Day II Flashcards
1
Q
define HTN
A
- Defined as a systolic pressure at or greater than 140 mmHg or diastolic pressure at or greater than 90 mmHg for 2 or more assessments of blood pressure
- For those over 60, blood pressure should be less than 150/90
- Prolonged, untreated, or poorly controlled HTN can cause peripheral vascular dz that primarily affects the heart, brain, eyes, and kidneys
- Hypertrophy of the left ventricle can develop as the heart pumps against resistance caused by the HTN
2
Q
essential HTN vs. secondary HTN
A
- Essential HTN: AKA primary HTN
- Most common
- No known cause
- Secondary HTN: caused by dz states, like kidney dz, or as an ADR of some meds
- Tx: occurs by removing the cause (adrenal tumor, medication)
3
Q
prehypertension
A
- client’s with a SBP of 120-139 mmHg or a DBP of 80-89 mmHg
- Lifestyle changes are necessary for these clients to help prevent cardiovascular disease
4
Q
health promotion and dz prevention of HTN
A
- Maintain body mass index of less than 30
- Clients who have DM should keep blood glucose w/in a recommended reference range
- Limit caffeine and alcohol intake
- Use stress management techniques during times of stress
- Stop smoking: nicotine patches or engaging in a smoking cessation class are potential strategies
- Engage in exercise that provides aerobic benefits at least 3 times a week
- Limit sodium and fat intake
5
Q
explain the 4 mechanisms that regulate BP
A
-
Arterial baroreceptors:
- Baroreceptors are located in the carotid sinus, aorta, and left ventricle
- They control BP by altering the heart rate. They also cause vasoconstriction or vasodilation.
- Regulation of body fluid volume: properly functioning kidneys retain fluid when a client is hypotensive and excrete fluid when a client is hypertensive
- RAAS: renin is converted into Ang II, which causes vasoconstriction and controls aldosterone release, causing the kidneys to reabsorb sodium and inhibit fluid loss
- Vascular autoregulation: maintains consistent levels of tissue perfusion
6
Q
risk factors of essential HTN
A
- Positive family hx
- Excessive sodium intake
- Physical inactivity
- Obesity
- High alcohol consumption
- African American
- Smoking
- Hyperlipidemia
- Stress
- Age greater than 60 or postmenopausal
7
Q
risk factors of secondary HTN
A
- Kidney disease
- Cushing’s disease (excessive glucocorticoid secretion)
- Primary aldosteronism (causes HTN and hypokalemia)
- Pheochromocytoma (excessive catecholamine release)
- Brain tumors, encephalitis
- Meds like estrogen, steroids, and sympathomimetics
- Pregnancy
8
Q
expected finidngs in clients who have HTN
A
- Clients who have HTN can experience few or no manifestations. Monitor for the following.
- HAs, particularly in the morning
- Facial flushing
- Dizziness
- Fainting
- Retinal changes, visual disturbances
- Nocturia
9
Q
stages of HTN
A
- When a BP reading is elevated, take it in both arms and w/ the client sitting and standing
- There are levels of HTN:
- preHTN: 120-139/80-89
- Stage I HTN: 140-159/90-99
- Stage II HTN: greater than or equal to 160/greater than or equal to 100
10
Q
lab tests for HTN
A
- no lab tests can diagnose, but several can identify the causes of secondary HTN
- BUN, creatinine: elevation is indicative of kidney dz
- Elevated serum corticoids: detects Cushing’s dz
- Blood glucose and cholesterol studies: identify contributing factors related to blood vessel changes
11
Q
diagnostic procedures for HTN
A
- ECG: evaluates cardiac functions
- Tall R waves: often seen with left ventricular hypertrophy
- CXR: shows cardiomegaly
12
Q
meds for HTN
A
- used when HTN is not responsive to lifestyle changes alone
- Diuretics are first line, but many ppl require a combination of meds
- Client edu: instruct clients to change positions slowly, and to be careful when getting out of bed, driving, and climbing stairs until the med’s effects are fully known
- classes of HTN meds:
- diuretics
- CCBs
- ACE Inhibitors
- ARBs
- Aldosterone receptor antagonists
- beta blockers
- central alpha 2 agonists
- alpha adrenergic antagonists
13
Q
what are the types of diuretics used to tx HTN and how do they work?
