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114 Cards in this Set
- Front
- Back
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Types of HTN?
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Essential
Secondary |
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What is the cause of essential HTN?
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No specific cause
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What are risk factors for essential HTN?
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No specific cause, could be any one of these: diet, obesity, smoking, stress, alcohol, family hx
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What are the causes of secondary HTN?
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Renal Disease
Hyperfunction of adrenal Medulla Pheochromacytoma coarctation of aorta |
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What is the main cause of secondary HTN?
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Renal Disease
kidneys will release renin and start the RAAS |
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What happens when the adrenal medulla hyperfunctions?
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produces catecholines - epinephrine and norepinephrine
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How does catecholine production affect HTN?
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Too much epi or norepi causes vasoconstriction which leads to high BP
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What is a pheochromacytoma?
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A tumor of the adrenal gland that over produces catecholines.
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What is the coarctation of the aorta?
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Narrowing after the major vessels...then returns to normal size.
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What effect does coarctation have?
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More blood gets to upper extremities.
pulses will be stronger in upper. RAAS might kick in because kidney perfusion will be low. Lower extremity pulses will be lower then upper pulses |
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Problems that cause hypertension in the elderly?
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arteriosclerosis - PVR
baroreceptors become insensitive. renal profusion problems RAAS system kicks in Some meds |
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Some meds that elderly take that increase HTN or BP.
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Hormone replacement - estrogen increase HTN
Glucocorticoids - increase BP Mineral corticoids - increase BP |
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Do all HTN patients have symptoms?
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No, some are symptom free
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Risk factors for HTN
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diabetes, smoking, obesity, diet high fat - high Na, sedentary lifestyle
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Symptoms of HTN
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headaches, BP high on 2 diff occasions, bruits, tachycardia, diaphoretic, pheochromocytoma, retinal changes
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Values for Sodium Lab test
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Sodium
135 - 145mEq/L normal |
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Lab Tests for HTN
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sodium, potassium, creatinine, BUN, cholesterol, HDL, LDL, Triglycerides, renin levels, 24 hour urine creatinine clearance and protein, catecholamines, EKG, ECG
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Values for Potassium Lab tests
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3.5 - 5.0mEq/L
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In the CBC lab values increased creatinine and BUN will tell you about?
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How well the kidney is functioning.
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Increased cholesterol, HDL, LDL, and trigly might indicate
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narrowing of arteries or arteriosclerotic
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How often are renin levels drawn
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This is not done very often. Expensive test
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What is the 24 hour urine for creatinine clearance and protein
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Save urine for 24 hours...can tell if creatinine and protein is spilling into the urine which could mean kidney damage
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What are the 3 Kidney Catecholimines?
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Norepinephrine and epinephrine and vanillymandelic acid - VMA
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What is vanillymandelic acid - VMA?
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When catecholines are broken down VMA is increased
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What are the looking for on the EKG?
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electrical activity
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What are they looking for in the ECG?
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Chamber size, blood flow to heart, problems with valves
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What are the looking for in the MRI - in relation to HTN
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will show tumors on adrenal glands - pheochromocytoma
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Interventions for HTN
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Diet changes, weight reduction, decrease alcohol, smoking cessation, meds
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What specific diet changes for HTN?
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No added salt
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Why no salt substitutes
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Salt substitutes usually are made of potassium - rapid increase of potassium could lead to Hyperkalemia which could lead to cardiac problems
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What types of weight reduction for HTN?
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physical activity
fitness plan |
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Why decrease alcohol?
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empty calories in alcohol leads to increased arterial BP.
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What are the 3 classes of diuretics?
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Thiazides
Loop diuretics K-Sparing Diuretics |
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What is the main action of thiazides?
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Decrease Na and H2O absorption.
Increase urine output. |
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Interventions for Thiazides include.
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monitor fluids/electrolytes
Monitor K levels encourage K rich foods in diet. |
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Common drug in thiazides.
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HCTZ - hydrochloridetheazides
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Problems and Considerations in thiazides
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Can cause hyperglycemia
increase blood lipids additional antilipid drugs might be rx K levels get very low |
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What is main action of Loop diuretics?
