NCLEX Review & Nursing School

HYPERTENSION

What is hypertension?
– A SIGNIFICANT AMOUNT OF PRESSURE WITHIN THE BLOOD VESSELS
– EXCEEDS 140 MMHG SYSTOLIC AND 90 MMHG DIASTOLIC,
– LIFESTYLE CHANGES IS ALWAYS IMPORTANT: NO SMOKING * REDUCING ALCOHOL INTAKE.
* Remind patient that lifestyle changes such as smoking cessation and proper diet is essential.
– several factors such as the fluid volume within the body, which is regulated by the kidneys through the renin- angiotensin system.

Secondary Hypertension can be caused by:
– Cushing’s Disease (Too much Glucocorticoids)
– Brain Tumors
– Pheochromocytoma

* Remind Patient that smoking is the biggest factor.
* If Diet and exercise is not enough, meds are used.

♣ Pharmacology Drugs for Hypertension:

DIURETICS
– Helps get rid of the sodium and fluid in the body.
– Diuretics interferes with the sodium absorption in the kidney.
– Increases the urine output.  Decreases the preload and afterload.

MAJOR SIDE EFFECTS:

• – HYPONATREMIA
• – ORTHOSTATIC HYPOTENSION
• – DEHYDRATION

TYPES OF DiURETICS

(Drugs that you will encounter in the NCLEX exam)

Pottasium Sparing Diuretics
SPIRONOLACTON (ALDACTONE)
AMILORIDE (MIDAMOR)

Loop Diuretics
BUMETANIDE (BUMEX)
FUROSEMIDE (LASIX)

Osmotic Diuretics
MANNITOL

Thiazade Diuretics
HYDROCHLOROTHIAZIDE (HYDRODIURIL)
CHLOROTHIAZIDE (DIURIL)
CAUSES THE DEPLETION OF SODIUM AND WATER.
♣ CAN INDUCE HYPERGLYCEMIA

BETA (ADRENERGIC) BLOCKERS

As you have learned in Nursing School, beta adrenergic blockers are drugs that help lower blood pressure, pulse rate and cardiac output.  Beta Blockers are an important set of drugs to know for the NCLEX.  Sometimes, beta blockers are also used to treat migraine headaches an other vascular headaches.  Beta blockers are also used to treat glaucoma and used to prevent myocardial infarctions.

Try to remember that what beta blockers do is they act by blocking the sympathetic vasomotor response.  For the NCLEX, try to remember that the syllable for beta blockers is usally (olol).  Potential side effects of beta blocker that is necessary to know for the NCLEX would include: Orthostatic hypotension, bradycardia, nausea and vomiting, diarrhea and some of the symptoms may MASK hypoglycemia.

HYPOGLYCEMIC SYMPTOMS.

NURSING INTERVENTIONS FOR CLIENTS TAKING BETA BLOCKERS:

Make sure that you monitor the client’s blood pressure, heart rate and rhythm, before administering the beta blocker.  Monitor the client for signs of edema.  The nurse should also assess the lungs sounds for signs of rales and ronchi.  When patient are taking beta blockers, it is also very important to monitor the changes in lab values such as (protien, BUN and creatinine) which can indicate nephrotic syndrome.  Nursing teaching for the NCLEX would include: Teaching the Client to rise slowly (ORTHOSTATIC HYPOTENSION) * (A SAFETY ISSUE), report any signs of bradycardia, dizziness, confusion depression or fever.  It is also very important to taper off the medication properly.

Calcium Channel Blockers

1. – PREVENTS THE MOVEMENT MECHANISM OF CALCIUM WITHIN THE CARDIAC SYSTEM.
2. – THEREFORE DECREASING THE CARDIAC WORKLOAD, AND CARDIAC MUSCLE CONTRACTILIY.
3. – MEDICATIONS INCLUDE THE “DIPINE” : DILITAZEM (CARDIZEM), AMLOPIDINE (NORVASC), NEFEDIPINE, NICARDIPINE.
4. – USED TO TREAT ANGINA.

• VASODILATORS (PERHERAL)
• ALPHA ADRENERGIC BLOCKERS
• DIURETICS

ACE INHIBITOR

1. – ACE INHIBITORS “BLOCKS” THE CONVERSION OF ANGIOTENSIN 1 TO ANGIOTENSIN 2.
2. – ALTERS THE “BLOOD PRESSURE” MECHANISM THROUGH THE RENIN-ANGIOTENSIN SYSTEM.
3. MEDICATIONS INCLUDES THE “PRIL” : CATOPRIL, ENALAPRIL, LISINOPRIL, RAMIPRIL.
4. SIDE EFFECTS: COUGH, TACHYCARDIA, NAUSEA AND VOMITING.
5. GIVE ON AN EMPTY STOMACH OR 2-3 HRS. AFTER A MEAL.

We can easily connect Hypertension with several diseases which can be a complication of Hypertension:

Hypertension can lead to
– Aneurysms
– Atherosclerosis
– Heart Failure
– Myocardial Infarction

CARDIAC CATHETERIZATION (Procedure)

– a procedure that is done by the  PHYSICIAN *

– This used to determine specific diseased areas of the heart.  There would be a catheter that would be inserted through the arteries and into the heart.  This enables the physician to visualize the vessels, the coronary arteries and the valves of the heart.

NCLEX Note:  The nurse plays a big role PRIOR and AFTER this procedure:

Interventions:

• THE CLIENT MUST BE NPO AT LEAST 6-12 HRS. PRIOR TO THE PROCEDURE.
• ASSESS ANY NUMBNESS OR TINGLING FEELING IN THE SITE/AREA.
• ASSESS FOR ANY BLEEDING, PAIN OR WARMTH SENSATION WITHIN THE SITE.
• KEEP PATIENT IN BED FOR 8 HRS. TO NOT DISLODGE ANY CLOT FROM AN ARTERY
• IF FEMORAL ARTERY IS USED, KEEP LEG STRAIGHT FOR 8 HOURS.
• INCREASE FLUID INTAKE TO ASSIST KIDNEYS IN EXCRETING THE DYE.

Magnetic Resonance Imaging (MRI)  (Diagnostic Procedure)
– noninvasive diagnostic test that produces image of the heart and vessels.

BEFORE PROCEDURE:

• EVALUATE THE CLIENT FOR A PRESENCE OF PACEMAKER