HTN Flashcards
What is a normal BP?
120/80 mmHg
What is considered elevated BP?
120-129/ 80 mmHg
What is considered HTN stage 1?
130-139/80-89 mmHg
What is considered stage 2?
SBP 140 or greater/ DBP 90 or greater mmHg
How is HTN diagnosed?
2 or more contacts w/ HCP
WHat are the symptoms of HTN?
No symptoms; pt will experience s/s of target end organ damage.
What are the non modifiable risk factors of HTN?
Age,gender, family hx
What are the modifiable risk factors of HTN?
Life style/ overweight/obesity
What is the nursing intervention focus?
Modifiable factors
HTN is often called the ____ killer
Silent
What percentage of cases are from HTN being the primary cause?
95%
What are the illnesses when HTN is the secondary cause?
Renal disease, medication side effects
HTN is a risk factor for _____(6)
- heart disease
- DM
- dyslipidemia
- obesity
- sleep apnea
- sedentary LS
What is the patho of HTN in the gero population?
-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
BP Goals for elderly
<140/90 for ages 65-79
-SBP 140-145 for 80 years or older
What are the major HTN risk factors? (8)
- advancing age
- African American
- excessive alcohol intake
- family history
- gender
- obesity
- poor diet (especially high in sodium)
- sedentary lifestyle
Prolonged hypertension target organs
- Heart: MI, HF, CAD
- Kidneys: CKD
- Brain: Stroke (CVA)
- Eyes: Impaired vision, reports of seeing spots from eyes
- Peripheral vascular disorders
HTN Clinical manifestations
- 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)
Assessment and diagnostic studies for HTN (BP, lab levels, kidney, heart, what else)
- 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
Non-pharmacological management for all patients (5)
- heart healthy diet (DASH): culturally appropriate
- reducing sodium intake—- <2g/day
- increasing physical activity
- limiting alcohol
- losing weight for those who are overweight
Pharmacological management goals
- 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
Pharmacological management: First line meds
- 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
Medical management goals
- prevent complications
- maintain BP or lower than 130/80
- life style modifications
- Diet: DASH-like culturally appropriate, alcohol, salt
- weight management, physical activity
HTN and Dementia
-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
Gero HTN treatment
- 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
What is the DASH diet?
Rich in fruits and vegetables, whole grains, and low-fat dairy foods
Drug therapy for HTN (2 types)
- decreased blood volume (diuretics)
- reduced blood vessel resistance by vasodilation (ex CCB)
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)
- 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)
Potassium sparing diuretics (how it works, monitor for, contraindicated for, taken when, avoid what, examples)
- 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
Aldosterone receptor blockers (—one) (how it works, monitor for, do not give with, when to take, example)
- 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
ACE inhibitors (pril) (end in what, examples, how it works, side effects, risk for)
- 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
When to notify MD w/ all hypertension meds
Sudden weight gain
Saying for ace inhibitors
Give them ACE and they’ll cough in your swollen face
Angiotensin II receptor blocks (ARBs) —___sartan - (how it works, how long to see full effect, doesn’t cause what, examples, risk for)
- 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
Calcium channel blockers (what to think, what does calcium do, how does this lower BP?)
- THINK BLOCK CALCIUM
- calcium has to do with the transmission of nerve impulses and affects vascular smooth contractions
- results in dilation
How do calcium channel blockers work?
- dilates coronary and systemic arteries resulting in lower BP
- decreases myocardium contractility
- slow AV conduction and decreases HR
CCB (ends in what and examples)
- ends in “pine”
- ex: nifedipine, amlodipine, diltfiazem
Caution for what for calcium Channel blockers and contraindication
- heart failure patients
- contraindicated in bradycardia
Beta blockers (lol) (Examples, how it works, may cause what, assess for, increased mortality in which pt)
- 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
Central alpha 2 antagonists (how it works, examples, what happens if discontinued suddenly, what is noted w/decreased side effects)
- 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
Alpha 1 blockers (Zosin) (how it works, examples, contraindications)
- produces vasodilation, decreased vascular resistance, decrease BP
- ex: terazosin, prazosin
- contraindications: angina, CAD
Combined alpha and beta blockers (lol) (examples, monitor for, what can give a quick decrease in dangerous HTN)
- carvedilol, labetolol
- monitor for OTH
- labetolol IV: quick decrease in dangerous HTN
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)
- 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
Direct renin inhibitors (example, monitor for)
-aliskerin: monitor for angioedema, renal function, hyperkalemia and hypotension
Nursing interventions: education and activation
- 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
Nursing interventions (how many meds are most patients on, high risk for, what to do is that happens)
- 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
About half of patients do not adhere to medications prescribed HTN, what should nurses do?
-assess for non adherence and advocate for patients
When is the best time for a patient to take antihypertensive meds and why?
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
Nursing interventions goal
-BP under set parameter, patient adheres to medication therapy and reports adverse affects
If BP is unchanged after starting meds, what do you do?
Investigate compliance…is pt taking meds?
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)
- 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
Hypertensive urgency (values and S/S, if pt on HTN meds investigate what, IV therapy may cause ____, PO goal of ____, close outpatient _____)
- 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
