HTN week 2 Flashcards
What is normal blood pressure
less than 120 systolic
less than 80 diastolic
What constitutes blood presure?
Cardiac output (CO) * Peripheral vascular resistance (PVR)
What is peripheral vascular resistance?
diameter of the blood vessel and the viscosity of the blood
What constitutes cardiac output?
HR x SV
What is stroke volume
Amount of blood pumped from ventricles per beat
What does hypertension mean?
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
Management of BP
Decrease of PVR or blood volume
Decrease the strength, force and rate of myocardial contraction
BP goal with geriatric
140/90 is goal with treatment
Geriatric treatment for HTN must consider other physiological changes: pulse pressure
geriatrics have a wider pulse pressure (noraml is 40 mm/hg) and they also have atherosclerosis
Geriatric treatment for HTN must consider other physiological changes: lower intravascular volume
tend to be dehydrated because of loss of thirst mechanism
Geriatric treatment for HTN must consider other physiological changes: renal blood flow
renal blood flow decreases with age. Due to this, is it important to monitor renal functions as some medications can influence renal perfusion
Geriatric treatment for HTN must consider other physiological changes: NSAIDS
can raise BP with long term use and many elderly take NSAIDs
Proper assessment of blood pressure
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
physical assessment with HTN
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
What labs are we going to want to consider to obtain when someone has HTN
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)
Labs/diagnostics for HTN
UA, BUN, creatinine, creatine clearance, BMP, CBC, ECG
Interventions for HTN
Lifestyle changes - weight, sodium intake, better diet, activity, stop smoking, decrease ETOH and caffeine, medications, stress management
HTN complications
CAD, left ventricular hypertrophy, HF, CVA, PVD, nephrosclerosis, retinal damage, hypertensive crisis
HTN priority medications
- Hydrochlorthiazide (thiazide diuretic, k+ waisting)
- Atenolol (BB)
- Lisinopril (ACE
- Nifedipine, verapamil (Ca2+ Channel blockers)
HTN education
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
rebound HTN
HTN from stop taking med
Medication tolerance HTn
fx are not as good so patient may need new dose or new medication
Why should somone with HTN avoid nasal decongestants?
they contain vasoconstrictors
What is the typical treatment for AA with HTN and why
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
What impact do NSAIDs, ACE and ARB have on hypertension
decrease antihypertensive effect
patient teaching for clien taking thiazide for HTN
fx not seen for 3-4 weeks
ACE monitoring for HTn
ACE exert therapeutic effect within 1 hour of administration, risk of hypotension within first five hours
Observe first dose ACE for angioedema
Treatment of HTN crisis
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
When someone is in a hypertensive crisis, why is it important that we do not lower the BP too fast?
risk of cerebral hypotension, eye issues, kidney issues, MI or CVA
In what condition would it be appropriate to quickly reduce a hypertensive crisis and why
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
Pharmacological management of hypertensive crisis: IV medication
Iv med that you are titrating based on the med they are getting and how they’re responding to it
Pharmacological management of hypertensive crisis: sodium nitroprusside - IV titration
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
What are 2 oral medications used in hypertensive crisis
Labetalol
Clonidine
