HYPERTENSION Flashcards
A systolic blood pressure (SBP) of 140 mm Hg or higher or a diastolic blood pressure (DBP) of 90 mm Hg or higher, based on the average of two or more accurate blood pressure measurements taken 1 to 4 weeks apart by health care provider.
Hypertension
Normal Blood Pressure
120/80
Systolic and Diastolic BP of Prehypertension
Systolic: 120-139
Diastolic: 80-89
Systolic and Diastolic of Stage 1 Hyperstension
Systolic: 140-159
Diastolic: 90-99
Systolic and Diastolic of Stage 2 Hypertension
Systolic: ≥160
Diastolic: ≥100
Primary Hypertension
-Essential HTN (Hypertension)
-High blood pressure from an unidentified cause
-95% of cases
Occurs when a cause for a high blood pressure can be identified
Secondary Hypertension
Major Risk Factors of Hypertension
-Advancing adult age
-African American
-Drinking too much alcohol (i.e.. more than two drinks per day for men and more than one drink per day for women)
-Family History
-Gender-Related
- Men have greater risks until
45 and 64 years of age
-Women have greater risks at
65 years of age and later
- Overweight obesity
-Poor diet habits, particularly if it includes too much salt.
Clinical Manifestations of Hypertension
-Generally Asymptomatic
-SBP ≥ 140mmHg or DBP ≥ 90
mmHg
Common Symptoms of Hypertension
-Nose Bleeds
-Headaches
-Chest Pain
-Blood in urine
-Shortness of breath
-Vomiting or nausea
-Palpitations
-Dizzines
-Blurry Vision
Complications of Hypertension
-Coronary Artery Disease
-Chronic Renal Failure
-Congestive Heart Failure
-Cardiac Arrest
-Cerebrovascular Accident
Medical Management of Hypertension
-Weight Reduction
- Dietary Management (Utilize Dash)
-Moderation of alcohol consumption
-Avoidance of tobacco products
-Stress management
-Drug therapy (treatment and control)
T/F A weight loss of 22 lbs (10 kg) may decrease SBP by approximately 5 to 20 mmHg.
True
Drugs that decrease the volume of circulating blood
Diuretics
Drugs that reduce systemic vascular resistance
-Adrenergic Blockers
-Angiotensin inhibitors
-Calcium-channel blockers
-Direct vasodilators
A diuretics that inhibits Na+ reabsorption at distal convoluted tubule
Thiazide Diuretics
Thiazide Diuretics Drugs
-Chlorothiazide (Diuril)
-Hydrochlorothiazide (Hydrodiuril)
Inhibits Na+ reabsorption at ascending limb of Loop of Henle
Loop Diuretics
Loop Diuretics Drugs
Furosemide (Lasix)
Side Effects of Thiazide Diuretics
-Orthostatic hypotension
-Mild Hypokalemia
Side Effects of Loop Diuretics
-Orthostatic hypotension
-mild hypokalemia
Inhibits Na+-retaining and K+- wasting effects of aldosterone at the tubules
Potassium-sparing Diuretics
Side Effects of Potassium-sparing Diuretics
-Orthostatic hypotension
-Hypotension
-Hyperkalemia
Adrenergic Receptors
-Alpha 1 (a1)
-Alpha 2 (a2)
-Beta 1 (B1)
-Beta 2 (B2)
Alpha 1 (a1)
-Vasoconstriction
-Increased peripheral resistance
-Increased blood pressure
Alpha 2 (a2)
Inhibits release of NE
Beta 1 (B1)
-Increased HR
-Increased myocardial contractility
-Increased renin secretion
Beta 2 (B2)
-Vasodilation
-Decreased peripheral resistance
-Bronchodilation
What are the Alpha-Adrenergic Blockers?
