Coronary Artery Disease and Hypertension Flashcards by Yaz Bassi

why is it difficult to sometimes determine if patients have HTN?

hospitalization and surgery can cause a stress response that elevates blood pressure due to
-pain,
-anxiety
-fear,
-white coat (or “green suit”) hypertension
-fluid retention

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What is white coat or “green suit” HTN caused by?

caused by anxiety when interacting with healthcare providers –

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What are 7 things the nurse should do to ensure a accurate BP reading.

putting the cuff on the client’s bare arm,
using the correct cuff size,
not having a conversation while taking the blood pressure,
making sure the client has emptied their bladder first,
sitting on a chair that supports the back and the feet,
making sure that the client doesn’t cross their legs 7. supporting the client’s arm at the level of their heart.

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**A client with no previous history of hypertension or other health condition suddenly develops a BP of
188/116. After verifying the BP, what should the nurse tell the client? **
A. The client should be scheduled to re-check blood pressure in 2 weeks
B. More diagnostic testing may be necessary to determine the cause of the hypertension
C. There is an immediate danger of stroke and hospitalization will be required
D. Reducing dietary fat content and calories will lower his blood pressure

B. More diagnostic testing may be necessary to determine the cause of the hypertension

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what does using an AOBP (or automated office blood pressure) involve

having the client sit quietly in a room for
several minutes while the machine takes several blood pressure readings and averages them.

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Why is the AOBP a more preffered method of taking BP in a clinic?

AOBP is the preferred method because it’s more accurate than manual measurement, and it has a reduced “white coat” effect,

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what does a sudden increase in blood pressure in a client with no previous hypertension history or risk
factors indicate?

that the hypertension may be secondary to some other problem

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**William’s physician asks him about any health conditions that could cause secondary hypertension. An example of such a condition is: **
A. Reflex syncope
B. Obstructive sleep apnea
C. Intoxication or abuse of benzodiazepine medications
D. Diabetic autonomic neuropathy

B. Obstructive sleep apnea

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sleep apnea can lead to what?

autonomic dysfunction with elevated levels of catecholamines, such as epinephrine

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what does HTN speed the process of?

atherosclerosis development

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atherosclerosis definition

fatty deposits accumulate within the walls of arteries, causing them to become more narrow, and reducing blood flow to the organs and extremities.

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what is atherosclerosis in the peripheral arteries called?

peripheral arterial
disease.

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what is intermittent claudication.

when blood flow is so reduced to the cells in the legs that the tissues become ischemic, and it causes severe cramping pain in the legs, whenever oxygen demand is increased

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what complications can occur from peripheral arteries disease?

arterial ulcer or intermittent claudication

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In order to detect, injuries such as arterial ulcer or intermittent claudication (caused by PAD) the nurse should monitor for what?

decreased circulation to the extremities, including
decreased (or absent) peripheral pulses, cold feet, and lower leg ulcers.

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What are the target organs that can become damaged by HTN?

Arteries
Heart
brain
kidneys
eyes

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The development of atherosclerotic plaques in the coronary arteries can lead to what three conditions?

coronary artery disease, angina, and heart attack.

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Hypertension
can cause a).. hypertrophy or b)..

a) left ventricular
b) Heart failure

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3 things

signs of heart failure

shortness of breath, weakness, or fatigue

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To detect changes to the heart such as left ventricular hypertrophy or heart failure, the nurse should monitor for what?

the nurse should monitor for symptoms of ischemic chest pain and signs of heart failure

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atherosclerotic plaques in the arteries leading to the brain – such as the carotid arteries – which can lead to?

an ischemic stroke or hemorrhagic stroke

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symptoms of a TIA typically last a).. and they resolve completely in about b)..

a) less than a hour
b) 24 hours.

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To detect any of these changes in the brain, the nurse should monitor clients with hypertension for an

altered level of consciousness, confusion, delirium, or other neurological changes, such as drooping of one side of the face, weakness on one side of the body, and slurred or jumbled speech.

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what is hypertensive nephrosclerosis.

hypertension causes narrowing of the arteries and arterioles in the kidneys, reducing blood flow.
and
damages the glomeruli in the kidneys, which reduces the ability of the glomeruli to filter the
blood.

