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Nursing 272: Final Semester > Unit 2: Hypertensive Crisis > Flashcards

Unit 2: Hypertensive Crisis Flashcards

1
Q

Hypertensive Crisis

A

acute severe elevation in BP

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2
Q

Hypertensive Urgency

A
  • DBP greater than or equal to 120 mmHg

- no sign of target organ damage (TOD)

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3
Q

Hypertensive Emergency

A
  • DBP greater than or equal to 120 mmHg

- evidence of target organ damage (TOD)

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4
Q

Target Organ Damage (TOD)

A

damage to the heart, eyes, or kidneys caused by hypertension

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5
Q

Hypertension Laboratory Diagnostic Testing

A
  • Renal System
  • Endocrine
  • Metabolic
  • Other: hematocrit, electrocardiogram, and chest x-ray
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6
Q

Renal System Tests for Hypertension and expected findings if TOD is present

A
  • Microscopic urinalysis
  • Proteinuria
  • Serum BUN and/or Creatinine

> If TOD present:

  • proteinuria
  • elevated BUN + Creatinine
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7
Q

Endocrine System Function Tests and expected findings if TOD present

A
  • Serum Sodium
  • Serum Potassium
  • Serum Calcium
  • TSH (thyroid-stimulating hormone)

> If TOD Present:

  • increased sodium
  • increased potassium
  • increased TSH
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8
Q

Metabolic Function Tests and expected findings if TOD present

A
  • Fasting blood glucose
  • Total cholesterol
  • HDL and LDL cholesterol
  • Triglycerides

> If TOD present

  • glucose > than 100 mg/dL
  • increased LDLs and Triglycerides
  • decreased HDLs
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9
Q

What would the Hematocrit level show if TOD is present?

A

decreased hematocrit

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10
Q

What would Electrocardiogram/ Chest x-ray show if TOD present?

A

left ventricular hypertrophy

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11
Q

Medications Used for Hypertension

A
  • Diuretics
  • Calcium Channel Blockers
  • Angiotensin-converting enzyme inhibitors (ACE Inhibitors)
  • Angiotensin II Receptor Blockers (ARBs)
  • Beta Blockers
  • Combined Alpha and Beta Blockers
  • Vasodilators
  • Central Agonists
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12
Q

Diuretics

A
  • act on the kidneys to help the body eliminate sodium and water, reducing blood volume
  • often first choice, but not only choice
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13
Q

Calcium Channel Blockers

A 
>Amlodipine besylate (Norvasc)
>Diltiazem (Cardizem)
>Nifedipine (Adalat cc, Procardia XL)
-help relax/dilate the muscles of blood vessels (vasodilation)
-some slow HR
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14
Q

Angiotensin Converting Enzyme Inhibitors (ACE Inhibitors)

A
  • help dilate/relax blood vessels by blocking the formation of angiotensin II, which is a vasoconstrictor
  • reduces BP
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15
Q

Angiotensin II Receptor Blocker (ARBs)

A
  • helps relax/dilate blood vessels by blocking the action not the formation of angiotensin II, the vasoconstrictor
  • used in pts intolerant of ACE inhibitors
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16
Q

Beta Blockers

A
  • reduce the afterload on the heart
  • dilate blood vessels
  • causes heart to beat more slowly and with less force
17
Q

Combined alpha and beta blockers

A
  • reduce nerve impulses that promote vasoconstriction
  • slows the HR
  • reduces afterload
18
Q

Vasodilators

A

relax the muscle tissue in the blood vessel walls

-lowers BP

19
Q

Central Agonists

A

decrease blood vessels ability to contract and cause vasoconstriction

20
Q

Nursing Assessments

A
  • Neurological Assessment
  • Blood Pressure
  • Heart Rate
  • Examination of optic fundi
  • Auscultation for carotid, abdominal, and femoral bruits (check for blood flow through a stenosed or narrow vessel)
  • Palpation of lower extremities for edema and pulses
  • Serum creatinine, BUN, estimated glomerular filtration rate, and 24 hour urine for creatinine clearance
  • Albumin excretion rate
  • BMI and waist circumference
21
Q

Nursing Actions

A
  • Administer antihypertensive medications as ordered

- Provide pt w/ DASH diet for meals

22
Q

Nurse Teachings

A
  • Adherence to antihypertensive medication regimen and lifestyle changes
  • Moderate exercise
  • Limit alcohol
  • Stress reduction
  • Smoking Cessation
  • Monitoring of BP at home
  • S/S of stroke, aneurysm, and TOD
23
Q

Neurological Assesement

A

assess s/s that could indicate TOD and cerebrovascular disease leading to complications (stroke and aneurysm)

24
Q

Assessment: Blood Pressure

A

early detection and treatment can prevent or minimize TOD

25
Q

Assessment: Heart Rate

A

increased peripheral vascular resistance (PVR) can lead to increased HR or increased stroke volume to compensate for the increased PVR

26
Q

Assessment: Examination of Optic Fundi

A

HTN can lead to retinal damage and eventually retinal hemorrhage b/c of vascular changes caused by HTN

27
Q

Assessment: Auscultation for carotid, abdominal, and femoral bruits

A

bruits are sounds created by blood flow through a stenosed or narrowed vessel

28
Q

Assessment: Palpation of the lower extremities for edema and pulses

A

weak pulses and peripheral edema can = kidney disease and/or HF

29
Q

Assessment: Serum Creatinine, BUN, estimated glomerular filtration rate, and 24 hour urine collection for creatinine clearance

A

-abnormal levels = renal disease

30
Q

Assessment: Albumin excretion rate

A

microalbuminuria (low levels of urinary albumin excretion of 30 to 300 mg/d) is a marker of early cardiac, renal, and retinal structural and functional changes in essential hypertension

31
Q

Assessment: Calculation of BMI and Waist Circumference

A

obesity and diet are major risk factors for HTN

Nursing 272: Final Semester (79 decks)

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