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increase urine output
not K sparing decrease BP the more you give the better response you get |
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Interventions for loop diuretics.
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monitor K levels
encourage K rich foods |
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Problems and considerations for loop diuretics.
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hypokalemia, ototoxic if given too quickly in an IVP, dehydration, dry skin, dry mouth, dry mucous membranes
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Common drugs in loop diuretics class?
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lasix, furosemide, bumetanide, torsemide
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What are the 3 antihypertensives?
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Beta Blockers
Calcium channel blockers ACE inhibitors |
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What is mechanism of action for beta blockers?
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decrease HR by reducing the strength of contraction
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What are problems and considerations for beta blockers
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dyspnea, wheezing - might prevent bronchial dialation, monitor HR
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What is the type of Beta blocker we talked about in class?
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Propanolol
ends in -ol |
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How do calcium channel blockers work?
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decreases strength of heart muscle contraction
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Problems and Considerations for CCB.
calcium channel blockers |
Dizziness, headache, redness in face, edema in lower extremities, rapid HR, Slow HR, constipation, reflex tachycardia
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What is reflex tachycardia?
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BP gets too low HR will speed up to keep homeostasis
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Calcium channel blocker drugs are?
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Norvasc
the rest end in -ine |
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What is the mechanism of action on ACE inhibitors?
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blocks the enzyme angiotensin from converting to angio 1 --> angio 2.
prevents vasoconstriction reduces PPR Reduces blood volume |
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What are considerations or problems for ACE inhibitors?
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Orthostatic HTN is common when tx begins.
Chronic cough might develop - stop med Angioedema - swelling of mucous membranes |
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Why is angioedema in ACE inhibitor use bad?
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This is a swelling of the mucous membranes...if MM swell around larynx or throat area, this could block the airway.
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Why don't we use the term CHF anymore? What do we use instead?
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It implies fluid problems
Now we use Heart Failure |
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What is digoxin used for?
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To decrease the HR
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What does digoxin do?
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It slows the HR
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What do nurses assess before giving Digoxin?
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Apical pulse for 1 full minute
If less than 60 hold med |
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What is arteriosclerosis?
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A hardening of the arteries.
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How does HTN and arteriosclerosis relate to each other?
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when blood is pumped through artery...the artery should expand to compensate for the extra pressure...with arteriosclerosis the arteries cannot expand because of hardening...this causes HTN
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What is the intimal lining?
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The innermost lining of a lymphatic vessel, vein, or artery.
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What is atherosclerosis?
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Involves the formation of plaque inside the artery walls.
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When arteries leading to your limbs are effected by atherosclerosis, you may develop circulation problems to your arms and legs called?
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Peripheral Arterial Disease
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When arteries to your heart are affected by atherosclerosis, you may end up with...
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coronary artery disease
or heart attack |
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When arteries to your brain are affected by atherosclerosis, you may end up with....
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TIA
trans ischemic attack stroke |
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What do you call a bulge in the artery wall?
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Aneurysm
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How do you protect yourself from hardened or blocked arteries?
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Healthy lifestyle
medications |
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How long does it take to see the effects of atherosclerosis?
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Sometimes it can be 20 - 40 years.
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What are the theories r/t atherosclerosis?
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Platelet Aggregation Theory
Lipid Theory |
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Explain Platelet Aggregation Theory.
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Damage to the intima, platelets gather at injury causing smooth muscle to proliferate. Platelets bunch up and causes narrowing of the artery or can even completely occlude the flow of blood.
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Explain Lipid Theory.
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Injury to intima. Fats and triglycerides accumulate at the site of injury. Leads to narrowing of the artery or can completely occlude the spot. Usually will effect larger arteries.
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Which theory is the better theory?
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A combination of the theories is the probable cause of most narrowing of the arteries.
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What are risk factors for plaque formation?
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Age, family hx, being male, smoking
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What age is more at risk for developing atherosclerosis?
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Men = 45
women = 55 |
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Who is more at risk for atherosclerosis? Men or women?
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Men
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What increases the risk for atherosclerosis in women?
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Menopause unless on estrogen therapy.
