Hypertensive

Question 1

Mechanisms for regulating BP
a) Short-term
b) Long-term

Answer 1

a) regulate blood vessel diameter, heart rate, and contractility
b) regulate blood volume

Question 2

Short-Term
Mechanisms of Rising BP?
a) Stimulation of the “baroreceptors” in?
b) Increase what system?
c) increased cardiac output

Answer 2

a) Carotid sinus
Aortic arch
Large arteries of the neck and thorax
b) Increased impulses to the brain (SNS)
Increased activity of sympathetic cardiac nerves
c) release of epinephrine and norepinephrine

Question 3

Sympathetic nervous system?

Answer 3

body’s rapid involuntary response to dangerous or stressful situations

Question 4

Long Term Mechanisms
Increasing BP
a) Control fluid volume via what system?
b) What enzyme causes inc BP?
c) RASS system pathway?

Answer 4

a) Renal
b) Renin
c) angiotensinogen activating it to angiotensin I to angiotensin II
stimulates the cells of the adrenal cortex to release the hormone aldosterone

Question 5

a) HTN systolic BP?
b) HTN diastolic BP?
c) Untreated HTN cause?

Answer 5

a) 140 or greater
b) 90 or greater
c) Stroke
Arteriosclerosis
HF
Kidney failure

Question 6

HTN crisis definition
a) BP to be?
b) Other factor to confirm?

Answer 6

a) systolic BP >210 mmHg
diastolic BP >130 mmHg
b) Positive lab studies
Clinical evidence of progressive organ damage

Question 7

HTN crisis are more common in?

Answer 7

Older patients (50+)
African Americans
Men more likely than women

Question 8

HTN Crisis
a) most common cause?
b) next most common cause?

Answer 8

a) essential HTN
b) Anything about kidney
renal artery stenosis
acute glomerulonephritis
kidney transplantation
Pregnancy-related eclampsia

Question 9

HTN Crisis
What to assess?

Answer 9

A rapid but thorough systems review of Patient
Neurologic: blurry vision
Cardiac: chest pain
Renal: decrease in urine output

Question 10

HTN crisis: nursing care
a) how to take BP?
b) what reason may BP cannot be accurate?

Answer 10

a) Take BP in both arm
If there is more than 20 mmHg pressure between arms
Assessing for aortic dissection (CT)
-if aortic dissecting, BP result might different in different arm
aortic dissection=a tear in the inner layer of the large blood vessel branching off the heart

Question 11

,

Assessment (what look for?)

Answer 11

Presence of JVD
Lungs: Rales(crackles)
Lower extremity edema
Quick Neuro assessment

Question 12

Laboratory orders includes?

Answer 12

CBC
Blood chemistry panel
BUN, creatinine
Electrolytes
Urinalysis

Question 13

a) Which procedure need to be obtained?
b) Check aortic dissection?
c) Check stroke or intracranial hemorrhage?

Answer 13

a) CXR and ECG
b) Thoracic CT scan with contrast
c) Head CT scan

Question 14

a) HTN emergency?
b) HTN urgency?

Answer 14

a) both systolic and diastolic BP
acute target organ disease
b) HTN
Negative lab test
absence of acute target organ disease

Question 15

Possible organ damage
HTN emargency

Answer 15

hypertensive encephalopathy(mental change)
intracranial hemorrhage
acute myocardial infarction
acute left ventricular failure with pulmonary edema
dissecting aneurysm
acute renal failure
eclampsia of pregnancy(Seizures)

Question 16

Possible S/S
HTN urgency?

Answer 16

headache
shortness of breath
pedal edema

Question 17

Rate of BP reduction
a) Goal to reduce MAP?
b) If stable?

Answer 17

a) by no more than 25%(Within minutes to 1 hr)
b) to 160/100 to 110 mmHg within the next 2 to 6 hr

Question 18

What happens if drop BP too fast in a hypertensive emergency?

Answer 18

damage the blood flow to organs

Question 19

Vasodilators
Nitroprusside
a) act where?
b) effect?
c) action?
d) risk?

Answer 19

a) arterial and venous vasodilator
b) effect on both side
Reduces after-load and pre-load
to decrease MAP
modest increase or no change in CO
c) onset: Immediate
Duration:3 to 5 minutes
d) Thiocyanate poisoning
-Draw thiocyanate levels after 48 hours hr

Question 20

Nitroglycerin (NTG)
vasodilators
a) act where?
b) effect?
c) action?
d) risk?

Answer 20

a) peripheral vasodilator, on the venous vessels
b) decrease in preload and CO
increases coronary blood flow
Dec venous side(preload) rather than afterload(arteial)
c) Onset: Immediate.
Duration:3 to 5 minutes.
Continue until BP is controlled with oral agents

Question 21

Beta1 Blocker
Labetalol
a) act where?
b) effect?
c) action?
d) risk?

Answer 21

a) an alpha-1-blocker and nonselective beta-blocker
b) Decreasing systemic vascular resistance, MAP and heart rate
a slight decrease in CO
c) Onset: 5 to 10 minutes
Duration: 3 to 8 hours

Question 22

CCB
Nicardipine

Answer 22

a) Increases SV and has strong cerebral and coronary vasodilatory activity
b) Makes it easier for the heart to pump and reduces its workload
c) Onset: 5 to 10 minutes
Duration: 2 to 4 hours

Question 23

HTN crisis
complications

Answer 23

Cardiac Impairment
-myocardial damage, HF
Neurologic Deficit
-Permanent neurologic compromise r/t CVA
-Hemorrhage
-hypertensive encephalopathy
Renal Impairment
Renal insufficiency and failure