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medsurg
hypertension
| Question | Answer |
|---|---|
| million hearts campaign is | hypertension control change package (HCCP) and is used to improve hypertension control |
| million hearts campaign is important because | americans suffer more than 1.5 million heart attacks and strokes, and HTN increases the risk for the heart disease and stroke |
| million hearts campaign recommends | aspirin for high-risk pts, BP control, cholesterol management, smoking cessation |
| HTN category: normal | SBP: <120 DBP: <80 |
| HTN category: elevated | SBP: 120-129 DBP: <80 |
| HTN category: stage I HTN | SBP: 130-139 DBP: 80-89 |
| HTN category: stage II HTN | SBP: >140 DBP: >90 |
| primary (essential) HTN total to | 95% HTN emergencies |
| primary (essential) HTN has | idiopathic and incidence |
| primary (essential) HTN prevalence increases | with age 65-74 yr = 64% increase in men and 69.3% increase in women |
| modifiable risk factors | salt, obesity, high alcohol intake, smoking |
| non modifiable risk factors | genetic and family Hx = higher chance higher age race |
| secondary HTN results from | another disease process (ex: diseased kidneys or OSA) or side effects from a medication (ex: steroids) |
| HTN affects on the body: arteries of retina | blurred or lost vision |
| HTN affects on the body | overtime thickens heart muscle which then struggles to pump blood through narrow arteries and cuts off blood to the heart, if a piece of the build up breaks off it can lead to MI and HF |
| complications of HTN: end-organ damage | hemorrhage, stroke LVH, CHD, CHF retinopathy peripheral vascular disease renal failure, proteinuria |
| diagnosis of HTN | blood pressure reading |
| accurate BP reading | pt seated in chair, relaxed, legs uncrossed, back and arm supported |
| how many readings are needed | 2 readings with 1-2 minute interval between |
| if disparity | higher value determines, go with the higher level is SBP is normal but DBP is elevated |
| white coat syndrome | pt experiencing increased BP in exam setting but not in other settings, caused by anxiety and stress of seeing a healthcare worker in a white lab coat |
| how to get an accurate reading on someone with white coat syndrome | wait a little to get a more accurate reading |
| diagnostic tests for HTN | routine ECG, CBC, urinalysis, fasting glucose, potassium, sodium, creatinine (tells you about kidneys), cholesterol, lipid profile, HDL, LDL and triglycerides |
| diagnosis of secondary HTN | creatinine clearance, urine albumin, calcium, uric acid, plasma renin activity/aldosterone measurements |
| lifestyle modification | important for all pts lose weight, eat fruits and veggies, reduce salt intake, become active, moderate alcohol intake |
| monitoring salt | decrease sodium CDC rec: no more tha 2300mg/day AHA rec: less than 1500mg/day |
| DASH | dietary approaches to stop HBP |
| DASH diet | grains: 7-8 servings/day veggies: 4-5 servings/day fruits: 4-5 servings/day nonfat/low fat dairy: 2-3 servings/day meats, poultry, fish: <2 servings/day nuts, seeds, beans: 4-5 servings/day |
| exercise reccomendations | 10 minutes at a time, 3x/day and 5 days/week |
| lifestyle modification: weight reduction | decreases SBP: 5-20 mmHg per 10kg of weight loss |
| lifestyle modification: adopting DASH eating plan | decreases SBP: 8-14 mmHg |
| lifestyle modification: dietary sodium reduction | decreases SBP: 2-8 mmHg |
| lifestyle modification: physical activity | decreases SBP: 4-9 mmHg |
| lifestyle modification: moderation of alcohol consumption | decreases SBP: 2-4 mmHg |
| BP goals for pt with HTN | <130/80 using life modifications or meds |
| first line and later line treatments | thiazide type diuretics calcium channel blockers ACE inhibitors - block conversion of angio I to II ARBs |
| stage I HTN treatment | start with modifications single antihypertensive drug BP goal of <130/80 |
| stage II HTN treatment | combination of 2 first-line antihypertensive drugs with an avg BP more than 20/10 mmHg above the BP target |
| better drugs for pts of African descent | thiazide-type diuretics or CCB as initial therapy |
| better drugs for pts with chronic kidney disease | ACE inhibitors or ARBs |
| what is important with ACE inhibitors or ARBs | should not be used simultaneously because they work the same |
| better drugs for HTN with stable ischemic heart disease | beta blockers, ACE inhibitors or ARBs as first line drug therapy |
| better drugs for heart failure with preserved ejection fraction | diuretics prescribed to control fluid overload to get rid of fluid then can be on ACE or ARB after management of fluid overload, prescribed ACE inhibitors or ARBs and beta blockers to attain SBP of <130 |
| better drugs for heart failure with reduced ejection fraction | calcium channel blockers not recommended |
| each medication was about equal in effect however... | wide variability in response some drugs work well with pts and some do not, not clear why |
| when prescribing drugs, you need to consider | cost, concurrent diagnoses, drug interactions GOAL: reach BP target |
| follow up on Tx for HTN | need to monitor Na and K |
| complimentary therapies for HTN | behavioral and mind body therapies yoga, tai chi, mindfulness stress reduction, guided imagery |
| poor treatment adherence | pts not following medical advice because they have no symptoms, medication side effects, cost |
| poor treatment adherence: medication side effects | fatigue, if on diuretic they could be peeing alot, if on beta blockers they could have erectile dysfunction |
| why is pt education so important | they need to know why they have to be on them |
| malignant HTN aka hypertensive crisis | BP over 180/120 |
| symptoms of malignant HTN | blurred vision, ha, confusion or may have no symptoms |
| malignant HTN requires | immediate treatment |
| short term target BP for malignant HTN | less than 160/100 |
| mean arterial pressure should not be | lowered more than 10%-20% in the first hour, should be lowered slowly because of cerebral or cardiac ischemia can happen if its done too fast, then approx 25% during the next 23 hrs |
| malignant HTN adverse outcomes | cerebral edema, retinal hemorrhage, acute renal damage |
| malignant HTN causes | unknown (idiopathic), pt abruptly discontinues meds and then goes off, preeclampsia of pregnancy (post birth) |
| therapy for malignant HTN | medications and immediate actions |
| medications for malignant HTN | nitrates, clonidine, captopril, furosemide (pts with fluid overload) |
| monitor malignant HTN | q5-30 minutes |
| major exceptions for gradual lowering BP | acute ischemic stroke, acute aortic dissection, spontaneous hemorrhagic stroke |
Created by:
leh195