Hypertension - EXAM 4 Flashcards Preview

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Flashcards in Hypertension - EXAM 4 Deck (47):
1

What are sodium restricted diets?

Sodium resitricted diets are important in managing not only problems affecting the heart and blood vessels but also problems affecting the kidneys and liver. Often times fat-restricted diets and sodium-restricted diets are ordered together, although can be separate.

2

How much does the American Heart Association recommend limiting sodium intake to?

2,400 mg/day

3

Where does sodium come from in our diet?

Processed foods have the most sodium, unprocessed foods have the least

Dairy products like cheese

Sodium bicarbonate

Sodiium saccharin

Monosodium glutamate

4

What is a DASH diet?

A diet rich in fruit, vegetables, low fat dairy products, reduced amounts of red meat, and reduced amounts of sweets and sugar significantly lower SBP and DBP even when sodium is not restricted

5

What are some ways to decrease salt intake?

  1. Remove the salt shaker from the table
  2. Do not add salt during cooking
  3. Prepare foods with sodium free spices: basil, bay leaves, curry, garlic, ginger, lemon, mint, oregano, pepper, rosemary, thyme
  4. Read labels to determine salt/sodium content. Consider alternatives for the visually impaired
  5. Eat high salt foods in moderation and use low salt or salt free products regularly
  6. Use these foods sparingly:
    1. Foods prepared in brine (pickles, olives, sauerkraut)
    2. Salty, cured, or smoked meats and fish
    3. Potato chips, pretzels, salted popcorn, salted nuts, salted crackers
    4. Bouillon cubes, seasoned salts, soy, worcestershire and BBQ sauces, prepared horseradish, catsup, and mustard
    5. Cheeses, especially processed types
    6. Canned and instant soups and sauces

6

What is important to note about salt substitutes?

They often contain potassium and would be contraindicated on a potassium restricted diet. Caution must be used if the patient is taking a potassium-sparing diuertic or ACE inhibitor

7

hydrochlorothiazide (HCTZ, Hydrodiuril)

Classification: Thiazide Diuretic, Potassium wasting

Mechanism of Action: Interferes with Na absorption in distal tubule of npehron. Decreases blood volume. Decreases Na in serum and increase Ca in serum.

Use: HTN, CHF

Side/adverse effects: Postural hypotension, dehydration, hypokalemia, weakness

Nursing Implications:

  1. Monitor serum electrolytes
  2. BUN
  3. I/O
  4. BP
  5. Edema

 

8

lisinopril (Prinivil, Zestril)

Classification: ACE Inhibitor

Mechanism of Action: Interrupts renin/angiotensin sequence blocking formation of angiotensin II. Promotes vasodilation by prevention vasoconstriction. Decreases preload and afterload.

Side/Adverse Effects: Dry cough, rash, hyperkalemia, angioedema, neutropenia

Nursing Implications:

  1. Monitor BP
  2. Monitor renal function
  3. Monitor K levels
  4. Take on empty stomach 1 hour before or 2 hours after
  5. Increase risk of lithium toxicity for patients taking lithium
  6. Notify provider promptly of any indication of infection

 

9

losartan potassium (cozaar)

Classification: Angiotensin II receptor antagonist also called Angiotensin Receptor Blockers (ARB)

Mechanism of Action: Blocks angiotensin II receptor found in vascular. Produces vasodilation. Activates alpha receptors, myocardial contraction, decreases afterload

Use: HTN

Side/Adverse Effects: dizziness, HA, orthostatic changes with diuertic use or other anti HTN agents, increased potassium levels

Nursing Implications:

  1. Monitor BP
  2. Monitor CBC
  3. Monitor Electrolytes
  4. LFT
  5. Full effect on BP may not be seen for 3-6 weeks
  6. Monitor for hyperkalemia
  7. Monitor for increase in BUN and Cr in long term use

 

 

10

amlodipine (Norvasc)

Classification: Calcium channel blocker

Mechanism of Action: blocks calcium influx across cell membranes of vascular and cardiac smooth muscle, thus causing vasodilation and decreased SVR

