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NURS 347 EXAM 3 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What does hypertension mean?

A

High blood pressure

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2
Q

As blood pressure increases so does the risk of? (5)

A

Myocardial infarction
Heart failure
Stroke
Renal disease
retinopathy

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3
Q

Hypertension effects about what percentage of United state adults?

A

46%

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4
Q

What is hypertension management??
What are the 2 target goals

A

Target goals are based on
Age & comorbidities

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5
Q

Who has the highest risk of hypertension?
Race & gender

A

Black people
Female

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6
Q

Black people have less of response to what?
And why does this effect them on getting angioedema?

A

Renin inhibiting medication

Because we want to stop our reninfrom our kidneys from sodium/fluid retention but since they have less response to the actual medication to renin it’s hard

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7
Q

Black people are at increased risk of what?
And how does that work?

A

Angioedema with ACE inhibitors
( Angiotensin converting enzyme)

The whole point of the the renin system is to sodium/fluid retention but since the ACE inhibitor is going to double that retention, we are going to cause edema ( swelling )

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8
Q

Which race group is less likely to receive treatment?

A

Hispanics

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9
Q

Hypertension is more common on men before the age of what?

A

Before middle age

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10
Q

Women have a higher risk of getting hypertension how (3)?

A

Oral contraceptives
Preeclampsia
After menopause

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11
Q

What does blood pressure mean ?

A

Force exerted by blood against walls of blood vessels

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12
Q

What is the blood pressure function ?

A

Cardiac output and systemic vascular resistance

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13
Q

What is the formula for BP?

A

CO = SV x HR
cardiac output = stroke volume X heart rate

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14
Q

How does the sympathetic nervous system effect our blood pressure?
It increased what 6 things?
CHII!!!

A

Cardiac contractility within seconds
Heart Rate
Increase Cardiac output
Increase systemic vascular resistance
Renin release
Vasoconstriction

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15
Q

How does Parasympathetic effect blood pressure? (3)
It does what to your blood pressure?

A

It decreases your heart rate ( vagus nerve )
Decrease Cardic output

Decrease BP

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16
Q

Sympathetic causes what?
What happens to pupils?
What happens to saliva?
What happens to heart beat?
What happens to airways?
What happens to digestion?
What happened to liver?
What happens to intensities?
Also secrete what??
What happens to bladder?

A

Dilate pupils
Inhibit salivation
Increase heartbeat
Relax airways
Inhibit stomach activity
Inhibit gallbladder
Inhibit Activity intensities
Secrete epinephrine/adrenaline
Relaxes bladder

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17
Q

Parasympathetic
What happens to pupils?
What happens to saliva?
What happens to heart beat?
What happens to airways?
What happens to digestion?
What happened to liver?
What happens to intensities?
What happens to bladder?

A

Constrict pupils
Stimulate salvia
Slow heartbeat
Constrict airways
Stimulate stomach
Stimulate gallbladder
Stimulate intestines
Contract bladder

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18
Q

What are the 5 sns receptors that effect blood pressure?

A

A1
a2
B1
B2
Dopamine

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19
Q

How does A1 receptor effect blood pressure?

A

Vasoconstriction
Increased contractility
( positive inotropic ; contraction )

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20
Q

How does A2 sns receptors affect blood pressure?
And explain the process of this?

A

Inhibit release of norepinephrine

When there isn’t a release of nonreponephrine, the blood pressure will drop

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21
Q

How does B1 sns affect blood pressure?

A

Increase contractility
Heart rate ( Chronotropic )
Conduction

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22
Q

What is the B2 sns affect receptor mean for Blood pressure?

A

Vasodilation

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23
Q

What does dopamine do for sns receptor affecting blood pressure?

A

Vasodilator

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24
Q

Where are baroreceptors located?

A

Carotids and aortic arch

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25
Q

Baroreceptors are sensitive to what and what happens to our blood pressure?

A

Sensitive to stretching which happened with increased blood pressure

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26
Q

What are the function of Baroreceptors ?

A

Monitor how much blood you have your blood vessels and fixing it to have a normal BP

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27
Q

When the Baroreceptors notice a low blood pressure what does it do?

A

Activates the SNS
And increase heart rate etc

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28
Q

When Baroreceptors detect a high blood pressure it’s going to do what?

A

Sending inhibitor impulse’s sympathetic nervous system

( Pretty much to stop SNS impulses from happening )

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29
Q

When the Baroreceptors send inhibitory impulses sns ? What does it cause? (3)

A

Decreased heart rate
Decreased force of cardiac contraction
Increased vasodilation of arterioles

( pretty much stopping sns impulses to happen and focus on psn )

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30
Q

When you have chronic hypertension what does that cause to Baroreceptors?

