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Nursing 2 Exam 3 > Unit 11 Hypertension > Flashcards

Unit 11 Hypertension Flashcards

1
Q

What is Cardiac Output and how is it calculated?

A

Volume of blood pumped by each ventricle in one minute; CO= SV x HR

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2
Q

What is Stroke Volume?

A

Amount of blood ejected with each heart beat

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3
Q

What is Systemic Vascular Resistance?

A

Force opposing the forward flow of blood from the heart, created primarily from the resistance in the smaller arterioles

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4
Q

What is the mean arterial pressure goal?

A

> 60

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5
Q

How is pulse pressure calculated and what is the norm?

A

SBP - DBP, 40

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6
Q

How is BP calculated?

A

CO x SVR

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7
Q

Which systems regulate BP in the body?

A

Sympathetic nervous system
Vascular endothelium
Renal system
Endocrine system

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8
Q

What do Baroreceptors do?

A

indicate pressure

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9
Q

Norephinehprine stimulates alpha and beta receptors, what does it do to alpha 1 and alpha 2 receptors?

A

It will cause vasoconstriction increasing BP

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10
Q

What does positive inotropic effect mean?

A

Heart beats stronger and faster

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11
Q

What does positive chronotropic mean?

A

Increase in heart rate

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12
Q

What happens when Beta 1 is stimulated?

A

Positive inotropic, chronotropic, domotropic effect and increased renin secretion

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13
Q

What happens when Beta 2 is stimulated?

A

Bronchodialation

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14
Q

Describe Endothelium.

A

Lines the entire cardiovascular system
One cell thick
Secretes vasoactive substances called Nitric oxide and Endothelin.

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15
Q

What does Nitric oxide do and what does Endothelin do?

A

Vasodilation, Vasoconstriction

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16
Q

With which 2 hormones does the endocrine system increase or decrease BP and how?

A

ADH which promotes reabsorption of water in kidneys increasing BP

Atrial Natriuretic Peptide (ANP) -secreted by cardiac cells and opposed the effects of ADH and aldosterone decreasing BP

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17
Q

What are the types of Hypertension, describe them, and what monitoring improves outcomes?

A

Isolated systolic hypertension- Elevated systolic, more common in older adults

White-coat hypertension- anxiety related like when at doctors office

Masked hypertension- lower BP in doctors office, usually higher at work or at home

Secondary hypertension- specific cause
Primary hypertension- non-specific

At home BP monitoring improves outcomes

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18
Q

What is the goal with secondary hypertension, the % of cases, and what are some example causes?

A

Goal is to eliminate underlying cause

5-10% of cases, and some examples would be:

Endocrine disorders, Medications, Neurological disorders, Renal disease, pregnancy, sleep apnea.

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19
Q

What is the hallmark of primary HTN and what percent of cases does it account for?

A

persistently elevated systemic vascular resistance(SVR)

90-95%

hypertension WITHOUT specific identifiable cause

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20
Q

What BP reading indicates Hypertension and what is the one exception?

A

140/90

Adults age 50 and older 150/90

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21
Q

What are treated in hypertension?

A

risk factors

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22
Q

Why do we measure BP?

A

to collect information to decide in the care and treatment of our PTs

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23
Q

What are modifiable risk factors of hypertension?

A 
Obesity 
Inactivity
Diabetes
Excess sodium 
Elevated serum lipids
Excessive alcohol intake
Smoking
Increased stress
Lower socioeconomic status
24
Q

