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exam two week 7_ starting with hypertension (1)
exam two week 7_ starting with hypertension (1)
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exam two week 7: starting with hypertensionWhat is hypertension? HTN - CORRECT ANSWER--high blood pressure
-Hypertension exists when systolic blood pressure is greater than 120 MM/HG or diastolic blood
pressure is greater than 80 MM/HG for extended periods of time. It is one of the most modifiable
risk factors that can lead to the development of cardiovascular disease.
-make sure extended period of time
-modifiable mean? subject to change or fix
•Mrs. Lyra Silvertongue, a 65-year-old first generation born in the US, with parents who
immigrated to the US from Greece. She is married and has 5 children and 10 grandchildren. She
came into the hospital last night with extreme headache, nausea, lethargy, and dehydration. She
has a history of HTN, obesity, and is a current smoker (1/2 pack a day for 45 years). Her only
surgical history includes 2 c-sections with her 4th and 5th births due to preeclampsia. It's 7am, and
you are caring for her today.
•What risk factors does LS have for HTN?
•What more would you like to know?
•What about prescribed medications? - CORRECT ANSWER-•What risk factors does LS have for
HTN? Obesity, smoker, history of HYN, age.
•What more would you like to know? what are her vitals, b/p, I and O, when did the symptoms
start, heart rate.
•What about prescribed medications? anticoagulant.
factors that influence blood pressure - CORRECT ANSWER-don't need to know
what are the four classifications of hypertension? - CORRECT ANSWER--normal: <120 and <=80
-prehypertension: 120-129 or <=80 (Lifestyle modification & No drugs unless indications)
-hypertension: stage 1 130-139 or 80-89
(Lifestyle modifications & Thiazide-type drugs for most; may consider ACE inhibitors, ARB, BB,
CCB or combination)
-stage 2: >140 or >=90
(Lifestyle modifications & two drug combination for most &(usually thiazide-type diuretic and ACE
inhibitors, ARB, BB or CCB)
what are the two types of hypertension? - CORRECT ANSWER--primary hypertension
-secondary hypertension
what is primary hypertension? - CORRECT ANSWER-Essential or Idiopathic
•Accounts for 90-95% of all cases
•Without an identified cause
•Contributing Factors-
Increased sodium intake
Increased Sympathetic Nervous System Activity
Greater than ideal body weight
Excessive alcohol consumption
Tobacco use
Risk factors: •Age
•Alcohol
•Cigarette smoking
,•Diabetes mellitus
•Elevated serum lipids
•Excess dietary sodium
•Gender
•Family history
•Obesity
•Ethnicity
•Sedentary lifestyle
•Socioeconomic status
•Stress
what are the clinical manifestations of primary hypertension? - CORRECT
ANSWER--asymptomatic
-secondary symptoms: •Fatigue
•Reduced activity tolerance
•Dizziness
•Palpitations
•Angina
•Dyspnea
what are complications of primary hypertension?
and what is the diagnostic studies? - CORRECT ANSWER--target organ disease: heart failure,
coronary artery disease, etc.
-Several elevated BP readings over several weeks
•UA, BUN, Cr, CBC (checking the kidney function)
•Serum electrolytes
•Serum lipid profile
•ECG
•**Critical thinking-Why are we drawing all of these labs and why and ECG?
what is secondary hypertension? - CORRECT ANSWER--Accounts for 5% -10% of hypertension
in adults
Relating to an underlying cause-
Renal Disease
OSA
Endocrine Disorders - eg- thyroid disease Neurologic disorders- eg- brain tumor
Pregnancy induced hypertension
Drug- induced - eg- oral contraceptives, corticosteroids
Congenital - narrowing of the aorta
**See table 32.3 on page 681 in Lewis
•Treatment-
•Identify the underlying cause and treat that, but what about pregnancy-what do you think happens
then? check bp frequently, modify their lifestyle
•**Secondary HTN is a contributing factor to Hypertensive Crisis, which we discuss further in the
presentation
For ethnicities, there are three factors associated with ___ prevalence of hypertension. What are
they? - CORRECT ANSWER--increased
•People born out of the US
, •Living in a household that does not speak English
•Living in a household with limited time living in the US
•Blacks have the highest prevalence of HTN in the world
•Hispanics are less likely to receive treatment for HTN than whites and blacks
what are some Gerontologic Considerations? - CORRECT ANSWER-•Loss of elasticity in the
large arteries - atherosclerosis
•Increase collagen and stiffness of the myocardium
•Increased peripheral vascular resistance
•Decreased renal function
what medication do you give for someone with hypertension?
A medication beta blockers? - CORRECT ANSWER--metoprolol (toprol)
-causes the heart to beat slower with less force=lowers blood pressure
-we are causing the heart to beat slower we are also lowering their heart rate. Always check their
recent bp before giving a bp medication. also have a recent heart rate.
what medication do you give for someone with hypertension?
Medications- calcium channel blockers? - CORRECT ANSWER--verapamil (Calan)
•Blocks BP by preventing calcium from entering cells of the heart and arteries)
-calcium causes the heart and arteries to contract stronger. Block it from entering then vessels can
relax and open lowering your bp.
what medication do you give for someone with hypertension?
Medications-ACE's (angiotensin-converting enzyme inhibitor) - CORRECT ANSWER-•Captopril
(Capoten)
•Blocks angiotensin - allows meds to dilate veins and arteries
what medication do you give for someone with hypertension?
Medications-ARB's (Angiotensin II Receptor blockers) - CORRECT ANSWER-•Losartan (Cozar)
•Blocks the action of angiotensin II- veins and arteries dilate
what medication do you give for someone with hypertension?
Medications-diuretics - CORRECT ANSWER-•Loop: (furosemide (Lasix) -non-K sparing (non
potassium sparing- going to lose potassium so need to watch potassium levels. Pulling fluid off
need to monitor I and O.)
• Thiazide: hydrochlorothiazide
• Potassium-Sparing Diuretics:
•**Table 32.7 in Lewis text on page 689 very helpful
Aldosterone Antagonists-Eplerenone (Inspra) and Spironolaction (Aldactone)
Works by inhibiting the Na and K excreting effects of aldosterone (a natural substance in the body
that raises blood pressure) in the distal and collecting tubules
what is a hypertensive crisis?
and what causes it? - CORRECT ANSWER-•A severe and abrupt elevation in BP arbitrarily
defined as a SBP: greater then 180 DBP >= 120-140 mm/Hg
•Rising BP triggers endothelial damage → release of vasoconstrictor substances → end organ
damage
Causes
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