Rnur 238 Adult Ii - Unit 2 Hypertension Ppt

Front 1

Give the JNC7 parameters for normal, pre, Stage 1 & Stage 2 Hypertension.

Back 1

Normal: <= 120/80
Pre: 120-139/80-89
Stage 1: 140-159/90-99
Stage 2: 160+/100+

Front 2

What are some associated risk factors r/t hypertension?

Back 2

Obesity
Smoking
Stress
Arterio & Atherosclerosis
Family Hx (DM, Hyperlipidemia)
Age
Race - esp. A.A.
Diet high in salt & saturated fats

Front 3

What is the significant difference between Primary/Essential Hypertension vs. Secondary Hypertension?

Back 3

Primary/Essential - no known cause

Secondary - r/t other disorders such as renal, endocrine, metabolic, CNS, coarctation of the aorta, pheochromocytoma.

Front 4

What diet is suggested for hypertension?

What does this diet consist of?

Back 4

DASH diet (Dietary Approach to Stop Hypertension)

7-8 grains
4-5 vegetables
4-5 fruits
2-3 low fat or fat free foods
2 or fewer meats, fish & poultry
4-5 weekly nuts, seeds & dried beans

Front 5

What is pheochromocytoma?

Back 5

a tumor of the adrenal gland, causing an increase in release of adrenaline & aldosterone, increasing blood pressure.

Front 6

What are the common S&S of moderate to severe Hypertension?

Back 6

Headache - morning occipital
Dizziness & Fatigue
Palpitations
Nosebleeds
Balance problems
Eye redness

Front 7

What systems can be most impacted by prolonged hypertension. What types of things occur to these systems?

Back 7

* Eyes: Hypertensive Retinopathy, Narrowing of vessels, Hemorrhages
* Heart: LV Hypertrophy, HF, Hardening of the Coronary Arteries
* Kidneys: Damaged filtration resulting in Proteinuria
* Brain: Vascular dementia (Mult. Mini strokes or Large Stroke)

Front 8

What is the first class drug to treat hypertension? Which drug specifically in this class is used first?

Back 8

Diuretics - Hydrochlorothiazide

Front 9

What parts of the renal tubule do the 3 different groups of diuretics act on? Thiazides, Loops & Potassium Sparings?

Back 9

Loop Diuretics - act on the ascending loop of henley causing decreased sodium reabsorption & increasing potassium excretion.

Potassium Sparing Diuretics - act on the distal convoluted tubule & prevent reabsorption of sodium in exchange for potassium.

Thiazide Diuretics - act on the distal convoluted tubule inhibiting sodium chloride reabsorption.

Front 10

If you had a patient who needed a diuretic but had renal insufficiency, which diuretics would you choose or not choose?

Back 10

Choose - Loop & Potassium Sparing
Not Choose - Thiazide (Contraindicated

Front 11

What do thiazide type diuretics cause you to excrete or retain?

Back 11

Excrete - Sodium, Chloride, Potassium & Bicarbonate
Retain - Uric Acid & Calcium

Front 12

Which patients would thiazide diuretics be best for & not be best for? Why?

Back 12

Best for - Osteoarthritis, b/c you retain calcium
Worst for - Gout, b/c you retain Uric Acid

Front 13

What are the adverse effects of Thiazide Diuretics?

Back 13

Hyperglycemia, Hyperlipidemia

Front 14

Which patients would loop diuretics be best for?

Back 14

CHF & Edema Patients.

Front 15

What do loop diuretics cause you to excrete or retain?

Back 15

Same as thiazide diuretics (excrete sodium, chloride, potassium, bicarbonate; retain uric acid) except Calcium is excreted instead of retained.

Front 16

Which diuretic would you not give to patients with hyperlipidemia or hyperglycemia?

Back 16

Thiazide

Front 17

What do potassium sparing diuretics cause you to excrete or retain?

Back 17

Excrete: Sodium Chloride
Retain: Potassium

Front 18

What action do Beta Adrenergic Blockers have?

Back 18

It suppresses the SNS response by blocking the hormone adrenaline (secreted from the adrenal gland) at the beta receptors in the heart & lungs. Adrenaline would increase blood pressure/heart rate so by blocking it, you effectively reduce blood pressure. It also suppresses the release of renin which is part of the RAAS system, resulting in more vasodilation (lowering BP).

