Shock & Hypertension

Front 1

shock

Back 1

-decrease in blood flow to body tissues

Front 2

types of shock

Back 2

distributive-(neurogenic,septic, anaphylactic)
hypovolemic
cardiogenic

Front 3

initial stage of shock

Back 3

few signs
BP may be normal or slightly decreased
SNS stimulation maintains perfusion

Front 4

Compensatory stage of shock

Back 4

Fluid shift occurs
SNS stimulation maintains perfusion
Bp may be decreased
tachycardia, tachypnea, hyperpnea, decreased urine output, reports of thirst, hypothermia, LOC changes
blood shunted away from skin-pale and cold
fluid shift-tissue to vessel(dry oral mucousa, tenting

Front 5

Progressive stage of shock

Back 5

failure of compensatory mechanisms
profound vasoconstriction
aerobic to anaerobic metabolism causing metabolic acidosis(lactic acid release)
listless, confused, BP less than 80, tachycardia, cold, pale, ogliguria hypothermia, cyanosis
rapid thready weak pulse
need 2 IV 16 gauge

Front 6

irreversible stage of shock

Back 6

near death
comfort measure are taken
BP=0
unconsciuos, unresponsive
cheyne stokes, anuria, mottling, crackles

Front 7

treating hypovolemic shock

Back 7

Hypovolemic-IV fluids- NS, colliods, albumin(hypertonic)

Front 8

treating cardiogenic shock

Back 8

preload reduction-diuretics
intra-aortic balloon pump
NO fluids
levophed *last resort* (profound vasoconstriction)
Dobutamine & dobutrex-mimics or stimulates SNS to increase heart rythym to constrict blood vessels

Front 9

treating septic shock

Back 9

anti-infectives
lots of fluids

Front 10

treating anaphylactic shock

Back 10

Epinepherine, benadryl, steroids
need to restore breathing

Front 11

treating neurogenic shock

Back 11

fluids, correct underlying problem

Front 12

Arterial line monitoring

Back 12

provides access for ABG samples
monitors BP
ussually inserted in radial artery

Front 13

blood transfusions

Back 13

indicated for-Hbg below 7, severe blood loss, surgery, anemia
must be typed and cross-matched(mix blood from donor & recipient to see reaction)
2 RN's must sign

Front 14

types of blood products

Back 14

packed red blood cells-increases oxygen carrying capacity of blood
platelets- controls or prevents bleeding-pooled from several donors
fresh frozen plasma-freezing preserves clotting factors

Front 15

nursing considerations for transfusion

Back 15

large bore IV- 16 gauge
name, blood type, expiration date, unit #, pt. ID #
Vitals before start
start slowly
must be infused within 4 hrs
monitor for infusion reaction
vitals frequently

Front 16

signs of blood rejection and indications

Back 16

fever, warmth, itching, chills, itching, weakness, dyspnea, tachycardia, hypotension
stop infusion
open normal saline
check vitals
obtain blood and urine samples
may be treated with Lasix and benadryl

Front 17

hypertension

Back 17

primary- no known reason
secondary- known underlyng cause

Front 18

diagnosis of hypertension

Back 18

3 or more BP's 140/90
3 visits
both arms
check BUN CRE glucose & cholestrol

Front 19

risk factors hypertension
non-modifiable

Back 19

age, sex, race, family history, obesity(central ab), smoking

Front 20

Blood pressure formula

Back 20

cardiac output x systemic vascular resistance

Front 21

cardiac output

Back 21

amount of blood pumped by ventricle in one minute

Front 22

influences on BP

Back 22

SNS- epinepherine,adreneline(tachy vasoconstriction)-beta blockers
Renal system-if Na & H2O are not excreting there will be retension-diurectics renin(angiotensen I&II impairment)ACe inhibitors
Endocrine system-aldesterone(secretion of Na & H2O)impairment causes retension

