HTN Flashcards
Define the Following:
- Primary Hypertension:
- Secondary Hypertension:
- White Coat Hypertension:
- Isolated Systolic HTN
- Malignant HTN
- PIH
- Idiopathic, kidneys are implicated but not sure why
- Identifiable cause ex. renal failure
- HTN in a clinical setting
- Systolic >140, diastolic not above 90
- Diastolic >120
- Pregnancy Induced HTN
What is BP?
What is the SBP?
What is the DBP?
BO = CO x VR
Pumping pressure
Filling pressure
- What is the Dx of HTN?
2. What cant you have in the time of testing the BP?
- 2 separate BP readings 5 minutes apart
2. Caffeine, alcohol, smoking
Why would BP be altered in the hospital? (4)
- Meds
- Pain
- Recent activity
- Nervousness
What is the main concern of HTN?
Causes damage to target organs
Which are some of the organs that can be targeted?
Heart, Kidneys, Vessels, Retina
What would hypertrophy when there is increased stress on the heart?
L ventricle
What are the modifiable risk factors of HTN? (6)
- Stress
- Obesity
- Nutrition
- Substance abuse (alcohol, smoking, cocaine, caffeine)
- Oral contraceptives
- Sedentary lifestyle
What is the BMI for obesity?
> 25
What are the non modifiable risk factors of HTN?
- Age
- Gender
- Ethnicity
- Familiar Hx
- Insulin resistance syndrome/ Metabolic syndrome
What sex, have an increase risk of HTN?
Men and post menopausal women
Different antihypertensives work on what…
Different parts of the control system of BP
How do you feel when you have low BP?
Dizzy, tired
What do Beta Blockers do?
Decrease HR and myocardial Contractility, therefore reducing CO
What is a problem that Beta Blockers can cause?
Problems of inadequate CO, Low HR
What do direct vasodilators do?
They can be used for various reasons because they act on arteries and veins… but primarily which one?
Act on smooth muscle of arterioles/ veins causing vasodilation
What do Angiotensin 11 receptor blockers do?
Block the angiotensin 11 to active the adrenal cortex to secrete aldosterone (therefore Na+ and H20 is not reabsorbed)
What do ACEI do?
Block formation of angiotensin 11 from angiotensin 1, there fore the RAAS system will not continue on, therefore Na+ and H20 will not be reabsorbed
What do Ca+ channel Blockers do?
Block the calcium ion channels in smooth muscle, resulting is vasodilation
What do diuretics do?
What about a K+ sparing diuretic, what would you expect to see?
Decrease fluid volume by increasing the urine output.
K+ sparing would retain some K+ while excreting in hopes of not causing hypokalemia.
- Do children usually have higher BP or lower BP than adults?
- Why do children nowadays have higher BP than children in the past?
- Normally lower
2. D/t increase of Type 2 DM, and obesity
Define Pregnancy Induced HTN
Gestational HTN BP >140/>90
What are the risk factors for PIH?
- Age
- Black race
- Familiar Hx
- Chronic renal failure
- Diabetes
- High BMI
What age is an increased risk of PIH?
40
There are 3 stages of eclampsia. what are they?
- Mild pre-eclampsia
- Severe pre-eclampsia
- Eclampsia
How is mild pre-eclampsia dx?
BP >140/>90 2 different occasions, 6 hours apart.
If you already had HTN.. then became pregnant… how would you Dx Mild pre eclampsia?
Systolic up 30 mm/hg from before or diastolic up 15 mm/hg
How would you Dx Severe pre-eclampsia?
Systolic BP > / = 160
Diastolic BP > / = 110
(taken on 2 different occasions, 6 hours in between readings)
PLUS 1 other characteristics…
What are some of the added characteristics to Dx Severe pre eclapmsia?
- Proteinuria
- Pulmonary Edema
- Persistent headaches
- Decreased Urine output
- Epigastric Pain
What is Ecamplsia?
Presence of seizures that cannot be attributed to other causes, after the patient had pre-eclampsia.
What is the concern for eclampsia?
The placenta detaching.
Define Orthostatic HTN:
Change in BP from sitting to standing
Systolic drops >/= 20 mm/hg
Diastolic >/= 10 mm/hg
What are some causes for orthostatic HTN?
