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occurs when the systolic blood pressure is above 140 mm Hg or the diastolic blood pressure is above 90 mm Hg

No known cause. Accounts for 90-95% of all cases. No identified cause.

related to other identified causes. Some of these include:

• -renal disease
• -hyperaldosterone, cushings disease,thyroid/parathyroid disorder
• -sleep apnea
• -pregnancy
• -medications

• Obesity
• Diabetes
• Elevated cholesterol and triglycerides
• smoking
• sedentary lifestyle
• family history
• age

Each time the heart contracts pressure is exerted by the blood vessels

Hypertension can result from an increase in cardiac output, an increase in peripheral or both

Arterial opening is an important determinant of peripheral vascular resistance

Vessels have the ability to widen or narrow quickly in response to body needs (such as oxygen demands of nearby tissues, temperature regulation,fluid loss NS response)

Elevated blood pressure roughs up the normally smooth lining

Sets the stage for fat streaks, blood cells, or calcium to adhere

Thickening and buildup reduces blood flow and increases resistance.

1. Damage to the endothelial lining of the arteries

2. Increased workload of the heart causes heart failure

3. Rupture of hemorrhage of arterioles

Brain, Heart, Kidneys, Blood Vessels, Eyes

Sympathetic Nervous System and RAAS (Renin-agiotensin-aldosterone-system)

activity in response to feedback mechanisms signals

• -vessels to constrict or to relax and open
• -fluid retention
• -heart rate and contractility

Important pathway causing vasoconstriction and sodium/fluid retension

• -Hypertension is under diagnosed 
• -No visible symptoms
• -Often called the "silent killer"

age-related to ↓ elasticity of blood vessels

• family history
• ethnicity
• obesity
• diabetes, sleep apnea
• Diet
• alcohol consumption
• oral contraceptives in women
• smoking

Elevated blood pressure readings

Most people have no outward symptoms

• Sometimes (infrequently) reported by patients:
•   -Dull headache, Nosebleeds,Dizziness, Blurred Vision

1.They decrease the volume of circulating blood

2. They reduce peripheral vascular resistance

Blood pressure and heart rate

• Mechanism of Action
• ↑ urine output ↓ Blood volume

Inhibits sodium reabsorption in kidneys

• Side Effect & Adverse Effects
• Volume depletion/dehydration
• ↓ K (hypokalemia)
• ↓ sodium (hyponantremia)

• Headache
• Weakness
• Vertigo
• Orthostatic hypotension
• Dry mouth

• Inhibits conversion of angiotensin 1 to angiotensin 2 resulting in vasodilation lower peripheral resistance
• ↓ blood volume

• Side Effects & Adverse Effects
• Persistent, dry cough
• Hyperkalemia (high K)-especially in patients with kidney disease 
• First dose hypotension
• Angioedema(usually stridor) (potentially fatal)

• -Maintain 140/90 or lower
• -Maintian 130/80 or lower in patients with diabetes or chronic kidney disease

• Pain-where, how often,how severe
• Dizziness
• Vision
• Breathing, SOB
• Fatigue
• Urinating
• Sexual dysfunction

• -Blood pressure
• -Heart rate, rhythm
• -Peripheral pulses
• -Peripheral edema

• -Emphasize concept of controlling rather than curing hypertension
• -For most will be a lifelong, chronic illness.
• -Treatment will Greatly decrease associated cardiovascular risks.

• -A Hypertensive crisis exists when blood pressure is severely elevated.
• -Acute situation that requires prompt treatment to halt or prevent serious damage to target organs
• -Severity of situation is determined by evidence of organ damage. (cerebral hemorrhage,MI,heart failure, Kidney failure)

• -No clear guidelines
• -200/120 requires immediate treatment
• -180-199 systolic or 110-119 may require immediate treatment or evaluation within 24-48 hrs
• Hypertensive EMERGENCY there is evidence of target organ damage.
• -Hypertensive URGENCY no organ damage is evident (Sometimes called asymptomatic severely elevated blood pressure)

Occurs when O2 molecules enter the tissues of the body

        -Blood is oxygenated in the lungs where oxygen molecules travel from the air and into the blood

A persons temp,pulse,respiration, blood pressure and pain assessment

-ex: 98.5-72-18-120/80. pt denies pain 0/10

• Respiratory infectious diseases 
•       -Flu
•       -Pneumonia
• Hypertension
• Coronary Artery Disease (CAD)
• Chronic Obstructive Pulmonary Disease (COPD)
• Anemia

• -Nervous system
• -Cardiovascular system
• -Respiratory system
• -Metabolic processes
• -Hormones
• -Electrolytes

-They refect how the circulatory,respiratory,nervous,and endocrine systems are functioning.

