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Unit 6B - Perfusions and HTN
Test 3
136
Nursing
Undergraduate 3
06/24/2014

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Term
What is the definition of HTN?
Definition
Systolic at or above 140mm HG
Dystolic at or above 90mm Hg
Term
What is HTN defined as w/ diabetes or heart dx?
Definition
130/90
Term
What is a NORMAL BP RANGE?
Definition
<120/<80
Term
What is isolated systolic hypertension?
Definition
SBP at or above 140 with DPB below 90
Term
Who suffers from ISH?
Definition
Older adults. No symptoms.
Term
What is prehypertensive?
Definition
120 to 139 systolic
80 to 89 diastolic
Term
What the the prehypertenisve time good for?
Definition
implement changes to reduce morbidity r/t coronary, cerebral, renal, and PVD
Term
What is systemic arterial pressure equal to?
Definition
Cardiac Output + Peripheral Veinous Resistance
Term
What is cardiac volume equal to?
Definition
Stroke volume + heart rate
Term
Who maintains control of peripheral vascular resistance?
Definition
(vessel constriction or dilation) is maintained by the autonomic nervous system and hormones norepinephrine and epinephrine
Term
What is the avg SV?
Definition
70 mL
Term
What is cardiac output?
Definition
Amount of blood pumped/min
Term
What do sympathetic nerve fibers do to the heart?
Definition
speed up the heart
Term
What do parasympathetic nerve fibers do to the heart?
Definition
slows down the heart (vagus)
Term
If something increases PVR, HR, or SV, what else does it increase? (vice versa)
Definition
systemic arterial pressure
Term
What are the 4 stabilizing mechanisms of blood pressure?
Definition
Arterial baroreceptor system
Regulation of body fluid volume
Renin-angiotensin/aldosterone system
Vascular autoregulation
Term
Where are the arterial baroreceptors found?
Definition
carotid sinus, aorta, and left ventricle
Term
How do baroreceptors regulate BP?
Definition
monitoring the SAP and vagally mediate slowing of heart and vasodilation to drop pressure
Term
Do baroreceptors work in HTN?
Definition
NO
Term
How do norepi and epi increase BP?
Definition
through vasoconstriction.
Term
What does excess sodium mean?
Definition
excess fluid volume= Increased BP
Term
Normal kidney function causes a _____ in SAP
Definition
rise
Term
What causes SAP to fall in the kidneys?
Definition
Diuresis
Term
What are the elements of an unhealthy kidney?
Definition
-Fluid overload
-Elevated wastes like urea, creatinine, potassium
-Changes in hormone levels controlling: BP, RBC, uptake of calcium
Term
What is RENIN?
Definition
Renin (produced by kidney) acts on angiotensin (I to II) which vasoconstricts and releases aldosterone to reabsorb sodium-inhibits fld loss increasing volume & BP

Renin is an enzyme produced by the kidneys that causes vasoconstriction, increases peripheral resistance and increases cardiac output.
Term
What happens when RENIN is imbalanced?
Definition
may cause increased Peripheral vascular resistance in hypertension.
Term
What are rein levels like in high blood pressure?
Definition
renin levels should fall because the increased renal arteriolar pressure should inhibit renin secretions
Term
What are the renin levels like in essential htn?
Definition
renin levels are normal.
Term
What is vascular autoregulation?
Definition
Sustained high BP produces thickening of the arterioles, perfusion decreases, organs are damaged
Term
What does vascular auto regulation cause?
Definition
Stroke, PVD, Renal failure, MI
Term
What is malignant hypertension?
Definition
Severe, & rapidly progressing
Term
What are the s/s of malignant htn?
Definition
: Morning HA, blurred vision, uremia
Term
Who is effected by malignant htn?
Definition
30s-50s
Term
What is the BP range of malignant htn?
Definition
Systolic >200 diastolic >150
Term
What results from malignant htn?
Definition
HF, Stroke, renal failure
Term
What are the risk factors for primary htn?
Definition
African American
High intake salt or caffeine
Reduced K, Ca,or mg intake
Obesity
Smoking
Stress
Greater than 60
Family hx*
Excessive calories
Inactivity
Excessive Etoh
Hyperlipidemia
Term
What is secondary htn?
