ch 32 hypertension Flashcards
what two things control blood pressure
- cardiac output
- systemic vascular resistance
what location in body do alpha 1 receptors act on (2)
- vascular smooth muscle
- heart
what location in body do alpha 2 receptors act on
vascular smooth muscle
how do alpha 1 and 2 receptors affect bp
vasoconstriction
how do beta 1 receptors affect bp (3)
- increase heartrate
- increase force of contraction
- increase speed of conduction
what location in body do beta 1 receptors act on
heart
what location in body do beta 2 receptors act on (2)
- heart
- lungs
example of beta 2 agonist med that causes bronchodilation
albuterol
what is the effect of angiotensin II on bp
vasoconstriction
what is the effect of aldosterone on the body (4)
- decreases urine output
- increases sodium
- increases fluids
- increases bp flow
what is considered normal bp
<120/<80
what is considered elevated bp
120-129/<80
what is considered stage 1 HTN
130-139/80-89
what is considered stage 2 HTN
> 140/>90
common causes that can cause secondary HTN (7)
- cirrhosis
- drug related (estrogen, oral contraceptives, NSAIDs, SNS stimulants)
- endocrine disorders (pheochromocytoma, cushing syndrome, thyroid disease)
- neurologic disorders (brain tumors, TBI)
- pregnancy induced HTN
- renal disease (renal artery stenosis, glomerulonephritis)
- sleep apnea
4 contributors to primary HTN
- sympathetic nervous system
- renal system
- insulin resistance
- endothelial cell damage
risk factors for developing primary HTN (8)
- hereditary
- environment (diet and exercise)
- demographic (older age)
- water and sodium retention
- smoking
- alcohol abuse
- hyperglycemia
- increased cholesterol
force opposing movement of blood within blood vessels
systemic vascular resistance
what hormone from SNS do alpha receptors respond to
norepinephrine
what hormone(s) from SNS do beta 1 receptors respond to
epinephrine + norepinephrine
what hormone(s) from SNS do beta 2 receptors respond to
epinephrine
how do beta 2 receptors affect bp (1)
vasodilation
how do baroreceptors affect bp (3)
- decrease heart rate
- decrease force of contraction
- vasodilation
what 2 substances are produced by the endothelium that cause vasodilation
- nitric oxide
- prostacyclin
what substance is produced by the endothelium that causes vasoconstriction
endothelin
what 2 things can reduce endothelial cell function
- smoking
- diabetes
how does angiotensin II increase bp (2)
- vasoconstrictor
- stimulates adrenal cortex to secret aldosterone
how do prostaglandins secreted by renal medulla affect bp
vasodilation, lowers bp
what age range is more common for HTN to develop in men
before early middle age
what factors in women are linked with higher prevalence of HTN (4)
- use of oral contraceptives
- h/o preeclampsia
- post-menopause (64 yo+)
- older age (70-79)
hemodynamic hallmark that is pathophysiology of primary HTN
persistently increased systemic vascular resistance
target organs of hypertension (5)
- heart
- brain
- peripheral vessels
- kidneys
- eyes
4 conditions of the eyes resulting from HTN
- AV nicking
- narrowing or retinal arterioles
- hemorrhages
- papilledema
2 conditions of the brain resulting from HTN
- stroke
- transient ischemic attack
3 conditions of the kidneys resulting from HTN
- microalbuminuria
- proteinuria
- serum creatinine >1.5
3 conditions of the heart resulting from HTN
- CAD
- heart failure
- left ventricular hypertrophy
1 condition of the sexual organs resulting from HTN
erectile dysfunction
2 conditions of the peripheral vascular system resulting from HTN
- intermittent claudication
- faint/absent peripheral pulses
S+S HTN (4) seen with severe HTN
“silent killer”
- fatigue
- dizziness
- palpitations, chest pain
- dyspnea
diagnostic studies looking for target organ damage or evaluating for secondary HTN (6)
- urinalysis
- metabolic panel
- complete blood count
- ECG
- TSH
- serum lipid profile
how many separate occasions does a pt have to have high blood pressure to be considered hypertensive
2 separate occasions
what will happen to bp if bp cuff is too big
false low bp reading
what will happen to bp if bp cuff is too smal
false high bp reading
recommended lifestyle changes for pt with HTN (6)
- stop smoking
- exercise (150 mins/week)
- lose weight
- moderate alcohol consumption
