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ADULT Health > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is blood pressure?

A

The force of blood against the arterial walls

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2
Q

What is Systolic pressure? Normal Values???

A

The pressure during the contractile phase (when the heart contracts).
Normal values: Less than 120 mmHg

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3
Q

What is Diastolic pressure? Normal Values??

A

The pressure when the heart relaxes.
Normal values: Less than 80 mmHg

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4
Q

What is the normal values for Mean Arterial Pressure? What is the threshold????***

A

Normal values: 70-100 mmHg
Threshold: 90 mmHg!!!

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5
Q

What is the formula for how blood pressure is maintained??

A
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6
Q

What is Cardiac output (C.O.)? and How much is it normally?

A

The total volume ejected from the heart in Liters/min.
3.5-8 L/min!!!

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7
Q

What are included in Cardiac output?

A

Stroke Volume x Heart Rate

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8
Q

What are included in Stroke Volume?

A
  1. Preload
  2. Afterload
  3. Contractility
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9
Q

How much is normally in Stroke volume?

A

70-100 ml

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10
Q

What’s heart rate normal values?

A

60-100 BPM

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11
Q

What are preload, afterload, and contractility?

A
  1. Preload –> How much VOLUME is returning to the heart.
  2. Afterload –> The pressure the ventricles must work AGAINST to open the semilunar valves to pump the blood out of the heart
  3. Contractility –> The STRENGTH of cardiac cells to contract/shorten!
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12
Q

What is Stroke Volume?

A

How much is ejected with every single beat of the heart!!
Which is 70-100 L/min!!

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13
Q

What is the Starling Mechanism??

A

OPTIMAL** volume/ stretch of the heart will cause a good forceful of contraction in return. Not too much or too little volume, but just enough!!

IF I’m hypervolemic, have congestive heart failure, or renal failure, and I’m overloaded with volume and preload is TOO HIGH, my heart stretches too much (too much volume) and I don’t get a good forceful contraction in return.

IF vessels that are too tight and constricted would increase SVR and be very hard for heart to pump against. OR if it’s too dilated and floppy

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14
Q

According to the Starling Mechanism, what happens if there’s too much or too little volume?

A

IF I’m hypervolemic, have congestive heart failure, or renal failure, and I’m overloaded with volume and preload is TOO HIGH, my heart stretches too much (too much volume) and I don’t get a good forceful contraction in return.

IF vessels that are too tight and constricted would increase SVR and be very hard for heart to pump against. OR if it’s too dilated and floppy.

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15
Q

What is the MOST POWERFUL vasoconstrictor????

A

ANGIOTENSIN II

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16
Q

What is calcium for?

A

Major contributions to STRENGTHEN CONTRACTION!!!

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17
Q

What would happen if a pt. took too much of their prescribed calcium channel blocker?

A

Contraction strength decreases MAJORLY

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18
Q

What does aldosterone do?

A

Reabsorb or Hold on to Sodium and Water!!

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19
Q

What 2 systems work together when Blood Pressure is LOW??

A

RAAS and Sympathetic Nervous System

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20
Q

What does AGANISM means??
What does INHIBITION means?

A
  1. Stimulation
  2. Blocking
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21
Q

Calcium is a MAIN CONTRIBUTOR of what??

A

Contractility/contraction strength!!!!!

22
Q

Is there an exception where we block Beta 2? (When do we use Beta2 Blocker?)

A

NEVER!!!! WE SHOULD NEVER BLOCK BETA 2 because we don’t want to block the airway/constrict the bronchioles bc then we won’t be able to breathe!!!!!

23
Q

What’s a normal C.O.? Stroke Volume? Heart Rate??

A

C.O. = 3.5-8 L/min
SV = 65-100 L/min
HR = 60-100BPM

24
Q

What are Contractility affected MOSTLY by???
What other things are affected by it??

A

CALCIUM!!!!!!
Also Thyroid hormone, oxygen, and sympathetic hormones!

25
Q

What are the 4 Systems that regulate the BP????

