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Adam G. > Med Surg Chapter 33 Hypertension > Flashcards

Med Surg Chapter 33 Hypertension Flashcards

1
Q

What other conditions can develop as a result of hypertension (try to name 2 out of 4)?

A
  1. ) Myocardial Infarction (MI)
  2. ) Heart Failure (HF)
  3. ) Stroke (CVA)
  4. ) Renal Disease
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2
Q

What must pts with hypertension do (2 things) to have it considered they are “managing” the condition (1 of them is the measurement range)?

A
  1. ) Keep BP less than 140/90 mm Hg

2. ) If higher than 140/90 mm Hg, have at least 2 antihypertensive meds prescribed.

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3
Q

When is hypertension more common in men?

A

Before age 45

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4
Q

Why is hypertension more common in women than men after age 64?

A
  1. ) Menopause-related factors (e.g. estrogen withdrawal)
  2. ) Overproduction of pituitary hormones
  3. ) Weight gain
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5
Q

True or False: oral contraceptives increases the risk of developing hypertension in women?

A

True

*I haven’t seen the effects on men. Stand by for future tests.

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6
Q

Which racial group has the highest prevalence of hypertension?

A

African Americans

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7
Q

What are some reasons Mexican Americans tend to have less well-managed hypertension than Caucasians?

A
  1. ) Less likely to receive treatment
  2. ) Lower rates of BP control
  3. ) Have lower levels of awareness of hypertension and its treatments.
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8
Q

What are the two factors that equal blood pressure?

BP = _________ x ___________

A

BP = Cardiac output x Systemic vascular resistance

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9
Q

What is systemic vascular resistance (SVR)?

A

The force opposing the movement of blood within the blood vessels.

The radius of the small arteries and arterioles is the principal factor determining vascular resistance.

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10
Q

How does the nervous system primarily increase BP?

A

Activating the sympathetic nervous system (SNS).

SNS increases HR and cardiac contractility, produces widespread vasoconstriction in the peripheral arterioles, and promotes the release of renin from the kidneys.

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11
Q

What effects do norepinhephrine (NE) have on the body to affect BP?

A
  1. ) Causes peripheral vasoconstriction
  2. ) Increases HR
  3. ) Increases force of contraction
  4. ) Increases speed of conduction in heart
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12
Q

How do baroreceptors affects BP?

A

When stimulated by INCREASED BP, send inhibitory impules to sympathetic vasomotor center to inhibit SNS (decreasing HR, force of contraction, and causing vasodilation of peripheral arterioles).

When senses DECREASED BP, activates SNS (causes peripheral constriction, increased HR, and increased contractility of the heart).

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13
Q

What vasoactive substances are produced by the vascular endothelium? What do they do?

A
  1. ) Nitric oxide & prostacyclin - Maintains low arterial tone, inhibits growth of smooth muscle layer, and inhibits platelet aggregation.
  2. ) Endothelin (ET) - A potent vasoconstrictor. Causes adhesion and aggregation of neutrophils, stimulates smooth muscle growth.
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14
Q

How do the kidneys help regulate BP (2 ways)?

A
  1. ) Control sodium excretion

2. ) Control ECF volume

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15
Q

What two ways does Angiotensin II increase BP?

A
  1. ) Acts as a potent vasoconstrictor to increase SVR

2. ) Indirectly raises BP by stimulating the adrenal cortex to secrete aldosterone.

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16
Q

What changes can angiotensin II cause in the heart to lead to primary hypertension?

A
  1. ) Causes vasoconstriction in the heart

2. ) Tissue growth, which remodels the vessel walls

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17
Q

What effect do prostaglandins have on the body to effect BP?

A

Act as vasodilators to decrease SVR.

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18
Q

What effects do the natriuretic peptides atrial natriuretic peptide (ANP) and b-type natriuretic peptide (BNP) have on bloodpressure

*These peptides are secreted from heart tissue

A

Antagonize the effects of ADH and aldosterone, resulting in natriuresis (excretion of sodium in urine) and diuresis.

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19
Q

How does epinephrine increase BP?

A
  1. ) Increases HR and myocardial contractility

2. ) Causes vasoconstriction of peripheral arterioles

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20
Q

How does aldosterone increase BP?

A

Stimulates kidneys to retain sodium and water

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21
Q

What are the ranges for:

  1. ) Normal BP
  2. ) Prehypertension
  3. ) Hypertension, stage 1
  4. ) Hypertension, stage 2
A

SBP (mm Hg) DBP (mm Hg)

1.) 120 and 160 and >100

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22
Q

True or false: Systolic BP (SBP) DECREASES with aging?