Definition
Cause: Disease or drugs
Term
What is the most common cause of secondary htn?
Definition
Renal disease
Term
What is renal artery stenosis?
Definition
narrowing of one or more of the main arteries carrying blood directly to the kidneys.
Term
How is renal artery stenosis treated?
Definition
Stints
Term
What causes renal disease?
Definition
Adrenal medulla/cortex dysfunction
Term
What is the effect of renal disease?
Definition
Excessive aldosterone causes HTN and low K+
Term
What is an adenoma?
Definition
benign tumor that can also cause secondary HTN.
Term
What is Pheochromocytomas?
Definition
HTN EMERGENCY/CRISIS
Term
How does pheochromocytomas cause HTN emergency?
Definition
tumor releases catecholamines) epinephrine and norepinephrine which causes palpitations, sweating, HA, fainting, tremors, nausea, dyspepsia, pallor, chest or abd pain, hyperglycemia, weakness, anxiety, and HTN emergency. Is surgically corrected.
Term
What is Cushings syndrome?
Definition
A person has too much glucocorticoids in their system due to taking steroids to treat another disorder.
Term
What are the s/s of Cushings disease?
Definition
(moon face, weakness, thinning skin, easy bruising, wt gain, depression, symptoms of DM r/t glucocorticoid hormone opposed the action of insulin.
Term
What drugs cause secondary HTN?
Definition
NSAIDs
Cocaine/amphetamines
Oral contraceptives (estrogen)
Steroids
Sympathomimetics
Cyclosporine & tacrolimus
Erythropoietin
Term
What steroids cause secondary HTN?
Definition
Glucocorticoids (cortisol)
Mineralocortiocoids (aldosterone)
Term
Does Sleep Apnea cause secondary HTN?
Definition
yes
Term
Who has a higher incidence of HTN - men or women?
Definition
Higher % of men than women until age 45
Women slightly higher % than men ages 45-54
Women have much higher % of HTN after age 54
Term
Which ethnicity has the highest incidence of HTN?
Definition
African Americans in the US
Term
What are African Americans most likely to die from?
Definition
stroke, heart disease, and kidney disease
Term
What are the risk factors for HTN?
Definition
Age, ethnic origin/ race, family hx, dietary intake: calories, sodium, potassium containing foods, alcohol, exercise, hx of renal or cardiovascular dx, current drug therapy or illicit drugs
Term
What are the s/s of htn?
Definition
Usually have no symptoms
May have HA, dizziness, fainting, facial flushing
Term
When you assess, what should you do?
Definition
-Obtain BP in both arms. Two or more readings each visit, use average.
-May do orthostatic BP- if decrease in BP 20mm Hg systolic or 10 mm/Hg diastolic.
-Funduscopic eye exam to monitor vascular changes in the retina
-Abdominal Bruits= renal vascular dx.
Term
What are the s/s of pheochromocytoma?
Definition
Tachycardia, sweating, pallor
Term
When are the femoral pulses delayed?
Definition
coarctation of the aorta.
Term
What psychosocial stressors are r/t HTN?
Definition
job-related, economic, other life stressors and coping strategies.
Term
What diagnostics should be looked at w/ HTN?
Definition
UA, BUN, Creatinine
24hr urine (GFR, 100)
Term
What does a decreased GFR mean?
Definition
renal disease
Term
What are the GFR rates for men and women?
Definition
normal 107-139 mL/min and lower for women 87-107 mL/min
Term
What can a chest X-ray show?
Definition
cardiomegaly AKA enlarged heart
Term
What can an ECG show?
Definition
Left sided hypertrophy r/t HTN
Term
What is orthostatic htn?
Definition
Decrease in blood pressure with changes of position
Term
How far does BP drop with orthostatic htn?
Definition
20mmHg systolic/ 10mmHg diastolic
Term
When should you check BP if orthostatic htn is a risk?
Definition
Lying, sitting, standing
Term
What lifestyle modifications can be made to avoid HTN?
Definition
Sodium restriction
Weight management
Etoh moderation
Exercise
Relaxation techniques
Tobacco and caffeine avoidance
Term
What drugs are used to treat HTN?
