Chapter 16

Question 1

Cardiac Output (CO)

Answer 1

CO = SV (Stroke Volume) x HR (heart rate)

Question 2

End- diastolic volume

Answer 2

• the preload

- amount of blood returned to the heart

Question 3

Systemic Vascular Resistance (SVR or afterload)

Answer 3

• determined by the radius of arteries and the degree of vessel compliance
• SVR = BP/CO

Question 4

Blood Pressure (BP)

Answer 4

BP = CO x SVR

Question 5

Hypertension

Answer 5

• increases morbidity and mortality associated with heart disease, kidney disease, peripheral vascular disease, and stroke
• Is determined by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
• is classified as a higher than usual Diastolic and/or Systolic blood pressure

Question 6

Prehypertension

Answer 6

• a range of pressures between normal and stage 1 hypertension in an effort to initiate interventions early enough to prevent or deter progression of the disease process

Question 7

Numbers the classify Hypertension

Answer 7

Normal: SBP < 120 and DBP < 80
Prehyp: SBP 120-139 and DBP 80-89
Stage 1 Hyp: SBP 140-159 and DBP 90-99
Stage 2 Hyp: SBP >or= 160 and DBP >or+ 100

Question 8

Primary Hypertension

Answer 8

• also called essential hypertension
• is an idiopathic disorder
• most common form
• Systolic BP: major risk factor of CV disease

Question 9

Subtypes of Primary Hypertension

Answer 9

Isolated systolic: SBP >or= 140 while DBP < 90
Isolated Diastolic: DBP >or= 90 while SBP < 140
Combined: Both exceed hypertension levels

Question 10

Nonmodifiable risk factors of Primary Hypertension

Answer 10

• family history
• age
• ethnicity/genetics

Question 11

Modifiable Risk Factors of Primary Hypertension

Answer 11

• diet/weight
• Metabolic issues
• high blood glucose levels/diabetes
• high cholesterol
• alc and cigs

Question 12

Outcomes of Primary Hypertension

Answer 12

• sometimes called the silent killer as damage to organs is done before diagnosis
• Results in end-organ damage

Question 13

Treatment of Primary Hypertension

Answer 13

• lifestyle changes such as weight loss and exercise, decrease in sodium intake, moderation of alcohol
• Drug therapy but will affect heart rate, SVR, and/or SV

Question 14

Secondary Hypertension

Answer 14

• hypertension attributed to a specific identifiable pathology or condition
• most common in infants and preschoolers
• most common cause is renal disease and coarctation of the aorta
• other causes are obstructive sleep apnea
• Adult secondary can be attributed to : Renal artery stenosis, Pheochromocytoma, Pregnancy, Obesity/sleep apnea, and Hyperaldosteronism

Question 15

Hypertensive Emergency

Answer 15

• a sudden increase in either both SBP or DBP with evidence of end organ damage
• treated with rapid but controlled reduction of blood pressure using parenteral antihypertensive agents under close monitoring (ICU)

Question 16

Hypertensive Urgency

Answer 16

• similar blood pressure elevation without evidence of end organ damage
• treated with oral medications to bring blood pressure under control over 24-48 hrs

Question 17

Orthostatic (postural) Hypotension

Answer 17

• an extreme response to the change from supine to upright position; activation of the short term control mechanisms is slow or inadequate
• causes a decrease in SBP (>or= 20 or >or=10 in 3min) when moving to an upright position
• excessive increase in heart rate may also be diagnostic (20-30 BPM)
• results in dizziness(presinkapy), blurred vision, confusion, and possible syncope

Question 18

Orthostatic Hypotension may be the result of

Answer 18

• problem with vasomotor or baroreceptor responese
• adverse effect of drug therapy
• arterial stiffness
• volume depletion
• secondary disease process
• Vasovagal reaction
• cardiac dysrhythmias

Question 19

Treatment for Orthostatic Hypotension

Answer 19

• review medical history
• slow positional changes
• avoid high temps
• avoind large carbs/heavy metals
• squatting /bending forward or crossing legs at onset can reduce effects
• elastic compression stockings, abdominal binders, elevate head of bed
• increase salt and fluid intake

Question 20

Renin-Angiotensin-aldosterone system (RAAS)

Answer 20

• important regulator of BP
• juxtaglomerular cells when stimulated by low arterial pressure release renin which activates angiotensinogen to angiotensin I
• Angiotensin I when in contact with ACE activates angiotensin II, a potent vasoconstrictor and stimulates release of aldosterone
• Aldosterone, a hormone, causes reabsorption of sodium and water passively follows

Question 21

Monitoring Blood Pressure (measurement)

Answer 21

• components of monitoring include SBP, DBP,, SV, SVR, and Mean Arterial Pressure (MAP)
• ## there are both direct and indirect methods

Question 22

Mean Arterial Pressure (MAP)

Answer 22

the calculated average pressure within the circulatory system throughout the cardiac cycle
- MAP = (2 x DBP) + SBP/ 3

Question 23

Direct BP Monitoring

Answer 23

• requires an intraarterial catheter and specialized equipment to transduce arterial fluid pulsations into electrical signals (waveforms)
• catheder placed in radial artery
• most accurate method

Question 24

Indirect BP Monitoring

Answer 24

• commonly measuredd via the brachial artery using a stethoscope and sphugmomanometer or automated oscillometric system
• Auscultation of Korotkoff sounds (SBP is onset of Korotkoff sounds) (DBP is disappearance of Korotkoff sounds)