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Nursing 2 Exam 3 > Unit 11 Hypertension > Flashcards

Unit 11 Hypertension Flashcards

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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
Q

How would the clinical manifestations of hypertension be described?

A

Asymptomatic until severe, related to end organ damage

26
Q

What are the eventually severe complications of hypertension?

A

Stroke, Heart attack (MI), Heart failure, Kidney Failure, Blindness(Retinal Hemorrhage)

27
Q

What is an early sign of kidney failure and the number one cause?

A

high urine protein and diabetes

28
Q

How is hypertension diagnosed?

A

Basic laboratory tests: evaluate end organ disease, assess cardiovascular risk, baseline data prior to treatment
Consider white coat syndrome
-self monitoring of BP

29
Q

What are some Diagnostic studies of hypertension?

A 
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
Q

What is the general goal of hypertension and what are the interventions?

A

General goal is BP < 140/90 and to prevent complications

Interventions would be lifestyle modifications and Pharmacological therapy

31
Q

What are lifestyle modifications of hypertension?

A 
Weight reduction
DASH diet
reduced sodium intake
limited alcohol consumption 
Increased physical activity 
Smoking cessation 
Reduce stress
32
Q

What is the biggest lifestyle modification for hypertension and how much could BP be lowered?

A

Weight reduction 5-20 mm HG per 10 kg

33
Q

What is the DASH diet high and low in?

A

High in fruits, vegetables, and whole grain

Low in fat, carbs, and meat

34
Q

Healthy and at risk adults should have how much sodium a day?

A

Healthy adults: less than or equal to 2400 mg a day

At risk adults: less than or equal to 1500 mg a day

35
Q

In terms of alcohol how many drinks should men and women be limited to per day with hypertension?

A

Two drinks for men

One drink for women

36
Q

What kind of exercise is recommended for hypertension?

A

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
Q

What are the Pharmacological Therapy classes of the medications used to control BP?

A
  • 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
Q

Name a Thiazide-type diuretic and describe it.

A

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
Q

Name the Loop diuretic and describe it.

A

furosemide

  • Increases excretion of Na and Cl
  • Risk of HYPOkalemia and orthostatic hypotension
  • Less effective for HTN than thiazides
40
Q

Name the potassium-sparring diuretics, which two are also classified as *Aldosterone Receptor Blockers, and describe them.

A

*spironolactone
*aplereonone
amiloride- works by inhibiting Na+ reabsorption

  • risk of HYPERkalemia and orthostatic hypotension
  • not recommended for use with ACEI’s or ARBs
41
Q

What is important regarding the use of ACE-Is and ARBs?

A
  • SHOULD NOT BE USED TOGETHER

- recommended for all adult PT’s with chronic kidney disease for hypertension therapy

42
Q

Name ACEIs, their action, and common side effect

A

enalpril (pril)
captopril

  • prevents the conversion of angiotensin I to angiotensin II
  • Common side effect is a persistent, dry cough
43
Q

Name the ARBs and describe them.

A

losartan
valsartan

  • prevents/blocks the action of angiotensin II
  • Full antihypertensive effect may take up to 6 weeks
44
Q

Name the Calcium Channel Blockers (CCBs) and describe them.

A

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
Q

Name the alpha (a) blocker medication and describe it.

A

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
Q

What is the cardio-selective beta (B1) blocker and describe it.

A

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
Q

Which is the non-selective B-blocker and describe it.

A

propranolol

  • Blocks B1 & B2 effects
  • Increased risk of bronchospasm especially in PTs with hx of asthma
48
Q

What is the combination a and b Beta-blocker?

A

carvedilol

49
Q

Which medications are vasodilators, describe them and how they are given.

A

hydralazine
nitroprusside

  • cause arterial vasodilation resulting in decreased SVR and BP
  • Given IV for hypertensive crisis
  • Requires intravascular BP monitoring
50
Q

What is important to note regarding nitroprusside ?

A

nitroprusside is metabolized to cyanide (toxic) so it is important to monitor levels with continuous IV infusion.

51
Q

What are the two types of Hypertensive crisis?

A

Hypertensive Emergency and Urgency

52
Q

What is considered/happens in Hypertensive Emergency and what is given for it?

A

BP > 180/120

IV nitroprusside is given for rapid reduction in BP

Target organ damage occurs

53
Q

What is considered/happens in Hypertensive Urgency and what is given for it?

A

BP > 160/110

Oral meds given for gradual reduction in BP

Symptoms: headache, epistaxis

No impending organ damage

54
Q

What is the most important nursing care priority?

A

Health promotion and prevention; EDUCATION

55
Q

What are expected outcomes for hypertension?

A
  • PT will maintain BP at desired goal
  • adhere to therapeutic plan
  • experience minimal or no side effects of therapy
56
Q

What can the nurse identify and educate about hypertension medications and their side effects?

A
  • orthostatic hypotension

- sexual problems

Nursing 2 Exam 3 (5 decks)

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