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Hypertension!
| Question | Answer |
|---|---|
| BP > 140/90 recorded at least 2 separate times | Hypertension |
| BP > 160/90 in elderly | Hypertension |
| HTN is the major cause of... | heart failure, stroke, renal failure, retinal damage |
| HTN is associated with... | ESRD, CAD, CHF, MI, CVA-TIA |
| normal BP | <120 (systolic)/<80 (diastolic) |
| PreHTN | 120-139/80-89 |
| Stage 1HTN | 140-159/90-99 |
| Stage 2 HTN | >160/>100 |
| Rx for stage 1 | drugs, see HCP qmonth til BP controlled; then q3-6months |
| Rx for stage 2 | drugs, see HCP more freq., usually > one med. to control |
| Complications of prolonged HTN | elastic tissues in arterioles replaced by fibrous collagen tissue--> less distensible--> leads to decr tissue perfusion |
| more complications of prolonged HTN | direct damage to endothelium of arteries-platelets lay down to try to repair->incr atheroma-->occulsion |
| (normal) BP is pressure exerted by blood on vessels thru which it flows.. | systolic-press. exerted during ventricular contraction (CO)diastolic-press. exerted during ventricular relaxation (PVR) |
| BP is regulated by what 2 factors? | *blood flow--determined by CO:rate, strength, blood volume*Peripheral Vascular Resistance(PVR)-determined by diameter of bld vessels & bld viscosity |
| most common characteristic of HTN | incr PVR as result of narrowing of artioles |
| What is the mechanism of BP control in the nervous system? | -vasomotor center in medulla stimulated by barorecptors(in carotids) or by psychogenic stress-> release of catecholamines-norepinephrine->bld vessel constriction & incr PVR-epinephrine secreted-> vasoconstriction & incr ventri. contraction force & CO |
| What is the mechanism of BP control in Endocrine system? | -incr. serum NA-> incr ADH release by pituitary-> kidneys retain water->incr bld volume-> incr CO |
| What is the mechanism of BP control in the Renal system? | -reduced bld flow to kidneys(renal ischemia)-> stimulates renin release from kidn.->renin leads to formation of angiotension(vasoconstrictor)-angiotension stimulate secretion of aldosterone (promotes retention of Na & H2O) |
| Labile HTN | intermittently incr BP (ex. giving a speech) |
| Resistant HTN | doesn't respond to usual Rx(Tx) |
| Accelerates HTN | -aka malignant-severe with rapid progression-kill fast-produces pathologic changes in kidneys, heart, brain & eyes-unless medical Rx success-fatal in 2yr-most-black males<40yo-need good teaching |
| Secondary HTN | develops as result of other primary disease processes |
| ISH | aka Isolated systolic HTN-->esp elderly-decr elasticity of major bld vessels(incr PVD)-->also assoc with arteriosclerosis |
| Primary HTN | aka essential or idiopathic--cause unknown--90-95% of pts with HTN |
| What are the risk factors for HTN? | +family Hx, age 30-70, women>men but less dram. affected, Black:white 2:1, incr Na intake, obesity BMI >30, smoke, lack of activity, alcohol, stress, incr serum cholesterol & triglycerides, incr caffeine intake, decr in Ca & Mg intake, BCP&estrogen suppl. |
| What are some Px factors? | decr Na < 6g/d, incr K,Ca,&Mg intake, limit alcohol (1oz liquor,8oz wine,24oz beer/day), nrml wt range, reg. exercise (5xs/wk), biofeedback, stress reduction, avoid tobacco |
| What do you assess first? | determine type&severity--note rate of disease progression & assess target organ damage--PCs |
| What do you get from pt? (subjective) | family Hx, Hx of renal/CV, age of dx, Rx, compliance, understanding |
| If there are s/s, what are they? (checking target organ damage) | Brain--HA, blurred vision, drowsiness, vertigo, numbness, tinglingHeart--SOB, chest pain, led edema, nocturiaPVD--intermittent claudication (can have pain in legsspontaneous epistaxis (nosebleed) |
| In the presence of these risk factors, increases risk of c-v complications? | impaired renal function(microalbuminuria), obesity&inactivity, smoking, incr stress(vasoconstriction), DM, age>55(m) &age>65(F) |
| What are some of the objective things you can do? | BP-both arms--supine&standing, ck peripheral pulses, ck retina to note vascular changes (fundoscopic exam-in H&P report) |
| If do you do not have the correct BP cuff size for your pt, how might it affect the BP reading? | too small--false incrtoo large--false decr |
| The clinical care goal for HTN pts is.. | to maintain systolic <120 & diastolic <80 |
| What are the stepped care approaches in order? | #1use a diuretic, beta blocker, Ca antagonist, or ACE inhibitor#2if ineffective after 1-3months, incr dosage, add a 2nd drug of a differ class, or subs another drug#3add a 3rd drug of a differ class or subs a 2nd drug#4add a 4th drug of a differ cla |
| After 1 year of satisfactory BP control, what might happen? | a step-down approach may be effective in pts also adhering to non-pharmacologic measures |
| What action takes place before admin. of HTN meds? | Check BP!! if <90/ hold and call MD or if significant decr from baseline-hold and call MD |
| What does pre-op usually do? | they usually give anti-HTN meds |
Created by:
bwilkins2828
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