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Medical-Surgical Nursing

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