hypertension Flashcards by Amanda S.

hypertension

Systolic blood pressure > 129 mmHg.
OR
Diastolic blood pressure > 80 mmHg

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hypertension for older ppl - numbers (Older than 150 yrs is hyper)

Systolic > 150 mmHg OR Diastolic blood pressure > 89 mmHg in the geriatric patient

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blood pressure is (my BP in CO is severe)

Blood Pressure = Cardiac Output x Systemic Vascular Resistance
BP = CO x SVR

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in early hypertension, CO is

normal. in older, it’s predominant.

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Short term mechanisms
that regulate bp

Sympathetic nervous system
Baroreceptors
Vascular endothelium

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long term mechanisms
that regulate bp

Renal, Na+

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aldosterone lowers what electrolyte?

K+, which raises the bp

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Sympathetic nervous system - what neutransmitter/hormone

Norepinephrine

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alpha-1 (the alpha constricts)

Vasoconstrict, ↑contractility

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alpha-2 (alpha 2nd in line constricts)

vasoconstrict

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beta-1 (better one increase my heart, Renin)

↑ contractility, HR, conduction, renin secretion

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beta-2 (Bettoo is wide)

vasodilation

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dopamine - dilates or constricts? (happy when you’re open)

vasodilation

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Baroreceptors in carotid

Baroreceptors
Stimulated by ↑ BP or ↓ BP

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Vascular endothelium
Vasoactive substances (prosty with nitrous vasoactivates)

Nitric oxide
Prostacyclin
Endothelian (ET-1, ET-2, ET-3)

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Elevated Blood Pressure (Pre-hypertension) (121 minutes elevated me)

Systolic BP 121-129

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Stage 1 HTN

Systolic BP 130-139 mmHg or Diastolic BP 80-89 mmHg
Can be treated with lifestyle modifications and if needed, a thiazide diuretic

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Stage 2 HTN (so close)

Systolic BP >140 mmHg or Diastolic BP >90 mmHg

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Having or being at risk developing cardiovascular disease

( < 10% in next 10 years) also determines course of interventions

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hypertension crisis - and what is diastolic? (the crisis is 180 degrees)

systolic above 180, or diastolic above 120

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hypertension crisis - target organs, or organs most at risk (just 3)

heart, eyes, kidneys

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Primary (essential or idiopathic) hypertension

Elevated BP without an identified cause
90% to 95% of all cases

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Secondary hypertension

Elevated BP with a specific cause
5% to 10% of adult cases

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Primary (essential or idiopathic) hypertension

Contributing factors
↑ SNS activity
↑ Sodium-retaining hormones and vasoconstrictors
Diabetes mellitus
> Ideal body weight
↑ Sodium intake
Excessive alcohol intake
can be genetic and how that interacts with environment.

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Secondary hypertension - causes - (The second I hint at the narrowing pass, my kidneys, brain, thyroid and liver can't sleep)

Coarctation (narrowing) of aorta Renal disease (number 1 cause aside from obesity and alcohol) Endocrine disorders Neurologic disorders Cirrhosis Sleep apnea thyroid, oral contraceptives

Isolated Systolic HTN (ISH) (isolated at age 55)

SBP > mmHg, DBP < 90 mmHg Diostolic BP rises until age 55 then declines

Pseudo hypertension

Cuff measurement overestimates the true intraarterial blood pressure Clue can be a + Osler’s Sign Patient has a palpable although pulseless radial artery while the BP cuff is inflated above the systolic pressure

Modifiable risk factors - what about diabetes?

Cigarette smoking, obesity, stress, excessive alcohol consumption, increased dietary salt intake, diabetes mellitus, medications (NSAIDS, oral contraceptives, antidepressants and nasal decongestants)

Non-modifiable risk factors - what about arteriosclerosis?

Hereditary predisposition, advancing age, African-American race, arteriosclerosis, renal disease and pregnancy.

Socioeconomic status

COVID-19 Essential workers Closer living conditions Use of public transportation Healthcare disparities

Environment

Food deserts ETOH Access to care Pollution

Racism & Discrimination

Causes increased and chronic stress Causes “weathering” Increase in stress response Decrease of lifespan Shortening of telomers

A new study in JAMA Cardiology (Hongwell, J., Kim, A. Ebinger, J. et al. 2020) found that sex differences in

blood pressure trajectories begin early and persist with aging.

Women are more likely than men to develop (women in CDM are not HF)

coronary microvascular dysfunction (CMD) and heart failure with preserved EF especially in the setting of HTN

Women when compared to men exhibited a steeper increase in

BP, including MAP, measures that began as early as in their 30’s and continued throughout their life.

Limit sodium intake - and what about high risk groups?

