TYPES OF BLOOD PRESSURE MEDICATIONS

Diuretics Diuretics help the body get rid of excess sodium (salt) and water and help control blood pressure. They
are often used in combination with additional prescription therapies.
Beta-blockers Beta-blockers reduce the heart rate, the heart's workload and the heart's output of blood, which lowers
blood pressure.
ACE inhibitors Angiotensin is a chemical that causes the arteries to become narrow, especially in the kidneys but also
throughout the body. ACE stands for Angiotensin-converting enzyme. ACE inhibitors help the body
produce less angiotensin, which helps the blood vessels relax and open up, which, in turn, lowers
blood pressure.
Angiotensin II These drugs block the effects of angiotensin, a chemical that causes the arteries to become narrow.
receptor blockers Angiotensin needs a receptor- like a chemical "slot" to fit into or bind with- in order to constrict the
blood vessel. ARBs block the receptors so the angiotensin fails to constrict the blood vessel. This
means blood vessels stay open and blood pressure is reduced.
Calcium channel This drug prevents calcium from entering the smooth muscle cells of the heart and arteries. When
blockers calcium enters these cells, it causes a stronger and harder contraction, so by decreasing the calcium,
the hearts' contraction is not as forceful. Calcium channel blockers relax and open up narrowed blood
vessels, reduce heart rate and lower blood pressure.
Alpha blockers These drugs reduce the arteries' resistance, relaxing the muscle tone of the vascular walls.
Alpha-2 Receptor These drugs reduce blood pressure by decreasing the activity of the sympathetic (adrenaline-
Agonists producing) portion of the involuntary nervous system. Methyldopa is considered a first line
antihypertensive during pregnancy because adverse effects are infrequent for the pregnant woman or
the developing fetus.

RAAS SYSTEM
The renin-angiotensin-aldosterone system (RAAS) plays an important role in regulating blood volume and systemic vascular
resistance, which together influence cardiac output and arterial pressure. As the name implies, there are three important
components to this system: 1) renin, 2) angiotensin, and 3) aldosterone. Renin, which is released primarily by the kidneys,
stimulates the formation of angiotensin in blood and tissues, which stimulates the release of aldosterone from the adrenal cortex.

Renin is a proteolytic enzyme that is released into the circulation by the kidneys. Its release is stimulated by:
• sympathetic nerve activation (acting through β1-adrenoceptors)
• renal artery hypotension (caused by systemic hypotension or renal artery stenosis)
• decreased sodium delivery to the distal tubules of the kidney

Juxtaglomerular (JG) cells associated with the afferent arteriole entering the renal glomerulus are the primary site of renin storage
and release. A reduction in afferent arteriole pressure causes the release of renin from the JG cells, whereas increased pressure
inhibits renin release. Beta1-adrenoceptors on the JG cells respond to sympathetic nerve stimulation by releasing renin.
Specialized cells (macula densa) of distal tubules lie adjacent to the JG cells of the afferent arteriole. The macula densa senses the
concentration of sodium and chloride ions in the tubular fluid. When NaCl is elevated in the tubular fluid, renin release is
inhibited. In contrast, a reduction in tubular NaCl stimulates renin release by the JG cells. There is evidence that prostaglandins
(PGE2 and PGI2) stimulate renin release in response to reduced NaCl transport across the macula densa. When afferent arteriole
pressure is reduced, glomerular filtration decreases, and this reduces NaCl in the distal tubule. This serves as an important
mechanism contributing to the release of renin when there is afferent arteriole hypotension, which can be caused by systemic
hypotension or narrowing (stenosis) of the renal artery that supplies blood flow to the kidney.

When renin is released into the blood, it acts upon a circulating substrate produced by the liver, angiotensinogen, that undergoes
proteolytic cleavage to form the decapeptide angiotensin I. Vascular endothelium, particularly in the lungs, has an enzyme,
angiotensin converting enzyme (ACE), that cleaves off two amino acids to form the octapeptide, angiotensin II (AII). Note that
many other tissues in the body (heart, brain, vascular) also can form AII.