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Along with diabetes, a)... is a leading cause of end-stage renal disease.

a) hypertension

What is end-stage renal disease.

when kidney function is so impaired, that the kidneys can no longer perform the essential functions to filter the blood and maintain fluid and electrolyte balance to keep a person alive.

What GFR will a person with end stage renal disease typically have?

GFR of less than 15. | person would need dialysis, or a kidney transplant.

In order to monitor for kidney damage due to HTN, what blood test should patients have done

urea and creatinine levels, and glomerular filtration rate (GFR). As well as test done to detect proteins in the urine

Because symptoms of retinal eye damage don’t become apparent until a lot of damage has been done, it’s important first a) ... and second, b)..

a) to control the hypertension b) to ensure that people with chronic hypertension are routinely screened by an optometrist or ophthalmologist.

**What information is most important for a nurse to include when teaching a client with newly diagnosed hypertension? **  Annual blood pressure checks are needed to monitor the effectiveness of therapy  Most people are able to control hypertension through lifestyle changes  Hypertension usually causes no symptoms until significant damage occurs  Dietary sodium restriction will control blood pressure for most people

 Hypertension usually causes no symptoms until significant damage occurs

In people with hypertension, their blood pressure should be checked by the health care provider every a)..

a).. 3–6 months

For most people with hypertension, it’s recommended to achieve a systolic blood pressure of a) ... and a diastolic blood pressure of b) ..

a) 140 or lower. b) 90 or lower.

diabetic clients with hypertension should aim for a systolic blood pressure of a) .., and a diastolic blood pressure of b)..

a) 130 or less b) 80 or less.

For those high-risk people, it’s recommended that they receive intensive therapy, and that they should aim for a target systolic blood pressure of a).. and a diastolic blood pressure of b)..

a) 120 or lower b) there’s no specific, target diastolic pressure).

People who fall into the "high risk" category of people with HTN include those who

people who are at least 50 years old - AND they have a systolic blood pressure of 130 or greater, - AND they have at least one more risk factor, such as being 75 years or older, or having clinical orsubclinical cardiovascular disease or have chronic kidney disease or have global cardiovascular risk of 15% or greater

People who have clinical signs of cardiovascular disease are those who are

showing some symptoms, or who have already had some type of cardiovascular complication, such angina, a stroke, or a TIA.

Some diagnostic tests that can determine sub-clinical CVD...

abnormal electrocardiogram, or performing a cardiac ultrasound and then learning that the heart wall is thickened

what does a global cardiovascular risk of 15% or greater indicate

the risk that people have of having a heart attack or dying in the next 10 years.

statin drugs are used to

reduce cholesterol

reducing cholesterol has only been shown effective in protecting against vascular complications of hypertension in people

over the age of 40 who have three or more cardiovascular risk factors

**William says that he saw a television commercial about a new blood pressure drug, and asks how Aliskiren works? **  It blocks the conversion of angiotensinogen to angiotensin I  It enhances the effect of natriuretic peptide hormones  It is a long-acting diuretic that blocks reabsorption of NaCl in the kidney  It reduces systemic vascular resistance by promoting direct arterial vasodilation

 It blocks the conversion of angiotensinogen to angiotensin

What drugs are often prescribed for HTN

thiazides and thiazide-like diuretics, ACE inhibitors, angiotensin receptor blockers (ARBs), long-acting calcium channel blockers (CCBs), beta blockers, and single pill combinations.

Why are beta blockers not a good idea for patients with HTN and diabetes

Beta blockers are associated with impaired glucose tolerance and an increased risk of developing diabetes… and in people who already have diabetes, they can cause people to experience asymptomatic hypoglycemia

Why may single pill combinations be a better option for patients

single pill combinations enable clients to adhere better to medication regimens and different medications help to lower blood pressure through different mechanisms,

# 8 eight lifestyle modifications can help reduce blood pressure and reduce his risk for cardiovascular disease

1. Smoking cessation 2. Physical exercise 3. Healthy body weight 4. Healthy diet 5. Restrict sodium 6. Increase potassium 7. Manage stress 8. Limit alcohol intake.

Canadian Society for Exercise Physiology recommend that adults should get a).. of moderate to vigorous aerobic physical activity per week,

150 minutes

people with hypertension should aim for a body weight with a body mass index between a) ..

18.5 and 24.9,

people with hypertension should aim for a waist circumference that’s less than a).. for men, or less than b).. for women.

a) 102 cm b) 88 cm

People with more abdominal and visceral fat have a higher risk for a).. and it’s associated with insulin resistance, elevated blood triglycerides and cholesterol

cardiovascular disease and diabetes

What does DASH stand for?

dietary approaches to stop hypertension.

The DASH diet is a weight loss diet **True or false**

**False** but it can be adapted to reduce calories to help people lose weight

What types of portions does the DASH diet consist of?

larger portions of whole grains, fruits, and vegetables… some dairy… and smaller portions of meats, fats, and sweets.

Hypertension Canada recommends that people should restrict their sodium to a)

2000 mg per day.

Health Canada recommends that an adequate daily intake of sodium is only a)..

1500 mg per day,

Health Canada lists a)… mg of sodium as the maximum “tolerable upper intake level”

2300 mg of sodium

Health Canada has found that most Canadians don’t get their adequate daily intake of potassium which is a).

4700 mg per day

People on these three medications should be cautious about their potassium intake as these medications reduce potassium excretion

ACE inhibitors, ARBs, and aldosterone blockers (such as spironolactone).

In people who have high levels of stress, engaging in a).., and b).. may help lower blood pressure.

a) cognitive-behavioural interventions b) learning relaxation techniques

What is a "standard drink"

it’s a measure of how much pure alcohol is in a drink.

**The physician recognizes that William's age (52) and sex (male) are both risk factors for coronary artery disease (CAD). What is another major risk factor for CAD? **  A low serum homocysteine level  A history of diabetes mellitus  Elevated serum high-density lipoprotein (HDL) levels  Presence of an abdominal aortic aneurism

 A history of diabetes mellitus

Total cholesterol is a measurement of

all the cholesterol in the blood, both high- and low-density lipoproteins,

What range should total cholesterol be in

**3.61-5.15 mmol/L. **

What are Triglycerides?

they are fats (or lipids) that come from the food that we eat. They can be used for energy, and the body stores any excess in fat cells and liver cells.

triglyceride levels should be between a)… and in women, triglyceride levels should be between b)...

a) 0.45 and 1.81 b) 0.40 and 1.42 mmol/L.

We want LDLs to be lower than?

lower than 2.59 mmol/L

We want HDLs to be higher than

higher than 1.55 mmol/L

dyslipidemia, which involves ELEVATED levels a).. or LDL cholesterol, and/or LOW levels b)

a) of total cholesterol, triglycerides b) of HDL cholesterol.

** What are the typical characteristics of pain in chronic stable angina? **  Pain may radiate up into the neck or jaw  Pain increases when taking a deep breath  Pain feels electric or “zapping”  Pain usually lasts for 20 minutes or longer

 Pain may radiate up into the neck or jaw

Angina (or cardiac pain) is often NOT described as a)..

pain.

People experiencing angina may explain it as

may describe it as pressure, squeezing, or heaviness…

Angina pain often has a a).. onset

gradual

non-cardiac pain often has an a).. onset,

abrupt

Angina pain often lasts about a), and it gradually improves with rest

3-5 minutes

Where is angina pain often described to be felt?

may be in the centre of the chest, up into the neck and jaw, in the area of the stomach, or it may radiate out into one or both arms

Ruptured atherosclerotic plaques can cause a).. that can block blood vessels.

thromboemboli

What populations may experience atypical symptoms of cardiac pain

women, diabetics, elderly with other comorbities

The P wave is where the

atria depolarize

QRS complex is where the

ventricles depolarize.

The T wave is where the

ventricles repolarize,

When people are being assessed for cardiac problems, what part of a ECG is important to focus on

ST segment.