- stress management
- diet (low salt, low cholesterol, healthy fats)
how much will bp decrease for every 1 kg weight loss
1 mmHg
how much sodium should pt with HTN consume per day
1500 mg/day or less
common side effect and rare side effect of ACE inhibitors (2)
cough
angioedema
what side effect can result from the combo of aspirin + furosemide
tinnitus
what labs should you check before administering thiazide diuretics (2)
- sodium
- chloride
effect of thiazide diuretics
- inhibits sodium and chloride reabsorption on distal tubule
- lowers bp by reducing blood volume
what time of day should pt take diuretic
morning
what side effects should you monitor for with diuretics (4)
- hypokalemia
- hyponatremia
- hyperglycemia
- orthostatic hypotension
effect of loop diuretics
-increases urine output on loop of henle
example of 1 loop diuretic
furosemide
what ending characterizes ACE inhibitors
-pril
effect of ACE inhibitors
-prevents conversion angiotensin 1 to angiotensin 2
are ACE inhibitors or ARBs preferred for patients with T2 diabetes
ACE
-they can help prevent neuropathy
can pregnant pts take ACE inhibitors, ARBs, or calcium channel blockers
no
very teratogenic
can you combine ACE inhibitors with ARBs
no! very potent
when should you hold anti-HTN meds
if systolic is less than 110
what ending characterizes ARBs
-sartans
effect of ARBs
blocks receptor sites for angiotensin 2
produce vasodilation
effect of calcium channel blockers
- blocks calcium to myocardium
- decreases cardiac output and force
what VS should you check before admin of calcium channel blockers (2)
- bp
- HR
what food cannot be given with calcium channel blockers
grapefruit juice
preferred anti-HTN med for african american pt
calcium channel blockers
what pt should we use cautious use of calcium channel blockers with
pts with conditions that affect cardiac output (HF)
common side effect dihydropiridines
peripheral edema
common ending for dihydropiridines
-pine
+verapamil
common ending for beta blockers
-lol
what area of body does b1 blockers and b2 blockers affect
b1=heart
b2=lungs
what pt should we use cautious use of b2 blockers with (3)
- asthma
- COPD
- T1 DM
what adverse effect can b2 blockers have in pts with T1 DM
suppresses SNS response
*hypoglycemic unawareness
effect of b blockers
decreases HR and force
when should you hold b blocker
if HR less than 60 bpm
side effects b blockers (6)
- hypotension
- bradycardia
- drowsiness
- SOB
- edema
- cough
effect of a blockers
- vasodilation
- decreased bp
side effects a blockers (4)
- vertigo
- sexual dysfunction
- palpitations
- orthostatic hypotension
preferred a blocker during pregnancy
methyldopa
a blocker used for HTN emergency as IVP (and frequently used for pts with renal impairment)
hydralazine
a blockers (4)
- doxazosin
- clonidine
- methyldopa
- hydralazine
what pt should anti-HTN meds be held for on treatment morning
dialysis patients (exception = give b blockers)
important nursing considerations with HTN in older adults (2)
- may be auscultatory gap (inflate cuff high enough to get 1st beat)
- higher risk falls with orthostatic hypotension
severe abrupt. increase in bp
hypertensive crisis
what bp is considered urgent and what is considered emergent
-around 180/100 for both
urgent has no S+S end organ damage
emergent has S+S end organ damage
treatment hypertensive crisis (3)
- IV bp meds (calcium channel blocker and diuretics)
- monitor neuro status
- don’t lower bp too fast (=stroke)
what time of day should methyldopa and doxazosin be taken
bedtime
- reduces sedative effect methyldopa
- reduces orthostatic hypotension doxazosin
3 1st line drugs for HTN
- thiazide diuretic
- calcium channel blocker
- ACE inhibitor or ARB
high risk OTC meds for pts with HTN
- high sodium antacids
- NSAIDs
- appetite suppressants
- cold + sinus meds
what should pts on anti-HTN meds avoid for 3 hours after taking meds (3)
- hot baths
- strenuous exercise
- excessive alcohol
possible emergent causes of hypertensive crisis (8)
- encephalopathy
- head injury (hemorrhage)
- dissecting aortic aneurysm
- pheochromocytoma
- stopped taking meds (rebound HTN)
- recreational drugs
- preeclampsia
- renovascular HTN
S+S aortic dissection (2)
- sudden severe back pain
- chest pain
most effective IV drug for hypertensive crisis
sodium nitroprusside
