Ch 27 Flashcards
The forced produced by the volume of blood in the arterial
BP
Older adults are at increased risk for development of ___ from __ drugs
Hypokalemia
Potassium-waisting diuretic
The ___,___ & ___ regulate arterial pressure
Autonomic nervous system
Kidneys
Various endocrine glands
Determined by the force & volume of blood that the LEFT VENTRICLE ejects during systole and the ability of the arterial system to distend at the time of ventricular contraction
Systolic BP
Reflects arterial pressure during ventricular relaxation. It depends on the resistance of the arterioles and the diastolic filling times
Diastolic BP
Central aortic systolic pressure (CASP), the pressure of blood at the ____ as blood is pumped from the left ventricle, can be lowered by as much as 30 mm hg than the corresponding ___ systolic pressure
Root of the aorta
Brachial arm
Pre hypertension
Systolic 120-139
Diastolic 80-89
When elevated BP causes cardiac abnormalities
Hypertensive heart disease
When vascular damage is present without heart involvement
Hypertensive vascular disease
Sustained elevated BP with no known cause .. about 95% of cases
Essential hypertension
Elevated BP that results from or is secondary to some other disorder
Secondary hypertension
____ (elevated serum sodium level) increases blood volume which raises BP
Hypernatremia
A low serum potassium level may cause ___ as the kidneys try to maintain a balanced number of cations in body fluid
Sodium retention
Defects in BP regulation may result from impairment in the __
Renin-angiotensin-aldosterone system
A chemical that kidneys release to raise BP
And increase vascular fluid volume in response to renal HYPOperfusion
Renin
Normal BP
Systolic less than 120
Diastolic less than 80
Elevated BP
Systolic 120-129
Diastolic less than 80 (bc systolic is still elevated)
For people with a ___ response, hypertension may be correlated with a higher than usual release of ___ such as __ and ___ which elevate BP
Heightened stress
Catecholamines
Epinephrine
Norepinephrine
Secondary hypertension may accompany any primary condition that affects ___ or __ or causes ___
Fluid volume
Renal function
Arterial vasoconstriction
Predisposing conditions of secondary hypertension
SATA ( 9)
-Kidney disease
-Pheochromocytoma (benign tumor of adrenal medulla)
-Hyperaldosteronism(increased secretion of mineralocorticoid by adrenal cortex)
-Atherosclerosis
-Use of cocaine
-Use of cardiac stimulants
*Weight control drugs
*Caffeine
-Use of oral contraceptives
Hypertension causes the heart to __
Work harder to pump against the increased resistance
The size of the heart muscle ___
Increases
When the heart can no longer pump adequately to meet the body’s metabolic needs ___ occurs
HF
The extra work and the greater mass increases the hearts need for __
Oxygen
In addition to its direct effects on the heart, high BP damages the __ system
Arterial vascular system
The increased resistance of the Arterioles to the flow of blood causes serious complications in other body organs including ___,___,___, & ___
Eyes
Brain
Heart
Kidneys
Hemorrhage of tiny arteries in the retina may cause ___
Marked visual disturbances or blindness
A CVA accident may result from
Hemorrhage or occlusion of blood vessels in the brain
MI may result from occlusion of a
Branch of a coronary artery
Impaired circulation to the kidneys may result in
Renal failure
The onset of hypertension is considered
“The silent killer”
As the BP becomes elevated, clients may identify sympathetic such as a ___ or ___, ___,___,____,____,___ &___
(8)
Throbbing or pounding
Headache
Dizziness
Fatigue
Nose bleeds (epistaxis)
Blurred vision
Confusion
An___ exam may reveal vascular changes in the eyes, retinal hemorrhages or edema of the optic nerves knows as ___
Ophthalmic
Papilledema
3 tests that may reveal an enlarged LEFT ventricle
Electrocardiography
Echocardiography
Chest radiography
A test that detects how well or inefficiently the heart pumps, can detect HF that may be associated with hypertension
MUGA (multiple gated acquisition) scan
An ophthalmologic test using IV dye, often reveals leaking retinal blood vessels
Flourescein angiography
If the causes is related to dysfunction of the adrenal gland, a ___ detects elevated Catecholamines
24- hour collected urine specimen
The primary objective of therapy for hypertension is to
Lower the BP & prevent major complications
Items that contain significant sodium
SATA(10)
Pickles
Green olives
Sauerkraut
Mustard
Catsup
Bbq sauce
Pizza sauce
Canned soup
Packaged mixes
Cheese
Believed that in persons older than __ reducing the __ below __ is more important than that decreasing the ___
60
Systolic pressure
150 mm Hg
Diastolic BP
Clients who require drug therapy may be treated initially with one drug, usually a___. However, most people with hypertension will need two or more antihypertensives meds to reduce their BP to target level
Thiazide diuretic (potassium waisting)
Secondary hypertension often resolves by
Treating it’s cause
All drugs used to reduce BP can produce __ & __ when rising to a sitting or standing position. Teach clients how to reduce symptoms of ___ as they adjust to their meds
Dizziness and syncope
Hypotension
___ may cause a persistent cough until the med is D/C
ACE inhibitors (-prils)
Intended use of calcium channel blockers
Relieve angina by DILATING arteries, improving myocardium blood supply and reduces myocardial oxygen demand
Calcium channel blockers
1-1trade
Nifedipine (Procardia)
Safety warnings for nurses with beta blockers
Drug is held if HR is less than 60 or above 120
*count apical 1 full minute
Risk for decreased cardiac output, nursing process
-encourage adherence to treatment with salt/sodium restrictions (doing so decreases blood volume and improves the potential for greater CO)
-administer prescribed antihypertensives (they use various mechanisms to control BP, including INCREASING URINE ELEMINATION, blocking production of angiotensin, & dilating blood vessels)
Injury risk related to syncope & dizziness secondary to side effect of antihypertensive drugs
Monitor postural changes in BP by assessing client while lying sitting & standing
Orthostatic hypotension - ortho vitals - lie down- call Dr
More serious forms of elevated BP that can develop in clients with either essential or secondary hypertension
Accelerated and malignant hypertension
Considered a hypertensive crisis
Accelerated hypertension
Accelerated hypertension is manifested by ___ accompanied by __ and ___
Markedly elevated BP
Hemorrhages and exudates in the eyes
If untreated accelerated hypertension may progress to
Malignant hypertension
Malignant hypertension is ___ accompanied by ___
Dangerously elevated BP
Papilledema
Malignant hypertension is ___ unless BP is quickly reduced
Fatal
Even with intensive treatment of malignant hypertension the ___,___ and __ may be ___
Kidneys, brain & heart
Permanently damaged
Consequences are life threatening when the BP in the ___ system becomes extremely elevated. Some ___ already may have ruptured or will soon
Vascular
Arterial blood vessels
Retinal hemorrhages can lead to
Blindness
A stroke occurs if__ in the ___ rupture & bleed
Vessels
Brain
If a __ has developed in the __ from ___ it may burst and cause __ & ___
Aneurysm
Aorta
Chronic hypertension
Hemorrhage
Shock
The onset of sudden ___ accompanied by ___ indicates that an aortic ___ is ___ or has __
Severe back pain
Hypotension
Aneurysm
Dissecting
Ruptured
In true hypertensive emergencies the goal is to lower the BP within __ to ___ hrs by using ___
1 to 2 hours
Potent IV drugs
