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Medsurg Exam 2 > HTN > Flashcards

HTN Flashcards

(59 cards)

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1
Q

as BP increases, so does the risk for:

A

MI
HF
Stroke
renal disease

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2
Q

percentage of people greater than 20 with hypertension are aware of having high BP

A

83%

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3
Q

percentage of people being treated for HTN

A

76%

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4
Q

percentage of those aware but do not have HTN controlled

A

48%

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5
Q

equation for blood pressure

A

blood pressure = cardiac output x systemic vascular resistance

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6
Q

what is systemic vascular resistance

A

the amount of force exerted on circulating blood by the vasculature of the body

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7
Q

factors influencing blood pressure

A

CO
systemic vascular resistance
SNS
baroreceptors
vascular endothelium
renal system
endocrine system

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8
Q

neurohormonal factors influencing BP

A

angiotensin - vasoconstrictor
norepinephrine - increase and maintain BP

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9
Q

normal BP (more of an average than a expectation)

A

less than 120
less than 80

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10
Q

prehypertension

A

120-139
80-89

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11
Q

hypertension, stage 1

A

140-159
90-99

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12
Q

hypertension, stage 2

A

greater than 160
greater than 100

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13
Q

etiology of primary hypertension

A

-Also called essential or idiopathic hypertension
-Elevated BP without an identified cause
-90% to 95% of all cases
-Exact cause unknown but several contributing factors

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14
Q

etiology of secondary hypertension

A

-Elevated BP with a specific cause
-5% to 10% of adult cases
-Clinical findings relate to underlying cause
-Treatment aimed at removing or treating cause

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15
Q

risk factors for primary hypertension

A

Age
Alcohol
Tobacco use
Diabetes mellitus
Elevated serum lipids
Excess dietary sodium (water retention)
Gender
Family history
Obesity
Ethnicity
Sedentary lifestyle
Socioeconomic status
Stress

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16
Q

possible factors for reason behind primary HTN

A

Genetic links
Water and sodium retention
Stress and increased SNS activity
Altered renin-angiotensin-aldosterone system (RAAS)

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17
Q

CM of severe HTN

A

Fatigue
Dizziness
Palpitations
Angina
Dyspnea

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18
Q

Target organ diseases occur most frequently from HTN in:

A

Heart
Brain
Peripheral vascular disease
Kidney
Eyes

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19
Q

diagnostic studies for HTN

A

Measurement of BP
Urinalysis
BUN and serum creatinine (in blood)
Creatinine clearance (in urine)
Serum electrolytes, glucose
Serum lipid profile (
Uric acid levels
ECG
Echocardiogram
Ambulatory blood pressure monitoring (ABPM)

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20
Q

What is Ambulatory blood pressure monitoring (ABPM)

A

Noninvasive, fully automated system that measures BP at preset intervals over 24-hour period
Teach patient to hold arm still and keep diary
Many applications for use

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21
Q

overall goals for HTN

A

control BP
reduce CVD risk factors and target organ disease

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22
Q

lifestyle modifications for HTN

A

Weight reduction
-Weight loss of 22 lb (10 kg ) may decrease SBP by approx. 5 to 20 mm Hg - Calorie restriction and physical activity

DASH eating plan (dietary approaches to stop htn)
-Fruits, vegetables, fat-free or low-fat milk, whole grains, fish, poultry, beans, seeds, and nuts

Dietary sodium reduction
-< 2300 mg/day for healthy adults
-< 1500 mg/day for
African Americans
-Middle-aged and older
-Those with hypertension, diabetes, or chronic kidney disease

Moderation of alcohol intake

Physical activity
-Moderate-intensity aerobic activity, at least 30 minutes, most days of the week
-Vigorous-intensity aerobic activity at least 20 minutes, 3 days a week
-Muscle-strengthening activities at least 2 times a week
-Flexibility and balance exercises 2 times a week

Avoidance of tobacco products
-Nicotine causes vasoconstriction and elevated BP
-Smoking cessation reduces risk factors within 1 year

Psychosocial risk factors
-Low socioeconomic status, social isolation and lack of support, stress, negative emotions
-Activate SNS and stress hormones

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23
Q

pt teaching for drug therapy

A

Follow-up care
Identify, report, and minimize side effects
Orthostatic hypotension
Sexual dysfunction (beta blockers)
Dry mouth (diuresis)
Frequent urination
Time of day to take drug

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24
Q

Failure to reach goal BP in patients taking full doses of an appropriate 3-drug therapy regimen that includes a diuretic

