Fluids and Electrolytes, Metabolism and Endocrine (NCM103) Cardiovascular System: Hypertension, Peripheral Disorders
Hypertension (HTN) Persistent elevation of Blood Pressure To be considered HTN: Has to be taken twice from initial up to 3 rd week Has to be taken by a health care provider Systolic Pressure > 140 mm Hg; Diastolic Pressure > 90 mm Hg
Classification of Blood Pressure for Adults Classification Systolic BP (mm Hg) Diastolic BP (mm Hg) Normal < 120 < 80 Prehypertension 120 139 80 89 Stage 1 Hypertension 140 159 90 99 Stage 2 Hypertension > 160 > 100
Diagnostic Procedure For Prehypertension Get a Check Up once every 6 months
Types of Hypertension 1. Primary Hypertension o 90% - 95% o Unknown cause NOT CURABLE, But CONTROLLABLE Not associated with any possible cause! (Idiopathic) 2. Secondary Hypertension o 5% - 10% o Related to known cause 1. Pregnancy Induced Hypertension (PIH) 2. Kidney Disorders 3. Liver Disorders
Risk Factors (Vasoconstriction!!) 1. Dyslipidemia (Abnormal blood fat levels) 2. Obesity Associated with Atherosclerosis 3. Diabetes Mellitus 4. Sedentary Lifestyle Causes: 1. Sympathetic Nervous System Activity 2. Renal Reabsorption of Na, Cl and H 2 O 3. Activity of Renin-Angiotensin-Aldosterone 4. Vasodilation 5. Resistance to insulin action
Topics Discussed Here Are: 1. Hypertension 2. Buergers Disease 3. Raynauds Disease 4. Aneurysm Thoracic Abdominal 5. Phlebitis 6. Thrombophlebitis/Phlebothrombosis 7. Varicose Veins LOOKY HERE Most Important is the DIASTOLIC Reading Because it is the ventricular relaxation
Rule of Thumb! Age + 100 = Systole! NONE = Diastole XD Caused by STIMULATION of Sympathetic Nervous System usually by STRESS!!
jcmendiola_Achievers2013 Clinical Manifestation SILENT KILLER They dont present clinical manifestations! ONLY BP Nuxial pain / rigidity Morning frontal lobe head ache Dizziness Chest pain
Management Non-Pharmacologic Management Lifestyle Changes 1. Weight Reduction Maintain normal body weight 2. Adopt DASH (Dietary Approaches to Stop Hypertension) Diet rich in fruits, vegetables, low at dairy products and reduced saturated and total fat 3. Dietary Sodium Reduction 2.4 g 6 g Na 4. Physical Activity Regulates aerobic physical activity as brisk walking (30 mins) 5. Moderation of alcohol intake No more than 2 drinks per day (24 oz beer, 10 oz wine, 3 oz 80% whisky)
Pharmacologic Management Initial medications Diuretics, Beta Blockers / Both Initially LOW DOSE If BP does not fall to less than 140/90 mm Hg Dose gradually increased and additional medications are given If diuretics are discontinued Can cause REBOUND HYPERTENSION ( BP MUCH HIGHER THAN BEFORE) So, drugs SHOULD be GRADUALLY decreased Side Effect of Anti Hypertension ORTHOSTATIC HYPOTENSION / POSTURAL HYPOTENSION To Prevent Orthostatic Hypotension Take medications at NIGHT (Before Sleep) Take in the morning (Lie in bed for 20 30 mins before continuing ADLs) Dont stay too long under the SUN! Dont take a bath with WARM water, but with LUKEWARM water
Peripheral Disorders 1. Buergers Disease - Thromboangitis Obliterans (Other name XD) Presence of Blood Clot + Inflammation of Artery Affected: Blood Vessels of LOWER EXTREMITIES - More common among males - Cause: SMOKING Most common ` Nicotine causes VASOCONSTRICTION and VISCOSITY of Blood O Can cause CLOT FORMATION O Blood FLOW to LOWER EXTREMITIES - Manifestations: 1. Temperature 2. Paleness / Pallor 3. Cyanosis (Peripheral)
