three of the following four goals, depending on the primary and secondary causes. Select all that apply. a) Impairing the synthesis of norepinephrine. b) Modifying the rate of myocardial contraction. c) Decreasing renal absorption of sodium. d) Increasing the force of cardiac output to overcome peripheral resistance.

ABC

A 59-year-old client has just received a diagnosis of hypertension from his cardiologist after the completion of diagnostics. After discussing the diagnosis and its consequences with the physician, the client asks you questions regarding his condition. What can the client do to decrease the consequences of his hypertension? Select all that apply. a) Manage stress effectively. b) Use smokeless tobacco. c) Lose weight. d) Get plenty of rest.

AC

catopril (capoten), enalapril (vasotec), lisinopril (prinivil, zestril), and ramipril (altace) are examples of what med

ACE inhibitors

step 1 for younger than 55 years

ACE inhibitors

Treatment of Stage A HF

ACE inhibitors ARBs

List of drugs used to treat hypertension

ACE inhibitors ARBs Beta blockers Calcium channel blockers Alpha blockers

These two medications should not be combined for hypertensive treatment

ACE inhibitors and ARB/renin inhibitor

meds used for treatment of Mitral regurgitation

ACE inhibitors, ARBs, and beta-blockers

Treatment for Stage C HFpEF

ACEi or ARB beta blockers

losartan (cozaar) and valsartan (diovan) are examples of what med

ARBs

Assessment of other systems - Abdomen

Abdominal distention: ascites from HF Hepatojugular reflex: HF Bladder distention: reduced urin output from heart problems

Indications for Permanent Pacemakers

Acquired AV block • Second-degree AV block • Third-degree AV block • Atrial fibrillation with a slow ventricular response • Bundle branch block • Cardiomyopathy • Dilated • Hypertrophic • Heart failure • SA node dysfunction • Tachydysrhythmias (e.g., ventricular tachycardia

Cardiovascular Assessment - Activity and Exercise

Activity-induced angina or SOB indicate CAD Look at barriers in the home (stairs, multilevel) Changes in activity tolerance need to be reported

Table 25-2 Chest Pain: ACS Location, character, duration, precipitating events and aggravating factors, alleviating facotors

Acute Coronary Syndrom Character: same as angina, pain or discomfort ranges from mild to severe, associated with SOB, diaphoresis, palpitations, unusual fatigue, and n/v Lasts less than 15 minutes Comes on with emotional upset or unusual physical exertion occurring within 24 hours of symptom onset, can occur at rest or asleep Relieved with: morphine, repercussion of coronary artery with thrombolytic agent or percutaneous coronary intervention

Hypertensive emergency

Acute, life-threatening elevation in BP; BP >180/120, must be lowered immediately to prevent dmg to organs; EX: pregnancy induced HTN, intercranial hemorrhage, AMI

Treatment of Stage C Heart Failure

Adding aldosterone antagonists

Step 2 after 1 month unsuccessful reassessment with both groups

Adding another medication (A+C or A+D)

treatment of stage B heart failure

Adding beta blockers

three physical activities to help with decrease hypertension

Aerobic Dynamic resistance Isometric resistance

Incidence of HTN is greater in what population?

African Americans and in hispanics

aortic stenosis may be caused by what?

Age, diabetes, hypertension, smoking, elevated LDL, degenerative calcific changes of the valve

Common diagnostic test for hypertension

Ambulatory blood pressure monitoring (ABPM)

nursing considerations for ACE inhibitors

Angioedema Dry nonproductive cough hyperkalemia

Side effects of ACE inhibitors

Angioedema (swelling of the lips and face) , Dry cough, hyperkalemia

Renin activates the conversion of

Angiotensin I to angiotensin II

Prodysrhythmia

Antidysrhythmia drugs can cause lifethreatening dysrhythmias similar to those for which they are given. The patient who has severe left ventricular dysfunction is the most susceptible to prodysrhythmias. Digoxin and class IA, IC, and III antidysrhythmia drugs can cause a prodysrhythmic response. The first several days of drug therapy are the vulnerable period for developing prodysrhythmias. For this reason, many oral antidysrhythmia drug regimens are started in a monitored hospital setting.

Cardiovascular assessment - Family History

Ask if anyone in family has heart issues

Cardiovascular Assessment - past health, family, and social history

Ask pt if anyone in family has a history of genetic disorders that places them at risk for CVD

Cardiovascular System Assessment - Pain, discomfort

Ask pt to identify quantity of pain (0-10), location, and quality Radiation to other areas Any associated signs or symptoms (diaphoresis, nausea) Identify events that precipitate the onset, duration, and measures that aggravate pain

Cardiac Assessment - Coping and Stress Tolerance

Assess pt for depression Stress is strongly linked to cardiovascular events and MI

clinical significance of A Fib

Atrial fibrillation results in a decrease in CO because of ineffective atrial contractions (loss of atrial kick) and/or a rapid ventricular response. Thrombi (clots) form in the atria because of blood stasis. An embolized clot may develop and move to the brain, causing a stroke. Atrial fibrillation accounts for as many as 17% of all strokes.

ECG characteristics of AFlutter

Atrial rate is 200 to 350 bpm. The ventricular rate varies based on the conduction ratio. In 2:1 conduction, the ventricular rate is typically found to be approximately 150 bpm. Atrial rhythm is regular, and ventricular rhythm is usually regular. The atrial flutter waves represent atrial depolarization followed by repolarization. The PR interval is variable and not measurable. The QRS complex is usually normal. Because the AV node can delay signals from the atria, there is usually some AV block in a fixed ratio of flutter waves to QRS complexes.

Blood Pressure Regulation

Autonomic nervous system: Baroreceptors Chemoreceptors - detect hypercapnia Renal system (RAS and fluid balance) Endocrine system (RAS) External factors also affect BP (caffeine, smoking, stress, alcohol, sodium, relaxation, stress)

A 66-year-old client presents to the emergency room (ER) complaining of a severe headache and mild nausea for the last 6 hours. Upon assessment, the patient's BP is 210/120 mm Hg. The patient has a history of HTN for which he takes 1.0 mg clonidine (Catapres) twice daily for. Which of the following questions is most important for the nurse to ask the patient next? a) "Are you having chest pain or shortness of breath?" b) "Have you taken your prescribed Catapres today?" c) "Did you take any medication for your headache?" d) "Do you have a dry mouth or nasal congestion?"

B

A client in a clinic setting has just been diagnosed with hypertension. She asks what the end goal is for treatment. The correct reply from the nurse is which of the following? a) To stop smoking and increase physical activity to 30 minutes/day most days of the week b) To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less c) To prevent complications/death by achieving and maintaining a blood pressure of 145/95 or less d) To lose weight, achieve a body mass index of 24 or less, and to eat a diet rich in fruits and vegetables

B

A client with newly diagnosed hypertension asks what she can do to decrease the risk for related cardiovascular problems. Which of the following risk factors is modifiable by the client? a) Impaired renal function b) Dyslipidemia c) Age d) Family history

B

A client, newly prescribed a low-sodium diet due to hypertension, is asking for help with meal choices. The client provides four meal choices, which are favorites. Which selection would be best? a) Hot dog with ketchup and relish on whole wheat bun b) Green pepper stuffed with diced tomatoes and chicken c) Creamed chipped beef over toast with mashed potatoes d) Toasted cheese sandwich on whole wheat toast with tomato soup

B

A female client, aged 82 years, visits the clinic for a blood pressure (BP) check. Her hypertension is not well controlled, and a new blood pressure medicine is prescribed. What is important for the nurse to teach this client about her blood pressure medicine? a) Take the medicine on an empty stomach. b) A possible adverse effect of blood pressure medicine is dizziness when you stand. c) There are no adverse effects from blood pressure medicine. d) A severe drop in blood pressure is possible.

B

A nurse educator is teaching a small group of clients about hypertension and dietary changes that will assist in lowering blood pressure readings. The nurse is specifically discussing the (Dietary Approaches to Stop Hypertension (DASH) diet and teaches the clients that the food group with the largest number of servings per day is which of the following? a) Low-fat or fat-free dairy foods b) Grains and grain products c) Fruits d) Vegetables

B

A nurse is discussing with a nursing student how to accurately measure blood pressure. Which of the following points does the nurse emphasize? a) The size of the cuff does not matter as long as it fits snugly around the arm. b) A cuff that is too small will give a false low blood pressure. c) A cuff that is too large will give a false high blood pressure. d) A cuff that is too small will give a false high blood pressure.

B

A nursing class is practicing measurement of blood pressure. One otherwise healthy participant, 46 years old, is 138/90. This man requires follow-up. In which classification of hypertension is he according to the JNC 7 (Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood pressure) recommendation? a) Stage 2 with compelling indications b) Stage 1 c) Stage 1 with compelling indications d) Stage 2

B

A patient is brought to the emergency department with complaints of a bad headache and an increase in blood pressure. The blood pressure reading obtained by the nurse is 260/180 mm Hg. What is the therapeutic goal for reduction of the mean blood pressure? a) Reduce the blood pressure by 50% within the first hour of treatment. b) Reduce the blood pressure by 20% to 25% within the first hour of treatment. c) Rapidly reduce the blood pressure so the patient will not suffer a stroke. d) Reduce the blood pressure to about 140/80 mm Hg.

B

A patient's medication regimen for the treatment of hypertension includes hydrochlorothiazide. Following administration of this medication, the nurse should anticipate what effect? A)Drowsiness or lethargy B)Increased urine output C)Decreased heart rate D)Mild agitation

B

According to the DASH diet, how many servings of vegetables should a person consume per day? a) 7 or 8 b) 4 or 5 c) 2 or fewer d) 2 or 3

B

As recommended follow-up for a person diagnosed with prehypertension initially, it's recommended the person gets his or her blood pressure rechecked within which timeframe? a) Confirm within 2 months b) 1 year c) Evaluate within 1 month d) 2 year

B

Officially, hypertension is diagnosed when the patient demonstrates a systolic blood pressure greater than ______ mm Hg and a diastolic blood pressure greater than _____ mm Hg over a sustained period. a) 120, 70 b) 140, 90 c) 130, 80 d) 110, 60

B

The hospital nurse cares for many patients who have hypertension. What nursing diagnosis is most common among patients who are being treated for this health problem? A)Deficient knowledge regarding the lifestyle modifications for management of hypertension B)Noncompliance with therapeutic regimen related to adverse effects of prescribed therapy C)Deficient knowledge regarding BP monitoring D)Noncompliance with treatment regimen related to medication costs

B

The nurse is caring for a client newly diagnosed with secondary hypertension. Which of the following conditions contributes to the development of secondary hypertension? a) Hepatic function b) Renal disease c) Acid-based imbalance d) Calcium deficit

B

The nurse is caring for an older adult with a diagnosis of hypertension who is being treated with a diuretic and beta-blocker. Which of the following should the nurse integrate into the management of this client's hypertension? A)Ensure that the patient receives a larger initial dose of antihypertensive medication due to impaired absorption. B)Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion. C)Recognize that an older adult is less likely to adhere to his or her medication regimen than a younger patient. D)Carefully assess for weight loss because of impaired kidney function resulting from normal aging.

B

The nurse is providing care for a patient with a new diagnosis of hypertension. How can the nurse best promote the patient's adherence to the prescribed therapeutic regimen? A)Screen the patient for visual disturbances regularly. B)Have the patient participate in monitoring his or her own BP. C)Emphasize the dire health outcomes associated with inadequate BP control. D)Encourage the patient to lose weight and exercise regularly.

B

The nursing lab instructor is teaching student nurses how to take blood pressure. To ensure accurate measurement, the lab instructor would teach the students to AVOID which of the following actions? A)Measuring the BP after the patient has been seated quietly for more than 5 minutes B)Taking the BP at least 10 minutes after nicotine or coffee ingestion C)Using a cuff with a bladder that encircles at least 80% of the limb D)Using a bare forearm supported at heart level on a firm surface

B

When measuring the blood pressure in each of the patient's arms, the nurse recognizes that in the healthy adult, which of the following is true? a) Pressures may vary 10 mm Hg or more between arms. b) Pressures should not differ more than 5 mm Hg between arms. c) Pressures must be equal in both arms. d) Pressures may vary, with the higher pressure found in the left arm.

