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Med Surg Week 3 Notes

by: Anna Collins

Med Surg Week 3 Notes NURS 3205

Marketplace > University of Memphis > NURS 3205 > Med Surg Week 3 Notes
Anna Collins
University of Memphis
GPA 3.8

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About this Document

These notes include pathophysiology, clinical manifestations, drug therapy of HTN, PAD, CAD and more.
Nurs Adult I/Common Hlth Alt
Class Notes
medsurg, Hypertension, CAD, PAD, Nursing
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This 10 page Class Notes was uploaded by Anna Collins on Monday September 12, 2016. The Class Notes belongs to NURS 3205 at University of Memphis taught by Harrell in Fall 2016. Since its upload, it has received 9 views.


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Date Created: 09/12/16
Adult 1/Med Surg Week 3 Hypertension Page 709  Hypertension AKA high blood pressure.  Known as the silent killer.  There are no symptoms that portray Hypertension.  Hypertension affects the arteries. **The heart has to pump against systemic vascular resistance (SVR) to get the blood throughout the body. **We want the SVR to be low. If SVR is high, the heart has to pump harder against the resistance, which will cause HTN. Blood Pressure  Good B/P-- <120/<80  Systole= heart contracts  Diastole= heart relaxes  BP is up= SVR is up  BP is down= SVR is down  Prehypertension= 120/80 **High BP is typically found when a patient comes into a clinic for another reason & the healthcare provider catches it. **We need 3 consecutive high blood pressures to diagnose HTN. Diet & Exercise  We are going to try diet & exercise first. (Low sodium diet.)  Avoid: canned/processed foods, sodas, greasy foods, fried foods, etc.  Eat natural foods, fiber rich foods, fruits/veggies, grilled foods, etc.  Walk at least 30 mins a day. **Diet and exercise can completely cure pre-hypertension stage. Drug Therapy:  Lasix & Furosemide  Diuretics (excrete excess fluid.)  “IDEs”  Ace inhibitors: “prils.”  Teach: potassium depletion (may need a potassium supplement.)  Take diuretics in the morning (avoid peeing all night.)  Watch for 1 dose effect—Orthostatic Hypotension. **When you take the 1 dose, lay down or at least sit down.  Most diuretics are not potassium sparing.  If the potassium is 3. 5, a nurse would anticipate an order for a potassium supplement.  Side effects of HTN drugs: “ace” inhibitors= dizziness. Others: dizziness, fatigue, excessive urination, and erectile dysfunction. **Most patients are noncompliant with taking their HTN drugs because they are very costly. Especially drugs that have to be combined with another. **WWKYP with Hypokalemia= cardiac dysrhythmias—heart will stop. Risk Factors  Obesity  Excessive alcohol consumption  Genetics  African American race  Diabetes  Smoking  Prolonged exposure to stress Hypertensive Crisis  Sudden drop in BP will cause confusion. Gradually lower BP.  A nurse would not expect a good BP after only one day of HTN meds. **VERY high blood pressure + organ damage= Hypertensive emergency! **VERY high blood pressure + but no evidence of organ damage= Hypertensive urgency!  Hypertensive urgency= urgent but not life threatening.  Hypertensive emergency= deadly! **EMERGENCY= med given by IV push. **URGENCY= med given PO.  If you don’t catch & treat a hypertensive crisis, the patient could blow a blood vessel, cause kidney failure, or an aneurism. Adult 1/Med Surg Week 3 Coronary Artery Disease (CAD) Page 731  CAD is a type of blood vessel disorder that is included with atherosclerosis.  Atherosclerosis simply means “hardening of the arteries” by build up of plaque. (There has to be an endothelial injury for plaque to start forming.)  Atherosclerosis is the major cause of CAD.  Coronary Arteries supply blood to the heart.  Hypertension will eventually lead to CAD.  It’s during diastole that the coronary arteries perfuse blood throughout the body.  CAD will progress to ACS if we don’t catch it. Developmental Stages of CAD  CAD is a progressive disease that occurs over many years.  (1) Fatty streak.  (2) Fibrous plaque  (3) Complicated lesion Risk Factors  NONmodifiable: o Age o Gender o Ethnicity o Family history o Genetics  Modifiable: o Elevated serum lipids o Elevated blood pressure o Tobacco use o Physical inactivity o Obesity o Diabetes o Metabolic Syndrome o Psychologic states o Elevated homocysteine level Clinical Manifestations  Pain (chest/epigastric area.)  Elevated blood pressure  Elevated heart rate  Clammy & cool to the touch  Nausea and vomiting  Fever (100.4)  Abnormal heart sounds Angina  Chronic Stable Angina: Myocardial ischemia, secondary to CAD. o Episodic pain lasting 5-15 minutes. o Provoked by exertion. o Relieved by rest or nitroglycerin.  Prinzmetal’s Angina: Coronary vasospasm o Occurs primarily at rest. o Triggered by smoking and increased levels of some substances (epinephrine, histamine.) o May occur in presence OR absence of CAD.  