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303 Med Surg > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What artery and vein are the only ones that transport oxygen-poor and oxygen-rich blood?

A

Pulmonary artery and vein

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2
Q

What is the flow of blood through the heart?

A

Blood circulates from the left side of the heart into arteries, arterioles, capillaries, venules, and veins, and then back to the right side of the heart.

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3
Q

What is SVR?

A

Systemic vascular resistance. It is the force opposing the movement of blood within the blood vessels.

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4
Q

What is blood pressure?

A

Cardiac output (CO) x systemic vascular resistance (SVR)

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5
Q

What are short-term mechanisms that affect BP?

A

involves the SNS and vascular endothelium which are active within a few seconds

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6
Q

What are long-term mechanisms that affect BP?

A

Renal and hormonal processes that regulate arteriolar resistance and blood volume.
These mechanisms work in response to the body’s demands

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7
Q

Normal BP according to CDC

A

Less than 120/80

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8
Q

What is Primary Hypertension?

A

Elevated BP without a known or identifiable cause (90-95% of all cases)

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9
Q

What are the contributing factors of Primary HTN?

A
  1. Increased SNS activity
  2. Increased sodium-retaining hormones and vasoconstrictors
  3. Diabetes mellitus
  4. Greater than ideal body weight
    a. Patient’s BMI important concern
  5. Increased sodium intake
    a. Hard not to get enough salt
  6. Excessive alcohol intake
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10
Q

What are the risk factors of HTN?

A

i. Age
ii. Alcohol
iii. Cigarette smoking
iv. Diabetes mellitus
v. Elevated serum lipids
1. High cholesterol
vi. Excess dietary sodium
vii. Biological sex

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11
Q

What is Secondary HTN?

A

Elevated BP with specific cause usually r/t target organ disease.

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12
Q

What are the contributing factors of Secondary HTN?

A
  1. Cortication (stricture) of aorta
  2. Renal disease
  3. Endocrine disorders
  4. Neurologic disorders
  5. Cirrhosis
  6. Sleep apnea
  7. Family hx (If pt.’s BP is high, ask if anyone in their immediate family have HTN)
  8. Obesity
  9. Ethnicity
    a. African Americans
    b. Asian
    c. Hispanics
  10. Sedentary lifestyle
    a. Also contributes to atherosclerosis.
  11. Socioeconomic status
    a. Associated with malnutrition/lack of nutrition
  12. Stress (Excites the SNS)
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13
Q

What is the pathophysiology of HTN?

A

a. Water and sodium retention
- High sodium intake can activate a number of pressor mechanisms
- Causes kidneys to retain fluid
- Leading to high BP
b. Stress and increased SNS activity
- Increased vasoconstriction
- Elevated HR
- Increased renin release= altered renin-angiotensin mechanism
- Arterial constriction and vascular hypertrophy
c. Endothelial cell function
- Genetic and hereditary factors
- Insulin and hyperinsulinemia
- High insulin concentration stimulates SNS activity and impairs nitric oxide
ii. Vascular hypertrophy, elevated renal NA+ reabsorption = H2O retention

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14
Q

Clinical Manifestations of HTN

A

a. “silent killer” some people can show no symptoms
b. Symptoms often secondary to target organ disease
i. Fatigue
ii. Reduced activity tolerance
iii. Dizziness
iv. Palpitations and/or angina
v. Dyspnea

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15
Q

What are some complications of HTN?

A

a. Target organ diseases occur most frequently in the heart
i. Heart = CAD, LVH, HF
ii. Brain = cerebrovascular disease, increased risk of CVA
iii. Peripheral vasculature
iv. Kidney = CKD
v. Eyes = retinal damage

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16
Q

What are diagnostic studies for HTN?

A

a. Hx and physical examination
b. Bilateral BP measurement (Take on both arms, Use higher reading)
c. Office BP measurement (Pt. should be seated at rest for 5 minutes, Take at least two measurements)
d. UA, creatinine clearance
e. Serum electrolytes, glucose (Sodium, potassium, calcium, magnesium)
f. Serum lipid profile
g. EKG- gold standard for dxg the electrics of the heart
h. Echocardiogram

17
Q

Nursing Management of HTN

A

a. Control BP
b. Reduce CVD risk factors
c. Strategies for adherence to regimens
d. Lifestyle modifications
i. Weight reduction goals
- Weight loss of 10 kg may decrease SBP by 5 to 20 mm Hg
- Consider patient’s cultural beliefs and individual attitudes when formulating treatment goals
e. Patient teaching/education includes
- Nutrition therapy
- Drug therapy (Side effects and adverse effects of drugs may cause pt. to not adhere to medication regimen, Teach coping mechanisms to deal with effects, Teach the importance of how it minimizes effects)
iii. Lifestyle modification
iv. Home monitoring of BP

18
Q

What is orthostatic hypotension?