Use: HTN, vasospasm (coronary), angina, vasodilates everything

Side/Adverse Effects: peripheral or facial edema, postural hypotension, palpitations, tachy/bradycardia

Nursing Implications:

  1. Monitor HR
  2. Monitor BP
  3. Monitor weight
  4. Monitor for postural changes especially when combined with other anti HTN meds and diuretics
  5. Avoid grapefruit juice due to food/drug interaction

11

metoprolol (Lopressor)

Classification: Beta-adrenergic antagonist, primarily beta1

Mechanism of Action: Decreases HR and CO, Lowers BP, slows sinus conduction, decreases myocardial automaticity, antihypertension action may be due to antagonism of catecholamines

Use: Mild-severe HTN, long term treatment of angina, decreased mortality after AMI

Side/Adverse Effects: Bradycardia, orthostatic hypotension, complete heart block, bronchospasm

Nursing Implications:

  1. Check HR and BP prior to administration
  2. Monitor I/O
  3. Daily weights
  4. Patient to change position slowly
  5. Cautious use in patients with COPD and asthma
  6. Avoid sudden withdrawal of medication

12

What are the risk factoes of HTN?

  1. Age over 50
  2. More than 1 oz of alcohol per day
  3. Smoking
  4. Diabetes
  5. Elevated serum lipid levels (elevated cholesterol and/or triglycerides)
  6. Excessive sodium intake
  7. Male less than 55 or female over 55
  8. Family history of HTN or CVD
  9. Obesity
  10. BMI
  11.  

13

Why is it important to have adequate blood volume?

Blood volume in the circulatory system depends on a blood volume that is sufficient to fill the blood vessels and a pressure difference across the system that provides force to move blood forward. The total blood volume is a function of age a body weight, ranging from 85-90 mL/kg in the neonate and from 70-75mL/kg in the adult

14

What is the importance of the ability of the heart to effectively pump?

The circulatory system is divided into two parts: the low-pressure pulmonary circulation, linking circulation and gas exchange in the lungs AND the high pressure system circulation, providing oxygen and nutrients to the tissues

Blood flows down a pressure gradient from the high-pressure arterial circulation to the low-pressure venous circulation

15

What is the importance of vascular tone?

Ability of blood vessels to vasodilate and vasoconstrict in respoinse to changing hemodynamic states under the influence of the autonomic nervous system and RAAS

16

What is blood pressure?

The force exerted by the blood against the walls of the blood vessels

BP = Cardiac Output (CO) X Systemic Vascular Resistance (SVR)

17

If HR increases, what happens to CO?

Increases in HR or force of a contraction leads to an increase in CO

18

What will increase CO?

Factors that increase preload will increase CO

19

What is SVR?

Systemic vascular resistance. SVR refers to the resistance of blood flow created by the constriction or dilation of the systemic blood vessels. Vasoconstriction leads to an increased SVR and vasodilation leads to a decrease in SVR. It can be said that systemic vascular resistance is affected by preload, afterload, and contractility of the heart muscle.

20

How is HTN diagnosed?

Diagnosis of hypertension is based on the average of 2 or more seated BP readings on two or more office visits. Patients should be seated quietly for 5 minutes, feet on floor, and arm supported at heart level. Use appropriate size cuff and measure BP in both arms.

21

What are the BP parameters?

Normal: less than 120/less than 80

Pre Hypertension: 120-139/80-89

Hypertension Stage I: 140-159/90-99

Hypertension Stage II: greater than or equal to 160/greater than or equal to 100

22

When should pharmacological treatment be initiated for HTN?

  • In general population 60 or older: systolic BP of 150 mm Hg or diastolic BP of 90 mm Hg or higher
  • General population younger than age 60: SBP of 140 or higher and DBP of 90

23

What is primary hypertension?

Elevated BP without identifable cause that accounts for 90-95% of hypertensive cases

24

What are the possible contributing factors of primary HTN?

  1. Increased SNS activity (stress, pain, fear, anxiety)
  2. Increased sodium intake
  3. Overweight
  4. DM
  5. Excessive alcohol intake
  6. Tabacco use

25

What is secondary HTN?

