CARDIAC OUTPUT

 is the volume of blood pumped by the heart per minute (mL blood/min). Cardiac output is a function of heart rate and stroke volume.

HEART RATE

is simply the number of heart beats per minute

PRELOAD

is the pressure stretching the ventricle of the heart,^[1] after passive filling of the ventricle and subsequent atrial contraction. If the chamber is not mentioned, it is usually assumed to be the left ventricle.

AFTERLOAD

 is used to mean the tension produced by a chamber of the heart in order to contract.^[1] If the chamber is not mentioned, it is usually assumed to be the left ventricle

SYSTOLE

THE CONTRACTION OF THE HEART, DURING WHCH BLOOD IS PUMPED INTO THE ARTERIES

DIASTOLE

EXPANSION OF THE HEART ON EACH BEAT; THE RHYTHMIC EXPANSION OF THE CHAMBERS OF THE HEART AT EACH HEARTBEAT, DURING QHICH THEY FILL WITH BLOOD

CORONARY ARTERIES

are the vessels which bring the blood to the heart muscle.

PVR

a resistance to the flow of blood determined by the tone of the vascular musculature and the diameter of the blood vessels. It is responsible for blood pressure when coupled with stroke volume.

ANTI EMBOLIC STOCKINGS

are designed specifically for bed bound (non-ambulatory) patients to help prevent blood from pooling in the veins of the leg. Pooling of blood in the veins of the leg may contribute to blood clots forming in the veins.

Anti-embolism stockings are generally made for short duration of wear during a hospitalization.

SEQUENTIAL COMPRESSION DEVICES

, (also known as Lymphodema pumps) are designed to limit the development of Deep Vein Thrombosis (DVT) and Peripheral Edema in immobile patients. When a patient is immobile for long periods of time, as in recuperation from an injury, blood tends to pool in the calf area of the lower leg

INFARCTION

AN AREA OF TISSUE THAT HAS RECENTLY DIED AS A RESULT OF THE SUDDEN LOSS OF ITS BLOOD SUPPLY, E.G. FOLLOWING BLOCKAGE OF AN ARTERY BY A BLOOD CLOT

MEN

HYPERTENSION

SYSTOLIC ( HEART EJECTS BLOOD INTO THE PULMONARY AND SYSTEMATIC CIRCULATIONS)

BLOOD PRESSURE OF 140 OR HIGHER OR DIASTOLIC (VENTRICLES FULL WITH BLOOD) PRESSURE OF 90 OR HIGHER ( 3 TIMES AT SEPARATE OCCASIONS)

PRE-HYPERTENSION

BLOOD PRESSURE IS

120-139/ 80-89

AFRICAN AMERICAN 

WHAT RACE ARE MOST RISK FOR HYPERTENSION?

JNCVI

COMMITTEE CREATED TO PREVENT, DETECT, AND EVALUATION AND TREATMENT FOR HTN TO DECREASE DEATH

IF PATIENT HAS A HIGH BLOOD PRESSURE, DO ASSESSMENT, AND IF HISTORY OF HIGH BLOOD PRESSURE, GIVE MEDICATION AND SEND HOME.

WHAT DO YOU DO FIRST IF PT. HAS HIGH BLOOD PRESSURE?

HYPERTENSION

EXCESS PRESSURE IN ARTERIAL PORTION OF SYSTEMATIC CIRCULATION

EPICARDIUM

THE HEART OUTER MOST LAYER

MYOCARDIUM

THE CARDIAC MUSCLE CELLS THAT FORM THE BULK OF THE HEART CONTRACT WITH EACH BEAT. PATIENTS WITH HTN, GETS BIGGER BECAUSE HEART PUMPING SO MUCH

ENDOCARDIUM

LINES THE INSIDE OF THE HEART'S OF THE HEART'S CHAMBER AND GREAT VESSELS

FROM THE BODY-> SVC-> RA-> THROUGH THE TRICUSPID VALVE-> RIGHT VENTRICLE-> THROUGH THE PULMONIC VALVE-> PULMONARY ARTERY-> DEOXYGENATED BLOOD TO THE LUNGS (PICK UP O2)-> PULMONARY VEINS-> LA-> THROUGH THE BICUSPID VALVE-> LV-> AORTIC VALVE->AORTA-> HEART

CIRCULATION OF BLOOD?

MURMUR SOUND

CARDIAC OUTPUT

AMOUNT OF BLOOD EJECTED FROM THE HEART WHEN IT PUMPS. ( IF IT PUSHES OR COME OUT)

PVR

(PERIPHERAL VASCULAR RESISTANCE)

AWAY FROM THE HEART- RESISTANCE OF THE FLOW OF BLOOD DETERMINED BY THE VISCOSITY OF THE BLOOD, LENGTH AND DIAMETER OF THE BLOOD VESSEL. l

LOTS OF PRESSURE AGAINST PERIPHERY-HTN

PRELOAD

BLOOD RETURNS TO THE HEART FROM THE SVC, POUR INTO THE HEART (RIGHT ATRIUM) AND THE HEART STETCH IS THE TENSION. THE STRETCH AFTER THE BLOOD FLOWS INTO THE RA.

