hypertension Flashcards
hypertension
Systolic blood pressure > 129 mmHg.
OR
Diastolic blood pressure > 80 mmHg
hypertension for older ppl - numbers (Older than 150 yrs is hyper)
Systolic > 150 mmHg OR Diastolic blood pressure > 89 mmHg in the geriatric patient
blood pressure is (my BP in CO is severe)
Blood Pressure = Cardiac Output x Systemic Vascular Resistance
BP = CO x SVR
in early hypertension, CO is
normal. in older, it’s predominant.
Short term mechanisms
that regulate bp
Sympathetic nervous system
Baroreceptors
Vascular endothelium
long term mechanisms
that regulate bp
Renal, Na+
aldosterone lowers what electrolyte?
K+, which raises the bp
Sympathetic nervous system - what neutransmitter/hormone
Norepinephrine
alpha-1 (the alpha constricts)
Vasoconstrict, ↑contractility
alpha-2 (alpha 2nd in line constricts)
vasoconstrict
beta-1 (better one increase my heart, Renin)
↑ contractility, HR, conduction, renin secretion
beta-2 (Bettoo is wide)
vasodilation
dopamine - dilates or constricts? (happy when you’re open)
vasodilation
Baroreceptors in carotid
Baroreceptors
Stimulated by ↑ BP or ↓ BP
Vascular endothelium
Vasoactive substances (prosty with nitrous vasoactivates)
Nitric oxide
Prostacyclin
Endothelian (ET-1, ET-2, ET-3)
Elevated Blood Pressure (Pre-hypertension) (121 minutes elevated me)
Systolic BP 121-129
Stage 1 HTN
Systolic BP 130-139 mmHg or Diastolic BP 80-89 mmHg
Can be treated with lifestyle modifications and if needed, a thiazide diuretic
Stage 2 HTN (so close)
Systolic BP >140 mmHg or Diastolic BP >90 mmHg
Having or being at risk developing cardiovascular disease
( < 10% in next 10 years) also determines course of interventions
hypertension crisis - and what is diastolic? (the crisis is 180 degrees)
systolic above 180, or diastolic above 120
hypertension crisis - target organs, or organs most at risk (just 3)
heart, eyes, kidneys
Primary (essential or idiopathic) hypertension
Elevated BP without an identified cause
90% to 95% of all cases
Secondary hypertension
Elevated BP with a specific cause
5% to 10% of adult cases
Primary (essential or idiopathic) hypertension
Contributing factors
↑ SNS activity
↑ Sodium-retaining hormones and vasoconstrictors
Diabetes mellitus
> Ideal body weight
↑ Sodium intake
Excessive alcohol intake
can be genetic and how that interacts with environment.
Secondary hypertension - causes - (The second I hint at the narrowing pass, my kidneys, brain, thyroid and liver can’t sleep)
Coarctation (narrowing) of aorta
Renal disease (number 1 cause aside from obesity and alcohol)
Endocrine disorders
Neurologic disorders
Cirrhosis
Sleep apnea
thyroid, oral contraceptives
Isolated Systolic HTN (ISH) (isolated at age 55)
SBP > mmHg, DBP < 90 mmHg
Diostolic BP rises until age 55 then declines
Pseudo hypertension
Cuff measurement overestimates the true intraarterial blood pressure
Clue can be a + Osler’s Sign
Patient has a palpable although pulseless radial artery while the BP cuff is inflated above the systolic pressure
Modifiable risk factors - what about diabetes?
Cigarette smoking, obesity, stress, excessive alcohol consumption, increased dietary salt intake, diabetes mellitus, medications (NSAIDS, oral contraceptives, antidepressants and nasal decongestants)
Non-modifiable risk factors - what about arteriosclerosis?
Hereditary predisposition, advancing age, African-American race, arteriosclerosis, renal disease and pregnancy.
Socioeconomic status
COVID-19
Essential workers
Closer living conditions
Use of public transportation
Healthcare disparities
Environment
Food deserts
ETOH
Access to care
Pollution
Racism & Discrimination
Causes increased and chronic stress
Causes “weathering”
Increase in stress response
Decrease of lifespan
Shortening of telomers
A new study in JAMA Cardiology (Hongwell, J., Kim, A. Ebinger, J. et al. 2020) found that sex differences in
blood pressure trajectories begin early and persist with aging.
Women are more likely than men to develop (women in CDM are not HF)
coronary microvascular dysfunction (CMD) and heart failure with preserved EF especially in the setting of HTN
Women when compared to men exhibited a steeper increase in
BP, including MAP, measures that began as early as in their 30’s and continued throughout their life.
Limit sodium intake - and what about high risk groups?