A

False.

SBP INCREASES with age

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23
Q

What is Primary Hypertension?

A

Elevated BP WITHOUT an identified cause.

*Approximately 90-95% of all cases of hypertension

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24
Q

What are risk factors for developing primary hypertension (13 listed)?

A
  1. ) Increasing age
  2. ) Alcohol (excessive intake)
  3. ) Tobacco (Smoking or Chewing)
  4. ) Diabetes mellitus
  5. ) Elevated serum lipids (cholesterol and triglycerides)
  6. ) Excess dietary sodium
  7. ) Gender: Male 64 years
  8. ) Family History
  9. ) Obesity
  10. ) Ethnicity (African American)
  11. ) Sedentary lifestyle
  12. ) Lower socioeconomic status
  13. ) Stress
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25
Q

What is Secondary Hypertension?

A

Elevated BP WITH a specific cause that can be identified and corrected.

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26
Q

What are some causes of secondary hypertension (8 listed)?

A
  1. ) Cirrhosis
  2. ) Coarctation or congenital narrowing of the aorta
  3. ) Drug related:
    - Estrogen replacement therapy
    - Oral contraceptives
    - Corticosteroids
    - NSAIDs
    - Sympathetic stimulants (e.g. cocaine)
  4. ) Endocrine disorders
    - Pheochromocytoma
    - Cushing syndrome
    - Thyroid disease
  5. ) Neurologic disorders
    - Brain disorders
    - Quadriplegia
    - Traumatic brain injury
  6. ) Pregnancy-induced hypertension
  7. ) Renal disease
    - Renal artery stenosis
    - Glomerulonephritis
  8. ) Sleep apnea
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27
Q

What are usually the symptoms of hypertension?

A

None. HTN is usually asymptomatic until it becomes severe and target organ disease occurs.

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28
Q

What organs are usually the targets of target organ diseases (the most common complication of HTN)?

A
  1. ) Heart (hypertensive heart disease)
  2. ) Brain (CVA)
  3. ) Peripheral vessels (peripheral vascular disease)
  4. ) Kidneys (nephrosclerosis)
  5. ) Eyes (retinal damage)
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29
Q

How is HTN a major contributor to coronary artery disease (CAD)?

A

HTN is a major risk factor for developing atherosclerosis (resulting in stiff arterial walls and a narrowed lumen).

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30
Q

What are the three major heart diseases caused by HTN?

A
  1. ) Coronary artery disease (CAD)
  2. ) Left Ventricular Hypertrophy
  3. ) Heart Failure (HF)
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31
Q

How much more likely are people with HTN to have a CVA than those with normal BP?

A

4x more likely (due to the development of atherosclerosis, the most common cause of CVA)

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32
Q

What is a classic symptom of peripheral vascular disease caused by HTN?

A

Intermittent claudication (ischemic leg pain precipitated by activity and relieved with rest)

33
Q

How is peripheral vascular disease caused by HTN?

A

Development of atherosclerosis in peripheral vessels

34
Q

How is renal disease caused by HTN?

A

Develops due to ischemia from narrowing of the renal blood vessels.
-Leads to atrophy of tubules, destruction of glomeruli, and eventual death of nephrons.

35
Q

What is usually the earliest manifestation of renal disease?

A

Nocturia

36
Q

What laboratory findings indicate renal disease (4 listed)?

A
  1. ) Microalbuminuria
  2. ) Proteinuria
  3. ) Microscopic hematuria
  4. ) Elevated serum creatinine and blood urea nitrogen (BUN)
37
Q

What are manifestations of retinal damage?

A
  1. ) Blurring vision
  2. ) Retinal hemorrhage
  3. ) Loss of vision
38
Q

What are some diagnostic studies performed on those with HTN?

A
  1. ) H&P
  2. ) Routine urinalysis
  3. ) Basic metabolic panel
    • Serum glucose
    • Sodium
    • Potassium
    • Chloride
    • Carbon dioxide
    • BUN and Creatinine
  4. ) Complete blood count
  5. ) Serum lipid profile
    • Total lipids
    • triglycerides
    • HDL and LDL cholesterol
    • Total-to-HDL cholesterol ratio
  6. ) Serum uric acid
  7. ) 12-lead ECG
  8. ) Optional:
    • 24-hr urinary creatinine clearance
    • Echocardiography
    • Liver function studies
    • Serum TSH
39
Q

What is ambulatory BP?

