EXAM 4 Flashcards
1
Q
HTN is greater in
A
african americans
2
Q
what is considered HTN
A
Systolic blood pressure ≥140 mm Hg OR Diastolic blood pressure ≥90 mm Hg OR Current use of antihypertensive medication(s)
3
Q
pre HTN definition
A
Systolic BP: 120 to 139 mm Hg
OR
Diastolic BP: 80 to 89 mm Hg
4
Q
STAGE 1 HTN
A
systolic: 140-159
diastolic: 90-99
5
Q
STAGE 2 HTN
A
systolic: >160
diastolic: >100
6
Q
5 factors that influence HTN
A
insulin resistance
Increased sympathetic nervous system activity
Increased reabsorption of sodium, chloride and water by the kidneys
Increased activity of the renin-angiotensin system
Decreased vasodilatation
7
Q
5 symptoms of severe htn
A
Fatigue Dizziness Palpitations Angina Dyspnea
8
Q
htn target organ disease
A
Heart Brain Peripheral vascular disease Kidney Eyes
9
Q
serum creatinine
A
0.6-1.2
10
Q
Noninvasive, fully automated system that measures BP at preset intervals over 24-hour period
A
Ambulatory blood pressure monitoring (ABPM)
11
Q
Fruits, vegetables, fat-free or low-fat milk, whole grains, fish, poultry, beans, seeds, and nuts
A
dash eating plan
12
Q
why are beta blockers a black box warning
A
due to bronchospasms and hyperactive airway
13
Q
what to check before giving betablocker
A
bp and hr
14
Q
tell the patient to report what 4 things if they are taking a HTN med
A
Orthostatic hypotension
Sexual dysfunction
Dry mouth
Frequent urination
15
Q
Most common form of hypertension in individuals age >50
A
isolated systolic hypertension
16
Q
hypertensive emergency
A
Occurs over hours to days
BP >220/140 with target organ disease
17
Q
hypertensive urgency
A
Occurs over days to weeks
BP >180/110 with no clinical evidence of target organ disease
18
Q
-pril
A
ace inhibitors
19
Q
a syndrome whereby a patient’s feeling of anxiety in a medical environment results in an abnormally high reading when their blood pressure is measured.
A
white coat hypertension
20
Q
bp goal for diabetes
A
130/80
21
Q
can prevent adequate bp
A
NSAIDS
22
Q
depolarization of the atria
A
p wave
23
Q
depolarization of the ventricles
A
qrs
24
Q
repolarization of the ventricles
A
t wave
25
if present may represent repolarization of the perkingie fibers
u wave
26
what equals blood pressure
systemic vascular resistance x cardiac output = blood pressure
27
relaxing and refilling
diastolic
28
contractions
systolic
29
blood pressure
measures arterial pressure
30
what to do for a person with white coat pnomenom
ambulatory blood pressure monitoring
31
first line treatment for hypertension
hydrochlorothiazide- diuretic
32
what teaching do we want to tell them about hydrochlorothiazide.
change positions slowly due to orthostatic hypotension; decreasing sodium
33
all diuretics cause
orthostatic hypotension
34
3 things to do before giving diuretics
check bp, creatinine, and electrolytes
35
nitroglycerin is given
for chest pain
36
sob
orthopnea
37
calcium channel blocker
can cause prolonged QT syndrome; slow conduction due to HR going down
38
slow heart rate =
slow conduction ; abnormal heart block
39
angina indicates
ischemia of the coronary artery
40
dyspnea on exertion/ sob is the first sign of
heart failure
41
why do you have shortness of breath
blood isnt moving like its suppose to and it backs up
42
if cuff is too big
bp will be low
43
If cuff is too small
bp will be high
44
bp with orthostatic hypotension
bp and pulse supine then sitting then standing, if they can tolerate to stand ; 1-2 minutes between position changes
45
what is considered positive orthostatic hypotension
↓ of 20 mm Hg or more in SBP, ↓10 mm Hg or more in DBP, or ↑ 20 beats/minute or more in heart rate
46
what helps with orthostatic hypotension
HYDRATION
47
Most common form of hypertension in individuals age >50
isolated systolic htn
48
postprandial hypotension
seen in older adults
49
hypertensive emergency
onset is hours to days
| with target organ damage
50
hypertension urgency
onset is days to weeks
| no target organ damage
51
htn and then rapidly drop their bp
blood dumps and the can cause damage
52
how is iv drug therapy managed
any meds a pt needs in a hypertensive crisis will get it through an iv. the meds are titrated (adjusting meds based on parameters) to MAP
53
what is blood pressure
cardiac output x peripheral resistance
54
risk factors of atherosclerosis
htn, tobacco use, diabetes, infections, toxins, hyperlipidemia, hyperhomocysteinemia
55
stable angina
they have the pain then it goes away, have it then goes
56
why does stable angina go away
because the plaque build up in the artery is stable
57
unstable angina
unstable lesion
58
pain not going away, increasing in intensity, increasing in severity; not relieved
lesion is complicated and is unstable
59
Thickening/hardening/narrowing or coronary arteries that result from risk factors like HTN
atherosclerosis
60
Arterial anastomoses (or connections) within the coronary circulation
collateral circulation
61
things you can change to improve your health
modifiable risk factors
62
chronic stress; chronic inflammation
CPR; NOT MODIFIABLE
63
CAD gender risk
younger men and older women
64
unsaturated fats
are good!! HDL ; protective for cardiovascular disease
65
gerontologic 2 risk factors
reducing their lipids and treating their blood pressure
66
clinical manifestation of ischemia
angina/chest pain
67
is ischemia reversible?
