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Circulatory Assessment and Vital Signs *(Unit 4)* (Medications for HTN…
Circulatory Assessment and Vital Signs *
(Unit 4)*
Anatomy of the Heart
Layers
Epicardium: Outermost layer
Pericardium: Surrounds the Heart and protects it
Myocardium: Bulk of heart cells
Endocardium: Lining the inside chambers of the heart
*
Chest pain r/t lack of blood flow to the muscle of the heart
Valves
S1
Tricuspid
Mitral
S2
Aortic
Pulmonary
Relaxation: Diastole (filling of the ventricals)
Contraction: Systole
Vital Signs
Pulse (60-100)
Apical (5th intercostal space)
Pulses in extremities
0: No pulse
+1: Weak
2+: Normal
+3 Full normal
+4: Bounding
Respirations (12-20)
Men: abdominal
Women: thoracic
Bradypnea: <12/min
Tachyonea: >20/min
Apnea: pausing in breathing
Eupnea: Normal
Hypoventilation: Decrease in volume of breath
Respiratory Acidosis
Hyperventilation: Retain CO2; short and shallow
Respiratory Alkalosis
Rhythm
Cheyne-stokes
Abnormal, deep, shallow, apena
Kussmaul
Hyperventilation (DKA)
Biots
Shallow interrupted by apnea
Temperature: (97-99)
101 or >=admin. Tylenol with orders
Regulated by the hypothalamus
Febrile=Temp. present
Afebrile= No temp.
Lowest temp. would be from 4-6 am.
Blood Pressure: (90-140/60-90)
Ideally 120/80
O2 Saturation >92%
Pain
Hypertension
(
HTN)
BP persistently above 120/80
Diagnosed with 2 different BPs obtained at 2 different times
Often asymptomatic
Primary HTN: Cause unknown
Secondary HTN: Known cause
Orthostatic BP (BP changes with position changes)
Peripheral Vaso-dialation
Lying>Sitting>Standing
Rise in pulse: 15-30 BPM
Decrease in BP by 20 systolic or 10 diastolic
Medications for HTN
Cardiac Glycoside
Digoxin, Lanoxin
Decreases HR in a-fib; Increases strength of contractions
HR<60=HOLD!
Diuretics
Lasiks, Aldactone
Loop and Thiazide Spare K+
Pull off fluid volume
Decreases BP
ACE Inhibitors (-prils)
Lisinopril
Dialate vessels and increase renal blood flow
Inhibit angio-tensin II
Decreases Na+ retention
Blocks aldosterone
ARBs (-sartans)
Losartan
Angio-intensin Receptor Blockers
Relax blood vessels
Decrease BP
Heart pumps esier
Statins
Decrease Cholesterol
Can cause muscle aches
Beta-Blockers (-olol)
Metoprolol, Atenolol
Dialate vessels
Decrease HR
Decrease BP
Beneficial for the Heart
Nitrates
Nitro, Isosorbride
Dialate vessels
Decrease Blood flow
Can decrease BP and HR
Ca+ Channel Blockers
Norvasc, Cardizem
Slow movement of Ca+ into the cells of the heart
Decrease BP
Regulate HR
Arteriosclerosis
Arteries become narrowed d/t plaque build up
Risk for DVT
May need a vasodialator
Peripheral Vascular Disorders (PVD)
Venous Leg Ulcers
Ruddy (Red), beefy granular appearance
Wound large and Irregular
Moderate to Heavy drainage
Skin brownish, macerated, edematous
Pain may be present
Medial lower leg
Varicose Veins
May be painful
Common esecially with aging
Engorged and distended
Often a rest of long term standing (Nurses)
Surgical and non-surgical treatment
Peripheral Artery Disorders (PAD)
Arterial Leg Ulcers
Distal to impaired blood supply
Pale, Gray, yellow (NO redness)
No new granulation
Wound bed sharply defined; punched out appearance
May be superficial or deep
Minimal drainage
Skin reddened, SHINY, tight, hairless
Usually painful
Hemociterain: breakdown of RBC causing brown look