A
  1. Arterial BARORECEPTOR system:
    1) Pressure sensors: Carotid sinuses, Aorta, & LEFT VENTRICLE
    2) Vagal stimulation (PSNS) stimulated when BP is HIGH
    3) SNS help (Alpha and Beta receptors) when BP is LOW
  2. RAAS when BP is low:
    1) Sodium and water retention
    2) Vasoconstriction
  3. Vascular auto-regulation:
    1) Blood vessels produce things that help to SELF-REGULATE like NITRIC OXIDE (vasodilates) and ENDOPHYTUS (vasoconstricts)!!!
  4. Natriuretic peptides OR “sodium diuretics”; RESPONDS TO INCREASED volume changes!!
    1) ANP, BNP, CNP
    - ANP (atrium)
    - BNP (Brain)
    - CNP (Blood vessels)
    2) When BP is high, they promote diuresis & fluid excretion basically a sodium diuretic!!
26
Q

When is RAAS stimulated????

A

when BP is LOWW!!!!

27
Q

What is the 2 main end results of Angiotensin II????***

A

Vasoconstricting and Holding on to fluid (sodium and water retention)!!

28
Q

What is the vascular auto regulation system AND what’s included in the system??

A

Blood vessels producing things to self-regulate:

  1. Nitric acid –> Vasodilator!
  2. Endophytus –> Vasoconstrictor!
29
Q

How does the RAAS system work??

A
  1. Kidneys sense the LOW BP and release Renin
  2. Renin converts Angiotensionogen (in the liver) to Angiotensin I
  3. ACE (in the lungs and kidneys) will convert Angiotensin I to II
  4. Angiotensin II EXPLODES:
    1) Increase SNS
    2) Produce ALDOSTERONE (to retain sodium and water)
    3) Produce ADH/Anti-diuretics to hold on to fluid in the body
    4) VASOCONSTRICTS
30
Q

What are the most common conditions of hypertension that it can LEAD to??

A
  1. ATHEROSclerotic Cardiovascular disease
  2. Heart failure
  3. Stroke
  4. Renal failure
  5. ..and DEATH!!!! That’s why it’s also known as “Silent Killer”
31
Q

What are the treatment goals for hypertension in ppl over 60 yrs of age and ppl less than 60 yrs of age??***

A
  1. Over 60 years of age, Keep BP LESS than 150/90
  2. Less than 60 yrs of age, keep BP LESS than 140/90
    (remember its cz the threshold is 90)
32
Q

What are the 2 types of hypertension????
What are the risk factors for the first type of hypertension????

A
  1. Primary (essential) –> NO KNOWN CAUSE (MOST COMMON***)
    - No known cause, but MANY associated Risk factors:
    1) Cigarrete smoking
    2) Obesity
    3) Physical inactivity
    4) DYSlipidemia
    5) Diabetes Mellitus
    6) MicroALBUMINuria or GFR less than 60 ml/min
    7) Age (men older than 55, women older than 65)
    8) Family history of premature CV disease
    ALSO…..
    1) African American
    2) SALT sensitivity
    3) Renin Elevation
    4) Insulin resistance
    5) Vit. D deficiency
  2. Secondary –> Due to underlying disorder than increases susceptibility to hypertension; they are Treatable Causes:
    1) RENAL DISEASE (Most Common**)
    2) PHEOchromaCYTOMA
    3) Cushing Syndrome and Hyperthyroidism
    4) Renal artery stenosis
    5) PREGNANCY
    6) Coarctation of the aorta
    7) Certain Drugs: NSAIDS, Corticosteroids, Oral contraceptives
    8) OBSTRUCTIVE SLEEP APNEA (OSA) - the airway obstruction activate the SNS and increases BP
33
Q

Being what kind of race can Cause Primary/essential Hypertension???

A

African American!!!!

34
Q

What are the underlying disorder than increases the risk to hypertension of SECONDARY HYPERTENSION??

A

Secondary hypertension/TREATABLE CAUSES. Some risk factors:
1) RENAL DISEASE (Most Common**)
2) PHEOchromaCYTOMA
3) Cushing Syndrome and Hyperthyroidism
4) Renal artery stenosis
5) PREGNANCY
6) Coarctation of the aorta
7) Certain Drugs: NSAIDS, Corticosteroids, Oral contraceptives
8) OBSTRUCTIVE SLEEP APNEA (OSA) - the airway obstruction activate the SNS and increases BP

35
Q

What kind of sleep disorder is identified as a risk factor for Secondary Hypertension????

A

Obstructive Sleep Apnea (OSA)

36
Q

Which type of hypertension is known to have Treatable CAUSES??????***

A

SECONDARY!!!!!

37
Q

What is the most common secondary hypertension risk factor????

