Perfusion: HTN Flashcards
Define HTN
SBP greater than 120mmHg or DBP greater then 80mmHg for extended periods of time
What is blood pressure ?
the force exerted by the blood against the walls of the blood vessels
What is systemic vascular resistance ?
resistance to blood flow offered by all of the systemic vasculature
- except pulmonary vasculature
What makes up BP ?
cardiac output (CO) X peripheral resistance (PVR)
What causes an increase in systemic vascular resistance ?
when blood vessels constrict
- vasoconstriction
What does the receptor A1 and A2 adrenergic do ?
vasoconstriction
What does the receptor B2 adrenergic do ?
vasodilation
What are the different stages of HTN ?
- Normal: <120 and <=80
- Prehypertension: 120-129 or <=80
- HTN Stage 1: 130-139 or 80-89
- HTN Stage 2: >140 or >=90
What is primary HTN ?
essential or idiopathic
- “the silent killer”
- 90-95% of all cases
- without an identified cause
What are some contributing factors of primary HTN ?
- increased Na intake
- increased SNS activity
- greater than ideal body weight
- excessive alcohol consumption
- tobacco use
What are risk factors of primary HTN ?
- age
- alcohol
- cig smoking
- DM
- elevated serum lipids
- excess dietary Na
- gender
- family history
- obesity
- ethnicity
- sedentary lifestyle
- socioeconomic status
- stress
What are the S&S of primary HTN ?
asymptomatic (usually)
- secondary symptoms (if they aren’t asymptomatic then)
- fatigue
- reduced activity tolerance
- dizziness
- palpations
- angina
- dyspnea
What are some complications of primary HTN ?
target organ disease
- CAD
- heart failure
- cerebrovascular disease (TIA’s/stroke)
- PVD
- retinal damage
What are diagnostic studies for primary HTN ?
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
Why would someone with HTN need to be on an ECG ?
to monitor the damage that the side effects of HTN cause
- like heart attack
- hypertrophy of heart muscle
What is secondary HTN ?
relating to an underlying cause
- 5-10% of HTN
- contributing factor to hypertensive crisis
What is the Tx for secondary HTN ?
identify the underlying cause and tx that
What are some relating underlying causes of secondary HTN ?
- renal disease
- sleep apnea
- endocrine disorders (thyroid disease)
- neurologic (brain tumor)
- pregnancy induced HTN
- drug induced (oral contraceptives, corticosteroids)
- congenital (narrowing of the aorta)
What are some gerontologic considerations for HTN ?
- loss of elasticity in the large arteries (atherosclerosis)
- increase collagen and stiffness of the myocardium
- increased peripheral vascular resistance
- decreased renal function
What is the DASH diet ?
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
What are the sodium guidelines for the DASH diet ?
- initially decrease daily sodium intake to less than 2,300 mg
- gradually decrease daily sodium intake to less than 1,500mg
What foods are high in Potassium ?
- apricots
- bananas
- tomatoes
- potatoes
- fresh fruits and vegetables
What foods are good to eat on a DASH diet ?
- low fat dairy
- lean meats, poultry, fish nuts
- whole grains, beans, veggies
- Mrs Dash or salt less seasoning blends
- olive oil
What med category is Metoprolol ?
Beta blocker
- causes the heart to beat slower and with less force
- lowers BP
can cause bradycardia
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
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
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
What med category is Spironolactone ?
works by inhibiting the Na and K excreting effects of aldosterone
- natural substance in the body that raises BP
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
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
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
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
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
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
What is Hypertensive Encephalopathy ?
brain dysfunction that is caused by extremely high BP
What are some S&S of Hypertensive Encephalopathy ?
- HA
- nausea, vomiting
- seizures
- confusion
- stupor
- coma
- blurred vision
- transient blindness
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
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
