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93 Cards in this Set

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Hypertension is defined as what?
the persistent elevation of systolic blood pressure >140 mmHg or diastolic BP > 90 mmHG

OR

the current use of antihypertensive medications
Blood pressure = _________X__________
Cardiac output X systemic vascular resistance
What are baroreceptors?
specialized nerve cells located in the carotid artery and aortic arch that detect changes in BP
What occurs when baroreceptors sense an increase in BP?
- they send inhibitory impulses to the sympathetic vasomotor center in the brain
- increase parasymptathetic activity
A fall in BP sensed by baroreceptors leads to what?
activation of the SNS
What happens to baroreceptor response in the presence of long-standing hypertension?
the baroreceptors become adjusted to elevated levels of BP and recognize them as normal
How do the kidneys contribute to BP regulation?
- control sodium excretion
- RAAS
What are the two jobs of angiotensin II?
- stimulate adrenal cortex to secrete aldosterone
- direct acting vasoconstrictor
What category of hypertension?

<120 systolic or <80 diastolic
Normal
What category of hypertension?

120-139 systolic or 80-89 diastolic
Prehypertension
What category of hypertension?

140-159 systolic or 90-99 diastolic
Stage 1 hypertension
What category of hypertension?

>160 systolic or >100 diastolic
Stage 2 hypertension
What is primary hypertension?
elevated BP without an identifiable cause
Is Primary or secondary hypertension more common?
primary- accounts for 90-95% of cases
Although there is no identifiable cause for primary hypertension, several contributing factors have been identified. List them (6)
- increased SNS activity
- increased sodium-retaining hormones and vasoconstrictors
- diabetes mellitus
- > ideal body weight
- increased sodium intake
- excessive alcohol intake
What is secondary hypertension?
elevated BP with a specific cause that often can be identified and corrected (5-10% of cases)
What are 6 contributing factors for the development of secondary hypertension?
- coarctation of the aorta
- renal disease
- endocrine disorders
- neurologic disorders
- cirrhosis
- sleep apnea
For persons over age 50, is SBP or DBP a more important risk factor?
SBP
People who are normotensive at 55 years of age have a ___% lifetime risk for developing HTN.
90%
People with HTN should limit their daily alcohol intake to how much?
1 oz of alcohol
What are 13 risk factors associated with HTN?
- age
- alcohol intake
- cigarette smoking
- diabetes mellitus
- elevated serum lipids
- gender (<55 more prevalent in men, >55 more prevalent in women)
- excess sodium intake
- family history
- obesity
- ethnicity (twice as high in african americans)
- sedentary lifestyle
- socioeconomic status (higher incidence in lower socioeconomic groups)
- stress
While heredity does play a part in the development of HTN, in most cases it results from a combination of what 3 factors?
- environmental, demographic, and genetic factors
A high sodium intake might activate what?
a number of pressor mechanisms that result in water retention
What are 4 demographic groups that have been associated with having "salt sensitivity"?
- the obese
- older adults
- african americans
- those with diabetes or renal disease
How are stress and increased sympathetic nervous system activity related to HTN development?
- prolonged stress may persist to a pathologic degree
- Stress stimulates SNS, which increases vasoconstriction, increases HR, and increases renin release (all leads to increased BP)
- people exposed to repeated stress have a greater development of HTN
How does high insulin concentrations contribute to HTN?
- stimulates SNS activity and impairs nitric oxide-mediated vasodilators
How does an altered renin-angiotensin pattern contribute to HTN?
-excessive renin secretion results in vasoconstriction, thus increasing BP
How can endothelia cell dysfunction contribute to HTN?
endothelial cells produce vasoconstrictive agents, excess production leads to HTN
- decreased response to nitric oxide results in a delayed vasodilative action
Hypertension is often call the "silent killer". Why?
b/c it is frequently asymptomatic until target organ disease has occured
Symptoms of hypertension are usually the result of what?
the effects of the blood vessels in various organs/tissues
What are 6 secondary symptoms seen in HTN?
- fatigue
- reduced activity tolerance
- dizziness
- palpitations
- angina
- dyspnea
The target organs most commonly affected by HTN are what? (5)
- heart
- brain
- peripheral vasculature
- kidney
