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medsurg
hypertension
| Question | Answer |
|---|---|
| hypertension (HTN) | defined as a blood pressure (BP) ≥ 130/80 mmHg or currently receiving pharmacological treatment to lower blood pressure. |
| million hearts campaign | 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 (ABCS of heart health) |
| Normal BP | <120/80 |
| HTN elevated BP | 120-129/ <80 |
| HTN stage I | 130-139/ 80-90 |
| HTN stage II | >140/ >90 |
| primary (essential) HTN | idiopathic (unknown cause) incidence |
| primary (essential) HTN modifiable risk factors | diet, sodium intake, alcohol, smoking, obesity |
| primary (essential) HTN nnon-modifiable risk factors | genetics, family Hx, age, race |
| secondary hypertension | results from another disease (ex: sleep apnea) or side effects of medications (ex: prednisone) |
| HTN affects on 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 |
| HTN effects on eyes | burry or lost vision retinopathy |
| complications of hypertension: end organ damage | hemorrhage, stroke, LVH, CHD, CHF, retinopathy, PVD, renal failure, proteinuria |
| diagnosis of HTN | BP reading |
| diagnosis of HTN position | seated in chair, relaxed, legs uncrossed, back and arms supported |
| diagnosis of HTN requirements | 2 readings with two minutes between. both arms average of >2 readings taken at >2 office visits. |
| white coat syndrome | pt experiencing increased BP in clincal 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 minutes after to take it |
| diagnostic tests for HTN routine | routine ECG, CBC, urinalysis, fasting glucose, potassium, sodium, creatinine (tells you about kidneys), cholesterol, lipid profile, HDL, LDL and triglycerides |
| diagnosis for secondary HTN | creatinine clearance, urine albumin, calcium, uric acid, plasma renin activity/aldosterone measurements |
| lifestyle modifications | important for everyone lose weight, eat fruits and veggies, reduce salfe intake, become active, moderate alcohol intake |
| restrictions of salt | decrease NA intake CDC recommends no more than 2300mg/day AHA recommends less than 1500mg/day |
| DASH acronym | 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 | exercise 10 minutes at a time, 3 times a day, 5 days a week can help to lower blood pressure |
| lifestyle modification: weight reduction | maintain normal body weight (BMI 18.5-24.9) decreases systolic 5-20 mmHg per 10kg of weight loss |
| lifestyle modification: DASH diet | decreases systolic 8-14 mmHg |
| lifestyle modification: sodium intake | decreases systolic 2 to 8 mmHg |
| lifestyle modification: physical activity | decreases systolic 4-9 mmHg |
| lifestyle modification: moderation of alcohol | decreases systolic 2 to 4 mmHg |
| blood pressure GOAL for someone with HTN | <130/80 |
| first line and later line Tx | thiazide duretics calcium channel blockers Angiotensin Converting Enzyme inhibitors (ACE inhibitors) Angiotensin Receptor Blockers (ARBs) |
| stage 1 hypertension Tx | single antihypertensive drug BP goal of <130/80 |
| stage 2 hypertension Tx | combination of 2 first line antihypertensive drugs with an average BP more than 20/10 mmHg above BP target |
| best drugs for pts with african descent | thiazide duretics or CCB as initial therapy |
| best drugs for pts with CKD | ACE inhibitors or ARBs should NOT be used simultaneously bc they work the same |
| best drug for pts with stable ischemic heart disease | beta blockers, ACE inhibitors, or ARBs as first line drug therapy |
| best drug for pts with heart failure with preserved ejection fraction | diuretics to control fluid overload...after management, ACE inhibitors or ARBs and beta blockers to attain SBP of less than 130 mmHg |
| worst drug for pts with heart failure with preserved ejection fraction | calcium channel blockers are not recommended |
| each medication was equal in effect but keep in mind... | wide variability in response, some drugs work well with patients and some drugs do not |
| when prescribing, also consider | cost, concurrent diagnoses, drug interactions |
| follow up of Tx for HTN | need to monitor Na and K, esp when on diuretic |
| complimental therapies for HTN | behavioral and mind/body therapies yoga, tai chi, mindfulness, guided imagery |
| poor treatment adherence | patients not following medical instructions because they have no symptoms, bad med side effects, high cost ex: fatigue on diuretics, erectile dysfunction on beta blockers |
| malignant HTN hypertensive crisis | BP over 180/120 |
| symptoms of malignant HTN | blurrerd vision, headache, confusion, may be asymptomatic |
| Tx of malignant HTN | requires immediate Tx |
| target for malignant HTN (short term) | <160/<100 |
| MAP (mean arterial pressure) for malignant HTN | should not be lowered more than 10% - 20% first hour then approx. 25% during next 23 hours |
| malignant hypertension adverse outcomes | cerebral edema retinal hemorrhage actue renal damage |
| malignant hyper tension causes | unknown abruptly stopping medications preeclampsia of pregnancy |
| malignant hypertension therapy | medications and immediate actions monitor BP Q 5-30 minutes bedrest, quiet environment |
| malignant hypertension therapy medications | IV meds often nitrates clonidine captopril furosimide (pts with fluid overload) |
| major exceptions for gradual lowering of BP | acute ischemic stroke, acute aortic dissection spontaneous hemorrhagic stroke |
| major exceptions for gradual lowering of BP - acute ischemic stroke | BP not usually lowered unless >185/110 if pt to receive reperfusion therapy |
| major exceptions for gradual lowering of BP - acute aortic dissection | systolic BP rapidly lowered to 100-120 mmHg |
| major exceptions for gradual lowering of BP - spontaneous hemorrhagic stroke | BP rapidly lowered if no contraindications |
Created by:
ago24