Exam 2 HTN

Question 1

Errors in Blood Pressure

Answer 1

Arm too low blow heart
Arm too high above heart
Arm not supported raise blood pressure

Changes in elderly

Question 2

Arm too low blow heart
Arm too high above heart
Arm not supported raise blood pressure

Changes in elderly

Answer 2

Errors in Blood Pressure

Question 3

Feet flat on floor don’t cross legs will raise bp

Elderly needs to take more than once during a visits – might want to take there blood pressure standing take a tilt blood pressure for orthostatic

Answer 3

Possible errors in blood pressure

Question 4

Assessment/Diagnostic Tests

Answer 4

One high does not mean high blood pressure
Need more than one time at different times
Don’t worry about the stages 120 over 80 is consider pre hypertension
When screening and test are looking for causes but it does not diagnose blood pressure

Question 5

One high does not mean high blood pressure
Need more than one time at different times
Don’t worry about the stages 120 over 80 is consider pre hypertension
When screening and test are looking for causes but it does not diagnose blood pressure

Answer 5

Assessment/Diagnostic Tests

Question 6

what are the goals for patients with hypertension?

Answer 6

Goal is to keep blood pressure to keep under 140 over 90 is dx with hypertension
Co morbidly 130 over 80 kidney and diabetes

Question 7

Goal is to keep blood pressure to keep under 140 over 90 is dx with hypertension
Co morbidly 130 over 80 kidney and diabetes

Answer 7

what are the goals for patients with hypertension?

Question 8

31% of adults have hypertension
Highest in Hispanics and African American
Most have primary (essential) hypertension

Answer 8

Statistics

Question 9

t/f patient with primary (essential) does not have a know cause

Answer 9

TRUE

Question 10

Risk factors for primary (essential) hypertension

Answer 10

Family hx
Increased sodium
Inactivity
Stress
Hyperlipidemia
Smoking
African American
High alcohol consumption
Obesity
Diabetes

Question 11

Family hx
Increased ______
Inactivity
Stress
_____________
Smoking
African American
High alcohol consumption
Obesity
Diabetes

Answer 11

Risk factors for primary (essential) hypertension
sodium
Hyperlipidemia

Question 12

Risk for secondary HTN

Answer 12

Renal disease
Several endocrine related disorders
Brain tumors, encephalitis
Medications-estrogen, steroids, sympathomimetics

Question 13

Renal disease
Several endocrine related disorders
Brain tumors, encephalitis
Medications-estrogen, steroids, sympathomimetics

Answer 13

Risk for secondary HTN

Question 14

t/f secondary htn is not cause by another disease

Answer 14

FALSE; it is caused

Question 15

s/s of htn

Answer 15

May have few or no sx
Headache
Dizziness
Fainting
Changes in vision

Question 16

May have few or no sx
Headache
Dizziness
Fainting
Changes in vision

Answer 16

s/s of htn

Question 17

t/f sometimes when there is No compliance when it comes to drug regiment because drug make them feel worse compared to not taking meds for hypertension

Answer 17

TRUE

Question 18

Changes related to the elderly

Answer 18

Elderly are at a higher risk

Will not have flexible artery

Have palpable buildup

Sometimes bottom number in pt in elder will have an okay systolic isolated systolic hypertension

Question 19

Elderly are at a higher risk

Will not have flexible artery

Have palpable buildup

Sometimes bottom number in pt in elder will have an okay systolic isolated systolic hypertension

Answer 19

Changes related to the elderly

Question 20

Damages blood vessels particularly heart, kidneys, brain and eyes.
Predispose to cognitive decline
Some outcomes of uncontrolled bp are MI, heart failure, renal failure, strokes, and impaired vision, Left Ventricular hypertrophy

Answer 20

prolonged htn

Question 21

proplonged htn

Answer 21

Damages blood vessels particularly heart, kidneys, brain and eyes.
Predispose to cognitive decline
Some outcomes of uncontrolled bp are MI, heart failure, renal failure, strokes, and impaired vision, Left Ventricular hypertrophy

