HTN 33 Flashcards
0
Q
Ethnic group with highest prevalence of hypertension
A
African American
1
Q
Healthy people: prevention and control of hypertension
A
Maintain a healthy weight, reduce salt and sodium intake, increase level of physical exercise, limit consumption of alcohol to moderate levels, monitor blood pressure and know if blood pressure is high, low, normal, or borderline, if ordered, take bp meds
2
Q
What are men more likely to suffer from hypertension?
A
MI over stroke
3
Q
Arterial BP is a function of
A
CO and systemic vascular resistance
4
Q
What is a principal factor for determining vascular resistance?
A
Radius of the small arteries and arterioles. A small change in the radius, can create a major change in SVR
5
Q
Mechanisms that regulate BP are
A
CO and SVR
6
Q
A decrease in BP is addressed in the body by (what system)
A
SNS
7
Q
Increase in SNS activity results in
A
Increase in HR, and ❤️ contractibility, widespread vasoconstriction in the peripheral arterioles, and promote the release of rennin from the kidneys
8
Q
NE receptors can be found
A
SA node, myocardium, and vascular smooth muscle
9
Q
Significant cardiovascular SNS change due to aging
A
Diminished responsiveness of cardiovascular cells to SNS stimulation
10
Q
Where is the sympathetic vasomotor center?
A
Brainstem
11
Q
A fall in BP results in ( describe the events)
A
The baroreceptors sense the change, which leads to the activation of the SNS. Peripheral arterioles constrict, HR increases, heart contractility increases
12
Q
What is the baroreceptors response to long term elevated BP
A
Come to recognize the elevated BP as normal
13
Q
Substances produced by vascular endothelium
A
Vasoactive substances and growth factor
Nitric oxide, and endothelium- derived relaxing factor which inhibit platelet aggregation
Prostacyclin and endothelium- derived hyperpolarizing factor
Endothelin
14
Q
What does endothelin do?
A
Vasoconstrictor (very potent)
15
Q
Which endothelin is the most potent if the three subclasses?
A
ET-1
16
Q
What does ET-1 do?
A
Vasoconstrictor, causes adhesion, and aggregation of neutrophils and stimulates smooth muscle growth
17
Q
Define hypertension
A
SBP greater than or equal to 140, couples with average DBP of greater than or equal to 90 or current use of antihypertensive medication
18
Q
Prehypertension is
A
SBP from 120 to 139 or DBP 80 to 89
19
Q
Isolated systolic hypertension
A
Average systolic bp greater than or equal to 140 coupled with an average diastolic bp less than 90. Common in older adults
20
Q
Why do older adults commonly have isolated systolic hypertension?
A
Loss of elasticity in larger arteries from atherosclerosis
21
Q
Psuedohypertension
A
Occurs with advanced atherosclerosis. Sclerotic arteries do not collapse when cuff is fully inflated. Needs to be measured with intraarterial catheter
22
Q
Primary hypertension
A
Elevated bp without an identified cause
23
Q
Occurrence of primary hypertension
A
90% to 95% of all cases
24
Secondary HTN
Elevated do to a cause that can be identified and corrected
25
People over 50 who suddenly develop high BP should be considered for (especially when severe)
Secondary HTN
26
Tx of secondary HTN
Treat underlying cause
27
classic symptom of peripheral vascular dz involving the arteries in the leg
intermittent claudication
28
ischemia caused by narrowed lumen of the intrarenal blood vessels
renal dysfunction
29
manifestations of severe retinal damage
blurring of vision, retinal hemorrhage and loss of vision
30
gradual narrowing of the arteries and arterioles leads to (in the kidney)
atrophy of the tubules, destruction of the glomeruli, destruction of the glomeruli and eventual death of the nephrons
31
white coat HTN
patients have elevated BP readings in a clinical setting and normal readings when BP is measured elsewhere
32
BP is usually highest (part of the day)
in the early morning
33
BP is usually lowest (part of the day)
at night
34
% that BP drops by from day to night
usually 10% or more
35
lifestyle modifications
wt reduction, Dietary approaches to stop hypertension (DASH), dietary sodium reduction, moderation of alcohol consumption, regular physical activity, avoidance of tobacco, manage psych r/f
