Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS3313 Adult Health > Chapter 27 Hypertension > Flashcards

Chapter 27 Hypertension Flashcards

1
Q

Hypertension (HTN)

A

A condition in which the force of the blood against the artery walls is too high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the parameters to diagnose hypertension?

A

Must be based on an average of 2+ accurate readings taken between 1-4 weeks apart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Blood Pressure (BP)

A

The pressure that the blood exerts against the walls of the arteries as it passes through them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Systolic BP (SBP)

A

Arterial pressure when the heart contracts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Diastolic Pressure (DBP)

A

Arterial pressure when the heart relaxes and fills with blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Mean Arterial Pressure (MAP)

A

Average pressure w/in the artery during one full cardiac cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Ambulatory BPM

A

Assesses daytime & nighttime BP during routine daily activities typically, for one 24 hr period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Home BPM

A

Assesses BP at specific times during the day & night over a longer period while the patient is seated & resting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Normal BP Reading

A

Systolic: Less than 120 mmHg

Diastolic: Less than 80 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Elevated BP Reading

A

Systolic: 120-129 mmHg
and
Diastolic: Less than 80 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

HTN Stage 1 BP Reading

A

Systolic: 130-139 mmHg
or
Diastolic: 80-89 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

HTN Stage 2 BP Reading

A

Systolic: 140-159 mmHg
or
Diastolic: 90-99 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hypertensive Crisis

A

Systolic: Higher than 180 mmHg
and/or
Diastolic: Higher than 120 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

With which type of patients, would you see hypertensive crisis occur in?

A

Secondary HTN

Poorly controlled HTN

Undiagnosed HTN

Abrupt discontinuation or non adherence of med->rebound hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hypertensive Urgency

A

BP is severely elevated: SBP >180 mmHg or DBP >120 mmHg, in stable patient w/ NO EVIDENCE of impending target organ damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Nursing Considerations for Hypertensive Urgency

A

Explore reason for nonadherence
* Finances, anxiety, misunderstandings, miscommunication, drug side
effects, or recreational drug use
* Use team approach and mobilize resources to prevent nonadherence
from continuing or recurring

Frequency of vital signs assessment based on clinical judgement
and varies with patient’s condition
* Every 5 mins with rapidly changing BP is appropriate
* Every 15 or 30mins in a more stable situation should be sufficient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treatment for Hypertensive Urgency

A

Restart antihypertensive meds or increase dosages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Hypertensive Emergency

A

BP is extremely elevated >180/120 mm Hg with new or worsening target organ damage:
* Hypertensive encephalopathy
* Ischemic stroke
* Myocardial infarction
* Heart failure with pulmonary edema
* Dissecting aortic aneurysm
* Renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Nursing Considerations for Hypertensive Emergency

A

Rapid, focused assessment needed to determine possible cause and target organ involvement:
* Aortic Dissection – goal is to reduce SBP to <120 mmHg within the first hour of treatment
* Severe Preeclampsia/Eclampsia or Pheochromocytoma Crisis – goal is to reduce SBP to <140 mm Hg with first hour of treatment
* Goal for other cases of HTN emergency
* Reduce SBP by no more than 25% in first hour of treatment
* If stable, reduce to 160/100 mm Hg within the next 2-6 hours
* End goal of normal, controlled BP within 24-48 hours of initial treatment

ICU admission required for frequent and continuous monitoring of BP and cardiovascular status

Antihypertensive medication of choice
* IV meds such as nicardipine, labetalol, esmolol, nitroglycerin, and nitroprusside

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Hypertension Risk Factors

A

Advancing Adult Age

Ethnicity: African-American

Chronic kidney disease

Diabetes

Excess alcohol consumption

Family History

Gender:
-Men have greater risk until age of 64 yrs old
-Women have greater risk at 65 yrs old and up

Hypercholesterolemia

Obesity

Poor diet habits: Excess salt intake, limited intake of veggies, fiber, fish fats, & potassium

Sedentary lifestyle

Use of tobacco & nicotine prods & exposure to 2nd hand smoke

Sleep apnea

Stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

In which ethnic group, is hypertension most prevalent?

