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Exam 2 - HTN - Flashcards

Flashcard Deck Information

Class:NUR 330 - Heath Assess & Nursing Therap
Subject:Nursing
University:Michigan State University
Term:Fall 2012
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JNC7 Definition of High Blood Pressure Systolic > 140
Diastolic > 90
based on average of two or more accurate blood pressure measurements taken during two or more contacts
Primary Hypertension Essential hypertension is the form of hypertension that by definition, has no identifiable cause.
Secondary Hypertension Secondary hypertension is a type of hypertension which by definition is caused by an identifiable underlying secondary cause.
Is Primary or Secondary Hypertension the most common? Primary
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What are the symptoms of Hypertension? Usually none until actual organ damage is done causing:
retinal damage
Renal damage
MI
Cardiac hypertrophy 
Stroke
Dislipidemia High blood cholesterol levels
What two renal problems are associated risk factors of hypertension? Microalbuminuria and a GFR < 60
What is the goal blood pressure for people that have high blood pressure and DM or chronic kidney disease? < 130/80
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Stage 1 Hypertension 140-159 systolic
90-99 diastolic
Stage 2 hypertension 160 greater than or equal to systolic
diastolic greater than or equal to 100
According to JNC if a patient does not reach goal BP with initial drug choices what happens next? Optimize dosage or add additional drugs until goal BP is achieved. Consider consultation with specialist
DASH Dietary Approaches to Stop Hypertension
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What is usually the first antihypertensive used? Thiazide Diuretic
What three things must you assess with a patient on thiazide diuretics? Potassium wasting diuretic? (supplement)
Turgor and Edema? (dehydration)
Thiazide Diuretics Decrease Blood volume, Renal Blood Flow, and CO
Depletion of ECF
Negative sodium balance and mild hypokalemia
Directly affect vascular smooth muscle
Loop Diuretics Volume depletion
Blocks Na, Cl, and H2O reabsorption

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Potassium Sparing Diuretics Block sodium resorption
Acts on DT independently of aldosterone
Aldosterone Receptor Blockers Competitive inhibitor of aldosterone binding
Central alpha-2 agonists and other Centrally Active Drugs Impair synthesis and reuptake of Norepinephrine 
Beta Blockers Block SNS 
especially sympathetics in heart causing a decrease HR and BP
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Beta Blockers with Intrinsic Sympathomimetic Activity Block cardiac beta 1 and 2 receptors
Slow AV conduction so act as a antiarrythmic
Alpha 1 Blockers Peripheral vasodilation directly on blood vessels, similar to hydralazine
Combined alpha and Beta blockers Block these receptors causing peripheral vasodilation and decrease TPR
Vasodilators Stimulate dopamine and alpha 2 adrenergic receptors
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ACE Inhibitors Inhibit conversion of angiotensin I to II 
Lower TPR
Angiotensin II Antagonists Block Ang I actions 
Reduce TPR
Nondihydropyridines Inhibit calcium ion influx
Reduce cardiac afterload

Calcium channel blocker
Dihyropiridines Inhibit calcium ion influx across membranes
Vasodilation on coronary arteries and peripheral arterioles
Decreased cardiac work and energy consumption increased delivery of oxygen to myocardium

Calcium channel blocker
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What must a nurse emphasize with the treatment of HTN? Control rather than cure
Monotherapy Limiting of medications making compliance easier
Hypertensive Emergency BP > 180/120and must be lowered immediately to prevent organ damage
Hypertensive Urgency BP is very high but no evidence of immediate or progressive target organ damage
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Goals of treatment for Hypertensive Emergency Reduction of BP 25% first hr
Reduce to 160/100 over 6 hours
Gradual reduction over a few days
Exceptions to normal goals of hypertensive emergency include what two conditions? ischemic stroke and aortic dissection
Medications used in a Hypertensive Emergency Vasodilators (IV)
What must be assessed in a hypertensive urgency? For potential evidence of target organ damage
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Medications used in hypertensive urgency Fast acting oral agents such as beta blockers or ACE inhibitor or alpha 2 agonist
Flow rate equation Change in pressure / resistance
Hemodynamic Resistance Opposition of blood flow
Dependent on blood viscosity and opening and size of the blood vessel
What is the most important peripheral vascular regulating mechanism? SNS
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What characterizes all peripheral vascular diseases? Reduced blood flow through peripheral blood vessels
Type of Pain in Arterial insufficiency? Venous? Arterial: intermittent claudication distal to site of diseased valve

