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Nursing G140 Exam #1 (MS) > HTN > Flashcards

HTN Flashcards

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1
Q

What is a normal BP?

A

120/80 mmHg

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2
Q

What is considered elevated BP?

A

120-129/ 80 mmHg

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3
Q

What is considered HTN stage 1?

A

130-139/80-89 mmHg

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4
Q

What is considered stage 2?

A

SBP 140 or greater/ DBP 90 or greater mmHg

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5
Q

How is HTN diagnosed?

A

2 or more contacts w/ HCP

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6
Q

WHat are the symptoms of HTN?

A

No symptoms; pt will experience s/s of target end organ damage.

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7
Q

What are the non modifiable risk factors of HTN?

A

Age,gender, family hx

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8
Q

What are the modifiable risk factors of HTN?

A

Life style/ overweight/obesity

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9
Q

What is the nursing intervention focus?

A

Modifiable factors

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10
Q

HTN is often called the ____ killer

A

Silent

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11
Q

What percentage of cases are from HTN being the primary cause?

A

95%

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12
Q

What are the illnesses when HTN is the secondary cause?

A

Renal disease, medication side effects

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13
Q

HTN is a risk factor for _____(6)

A
  • heart disease
  • DM
  • dyslipidemia
  • obesity
  • sleep apnea
  • sedentary LS
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14
Q

What is the patho of HTN in the gero population?

A

-accumulation of atheroslerotic plaques —> loss of elasticity of arteries from atherosclerosis —> impaired baroreceptor function (greater r/o ortho hypo) —> increased vascular resistance —> decreased renal function

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15
Q

BP Goals for elderly

A

<140/90 for ages 65-79

-SBP 140-145 for 80 years or older

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16
Q

What are the major HTN risk factors? (8)

A
  • advancing age
  • African American
  • excessive alcohol intake
  • family history
  • gender
  • obesity
  • poor diet (especially high in sodium)
  • sedentary lifestyle
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17
Q

Prolonged hypertension target organs

A
  • Heart: MI, HF, CAD
  • Kidneys: CKD
  • Brain: Stroke (CVA)
  • Eyes: Impaired vision, reports of seeing spots from eyes
  • Peripheral vascular disorders
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18
Q

HTN Clinical manifestations

A
  • mainly asymptomatic
  • retinal damage (late sign)
  • CAD, angina, MI, LVH (left ventricular hypertrophy), HF (all late signs)
  • increased BUN, creatinine, nocturnal (CKI) (late sign)
  • TIA (transient ischemic attack), stroke, cerebral infarction (late sign)
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19
Q

Assessment and diagnostic studies for HTN (BP, lab levels, kidney, heart, what else)

A
  • patients history
  • BP measurement: Both arms and pulses
  • cholesterol levels, serum Na and K
  • kidney: Creatinine, GFR
  • heart: Cardiac markers, ECG, echocardiogram
  • retinal exam, brain MRI
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20
Q

Non-pharmacological management for all patients (5)

A
  • heart healthy diet (DASH): culturally appropriate
  • reducing sodium intake—- <2g/day
  • increasing physical activity
  • limiting alcohol
  • losing weight for those who are overweight
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21
Q

Pharmacological management goals

A
  • SBP <130 and DBP <80
  • may individualize for DM, CKD, ASCVD risk at or more than 10%
  • if SBP > 140 or DBP > 80: probably need two classes of meds
  • thiazides and CCB for black patients
22
Q

Pharmacological management: First line meds

A
  • thiazides diuretics
  • angiotensin converting enzyme inhibitors (ACEI) or angiotensin-receptor blockers (ARBs)
  • Calcium channel blockers (CCB)
  • Beta blockers not first line for HTN
  • thiazides and CCB first line choice for black adults
23
Q

Medical management goals

A
  • prevent complications
  • maintain BP or lower than 130/80
  • life style modifications
  • Diet: DASH-like culturally appropriate, alcohol, salt
  • weight management, physical activity
24
Q

HTN and Dementia

A

-patients who lowered their BP to below 120 had a reduced rate of 19% of developing mild cognitive impairment, and 15% reduction in incidence of MCI and dementia compared to people who had a target BP of 140

25
Q

Gero HTN treatment

A
  • begin with lifestyle modifications
  • start with lowest medication dose due to less albumin
  • assess for poly pharmacy interactions
  • monitor OTH, hyperkalemia
  • teach about postural hypotension and fall prevention
26
Q

What is the DASH diet?

A

Rich in fruits and vegetables, whole grains, and low-fat dairy foods

27
Q

Drug therapy for HTN (2 types)

A
  • decreased blood volume (diuretics)

- reduced blood vessel resistance by vasodilation (ex CCB)

28
Q

Thiazides and Loop diuretics (—thiazide, —ide). (What does it inhibit and where, which one is more potent/has a shorter duration of action, monitor for, examples)

A
  • inhibit Na retention in different areas of the kidneys
  • loop diuretics are more potent, but have a shorter duration of action
  • monitor for hypokalemia, digoxin toxicity, ortho hypo
  • examples: furosemide, chlorothiazide)
29
Q

Potassium sparing diuretics (how it works, monitor for, contraindicated for, taken when, avoid what, examples)

A
  • reduce Na and K exchange in the renal tubules
  • monitor for orthostatic hypotension and hyperkalemia
  • contraindicated in RF
  • TAKE AFTER MEALS
  • avoid K supplements
  • ex: amiloride, tramterene
30
Q

Aldosterone receptor blockers (—one) (how it works, monitor for, do not give with, when to take, example)