-Many things can affect VS

-An alternation in one VS often affects others and needs to be seen in context with other health care assessments

• Technique
•   -Inspection
•   -Palpation
•   -Percussion 
•   -Auscultation
•   
• Stethoscope

• Balance of heat produced and lost from the body
•           normal temperature range:
•            36-38 C    96.8-100 F
• Heat produced-heat lost=body temp

Core temp-temp of the deep tissues, relatively constant

Surface temp-fluctuates

• -Is a by product of metabolism 
• -Food is the main fuel for metabolism
• -Increase metabolism increase heat

is lost mainly through the skin by

• radiation           convection
• conduction         evaporation

Hypothalamus (set point)-is the thermo-regulatory center controlling body temperature.

•         Anterior-controls heat production
•         Posterior-controls heat loss

Body becomes too warm superficial vessels dilate and leads to heat loss

Body becomes too cold and superficial vessels constrict leads to heat conservation

• -Thyroxin
• -Progesterone
• -Testosterone

  -Increased temperature-see increased metabolism,fluid loss,R, & tissue O2 demands.

-Stress-physical/emotional

-Gender-female greater fluctuation

-Circadian rhythm- (24 hour cycle) 1-2 F change, lowest 1-4 am and highest 4-7pm

-Age

very young and very old are more sensitive to environment changes

Overexposure to heat T-↑ 105 F

• Signs and Symptoms
•     Giddiness,confusion,delirium,hot dry skin

Heat exposure that leads to diaphoresis(profuse sweating) and fluid and electrolyte imbalance

• from heat loss as a result of exposure to cold
•     -Temp below 95 F, shivering,poor judgment and memory, depression
•     -usually develops slowly-person thinks "Im Ok"

• Results of:
•  -Pyrogens(bacteria & viruses)
• which trigger the immune response

•   -Hypothalamus 
•      raises the set point so the bosy produces & conserves more heat

1) chills,shivers,feel cold- new set point

2) feel warm & dry-at set point

3) feel warm, flushed, diaphoretic-set point drops

Temperature above normal 100.4

• Constant        Intermittent
• Crisis             Remittent
• Relapsing       Lysis

• -Narrower range of body temp
• -Reduced metabolism
• -Reduced sweat gland activity
• -Less subcutaneous tissue
• -Poor vasomotor control

• -Immunizations
• -Annual Physical
• -Documentation regarding illness,treatment,response

• -Non-pharmacological comfort interventions
•       -Provide rest,dry linens/clothes
•       -Offer well balanced meals
•       -Frequent oral hygiene
• -Cooling techniques
•       -Tepid sponge baths, room temp 70-80
•       -decrease clothing, cooling blanket

• Antipyretics
•    -Expected effects-reduce fever and pain with action therapists in 30-60 min

•    -Acetaminophen
•    -ASA
•    -NSAIDS

Contraction of the left ventricle sends a wave of blood into the arteries causing their walls to distend-felt as a beat then walls relax until next beat.

Apical pulse is more accurate than a peripheral

• Pulse rate- heart rate- BPM (beats per minute)
• Stroke Volume-amount of blood amount of blood ejected from the heart with each beat 
• Stroke Volume×Heart Rate=Cardiac Output

• -Automaticity
• -SA node
• -Blood volume
• -Stroke volume

Sympathetic Nervous System-stimulation of the SA node increases heart rate and force of contraction

Parasympathetic- stimulation of SA node via vagus nerve decreases heart rate.

• -Cardiovascular and respiratory systems are closely related
• -Chief function-supplies O2 to the blood and removes CO2 from the blood
• -Circulatory System-brings O2 to the cells and removes CO2

• -ADH-regulates vascular volume
• -Aldosterone-affects vascular volume
• -Epinephrine & norepinephrine-affect rate
• -Renin-causes vasoconstriction

Maintain rhythmicity of the heart

•   -K-potassium:3.5 mEq/L
•   -Na-Sodium:135-145 mEq/L
•   -Ca-Calcium: 9-10.5 mg/dL

Blood drawn from radial or femoral artery to assess patients oxygen status and acid base balance

•        -pH 7.35-7.45
•        -PaCO2 35-45 mmHg
•        -PaO2 70-100mm Hg
•        -HCO3 19-25 mEq/L
•        -O2 saturation 95-100%

• Rate
•     60-100 bpm
•       Bradycardia<60 bpm
•       Tachycardia >100 bpm
• Rhythm
•       Regular
• Equality
•        Equal in both extremities
• Amplitude
•        +3

• Amplitude                 Strength 
•        0                         Absent
•       +1                        Thready 
•       +2                        Weak
•       +3                        Normal
•       +4                        Bounding

•         Color
•         Temperature
•         Pulse
•         Capillary Refill-less than 3 seconds
•      -Sensation
•         Paresthesia
•         Absence of feeling
•      -Motion
•         -Weakness,Paralysis

