HTN 33 Flashcards

0
Q

Ethnic group with highest prevalence of hypertension

A

African American

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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

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2
Q

What are men more likely to suffer from hypertension?

A

MI over stroke

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3
Q

Arterial BP is a function of

A

CO and systemic vascular resistance

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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

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5
Q

Mechanisms that regulate BP are

A

CO and SVR

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6
Q

A decrease in BP is addressed in the body by (what system)

A

SNS

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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

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8
Q

NE receptors can be found

A

SA node, myocardium, and vascular smooth muscle

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9
Q

Significant cardiovascular SNS change due to aging

A

Diminished responsiveness of cardiovascular cells to SNS stimulation

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10
Q

Where is the sympathetic vasomotor center?

A

Brainstem

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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

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12
Q

What is the baroreceptors response to long term elevated BP

A

Come to recognize the elevated BP as normal

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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

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14
Q

What does endothelin do?

A

Vasoconstrictor (very potent)

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15
Q

Which endothelin is the most potent if the three subclasses?

A

ET-1

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16
Q

What does ET-1 do?

A

Vasoconstrictor, causes adhesion, and aggregation of neutrophils and stimulates smooth muscle growth

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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

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18
Q

Prehypertension is

A

SBP from 120 to 139 or DBP 80 to 89

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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

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20
Q

Why do older adults commonly have isolated systolic hypertension?

A

Loss of elasticity in larger arteries from atherosclerosis

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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

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22
Q

Primary hypertension

A

Elevated bp without an identified cause

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23
Q

Occurrence of primary hypertension

A

90% to 95% of all cases

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24
Q

Secondary HTN

A

Elevated do to a cause that can be identified and corrected

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25
Q

People over 50 who suddenly develop high BP should be considered for (especially when severe)

A

Secondary HTN

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26
Q

Tx of secondary HTN

A

Treat underlying cause

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27
Q

classic symptom of peripheral vascular dz involving the arteries in the leg

A

intermittent claudication

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28
Q

ischemia caused by narrowed lumen of the intrarenal blood vessels

A

renal dysfunction

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29
Q

manifestations of severe retinal damage

A

blurring of vision, retinal hemorrhage and loss of vision

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30
Q

gradual narrowing of the arteries and arterioles leads to (in the kidney)

A

atrophy of the tubules, destruction of the glomeruli, destruction of the glomeruli and eventual death of the nephrons

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31
Q

white coat HTN

A

patients have elevated BP readings in a clinical setting and normal readings when BP is measured elsewhere

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32
Q

BP is usually highest (part of the day)

A

in the early morning

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33
Q

BP is usually lowest (part of the day)

A

at night

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34
Q

% that BP drops by from day to night

A

usually 10% or more

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35
Q

lifestyle modifications

A

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

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36
Q

DASH diet

A

emphasize fruits, vegetables, fat free or low fat milk and milk products, whole grains, fish, poultry, beans, seeds and nuts

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37
Q

overweight persons have increased risk for

A

HTN and CVD

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38
Q

alcohol should be limited to

A

no more than 2 drinks per day for men, and no more than 1 drink per day for women or lighter men

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39
Q

restrict sodium to

A

less than or equal to 2300mg per day, those with HTN, DM, CKD should have less than or equal to 1500mg/day

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40
Q

physical activty recommended by the American Heart Association and American college of Sports Medicine

A

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

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41
Q

effects of Nicotine in HTN patients

A

cause vasoconstriction and increases BP

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42
Q

psychosocial risk factors

A

low SE status, social isolation, lack of support, stress at work and in family life, negative emotions

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43
Q

drug therapy for prehypertension

A

drug therapy is not recommended for prehypertension unless it is required by another condition, such as diabetes mellitus or chronic kidney dz

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44
Q

drug therapy actions (2)

A

decrease the volume of circulating blood and reduce SVR

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45
Q

action of diuretics

A

promote sodium and water excretion, reduce plasma volume and reduce vascular response to catecholamines