36
DASH diet
emphasize fruits, vegetables, fat free or low fat milk and milk products, whole grains, fish, poultry, beans, seeds and nuts
37
overweight persons have increased risk for
HTN and CVD
38
alcohol should be limited to
no more than 2 drinks per day for men, and no more than 1 drink per day for women or lighter men
39
restrict sodium to
less than or equal to 2300mg per day, those with HTN, DM, CKD should have less than or equal to 1500mg/day
40
physical activty recommended by the American Heart Association and American college of Sports Medicine
moderate-intensity aerobic physical activity for at least 30 minutes most days (5 or more) per week or vigorous intensity aerobic activty for at least 20 minutes 3 days per week
41
effects of Nicotine in HTN patients
cause vasoconstriction and increases BP
42
psychosocial risk factors
low SE status, social isolation, lack of support, stress at work and in family life, negative emotions
43
drug therapy for prehypertension
drug therapy is not recommended for prehypertension unless it is required by another condition, such as diabetes mellitus or chronic kidney dz
44
drug therapy actions (2)
decrease the volume of circulating blood and reduce SVR
45
action of diuretics
promote sodium and water excretion, reduce plasma volume and reduce vascular response to catecholamines
46
actions of adrenergic inhibiting agents
diminish the SNS effect that increase BP. Work on vasomotor center and peripherally to inhibit NE release or to block the adrenegic receptors on blood vessels
47
action of direct vasodilators
decrease BP by relaxing vascular smooth muscle and reducing SVR
48
action of calcium channel blockers
increase sodium excretion and cause vasodilation by preventing the movement of extracellular calcium into the cell
49
action of angiotensin-converting enzyme (ACE) inhibitor
prevent the conversion of angiotensin I to A-II mediated vasoconstriction and sodium and water retention
50
action of A-II receptor blockers (ARBs)
prevent A-II from binding to its receptors in the blood vessel walls
51
follow up teaching for anti HTN drug therapy management
return for follow up appt and adjustment of medication at monthy intervals until goal BP is reached, after BP is stable visits should be at 3 to 6 month intervals
52
important education point regarding side effects of drug therapy that may encourage compliance
many side effects may be an initial response to a drug and may decrease over time
53
common side effect of antihypertensive medication
orthostatic hypotension
54
planning goals for pt with HTN (4)
1) achieve and maintain the goal BP 2) understand, accept and implement the therapeutic plan, 3) experience minimal or no unpleasant side effects of therapy, 4) be confident of the ability to manage and cope with this condition
55
primary prevention of HTN
lifestyle modifications that prevent or delay the expected rise in BP in susceptible people (more cost effective)
56
Blood Pressure measurement: Oscillatory or auscultatory method
take BP at least 2 times, at least 1 minute apart, average the pressure
57
common causes of othostatic hypotension
intravascular volume loss and inadequate vasoconstrictor mechanism related to disease or medications
58
screening in the community (teaching)
inform each person in writing of numeric value of the reading and if necessary why futer evaluation is important
59
screen efforts shouldfocus on (3)
1) controlling BP in persons already identified as having HTN, 2) id and control BP in at risk groups (family hx, obesity, African American) 3)screen those with limited access to health care
60
modifiable cardiovascular risk factors
HTN, obesity, DM, tobacco use, physical inactvity
61
nurse responsibility for long term management of HTN
patient teaching for reducing BP and complying with treatment plan
62
clinical manifestations of hypertension
fatigue, reduced activity tolerance, dizziness, palpitations, angina, and dyspnea
63
most common complications of HTN (heart, brain, kidney, peripheral vascular, eye)