B

When teaching a patient about hypertension and lifestyle changes the nurse emphasizes that which of the following should be included in the diet? a) Chloride-containing foods b) Fresh fruits and vegetables c) Whole milk and cheeses d) A glass of red wine

B

When treating hypertensive emergencies, the nurse identifies the most appropriate route of administration for antihypertensive agents as being which of the following? a) Sublingual b) Continuous IV infusion c) Oral d) Intramuscular

B

Which of the following nursing diagnosis is the nurse most correct to choose when caring for a client with long-standing hypertension? a) Impaired Gas Exchange b) Ineffective Tissue Perfusion c) Risk for Decreased Cardiac Output d) Activity Intolerance

B

Which of the following terms is given to hypertension in which blood pressure that is controlled with therapy becomes uncontrolled (abnormally high) with the discontinuation of therapy? a) Primary b) Rebound c) Essential d) Secondary

B

Choose the statements that correctly match the hypertensive medication with its side effect. Select all that apply. a) Beta-blockers may cause sedation. b) With thiazide diuretics, monitor serum potassium levels. c) Direct vasodilators may cause headache and tachycardia. d) With ACE inhibitors, assess for bradycardia. e) With adrenergic inhibitors, cough is a common side effect.

BC

A nurse is providing education about hypertension to a community group. One client reports that his doctor has diagnosed him with hypertension, but that he feels just fine. He asks, "What would happen if I did not treat my hypertension?" Which of the following are possible consequences of untreated hypertension? Choose all that apply. a) Pancreatitis b) Stroke c) Myocardial infarction d) Coronary artery disease e) Tension pneumothorax

BCD

The nurse is reviewing the medication administration record of a patient who takes a variety of medications for the treatment of hypertension. What potential therapeutic benefits of antihypertensives should the nurse identify? Select all that apply. A)Increased venous return B)Decreased peripheral resistance C)Decreased blood volume D)Decreased strength and rate of myocardial contractions E)Decreased blood viscosity

BCD

The nurse will relay that risk factors and cardiovascular problems related to hypertension include which of the following? Select all that apply. a) Decreased low-density lipoprotein (LDL) levels. b) Obesity (BMI ≥ 30 kg/m2) c) Smoking d) Age ≥55 in men e) Elevated high-density lipoprotein (HDL) cholesterol

BCD

A nurse providing education about hypertension to a community group is reviewing consequences of the disease. Which of the following would the nurse identify as target organs for hypertensive damage? Choose all that apply. a) Stomach b) Kidneys c) Brain d) Eyes e) Heart

BCDE

Which of the following are among the lifestyle changes that can help prevent and control hypertension? Choose all that apply. a) Increased intake of dietary sodium b) Weight reduction c) Increased physical activity d) Increased intake of dietary protein e) Substitution of low-fat for whole dairy products in diet

BCE

Which of the following statements are true when the nurse is measuring blood pressure (BP)? Select all that apply. a) Using a BP cuff that is too large will give a higher BP measurement. b) The patient's arm should be positioned at the level of the heart. c) The patient's BP should be taken 1 hour after the consumption of alcohol. d) Using a BP cuff that is too small will give a higher BP measurement. e) Ask the patient to sit quietly while the BP is being measured.

BDE

Hypertension

BOTH a cause and a complication chronic kidney disease. The kidneys are very vascular --> leading to why so many Diabetics are on Dialysis. -when there is vessel damage, there is decreased blood supply to the nephrons.....the kidneys stop working properly...they can't do their job to manage electrolytes or get rid of toxins in the body... can't excrete urea and creatinine in the urine. And because of the vessel damage from hypertension, this whole cycle is set into motion because they aren't being perfused well, urine output has decreased so renin production is stimulated which causes increased blood pressure in an attempt to increase blood flow to the kidneys......in other words this whole vicious cycle takes place * SO BLOOD PRESSURE CONTROL IS THE KEY TO SLOWING THE PROGRESSION OF CHRONIC KIDNEY DISEASE*

Potassium sparing diuretics

Blocks Na+ reabsorption; causes K+ retention EX: Spirolactone Midamor amiloride triamterene Dyrenium

Alpha1-adrenergic blockers

Blocks a1-adrenergic receptors in arteries, smooth muscles, and CNS tissues; decreases PR

Angiotensin Receptor Blocker

Blocks the effects of angiotensin II; reduces PR

Beta-blockers

Blocks the sympathetic nervous system, producing slower HR and lowered BP; CARDIO PROTECTIVE

A 44-year-old client has a history of hypertension. As her nurse, you engage her in client education to make her aware of structures that regulate arterial pressure. Which of the following structures is a component of that process? a) Parasympathetic nervous system b) Lungs c) Kidneys d) Limbic system

C

A client diagnosed with hypertension begins drug therapy using an antihypertensive agent. The nurse instructs the client's spouse to remove any objects in the home that can lead to falls. The nurse knows that the teaching has been successful when the client restates which of the following? a) "Insomnia is a common side effect of antihypertensive medications." b) "Constant thirst is a common side effect of antihypertensive therapy." c) "Antihypertensive drugs can lead to falls." d) "Antihypertensives can lead to memory loss."

C

A client is taking 50 mg of oral spironolactone twice a day to assist with blood pressure control. While the nurse is performing the morning assessment, the client reports nausea, general muscle cramps, and weakness. The telemetry strip shows a peaked, narrow T-wave, which is a change. What electrolye imbalance does the nurse suspect? a) Hyponatremia b) Hypernatremia c) Hyperkalemia d) Hypokalemia

C

A group of student nurses are practicing taking blood pressure. A 56-year-old male student has a blood pressure reading of 146/96 mm Hg. Upon hearing the reading, he exclaims, "My pressure has never been this high. Do you think my doctor will prescribe medication to reduce it?" Which of the following responses by the nursing instructor would be best? A)"Yes. Hypertension is prevalent among men; it is fortunate we caught this during your routine examination." B)"We will need to reevaluate your blood pressure because your age places you at high risk for hypertension." C)"A single elevated blood pressure does not confirm hypertension. You will need to have your blood pressure reassessed several times before a diagnosis can be made." D) "You have no need to worry. Your pressure is probably elevated because you are being tested."

C

A newly diagnosed patient with hypertension is prescribed Diuril, a thiazide diuretic. What patient education should the nurse provide to this patient? A)Eat a banana every day because Diuril causes moderate hyperkalemia. B)Take over-the-counter potassium pills because Diuril causes your kidneys to lose potassium. C)Diuril can cause low blood pressure and dizziness, especially when you get up suddenly. D)Diuril increases sodium levels in your blood, so cut down on your salt.

C

A nurse is educating about lifestyle modifications for a group of clients with newly diagnosed hypertension. While discussing dietary changes, which of the following points would the nurse emphasize? a) The taste buds never adapt to decreased salt intake. b) A person with hypertension should never consume alcohol. c) It takes 2 to 3 months for the taste buds to adapt to decreased salt intake. d) There is usually no need to change alcohol consumption for clients with hypertension.

C

A nurse is performing blood pressure screenings at a local health fair. While obtaining subjective assessment data from a patient with hypertension, the nurse learns that the patient has a family history of hypertension and she herself has high cholesterol and lipid levels. The patient says she smokes one pack of cigarettes daily and drinks about a pack of beer every day. The nurse notes what nonmodifiable risk factor for hypertension? A)Hyperlipidemia B)Excessive alcohol intake C)A family history of hypertension D)Closer adherence to medical regimen

C

A nurse is providing education about lifestyle modifications to a group of clients who have been newly diagnosed with hypertension. The nurse would include all the following statements except: a) Engage in aerobic activity at least 30 minutes/day most days of the week. b) Maintain a waist circumference of 40 (men) and 35 (women) inches or less. c) Limit alcohol consumption to no more that 3 drinks per day for men and 2 drinks per day for women. d) Maintain a normal body mass index of about 24.

C

A nurse is teaching a 38-year-old man with newly diagnosed hypertension who asks if there is any harm in stopping his antihypertensive medication if he decides to discontinue it. The correct reply addresses the consequence of stopping antihypertensive medications abruptly. Which of the following statements from the nurse would be appropriate? a) "Rebound hypotension can occur." b) "Postural hypertension can occur." c) "Rebound hypertension can occur." d) "Postural hypotension can occur."

C

A nurse is teaching about lifestyle modifications to a group of clients with known hypertension. Which of the following statements would the nurse include in the education session? a) Limit alcohol consumption to no more that 3 drinks per day. b) Maintain a waist circumference of 45 (men) and 40 (women) inches or less. c) Engage in aerobic activity at least 30 minutes/day most days of the week. d) Maintain a body mass index between 30 and 35.

C

A patient in a hypertensive emergency is admitted to the ICU. The nurse anticipates that the patient will be treated with IV vasodilators, and that the primary goal of treatment is what? A)Lower the BP to reduce onset of neurologic symptoms, such as headache and vision changes. B)Decrease the BP to a normal level based on the patient's age. C)Decrease the mean arterial pressure between 20% and 25% in the first hour of treatment. D)Reduce the BP to £ 120/75 mm Hg as quickly as possible.

C

A student nurse is taking care of an elderly patient with hypertension during a clinical experience. The instructor asks the student about the relationships between BP and age. What would be the best answer by the student? A)Because of reduced smooth muscle tone in blood vessels, blood pressure tends to go down with age, not up. B)Decreases in the strength of arteries and the presence of venous insufficiency cause hypertension in the elderly. C)Structural and functional changes in the cardiovascular system that occur with age contribute to increases in blood pressure. D)The neurologic system of older adults is less efficient at monitoring and regulating blood pressure.

C

A systolic blood pressure of 135 mm Hg would be classified as which of the following? a) Stage 2 hypertension b) Stage 1 hypertension c) Prehypertension d) Normal

C

An 87-year-old client was just recently diagnosed with prehypertension. She is to meet with a dietitian and return for a follow-up with her cardiologist in 6 months. As her nurse, what would you expect her treatment to include? a) Procedural interventions b) No intervention, just observation c) Nonpharmacological interventions d) Pharmacological interventions

C

An older adult is newly diagnosed with primary hypertension and has just been started on a beta-blocker. The nurse's health education should include which of the following? A)Increasing fluids to avoid extracellular volume depletion from the diuretic effect of the beta-blocker B)Maintaining a diet high in dairy to increase protein necessary to prevent organ damage C)Use of strategies to prevent falls stemming from postural hypotension D)Limiting exercise to avoid injury that can be caused by increased intracranial pressure

C

It is appropriate for the nurse to recommend smoking cessation for patients with hypertension because nicotine a) decreases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. b) decreases circulating blood volume. c) increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. d) increases the heart rate, constricts arterioles, and increases the heart's ability to eject blood.

