NUR 242 Exam 4 Study Guidelines
u u u u u
RecapuNotes
CholesteroluValuesuLDL/HD
L/TotaluCholesteroluHDLu=ug
reateruthanu40
LDLu=ulessuthanu100
TotaluCholesterolu=ulessuthanu200
Lipidsulessuthanu150umalesuandulessuthanu135ufemales
HeartuPlacements
2nduintercostalurightusternumu=uaortauvalveu2n
d
intercostaluleftusternumu=upulmonicuvalve
u
Erb’supointubestus1us2nsounduisu3rduintercostalutouleftuofusternumu–
NoturequiredutouidentifyuinucpeuTricuspiduvalveu4thuintercostaluspaceuleftuofusternum
u
Mitralu5thuintercostaluspaceumiduclavicular,uapicaluunderubreastutissue.
HealthyuheartuDiet/Exerciseu=ulowufatulowucholesterolulowusodiumudiet,umoderateuregularuexerciseuneedsuprogramuregi
menuanduincreaseuomegau3,umanageustress,uandusmokingucessationuclassuoruquitting
Cardiac
Topics:uHTN,uPAD,uAmputation,uDVT,uCAD,uHF,uVentricularuTachycardia,uVentricularuFibrillation,uSinusurhythm,uSi
nusubradycardia,uSinusuTachycardia.uDon’tuforgetutoureviewucardiacumeds:uACEuinhibitors,ubetaublockers,ucalciumucha
nnelublockers,ucardiotonicu(digoxin),udiureticsu(potassiumusparinguandunon-
sparing).uReviewulabsusuchuasucholesteroluandulipidulevels,uaPTT,uPTTuanduPTunormalurangeuandutherapeuticulevels,u
BNP,utroponinuleveluforuCADu(touruleuoutuMI).uReviewuheartusounds/placement.
HTNu–uPersistentuBPuofu140/90uanduabove
• Pre-hypertensionu–uwhatuisuit?uWhatudoesuitulookulike
• Hypertension
o Whatuareutheuriskufactors?u–umodifiableuvsunon-modifiable
o Whatudoesuitulookulike?
o Howuisuitutreated?
▪ Includeuaddressingumedicationuteaching,usafety,usuchuas,umonitoringuparametersuanduwhatu
toudo.
• Malignantuhypertensionu–uWhatuisuit?uWhatudoesuitulookulike?uHowuisuitutreated?
Hypertensionu–
u NormaluBlooduPressureuisu120/80uPrehypertension
1
, NUR 242 Exam 4 Study Guidelines
u u u u u
• 121-139u(systolic)
• 81-89u(diastolic)
• Getsuworseuoverutimeu
Hypertension
• Persistentuelevationuofusystolicuorudiastolicu–
uNEEDSuMOREuTHANuONEuREADINGuTOuDIAGNOSEuneedsuautrend.
• Whatuisutheucurrentustandard???
• 140usystolic
• 90udiastolicu
Type
• Primaryu(essential)u–unouobviousumedicalucause
• Secondaryu-ucausedubyuotheruconditionsuthatuaffectutheukidneys,uarteries,uheartuoruendocrineusystem
• Isolatedusystolicu-ucausedubyuotheruunderlyinguconditions,usuchuasuauleakyuheartuvalve,uoruhyperthyroidism)
• Refractoryu-uresistantuhighubloodupressureudespiteutreatmenturegimen
• Malignantu-
uausuddenuandurapidudevelopmentuofuextremelyuhighubloodupressureuwithudiastolicutypicallyuaboveu130
PathophysiologyuofuHypertension
• Primaryu(essential)uhypertension
– persistentlyuelevateduvascularuresistance
• Secondaryuhypertension
– Renaluanduadrenaluglandudiseases
– Medicationsuandufoods
– Acuteustress
Assessment
• MoreucommonuinuAfrican-American
• Increasesuwithuage
• Moreucommonuinumenuinuearlyuage
• Womenuafterumenopause
• Pregnancy
• Sometimesunousymptomsuuntilupt.ucomesuinuwithustroke,uMI,uoruseizures.u
Manifestations
• Earlyustages—none
• Progressiveustages
➢ Headache
➢ Fatigueuandudizziness
2
, NUR 242 Exam 4 Study Guidelines
u u u u u
➢ Palpitations
➢ Flushing
➢ Blurreduvision
➢ Epistaxis
Syncope
• Syncope
• Posturaluhypotension
• Normaluresponseuwhenustanding
• Syncopaluresponseuwhenustanding
• Syncopeumanagement
ComplicationsuofuHypertension
➢ MI
➢ Stroke
➢ Atherosclerosis
➢ *Nephropathy
➢ PVDu(PAD)
➢ Aorticuaneurysms
➢ HeartuFailure
➢ Hypertensiveucrisis
HypertensiveuCrisis/MalignantuHypertension
• SevereuincreaseuinuB/Pu(diastolicu>u130)
• Mayuleadutoustroke
• Organudamage
• Mayudeveloputouleftuventricularufailure
SignsuanduSymptoms-uthatuareulifeuthreatening.
