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Med/Surg > Assessment and Management of Patients with Hypertension > Flashcards

Assessment and Management of Patients with Hypertension Flashcards

1
Q

Most common chronic disease among U.S. adults

A

Hypertension

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2
Q

Hypertension = a systolic blood pressure (SBP) of

A

140 mm Hg or higher

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3
Q

Hypertension =a diastolic blood pressure (DBP) of

A

90 mm Hg or higher

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4
Q

To diagnose hypertension, 2 accurate blood pressure measurements must taken

A

1 to 4 weeks apart by a health care provider

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5
Q

Primary hypertension is also called

A

essential hypertension

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6
Q

In primary hypertension, 95% of patients do not have

A

an identifiable cause

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7
Q

Type of hypertension:

5% of patients; renal disease, sleep apnea, pregnancy related

A

Secondary hypertension

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8
Q

About ___% of the adult population of the U.S. has hypertension

A

33% or 1/3

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9
Q

about 1/3 of people with hypertension, do not

A

know they have it

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10
Q

About ___% do not have their hypertension under control

A

45-50%

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11
Q

In systolic BP, blood is

A

pushing out

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12
Q

In diastolic BP, the heart is

A

at rest

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13
Q

When the arteries feed the heart muscle, if the diastolic BP is too high it leads to

A

compromised nutrition

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14
Q

Genetics = __% of hypertension cases

A

30%

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15
Q

3 Determinants of high BP:

A

Heart rate
Stroke Volume
Peripheral vascular resistance

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16
Q

Amount of blood pumped out of the ventricles on each beat

A

Stroke Volume

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17
Q

The resistance in the circulatory system that is used to create blood pressure

A

Peripheral vascular resistance (PVR)

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18
Q

BP =

A

HR x SV x PVR

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19
Q

Usual symptoms other than elevated BP

A

None

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20
Q

BP symptoms related to organ damage are seen

A

late and are serious

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21
Q

BP symptoms related to organ damage:

A

Retinal and other eye changes
Renal damage
Myocardial infarction
Cardiac hypertrophy
Stroke
Angina
SOB
Alteration in speech or balance

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22
Q

Temporary block of blood flow through coronary arteries when under stress

A

Angina

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23
Q

Who is sometimes more helpful in identifying symptoms of high BP?

A

Patient’s partner

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24
Q

Controlled or stable angina means

A

patient knows what sets it off

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25
Q

A major Risk Factors of hypertension

A

Microalbuminuria or GFR <60 mL/min

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26
Q

Age when most people are diagnosed

A

Men 45
Women 55

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27
Q

Optometrist knows if a patient has hypertension when

A

He sees broken vessels in eye

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28
Q

Tests that confirm hypertension

A

Urinalysis (hyperalbuminemia)
Blood chemistry (bun and creatinine)
ECG

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29
Q

Uncontrolled hypertension can cause damage to what parts of the body?

A

Brain= stroke
kidneys= failure
eyes= retinal damage
heart= MI, PVD

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30
Q

Medical Management:

For adults, maintain blood pressure at

A

<140/90 mm Hg

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31
Q

Medical Management:

For older adult patients, maintain BP at

A

<150/90 mm Hg

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32
Q

Pharmacologic therapy used for hypertension is the same for

A

Heart failure

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33
Q

Aim of pharmacologic therapy

A

Decrease peripheral resistance, blood volume
Decrease strength and rate of myocardial contraction

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34
Q

DASH diet should be followed at least

A

5 days a week

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35
Q

Alcohol consumption per day should be

A

1 or less for women/ light weight
2 or less for men

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36
Q

Stage I hypertension med for AA and patient’s >60 yrs old

A

Calcium channel blocker or thiazide diuretic

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37
Q

Stage I hypertension med for non-AA and patients <60 yrs old

A

ACE inhibitors or ARB’s

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38
Q

What population has 3x higher risk of angioedema and more cough attributed to ACE Inhibitors?

A

African Americans and Asians

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39
Q

SBP 140-160 mmHg or DBP 90-100 is

A

Stage I hypertension

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40
Q

SBP 160+ mmHg or DBP 100 mmHg is

A

Stage II hypertension

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41
Q

SBP 140-160 mmHg or DBP 90-100 is

A

Stage I hypertension

42
Q

Med that decreases serum sodium levels and blood volume

43
Q

Med that blocks the conversion of angiotensin I to angiotensin II; an angiotensin II receptor blocker; blocking effects of angiotensin on blood vessels

A

ACE Inhibitor

44
Q

Med that leads to a decrease in heart rate and strength of contraction as well as vasodilatation

A

Beta-Blocker

45
Q

Med that relaxes muscle contraction or other autonomic blockers

A

Calcium Channel Blocker

46
Q

Med that acts directly on vascular smooth muscle to cause muscle relaxation, leading to vasodilatation, and drop in blood pressure

A

Vasodilators

47
Q

Patient teachings

A

Do not double dose if missed
Do not stop drug abruptly
Monitor BP weekly, weight
Check peripheral edema
Instruct patient to rise slowly minimize orthostatic hypotension

48
Q

Difference between Apical and radial pulse is called

A

Pulse deficit

49
Q

Hypertension meds:

The “-prils”

A

ACE inhibitors

50
Q

Hypertension meds:

Causes decrease in aldosterone production, and a small increase in serum potassium levels along with sodium and fluid loss

A

ACE inhibitors

51
Q

Hypertension meds:

Treatment of hypertension, congestive heart failure (CHF), diabetic nephropathy, left ventricular dysfunction following an MI

A

ACE inhibitors

52
Q

Most common ACE inhibitor

A

Lisinopril

53
Q

Hypertension meds:

Main adverse reactions are Angioedema and cough

A

ACE inhibitors

54
Q

Cough caused by ACE inhibitors

A

bradykinin

55
Q

Hypertension meds:

ARB’s stands for

A

Angiotensin II Receptor Blockers

56
Q

Hypertension meds:

Meds that end in “-sartan”

57
Q

Hypertension meds:

Most common ARB meds

A

losartan (Cozaar) and valsartan (Diovan)

58
Q

Hypertension meds:

ARB’s Caution:

A

Hepatic or renal dysfunction, and hypovolemia
Patient must be well hydrated

59
Q

Hypertension meds:

Main adverse reactions with ARB’s

A

increase in K+, hypotension, headache

60
Q

Hypertension meds:

ARB’s are less effective if taken with

A

phenobarbital (anti-seizure med)

61
Q

Hypertension meds:

Med that lets the heart rest, slows HR, decreases strength of contraction, decreases PVD. Treats essential hypertension. extended release form

A

Calcium Channel Blockers

62
Q

Hypertension meds:

Most common Calcium channel blocker

A

Amlodipine

63
Q

Hypertension Med:

Contraindications: digoxin because it increases contractility, Cyclosporine (immunosuppressant, anti-rejection med)

A

Calcium Channel Blockers

64
Q

Hypertension Med:

SE: peripheral edema, dysrhythmias, atrial blocks, and impotence

A

Calcium Channel Blockers

65
Q

Hypertension med:

Most common adverse effects: GI symptoms (constipation)

A

Calcium Channel Blocker

66
Q

Hypertension med:

Should not be taken with grapefruit juice cause it inactivates the enzyme and leads to high levels of drug (lasts 4-5 days)

A

Calcium Channel Blockers

67
Q

Hypertension med:

Least commonly used drug

A

Alpha1-blockers

68
Q

Hypertension med:

block arterial vasoconstriction> decrease heart rate. Action causes higher blood flow to kidneys> decrease renin secretion>decrease Angiotensin II>vasodilation

A

Beta Adrenergic blockers

69
Q

Hypertension med:

Most common Beta Adrenergic blocker

A

metropolol

70
Q

Hypertension med:

Call doctor is BP is less that

71
Q

Hypertension med:

Increase the excretion of sodium and water from the kidney to lower blood pressure

72
Q

Hypertension med:

3 kinds of diuretics

A

Thiazides
potassium sparing
loop

73
Q

Hypertension med:

name of a loop diuretic

A

furosemide (Lasix)

74
Q

Hypertension med:

Common potassium sparing diuretic

A

spironolactone (Aldactone)

75
Q

Hypertension med:

Common thiazide med

A

hydrochlorothiazide (HCTZ)

76
Q

Hypertension med:

Potassium sparing and thiazide diuretics work at the

A

distal convoluted tubule

77
Q

Hypertension med:

Loop diuretics work at

A

the ascending loop of henle

78
Q

Hypertension med:

Can be used as monotherapy or adjunct

79
Q

Hypertension med:

K+ wasting and dose dependant

A

Thiazide and loop

80
Q

Hypertension med:

Caution:
Gout
Systemic lupus
Diabetes
Hyperparathyroidism

81
Q

Hypertension med:

Contraindicated, causes lithium toxicity

82
Q

Hypertension med:

Most commonly used diuretic; less powerful than new drugs; larger margin of safety for home use

A

Furosemide (Lasix)

83
Q

Hypertension med:

Actions:
Block the chloride pump in the ascending loop of Henle
This causes reabsorption of sodium and chloride

A

Loop diuretics

84
Q

Hypertension med:

Diuretic that decreases potassium and can lead to digoxin toxicity

A

Loop diuretics

85
Q

Hypertension med:

Not as powerful as the loop diuretics, but they retain potassium instead of wasting it.

A

Potassium Sparing diuretics

86
Q

Hypertension med:

If lasix and spironolactone are given together, which one is stronger?

A

Spironolactone

87
Q

Hypertension med:

Must watch for hyperkalemia

A

Potassium Sparing diuretics

88
Q

Hypertension med:

SE: breast tenderness, decrease in testosterone, decrease in sodium (hyponatremia)

A

Potassium sparing diuretics

89
Q

Nocturia is cause by

A

ANS - kidneys are better perfused

90
Q

Why is a BP of 150/90 ok for a person over 60 yrs?

A

Because of atherosclerosis

91
Q

Daily sodium intake should be limited to

92
Q

Patient teaching:

Caution patient and caregivers that HTN meds can cause

A

Hypotension

93
Q

reflexes can be compromised by

A

diuretics (decrease in extracellular volume) and adrenergic antagonists (inhibition of sympathetic nervous system).

94
Q

Blood pressure >180/120 mm Hg is considered a

A

Hypertensive emergency and must be lowered immediately to prevent damage to target organs

95
Q

Blood pressure is very elevated but no evidence of immediate or progressive target organ damage

A

Hypertensive urgency

96
Q

Aim of care in hypertensive emergency

A

Reduce blood pressure 20% to 25% in first hour
Reduce to 160/100 mm Hg over 6 hours
Then gradual reduction to normal over a period of days

97
Q

BP that is too low causes loss of

98
Q

Hypertensive emergency is usually managed in the

A

ICU with IV meds

99
Q

Hypertensive urgency is seen with s/s of

A

nosebleeds, headache, anxiety

100
Q

Hypertensive urgency is usually treated with what type of meds

101
Q

Hypertensive urgency is usually treated at

A

a med/surg floor

Med/Surg (17 decks)

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