Hypertension

Question 0

What is the most sensitive organ to any change in perfusion

Answer 0

Brain

Question 1

What are 3 elements that need to stay the same in the brain

Answer 1

Oxygen
Blood pressure
Glucose

Question 2

3 essential organs

Answer 2

Heart
Kidneys
Blood/brain

Question 3

What are some signs something is wrong with perfusion

Answer 3

Pale, cyanotic, confusion, sweating, sob, dizzy, blurred vision

Question 4

What is a blood glucose reading when a person starts to feel bad

Answer 4

60-70

The brain is responding to low blood glucose

Question 5

1st sign or symptom of any change in cardiac output is r/t

Answer 5

Brain or LOC

Question 6

Areas to put stethoscope

Answer 6

APTM

Question 7

What is PMI? Where can you hear it?

Answer 7

Point of maximal impulse
It is a place to put your stethoscope
5th ICS MCL Left Side

Question 8

What % or oxygen does room air give you

Answer 8

21%

Question 9

When do the coronary arteries fill

Answer 9

During diastole

Question 10

What percent of oxygen is 2L nasal cannula

Answer 10

24%

Question 11

What is the normal shape of the heart

Answer 11

Football shaped

Question 12

Why do we care about shape of the heart

Answer 12

Because if it enlarges we will have pumping problems

Question 13

What return blood back to right side of heart

Answer 13

Vena cava

Question 14

What are three things that make a heart beat happen

Answer 14

Calcium, sodium, potassium

Need to be in adequate supply

Question 15

Is the mitral valve on the side with high or low pressure?

Answer 15

HIGH pressure

Has to have more strength because left side is a higher pressure system

Question 16

What is mechanical function of the heart measured by

Answer 16

Blood pressure, O2 sat, pulse, LOC, oriented

Question 17

Systole+diastole= _________ function

Answer 17

Mechanical

Question 18

Depolarization and repolarization = _________ function

Answer 18

Electrical

Question 19

When does depolarization happen

Answer 19

Just before systole

Question 20

Electrical firing impulse. Wave of electrical impulse that will trigger contraction

Answer 20

Depolarization

Question 21

Electrical recharging. The myocardial cells recharge and rest after a contraction.. And get ready for the next one

Answer 21

Repolarization

Question 22

What is the heart rate regulated by

Answer 22

ANS

autonomic nervous system

Question 23

What is stroke volume affected by

Answer 23

Preload
Afterload
Contractility

Question 24

What does Frank Starling's Law say

Answer 24

The more the myocardial fibers are stretched, the greater the force of contraction...to a point

Question 25

What comes first electrical or mechanical activity

Answer 25

Electrical activity (depolarization) precedes mechanical activity (systole) Chemical --> electrical --> mechanical conduction of the heart

Question 26

CO= ____ x ______

Answer 26

CO= SV x HR

Question 27

Exchange nutrients and metabolic waste

Answer 27

Capillaries

Question 28

ANS= _____ and ______ | What happens in the two components

Answer 28

ANS= parasympathetic and sympathetic Parasympathetic- dilates arteries Sympathetic- increase HR, vasoconstriction, mostly related to afterload

Question 29

What is the most potent vasoconstrictor in body

Answer 29

Aldosterone | -trying to conserve volume

Question 30

What triggers a response when there is hypovolemia

Answer 30

Kidneys

Question 31

What controls BP min to min and sec to sec

Answer 31

Baroreceptors and chemoreceptors

Question 32

What are baroreceptors sensitive to?

Answer 32

Stretch or pressure

Question 33

What so chemoreceptors respond to

Answer 33

Decreased O2 Increased CO2 Decreased pH Electrolyte content

Question 34

Pulse pressure= | What increases/decreases?

Answer 34

Pulse Pressure= SBP-DBP Increase- exercise,atherosclerosis Decreased- hypovolemia, heart failure

Question 35

Heart failure is also known as

Answer 35

Pump failure

Question 36

The perfusion pressure to bring blood and oxygen to organs in the body

Answer 36

Mean Arterial Pressure

Question 37

If the Mean Arterial Pressure is ... Too high = Too low=

Answer 37

Too high= increased pressure | Too low= underperfused and ischemia

Question 38

What is the pressure exerted on the walls of arteries

Answer 38

Arterial BP

Question 39

Stage 2 hypertension criteria

Answer 39

SBP > 160 | DBP > 100

Question 40

How is arterial pressure elevated

Answer 40

By rise in CO or SVR

Question 41

What is the most common cause of HTN

Answer 41

Primary HTN | Elevated BP without an identifiable cause

Question 42

Work horse muscle of the heart

Answer 42

Left ventricle

Question 43

What do Angiotension II and Aldosterone do in Renin-Angiotension -aldosterone system

Answer 43

Angiotension II- potent vasoconstrictor | Aldosterone- sodium retention

Question 44

Complications of HTN

Answer 44

Major risk factor for CAD Left Ventricular Hypertrophy Heart Failure

Question 45

Symptoms of HTN? When do you see them?