A

African Americans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Primary/Essential HTN

A

High BP due to an unknown cause, usually due to multitude of co-morbidities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Secondary Hypertension

A

High BP due to an identifiable cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Indications for Secondary HTN Screening

A

New-onset of high BP

Poorly controlled HTN

HTN resistant to 3 or more drugs

Abrupt onset of HTN

Patients younger than 30 yrs old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Conditions Associated w/New Diagnosis of HTN

A

Excessive target organ damage

Cerebral Vascular Disease

Retinopathy

LT ventricular hypertrophy

HF w/preserved ejection fraction

Coronary artery disease

CKD

Peripheral arterial disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Formula to Calculate BP

A

BP = CO (Cardiac Output) X R (Resistance)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Systemic Vascular Resistance

A

The pressure in the peripheral blood vessels that the heart must overcome to pump blood into the system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Formula to Calculate Cardiac Output (CO)

A

CO = HR (Hear rate) X SV (Stroke volume)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Cardiac Output (CO)

A

The amount of blood pumped by the heart per minute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Stroke Volume (SV)

A

The amount of blood pumped out of the heart with each contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How does increased venous return increase stroke volume?

A

More fluid in the vasculature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Factors that can Cause Hypertension

A

Increase in CO (usually rel to expansion in vascular volume)

Increase in peripheral resistance (constriction of blood vessels)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

In order for hypertension to occur…

A

… there must be a change in 1 or more factors affecting peripheral resistance or cardiac output

Additionally, there must be a problem w/ the body’s monitoring/pressure regulation control system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Common Causes of Secondary HTN

A

CKD

Cushing’s syndrome

Hyperaldosteronism

Hyperparathyroidism

Hypo/Hyperthyroidism

NSAID/Substance abuse

Obstructive sleep apnea

Preeclampsyia

Polycystic kidney disease

Renal artery stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Physiological Processes that can Lead to Hypertension

A

Increased SNS activity due to ANS dysfunction

Increased renal absorption of Na+, Cl-, & water due to genetic variation in pathways in how kidneys handle sodium

Increased RAAS system activity-> extracellular fluid volume expansion & increased systemic vascular resistance

Decreased vasodilation of the arterioles due to vascular endothelium dysfunction

Insulin resistance

Activation of the innate & adaptive components of the immune response that contribute to vascular inflammation & dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

High levels of Insulin & HTN (Type II Diabetes & Metabolic Disease)

A

Lead to renal dysfunction & cause enhanced levels of Na+ retention-> RAAS dysfunction

37
Q

Renin-angiotensin-aldosterone system (RAAS)

A

Compensatory process that leads to increased BP via increased fluid retention (increases preload) & vasoconstriction via angiotensin II

38
Q

Aldosterone

A

Promotes Na+ and H2O retention by kidneys

increases blood volume & BP

39
Q

If sodium is retained…

A

…H2O is also retained

40
Q

Immunity/Inflammatory Response in HTN

A

Chronic low levels of immune mediators-> immunity cells can begin damaging endothelium

41
Q

Prostaglandin Effect on Vasculature

A

Causes vasoconstriction

42
Q

Gerontological Considerations for Hypertension

A

Increase in BP due to changes in heart, blood vessels, and kidneys:
-Accumulation of atherosclerotic plaque

-Fragmentation of arterial elastins

-Increased collagen deposits

-Impaired vasodilation

-Renal dysfunction

Decreased elasticity

Stiffening of major blood vessels (aorta)

Volume expansion

Isolated systolic HTN is predominant in older adults

43
Q

Isolated Systolic Hypertension

A

A disorder most comm seen in older adults in which the systolic BP is greater than 140 mmHg & diastolic BP is less than 80 mmHg

44
Q

Clinical Manifestations of Hypertension

A

Known as “the silent killer” since there are NO warning signs
-Usually most people do not know they have it

Fatigue

Reduced activity tolerance

Dizziness

Palpitations

Angina

Dyspnea

45
Q

Target Organ Damage

A

Manifestations of pathophysiologic changes in various organs as a consequence of hypertension

