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Medsurg Exam 2 > HTN > Flashcards

HTN Flashcards

1
Q

as BP increases, so does the risk for:

A

MI
HF
Stroke
renal disease

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2
Q

percentage of people greater than 20 with hypertension are aware of having high BP

A

83%

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3
Q

percentage of people being treated for HTN

A

76%

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4
Q

percentage of those aware but do not have HTN controlled

A

48%

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5
Q

equation for blood pressure

A

blood pressure = cardiac output x systemic vascular resistance

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6
Q

what is systemic vascular resistance

A

the amount of force exerted on circulating blood by the vasculature of the body

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7
Q

factors influencing blood pressure

A

CO
systemic vascular resistance
SNS
baroreceptors
vascular endothelium
renal system
endocrine system

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8
Q

neurohormonal factors influencing BP

A

angiotensin - vasoconstrictor
norepinephrine - increase and maintain BP

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9
Q

normal BP (more of an average than a expectation)

A

less than 120
less than 80

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10
Q

prehypertension

A

120-139
80-89

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11
Q

hypertension, stage 1

A

140-159
90-99

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12
Q

hypertension, stage 2

A

greater than 160
greater than 100

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13
Q

etiology of primary hypertension

A

-Also called essential or idiopathic hypertension
-Elevated BP without an identified cause
-90% to 95% of all cases
-Exact cause unknown but several contributing factors

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14
Q

etiology of secondary hypertension

A

-Elevated BP with a specific cause
-5% to 10% of adult cases
-Clinical findings relate to underlying cause
-Treatment aimed at removing or treating cause

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15
Q

risk factors for primary hypertension

A

Age
Alcohol
Tobacco use
Diabetes mellitus
Elevated serum lipids
Excess dietary sodium (water retention)
Gender
Family history
Obesity
Ethnicity
Sedentary lifestyle
Socioeconomic status
Stress

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16
Q

possible factors for reason behind primary HTN

A

Genetic links
Water and sodium retention
Stress and increased SNS activity
Altered renin-angiotensin-aldosterone system (RAAS)

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17
Q

CM of severe HTN

A

Fatigue
Dizziness
Palpitations
Angina
Dyspnea

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18
Q

Target organ diseases occur most frequently from HTN in:

A

Heart
Brain
Peripheral vascular disease
Kidney
Eyes

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19
Q

diagnostic studies for HTN

A

Measurement of BP
Urinalysis
BUN and serum creatinine (in blood)
Creatinine clearance (in urine)
Serum electrolytes, glucose
Serum lipid profile (
Uric acid levels
ECG
Echocardiogram
Ambulatory blood pressure monitoring (ABPM)

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20
Q

What is Ambulatory blood pressure monitoring (ABPM)

A

Noninvasive, fully automated system that measures BP at preset intervals over 24-hour period
Teach patient to hold arm still and keep diary
Many applications for use

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21
Q

overall goals for HTN

A

control BP
reduce CVD risk factors and target organ disease

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22
Q

lifestyle modifications for HTN

A

Weight reduction
-Weight loss of 22 lb (10 kg ) may decrease SBP by approx. 5 to 20 mm Hg - Calorie restriction and physical activity

DASH eating plan (dietary approaches to stop htn)
-Fruits, vegetables, fat-free or low-fat milk, whole grains, fish, poultry, beans, seeds, and nuts

Dietary sodium reduction
-< 2300 mg/day for healthy adults
-< 1500 mg/day for
African Americans
-Middle-aged and older
-Those with hypertension, diabetes, or chronic kidney disease

Moderation of alcohol intake

Physical activity
-Moderate-intensity aerobic activity, at least 30 minutes, most days of the week
-Vigorous-intensity aerobic activity at least 20 minutes, 3 days a week
-Muscle-strengthening activities at least 2 times a week
-Flexibility and balance exercises 2 times a week

Avoidance of tobacco products
-Nicotine causes vasoconstriction and elevated BP
-Smoking cessation reduces risk factors within 1 year

Psychosocial risk factors
-Low socioeconomic status, social isolation and lack of support, stress, negative emotions
-Activate SNS and stress hormones

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23
Q

pt teaching for drug therapy

A

Follow-up care
Identify, report, and minimize side effects
Orthostatic hypotension
Sexual dysfunction (beta blockers)
Dry mouth (diuresis)
Frequent urination
Time of day to take drug

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24
Q

Failure to reach goal BP in patients taking full doses of an appropriate 3-drug therapy regimen that includes a diuretic

A

resistant HTN

25
Q

reasons for resistant HTN

A

Improper BP measurement
Drug-induced
Associated conditions
Identifiable causes of secondary hypertension

26
Q

subjective data for nursing assessment of HTN

A

Past health history
-Hypertension
-Cardiovascular, cerebrovascular, renal, thyroid disease
-Diabetes mellitus, pituitary disorders, obesity, dyslipidemia
-Menopause or hormone replacement
Drugs
Family history
Salt and fat intake
Weight gain or loss
Nocturia
Fatigue, dyspnea on exertion, palpitations, pain
Dizziness, blurred vision
Erectile dysfunction
Stressful events