Question 22

t/f the more damage to blood vessels the longer you don’t treat it

Answer 22

TRUE

Question 23

Clinical manifestations

Answer 23

May be none other than elevated bp
Retinal changes (hemorrhages)
Papilledema
Left ventricular hypertrophy
Heart failure may occur if damage is severe
Pathologic changes in kidneys (increased bun, nocturia)
Stroke, TIA

Question 24

May be none other than elevated bp
Retinal changes (hemorrhages)
Papilledema
Left ventricular hypertrophy
Heart failure may occur if damage is severe
Pathologic changes in kidneys (increased bun, nocturia)
Stroke, TIA

Answer 24

Clinical manifestations

Question 25

t/f Heart can enlarge because it working hard to circulate blood

Answer 25

TRUE

Question 26

_________________ Might see at the eye doctor edema of the optic never

Answer 26

Papilledema

Question 27

Treatment

Answer 27

Lifestyle modifications: Weight reduction DASH diet Reduce sodium intake Increase physical activity Only moderate alcohol consumption

Question 28

Lifestyle modifications: Weight reduction DASH diet Reduce sodium intake Increase physical activity Only moderate alcohol consumption

Answer 28

Treatment

Question 29

more treatment

Answer 29

Ideal below 130 over 80 renal or diabetes Hypertension below 140 over 90 Thiazide diuretic is the first line of defense After they will try Beta blocker Under 140 over 90 is achieved they want to decrease the dose Could also used loop diuretic Elderly may start at half does for any medication dealing with hypertension Change diet and increase exercise need low sodium

Question 30

Ideal below 130 over 80 renal or diabetes Hypertension below 140 over 90 Thiazide diuretic is the first line of defense After they will try Beta blocker Under 140 over 90 is achieved they want to decrease the dose Could also used loop diuretic Elderly may start at half does for any medication dealing with hypertension Change diet and increase exercise need low sodium

Answer 30

more treatment

Question 31

patient teaching

Answer 31

Patient needs to be aware: No decongestants that has in sudfedran Watch sodium on OTC meds

Question 32

Patient needs to be aware: No decongestants that has in sudfedran Watch sodium on OTC meds

Answer 32

patient teaching

Question 33

what should pt watch for?

Answer 33

Watch for chest pain shob nose bleeds

Question 34

assesment

Answer 34

Carefully monitor bp at frequent intervals Hx to assess for s/s of organ damage rt bp Pay specific attention to apical and peripheral pulses Able to afford medications Are they taking their meds (knowledge deficit, noncompliance)

Question 35

Carefully monitor bp at frequent intervals Hx to assess for s/s of organ damage rt bp Pay specific attention to apical and peripheral pulses Able to afford medications Are they taking their meds (knowledge deficit, noncompliance)

Answer 35

assessment

Question 36

patient teaching

Answer 36

Beta blockers may cause sexual dysfunction Need to teach them how to take bp Want to teach change position slowly 1.5 to 2 gram a day Teach to reduce stress 50 % will stop taking it in the first year because of side affect and noncomplaice and not feel better while one the meds Only can control not cure

Question 37

Beta blockers may cause sexual dysfunction Need to teach them how to take bp Want to teach change position slowly 1.5 to 2 gram a day Teach to reduce stress 50 % will stop taking it in the first year because of side affect and noncomplaice and not feel better while one the meds Only can control not cure

Answer 37

patient teaching

Question 38

DASH DIET

Answer 38

Dietary approaches to stop hypertension NA Whole grains Vegetables Dairy Lean meat, poultry, fish Nuts, seeds, legumes Fats Sweets Alcohol Limit sodium and have a good healthy diet Limit sweet Limit caffeine if it is having an affect

Question 39

Dietary approaches to stop hypertension NA Whole grains Vegetables Dairy Lean meat, poultry, fish Nuts, seeds, legumes Fats Sweets Alcohol Limit sodium and have a good healthy diet Limit sweet Limit caffeine if it is having an affect

Answer 39

DASH DIET

Question 40

t/f Rebound hypertension may occur is they suddenly stop the meds

Answer 40

TRUE

Question 41

Tell them not to abruptly stop medications Make sure they don’t run out.

