HTN

Question 1

What is the impact of HTN in society:

Answer 1

Nearly 1000 deaths/day; 67 M americans ahve HTN; 1-3 ration; incidence in children increases risk of HTN d/t obesity

Question 2

Why is HTN known as the “silent Killer’?

Answer 2

HTN is not associated w/symptoms that would prompt individuals to seek medical help; severe target organ damage will be the result of un-tx HTN

Question 3

What are the goals of HEALTHY PEOPLE in the reduction of HTN:

Answer 3

healthy weight, reduce NA intake, increase exercise, limit EtOH, know/monitor bld pressure, take medications if ordered

Question 4

What are the types of comorbidities that are a MAJOR contributor to HTN:

Answer 4

heart attack, stroke, HF, kidney failure, cardiovascular disease

Question 5

What ethnicites have the highest HTN incidences:

Answer 5

African/ mexican, Native Americans

Question 6

What area of the US has the highest incidence of HTN regardless of race:

Answer 6

Stroke Belt or southeastern US

Question 7

A persistent/sustained elevation of BP at >140/90 mmHg is defined as:

Answer 7

HTN

Question 8

The classification of HTN is based on what:

Answer 8

The average of two or more office visit occasions

Question 9

Stage 2 HTN is:

Answer 9

> 160/100

Question 10

PreHTN is:

Answer 10

120-39/80-89

Question 11

What is the elderly impact of HTN:

Answer 11

Not considered a normal part of aging, but common among pts >60 yo; increases w/age; prone to drug overdosing d/t decreased renal function; Isolated systolic HTN is more common in older adults

Question 12

The force exerted by the blood against the walls of the bld vessels is defined as:

Answer 12

BP

Question 13

The total bld flow through the systemic or pulmonary circulation per min is defined as:

Answer 13

CO (also described as the stroke volume of blood pumped out by L ventricle per beat)

Question 14

The force that opposes the movement of blood within the blood vessels is defined as:

Answer 14

systemic vascular resistance (SVR)

Question 15

What is the principal factor in determining vascular resistance:

Answer 15

The radius of the small arteries and arterioles

Question 16

What happens if the systemic vascular resistance is increased but the CO is the same or increases:

Answer 16

arterial BP increases

Question 17

An elevated BP w/specific causes that can be identified and corrected: narrowing of the aorta, renal disease, endocrine disorders, neurological disorders, sleep apnea, medications, PIH (pregnancy-induced HTN), and pheochromocytoma (adrenal tumor) is defined as what type of HTN:

Answer 17

Secondary HTN

Question 18

An elevated BP w/out identified causes (accounts for 90% of cases) such as: increased activity of the SNS, overproduction of Na retaining hormone, increased Na intake, obesity, excessive EtOH intake, and DM is what type of HTN:

Answer 18

Primary/Essential HTN

Question 19

How does heredity affect HTN:

Answer 19

strongly familial d/t activities/dietary factors; 30 % genetic factor in some populations

Question 20

How does water and NA affect HTN:

Answer 20

Increased Na intake causes water retention; in some degree, NA intake triggers the development of HTN according to studies done on primitive vs. industeralized and salt loading studies

Question 21

Arterial BP increases with the increase of what:

Answer 21

CO or systemic/peripheral vascular resistance

Question 22

How does the renin-angiotensin-aldosterone system affect BP

Answer 22

Decreased BP/SNS stimulation causes renin to to be secreted from the JA of the kidneys–>Renin converts A-1 to A-2–>A-2 increases BP as a vasoconstrictor (increasing SVR), and causes adrenal glands to secrete aldosterone which cause NA and water retention increasing blood volume=increasing CO=increasing BP

Question 23

How does Stress affect HTN:

Answer 23

stress increases the SNS activity–>increased SNS activity causes vasoconstriction, increased HR, and increased renin release

Question 24

How does insulin resistance/hyperinsulinemia affect HTN:

Answer 24

present in PRIMARY HTN (DM); high insulin stimulates SNS activity, impairs nitric oxide mediated vasodilation, vascular hypertrophy, increased Na retention

Question 25

How does endothelial cell dysfunction affect HTN:

Answer 25

contributes to atherosclerosis, High levels of endothelin prolongs vasoconstriction, decreased vasodilator response to nitric oxide

Question 26

How does gender and age play a role in HTN:

Answer 26

HTN is prevalent in males young/middle-age; prevalent in women after 55 yo; BP rises progressively w/increasing age, but HTN is not a normal aging process

Question 27

What are the major target organ complications of HTN:

Answer 27

Cerebrovascular disease, retinopathy; hypertensive heart disease (CAD, LVH, HF); aortic aneurysm; nephrosclerosis, PVD, neuropathy

Question 28

Transient ischemic attack (neurological dysfunction d/t bld loss) or stroke (commonly d/t atherosclerosis); intracranial pressure is a manifestation of what target organ disease:

Answer 28

cerebrovascular disease

Question 29

Narrowing of the retinal arterioles; arteriovenous nicking (arteriole crossing over vein), or hemorrhagic/exudate w/or w/o papiledema (all causing vision blurred/loss of vision/retinal hemorrhage) are manifestations of what target organ complication of HTN:

Answer 29

retinopathy

Question 30

EKG/clinical/radiologic evidence of CAD d/t MI...; LVF/HF; left ventricular dysfunction are manifestations of what target organ complication of HTN:

Answer 30

hypertensive heart disease/cardiac disease

Question 31

One/more pulses in extremities that are reduced or absent; intermittent abd bruits/thrills; abd aneurysm (all sped up by atherosclerosis) are manifestations of what target organ complication of HTN:

Answer 31

PVD (peripheral vascular disease)

Question 32

Atrophy of renal tubules, destruction of glomeruli, eventual death of nephrons all indicated by proteinuria, microalbuminuria, heaturia, nocturia are manifestations of what target organ complication of HTN:

Answer 32

Nephrosclerosis

Question 33

Atherosclerosis contributes to what major complications of HTN:

Answer 33

ischemic stroke, heart attack, peripheral arterial disease

Question 34

What's the difference between atherosclerosis and arteriosclerosis:

Answer 34

Atherosclerosis has plaque; arteriosclerosis is hardening of the vessels

Question 35

What is the subjective assessment for HTN:

Answer 35

PMHx, medications (birth control increases BP), functional health patterns

Question 36

Objective assessment of HTN include:

Answer 36

physical exam-neurological, CV, musculoskeletal, renal; most people have no S/S of HTN; accurate BP taking (measured w/arm at heart level)

Question 37

Diagnostic assessment include:

Answer 37

assessing the risk/comorbidities; determine identifiable cause of HTN; assess presence of target organ damage; obtain lab tests: CBC, *K/Ca*, glucose, BUN, Creat

Question 38

What is the normal level of K:

Answer 38

3.5-5.1

Question 39

What is the normal level of Ca:

Answer 39

8.5-10.3

Question 40

What is the normal level of glucose:

Answer 40

65-99

Question 41

What is the normal level of BUN:

Answer 41

8-22

Question 42

What is the normal level of creat:

Answer 42

0.5-1.3

Question 43

What dx study may show evidence of an ischemic heart disease and LVF:

Answer 43

ECG

Question 44

What dx study may show STRUCTURAL heart disease and LVF:

Answer 44

echocardiogram

Question 45

Common nsg dx include:

Answer 45

sexual dysfunction, ineffective health maintenance; ineffective therapeutic regimen management, disturbed body image

Question 46

The collaborative intervention for primary HTN is:

Answer 46

To RETAIN wellness via stratification and tx; independent nsg intervention includes screening and teaching

Question 47

The collaborative intervention for secondary HTN is:

Answer 47

To ATTAIN wellness via drug therapy: monitor effectiveness of drugs/side effects/contraindications

Question 48

Drugs that promote the excretion of water and electrolytes by the kidneys to reduce BP/edema; first line of drugs to tx HTN are defined:

Answer 48

diuretics

Question 49

Most commonly Rx diuretic that works on the distal convoluted tube; has 3 hypers/2hypos (hyper:calcemia/glycemia/uricemia; hypos:kalemia/natremia; inhibits Na, h2O, Cl, K reabsorption

Answer 49

thaizides (HCTZ)

Question 50

When taking thiazides, considerations would be:

Answer 50

DO not give in Renal pts (use Loops) monitor K level in the elderly, NSAIDs reduce effect; avoid sulfonamide allergies