Angiotensin II has several very important functions:

• Constricts resistance vessels (via AII [AT1] receptors) and increases systemic vascular resistance and arterial pressure
• Stimulates sodium transport (reabsorption) at several renal tubular sites, increasing sodium and water retention by the
body
• Acts on the adrenal cortex to release aldosterone, which acts on the kidneys to increase sodium and fluid retention
• Stimulates the release of vasopressin (antidiuretic hormone, ADH) from the posterior pituitary, which increases water
retention by the kidneys
• Stimulates thirst centers within the brain
• Facilitates norepinephrine release from sympathetic nerve endings and inhibits norepinephrine re-uptake by nerve
endings, enhancing sympathetic adrenergic function
• Stimulates cardiac hypertrophy and vascular hypertrophy
The renin-angiotensin-aldosterone pathway is not only regulated by the mechanisms that stimulate renin release, but it is also
modulated by natriuretic peptides released by the heart. These natriuretic peptides act as an important counter-regulatory system.
CAP VS. HAP
CAP is the abbreviation for Community Acquired Pneumonia and is used to define pneumonia that develops within 48 hours of
admission to hospital. HAP is the abbreviation for Hospital Acquired Pneumonia and defines pneumonia that develops > 48 hours
post admission to hospital. It is also called nosocomial pneumonia.

MODERATE RISK PNEUMONIA

People with mild pneumonia can be treated at home and are given antibiotics in tablet form.

The signs of moderate pneumonia include drowsiness and confusion, low blood pressure, worsening shortness of breath, and risk
factors such as old age and underlying diseases. People with these symptoms need to have treatment at a hospital. Some will be
given a combination of two different antibiotics, at least at the beginning of the treatment.

Pneumonia is classified as severe when the heart, the kidneys or the circulatory system are at risk of failing, or if the lungs can no
longer take in enough oxygen. Treatment with an antibiotic infusion in intensive care is then usually needed, sometimes with
artificial respiration or additional drugs such as corticosteroids.

Pneumonia in children is only classified as either “not severe” or “severe.”

ACCESS OF HEMODIALYSIS
1. Fistula: an access made by joining an artery and vein in your arm.
2. Graft: an access made by using a piece of soft tube to join an artery and vein in your arm.
3. Catheter: a soft tube that is placed in a large vein, usually in your neck.
A central venous catheter (CVC) is a type of access used for hemodialysis. Tunneled CVCs are placed under the skin and into a
large central vein, preferably the internal jugular veins. CVCs are meant to be used for a short period of time until a more
permanent type of dialysis access has been established. The advantage of central venous catheter is their ability to be inserted
quickly, easily and that allow immediate access for haemodialysis.

GFR TEST

CYTOKINES
Cytokines are signaling proteins that help control inflammation in your body. They allow your immune system to mount a defense
if germs or other substances that can make you sick enter your body. Too many cytokines can lead to excess inflammation and
conditions like autoimmune diseases.

PNEUMONIA BACTERIA
The typical bacteria which cause pneumonia are Streptococcus pneumoniae, Staphylococcus aureus, Group A Streptococcus,
Klebsiella pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, anaerobes, and gram-negative organisms.

