Term
| What is the definition of HTN? |
|
Definition
Systolic at or above 140mm HG
Dystolic at or above 90mm Hg |
|
|
Term
| What is HTN defined as w/ diabetes or heart dx? |
|
Definition
|
|
Term
| What is a NORMAL BP RANGE? |
|
Definition
|
|
Term
| What is isolated systolic hypertension? |
|
Definition
| SBP at or above 140 with DPB below 90 |
|
|
Term
|
Definition
| Older adults. No symptoms. |
|
|
Term
|
Definition
120 to 139 systolic
80 to 89 diastolic |
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|
Term
| What the the prehypertenisve time good for? |
|
Definition
| implement changes to reduce morbidity r/t coronary, cerebral, renal, and PVD |
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|
Term
| What is systemic arterial pressure equal to? |
|
Definition
| Cardiac Output + Peripheral Veinous Resistance |
|
|
Term
| What is cardiac volume equal to? |
|
Definition
| Stroke volume + heart rate |
|
|
Term
| Who maintains control of peripheral vascular resistance? |
|
Definition
| (vessel constriction or dilation) is maintained by the autonomic nervous system and hormones norepinephrine and epinephrine |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Amount of blood pumped/min |
|
|
Term
| What do sympathetic nerve fibers do to the heart? |
|
Definition
|
|
Term
| What do parasympathetic nerve fibers do to the heart? |
|
Definition
| slows down the heart (vagus) |
|
|
Term
| If something increases PVR, HR, or SV, what else does it increase? (vice versa) |
|
Definition
| systemic arterial pressure |
|
|
Term
| What are the 4 stabilizing mechanisms of blood pressure? |
|
Definition
Arterial baroreceptor system
Regulation of body fluid volume
Renin-angiotensin/aldosterone system
Vascular autoregulation |
|
|
Term
| Where are the arterial baroreceptors found? |
|
Definition
| carotid sinus, aorta, and left ventricle |
|
|
Term
| How do baroreceptors regulate BP? |
|
Definition
| monitoring the SAP and vagally mediate slowing of heart and vasodilation to drop pressure |
|
|
Term
| Do baroreceptors work in HTN? |
|
Definition
|
|
Term
| How do norepi and epi increase BP? |
|
Definition
| through vasoconstriction. |
|
|
Term
| What does excess sodium mean? |
|
Definition
| excess fluid volume= Increased BP |
|
|
Term
| Normal kidney function causes a _____ in SAP |
|
Definition
|
|
Term
| What causes SAP to fall in the kidneys? |
|
Definition
|
|
Term
| What are the elements of an unhealthy kidney? |
|
Definition
-Fluid overload
-Elevated wastes like urea, creatinine, potassium
-Changes in hormone levels controlling: BP, RBC, uptake of calcium |
|
|
Term
|
Definition
Renin (produced by kidney) acts on angiotensin (I to II) which vasoconstricts and releases aldosterone to reabsorb sodium-inhibits fld loss increasing volume & BP
Renin is an enzyme produced by the kidneys that causes vasoconstriction, increases peripheral resistance and increases cardiac output. |
|
|
Term
| What happens when RENIN is imbalanced? |
|
Definition
| may cause increased Peripheral vascular resistance in hypertension. |
|
|
Term
| What are rein levels like in high blood pressure? |
|
Definition
| renin levels should fall because the increased renal arteriolar pressure should inhibit renin secretions |
|
|
Term
| What are the renin levels like in essential htn? |
|
Definition
|
|
Term
| What is vascular autoregulation? |
|
Definition
| Sustained high BP produces thickening of the arterioles, perfusion decreases, organs are damaged |
|
|
Term
| What does vascular auto regulation cause? |
|
Definition
| Stroke, PVD, Renal failure, MI |
|
|
Term
| What is malignant hypertension? |
|
Definition
| Severe, & rapidly progressing |
|
|
Term
| What are the s/s of malignant htn? |
|
Definition
| : Morning HA, blurred vision, uremia |
|
|
Term
| Who is effected by malignant htn? |
|
Definition
|
|
Term
| What is the BP range of malignant htn? |
|
Definition
| Systolic >200 diastolic >150 |
|
|
Term
| What results from malignant htn? |
|
Definition
| HF, Stroke, renal failure |
|
|
Term
| What are the risk factors for primary htn? |
|
Definition
African American
High intake salt or caffeine
Reduced K, Ca,or mg intake