AFTERLOAD

RESISTANCE AGAINST WHICH THE HEART MUST PUMP TO EJECT THE BLOOD.

AFTERLOAD 

(AWAY FROM THE HEART)

HYPERTENSION IS RELATED TO AFTERLOAD OR PRELOAD?

IT SHOULD BE SLOW. 45 BEATS/MIN IS GOOD FOR PEOPLE WHO EXERCISE

IF YOU EXERCISE A LOT WOULD YOUR HEART

BE FAST OR SLOW?

MORE PRESSURE

FOR VESSEL LENGTH THE LONGER  NEED MORE PRESSURE OR LESS PRESSURE?

BLOOD VISCOSITY

THICKNESS OF BLOOD

HIGH

IF YOU HAVE A THICK BLOOD,

WOULD YOU BP BE HIGH OR LOW

COMPLIANCE

ABILITY TO STRETCH

DECREASE

MORE FATTY FOODS AND SMOKING 

WOULD DECREASE OR INCREASE COMPLIANCE?

INCREASE

MORE FATTY FOODS AND SMOKING

WOULD INCREASE OR DECREASE PRESSURE?

SYMPATHETIC NERVOUS SYSTEM

THIS SYSTEM CAUSES VASOCONSTRICTION AND INCREASES THE HEART RATE AND BLOOD PRESSURE.

IT OPEN LUNGS, I.E. ANGER, MOOD, STRESS

BETA BLOCKERS

ANYTHING THAT ENDS OLOL

WHAT KIND OF DRUGS THAT CAN BLOCK SNS STIMULATION AND TREAT HIGH BP?

RENNIN

WHAT PRODUCES IN THE KIDNEY,

WHEN THE BP IS LOW TO INCREASE THE BLOOD PRESSURE

Ach inhibitors

BLOCK ANGIOTENSIN TO ANGIOTENSIN II

Angiotensin Retention blockers (ARB)

all end in RTAN to decrease blood pressure.

Aldosterone and (ADH) antidiuretic hormone

hormone that increase blood pressure which promote sodium and water retention. 

Give diuretic 

 medicine that decrease blood pressure because it eliminates water (make you pee, which lowers the volume and less pressure.  

Etiology and Classification

1.      Idopathic- most common- 90% (don’t know the cause)

2.      Systolic HTN if upper number is higher

3.      Diastolic HTN if lower number is higher

4.      White Coat- bp goes up when see doctors with white coats.

5.      Pre-hypertension- 120-139/80-89

6.      Secondary HTN- very bad, there is a cause, very elevated bp.

·         Kidney disease most identifiable cause of high blood pressure.  Disruption of blood supply will stimulate rennin (low BP) which will àangiotensin IàAngiotensin IIàincrease B.P.

7.      Malignant- bp never come down

ETIOLOGY AND CLASSIFICATION OF HYPERTENSION

Risk Factors for hypertension

RISK FACTORS OF HYPERTENSION

·         Headache, tinnitus (ringing in the ears), fatigue, retinal changes (visual disturbances), palpation, Nose/Vomit nose bleeds (epistaxis).

·         Decreased CO-CP, MI, diaphoresis, SOB,CHF

SUBJECTIVES (SIGNS OF HTN)

·         Elevated BP

·         Erectile dysfunction (ED)

·         Epistaxis- nose bleeds

·         Cardiac hypertrophy- shift of point of maximum impulse (PMI)

·         Sexual organs

·         Absent or presence of target organ damage, brain, Kidneys, heart, liver, sexual organs, everything goes down- Target organs

OBJECTIVES (SYMPTOMS OF HTN)

Assessment

Blood pressure/heart rate-

·         Orthostatic B/P- laying, sitting, standing

·         Before medication- check the bp before pulling medication and right before administer medication bc patient can change their bp from laying to walking.

Equipment

·         Proper cuff size- bigger cuffs for bigger clients, ok to delegate but for new students do it yourself

·         Weight

·         Horman’s sign- DVT- lovenox- blood thinner.

