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NURS362 - Practice of Nursing III > Week 11: Nursing Management of the Client w/ HTN > Flashcards

Week 11: Nursing Management of the Client w/ HTN Flashcards

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1
Q

What is the most commo risk factor for cardiovascular disease?

A

Hypertension

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2
Q

What is difficult regarding HTN

A

it is a silent/quiet disease so typically it is very hard to see symptomology-wise

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3
Q

The American Heart Association defines HTN as what

A

SBP >130

DBP >80

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4
Q

What does HTN effect in reference to the vessel walls

A

Increases the pressure on the vessel walls

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5
Q

What does HTN effect in reference to rates of atherosclerosis

A

increases the rate of atherosclerosis

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6
Q

What does HTN do in regard to the vessel lumen?

A

Increases narrowing of the vessels (obstruction)

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7
Q

What does HTN do to the organs?

A

It damages the small vessels to the organs

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8
Q

What does HTN do to the heart

A

increases the workload

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9
Q

HTN increases incidence of …

A

thrombus formation

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10
Q

HTN particularly damages the vessles in the ____, ____ and ___

A

Brain

Kidney

Heart

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11
Q

HTN leads to increased workload of the heart, so what can occur after that

A

R/L Ventricle Hypertrophy and Ventricle Dilation

This enlargement leads to increased ventricular workload leading to trouble functioning

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12
Q

There is a sharp increase in what with HTN

A

Thrombus Formation (particularly in the brain)

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13
Q

HTN Related Thrombi can cause what

A

Infarcts

CVA

Mesenteric, Renal Artery Thrombi

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14
Q

What gender is more likely to have HTN

A

Male

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15
Q

What groups have higher incidence of HTN

A

Non Hispanic AA > Non Hispanic Caucasian > Non Hispanic Asian > Hispanic

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16
Q

1 in ___ children meet the HTN guidelines currently

A

1 in 25

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17
Q

Risk Factors for HTN

A

Family Hx of Cardiac Diseases and HTN Increased Risk

Smoking

Dyslipidemia (Cholesterol Narrows the vessels more)

Diabetes Mellitus (decreased vascularity and hardening of the vessels)

Obesity

Inactivity

Poor Educatuin

Low SES

Older Age

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18
Q

What are the Hypertension Disparities African Americans Face Compared to other groups

A

Highest Prevalence of HTN

Develop at a younger age

Higher Mortality Rate

Women > Men

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19
Q

What is the relationship between African Americans and ACE Inhibitors

A

Do NOT respond well to ACE Inhibitor drugs - disparity in HTN rates then

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20
Q

What are the HTN Disparities Hispanic Americans Face Compared to other groups

A

Lower Awareness of HTN and tx

Less likely to receive treatment than AA or Cauc.

Lower rates of adequate BP Control

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21
Q

What are the HTN Disparities Asian Americans Face Compared to other groups

A

Similar disparities to AA

Higher incidences of SE w/ ACE Inhibitors

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22
Q

What are the HTN Disparities Native Americans Face Compared to other groups

A

lower rates of BP control than AA and Cauc

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23
Q

Male Gender Differences for HTN

A

HTN More common BEFORE age 55

More likely to suffer an MI than stroke

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24
Q

Female Gender Differences for HTN

A

HTN more common after 55

More likely to suffer a stroke than an MI

Links to menopause related factors and oral contraceptive use

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25
Q

Normal BP

A

<120/<80

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26
Q

Elevated BP

A

120-129/<80

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27
Q

Stage 1 HTN BP

A

130-139/80-89

28
Q

Stage 2 HTN BP

A

> or equal 140 / > or equal to 90

29
Q

Types of HTN

A

Primary (Essential, Idiopathic) HTN

Secondary HTN

30
Q

Primary HTN

A

95% of all cases

“Essential” or “Idiopathic” HTN

Numerous contributing factors

31
Q

Secondary HTN

A

Less common

Stems from another disorders (renal disease, alcohol abuse, pregnancy, etc)

32
Q

Why is 75% of those with HTN not controlled?

A

Excess Body Weight (High Obesity in USA)

Insufficient Physical Activity

Lifestyle Modifications - may not feel they can do it

Complacency among providers

Poor compliance

absence of symptoms (AKA “The silent killer”)

33
Q

What sort of complications occur from longstanding, untreated HTN

A

end-organ damage

heart disease

angina/MI (CAD)

Heart Failure

Other vascular disorders

Common: Renal Issues - bad bloodflow

34
Q

Metabolic Syndrome

A

A group of physical characteristics/conditions that appear to predispose people to heart disease

May require interventions to delay or prevent heart disease

One of the characteristics is related to HTN

Also called “Insulin Resistance Syndrome,” “Syndrome X,” or “Cardiovascular Dysmetabolic Syndrome”

35
Q

What are the 5 things that define metabolic syndrome

A
  1. Abdominal Obesity
  2. HTN
  3. Dyslipidemia (low HDL, high trig)
  4. Hyperinsulinemia (and insulin resistance)
  5. Glucose Intolerance
36
Q

What abdominal size is considered obesity for metabolic syndrome in men and women

A

> 35 “ in women

> 40 “ in men

37
Q

Causes of Metabolic Syndrome

A

Abdominal Obesity (Apples v pears - fat in central area)

Physical Inactivity

Genetic Factors

Diet (High saturated fat intake)

Aging

Hormones

38
Q

Management of HTN Depends on What?

