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Hypertension
Medical-Surgical Nursing
| Question | Answer |
|---|---|
| What is the "silent killer?" | Hypertension |
| What is the definition of hypertension? | A blood pressure (BP) of 130/80 mmHg or above |
| What is blood pressure? | The force exerted by the blood against the walls of the blood vessel |
| Which race has the highest prevalence of hypertension? | African-Americans |
| Which gender is more likely to have hypertension before middle age? | Men |
| Why is hypertension more common in women after age 64 years? | It's attributed to menopause-related factors (e.g., estrogen withdrawal) |
| How does the nervous system increase BP? | By activating the sympathetic nervous system (SNS) |
| What are baroreceptors? | Specialized nerve cells located in the carotid arteries and arch of the aorta |
| What is renin? | An enzyme that converts angiotensinogen into angiotensin I |
| What converts angiotensin I to angiotensin II? | Angiotensin-converting enzyme (ACE) |
| Is angiotensin II a vasodilator or vasoconstrictor? | Vasoconstrictor |
| How does angiotensin II affect BP? | It increases BP by being a potent vasoconstrictor and by stimulating the secretion of aldosterone |
| How do prostaglandins affect BP? | They're vasodilators; therefore, they lower BP |
| What is natriuresis? | Excretion of sodium in the urine |
| What releases aldosterone? | The adrenal cortex |
| How does aldosterone affect the kidneys? | It stimulates them to retain sodium and water, thereby increasing BP |
| What stimulates the release of aldosterone? | Angiotensin II |
| What are other names for primary hypertension? | Idiopathic or essential hypertension |
| What is primary hypertension? | An elevated BP without an identified cause |
| What is secondary hypertension? | Elevated BP with a specific cause that can often be identified and corrected (e.g., cirrhosis of the liver) |
| What are cardiovascular complications of hypertension? | Coronary artery disease (CAD), left ventricular hypertrophy, heart failure, cerebrovascular disease, peripheral vascular disease (PVD), and aneurysms |
| What is the most common cause of cerebrovascular disease? | Atherosclerosis |
| What occurs when the heart's compensatory mechanism are overwhelmed and enough blood can no longer be pumped? | Heart failure |
| What can occur after a marked rise in BP if cerebral blood flow is not decreased by autoregulation? | Hypertensive encephalopathy |
| What is autoregulation? | A physiologic process that maintains constant cerebral blood flow despite fluctuations in BP |
| What are peripheral venous complications of hypertension? | Peripheral vascular disease (PVD), aortic aneurysm, and aortic dissection |
| What is an early manifestation of renal disease? | Nocturia |
| What are manifestations of severe retinal damage? | Blurred vision, retinal hemorrhage, and loss of vision |
| What labs should be done routinely to assess for renal involvement with hypertension? | Urinalysis, BUN, and creatinine levels |
| What test is performed if left ventricular hypertrophy is suspected? | Echocardiography |
| When is ambulatory BP monitoring indicated? | White coat hypertension, suspected antihypertensive drug resistance, hypotensive symptoms with antihypertensive drugs, episodic hypertension, or SNS dysfunction |
| What does the DASH eating plan emphasize? | Fruits, vegetables, low-fat dairy products, whole grains, fish, poultry, beans, seeds, and nuts |
| What are some lifestyle modifications to help prevent or reduce hypertension? | Weight reduction, DASH diet, moderation of alcohol and sodium intake, increasing aerobic exercise, smoking cessation, and management of psychosocial risk factors |
| How does nicotine affect BP? | It causes vasoconstriction, which increases BP |
| What is resistant hypertension? | The failure to reach goal BP in patients taking full doses of an appropriate 3 drug regimen that includes a diuretic |
| What is a common cause of resistant hypertension? | Overactive renal nerves |
| What are S/S of hypertension? | BP at or above 130/80 mmHg, epistaxis, facial flushing, dizziness, and headache |
| What are primary prevention methods for hypertension? | Lifestyle modifications that prevent, or delay, rise in BP in at-risk people (e.g., DASH diet) |
| What is orthostatic hypotension? | A decrease in SBP of 20 mmHg and 10 mmHg in DBP and/or an increase in pulse of 20 bpm when a patient moves from supine to standing |
| What are common causes of orthostatic hypotension? | Dehydration and inadequate vasoconstrictor mechanisms related to disease or drugs |
| When does hypertensive crisis occur? | When SBP is greater than 180 mmHg and/or DBP greater than 110 mmHg |
| What is the difference between hypertensive urgency and emergency? | The presence or absence of target organ damage |
| Describe hypertensive urgency. | Develops over hours or days and has no clinical evidence of target organ damage |
| Describe hypertensive emergency. | Has clinical evidence of target organ disease and requires hospitalization |
| What can occur if hypertensive emergency is left untreated? | Encephalopathy, intracranial or subarachnoid hemorrhage, heart failure, MI, renal failure, dissecting aortic aneurysm, or retinopathy |
| What is used in guiding and evaluating drug therapy in hypertensive emergency? | Mean arterial pressure (MAP) |
| How is mean arterial pressure (MAP) determined? | MAP= (SBP+2DBP)/3 |
| What happens if hypertensive emergencies are lowered too quickly? | Can decrease cerebral, coronary, or renal perfusion |
| What is the most effective IV drug to treat hypertensive emergencies? | Sodium nitroprusside |
| Which calcium channel blocker is used to treat hypertensive emergencies? | Clevidipine |
| How often should you assess V/S when initially giving IV antihypertensive drugs for hypertensive emergencies? | Every 2-3 minutes |
| True or False: Hypertensive urgencies can be managed with oral agents. | True |
Created by:
shrewsburysd
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