jcmendiola_Achievers2013 4. Heaviness (Numbness) Due to poor healing process, lack of blood supply 5. Pain at the calf muscles ` Intermittent Claudication (WARNING) O Pain is experienced while walking or standing for a long time O Pain is relieved by rest 6. Trophic Changes ` Skin is STRETCHABLE / SHINY ` Decrease growth of hair ` Sole of patient is very THICK ` Clubbing of toenails - Plan of Care 1. Preventive Measures ^ STOP SMOKING ^ DO NOT SMOKE 2. Perform Leg Exercises ^ Buerger-Allen Exercise ; Fix on bed, lower extremities elevate 45 (for 30 60 secs) ; Sit on edge of the bed, dangle legs (for 30 60 secs) ; Go back to bed, but legs are now flat (for 30 60 secs) ^ To improve the circulation on the lower extremities ^ To further enhance blood flow, ask patient to WIGGLE the toes ^ Put blanket / top sheet on top of legs to promote vasodilation 3. Care of the Foot (Podiatrist) ^ Dont walk BAREFOOT to prevent wound formation and gangrene formation ^ PUT ON SOCKS ^ Buy a pair of shoes on the afternoon, because feet are LARGER in the afternoon ^ Buy 1 size bigger ^ Get a basin with lukewarm water, liquid soap/baby oil then immerse feet for 15 30 mins, get pumice stone / face towel / loofa then wipe off outer layers of the skin ^ If Gangrene has formed AMPUTATION
2. Raynauds Disease o Counterpart of Buergers Disease The UPPER EXTREMITIES are AFFECTED o Not common in the Philippines o Brought about by: STRESS and COLD
3. Aneurysm - A localized sac / dilatation formed at weak points on the wall of the arteries
Types of Aneurysms a. Thoracic Aortic Aneurysm a. Incidence = More in men (40 70 y/o) b. Cause 85% due to atherosclerosis c. Clinical Manifestations: Some may be ASYMPTOMATIC 1. Pain - Constant and Boring - Occurs when patient is SUPINE 2. Dyspnea (SOB) 3. Coughing 4. Stridor
jcmendiola_Achievers2013 5. Compression on Larynx - Changes in voice, absence of or total absence of voice 6. Compression on Esophagus: Dysphagia~ d. Diagnostic Tests Chest X-Rays TEE Management: ; SURGERY b. Abdominal Aortic Aneurysm Cause: Atherosclerosis Congenital Weakness Trauma Clinical Manifestations: 40% have symptoms Feels their heart beat in the abdomen when lying or abdominal mass / throbbing Assessment Findings Palpate abdomen, can feel a PULSATING mass Pulsating mass at the MIDDLE and UPPER ABDOMEN Systemic bruit over the mass THRU AUSCULTATION Diagnostic Findings: Ultrasonography CT Scan Management: Pharmacologic Therapy a. Anti-Hypertensive Drugs b. Diuretics c. Beta Blockers d. ACE Inhibitors e. Ca + Channel Blockers Prevent RUPTURE OF ANEURYSM!! - Surgery o Treatment of Choice For more than 5.5 cm big (2 inches) Involves: Resection of vessel Endovascular grafting Transluminal placement and attachment of sutureless aortic graft prostheses
Phlebitis, Thrombophlebitis, Phlebothrombosis
Phlebitis Definition: Inflammation of the vein Causes: 1. Prolonged intravenous therapy (2 3 weeks) 2. Prolonged intravenous therapy of HIGHLY IRRITATING drugs Local Manifestations: Redness (Rubor) Heat (Calor) Pain (Dolor) Swelling (Tumor) Systemic Manifestations: Fever Level of WBC
jcmendiola_Achievers2013 Lower Extremity Heart Congestion Stretch/Dilate Varicosities Will turn into REDDISH or BLUISH color Heart Legs Artery Vein (Valves) VEIN YAN NA MAY VALVE LOL Brought About By: 1. Needle out of place 2. Inflamed Vein a. Notify Physician b. Remove IV c. Apply PRESSURE with COLD COMPRESS!
Thrombophlebitis / Phlebothrombosis Common cause: Blood Clot (Thrombus) Definition: o Thrombophlebitis Blood Clot + Inflammation of Veins o Phlebothrombosis Blood Clot + with or without inflammation of veins Important Nursing Responsibilities 1. NEVER Massage affected part a. Embolus Moving Blood Clot b. Thrombus Non-moving Blood Clot 2. NEVER Apply HOT Compress - Deep Vein Thrombosis (DVT) Legs are swollen Pain Keep patient on rest Apply elastic bandage Anti-coagulants
Varicose Veins - Dilation of veins - Saphenous Vein Most common to dilate At the Lower Extremities
- Causes: Prolonged standing - Presence of: Bluish/Reddish Heat Heaviness / Numbness Cramping sensation - Diagnostic Test Trendelenburg Test + Draining of blood on lower extremities + Then stand, observe Saphenous veins how they fill up 1. Gradually = (-) Trendelenburg Test; (-) Varicose Veins 2. Abruptly = (+) Trendelenburg Test (+) Varicose Veins
- Management: 1. Use Support Stockings 2. When resting, elevate lower extremities 3. DONT CROSS LEGS - Surgery 1. Vein Stripping Ligation of Saphenous Veins 2. Sclerotherapy Injecting of solution at site of varicosities, formation of hematoma