• Restlessness
• LOCuchanges
• Seizures
• Blurreduvision/Visualuchanges.
• Dizziness
• SevereuHeadache
• Agitation
• N/V
• Renaluinsufficiency
• Hemolyticuanemia
• Leftuventricularufailureu(LVF)
• PulmonaryuEdemau(PE)
• Ptucanucomeuinucomatose
NoteuUsuallyutheseuareutheupatientsuthatuenduupuinuICUuanduneeduPOTENTuanti-hypertensiveumedicationsuIV.
MedicaluManagement/Treatment
• Revolvesuaroundu3udruguregimen:
➢ Diureticsu–udecreasesuvolumeuload—
Needutoumonitorupotassiumulevelsuhyper/hypokalemiaumonitoringuisuessential.
3
, NUR 242 Exam 4 Study Guidelines
u u u u u
➢ Betaublockersu-
ubyublockingutheueffectuofunorepinephrineuanduepinephrine,ubetaublockersureduceuhearturateuandudilat
eublooduvessels;umightunotubeutoleratedubyupersonsuwithuasthma,ucongestiveuheartufailure,udepression
uoruunderlyingufatigue
➢ ACEuinhibitorsu–uinhibituconversionuofuAngiotensinuIutouAngeiotensinuII,uthereforeuservesupurpose
ofusodiumuexcretionuinuurine
➢ Ca++uchannelublockersu-ublockuvoltage-
gateducalciumuchannelsuinublooduvesselsucausingulessumuscleucontractionuthereforeuincreasingu
arterialudiameteru(usuallyugivenutoupeopleuwhoucannotutolerateubetaublockers,upeopleuwithuasth
ma,uorudepressionuslowsuhearturateuandudilatesublooduvessels.)
➢ LifeustyleumodificationuchangesusuchuasutheuDashudiet.uLowusodiumulowufat,udiet
Interventions ➢ Teachuaboutupotassiumuandusaltusubstitutes
• Weightureduction
• Lifestyleumodifications
• Dietaryuchanges
• DASHudietu-uDietaryuApproachesutouStopuHypertension;ulowusodium,usaturatedufat,ucholesteroluandutotalufat
• Clientuteaching
✓ Exerciseu(helpsuincreaseuHDL)
✓ Alcoholurestriction
✓ Caffeineurestriction
✓ Relaxationutechniques
✓ Smokingucessation
✓ Potassiumusupplementation
✓ Pharmacologicuinterventions
PVD/PADu(Peripheraluvascularudisorder/Peripheraluarterialudisorder=uTheyuareutheusame.u–
uOcclusionuof uperipheraluarteriesu- uinsufficient ubloodusupply
• Whatuareutheuriskufactors?
• Whatudoesuitulookulike?
• Howuisuitutreated?u(medicaluandusurgicalu–urevascularization)
• Postuopucareuforufem-popubypassusurgery?
• Whatuareutheucomplications?