ST-segment depression is caused by

cardiac ischemia | (where the heart cells aren’t getting enough oxygen)

If the T-wave is inverted, it could mean that the ischemic heart tissue isn’t able to a)

re-polarize normally,

What is a infarction,

an interruption in the supply of oxygen to the heart, resulting in myocardial cell death,

deeper and larger Q waves are called

pathological Q-wave. develop when there is irreversible damage to the heart, and some areas of the heart are unable to depolarize

Elevation of the ST-segment often indicates

injury or infarction

very severe ST elevation indicates a poor prognosis for the client and may be referred too as a

tombstone

STEMI stands for

ST-elevation myocardial infarction | HEART ATTACK

An NSTEMI is a

non-ST elevation myocardial infarction. | STILL A HEART ATTACK, but no ST segment elevation

**What blood test will most accurately identify if William is experiencing a myocardial infarction? **  Lactate dehydrogenase (LDH)  Troponin  B-type natriuretic peptide (BNP)  C-reactive protein

 Troponin

Troponins are proteins that are found in

cardiac muscle cells

**The cardiologist schedules William to have a coronary angiography. The purpose of this test is to: **  Record the electrical activity in the heart and analyze any rhythm disturbances  Evaluate the patency of the coronary arteries and the location of any blockages due to atherosclerotic plaques  Show the structure of the heart walls, sow the direction and flow of blood through the heart chambers, and measure ejection fraction  A radioactive isotope is injected, the radioactive uptake is recorded, showing myocardial contractility, perfusion, and acute cell injury

 Evaluate the patency of the coronary arteries and the location of any blockages due to atherosclerotic plaques

Before a patient goes for a coronary angiography, it’s important for the nurse to check if the patient has an

allergy to IV contrast agents, iodine, or shellfish

What is a stress test

when the healthcare provider watches for any changes in the electrical activity of his heart (on an ECG), while his heart is being stressed.

What can a echocardiogram show

structure, function, measure the dimensions of the walls of his heart, the size of each chamber, see if the heart is moving and contracting as it should, and measure the amount of blood being pumped from each of the chambers of the heart.

What is a hypertensive crisis

sudden increase in blood pressure with a diastolic blood pressure greater than 120 mm Hg.

There is two levels of a hypertensive crisis, the lower level is characterized by what

Happens a bit more gradually, over days-to weeks and there’s no evidence of target organ damage yet.

There is two levels of a hypertensive crisis, the higher level is characterized by what

develops a lot faster, over hours-to-days, and it’s more serious, because there is actually evidence of target organ damage.

signs of hypertensive encephalopathy,

headache, nausea, vomiting, seizures, or an altered level of consciousness.

a mild headache isn’t uncommon in a hypertensive crisis **True or false**

TRUEEEE

**What is the most common cause of a hypertensive crisis? **  Excessive psychological and/or emotional stress  Fluid overload  Physical exertion  Not taking prescribed antihypertensive medications

 Not taking prescribed antihypertensive medications

What medications have the possibility to increase BP

***NSAIDS** interfere with excretion of sodium from kidneys ***Corticosteroids** cause retention of sodium and water ***Several antidepressants** ***Cold medications** (decongestants) ***Stimulants** (e.g. Ritalin/methylphenidate).

when there’s no target organ damage in a hypertensive crisis, the goal is to

lower blood pressure gradually and cautiously.

In a hypertensive emergency with acute target organ damage, what medications might be prescribed

nitrates (such as nitroglycerine), calcium channel blockers (such as nicardipine), adrenergic blockers (such as labetalol).

Whenever caring for a client with coronary artery disease, the nurse should START EVERY SHIFT by:

making sure they’re familiar with the client’s baseline vital signs, and verify that the oxygen and suction are working during the safety check

**When the nurse teaches William about using nitroglycerin spray, what common side effect should the nurse warn him about? **  Dry cough  Blurry vision  Pounding headache  Peptic ulcer

 Pounding headache orthostatic hypotension is also common | people can treat nitroglycerine headaches with acetaminophen.

Nitroglycerine spray is a rescue medication and should be kept

within reach of the patient

what is the correct way to have a patient administer nitroglycerin, and how long will it take to show effect

correct way to administer nitro spray is to have client lift up their tongue and then spray it under tongue. | The nitro should take effect in 5 minutes.

it’s important to always check the blood pressure a).. administering nitro spray.

before and after

If a patient is having angina chest pain, and the nurse finds that oxygen saturation is abnormally low, the nurse a).. BUT, if the oxygen saturation is normal for this client, the nurse b)..

a) will administer supplemental oxygen. b) WON’T administer oxygen.