<2300 mg/day
< 1500 mg/day for high-risk groups, diabetes, kidney disease, age 50+, HTN
effects of aging on BP
↑ arteriosclerosis/
atherosclerosis
↓ elasticity
↑ collagen
↑ peripheral vascular resistance (PVR)
↓ adrenergic receptor sensitivity
↓baroreceptor reflexes
↓renal function (after age 40)
↓ metabolism
HTN Referred to as the
“silent killer” because patients are frequently asymptomatic until target organ disease occurs
Symptoms are often secondary to (target first, symptoms last)
to target organ disease and can include
Fatigue, reduced activity tolerance
Dizziness
Palpitations, angina
Dyspnea
how to assess HTN? (just exam and labs)
Medical history
Physical examination
Routine labs
Fundoscopic exam for (the eye is fund)
retinal changes
BMI calculation to
identify risk factor
Auscultation for (auscultation for CAF is brutal)
carotid, abdominal and femoral bruits
Palpation of
thyroid gland
Through exam of
heart and lungs
Abdominal exam for enlarged kidneys, masses and aortic pulsation
Palpation of lower extremities for
edema and pulses
Neurological assessment
routine labs (HTN gets EVERY lab)
kidneys, urinalysis, BUN creatinine, sodium, K, Ca, TSH, glucose, cholesterol, LDL, HDL, hematocrit, ECG, CXR, liver function tests, might have left ventricular hypertrophy.
assessment for HTN
Assess/ monitor for symptoms of hypertension
( headaches, dizziness and visual changes)
Intake and output, daily weights, and renal studies to assess for fluid volume excess, also central venous pressure, etc.
Drug therapy adherence
Antihypertensive drug therapy effects
( orthostatic hypotension, sexual dysfunction, etc.)
hypertensive crisis
BP > 220/140
Causes acute target organ damage
management of hypertensive crisis
Treatment based on symptoms
Antihypertensive IV drug therapy
Titrate drug
Do not lower BP > 25% per hour
Frequent neurological assessments
Monitor cardiac, pulmonary, renal function
Identify cause
If patient does not have any target organ damage manage with oral antihypertensives after crisis
Educate
impacts and complications
Target organ diseases occur most frequently in the
Heart
Brain
Peripheral vasculature - PVD
Kidney -nephrosclerosis
Eyes
complications of HTN
Hypertensive heart disease
Coronary artery disease
Left ventricular hypertrophy
Heart failure
Cerebrovascular disease
Stroke
Peripheral vascular disease
Nephrosclerosis
Retinal damaged
diagnostic studies - 12 lead for what? (Hint 12 monkeys)
12- lead ECG- used to determine presence of ventricular hypertrophy/remodeling related to hypertension
Ophthalmic exam
Echocardiogram
drugs classes that treat HTN
Diuretics
Adrenergic inhibitors (Adriene blocks adrenaline)
Direct vasodilators
Angiotensin-converting enzyme inhibitors
Angiotensin II receptor blockers
Calcium channel blockers
drug side effects - use caution with who? (A hint that COPD is not compatible)
Orthostatic hypotension
Pre/Syncope
Sexual dysfunction
Dry mouth
Frequent urination
Dry cough
use these meds with caution with ppl who have COPD
nursing management
Achieve and maintain the individually determined goal BP.
Understand, accept, and implement the therapeutic plan.
Experience minimal or no unpleasant side effects of therapy.
Be confident of ability to manage and cope with this condition.
alpha
constrict
beta
dilate
dopamine
dilate
Papilledema - associated with hypertension
eyes
teaching plan to minimize orthostatic hypotension, (NOT chair, think of Alex)
Flex your calf muscles, avoid alcohol, and change positions slowly
hypertensive crisis - symptoms (my headache is a crisis)
sudden ↑ BP, headache, N, V, seizures, confusion, coma
hypertensive crisis can cause (MI brain bleeds into my liver and kidneys dissecting them)
encephalopathy, intracranial bleeding, subarachnoid bleeding, MI, acute liver failure, renal failure (AKI), dissecting aortic aneurysm, retinopathy
frequent episodes of ventricular fibrillation - treatment?
internal cardioverter defibrillator insertion
Digitalis and diuretics are withheld for how long before cardioversion?
24 to 72 hours before cardioversion
Which nursing intervention is required to prepare a client with cardiac dysrhythmia for an elective electrical cardioversion
Instruct the client to restrict food and oral intake
3rd level heart block - do what?
just alert provider, not an emergency
asystole caused by “Hs and Ts”
“Hs and Ts”: hypoxia, hypovolemia, hydrogen ion (acid/base imbalance), hypo- or hyperglycemia, hypo- or hyperkalemia, hyperthermia, trauma, toxins, tamponade (cardiac), tension pneumothorax, or thrombus (coronary or pulmonary).
+1 pulse
Difficult to palpate and is obliterated with pressure.
does the heart size increase or decrease with age?
increases due to hypertrophy
heart murmurs are common in
older adults
Women typically develop CAD (Women only benefit when Caddy)
10 years later than men bc of estrogen
6 Ps are arteries or veins?
arteries
S4 is common in
older adults with hypertension
normal BUN values (honey buns at 8 am)
8 - 20
creatinine levels (halloween creature - buf)
male - .6 - 1.2
female - .4 - 1
pharacologic stress test avoid what? (I’m feelin stressed)
avoid xanthine derivatives including theophylline, aminophylline, and caffeine
catherization - how long to fast before?
8 - 12 hrs.
1 cause of hypertension after smoking and obesity?
renal disease
1 and 2 (beta and alpha)
1 = antagonist
2 = agonist