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46
Q

actions of adrenergic inhibiting agents

A

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

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47
Q

action of direct vasodilators

A

decrease BP by relaxing vascular smooth muscle and reducing SVR

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48
Q

action of calcium channel blockers

A

increase sodium excretion and cause vasodilation by preventing the movement of extracellular calcium into the cell

49
Q

action of angiotensin-converting enzyme (ACE) inhibitor

A

prevent the conversion of angiotensin I to A-II mediated vasoconstriction and sodium and water retention

50
Q

action of A-II receptor blockers (ARBs)

A

prevent A-II from binding to its receptors in the blood vessel walls

51
Q

follow up teaching for anti HTN drug therapy management

A

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
Q

important education point regarding side effects of drug therapy that may encourage compliance

A

many side effects may be an initial response to a drug and may decrease over time

53
Q

common side effect of antihypertensive medication

A

orthostatic hypotension

54
Q

planning goals for pt with HTN (4)

A

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
Q

primary prevention of HTN

A

lifestyle modifications that prevent or delay the expected rise in BP in susceptible people (more cost effective)

56
Q

Blood Pressure measurement: Oscillatory or auscultatory method

A

take BP at least 2 times, at least 1 minute apart, average the pressure

57
Q

common causes of othostatic hypotension

A

intravascular volume loss and inadequate vasoconstrictor mechanism related to disease or medications

58
Q

screening in the community (teaching)

A

inform each person in writing of numeric value of the reading and if necessary why futer evaluation is important

59
Q

screen efforts shouldfocus on (3)

A

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
Q

modifiable cardiovascular risk factors

A

HTN, obesity, DM, tobacco use, physical inactvity

61
Q

nurse responsibility for long term management of HTN

A

patient teaching for reducing BP and complying with treatment plan

62
Q

clinical manifestations of hypertension

A

fatigue, reduced activity tolerance, dizziness, palpitations, angina, and dyspnea

63
Q

most common complications of HTN (heart, brain, kidney, peripheral vascular, eye)

A

heart:HTN heart dz, brain: cerebrovascular dz, peripheral vasculature: peripheral vascular dz, kidney: nephrosclerosis, eyes: retinal damage

64
Q

major risk factor for CAD

A

HTN

65
Q

sustained high BP increases cardiac workload and produces

A

left ventricular hypertrophy

66
Q

increased contractility increases

A

myocardial work and oxygen consumption

67
Q

heart failure develops when

A

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
Q

stroke risk in with HTN

A

4 times higher than nonHTN

69
Q

sites common for the distribution of atherosclerotic plaques

A

birfurcation of the common carotid artery into the internal and external carotid arteries

70
Q

thromboembolism are produced by

A

portions of the atherosclerotic plaque or blood clot that form break off nd travel to cerebral vessels

71
Q

Thromboemboli may lead to

A

transient ischemic attacks or a stroke

72
Q

autoregulation

A

physiologic process that maintains constant cerebral blood flow despite fluctuation in BP

73
Q

hypertensive encephalopathy may occur

A

after a marked rise in BP if the cerebral blood dlow is not decreased by autoregulation

74
Q

mechanism that causes cerebral edema

A

BP exceeds body’s ability to autoregulate, cerebral vessels suddenly dilate, capillary permeability increase and cerebral edema develops

75
Q

Why patients should monitor BP at home

A

readings are often lower than those taken in office and are a better predictor of CVD risk

76
Q

Patient teaching for home BP monitoring

A

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
Q

reasons for HTN patient noncompliance

A

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
Q

age related changes that play a role in HTN

A

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
Q

hypertensive crisis is

A

hypertensive urgency or emergency

80
Q

HTN crisis is determined by

A

the degree of target organ damage and how quickly the BP must be lowered

81
Q

hypertensive encephalopathy

A

a HTN emergency which a sudden rise in BP is associated with servere headaches, N/V, seizures, confusion and coma

82
Q

pt assessment in HTN encephalopathy

A

make sure to include signs for neurologic dysfunction, retinal damage, heart failure, pulmonary edema, renal failure

83
Q

describe African American ethnic health disparities

A

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
Q

African Americans and whites living in the ________ United States have higher incidence of HTN than other places in the US

