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HTN (Med Surg)

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cdunbar4's version from 2016-11-22 01:42

Section 1

Question Answer
Major RF for what 4 other diseases?artherosclerotic CVD; CVA; renal failure; HF
Major Complications of HTNCHF; renal failure; CVA; acute MI; retinal hemorrhage
HTN definitionsystolic > or equal to 140 OR diastolic > or equal to 90
Pre-HTN definition?systolic 120-139; diastolic 80-89
What determines BP (broad strokes)?CO x SVR (systemic vascular resistance)
Cardiac Output ishow much fluid and how hard and fast it is pumping
peripheral resistance how narrow are the vessels the heart must pump fluid through
Cardiac factors that influence COheart rate; intropic state (contractility); Neural; Humoral
Renal Fluid Volume Control factors that influence CORAAS; aldosterone; Natriuertic Peptides
SNS receptors that affect SVRa-adrenergic receptors (vasoconstriction); B-adrenergic receptors (vasodilation)
Humoral factors (blood content thick/thin) that affect SVRvasoconstrictors: Angiotensin; Norepi
Local regulation factors that influence SVRvasodilators: prostaglandins; EDRF and Vasoconstrictors: Endothelin
Renin-angiotensin rolesconstricts vessels, stimulates ADH release, stimulates thirst, stimulates aldosterone
Aldosterone functionkidneys retain sodium and therefore, water
atrial natriuretic factor is produced by _____ ______ and function is?right atrium; excrete sodium and therefore, water
Aldosterone MOA↑ aldosterone → ↑Na reabsorption → ↑H2O reabsorption → ↑blood volume → ↑CO
Stage 1 vs. Stage 2 HTN systolic/diastolic1= 140-159/90-99 2= greater or equal to 160/100
Isolated systolic HTNSPB > or equal 140/<90; usually elderly d/t ↓ compliance (elasticity) of aorta with age. Should be treated.
PseudoHTNBP is elevated with BP cuff, but normal when measured intra-arterially
Primary HTN 90-95% of all cases; elevated BP w/o identified cause
Contributing factors Primary HTN↑SNS, ↑prod. of Na-containing hormones; ↑prod. of vasoconstrictors; ↑Na intake; DM; overweight; ETOH
Secondary HTN5-10% of all adult cases and 80% in kids; elevated BP WITH a specific cause (can be identified and corrected)
Some causes secondary HTNcoarctation or congenital narrowing of aorta, renal disease, endocrine disorders, brain tumors, sleep apnea, new meds, cirrhosis, pregnancy-induced
If age is <20 or >50 and BP suddenly ↑'ssuspect secondary HTN
For persons over age 50, is SBP or DBP more important as a CVD RF?SBP
There are many RF for HTN, in most cases, HTN results from the interaction of what 3 main factors?Environmental; demographic; genetic
How does stress affect BPincreased SNS activity produces ↑vasoconstriction/HR/and renin release
Diabetes and HTNinsulin resistance and hyperinsulinemia= high insulin concentration stimulates SNS activity & impairs nitric oxide-mediated vasodilation
Aside from a routine BP check, what might clue you in to a BP problem?Sx secondary to target organ disease, can include: fatigue, reduced activity tolerance; dizzy; palpitations/angina; dyspnea...and more
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Section 2

Question Answer
Target organ disease occurs most frequently in which areas of the body, what complications for each?Heart (CHF, MI); Brain (CVA, TIA); peripheral vasculature; kidney (renal insufficiency/failure); eyes (retinal hemorrhage)
Hypertensive heart diseaseCAD; Left ventricular hypertrophy; HF
How to diagnose (aside from H&P)?BP measured in both arms: pt sits quietly seated for 5 minutes, feet flat on floor and arm supported AT THE LEVEL OF THE HEART. Right size cuff, use arm with higher rdg for future measurements
Diagnostics can include urinalysis, creatinine clearance, BUN/serum creatinine (why)?Check kidney function
Serum electrolytes, glucose diagnostics to check forDiabetes
Why check serum lipid profile?It's a RF, esp. if LDL is elevated.
ECG, EKG check cardiac rhythm changes and cardiac structural changes (CAD, LVH, HF)
What is "white coat" phenomenon?BP normal at home, but elevated in clinical setting
What does COLD algorithm mean?Treatment for HTN
Stage 1 HTN Initial drug choice w/o compelling indications (and after implementing lifestyle mods first)SBP 140-159 or DBP 90-99; thiazide-type diuretics for most; may consider ACE inhibitor; ARB; BB; CCB; or combo
Stage 2 HTN initial drug choices w/o compelling indications (and after lifestyle mods)for SBP >160 or DBP >100; two-drug combo for most (usu thiazide-type diuretic & ACE inhibitor, or ARB, BB, CCB)
Drug choices for HTN WITH compelling indicationsdiuretics, ACE inhibitors, BB's, CCB's as needed
If person is still not at goal BP after initial drug choices, then what?Optimize dosages or add additional drugs until goal BP is achieved. Consider consultation with HTN specialist
Overall goals of HTNControl BP, Reduce CVD risk factors, TEACH and MOTIVATE pts to comply is key!
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Section 3

