1
|
|
2
|
- Neural
- Hormonal
- Vascular
- Vascular Remodeling
|
3
|
- Renin is released in response to (pg 810)
- ________
- ________
- ________
- Renin converts angiotensinogen to angiotensin I
- Angiontensin-converting enzyme (ACE) produces angiontensin II
|
4
|
- Strongly constricts arterioles
- Increases/Decreases? peripheral vascular resistance
- Increases BP by direct vasoconstriction, stimulation of the SNS, and
stimulation of catecholamine release
- Stimulates secretion of Aldosterone
|
5
|
- Kidneys retain sodium and H2O
- Retention of sodium and water increases (pg 810)
- ______ _____
- ______ _____
- ______ _____
|
6
|
- Regulates _______ reabsorption by the kidneys
- Released in response to decreased blood volume and blood pressure
- Causes
- Retention of fluids
- vasoconstrction
|
7
|
- Endothelium damage
- Production of vasoconstrictor
- Inability to respond to vasodialators
|
8
|
- Unknown etiology
- One or more of the compensatory mechanisms has gone awry
|
9
|
|
10
|
|
11
|
- Angitensinconverting enzyme (ACE) Inhibitors (yes)
- Angitensin II Receptor Antagonists (no)
- Antiandrenergics (yes)
- Calcium Channel Blockers (yes)
- Diuretics (yes)
|
12
|
- Block the enzyme that converts angiotensin I to angiontensin II
- Decrease vasoconstriction
- Decrease aldosterone production
- Prevent or reverse remodeling of heart and vessels
|
13
|
- Caucasians-May be effective alone
- African-Americans maybe used in combination with diuretic
|
14
|
- Choice for diabetic nephropathy
- Renal protective
|
15
|
- 10-20 % experience persistent cough
- Hypotension
- Hyperkalemia
- Renal failure
- Sexual dysfunction
|
16
|
|
17
|
- Check BP accurately and repeatedly
- Monitor renal function (pg 825)
- Hyperkalemia
- Jaundice
|
18
|
- Give one hour ac
- Continue to take even if feeling well
- Antacids 2 hours before or after
|
19
|
- Decrease
- Heart rate
- Force of myocardial contraction
- Cardiac output
- Renin release from the kidney
|
20
|
- Drug of first choice
- <50 with high renin hypertension
- Tachycardia
- Angina
- MI
- Left ventricular hypertrophy
|
21
|
- Greater effect on Asians
- African-American part of multi-drug regimen
- Can be used for children
|
22
|
- Available PO & IV
- Available in extended release
- Cardio selective beta blocker
|
23
|
- Fatigue
- Bradycardia
- CHF
- Pulmonary Edema
- Impotence
|
24
|
- Monitor BP, ECG, Pulse
- I & O & daily weights
- BUN
- Liver function
|
25
|
- Pulse & BP at home
- May cause drowsiness
- Drug must be tapered
- Impotence
|
26
|
- Hepatic Impairment
- Renal Impairment
|
27
|
- Used for several CV disorders
- In hypertension
- Dilate peripheral arteries
- Decrease vascular resistance
- Choice for clients with angina
- Can use for renal impairment
- Use with caution with hepatic impairment
|
28
|
- Prevent movement of extracellular Ca into the cell (pg 788)
- SR?
|
29
|
- 2nd and 3rd degree heart block
- Cardiogenic shock
- Congestive heart failure
- Severe bradycardia
- Hypotension
|
30
|
- Peripheral edema
- Arrythmias
- CHF
- Stevens Johnson Syndrome
|
31
|
- Do not crush, break, or chew
- With or without meals
- May cause drowsiness
- Photosensitivity
|
32
|
- Therapeutic
- Goal of tx is usually 140/90
- Adverse Effects
- Monitor postural hypotension
- I & O
- Bradycardia
- Antiacids, andrenergics, & NSAIDS
|
33
|
- Nephron processes (pg 832)
- ______ ______
- ______ ______
- ______ ______
- Maintain fluid volume, electrolyte concentration, & pH
- Cellular waste
- 400 ml/d
|
34
|
- Pressure pushes H2O, electrolytes other solutes out
- End product is approx 2L urine/d
|
35
|
- Most occurs in proximal tubule
- Glucose, amino acids, and approx 80% of H2O, Sodium, Potassium, &
Chloride
- Loop of Henle
- Descending limb H2O
- Ascending Sodium
- Distal Tubule
- Exchange sodium & potassium
- H2O
|
36
|
- ADH promotes reabsorption of ____
- Urine becomes more concentrated
- Aldosterone promotes sodium-potassium exchange
- Promotes sodium retention and potassium loss
|
37
|
- Proximal tubule
- Uric acid, Cr, Hydrogen ions, & ammonia
- Distal tubule
- Potassium ions, hydrogen ions, & ammonia
- Hydrogen balance maintains pH
|
38
|
|
39
|
- Decrease blood pressure by sodium & water depletion
- Initially, BV & CO are decreased
- Eventually, CO normalizes but vascular resistance is decreased
- May be used alone or in combination with anti-hypertensives
|
40
|
- Chemically related to sulfonamides
- Decrease reabsorption of sodium, H2O, Chloride, & bicarb @ distal
convoluted tubule
- Not a strong diuretic
- Ineffective for immediate diuresis
- DOC for long term management
|
41
|
- Diuresis in about 2 hours
- Promotes excretion of chloride, potassium, magnesium, & bicarb
|
42
|
- Allergy to ____
- Pregnancy
|
43
|
- Inhibit sodium & chloride reabsorption at the ascending limb of the
loop of Henle
- Significant diuresis, w/i 5 min (IV)
- High ceiling
- Postdiuretic phase may absorb more sodium
- DOC in impaired renal function
|
44
|
- Most commonly used
- Do not give if discolored
- Ototoxicity
|
45
|
- Serum potassium levels (what is normal?)
- EKG
- Hypotension
- N&V, anorexia
- Muscle weakness
- Confusion
|
46
|
- Avoid excess table salt
- Periodic serum potassium levels
- Increase potassium rich foods
- Diabetic?
- Photosensitivity
- Change positions slowly
- Take with food
|
47
|
- Distal tubule to decrease sodium reabsorption and potassium excretion
- Weak diuretic
- Usually in combination
|
48
|
- Aldosterone antagonist
- Major side effect hyperkalemia
- Do not use with renal insufficiency
|
49
|
- No salt substitutes
- No potassium supplements
|
50
|
|
51
|
- Give in AM
- I & O, daily weights, BP
- Assess for edema
- Monitor for coughing
- Skin turgor
- Hyperglycemia
- Hyperuricemia
- Pulmonary edema
|
52
|
- Hyperkalemia
- Potassium over ?
- ECG changes
- Arrhythmias
|
53
|
- The nurse is explaining HTN to a client. Which is the best explanation
for why hypertension develops?
- “Americans have a poor diet”
- “Its is because of your sedentary lifestyle”
- “we really don’t understand the reasons behind hypertension”
- “one or more of the body’s compensatory systems has gone awry”
|
54
|
- A client with an order for Furosimide (Lasix) is experiencing
hypokalemia.
- What should the nurse do?
- A) Give the Furosimide with a K+ supplement
- Give Spironolactone (Aldactone) STAT
- Hold the Furosimide
- Call the lab
|