ASSESSMET FOR HTN

Diagnostic Tests

·         ECG-non invasive

·         Holt monitor- non invasive

·         Urinalysis

·         Blood glucose

·         Hematocrit- influence viscosity, increase viscous blood will increase bp

·         Serum potassium, creatinin, and calcium

·         Cholesterol and lipoprotein including HDL (good fats) and LDL (bad fats), and triglycerides

DIAGNOSTIC TESTS FOR HYPERTENSION

Nursing diagnosis

·         Sexual dysfunction

·         Denial, anxiety, defensive coping, grief

·         Knowledge deficit

·         Noncompliance

·         Decrease cardiac output

·         Impaired tissue perfusion

NURSING DIAGNOSIS FOR HTN

·         Avoid target organ damage, no edema

·         Pt will check and maintain desire bp

·         Pt will experience no unpleasant side effects of meds (such as beta blockers-erectile dysfunction)

·         Pt will verbalize three ways to decrease stress.

GOALS FOR HTN

1.      Monitor electrolytes, bun, creatinine

2.      Sodium- for client with low low bp, give salt water to increase bp. 

3.      Potassium- Normal 3.5-5.5.  Too much K in body, give Keylon bc Too much potassium can cause cardiac arrest. If potassium level too high, give diuretic bc potassium follows water. 

4.      Weight, maintain weight or lower if obese

5.      Encourage client to relax, change diet, exercise most days of the week.

6.      Potassium chloride is a salt substitution

7.      Don’t give pt false reassurance, don’t ignore them, encourage more feelings so they can tell you more

NURSING INTERVENTION FOR HTN

·         DASH- Dietary approaches to stop hypertension- eat grains 7-8 servings per day, veg, fruits, non-fat. 

Medication

·         Ace inhibitors block conversion of AI to AII by inhibiting action of angiotensin converting enzyme. Block the enzyme. Prevents vasoconstriction.

Side effects: Cough non productive take them off and give

·         ARBs (angiotensin retention blockers) - blocks AII receptors.  no side effects (more exspensive)

·         Beta Blockers- (adrenergic response ends in OLOL) block sympathetic (blocking the heart), decrease heart rate, lungs- bronchospasm, don’t give to asthma or obstructive pulmonary disease patients.  Propanolol, metoprolol.  Decrease bp and pvr and co.

·         Calcium channel blockers- vasodilation- wll decrease bp- will block calcium channel in the muscle. Side effect is EDEMA.

NURSING INTERVENTION FOR HTN

Diuretics

Major side effects: Work in the loop of henle, in which water is eliminated and potassium follows water, so do not give diuretics if potassium level is low.  Normal level is 3.5-5.5.

1.      Lasix- is very strong, and patients will refuse to take because they will be running to the restroom, will give in the hospital for a short period of time.  Have to take potassium bc its soo strong and will take away lots of potassium.

2.      HCTZ  (Diuril)- helps decrease sodium.  It prevents reabsorption.  It takes away potassium, but at mild version.

Give potassium replacement to both lasis and HCTZ medications.

3.      Aldactone- potassium sparing.  Potassium stays, it doesn’t go way, and sodium follows water. 

Hypokalemia and weakness of arrhthymias- heart skips a beat, irregular heart beat, going too fast.  Give foods high in potassium, bananas, tomatoes, cantelope

Hyperkalemia (too much calcium)- Give Kayexalate or insulin IV (K moves into the body with glucose and insulin. 

SIDE EFFECTS OF DIUERETICS

Calcium channel blockers

SIDE EFFECT- EDEMA!!!!

Vasodilation- decrease bp, hypotension.  It inhibits the flow of calcium ions across the cell membrane of vascular tissue and cardiac cells, which relax arterial smooth muscle, lowering peripheral resistance through vasodilatation. 

·         Nifedipine- sublingual/ by mouth (PO). Watch patient to make sure bp doesn’t decrease too much. 

May impair cardiac function by worsening heart failure.  Do not give to patients with hypotension.  Side effects is constipation so drink lots of fluids and high in fiber food. 

·         Diltiazem- reduce stroke volume and cardiac output.

·         Verapamil- may impair cardiac function , worsening heart failure. 

SIDE EFFECTS OF CALCIUM CHANNEL BLOCKERS

ACE inhibitors end in PRIL

Do not give to pregnant patients!!!

When blood pressure is low, rennin is produced by the kidney and renninàAngiotensin IàAngiotensin II, which is a vasoconstrictor, it also promotes sodium and water retention and will increase b.p.

Ace inhibitors block the conversion of AI to AII and

All end in PRIL. . . enalapril, captopril, ramipril (Side effects, cough, so give ARB)-Angiotensin retention blockers- Losartan. 

Interventions

·         Id current behaviors that contribute to hypertension, include the family by using the knowledge of risk factors such as age, smoking, stress, diet, obesity.

·         Develop realistic short term goals for non-compliance clients and increase knowledge of HTN. 

Secondary Hypertension

Elevated bp resulting from an identifiable underlying process such as kidney disease. 

ACE INHIBITORS

INTERVENTIONS AND SIDE EFFECTS