Perfusion

OCTOBER 14, 2021

N3015 HEALTH ALTERATIONS II
ASHLEY CRANE
Concept: Perfusion
Interrelated Concepts
 Extra Exemplars

 Atrial Fibrillation
 Valve Disorders
 Endocarditis
 Pulmonary Hypertension
 Hypertension
 Aneurysm
 Shock
 Objectives

 To review the nursing care of individuals and families living with hypertension
 To discuss treatment, including lifestyle and medications
 Hypertension

 BP is force of blood pushing against walls of blood vessels as blood flows

 Prolonged, untreated, poorly controlled HTN affects heart, brain, eyes and kidneys

 Most Imp Indicator of CVD

 An elevated BP in the arteries above normal range

BP < 130/85
“ less than 120/80 text book optimal BP ”
 HTN: Diagnosis

 SBP >140 mm Hg or DBP > 90 mm Hg over a sustained period

 Based on the average of two or more blood pressure assessments
(to be diagnosed with HTN)
OR
 Home monitoring BP is equal to or greater than 135/85
 BP pre-hypertension must f/u annually

A single BP does not confirm HTN

 HTN: Etiology & Risk Factors

 Genetics (+family history)  Vitamin D Deficiency

 Obesity  Diet
 Stress  Ethnicity
 sodium intake  Age >60 (post menopausal)
 ETOH  Smoking
 Physical Inactivity
 Hyperlipidemia
 HTN

 Primary  “White coat effect”- BP in office, normal out

 Essential or idiopathic (risk factors on previous of office setting
slide)
 No known cause  Malignant HTN: Emergency BP>180/120,
 90 - 95% HTN is primary develops suddenly

 Secondary
 Identified cause (e.g. renal disease, pregnancy,
brain tumor, etc.)
 Complications

 Cardiovascular disease  Emergency situation : hypertensive crisis

 Heart failure  BP elevated and must be lowered immediately
or within a few hours
 Stroke
 Dissecting AAA, intracranial hemorrhage,
 Ischemic heart disease
perioperative HTN
 IV vasodilators to lower immediately
 Kidney disease  Oral doses of diuretics, B-blockers, ACE
inhibitors, Ca+ channel blockers (perioperative)
 Clinical Manifestations: Assessment

 Elevated BP- “silent killer”

 Headache
 Fatigue
 Visual disturbances (retinal damage)
 Dizziness
 Palpitations
 Flushed
 Epistaxis
 Shortness of breath
 Nocturia
 Assessment : Diagnostic tests

 Urinalysis - Protein/Albumin levels, renal function

 Chemistry elevated - renal functions (Na+, K+, Creatinine)

 Cholesterol Levels - elevated CVD

 EKG - LT ventricular hypertrophy

 Fasting blood glucose - insulin resistance

 Treatment

Goal: To reduce risk complications and prevent progression of HTN

 Nursing Interventions

Educate client about risk factors for HTN and CVD

 Nursing Interventions: LIFESTYLE

 Weight loss - gradual

 Limit ETOH 1-2 servings per day
 Activity 30 minutes per day
 Vitamin D supplement
 Stop smoking - nicotine replacement
 Stress management - yoga
 Restrict caffeine (HR & vasoconstricts)
 Regular check ups
 Diet - What would you recommend?
 DASH Diet

 Eat more fruits, vegetables, and low-fat • Low fat dairy products 2-3 servings per
dairy foods. Cut back on foods that are day
high in saturated fat, cholesterol, and • Meat, fish, poultry 2 servings per
trans fats. day
• Fats & oils 2-3 per day
• Grains 7-8 servings per day • Nuts, seeds, dry beans 1-5 week
• Vegetables 4-5 servings per day • Sweets & added sugars 5 per week
• Fruits 4-6 servings per day
 Education

 Adherence to treatment important -  Watch for electrolyte imbalance

medications (e.g., K+)

 Follow up care - reg check ups  Resources to pay for medications -

available programs
 Get up slowly - postural hypotension

 How to do self BP checks

 Psychological Support - life long dx
 Pharmacological Therapy

Initial treatment : diuretics & b-blockers

 Diuretics:
 Thiazide diuretics (hydrochlorothiazide)
 Loop diuretics (lasix)
 K+ sparing diuretics (spironolactone)
 What are S/S to watch for?
 B-blockers:

 Vasodilate, heart rate slows, less force

 Propranolol

 Metoprolol

These meds can mask hypoglycemia in pts with Diabetes

Can cause weakness/fatigue
Do not stop suddenly as can cause rebound HTN
 Calcium-Channel Blockers:

 Vasodilate
 Verapamil

 Amlodipine

 Diltiazem

Avoid grapefruit juice

 ACE inhibitors

 Prevent conversion of angiotensin I to II - prevents vasoconstriction

 Ramipril, Lisinopril, Perindopril
 Can cause heart and kidney problems (watch for heart failure)
 Can cause angioedema (swelling of throat tissue)
 Can cause persistent cough
 What are some nursing considerations for these meds???
 When would you with hold these?
 ARBS (Angiotensin II-Receptor
Antagonists)

 Losartan
 Good option for pts who experience cough with ACE Inhibitor
 Monitor for angioedema or heart failure
 Change positions slowly (postural hypotension)
 ARBS can cause hyperkalemia
 Goal of Anti-hypertensives

 BP < 140/80

 BP <150/90 those > 60

Multidisciplinary Approach
 References

El Hussein, M., & Osuji, J. (2019). Brunner & Suddarth’s textbook of Canadian medical-surgical

nursing (4th ed.). Wolters Kluwer/Lippincott Williams & Wilkins.

Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.). Elsevier.