C

Primary or essential hypertension accounts for about 95% of all hypertension diagnoses—with an unknown etiology. Secondary hypertension accompanies specific conditions that create hypertension as a result of tissue damage. Which of the following conditions contribute to secondary hypertension? a) Calcium deficit b) Hepatic function c) Arterial vasoconstriction d) Acid-base imbalance

C

The best way to detect PAPILLEDEMA is through: a) An MRI b) Laboratory tests c) Ophthalmic examination d) Using a sphygmomanometer

C

The critical care nurse is caring for a patient just admitted in a hypertensive emergency. The nurse should anticipate the administration of what medication? A)Warfarin (Coumadin) B)Furosemide (Lasix) C)Sodium nitroprusside (Nitropress) D)Ramipril (Altace)

C

The nurse is assessing a patient new to the clinic. Records brought to the clinic with the patient show the patient has hypertension and that her current BP readings approximate the readings from when she was first diagnosed. What contributing factor should the nurse first explore in an effort to identify the cause of the client's inadequate BP control? A)Progressive target organ damage B)Possibility of medication interactions C)Lack of adherence to prescribed drug therapy D)Possible heavy alcohol use or use of recreational drugs

C

The nurse is caring for a patient prescribed loop diuretic Bumex (bumetanide) for the treatment of stage 2 hypertension. Which of the following indicates the patient is experiencing an adverse effect of the medication? a) Urine output of 90 cc/mL 1 hour after medication administration b) Blood glucose value of 160 mg/dL c) Serum potassium value of 3.0 mEq/L d) Electrocardiogram (EGG) tracing demonstrating peaked T waves

C

The nurse is collaborating with the dietitian and a patient with hypertension to plan dietary modifications. These modifications should include which of the following? A)Reduced intake of protein and carbohydrates B) Increased intake of calcium and vitamin D C)Reduced intake of fat and sodium D)Increased intake of potassium, vitamin B12 and vitamin D

C

The nurse is completing a cardiac assessment on a patient. The patient has a blood pressure (BP) reading of 126/80. The nurse would identify this blood pressure reading as which of the following? a) Stage 1 hypertension b) Normal c) Prehypertension d) Stage 2 hypertension

C

The nurse is creating a community teaching demonstration focusing on the cause of blood pressure. When completing the visual aid, which body structures represent the mechanism of blood pressure? a) Kidneys and autonomic nervous system b) Brain and sympathetic nervous system c) Heart and blood vessels d) Lung and arteries

C

The nurse is employed in a physician's office and is caring for a client present for an annual exam. A blood pressure of 124/84 mm Hg is documented. Following revised guidelines for identifying hypertension, which educational pamphlet is help? a) Use of beta-blockers for treatment of hypertension b) Diagnostic testing for determining cardiac functioning c) Stress reduction to lower prehypertensive state d) Increasing fluids for low blood pressure

C

The nurse is evaluating the types of medications prescribed for a client's hypertension. Which of the following medication classifications establishes an action on vasoconstrictive hormones in the blood stream? a) Calcium channel blocker b) Loop diuretic c) ACE inhibitor d) Beta-blocker

C

The nurse is obtaining a healthy history from a client with blood pressure of 146/88 mm Hg. The client states that lifestyle changes have not been effective in lowering the blood pressure. Which medication classification does the nurse anticipate first? a) Beta-blocker b) ACE inhibitors c) Thiazide diuretic d) Calcium channel blocker

C

The nurse is providing care for a patient with a diagnosis of hypertension. The nurse should consequently assess the patient for signs and symptoms of which other health problem? A)Migraines B)Atrial-septal defect C)Atherosclerosis D)Thrombocytopenia

C

The nurse understands that an overall goal of hypertension management includes which of the following? a) The patient maintains a normal blood pressure reading. b) There are no complaints of sexual dysfunction. c) There is no indication of target organ damage. d) There is no complaint of postural hypotension.

C

What is the most common cause of malignant hypertension? a) Pheochromocytoma b) Dissecting aortic aneurysm c) Untreated hypertension d) Pyelonephritis

C

When monitoring a patient who has HYPERTENSION & CHRONIC KIDNEY DISEASE, the target pressure for this individual should be less than which blood pressure reading? a) 120/70 mm Hg b) 110/60 mm Hg c) 130/80 mm Hg d) 140/90 mm Hg

C

Which ethnic background would the nurse screen for hypertension at an early age? a) Mexican population b) Japanese population c) African American population d) Asian population

C

Which of the following conditions contributes to secondary hypertension? a) Acid-based imbalance b) Calcium deficit c) Arterial vasoconstriction d) Hepatic function

C

Which of the following diagnostic tests may reveal an enlarged left ventricle? a) Fluorescein angiography b) Positron emission tomography (PET) scan c) Echocardiography d) Computed tomographic scan

C

Which of the following findings indicates that hypertension is progressing to target organ damage? a) Blood urea nitrogen (BUN) level of 12 mg/dL b) Chest x-ray showing pneumonia c) Retinal blood vessel damage d) Urine output of 60 cc/mL over 2 hours

C

Which of the following is the nurse most correct to recognize as a direct effect of client hypertension? a) Hyperglycemia resulting from insulin receptor resistance b) Emphysema related to poor gas exchange c) Renal dysfunction resulting from atherosclerosis d) Anemia resulting from bone marrow suppression

C

modification that has been found to have the greatest effect in reducing blood pressure measurements. a) Sodium reduction b) Adopting the DASH approach to eating c) Weight reduction d) Physical activity

C

Target organ damage from untreated/undertreated hypertension includes which of the following? Select all that apply. a) Diabetes b) Hyperlipidemia c) Stroke d) Heart failure e) Retinal damage

CDE

Treatment of Pulseless Electrical Activity

CPR followed by drug therapy, such as epi, and intubation. correcting underlying cause is critical.

treatement of asystole

CPR with initiation of ACLS measures. Drug therapy with epi or vassopresin, and intubation.

Blood pressure regulation - things that affect BP

Caffeine Smoking Stress Alcohol Soidium Relaxation Stress

When are ARBs recommended

Cannot tolerate ACE inhibitors

Male Chest Pain

Chest pain Parin in left arm or neck

Class of heart failure associated with no limitation of physical activity, ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea

Class I

Class of heart failure that leads to slight limitation of physical activity, comfortable at rest but ordinary physical activity results in fatigue, palpitation, dyspnea.

Class II

Class of heart failure that leads marked limitation of physical activity, comfortable at rest, but less than ordinary activity causes fatigue, palpitations, or dyspnea

Class III

Aldosterone is recommended for patients receiving standard therapy under what

Class III/IV

Class fo heart failure that is unable to carry out any physical activity without discomfort, symptoms of cardiac insufficiency at rest. If any physical activity don, discomfort increased

Class IV

Aldosterone receptor blockers (antagonists)

Competitive inhibitors of aldosterone binding; Na+ reabsorption in kidney in Kidey, heart, brain

Action if reassessment at one month does meet the goal

Continue with medications and reassess at 3/6 months

A 55-year-old patient comes to the clinic for a routine check-up. The patient's BP is 159/100 mm Hg and the physician diagnoses hypertension after referring to previous readings. The patient asks why it is important to treat hypertension. What would be the nurse's best response? A)Hypertension can cause you to develop dangerous blood clots in your legs that can migrate to your lungs. B)Hypertension puts you at increased risk of type 1 diabetes and cancer in your age group. C)Hypertension is the leading cause of death in people your age. D)Hypertension greatly increases your risk of stroke and heart disease.

D

A 77-year-old woman presents to the local community center for a blood pressure screening. The women's blood pressure is recorded as 180/90 mm Hg. The woman has a history of hypertension, but she currently is not taking her medications. Which of the following questions is most appropriate for the nurse to ask the patient first? a) "Are you having trouble paying for your medication?" b) "What medications are you prescribed?" c) "Are you able to get to your pharmacy to pick up your medications?" d) "Why is it that you are not taking your medications?"

D

A client with high blood pressure is receiving an antihypertensive drug. The nurse knows that antihypertensive drugs commonly cause fatigue and dizziness, especially on rising. When developing a client teaching plan to minimize orthostatic hypotension, which instruction should the nurse include? a) "Avoid drinking alcohol and straining at stool, and eat a low-protein snack at night." b) "Rest between demanding activities, eat plenty of fruits and vegetables, and drink 6 to 8 cups of fluid daily." c) "Wear elastic stockings, change positions quickly, and hold onto a stationary object when rising." d) "Flex your calf muscles, avoid alcohol, and change positions slowly."

D

A community health nurse teaching a group of adults about preventing and treating hypertension. The nurse should encourage these participants to collaborate with their primary care providers and regularly monitor which of the following? A)Heart rate B)Sodium levels C)Potassium levels D)Blood lipid levels

D

A nurse is discussing with students how to accurately measure blood pressures. Which of the following information is the nurse certain to emphasize? a) Position the client's forearm above the level of the heart. b) Center the cuff bladder directly over the radial artery. c) The size of the cuff does not matter as long as it fits snugly around the arm. d) Routinely calibrate the sphygmomanometer.

D

A nurse is providing education about lifestyle modifications to a group of clients who have been newly diagnosed with hypertension. The nurse would include all the following statesments except: a) Maintain a waist circumference of 40 (men) and 35 (women) inches or less. b) Engage in aerobic activity at least 30 minutes/day most days of the week. c) Maintain a normal body mass index of about 24. d) Limit alcohol consumption to no more that 3 drinks per day for men and 2 drinks per day for women.

D

A patient arrives at the clinic for a follow-up visit for treatment of hypertension. The nurse obtains a blood pressure reading of 180/110 but finds no evidence of impending or progressive organ damage when performing the assessment on the patient. What situation does the nurse understand this patient is experiencing? a) Secondary hypertension b) Hypertensive emergency c) Primary hypertension d) Hypertensive urgency

D

A patient in hypertensive emergency is being cared for in the ICU. The patient has become hypovolemic secondary to natriuresis. What is the nurse's most appropriate action? A)Add sodium to the patient's IV fluid, as ordered. B)Administer a vasoconstrictor, as ordered. C)Promptly cease antihypertensive therapy. D)Administer normal saline IV, as ordered

D

A patient in hypertensive urgency is admitted to the hospital. The nurse should be aware of what goal of treatment for a patient in hypertensive urgency? A)Normalizing BP within 2 hours B)Obtaining a BP of less than 110/70 mm Hg within 36 hours C)Obtaining a BP of less than 120/80 mm Hg within 36 hours D)Normalizing BP within 24 to 48 hours

D

A patient is admitted to the ICU with a diagnosis of hypertension emergency/crisis. The patient's blood pressure (BP) is 200/130 mm Hg. The nurse is preparing to administer IV Nitropress (nitroprusside). Upon assessment, which of the following patient findings requires immediate intervention by the nurse? a) Nausea and severe headache b) Chest pain score of 3/10 (on a scale of 1 to 10) c) Urine output of 40 cc/mL over the last hour d) Left arm numbness and weakness

D

A patient is being treated for HYPERTENSIVE EMERGENCY. When treating this patient, the priority goal is to lower the mean blood pressure (BP) by which percentage in the first hour? a) 45% b) 35% c) 40% d) Up to 25%

D

A patient with newly diagnosed hypertension has come to the clinic for a follow-up visit. The patient asks the nurse why she has to come in so often. What would be the nurse's best response? A)We do this so you don't suffer a stroke. B)We do this to determine how your blood pressure changes throughout the day. C)We do this to see how often you should change your medication dose. D)We do this to make sure your health is stable. We'll then monitor it at routinely scheduled intervals.

D

A patient's recently elevated BP has prompted the primary care provider to prescribe furosemide (Lasix). The nurse should closely monitor which of the following? A)The client's oxygen saturation level B)The patient's red blood cells, hematocrit, and hemoglobin C)The patient's level of consciousness D)The patient's potassium level

D

Hypertension is defined as "sustained elevations in systolic or diastolic blood pressures that exceed prehypertension levels." What are some of the consequences of hypertension that make it such a health menace in the United States? a) Cerebrovascular accident b) Cardiac failure c) Renal disease d) All options are correct.

D

It is important for the nurse to encourage the patient to rise slowly from a sitting or lying position because: a) Gradual changes in position provide time for the heart to reduce its rate of contraction to resupply oxygen to the brain. b) Gradual changes in position help reduce the blood pressure to resupply oxygen to the brain. c) Gradual changes in position help reduce the heart's work to resupply oxygen to the brain. d) Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain.

D

The home health nurse is caring for a patient who has a comorbidity of hypertension. What assessment question most directly addresses the possibility of worsening hypertension? A)Are you eating less salt in your diet? B)How is your energy level these days? C)Do you ever get chest pain when you exercise? D)Do you ever see spots in front of your eyes?

D

The nurse in an oncology clinic notes that the client being treated has hypertension. What tumor is a predisposing condition for secondary hypertension? a) Wilms' tumor b) Astrocytoma c) Lymphoma d) Pheochromocytoma

D

The nurse is caring for a female client who has had 25 mg of oral hydrochlorothiazide added to her medication regimen for the treatment of hypertension (HTN). Which of the following instructions should the nurse give the patient? a) "You may drink alcohol while taking this medication." b) "Take this medication before going to bed." c) "You may develop dry mouth or nasal congestion while on this medication." d) "Increase the amount of fruits and vegetables you eat."