A

An automated system that measures BP in intervals over a 24-hour period.

*Have patient’s keep a BP diary during measurements.

40
Q

What dietary adjustments can be made for those with HTN?

A
  1. ) Restrict salt and sodium
  2. ) Restrict cholesterol and saturated fats
  3. ) Maintain adequate intake of potassium
  4. ) Maintain adequate intake of calcium and magnesium
  5. ) Moderation of alcohol intake
  6. ) Encourage the DASH eating plan
41
Q

What is the DASH eating plan?

A

Emphasizes fruit, vegetables, fat-free or low-fat milk and milk products, whole grains, fish, poultry, beans, seeds, and nuts

Contains less red meat, salt, sweets, added sugars, and sugar-containing beverages

42
Q

What lifestyle modifications can those with HTN make?

A
  1. ) Weight reduction (if obese)
  2. ) DASH eating plan
  3. ) Reduced dietary sodium
  4. ) Moderation of alcohol
  5. ) Increased physical activity
  6. ) Avoidance of Tobacco products
  7. ) Management of Psychosocial factors (stress, anger, depression, etc.)
43
Q

What should the sodium restriction be for those with increased risk of HTN (African American, Middle-aged or older, HTN, DM, or Chronic Kidney disease)?

A

Less than or equal to 1500 mg/day

*The usual amount for Healthy adults is 2300 mg/day

44
Q

What is an added benefit of lower sodium intake for those on diuretic therapy?

A

Lessens the risk for developing Hypokalemia

45
Q

How much alcohol (MAX) is recommended daily for 1.) Men and 2.) Women

A
  1. ) 2 or less drinks per day

2. ) 1 drink per day

46
Q

How much physical activity is adequate to achieve the recommended amount?

A

Moderate-intensity aerobic activity for at least 30 minutes most days (more than 5 days/week) or vigorous-intensity aerobic activity for at least 20 minutes 3 days/week
Muscle-strengthening activities at least 2 days/week

47
Q

How do tobacco products contribute to developing HTN?

A

Nicotine causes vasoconstriction

48
Q

What effects can negative psychosocial factors have on the cardiovascular system?

A
  1. ) Hypertension and tachycardia
  2. ) Inflammation
  3. ) Endothelium dysfunction
  4. ) Increased platelet aggregation
  5. ) Insulin resistance
  6. ) Central obesity
49
Q

What are the two main functions of drugs that treat HTN?

A
  1. ) Decrease the volume of circulating blood

2. ) Reduce SVR

50
Q

What are the classes of drugs used to treat HTN?

A

Diuretics, Adrenergic (SNS) Inhibitors, Direct Vasodilators, Angiotensin and Renin inhibitors, and Calcium Channel Blockers

51
Q

How do diuretics reduce BP?

A
  1. ) Promote sodium and water excretion
  2. ) Reduce plasma volume
  3. ) Reduce the vascular response to catecholamines (epinephrine and norepineprhine)
52
Q

How do adrenergic (SNS) inhibitors reduce BP?

A

Decreasing SNS effects that increase BP (e.g. inhibit NE release or block the adrenergic receptors of on blood vessels).

53
Q

How do direct vasodilators decrease BP?

A

Relaxing vascular smooth muscle and reducing SVR

54
Q

How do Calcium Channel Blockers reduce BP?

A

Increasing sodium excretion and causing vasodilation by preventing the movement of extracellular calcium into cells

55
Q

What are the two types of angiotensin inhibitors and how do they work to lower BP?

A
  1. ) Angiotensin-converting enzym (ACE) inhibitors
    • Prevent the conversion of angiotensin I to II, thus reducing A-II mediated vasoconstriction and sodium and water retention.
  2. ) Angiontensin II Receptor Blockers (ARBs)
    • Prevent A-II from binding to its receptors in the blood vessel walls.
56
Q

True or False: Orthostatic Hypotension is a common side effect of HTN medication?

A

True.

Results from an alteration of the autonomic nervous system’s mechanisms for regulating BP, which are required for position changes

57
Q

True or False: Sexual activity is not affected by antihypertensive medication?

A

False

Problems can range from reduced libido to erectile dysfunction.

*Changing to another antihypertensive drug may decrease or remove these side effects.

58
Q

When is a good time to take a diuretic?

A

In the morning, to reduce the likelihood of nightime voiding, resulting is sleep loss

59
Q

What is “resistant HTN”?

