Unit 3 Exam Study Guide PDF

UNIT 3 EXAM WEEK 7!!! **FIRST POWERPOINT: HTN AND HF** Hypertension (HTN) = Elevated Blood Pressure (BP) = Can Lead to Cardiovascular Disease (CVD) - - - Hypertension = Increased Vascular Tension of the force of blood pushing against the vessel walls - Cardiac Output = Systemic Vascul...

UNIT 3 EXAM WEEK 7!!! **FIRST POWERPOINT: HTN AND HF** Hypertension (HTN) = Elevated Blood Pressure (BP) = Can Lead to Cardiovascular Disease (CVD) - - - Hypertension = Increased Vascular Tension of the force of blood pushing against the vessel walls - Cardiac Output = Systemic Vascular Resistance (SV) X HR - if increased and CO stays constant or increases -- BP will increase - SV = blood pumped out of LV (70ml) - SV increases = increase BP - SV decreases = hypotension =increased SNS = vasoconstriction - PNS = decrease BP via the vagus nerve - Baroceptosr nerve cells in the aorta & carotid artery & brainstem communicate to regulate BP Vascular Endothelium = Single-Cell layer of blood vessels Important Function: - Platelet adhesion - Coagulation regulation - Immune function - Regulate Fluids in vessels & extracellular space - Damaged vascular endothelium can cause excessive vasoconstriction or dilation (smoking, DM) Calculate the mean arterial pressure (MAP): 118/70 MAP = (SBP + 2DBP) / 3 MAP = (140 + 2 x 80) /3= 100 mm Hg MAP \>65 is the goal = Best Perfusion - The initial goal is to decrease MAP by no more than 20% to 25% or to decrease MAP to 110 to 115 mm Hg. - Lowering the BP too quickly or too much may decrease cerebral, coronary, or renal perfusion. A rapid decrease could cause a stroke, MI, or renal failure. **[Hypertension: Risk Factors]** **Modifiable** Alcohol/tobacco Diabetes\* Obesity HLD Sedentary lifestyle Stress Salt Intake \*\*Decrease can Decrease BP for some people easily\*\* **Nonmodifiable** Ethnicity Gender: Male Higher Risk Factor Females after menopause Age [Hypertension: Health Equity] Breaking down the risk factors: - Black populations have the highest prevalence in the world - develop at a younger age - Higher incidence among women than men - Highest death rate - Hispanic populations are less likely to receive treatment - Have lower rates of BP control - Have lower levels of awareness of HTN and treatment **[Hypertension: Clinical Manifestations]** "Silent killer" -- asymptomatic until severe or target organ disease occurs - Fatigue -- these symptoms pull back to our perfusion content - Dizziness - Palpitations - Angina (pain) - Dyspnea - Target organs: highly sensitive, brain, kidneys, eyes, heart [Hypertension: Complications] - Coronary Artery Disease (CAD) - Left Ventricular Hypertrophy (LVH) - Heart Failure (HF) - Atherosclerosis (plague arteries) - Stroke with mild HTN x 4 Risk! - Increase Peripheral Vascular Disease (PVD) = Peripheral Artery or Veinous Disease (PAD or PVD) - CKD Renal System How it Affects & Controls BP, HTN, Cardiac, The Human Bodies Homeostasis: - - - - - - Diagnostics HTN: Diagnostics: rule out other problems and cause - Extensive H&P - Urinalysis (BUN, Cr) Renal Function - Blood sugar - CBC/BMP - Lipid profile (total lipids, triglycerides, HDL and LDL cholesterol, total-to-HDL cholesterol ratio) - ECG - What is "good" cholesterol? What is "bad" cholesterol? Hypertension: Interprofessional Care: Nursing Goal: health promotion in all populations across the community: promote adherence to monitoring, treatment, and f/u - Eat better: Dash (dietary approaches to stop HTN) low fat, whole grains, fish, poultry, beans, decrease Na 2300mg/day or less (right now average is 4200) - Be active: 30 mins/day x 5 days - Quit tobacco/alcohol - Sleep - Weight management: every kg lost = 1mmhg down - Control cholesterol - Manage blood