A

southeastern

85
Q

Africans American (drug therapy)

A

they produce less renin and do not respond as well to angiotensin inhibitors

86
Q

describe health care disparities of Mexican Americans

A

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
Q

Who has the higher risk of angioedema and have a higher incidence of cough as sides effects of ACE inhibitors

A

African Americans and Asians

88
Q

After age 64, HTN is more common in (men or women)

A

women

89
Q

before age 45 HTN is more common in (men or women)

A

men

90
Q

Women with HTN are more likely to suffer what complication

A

stroke over MI

91
Q

ACE inhibitor induced cough and diuretic induced hyponatremia are more common in (men or women)

A

women

92
Q

HTN occurs in ___% of African American women after age 75

A

75

93
Q

What prescription medication makes HTN two to three times more common in women than those who do not take it?

A

oral contraceptives

94
Q

part of the rise in BP in women is attributed to

A

menopause related factors such as estrogen withdrawl, overproduction of pituitary hormone and wt gain

95
Q

HTN side effect of contraceptives are seen during

A

initial period of use, dosage change, and women who are older or obese

96
Q

factors influencing BP

A

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
Q

causes of secondary HTN

A

cirrohsis, coarctation or congenital narrowing of the aorta, endocrine disorders, meds, neurological disorders, pregnancy, renal dz, sleep apnea

98
Q

Risk factors for primary HTN

A

age, alcohol, cigarette smoking, DM, elevated serum lipids, excess dietary sodium, gender, family hx, obesity, ethnicity, sedentary lifestyle, low SE, stress

99
Q

Dx of HTN (long list)

A

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
Q

what do you need to do if you use the forearm for BP measurement?

A

DOCUMENT THE SITE

101
Q

what do you do if bilateral measurements are not equal?

A

use the arm with the highest BP for all measurements

102
Q

a BP cuff that is too small will read a reading that is

A

too high

103
Q

a BP cuff that is too large will read a read that is

A

too low

104
Q

name some high risk over the counter medications for HTN

A

high sodium antacids, appetite suppressants, cold and sinus medications

105
Q

what should a patient do if a sexual dysfunction problem develops as an ADR?

A

talk to the DR about changing the dose or drug

106
Q

how can a patient reduce orthostatic hypotension

A

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
Q

patient teaching for HTN medications (at home to avoid additional complications)

A

avoid hot baths, excessive ETOH, and strenuous exercise within 3 hours of taking meds that promote vasodilation

108
Q

Patient teaching for K+ wasting diuretics

A

eat food high in K+, citrus fruits, green leafys)

109
Q

special teaching regarding Labetalol (Normodyne)

A

do not discontinue drug abruptly as this may precipitate angina and/or heart failure

110
Q

causes of HTN crisis

A

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
Q

teaching regarding Clonidine (Catapres)

A

change positions slowly to limit orthostatic hypotension, drug may cause drowsiness, do not discontinue abruptly to prevent rebound HTN

112
Q

What class is metoprolol (Lopressor)?

A

Beta adrenergic blocker

113
Q

Action of metoprolol

A

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
Q

Side effects of metoprolol

A

Hypotension, bronchospasms, atrioventricular conduction block, impaired peripheral circulation
Nightmares, depression, ED, weakness, reduced exercise capacity

115
Q

Sudden withdrawal of beta adrenergic blockers may cause

A

Rebound HTN and exacerbate symptoms of ischemic heart dz

116
Q

It is important to keep in mind that there many beta adrenergic blockers and they differ in

A

Lipid solubility, selectivity, and presence of partial sympathomimetic effect which explains different therapeutic and side effects fir each different agent

117
Q

You must monitor what when giving beta adrenergic blockers

A

Pulse and bp

118
Q

Why do you need to use caution with beta adrenergic blockers with pts with DM

A

The drug may depress the tachycardia associated with hypoglycemia

119
Q

IV administration of beta adrenergic have

A

Rapid onset and short duration on action

120
Q

Nonselective beta adrenergic agents may cause what side effect in pt with asthma

A

Bronchospasm