A

Failure to reach goal BP in pts who are taking full doses of an appropriate 3 drug therapy regimen that includes a diuretic.

60
Q

What is the recommended primary intervention for lowering BP?

A

Following the DASH diet and lowering sodium intake

61
Q

True or False: BP should be measured in both arms during the initial assessment?

A

True.

*Use the arm with the highest BP to measure twice more with 1 minute intervals. Record the average pressure as the value for the visit.

62
Q

If measuring BP using the forearm, where should the stethescope be placed?

A

Over the radial artery

63
Q

Which patients must definitely have postural (orthostatic) changes in BP and pulse measured?

A

Older adults, people taking antihypertensive drugs, and patients who report symptoms consistent with reduced BP on standing.

64
Q

What is indication for orthostatic hypotension?

A

1.) A decrease of 20 mmHg or more in SBP,
2.) a decrease of 10 mmHg or more in DBP,
and/or
3.) an increase in the HR of 20 beats/minute or more from supine to standing.

65
Q

When should pts measure their BP at home?

A

First thing in the morning (if possible, before taking medications) and at night before going to bed.

66
Q

True or False: The prevalence of HTN increases with age?

A

True

This is due to:

  1. ) Loss of elasticity in large arteries from atherosclerosis
  2. ) Increased collagen content and siffness of the myocardium
  3. ) Increased peripheral vascular resistance
  4. ) Decreased adrenergic receptor sensitivity
  5. ) Blunting of baroreceptor reflexes
  6. ) Decreased renal function
  7. ) Decreased renin response to sodium and water depletion
67
Q

Why must extra care be taken when giving antihypertensive medications to geriatric patients?

A

The metabolism and excretion of drugs may be prolonged and absorption of some drugs may be altered as a result of decreased blood flow to the gut.

68
Q

What are the preferred antihypertensive drugs for geriatric patients?

A

Low-dose thiazides, calcium channel blockers, and RAAS blockers (diuretics should always be the first or second drug ordered for this population)

69
Q

What is a hypertensive crisis?

A

Used to decribe either a:
1.) hypertensive emergency: BP is severly elevated (often above 220/140 mmHg) with clinical evidence of target organ disease
or
2.) Hypertensive urgency: BP is severly elevated (usually above 180/110 mmHg), but there is NO clinical evidence of target organ disease.

70
Q

What is the most important factor when determining if BP change is an emergency?

A

The rate of rise of BP (rather than the absolute value)

71
Q

Who is more likely to incur a hypertensive crisis?

A

Those who have not adhered to their medication regimen or who have been undermedicated.

72
Q

What is some clinical manifestations of a hypertensive emergency?

A
  1. ) Hypertensive encephalopathy - Sudden rise in BP associated with severe headache, nausea, vomiting, seizures, confusion, and coma. Leads to cerebral edema. Retinal examination shows exudates, hemorrhages, and/or papiledema.
  2. ) Rnal insufficiency/renal failure
  3. ) Rapid cardiac decompensation (ranging from unstable agina to MI and pulmonary edema)
  4. ) Aortic dissection, which will cause sudden, excrutiating chest and back pain and possibly reduced or absent pulses in the extremities.
73
Q

What indication determines the seriousness of a hypertensive crisis?

A

The link between elevated BP and signs of new or progressive target organ disease.

74
Q

What is used instead of BP readings to evaluate and guide drug therapy for a hypertensive crisis?

A

Mean arterial pressure (MAP):

MAP = (SBP + 2 DBP) / 3

75
Q

What is the initial goal for treating hypertensive crisis?

A

Decrease MAP by NO MORE than 20% to 25% or to decrease MAP to 110 to 115 mmHg

76
Q

What is the most effective drug for treating hypertensive emergencies?

A

Sodium nitroprusside (Nitropress), a vasodilator

77
Q

How often should BP be assessed during the initial administration of an IV antihypertensive?

A

Every 2 to 3 minutes

78
Q

Aside from BP, what other observations should be made for pts receiving IV antihypertensive drugs?

A
  1. ) ECG (for heart dysrhythmias and signs of ischemia or MI).
  2. ) Urine output (assess hourly)
  3. ) Neurologic function (LOC, pupillary size and reaction, movement of extremities
  4. ) Pulmonary edema
79
Q

Which oral drugs are often used for hypertensive URGENCY?

A

captopril (Capoten), labetalol, clonidine (Catapres, and amlodipine (Norvasc)

Adam G. (12 decks)

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