heart:HTN heart dz, brain: cerebrovascular dz, peripheral vasculature: peripheral vascular dz, kidney: nephrosclerosis, eyes: retinal damage
64
major risk factor for CAD
HTN
65
sustained high BP increases cardiac workload and produces
left ventricular hypertrophy
66
increased contractility increases
myocardial work and oxygen consumption
67
heart failure develops when
the heart's compensatory adaptation are overwehelmed and the heart can no longer pump enough blood to meet the metabolic needs of the body
68
stroke risk in with HTN
4 times higher than nonHTN
69
sites common for the distribution of atherosclerotic plaques
birfurcation of the common carotid artery into the internal and external carotid arteries
70
thromboembolism are produced by
portions of the atherosclerotic plaque or blood clot that form break off nd travel to cerebral vessels
71
Thromboemboli may lead to
transient ischemic attacks or a stroke
72
autoregulation
physiologic process that maintains constant cerebral blood flow despite fluctuation in BP
73
hypertensive encephalopathy may occur
after a marked rise in BP if the cerebral blood dlow is not decreased by autoregulation
74
mechanism that causes cerebral edema
BP exceeds body's ability to autoregulate, cerebral vessels suddenly dilate, capillary permeability increase and cerebral edema develops
75
Why patients should monitor BP at home
readings are often lower than those taken in office and are a better predictor of CVD risk
76
Patient teaching for home BP monitoring
teach to ensure accuracy. Instruct not to smoke, exercise or drink caffeine for 30 minutes before measuring BP. Sit quietly after resting for 5 minutes
77
reasons for HTN patient noncompliance
inadequate patient teaching, unpleasant side effects of drugs, return of BP to normal range while on medication, lack of motivation, high cost of drugs, lack of insurance, lack of trusting relationship between pt and health care provider
78
age related changes that play a role in HTN
1) loss of tissue elasticity, 2) increased collagen content and stiffness of myocardium 3) increased peripheral vascular resistance, 4) decreased adrenergic receptor sensitivity, 5) blunting of baroreceptor reflexes 6) decreased renal function 7) decreased renin response to sodium and water depletion
79
hypertensive crisis is
hypertensive urgency or emergency
80
HTN crisis is determined by
the degree of target organ damage and how quickly the BP must be lowered
81
hypertensive encephalopathy
a HTN emergency which a sudden rise in BP is associated with servere headaches, N/V, seizures, confusion and coma
82
pt assessment in HTN encephalopathy
make sure to include signs for neurologic dysfunction, retinal damage, heart failure, pulmonary edema, renal failure
83
describe African American ethnic health disparities
African Americans have higher prevalence of HTN in the world, African Americans develop HTN at a younger age than whites, African American women have higher incidence of HTN then men, African Americans have more aggressive HTN, and higher mortality rate
84
African Americans and whites living in the ________ United States have higher incidence of HTN than other places in the US
southeastern
85
Africans American (drug therapy)
they produce less renin and do not respond as well to angiotensin inhibitors
86
describe health care disparities of Mexican Americans
lower awareness of HTN and treatment than African Americans and whites, less likely to be treated. Mexican American and Native Americans have lower rates of adequate blood pressure control than whites and African Americans
87
Who has the higher risk of angioedema and have a higher incidence of cough as sides effects of ACE inhibitors
African Americans and Asians
88
After age 64, HTN is more common in (men or women)
women
89
before age 45 HTN is more common in (men or women)
men
90
Women with HTN are more likely to suffer what complication
stroke over MI
91
ACE inhibitor induced cough and diuretic induced hyponatremia are more common in (men or women)
women
92
HTN occurs in ___% of African American women after age 75
75
93
What prescription medication makes HTN two to three times more common in women than those who do not take it?