A
- Thiazide diuretics: like HCTZ, inhibits water reabsorption and increases potassium excretion
- Loop diuretics: like furosemide, dec Na reabsorption and inc K excretion
- Potassium sparing diuretics: like spironolactone, affect the DCT and prevent reabsorption of Na in exchange for K
14
Q
nursing considerations and client edu for diuretics used to tx HTN
A
- Nursing Considerations: monitor K levels and watch for muscle weakness, irregular pulse, and dehydration
- Thiazide and loop diuretics: can cause hypokalemia
- Potassium sparing: can cause hyperkalemia
- Client edu:
- Encourage client to keep all appts w/ provider to monitor efficacy of medications and possible electrolyte imbalance
- If taking K wasting diuretic, encourage consumption of K rich foods
15
Q
CCBs used to tx HTN
A
- verapamil, amlodipine, diltiazem
- After movement of calcium ions thru the cell membrane, vasodilation and lowered BP results
- Nursing considerations:
- Monitor BP and pulse and change client’s position slowly
- Use cautiously if pt has HF
- Client edu:
- Verapamil: constipation is common so inc fluids and inc fiber intake
- Dec or inc in HR and AV can occur
- Teach client to take pulse and call provider if irregular or lower than expected
- Avoid grapefruit juice
16
Q
ACE Inhibitors used to tx HTN
A
- lisinopril, enalapril
- Prevent conversion of Ang I to Ang II which prevents vasoconstriction
- Nursing considerations:
- Watch BP and pulse
- Watch for evidence of HF like edema
- Client edu:
- Teach client to report a cough (ADR)
- Report signs of HF
17
Q
ARBs used to tx HTN
A
- valsartan, losartan
- Good for clients who take ACE inhibitors but have a cough or have hyperkalemia
- Do not require a dosage adjustment for older adults
- Nursing considerations:
- Watch for signs of angioedema or HF
- Client edu:
- Change positions slowly
- Report signs of angioedema (swollen lips, face) or HF
- Avoid foods high in K and have serum K levels monitored b/c ARBs can cause hyperkalemia
18
Q
aldosterone receptor antagonists used to tx HTN: medication and action
A
- eplerenone
- Block aldosterone’s action which promotes the retention of K and excretion of Na and water
19
Q
aldosterone receptor antagonists used to tx HTN: nursing considerations
A
- Monitor kidney fcn, triglycerides, Na, and K
- Risk of adverse effects inc with deteriorating kidney fcn
- Risk inc as dose inc
- Monitor K levels every 2 weeks for first few months and every 2 months thereafter
- Avoid taking K supplements or K sparing diuretics
20
Q
aldosterone receptor antagonists used to tx HTN: client edu
A
- Teach client about food, med, herbal interactions like grapefruit juice and St. John’s wort can increase ADRs
- Instruct the client not to take salt substitutes with K or other foods rich in K
21
Q
beta blockers used to tx HTN
A
- metoprolol, atenolol
- For clients who have unstable angina or MI
- Decrease cardiac output and block the release of renin, subsequently decreasing vasoconstriction of the peripheral vasculature
- Nursing considerations:
- Monitor BP and pulse
- Meds mask hypoglycemia in clients who have DM
- Client edu:
- Teach the client that these meds can cause fatigue, weakness, depression, and sexual dysfunction
- Do not d/c abruptly
- Teach about S/S of hypoglycemia that do not include tachycardia, which beta blockers suppress
22
Q
central alpha 2 agonists used to tx HTN
A
- clonidine
- Reduce peripheral vascular resistance and dec BP by inhibiting the reuptake of NE
- Nursing considerations:
- Monitor BP and pulse
- Med is not for 1st line management of HTN
- Client edu:
- ADRs: sedation, orthostatic hypoTN, impotence
23
Q
alpha adrenergic antagonists used to tx HTN
A
- prazosin
- Reduce BP by causing vasodilation
- Nursing considerations:
- Start tx w/ low dose of med and give at night
- Monitor BP for 2 hours after starting tx
- Client edu:
- Rise slowly to prevent postural hypoTN