Answer 41

Rebound hypertension

Question 42

History and risk factors Assess potential symptoms of target organ damage Personal, social, and financial factors that will influence the condition or its treatment

Answer 42

nursing history and assessment

Question 43

Do they have chest pain or blurry vision or alerted speech do they have nose bleeds nocturia Let your pt know that they are at a higher risk for strokes this may help with compliance

Answer 43

Assessment

Question 44

Deficient knowledge regarding the relation between the treatment regimen and control of the disease process Noncompliance with therapeutic regimen related to side effects of prescribed therapy

Answer 44

Nursing Diagnosis

Question 45

Understanding of the disease process and its treatment Participation in a self-care program Absence of complications

Answer 45

Planning and Goals

Question 46

Patient education Support adherence to the treatment regimen Consultation and collaboration Follow-up care Emphasize control rather than cure Reinforce and support lifestyle changes A lifelong process

Answer 46

Interventions

Question 47

Reports knowledge of disease management sufficient to maintain adequate tissue perfusion Maintains blood pressure at less than 140/90 mm Hg with no symptoms of angina, palpitations, or vision changes; stable BUN and serum creatinine levels; and palpable peripheral pulses Adheres to the self-care program Reduces calorie, Na, and fat intake; exercises regularly; takes medications as prescribed and reports side effects; measures BP; abstains from tobacco and excessive alcohol intake; keeps appointments

Answer 47

evaluation

Question 48

Has no complications Reports no changes in vision; exhibits no retinal damage on vision testing Maintains pulse rate and rhythm and respiratory rate within normal ranges; reports no dyspnea or edema Maintains urine output consistent with intake; has renal function test results within normal range Demonstrates no motor, speech, or sensory deficits Reports no headaches, dizziness, weakness, changes in gait, or falls

Answer 48

evaluation

Question 49

Medication regimen can be difficult to remember Expense can be a challenge Monotherapy, if appropriate, may simplify the medication regimen and make it less expensive Ensure that older adult patients understand the regimen and can see and read instructions, open medication containers, and get prescriptions refilled. Include family and caregivers in educational program

Answer 49

Gerontologic considerations

Question 50

Hypertensive emergency Hypertensive urgency

Answer 50

Poorly controlled or undx hypertension or stopped their meds

Question 51

Over 180 or 200 Will start seeing target organ damage kidney vision problems Will need IV medication PO will not help and will not do it fast enough

Answer 51

Emergency

Question 52

bp is extremely elevated (more than 180/120) and must be lowered immediately (generally not less than 140/90) must be done to prevent damage to target organs. Reduce mean bp by up to 25% in first hour and to about 160/100 in up to 6 hours and then gradually decline.

Answer 52

Hypertensive Emergency

Question 53

things to know during a hypertensive emergency?

Answer 53

To kidney heart brain might have a stroke Don’t want to bring it down below 140 over 90 Will not need to know percent or numbers Just know you need to however it quickly Will need to give vasodilators

Question 54

BP very elevated but no evidence of progressive target organ damage. Elevated blood pressure associated with severe headache, nosebleeds, or anxiety are urgencies. Oral agents given with goal of normalizing bp in 24 to 48 hours. Beta blockers, ace inhibitors

Answer 54

Hypertensive urgency

Question 55

hypertensive urgency

Answer 55

BP very elevated but no evidence of progressive target organ damage. Elevated blood pressure associated with severe headache, nosebleeds, or anxiety are urgencies. Oral agents given with goal of normalizing bp in 24 to 48 hours. Beta blockers, ace inhibitors

Question 56

Daily weight I/Os Urine output Response of blood pressure Electrolytes Take pulse Ischemic episodes or TIAs

Answer 56

Hypertension Care: DIURETIC

Question 57

Hypertension Care: DIURETIC

Answer 57

Daily weight I/Os Urine output Response of blood pressure Electrolytes Take pulse Ischemic episodes or TIAs

Question 58

hypertensive emergency

Answer 58

bp is extremely elevated (more than 180/120) and must be lowered immediately (generally not less than 140/90) must be done to prevent damage to target organs. Reduce mean bp by up to 25% in first hour and to about 160/100 in up to 6 hours and then gradually decline.