Obesity
Smoking
Stress
Greater than 60
Family hx*
Excessive calories
Inactivity
Excessive Etoh
Hyperlipidemia |
|
|
Term
|
Definition
|
|
Term
| What is the most common cause of secondary htn? |
|
Definition
|
|
Term
| What is renal artery stenosis? |
|
Definition
| narrowing of one or more of the main arteries carrying blood directly to the kidneys. |
|
|
Term
| How is renal artery stenosis treated? |
|
Definition
|
|
Term
| What causes renal disease? |
|
Definition
| Adrenal medulla/cortex dysfunction |
|
|
Term
| What is the effect of renal disease? |
|
Definition
| Excessive aldosterone causes HTN and low K+ |
|
|
Term
|
Definition
| benign tumor that can also cause secondary HTN. |
|
|
Term
| What is Pheochromocytomas? |
|
Definition
|
|
Term
| How does pheochromocytomas cause HTN emergency? |
|
Definition
| tumor releases catecholamines) epinephrine and norepinephrine which causes palpitations, sweating, HA, fainting, tremors, nausea, dyspepsia, pallor, chest or abd pain, hyperglycemia, weakness, anxiety, and HTN emergency. Is surgically corrected. |
|
|
Term
| What is Cushings syndrome? |
|
Definition
| A person has too much glucocorticoids in their system due to taking steroids to treat another disorder. |
|
|
Term
| What are the s/s of Cushings disease? |
|
Definition
| (moon face, weakness, thinning skin, easy bruising, wt gain, depression, symptoms of DM r/t glucocorticoid hormone opposed the action of insulin. |
|
|
Term
| What drugs cause secondary HTN? |
|
Definition
NSAIDs
Cocaine/amphetamines
Oral contraceptives (estrogen)
Steroids
Sympathomimetics
Cyclosporine & tacrolimus
Erythropoietin |
|
|
Term
| What steroids cause secondary HTN? |
|
Definition
Glucocorticoids (cortisol)
Mineralocortiocoids (aldosterone) |
|
|
Term
| Does Sleep Apnea cause secondary HTN? |
|
Definition
|
|
Term
| Who has a higher incidence of HTN - men or women? |
|
Definition
Higher % of men than women until age 45
Women slightly higher % than men ages 45-54
Women have much higher % of HTN after age 54 |
|
|
Term
| Which ethnicity has the highest incidence of HTN? |
|
Definition
| African Americans in the US |
|
|
Term
| What are African Americans most likely to die from? |
|
Definition
| stroke, heart disease, and kidney disease |
|
|
Term
| What are the risk factors for HTN? |
|
Definition
| Age, ethnic origin/ race, family hx, dietary intake: calories, sodium, potassium containing foods, alcohol, exercise, hx of renal or cardiovascular dx, current drug therapy or illicit drugs |
|
|
Term
|
Definition
Usually have no symptoms
May have HA, dizziness, fainting, facial flushing |
|
|
Term
| When you assess, what should you do? |
|
Definition
-Obtain BP in both arms. Two or more readings each visit, use average.
-May do orthostatic BP- if decrease in BP 20mm Hg systolic or 10 mm/Hg diastolic.
-Funduscopic eye exam to monitor vascular changes in the retina
-Abdominal Bruits= renal vascular dx. |
|
|
Term
| What are the s/s of pheochromocytoma? |
|
Definition
| Tachycardia, sweating, pallor |
|
|
Term
| When are the femoral pulses delayed? |
|
Definition
| coarctation of the aorta. |
|
|
Term
| What psychosocial stressors are r/t HTN? |
|
Definition
| job-related, economic, other life stressors and coping strategies. |
|
|
Term
| What diagnostics should be looked at w/ HTN? |
|
Definition
UA, BUN, Creatinine
24hr urine (GFR, 100) |
|
|
Term
| What does a decreased GFR mean? |
|
Definition
|
|
Term
| What are the GFR rates for men and women? |
|
Definition
| normal 107-139 mL/min and lower for women 87-107 mL/min |
|
|
Term
| What can a chest X-ray show? |
|
Definition
| cardiomegaly AKA enlarged heart |
|
|
Term
|
Definition
| Left sided hypertrophy r/t HTN |
|
|
Term
|
Definition
| Decrease in blood pressure with changes of position |
|
|
Term
| How far does BP drop with orthostatic htn? |
|
Definition
| 20mmHg systolic/ 10mmHg diastolic |
|
|
Term
| When should you check BP if orthostatic htn is a risk? |
|
Definition
|
|
Term
| What lifestyle modifications can be made to avoid HTN? |
|
Definition
Sodium restriction
Weight management
Etoh moderation
Exercise
Relaxation techniques
