Hypertension Flashcards
What are the categories and ranges for hypertension?
- Normal = < 120 and < 80
- Elevated = 120-129 and < 80
- Stage 1 = 130-139 or 80-90
- Stage 2 = ≥ 140 or ≥ 90
What are the 3 types of hypertension?
- Primary
- Secondary
- Milignant
Define Primary hypertension
- Primary hypertension is not known; but, it is known that the disease is associated with risk factors such as genetic predisposition, stress, obesity, and a high-sodium diet.
Define Secondary hypertension
hypertension that results from a number of conditions that impair blood pressure regulation
Define Malignant
hypertension, results from either Primary or Secondary and can cause blood pressures as high as 240/150 mm Hg, possibly leading to coma and death.
Hypertension can contribute to the development of atherosclerosis, increases the workload of the heart and can reduce perfusion to major organs resulting in:
- Transient ischemic attacks (TIA)
- Strokes
- MI
- Left ventricular hypertrophy
- CHF/CAD
- Renal Failure
What kind of underlying disorders/conditions may cause Secondary hypertension?
- Renal
- Endocrine
- Vascular
- Neurological
- Thyroid/parathyroid dysfunction
- Hypercalcemia
- Sleep apnea
- Pregnancy
- Toxemia (now called hypertensive disease of pregnancy)
What substances may contribute to Secondary hypertension?
- Use of estrogen containing oral contraceptives
- Alcohol
- Cocaine
- NSAIDS
- OTC medication
- Some herbal remedies containing ephedrine, licorice or nicotine.
Although the cause is unknown, Malignant hypertension may be associated with…
- Dilation of cerebral arteries
- Generalized arteriolar fibrinoid necrosis
Studies have shown that a BP drop by 5mmHg can decrease strokes and intracerebral hemorrhage by how much?
- Strokes = 34%
- ICH = 21%
TRUE OR FALSE
Steroids, oral contraceptives and cold medications do not cause hypertension.
False
What are some early s/s of hypertension?
- Malaise
- Fatigue
- General weakness
- Vague sense of discomfort
In regards to hypertension, when taking a patients hx, we should establish any hx of…
- Lightheadedness
- Dizziness
- Nosebleeds
- Ringing in the ears
- Blurred vision
What are the general s/s that may indicate hypertension?
- Loss of vision,
- shortness of breath,
- chest pain,
- confusion,
- increased irritability,
- seizures,
- transient paralysis or stupor,
- sleepiness,
- visual disturbances,
- severe headaches, or
- vomiting.
Fundascopic examination of the retina in a pt w/ HTN may reveal…
- hemorrhage
- fluid accumulation
- narrowed arterioles
During a physical assessment of a pt w/ suspected HTN, what is being noted while assessing peripheral pulses?
- Bounding pulses
- Alternating strength of pulse
When auscultating the heart of a pt, what may be suggestive of hypertension?
Presence of S4 heart sound
How do we assess if a pt may have hypertension with BP readings?
- measure blood pressure in both arms three times 3 to 5 minutes apart while the patient is at rest in the sitting, standing, and lying positions
- Three readings above 140/90 mm Hg indicate hypertension.
Hypertension should not be diagnosed on the basis of one reading unless it is greater than _____ / _____mm Hg
210/120
What 3 mental states can exacerbate BP?
- Stress
- Anxiety
- Fear
Hypertension can result in changes in lifestyle and perception of body image. As such, we should assess the patient’s _____ _____.
coping mechanisms
What six lifestyle modifications can help reduce hypertension?
- Sodium restriction
- Weight reduction
- Reduced alcohol intake
- Exercise
- Decrease stress levels (relaxation/meditation)
- Avoid alcohol, smoking
What diagnostic labs may be requested to ascertain the effects of existing HTN in a PT?
- BUN
- Serum creatinine
- Total cholesterol
- Triglycerides
- Electrocardiogram
What is the purpose of a BUN test for a hypertensive pt?
Determines if renal dysfunction or fluid imbalances are present as a complication of hypertension
What is the normal range for BUN and how would an hypertensive abnormality be indicated?
- 5-20 mg/dL
- Elevated levels may be indicative of abnormality
What is the purpose of a Creatinine test for a hypertensive pt?
Determines if renal dysfunction is present as a complication of hypertension
What is the normal range for Creatinine and how would an hypertensive abnormality be indicated?
