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AH-Lewis Ch. 33

Hypertension

QuestionAnswer
Hypertension is defined as? a persistant systolic blood pressure 140 and diastolic pressure 90
What does hypertension mean? that the heart is working harder than normal, putting both the heart and the blood vessels under strain
What is prehypertension? 120-139 and 80-89
CVD is the? #1 death of women
What is blood pressure? the force exerted by the blood against the walls of blood vessels
What is cardiac output? the total blood flow through the systemic or pulmonary circulation per minute
What is systemic vascular resistance? the force opposing the movement of blood within the blood vessels
What is the principal factor determining vascular resistance? small arteries
BP is regulated by both? short term and long term mechanisms
Short term mechanisms are activated? within a few seconds
Long term mechanisms include? renal and hormonal processes that regulate arteriolar resistance and blood volume
The nervous system increases BP primarily by? activation of the SNS
Changes in BP are sensed by? baroreceptors
Where are baroreceptors? in the carotid artery and the arch of the aorta
What does norepinephrine activiate? receptors location in the SA node, myocardium and vascular smooth muscle
What increases CO and SVR? SNS
What increase HR and cardiac contractility? SNS
What promotes release of renin from kidneys? SNS
What are baroreceptors? nerve cells located in the carotid arteries and arch of the aorta
Inhibition of sympathetic activity results in? decreased heart rate, decreased force of contraction, and vasodilation of periperal arterioles
Increased Parasympathetic activity reduces? HR
What is vascular endothelium? single layer that lines the blood vessels
What is endothelin? an etremely potent vasoconstrictor
What are the three subclasses of endothelines? ET1 ET2 and ET3
what does ET1 do? vasocontriction, adhesion and aggregation of neutrophiles and stimulates smooth muscle growth
How do the kidneys regulate BP? controlling Na excretion and ECF volume
What also helps BP regulation? renin angiotensin aldosterone system
What is renin (ACE)? an exzymes that converts angiotension 1 to angiotension 2
What is Angiotension 2? a potent vasoconstrictor and increases vascular resistance, increase in BP
What do prostaglandins do? decrease SVR and lower BP
What is the classification of BP based on? the average of age of two or more properly measured, seated BP readings on each of two or more office visits
What is isolated systolic hypertension? an average SBP of 140 coupled with an average DBP 90
What is pseudohypertension? false hypertension
What is osler's sign? a palpable radial or brachial artery after the blood pressure cuff is fully inflated
What is the only way to measure BP in pseudohypertension? intraarterial catheter
What is primary hypertension? elevated BP without an identified caused
What is secondary hypertension? elevated BP with a specific cause that often can be identified and corrected
What is the treatment for secondary hypertension? getting rid the the underlying cause
What is the hallmark of hypertension? persistently increase SVR
Excessive Na intake is considered responsible? for initiation of prehypertension
What is commonly associated with BP salt sensitivity? obesity, increasing age, african american, diabetes, and chronic kidney disease
High plasma renin activity results in? the increased conversion of angiotensinogen to angiotensin 1
Atertial pressure is influenced by factors such as? anger, fear, and pain
Abnormalities of glucose, insulin and lipoprotein are common is? primary hypertension
Hypertension is often called? the silent killer
What are secondary symptoms of hypertension? fagigue, dizziness, palpitation, angina, and dyspnea
What are the most common complication of hypertension? target organ diseases
Hypertension is a major risk factor for? CAD
Sustained high BP increases the? cardiac workload and produces left ventricular hypertrophy
When does heart failure occur? when the heart's conmensatory adaptation are overwhelmed and the heart can no longer pump enough blood to meet the metabolic needs of the body
What is the most common cause of cerebrovascular disease? atherosclerosis
Hypertensice encephalopahty may occur after a marked rise? in BP if the cerebral blood flow is not decreased by autoregulation
Hypertension speeds up the process of? atherosclerosis
What is intermittent claudication? ischemic muscle pain precipitated by activity and relieved with rest
The appearance of the retina provides important info about the severity and duration of the? hypertensive process
The retina is the only place in the body where the blood vessels can be? directly visualized
Basic lab studies are performed to? rule out causes of secondary hypertension, eveluate target organ disease, determine overall heart risk, establish baseline leveles
What is white coat hypertension? when someone only has an elevated BP in a hospital setting
what is ABPM? noninvasive, fully automated system that measures BP at preset intervals over a 24 hr period
What are lifestyle modifications for a hypertensive person? weight loss, DASH, Na reduction, Moderation of alcohol consumption, regular aerobic physical activity, no tobacco
What does the DASH eating plan include? eating several fish each week, drinking lots of water
If you have hypertension you should not consume more than how many alcohol drinks? 2
Drug therapy is not recommended for people with? prehypertension
What are the two main actions of drugs that treat hypertension? they decrease the volume of circulating blood and the reduce SVR
What are the two types of angiotensin inhibitors? angiotension converting enzyme inhibitors and A II receptor blockers
What are theazide type diurects used for? initial therapy for most pt's with hypertension
Many pt's that are hypertensive require how many meds? 2
What is a common AE of hypertensive drugs? orthostatic hypotension
BP is lowest at? night
BP is high? shortly after waking up
What is resistant hypertension? the failure to reach goal BP in pt's who are adhering to full doses of an appropriate three drug therapy regiman that includes a diurects
What are the overall goals for a pt with hypertension? achive and maintain the goal BP, understand, accept and implement the therapeutic plan, experience minimal or no unpleasant side effect of therapy, be confident of ability to manage and cope with condition
What is orthostatic hypotension? increase of 20 beats/min or more in pulse from supine to standing
Family and pt teaching includes? nutrional therapy, drug therapy, physical activity, home monitoring of BP and tobacco sensation
What is a major problem in long term management of the pt? noncompliance
What is ausculatory gap? the gap between the first korotokoff sound and the next beat
What is hypertensive crisis? severe and abrupt elevation in BP
Hypertensive crisis is classified by?
What is hypertensive emergency? develops over hours or days
What is hypertensive urgency? which develops over days or weeks, BP is severely elevated but there is no clinical evidence or target organ damage
What is hypertensice encephalopathy? a syndrome in which a sudden rise in BP is associaed with headache, nausea, vomiting, seizures, confusion, stupor and coma
Hypertensive emergencies require? hospitalization, IV administraction, and intensive care monitoring
When treating hypertensive emergencies what is used to guide and avaluate therapy? Mean atertial pressure
Hypertensive urgencies can be managed with? oral agents
Created by: alicia.rennaker