- eyes
What are 3 diseases of the heart that occur as a result of HTN?
- CAD
- Left Ventricular hypertrophy
- heart failure
What type of cerebrovascular problems might occur b/c of HTN?
- cerebral atherosclerosis
- stroke
What is intermittent claudication and what is it a classic symptom of?
- ischemic muscle pain precipitated by activity and relieved with rest
- classic symptom of peripheral vascular disease involving the arteries
HTN can speed up the process of atherosclerosis in the peripheral blood vessels. This may lead to what 3 things?
PVD
aortic aneurysm
aortic dissection
What problems are seen with the kidneys and HTN?
- some degree of renal dysfunction is usually present in the HTN patient, even with minimal BP rise
- HTN is one of the leading causes of end-stage renal disease (esp. among AAs)
What are 4 common laboratory indications of renal dysfuction?
- microalbuminuria
- proteinuria
- microscopic hematuria
- elevated BUN and creatinine levels
What is one of the earliest manifestations of renal dysfunction?
nocturia
Why is the examination of the retina so important in the evaluation of the HTN patient?
-b/c the retina is the only place in the body where blood vessels can be directly visualized
- damage to retinal vessels provide an indication of concurrent vessel damage in the heart, brain, and kidney
What are 3 manifestations of severe retinal damage?
- blurred vision
- retinal hemorrhage
- loss of vision
Diagnostic testing for HTN often begins with basic laboratory studies. What are the 4 primary purposes of these lab studies?
1. identify or rule out causes of secondary HTN
2. evaluate target organ disease
3. determine overall cardiovascular risk
4. establish baseline levels before initiating therapy
Creatinine clearance (the rate at which creatinine is cleared from circulation) reflects what?
glomerular filtration rate
Decreases in creatinine clearance indicate what?
renal insufficiency
What type of laboratory data would be helpful in detecting hyperaldosteronism, a cause of secondary hypertension?
serum electrolytes (especially potassium)
Why is it important to take a BP measurement in both arms?
b/c future readings will be used for subsequent measurements
When is BP the highest, early morning or night?
early morning
What are some guidelines to obtaining a BP measurement in the office setting?
- use the auscultatory method with a properly calibrated instrument
- have patient sit quietly for 5 minutes in a chair, with feet on the floor, and the arm supported at heart level
- use an appropriate sized cuff
- obtain at least 2 measurements
What is the purpose of an ECG when assessing HTN?
- provides info about the presence of LVH, cardiac ischemia, or previous MI
What is "white coat" hypertension?
- a phenomenon where a person has high BP readings in a clinical setting, but normal BP readings elsewhere
If white coat hypertension is suspected, what is done?
ABPM (ambulatory blood pressure monitoring) is prescrbed
In addition to diagnosing white coat hypertension, what are other indications for ABPM?
- suspected drug resistance
- hypotensive symptoms with hypotensive medications
- episodic hypertension
- SNS dysfunction
What is the overall goal in treating a patient with hypertension?
- control BP and reduce overall cardiovascular risk
What is indicated for all patients with prehypertension and hypertension?
lifestyle modifications
When discussing lifestyle modifications with a patient, the nurse should specifically address what 6 things?
1. weight reduction
2. DASH (dietary approaches to stop hypertension) eating plan
3. dietary sodium reduction
4. moderation of alcohol consumption
5. regular aerobic physical activity
6. avoidance of tobacco use
What is the usual drug regimen for the stage 1 hypertensive persons?
thiazide-type diuretics
What is the usual drug regimen for stage 2 hypertensive persons?
two-drug combination for most (thiazide-type diuretic and ACE inhibitor (or ARB, BB or CCB)
True/False:

If a person is prehypertensive, they will not be placed on medication however they will be encouraged to modify their lifestyle.
True in most cases, however if a compelling indication is present (heart failure, diabetes, chronic kidney disease, etc.) there may be an indication for drug therapy in addition to lifestyle modifications
What are some nursing strategies for encouraging adherence to regimens?
- empathy (increases trust)
- motivation
- acknowledging adherence
Lowering BP has shown a ___-___% reduction in stroke incidence.
35-40%
Lowering BP has shown a ___-___% reduction in MI.
20-25%
Lowering BP has shown a ___% reduction in heart failure.
50%
True/False:

If a person is prehypertensive, they will not be placed on medication however they will be encouraged to modify their lifestyle.
True in most cases, however if a compelling indication is present (heart failure, diabetes, chronic kidney disease, etc.) there may be an indication for drug therapy in addition to lifestyle modifications
What are some nursing strategies for encouraging adherence to regimens?
- empathy (increases trust)
- motivation
- acknowledging adherence
Lowering BP has shown a ___-___% reduction in stroke incidence.
35-40%
Lowering BP has shown a ___-___% reduction in MI.
20-25%
Lowering BP has shown a ___% reduction in heart failure.
50%
A weight reduction of 10 kg may decrease SBP how much?
5-20 mmHg
When managing HTN, sodium intake should not exceed what?
2-4 g daily
What is the daily recommendation for alcohol consumption in men and women?
Men, no more than 2 drinks
Women, no more than 1 drink
What is the recommendation for physical activity when managing HTN?
At least 30 mins of aerobic activity on most days of the week
What are the 2 primary goals of drugs given to treat HTN?
- reduce SVR
- reduce the volume of circulating blood
What are the 5 classes of drugs used to treat hypertension?
1. diuretics
2. adrenergic inhibitors
3. direct vasodilators
4. angiotensin inhibitors
5. calcium channel blockers
How do diuretics work in the treatment of HTN?
- promote sodium and water excretion
- reduce plasma volume
- decrease sodium in the arterial walls
- reduce vascular response to catecholamines
How do adrenergic-inhibiting agents work in the treatment of HTN?
- diminish the SNS effects that increase BP
How do direct vasodilators work?
decrease BP by relaxing vascular smooth muscle and decreasing SVR
How do calcium channel blockers work in the treatment of HTN?
- increase sodium excretion and cause arteriolar vasodilation by preventing the movement of extracellular calcium into cells
What are the 2 types of angiotensin inhibitors and how do they work?
ACE inhibitors prevent A-I from converting to A-II.
ARBs prevent binding of A-II to the arterial walls.
Most patients who are hypertensive will require at least how many medications?
2
What are 3 common side effects of thiazide and loop diuretics?
hyperuricemia
hyperglycemia
hypokalemia
ACE inhibitors lead to high levels of bradykinin, which leads to what?
coughing
What are 4 common and undesirable side effects of HTN drug therapy that may lead to noncompliance?
- orthostatic hypotension
- sexual dysfunction
- dry mouth
- frequent urination
When assessing an individual for HTN, what are 3 types of subjective data that the nurse will obtain? objective data?
- past health history
- medications
- functional health patterns

objective = target organ damage
The overal goals for the patient with hypertension are what? (4)
1. achieve and maintain the individually determined goal BP
2. understand, accept, and implement the therapeutic plan
3. experience minimal or no unpleasant side effects of therapy
4. be confident of ability to manage and cope with this condition
The prevalence and severity of HTN is increased in what population group?
African Americans
What population groups (2) have lower rates of BP pressure control/treatment?
- mexican american and native americans
(def)

a severe and abrupt elevation in BP, arbitrarily define as a DBP >140mmHg
Hypertensive crisis
What is most important in determining the need for emergency treatment in a hypertensive crisis?
the rate of rise is more important than the absolute value
True/False:

Patients with chronic hypertension can tolerate a much higher BP than perviously normotensive people.
True
Hypertensive crisis occurs most commonly in what type of patients?
those with a history of hypertension who have failed to comply with regimen or have been undermedicated
What is a hypertensive emergency?
a severe elevation in BP with evidence of acute target organ damage
A hypertensive emergency can precipitate what 5 severe problems?
- hypertensive encephalopathy
- cerebral hemorrhage
- acute renal failure
- myocardial infarction
- heart failure with pulmonary edema
What nursing actions are carried out when caring for a patient in hypertensive crisis? (5)
- IV therapy (titrate to arterial pressure)
- monitor cardiac and renal function
- neurological checks
- determine cause
- educate to avoid future crisis