0.5 - 1.2 mg/dL
What is the purpose of a Total cholesterol test for a hypertensive pt?
Used for screening to determine risk of coronary heart disease; assesses for hyperlipidemia
What is the normal range for Total cholesterol and how would an hypertensive abnormality be indicated?
- Range
- Individual variations, but desireable are:
- < 200 mg/dL
- Abnormal levels are
- Borderline high = 200-239
- High = > 239
What is the purpose of a Triglyceride test for a hypertensive pt?
Used for screening and initial classification of risk of coronary heart disease; elevations determine hyperlipidemia
What is the purpose of an ECG for a hypertensive pt?
Electrical conduction system may be altered by hypertrophied left ventricle
How would the ECG be abnormally altered for the HTN pt?
- ECG may be normal or
- show signs of left ventricular hypertrophy:
- conduction delays,
- ST-T changes
What four types of medications help complications that may arise from HTN?
- ACE inhibitors & Angiotensin II receptor blockers (ARBS)
- Beta blockers
- Calcium channel blockers
- Diuretics
What do Adrenergic-inhibiting agents do?
They decrease the SNS effects that increase BP.
Adrenergic inhibitors include drugs that work centrally on the _____ center and peripherally to inhibit _____ release or to block the _____ receptors on blood vessels.
- Vasomotor
- Norepinephrine
- Adrenergic
What do Angiotensin-converting enzyme (ACE) inhibitors do?
They prevent the conversion of angiotensin I to angiotensin II and reduce angiotensin II (A-II)–mediated vasoconstriction and sodium and water retention.
What do A-II receptor blockers (ARBs) do?
They prevent angiotensin II from binding to its receptors in the walls of the blood vessels.
What do Calcium channel blockers (CCB) do?
They increase sodium excretion and cause arteriolar vasodilation by preventing the movement of extracellular calcium into cells.
What do Direct vasodilators do?
Decrease the BP by relaxing the vascular smooth muscle and reducing SVR (systemic vascular resistance).
What do diuretics do?
Diuretics promote:
- sodium and water excretion,
- reduce plasma volume, and
- reduce the vascular response to catecholamines.
What does angiotensin II do?
Binds to its receptors (AT1) on blood vessels stimulating vasoconstriction and aldosterone release.
What is aldosterone, what is it responsible for and what do high levels cause?
- Aldosterone is a steroid hormone.
- Its main role is to regulate salt and water in the body, thus having an effect on blood pressure.
- Too much causes the kidneys to retain water and sodium and flush potassium
A test for catecholamines tests for what hormones?
- Epinepherine
- Norepinephrine
- Dopamine
Catecholamines are produced by…
- Nerve tissue in the brain
- The adrenal glands
What do catecholamines do?
- Prep the fight or flight response
- Catecholamines increase heart rate, blood pressure, breathing rate, muscle strength, and mental alertness.
- They also lower the amount of blood going to the skin and intestines and increase blood going to the major organs, such as the brain, heart, and kidneys.
What are the significant SFX of Ace inhibitors?
- Angiodema, (non-pitting edema of submucosal tissues)
- MD may switch to an angiotensin II receptor blocker (ARB)
- Coughing
- increased potassium, decreased sodium,
- increased creatinine
- leads to renal failure
How is K+ related to heart function?
- Directly effects contractility (timing and function) and health of muscles, including the heart
- Lets nutrients into cells and removes waste products
What are the effects of elevated potassium on the heart?
Too much potassium can lead to dysrhythmias
What is the role of the renal system related to K+?
kidneys control how much potassium is in your body by filtering any excess out of your blood.
What can decreased sodium can result in
- Dehydration
- Kidney failure
- Reduced BP
- CHF
What is creatinine?
Creatinine is a chemical waste product that’s produced by your muscle metabolism
How are creatinine levels managed in the body?
- Healthy kidneys filter creatinine and other waste products from your blood.
- The filtered waste products leave your body in your urine.
What are elevated creatinine levels indicative of?
Poor kidney function, since they aren’t being eliminated via urine
A serum creatinine tests measures levels in…
The blood
What are the significant SFX of Beta Blockers?
- increased potassium,
- increased bronchospasms in COPD and asthma.