Tobacco and caffeine avoidance |
|
|
Term
| What drugs are used to treat HTN? |
|
Definition
ACE inhibitors
ARB
Beta blockers
Calcium Channel Blockers
Diuretics |
|
|
Term
| How do ACE inhibitors work? |
|
Definition
| Block conversion of angiotensin I to II |
|
|
Term
| Why do ACE inhibitors need to block angiotension I->II? |
|
Definition
| Prevents vasoconstriction |
|
|
Term
| What needs to be monitored? |
|
Definition
Hyperkalemia, hypotension, S&S of heart failure
Monitor Bp & pulse |
|
|
Term
| What should be monitored in older people taking ACE inhibitors? |
|
Definition
|
|
Term
| What is the most complain of s/e with ACE? |
|
Definition
|
|
Term
|
Definition
| Selectively block the receptors for angiotensin II |
|
|
Term
| What is the therapeutic effect of ARB? |
|
Definition
|
|
Term
| Are ARBS or ACE effective in african amercans? |
|
Definition
| NO! Renin is not the problem. Calcium channel blockers. |
|
|
Term
| What should you monitor for when administering ARBS? |
|
Definition
|
|
Term
| What is the ending of ARB drugs? |
|
Definition
|
|
Term
| What is the ending of ACE drugs? |
|
Definition
|
|
Term
| Are alpha adrenergic blockers the initial treatment? |
|
Definition
|
|
Term
|
Definition
| Blocks receptors= vasodilation, relax smooth muscles |
|
|
Term
| Why don't people take AA blockers? |
|
Definition
|
|
Term
| What are the side effects of AA blockers? |
|
Definition
| weakness, ortho hypo, dry mouth, impotence |
|
|
Term
| What are some AA blockers? |
|
Definition
Prazosin (Minipress),
Cardura, Hytrin |
|
|
Term
| What is the precaution with the 1st dose? |
|
Definition
works quickly
Monitor for side effects |
|
|
Term
| When are Cardura/Hytrin prescribed? |
|
Definition
| when pts have benign prostatic hypertrophy BPH because of the dilating effect of the vessels, thus decreasing hypertrophy and inproving bld flow. |
|
|
Term
| How do beta blockers work? |
|
Definition
| Binds to beta receptors decrease catecholamines |
|
|
Term
| What are the 4 B's of beta blockers? |
|
Definition
Bradycardia, ↓ contractility
Bronchial constriction
Blood pressure too low
Blood sugar-mask low |
|
|
Term
| Do BB decrease or increase heart's contractility? |
|
Definition
| Decrease HR and myocardial contractility. |
|
|
Term
| How do BB decrease contractility? |
|
Definition
| Decrease epinephrine and Norepinephrine. |
|
|
Term
| What should be cautioned in diabetic pts taking BB? |
|
Definition
| may not have the usual manifestaions of hypoglycemia because the sympathetic nervous system is blocked |
|
|
Term
| What are BB the #1 choice for? |
|
Definition
| hypertensive patient with ischemic heart disease because the heart is the most common target of end-organ damage with HTN. |
|
|
Term
| What is the treatment plan for unstable angina/MI? |
|
Definition
| treat with beta blockers or calcium channel blockers in combination with ACE inhibitors or ARBs to control HTN along with management of lipids and aspirin. |
|
|
Term
| How do calcium channel blockers work? |
|
Definition
| Interferes with calcium ion flux which results in vasodilation & decrease contractility |
|
|
Term
| What is the major side effect of calcium channel blockers? |
|
Definition
|
|
Term
| What do CC blockers worsen? |
|
Definition
|
|
Term
| What other s/e are associated w/ CC blockers? |
|
Definition
HA
Syncope
Constipation- ↑fiber
Bradycardia, hypotension
Teach pulse, BP |
|
|
Term
| What teaching should be included w/ cc blockers? |
|
Definition
| How to take pulse/BP, increase fiber w/ constipation, when to call PCP |
|
|
Term
| What are some CC blockers? |
|
Definition
| Verapamil, nifedipine, diltiazem |
|
|
Term
| How do central alpha agonists work? |
|
Definition
| Acts on CNS preventing reuptake of norepinephrine, lowering PVR and BP |
|
|
Term
| What are the s/e of central alpha agonists? |
|
Definition
| sedation, postural hypotension, dry mouth, bradycardia |
|
|
Term
| Why are central alpha agonists NOT given with beta blockers? |
|
Definition
| accentuation of bradycardia |
|
|
Term
| Should you abruptly stop central alpha agonists? |
|
Definition
|
|
Term
| Do C.A.A. cause Na and H2O retention? What can you do? |
