ch 37 for exam 4
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| definition of hypertension | persistent BP greater than or equal to 140/90 or the current use of hypertensive medication
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| what does culture have to do with it? | detected in people 30-50 and is increasingly being found in children
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| secondary hypertension | more common in preadolescences with most cases caused by renal disease; underlying factors such as kidney disease, arterial conditions, drugs and pregnancy
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| primary hypertension | more common in adolescents; 90-95% of all cases, unk cause,
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| hypertension | the silent killer because it often has no symptoms
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| complications of HTN | damage to the heart, blood vessels, kidneys, brain, eyes, MI, HF, stroke, kidney disease, blindness, most predominant in african-american males
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| prehypertension | 120-139/80-89
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| stage 1 HTN | 140-159/90-99
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| stage 2 HTN | ↑160/100
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| HTN risk groups | A= no major risk factors, no target organ damage
B= one or more risk factors not including diabetes, no target organ damage
C= organ damage, cardiovascular disease with or without other risk factors
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| isolated pressure elevations | caused by atherosclerosis, occur in older adults
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| factors that determine BP | cardiac output and peripheral vascular resistance
BP=CO x PVR
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| CO | the volume of blood pumped by the heart in one minute
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| PVR | force in the blood vessels that the LV must overcome to eject blood from the heart
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| diameter of blood vessels | regulated by vasomotor center; SNS extends from the medulla to the spinal cord to the thoracic and abd region
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| stimulation of SNS | causes release of epi and norepi= catecholamines= vasoconstrictors;
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| vasoconstriction causes | blood flow to the kidneys to be restricted which leads to the production of renin
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| renin production leads to | the formation of angiotensin
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| angiotensin stimulates | the adrenal cortex to secrete aldosterone
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| aldosterone is a | hormone that promotes sodium and water retention
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| age related changes affecting BP | atherosclerotic changes; decreased CO and increased PVR; pulse pressure widens in response to decreased elasticity of aorta
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| PVR increases | 1% for every year above 60
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| risk factors for HTN | dyslipidemia, atherosclerosis, DM, tabacco use, men over 55 and women over 65, family hx, sedentary lifestyle, obesity, stress, stimulants
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| S&S of HTN | no symptom, occipital HA, light-headedness, epistaxis, organ damage
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| sustained HTN | causes the LV to work harder which causes hypertrophy and HF
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| indications of renal failure | nocturia, azotemia, proteinuria, hematuria
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| azotemia | accumulation of nitrogen waste products in the blood;
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| treatment of HTN | goal = gradually reduce PVR and BP
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| lifestyle modification | quit smoking, sodium and alcohol restriction, relaxation techniques, exercise,
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| pharmacologic therapy | used if lifestyle modification does not achieve a reduced BP; JNC recommends hydrochlorothiazide for initial therapy
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| diuretics | thiazide type, loop, potassium sparing; especially effective in treating african american pts;
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| monitor pts taking diuretics for | fluid and electrolyte imbalances, I&O
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| beta-adrenergic receptor blockers | (lols) decreased HR, strength of cardiac contraction and bronchial constriction; labetalol is less effective for african-americans;
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| SE of beta-adrenergic receptor blockers | bradycardia, hypotension, increased LDLs; contraindicated in pts with asthma, hypoglycemia, COPD, heart block, CHF;
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| NC for beta-adrenergic receptor blockers | monitor of bradycardia, hypotension, hypoglycemia - diaphoresis may be only sign
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| calcium antagonists | (zem and pines)
reduce HR, decreases force of contration, dilates peripheral blood vessels
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| SE of calcium antagonists | flushing, dizziness, HA
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| NC for calcium antagonits | monitor for hypotenion, bradycardia, and edema
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| angiotensin-converting enzyme inhibitors ACE | decreases peripheral resistance, decrease fluid retention,
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| SE of ACE | chronic cough, dizziness, HA, fatigue, angioedima, hyperkalemia, hypotension
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| angiotensin II receptor antagonists | (tans)
prevent vasoconstriction in response to angiotensin, prevent the release of aldosterone which reduces blood volume,
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| SE of angiotensin II receptor antagonists | dizziness
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| central andrenergic blockers | inhibit impulses from the vasomotor center that maintain the muscle tone in blood vessels, reduces peripheral resistance; clonidine and methyldopa
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| alpha-adrenergic receptor blockers | (sins)
reduce peripheral resistance
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| SE of alpha-adrenergic receptor blockers | orthostatic hypotension, dizziness, HA and drowsiness
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| NC for alpha-adrenergic receptor blockers | pt should lie down for 2 hours after initial dose of when increasing dose, best given at HS for this reason
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| NC for administering HTN drugs | monitor for therapeutic and adverse effects, pt education
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| NC for pts with HTN | early detection, education and promotion of adherence are the keys to BP control;
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| BP cuff too small | false high
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| BP cuff too big | false low
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| most accurate BP reading | assess systolic pressure by palpation of brachial pulse while inflating the cuff
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| most valid BP reading | are obtained in the home
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| if BP is elevated initially | reassess it again in 1-5 minutes
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| if BP is severely elevated | diastolic above 115 the pt is in imminent danger of a stroke and immediate medical care is needed
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| DASH diet | is high in fruits and veggies, low fat, whole grains, poultry and fish, nuts, K, C and mg,
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| sodium | no more than 2 g; RDA is 2400 mg
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| orthostatic hypotension | sudden drop in SBP of 20 mmHg when going from a lying or sitting position to a standing position
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| common side effect of many antiHNT drugs | sexual dysfunction
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| hypertensive emergencies | severe HA, blurred vision, nausea, restlessness and confusion with very elevated BP - DBP ↑ 130;
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| malignant HTN | DBP above 140, most common in african american men ages 30-40
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| TX of hypertensive emergency | goal: rapidly reduce BP to nonlife-threatening level and then bring it slowly within normal range
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| NC for pts in hypertensive emergency | closely monitor BP, pulse, resp, LOC, IV access, I&O, N/V may indicate impending seizure or coma, interventions: take VS before each dose of medication; seizure measures to be taken- raise bed rails, elevate HOB, education
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