A

To reset baseline
( pretty much hypertensive state is there new normal, so like 130/90 is there new normal BP and the Baroreceptors don’t detect a need to change )

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31
Q

What are 3 factors that influence blood pressure?

A

Vascular endothelium
Renal system
Heart cells : natriuretic peptides : ANP/BNP

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32
Q

How does vascular endothelium affect blood pressure?
What will it produce in order to maintain?

A

It produces vasoactive substances to maintain low arterial tone

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33
Q

Explain how vascular endothelium effects blood pressure

A

Along side the blood vessel, there are endothelium cells

These endothelium cells are regulated by our vascular tone

However when we have hypertension these endothelium cells are distrusted and causes vasocative substances to be released and causes our body to constrict

Since the whole job of a vascular tone is to help with constriction of blood vessel to allow blood to come, but if we have high blood pressure we are going to constrict even more and not let that blood flow come in

Causing that low arterial tone
Meaning not all the blood is being pushed through, just bit by bit cause of that constriction

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34
Q

Not only does vascular endothelium cells effect our blood pressure but if we (2) it also effects the elasticity of vessels
Think of which diseases

A

Smoke
Diabetic mellitus

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35
Q

How does our renal system effect our blood pressure? (3)

A

Controls sodium excretion & extracellular fluid volume

Renin system

Prostaglandins - vasodilators

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36
Q

How does the control sodium excretion and ECF from the renal system effect our blood pressure?

A

If our reneal system is good enough
We will be able to excret a good amount of sodium and extracellular fluid

However with hypertension, it won’t be so it’ll retain it and cause high blood pressure

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37
Q

How does RAAS from renal system effect blood pressure ?

A

It’s our body’s response to the change and in low BP and will try to retain sodium and fluids in order to try to increase it but without good sodium excretion, the body will overaccumilate in collection of sodium

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38
Q

How does prostaglandins from ther renal system effect our blood pressure?

A

Our body produces prostaglandins in order to try to lower it by working as a
Vasodilator

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39
Q

How does natriuretic peptides work to effect blood pressure?

A

They oppose ( anti diuretic hormone ) ADH and Aldosterone

Which pretty much these two help retain fluids and sodium but since they are being opposed

It helps us lower blood pressure & lower blood volume

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40
Q

What are the steps of how epinephrine and nonepinephrine factor into influence our blood pressure? (7)

A

Epinephrine and nonepnephrine are relaxed by the adrenal medulla

They both increase cardiac output and contractility

This activates B2 receptors in the skeletal muscle and causes Vasodilation

Then it activates A1 adrenergic receptors in the skin & kidneys and causes vasoconstriction

Which also angiotensin 2 stimulates aldosterone to be released from the adrenal cortex in order to promote Fluid retention

Also ADH comes from posterior partition to increase fluid volume retention

All of this causing our blood pressure to increase

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41
Q

What’s normal blood pressure
Elevated blood pressure
HTN stage 1
HTN stage 2

A

120/80
120-129/80
130-139/80-89
140+/90+

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42
Q

Primary/essential Hypertension
Elevated BP is due to what?
And what percentages of all cases?

A

Unknown cause
90-95% of all cases of hypertension

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43
Q

What are the many contributing causes of primary/essential hyper tension? (9)
EEEOOO anagram

A

Altered endothelial function
Diabetes
Excess alcohol
Increased SNS activity
Increase sodium intake
Overproduction of Sodium
Overweight
retaining hormones
Tobacco

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44
Q

Secondary HTN
Elevated blood pressure is what cause?
And it accounts to what percentage of cases ?

A

Specific ; sudden development cause
5-10%

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45
Q

What are some findings that related to secondary HTN ? (8)

A

Aortic problems
Cirrhosis
Drug related
Endocrine
Neurological
Pregnancy induced
Renal problems
Sleep apnea

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46
Q

What is the treatment of secondary HTN?

A

Removing or treating the underlying cause

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47
Q

What’s the big difference between primary and secondary HTN?

A

Primary is like genetics and preventable
Secondary is sudden development due to underlying cause like pregnancy

48
Q

Pathophysiology
Primary hypertension
How do we get increase blood pressure?

A

Increase CO or increase SVR

49
Q

As hypertension progresses what rises and what goes back to normal?

