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z_MEDSURGE: FINAL REVIEW > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What are the categories and ranges for hypertension?

A
  • Normal = < 120 and < 80
  • Elevated = 120-129 and < 80
  • Stage 1 = 130-139 or 80-90
  • Stage 2 = ≥ 140 or ≥ 90
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2
Q

What are the 3 types of hypertension?

A
  • Primary
  • Secondary
  • Milignant
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3
Q

Define Primary hypertension

A
  • 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.
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4
Q

Define Secondary hypertension

A

hypertension that results from a number of conditions that impair blood pressure regulation

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5
Q

Define Malignant

A

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.

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6
Q

Hypertension can contribute to the development of atherosclerosis, increases the workload of the heart and can reduce perfusion to major organs resulting in:

A
  • Transient ischemic attacks (TIA)
  • Strokes
  • MI
  • Left ventricular hypertrophy
  • CHF/CAD
  • Renal Failure
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7
Q

What kind of underlying disorders/conditions may cause Secondary hypertension?

A
  • Renal
  • Endocrine
  • Vascular
  • Neurological
  • Thyroid/parathyroid dysfunction
  • Hypercalcemia
  • Sleep apnea
  • Pregnancy
  • Toxemia (now called hypertensive disease of pregnancy)
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8
Q

What substances may contribute to Secondary hypertension?

A
  • Use of estrogen containing oral contraceptives
  • Alcohol
  • Cocaine
  • NSAIDS
  • OTC medication
  • Some herbal remedies containing ephedrine, licorice or nicotine.
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9
Q

Although the cause is unknown, Malignant hypertension may be associated with…

A
  • Dilation of cerebral arteries
  • Generalized arteriolar fibrinoid necrosis
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10
Q

Studies have shown that a BP drop by 5mmHg can decrease strokes and intracerebral hemorrhage by how much?

A
  • Strokes = 34%
  • ICH = 21%
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11
Q

TRUE OR FALSE

Steroids, oral contraceptives and cold medications do not cause hypertension.

A

False

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12
Q

What are some early s/s of hypertension?

A
  • Malaise
  • Fatigue
  • General weakness
  • Vague sense of discomfort
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13
Q

In regards to hypertension, when taking a patients hx, we should establish any hx of…

A
  • Lightheadedness
  • Dizziness
  • Nosebleeds
  • Ringing in the ears
  • Blurred vision
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14
Q

What are the general s/s that may indicate hypertension?

A
  • Loss of vision,
  • shortness of breath,
  • chest pain,
  • confusion,
  • increased irritability,
  • seizures,
  • transient paralysis or stupor,
  • sleepiness,
  • visual disturbances,
  • severe headaches, or
  • vomiting.
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15
Q

Fundascopic examination of the retina in a pt w/ HTN may reveal…

A
  • hemorrhage
  • fluid accumulation
  • narrowed arterioles
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16
Q

During a physical assessment of a pt w/ suspected HTN, what is being noted while assessing peripheral pulses?

A
  • Bounding pulses
  • Alternating strength of pulse
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17
Q

When auscultating the heart of a pt, what may be suggestive of hypertension?

A

Presence of S4 heart sound

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18
Q

How do we assess if a pt may have hypertension with BP readings?

A
  • 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.
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19
Q

Hypertension should not be diagnosed on the basis of one reading unless it is greater than _____ / _____mm Hg

A

210/120

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20
Q

What 3 mental states can exacerbate BP?

A
  • Stress
  • Anxiety
  • Fear
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21
Q

Hypertension can result in changes in lifestyle and perception of body image. As such, we should assess the patient’s _____ _____.

A

coping mechanisms

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22
Q

What six lifestyle modifications can help reduce hypertension?

A
  • Sodium restriction
  • Weight reduction
  • Reduced alcohol intake
  • Exercise
  • Decrease stress levels (relaxation/meditation)
  • Avoid alcohol, smoking
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23
Q

What diagnostic labs may be requested to ascertain the effects of existing HTN in a PT?

A
  • BUN
  • Serum creatinine
  • Total cholesterol
  • Triglycerides
  • Electrocardiogram
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24
Q

What is the purpose of a BUN test for a hypertensive pt?

A

Determines if renal dysfunction or fluid imbalances are present as a complication of hypertension

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25
Q

What is the normal range for BUN and how would an hypertensive abnormality be indicated?

