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NURS 3512 - Class 1-6 > Week 3 - Hypertension/Hypertensive Crisis > Flashcards

Week 3 - Hypertension/Hypertensive Crisis Flashcards

1
Q

what is considered HTN

A
  • SBP >140

- or DBP >90

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2
Q

HTN is a risk factor for…

A
  • CAD
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3
Q

BP is determined by

A

CO x SVR

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4
Q

what is cardiac output (CO)

A
  • total blood flow thru the systemic or pulmonary circulation per minute
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5
Q

what is SVR

A
  • systemic vascular resistance

= force opposing the movement of blood within blood vessels

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6
Q

what determines SVR

A
  • radius of arteries & arterioles (vasoconstriction & dilation)
  • a small change in radius of arterioles = major change in SVR
    ex. if SVR is increased but CO remains contstant, BP will increase
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7
Q

what is CO determines by

A
  • stroke volume (amt of blood pumped by the left ventricle per beat) x HR
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8
Q

what are alpha adrenergic receptors located and what do tehy do?

A
  • located in peripheral vasculaure & cause vasoconstriction
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9
Q

where are beta receptors located and what do they do?

A
  • beta 1 = in heart & increase HR, contractility, increased speed of conduction
  • beta 2 = in lungs & cause vasodilation
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10
Q

what role does the RAAS have in BP

A
  • renin secreted if decreased blood flow to kidneys, low BP, sympathetic simultation
    = angio 2= vasoconstriction
    = aldo = keep Na and water

= raised BP

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11
Q

what is isolated systolic HTN

A
  • sustained elevation in SBP >140 but DBP <90
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12
Q

what does isolated systolic HTN result in

A
  • increased pulse pressure (difference between SBP and DBP)
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13
Q

HTN is classified as…

A
  • primary or

- secondary

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14
Q

what is primary HTN

A
  • HTN with an unknown cause
  • thought to be complex interaction between genes and enviro
  • 90-95% of HTN cases
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15
Q

what are contributing factors for primary HTN (12)

A
  • increased SNS activity
  • overproduction of na-retaining hormones & vasoconstrictors
  • obesity
  • increased sodium intake
  • DM
  • excessive alcohol intake
  • advancing age
  • elevated serum lipids
  • more prevalent in males
  • FHx
  • sedentary lifestyle
  • stress
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16
Q

what is secondary HTN

A
  • HTN with a specific cause that can be identified and corrected
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17
Q

what are causes of secondary HTN (7)

A
  • renal disease
  • endocrine disorders
  • neuro disorders
  • sleep apnea
  • meds
  • congential narrowing of aorta
  • pregnancy induced
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18
Q

describe what symptoms of HTN are like

A
  • “silent disease” = frequently asymptomatic until it is severe and target-organ disease has occurred
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19
Q

what is target-organ disease

A
  • when pts with HTN experience a variety of symptoms secondary to effects on blood vessels in various organs and tissues , or to the increased workload of the heart
  • chronic HTN leads to damage of organs
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20
Q

what organs can HTN effects (5)

A
  • heart
  • brain
  • kidneys
  • eyes
  • peripheral vasculature
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21
Q

what symptoms can HTN/target-organ disease cause (6)

A
  • fatigue
  • reduced activity intolerance
  • dizziness
  • palpitations
  • angina
  • dyspnea
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22
Q

what are common complications of HTN caused by

A
  • caused by target organ disease
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23
Q

what complication can occur in the heart due to HTN (4)

A
  • hypertensive heart disease
  • CAD
  • heart failure
  • left ventricular hypertrophy
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24
Q

how does HTN contribute to CAD

A
  • the shear stress results in endothelial dysfnxn = impairement in synthesis & release of nitric oxide = promote development and acceleration of atheroscleoris and plaque formation
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25
Q

how does HTN cause LV hypertrophy

A
  • sustained high BP = increased cardiac workload = hypertrophy
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26
Q

what does LV hypertrophy leads

A
  • intially, its a compensatory mechanism that strengthens cardiac contraction and increases CO
  • then increased contractility increases myocardial work and O2 consumption = heart cannot meet demands = HF
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27
Q

how does HTN lead to HF

A
  • occurs when the heart’s compensatory adaptations are overwhelmed & heart cannot pump enough blood to meet metabolic needs of the body
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28
Q

what complication can occur in the brain d/t HTN (2)