A
  • inhibits Na retaining and K excreting effects of aldosterone in renal tubules
  • monitor for ortho hypo and hyperkalemia
  • do not give with potassium sparing diuretics or K supplements
  • take after meals
  • ex: spirinolactone
31
Q

ACE inhibitors (pril) (end in what, examples, how it works, side effects, risk for)

A
  • end in “pril”
  • ex: captopril, enalapril,lisinopril
  • block conversion of angiotensin I to angiotensin II, decreases vascular resistance —> vasodilation (decrease SBP), decreases Na and H2O retention
  • Side Effects: Otho hypo, hacking cough, angioedema (EMERGENCY)
  • risk for —> hyperkalemia
32
Q

When to notify MD w/ all hypertension meds

A

Sudden weight gain

33
Q

Saying for ace inhibitors

A

Give them ACE and they’ll cough in your swollen face

34
Q

Angiotensin II receptor blocks (ARBs) —___sartan - (how it works, how long to see full effect, doesn’t cause what, examples, risk for)

A
  • blocks angiotensin II producing vasodilation and increased Na and water excretion
  • take 3-6 weeks to see full effect
  • does not cause cough as in ACE inhibitors
  • ex: losartan and valsartan
  • risk for hyperkalemia
35
Q

Calcium channel blockers (what to think, what does calcium do, how does this lower BP?)

A
  • THINK BLOCK CALCIUM
  • calcium has to do with the transmission of nerve impulses and affects vascular smooth contractions
  • results in dilation
36
Q

How do calcium channel blockers work?

A
  • dilates coronary and systemic arteries resulting in lower BP
  • decreases myocardium contractility
  • slow AV conduction and decreases HR
37
Q

CCB (ends in what and examples)

A
  • ends in “pine”

- ex: nifedipine, amlodipine, diltfiazem

38
Q

Caution for what for calcium Channel blockers and contraindication

A
  • heart failure patients

- contraindicated in bradycardia

39
Q

Beta blockers (lol) (Examples, how it works, may cause what, assess for, increased mortality in which pt)

A
  • ex: metoprolol, atenolol, propranolol
  • decreases work load of the heart (decrease BP, HR, and contractility)
  • may cause bronchospasm (caution in COPD and asthma patients)
  • may cause mental depression
  • asses for OTH
  • increased mortality in diabetes patients
40
Q

Central alpha 2 antagonists (how it works, examples, what happens if discontinued suddenly, what is noted w/decreased side effects)

A
  • decreases sympathetic outflow producing vasodilation, decrease peripheral vascular resistance, decrease BP
  • ex: clonidine, methyldopa, guanabenz
  • sudden discontinuation-rebound HTN, tachycardia, HA, tremors, sweating
  • transdermal patch-noted w/ decreased side effects
41
Q

Alpha 1 blockers (Zosin) (how it works, examples, contraindications)

A
  • produces vasodilation, decreased vascular resistance, decrease BP
  • ex: terazosin, prazosin
  • contraindications: angina, CAD
42
Q

Combined alpha and beta blockers (lol) (examples, monitor for, what can give a quick decrease in dangerous HTN)

A
  • carvedilol, labetolol
  • monitor for OTH
  • labetolol IV: quick decrease in dangerous HTN
43
Q

Drug therapy: direct vasodilator ( what is reserved for hypertensive crisis, what needs to be monitored, what drug is contraindicated for CAD/HF patients, monitor apical pulse before which drug)

A
  • several IV forms (nitroglycerine) reserved for hypertensive crisis
  • ICU/tele monitoring, severe side effects
  • hydralazine: contraindicated for CAD, HF
  • minoxidil: monitor apical pulse before admin
44
Q

Direct renin inhibitors (example, monitor for)

A

-aliskerin: monitor for angioedema, renal function, hyperkalemia and hypotension

45
Q

Nursing interventions: education and activation

A
  • lifestyle changes (weight loss, activity level)
  • diet: DASH, low CHO, low fats, sodium reduction
  • medication therapy: how to take, side effects, discontinuation, rebound HTN
  • activity: long term, individually tailored
46
Q

Nursing interventions (how many meds are most patients on, high risk for, what to do is that happens)

A
  • most patients on 2-3 meds
  • high risk for ortho hypo (teach slow moving position after lying or sitting)
  • if OTH may need to hold medication and change dose
47
Q

About half of patients do not adhere to medications prescribed HTN, what should nurses do?

A

-assess for non adherence and advocate for patients

48
Q

When is the best time for a patient to take antihypertensive meds and why?

A

Before bed rather in the morning allows for stabilized BP through the day and is associated with reduced risk of MI, HF, stroke and death by cardiovascular disease

49
Q

Nursing interventions goal

A

-BP under set parameter, patient adheres to medication therapy and reports adverse affects

50
Q

If BP is unchanged after starting meds, what do you do?

A

Investigate compliance…is pt taking meds?

51
Q

Hypertensive emergency (values and S/S, what to do for normotensive patients, which kind of drug use, if pt is already on HTN meds what to investigate)

A
  • SBP >180 and DBP >120 and evidence of end organ damage (HA, confusion, renal dysfunction)
  • life threatening for normotensive patients: IV Vasodilators
  • cocaine/crack use
  • if patient on HTN meds, investigate compliance
52
Q

Hypertensive urgency (values and S/S, if pt on HTN meds investigate what, IV therapy may cause ____, PO goal of ____, close outpatient _____)

A
  • SBP >180 and DBP > 120, no evidence of end organ damage
  • if pt on HTN meds, investigate compliance
  • IV therapy may cause hypotension; PO of goal of normalizing BP in 24-48 hours
  • close outpatient follow up

Nursing G140 Exam #1 (MS) (5 decks)

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