Review of Blood Pressure Foundations (Nursing)

00:02 Hi, and welcome to 1 of our video about the medications we use to treat hypertension.

00:07 In this 1, we're going to focus on the renin-angiotensin-aldosterone system.

00:12 We call that the RAAS.

00:15 Now, let's do a quick review of blood pressure categories.

00:19 You're going to see those appear behind me.

00:22 Remember that normal is < 120 systolic, < 80 diastolic.

00:27 You're starting to get into the elevated range when you're 120 - 129, or <80.

00:33 Stage 1 hypertension is 130 - 139, or 80 - 89 diastolic.

00:39 High blood pressure stage 2 is 140 or higher on a systolic reading, 90 or higher on a diastolic reading.

00:48 Now, we use the number 180/120 to indicate a severe hypertensive crisis.

00:55 This patient is in immediate -- in imminent danger and needs to be at the hospital for treatment.

01:00 So this is just a quick review of the blood pressure categories.

01:04 If you haven't got a chance yet, make sure you check out our Blood Pressure video.

01:09 Okay, now we use lots of different medications to treat hypertension.

01:13 So I'm going to kind of give you an overview of some of the medications that we use, and some study tips.

01:20 So, ACE inhibitors are angiotensin- converting enzyme inhibitors, but we just call them ACE inhibitors for short.

01:29 If you look at their generic ending, they all end in P-R-I-L.

01:35 So when you're looking at generic names, this will help you remember like if you can't recognize what family or category the drug goes into, you want to look for the ending P-R-I-L, and you've got a pretty good chance that it's an ACE inhibitor.

01:49 Angiotensin II receptor blockers are ARBs and they end in "tan," and we'll talk about those drugs as we move through the rest of the video.

02:00 Beta-adrenergic blockers are also called beta blockers for short, and they end in "olol," O-L-O-L.

02:09 And finally, calcium channel blockers, some of them end in "pine," P-I-N-E.

02:15 So, make sure that you circle those things that we have in quotation in your notes, and that's going to come up very helpful as you're memorizing generic drug names, and which family they belong to.

02:27 Now, some other medications that we use to treat hypertension are sympatholytic drugs.

02:33 We're talking about drugs other than beta blockers.

02:35 In other videos, we've discussed sympathomimetic drugs.

02:40 Those are things that imitate the sympathetic nervous system being stimulated.

02:45 This is the opposite.

02:47 So, underline the letters L-Y-T-I-C.

02:50 Lytic means to -- go against.

02:53 So, sympatholytic drugs will do the opposite of what the sympathetic nervous system does.

03:00 So, since the sympathetic nervous system causes-- potent vasoconstriction and your heart go faster rate to go faster, sympatholytic drugs will do the opposite.

03:12 Direct vasodilators are another group of medications that we use to treat high blood pressure or hypertension.

03:18 They directly vasodilate and we end up with a lower blood pressure.

03:24 Now we have another group that sounds really intimidating, but I promise that it isn't, but it's selective aldosterone-receptor antagonists or blockers.

03:34 The words "antagonist" or "blocker" are usually used interchangeably, so don't let that confuse you when you see it.

03:40 Beta blockers, beta-adrenergic antagonist, selective aldosterone receptor antagonist, or we could also call them selective aldosterone blockers, it would mean the same thing.

03:51 So that gives you an overview of the types of big groups of medication that we'll be looking at through the multiple videos.

03:58 Now, blood pressure, remember, that's the pressure in the blood in the circulatory system, the whole thing; the arteries, the veins, and the capillaries.

04:06 So that's what your blood pressure is.

04:09 When you measure a blood pressure, when you use a sphygmomanometer to actually measure a patient's blood pressure, you're looking at the systolic pressure and the diastolic pressure.

04:19 Now, if you haven't watched our blood pressure video yet, you probably don't know why my hand is moving up and down, but remember, the systolic blood pressure is the number that goes on the top.

04:27 That's the pressure that the heart pushes against those vessels and the arteries, blood leaving.

04:32 And the diastolic blood pressure is when that heart is getting its own perfusion of oxygenated blood.

04:40 So let's look at the 5 key players in your body for maintaining a normal, adequate blood pressure, okay? Number 1 are the arterioles.

04:50 They're kind of like the control valves.

