HTN week 2

Question 1

What is normal blood pressure

Answer 1

less than 120 systolic

less than 80 diastolic

Question 2

What constitutes blood presure?

Answer 2

Cardiac output (CO) * Peripheral vascular resistance (PVR)

Question 3

What is peripheral vascular resistance?

Answer 3

diameter of the blood vessel and the viscosity of the blood

Question 4

What constitutes cardiac output?

Answer 4

HR x SV

Question 5

What is stroke volume

Answer 5

Amount of blood pumped from ventricles per beat

Question 6

What does hypertension mean?

Answer 6

Hypertension means there has been a change in one of the factors affecting BP or CO AND there also is a problem with the body’s control system that monitor and regulate BP

Question 7

Management of BP

Answer 7

Decrease of PVR or blood volume

Decrease the strength, force and rate of myocardial contraction

Question 8

BP goal with geriatric

Answer 8

140/90 is goal with treatment

Question 9

Geriatric treatment for HTN must consider other physiological changes: pulse pressure

Answer 9

geriatrics have a wider pulse pressure (noraml is 40 mm/hg) and they also have atherosclerosis

Question 10

Geriatric treatment for HTN must consider other physiological changes: lower intravascular volume

Answer 10

tend to be dehydrated because of loss of thirst mechanism

Question 11

Geriatric treatment for HTN must consider other physiological changes: renal blood flow

Answer 11

renal blood flow decreases with age. Due to this, is it important to monitor renal functions as some medications can influence renal perfusion

Question 12

Geriatric treatment for HTN must consider other physiological changes: NSAIDS

Answer 12

can raise BP with long term use and many elderly take NSAIDs

Question 13

Proper assessment of blood pressure

Answer 13

Assess in both arms (should not be off by more than 10 mm), at least 1 minute between readings, arm at level of heart, correct cuff size

Question 14

physical assessment with HTN

Answer 14

Usually asymptomatic: ask about HA, epistaxis, fatigue, angina, dizziness, anxiety, visual disturbances, dyspnea

Weight, BMI

ask about smoking, sodium intake, ETOH, activity, diet, comorbidities, dull headache in am, eyes for hypertensive retinopathy

Question 15

What labs are we going to want to consider to obtain when someone has HTN

Answer 15

Proteinuria (sign that HTN effected the kidneys and they are spilling protein into the urine

Creatinine clearance (checks kidney functions)

EKG - left ventricular hypertrophy (late sign)

Question 16

Labs/diagnostics for HTN

Answer 16

UA, BUN, creatinine, creatine clearance, BMP, CBC, ECG

Question 17

Interventions for HTN

Answer 17

Lifestyle changes - weight, sodium intake, better diet, activity, stop smoking, decrease ETOH and caffeine, medications, stress management

Question 18

HTN complications

Answer 18

CAD, left ventricular hypertrophy, HF, CVA, PVD, nephrosclerosis, retinal damage, hypertensive crisis

Question 19

HTN priority medications

Answer 19

1. Hydrochlorthiazide (thiazide diuretic, k+ waisting)
2. Atenolol (BB)
3. Lisinopril (ACE
4. Nifedipine, verapamil (Ca2+ Channel blockers)

Question 20

HTN education

Answer 20

Orthostatic hypotension –> falls
BP tracking
Lifelong treatment –> adherence and lifestyle changes
Fish oils and omega 3 fatty acids can be good
Call HCP before using OTC medications

Question 21

rebound HTN

Answer 21

HTN from stop taking med

Question 22

Medication tolerance HTn

Answer 22

fx are not as good so patient may need new dose or new medication

Question 23

Why should somone with HTN avoid nasal decongestants?

Answer 23

they contain vasoconstrictors

Question 24

What is the typical treatment for AA with HTN and why

Answer 24

Since they are at higher risk for developing HTN, they will be put on thiazide diuretic and calcium channel blocker as first line of therapy

Question 25

What impact do NSAIDs, ACE and ARB have on hypertension

Answer 25

decrease antihypertensive effect

Question 26

patient teaching for clien taking thiazide for HTN

Answer 26

fx not seen for 3-4 weeks

Question 27

ACE monitoring for HTn

Answer 27

ACE exert therapeutic effect within 1 hour of administration, risk of hypotension within first five hours

Observe first dose ACE for angioedema

Question 28

Treatment of HTN crisis

Answer 28

a. decrease BP by 10% in the first hour
b. next 3-12 hours: decrease BP 15% (goal 160/110)
c. gradual reduction over next 48 hours

Question 29

When someone is in a hypertensive crisis, why is it important that we do not lower the BP too fast?

Answer 29

risk of cerebral hypotension, eye issues, kidney issues, MI or CVA

Question 30

In what condition would it be appropriate to quickly reduce a hypertensive crisis and why

Answer 30

aortic aneurism because you do not want the high BP to cause it to dissect (?) or bust and have them bleed to death very quickly

Question 31

Pharmacological management of hypertensive crisis: IV medication

Answer 31

Iv med that you are titrating based on the med they are getting and how they’re responding to it

Question 32

Pharmacological management of hypertensive crisis: sodium nitroprusside - IV titration

Answer 32

Thiocyanate toxicity risk
The longer patient on it, higher chance of developing toxicity

Needs to be protected from light

This is an IV medication that you would start with in hypertensive crisis

Question 33

What are 2 oral medications used in hypertensive crisis

Answer 33

Labetalol

Clonidine