yes!
68
what to give a patient with angina
nitroglycerin to dilate arteries and oxygen. the pain goes away because the rbc are now getting oxygen
69
ischemia results from
narrowed and thick arteries
70
when do you get ischemia
when arteries are blocked 75% or more
| you will get hypoxic within 10 seconds of occlusion
71
heart cells can stand HOW long without blood flow
20 minutes; after 20 minutes the blood vessels are irreversibly damaged
72
by product of anaerobic metabolism
lactic acid
73
what is the cardiac pain that patients feel
lactic acid build up
74
start when youre increasing demand for oxygen
chest pain that has a precipitating factor such as stress, activity, position changes
predictable
stable angina
75
5-15 minutes
stable angina
76
control with drugs; nitrates/oxygen
stable angina
77
ST segment depression and/or T-wave inversion
unstable and stable angina
78
unstable angina is more likely to progress to
an MI
79
nitroglycerin
acute nitrate so it works quickly and is why its given at the hospital
80
wont treat the chest pain
aspirin ; for platelets
81
nitroglycerin give sublingual why
It works faster; acute. dont chew or drink water ; short acting for people to take while at home
82
vasodilates
nitroglycerin
83
how many doses for how long -nitroglycerin
3 doses every 5 minutes and after the third dose if they are still having chest pain they need to call 911
84
if patient knows they are about to exert themselves in a certain activity what can they do
take nitroglycerin prophylactically 5-10 minutes before activity; sex
85
prevents the occurrences of angina
long acting nitrates
86
side effects of long acting nitrates
orthostatic hypotension, headache (to help w headache give acetaminophen )
87
oral long acting nitrate
isosorbide, -trates
88
#1 reason to hold nitroglycerin
hypotension because its bringing down their bp
89
completed occluded
stemi
| st elevation myocardial infarction
90
partial occlusion of a coronary artery
non stemi
91
complete occlusion of coronary artery
stemi
92
how to tell if its a stemi or non
ekg
93
complete occlusion means
reperfuse
94
mi symptoms in women
fatigue followed by abdominal pain
95
ask about chest pain that is likely myocardial
nausea, vomiting, sob, diaphoresis
96
initially for an MI HR and BP
go up
97
what do you expect to hr and bp after awhile with a mi
hr goes down patient is about to code
98
3 evidence to acute heart failure
crackles, jvd, abnormal heart sounds
99
fluid volume overload
s3 heart sound
100
troponin elevation
positive is 0.01
101
cardiac enzymes
troponin
CK-MB
myoglobin
102
most significant enzyme
troponin
103
what is morphine for
vasodilator and decreases oxygen consumption
104
why do you want to give someone a stool softener for acute coronary syndrome
avoid vasovagal stimulation which can lead to bradycardia which can lead to dysrhythmia
105
hallmark sign of pericarditis
pericardial friction rub
106
potassium wasting
hydrochlorohiazide
107
potassium sparing
Spironolactone
108
increased heart rate and is used for sinus brady patients
atropine
109
potassium wasting that is best for heart failure patients
lasix
110
what med treats a flutter and a fib
adenosine
111
increases cardiac out put
Dobutamine
112
normal ejection fraction
>55%
113
SOB, crackles, orthopnea, dyspnea on exertion, paroxysmal nocturnal dyspnea, oliguria
left sided heart failure
114
JVD, peripheral edema, hepatomegaly, peripheral congestion, pitting edema, ascites
right sided heart failure
