Exam 3- Hypertension

Question 1

Symptoms of hypertension

Answer 1

NONE
Or if severe HTN=
Headache
Bounding pulse

Question 2

Late physiologic changes with hypertension

Answer 2

Sclerosis
Tortorous:twisted arteries
Narrow lumen
Decreased blood flow
Occlusion and hemorrhage
Target organ damage

Question 3

Nursing diagnosis for patients with hypertension

Answer 3

Ineffective management of therapeutic regimen.
Knowledge deficit.
Ineffective coping
Anxiety
Imbalanced nutrition: > body requirements
Altered health maintenance
Risk for impaired tissue perfusion

Question 4

General features of metabolic syndrome

Answer 4

Abdominal obesity
Atherogenic dyslipidemia
	Elevated triglycerides
	Small LDL particles
	Low HDL cholesterol
Raised blood pressure
Insulin resistance ( glucose intolerance)
Prothrombotic state
Proinflammatory state

Question 5

Arterial Compliance

Answer 5

Ability of the vessel to stretch

stretchability = compliance

Question 6

Athersclerosis

Answer 6

Decrease in compliance leads to a decrease in pulse pressure.

Question 7

Preload

Answer 7

Venous return from the upper body to the right atrium - Controlled By:

1. Blood Volume: Diuretics, ACE Inhibitors
2. Venouse Dilation: Nitrates, Antagonists, Ca block

Question 8

Afterload

Answer 8

Work required to open the aortic valve, eject volume of loaded blood, resistance to flow in arteries. Peripheral Vascular Resistance (PFR) Affected by:
Vasoldialtors, ACE inhibit, Ca block

Question 9

What is hypertension

Answer 9

Chronically increased BP that damages arteries and impacts blood flow to end organs.

Question 10

Two types of Hypertension

Answer 10

Primary HTN (idiopathic): No known cause = 90-95%
Secondary HTN - Definable Cause; sleep apnea, drugs, kidney disease, coarctation of the aorta, thyroid disease, shronic steroid Rx

Question 11

Risk Factors of Hypertension

Answer 11

Genetics, ethnicity, age gender, geography

Stress, obesity, diet, smoke, alcohol, blood glucose control, phys activity

Question 12

Hypertension Patho

Answer 12

• Stretch & chemoreceptors may become desensitized.
• Na reabsorption threshold changes; Na retention over time.
• Overproduction of Na retaining hormones
• Increased SNS effect
• increased renin
• insulin resistance and hyperinsulinemia
• Endothelial cell dysfunction

Question 13

Pharmacologic Mgmt of Hypertension

Answer 13

• Diuretics:
• Beta Blockers:
• ACE inhibitors:
• Calcium Channel Blockers:
• ARBs Angiotensin II Antagonists

Question 14

Diuretics

Answer 14

Act on kidneys to increase urine output.
Thiazide: Promotes renal excretion of water, Na, K, H - Hydrodiuril (hydrochlorathiazide)
Loop: Inhibits absorption of Na and Cl from ascending loop of Henle; Lasix (furosemide)
Potassium Sparing: Competes with aldosterone for receptor sites in distal renal tubes: Spironaldactone.

Question 15

Beta Blockers

Answer 15

Block action at beta receptor sites to slow heart rate, decrease BP and decrease contractility
**Do NOT give diabetic- it masks S&S of Hypoglycemia
Lopressor (metoprolol)
Tenormin (atenolol)

Question 16

ACE inhibitors

Answer 16

Block conversion of angiotensin I to angiotensin II. Helps blood vessels relax, helps decrease pressure on heart.

• Captopril, enalapril, fosinopril, lisinopril
• reduces periph vas resistance w/o changing CO. Leads to vasodil and helps prevent target organ damage.
• Good for diabetics: does not raise sugar AND protects kidneys.
• Side effect: Cough

Question 17

Calcium Channel Blockers

Answer 17

Blocks entry of calcium ions into smooth muscle channels in arterials causing smooth muscle relaxation

• Decrease BP and Slows HR
• Used for cardio protective effects with angina, a-fib, diabetes. Can control irregular heartbeat.
• Cardizem (diltiazem); Procardia (nifedipine)

Question 18

ARBs Angiotensin II Antagonists

Answer 18

Block action of Ang II from all pathways from which its formed. Inhibits constriction of vessels and increases release of H2O and Na.

• Good for Type 2 Diabetics
• Cozaar (Iosartan)
• Diovan (valsartan)

Question 19

Vasodilators

Answer 19

2nd line therapy
Relaxes arterioles, lowers peripheral vascular resistance and BP
- Can increase HR, can cause Hypotension
- Hydralazine (apresoline)
- Minolxidil
- Isordil (isosorbide)

Question 20

Contractility

Answer 20

Forcefulness of contraction. Affected by:
B antagonists
Ca block

Question 21

Heart Rate Affected by?

Answer 21

B antagonists

Ca channel blockers