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Perfusion: HTN Flashcards

1
Q

Define HTN

A

SBP greater than 120mmHg or DBP greater then 80mmHg for extended periods of time

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2
Q

What is blood pressure ?

A

the force exerted by the blood against the walls of the blood vessels

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3
Q

What is systemic vascular resistance ?

A

resistance to blood flow offered by all of the systemic vasculature
- except pulmonary vasculature

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4
Q

What makes up BP ?

A

cardiac output (CO) X peripheral resistance (PVR)

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5
Q

What causes an increase in systemic vascular resistance ?

A

when blood vessels constrict
- vasoconstriction

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6
Q

What does the receptor A1 and A2 adrenergic do ?

A

vasoconstriction

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7
Q

What does the receptor B2 adrenergic do ?

A

vasodilation

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8
Q

What are the different stages of HTN ?

A
  • Normal: <120 and <=80
  • Prehypertension: 120-129 or <=80
  • HTN Stage 1: 130-139 or 80-89
  • HTN Stage 2: >140 or >=90
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9
Q

What is primary HTN ?

A

essential or idiopathic
- “the silent killer”
- 90-95% of all cases
- without an identified cause

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10
Q

What are some contributing factors of primary HTN ?

A
  • increased Na intake
  • increased SNS activity
  • greater than ideal body weight
  • excessive alcohol consumption
  • tobacco use
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11
Q

What are risk factors of primary HTN ?

A
  • age
  • alcohol
  • cig smoking
  • DM
  • elevated serum lipids
  • excess dietary Na
  • gender
  • family history
  • obesity
  • ethnicity
  • sedentary lifestyle
  • socioeconomic status
  • stress
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12
Q

What are the S&S of primary HTN ?

A

asymptomatic (usually)
- secondary symptoms (if they aren’t asymptomatic then)
- fatigue
- reduced activity tolerance
- dizziness
- palpations
- angina
- dyspnea

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13
Q

What are some complications of primary HTN ?

A

target organ disease
- CAD
- heart failure
- cerebrovascular disease (TIA’s/stroke)
- PVD
- retinal damage

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14
Q

What are diagnostic studies for primary HTN ?

A

several elevated BP readings over several weeks to classify as HTN (at least 2 readings)
- UA, BUN, Cr, CBC
- serum electrolytes
- serum lipid profiles
- ECG

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15
Q

Why would someone with HTN need to be on an ECG ?

A

to monitor the damage that the side effects of HTN cause
- like heart attack
- hypertrophy of heart muscle

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16
Q

What is secondary HTN ?

A

relating to an underlying cause
- 5-10% of HTN
- contributing factor to hypertensive crisis

17
Q

What is the Tx for secondary HTN ?

A

identify the underlying cause and tx that

18
Q

What are some relating underlying causes of secondary HTN ?

A
  • renal disease
  • sleep apnea
  • endocrine disorders (thyroid disease)
  • neurologic (brain tumor)
  • pregnancy induced HTN
  • drug induced (oral contraceptives, corticosteroids)
  • congenital (narrowing of the aorta)
19
Q

What are some gerontologic considerations for HTN ?

A
  • loss of elasticity in the large arteries (atherosclerosis)
  • increase collagen and stiffness of the myocardium
  • increased peripheral vascular resistance
  • decreased renal function
20
Q

What is the DASH diet ?

A

Dietary Approaches to Stopping Hypertension
- low Na, high K, high Ca
- proven to lower BP and LDL cholesterol
- high in protein and fiber
- low in saturated fats

21
Q

What are the sodium guidelines for the DASH diet ?

A
  • initially decrease daily sodium intake to less than 2,300 mg
  • gradually decrease daily sodium intake to less than 1,500mg
22
Q

What foods are high in Potassium ?

A
  • apricots
  • bananas
  • tomatoes
  • potatoes
  • fresh fruits and vegetables
23
Q

What foods are good to eat on a DASH diet ?

A
  • low fat dairy
  • lean meats, poultry, fish nuts
  • whole grains, beans, veggies
  • Mrs Dash or salt less seasoning blends
  • olive oil
24
Q

What med category is Metoprolol ?

A

Beta blocker
- causes the heart to beat slower and with less force
- lowers BP
can cause bradycardia

25
What med category is Verapamil (Calan) ?
calcium channel blockers - blocks BP by preventing calcium from entering cells of the heart and arteries - side effect: peripheral edema
26
What med category is Captopril (Capoten) ?
ACE (Angiotensin-Converting Enzyme Inhibitor) - blocks angiotensin which allows meds to dilate veins and arteries - side effects (Lisinopril) : dry cough, postural hypotension, high potassium
27
What med category is Losartan ?
ARBs (Angiotensin II Receptor Blockers) - blocks the action of angiotensin II: causes veins and arteries to dilate - side effect: orthostatic hypotension and HA
28
What med category is Spironolactone ?
works by inhibiting the Na and K excreting effects of aldosterone - natural substance in the body that raises BP
29
What is hypertensive crisis ?
severe and abrupt elevation in BP defined as DBP >=120-140 mmHg - rising BP triggers endothelia damage which releases vasoconstrictor substance which causes organ damage
30
What causes HTN crisis ?
- exacerbation of chronic HTN - preeclampsia, eclampsia (a seizure) - drugs (cocaine, amphetamines) - rebound HTN (we lowered pressure to much and they stopped taking their BP med and then their BP sudden has gone back up) - head injury (trauma) - acute aortic dissection
31
What is Hypertensive Urgency ?
BP is severely elevated but there is no clinical evidence of target organ damage - develops over hrs to days - you know there is no organ damage because they aren't having pain (like in their head or chest) and have no symptoms
32
What is Tx for hypertensive urgency ?
- pt not required to hospitalize but needs frequent follow up - does not require IV meds but oral antihypertensive meds - allow pt to sit for 10-20 mins in a quiet environment may significantly reduce BP
33
What is hypertension emergency ?
BP is severely elevated with evidence of acute target organ damage, especially to CNS (>180/120) - pt doesn't get to go home
34
What can Hypertension Emergency cause ?
- encephalopathy - acute left ventricular failure with pulmonary edema - MI - renal failure - dissecting aortic aneurysm - intracranial or subrachnoid hemorrhage - - retinopathy - chest pain, SOB, blurry vision, HA
35
What is Hypertensive Encephalopathy ?
brain dysfunction that is caused by extremely high BP
36
What are some S&S of Hypertensive Encephalopathy ?
- HA - nausea, vomiting - seizures - confusion - stupor - coma - blurred vision - transient blindness
37
What meds are used for HTN crisis ?
IV meds (Nitropres), (Nitride), nitroglycerin (IV or PO dissolving tablet) - BP and pulse taken every 2-3 mins - if IV, titrate drug according to level of BP - hourly urinary output - bedrest (don't want them moving around cause it can increase BP or they can feel dizzy) - neurologic checks (monitor cardiac, pulmonary, and renal systems for decompensation
38
What are nursing considerations for BP meds ?
- always have recent BP and HR and know I&O's prior to med admin - give meds on time - if your pt's BP is normal and their med is due you still give the BP med because if you don't then their BP will increase

Med-Surg (23 decks)

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