46
Q

Target Organ Damage: Eyes

A

Retina changes:
-Hemorrhages

-Exudate

-Arteriolar narrowing

-Cotton-wool spots (small infarctions)

Papilledema: Swelling of the optic disc
-Seen in severe HTN

47
Q

Target Organ Damage: Heart

A

CAD w/angina & MI leads to left ventricular hypertrophy

LVH occurs in response to increased workload placed on the ventricle as it contracts against higher systemic pressure
-When heart damage is extensive, HF follows

48
Q

LVH

A

Left Ventricular Hypertrophy

Thickening of the wall w/in LT ventricle

49
Q

Target Organ Damage: Kidneys

A

Increased BUN & serum creatinine levels-> nocturia manifestation

Electrolyte imbalances

50
Q

Target Organ Damage: Cerebrovascular Involvement

A

Transient ischemic attack (TI) or stroke

Alterations in vision or speech

Dizziness

Weakness

Sudden fall

Permanent or transient hemiplegia (paralysis on one side)

51
Q

Nursing Considerations for Obtaining Accurate BP Reading

A

Equipment: BP cuff

Patient Instruction:
-Avoid eating, smoking, drinking caffeinated beverages, & physical activity 30 mins prior to BP measuring

-Empty bladder

-Sit quietly for 5 min before measurement

-Sit w/ back supported, arm at heart level on firm surface, w/ both feet on the ground
a) Avoid talking while measurement is being taken

Choose appropriately sized cuff: Width of at least 40% limb circumference & length of at least 80-100% limb circumference

Wrap cuff firmly around arm: Center cuff directly over brachial artery

Record BP results of both arms & take subsequent measurement from the arm w/higher reading
-Should vary no more than by 5 mmHg
-Take 2 readings between 1-2 mins apart & use average of measurements
-Document BP measurement site & position of the patient

52
Q

Patient Assessment

A

Assess for s/s of target organ damage:
-CV assessment
- Neck assessment for bruits, distended veins, or enlarged thyroid gland
-Auscultate upper abdomen for kidney arterial stenosis
-Eyes
-Neuro assessment

Assess health history:
-Screen for primary or secondary HTN
-Review patient’s ambulatory or home BP measurement techniques and verify its accuracy
-Assess family history and cardiovascular risk factors
-Examine personal, social, or financial factors; health beliefs, depressive symptoms, social support, and concomitant comorbidities

Lab & Diagnostic Studies
* 12-lead EKG
* Echocardiogram
* Urinalysis: Look for albumin for kidney damage
* Blood chemistries

53
Q

Masked Hypertension

A

BP that is typically suggestive of a diagnosis of HTN that is paradoxically normal in a healthcare setting

54
Q

White Coat Hypertension

A

BP that increases to hypertensive readings in healthcare settings that is paradoxically w/in the normal ranges in other settings

55
Q

Goal of Hypertension Treatment

A

Prevent complications (target organ damage) & death by maintaining a BP reading lower than 130/80 mmHg

56
Q

Medical Management of a Patient w/out Prior Diagnosis of HTN w/ Elevated BP

A

BP Reading: SBP of 120-129 mmHg & DBP of <80 mmHg

Should be advised to follow up w/additional BP readings w/in 3-6 months

57
Q

Medical Management of a Patient w/BP that could be consistent w/HTN

A

BP Readings: SBP > or equal to 130 mmHg or DBP of > or equal to 80 mmHg

Should follow-up w/ additional BP readings w/in 1 month’s time to confirm or rule out diagnosis

Patient’s w/suspected masked or white coat HTN: BP should be based on HPBM or ABPM

58
Q

Medical Management of Patients w/BP Reading of > or equal to 160/100 mmHg

A

Diagnosed w/HTN & begin treatment w/antihypertensive meds

59
Q

Lifestyle Changes for Hypertension

A

Weight loss, DASH diet, physical exercise, reduced NA+ intake, increased K+ intake, smoking cessation, & decreased alcohol intake