|
Definition
|
|
Term
| Should you take C.A.A. after MI? |
|
Definition
|
|
Term
|
Definition
| Catapres (clonidine) patch, 7 days |
|
|
Term
|
Definition
| Inhibits sodium and water reabsorption from kidneys therefor -> Lowers BP, decreases edema in HF and renal or liver dx |
|
|
Term
| What teaching and monitoring is needed? |
|
Definition
Monitor VS, I&O,
electrolytes, glucose
Take early in the morning
Orthostatic Hypo (careful in the elderly) |
|
|
Term
| What electrolytes need to be monitored? |
|
Definition
Electrolytes:
Potassium,
Magnesium
Chloride
bicarbonate |
|
|
Term
| Where do loop diuretics work? |
|
Definition
| loop of hence (proximal tubule) |
|
|
Term
| What do loop diuretics decrease? |
|
Definition
|
|
Term
| What are diuretics good for? |
|
Definition
|
|
Term
| What are the side effects of loop diuretics? |
|
Definition
| Orthostatic hypotension, hyperglycemia, tinnitus |
|
|
Term
| What are 2 loop diuretics? |
|
Definition
|
|
Term
| What electrolyte imbalance is expected w/ loop diuretics? |
|
Definition
K+ wasting, Ca & magnesium too
hypocalcemia, hypomagnesia, hypokalemic |
|
|
Term
| Where do thiazide diuretics work> |
|
Definition
|
|
Term
| How do thiazide diuretics work? |
|
Definition
| Prevent Na and water reabsorption, promote potassium excretion |
|
|
Term
| What are the side effects of thiazide diuretics? |
|
Definition
| hypokalemia, syncope, Orthostatic hypotension |
|
|
Term
| What is the big thiazide diuretic? |
|
Definition
|
|
Term
| What are the s/s of hypokalemia? |
|
Definition
| muscle weakness, leg cramps, cardiac dysrhythmias |
|
|
Term
| What should you monitor for when giving this drug? |
|
Definition
-Monitor wt.- wt gain of 2.2 lbs= 1 liter of body flds.
-Calcium and uric acid levels must be check; thiazides block calcium and uric acids excretion.
-Glucose; thiazides affection the metabolism of carbohydrates and hyperglycemia an occur.
-Cholesterol, low density lipoprotein and trigliceride levels may increase with thiazide diuretics, may be ordered a lipid lowering agent. |
|
|
Term
| What are the drug intrxns of thiazide diuretics? |
|
Definition
Drug interactions: digoxin (if taking dig and hypokalemia occurs, digitalis toxicity frequently results), corticosteroids, antidiabetics ginko licorice
Monitor: |
|
|
Term
| Who shouldn't take thiazides? |
|
Definition
| Contraindicated in renal failure. |
|
|
Term
| What are K+ sparing diuretics? |
|
Definition
|
|
Term
| How do K+ sparing diuretics work? |
|
Definition
| Works in the collecting tubules: Promotes Na and H20 loss but retains K |
|
|
Term
| What electrolyte imbalance can happen w/ K+ sparing? |
|
Definition
|
|
Term
| What ECG changes can you see with hyperkalemia? |
|
Definition
|
|
Term
|
Definition
| an aldosterone antagonist. Aldosterone is a hormone that promotes sodium retention and potassium excretion. |
|
|
Term
|
Definition
blocks the action of aldosterone and inhibits the sodium potassium pump( potassium is retained and sodium is excreted).
Good for Cardiac patients. |
|
|
Term
| How do you do emergency management of HTN? |
|
Definition
-ASSESS FIRST!
-IV anti-hypertensive
-O2 therapy
-Semifowlers
-monitor vital signs every 5 mins
-watch for complications |
|
|
Term
| What are the s/s of hypertensive crisis? |
|
Definition
Severe HA
Extremely high Bp
Dizziness
Blurred vision
Disoritentation |
|
|
Term
| What complications come from hypertensive crisis? |
|
Definition
| Seizures, weakness, dysrhymias, CP |
|
|
Term
| What teaching is involved with home care management? |
|
Definition
. Dose, times for admin, side effects, drug interactions
Stress rx must be taken as prescribed and refilled. Suddenly stopping drugs like beta blockers can result in angina, MI, rebound HTN.
Report unpleasant SE: fatigue, cough, sexual dysfunction. |
|
|
Term
| What lifestyle changes need to be taught for home management? |
|
Definition
| low sodium, wt reduction, alcohol restrictions, stress management, exercise, stop tobacco |
|
|
Term
| What is noncompliance usually r/t? |
|
Definition
Knowledge deficit
Side effects
Cost |
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|
