Lecture 5: Hypertension and Smoking

Question 1

BP = ____ x _____

Answer 1

cardiac output x systemic ventricular resistance

Question 1

CO = _______ x _______

Answer 1

heart rate x stroke volume

(Force of pulsing form the blood vessel, a small change can make a big difference in the SVR

Heart pumps out the left ventricle, if we are going to constrict those vessels the heart has to overcome that resistance

SVR is increased, BP has to increase)

Question 2

what does SVR mean

Answer 2

systemic ventricular resistance

• impacts vessel diameter (more resistance means heart has to work harder)
• controls w vasoconstriction/vasodilation

Question 3

What are baroreceptors?

Answer 3

• In the SNS
• Specialized nerve cells in the carotid sinus and aortic arch

Question 4

what is released from sympathetic nerve endings

Answer 4

NE

Question 5

What are SNS receptors classified as

Answer 5

a1 - vasoconstriction
a2 - vasoconstriction
b1 - increase contractility, heart rate, conduction, renin (heart)
b2 - dilate bronchial passages (lungs)

Question 6

what is the vascular endothelium

Answer 6

single layer of cells lining the blood vessels

Question 7

what is the 3 parts of the vascular endothelium

Answer 7

1. Nitric oxide: lowers arterial tone, inhibits muscle growth
2. Endothelin: vasoconstrictor, promotes smooth muscles growth
3. Prostaglandins

Question 8

Renin Angiotensin Aldosterone Sys (RAAS)

Answer 8

• Juxtaglomerular apparatus releases renin
• renin converts angiotensin -> angiotensin 1
• angiotensin 1 goes to lungs where angiotensin converting enzyme (ACE) -> angiotensin 2
• vasoconstrictor
• stim kidney to secrete aldosterone (keeps in h2o and Na)

causes BP to rise at the end, falls at beginning

Question 9

in heart failure ______ are secreted in response to high ventricular filling

Answer 9

natriuretic peptides

Question 10

Factors influencing BP

Answer 10

BP = CO x SVR

CO:
- cardiac: HR, contractivity, conductivity
Renal Fluid Control
- natriuretic peptides
- RAAS sys

SVR:
- SNS: vasoconstriction, vasodilation
- Neurohormonal: vasoconstrictors; angiotensin and NE
- Nitric oxide, prostaglandins, endothelin

Question 11

what are naturistic peptides

Answer 11

• used in HF
• decrease BP
• high ventricular pressure

Question 12

stage 1 hypertension

Answer 12

140-159/90-99

90-95% adults
complex interactions

Question 13

stage 2 hypertension

Answer 13

160/100

5-10% adults, 80% children

Question 14

hypertension manifestations

Answer 14

• silent disease: asymp until target-organ disease has occurred

2ndary sympt: fatigue, reduced activity tolerance, dizziness, palpitations, angina, dyspnea

Question 15

target-organs of hypertension

Answer 15

1. heart: hypertensive heart disease
2. brain: cerebrovascular disease
3. peripheral vasculature: peripheral arterial disease
4. kidneys: nephrosclerosis
5. eyes: retinal damage

Question 16

diagnostic studies for hypertension

Answer 16

• urinalysis
• blood chem (Na, K, Cr, BUN)
• fasting blood glucose
• fasting total cholesterol, HDL, LDL, triglycerides, ECG

Question 17

white coat hypertension

Answer 17

bp high at doc office

Question 18

masked hypertension

Answer 18

bp only high at home

Question 19

hypertension nursing management

Answer 19

common sense stuff + DASH diet

Question 20

diuretics + nursing considerations for hypertension

Answer 20

• thiazide (inhibit Na reabsorption) and related (indapamide, metolazone)
• loop (furosemide)
• potassium sparing (amiloride, spironolactone)

nursing considerations:
- orthostatic hypotension
- electrolyte imbalance
- consideration of renal failure

Question 21

adrenergic inhibitors + nursing considerations for hypertension

Answer 21

• central-acting adrenergic antagonists (clonidine, methyldopa)
• a1 blockers (doxazosin, prazosin, terazosin)
• b blockers (atenolol, bisoprolol, metoprolol)
• combined a and b blocker (labetalol)

nursing considerations:
- withdrawal syndrome (rebound HTN)
- orthostatic hypotension (give a1 at bedtime)
- lowered HR w B blocker

Question 22

Direct vasodilators

Answer 22

ex: hydralazine (for hypertensive crisis), nitroglycerin (relaxes arterial smooth muscle reducing vascular resistance), sodium nitroprusside

nursing considerations: BP monitoring for hypertensive crisis (q5min), may be titrated or given as loading doses

Question 23

Angiotensin inhibitors

Answer 23

• ACE inhibitors (captopril, enalapril, perindopril, (-PRIL): main side effect is cough
• Angiotensin 2 receptor blockers: ARBs (end w -SARTAN): increase salt/water excretion

nursing considerations:
- ACEi’s should not be used w K+ sparing diuretics
- reduced effectiveness w ASA/NSAIDS

Question 24

Calcium channel blockers

Answer 24

ex: amlodipine, diltiazem, nifedipine, verapamil

Nursing considerations:
- caution w HF
- contraindicated in 2nd and 3rd degree hemoglobin
- sustained release formulations available

Question 25

nursing management in a hypertension emergency

Answer 25

• monitoring BP/pulse
• mean arterial pressure: SBP + 2(DBP) / 3
• cardiac monitoring
• renal function
• neuro checks

Question 26

Smoking pharmacology interventions

Answer 26

• nicotine patch
• nicotine gum
• nicotine lozenge
• varenicline
• e-cigs