Study These Flashcards
A

resistant HTN

25
reasons for resistant HTN
Improper BP measurement Drug-induced Associated conditions Identifiable causes of secondary hypertension
26
subjective data for nursing assessment of HTN
Past health history -Hypertension -Cardiovascular, cerebrovascular, renal, thyroid disease -Diabetes mellitus, pituitary disorders, obesity, dyslipidemia -Menopause or hormone replacement Drugs Family history Salt and fat intake Weight gain or loss Nocturia Fatigue, dyspnea on exertion, palpitations, pain Dizziness, blurred vision Erectile dysfunction Stressful events
27
objective data for nursing assessment of HTN
Blood pressure readings Heart sounds (S3 - HF, S4 - HTN) Pulses (bounding) Edema Body measurements (BMI) Mental status changes (dizziness, weak, confusion)
28
possible nursing diagnoses for HTN
Ineffective health management Anxiety Sexual dysfunction Risk for decreased cardiac perfusion Risk for ineffective cerebral and renal perfusion Potential complications: stroke, MI
29
For nursing planning for HTN pt will:
Achieve and maintain goal BP Follow the therapeutic plan -Including HCP appointments Experience minimal side effects of therapy Manage and cope with this condition
30
health promotion for HTN
Primary prevention via lifestyle modification Individual patient evaluation and education Screening programs Cardiovascular risk factor modification
31
ambulatory care for pt with HTN
Evaluate therapeutic effectiveness Detect and report adverse effects Assess and enhance compliance Patient and caregiver teaching
32
necessities for home BP monitoring
Patient teaching is critical for accuracy Proper equipment Proper procedure Frequency Accurate recording and reporting Target BP
33
reasons for poor adherence to treatment plan
Inadequate teaching Low health literacy Unpleasant side effects of drugs Return to normal BP while on drugs High cost of drugs Lack of insurance
34
nursing measures to enhance compliance of HTN treatment
Individualize plan Active patient participation Select affordable drugs Involve caregivers Combination drugs Patient teaching
35
parameters for hypertensive crisis
SBP >180 mmHg and/or DBP >110 mmHg
36
Develops over hours to days May not require hospitalization
hypertensive urgency
37
Very severe problems can result if prompt treatment is not obtained
hypertensive emergency
38
importance for hypertensive crisis
Rate of rise more important than absolute value
39
clinical manifestations of hypertensive crisis
Hypertensive encephalopathy (Headache, nausea/vomiting, seizures, confusion, coma) Renal insufficiency Cardiac decompensation(MI, HF, pulmonary edema) Aortic dissection
40
Hypertensive Crisis Nursing and Interprofessional Mgmt during hospitalization
IV drug therapy: titrated to MAP Monitor cardiac and renal function Neurologic checks Determine cause Education to avoid future crisis
41
medications for antihypertension
ABCDD ACE inhibitors (-pril) beta blockers (-olol) calcium channel blockers (-pine -amil) diuretics digoxin
42
examples of ACE inhibitors
captopril enalapril fosinopril lisinopril benazopril
43
examples of beta blockers
acebutolol metoprolol propanaolol nedolol
44
examples of CCB
verapamil nifedipine diltiazem amlodipine nicardipine
45
examples of loop diuretics (-nide -mide)
furosemide bumatanide torsemide
46
examples of thiazide diuretics
hydrochlorothiazide chlorothiazide methyclothiazide
47
osmotic diuretic
mannitol
48
K+ sparing diuretic
spironolactone
49
nursing considerations for diuretics
Monitor K+ levels I/O monitoring BP monitoring Give in AM to prevent nocturia Fall risks Orthostatic hypotension
50
MOA of ACE inhibitors
dilates blood vessels lowers BP does not directly affect HR
51
MOA of beta blockers
decrease resistance decrease workload decrease CO
52
MOA of CCB
blocks movement of calcium relax blood vessels decrease BP increase supply O2 to heart decrease workload
53
MOA of digoxin
increase force of contraction = increase CO beats slower slows impulses sent through AV node-squeeze more blood
54
MOA of ARBs
lower blood pressure by decreasing vasoconstriction and decreasing sodium and water reabsorption in the kidneys
55
nursing considerations of ACE inhibitors
monitor BP potassium retention dry cough angioedema - swelling of face and tongue orthostatic hypotension dizziness BUN and creatinine
56
examples of ARBs
losartan valsartan irbesartan
57
nursing considerations of ARBs
Change position slowly Monitor K+ levels Monitor renal labs Monitor liver labs BP monitoring Don't overlap medications (ACE inhibitors)
58
nursing considerations of CCB
do not give with BB monitor BP stevens-johnsons syndrome orthostatic hypotension needs tapering monitor HR (contractility) No heart block pts constipation
59
nursing considerations for beta blockers
monitor BP contraindicated with asthma and COPD rebound tachycardia and HTN monitor blood sugar orthostatic hypotension bradycardia

Medsurg Exam 2 (6 decks)

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