A
  • cerebrovascular disease

- hypertensive encephalopathy

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29
Q

what is cerebrovascular disease

A
  • group of conditions that effect blood flow to the brain
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30
Q

what is the most common cause of cerebrovascular disease

A
  • athersclerosis
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31
Q

what is a major risk factor for cerebral atherosclerosis and stroke

A
  • HTN
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32
Q

what can atherosclerotic plaques in the carotid artery lead to

A
  • can break off and travel to intracerebral vessels = TIA or stroke
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33
Q

when does hypertensive encephalopthy occur

A
  • after a marked rise in BP if the cerebral blood flow cannot be decreased by autoregulation
  • autoregulation = physiological process that maintains constant cerebral blood flow despite fluctuation in arterial BP*
34
Q

what happens in the brain when arterial BP exceeds the body’s ability to autoregulate cerebral blood flow

A
  • cerebral blood vessels suddenly dilate = cerebral edema = increased ICP
35
Q

what complication can occur in the peripheral vasculature d/t HTN

A
  • peripheral vascular disease
36
Q

what is peripheral vascular disease? how does HTN lead to this

A
  • a blood circulation disorder that causes the blood vessels outside of your heart and brain to narrow, block, or spasm
  • HTN = increased atherosclerosis
37
Q

what is a classic symptom of peripheral vascular disease

A
  • intermittent claudication = ischemic muscle pain precipitated by activity and relieved w rest
38
Q

what complication can occur in the kidneys d/t HTN (2)

A
  • nephrosclerosis

- ESRD

39
Q

how does HTN lead to nephrosclerosis

A
  • direct result of ischemia caused by the narrowed lumen of the intrarenal blood vessels
    = eventual death of nephrons
40
Q

what is a sign of nephrosclerosis (3)

A
  • microalbuminuria
  • elevated BUN
  • elevated creatinine
41
Q

what complication occurs in the eyes d/t HTN

A
  • retinal damage
42
Q

what are signs of retinal damage (3)

A
  • blurred vision
  • retinal hemorrhage
  • loss of vision
43
Q

how is HTN diagnosed

A
  • not based on a single elevated BP

- requires severeal elevated BP readings over several weeks

44
Q

what findings can be used to diagnose HTN (6)

A
  • history
  • physical exam
  • electrolytes (K+ indicated hyperaldo)
  • BG (monitor for development of DM)
  • cholestrol and triglyceride lvls
  • ECG
45
Q

what does collaborative care of HTN focus on (3)

A
  • risk stratification
  • lifestyle modifications
  • meds
46
Q

what lifestyle modifications are included in treatment of HTN (6)

A
  • dietary changes
  • limitation of alcohol intake
  • regular physical activity
  • avoidance of tobacco use
  • stress management
  • weight reduction
47
Q

what is emphasized in nutritional therapy for a pt with HTN (6)

A

emphasize

  • fruit
  • veggies
  • low-fat dairy
  • fibre
  • whole grains
  • protein
48
Q

what is reduced in nutritional therapy for a pt with HTN (5)

A
  • sat fats
  • cholestrol
  • sodium
  • maintain K+, Ca, Mg
  • calories restriction if overweight
49
Q

why is weight reduction imp for manageemnt of HTn

A
  • obesity = increased incidence of HTN and increased cardio risk
  • weight reduction = signif effect on lowering BP
50
Q

what weight loss strategies are used for a pt with HTN (3)

A
  • increased physical activity
  • behavioral intervention
  • decreased cal, na, fat
51
Q

why is modification of alcohol consumption imp for treatment of HTN

A

excessive alcohol = strongly associated w HTN

52
Q

what guidelines are used for alcohol consumption

A
  • 2 drinks or fewer per day
  • should not exceed 14 drinks per week for men
  • & 9 drinks per week for women
53
Q

what physical activity guidelines are recommended for pts w HTN

A
  • 30-60 min of moderate intensity exercise, 4-7 days per week
54
Q

what benefits does physical activity have for a pt with HTN (3)

A
  • lowers BP
  • promote relaxation
  • decrease/control body weight
55
Q

why is avoidance of tobacco products imp for treatment of HTN

A
  • nicotine = vasoconstriction = increased BP
56
Q

what drugs are used in treatment of HTN (5)

A
  • diuretics
  • adrenergic inhibitors
  • direct vasodilators
  • RAAS inhibitors
  • Ca channel blockers
57
Q

what action do diuretics have in reduction of BP (4)

A
  • promote Na and water excretion
  • reduce plasma vol
  • reduce vascular response to catecholamines
  • decrease Na in arteriolar walls
58
Q

what do adrenergic inhibitors do?