Elevated BP due to an identifable cause. Accounts for 5-10% of hypertensive cases.

26

What are the possible causes of secondary HTN?

Pregnancy, renal disease, cirrhosis

27

What might be the cause of HTN in children?

  1. Glomrulonephritis
  2. Congenital heart disease

28

What long term effects can HTN have on the body?

  1. Leading cause of stroke
  2. Stroke is the third leading cause of death in the US
  3. Leading risk factor for end stage renal disease
  4. Major risk factor for coronary artery disease and development of heart failure

29

What are the complications of HTN on the heart?

  1. Coronary artery disease (CAD)
  2. Left ventricular hypertrophy (LVH)
  3. Heart Failure (CHF)

30

What are the complications of HTN on the brain?

  1. Atherosclerosis
  2. Carotid artery disease
  3. Stroke (CVA)

31

What are the complications of HTN on the peripheral vascular system?

Peripheral vascular disease (PVD)

32

What are the complications of HTN on the kidneys?

  1. Nephrosclerosis
  2. ESRD

33

What are the complications of HTN on the eyes?

Retinal damage

34

Why are diagnostic studies performed for HTN?

  1. To rule out primary causes of HTN
  2. Evaluate for target organ damage

35

What additional studies may be done for HTN patients?

  1. 12 lead ECG
  2. Echocardiogram
  3. Serum lipid level (provides additional risk factor information)
  4. Electrolytes/HbA1c
  5. Ankle Branchial Index
  6. BUN/Cr
  7. Urinalysis
  8. Eye examination

36

What lifestyle modifications should be done for exercise and fitness?

  1. Moderate intensity aerobic exercise for 30 minutes minimum 5 days a week
  2. Vigorous intensity exercise 2X/week that will maintain/increase muscle stength and raise HR by 30

37

What lifestyle modiciations should be taken regarding weight management?

  1. Body mass index between 18.5 and 24.9 are considered healthy and present minimal risk of CVD
  2. Excess weight increases workload on heart. BP, blood cholesterol, and triglyceride level
  3. Abdominal obesity worsens the risk for CVD metabolic syndrome

38

What diet modifications should be taken?

  1. Read food labels
  2. Limit cholesterol to less than 300 mg/d
  3. DASH diet
  4. Focus on low fat fruit/vegetables, whole grain
  5. Select fat free, 1% fat and low-fat dairy products
  6. Choose lean meats and poultry without skin
  7. Total fat less than 30% of daily calories
  8. Target triglycerides less than 150 mg/dl
  9. Target total cholesterol

39

What lifestyle modifications should be taken regarding smoking

don't smoke

avoid second hand smoke

40

What lifestyle modifications should be taken for alcohol?

  1. A drink is 12 oz beer, 4 oz wine, 1.5oz spirits
  2. If you don't drink, don't start
  3. Women 1 drink/day
  4. Men 2 drinks/day
  5. Alcohol in excess associated with increased triglycerides

41

What lifestyle modifications should be taken for stress management?

Find ways to alleviate stress

42

What should be taught to patients concerning medication therapy for HTN?

  1. BP monitoring, may also need to monitor HR
  2. Explain lifestyle modifications will not cure HTN
  3. Be specific about medication name, action, doses, and SE
  4. Do not discontinue medication abruptly. Fill prescription before completely out
  5. Need to determine if potassium needs to be restricted or supplemented
  6. Avoid hot baths or saunas
  7. Rise slowly from laying or seated position
  8. Orthostatic hypotension
  9. Discuss with PCP if sexual/erectile dysfunction occurs
  10. Caution about combining anti-HTN medications with otc meds
  11. SE of medications often diminishes over time

43

Which medications affect HR as well as BP?

Beta blockers

Calcium channel blockers

44

What do angiotensin inhibitors do to SVR and blood volume

Decrease SVR and blood volume

45

What do adrenergic inhibitors do to SVR and blood volume?

Decrease SVR

46

What do calcium channel blockers do to SVR and blood volume?

decrease SVR

47

What do diuretics do to SVR and blood volume?

Decrease blood volume

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