oral contraceptives
94
part of the rise in BP in women is attributed to
menopause related factors such as estrogen withdrawl, overproduction of pituitary hormone and wt gain
95
HTN side effect of contraceptives are seen during
initial period of use, dosage change, and women who are older or obese
96
factors influencing BP
cardiac: heart rate, contractility, conductivity;
Renal fluid volume control: renin-angiotensin aldosterone system, natriuretic peptides, SNS: alpha 1 or 2 adrenergic receptors, beta 2 adrenergic receptors;
Neurohomoronal: vasoconstrictors- angiotension, norepinephrine;
local regulation: vasodilators- prostaglandins, EDRF, vasoconstrictor :Endothelin
97
causes of secondary HTN
cirrohsis, coarctation or congenital narrowing of the aorta, endocrine disorders, meds, neurological disorders, pregnancy, renal dz, sleep apnea
98
Risk factors for primary HTN
age, alcohol, cigarette smoking, DM, elevated serum lipids, excess dietary sodium, gender, family hx, obesity, ethnicity, sedentary lifestyle, low SE, stress
99
Dx of HTN (long list)
hx, physical examination, routine urinalysis, basic metabolic pannel, CBC, serum lipid profile, serum uric acid, 12 ECG, echocardiogram, 24hr urinary creatinine clearance, liver function studys, serum TSH
100
what do you need to do if you use the forearm for BP measurement?
DOCUMENT THE SITE
101
what do you do if bilateral measurements are not equal?
use the arm with the highest BP for all measurements
102
a BP cuff that is too small will read a reading that is
too high
103
a BP cuff that is too large will read a read that is
too low
104
name some high risk over the counter medications for HTN
high sodium antacids, appetite suppressants, cold and sinus medications
105
what should a patient do if a sexual dysfunction problem develops as an ADR?
talk to the DR about changing the dose or drug
106
how can a patient reduce orthostatic hypotension
rise from the bed slowly, sit on the side of the bed for a few minutes, stand slowly, and begin moving only if there are no symptoms. Do not stand still for prolonged periods of time, do leg exercises to increase venous return, sleep with the head of the bed raised or on pillows. lie or sit down when dizziness occurs
107
patient teaching for HTN medications (at home to avoid additional complications)
avoid hot baths, excessive ETOH, and strenuous exercise within 3 hours of taking meds that promote vasodilation
108
Patient teaching for K+ wasting diuretics
eat food high in K+, citrus fruits, green leafys)
109
special teaching regarding Labetalol (Normodyne)
do not discontinue drug abruptly as this may precipitate angina and/or heart failure
110
causes of HTN crisis
exacerbation of chronic HTN, renovascular HTN, preeclampsia, eclampsia, pheochromocytoma, drugs (cocain, amphetamines) MAOIs taken with tyramine, rebounding HTN, necrotizing vasculitis, head injury, acute aortic dissection
111
teaching regarding Clonidine (Catapres)
change positions slowly to limit orthostatic hypotension, drug may cause drowsiness, do not discontinue abruptly to prevent rebound HTN
112
What class is metoprolol (Lopressor)?
Beta adrenergic blocker
113
Action of metoprolol
Reduce bp by antagonizing beta adrenergic effects
Selective for beta 1 receptors
Decreases CO, peripheral resistance, cardiac oxygen consumption, decreases renin secretion by kidneys
114
Side effects of metoprolol
Hypotension, bronchospasms, atrioventricular conduction block, impaired peripheral circulation
Nightmares, depression, ED, weakness, reduced exercise capacity
115
Sudden withdrawal of beta adrenergic blockers may cause
Rebound HTN and exacerbate symptoms of ischemic heart dz
116
It is important to keep in mind that there many beta adrenergic blockers and they differ in
Lipid solubility, selectivity, and presence of partial sympathomimetic effect which explains different therapeutic and side effects fir each different agent
117
You must monitor what when giving beta adrenergic blockers
Pulse and bp
118
Why do you need to use caution with beta adrenergic blockers with pts with DM
The drug may depress the tachycardia associated with hypoglycemia
119
IV administration of beta adrenergic have
Rapid onset and short duration on action
120
Nonselective beta adrenergic agents may cause what side effect in pt with asthma
Bronchospasm
