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Med Surg 2week 2 Study Notes
Hypertension Chapter 27 Epidemiology โ 32.6% of adults have HTN โ Prevalence: Hispanics, African Americans โ โSilent Killerโ โ Accompanies other risk factors for atherosclerotic heart disease โ Dyslipidemia โ Obesity โ DM, metabolic syndrome โ OSA Risk Factors โ Contributes to rate at which atherosclerotic plaque accumulates โ Major contributor to death related to cardiac, cerebrovascular, renal and peripheral vascular disease. โ Outcomes=> โ AMI, heart failure, renal failure, CVA, impaired vision, LVH โ CAKE o Coronary vascular disease o Brain (stroke) o Kidneys (renal failure) o Eyes (impaired vision) HTN Know these Primary Hypertension โ โEssential Hypertensionโ o Unidentified causes โ High blood pressure from an unidentified cause โ 95% of cases Secondary Hypertension โ Cause for HTN is identified โ Renal disease โ Hyperaldosteronism
โ Medications (prednisone) โ Pregnancy โ 5% of cases What is Blood Pressure? Blood pressure is the product of: โ Cardiac Output x Peripheral Resistance โ Cardiac Output= HR x Stroke Volume (SV) โ HTN results in=> โ โ CO (HR x SV) โ โ peripheral resistance (constriction of blood vessels) Risk Factors Pathophysiology โ Genetic= 40 single gene mutations identified โ Increased sympathetic nervous system activity related to dysfunction of the ANS โ Increased renal reabsorption of sodium, chloride and water โ Increased activity of RAA system: expansion of extracellular fluid volume and โSVR
Assessment and Diagnostic Findings โ Health history โ HPI โ Physical examination โ Retinal examination โ Laboratory โ Urinalysis โช Kidney function โ Blood chemistry โ Lipid profile โ 12-lead EKG โ Echocardiography โ Risk factor assessment as per Joint National Committee of Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) 7 โ Classifies HTN โ Guides treatment Blood Pressure Classifications
JNC Medical Management โ Prevent complications and death โ Achieve and maintain arterial BP at 140/90 mm Hg or lower โ 130/80 mm Hg for people with DM or CKD Pharmacologic Management โ Uncomplicated HTN โ Diuretics, beta blockers or both โ First line of defense are diuretics โ Promote adherence โ Prescribe simplest treatment schedule โ Ideally one pill/day
Pharmacologic Management Calcium Channel Blockers Diltiazem Verapamil Norvasc Clevidipine Direct Renin Inhibitors Tekturna Lifestyle Modifications โ Weight reduction โ DASH diet โ Dietary sodium restriction โ Dietary potassium increase โ Regular physical activity โ Moderate consumption of alcohol DASH Dietary approaches to stop hypertension: โ Grains: 7-8 servings per day โ Vegetables 4-5 servings per day โ Fruits 4-5 servings per day โ Low fat/Fat free dairy 2-3 servings per day โ Meat 2 or fewer servings per day โ Nuts/seeds 4-5 servings per week
Nursing Process โ Assessment โ Measuring BP (Chart 27-3; p. 869) โ Nursing Diagnosis โ Knowledge deficit regarding the relation of the treatment regimen and control of the disease process โ Noncompliance with therapeutic regimen related to side effects of prescribed therapy โ Collaborative Problems/Complications โ LVH โ AMI/Heart failure โ CVA/TIA โ CKD โ Retinal hemorrhage Nursing Process โ Nursing Interventions โ Increasing knowledge โ Promoting adherence to therapy โ Promoting home and community-based care โ Evaluation โ Maintains adequate tissue perfusion โ Adheres to self-care program โ Has no complications Hypertensive Crisis โ When SBP exceeds 180 mmHg or the DBP exceeds 120 mmHg Hypertensive Crisis Classification Hypertensive Emergency โ Clinical dysfunction of target organ โ Extremely elevated BP โ HTN of pregnancy โ AMI โ Dissecting Aortic Aneurysm
Heart Failure Chapter 25 NOVA SOUTHEASTERN UNIVERSITY Ron and Kathy Assaf COLLEGE OF NURSING Chronic Heart Failure โ 6 million people diagnosed with heart failure โ > 75 years of age โ Most common reason for hospitalization for those over 65 โ 25% of patients discharged with CHF are readmitted within 30 days โ Economic burden: $30 billion annually Types of Heart Failure โ Diagnosed by echocardiogram โ Normal Ejection fraction (EF 55-65%) โ Systolic heart failure โ Alteration in ventricular function โ Weakened heart muscle โ Severely reduced EF โ Diastolic Heart failure โ Less common โ Stiff and noncompliant heart muscle=> difficult for ventricle to fill โ Normal EF
NYHA classification Systolic Heart Failure Symptoms
- SOB when they lay down
- PND: paradoxical nocturnal dyspnea
- Pink frothy septum
- S3 heart sound (murmur) galloping sound
- BNP is the lab to rule out HF. If level is over 100 they are developing HF.