27
Q

objective data for nursing assessment of HTN

A

Blood pressure readings
Heart sounds (S3 - HF, S4 - HTN)
Pulses (bounding)
Edema
Body measurements (BMI)
Mental status changes (dizziness, weak, confusion)

28
Q

possible nursing diagnoses for HTN

A

Ineffective health management
Anxiety
Sexual dysfunction
Risk for decreased cardiac perfusion
Risk for ineffective cerebral and renal perfusion
Potential complications: stroke, MI

29
Q

For nursing planning for HTN pt will:

A

Achieve and maintain goal BP
Follow the therapeutic plan
-Including HCP appointments
Experience minimal side effects of therapy
Manage and cope with this condition

30
Q

health promotion for HTN

A

Primary prevention via lifestyle modification
Individual patient evaluation and education
Screening programs
Cardiovascular risk factor modification

31
Q

ambulatory care for pt with HTN

A

Evaluate therapeutic effectiveness
Detect and report adverse effects
Assess and enhance compliance
Patient and caregiver teaching

32
Q

necessities for home BP monitoring

A

Patient teaching is critical for accuracy
Proper equipment
Proper procedure
Frequency
Accurate recording and reporting
Target BP

33
Q

reasons for poor adherence to treatment plan

A

Inadequate teaching
Low health literacy
Unpleasant side effects of drugs
Return to normal BP while on drugs
High cost of drugs
Lack of insurance

34
Q

nursing measures to enhance compliance of HTN treatment

A

Individualize plan
Active patient participation
Select affordable drugs
Involve caregivers
Combination drugs
Patient teaching

35
Q

parameters for hypertensive crisis

A

SBP >180 mmHg and/or DBP >110 mmHg

36
Q

Develops over hours to days
May not require hospitalization

A

hypertensive urgency

37
Q

Very severe problems can result if prompt treatment is not obtained

A

hypertensive emergency

38
Q

importance for hypertensive crisis

A

Rate of rise more important than absolute value

39
Q

clinical manifestations of hypertensive crisis

A

Hypertensive encephalopathy (Headache, nausea/vomiting, seizures, confusion, coma)
Renal insufficiency
Cardiac decompensation(MI, HF, pulmonary edema)
Aortic dissection

40
Q

Hypertensive CrisisNursing and Interprofessional Mgmt during hospitalization

A

IV drug therapy: titrated to MAP
Monitor cardiac and renal function
Neurologic checks
Determine cause
Education to avoid future crisis

41
Q

medications for antihypertension

A

ABCDD
ACE inhibitors (-pril)
beta blockers (-olol)
calcium channel blockers (-pine -amil)
diuretics
digoxin

42
Q

examples of ACE inhibitors

A

captopril
enalapril
fosinopril
lisinopril
benazopril

43
Q

examples of beta blockers

A

acebutolol
metoprolol
propanaolol
nedolol

44
Q

examples of CCB

A

verapamil
nifedipine
diltiazem
amlodipine
nicardipine

45
Q

examples of loop diuretics (-nide -mide)

A

furosemide
bumatanide
torsemide

46
Q

examples of thiazide diuretics

A

hydrochlorothiazide
chlorothiazide
methyclothiazide

47
Q

osmotic diuretic

A

mannitol

48
Q

K+ sparing diuretic

A

spironolactone

49
Q

nursing considerations for diuretics

A

Monitor K+ levels
I/O monitoring
BP monitoring
Give in AM to prevent nocturia
Fall risks
Orthostatic hypotension

50
Q

MOA of ACE inhibitors

A

dilates blood vessels
lowers BP
does not directly affect HR

51
Q

MOA of beta blockers

A

decrease resistance
decrease workload
decrease CO

52
Q

MOA of CCB

A

blocks movement of calcium
relax blood vessels
decrease BP
increase supply O2 to heart
decrease workload

53
Q

MOA of digoxin

A

increase force of contraction = increase CO
beats slower
slows impulses sent through AV node-squeeze more blood

54
Q

MOA of ARBs

A

lower blood pressure by decreasing vasoconstriction and decreasing sodium and water reabsorption in the kidneys

55
Q

nursing considerations of ACE inhibitors

A

monitor BP
potassium retention
dry cough
angioedema - swelling of face and tongue
orthostatic hypotension
dizziness
BUN and creatinine

56
Q

examples of ARBs

A

losartan
valsartan
irbesartan

57
Q

nursing considerations of ARBs

A

Change position slowly
Monitor K+ levels
Monitor renal labs
Monitor liver labs
BP monitoring
Don’t overlap medications (ACE inhibitors)

58
Q

nursing considerations of CCB

A

do not give with BB
monitor BP
stevens-johnsons syndrome
orthostatic hypotension
needs tapering
monitor HR (contractility)
No heart block pts
constipation

59
Q

nursing considerations for beta blockers

A

monitor BP
contraindicated with asthma and COPD
rebound tachycardia and HTN
monitor blood sugar
orthostatic hypotension
bradycardia

Medsurg Exam 2 (6 decks)

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