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Foundations 2 > Unit 3- Hypertension > Flashcards

Unit 3- Hypertension Flashcards

1
Q

4 bodily mechanisms that regular BP

A
  1. arterial baroreceptors
  2. regulation of body-fluid volume
  3. renin-angiotensisn system
  4. vascular autoregulation
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2
Q

arterial baroreceptors

A
  • located in carotid sinus, aorta, L ventricle and send stretch signals to CNS
  • control BP by altering HR
  • also cause vasoconstriction/dilation
  • short term effect
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3
Q

regulation of body fluid volume

A

•properly fxning kidneys retain (hypotensive) or excrete (hypertensive) fluid

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4
Q

renin-angiotensin system

A

•vasoconstricts
•controls aldosterone release, which causes kidneys to reabsorb Na+ and inhibit fluid loss
*increases blood volume and pressure

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5
Q

vascular autoregulation

A

•maintains consistent levels of tissue perfusion

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6
Q

systolic pressure

A

•pressure that L ventricle must generate to pump blood into system

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7
Q

diastolic pressure

A

•pressure on arterial walls during relaxation (filling) phase of cardiac cycle

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8
Q

preload

A
  • circulating volume

* volume entering R side of heart

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9
Q

afterload

A

•pressure L ventricle has to overcome to eject blood into circulation

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10
Q

what influence BP

A

•cardiac output
-CO= SVxHR
•peripheral vascular resistance
-maintained by ANS, epi, and NE

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11
Q

increased PVR, HR, or SV…

A
  • systemic arterial pressure increases

* BP elevated

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12
Q

decreased PVR, HR, or SV…

A
  • systemic arterial pressure decreases

* BP lowered

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13
Q

hypertension

A
  • systolic BP at or above 140 mmHg

* or diastolic BP at or above 90 mmHg

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14
Q

essential (primary) hypertension

A
  • most common HTN
  • no known cause
  • results in damage to vital organs caused by medial hyperplasia (thickening) of arterioles
  • end result = MI, stroke, PVD, renal failure
  • short life expectancy
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15
Q

secondary hypertension

A
  • caused by certain dz states or an adverse effect of some meds
  • tx involves removing the cause (adrenal tumor, med, etc)
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16
Q

dz states that can cause HTN

A
  • renal dz
  • RAS- renal artery stenosis
  • Cushing’s syndrome
  • Pregnancy (preeclampsia)
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17
Q

drugs that can cause HTN

A
  • estrogen

* glucocorticoids

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18
Q

pre-hypertension

A

•systolic BP of 120-139
•diastolic BP of 80-89
*life-style changes necessary to prevent CVD

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19
Q

incidence of HTN

A
  • highest in AA females
  • more men before age 45
  • more women after age 54
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20
Q

isolated systolic hypertension (ISH)

A

•systolic > 140
•diastolic < 90
•major concern for OA
-systolic BP better indicator of risk for heart dz, stroke, PVD as people age

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21
Q

malignant HTN

A

•severe elevated BP that rapidly progresses
•systolic > 200
•diastolic > 150
•age 30-50
*must treat promptly to avoid renal/LV failure and stroke

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22
Q

s/s malignant HTN

A

•blurred vision
•dyspnea
•uremia
*most prevalent in the morning

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23
Q

uremia

A

•kidney not filtering blood

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24
Q

risk factors for essential HTN

A
  • family hx
  • AA ethnicity
  • hyperlipidemia
  • excess caffeine/Na/etoh
  • smoking
  • stress
  • overweight/obesity; inactive
  • low K, Ca, Mg
  • age > 60
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25
Q

what increase SV

A
  • more viscous blood

* anything that causes vasoconstriction

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26
Q

CO drop

A
  • vessels vasoconstrict to maintain BP

* possible result of atherosclerosis

27
Q

HTN complications

A
  • PVD
  • End organ damage (retina, kidney, heart)
  • LVH
  • MI
  • stroke
  • atherosclerosis
  • nephrosclerosis
28
Q

left ventricular hypertrophy (LVH) etiology

A
  • heart pumping against extreme resistance caused by HTN

* tall R waves on EKG

29
Q

nephrosclerosis

A
  • hardening of the renal arterioles with reduced blood flow and contraction of the kidney
  • terminates with uremia and renal failure
30
Q

s/s HTN

A 
•headaches (AM)
•dizziness
•fainting
•visual changes/disturbances
•nocturia
•elevated BP in both arms
*often asymptomatic until organ damage occurs
31
Q

labs for HTN

A

•no labs for HTN, but labs for damage

  • elevated BUN -> renal dz
  • elevated creatinine -> renal dz
  • elevated corticoids -> Cushing’s dz
32
Q

diagnostic procedures for HTN

A
  • EKG for LVH (tall R)