A
  • 5-20 mg/dL
  • Elevated levels may be indicative of abnormality
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26
Q

What is the purpose of a Creatinine test for a hypertensive pt?

A

Determines if renal dysfunction is present as a complication of hypertension

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27
Q

What is the normal range for Creatinine and how would an hypertensive abnormality be indicated?

A

0.5 - 1.2 mg/dL

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28
Q

What is the purpose of a Total cholesterol test for a hypertensive pt?

A

Used for screening to determine risk of coronary heart disease; assesses for hyperlipidemia

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29
Q

What is the normal range for Total cholesterol and how would an hypertensive abnormality be indicated?

A
  • Range
    • Individual variations, but desireable are:
    • < 200 mg/dL
  • Abnormal levels are
    • Borderline high = 200-239
    • High = > 239
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30
Q

What is the purpose of a Triglyceride test for a hypertensive pt?

A

Used for screening and initial classification of risk of coronary heart disease; elevations determine hyperlipidemia

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31
Q

What is the purpose of an ECG for a hypertensive pt?

A

Electrical conduction system may be altered by hypertrophied left ventricle

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32
Q

How would the ECG be abnormally altered for the HTN pt?

A
  • ECG may be normal or
  • show signs of left ventricular hypertrophy:
  • conduction delays,
  • ST-T changes
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33
Q

What four types of medications help complications that may arise from HTN?

A
  • ACE inhibitors & Angiotensin II receptor blockers (ARBS)
  • Beta blockers
  • Calcium channel blockers
  • Diuretics
34
Q

What do Adrenergic-inhibiting agents do?

A

They decrease the SNS effects that increase BP.

35
Q

Adrenergic inhibitors include drugs that work centrally on the _____ center and peripherally to inhibit _____ release or to block the _____ receptors on blood vessels.

A
  • Vasomotor
  • Norepinephrine
  • Adrenergic
36
Q

What do Angiotensin-converting enzyme (ACE) inhibitors do?

A

They prevent the conversion of angiotensin I to angiotensin II and reduce angiotensin II (A-II)–mediated vasoconstriction and sodium and water retention.

37
Q

What do A-II receptor blockers (ARBs) do?

A

They prevent angiotensin II from binding to its receptors in the walls of the blood vessels.

38
Q

What do Calcium channel blockers (CCB) do?

A

They increase sodium excretion and cause arteriolar vasodilation by preventing the movement of extracellular calcium into cells.

39
Q

What do Direct vasodilators do?

A

Decrease the BP by relaxing the vascular smooth muscle and reducing SVR (systemic vascular resistance).

40
Q

What do diuretics do?

A

Diuretics promote:

  • sodium and water excretion,
  • reduce plasma volume, and
  • reduce the vascular response to catecholamines.
41
Q

What does angiotensin II do?

A

Binds to its receptors (AT1) on blood vessels stimulating vasoconstriction and aldosterone release.

42
Q

What is aldosterone, what is it responsible for and what do high levels cause?

A
  • 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
43
Q

A test for catecholamines tests for what hormones?

A
  • Epinepherine
  • Norepinephrine
  • Dopamine
44
Q

Catecholamines are produced by…

A
  • Nerve tissue in the brain
  • The adrenal glands
45
Q

What do catecholamines do?

A
  • 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.
46
Q

What are the significant SFX of Ace inhibitors?

A
  • 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
47
Q

How is K+ related to heart function?

A
  • Directly effects contractility (timing and function) and health of muscles, including the heart
  • Lets nutrients into cells and removes waste products
48
Q

What are the effects of elevated potassium on the heart?

A

Too much potassium can lead to dysrhythmias

49
Q

What is the role of the renal system related to K+?

A

kidneys control how much potassium is in your body by filtering any excess out of your blood.

50
Q

What can decreased sodium can result in

A
  • Dehydration
  • Kidney failure
  • Reduced BP
  • CHF
51
Q

What is creatinine?

A

Creatinine is a chemical waste product that’s produced by your muscle metabolism

52
Q

How are creatinine levels managed in the body?

A
  • Healthy kidneys filter creatinine and other waste products from your blood.
  • The filtered waste products leave your body in your urine.
53
Q

What are elevated creatinine levels indicative of?

A

Poor kidney function, since they aren’t being eliminated via urine

54
Q

A serum creatinine tests measures levels in…

A

The blood

55
Q

What are the significant SFX of Beta Blockers?