• -Medications              -Exercise
• -Hemorrhage             -Gender
• -Postural changes       -Temp
• -Pulmonary                -Environment
• disease                      -Psychosocial state-pain, 
• -age                             anxiety,relaxation

The process of transporting O2 from the atmosphere to body cells and transporting CO2 from body cells to the atmosphere

Involves ventilating lungs & exchange of gases at alveoli

Involves exchange of gases from blood to cells and cells to blood

Movement of gases in & out of the lungs

Exchange of O2 & CO2 between alveoli & circulating blood-assess O2 saturation

Exchange of O2 & between circulating blood & tissue cells-assess O2 saturation

Maintains rhythm & depth of respiration & balance between inspiration & expiration

Automatic control of breathing

Voluntary control of breathing

Controls the oxygenation and delivery of blood to cells

• Factors to consider
•  
• Quality of blood 
•      -Hgb 12-18 g/dL
•  
• Quality of blood-Hct
•      -F 37-48%
•      -M 42-52%

Anything that increases metabolism increases respirations

CO2, O2 & H+ affect blood pH- most important factor is CO2 level

Stimulate respirations to maintain normal blood gases

the percentage of Hgb bound with O2 in the arterial circulation

SaO2-95-100%

Anything that alters perfusion/diffusion will affect this anemia-insufficient respiratory status

-Assess over trachea,bronchi,and peripheral lung fields

-Normal lung sounds are quiet and heard only through the stethoscope

-Abnormal sounds(adventitious) caused by narrowing, moisture, inflammation or consolidation

-Normal 

• -Abnormal
•     Ruddiness
•     Cyanosis-blue
•     Pallor-pale

• result of chronic O2 deficiency
•      Normal-angle between nail & skin=160  degrees

• Abnormal(clubbing)
•      180 degree-flat to > 180 degree
•      Nail base is spongy & swollen
• 

• -Cough
• -Body position
• -Shape of chest cavity
• -History of smoking
• -Activity tolerance
• -Shortness of breath

• -Variations through life span 
• -Changes associated with aging
•    ↓ elasticity

   ↓ maximum capacity

   ↓ thoracic and abdominal muscle strength


   -These changes increases the risk for disease like pneumonia

•  Positioning
•    -fowlers
•  O2 administration
•    -O2 via nasal cannula
•  Fluid intake
•    -2-3L daily if medically able

• Expected effects/outcomes/contradictions
•    Nicotine supplements
•       Gum
•       Patch
•   Bronchodilators
• Reduction of risk potential
•     Assessment of VS before administering meds affecting respirations

systolic-diastolic=PP

SVxHR=CO

• Increased CO=Increased BP
• Increased HR=Increased BP up to a point

• Blood Volume-(5-6L)
•  increased-elevated BP,decreased=lower BP

Viscosity(amount RBC in plasma), increased=increased BP

• Elasticity of vessels-decreased leads to increased BP
• Peripheral resistance-increase see increased BP,decrease see decreased BP

• Cardiac reflex center-In Medulla-ANS
•       -Stimulate parasympathetic branch impulses to heart via vagus nerve, decrease rate

• Vasomotor reflex center-In Medulla
•      -Regulates vasoconstriction/vasodilation of vessels

• -Pressure sensitive receptors (pressure receptors)
• -Located in aortic arch and walls of arteries
• -Respond to changes in diameter of vessels
• -Send impulses to cardiovascular center

• Hormones
•    -ADH-recall
•    -Aldosterone-recall
•    -Renin-recall
• Electrolytes
•    -Role in normal heart rhythm so influence BP
• Blood gases
•     -↓O2-Vasoconstriction

    -↑ CO2-Vasodilation

• Normal Values
•   -Systolic <120mmHg
•   -Diastolic <80 mmHg
• Consider 
•   -Baseline
•   -Position changes
•   -Cuff size

• Phase 1-faint tapping sounds
• Phase 2-muffled or swishing sounds-may disappear up to 40 mmHg
• Phase 3-loud sounds
• Phase 4-softer fading muffled sounds
• Phase 5-last sound heard(diastolic pressure)

• -Below normal BP-systolic <90 -normal for some
• Other S&S-tachycardia,pallor,confusion,clammy skin,mottled skin (Report Immediately)
• Causes
•   -Dilation of arteries
•   -Decreased blood volume
•   -Failure of heart's pumping ability

-Systolic drop of at least 20 mmHg or diastolic by at least 10 mmHg after position change supine to sitting, sitting to standing or supine to standing assess BP and pulse 1-3 minutes after each position change

-Causes; dehydration, blood loss, prolonged bed rest, older, surgery

-Other S&S-weak, dizzy,faint

• Resistance to blood flow increases yearly
•   -↓ elasticity of arteries and the size of the lumen

  -Resulting in ↑ systolic and diastolic pressure

• Expected effects/outcomes
• Adverse effects-contradictions 
•     -Orthostatic hypotension
•     -Electrolyte imbalance