• Amputation
• Postuopucare
PeripheraluArterialuDiseaseuanduDeepuVeinuThrombosis
Overview
4
u u u u u
RecapuNotes
CholesteroluValuesuLDL/HD
L/TotaluCholesteroluHDLu=ug
reateruthanu40
LDLu=ulessuthanu100
TotaluCholesterolu=ulessuthanu200
Lipidsulessuthanu150umalesuandulessuthanu135ufemales
HeartuPlacements
2nduintercostalurightusternumu=uaortauvalveu2n
d
intercostaluleftusternumu=upulmonicuvalve
u
Erb’supointubestus1us2nsounduisu3rduintercostalutouleftuofusternumu–
NoturequiredutouidentifyuinucpeuTricuspiduvalveu4thuintercostaluspaceuleftuofusternum
u
Mitralu5thuintercostaluspaceumiduclavicular,uapicaluunderubreastutissue.
HealthyuheartuDiet/Exerciseu=ulowufatulowucholesterolulowusodiumudiet,umoderateuregularuexerciseuneedsuprogramuregi
menuanduincreaseuomegau3,umanageustress,uandusmokingucessationuclassuoruquitting
Cardiac
Topics:uHTN,uPAD,uAmputation,uDVT,uCAD,uHF,uVentricularuTachycardia,uVentricularuFibrillation,uSinusurhythm,uSi
nusubradycardia,uSinusuTachycardia.uDon’tuforgetutoureviewucardiacumeds:uACEuinhibitors,ubetaublockers,ucalciumucha
nnelublockers,ucardiotonicu(digoxin),udiureticsu(potassiumusparinguandunon-
sparing).uReviewulabsusuchuasucholesteroluandulipidulevels,uaPTT,uPTTuanduPTunormalurangeuandutherapeuticulevels,u
BNP,utroponinuleveluforuCADu(touruleuoutuMI).uReviewuheartusounds/placement.
HTNu–uPersistentuBPuofu140/90uanduabove
• Pre-hypertensionu–uwhatuisuit?uWhatudoesuitulookulike
• Hypertension
o Whatuareutheuriskufactors?u–umodifiableuvsunon-modifiable
o Whatudoesuitulookulike?
o Howuisuitutreated?
▪ Includeuaddressingumedicationuteaching,usafety,usuchuas,umonitoringuparametersuanduwhatu
toudo.
• Malignantuhypertensionu–uWhatuisuit?uWhatudoesuitulookulike?uHowuisuitutreated?
Hypertensionu–
u NormaluBlooduPressureuisu120/80uPrehypertension
1
, NUR 242 Exam 4 Study Guidelines
u u u u u
• 121-139u(systolic)
• 81-89u(diastolic)
• Getsuworseuoverutimeu
Hypertension
• Persistentuelevationuofusystolicuorudiastolicu–
uNEEDSuMOREuTHANuONEuREADINGuTOuDIAGNOSEuneedsuautrend.
• Whatuisutheucurrentustandard???
• 140usystolic
• 90udiastolicu
Type
• Primaryu(essential)u–unouobviousumedicalucause
• Secondaryu-ucausedubyuotheruconditionsuthatuaffectutheukidneys,uarteries,uheartuoruendocrineusystem
• Isolatedusystolicu-ucausedubyuotheruunderlyinguconditions,usuchuasuauleakyuheartuvalve,uoruhyperthyroidism)
• Refractoryu-uresistantuhighubloodupressureudespiteutreatmenturegimen
• Malignantu-
uausuddenuandurapidudevelopmentuofuextremelyuhighubloodupressureuwithudiastolicutypicallyuaboveu130
PathophysiologyuofuHypertension
• Primaryu(essential)uhypertension
– persistentlyuelevateduvascularuresistance
• Secondaryuhypertension
– Renaluanduadrenaluglandudiseases
– Medicationsuandufoods
– Acuteustress
Assessment
• MoreucommonuinuAfrican-American
• Increasesuwithuage
• Moreucommonuinumenuinuearlyuage
• Womenuafterumenopause
• Pregnancy
• Sometimesunousymptomsuuntilupt.ucomesuinuwithustroke,uMI,uoruseizures.u
Manifestations
• Earlyustages—none
• Progressiveustages
➢ Headache
➢ Fatigueuandudizziness
2
, NUR 242 Exam 4 Study Guidelines
u u u u u
➢ Palpitations
➢ Flushing
➢ Blurreduvision
➢ Epistaxis
Syncope
• Syncope
• Posturaluhypotension
• Normaluresponseuwhenustanding
• Syncopaluresponseuwhenustanding
• Syncopeumanagement
ComplicationsuofuHypertension
➢ MI
➢ Stroke
➢ Atherosclerosis
➢ *Nephropathy
➢ PVDu(PAD)
➢ Aorticuaneurysms
➢ HeartuFailure
➢ Hypertensiveucrisis
HypertensiveuCrisis/MalignantuHypertension
• SevereuincreaseuinuB/Pu(diastolicu>u130)
• Mayuleadutoustroke
• Organudamage
• Mayudeveloputouleftuventricularufailure
SignsuanduSymptoms-uthatuareulifeuthreatening.