Front 19

What are the important things to note about Beta Adrenergic Blockers?

Back 19

1 - Check HR before administration
2 - Caution in COPD pts - Beta receptors are in the heart & the lungs, blocking the receptors in the lungs results in bronchial constriction
3 - Caution in DM pts - Beta Blockers mask S&S of hypoglycemia
4 - Don't stop abruptly. Sudden disruption can cause rebound hypertension resulting in a hypertensive crisis.

Front 20

If a patient is experiencing headaches r/t hypertension, which meds might be given?

Back 20

Beta Adrenergic Blockers or Calcium Channel Blockers.

Front 21

Which suffix should be recognized with beta blockers?

Back 21

"lol"

Front 22

What lab tests might be run r/t hypertension? Why?

Back 22

Why - to identify causes of secondary hypertension or to identify damage to systems r/t primary hypertension.

BUN/Creatinine - elevation indicates renal disease
Serum Corticoids - elevation indicates Cushings disease
Blood Glucose & Cholesterol studies - identify contributing factors r/t blood vessel changes.

Front 23

What ECG change might be seen with Hypertension?

Back 23

Tall R-Waves are indicative of Left Ventricular Hypertrophy.

Front 24

What is the action of calcium channel blockers?

Back 24

Since calcium influences the contractility of the heart, a lack of calcium reduces the contractility reducing blood pressure. Also, calcium makes the arteries more rigid so preventing calcium in the arterial cells, allows for more dilation, reducing blood pressure.

Front 25

What are the two groups of Calcium Channel Blockers and how can you identify them?

Back 25

1 - Nondihydropyridines, no identifier
2 - Dihydropyridines, generic names ends in "pine"

Front 26

What are the important things to know about Calcium Channel Blockers?

Back 26

1 - take with a full glass of water
2 - do not drink grapefruit juice

Front 27

What are some of the calcium channel blocking drugs we should recognize?

Back 27

Nifedipine (Adalat, Procardia)
Verapamil (Calan)
Amlodipine (Norvasc)

Front 28

What are some of the beta blocking drugs we should recognize?

Back 28

Metoprolol succinate (Toprol XL)
Propranolol (Inderal)

Front 29

What suffix should be recognized for Angiotensin II Receptor Blockers (ARBs)?

Back 29

Generic name ends in "sartan"

Front 30

Name some of the drugs we should recognize as Angiotensin II Receptor Blockers (ARBs).

Back 30

losartan (Cozaar)

Front 31

What is the action of the Angiotensin II Receptor Blocker?

Back 31

Angiotensin II is a powerful vasoconstrictor. B/C Ang II is blocked, vasoconstriction does not occur; also the reception of Ang II signals the adrenal gland to release aldosterone which tells the kidneys to retain fluids; therefore, by blocking Angiotensin II in the body allows for vasodilation and excretion of fluids reducing blood pressure.

Front 32

What should you know about Angiotensin II Receptor Blockers?

Back 32

They are often given when ACE inhibitors must be D/C'd b/c of the side effects of cough which ARB's do not cause.

Can cause angioedema.

CI in pts w/ single remaining kidney or bilateral renal stenosis.

Front 33

How can you easily identify Angiotensin Converting Enzyme Inhibitors (ACE Inhibitors)?

Back 33

generic name commonly ends in "pril"

Front 34

What drug should you know for ACE Inhibitors?

Back 34

Lisinopril (Prinivil)

Front 35

What is the action of ACE inhibitors?

Back 35

Angiotensin Converting Enzyme is a significant portion of the Renin Angiotensin Aldosterone System (RAAS). It converts Ang I to Ang II (a powerful vasoconstrictor). If ACE is blocked, then Ang II is never produced thereby reducing BP.

Front 36

What is a common side effect of ACE inhibitors?

Back 36

Hyperkalemia, coughing & angioedema.

Front 37

What is the most likely NANDA related to Hypertension?

Back 37

Ineffective Tissue Perfusion

Front 38

What should be done prior to the administration of any antihypertensive medication?

Back 38

Check blood pressure prior to administration.

In addition, pulse should be checked with Alpha Adrenergic Blockers, Beta Adrenergic Blockers & Calcium Channel Blockers.