A

A decrease of 20 mm Hg or more in SBP and decrease of 10 or more in DBP and/or increase of 20 bpm in pulse from supine to standing
- Orthostatic changes in BP and pulse should be measure in older adults taking antihypertensive drugs and in pts. who report symptoms consistent with reduced BP upon standing
1. Light-headedness
2. Dizziness
3. Syncope

19
Q

What are some considerations for the older population and HTN?

A

i. Prevalence of HTN increases with age
ii. Lifetime risk of developing HTN is 90% for normotensive men and women over 55
iii. Wide gap between the first Korotkoff sound and subsequent beats
iv. Orthostatic hypotension often occurs because of impaired baroreceptor reflex mechanisms, volume depletion, and chronic disease states, such as decreased renal and hepatic fxn or electrolyte imbalance

20
Q

Subjective data for nursing assessment of HTN

A
  1. Past health hx
  2. Medications
  3. Functional heath patterns
21
Q

Objective data for nursing assessment of HTN

A
  1. Target organ damage
  2. Take BP
  3. Dizziness, mental confusion
  4. Voiding patterns
22
Q

What are some nursing diagnoses for HTN?

A

i. Ineffective health maintenance
ii. Anxiety
iii. Sexual dysfunction
iv. Ineffective self-health management
v. Disturbed body image
vi. Ineffective tissue perfusion- cap refill time greater than 3 seconds

23
Q

What is the effect of HTN on the heart and kidneys?

A
  • the kidneys contribute to BP regulation by controlling sodium excretion and extracellular fluid
  • sodium retention results in water retention, causing an increase in ECF volume –> increases venous return to the heart and SV.
24
Q

What are the effects of aging on the cardiovascular system?

A
  • Leading cause of death in adults older than 65
  • Most common problem = coronary artery disease (CAD) d/t atherosclerosis
  • Aging process, disease, environmental factors, lifetime health behaviors
  • Age related changes
    o Collagen in heart increases and elastin decreases
     Affect the heart’s ability to stretch and contract
    o Response to physical and emotional stress
     Increased stress = CO and SV decrease due to reduced contractility and HR response
25
Q

What is a hypertensive crisis?

A

Hypertensive urgency or emergency
- Occurs at SBP >180 mmHg and/or DBP >120 mm Hg
- BPs can often be >220/140 mm Hg
- Occurs more in pts. with hx of HTN and who have not followed medication regimens

26
Q

What is the difference between hypertensive urgency and emergency?

A

Urgency = no clinical evidence of target organ disease, more common
Emergency = evidence of target organ disease and requires hospitalization

27
Q

What does a rapidly increasing BP do to the blood vessels during a hypertensive crisis?

A

can cause shearing of the endothelial surface due to turbulent blood flow within the vessels leading to further vascular damage and the release of more vasoconstricting substances
- Vicious cycle of BP elevation follows
- life-threatening damage to target organs

28
Q

Clinical manifestations of Hypertensive crisis

A
  • Often presents as hypertensive encephalopathy
    o Syndrome in which sudden rise in BP is assoc. with a headache, nausea, vomiting, seizures, confusion, and coma.
  • Increased cerebral capillary permeability
     cerebral edema, disruption in cerebral fxn
  • On retinal exam, hemorrhages and or papilledema are found
29
Q

What are causes of Hypertensive Crisis?

A
  • Acute aortic dissection
  • Exacerbation of chronic HTN
  • Head injury
  • Monoamine oxidase inhibitors are taken with tyramine-containing foods
  • Pheochromocytoma
  • Preeclampsia, eclampsia
  • Rebound hypertension (from abrupt withdrawal of some antihypertensive drugs, such as clonidine or β-blockers)
  • Recreational drug use (cocaine, amphetamines)
  • Renovascular hypertension
  • Renal insufficiency can occur (lack blood flow to kidneys d/t heart damage)
30
Q

What occurs in the Renin-Angiotensin-Aldosterone-System in relation to HTN and the kidneys?

A

Kidney secretes renin when stimulated by SNS, there is decrease in blood flow to the kidneys or decreased serum sodium concentration
Renin converts angiotensinogen to angiotensin I.
Angiotensin Converting Enzyme (ACE) converts A-I → A-II
A-II increases BP
Immediately: vasoconstrictor that increases SVR
Over a period of hours/days A-II increases BP indirectly by stimulating the adrenal cortex to secrete aldosterone

303 Med Surg (5 decks)

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