Definition
ACE inhibitors
ARB
Beta blockers
Calcium Channel Blockers
Diuretics
Term
How do ACE inhibitors work?
Definition
Block conversion of angiotensin I to II
Term
Why do ACE inhibitors need to block angiotension I->II?
Definition
Prevents vasoconstriction
Term
What needs to be monitored?
Definition
Hyperkalemia, hypotension, S&S of heart failure
Monitor Bp & pulse
Term
What should be monitored in older people taking ACE inhibitors?
Definition
Orthostatic hypotension
Term
What is the most complain of s/e with ACE?
Definition
cough
Term
How do ARBS work?
Definition
Selectively block the receptors for angiotensin II
Term
What is the therapeutic effect of ARB?
Definition
less vasoconstriction
Term
Are ARBS or ACE effective in african amercans?
Definition
NO! Renin is not the problem. Calcium channel blockers.
Term
What should you monitor for when administering ARBS?
Definition
Hyperkalemia
Term
What is the ending of ARB drugs?
Definition
SARTAN
Term
What is the ending of ACE drugs?
Definition
PRIL
Term
Are alpha adrenergic blockers the initial treatment?
Definition
No
Term
How do AA blockers work?
Definition
Blocks receptors= vasodilation, relax smooth muscles
Term
Why don't people take AA blockers?
Definition
Side effects
Term
What are the side effects of AA blockers?
Definition
weakness, ortho hypo, dry mouth, impotence
Term
What are some AA blockers?
Definition
Prazosin (Minipress),
Cardura, Hytrin
Term
What is the precaution with the 1st dose?
Definition
works quickly
Monitor for side effects
Term
When are Cardura/Hytrin prescribed?
Definition
when pts have benign prostatic hypertrophy BPH because of the dilating effect of the vessels, thus decreasing hypertrophy and inproving bld flow.
Term
How do beta blockers work?
Definition
Binds to beta receptors decrease catecholamines
Term
What are the 4 B's of beta blockers?
Definition
Bradycardia, ↓ contractility
Bronchial constriction
Blood pressure too low
Blood sugar-mask low
Term
Do BB decrease or increase heart's contractility?
Definition
Decrease HR and myocardial contractility.
Term
How do BB decrease contractility?
Definition
Decrease epinephrine and Norepinephrine.
Term
What should be cautioned in diabetic pts taking BB?
Definition
may not have the usual manifestaions of hypoglycemia because the sympathetic nervous system is blocked
Term
What are BB the #1 choice for?
Definition
hypertensive patient with ischemic heart disease because the heart is the most common target of end-organ damage with HTN.
Term
What is the treatment plan for unstable angina/MI?
Definition
treat with beta blockers or calcium channel blockers in combination with ACE inhibitors or ARBs to control HTN along with management of lipids and aspirin.
Term
How do calcium channel blockers work?
Definition
Interferes with calcium ion flux which results in vasodilation & decrease contractility
Term
What is the major side effect of calcium channel blockers?
Definition
Peripheral edema
Term
What do CC blockers worsen?
Definition
CHF
Term
What other s/e are associated w/ CC blockers?
Definition
HA
Syncope
Constipation- ↑fiber
Bradycardia, hypotension
Teach pulse, BP
Term
What teaching should be included w/ cc blockers?
Definition
How to take pulse/BP, increase fiber w/ constipation, when to call PCP
Term
What are some CC blockers?
Definition
Verapamil, nifedipine, diltiazem
Term
How do central alpha agonists work?
Definition
Acts on CNS preventing reuptake of norepinephrine, lowering PVR and BP
Term
What are the s/e of central alpha agonists?
Definition
sedation, postural hypotension, dry mouth, bradycardia
Term
Why are central alpha agonists NOT given with beta blockers?
Definition
accentuation of bradycardia
Term
Should you abruptly stop central alpha agonists?
Definition
no
Term
Do C.A.A. cause Na and H2O retention? What can you do?
Definition
Yes. Take w/ diuretic
Term
Should you take C.A.A. after MI?
Definition
NO
Term
What is a C.A.A?