* chest x-ray to show cardiomegaly

33
Q

non-pharmalogical HTN tx

A

•lifestyle changes

  • restrict Na intake
  • lose weight (BMI < 30)
  • reduce etoh/caffeine
  • stop smoking
  • exercise
  • de-stress
34
Q

pharmacologic HTN tx considerations

A

•specific to individual
•must teach patients
-trial and error to find most therapeutic
-change positions slowly
-be careful driving, moving, etc until effects known

35
Q

thiazide diuretics

A

•anti-hypertensive
•inhibits H2O and NA reabsorption
•increase K+ excretion
*hydrochlorothiazide (Hydrocot)

36
Q

loop diuretics

A

•anti-hypertensive
•decrease Na reabsorption
•increase K+ excretion
*furosemide (Lasix)

37
Q

K+ sparing diuretics

A 
•anti-hypertensive
•prevent reabsorption in DCT
•prevent reabsorption of Na
•INCREASE K+ levels
*Spironolactone (Aldactone)
38
Q

diuretic admin considerations

A
  • watch K+ levels closely

* monitor for hypotension

39
Q

calcium channel blockers

A

•act on Ca2+ channels in cell membrane, causing VASODILATION and decreasing BP
•use cautiously in HF pts
*Verapamil, amlodipine, diltiazem

40
Q

CCB adverse effects

A

•constipation
•AV block
*pt must monitor pulse and notify MD if irregular or lower than norm

41
Q

ACE inhibitors

A

•reduce BP by preventing vasoconstriction via inhibition of angio-II formation
*Enalapril, Captopril, Lisonipril

42
Q

ACEI adverse effects

A
  • hypotension
  • HF
  • renal failure
  • cough
  • angioedema
43
Q

angiotensin II receptor antagonissts

A

•used for pts w/ too many SE to ACEIs or w/ hyperkalemia
•can cause angioedema or HF
*Cozaar, Micardis

44
Q

aldosterone receptor antagonists

A

•block action of aldosterone, promoting retention of K+ and excretion of Na
*Inspra

45
Q

aldosterone receptor antagonists adverse effects

A 
•hyponatremia
•hyperkalemia
•elevated triglycerides
•interacts w/ GF juice
*don't take w/ K+ supplement
46
Q

beta blockers

A

•lower BP by decreasing CO and blocking release of renin

-decrease pulse AND vasoconstrict

47
Q

beta blocker adverse effects

A 
•fatigue
•weakness
•depression
•sexual dysfunction 
•hypoglycemia
•rebound HTN if stopped abruptly 
*metoprolol, atenolol
48
Q

central-alpha agonists

A

•decrease BP by reducing PVR and inhibiting reuptake of NE
•not a first line med b/c causes sedation, orthostatic hypotension, impotence
*clonidine (Catapres)

49
Q

alpha-adrenergic antagonists

A

•decrease BP by causing vasodilation
•start w/ low dose
•postural hypotension very common, so don’t drive until know effects
*minipress (Prazosin)

50
Q

ABPM

A

•ambulatory BP monitoring

51
Q

compliance w/ anti-HTN medication regimen based on…

A

•access to resources
•dosages/time
•side effects/interactions
*pt should take continuously and not stop suddenly

52
Q

nursing education for anti-HTN meds

A
  • ABPM
  • see PCP often
  • teach compliance
  • encourage lifestyle changes
53
Q

DASH diet

A
  • Dietary Approaches to Stop HTN
  • eat more fruits, vegetables, whole grains, fish, poultry, nuts
  • reduce red meat, saturated fats, sweets, sodium
54
Q

exercise for HTN patient

A
  • 150 minutes of moderate exercise/week

* strengthening at least 2x/week

55
Q

hypertensive crisis

A
  • occurs when pt doesn’t follow medication therapy regimen

* true medical emergency

56
Q

s/s hypertensive crisis

A 
•severe headache
•extremely high BP
-systolic > 240
-diastolic > 120
•blurred vision, dizziness, disorientation
•epistaxis
57
Q

hypertensive crisis RN tx

A 
•IV anti-hypertensive
-monitor BP every 5-15 min
•assess neurological status (pupils, LOC, strength)
•monitor ECG
•provide O2
•place in semi-Fowlers
58
Q

The nurse is caring for a patient who has severely elevated blood pressure. What symptom supports this condition

A

•epistaxis

59
Q

What is true about the management of HTN?

A

•lifestyle changes are indicated for persons with HTN

60
Q

The patient has a long history of HTN and has developed heart failure. The nurse would anticipate giving meds to do what?

A

•decrease after load

61
Q

What is NOT considered an influence on BP?

A

•respiratory rate

62
Q

A nurse is working with a newly diagnosed HTN patient who smokes, is overweight, and has never taken medication. What should the nurse take into consideration when educating this patient on lifestyle changes needed to regulate his BP?

A

•the patient should develop small measurable goals to achieve which will be more effective in the long run

63
Q

A patient who enters the ED has an initial BP reading of 160/96. What should the nurse do?

A

•take the BP again to ensure an accurate reading before proceeding

Foundations 2 (10 decks)

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