A
  1. BP Reading
  2. Presence of Risk Factors (Modifiable v Non-Modifiable)
  3. Presence of Organ Damage (Blood pressure goals lower than for those w/ no complications)
39
Q

What are the 2 big goals for management of HTN

A
  1. Prevention of disability and death

2. Maintenance of BP lower than 130/80

40
Q

When managing disability r/t HTN what is looked at?

A

Not the HTN itself but rather the conditions superceding it like cardiovascular disease, kidney disease, and stroke related conditions and neurological impairments

41
Q

What is the big intervention for Stage 1 HTN

A

Lifestyle Modifications!

42
Q

What sort of things fall under the interventions of lifestyle modifications

A

Weight loss

No nicotine / quit

limit substances increasing BP

stress management

taking meds as prescribed

regular med care

body movement

dietary changes

43
Q

10 pound weight gain can increase Systolic BP by ___ points

A

4

44
Q

Weight Loss Decreases what things

A

BP

Serum lipids

Improves Type II DM

Risk for CAD

45
Q

Why does Nicotine cause HTN

A

Because nicotine causes the release of catecholamines

Catecholamines then increase HR and BP

46
Q

What are some substances that increase BP

A

Caffeine

Oral Contraceptives

Tricyclic Antidepressants

Cold Medicine

Steroids

Illegal Drugs (narrow arteries)

Alcohol

47
Q

How often should one be moving their body to treat HTN

A

body movement at least 3-4 times a week

48
Q

DASH Diet

A

Dietary
Approaches to
Stop
Hypertension

49
Q

What sort of things are increased and decreased in the DASH diet

A

Intake - Fruit, Vegis, Low Fat Dairy

Decrease - fats, sweets, red meat, sodium

50
Q

What factors should be looked at during nursing hx and assessment

A

Hx and Risk Factors

Assess Potential Symptoms of Target Organ Damage

Personal, Social, Financial Factors

51
Q

What are some potential symptoms of target organ damage

A

angina

SOB

altered speech

altered vision

nosebleeds

HA

dizziness

balance problems

nocturia

52
Q

Why is it important to look at peripheral pulses alongside apical pulse with HTN assessment

A

Because the small vessels to the extremities are compromised with HTN leading to poor circulation

53
Q

What are some patient goals regarding HTN

A

patient understanding of disease process

patient understanding of tx regimen

patient participation and willingness in self care

absence of complications

54
Q

What are some nursing dx for HTN

A

knowledge deficit r/t treatment regimen and control of disease process

Noncompliance w/ therapeutic regimen r/t SE of prescribed therapy

55
Q

Important HTN Interventions

A

patient teaching

encourage adherence to treatment regimen

consultation / collaboration

follow up care

emphasize control rather than cure

reinforce and support lifestyle changes

lifelong process

referrals as necessary

56
Q

Important Nursing COnsiderations For Administration of Anti HTN Meds

A

check BP and HR BEFORE administration

parameters for when to hold

SE

acute/chronic issues affecting BP/HR

  • we want to know parameters and baseline so we dont bottom out the patient’s BP *
57
Q

Gerontologic Considerations of HTN

A

Postural Hypotension More Common - fall risk

Nonadherence to the Plan more common

Need to include the family/support system

Financial and Transportation Considerations

Understanding of therapeutic regimen - reading instructions and understand, and monotherapy

58
Q

Hypertensive Crisis

A

Includes Hypertensive Emergency and Hypertensive Urgency

59
Q

Hypertensive Emergency

A

BP > 180/120

Must be lowered immediately to prevent damage to the target organs

60
Q

Hypertensive Urgency

A

BP is v. high but no evidence of immediate or progressive target organ damage

61
Q

What is the goal for the BP after 1 hour, 6 hours, and after a few days for a patient in hypertensive emergency

A

Reduce BP 25% in 1 hour

Reduce to 160/100 over 6 hours

Gradual reduction from there to normal over the next few days

62
Q

What situation are we not doing gradual BP reduction of Hypertensive Emergency, but rather rapid dropping intervention

A

Ischemic Stroke and Aortic Dissection

63
Q

Important Aspects of Self Concept and HTN

A

Personal Identity - why do they have it

Body Image

Self Esteem

Role Performance

Stress Management / Stress

64
Q

The nurse teaches the client , who has recently been diagnosed with hypertension, about his diet restrictions: a low-calorie, low-fat, low sodium diet. Which of the following menu selections would best meet the client’s needs?

  1. Mixed green salad with blue cheese dressing, crackers and cold cuts
  2. Ham sandwich on rye bread and an orange
  3. Baked chicken, an apple, and a slice of wheat bread
  4. Hot dogs, baked beans, and celery and carrot sticks
A
  1. Backed chicken, an apple, and a slice of wheat bread
65
Q

An industrial nurse at a large printing plant finds a male employee’s blood pressure to be elevated on two occasions 1 month apart and refers him to his private physician. The employee is about 25 lbs. overweight and has smoked a pack of cigarettes daily for more than 20 years, The client’s physician prescribes (atenolol) Tenormin for the hypertension. The nurse should instruct the client to:

  1. Avoid sudden discontinuation of the drug
  2. Monitor BP annually
  3. Follow a 2 g sodium diet
  4. Discontinue the medication if severe HA develops
A
  1. Avoid sudden discontinuation of the drug

NURS362 - Practice of Nursing III (13 decks)

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