Venous: Aching, cramping
Pulses in Arterial insufficiency? Venous? Arterial: Diminished or absent

Venous: Present but may be difficult to palpate through edema
Skin changes occurring in an arterial insufficiency? Venous? Arterial: dorsum of foot, rubor, pallor, shiny, loss of hair, nails thick and rigid

Venous: medial and lateral malleoulus, thick and tough skin, red/blue, frequent dermatitis
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Ulcer characteristics in Arterial insufficiency? Venous? Arterial: Tips of toes, heel, toe webbs. painful, deep, circular, pale to black, dry gangrene, edema minimal

Venous: Medial malleolus, sometimes lateral malleolus and anterior tibial, painful if superficial, irregular border, beefy red to yellow, fibrinous, edema moderate to severe
Who had more pronounced PVD? The aging
If inactive what might be the first sign of PVD? Gangrene
Most reliable and inexpensive method for diagnosing PAD? ABI
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Mild to Moderate PAD ABI value .95-.50
.5 ABI value Rest pain and PAD 

Severe PAD ABI value .25 or less
The lower the ABI the _____ severe the PAD More
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Stenosis vs. Occlusion Stenosis is decreased flow while Occlusion is no flow
Color Flow Duplex Image Doppler used to visualize rate of flow in vessels
Helps determine level and extent of disease and tell whether it is stenosis or occlusion
Clinical Manifestations of Arterial Insufficiencies Depend on organ or tissue being impacted by atherosclerosis
Normal LDL Less than 100 mg/dL
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Diabetic goal LDL < 70 mg/dL
Total Cholesterol < 200 mg/dL
Triglycerides <150 mg/dL
Three major medications in treatment of PAD HMG-CoA reductase inhibitors
Antihypertensives
Antiplatelet agents
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Most common cause of an acute arterial occlusion emboli originating from post MI/a-fib
Assessment of acute arterial occlusion 6 P's
What are the 6 P's? Pallor
Paresthesia
Pulselessness
Paralysis
Poikilothermia
Buerger's Disease Recurring inflammation of the lower small and intermediate vessels believed to be autoimmune vasculitis which results in occlusion

Most often occurs in men ages 20-35

Aggravating factor: tobacco


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Raynaud's Disease Intermittent arterial vasoocclusion usually in fingertips or toes
Associated with other underlying diseases such as scleroma
Manifestations include color changes, numbness, tingling, and burning pain
Cold or stress are triggers
Occurs most frequently in young women

Thoracic Aortic Aneurysm Most common sight for dissecting aneurysm
Men age 40-70
1/3 of patients die of rupture
Abdominal Aortic Aneurysm 40% have symptoms
80% of diagnosis upon palpation
Surgery if more than 5.5 cm or 2 inches
1-4% mortality

Aortoilliac Disease Vessels Build up of circulation due to occlusion or stenosis of aortoilliac segment that is either assymptomatic or buttock or lower back pain
Men have impotence or decreased or absent femoral pulses

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Aortic Dissection Caused by arteriosclerosis but mostly poorly controlled HTN
Most common in aortic arch
Sudden severe tearing pain

Aortoilliac Endarterectomy surgeon identifies diseased area, clamps off its blood supply, removes the plaque, sutures the vessel shut, after blood flow is restored, 
Two common caused of PVD Thrombus formation
Defective valves