D

The nurse is caring for a patient with an intracranial hemorrhage. The patient is having a hypertensive emergency. Which of the following nursing intervention would take priority in this patient? a) Maintaining the BP at a significantly higher than normal level to prevent orthostatic hypotension. b) Reduction of the BP to 160/100 mm Hg within the half hour of treatment c) Reduction of the mean BP by up to 50% within the first hour of treatment d) Avoid lowering the blood pressure (BP) too quickly

D

The nurse is caring for an elderly client with a diagnosis of hypertension, who is taking several antihypertensive medications. Which saftey precaution is the nurse most likely to reinforce? a) Being sure to keep follow-up appointments b) Walking as far as the client is able every day c) Eating extra potassium due to loss of potassium related to medications d) Changing positions slowly related to possible hypotension

D

The nurse is instructing a client who is newly prescribed an antihypertensive medication. Which nursing instruction is emphasized to maintain client safety? a) Do not operate a motor vehicle. b) Use a pillbox to store daily medication. c) Take the medication at the same time daily. d) Sit on the edge of the chair and rise slowly.

D

The physician is ordering a test for the hypertensive client that will be able to evaluate whether the client has experienced heart damage. Which diagnostic test would the nurse anticipate to determine heart damage? a) Blood chemistry b) Fluorescein angiography c) Chest radiograph d) Multiple gated acquisition scan (MUGA)

D

The staff educator is teaching ED nurses about hypertensive crisis. The nurse educator should explain that hypertensive urgency differs from hypertensive emergency in what way? A)The BP is always higher in a hypertensive emergency. B)Vigilant hemodynamic monitoring is required during treatment of hypertensive emergencies. C)Hypertensive urgency is treated with rest and benzodiazepines to lower BP. D)Hypertensive emergencies are associated with evidence of target organ damage

D

Thiazide diuretics are part of this treatment approach for most complications except for: a) Diabetes mellitus b) Heart failure c) Recurrent stroke prevention d) Chronic kidney disease

D

Which diagnostic is the recommended method of determining whether left ventricular hypertrophy has occurred? a) ECG b) Blood chemistry c) BUN d) Echocardiogram

D

Which of the following describes a situation in which the blood pressure is severely elevated and there is evidence of actual or probable target organ damage? a) Hypertensive urgency b) Secondary hypertension c) Primary hypertension d) Hypertensive emergency

D

Which of the following is true regarding the African American population and the development of hypertension? a) Higher incidence of nonfatal stroke b) Decreased rate of stage 2 hypertension c) Later onset of disease d) Greater rate of stage 2 hypertension

D

Which of the following would be inconsistent as a component of metabolic syndrome? a) Elevated triglyceride levels b) Abdominal obesity c) Hypertension d) Hypotension

D

Which of the following would be inconsistent with a hypertensive urgency? a) Severe headache b) Epistaxis c) Anxiety d) Intracranial hemorrhage

D

You are doing the final checklist before sending home a 63-year-old female who has been newly diagnosed with hypertension. She is going to be starting her first antihypertensive medicine. What is one of the main things you should tell her and her husband to watch for? a) Tremor b) Persistent cough c) Blurred vision d) Dizziness

D

You are part of a group of nursing students who are making a presentation on chronic hypertension. What is one subject you would need to include in your presentation as a possible consequence of untreated chronic hypertension? a) Right-sided heart failure b) Pulmonary insufficiency c) Peripheral edema d) Stroke

D

what is often the 1st symptom of mitral stenosis?

DOE (dyspnea on exertion)

Loop diuretics (potassium depleting diuretic)

Decreases blood volume, blocks reabsorption of Na+, Cl, and water in kidneys Watch for volume & electrolyte depletion furosemide (lasix) bumetandine (Bumex) Toresmide (demadex)

Thiazide diuretics

Decreases blood volume, renal blood flow, and CO; decreases plasma volume; inexpensive -promote sodium water excretion Reduce plasma volume Reduce vascular response EX: chlorothiaxide (diuril) , hydroclorothiazide metolazone (Zaroxolyn)

Preload

Degree of stretch of the ventricular cardiac muscle fibers at the end of diastole (volume of blood in the ventricles is the highest so stretch is greatest) Results in stronger contraction and greater stroke volume

If an individual has a SBP and DBP in 2 categories

Designated in higher BP category

Vasodialators

Direct acting on smooth muscles relaxant that acts as a vasodilator primarily in arteries and arterioles

Step 4 after 1 month of unsuccessful reassessment

Diuretics, alpha blocker, or beta blockers

Medications (Classes)

Diuretics, beta-blockers, ace inhibitors, angiotensin II receptor blockers, alpha blockers, alpha-z receptor agonist, combined alpha and beta-blockers, central agonists, peripheral adrenergic inhibitors, and blood vessel dilators or vasodilators

Side effects of thiazide diuretics

Dry mouth, thirst, weakness, lethargy, postural hypotension, electrolyte imbalances (K+) FREQUENT VOIDING that fears with compliance and activity Take morning hours- no later than 2 HYPOKALEMIA- monitor potassium serum level and watch for weakness, irregular pulse.

S/S of heart failure

Dyspnea/fatigue with rest/exertion nocturnal dyspnea Fluid retention Cough Weight gain Anorexia Decrease daytime urination Increased nighttime urination

baroreceptors release what

E and NE

Cardiac Assessment - Sexuality and Reproduction

ED can be a side effect of medications (beta-blockers) PT may be worried that sexual activity can cause cardiac symptoms (tell pt qual to moderate activity) Get a full reproductive history from females

Hypertension:

EQUAL or MORE THAN 140/90mmHg Systolic > 140 Diastolic > 90

treatment of A Fib continued

Electrical cardioversion may convert atrial fibrillation to a normal sinus rhythm. If a patient is in atrial fibrillation for longer than 48 hours, anticoagulation therapy with warfarin is needed for 3 to 4 weeks before the cardioversion and for several weeks after successful cardioversion. Anticoagulation therapy is necessary because the procedure can cause the clots to dislodge, placing the patient at risk for stroke.

V tach without pulse

Emergency!! Treated in the same manner as Venticular Fibrilation (VF) (CPR) and rapid defibrillation are the first lines of treatment, followed by the administration of vasopressors (epinephrine) & antidysrhythmics (amiodarone) if defibrillation is unsuccessful.

Depolarization

Exchange of sodium and potassium ions that creates a positive charged intracellular space and negatively charged extracellular space (sodium goes into the heart cells (+), potassium goes out (-)

This recommendation is the most helpful in preventing prehypertension from progressing to hypertensive state

Exercise on a regular basis We would like to encourage regular exercise (30-45 min) 3-5 times a week. The decline in arterial function with aging is considered to be part of a physiologic process reflecting elevated blood pressure. However, the extent and rate of this decline can be manipulated. Various types of exercise programs are recommended for improving and / or manipulating the arterial function in middle-aged to older individuals.

Stress Test

Exercise or pharmacologic Noninvasive ways to evaluate the response of the cardiovascular system to stress

Fixed risk factors for hypertension (film cop)

Family history Increased age Low SEC/educational status Male sex CKD Obstructive sleep apnea Psychological stress

Stress Test - Nursing Considerations

Fast for at least 3 hours before the test and avoid stimulants (tobacco and caffeine) Clothes and suitable shoes should be worn after monitor for 15-20 minutes If pharm: pt feel flushing sensation or nausea but will disappear quickly, report any other symptoms, test may take 1 hr or up to 3 if imaging is preformed

signs and symptoms of infective endocarditis

Fever and heart murmur are primary presenting symptoms. Other symptoms include Janeway lesions (irregular red or purple flat macules on palms, fingers, hands, soles and toes) , Roth spots (hemorrhages with pale center in fundi of the eye), petechiae, Osler nodes (irregular nodulars on fingers/toes), splinter hemorrhages.

Maze procedure

For patients with drug-refractory atrial fibrillation or those who do not respond to electrical conversion, radiofrequency catheter ablation. The Maze procedure is a surgical intervention that stops atrial fibrillation by interrupting the ectopic electrical signals that are responsible for the dysrhythmia. Incisions are made in both atria, and cryoablation is used to stop the formation and conduction of these signals, and restore normal sinus rhythm.

Contractility

Force generated by the contracting myocardium

Action after assessing 10 year risk and it is high for stage 1 hypertension

Give meds and reassess in a month

Recommendation of treatment for stage 2 hypertension

Give meds and reassess one month

Action if reassessment at one month does not meet the goal

Give other meds

ECG characteristics

HR is 101 to 200 beats/minute and the rhythm is regular. The P wave is normal, precedes each QRS complex, and has a normal shape and duration. The PR interval is normal, and the QRS complex has a normal shape and duration.

ECG Characteristics of Paroxysmal Superventricular Tachycardia (PSVT)

HR is 150 to 220 beats/minute, and the rhythm is regular or slightly irregular. The P wave is often hidden in the preceding T wave. If seen, it may have an abnormal shape. The PR interval may be shortened or normal, and the QRS complex is usually normal.

ECG characteristics of Vfib

HR is not measurable. rhythm is irregular and chaotic. The p wave is not visible, and the PR interval and the QRS interval are not measurable.

ECG characteristics of bradycardia

HR less than 60 bpm, regular rhythm.

ECG characteristics of PVC's

HR varies according to intrinsic rate and number of PVCs. Rhythm is irregular because of premature beats. The P wave is rarely visible and is usually lost in the QRS complex of the PVC. Retrograde conduction may occur, and the P wave may be seen after the ectopic beat. The PR interval is not measurable. The QRS complex is wide and distorted in shape, lasting more than 0.12 second. The T wave is generally large and opposite in direction to the major direction of the QRS complex.

ECG characteristics of Premature Atrial Contraction (PAC)

HR varies with the underlying rate and frequency of the PAC, and the rhythm is irregular The P wave has a different shape from that of a P wave originating in the SA node, or it may be hidden in the preceding T wave. The PR interval may be shorter or longer than the PR interval coming from the SA node, but it is within normal limits. The QRS complex is usually normal. If the QRS interval is 0.12 second or more, abnormal conduction through the ventricles occurs.

Abnormal Heart Sound - Friction Rub

Harsh, grating sound Abrasion of inflamed pericardiac surfaces from pericarditis

Even in the absence of a hypertensive crisis, what signs and symptoms should we teach the hypertensive client or his significant other (s) to report?

Headaches, especially on awakening Chest pain Shortness of breath Weight gain or edema Changes in vision Nosebleeds Side effects of medcations

This condition can occur as a result of Left ventricular hypertrophy

Heart Failure

Effect of aldosterone antagonists

Helps with RAAS suppression in HF

Assessment of other Systems - Lungs

Hemoptysis: pulmonary edema cough: pulmonary congestion from HF Crackles: HF or atelecasis Wheezes: beta blockers side effect

A patient should be taught to use proper size of BP cuff , because too small of a cuff will give a false __________ reading

High

(Primary hypertension pathphysiology) Insulin resistance and hyperinsulemia

High insulin concentrations in the blood stimulates SNS activity and impairs nitricoxide-mediated vasoconstriction

Side effects of ARBS include

Hyperkalemia

Side effects of aldosterone receptors blockers (antagonists) include...

Hyperkalemia drowsiness headache, eleveated TRG levels, monitor potassium level with ACE or ARB= increase risk for hyperkalemia -don't give this

Side effects of potassium sparing diuretics

Hyperkalemia, drowsiness, lethargy, diarrhea, other GI effects Keeps potassium in body Avoid Salt Substitute HYPERKALEMIA weak, slow irreg pulse CAution with ARB's or ACE INHIB bc renal impairement

Major cause of coronary heart disease (CHD), cerebrovascular accident, and renal failure

Hypertension

drugs used only for hypertensive crisis

IV direct vasodilators

A secondary pacemaker from another site may fire in two ways... The first way...