Question Answer
Strategies for adherence to regimensempathy increases patient trust, motivation and adherence to therapy; consider cultural beliefs & individual attitudes in formulating tx goals; if problems ASSESS FIRST!
What is the DASH diet consist of? (Dietary Approaches to stop HTN)Rich in fruits, veggies, low/nonfat dairy, also includes grains (whole grains); lean meats, fish and poultry; nuts & beans
How does the DASH diet help with HTN?lowers cholesterol & facilitates losing weight by eating healthy and being flexible enough for ppl to manage
Weight loss of 10kg may decrease SBP by5-20mmHg
What are the 2 basic factors that go into ↑BP?increased fluids or increased resistance (this is where the drugs work, to either turn down spicket or take thumb off hose)
Primary actions of drugs to treat HTN work in 2 waysreduce SVR; reduce volume of circulating blood
The 2 basic factors that pharmacologic interventions haveamount of force of fluid in circulation and the resistance in the circulatory system to the pumping heart
Given the 2 basic factors in treating HTN, what do you basically want to accomplish with pharm agents?reduce the volume of fluid PRELOAD and decreased vascular resistance aka AFTERLOAD
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Section 4

Question Answer
Diuretic functionreduce preload: inhibits Na reabsorption in distal renal tubules; increase excretion of Na (and thus water) therefore ↓ circulating volume and, in 2-4 weeks... ↓BP
Adrenergic inhibitors reduce preload or afterload? What two drug classes?afterload; alpha and beta blockers (↓SNS activity that normally vasoconstricts= ↓SVR and ↓BP
Beta Blockers, you must monitor pulse...must be >90/60; can cause severe hypotension (tell ppl to get up and change positions slowly d/t orthohypoTN)
Direct vasodilators MOA. They reduce pre or after load?reduce SVR via vasodilation; reduce afterload by ↓SVR→↓BP
Direct vasodilators are very dangerous and are reserved for what patients?hospitalized patients, ER, you need to have IV access just in case of low BP
ACE inhibitors MOA, reduce pre or afterload?prevent angiotensin vasoconstriction → ↓resistance and ↓BP ; reduces AFTERload
ARBs (angiotensin II receptor blockers) MOA; reduce pre or afterload?vasodilation & excretion of Na and water, therefore ↓fluid volume and ↓BP by reducing preload
CCB's MOA; reduce pre or afterload and how?Block movement of Calcium into cells; reduces afterload by ↑vasodilation→↓SVR and ↓BP; ↓HR and contractility (force) of the heart → ↓fluid per heartbeat & ↓heartbeats per unit time →↓BP
GO OVER THE DRUGS IN THE TABLE IN THE BOOK AND KNOW THEM!!!ALSO A PICTURE: FIG 33-3 TO KNOW AS WELL
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Section 5

Question Answer
Nursing assessment: past HH of DM, cardiac/renal disease, what may need to happen? a more aggressive treatment will be prescribed
Nursing assessment: objectivecheck for target organ damage
Nursing Diagnosesineffective health maintenance; anxiety; sexual dysfunction; ineffective therapeutic regimen mgmt; disturbed body image; ineffective tissue perfusion
Collaborative problems aka PC's: adverse effects from antihypertensive therapy; Hypertensive crisis; stroke; MI
Common age-related change that contributes to HTN in the elderlydecreased elasticity within the arterial vessels (vessels can't swell up and stretch with more fluid because they are too stiff)
Isolated systolic HTNmost common form of HTN in individuals age >50
Auscultatory gapfind the 2nd rhythmic Kortokoff sound, wait 5 minutes and then find the higher one. Do not underestimate the SBP!
What is the baroreceptor reflexOne of the body's homeostatic mechanisms for maintaining BP. Provides a negative feedback loop in which an elevated BP causes BP to ↓; similarly a ↓BP depresses the baroreflex to cause a ↑in BP
Hypertensive ER = evidence of acute target organ damageHypertensive encephalopathy (cerebral hemorrhage); acute renal failure; MI; HF with pulmonary edema
Hypertensive Crisis you need to be hospitalizedIV drug therapy: titrated to mean arterial pressure....slowly decrease
MAP (mean arterial pressure) equationSBP + 2(DBP) divided by 3
Hypertensive crisis you should monitorcardiac and renal function; neurologic checks; determine cause; education to avoid future crises
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