A
  • increased potassium,
  • increased bronchospasms in COPD and asthma.
  • Depression & sexual dysfunction
  • Decreased HR & BP (due to vasodilation action of beta blockers)
56
Q

What type of meds are amlodopine/Norvasc and verapamil/Calan, what does each do in respect to hypertension and what are the SFX?

A
  • 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
57
Q

What type of med is Hydrochlorothiazide and Lasix?

A

Diuretics

58
Q

What part of the kidney does Hydrochlorothiazide (HCTZ) act upon?

A

Distal convoluted tubules

59
Q

Is Hydrochlorothiazide (HCTZ) more effective in patients with normal or abnormal kidney function?

A

Normal

60
Q

What is increased by Hydrochlorothiazide (HCTZ) and what are the SFX of each?

A
  • 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
61
Q

What is decreased by Hydrochlorothiazide (HCTZ) and what are the SFX of each?

A
  • Potassium
  • Heart palpations
  • arrhythmia
  • Sodium concentration
  • Dehydration
  • Lower BP
62
Q

All diuretics increase…

A

Creatinine

63
Q

Lasix is more effective in patients with healthy or impaired kidney function?

A

Impaired

64
Q

What does Lasix reduce?

A
  • Calcium
  • sodium
65
Q

What do we need to keep in mind about an increase of calcium in urine?

A

It can affect the pt with kidney stones

66
Q

Regarding pt education, how should we be able to communicate the pathophysiology of hypertension?

A
  • In layman’s terms, simple and easy to understand
  • Avoid technical/medical jargon
67
Q

Regarding pt education, what should we discuss with our pts regarding antihypertensives?

A
  • Action of med
  • Dosage
  • SFX
  • Risk factors
  • Self BP monitoring and journal keeping
68
Q

Regarding pt education, what key points of nutrition should be discussed in regards to hypertension?

A
  • Reduce sodium intake
  • Pts on potassium sparing diuretics should avoid excessive use of salt substitutes as they are high in potassium
69
Q

What are ways we can teach our PTs to reduce sodium intake?

A
  • 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
70
Q

What are some potassium rich foods?

A
  • Spinach,
  • broccoli,
  • potatoes,
  • leafy greans,
  • peas
  • mushrooms,
  • zuchhini
71
Q

What juices can also be a source of Potassium?

A
  • Orange,
  • tomato,
  • prune,
  • apricot,
  • grapefruit
72
Q

What BP measurements indicate a hypertensive crisis?

A
  • systolic > 180 mm Hg and/or diastolic > 120 mm Hg.
  • BPs often can be greater than 220/140 mm Hg.
73
Q

Hypertensive crisis are emergent. If untreated, what could happen?

retinopathy

A
  • encephalopathy,
  • intracranial or subarachnoid hemorrhage,
  • HF, MI,
  • renal failure,
  • dissecting aortic aneurysm, and
74
Q

Hypertensive emergencies have evidence of target organ disease. What is the tx?

A
  • Hospitalization required
  • Immediate intervention to lower BP is priority #1
75
Q

Hypertensive urgency has no clinical evidence of target organ disease. What is the tx?

A
  • Hospitalization may or may not be required
  • Gaining control and lowering BP for immediate and longterm tx is priority
76
Q

Why is potassium important?

A

It is critical to the proper functioning of nerve and muscles cells, particularly heart muscle cells

77
Q

What are the normal levels for potassium?

A

3.6 - 5.2 mmol/L

78
Q

Why is sodium important?

A
  • 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
79
Q

What are the normal levels for sodium?

A

135 – 145 mEq/L

80
Q

The overall goals for the patient with hypertension are that the patient will

A
  • achieve and maintain the goal BP
  • have minimal side effects of therapy
  • manage and cope with this condition
81
Q

IV agents used for hypertensive emergencies include:

A
  • vasodilators
    • sodium nitroprusside (most effective IV tx for hypertensive emergencies), fenoldopam, nicardipine
  • adrenergic inhibitors
    • phentolamine, labetalol, esmolol
  • the calcium channel blocker clevidipine (Cleviprex).
82
Q

Why may oral agents be given along with IV ones?

A

to help make an earlier transition to long-term therapy.

z_MEDSURGE: FINAL REVIEW (15 decks)

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