If the SA node fires more slowly than a secondary pacemaker, the electrical signals from the secondary pacemaker may "escape." The secondary pacemaker will then fire automatically at its intrinsic rate. These secondary pacemakers may start from the AV node at a rate of 40 to 60 times per minute or the His-Purkinje system at a rate of 20 to 40 times per minute.

treatment of V fib

Immediate initiation of CPR and advanced cardiac life support (ACLS). With the use of defibrillation and definitive drug therapy (epi, vasopressin.) there should be no delay in using a defibrillator once available.

Central alpha2-agonists

Impairs synthesis and reuptake of norepinephrine; displaces norepinephrine from storage sites

Cardiovascular assessment - Nutrition

Important for managing: hyperlipidemia, hypertension, diabetes Check cholesterol and sodium intake

clinical significance of Premature Atrial Contraction (PAC)

In persons with healthy hearts, isolated PACs are not significant. Patients may report palpitations or a sense that their hearts "skipped a beat." In persons with heart disease, frequent PACs may indicate enhanced automaticity of the atria or a reentry mechanism. Such PACs may warn of or start more serious dysrhythmias (e.g., supraventricular tachycardia).

clinical associations of Paroxysmal Superventricular Tachycardia (PSVT)

In the normal heart, PSVT is associated with overexertion, emotional stress, deep inspiration, and stimulants such as caffeine and tobacco. PSVT is also associated with rheumatic heart disease, digitalis toxicity, CAD, and cor pulmonale.

ACE inhibitors

Inhibits conversion of angiotensin I to angiotensin II; KIDNEY PROTECTIVE

Manifestations of HTN

Initially no s/s other than elevated BP

Full Cardiac Assessment

Inspection Palpation Percussion Auscultation (normal heart sounds, paradoxical splitting, gallops and murmurs, pericardial friction rub)

Electroyphysiologic Study (EPS)

Invasive procedure that diagnose and manages dysrhymias distinguish atrial and ventricles tachycardias when you can't tell it from an ecg

Cardiac Catheterization

Invasive procedure that diagnoses structural and functional disease of the heart Left sided heart caths have higher risk of CVAs

Cardiovascular Physical Assessment - General Appearance

LOC: changes indicate inadequate perfusion to the brain from low cardiac output or stroke Signs of distress (pain, comfort, anxiety, etc.) Size of pt (normal ,overweight, underweight)

when to prescribe beta blockers

LVEF<0.40 w/ or w/o symptoms

This can occur to heart as a response to increased workload place on the ventricles as it contracts against higher systemic pressure

Left ventricular hypertrophy Elevated systemic blood pressure increases the work of the left ventricle, leading to hypertrophy and increased myocardial oxygen demand

DASH diet

Low Na+, foods rich in nutrients like potassium, calcium, magnesium. Vegetables, fruits, low fat dairy products, fish, poultry, nuts (the los Na+ version) Eating a heart healthy diet is important for managing your blood pressure and reducing your risk of heart attack, heart disase, stroke, and other diseases. A high saturated fat diet contributes to plaque formation and narrowing vessels. The D.A.S.H. plan is proven effective for lowering blood pressure. This diet has also been proven to prevent osteoporosis, cancer, heart disease, stroke, and Diabetes. Combinations of two (or more) lifestyle modifications can achieve even better results.

(Primary hypertension pathphysiology) Altered renin-angiotension mechanism

May contribute to the development and maintenance of HTN

Explanation of ABPM

Measure BP at preset intervals over 24 hours

Cardiovascular Physical Assessment - Blood Pressure

Measure for hypotension or hypertension (140/90)

Ejection Fraction`

Measurement in percentage of blood leaving the heart as it contracts; pt below 35% is in HF and at risk for life threatening dysrhythmias

How is aortic stenosis treated?

Medications for HF or tx dysrhythmia Valve replacement Balloon valvuloplasty

nursing considerations for beta blockers

Monitor pulse and BP

Hypertension

Multifactorial; is a sign

Cardiovascular Assessment - Self-Perception and Self-Concept

Need to make sure to have appropriate interventions and adequate services in place to support pt recovery and improve the rate of adherence

Cardiovascular Assessment - Elimination

Nocturia is a common in pt with HF If pt has to strain during defecation, can trigger vagal response and cause H to slow --> syncopal episode If on blood thinner, test for occult blood in stool

Abnormal Heart Sounds - S3

Noncompliant ventricle Lub-dub-DUB In older adults means HF

Echocardiography

Noninvasive ultrasound test examines cardiac structure Can be preformed with an exercise or pharmacologic stress test (images obtained at rest and then again after the target heart rate is achieved)

Recommendation for treatment for stage 1 hypertension

Nonpharm and assess risk

Recommendation for treatment for elevated hypertension

Nonpharm interventions and reassess in 3 months

clinical associations of bradycardia

Normal sinus rhythm in aerobically trained athletes and in some people during sleep. It also occurs in response to carotid sinus massage, Valsalva maneuver, hypothermia, increased intraocular pressure, vagal stimulation, and administration of certain drugs (β-adrenergic blockers, calcium channel blockers). Common disease states like hypothyroidism, increased intracranial pressure, hypoglycemia, and inferior myocardial infarction (MI).

Obesity

Obesity-related hypertension has become an epidemic health problem, and a major risk for developing cardiovascular disease. - Metabolic syndrome We should encourage these people to achieve a weight loss to within 10% of their ideal weight.

rheumatic endocarditis

Occurs most often in SCHOOL-AGE CHILDREN after group A beta-hemolytic streptococcal pharyngitis; need to promptly recognize and treat "strep" throat to prevent rheumatic fever

Normotensive BP in office and out-of-office settings

Office:No hypertension Non-office: No hypertension

Repolarization

Once the depolarization is complete, the exchange of ions reverts to its resting state

Cardiovascular Assessment - Sleep and Rest

Orthopnea - can indicate worsening HF Paroxysmal nocturnal dyspnea - sudden awakening with SOB indicate worsening HF Sleep apnea: puts strain on the heart from intermittent hypoxemia

Very high for LDL cholesterol level

Over 190

Optimal HDL cholesterol

Over 60

Multifocal PVC's

PVCs that arise from different foci appear different in shape from each other

Unifocal PVC's

PVCs that have the same shape

Table 25-2 Anxiety and Panic Disorder Location, character, duration, precipitating events and aggravating factors, alleviating factors

Pain described as stating to dull ache Associated with diaphoresis, palpitations, shortness of breath, tingling of hands or mouth, feeling on unreality, or fear of losing control Duration: peaks in 10 minutes Precipitating Factors: can occur at any time (even sleep), can be associated with a trigger Treat: removal of stimulus, relaxation, medications to treat anxiety

Hypertensive urgency

Patient requires close monitoring of BP and cardiovascular status; can take your time, but not too long associated with severe headaches, nosebleeds, or anxiety are classified as urgencies.

relative refractory period

Period where the cell is capable of depolarizing early if an electrical stimulus is strong enough

S/S of right side failure

Peripheral edema Swelling Anorexia Weakness JVD Hepatomegaly

Alpha and beta blockers

Peripheral vasodilator acting directly on blood vessel

Reason that black patients have different beginning treatment at any age than others

Poor vaso-reactivity

treatment of v-tach

Precipitating causes (e.g., electrolyte imbalances, ischemia) must be identified and treated. If the VT is monomorphic and the patient is clinically stable (i.e., pulse is present) and has preserved left ventricular function -->IV procainamide, sotalol, or amiodarone is used. These drugs can also be used if the VT is polymorphic with a normal baseline QT interval.

Infective endocarditis treatment

Prolonged course of antibiotics, IV drug therapy for 2-6 weeks -Oral care, brushing and mouth wash -monitor temp -Abx before dental procedures -hand hygiene

Troponin

Protein released when heart is damaged Troponin T and troponin I

Cardiovascular Physical Assessment - Postural Blood Pressure Changes

Pt is considered to have postural hypotension is there is a decrease of at least 20 mmHg in systolic BP or 10 mmHg in diastolic BP

Cardiovascular Assessment - Roles and Relationships

Pt with lower levels of social support have increased risk for cardiac-related mortality and stroke Consult social services if necessary

To get an accurate BP reading the nurse should confirm that the patient has done this prior to the reading is taken

REST QUIETLY for 5 min

Radiofrequency in treatment of AFlutter

Radiofrequency catheter ablation is the treatment of choice for atrial flutter. The procedure is done in the EPS laboratory and involves placing a catheter in the right atrium. With use of a low-voltage, high-frequency form of electrical energy, the tissue is ablated (or destroyed), the dysrhythmia is ended, and normal sinus rhythm is restored.

Myocardial nuclear perfusion imaging (MNP)

Record of what's happening with in the heart Pt might get an MRI, ask back any pacemaker, or heart surgery that could have left staples in the heart

Hypertensive emergency

Reduce BP by 20% in first hour; reduce to 160/100 over 6 hours; organ dmg occuring

Afterload

Resistance to ejection of blood from the ventricle Inverse relationship between afterload and stroke volume (increased by arterial vasoconstriction --> decreased stroke volume)

specific organ damage diseases that manifest because of hypertension

Retinal/eye changes Renal damage Myocardial infarction Cardiac hypertrophy Stroke PVD

Side effects of loop diuretics

Risk of electrolyte imbalances; replacement may be needed *watch for volume and electrolyte depletion

Normal Heart Sounds

S1 (lub) and S2 (dub)

Hypertension

SBP greater than 140mm Hg and a DBP greater than 90mm Hg

S/S of left sided heart failure

SOB Dyspnea Wheezing Moist cough Confusion

A secondary pacemaker from another site may fire in two ways... The second way...

Secondary pacemakers can start is when they fire more rapidly than the normal pacemaker of the SA node. Triggered beats (early or late) may come from an ectopic focus or accessory pathway (area outside the normal conduction pathway) in the atria, AV node, or ventricles. This results in a dysrhythmia, which replaces the normal sinus rhythm.

Table 25-2 Musculoskeletal Disorders (costochondritis) Location, character, duration, precipitating events and aggravating factors, alleviating factors

Sharp or stabbing pain localized in anterior of the chest Most often unilateral Can radiate across chest to epigastrium or back Duration: hours to days Precipitating factors: most often follows respiratory tract infection with significant coughing, vigorous exercise, or posttrauma Some cases are idiopathic Exacerbated by deep inspiration, coughing, sneezing, and upper movement of torsos or arms Treatment: rest, ice, or heat Analgesic or anti-inflammatory medications

Table 25-2 Pericarditis chest pain Location, character, duration, precipitating events and aggravating factors, alleviating facotors

Sharp, severe substernal or epigastric chest pain Can radiate to neck, arms, and back Associated symptoms: fever, malaise, dyspnea, cough, nausea, dizziness, and palpitations Duration: intermittent Sudden onset, pain increases with inspiration, swallowing, coughing, and rotation of trunk Treat: sitting upright, analgesic, anti-inflammatory medications

Table 25-2 Pulmonary Disorders (pneumonia, pulmonary embolism) Location, character, duration, precipitating events and aggravating factors, alleviating facotors

Sharp, severe substernal or epigastric pain arising from inferior portion of pleura (referred to as pleuritic pain) Patient may be able to location pain Less than 30 minutes Follows an infection or noninfectious processes (MI, cardiac surgery, cancer, immune disorders, uremia) Pleuritic pain increases with inspiration, coughing, movement, and supine positioning Occurs in conjunction with community or hospital acquired lung infections or venous thromboembolism Treatment: treat underlying causes

Female Chest Pain

Simple presentation, If there are any 2 symptoms from nose to naval, get an EKG

Side effects of beta-blockers

Slow HR, weakness, lassitude, fatigue, n/v, lightheadedness (check vitals prior to giving)

transesophageal echocardiography (TEE)

Small transducers goes through the mouth into the esophagus to provide clearer images

modifiable risk factors for hypertension(su podd)

Smoking Unhealthy diet Physical inactivity Obesity Diabetes Dyslipidemia/hypercholesterolemia

Creatine Kinase (CK)

Specific to cells of the brain, myocardial, and skeletal muscle

Stage of heart failure where there is a presence of heart failure risk factors but no heart disease and no symptoms

Stage A

Stage/Class of heart failure where heart disease is present but there are no symptoms

Stage B Class I

Stage/class of heart failure of structural heart disease is present and symptoms have occurred

Stage C Class II/III

Stage/class of heart failure where there is presence of advanced heart disease with continued heart failure and symptoms requiring medical therapy

Stage D Class IV

This neurological event commonly occurs as a result of HTN

Stroke

B/P =

Stroke volume x heart rate x peripheral vascular resistance Blood pressure is determined by how much volume of blood the heart is pumping out with each contraction, how fast the heart is beating, and how much resistance or pressure there is in the arteries

Table 25-2 Esophageal disorders (vital hernia, reflux, esophagitis, or spasm) Location, character, duration, precipitating events and aggravating factors, alleviating factors

Substernal pain described as sharp, burning, or heavy; often mimics angina, can radiate to neck, arm, or shoulders Duration 5-60 minutes Precipitating events: recumbency, cold liquids, exercise Alleviating factor: food, antacid, nitroglycerin

Stage 1 hypertension

Systolic : 140-159 Diastolic : 90-99

Prehypertension

Systolic :120-139 Diastolic : 80-89

Stage 2 hypertension

Systolic >160 Diastolic >100

_____ provides the best images of the mitral valve.

TEE (transesophageal echocardiography)

true of false: echocardiography is used to diagnose and monitor progression of mitral regurgitation.

TRUE

Testing for hypertension

TSH Urinalysis Uric acid Urinary albumin EKG Echo SCr and eGFR Fasting blood glucose CBC Na, K, Ca

Step 3 after 1 month unsuccessful reassessment with both groups

Take all three medications

Echocardiography - Nursing Considerations

Tell pt test is painless, gel will be applied to the chest, turn to the side take a breath Test takes 30 to 45 minutes

Pacemaker

The artificial cardiac pacemaker is an electronic device used to pace the heart when the normal conduction pathway is damaged. The electrical signal (stimulus) travels from the pulse generator, through the leads to the wall of the myocardium. The myocardium is "captured" and stimulated to contract.

clinical significance of tachycardia

The clinical significance of sinus tachycardia depends on the patient's tolerance of the increased HR. The patient may have dizziness, dyspnea, and hypotension because of decreased CO. Increased myocardial oxygen consumption is associated with an increased HR. Angina or an increase in infarction size may accompany sinus tachycardia in patients with coronary artery disease (CAD) or an acute MI.

automaticity

The heart has specialized cells in the SA node, atria, AV node, and bundle of His and Purkinje fibers (His-Purkinje system), which can fire (discharge) spontaneously.

clinical significance of AFlutter

The high ventricular rates (greater than 100 beats/minute) and loss of the atrial "kick" (atrial contraction reflected by a sinus P wave) that are associated with atrial flutter decrease CO. This can cause serious consequences such as HF, especially in the patient with underlying heart disease. Patients with atrial flutter have an increased risk of stroke because of the risk of thrombus formation in the atria from the stasis of blood. Warfarin (Coumadin) is given to prevent stroke in pts who have atrial flutter.

implantable Cardioverter-Defibrilator

The implantable cardioverter-defibrillator (ICD) is an important technology for patients who (1) have survived SCD, (2) have spontaneous sustained VT, (3) have syncope with inducible VT or VF during EPS, or (4) are at high risk for future life-threatening dysrhythmias (have cardiomyopathy).

Excitability

The impulse started by the SA node or an ectopic focus must be conducted to the entire heart. The property of myocardial tissue that allows it to be depolarized by a stimulus is called excitability. The level of excitability isdetermined by the length of time after depolarization that the tissues can be restimulated.

treatment of tachycardia

The underlying cause of tachycardia guides the treatment. In clinically stable patients, vagal maneuvers can be attempted. In addition, IV β-adrenergic blockers (metoprolol [Lopressor]), adenosine (Adenocard), or calcium channel blockers (e.g., diltiazem [Cardizem]) can be given to reduce HR and decrease myocardial oxygen consumption. In clinically unstable patients, synchronized cardioversion is used.

For HTN to occur...

There must be a change in one or more factors affecting PR or CO

Diabetes Pt.

They are already at high risk for vascular problems.....they are already developing narrowed lumens and damaged blood vessels from all the glucose in their vascular system. high B/P cause even more damage

Cardiac Cath - PT education

They may fell palpitations (when Cath is passed to the left ventricle) Heat flash (when the median in infected on left) Desire to cough (median is injected on right) Be on alert for decrease in urinary output from dye (normal in the beginning, if prolonged a problem)

Isolated systolic hypertension

This type of hypertension is when BP > 160 and diastolic is normal; often seen in elderly

The nurse is reviewing the monitored rhythms of several patient in the cardiac step down unit. The patient with which cardiac arrhythmia has the greatest need of attention by the nurse?

Torsades de pointes

Lipids

Total Cholesterol: less than 200 mg/DL Triglycerides: less than 150 mg/dl HDL: over 45 mg/dl LDL: less than 70 mg/dl for cardiovascular pt and less than 130 mg/dl for healthy adults

Treatment of Premature Atrial Contraction (PAC's)

Treatment depends on the patient's symptoms. Withdrawal of sources of stimulation such as caffeine or sympathomimetic drugs may be needed. β-Adrenergic blockers may be used to decrease PACs.

treatment of PVC's

Treatment relates to the cause of the PVCs( oxygen therapy for hypoxia, electrolyte replacement). Assessment of the patient's hemodynamic status is important to determine if treatment with drug therapy is needed. Drug therapy includes β-adrenergic blockers, procainamide (Pronestyl), or amiodarone.

Cardiac Biomarkers of Myocardial Damange

Troponin Creatine Kinase Lipids Also: myoglobin, homocysteine, highly sensitive C-reactive protein

Abnormal Heart Sound - Murmur

Turbulent blood flow in the heart

Refractory Period

Two phases: 1. Effective (absolute) 2. Relative

Table 25-2 Chest Pain: Angina Pectoris Location, character, duration, precipitating events and aggravating factors, alleviating facotors

Uncomfortable pressure, squeezing, or fulness in substernal area Can radiate across chest to medial aspect of one or both arms, hands, jaw, shoulders, upper back, or epigastrium Radiates to arms and hands (numbness and tingling) Lasts 5-15 minutes Comes on with physical exertion, emotional upset, eating large meal, or exposure to extremes in temperature Treat: rest, nitro, oxygen

Desirable total cholesterol level

Under 200

Low men HDL cholesterol level

Under 40

Low women HDL cholesterol level

Under 50

Difference between hypertensive emergency and hypertensive urgency

Urgency does not have immediate or progressive target organ damage Difference in treatment

Hypertensive urgency vs emergency

Urgency: over 180 or 120 without end organ damage Emergency: with end organ damage

When is aldosterone receptors blockers (antagonists) used?

Used for patients with h/o MI or symptomatic ventricular dysfunction

Diagnostic Assessment - ECG

Used to diagnose dysrhythmias, conduction abnormalities, and chamber enlargement, myocardial ischemia, injury, or infarction

The automatic external defibrillator electrodes are placed on the patient who is unconscious and pulseless. The nurse prepares to immediately defibrillate if the monitor show which cardiac rhythm?

V-fib

treatment of Paroxysmal Superventricular Tachycardia (PSVT)

Vagal stimulation and drug therapy. Common vagal maneuvers include Valsalva, carotid massage, and coughing. IV adenosine is the drug of choice to convert PSVT to a normal sinus rhythm. This drug has a short half-life (10 seconds) and is well tolerated. IV β-adrenergic blockers, calcium channel blockers, and amiodarone (Cordarone) can also be used. If vagal stimulation and drug therapy are ineffective and the patient becomes hemodynamically unstable, synchronized cardioversion is used.

ECG characteristics of Vtach

Ventricular rate is 150 to 250 beats/ minute. Rhythm may be regular or irregular. AV dissociation may be present, with P waves occurring independently of the QRS complex. The atria may be depolarized by the ventricles in a retrograde fashion. The P wave is usually buried in the QRS complex, and the PR interval is not measurable. The QRS complex is distorted in appearance and wide (greater than 0.12 second in duration). The T wave is in the opposite direction of the QRS complex.

expected ejection fraction for people with diastolic heart failure

WNL or >50%

Cardiovascular assessment - meds

Want to ask pt if on calcium channel blockers or diuretics Aspirin: pt might not realize that its an anti thrombotic therapy for preventing for ACS, may not take consistently

What is the best indicator of fluid balance?

Weight 2.2 lbs equals 1 kg equal 1 liter of H2O

Non-pharmacological interventions for prevent and treatment of hypertension

Weight loss Healthy diet Reduced intake of dietary sodium Enhanced intake of dietary potassium

Ventricular Bigeminy

When every other beat is a PVC

When are loop diuretics used?

When thiazides fail or patient needs quick diuresis *K+ DEPLETING *prescribed cador- potass supplement with these meds -banana beats milk fish prune squash high in K+

stimulation of vagus nerve causes...

a decreased rate of firing of the SA node and slowed impulse conduction of the AV node.

Bigeminy pattern of premature atrial contractions

a pattern of premature atrial contractions occurring every other beat

Normal sinus rhythm

a rhythm that starts in the SA node at a rate of 60-100 bpm and follows the normal conduction pathway.

what heart sound is heard in mitral regurgitation?

a systolic murmur (high-pitched, blowing heard at the apex)

Treatment of Bradycardia

administration of atropine (an anticholinergic drug). If atropine (AtroPen) is ineffective, transcutaneous pacing, or a dopamine (Intropin) or epinephrine (Adrenalin) infusion iS considered. Permanent pacemaker therapy may be needed. If bradycardia is due to drugs, these may need to be held, discontinued, or given in reduced dosages.

Clinical Associations of Asystole

advanced cardiac disease, severe cardiac conduction system disturbance, or end stage HF.

Thiazide diueretics

advise patient to supplement with potassium rich foods elderly rise slow from bed/chair- Ortho Hypo Use with caution- DM & Gout- may increase sugar and worsen gout

Resistance left ventricle must overcome to circulate blood

afterload

Stroke Volume

amount of blood ejected from one of the ventricles per heart rate Average: 60 to 130mL determined by preload, afterload, and contractility

ARBs stands for

angiotensin receptor blockers

ACE inhibitors stands for

angiotensin-converting enzyme

homograft

another term used for allograft

heterograft

another term used for bioprosthesis

Conditions associated with rapid treatment for hypertensive crisis

aortic dissection severe preeclampsia/eclampsia pheochromocytoma crisis ischemic stroke

What is the treatment of choice for aortic regurgitation?

aortic valve replacement or valvuloplasty

clinical associations of vtach

associated with MI, CAD, significant electrolyte imbalances, cardiomyopathy, mitral valve prolapse, long QT syndrome, drug toxicity, and central nervous system disorders. This dysrhythmia can be seen in patients who have no evidence of cardiac disease.

Renal dysfunction occurs secondary to hypertension as a result of this

atherosclerosis The sustained high blood pressure and the increased peripheral resistance causes a disruption in the vascular endothelium, forcing plasma and lipoproteins into the vessels' intimal and subintimal layers and causing plaque fromation (atherosclerosis). Vessels are damaged which affects the entire cardiovascular system. Vessels that are thick and narrowed are unable to dilate....this is a problem when areas of the body need more oxygen which is brought there by blood.

comorbidities with HF

atrial fibrillation anemia depression

ECG Characteristics of A Fib

atrial rate may be as high as 350 to 600 bpm. P waves are replaced by chaotic, fibrillatory waves. Ventricular rate varies, and the rhythm is usually irregular. When the ventricular rate is between 60 and 100 bpm, it is atrial fibrillation with a controlled ventricular response. Atrial fibrillation with a ventricular rate greater than 100 bpm is atrial fibrillation with a rapid (or uncontrolled) ventricular response. The PR interval is not measurable, and the QRS complex usually has a normal shape and duration. At times, atrial flutter and atrial fibrillation may coexist.

Atrial Flutter

atrial tachydysrhythmia identified by recurring, regular, sawtooth-shaped flutter waves that originate from a single ectopic focus in the right atrium or, less commonly, the left atrium

mitral valve

atrioventricular valve located b/w the left atrium & left ventricle

tricuspid valve

atrioventricular valve located b/w the right atrium and right ventricle

Nervous control of the heart

autonomic nervous system controls impulse formation, speed of conduction, and strength of cardiac contraction. Vagus nerve fibers of parasympathetic nervous system and nerve fibers of sympathetic nervous system.

regurgitation

backward flow of the blood through a heart valve

Decreased cardiac output activates what

baroreceptors

annulus

base of heart valve that supports the valves leaflets

Cardiac Cath - Nursing interventions

before procedure: Renal fx test, allergies reviewed, signed informed consent, give mild sedative if needed PT need to be NPO After proceduresL pt on best rest for up to 6 hours, need a brace on the leg to keep insertion site straight Pt has to lay flat for the first hour after procedure Monitor vitals: every 15 minutes for the 1st hour, 30 minutes for the next 2 hours, then every 4-8 hours During vital signs check insertion site for bleeding or bruising Watch telemetry, pedal pulses, and temperature

mitral stenosis: if cardioversion is unsuccessful, the ventricular rate is controlled with what meds?

beta-blockers, digoxin, or calcium channel blockers

effect of ARBs

block angiotensin II outside of RAAS potent vasodilator

effect of beta blockers

blocks beta receptors from E/NE

In mitral valve prolapse, if dysrhythmias are documented and cause symptoms what is the patient educated to eliminate from diet?

caffeine, alcohol, and stop using tobacco products

step 1 for 55 years or older or black patients of any age

calcium channel blocker OR thiazide-type diuretics

An electrophysiologic study (EPS)

can identify the causes of heart blocks, tachydysrhythmias (dysrhythmias with rates greater than 100 beats/minute), bradydysrhythmias (dysrhythmias with rates less than 60 beats/minute), and syncope. An EPS study can also locate accessory pathways and determine the effectiveness of antidysrhythmia drugs.

Rebound hypertension

can occur if antihypertensive medications are suddenly stopped.

mitral stenosis: if a-fib develops, ______ is attempted to restore NSR (normal sinus rhythm).

cardioversion

effect of neurohormonal activation

catecholamine release RAAS system activation

Effective period

cells are completely unresponsive to any electrical stimulus Incapable or initiating an early depolarization

Supraventricular tachycardia

characterized by rapid atrial depolarization with a rate of 350-350 beats per minute

Atrial flutter

classically the p waves occur in a sawtooth pattern

how to prepare patient for ECG

clip excessive chest hair, rub skin with dry gauze until slightly pink. if skin is oily, wipe with alcohol first. if sweaty, apply skin protectant before electrode.

Sinus tachycardia

conduction pathway is the same in sinus tachycardia as that in normal sinus rhythm. The discharge rate from the sinus node increases because of vagal inhibition or sympathetic stimulation. The sinus rate is 101 to 200 beats/minute.

The Holter monitor

continuously records the ECG while the patient is ambulatory and performing daily activities. The patient keeps a diary and records activities and any symptoms. Events in the diary are correlated with any dysrhythmias seenon the ECG.

what is systolic heart failure?

contractile myocardial defect

three factors that affect stroke volume

contractility preload afterload

Premature Ventricular contractions

contraction coming from an ectopic focus in the ventricles. It is the premature (early) occurrence of a QRS complex. A PVC is wide and distorted in shape compared with a QRS complex coming down the normal conduction pathway

medications to avoid in HF

corticosteroids NSAIDs CaCBs tricyclic antidepressants metformin and avandia

side effects of ACE inhibitors

cough hypotension renal insufficiency hyperkalemia

how do you calculate HR on ECG

count the number of QRS complexes in one minute OR count the number of R-R intervals in 6 seconds and multiply that number by 10.

Symptoms management and reporting sections with HF

daily weights dyspnea fatigue

clinical significance of sinus brady

depends on how pt tolerates it. S&S of symptomatic bradycardia include pale, cool skin; hypotension; weakness; angina; dizziness or syncope; confusion or disorientation; and shortness of breath.

what type of dysfunction is where the ejection fraction is normal or increased

diastolic

what heart sound is heard with mitral stenosis?

diastolic murmur (low-pitched, rumbling) at the apex

Amount of pressure the heart must overcome to pump out

diastolic pressure

Mitral valve prolapse (medical management)

directed @ controlling symptoms.

cardiomyopathy

disease of the heart muscle

Dysrhythmias result from...

disorders of impulse formation, conduction of impulses, or both.

What are signs and symptoms of aortic stenosis?

dyspnea on exertion, angina, syncope, dizziness, pulmonary edema r/t left ventricular failure, orthopnea, hypotension

Paroxysmal Superventricular Tachycardia (PSVT)

dysrhythmia starting in an ectopic focus anywhere above the bifurcation of the bundle of His. PSVT occurs because of a reentrant phenomenon (reexcitation of the atria when there is a one-way block). Usually a PAC triggers a run of repeated premature beats. Paroxysmal refers to an abrupt onset and ending. Termination is sometimes followed by a brief period of asystole (absence of all cardiac electrical activity). Some degree of AV block may be present.

How is aortic stenosis diagnosed?

echocardiogram, echocardiography, cardiac MRI, CT, ecg

What is used to diagnose and monitor progression of mitral valve prolapse?

echocardiography

aortic regurgitation diagnosis can be confirmed by ______.

echocardiography (preferably transesophageal), cardiac magnetic resonance (CMR) imaging, radionuclide imaging, and cardiac catheterization

What are some test that will help determine the severity of mitral stenosis?

electrocardiography (ECG), exercise testing, and cardiac cauterization with angiography

ventricular trigeminy

every third beat is a PVC

often 1st and only sign of mitral valve prolapse is _______.

extra heart sound (referred to as "mitral click"

This body system would show early signs of hypertension

eyes Evidence of blood vessel damage in the retina indicates similar damage elsewhere in the vascular system.

true or false: mitral valve prolapse occurs more in men.

false (occurs more in women)

Atrial fibrillation

fine fibrillatory waves associated with increased risk of clot formation in the atria

aortic regurgitation

flow of blood back into left ventricle from the aorta during diastole

treatment of A Fib

goals of treatment include a decrease in ventricular response (to less than 100 beats/minute), prevention of stroke, and conversion to sinus rhythm, if possible. Ventricular rate control is a priority for pts with atrial fibrillation. Drugs used for rate control include calcium channel blockers (diltiazem), β-adrenergic blockers (metoprolol), dronedarone, and digoxin (Lanoxin). most common antidysrhythmia drugs used for conversion to and maintenance of sinus rhythm include amiodarone and ibutilide.

Clincial Significance of PVC's

health; not harmful. With disease, reduce CO and lead to angina and HF depending on frequency. PVCs in CAD or acute MI indicate ventricular irritability, assess the patient's physiologic response to PVCs. Obtain the patient's apical-radial pulse rate, since PVCs often do not generate a sufficient ventricular contraction to result in a peripheral pulse. This can lead to a pulse deficit.

Abnormal Heart Sounds - S4

heard before S1 LUB lub-dub

A complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood

heart failure

conditions that would increase preload

heart failure too much fluid

Most common type of heart failure associated with women due to HTN, diabetes, and aging

heart failure with preserved ejection fraction

Most common heart failure more often due to CAD, men, and higher mortality

heart failure with reduced ejection fraction

What to monitor if on beta blockers

heart rate blood pressure worsening heart failure ND hypogylcemia

two factors that affect cardiac output

heart rate stroke volume

bioprosthesis

heart valve replacement made by an animal heart valve (pigs, sometimes horses and cows)

allograft

heart valve replacement made from a human heart valve

autograft

heart valve replacement made from the patient's own heart valve

conditions that would decrease preload

hemorrhaging/bleeding

what heart sound is heard with aortic regurgitation?

high-pitched, blowing diastolic murmur heard at the third or fourth intercostal space at the left sternal border

Causes of Pulseless Electrical activity (PEA)

hypovolemia, hypoxia, metabolic acidosis, hyperkalemia, hypokalemia, hypoglycemia, hypothermia, toxins (e.g., drug overdose), cardiac tamponade, thrombosis (e.g., MI, pulmonary embolus), tension pneumothorax, and trauma.

Clinical Associations with Premature Atrial Contraction (PAC)

in a normal heart, can result from emotional stress or physical fatigue or from the use of caffeine, tobacco, or alcohol. can also be a result of hypoxia, electrolyte imbalnaces, and diseases such as hyperthyroidism, COPD, and CAD.

Side effects of aldosterone antagonists

increased K+ gynecomastia breast pain

Effect of E and NE

increased heart rate increased vasoconstriction increased contractility

stimulation of sympathetic nerves...

increases SA node firing, AV node impulse conduction, and cardiac contractility.

infective endocarditis

inflammation of endothelium that lines heart and cardiac valves. most commonly damages mitral valve, then aortic and tricuspid valves. commonly caused by bacteria that are normally present in the body. More common in OLDER ADULTS can also occur after an invasive medical or dental procedure. symptoms: valvular dysfunction, may affect organ systems, chest pain, CHF, clubbing, meningitis, low back pain, arthralgia, arthritis

aortic regurgitation may be caused by what?

inflammatory lesions that deform aortic valve leaflets or dilation of the aorta, preventing complete closure of the aortic valve

valve replacement

insertion of a device @ the site of a malfunctioning heart valve to restore blood flow in one direction through the heart

Premature Atrial Contraction (PAC)

is a contraction starting from an ectopic focus in the atrium (i.e., a location other than the SA node) and coming sooner than the next expected sinus beat. The ectopic signal starts in the left or right atrium and travels across the atria by an abnormal pathway. This creates a distorted P wave. At the AV node, it may be stopped (nonconducted PAC), delayed (lengthened PR interval), or conducted normally. If the signal moves through the AV node, in most cases it is conducted normally through the ventricles.

SA node

is the pacemaker of the heart. It spontaneously fires 60 to 100 times per minute

recovery period after stimulation

is the refractory phase or period. The absolute refractory phase or period occurs when excitability is zero and the heart cannot be stimulated.

If drugs or cardioversion does not convert atrial fibrillation to normal sinus rhythm...

long-term anticoagulation therapy is required. Warfarin is the drug of choice, and patients are monitored for therapeutic levels.

what heart sound is heard with aortic stenosis?

loud, harsh systolic murmur heard over the right second intercostal space radiating to the carotid artiries and apex of the left ventricle. -Murmur is low pitched, crescendo-desrescendo, rough,rasping, and vibrating

Therapies:

low sodium diet, low fat and exercise

Hypertension: nursing care

lowering/controlling BP -Education of treatment plan and lifestyle changes -Low sodium diet -limit alcohol -Self monitoring of own blood pressure -DO NOT STOP taking meds or can get REBOUND HTN -go to follow up appts -

how long does v-tach last?

may be sustained, longer than 30 seconds, or nonsustained, less than 30 seconds. The development of v-tach is an ominous sign. life threatening because decreased CO and possibility of development of VF, which is lethal.

total artificial heart

mechanical device used to aid a failing heart, assisting the right & left ventricles

ventricular assist device

mechanical device used to aid a failing right or left ventricle

number one cause of a hypertensive crisis

medication non-adherence

Moderation of alcohol intake with hypertension values

men: </= 2 drinks daily women: </= 1 drink daily

prevention of mitral stenosis is ________.

minimizing risk of and treatment for bacterial infections

Mitral valve prolapse (patho)

mitral looses elasticity & blood flows backwards from left ventricle to left atrium

Deformity that usually produces no symptoms is _____.

mitral valve prolapse

medication therapy with a single med

monotherapy

mitral valve prolapse (s/s)

most never have symptoms. few have fatigue, SOB, lightheadedness, dizziness, syncope, palpitations, chest pain, anxiety

aortic stenosis

narrowing of the orifice between the left ventricle and aorta

stenosis

narrowing or obstruction of a cardiac valve's orifice

Effect of poor heart pumping

neurohormonal activation

chord tendineae

non-distensible fibrous strands connecting papillary muscles to atrioventricular valve leaflets

mitral stenosis

obstruction to blood flowing from left atrium to left ventricle

Clinical Associations of VFib

occurs in acute MI and myocardial ischemia and in chronic diseases such as HF and cardiomyopathy. It may occur during cardiac pacing or cardiac catheterization procedures because of catheter stimulation of the ventricle. It may also occur with coronary reperfusion after thrombolytic therapy. Other clinical associations are electric shock, hyperkalemia, hypoxemia, acidosis, and drug toxicity.

relative refractory period

occurs slightly later in the cycle, and excitability is more likely. In states of full excitability, the heart is completely recovered.