- Depression & sexual dysfunction
- Decreased HR & BP (due to vasodilation action of beta blockers)
What type of meds are amlodopine/Norvasc and verapamil/Calan, what does each do in respect to hypertension and what are the SFX?
- They are calcium channel blockers
- Amlodopine causes peripheral vasodilation and decreases HR
- Verapamil is a negative inotropic (lowers the force or speed of contraction of muscles)
- SFX:
- Lower extremity edema
- Constipation
- Heart failure
What type of med is Hydrochlorothiazide and Lasix?
Diuretics
What part of the kidney does Hydrochlorothiazide (HCTZ) act upon?
Distal convoluted tubules
Is Hydrochlorothiazide (HCTZ) more effective in patients with normal or abnormal kidney function?
Normal
What is increased by Hydrochlorothiazide (HCTZ) and what are the SFX of each?
- Calcium
- Can contribute to renal calculi (kidney stones)
- Uric acid
- Makes gout worse
- Lipids
- Increases risk of atherosclerosis
- Glucose
- Can effect the diabetic
- Creatinine
- Leads to kidney failure
What is decreased by Hydrochlorothiazide (HCTZ) and what are the SFX of each?
- Potassium
- Heart palpations
- arrhythmia
- Sodium concentration
- Dehydration
- Lower BP
All diuretics increase…
Creatinine
Lasix is more effective in patients with healthy or impaired kidney function?
Impaired
What does Lasix reduce?
- Calcium
- sodium
What do we need to keep in mind about an increase of calcium in urine?
It can affect the pt with kidney stones
Regarding pt education, how should we be able to communicate the pathophysiology of hypertension?
- In layman’s terms, simple and easy to understand
- Avoid technical/medical jargon
Regarding pt education, what should we discuss with our pts regarding antihypertensives?
- Action of med
- Dosage
- SFX
- Risk factors
- Self BP monitoring and journal keeping
Regarding pt education, what key points of nutrition should be discussed in regards to hypertension?
- Reduce sodium intake
- Pts on potassium sparing diuretics should avoid excessive use of salt substitutes as they are high in potassium
What are ways we can teach our PTs to reduce sodium intake?
- Read labels and avoid foods w/ high sodium content
- Rinse canned meats and vegetables for 1 minute to remove most sodium
- Decrease intake of saturated fat cholesterol
- If pt is on potassium-losing meds, they will need to make sure to eat foods rich in potassium
What are some potassium rich foods?
- Spinach,
- broccoli,
- potatoes,
- leafy greans,
- peas
- mushrooms,
- zuchhini
What juices can also be a source of Potassium?
- Orange,
- tomato,
- prune,
- apricot,
- grapefruit
What BP measurements indicate a hypertensive crisis?
- systolic > 180 mm Hg and/or diastolic > 120 mm Hg.
- BPs often can be greater than 220/140 mm Hg.
Hypertensive crisis are emergent. If untreated, what could happen?
retinopathy
- encephalopathy,
- intracranial or subarachnoid hemorrhage,
- HF, MI,
- renal failure,
- dissecting aortic aneurysm, and
Hypertensive emergencies have evidence of target organ disease. What is the tx?
- Hospitalization required
- Immediate intervention to lower BP is priority #1
Hypertensive urgency has no clinical evidence of target organ disease. What is the tx?
- Hospitalization may or may not be required
- Gaining control and lowering BP for immediate and longterm tx is priority
Why is potassium important?
It is critical to the proper functioning of nerve and muscles cells, particularly heart muscle cells
What are the normal levels for potassium?
3.6 - 5.2 mmol/L
Why is sodium important?
- It is an electrolyte used for proper functioning of nerve and muscle cells
- It is critical to maintaining fluid balance in the body and effects BP accordingly
What are the normal levels for sodium?
135 – 145 mEq/L
The overall goals for the patient with hypertension are that the patient will
- achieve and maintain the goal BP
- have minimal side effects of therapy
- manage and cope with this condition
IV agents used for hypertensive emergencies include:
- vasodilators
- sodium nitroprusside (most effective IV tx for hypertensive emergencies), fenoldopam, nicardipine
- adrenergic inhibitors
- phentolamine, labetalol, esmolol
- the calcium channel blocker clevidipine (Cleviprex).
Why may oral agents be given along with IV ones?
to help make an earlier transition to long-term therapy.