04:53 So if we can impact those arteriole valves, we can have a really significant impact on blood pressure.

04:58 So number 1 are the arterioles.

05:01 Think of them as the control valves for maintaining a certain level of pressure in your system.

05:07 Baroreceptors.

05:08 Now these things are really cool.

05:10 There's the sensory nerves in the carotid sinus and aortic arches.

05:14 Now, they're kind of like alarms in the hospital, and I know when I worked in intensive care, you would have certain patients that just -- the alarms kept going off and off and off, but there really wasn't something wrong.

05:27 So we would kind of readjust the alarms based on whatever that patient needed.

05:32 Also, in nursing school, you might think of baroreceptors as that kind of friend that every day is a crisis.

05:38 You know what I'm talking about? You first meet somebody, and they have something that's really distressing.

05:44 And so, at first, you feel bad for them, but then, day after day after day, you realize every day is a crisis for them? Yeah.

05:53 Well, baroreceptors are pretty sensitive to that too.

05:56 Just like if I'm dealing with a person that everything's a crisis, you realize that a hangnail is a crisis in their life, you start to not getting really engaged.

06:04 You stop getting really engaged with them every time they get all distressed.

06:08 You'll learn that, "All right, I need to just give them some time.

06:11 Since everything is a big deal to them, I'm not going to get real upset every time they do." Baroreceptors recognize the same thing in the body.

06:20 Just like that friend that always is elevated and always kind of out of control, baroreceptors can actually reset themselves.

06:28 Just like in the hospital, nurses can reset alarms to match the patient.

06:32 When you have a friend who's driving you nuts because they're so crazy, you learn not to get real excited every day with them, baroreceptors learn that, "Wow, this person's blood pressure is up all the time," so they read just their response level.

06:47 It's a really cool thing about these sensory nerves in the carotid sinus and aortic arch.

06:53 Now, this is another one of those words that I thought was so fun to say when I started nursing school, medulla oblongata.

07:00 It just sounds cool, right? So you should probably say that at home, wherever you are.

07:05 Please practice it.

07:06 Medulla oblongata, it's pretty cool.

07:08 But it's the cardiovascular center of your brain.

07:12 So, we've hit 3 of the 5 key players: the arterioles, they have the major control valves.

07:19 The baroreceptors, they are those sensory nerves in the crowded sinus and the aortic arch.

07:24 Remember, what's cool about them is they can reset.

07:27 They start to realize that we can change that alarm level in the body when -- in regards to blood pressure.

07:33 And the medulla oblongata, the cardiovascular center of the brain.

07:39 Let's look at numbers 4 and 5.

07:41 Now you have hormones, as I say, hormones that come from the adrenal medulla.

07:47 Now, the adrenal medulla is in the adrenal gland, so where do you think that is located? Well, the adrenal glands sit on top of your kidneys.

07:57 They're not part of the kidney, but they sit on top of the kidneys.

08:00 That's why we call them adrenal glands.

08:02 Medulla is 1 of the 2 parts of the adrenal gland.

08:06 You have an adrenal medulla and adrenal cortex.

08:10 Now, the adrenal cortex is 1 that puts out corticosteroids, glucocorticoids, those other hormones.

08:17 But when we're talking about maintaining blood pressure, we're addressing things in the adrenal medulla, okay? So, we've got arterioles, baroreceptors, the medulla oblongata, and the hormones from the adrenal medulla.

08:33 Finally, you've got the renin angiotensin aldosterone system, and we're going to dig deeper into that in an upcoming part to the video.

08:42 We'll call it the RAAS just for short because some of these mouthfuls take a lot of time just to say, but I want you to stop, pause the video, see how many of these 5 key players you can recall without looking at your notes and try to write them down.

09:05 Okay, good work.

09:07 I hope you didn't cheat yourself by not trying to -- I -- Don't look at your notes until you've really tried to recall those 5 players.

09:15 The reason that's so beneficial for you is the energy, the mental energy that you put into recall is a good way to encode that information into your brains.

09:24 Why do you want it encoded? Because information that's encoded successfully gets moved over to your working memory and your long-term memory and that's where it's going to be available to you when you need it.

09:37 So it's okay if you try and then you can't remember all of them, then look at your notes.

09:41 But the more effort you can apply into remembering these things as we go along, the better your results are going to be in the long run.