60
Q

Dietary Approach to Stop Hypertension (DASH) Diet

A

Increase fruit, vegetables, and low-fat dairy prods w/ reduced content of saturated & total fat
-Restrict sweets

61
Q

If DASH diet is used in conjunction w/weight loss…

A

…it can lower SBP by 11-16 mmHg

62
Q

DASH Diet Recommended Servings of Grains & Grain Products

A

7 or 8 servings daily

63
Q

DASH Diet Recommended Servings of Veggies

A

4 or 5 servings daily

64
Q

DASH Diet Recommended Servings of Fruits

A

4 or 5 servings daily

65
Q

DASH Diet Recommended Servings of Low-fat or Fat-Free Dairy Foods

A

2 or 3 servings daily

66
Q

DASH Diet Recommended Servings of Lean Meat, Fish,
& Poultry

A

Less than or equal to 2 servings daily

67
Q

DASH Diet Recommended Servings of Nuts, Seeds, & Dry Beans

A

4 or 5 servings weekly

68
Q

Other Dietary Considerations for Hypertension

A

Incorporate low sodium, high potassium diet: less than 2g Na+/day, 3,500-5,000mg/day
-Aim for at least 1000 mg/day sodium reduction
-High potassium diet must be avoided in patients w/CKD

Limit alcohol consumption to 2 drinks or less per day in men
- 24 oz beer
- 10 oz wine
- 3 oz 80 proof whiskey

Limit alcohol consumption to 1 drink or less per day in women

69
Q

Exercise & Weight Loss Interventions for Hypertension

A

Maintain normal body weight
-Ideal body weight is best goal but, aim for at least 1 kg (2.2 lbs) weight loss
-Expect ~1 mmHg SBP decrease for every 1 kg reduction in weight

Regular aerobic phys activity (brisk walking) for at least 90-150 mins weekly

Regular dynamic resistance training 90-150 mins weekly

Regular isometric resistance training at least 3X a week

70
Q

First Line of Meds for Hypertension Management

A

Thiazide or thiazide-type diuretics

Angiotensin-converting enzyme (ACE) inhibitors

Angiotensin-receptor blockers (ARBs)

Calcium channel blockers (CCBs)

71
Q

Thiazide or Thiazide-type Diuretics

A

Inhibit Na+ reabsorption in the distal convoluted tubule of the nephron

Side effects include: hyponatremia, hypokalemia, and metabolic alkalosis

72
Q

Side Effects of Thiazide or Thiazide-Type Diuretics

A

Dry mouth

Thirst

Weakness

Drowsiness/lethargy

Muscle aches

Muscle fatigue

Fatigue

Tachycardia

GI disturbance

73
Q

Nursing Considerations for Thiazide or Thiazide-Type Diuretics

A

Monitor for side effects

Orthostatic hypotension may be potentiated by alcohol, barbiturates, opioids, or hot weather

Cause loss of Na+, K+, & Magnesium w/ increase in uric acid & Ca+2: Monitor for electrolyte imbalances

Encourage intake of potassium-rich foods

Gerontological considerations: Risk for orthostatic hypotension (be weary of fall risk)

74
Q

Angiotensin-converting enzyme (ACE) inhibitors

A

Block the conversion of angiotensin I to Angiotensin II

Side effects: Hyperkalemia, Angioedema, cough

75
Q

Nursing Considerations for ACE inhibitors

A

Can cause hyperkalemia

Side effects can include cough

Gerontological Considerations: Req reduced dosages & addition of loop diuretics when renal dysfunction is present

May cause reuptake of ACE2 receptors-> Makes pts more susceptible to infection w/ SARS-CoV-2

76
Q

Angiotensin-receptor Blockers (ARBs)

A

Block effects of angiotensin II at the receptor
-Reduces peripheral resistance

Side Effects: Hyperkalemia, angioedema, upregulation of ACE2 receptors

77
Q

Calcium Channel Blockers (CCB)

A

Inhibit Ca+2 ion influx
-Vasodilation

Side effects: headache, dizziness, skin flushing, peripheral edema, hypotension

78
Q

Clinical Manifestations of Hyponatremia

A

SALT LOSS

Seizures & Stupor

Abdominal cramping, attitude changes (confusion)

