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NURS 220 > LEC 3: Hypertension > Flashcards

LEC 3: Hypertension Flashcards

1
Q

What causes arterial blood pressure to rise?

A

For arterial blood pressure to rise, there is either an INCREASE in:

  1. Cardiac Output
  2. Systemic Vascular Resistance
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2
Q

What is considered to be a high normal blood pressure?

A

Hight Normal:

  • Systolic Blood Pressure: 130 to 139 mmHg
  • Diastolic Blood Pressure: 85 to 89 mmHg

*Follow up in 1 hour

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3
Q

When would you re-check a patients blood pressure if they where high normal?

A

Follow up in 1 hour

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4
Q

What is considered persistent elevation of blood pressure?

A
  • Systolic Blood Pressure: Greater than or equal to 140 mmHg
  • Diastolic Blood Pressure: Greater than or equal to 90 mmHg

*Need to do 2 or more readings after initial screening

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5
Q

How many more reading do you need to do when the patient has persistent elevation of blood pressure?

A

Need to do 2 or more readings after initial screening

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6
Q

Hypertension Increases With:

A

a. Age

b. Ethnicity
- African
- Indigenous

c. Family history/ genetics

d. Gender
- Men until age 55
- Women after age 55

e. Lifestyle
- Smoking
- ETOH
- Obesity
- SES
- Stress
- Inactivity

f. Diabetes

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7
Q

Hypertension Decreases With:

A

a. Prevention measures/ awareness
b. Medications
c. Lifestyle changes

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8
Q

Pathophysiology of Hypertension

A
  • Heredity: 40% of family history
  • Na and H2O retention
  • Stress and increased SNS activity: Flight or Fight
  • Altered Renin-Angiotension-Aldosteron mechanism
  • Insulin resistance and hyperinsulinemia
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9
Q

What are the two types of hypertension?

A
  1. Primary (essential) hypertension

2. Secondary hypertension

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10
Q

Primary Hypertentsion

A
  1. Referred to as the “silent killer” because patients are frequently ASYMPTOMATIC until target organ disease occurs
  2. Symptoms are often secondary to target organ disease and can include:
    - Fatigue, reduced activity tolerance
    - Dizziness
    - Palpitations, angina
    - Dyspnea
    - Headache
  3. Elevated blood pressure WITHOUT in identified cause
  4. 90 to 95% of patients
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11
Q

Secondary Hypertension

A
  1. Elevated blood pressure WITH a specific cause that can be identified and corrected
  2. 5 to 10% of patients
  3. Some causes of increased blood pressure are:
    - Coarctation of the aorta
    - Renal artery stenosis
    - Brain tumors
  4. Treatment is to eliminate cause
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12
Q

What are the target organ damage that occur with hypertension?

A
  1. Cardiac disease
  2. Cerebrovascular disease
  3. Peripheral vascular disease
  4. Renal damage
  5. Retinal damage
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13
Q

Collaborative Care: Assessment & Diagnosis

A
  1. Health history
  2. Head to toe assessment
  3. Multiple blood pressure readings over several weeks
  4. Labe test:
    - Urinalysis
    - K+
    - Na+
    - Creatinine
    - Fasting glucose
    - Cholesterol & triglyceride levels
  5. ECG
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14
Q

Collaborative Care: Nursing Interventrions

A
  1. Assess the risk
    - Monitor blood pressure regularly
  2. Encourage lifestyle modifications
    - Physical activity
    - Weight reduction
    - Reduced alcohol intake
    - Health eating/ low sodium diet
    - Relaxation therapy
    - Smoking cessation
  3. Patient adherence to treatment plan
  4. Drug therapy
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15
Q

What are the two main factors of drug therapy in hypertension?

A
  1. Reduce systemic vascular resistance

2. Decrease circulating blood volume

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16
Q

What do diuretics do?

A

Decrease blood volume

17
Q

What do vasodilators do?

A

Dilate blood vessels, which allows blood to flow more easily. They’re used to treat or prevent high blood pressure (hypertension)

18
Q

What are examples of vasodilator drugs?

A
  • Beta blockers
  • Calcium channel blockers
  • Angio retention blockers
19
Q

What is the goal of drug therapy in patients with hypertension?

A
  1. Get blood pressure below 140/90 mmHg
  2. Goal in diabetic patients: get blood pressure below 130/80 mmHg
  3. Goal in patients at high risk for CAD complications: Get systolic blood pressure below 120 mmHg
20
Q

Drug Treatment of Hypertension

A

a. Lifestyle modification

b. Initial drug therapy
* Usually start with beta blocker or diuretic
- Thiazide diuretic
- ACE-I
- ARB (angiotensin receptor blocker)
- Long acting CCB (calcium channel blocker)
- Beta blocker

c. Dual combination
* Give the beta blocker or diuretic a few months to see if it works, may add a second medication, wait etc.

d. Triple or quadruple therapy

21
Q

What are the key points to hypertension?

A
  1. Hypertension is a persistent elevation of blood pressure
  2. Most commonly primary hypertension
  3. Symptoms often asymptomatic until target organ damage
    - Overall goal is to achieve and maintain target blood pressure
    - Lifestyle modifications and drug therapy often both needed to achieve target blood pressure
    - Adherence to drug therapy an issue

NURS 220 (41 decks)

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