• Restlessness
• LOCuchanges
• Seizures
• Blurreduvision/Visualuchanges.
• Dizziness
• SevereuHeadache
• Agitation
• N/V
• Renaluinsufficiency
• Hemolyticuanemia
• Leftuventricularufailureu(LVF)
• PulmonaryuEdemau(PE)
• Ptucanucomeuinucomatose
NoteuUsuallyutheseuareutheupatientsuthatuenduupuinuICUuanduneeduPOTENTuanti-hypertensiveumedicationsuIV.
MedicaluManagement/Treatment
• Revolvesuaroundu3udruguregimen:
➢ Diureticsu–udecreasesuvolumeuload—
Needutoumonitorupotassiumulevelsuhyper/hypokalemiaumonitoringuisuessential.
3
, NUR 242 Exam 4 Study Guidelines
u u u u u
➢ Betaublockersu-
ubyublockingutheueffectuofunorepinephrineuanduepinephrine,ubetaublockersureduceuhearturateuandudilat
eublooduvessels;umightunotubeutoleratedubyupersonsuwithuasthma,ucongestiveuheartufailure,udepression
uoruunderlyingufatigue
➢ ACEuinhibitorsu–uinhibituconversionuofuAngiotensinuIutouAngeiotensinuII,uthereforeuservesupurpose
ofusodiumuexcretionuinuurine
➢ Ca++uchannelublockersu-ublockuvoltage-
gateducalciumuchannelsuinublooduvesselsucausingulessumuscleucontractionuthereforeuincreasingu
arterialudiameteru(usuallyugivenutoupeopleuwhoucannotutolerateubetaublockers,upeopleuwithuasth
ma,uorudepressionuslowsuhearturateuandudilatesublooduvessels.)
➢ LifeustyleumodificationuchangesusuchuasutheuDashudiet.uLowusodiumulowufat,udiet
Interventions ➢ Teachuaboutupotassiumuandusaltusubstitutes
• Weightureduction
• Lifestyleumodifications
• Dietaryuchanges
• DASHudietu-uDietaryuApproachesutouStopuHypertension;ulowusodium,usaturatedufat,ucholesteroluandutotalufat
• Clientuteaching
✓ Exerciseu(helpsuincreaseuHDL)
✓ Alcoholurestriction
✓ Caffeineurestriction
✓ Relaxationutechniques
✓ Smokingucessation
✓ Potassiumusupplementation
✓ Pharmacologicuinterventions
PVD/PADu(Peripheraluvascularudisorder/Peripheraluarterialudisorder=uTheyuareutheusame.u–
uOcclusionuof uperipheraluarteriesu- uinsufficient ubloodusupply
• Whatuareutheuriskufactors?
• Whatudoesuitulookulike?
• Howuisuitutreated?u(medicaluandusurgicalu–urevascularization)
• Postuopucareuforufem-popubypassusurgery?
• Whatuareutheucomplications?
• Amputation
• Postuopucare
PeripheraluArterialuDiseaseuanduDeepuVeinuThrombosis
Overview
4
