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ch 37 for exam 4

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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