Question 51

This diuretic works on the ascending Henle to cause rapid diuresis of Na, Cl, H20; considered to be the most potent of diuretics (except osmotics); potent K-wasting diuretic; can cause orthostatic hypotension:

Answer 51

Loop diuretics (Bumex or Lasix)

Question 52

What are some important considerations in the taking of loop diuretics:

Answer 52

hypokalemia especially if taking digoxin can cause toxicity; electrolytes should be monitored d/t rapid diuresis effect

Question 53

This diuretic acts on the collecting ducts; promotes Na and H2O excretion and RETAINS K; can cause hyperkalemia:

Answer 53

Potassium-sparing diuretics (spironolactone (aldactone)

Question 54

What are some important considerations of taking K-sparing diuretics:

Answer 54

Hyperkalemia (especially if taking ACE inhibitors)

Question 55

Beta-blockers decrease HR/contractility/renin release; NSAIDs decrease effectiveness of BBs; widely used for stage 1 and 2 HTN; what are the names of the common ones:

Answer 55

Propanolol (B1 &2), metoprolol/atenolol (B1)

Question 56

When are BBs contraindicated:

Answer 56

COPD, bradycardia, asthma (d/t bronchospasm)

Question 57

This type of BB will inhibit B1 and B2 to decrease HR, and bronchoconstriction:

Answer 57

propanolol (non-selective BB)

Question 58

This type of BB inhibits B! to decrease HR, contractility, renin release w/o affection bronchoconstriction:

Answer 58

Cardioselective BBs: metroprolol/atenolol

Question 59

This type of anti-HTN drug blocks angio 1 from converting to angio-2=prevents vasoconstriction; is recommended fro pts when BBs are contraindicated or ineffective; hyperkalemia (don't use w/k-sparing diuretic); chronic cough

Answer 59

ACE inhibitors (prils)

Question 60

This anti-HTN med blocks the chemical receptors for angi-2 on the arterioles to prevent the relase of aldoserone:

Answer 60

Angi-2 inhibitors (tans)

Question 61

Centrally acting alpha 2 agents have the three c's to inhibit the SNS causing dilations of Peripheral vessels; comes in a patch; decreaed PVR=increased vasodilation=diuretics need to be given

Answer 61

Catapress decreases cascade (nori-epi-renin release)

Question 62

Direct acting vasodilators reduce SVR and BP, used in HTN crisis, severe hypotension; tachycardia can occur d/t nervous system stimulation; what type of drugs are they:

Answer 62

Nipride and aprelosine

Question 63

A severe and abrupt elevation in BP >180/120 that can trigger endothelial damage=release of vasoconstriction substance=can lead to target organ failure; common in non-compliant pts or cocaine users is defined as:

Answer 63

HTN crisis

Question 64

What are the manifestations of HTN crisis:

Answer 64

depends on organ damage: S/S of neurological dysfunction, retinal damage, HF, pulmonary edema, renal failure

Question 65

What is used to measure HTN crisis to guide drug therapy:

Answer 65

mean arterial pressure (MAP = DBP = 1/3 of pulse pressure)

Question 66

What is the normal MAP:

Answer 66

70-100 mmHg

Question 67

How is HTN crisis treated:

Answer 67

Decrease MAP by 1-20% in the first 2 hrs, then GRADUALLY over the next 24 hrs; Direct acting Vasodilators are used (titration to prevent hypotension) intra-arterial line or automated BP monitoring machine is used; hourly urine output/neuro checks

Question 68

What are some common HTN misconceptions:

Answer 68

pt feels sick when he's HTN; pt has a hyper personality; Elevated DBP is more important than SBP; HTN can be cured; pt cannot live a normal life; increased cholesterol means HTN

Question 69

What are some important teaching guidelines when taking meds:

Answer 69

avoid hot baths/strenous exercise/intake of EtOH within 3 hrs of taking meds to promote vasodilation

Question 70

A dietary approach to stop HTN is called DASH:

Answer 70

Eat fish/plenty of fruits/veggies/increase whole grains/increase K, mg, CHON, fibers;

Question 71

DASH wants you to decrease what:

Answer 71

saturated fats and cholesterol, less than 2.4 grams of NA/day; avoid processed foods

Question 72

What are the components of lifestyle modifications:

Answer 72

DASH, weight reduction; Na reduction, aerobic activity, moderation of EtOH

Question 73

BMI should be between:

Answer 73

18.5-24.9