Lethargic

Tendon reflexes diminished, trouble concentrating (confused)

Loss of urine & appetite

Orthostatic hypotension, overactive bowel sounds

Shallow respirations (happens late due to skeletal muscle weakness)

Spasms of muscles

79
Q

Clinical Manifestations of Hypokalemia

A

“Everything is going to be LOW & SLOW”

Weak pulses: Irregular and thready

Orthostatic Hypotension

Depression ST, flat or inverted T wave and prominent u-wave

Shallow respirations with diminished breath sounds….due to weakness of accessory muscle movement to breath

Confusion, weak

Flaccid paralysis

Decrease deep tendon reflexes

Decreased bowel sounds

80
Q

The 7 L’s of Hypokalemia

A

1) Lethargy (confusion)

2) Low, shallow respirations (due to decreased ability to use accessory muscles for breathing)

3) Lethal cardiac dysrhythmias: ST depression, shallow T wave, projecting U wave

4) Lots of urine: frequent urination…kidneys unable to make the urine concentrated

5) Leg cramps

6) Limp muscles: Decrease deep tendon reflexes

7) Low BP & Heart

81
Q

Clinical Manifestations of Hyperkalemia

A

“MURDER”

Muscle weakness

Urine production: Little or none (renal failure)

Respiratory failure due to the decreased ability to use breathing muscles or seizures develop

Decreased cardiac contractility: weak pulse, low blood pressure

Early signs of muscle twitches/cramps…late profound weakness, flaccid

Rhythm changes: Tall peaked T waves, flat p waves, Widened QRS and prolonged PR interval

82
Q

First Line of Meds for Hypertension Management in African-American Patients

A

Without HF or CKD

Thiazide diuretic or calcium channel blocker
-NOT ACE inhibitors or ARBs

83
Q

Special Considerations for Pharmacological Treatment of HTN

A

Patients are first prescribed low doses
-If pt’s BP does not fall to less than 130/80 mmHg: Dose is gradually increased additional meds are included as necessary to achieve control

84
Q

Resistant Hypertension

A

High BP treated w/ 3+ antihypertensive medicine (1 must be a diuretic agent) of different classes

85
Q

Risk Factors for Resistant Hypertension

A

Older Age

Ethnicity: African-American descent

Obesity

CKD

Diabetes

86
Q

Nursing Considerations for Resistant Hypertension

A

Assess for patient adherence
- Ensure finances are not preventing them
- Check for pt understanding of med purpose
- Check that med side effects are tolerable

Patients should also be assessed for secondary hypertension

Older adults: Start low & go slow

Monotherapy, if appropriate, may simplify the med regimen & make it less expensive

Check for drug interactions w/ over-the-counter medication

Include family & caregivers in educational program

87
Q

Target BP

A

<130/80 for all adults regardless of age
-Exception: Target SBP <140 mmHg in patient 60 yrs & older w/history of stroke or TIA, reducing reoccurrence or w/in clinical judgement of provider

88
Q

Which med class is the biggest risk factor for falls?

A

Calcium channel blockers due to vasodilation

89
Q

Match assessment finding or intervention to cause or disorder

Assessment Finding/Intervention
1) SBP 120-129 mmHg & DBP <80 mmHg

2) BP >180/120 mmHg w/out target organ damage

3) Screened for risk of adverse cardiac events

4) Treat underlying cause to obtain normal BP

5) BP >180/120 mmHg w/ target organ damage

6) Essential w/ unknown cause

7) HTN caused by sleep apnea

8) SBP more than or equal to 140 mmHg or DBP more than or equal to 90 mmHg

Cause/Potential Disorder
a) Primary HTN

b) Secondary HTN

c) Elevated HTN

d) Stage 1 HTN

e) Stage 2 HTN

f) Hypertensive Urgency

g) Hypertensive Emergency

A

1) c

2) f

3) d

4) b

5) g

6) a

7) b

8) e

NURS3313 Adult Health (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions