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NURS 205 > Hypertension and Smoking Cessation > Flashcards

Hypertension and Smoking Cessation Flashcards

1
Q

Which organs are involved in blood pressure regulation?

A
  • Heart (cardiac output)
  • Kidneys (water balance)
  • Brain (coordination of signaling & controls messengers like hormones)
  • Nerves (send messages in short distances & controls dilation)
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2
Q

What is BP = CO x SVR?

A

Blood pressure = Cardiac Output x Systemic Vascular Resistance

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3
Q

What does BP = CO x SVR tell us?

A

Causes of why BP might be high

Different meds will act on different components of it

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4
Q

What is Systemic Vascular Resistance?

A

The force opposing the movement of blood in your blood vessels

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5
Q

What is the CO made up of?

A

Cardiac output = heart rate x stroke volume

CO = HR x SV

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6
Q

How does the Sympathetic Nervous System affect HR?

A

It can increase contractility (how hard the heart will pump) which can then increase SV

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7
Q

What else effects the SV?

A

The renal fluid volume (how much fluid is there that can get pushed around). This has to do w/ renin angiotensin aldosterone system, natriuretic peptides & antidiuretic hormones

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8
Q

Why does the SNS have the biggest affect on HR?

A

Baroreceptors: can increase or decrease HR

Norepinephrine

  • α1: vasoconstriction, ↑ contractility
  • α2: inhibit NE release, vasoconstriction
  • β1: ↑ contractility, ↑HR, ↑ conduction, ↑ renin
  • β2: vasodilation, gluconeogenesis
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9
Q

What are baroreceptors?

A

They’re specialized nerve cells in the carotid sinus; if stimulated b/w BP is high, they’ll try to decrease your sympathetic activity which will lower HR & contractility & have vasodilation. This is a negative feedback loop.

Ex: low BP - SNS constricts arterials, increased HR & increased contractility

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10
Q

What is a downside to baroreceptors?

A

If you constantly have a high BP, your baroreceptors can eventually get used to it & lose the ability to regulate it

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11
Q

What is norepinephrine used for?

A

Used in critical care to increase BP if it’s dangerously low

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12
Q

Where does the Parasympathetic Nervous System have an effect on?

A

Has a big affect through Vegas nerve (CN10)

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13
Q

What is RAAS? What does it do?

A

It sense that there is a low BP or a decreased Na. It’s also affected by the Sympathetic Nervous System

This Juxtaglomerular apparatus releases renin

Renin then converts angiotensin → angiotensin I

Angiotensin I goes to lungs where angiotensin converting enzyme (ACE) → angiotensin II

  • Angiotensin II is a potent vasoconstrictor
  • Angiotensin II stimulates kidney to secrete aldosterone (retain sodium and water)

Increase in fluid = increase in SV

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14
Q

What substances affect the Systemic Vascular Resistance (SVR?

A

Affected by SNS (alpha & beta adrenergic receptors)

RAAS causes vasoconstriction via angiotensin II

Neurohormonal vasoconstrictors like angiotensin & norepinephrine

Local regulation

  • Working on blood vessels
  • Nitric oxides
  • Endothelin
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15
Q

What is the vascular endothelium?

A

Single layer of cells lining blood vessels

  • Nitric oxide (NO) – lowers arterial tone, inhibits smooth muscle growth
  • Endothelin (ET) – vasoconstrictor, promotes smooth muscle growth
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16
Q

What is hypertension?

A

Sustained elevation of systemic arterial BP

SBP equal to or greater than 140 mm Hg
Or DBP equal to or greater than 90 mm Hg

17
Q

What is the etiology of hypertension?

A

Primary hypertension

  • 90-95% adults
  • Complex interactions

Secondary hypertension

  • 5-10% adults, 80% children
  • Coarctation of aorta, renal disease, endocrine disorder, neurological disorder, sleep apnea, medication, pregnancy
18
Q

What are the risk factors of HTN? (13)

A
  • Age
  • Alcohol consumption
  • Cigarette smoking
  • Glucose intolerance
  • Elevated lipids
  • High sodium intake
  • Gender
  • Family history
  • Obesity
  • Ethnicity
  • Sedentary lifestyle
  • Socioeconomic status
  • Psychosocial stress
19
Q

What is the pathophysiology of HTN? (7)

A
  • Genes
  • Sodium/water retention
  • Altered renin-angiotensin-aldosterone mechanism
  • Stress and increased SNS activity
  • Insulin resistance and hyperinsulinemia
  • Endothelial cell dysfunction
  • Obesity
20
Q

What are the clinical manifestations of HTN?

A

Lanthanic (silent) disease – asymptomatic until target-organ disease has occurred

Secondary symptoms: fatigue, reduced activity tolerance, dizziness, palpitations, angina, dyspnea

21
Q

What target-organ diseases may result from diabetes?

A

Heart
- Hypertensive heart disease

Brain
- Cerebrovascular disease

Peripheral vasculature
- Peripheral arterial disease

Kidneys
- Nephrosclerosis

Eyes
- Retinal damage

22
Q

How is HTN diagnosed?

A

Ambulatory BP measurement

Laboratory tests
- Urinalysis
- Blood chemistry (Na, K, Cr, BUN)
- Fasting blood glucose
- Fasting total cholesterol, HDL, LDL, triglycerides
ECG
23
Q

How is collaborative care implemented?

A

Risk stratification
- Target organ damage, cardiovascular risk

Lifestyle modifications

  • DASH diet
  • Weight reduction (BMI 18.5-24.9)
  • Alcohol consumption (2/day, w 9/wk, m 14/wk)
  • 30-60 min physical activity 4-7 days/week
  • Avoid tobacco
  • Stress management
24
Q

True or false: we prefer to have pts on long-acting meds

A

True

25
Q

Do you prescribe medication to someone who believes it won’t work?

A

No

26
Q

True or false: meds act on BP = CO x SVR

A

True

27
Q

List some examples of diuretics. What are the nursing considerations?

A

Thiazide and related (indapamide, metolazone)

Loop (furosemide)

Potassium sparing (amiloride, spironolactone)

Nursing considerations:

  • Orthostatic hypotension
  • Electrolyte imbalance
  • Consideration of renal failure
28
Q

List some examples of adrenergic inhibitors. What are the nursing considerations?

A

Central acting adrenergic antagonists (clonidine, methyldopa)

α1 adrenergic blockers (doxazosin, prazosin, terazosin)

β adrenergic blockers (atenolol, bisoprolol, metoprolol)

Combined α and β adrenergic blocker (labetalol)

Nursing considerations

  • Withdrawal syndrome (rebound HTN, tachycardia)
  • Orthostatic hypotension (give α1 at bedtime)
  • Lowered HR with β blockers
29
Q

List some examples of direct vasodilators. What are the nursing considerations?

A

Many available for IV use only (hydralazine, nitroglycerin, sodium nitroprusside)

Nursing considerations

  • BP monitoring for hypertensive crisis (q5min)
  • May be titrated or given as loading doses
30
Q

List some examples of angiotensin inhibitors. What are the nursing considerations?

A

Angiotensin Converting Enzyme (ACE) inhibitors (captopril, enalapril, perindopril, ramipril)

Angiotensin II Receptor Blockers – ARBs (candesartan, irbesartan, losartan, valsartan)

Nursing Considerations

  • Do not give ACEi and ARB together
  • ACEi’s should not be used with potassium-sparing diuretics, reduced effectiveness with ASA/NSAIDs
31
Q

List some examples of calcium channel blockers. What are the nursing considerations?

A

CCB (amlodipine, diltiazem, nifedipine, verapamil)

Nursing Considerations

  • Caution in heart failure
  • Contraindicated in 2nd and 3rd degree HB
  • Sustained release formulations available
32
Q

What is part of the nursing management for HTN?

A

Monitoring BP / pulse
- Mean arterial pressure MAP = SBP + 2(DBP) / 3

Cardiac monitoring

  • Renal function (hourly urine output)
  • Neurological checks
33
Q

What are the 4 A’s

A

Ask

  • Have you used any form of tobacco in the past 6 months?
  • Have you ever considered stopping?

Advise
- “As your nurse, the most important advice I can give you is to quit smoking.”

Assist

  • Minimal intervention (1-3 min): referral, self help material, NRT
  • Intensive intervention (personalize to current health/illness)

Arrange
- Follow up

34
Q

What is Vaping-associated Pulmonary Illness?

A

Canadians who use vape to self monitor for cough, SOB, chest pain

Severe pulmonary illness and death reported in US, related to vaping (cannabis and/or nicotine in some reports)

NURS 205 (12 decks)

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