A
  • diminish the sympathetic effects that increase BP
  • act centrally on vasomotor center
  • inhibit NE release
  • block adrenergic receptos on blood vessels

–> alpha and beta blockers

59
Q

what do direct vasodilators do

A
  • decrease BP by relaxing vascular smooth muscle & cause arteriolar vasodilation by preventing the movement of extracellular Ca into cells
60
Q

what are 2 examples of direct vasodilators

A
  • nitroglycerin

- nipride

61
Q

what are 3 types of RAAS inhibitors

A
  • ACE-I
  • ARBs
  • renin inhibitors
62
Q

describe how layering meds works for treatment of HTN

A
  • start w first drug at low dose, if BP not controlled in several weeks, dosage increased
  • second drug added (or substituted) if the first drug was ineffective or too many s/e (most pts require at least two meds + lifestyle changes)
  • third or fourth med may be added but only if the max doses of the first and second drug have been achieved
63
Q

what is step down therapy

A
  • after 1 year of optimum BP control, step down therapy may be tried
  • number and dose of meds is gradually decreases to the lowest amt required to control BP
64
Q

what is required w step down therapy

A
  • regular follow ups to detect elevations in BP
65
Q

what are potential s/e of diurectis (5)

A
  • hypokalemia
  • hyperglycemia
  • hyperuricemia
  • polyuria
  • dry mouth
66
Q

what are potential side effects pf ACE-I (3)

A
  • coughing
  • angioedema
  • hyperkalemia
  • may be switched to ARB if experiencing these*
67
Q

what are 2 potential side effects of adrenergic inhibitors

A
  • orthostatic hypotension

- sexual dysfnxn

68
Q

what are 2 potential s/e of vasodilators

A
  • orthostatic hypotension

- tachycardia

69
Q

what is important pt teaching r/t meds (5)

A
  • otrho hypotension –> rise slowly when moving from sitting/laying down to upright position
  • encourage to discuss s/e with HCP (esp. sexual dysfunction, as the s/e may be decreased by changing to a diff antiHTN drug)
  • sugarless gum can relieve dry mouth r/t diuretics
  • take diuretics earlier in day to prevent nocturia
  • BP highest after waking up & lowest at night = BP meds with 24 hr duration should be taken eary in morning
70
Q

what is a major challenge in management of HTN

A
  • adherence to prescribed treatment plan (meds, diet, exercise, smoking cessation, etc.)
71
Q

what is hypertensive crisis

A
  • severe & abrupt elevation in BP

- DBP > 120

72
Q

who does hypertensive crisis often occur in

A
  • pts with a hx of HTN who have failed to adhere to meds, or have been undermedicated
  • drug users on cocaine or meth
73
Q

what are S&S of hypertensive crisis (9)

A
  • headache
  • NV
  • seizures
  • confusion
  • stupor, coma
  • blurred vision
  • chest pain
  • dyspnea
  • high BP
  • signs of organ damage)
74
Q

how is hypertensive crisis classified

A
  • degree of organ involvement and rapidity in which the BP must be lowered
75
Q

what do hypertensive emergencies necessitate (3)

A
  • hospitalization
  • parental admin of antiHTN drugs
  • intensive care monitoring
76
Q

what is the initial treatment of hypertensive emergency

A
  • decrease MAP by 10-20% in first 1-2 hours with further gradual reduction over 24 hr
  • drop in BP too far/fast could = decreased cerebral perfusion*
77
Q

what IV drugs are used for hypoternsive crisis (3)

A
  • vasodilators
  • adrenergic inhibitors
  • ACE-I
78
Q

what is the most effective parental drug for treatment of hypertensive crisis

A
  • IV sodium nitroprusside (nipride, nitrate)
79
Q

what should you monitor during treatment of hypertensive crisis (6)

A
  • BP and pulse every 2-3 min during initial admin
  • continual ECG monitoring
  • hourly urinary output
  • neuro checks
  • assess cardiac, renal, pulmonary systems for decompensation r/t elevated BP
  • pt may be restricted to bed
80
Q

what is the onset of nipride

A
  • seconds to minutes
81
Q

the rate of drug admin is determined how for hypertensive crisis

A
  • titrated according to lvl of BP
82
Q

what should you monitor during HTN crisis (4)

A
  • BP
  • cardiac monitoring
  • dysrhythmias
  • UO –> could be low d/t nitroprusside

NURS 3512 - Class 1-6 (47 decks)

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