A

SVR increases
CO goes back to normal

50
Q

What does SVR increase mean?
And why does CO go back to normal

A

So if you have progressive hypertension
The more your body is needing to pump blood through constrict blood vessel causes that’s increase in SVR

That’s pretty much what it means
SVR increases/the force the blood is needing to get through the blood vessels but since it’s hypertension, those vessels are small and tight and needs more

At first we notice signs of trouble was but after some time it becomes our normal which is why CO gets back to normal because our Baroreceptors have gotten so use to it and reset the baseline

51
Q

What are some risk factors of hypertension?? (13)

A

Age > 50
Alcohol
Diabetes
Ethnicity - black
Excess Sodium intake
Family history
Gender
Increased serum lipids - cholesterol
Obesity
Sedentary lifestyle
Socioeconomic
Stress
Tobacco

52
Q

What’s the 5 primary hypertension pathophysiology?
Think of what is gonna cause this primary HTN
WASIE!!

A

Altered renin angiotensin aldosterone mechanism
Endothelial dysfunction
insulin resistance & hyperinsulinemia
Stress & increased SNS
Water and sodium retention

53
Q

How many people does high sodium diet develop into hypertension?

A

1 in 3 people

54
Q

In the textbook, it mentions how it is very difficult to understand in who does sodium effect blood pressure in, weather some people needs lots of sodium vs some need very little to see an increase in blood pressure, however

We understand it’s what type of component?
Provide an example
And having an increase risk of what?

A

Genetic component
Such as black people having more risk of hypertension through salt

Risk of renal dysfunction, endothelial dysfunction & heart failure

55
Q

How does altered renin angiotensin aldosterone system effect primary hypertension pathophysiology?

A

Our body noticed a low blood pressure which
Increases renin activates RAAS
However when we have high blood pressure we want to inhibit the release of renin but we can’t because that became our new normal. So renin is just constantly raising our blood pressure due to that sodium/fluid retention

56
Q

How does stress and increase sns activity effect primary hypertension pathophysiology? (3)
Si in Spanish!! !! Say it outside

A

Causes vasoconstriction
Increase heart rate
Increase renin release

57
Q

People exposed to high amounts of stress repeatedly are more likely to develop?

A

Hypertension

58
Q

How does insulin resistance and hyperinsulinemia effect primary hypertension pathophysiology? (4)

It stimulates what
Impairs what??
Causes what??
Increased what??

A

It stimulates sns and impairs vasodilation ( nitric oxide )

Causes vascular hypertrophy
Increase renal sodium reabsorption

59
Q

Hypertension is also know to be as the what? Because why?

A

Silent killer
Asymptomatic

60
Q

What are some secondary clinical manifestations of hypertension? (5)

A

Fatigue
Dizziness
Palpitations
Angina
Dyspnea

61
Q

Treatment goals
Age > 65, SBP > 130 ambulatory in community setting ??? Goal?

Age> 65, SBP > 130 care facility

Age>18 with HTN, CVD

All others without CVD

A

SBP<130
patient/team decision
130/80
<130/80

62
Q

What are the two purposes of medication?

A

Decrease circulating blood volume
Reduce systemic vascular resistance

63
Q

Why do we want to reduce systemic vascular resistance?

A

Because we don’t want our body to have to use so much force to try to squeeze through the blood vessels, that’s what’s causing our hypertension

64
Q

What are the 6 medications to help aid with hypertension?

A

Adrenergic inhibiting agents
Ace inhibitors
Angio 2 receptor blockers
Calcium channel blockers
Direct vasodilators
Diuretics

65
Q

How does adrenergic inhibiting agents work?

A

Decreasing sns stimulation

Working centrally on Vasomotor center and peripherally to inhibit noephinephrine release or block adrenergic receptors on blood vessels

66
Q

How does ACE inhibitors work?
This also is known to cause cough and hypotension!

A

Prevent conversion of angiotensin 1 to angiotensin 2

Reduce vasoconstriction and sodium and water retention

67
Q

How does A-2 receptors blockers work?

A

Prevent angiotensin 2 from binding to receptors in blood vessel walls

68
Q

How does calcium channel blockers work? (CCB)

A

Increase sodium excretion and cause arteriolar vasodilation by preventing the movement of extracellular CA into cells

69
Q

How does direct vasodilators work?

A

Relax vascular smooth muscle and reduce SVR

70
Q

How does diuretics work?

A

Reduce plasma volume by increased sodium and water excretion and reduce vascular response to catecholamines

71
Q

Hypertension drug therapy
Patient with hypertension
Patient with stage 2 hypertension
What do we give

A

Nonpharmacologic treatment
1 first line pharamacologic drug

Nonpharmacologic therapy
2 antihypertensives

72
Q

When giving out drug therapy for hypertension we want the patient to make monthly follows up until they met there goal, and after they meet there go how often do they come back in for a check up?