- Edema and weight gain due to fluid build up
- Decrease flow to brain, PT will get irritable and restless
- Less attention span Signs and symptoms of diastolic failure
- Liver failure
- Dependent edema (look at feet Etiology โ Coronary Artery Disease โ Cardiomyopathy โ Valvular disorders
โ s/s related to ventricle which is most affected (right or Left) โ May have s/s of both General Manifestations Left sided HF:
**- More pulmonary problem
- PND
- Orthopnea
- Pulmonary crackles
- Pink frothy sputum
- Weight gain
- Left sided failure can cause right sided failure Right side HF:
- Edema
- JVD
- Abdominal ascites
- Enlargement of liver Congestion:** โ Dyspnea/orthopnea/PND โ Cough โ Pulmonary crackles โ Weight gain โ Dependent edema โ Ascites โ JVD โ Fatigue Low cardiac output: โ Muscle wasting/weakness โ Lightheadedness/dizzy โ Unexplained confusion/AMS โ Resting tachycardia
โ Pallor/cyanosis Summary โ Right-sided failure โ RV cannot eject sufficient amounts of blood and blood backs up in the venous system. This results in peripheral edema, hepatomegaly, ascites, anorexia, nausea, weakness, and weight gain. โ Left-sided failure โ LV cannot pump blood effectively to the systemic circulation. Pulmonary venous pressures increase and result in pulmonary congestion with dyspnea, cough, crackles, and impaired oxygen exchange. โ Chronic heart failure is frequently biventricular. Diagnostic studies โ Assessment of ventricular function โ Echocardiogram โ Chest X-ray โ 12-lead EKG โ Serum electrolytes [CMP], Liver function tests, CBC
Nursing Process โ Assessment/health history โ Physical examination โ Mental status โ Lung sounds: crackles and wheezes โ Heart sounds: S โ Fluid status/signs of fluid overload โ Daily weight and I&O โช 2-3lbs weight gain in one day shows theyโre in HF โ Diagnosis โ Activity intolerance r/t decreased CO โ Excess fluid volume r/t HF syndrome โ Anxiety โ powerlessness Nursing Interventions โ Promote activity tolerance โ Manage fluid volume โ Control anxiety โ Monitoring for complications โ See page 808 Activity Intolerance โ Bed rest for acute exacerbations โ Encourage regular physical activity; 30โ45 minutes daily โ Exercise training โ Pacing of activities โ Wait 2 hours after eating for physical activity โ Avoid activities in extreme hot, cold, or humid weather โ Modify activities to conserve energy โ Positioning; elevation of the HOB to facilitate breathing and rest, support of arms
Fluid Volume Excess โ Assessment for symptoms of fluid overload โ Daily weight โ I&O โ Diuretic therapy; timing of meds โ Fluid intake; fluid restriction โ Maintenance of sodium restriction Patient Teaching โ Medications โ Diet: low-sodium diet and fluid restriction โ Monitoring for signs of excess fluid, hypotension, and symptoms of disease exacerbation, including daily weight โ Exercise and activity program โ Stress management โ Prevention of infection โ Know how and when to contact health care provider โ Include family in teaching Complications โ Hypotension โ Cardiogenic shock โ Dysrhythmias โ Thromboembolism โ Pericardial effusion โ Cardiac tamponade
