FINALS Hypertension Flashcards
Is there clinical indication for BLOCKING Beta 2 receptor????
NEVER!!!! That’s going to cause BRONCHOCONSTRICTION!!!!
ANY anti-hypertensive drugs that influence BLOOD VOLUME DIRECTLY (diuretics) OR influence DIAMETER OF BLOOD VESSELS are AT A MORE SERIOUS RISK FOR WHAT???
Risk for ORTHOSTATIC HYPOTENSION (bc it decreases their blood pressure)!!!!!!!!!!**
What do you need to know BEFORE giving THOSE anti-hypertensive drugs that DIRECTLY LOWERS THE HR????
KNOW THEIR HEART RATE BEFORE YOU GIVE IT!!!!!
Which drug can cause MASKING HYPOGLYCEMIA????
BETA BLOCKER!!!!!
WHAT IS THE ANTIDOTE FOR OVERDOSING BETA BLOCKERS??????
GLUCAGON!!!!!!
What are the risk factors of Hypertension?????
TWO TYPES OF HYPERTENSION
- PRIMARY =
- Smoking
- Obesity
- Physical inactivity
- Dyslipidemia
- DIABETES
- Microalbuminuria or GFR less than 60 ml/min
- Age (Men older than 55, Women older than 65)
- Fam hx
—————- - SECONDARY =
- RENAL DISEASE (MOST COMMON)
- Pheochromacytoma
- Cushing syndrome and Hyperthyroidism
- Renal artery stenosis
- Pregnancy
- Coarctation of the AORTA
- NSAIDS, CORTICOSTEROIDS, ORAL & CONTRACEPTIVES!!!
- OBSTRUCTIVE SLEEP APNEA
- What is Hypertensive Crisis?
- What’s the difference between Hypertension URGENCY vs EMERGENCY???
- What acute complications can occur when the BP is sustained at dangerous high levels (What organs are at acute risk with hypertensive crisis)??
- Urgency: Diastolic ≥ 120. NO TARGET ORGAN DAMAGE!!
- Emergency: Elevated BP WITH evidence of target organ damage!!
- Stroke, papilledema, heart failure, aortic dissection, and KIDNEY FAILURE!
——–
Acute complications:
ALWAYS THINK that Kidneys, Heart, Brain, and Eyes are at ACUTE RISK!!!
What are the Assessment and Patient Care for Hypertensive Crisis??????
Assessment:
1. Headache, dizziness
2. Blurred vision
3. Disorientation
4. Neuro changes
5. 12 Lead EKG & continuous monitoring. Alert for signs of heart attack (SOB, pain up into the jaw & radiating down the left arm)
6. LABS: Renal function, cardiac markers (TROPONINS, CPK-MB)
Patient Care:
1. Semi Fowler
2. Oxygen as needed
3. IV Beta Blockers
4. IV NitroPRUSSide (Nipride) and IV Nitroglycerin
5. Observe for neurologic, cardiac, & renal complications!
What are the target organ damage with HYPERTENSION???
- Cardio, cerebral, and peripheral Vascular!!!
A) Left ventricle hypertrophy
B) Cardiomyopathy
C) Heart Failure
D) Peripheral vascular disease: intermittent claudication
E) Cerebral Aneurysm
F) Ischemic or Hemorrhagic Stroke: vision & speech changes, unilateral motor alterations, headache
——- - KIDNEYS:
A) Lab changes: ↑ BUN & Creatinine, ↓ GFR, 24 hr Creatinine Clearance
B) Manifestations: fatigue, fluid retention, mental status alterations!
—— - EYES:
A) Hypertensive RETINOPATHY: ↑ pressure on the optic nerve, causing damage to the retina
B) Manifestations: Reduced/Loss vision, Double vision, headaches
How many seconds are in PR interval??
0.12 - 0.20 seconds!!!!!
- PR interval (from P wave & end at the start of Q wave)
An ELEVATION of ST segment indicates what????!!!***
MYOCARDIAL ISCHEMIA!!!!!
EACH little box in a rhythm strip is how many seconds???? A big box is how many little boxes and how many seconds???
- Small: 0.04 Seconds
- Big: 5 little boxes within 1 big box. So, (0.04secs)(5 boxes) = 0.2 Seconds!!!!!!
What is the normal QRS interval seconds???
0.04 - 0.10 Seconds!!!!!!
What would you do when a rhythm change occurs???????? What are the steps/rules?
- Is this rhythm alteration compromising their perfused ability??? (if it is, you’d see signs of low perfusion)
- Is this pt unstable? GOLDEN RULE OF STABLE: Systolic blood pressure of 90!!!
- You can have a pt with HR of 45 but they are alert & oriented, caps refills are okay. you checked their BP and it’s 110/60. YOU WOULD CALL THIS STABLE!!!!!! (No signs of poor perfusion too). BUT, IF their HR is 45 and their BP is 82/45, they are UNSTABLE!!! - INVESTIGATE:
1) OXYGENATION (O2 sat < 92%)
2) Electrolytes
3) Medications
*WHAT IS THE GOLDEN RULE OF STABLE????? (exam)
SYSTOLIC BLOOD PRESSURE OF 90!!!!!!!!1