sugar - Manage BP - HOW: Education Hypertension: Pharmacology - Remember: Anything that affects our cardiac output OR systemic vascular resistance will affect blood pressure - Diuretics: affect stroke volume: s/e: voiding - ACEI/ARBS: cardiac output (prils/sartans) - Beta Blockers: heart rate: libido/ED - Ca Channel blockers: SVR (dipine) - Remember: combo medications are common - Nursing considerations: Check BP and HR before administration, monitor for OHTN, know parameters and route/absorption, promote adherence - Older adults: more sensitive to side effects, especially hypotension - Goal: use non-pharmacology and 1 pharm for the first line, then introduce the second depending on stage and response - - Clonidine, guanfacine, methyldopa =educate sedation, dry mouth, bedtime take. - α1-Adrenergic Blocker: vasodilation: doxazosin (Cardura), phentolamine =educate orthostatic hypotension, bedtime take. - - - Hypertensive Crisis- how did we get here? Lack of education/adherence - Definition: SBP \>180mmHg and/or DBP \>120mmHg - Urgency: no target organ disease - Emergency: target organ disease - Encephalopathy -- swelling of the brain - Brain hemorrhage - MI, HF, - ARF -- renal failure - Aortic aneurism -- bursting of the aorta - Retinopathy -- Manifestations: encephalopathy r/t HTN - Severe headache - Nausea - Vomiting - Seizures - Confusion - Coma Management - Hospitalization of an IV antiHTN - Monitor BP and MAP with arterial line - Assess hourly urine output - Slowly lower to avoid stroke, renal failure and HF KNOW TH NURSING ASSESSMENT FOR HYPERTENSION ON CHART 36.10 IN THE BOOK  Hyperlipidemia --Lewis 827, 828 - Elevated total cholesterol = Lipid Profile - Start assessing at 20 years old every 5 years - CAD, genetics, DM 1-2 years - Tx focus on lower the LDL levels keep under 70 mg/dl high-risk clients - LDL less than 130mg/ml for low-risk CAD - Atorvastatin, Niacin, Simvastatin (zocor) - Inhibit cholesterol synthesis in the liver & Increase the number of LDL receptors. - Rosuvastatin (Crestor) --most given---s/e rare---liver damage, myalgia (muscle weakness) that could become rhabdomyolysis breakdown of skeletal muscles. - Lifestyle modifications can improve Lipid profiles Heart Failure: HTN Definition: inability of the heart to provide sufficient blood to meet the oxygenation needs of the body (central perfusion problem) - Normal LVEF is 55% to 65% (left ventricular ejection fraction). - Left-sided HF- most common - Systolic (LV) failure - Ejection fraction \94% - Lung sounds, skin vitals - Assess dyspnea/sob/orthopenea - Monitor amount and characteristics of sputum - Monitor mental status Patient safety - Nocturia - Weak - Mental status changes Nutrition - Na+ restricted diet - Dietary indiscretion is one of the of the most frequent causes of exacerbation - Fluid restriction Mobility - Conserve energy; individualize CHAPTER 36,38,41 -- LEWIS STUDY GUIDE QUESTIONS AND ANSWERS **SECOND PP -- STROKE PRESENTATION** Perfusion Ischemic Strokes (blockage =Thrombosis or Embolism) Embolic Stroke: - Traveling blood clots from the heart or body - 15% cause Atrial Fibrillation - 60-70% Thrombotic Stroke: - Brain clot (cerebral) - HTN, high cholesterol, arteriosclerosis, plaque, DM - Ischemic strokes = 87% Transient Ischemic Attack (TIA) -- when blood flow to the brain is temporarily blocked. A blood clot, narrow blood vessels, and restricted blood flow from the carotid arteries are the common causes. - Can lead to a Stroke - Same Symptoms of a Stroke - Neurological Assessment - Last \< 1 hour - Risk factors same as Strokes - Emergency! Ischemic Stroke Causes - \#1 HTN - Cardiac abnormalities: A fib, Heart defects (septal or ventricular) HF - Cholesterol -- high HDL - Birth control - DM - Obesity - Lifestyle - Alcohol use disorder - Genetics - AFIB = "p" waves buried KNOW HIK STROKE SCALE CVA signs and symptoms: - Numbness or weakness in the face, arm, or leg, especially on one side of the body - Confusion or trouble, speaking or understanding speech - Troubles, seeing in one or both eyes - Trouble walking, dizziness, or problems with balance - Severe headache with no known cause - Do a non-contrast computerized tomography (CT head) stat FAST: - Face troops - Arm weakness - Speech difficulty - Time is critical to decrease disability and prevent death What is the number one cause of stroke? What education would a nurse teach to prevent strokes? What is the difference between ischemic thrombotic and embolic stroke? How will you perform a neurological assessment? - ISCHEMIC STROKE IS A BRAIN BLOCKAGE - HEMORRHAGIC STROKE IS A BRAIN BLEED - BRAIN LOCATION, LOCATION + TIME = DISABILITY Do you want to teach in the community about stroke signs and symptoms? What would you teach? How would you teach? CVA (Stroke) Protocol & Treatment ED Door to Needle Time \< 60 minutes - Imaging: CT to rule out hemorrhage \180 mm hg, assess for improved V.S & LOC, hemorrhaging? - No heparin therapy can cause a bleed! - Caution: aspirin, high dose, even after stable with G.I. Issues = (peptic ulcers) Ischemic stroke medications - Antiplatelets make platelets slipper, non-clot together - Aspirin 81 mg (AGGRENOX) often with dipyridamole (persantine) - Ticlopidine or Clopidofrel (plavix) warning hold for surgery ten to 14 days prior - Atrial fibrillation add: warfarin (Coumadin), rivarozaban (Xarelto), dabigatran (Pradaxa), or apixaban (eloquis) - Statins (Simvastatin, lovastatin) - Not hemorrhage strokes! Different medications, different timing What is TPA? who is a candidate? medication's for ischemic stroke and why? what will be the nursing and interdisciplinary care? Interventions for strokes: - Trans. Luminal, angioplasty, balloon, and stents improve blood flow. - Stable, suture, and clips to close blood flow - Carotid endarterectomy remove artheromatous lesion Safe oral intake -- - swallow and gag evaluation by RN or speech therapist - Can eat need to sit up high flowers in a chair stay upright for 30 minutes after eating - Feed on non-affected side - Play food in line of vision - Tuck chin slightly - Eat with no distractions - Doubles swallow - Oral hygiene after eating often, helps prevention aspiration, and stimulates the mouth - Nutritional list will determine types and consistency or food What are the primary secondary and tertiary prevention of ischemic stroke? (CVA) What will the nursing education and care? Stroke complications -- - Ventilator - Aspiration in suctioning - Sepsis - Oral care every two hours - Internal nutrition - Breathe, gagging swallow - Ongoing neural assessment - Cardiac pulmonary renal - Mental health - Family changes  Goal: assess and start rehabilitation within 24 to 72 hours of stable Right CVA: - Left-sided neglect impulse spatial mobility issues - Dress left-sided first wash left sided first Left CVA: - Slower - Fearful - Anxiety - Vision issues Aphasia - an impairment of language, it may affect the ability to speak to read to write to comprehend people with aphasia caused by a stroke or brain injury, have a language disability, not a cognitive or intellectual disability. stroke, risk factors and prevention \#1 hypertension: Nonmodifiable risk factors: age. Genetics, heritage (blacks, Asian) Modifiable: cause 90% of strokes - Obesity, smoking, sleep apnea, no exercise, for nutrition, bad lifestyle, habits, hypertension, heart disease, diabetes, blood clot disorders, sickle cell, inflammatory disease (rheumatoid arthritis) - Systolic pressure goal = \