Microvascular Angina: Myocardial ischemia secondary to microvascular disease affecting the small, distal branches of the coronary arteries. o More common in women. o Triggered by activities (shopping, work, exertion.) o Treatment may include nitroglycerin.  Unstable Angina: Rupture of thickened plaque, exposing thrombogenic surface. o New-onset angina. o Chronic stable angina that increases in frequency, duration, and severity. o Occurs at rest or with minimal exertion. o Pain refractory to nitroglycerin. **Most common pain is “pressure” below the breastbone. The pain can move from the chest into the jaw, back, earlobe, and left/right arm. **Levin’s sign= when the patient makes a first and puts it over their chest stating they have chest pain. This most likely indicates that they are having a heart attack. **A patient with chronic stable angina should take nitroglycerin prior to physical activity. **WWKYP unstable angina= acute coronary syndrome because a heart muscle is not getting oxygen. **Heart attack= DEAD heart tissue. We can get some of the tissue back but not all. **A side effect of nitroglycerin that will kill your patient is orthostatic hypotension. Nursing Responsibilities: o Assess the patient (did they take their nitroglycerin.)  Pain (where, how long, relieved, etc.)  Restore blood flow to the heart muscle  Breath/heart sounds  Vital signs  Diagnostics: EKG (where and how much loss of oxygen), Troponin levels (protein that only comes out of heart muscles—will be elevated) CKMB (specific protein released from myocardial tissue), Myoglobin (protein released when there is damage to any muscle  BMONA—Beta blocker (1. Reduces heart rate. 2. Dilates smooth muscle.), Morphine IV (treats pain and relaxes patient), Oxygen (nasal cannula), Nitroglycerin (dilates), Aspirin (in the ambulance or at home= chew it up. Thins blood by antiplatelet mechanisms.)  Teaching: teach the patient to warm up & cool down while exercising—start low & slow. The goal is 30 mins 5 days a week, 7 if possible.  We want to start with passive ROM and transition into active ROM, eventually building up to getting the patient out of bed in the physical therapy room. **CAD + nitroglycerin + Viagra= DEAD (from vasodilation.) **If the patient has chest pain after heart surgery other than the pain from the incision, there is something bad going on & we need to solve quick. Diet for ACS  LOW fat & cholesterol  Patient needs GOOD fats such as fish (grilled, blackened, baked).  Omega 3 Fatty acids (fish oil tablets.) st **1 step in treating high cholesterol= decrease fat in diet & increase exercise. Then start some type of drug therapy (“statins”.) Table 34-5 Pg. 739 When the patient is taking “statin” drugs, the nurse needs to monitor muscle pain. Watch liver enzymes. **If the patient is not able to take “statin” drugs, use “niacin.” Adult 1/Med Surg Week 3 Peripheral Artery Disease (PAD) Page 833  Arterial diseases always take priority.  PAD involves thickening of artery walls, which results in a progressive narrowing of the arteries of the upper & lower extremities.  PAD is caused from Atherosclerosis & Arteriosclerosis. Risk Factors  SAME AS CAD Clinical Manifestations  Pain  Pallor  Pulselessness  Parasthesia  Polar  Intermittent claudication= leg pain relieved by rest. **ABI (Ankle Brachial Index) can be used to diagnose PAD. **Critical Limb Ischemia= restricted blood flow. **If the distal pulse is present, the proximal pulses are okay. **If you cant find a pedal pulse, use the Doppler. **If you are not able to find a pulse with the Doppler, check capillary refill. Acute Arterial Thrombus  A clot that moves and occludes blood flow.  The patient can lose their limb in a matter of minutes. This is a medical emergency.  Promote circulation (heat, massage, warm bath, warm foot soak, put the extremities in a downward position.) **If we can’t get blood flow back after doing these measures, then we have to do a bypass graft. (Post-op monitor pulse every 15 minutes.) Common Diseases  Burger’s Disease (caused by young males who smoke {cigarettes or marijuana} and it leads to having to have extremities amputated starting with fingers. o Teach the patient to stop smoking and it could go away.  Raynaud’s Disease (common in women—immune response that causes changes in blood flow; red, white, and blue hands.) o Teach the patient to avoid stressor and keep fingers/toes warm.  Venous Disease—Varicose Veins (nurses are at risk and they are also genetic; very painful and they can hold a lot of blood.) **WWKYP with venous disease= DVT (blood clot becomes loose & travels to the lungs causing a PE or it could go to the brain causing a stroke—both lead to death.) **Start heparin (monitor PTT) then start warfarin (monitor INR.) They will be on both of the drugs at the same time— bridge the patient from one med to the other. Clot Risk  Excessive sitting  Obesity  Physical inactivity Clinical Manifestations of PE  SOB  Tachycardia  Chest pain **Encourage movement to prevent DVT. **Normal INR—Healthy people= 1.1 or <. On warfarin/heparin= 2.0-3.0 **Normal PTT—25 to 35 seconds.


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