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hypertension
ch 37 for exam 4
| Question | Answer |
|---|---|
| definition of hypertension | persistent BP greater than or equal to 140/90 or the current use of hypertensive medication |
| what does culture have to do with it? | detected in people 30-50 and is increasingly being found in children |
| secondary hypertension | more common in preadolescences with most cases caused by renal disease; underlying factors such as kidney disease, arterial conditions, drugs and pregnancy |
| primary hypertension | more common in adolescents; 90-95% of all cases, unk cause, |
| hypertension | the silent killer because it often has no symptoms |
| complications of HTN | damage to the heart, blood vessels, kidneys, brain, eyes, MI, HF, stroke, kidney disease, blindness, most predominant in african-american males |
| prehypertension | 120-139/80-89 |
| stage 1 HTN | 140-159/90-99 |
| stage 2 HTN | ↑160/100 |
| HTN risk groups | A= no major risk factors, no target organ damage B= one or more risk factors not including diabetes, no target organ damage C= organ damage, cardiovascular disease with or without other risk factors |
| isolated pressure elevations | caused by atherosclerosis, occur in older adults |
| factors that determine BP | cardiac output and peripheral vascular resistance BP=CO x PVR |
| CO | the volume of blood pumped by the heart in one minute |
| PVR | force in the blood vessels that the LV must overcome to eject blood from the heart |
| diameter of blood vessels | regulated by vasomotor center; SNS extends from the medulla to the spinal cord to the thoracic and abd region |
| stimulation of SNS | causes release of epi and norepi= catecholamines= vasoconstrictors; |
| vasoconstriction causes | blood flow to the kidneys to be restricted which leads to the production of renin |
| renin production leads to | the formation of angiotensin |
| angiotensin stimulates | the adrenal cortex to secrete aldosterone |
| aldosterone is a | hormone that promotes sodium and water retention |
| age related changes affecting BP | atherosclerotic changes; decreased CO and increased PVR; pulse pressure widens in response to decreased elasticity of aorta |
| PVR increases | 1% for every year above 60 |
| risk factors for HTN | dyslipidemia, atherosclerosis, DM, tabacco use, men over 55 and women over 65, family hx, sedentary lifestyle, obesity, stress, stimulants |
| S&S of HTN | no symptom, occipital HA, light-headedness, epistaxis, organ damage |
| sustained HTN | causes the LV to work harder which causes hypertrophy and HF |
| indications of renal failure | nocturia, azotemia, proteinuria, hematuria |
| azotemia | accumulation of nitrogen waste products in the blood; |
| treatment of HTN | goal = gradually reduce PVR and BP |
| lifestyle modification | quit smoking, sodium and alcohol restriction, relaxation techniques, exercise, |
| pharmacologic therapy | used if lifestyle modification does not achieve a reduced BP; JNC recommends hydrochlorothiazide for initial therapy |
| diuretics | thiazide type, loop, potassium sparing; especially effective in treating african american pts; |
| monitor pts taking diuretics for | fluid and electrolyte imbalances, I&O |
| beta-adrenergic receptor blockers | (lols) decreased HR, strength of cardiac contraction and bronchial constriction; labetalol is less effective for african-americans; |
| SE of beta-adrenergic receptor blockers | bradycardia, hypotension, increased LDLs; contraindicated in pts with asthma, hypoglycemia, COPD, heart block, CHF; |
| NC for beta-adrenergic receptor blockers | monitor of bradycardia, hypotension, hypoglycemia - diaphoresis may be only sign |
| calcium antagonists | (zem and pines) reduce HR, decreases force of contration, dilates peripheral blood vessels |
| SE of calcium antagonists | flushing, dizziness, HA |
| NC for calcium antagonits | monitor for hypotenion, bradycardia, and edema |
| angiotensin-converting enzyme inhibitors ACE | decreases peripheral resistance, decrease fluid retention, |
| SE of ACE | chronic cough, dizziness, HA, fatigue, angioedima, hyperkalemia, hypotension |
| angiotensin II receptor antagonists | (tans) prevent vasoconstriction in response to angiotensin, prevent the release of aldosterone which reduces blood volume, |
| SE of angiotensin II receptor antagonists | dizziness |
| central andrenergic blockers | inhibit impulses from the vasomotor center that maintain the muscle tone in blood vessels, reduces peripheral resistance; clonidine and methyldopa |
| alpha-adrenergic receptor blockers | (sins) reduce peripheral resistance |
| SE of alpha-adrenergic receptor blockers | orthostatic hypotension, dizziness, HA and drowsiness |
| NC for alpha-adrenergic receptor blockers | pt should lie down for 2 hours after initial dose of when increasing dose, best given at HS for this reason |
| NC for administering HTN drugs | monitor for therapeutic and adverse effects, pt education |
| NC for pts with HTN | early detection, education and promotion of adherence are the keys to BP control; |
| BP cuff too small | false high |
| BP cuff too big | false low |
| most accurate BP reading | assess systolic pressure by palpation of brachial pulse while inflating the cuff |
| most valid BP reading | are obtained in the home |
| if BP is elevated initially | reassess it again in 1-5 minutes |
| if BP is severely elevated | diastolic above 115 the pt is in imminent danger of a stroke and immediate medical care is needed |
| DASH diet | is high in fruits and veggies, low fat, whole grains, poultry and fish, nuts, K, C and mg, |
| sodium | no more than 2 g; RDA is 2400 mg |
| orthostatic hypotension | sudden drop in SBP of 20 mmHg when going from a lying or sitting position to a standing position |
| common side effect of many antiHNT drugs | sexual dysfunction |
| hypertensive emergencies | severe HA, blurred vision, nausea, restlessness and confusion with very elevated BP - DBP ↑ 130; |
| malignant HTN | DBP above 140, most common in african american men ages 30-40 |
| TX of hypertensive emergency | goal: rapidly reduce BP to nonlife-threatening level and then bring it slowly within normal range |
| NC for pts in hypertensive emergency | closely monitor BP, pulse, resp, LOC, IV access, I&O, N/V may indicate impending seizure or coma, interventions: take VS before each dose of medication; seizure measures to be taken- raise bed rails, elevate HOB, education |
Created by:
nursingTSJC2013
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