A

3-6 months

73
Q

We always want to provide patient education; when giving medication to patients how are we going to educate them ? (3)

A

Tell them to report all side effects

If medication isn’t working, we can give them different ones to try for severe or undesirable

Why they need to continue commitment/adherence to therapy

74
Q

What are 4 common side effects of medication that we can provide patient education on? Explain each one too

A

Orthostatic hypotension
- dizzy or faint when Change position

Sexual problems
- reduced libido or wre tile dysfunction

Dry mouth
Sugarless gum or candy

Frequent voiding
- take diuretic daily in the day to avoid getting up at night

75
Q

What does resistant hypertension mean?

A

Failure to reach goal blood pressure with appropriate theory and drug regimen

76
Q

When you have resistant hypertension what does that increase to you have? (2)

A

Stroke and myocardial infarction

77
Q

What are the 6 causes of resistant hypertension?
Examples of each as well

A

Improper BP measurement
- wrong cuff size
Volume overload
- excess salt intake
Drug induced or other causes
- cocaine
Associated conditions
- alcohol, obesity
Secondary hypertension
- underlying cause like renal disease/failure
Overactive renal nerve
- renal nerve ablation

78
Q

What’s the treatment for resistant hypertension?

A

You want to determine the fact that may be causing it

79
Q

When providing nursing care we want to follow an anagram, what is it and what does it stand for? (8)

A

Diuretic

Daily weight
Input and output
Urine output
Response of blood pressure
Electrolytes
Take pulses
Ischemic episodes (TIA)
Complications 4
CAD, CRF, CHF, CVA

80
Q

What’s the nursing diagnosis for hypertension?
What we will see on our patient that will help us diagnosis hypertension (4)
Think of AEEP!! OUTLOUD

A

Altered blood pressure ( measurement )
Ineffective tissue perfusion
Impaired sexual function
Potential complications : stroke & myocardial infarction

81
Q

What are the goals/plans for nursing care for hypertension? (3)
Don’t over think this, what are we literally wanting to do and help our patient with

A

Achieve and maintain goal blood pressure

Minimal side effects

Manage and cope with condition

82
Q

How do you measure blood pressure?
What are the steps you need to do^
You don’t want to do what things prior to the blood pressure exam; at least 30mins
Always wanna make sure we deflate at what rate?
If you can’t use upper arm we can use what machine?
Always wanna get a good what?

A

Cuff on the arm brachial
Smoking, exercise or caffeine
We deflate at 2-3mm
We can use Doppler
Good cuff size

83
Q

How do we measure blood pressure in orthostatic hypotension?
We want to do what first?
Then ?
Normal(2) vs abnormal (4)

A

Blood pressure & hr after supine for 5 mins

Assist to stand
Measure BP and hr at 1-3mins of position change

Normal
decrease than SBP 10mm
Increase DBP & HR

Abnormal
Decrease SBP 20mm
Decrease DBP 10mm
HR increase 20+
Report lightheaded or dizzy

84
Q

Hypertension nursing implementation
We want to do primary prevention, what is it ??
2 main ones
(2) (4)
What are the first things we are trying to tell our patient !!

A

Lifestyles modifications
- decreasing sodium & following DASH
- education dangers of HTN

Individual patient evaluation & education
- screening programs
- identify risk factors for HTN&CAD
- BP measurement
- drugs/previous treatment

85
Q

How are we going to provide acute care for hypertension for our nursing implementation?(3)
Think of like simple things, and what are we going to recommend ??

A

Monitor their blood pressure & VS
If they have increase blood pressure follow up with health care provider
Refer to appropriate personnel
- dietician - physical therapist

86
Q

How/why are we going to use screen programs for nursing implementation for hypertension?

A

Community based screening that use to help identify groups or people with high blood pressure

87
Q

How are we going to perform ambulatory ( longer term care ) for hypertension for our nursing implementation? (9)
LONG TERM THINK HEADP!!

A

Help patient reduce blood pressure
Evaluate therapeutic effectiveness
Detect and report adverse effects
Assess and enhance adherence
Patient and caregiver teaching

Nutritional therapy
Drug therapy
Lifestyle modifications
Home blood pressure monitoring

88
Q

How are going to implement home blood pressure monitoring for hypertension?? (4)
( don’t over think, when they go home, we expect them to know and do these things ?!)

A

Using proper equipment & procedure
Changing lifestyle
Medication education
Adherence to therapy

89
Q

Why do we want to emphasize the important to patient adherence for hypertension when it comes to our nursing implementation?