Front 23

modifiable risk factors for hypertension

Back 23

sodium intake
lipid levels
alcohol
sedentary lifestyle
diabetes
stress

Front 24

signs of hypertension

Back 24

Silent killer(sometimes no sign)
headache, dizziness, angina, blurred vision, epitaxis

Front 25

cardiac effects of hypertension

Back 25

left ventricle has to work harder causing heart to enlarge and get flabby from overuse leading to CHF

Front 26

cerebral effects of hypertension

Back 26

increased pressure causes rupture=stroke

Front 27

peripheral vascular effects of hypertension

Back 27

ischemic changes to lower extremeties
pain and necrosis result

Front 28

renal effects of hypertension

Back 28

blood and oxygen are not getting to kidneys leading to renal failure

Front 29

retinal changes due to hypertension

Back 29

eyes are highly vascular
hemorrages occur from pressure

Front 30

conservative trreatment of hypertension

Back 30

dash dietary
exercise
cessation of smoking
stress management

Front 31

loop diurectics

Back 31

Lasix (furosemide) Decreases sodium
reabsorption in the
loop of henle,
promotes K
excretion
Monitor BP,K, I&O,
dehydration

Front 32

thiazide diurectics

Back 32

Hydrochlorothiazid
e (HCTZ)
Hydrodiuril
Prevents sodium
and water
reabsorption,
promotes K
excretion
Sulfa based, check
for allergies
Monitor BP, K, I
&O, dehydration

Front 33

vasodilators

Back 33

Nitrates Cause systemic Check BP can
vasodilation,
decrease preload
and afterload/SVR,
increase blood
flow to the heart
BP, cause headaches,
flushing, and
palpitations

Front 34

Central Acting
Inhibitors

Back 34

Catapres,
Wytensin, Aldomet
(older group)
Act on the CNS in
the brain, inhibits
vasoconstriction
Orthostasis

Front 35

Alpha adrenergic
blockers

Back 35

Minipres, Hytrin
(older group)
Peripheral
vasodilators act
directly on the
blood vessel
Orthostasis

Front 36

Beta (adrenergic)
blockers

Back 36

Lopressor
(metoprolol),
Tenormin (atenolol),
Corgard (nadolol)
Blocks response to
SNS stimulation
thereby preventing
vasoconstriction and
tachycardia. Results
in decreased in
heart rate and BP
Check BP and
pulse.
Don’t administer to
patients with COPD.
Don’t stop abruptly.

Front 37

Alpha and beta
blocker

Back 37

Normodyne
(labetolol), Coreg
(carvedilol)
Can be administer
IV in a hypertensive
emergency
Close monitoring of
BP, don’t administer
to patient’s with
COPD

Front 38

Ace Inhibitors

Back 38

Ace inhibitors Capoten (captopril), t
Vasotec (enalapril)
Inhibits conversion
of angiotensin I to
angiotensin II,
thereby inhibiting
vasoconstriction
1st line therapy, used
to prevent heart
failure and for renal
protection in
diabetics. Can lead
to dry cough

Front 39

ACE II (ARBS)-
angiotension
receptior blockers

Back 39

Cozaar (lozartan)
Diovan
Useful with renal
patients
Check BP and
pulse, headache,
dizzy, cough

Front 40

Calcium channel
blockers

Back 40

Calan (verapamil)
Cardizem (diltiazem)
Procardia
(nifedipine)
Relax smooth
muscle in arterial
walls, dilate
coronary arteries
Check BP and pulse
Do not give to
patients in heart
block
hypercalcemia-tetany

Front 41

nursing considerations a-line

Front 42

treatment of hypertensive crisis

Front 43

signs of hypertensive crisis

Front 44

Hypertensive Crisis

Back 44

„ Rapid rise in BP
„ Systolic> 240
„ Diastolic > 120
„ Goal: prevent target organ damage of
the heart, brain, or kidneys
„ Rapid decrease can result in stroke
„ Gradual reduction in BP (MAP)

Front 45

Goal of treatment for hypertensive crisis

Back 45

prevent target organ damage of
the heart, brain, or kidneys