Definition
Catapres (clonidine) patch, 7 days
Term
How do diuretics work?
Definition
Inhibits sodium and water reabsorption from kidneys therefor -> Lowers BP, decreases edema in HF and renal or liver dx
Term
What teaching and monitoring is needed?
Definition
Monitor VS, I&O,
electrolytes, glucose
Take early in the morning
Orthostatic Hypo (careful in the elderly)
Term
What electrolytes need to be monitored?
Definition
Electrolytes:
Potassium,
Magnesium
Chloride
bicarbonate
Term
Where do loop diuretics work?
Definition
loop of hence (proximal tubule)
Term
What do loop diuretics decrease?
Definition
decrease Na, Ch, H2O
Term
What are diuretics good for?
Definition
edema
Term
What are the side effects of loop diuretics?
Definition
Orthostatic hypotension, hyperglycemia, tinnitus
Term
What are 2 loop diuretics?
Definition
Furosemide, Torsemide
Term
What electrolyte imbalance is expected w/ loop diuretics?
Definition
K+ wasting, Ca & magnesium too

hypocalcemia, hypomagnesia, hypokalemic
Term
Where do thiazide diuretics work>
Definition
distal tubule
Term
How do thiazide diuretics work?
Definition
Prevent Na and water reabsorption, promote potassium excretion
Term
What are the side effects of thiazide diuretics?
Definition
hypokalemia, syncope, Orthostatic hypotension
Term
What is the big thiazide diuretic?
Definition
hydrochlorothiazide
Term
What are the s/s of hypokalemia?
Definition
muscle weakness, leg cramps, cardiac dysrhythmias
Term
What should you monitor for when giving this drug?
Definition
-Monitor wt.- wt gain of 2.2 lbs= 1 liter of body flds.
-Calcium and uric acid levels must be check; thiazides block calcium and uric acids excretion.
-Glucose; thiazides affection the metabolism of carbohydrates and hyperglycemia an occur.
-Cholesterol, low density lipoprotein and trigliceride levels may increase with thiazide diuretics, may be ordered a lipid lowering agent.
Term
What are the drug intrxns of thiazide diuretics?
Definition
Drug interactions: digoxin (if taking dig and hypokalemia occurs, digitalis toxicity frequently results), corticosteroids, antidiabetics ginko licorice
Monitor:
Term
Who shouldn't take thiazides?
Definition
Contraindicated in renal failure.
Term
What are K+ sparing diuretics?
Definition
Aldactone
Term
How do K+ sparing diuretics work?
Definition
Works in the collecting tubules: Promotes Na and H20 loss but retains K
Term
What electrolyte imbalance can happen w/ K+ sparing?
Definition
Low Na
Hyperkalemia
Term
What ECG changes can you see with hyperkalemia?
Definition
peaked T waves
Term
What is aldactone?
Definition
an aldosterone antagonist. Aldosterone is a hormone that promotes sodium retention and potassium excretion.
Term
How does aldactone work?
Definition
blocks the action of aldosterone and inhibits the sodium potassium pump( potassium is retained and sodium is excreted).
Good for Cardiac patients.
Term
How do you do emergency management of HTN?
Definition
-ASSESS FIRST!
-IV anti-hypertensive
-O2 therapy
-Semifowlers
-monitor vital signs every 5 mins
-watch for complications
Term
What are the s/s of hypertensive crisis?
Definition
Severe HA
Extremely high Bp
Dizziness
Blurred vision
Disoritentation
Term
What complications come from hypertensive crisis?
Definition
Seizures, weakness, dysrhymias, CP
Term
What teaching is involved with home care management?
Definition
. Dose, times for admin, side effects, drug interactions
Stress rx must be taken as prescribed and refilled. Suddenly stopping drugs like beta blockers can result in angina, MI, rebound HTN.
Report unpleasant SE: fatigue, cough, sexual dysfunction.
Term
What lifestyle changes need to be taught for home management?
Definition
low sodium, wt reduction, alcohol restrictions, stress management, exercise, stop tobacco
Term
What is noncompliance usually r/t?
Definition
Knowledge deficit
Side effects
Cost
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