-Centrally Acting
-a1-antagonist
Centrally-acting drugs
-Clonidine (Catapress)
-Methyldopa (Aldomet)
Reduces sympathetic outflow from CNS
Centrally-acting
Blocks a1 receptors resulting in peripheral vasodilation
a1-antagonist
Common symptoms of Alpha-Adrenergic Blockers
-Dry mouth
-Drowsiness
Common symptoms of Alpha-Adrenergic Blockers
-Dry mouth
-Drowsiness
What are the Beta-Adrenergic Blockers
-Cardioselective
-Non-selective
Block B1-adrenergic receptors: decreased CO and reduced sympathetic vasoconstrictor tone
Cardioselective
Cardioselective drugs
Atenolol
Esmolol (IV only)
Metoprolol
Non-selective drugs
Propanolol (Inderal)
Block B1 and B2- adrenergic receptors
Non-selective
Symptoms of Cardioselective
Bradycardia
Symptoms of Non-Selective
Bradycardia and Bronchoconstriction
What are the Angiostensin Inhibitors
-Ace Inhibitors (ends with “pril”)
-Angiosten II receptor Blockers (ends with “sartan”)
Ace inhibitors drugs
-Captopril (Capoten)
-Enalapril (Vasotec)
Inhibit ACE, reduce conversion of angiotensin I to angiotensin II
ACE Inhibitors
ACE inhibitors S/E
dry cough
Prevent action of Angiotensin-II and produce vasodilation and increased Na+ and water excretion
Angiotensin II receptor Blockers
Full effect on BP may not be seen for 3-6 weeks
Angiotensin II receptor Blockers
Angiotensin II receptor Blockers
-Losartan (Cozaar)
-Telmisartan (Micardis)
Cause vascular smooth muscle relaxation resulting in decreased SVR and arterial BP
Dihydropyridine
Drug of Choice of Dihydropyridine
-Amlodipine (Norvasc)
-Felodipine (Plendil)
-Nicardipine
-Nifedipine (Adalat)
Inhibit movement of Ca2+ across cell membrane, resulting in vasodilation
Non-Dihydropyridine
Drug of Choice of Non- Dihydropyridine
-Diltiazem
-Verapamil
What are the Calcium-Channel Blockers
-Dihydropyridine
-Non-Dihydropyridine
Direct Vasodilator drug
-Hydralazine (Apresoline)
Reduces SVR and BP direct arterial vasodilation
Hydralazine (Apresoline)
Nursing Management Goal for Hypertension
Goal: To lower and control blood pressure without adverse effects and undue costs
Nursing Management for Hypertension
-Patient Education
-Adherence to therapeutic regimen
-Follow-up care
Nursing Management: Patient Education
-Educate on disease process and how to control it.
-Teach patient how to self-monitor BP
-Encourage to consult a dietician for dietary management
-Instruct to limit alcohol intake and avid tobacco products
Nursing Management: Adherence
-Encourage participation in self-care activities
-Support patient in making small changes with each visit that moves them toward their goals.
-Check on progress of plans made during the previous visit
-Support groups
Is a clinical syndrome associated with abrupt, marked increased in BP that causes an acute or rapidly progressing end-organ damage
Hypertensive Crisis
Characterized by SBP >180 mm Hg or DBP > 120mmHg
Hypertensive Crisis
Normal BP follow-up recommended
Recheck in 2 years
Prehypertension BP follow-up recommended
Recheck in 1 year
Stage 1 Hypertension Follow-up Recommended
Confirm within 1 month
Stage 2 Hypertension Follow-up Recommendation
-Evaluate or refer to the source of care within 1 month
-For those with higher pressures (>180/100 mm Hg), evaluate and treat immediately or within 1 week, depending on clinical situation and complications
Types of Hypertensive Crisis
-Hypertensive Emergency
-Hypertensive Urgency
-
Severe BP elevation + actual or developing organ damage
Hypertensive Emergency
Severe BP elevation without evidence of impending or progressive end-organ damage
Hypertensive Urgency
Risk Factors of Hypertensive Crisis
-Poorly controlled hypertension
-Undiagnosed hypertension
-Abrupt discontinuation of medications
Hypertensive Emergency Medical Management Goal
Goal: Gradual reduction of pressure
Drug of choice for Hypertensive Emergency Medical
Nicardipine (Cardene)
Hypertensive Emergency
IVF of Choice:
PNSS
Hypetensive Urgency Medical Management Goal:
Normalize BP within 24 to 48 hours
Drug of choice (PO) for hypertensive urgency
-Labetalol (Trandate)
-Captopril (Capoten)
-Clonidine (Catapress)
Hypertensive Crisis Nursing Management
-Supportive Care
-Use infusion pump when giving
antihypertensive via IV
-Monitor vital signs frequently, especially BP
