Recap Notes Cholesterol Values LDL/HDL/Total Cholesterol HDL = greater than 40 LDL = less than 100 Total Cholesterol = less than 200 Lipids less than 150 males and less than 135 females Heart Placements 2nd intercostal right sternum = aorta valve 2nd intercostal left sternum = pulmonic valve Erb’...
NUR 242 Exam 4 Study Guidelines
Recap Notes
Cholesterol Values
LDL/HDL/Total Cholesterol
HDL = greater than 40 LDL = less than 100
Total Cholesterol = less than 200
Lipids less than 150 males and less than 135 females
Heart Placements
2nd intercostal right sternum = aorta valve
2nd intercostal left sternum = pulmonic valve
Erb’s point best s1 s2nsound is 3rd intercostal to left of sternum – Not required to identify in cpe
Tricuspid valve 4th intercostal space left of sternum
Mitral 5th intercostal space mid clavicular, apical under breast tissue.
Healthy heart Diet/Exercise = low fat low cholesterol low sodium diet, moderate regular exercise needs program regimen and increase omega 3, manage stress, and smoking cessation class or quitting
Cardiac
Topics: HTN, PAD, Amputation, DVT, CAD, HF, Ventricular Tachycardia, Ventricular Fibrillation, Sinus rhythm, Sinus bradycardia, Sinus Tachycardia. Don’t forget to review cardiac meds: ACE inhibitors, beta blockers, calcium channel blockers, cardiotonic (digoxin), diuretics (potassium sparing and non-sparing). Review labs such as cholesterol and lipid levels, aPTT, PTT and PT normal range and therapeutic levels, BNP, troponin level for CAD (to rule out MI). Review heart sounds/placement.
HTN – Persistent BP of 140/90 and above
•Pre-hypertension – what is it? What does it look like
•Hypertension oWhat are the risk factors? – modifiable vs non-modifiable
oWhat does it look like?
oHow is it treated?
Include addressing medication teaching, safety, such as, monitoring parameters and what to do.
•Malignant hypertension – What is it? What does it look like? How is it treated?
Hypertension – Normal Blood Pressure is 120/80
Prehypertension
1 NUR 242 Exam 4 Study Guidelines
•121-139 (systolic)
•81-89 (diastolic)
•Gets worse over time
Hypertension
•Persistent elevation of systolic or diastolic – NEEDS MORE THAN ONE READING TO DIAGNOSE needs a trend.
•What is the current standard???
•140 systolic
•90 diastolic
Type
•Primary (essential) – no obvious medical cause
•Secondary - caused by other conditions that affect the kidneys, arteries, heart or endocrine system
•Isolated systolic - caused by other underlying conditions, such as a leaky heart valve, or hyperthyroidism)
•Refractory - resistant high blood pressure despite treatment regimen
•Malignant - a sudden and rapid development of extremely high blood pressure with diastolic typically above 130
Pathophysiology of Hypertension
•Primary (essential) hypertension
–persistently elevated vascular resistance
•Secondary hypertension
–Renal and adrenal gland diseases
–Medications and foods
–Acute stress
Assessment
•More common in African-American
•Increases with age
•More common in men in early age
•Women after menopause
•Pregnancy
•Sometimes no symptoms until pt. comes in with stroke, MI, or seizures.
Manifestations
•Early stages—none
•Progressive stages
Headache
Fatigue and dizziness
2 NUR 242 Exam 4 Study Guidelines
Palpitations
Flushing
Blurred vision
Epistaxis
Syncope
•Syncope
•Postural hypotension
•Normal response when standing
•Syncopal response when standing
•Syncope management
Complications of Hypertension
MI
Stroke
Atherosclerosis
*Nephropathy
PVD (PAD)
Aortic aneurysms
Heart Failure
Hypertensive crisis
Hypertensive Crisis/ Malignant Hypertension
•Severe increase in B/P (diastolic > 130)
•May lead to stroke
•Organ damage
•May develop to left ventricular failure
Signs and Symptoms- that are life threatening .
•Restlessness
•LOC changes
•Seizures
•Blurred vision/Visual changes.
•Dizziness
•Severe Headache
•Agitation
•N/V
•Renal insufficiency
•Hemolytic anemia
•Left ventricular failure (LVF)
•Pulmonary Edema (PE)
•Pt can come in comatose Note Usually these are the patients that end up in ICU and need POTENT anti-hypertensive medications IV.
Medical Management/Treatment
•Revolves around 3 drug regimen:
Diuretics – decreases volume load—Need to monitor potassium levels hyper/hypokalemia monitoring is essential.
3 NUR 242 Exam 4 Study Guidelines
Beta blockers - by blocking the effect of norepinephrine and epinephrine, beta blockers reduce heart rate and dilate blood vessels ; might not be tolerated by persons with asthma, congestive heart
failure, depression or underlying fatigue ACE inhibitors – inhibit conversion of Angiotensin I to Angeiotensin II, therefore serves purpose of sodium excretion in urine
Ca++ channel blockers - block voltage-gated calcium channels in blood vessels causing less muscle contraction therefore increasing arterial diameter (usually given to people who cannot tolerate beta blockers, people with asthma, or depression slows heart rate and dilates blood vessels.)
Life style modification changes such as the Dash diet. Low sodium low fat, diet
Teach about potassium and salt substitutes Interventions
•Weight reduction
•Lifestyle modifications
•Dietary changes
•DASH diet - Dietary Approaches to Stop Hypertension; low sodium, saturated fat, cholesterol and total fat
•Client teaching
Exercise (helps increase HDL)
Alcohol restriction
Caffeine restriction
Relaxation techniques
Smoking cessation
Potassium supplementation
Pharmacologic interventions
PVD/PAD (Peripheral vascular disorder/Peripheral arterial disorder= They are the same. – Occlusion of peripheral arteries - insufficient blood supply
•What are the risk factors?
•What does it look like?
•How is it treated? (medical and surgical – revascularization)
•Post op care for fem-pop bypass surgery?
•What are the complications?
•Amputation
•Post op care Peripheral Arterial Disease and Deep Vein Thrombosis
Overview
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