Answer 45

- Rarely symptoms seen until late | - Later symptoms: headache upon awakening, dizziness, visual changes, epitaxis (nose bleeds)

Question 46

What is laminar blood flow

Answer 46

Normal blood flow, forward flow through health silky arteries

Question 47

What is turbulent blood flow

Answer 47

Intermittent blood flow, clots can develop

Question 48

BUN and Creatinine

Answer 48

Kidney function and perfusion | BUN can look at volume how hydrated someone is

Question 49

Cholesterol, serum lipids (HDL, LDL)

Answer 49

Lab test for atherosclerosis

Question 50

What can cause high triglyceride levels

Answer 50

Alcohol and simple sugars

Question 51

What can a chest x ray show

Answer 51

Oxygenation and size of heart

Question 52

What do you use a EKG for

Answer 52

Electrical conduction of the heart

Question 53

What is a Echocardiogram

Answer 53

Ultrasound to look at chamber and function of the heart

Question 54

What is the first thing you can do for HTN management

Answer 54

Lifestyle modifications (diet, exercise)

Question 55

When will you start symptoms with high blood pressure

Answer 55

Stage 2 hypertension SBP > 160 DBP > 100 First symptom could be a headache

Question 56

Normal circulating blood volume is where?

Answer 56

Intravascular

Question 57

What space may you see circulating blood volume if a person has fluid? Where should it be?

Answer 57

You may see it in interstitial spaces instead of normal intravascular

Question 58

What can high BP over a long period of time cause

Answer 58

Retinal damage

Question 59

What is hallmark of Primary HTN

Answer 59

Persistent increased SVR

Question 60

What is it called when you can actually feel turbulent of blood flow

Answer 60

Thrill

Question 61

What do diuretics deal with

Answer 61

Preload They help get rid of circulating volume Act on kidneys

Question 62

Examples of loop diuretics

Answer 62

Lasix | Bumex

Question 63

Are thiazides or loop diuretics more potent

Answer 63

Loop diuretics

Question 64

What do loop diuretics do

Answer 64

Prevent reabsorption of Na & Cl | Potassium depleting

Question 65

Examples of thiazides

Answer 65

Diuril and Zaroxolyn

Question 66

What must you have to use thiazides

Answer 66

Must have good kidney function

Question 67

With a decrease BP or cardiac output what neurological symptoms would you see? What would be effected?

Answer 67

Brain is effected Dizziness, light headedness, change in LOC, diaphoresis, pale The brain has to have constant supply because it stores nothing

Question 68

What is an example of a K+ sparing diuretic

Answer 68

Aldactone

Question 69

What are some characteristics of Aldactone

Answer 69

Act on collecting duct Weak diuretic Does NOT deplete potassium Long term maintenance only

Question 70

Who is somebody you would use a K+ sparing diuretic on

Answer 70

Cardiac pts or renal failure | They already have something major going on. Trying to control electrolytes

Question 71

What do ARBs deal with?

Answer 71

Afterload

Question 72

What is the most potent vasoconstrictor in the body

Answer 72

Angiotension II

Question 73

Suffix for ARBs

Answer 73

saratan

Question 74

Who is somebody you would give ACE inhibitor to?

Answer 74

Diabetics to protect their kidney | Even when BP is normal they are given in a protective way

Question 75

Suffix for Ace inhibitor

Answer 75

pril

Question 76

Side effects of ACE inhibitor

Answer 76

Dry cough, K+ retention

Question 77

What do beta blockers deal with

Answer 77

Afterload They block effects of increased workload on the heart

Question 78

What may sudden withdraw of beta blockers cause

Answer 78

Rebound HTN

Question 79

What do calcium channel blockers deal with

Answer 79

Afterload | They cause vasodilation by decreasing entry of Ca and relaxing smooth muscle cells that surround the arteries

Question 80

Common side effect of calcium channel blockers

Answer 80

Constipation

Question 81

How long does it take to see a drop in BP after taking a oral dose of a calcium channel blocker

Answer 81

30 min

Question 82

What could hypertensive crisis lead to

Answer 82

Massive heart attack or stroke from high pressure

Question 83

What is a lab test that you could see increased with a dehydrated patient

Answer 83

BUN

Question 84

Normal BUN

Answer 84

10-20

Question 85

Normal Creatinine

Answer 85

Less than 2

Question 86

Normal Serum potassium

Answer 86

3.5-5.5

Question 87

What are symptoms of hypertensive crisis related to

Answer 87

Perfusion

Question 88

BP to be classified as a hypertensive crisis

Answer 88

SBP > 250 | DBP > 140

Question 89

Characteristics of hypertensive crisis

Answer 89

``` Severe headache or dizziness Confusion/seizure/coma Blurred vision Nausea or vomiting Chest pain / sob Epitaxis ```

Question 90

What are foods high in potassium

Answer 90

Bananas and dark green leafy vegetables

Question 91

Drug of choice for hypertensive crisis? How do you give it?

Answer 91

Nipride | Given slowly because you want to slowly reduce the high pressure. The brain cannot handle huge changes in pressure

Question 92

What are two important things to remember about treating a patient in a hypertensive crisis

Answer 92

Give everything through an IV and get oxygen on immediately | Also, have crash cart ready