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The Cardiovascular System. Medication Administration and Hypertension. Essential functions of the heart. Collect deoxygenated blood Circulate it to the lungs where CO2 is exchanged for O2 Sends oxygenated blood to systemic circulation Repeat!. Coordination of systems. We work together!

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the cardiovascular system

The Cardiovascular System

Medication Administration and

Hypertension

essential functions of the heart
Essential functions of the heart
  • Collect deoxygenated blood
  • Circulate it to the lungs where CO2 is exchanged for O2
  • Sends oxygenated blood to systemic circulation
  • Repeat!
coordination of systems
Coordination of systems

We work together!

Don’t Forget Us!

what is hypertension
What is hypertension?
  • Force of blood against arterial walls of circulatory system
  • Fluctuates throughout the day
  • Systolic—pressure during contraction
  • Diastolic—pressure in vessels between contractions
  • Defined (now)

as ≥ 140/90

starting antihypertensive treatment i
Starting antihypertensive treatment I
  • In population age 60 years and older begin pharmacologic treatment at:

≥ 150/90

  • If treatment results in SBP lower than 150 and is well tolerated,

there is no need to

adjust treatment

starting antihypertensive treatment ii
Starting antihypertensive treatment II
  • In population under 60 years, start treatment at DBP > 90 to keep DBP

< 90.

population 18 years with diabetes
Population > 18 years with diabetes
  • Begin treatment at ≥ 140/90
  • Goal is to keep BP < 140/90
in general non black population including diabetes
In general non-Black population (including diabetes)
  • Start with thiazide diuretic or
  • Calcium channel blocker or
  • Angiotensin converting enzyme inhibitor or
  • Angiotensin

receptor blocker

in general black population including diabetes
In general Black population (including diabetes)
  • Start with thiazide diuretic or
  • Calcium channel blocker
in population with ckd
In population with CKD
  • Goal is to improve kidney function
  • Start with ARB or ACEi as initial or add-on therapy
  • Regardless of

race or diabetes

status

if goal not reached in 1 month
If goal not reached in 1 month…
  • Increase the dose or add second drug (CCB, ACEI, ARB)
  • If goal not reached with 2 drugs add a 3rd drug (month 2)
  • ACEI and ARB should not be used in same patient
  • If goal still not reached, drugs from other classifications

may be used

month 3)

  • If goal not reached at

this stage, referral to

hypertension specialist

is indicated

(month 4)

factors controlling blood pressure
Factors controlling blood pressure

COSVR

Heart rate Vascular

Stroke volume anatomy

Blood volume Neurohumoral

Inotropy factors

Preload

Renal H20, Na+

drugs that affect heart rate rhythm can
Drugs that affect heart rate & rhythm can:
  • Speed it up…
  • Slow it down…
  • Stabilize it…
how cardiovascular drugs affect heart rate
How cardiovascular drugs affect heart rate
  • Chronotropic—affects heart rate
    • Positive chronotropic—accelerates heart rate
    • Negative chronotropic—decelerates heart rate
  • Dromotropic—affects conduction velocity
    • Positive dromotropic—speeds up conduction
    • Negative dromotropic—slows down conduction
drugs that affect stroke volume can
Drugs that affect stroke volume can
  • Increase it…
  • Decrease it…
how cardiovascular drugs affect stroke volume
How cardiovascular drugs affect stroke volume
  • Maintenance of Preload through renal Na+ and H20 (neurohumoral)
  • Inotopic—affects force of cardiac contraction
    • Positive inotropic—strengthens contraction force
    • Negative inotopic—

weakens contraction

force

drugs that affect svr can
Drugs that affect SVR can
  • Increase it…
  • Decrease it…
effects of systemic vascular resistance
Effects of systemic vascular resistance
  • Blood vessel diameter regulates pressure
  • Diameter determined by smooth muscle tone
  • Healthy arterial walls stretch in response to blood pressue
  • In atherosclerosis, walls are less flexible and blood flow is decreased
nursing considerations diuretics
Nursing considerations:Diuretics
  • Monitor kidney function and renal output
  • Monitor for orthostatic hypotension
  • May require daily weight initially
  • Weight change of 2 lbs in 24 hours in remarkable and should be reported
  • Assess for lower extremity pitting edema
  • Auscultate for crackles and murmurs
  • Monitor electrolytes
  • Note ambulation safety for frequent urination
nursing considerations calcium channel blockers
Nursing considerations: Calcium channel blockers
  • Baseline EKG, heart rate, blood pressure
  • Monitor for effects of BP and HR
  • Monitor for CHF
  • Avoid grapefruit juice—increases absorption from GI

tract, increased effects

from CCB dose

nursing considerations aceis and arbs
Nursing considerations:ACEIs and ARBs
  • First dose can cause severe hypotension
  • Angioedema (larygeal swelling) a life-threatening side effect
  • Keep crash cart, O2 on standby
  • Monitor for neutropenia

(decrease WBCs), signs of

infection

  • Monitor for hyperkalemia