Human Processes 3 Exam Revision - Cardiovascular Disorders PDF

**Human Processes 3 -- Exam** Thursday 07 Nov 2024 *Revision* **Module 2: Cardiovascular Disorders** [Non-modifiable risk factors] - Age (\>65 years) - Sex (Men \65 years) - Family history - Ethnicity (Higher prevalence in African, Indigenous and South Asian) [Modifiable risk factor...

**Human Processes 3 -- Exam** Thursday 07 Nov 2024 *Revision* **Module 2: Cardiovascular Disorders** [Non-modifiable risk factors] - Age (\>65 years) - Sex (Men \65 years) - Family history - Ethnicity (Higher prevalence in African, Indigenous and South Asian) [Modifiable risk factors] - Hypertension, cholesterol levels, diabetes, pre-diabetes, smoking, obesity, high salt or low potassium diet, lack of exercise, chronic stress **Hypertension** A chronic medical condition in which the force of the blood against the walls of the arteries is elevated, increasing the risk of cardiovascular events such as myocardial infarction, cerebrovascular accident and CKD. +-----------------------+-----------------------+-----------------------+ | **Category** | **Systolic BP | **Diastolic BP | | | (mmHg)** | (mmHg)** | +=======================+=======================+=======================+ | Normal BP | -- | \< 80 | | | -- | | | | | | | | \10 mmHg difference may indicate vascular disease). - Ambulatory BP Monitoring (ABPM) may be used to confirm diagnosis. [Comprehensive Assessment] - History: Family history of hypertension or cardiovascular diseases, lifestyle habits (diet, exercise, smoking, alcohol). - Physical Assessment: Check for signs of end-organ damage (e.g., chest pain, vision changes, oedema). - Nursing Diagnoses: - Ineffective Health Maintenance - Risk for Decreased Cardiac Output - Risk for Stroke - Fluid Volume Excess related to impaired renal function **Management** [Lifestyle modifications ] - DASH Diet (Dietary Approaches to Stop Hypertension): High in fruits, vegetables, low-fat dairy, whole grains, low in Na+ and saturated fats - Sodium restriction: Aim for \ - Vasodilation - Decreased BP - Reduced fluid retention **Indications:** - Hypertension - Heart failure - reduce the workload on the heart - Post-myocardial infarction - improves heart function - Chronic kidney disease (CKD) -- slows progression -- especially in diabetic pt **Adverse effects:** - Cough (due to bradykinin buildup) (may switch to ARB if persists) - Hyperkalaemia (high potassium levels) - Hypotension (especially after the first dose) - Headaches - Loss of taste - Angioedema (Rare but serious swelling of the lips, tongue or throat) - Renal Impairment (monitor kidney function) **Contraindications:** - Pregnancy - Bilateral renal artery stenosis - History of angioedema - Allergy - Very low BP - Hyperkalaemia **Nursing Considerations:** - Monitor BP and potassium levels - Advise pt to avoid potassium supplements or rich foods - Educate about first-dose hypotension -- take dose at bedtime - Renal function should be periodically checked **Angiotensin II receptor blockers (ARB)** *Root: SARTAN (Irbesartan, Losartan)* - Block the receptors for angiotensin II - Prevent vasoconstriction and reduce aldosterone release - Decreases BP and fluid retention - Unlike ACE inhibitors, ARBs do not increase bradykinin levels, less likely to produce a cough **Indications:** - Hypertension - first-line treatment or alternative to ACE inhibitors - Heart failure - especially when ACE inhibitors are not tolerated - Chronic kidney disease (CKD) -- reduces progression in diabetic nephropathy - Post-myocardial infarction -- improves heart function **Adverse effects:** - Hyperkalaemia - Hypotension (especially after the first dose) - Dizziness/light-headedness - Renal impairment (monitor kidney function) - Angioedema (rare but possible) **Contraindications**: - Pregnancy - Bilateral renal artery stenosis - History of angioedema - Hyperkalaemia - Allergy **Nursing considerations:** - Monitor BP and potassium levels - Assess renal function (creatinine and GFR) - Educate pt to avoid potassium supplements or high-potassium foods - Educate first-dose hypotension -- take before bed - Alternative to ACE inhibitors: used if pt experiences cough **Calcium channel blockers (CCBs)** 1. [Dihydropyridines (DHPs) ] *Root: IPINE (Amlodipine, Nifedipine)* - Blocks calcium channels in the vascular smooth muscle of blood vessels, causing vasodilation and lowering BP - Less effect on heart rate or myocardial contractility, so mainly used for hypertension and angina. 2. [Non-Dihydropyridines (Non-DHPs)] *Verapamil, Diltiazem* - More effect on heart -- reduce heart rate and cardiac contractility by acting on calcium channels in the myocardium and SA/AV nodes. - Used to treat arrhythmias (AF), angina and sometimes hypertension (less often) **Indications:** - Hypertension - Angina pectoris - Arrhythmias (non-DHPs) - Raynaud's phenomenon (DHPs) - Migraine (Verapamil) **Adverse effects:** [Dihydropyridines (DHPs)] - Peripheral oedema (swelling in legs, and ankles) - Flushing and dizziness - Headache - Reflex tachycardia [Non-Dihydropyridines (Non-DHPs)] - Bradycardia (slow heart rate) - Heart block (disruption of electrical signals in the heart) - Constipation (especially Verapamil) - Worsening heart failure (due to reduced contractility) **Contraindications:** - Non-DHPs -- avoid heart failure and bradycardia - Severe hypotension - Use caution in pts on beta-blockers (risk of excessive bradycardia) **Nursing considerations:** - Monitor BP and HR - Assess for peripheral oedema (common with DHPs) - Advise pt to change positions slowly to avoid dizziness - Avoid grape juice -- can increase levels of some CCBs, leading to toxicity - Educate pt about signs of hypotension (dizziness, fainting) **Beta-adrenergic receptor inhibitors (beta blockers)** *Root: OLOL (Atenolol, Metoprolol)* 1. Cardioselective (β1-specific): - Atenolol - Metoprolol - Bisoprolol - Esmolol 2. Non-Selective (β1 and β2): - Propranolol - Nadolol - Timolol 3. Mixed (α and β Blockers): - Carvedilol - Labetalol - Block beta-adrenergic receptors (mainly 1 receptor in the heart) - Reduces HR (negative chronotropic) - Decrease cardiac output (CO) because of the lower HR and contractility - Lowers BP by reducing the heart's workload and the amount of blood being pumped How this works: 1. Beta-blockers slow the heart, giving it more time to fill with blood 2. CO = HR x Stroke Volume (SV), a lower HR leads to decreased CO 3. With lower HR and decreased force of contraction, BP decreases. β1 receptors (Cardio selective) (in the heart): Reduce heart rate, force of contraction, and cardiac output. β2 receptors (in the lungs and blood vessels): Cause bronchoconstriction and vasodilation inhibition (non-selective blockers affect both β1 and β2). **Reduces sympathetic nervous system activity**, leading to: - **Decreased heart rate (negative chronotropy)** - **Decreased force of contraction (negative inotropy)** - **Lower blood pressure** and reduced myocardial oxygen demand. **Indications:** - Hypertension - Heart failure - Post-myocardial infarction - Arrhythmias - Angina - Migraines - Glaucoma - CAD - Tachycardia - Some types of tremors **Adverse effects:** - Bradycardia - Hypotension - Fatigue and dizziness - Bronchospasm - Erectile Dysfunction - Cold extremities - Masks hypoglycaemia symptoms (caution in diabetic pts) - Weight gain **Contraindications:** - Asthma or COPD (non-selective beta-blockers may cause bronchoconstriction) - Bradycardia or heart block - Severe hypotension - Hypoglycaemia - Heart failure **Nursing Considerations:** - Monitor HR and BP before administration. Hold if HR \