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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

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
Normal BP
<120/<80
26
Elevated BP
120-129/<80
27
Stage 1 HTN BP
130-139/80-89
28
Stage 2 HTN BP
> or equal 140 / > or equal to 90
29
Types of HTN
Primary (Essential, Idiopathic) HTN Secondary HTN
30
Primary HTN
95% of all cases "Essential" or "Idiopathic" HTN Numerous contributing factors
31
Secondary HTN
Less common Stems from another disorders (renal disease, alcohol abuse, pregnancy, etc)
32
Why is 75% of those with HTN not controlled?
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
What sort of complications occur from longstanding, untreated HTN
end-organ damage heart disease angina/MI (CAD) Heart Failure Other vascular disorders Common: Renal Issues - bad bloodflow
34
Metabolic Syndrome
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
What are the 5 things that define metabolic syndrome
1. Abdominal Obesity 2. HTN 3. Dyslipidemia (low HDL, high trig) 4. Hyperinsulinemia (and insulin resistance) 5. Glucose Intolerance
36
What abdominal size is considered obesity for metabolic syndrome in men and women
>35 " in women >40 " in men
37
Causes of Metabolic Syndrome
Abdominal Obesity (Apples v pears - fat in central area) Physical Inactivity Genetic Factors Diet (High saturated fat intake) Aging Hormones
38
Management of HTN Depends on What?
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
What are the 2 big goals for management of HTN
1. Prevention of disability and death | 2. Maintenance of BP lower than 130/80
40
When managing disability r/t HTN what is looked at?
Not the HTN itself but rather the conditions superceding it like cardiovascular disease, kidney disease, and stroke related conditions and neurological impairments
41
What is the big intervention for Stage 1 HTN
Lifestyle Modifications!
42
What sort of things fall under the interventions of lifestyle modifications
Weight loss No nicotine / quit limit substances increasing BP stress management taking meds as prescribed regular med care body movement dietary changes
43
10 pound weight gain can increase Systolic BP by ___ points
4
44
Weight Loss Decreases what things
BP Serum lipids Improves Type II DM Risk for CAD
45
Why does Nicotine cause HTN
Because nicotine causes the release of catecholamines Catecholamines then increase HR and BP
46
What are some substances that increase BP
Caffeine Oral Contraceptives Tricyclic Antidepressants Cold Medicine Steroids Illegal Drugs (narrow arteries) Alcohol
47
How often should one be moving their body to treat HTN
body movement at least 3-4 times a week
48
DASH Diet
Dietary Approaches to Stop Hypertension
49
What sort of things are increased and decreased in the DASH diet
Intake - Fruit, Vegis, Low Fat Dairy Decrease - fats, sweets, red meat, sodium
50
What factors should be looked at during nursing hx and assessment
Hx and Risk Factors Assess Potential Symptoms of Target Organ Damage Personal, Social, Financial Factors
51
What are some potential symptoms of target organ damage
angina SOB altered speech altered vision nosebleeds HA dizziness balance problems nocturia
52
Why is it important to look at peripheral pulses alongside apical pulse with HTN assessment
Because the small vessels to the extremities are compromised with HTN leading to poor circulation
53
What are some patient goals regarding HTN
patient understanding of disease process patient understanding of tx regimen patient participation and willingness in self care absence of complications
54
What are some nursing dx for HTN
knowledge deficit r/t treatment regimen and control of disease process Noncompliance w/ therapeutic regimen r/t SE of prescribed therapy
55
Important HTN Interventions
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
Important Nursing COnsiderations For Administration of Anti HTN Meds
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
Gerontologic Considerations of HTN
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
Hypertensive Crisis
Includes Hypertensive Emergency and Hypertensive Urgency
59
Hypertensive Emergency
BP > 180/120 Must be lowered immediately to prevent damage to the target organs
60
Hypertensive Urgency
BP is v. high but no evidence of immediate or progressive target organ damage
61
What is the goal for the BP after 1 hour, 6 hours, and after a few days for a patient in hypertensive emergency
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
What situation are we not doing gradual BP reduction of Hypertensive Emergency, but rather rapid dropping intervention
Ischemic Stroke and Aortic Dissection
63
Important Aspects of Self Concept and HTN
Personal Identity - why do they have it Body Image Self Esteem Role Performance Stress Management / Stress
64
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
3. Backed chicken, an apple, and a slice of wheat bread
65
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
1. Avoid sudden discontinuation of the drug

NURS362 - Practice of Nursing III (13 decks)

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