A

RENAL DISEASE!!

38
Q
A
39
Q

What are the 3 ways to evaluate patients with hypertension??

A
  1. History
  2. Assessment
  3. Evaluate for target organ damage
40
Q

What are the Patient’s History u need to evaluate with Hypertension??

A
  1. Identify treatable causes (secondary conditions)
  2. Identify risk factors
  3. Examine med list
41
Q

What are the Patient’s Assessment u need to evaluate with Hypertension??

A
  1. MOST often ASYMPTOMATIC!!!**
  2. May have headache, dizziness, fainting, flushing, nose bleeds, dependent edema (in the lower leg)
  3. ***BP EVALUATION (two or more properly measured readings on two or more office visits ORRRR two consecutive readings during a single visit with extreme elevations)!
    1) Readings from BOTH arms
    2) Two readings per visit
    3) Consider timing: did they just arrive? did they rush to get there? REST FOR 3-5 Mins BEFORE MEASURING
    4) Arm hear level, Legs uncrossed
    5) RIGHT SIZE CUFF!!!!
42
Q

What are the 3 target organ damage of hypertension and how to evaluate them?

A
  1. Cardio, cerebral and peripheral vascular
    1) Left ventricle hypertrophy
    2) Cardiomyopathy
    3) Heart failure
    4) Peripheral vascular disease
    • Intermittent claudication
      5) Cerebral aneurysm
      6) Ischemic or hemorrhagic stroke: vision & speech changes, unilateral motor alterations, headache
      CHECH FOR:
      1) Dyspnea
      2) Edema
      3) Chest Pain
      4) EKG changes
  2. KIDNEYS
    1) Lab changes: elevated BUN & Creatinine, Decreased GFR, 24 hr Creatinine clearance
    2) Manifestations: fatigue, fluid retention & associated signs, mental status alterations

3) EYES
1) Hypertensive Retinopathy: damage to the vessels, increased pressure on the optic nerve, damage to the retina
2) Manifestations: Reduced vision, double vision, headaches

43
Q

What is an Alpha 1 AGONIST* drug called???

A

NEO-synephrine!!

44
Q

Beta 2 receptor** is to do what??

A
  1. Arteriolar dilation of heart, lungs, & skeletal muscle
  2. Dilation of the lungs
  3. In the liver, hepatic glycogenolysis happen
45
Q

What is a BETA 2 AGONIST** DRUG????

A

ALBUTEROL (Asthma)!!! bc this branchodilates (the lungs in ppl of asthma) !!!!!!!!

46
Q

Is there clinical indication for blocking beta 2 receptor???

A

NEVER!! U NEVER WANT TO CONSTRICT UR bronchioles!

47
Q

What is Agonizing means???>?? PLEASE KNOWWWW

A

STIMULATING!!!

48
Q

What are included in the Hypertensive Crisis?? What does it mean??

A

Hypertensive Urgency and Hypertensive emergency!! BP goes up, won’t come down! The patient will generally be admitted to the intensive care unit until stabilized and BP under control with P.O. meds

49
Q

What is Hypertensive urgency??? What is Hypertensive emergency??

A
  1. Diastolic greater than 120
  2. No obvious target organ damage

Hypertensive emergency:
1. Elevated BP
2. Evidence of target organ damage

50
Q

What acute complications can occur when the BP is sustained at dangerously high levels?

A
  1. Cardiovascular: myocardial infarction
  2. Neurologic: Stroke & cerebral edema
  3. Renal: acute failure
51
Q

What are the assessments of Acute complications of Hypertension??

A
  1. Headache, dizziness
  2. Blurred vision
  3. Disorientation
  4. Neuro assessment & changes
  5. 12 lead EKG & continuous monitoring. Alert for signs of heart attack: chest pain w/ radiation, SOB, Pain up into the jaw & radiating down the left arm, diaphoreses)
  6. Labs: Renal function (BUN & Creatinine; Creatinine is more renal specific!!!), cardiac markers for coronary ischemia: Troponins, CPK-MB.
52
Q

What are the patient care for acute complication of hypertension???

A
  1. Semi Fowlers
  2. Administer oxygen PRN
  3. IV beta blockers
  4. IV Nitroprusside (Nipride), IV Nitroglycerin
  5. Frequent BP monitoring
  6. Observe for neurologic, cardiac & rena; complications!

ADULT Health (24 decks)

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