<2300 mg/day < 1500 mg/day for high-risk groups, diabetes, kidney disease, age 50+, HTN

effects of aging on BP

↑ arteriosclerosis/ atherosclerosis ↓ elasticity ↑ collagen ↑ peripheral vascular resistance (PVR) ↓ adrenergic receptor sensitivity ↓baroreceptor reflexes ↓renal function (after age 40) ↓ metabolism

HTN Referred to as the

“silent killer” because patients are frequently asymptomatic until target organ disease occurs

Symptoms are often secondary to (target first, symptoms last)

to target organ disease and can include Fatigue, reduced activity tolerance Dizziness Palpitations, angina Dyspnea

how to assess HTN? (just exam and labs)

Medical history Physical examination Routine labs

Fundoscopic exam for (the eye is fund)

retinal changes

BMI calculation to

identify risk factor

Auscultation for (auscultation for CAF is brutal)

carotid, abdominal and femoral bruits

Palpation of

thyroid gland

Through exam of

heart and lungs Abdominal exam for enlarged kidneys, masses and aortic pulsation

Palpation of lower extremities for

edema and pulses Neurological assessment

routine labs (HTN gets EVERY lab)

kidneys, urinalysis, BUN creatinine, sodium, K, Ca, TSH, glucose, cholesterol, LDL, HDL, hematocrit, ECG, CXR, liver function tests, might have left ventricular hypertrophy.

assessment for HTN

Assess/ monitor for symptoms of hypertension ( headaches, dizziness and visual changes) Intake and output, daily weights, and renal studies to assess for fluid volume excess, also central venous pressure, etc. Drug therapy adherence Antihypertensive drug therapy effects ( orthostatic hypotension, sexual dysfunction, etc.)

hypertensive crisis

BP > 220/140 Causes acute target organ damage

management of hypertensive crisis

Treatment based on symptoms Antihypertensive IV drug therapy Titrate drug Do not lower BP > 25% per hour Frequent neurological assessments Monitor cardiac, pulmonary, renal function Identify cause If patient does not have any target organ damage manage with oral antihypertensives after crisis Educate

impacts and complications

Target organ diseases occur most frequently in the Heart Brain Peripheral vasculature - PVD Kidney -nephrosclerosis Eyes

complications of HTN

Hypertensive heart disease Coronary artery disease Left ventricular hypertrophy Heart failure Cerebrovascular disease Stroke Peripheral vascular disease Nephrosclerosis Retinal damaged

diagnostic studies - 12 lead for what? (Hint 12 monkeys)

12- lead ECG- used to determine presence of ventricular hypertrophy/remodeling related to hypertension Ophthalmic exam Echocardiogram

drugs classes that treat HTN

Diuretics Adrenergic inhibitors (Adriene blocks adrenaline) Direct vasodilators Angiotensin-converting enzyme inhibitors Angiotensin II receptor blockers Calcium channel blockers

drug side effects - use caution with who? (A hint that COPD is not compatible)

Orthostatic hypotension Pre/Syncope Sexual dysfunction Dry mouth Frequent urination Dry cough use these meds with caution with ppl who have COPD

nursing management

Achieve and maintain the individually determined goal BP. Understand, accept, and implement the therapeutic plan. Experience minimal or no unpleasant side effects of therapy. Be confident of ability to manage and cope with this condition.

alpha

constrict

beta

dilate

dopamine

dilate

Papilledema - associated with hypertension

eyes

teaching plan to minimize orthostatic hypotension, (NOT chair, think of Alex)

Flex your calf muscles, avoid alcohol, and change positions slowly

hypertensive crisis - symptoms (my headache is a crisis)

sudden ↑ BP, headache, N, V, seizures, confusion, coma

hypertensive crisis can cause (MI brain bleeds into my liver and kidneys dissecting them)

encephalopathy, intracranial bleeding, subarachnoid bleeding, MI, acute liver failure, renal failure (AKI), dissecting aortic aneurysm, retinopathy

frequent episodes of ventricular fibrillation - treatment?

internal cardioverter defibrillator insertion

Digitalis and diuretics are withheld for how long before cardioversion?

24 to 72 hours before cardioversion

Which nursing intervention is required to prepare a client with cardiac dysrhythmia for an elective electrical cardioversion

Instruct the client to restrict food and oral intake

3rd level heart block - do what?

just alert provider, not an emergency

asystole caused by “Hs and Ts”

“Hs and Ts”: hypoxia, hypovolemia, hydrogen ion (acid/base imbalance), hypo- or hyperglycemia, hypo- or hyperkalemia, hyperthermia, trauma, toxins, tamponade (cardiac), tension pneumothorax, or thrombus (coronary or pulmonary).

+1 pulse

Difficult to palpate and is obliterated with pressure.

does the heart size increase or decrease with age?

increases due to hypertrophy

heart murmurs are common in

older adults

Women typically develop CAD (Women only benefit when Caddy)

10 years later than men bc of estrogen

6 Ps are arteries or veins?

arteries

S4 is common in

older adults with hypertension

normal BUN values (honey buns at 8 am)

8 - 20

creatinine levels (halloween creature - buf)

male - .6 - 1.2 female - .4 - 1

pharacologic stress test avoid what? (I'm feelin stressed)

avoid xanthine derivatives including theophylline, aminophylline, and caffeine

catherization - how long to fast before?

8 - 12 hrs.

#1 cause of hypertension after smoking and obesity?

renal disease

1 and 2 (beta and alpha)

1 = antagonist 2 = agonist

hypertension Flashcards

(80 cards)