Ventricular tachycardia

occurs when there are three or more consecutive PVC's. (wide or broad shape QRS complex)

Sustained hypertension BP pattern

office: hypertension not office: hypertension

White coat BP pattern

office: hypertension not office: no hypertension

Masked Hypertension BP pattern

office: no hypertension not office: hypertension

Mitral regurgitation s/s

often asymptomatic. most common is dyspnea, fatigue, weakness. palpitations, SOB on exertion, & cough from pulmonary congestion may occur

Nursing considerations for ARBs

orthostatic hypotension and hyperkalemia

nursing considerations for thiazide and related diuretics

orthostatic hypotension hypokalemia alkalosis

Recommended to confirm the diagnosis of hypertension and titration of BP lowering meds

out-of-office BP

medical management of aortic regurgitation: patients are advised to avoid _____.

physical exertion, competitive sports, and isometric exercise.

effect of ACE inhibitor

prevent conversion of angiotensin I to angiotensin II

Elevated blood pressure without an identified cause but has several contributing factors

primary hyerptension

Clinical Significance of Paroxysmal Superventricular Tachycardia (PSVT)

prolonged episode and HR greater than 180 beats/minute will cause decreased CO because of reduced stroke volume. Symptoms often include hypotension, palpitations, dyspnea, and angina.

clinical significance of asystole

pt usually has end stage heart disease or has a prolonged arrest and cannot be resuscitated.

Ventricular fibrillation

rapidly fatal if not corrected in 3-5 minutes

clinical associations with AFlutter

rarely occurs in a healthy heart. It is associated with CAD, hypertension, mitral valve disorders, pulmonary embolus, chronic lung disease, cor pulmonale, cardiomyopathy, hyperthyroidism, and the use of drugs such as digoxin, quinidine, and epinephrine.

Not severe condition treatment for hypertensive emergency

reduce BP by max 25% over first hour 160/100-110 over next 2-6 hours Normal over next 24-48 hours

Severe condition treatment for hypertensive emergency

reduce SBP <140 during first hour reduce <120 in aortic dissection

What is the same end result for HFrEF and HFpEF

reduced cardiac output that does not metabolic demands

symptomatic bradycardia

refers to an HR that is less than 60 beats/minute and is inadequate for the patient's condition, causing the patient to experience symptoms (e.g., chest pain, syncope).

Sudden Cardiac Death

refers to death from a cardiac cause. Most SCDs result from ventricular dysrhythmias, specifically VT or Venticular Fibrilation (VF)

what happens when valves do not close completely?

regurgitation (blood flows backwards through the valve)

Hypertensive urgency treatment

reinstate oral antihypertensive drug therapy Close monitoring of blood pressure/CV status Assess for potential target organ damage

leaflet repair

repair of a cardiac valve's movable "flaps"

annuloplasty

repair of a cardiac valve's outer ring

valvuloplasty

repair of a stenosed or regurgitant cardiac valve by commissurotomy, annuloplasty, leaflet repair, or chordoplasty

chordoplasty

repair of chordae tendineae

clinical significance of V Fib

results in unresponsive, pulseless, and apneic state. If it is not rapidly treated, the pt will not recover.

mitral stenosis is most often caused by what?

rheumatic endocarditis

Medical management of Mitral Regurgitation

same as for heart failure

Elevated blood pressure with a specific cause, treatment aimed at removing/treating underlying cause

secondary hypertension

pulmonic valve

semilunar valve located b/w the right ventricle & pulmonary artery

aortic valve

semilunar valve located between the left ventricle and aorta

acute Mitral regurgitation usually manifests as _____.

severe congestive heart failure (CHF)

Venticular Fibrilation (VF)

severe derangement of the heart rhythm characterized on ECG by irregular waveforms of varying shapes and amplitude. This represents the firing of multiple ectopic foci in the ventricle. Mechanically the ventricle is simply "quivering," with no effective contraction, and consequently no CO occurs. Venticular Fibrilation (VF) is a lethal dysrhythmia.

If BP above 130/80, had CVD event, risk of >10 percent, and average blood pressure 130/80

should prescribe medications

another name for HTn

silent killer

Pulseless Electrical Activity

situation in which organized electrical activity is seen on the ECG, but there is no mechanical activity of the ventricles and the patient has no pulse. It is the most common dysrhythmia seen after defibrillation. Prognosis is poor unless the underlying cause is quickly identified and treated

treatment of AFlutter

slow ventricular response . Drugs used to control ventricular rate include calcium channel blockers and β-adrenergic blockers. Electrical cardioversion may be performed to convert the atrial flutter to sinus rhythm in an emergency (when the patient is clinically unstable) and electively. Antidysrhythmia drugs are used to convert atrial flutter to sinus rhythm (ibutilide [Corvert]) or to maintain sinus rhythm (amiodarone, flecainide [Tambocor], dronedarone [Multaq]).

effect of aldosterone release

sodium and water reabsorption

ways to improve adherence for these areas to improve HF

sodium restriction medications symptom management and reporting fluid restriction exercise

commissurotomy

splitting or separating fused cardiac valve leaflets

what happens when valves do not open completely?

stenosis (blood flow through the valve is reduced)

If not at high risk, no history of CVD, and still >140 or >90

still prescribe medications

clinical associations of PVC's

stimulants such as caffeine, alcohol, nicotine, aminophylline, epinephrine, isoproterenol, and digoxin. They are also associated with electrolyte imbalances, hypoxia, fever, exercise, and emotional stress. Disease states associated with PVCs include MI, mitral valve prolapse, HF, and CAD.

patients with mitral stenosis are advised to avoid _________.

strenuous activities, competitive sports, and pregnancy, because all of these increase the heart rate

clinical associations of tachycardia

stressors such as exercise, fever, pain, hypotension, hypovolemia, anemia, hypoxia, hypoglycemia, myocardial ischemia, heart failure (HF), hyperthyroidism, anxiety, and fear. It can also be an effect of drugs such as epinephrine, norepinephrine (Levophed), atropine, caffeine, theophylline (Theo-Dur), or hydralazine (Apresoline).

prolapse (of a valve)

stretching of an atrioventricular heart valve leaflet into the atrium during systole

What type of dysfunction is where the ejection fraction is decreased

systolic

hypertensive crisis

systolic > 180 diastolic > 110 Severely elevated blood pressure --- sometimes termed malignant or accelerated hypertension is referred to as a "hypertensive crisis" as blood pressure above these levels are know to cause **left ventricular failure* and *acute renal injury*

_____ is an early sign that a valve leaflet is ballooning into the left atrium.

systolic click

how will the heart compensate for low contractility

tachycardia

Common complication of hypertension

target organ damage

Sinus Bradycardia

the conduction pathway is the same as that in sinus rhythm but the SA node fires at a rate less than 60 beats/minute.

Blood Pressure

the force the blood exerts against the walls of the arteries during contraction (systole) and relaxation (diastole) of the heart.

Metabolic syndrome

the presence of *three or more* of the following condtions: 1. abdominal obesity (waist circumference >40 inches in men or >35 inches in women), 2. glucose intolerance (fasting glucose >100 mg/dL), 3. BP > 130/85 mm Hg, 4. high triglycerides (>150 mg/dL, or low HDL (<40 mg/dL in men or <50 mg/dL in women)

electrocardiography (ECG or EKG) is ______.

the process of recording the electrical activity of the heart over a period of time using electrodes placed on the skin.

orthotropic transplantation

the recipient's heart is removed & a donor heart is grafted into the same site

Sinus arrhythmia

the rhythm fluctuations occur with an increase in the rate on inspiration and a decrease in the rate on expiration

echocardiography is _____.

the use of ultrasound waves to investigate the action of the heart

the calcium channel blockers, diltiazem (cardizem) and verapamil (calan, isoptin) are contraindicated for patients with aortic regurgitation because ______.

they decrease ventricular contractility and may cause bradycardia

Asystole

total absence of ventricular electrical activity. Occasionally, P waves are seen. No ventricular contraction occurs because depolarization does not occur. Patients are unresponsive, pulseless, and apneic. Asystole is a lethal dysrhythmia that requires immediate treatment. Venticular Fibrilation (VF) may masquerade as asystole. Always assess the rhythm in more than one lead. The prognosis of a patient with asystole is extremely poor.

Cardiac Output

total amount of blood ejected by one of the ventricles in liters per minute average: 4-6L/min

Atrial Fibrillation

total disorganization of atrial electrical activity because of multiple ectopic foci, resulting in loss of effective atrial contraction. The dysrhythmia may be paroxysmal (beginning and ending spontaneously) or persistent (lasting more than 7 days). Atrial fibrillation is the most common, clinically significant dysrhythmia with respect to morbidity and mortality rates and economic impact.

Telemetry

transmission of radio waves from a battery operated transmitter to a central bank of monitors UAP can trim the hair on chest, clean the site of the electrodes, and pace them on the skin Nurse must verify placement and read the electrodes

treatment of polymorphic VT with prolonged baseline QT interval

treated with IV magnesium, isoproterenol, phenytoin (Dilantin), or antitachycardia pacing. Drugs that prolong the QT interval (dofetilide [Tikosyn]) should be discontinued. Cardioversion is used if drug therapy is ineffective.

defibrillation

treatment of choice to end VF and pulseless VT. It is most effective when the myocardial cells are not anoxic or acidotic. Rapid defibrillation (within 2 minutes) is critical to a successful patient outcome. Defibrillation involves the passage of an electric shock through the heart to depolarize the cells of the myocardium. The goal is that the following repolarization of myocardial cells will allow the SA node to resume the role of pacemaker.

true or false: Echocardiography is used to diagnose and quantify the severity of mitral stenosis.

true

true or false: regurgitation & stenosis affect all heart valves.

true

true or false: regurgitation and stenosis may occur at the same time in the same or different valves.

true

couplet

two consecutive PVC's

How is aortic stenosis prevented?

tx diabetes, hypertension, cholesterol, avoid tobacco

clinical associations with AFib

usually occurs in the patient with underlying heart disease, such as CAD, valvular heart disease, cardiomyopathy, hypertensive heart disease, HF, and pericarditis. It often develops acutely with thyrotoxicosis, alcohol intoxication, caffeine use, electrolyte disturbances, stress, and cardiac surgery.

Angiotensin II leads to

vasoconstriction aldosterone release

Cause of HTN with target organ diseases

vasoconstriction of blood vessels in the body

What is usually the first medication prescribed for patients with symptoms of aortic regurgitation?

vasodilators, such as calcium channel blockers, ACE inhibitors, or hydrazine

artifact

will see artifact on monitor when leads and elcetrodes are not secure, or when there is muscle activity or electrical interference. Artifact is a distortion of the baseline and waveforms seen on the ECG.

Two big considerations in the guidelines for pharmacological treatment for hypertension

younger than 55 years 55 years or older/black patients of any age

Nursing Diagnoses

• Risk for Noncompliance related to negative side effects of prescribed therapy versus the belief that treatment is not needed without the presence of symptoms • Risk for ineffective Self-Health Management related to lack of knowledge of condition, diet restrictions, medications, risk ractors, and follow-up care