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How does smoking increase the risk?
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Intimal damage
High carbon monoxide levels keep blood from transporting oxygen Nicotine causes release of catecholamines. Increased level of lipids. |
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What is a good LDL level?
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less than 130
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What does the LDL do in the body?
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transports cholesterol & triglycerides into the cell walls.
Can cause increased narrowing of the walls. |
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What is a good HDL level?
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Men = 35 - 60
Women = 35 - 85 Goal = above 40 |
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What does HDL do in the body?
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Transports cholesterol & triglycerides away from the cells...prevents the "laying down" of lipids on cell walls.
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Which is the good lipoprotein?
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HDL
High (happy) density lipoproteins |
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What decreases HDL?
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Smoking, obesity, physical inactivity, and diabetes
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What factors affect plaque formation?
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obesity, physical inactivity, and diabetic - hyperinsulinemia = HTN
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What are some assessments for atherosclerosis?
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BP, pulse, peripheral pulses with symmetry, cap refill, pain, bruits, AV fistula
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Lab Tests for atherosclerosis?
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LDL = low
HDL = higher Homocysteine levels |
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What is homocysteine?
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Proteins are broke down into this.
Value great than 15 = at risk for arteriosclerosis Won't usually see this test done |
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Interventions for atherosclerosis?
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Dietary changes
Drugs Exercise Smoking cessation |
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What are some drugs used for control of atherosclerosis?
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Bile Acid Sequestrant
Fibric Acid Nicitinic Acid HMG-CoA Reductase Inhibitors - "statins" |
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Which is most common drug for atherosclerosis?
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Statins
HMG-CoA Reductase Inhibitors - "statins" |
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What percentage of diet should fats be?
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30%
Saturated fats should be no more than 10% |
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Name 2 of the statins we talked about.
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Zocor and Lipitor
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How do statins work?
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Lowers the lipids by inhibiting the enzyme that takes part in producing cholesterol.
Lowers LDL and triglycerides. Tends to increase HDL's |
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Problems with statins?
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Liver Damage
Myopathy GI issues: heartburn, N/V |
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Which statin has the most GI issues?
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Methacor
this is a 1st gen drug and not used much anymore |
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Why is diabetes control important in relation to atherosclerosis?
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Diabetes can lead to HTN which can lead to atherosclerosis
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HTN is defined as:
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Defined as a systolic pressure greater than 140 and a diastolic pressure greater than 90 over a sustained period...more than one BP taken over more than 1 day.
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What is impact of cardiac output on BP?
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If CO increases so will BP
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How is cardiac output described?
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the amount of blood being pumped in 1 min
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What is PVR?
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Peripheral vascular resistance
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How does PVR effect BP?
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When constriction occurs - the same amount of blood is going through a more narrow system - this will increase BP.
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What is stroke volume?
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The amount of blood ejected from the heart in each beat.
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What happens to BP when stroke volume increases?
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BP will increase.
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What happens to BP with increased Fluid volume?
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BP will increase.
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How does the autonomic nervous system influence BP?
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Sympathetic system will increase PVC which will increase BP = HTN.
Baroreceptors will sense increased BP, which will stimulate the parasympathetic which will lower HR = decrease BP. |
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What is the RAAS?
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Renin Angiotensin Aldosterone System
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What is PVR related to?
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How dilated the vessels/arteries are in the periphery.
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What kicks the RAAS into gear?
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Lack of perfusion to the kidneys will release renin.
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What does renin do?
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It starts the process of RAAS which will cause angio 1 to be converted to angio 2.
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What does Angio 2 do?
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It is a potent vasoconstrictor - causing shunting of blood to major organs -specifically the kidneys.
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Where are the Angio 2 receptors located?
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In the adrenal glands
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What happens when angio 2 attaches to receptors?
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This will cause the release of aldosterone.
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What effect does aldosterone have on the kidneys?
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Causes kidneys to retain Na and water.
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Increase blood volume during RAAS will...
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perfuse vital organs
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When the RAAS system is in gear what happens to urine volume?
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It will decrease
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Increased blood volume
Decreased urine volume Will cause |
HTN
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