- Tall thin people
- Prolonged bed rest
- aging
- some meds
- Hpovolemia (low fluid volume)
What do you teach to a pt. with orthostatic HTN?
Rise slowly, use a walker, take your time, expect to feel dizzy, light headed and possible syncope
What are the Diagnostic Tests for HTN? (7)
- Urinalysis
- Electrolytes / Fasting Blood Glucose
- BUN & Creatinine
- Lipid Profile (Chol, HDL, LDL, Triglycerides)
- CRP
- 12 Lead ECG
- Echocardiogram
What is the urinalysis looking for?
Protein or albumin in the urine (compromised kidney function)
What is the purpose of looking at electrolytes?
Some antihypertensive meds will cause loss of K+, is it within range? Na+ plays an important role in fluid balance
What is the purpose of looking at BUN / Creatinine?
Liver function
What is the purpose of looking at the lipid profile?
Contributes to atherosclerosis, which contributes to HTN
What is the purpose of looking at CRP?
Looking for inflammation (can indicate atherosclerosis)
What is the purpose of the 12 lead ECG?
Looking at conductivity of the heart
What is the purpose of the echocardiogram?
Looking at structure / function of the heart
Treatment for HTN involves 3 phases. what are they?
- Lifestyle
- 1st Line therapies
- Combination pharmacology
For the treatment of HTN, what would the lifestyle modifications be?
- Quit smoking
- Decrease alcohol use (1-2 drinks/day)
- DASH diet
- exercise: light weights/ aerobic
- Tight monitoring of BG levels for diabetic pts.
What would the first line of therapies include?
Waiting to hear back..
What would the Combination pharmacology include?
Addition of a 2nd anti-hypertensive medications until results are achieved
If a patient initially changed their lifestyle and their BP was now 130/ 75, would you add the 1st line therapy? Why or why not?
No. First line therapy meds are given when patients HTN is 140/80 or higher AFTER they have made lifestyle changes
What is important about teaching a patient about HTN?
The damage that it causes to target organs:
- heart
- kidneys
- vessels
- eyes
- PVD
- Brain
When creating a care plan for a patient with HTN, what are some considerations that are important?
- Simple regimen
- Collaboration
- Family
- Support group
Diuretics:
- How do diuretics lower BP?
- What are the pre/post assessments?
- Common SE’s:
- Examples:
- Reduction in blood volume through increased excretion of Na+ and h20 (urination)
- BP, Lab values (K+), weight (is pt. retaining fluid?) I/O balance sheet
- hypotension, electrolyte imbalances, dehydration
- Feurosomide, HCTZ, Spironalactone (K+ sparing)
Beta Blockers:
- How do Beta Blockers decrease BP?
- What are the pre/post assessments? When would you hold the med?
- What are common SE?
- Examples?
- Blocking beta receptors (beta 1) to decrease contractility of the heart (more slowly and less force), therefore decreasing CO
- BP. Hold if Bp
ACEI:
- How do they work?
- What are pre/post assessments?
- Common SE?
- Examples?
- Inhibit conversion of Angiotensin 1 to Angiotensin 11
- BP, labs
- Hypotension, increase K+, cough
- Enalapril, captopril, ramipril, quinapril
ACEI can have a cough as a side affect. Why?
Believed to be associated with the increase in bradkinin levels produced by the ACEI
ARBS:
- How do they work?
- What are pre/post assessments?
- Common SE?
- Examples?
- Block the action of angiotensin 11 at the receptor site on the adrenal cortex
- BP, labs
- Hypotension, increased K+, dry cough
- Atacand, cozaar, micardis
Ca+ Channel Blockers:
- How do they work?
- What are pre/post assessments?
- Common SE?
- Examples?
- Block Ca+ channels causing smooth muscles to dialate
- BP, HR
- Hypotension, worsen heart failure
- Norvasc, renidil, diltiazem, verapamil
What juice do you not give with Ca+ channel blockers?
Grapefruit juice
Direct Vasodilation:
- How do they work?
- Pre/post assessments?
- Common Se?
- Examples?
- Direct peripheral arterial dilation (and THE VEINS!)
- BP q5 min if given IV, watch for reflex tachycardia
- Rapid hypotension, reflex tachycardia, headache, dizzy
- Hydralazine, Nipride