What are the non-modifiable risk factors of hypertension

A 
Age
Sex
-HTN more common in men before 45, after 64 women
Race
-A. A's greatest risk, worst outcome 
Positive family history
25
How would the clinical manifestations of hypertension be described?
Asymptomatic until severe, related to end organ damage
26
What are the eventually severe complications of hypertension?
Stroke, Heart attack (MI), Heart failure, Kidney Failure, Blindness(Retinal Hemorrhage)
27
What is an early sign of kidney failure and the number one cause?
high urine protein and diabetes
28
How is hypertension diagnosed?
Basic laboratory tests: evaluate end organ disease, assess cardiovascular risk, baseline data prior to treatment Consider white coat syndrome -self monitoring of BP
29
What are some Diagnostic studies of hypertension?
``` history and physical assessment Chest x-ray EKG CBC Lipid profile Liver function Thyroid function Echocardiogram 24 hr urine for creatinine clearance Opthalmic exam ```
30
What is the general goal of hypertension and what are the interventions?
General goal is BP < 140/90 and to prevent complications Interventions would be lifestyle modifications and Pharmacological therapy
31
What are lifestyle modifications of hypertension?
``` Weight reduction DASH diet reduced sodium intake limited alcohol consumption Increased physical activity Smoking cessation Reduce stress ```
32
What is the biggest lifestyle modification for hypertension and how much could BP be lowered?
Weight reduction 5-20 mm HG per 10 kg
33
What is the DASH diet high and low in?
High in fruits, vegetables, and whole grain | Low in fat, carbs, and meat
34
Healthy and at risk adults should have how much sodium a day?
Healthy adults: less than or equal to 2400 mg a day | At risk adults: less than or equal to 1500 mg a day
35
In terms of alcohol how many drinks should men and women be limited to per day with hypertension?
Two drinks for men | One drink for women
36
What kind of exercise is recommended for hypertension?
30 min average of moderate aerobic activity 3-5 days per week. Muscle strengthening twice a week Flexibility and balance for persons at risk for falls
37
What are the Pharmacological Therapy classes of the medications used to control BP?
- Thiazide-type diuretics - Calcium-channel blockers - Angiotensin-converting enzyme inhibitor (ACEIs) - Angiotensin II receptor blockers (ARBs) - Alpha (a) adrenergic blockers or Beta (B) adrenergic blockers - Direct vasodilators
38
Name a Thiazide-type diuretic and describe it.
hydrochlorothiazide (HCTZ) - Increases excretion of Na and Cl - Risk of HYPOkalemia and orthostatic hypotension - First choice of medication class for most PT's with hypertension
39
Name the Loop diuretic and describe it.
furosemide - Increases excretion of Na and Cl - Risk of HYPOkalemia and orthostatic hypotension - Less effective for HTN than thiazides
40
Name the potassium-sparring diuretics, which two are also classified as *Aldosterone Receptor Blockers, and describe them.
*spironolactone *aplereonone amiloride- works by inhibiting Na+ reabsorption - risk of HYPERkalemia and orthostatic hypotension - not recommended for use with ACEI's or ARBs
41
What is important regarding the use of ACE-Is and ARBs?
- SHOULD NOT BE USED TOGETHER | - recommended for all adult PT's with chronic kidney disease for hypertension therapy
42
Name ACEIs, their action, and common side effect
enalpril (pril) captopril - prevents the conversion of angiotensin I to angiotensin II - Common side effect is a persistent, dry cough
43
Name the ARBs and describe them.
losartan valsartan - prevents/blocks the action of angiotensin II - Full antihypertensive effect may take up to 6 weeks
44
Name the Calcium Channel Blockers (CCBs) and describe them.
amlodipine verapamil diltiazem - Inhibits movement of calcium across cell membrane resulting in vasodilation - Can reduce HR - Serum drug concentrations can be increased by grapefruit juice -Recommended in A. A population as initial treatment or in addition to thiazide diuretic
45
Name the alpha (a) blocker medication and describe it.
doxazosin - blocks a1 adrenergic receptors - results in peripheral vasodilation - reduced SVR and lowers BP - Taken at bedtime to reduce risks of orthostatic hypotension - NOT recommended as monotherapy for HTN
46
What is the cardio-selective beta (B1) blocker and describe it.
metoprolol - blocks B1 effects meaning its negative inotropic, chronotropic, and dromotropic. - decreases renin secretion - use in caution with PTs who have Diabetes as is may mask hypoglycemia-induced tachycardia
47
Which is the non-selective B-blocker and describe it.
propranolol - Blocks B1 & B2 effects - Increased risk of bronchospasm especially in PTs with hx of asthma
48
What is the combination a and b Beta-blocker?
carvedilol
49
Which medications are vasodilators, describe them and how they are given.
hydralazine nitroprusside - cause arterial vasodilation resulting in decreased SVR and BP - Given IV for hypertensive crisis - Requires intravascular BP monitoring
50
What is important to note regarding nitroprusside ?
nitroprusside is metabolized to cyanide (toxic) so it is important to monitor levels with continuous IV infusion.
51
What are the two types of Hypertensive crisis?
Hypertensive Emergency and Urgency
52
What is considered/happens in Hypertensive Emergency and what is given for it?
BP > 180/120 IV nitroprusside is given for rapid reduction in BP Target organ damage occurs
53
What is considered/happens in Hypertensive Urgency and what is given for it?
BP > 160/110 Oral meds given for gradual reduction in BP Symptoms: headache, epistaxis No impending organ damage
54
What is the most important nursing care priority?
Health promotion and prevention; EDUCATION
55
What are expected outcomes for hypertension?
- PT will maintain BP at desired goal - adhere to therapeutic plan - experience minimal or no side effects of therapy
56
What can the nurse identify and educate about hypertension medications and their side effects?
- orthostatic hypotension | - sexual problems

Nursing 2 Exam 3 (5 decks)

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