CKD DIET
Step 1: Choose and prepare foods with less salt and sodium
Why? To help control your blood pressure. Your diet should contain less than 2,300 milligrams of sodium each day.
 Buy fresh food often. Sodium (a part of salt) is added to many prepared or packaged foods you buy at the
supermarket or at restaurants.
 Cook foods from scratch instead of eating prepared foods, “fast” foods, frozen dinners, and canned foods that are
higher in sodium. When you prepare your own food, you control what goes into it.
 Use spices, herbs, and sodium-free seasonings in place of salt.
 Check for sodium on the Nutrition Facts label of food packages. A Daily Value of 20 percent or more means the
food is high in sodium.
 Try lower-sodium versions of frozen dinners and other convenience foods.
 Rinse canned vegetables, beans, meats, and fish with water before eating.
Look for food labels with words like sodium free or salt free; or low, reduced, or no salt or sodium; or unsalted or lightly
salted.
Step 2: Eat the right amount and the right types of protein
Why? To help protect your kidneys. When your body uses protein, it produces waste. Your kidneys remove this waste.
Eating more protein than you need may make your kidneys work harder.
 Eat small portions of protein foods.
 Protein is found in foods from plants and animals. Most people eat both types of protein. Talk to your dietitian about
how to choose the right combination of protein foods for you.
Animal-protein foods:
 Chicken
 Fish
 Meat
 Eggs
 Dairy
A cooked portion of chicken, fish, or meat is about 2 to 3 ounces or about the size of a deck of cards. A portion of dairy foods
is ½ cup of milk or yogurt, or one slice of cheese.
Plant-protein foods:
 Beans
 Nuts
 Grains
A portion of cooked beans is about ½ cup, and a portion of nuts is ¼ cup. A portion of bread is a single slice, and a portion of
cooked rice or cooked noodles is ½ cup.
Step 3: Choose foods that are healthy for your heart
Why? To help keep fat from building up in your blood vessels, heart, and kidneys.
 Grill, broil, bake, roast, or stir-fry foods, instead of deep frying.
 Cook with nonstick cooking spray or a small amount of olive oil instead of butter.
 Trim fat from meat and remove skin from poultry before eating.
 Try to limit saturated and trans fats. Read the food label.
Heart-healthy foods:
 Lean cuts of meat, such as loin or round
 Poultry without the skin
 Fish
 Beans
 Vegetables
 Fruits
 Low-fat or fat-free milk, yogurt, and cheese
Step 4: Choose foods and drinks with less phosphorus
Why? To help protect your bones and blood vessels. When you have CKD, phosphorus can build up in your blood. Too
much phosphorus in your blood pulls calcium from your bones, making your bones thin, weak, and more likely to break.
High levels of phosphorus in your blood can also cause itchy skin, and bone and joint pain.
 Many packaged foods have added phosphorus. Look for phosphorus—or for words with “PHOS”—on ingredient
labels.
 Deli meats and some fresh meat and poultry can have added phosphorus. Ask the butcher to help you pick fresh
meats without added phosphorus.
Step 5: Choose foods with the right amount of potassium
Why? To help your nerves and muscles work the right way. Problems can occur when blood potassium levels are too high or
too low. Damaged kidneys allow potassium to build up in your blood, which can cause serious heart problems. Your food and
drink choices can help you lower your potassium level, if needed.
 Salt substitutes can be very high in potassium. Read the ingredient label. Check with your provider about using salt
substitutes.
 Drain canned fruits and vegetables before eating.

AS A NURSE HOW WOULD YOU MAKE SURE THAT YOUR PATIENT IS TAKING HER MAINTENANCE MEDS
REGULARLY
1. Assess health preference, knowledge regarding disease process etc.
2. Health teaching – disease process, importance, pros and cons etc.
3. Health teaching SO explain nalang

HOW DOES WIPING THE PERINEUM FROM BACK TO FRONT CAUSE UTI
If she wipes from back to front, this could potentially bring forward E. coli from the perianal area to the urethra and hence be an
etiological factor in bacterial colonization of the urogenital tract.
WHY ARE FEMALE PTS SUSCEPTIBLE TO UTI
All women are at risk of bladder infections because of their anatomy. In women, the urethra is close to the anus. And the urethral
opening is close to the bladder. This makes it easier for bacteria around the anus to enter the urethra and to travel to the bladder.

In females, the urethra is short, only 3 to 4 cm (about 1.5 inches) long. The external urethral orifice opens to the outside just
anterior to the opening for the vagina. In males, the urethra is much longer, about 20 cm (7 to 8 inches) in length, and transports
both urine and semen.

WHY WAS THE ABG ANALYSIS ORDERED

Arterial blood gas (ABG) testing is a diagnostic test performed on blood taken from an artery that provides a glimpse of how
much oxygen and carbon dioxide are in your blood, along with your blood's pH level. ABG tests are used to evaluate respiratory
and kidney functions and give an overall look into the body's metabolic state.

TROPONIN I TEST
A troponin test measures the level of troponin in your blood. Troponin is a type of protein found in the muscles of your heart.
Troponin isn't normally found in the blood. When heart muscles become damaged, troponin is sent into the bloodstream. As heart
damage increases, greater amounts of troponin are released in the blood.

High levels of troponin in the blood may mean you are having or recently had a heart attack. A heart attack happens when blood
flow to the heart gets blocked. This blockage can be deadly. But quick diagnosis and treatment can save your life.