Virshow's Triad DVT and PE risk factors 
Endothelial damage
Venous Stasis
Altered coagulation 
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Is Homan a good tool for assessing DVT? No 
Cellulitis infection and swelling of skin tisses
Lymphangitis inflammation/infection of lymph channel
Lymphadenitis Inflammation/infection of the lymph nodes
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Primary Lymphedema Congenital tissue swelling r/t obstruction of lymph flow
Secondary Lymphedema Acquired obstruction of lymph flow causing tissue swelling
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 JNC7 Definition of High Blood PressureSystolic > 140
Diastolic > 90
based on average of two or more accurate blood pressure measurements taken during two or more contacts
 Primary HypertensionEssential hypertension is the form of hypertension that by definition, has no identifiable cause.
 Secondary HypertensionSecondary hypertension is a type of hypertension which by definition is caused by an identifiable underlying secondary cause.
 Is Primary or Secondary Hypertension the most common?Primary
 What are the symptoms of Hypertension?Usually none until actual organ damage is done causing:
retinal damage
Renal damage
MI
Cardiac hypertrophy 
Stroke
 DislipidemiaHigh blood cholesterol levels
 What two renal problems are associated risk factors of hypertension?Microalbuminuria and a GFR < 60
 What is the goal blood pressure for people that have high blood pressure and DM or chronic kidney disease?< 130/80
 Stage 1 Hypertension140-159 systolic
90-99 diastolic
 Stage 2 hypertension160 greater than or equal to systolic
diastolic greater than or equal to 100
 According to JNC if a patient does not reach goal BP with initial drug choices what happens next?Optimize dosage or add additional drugs until goal BP is achieved. Consider consultation with specialist
 DASHDietary Approaches to Stop Hypertension
 What is usually the first antihypertensive used?Thiazide Diuretic
 What three things must you assess with a patient on thiazide diuretics?Potassium wasting diuretic? (supplement)
Turgor and Edema? (dehydration)
 Thiazide DiureticsDecrease Blood volume, Renal Blood Flow, and CO
Depletion of ECF
Negative sodium balance and mild hypokalemia
Directly affect vascular smooth muscle
 Loop DiureticsVolume depletion
Blocks Na, Cl, and H2O reabsorption

 Potassium Sparing DiureticsBlock sodium resorption
Acts on DT independently of aldosterone
 Aldosterone Receptor BlockersCompetitive inhibitor of aldosterone binding
 Central alpha-2 agonists and other Centrally Active DrugsImpair synthesis and reuptake of Norepinephrine 
 Beta BlockersBlock SNS 
especially sympathetics in heart causing a decrease HR and BP
 Beta Blockers with Intrinsic Sympathomimetic ActivityBlock cardiac beta 1 and 2 receptors
Slow AV conduction so act as a antiarrythmic
 Alpha 1 BlockersPeripheral vasodilation directly on blood vessels, similar to hydralazine
 Combined alpha and Beta blockersBlock these receptors causing peripheral vasodilation and decrease TPR
 VasodilatorsStimulate dopamine and alpha 2 adrenergic receptors
 ACE InhibitorsInhibit conversion of angiotensin I to II 
Lower TPR
 Angiotensin II AntagonistsBlock Ang I actions 
Reduce TPR
 NondihydropyridinesInhibit calcium ion influx
Reduce cardiac afterload

Calcium channel blocker
 DihyropiridinesInhibit calcium ion influx across membranes
Vasodilation on coronary arteries and peripheral arterioles
Decreased cardiac work and energy consumption increased delivery of oxygen to myocardium

Calcium channel blocker
 What must a nurse emphasize with the treatment of HTN?Control rather than cure
 MonotherapyLimiting of medications making compliance easier
 Hypertensive EmergencyBP > 180/120and must be lowered immediately to prevent organ damage
 Hypertensive UrgencyBP is very high but no evidence of immediate or progressive target organ damage
 Goals of treatment for Hypertensive EmergencyReduction of BP 25% first hr
Reduce to 160/100 over 6 hours
Gradual reduction over a few days
 Exceptions to normal goals of hypertensive emergency include what two conditions?ischemic stroke and aortic dissection
 Medications used in a Hypertensive EmergencyVasodilators (IV)
 What must be assessed in a hypertensive urgency?For potential evidence of target organ damage
 Medications used in hypertensive urgencyFast acting oral agents such as beta blockers or ACE inhibitor or alpha 2 agonist
 Flow rate equationChange in pressure / resistance
 Hemodynamic ResistanceOpposition of blood flow
Dependent on blood viscosity and opening and size of the blood vessel
 What is the most important peripheral vascular regulating mechanism?SNS
 What characterizes all peripheral vascular diseases?Reduced blood flow through peripheral blood vessels
 Type of Pain in Arterial insufficiency? Venous?Arterial: intermittent claudication distal to site of diseased valve