A

Because it’s a major problem !!!
Causes more serious complications

90
Q

What are some reason for poor adherence? (6)

A

Inadequate teaching
Low health literacy
Unpleasant side effects of drugs
Return to normal blood pressure
High cost of drugs
Lack of insurance

91
Q

Lastly we want to promote measures that will enhance compliance when teaching about hypertension, what are they that we are going to implement as a nurse? (6)

A

Individualize plan
Active patient participation
Select affordable drugs
Involve caregivers
Combination drugs
Patient teaching

92
Q

Gerontologic considerations
Percentage risk and greater at what age?

A

90% risk
55 age

93
Q

What’s the 7 pathophysiology for gerontologic considerations
BDDDLII!!

A

Blunted Baroreceptors reflexes
Decreased renal function
Decreased renin response to sodium and water depletion
decreased adrenergic receptor sensitivity
Loss of elasticity in arteries
Increased collagen and stiffness in myocardium
Increase PVR

94
Q

Gerontologic considerations
Hypertension
Older patients are more likely to have what type of hypertension and means what?

A

White coat
Higher BP in hospitals than at home

95
Q

Gerontologic considerations
Hypertension
Elder will normally have altered what (3)?

A

Drug absorption
Metabolism
Excretion

96
Q

Gerontologic considerations
Eldery will have a wider what ?
So we have to assess for? (3)

A

Auscultatory gap
Orthostatic hypotension
Acute kidney injury
Postprandial hypotension

97
Q

We always want to be cautions of using what medication to treat hypertension for elders?

A

nsaids

98
Q

Most elderly patients starts with what type of medication? (1)
And then move onto? (2)

You also always want to smart small dose before going to big dose!!

A

Diuretics

Calcium channel blocker
Ace inhibitor

99
Q

What is hypertensive crisis?
Measurement ?

A

Emergency
Anything above 180/120

100
Q

Does hypertensive crisis emergency require hospitalization?

A

Yes!!! It’s an emergency

101
Q

What does hypertensive Crisis for emergency target and from that it can cause?
(8)

A

Target organ damage

Encephalopathy
Intracranial/subarachnoid hemorrhage
Heart failure
Myocardial infarction
Renal failure
Aneurysm
Retnioplathy

102
Q

When hypertensive emergency is untested what happens?

A

79% death rate

103
Q

Hypertensive urgency, does it need hospitalization?

A

No

104
Q

Hypertensive urgency, does it have organ disease?

A

No

105
Q

Hypertensive urgency is mainly associated with what? And examples

A

Chronic stable discords
- stable angina
- chronic heart failure
- prior myocardial infarction
- CVA

106
Q

Hypertensive crisis
What can cause it? (3)
And leads to ? (3)

A

Cocaine
Amphetamines
LSD

Stroke
myocardial infarction
Encephalopathy

107
Q

What are clinical manifestations of hypertensive encephalopathy? (6)
Think of the brain 🧠

A

Headache
Nausea/vomitting
Seizures
Confusion
Coma
Retinal changes

108
Q

What are some clinical manifestations if hypertensive crisis for cardiac decompensafion? (4)

A

Myocardial infarction
Pulmonary edema
Chest pain
Dyspnea

109
Q

What are clinical manifestations of hypertensive crisis for aortic dissection? (2)

A

Chest/back pain
Reduce/absent peripheral pulses

110
Q

What is the hypertensive crisis emergency nursing care ? (2)
Emergency is causing a target to what??

A

Treat related BP to evidence target organ
IV drugs : slow titration

111
Q

What type of drugs are we going to be giving to a hypertensive crisis emergency patient? (3)

A

Adrenergic inhibitors
Calcium Channel blockers
Vasodilators ( sodium nitroprusside )

112
Q

We always want to asses a patients vitals, but what’s so important to understand that when giving drugs to a patient with hypertensive crisis Emerengency is?

A

They are rapid onset

113
Q

What are some special considerations to take into play with hypertensive crisis emergency? (3)

A

Aortic dissection
Acute ischemic stroke
Post stroke patients

114
Q

What are nursing implementations we are going to do for hypertensive crisis? (5)

A

Monitor cardiac/renal function
Neurological checks
Bed rest
Determine cause
Education to prevent further

115
Q

Hypertensive urgency - outpatient
What types of medications will we give? (4)
And they require a follow up often in 24 hours? True of false?

A

Captopril
Labefaol
Clonidine
Amlodipine

True

116
Q

As treatment for hypertensive crisis a patient has recieved sodium nitroprusside for 3 days. For which reason would the nurse plan to monitor the patient thiocyanate levels?

A

The medication is metabolized to cyanide and then thiocyanate

It can reach lethal levels

117
Q

How much sodium do you restrict on a hypertensive patient?

A

1500mg

NURS 347 EXAM 3 (9 decks)

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