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The Cardiovascular System

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

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  1. The Cardiovascular System Medication Administration and Hypertension

  2. 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!

  3. Coordination of systems We work together! Don’t Forget Us!

  4. 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

  5. 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

  6. Starting antihypertensive treatment II • In population under 60 years, start treatment at DBP > 90 to keep DBP < 90.

  7. Population > 18 years with diabetes • Begin treatment at ≥ 140/90 • Goal is to keep BP < 140/90

  8. In general non-Black population (including diabetes) • Start with thiazide diuretic or • Calcium channel blocker or • Angiotensin converting enzyme inhibitor or • Angiotensin receptor blocker

  9. In general Black population (including diabetes) • Start with thiazide diuretic or • Calcium channel blocker

  10. 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

  11. 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)

  12. Factors controlling blood pressure COSVR Heart rate Vascular Stroke volume anatomy Blood volume Neurohumoral Inotropy factors Preload Renal H20, Na+

  13. Drugs that affect heart rate & rhythm can: • Speed it up… • Slow it down… • Stabilize it…

  14. 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

  15. Drugs that affect stroke volume can • Increase it… • Decrease it…

  16. 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

  17. Drugs that affect SVR can • Increase it… • Decrease it…

  18. 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

  19. Types of blood pressure medications classified by function

  20. Sites of action of antihypertensives

  21. 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

  22. 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

  23. 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

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