Venous: Aching, cramping
 Pulses in Arterial insufficiency? Venous?Arterial: Diminished or absent

Venous: Present but may be difficult to palpate through edema
 Skin changes occurring in an arterial insufficiency? Venous?Arterial: dorsum of foot, rubor, pallor, shiny, loss of hair, nails thick and rigid

Venous: medial and lateral malleoulus, thick and tough skin, red/blue, frequent dermatitis
 Ulcer characteristics in Arterial insufficiency? Venous?Arterial: Tips of toes, heel, toe webbs. painful, deep, circular, pale to black, dry gangrene, edema minimal

Venous: Medial malleolus, sometimes lateral malleolus and anterior tibial, painful if superficial, irregular border, beefy red to yellow, fibrinous, edema moderate to severe
 Who had more pronounced PVD?The aging
 If inactive what might be the first sign of PVD?Gangrene
 Most reliable and inexpensive method for diagnosing PAD?ABI
 Mild to Moderate PAD ABI value.95-.50
 .5 ABI valueRest pain and PAD 

 Severe PAD ABI value.25 or less
 The lower the ABI the _____ severe the PADMore
 Stenosis vs. OcclusionStenosis is decreased flow while Occlusion is no flow
 Color Flow Duplex ImageDoppler used to visualize rate of flow in vessels
Helps determine level and extent of disease and tell whether it is stenosis or occlusion
 Clinical Manifestations of Arterial InsufficienciesDepend on organ or tissue being impacted by atherosclerosis
 Normal LDLLess than 100 mg/dL
 Diabetic goal LDL< 70 mg/dL
 Total Cholesterol< 200 mg/dL
 Triglycerides<150 mg/dL
 Three major medications in treatment of PADHMG-CoA reductase inhibitors
Antihypertensives
Antiplatelet agents
 Most common cause of an acute arterial occlusionemboli originating from post MI/a-fib
 Assessment of acute arterial occlusion6 P's
 What are the 6 P's?Pallor
Paresthesia
Pulselessness
Paralysis
Poikilothermia
 Buerger's DiseaseRecurring inflammation of the lower small and intermediate vessels believed to be autoimmune vasculitis which results in occlusion

Most often occurs in men ages 20-35

Aggravating factor: tobacco


 Raynaud's DiseaseIntermittent arterial vasoocclusion usually in fingertips or toes
Associated with other underlying diseases such as scleroma
Manifestations include color changes, numbness, tingling, and burning pain
Cold or stress are triggers
Occurs most frequently in young women

 Thoracic Aortic AneurysmMost common sight for dissecting aneurysm
Men age 40-70
1/3 of patients die of rupture
 Abdominal Aortic Aneurysm40% have symptoms
80% of diagnosis upon palpation
Surgery if more than 5.5 cm or 2 inches
1-4% mortality

 Aortoilliac Disease VesselsBuild up of circulation due to occlusion or stenosis of aortoilliac segment that is either assymptomatic or buttock or lower back pain
Men have impotence or decreased or absent femoral pulses

 Aortic DissectionCaused by arteriosclerosis but mostly poorly controlled HTN
Most common in aortic arch
Sudden severe tearing pain

 Aortoilliac Endarterectomysurgeon identifies diseased area, clamps off its blood supply, removes the plaque, sutures the vessel shut, after blood flow is restored, 
 Two common caused of PVDThrombus formation
Defective valves

 Virshow's TriadDVT and PE risk factors 
Endothelial damage
Venous Stasis
Altered coagulation 
 Is Homan a good tool for assessing DVT?No 
 Cellulitisinfection and swelling of skin tisses
 Lymphangitisinflammation/infection of lymph channel
 LymphadenitisInflammation/infection of the lymph nodes
 Primary LymphedemaCongenital tissue swelling r/t obstruction of lymph flow
 Secondary LymphedemaAcquired obstruction of lymph flow causing tissue swelling
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