Nursing Care for Patients with HTN & Discharge Planning – Flashcards
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Causes of primary HTN:
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a. Excess sympathetic nervous system activity b. Altered function of renin-angiotensin-aldosterone system and salt/fluid intake c. Atrial natriuretic peptide factor affecting motor tone and Na and water excretion d. Insulin resistance--sodium retention by the kidneys
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Explain the steps of the Renin-Angiotensin Aldosterone system:
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1. ↓ perfusion, ↓ GFR 2. Nephrons produce renin 3. Angiotensin I 4. Angiotensin II (vasoconstriction, thirst) 5. Aldosterone ↑ absorption Na & H20 6. ↑ excretion K and H ions
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HTN ranges Normal: Pre-HTN: Stage I HTN: Stage II HTN:
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Normal: <120/160/>100
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Races that have higher risks for HTN:
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African Americans and Hispanics
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Evidence-based campaign aimed at controlling HTN:
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Million Hearts Campaign
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ABCS of controlling HTN:
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Aspirin BP Control Cholesterol management Smoking cessasation
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How to diagnose HTN:
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>2 readings in 3-6 visits No BP meds Both arms, seated
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Recommended salt intake in mg:
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2300 mg/day
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Four medications that can cause HTN:
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Oral contraceptives Antidepressants Transplant Drugs Cortisone and other steroids
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HTN is the leading cause of patients requiring:
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Dialysis for kidney failure
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Diagnostic Tests for HTN:
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1. ECG/EKG 2. Urinalysis 3. Blood glucose 4. Hematocrit 5. Serum K, Creat, Ca 6. Cholesterol, lipids 7. Urinary albumin, c-reactive protein, homocysteine levels
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What disease goes hand-in-hand with HTN?
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Diabetes
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At what point should prehypertension be treated?
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130/80 and diabetic or renal disease
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Describe the DASH diet:
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7-8 servings grains/day 4-5 veggies 4-5 fruit non-fat/low-fat dairy 2-3 Meat/fish <2 servings Nuts,seeds,beans 4-5 Sweets 5 servings per week
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Drug combination for HTN:
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Thiazide diuretic plus one ACE, ARB, BB, or CCB.
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Diuretics are better for what type of patients with HTN?
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Elders, blacks, obese
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Beta Blockers are better for what type of patients with HTN?
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Chronic HTN pts When hydrochlorothiazide causes heart rate changes
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ACE Inhibitors & ARBs are better for what type of patients with HTN?
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Diabetics, HF, MI, chronic kidney disease
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The first week of drug therapy, you should monitor:
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Monitor Na and K 10% hypokalemia
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Treatment adherence is poor because:
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1. No symptoms 2. Med side effects 3. Men lose potency 4. Mood change 5. Patients need motivation!
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Something important to remember when treating hypertensive crisis:
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Lower the BP slowly!
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Three adverse outcomes of hypertensive crisis:
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Cerebral edema Retinal hemorrhage Acute renal damage
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If a patient is prescribed one medication, what stage of HTN are they?
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Stage I
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What is the target BP for patients with diabetes and HBP?
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140
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What determines the ability to be admitted into a LTACH?
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Anticipated at least 25 days of care
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How do LTACHs and IRFs differ?
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3 hrs of intense PT
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What are requirements for who live in an assisted living facility?
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Being able to afford the care
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What is required before Medicare will pay for skilled nursing care?
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3 days as an inpatient
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What is the difference between skilled nursing care and custodial care?
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Custodial care does not get paid by medicare.
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Who qualifies for paid home care visits?
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Homebound patients
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Hospice is for patients with a prognosis of:
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6 months or less.
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Nursing role in hospice care:
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Support patient and family Advocate to physician, patient, and family.
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Legal form that states who you want to make decisions for you; person is authorized to speak for you if you are unable to make your own decisions (legal & medical)
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Power of Attorney
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Written statement of wishes, preferences and choices regarding EOL health care decisions
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Advanced directive
