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Summary Nur 323 Exam 3 Study Guide
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This is a comprehensive and detailed study guide on Exam 3 for Nur 323. *Essential Study Material!!
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Med Surg Exam 3Hypertension & Elevated Cholesterol
“the silent killer” asymptomatic until target organ disease occurs
Vasodilation decrease BP
Vasoconstriction increase BP
Blood Pressure
Arterial BP
Systolic BP
Diastolic BP
Pulse pressure
Factors influencing BP
o CO
o SVR
BP= CO x SVR
Cardiac Output is increased by
Increased force of contraction
o Positive inotropic effect
Increased rate of contraction
o Positive chronotropic effect
Increased speed of conduction
o Positive dromotropic effect
Hypertension
Persistent elevation of at least one of the following
o Systolic BP ≥140
o Diastolic BP ≥90
o Current use of antihypertensive medications
Based on average of 2+ readings on 2+ office visits
Normal BP
<120/<80
Prehypertension
120-139/80-89
Hypertension Stage 1
140-159/90-99
Hypertension Stage 2
≥160/≥100
Measuring BP
, Initially take BP at least 2 times at least 1 minute apart
o record average pressure as value for visit
Initially check BP on both arms to detect any differences
o Document finding; use arm with higher reading for subsequent BP measures
Correct cuff size, proper placement on arm, place at level of heart, arm resting on
surface, patient’s feet flat on floor (if sitting)
Hypertension
Major health problem
o Direct relationship between HTN and CVD and proportional risk for MI, HF, CVA,
RF
Cultural, ethnic, and gender differences
Etiology of HTN
Primary HTN (essential/idiopathic)
o Elevated BP without identified cause (90-95% of all cases)
Secondary HTN
o Elevated BP with specific cause (5-10% adult cases)
Risk factors for primary HTN
Age, alcohol use, cigarette smoking, DM, elevated serum lipids, excess dietary sodium,
gender, family history, obesity, ethnicity, sedentary lifestyle, socioeconomic status, stress
Clinical Manifestations
Symptoms often secondary to target organ disease or increased workload of heart
o Fatigue; reduced activity tolerance
o Dizziness
o Palpitations; angina
o Dyspnea
Complications
Target organ diseases occur most frequently in the
o Heart, brain, peripheral vasculature, kidney, eyes
Heart disease
o CAD
o Left ventricular hypertrophy
o HF
Cerebrovascular disease
o Stroke
PVD
o Aortic aneurysm/dissection
o Intermittent claudication
Nephrosclerosis
, o HTN is one of the leading causes of ESRD
Retinal damage
o Appearance of retina provides important information about severity/duration of
HTN
o Blurring of vision to loss of vision
Diagnostic Studies
“white coat” phenomenon may precipitate need for ambulatory BP monitoring (ABPM)
o Syndrome when patients anxiety feelings in medical environment results in
abnormal high reading of BP when measured
o Self-monitoring at home and work is a practical, economic approach that may be
considered before ABPM
o Non-invasive; fully automated system that measures BP at preset intervals over
24-hour period
Evaluate target organ disease
Establish baseline levels before starting treatment
o Kidney function: U/A, BUN, Creatinine
o Serum electrolytes
o Serum lipid profile
o ECG
o Echocardiogram
o Eye exam (reflective of status of target organs)
Overall goals:
Achieving and maintaining goal BP
Reduce CVD risk factors and target organ disease
Clinical Management
Lifestyle modifications
o Weight reduction
Weight loss of 10kg can decrease SBP by ~5-20 mmHg
o DASH eating plan
o Dietary sodium reduction
<2,300 mg of sodium/day
o Moderate alcohol consumption
o Men: no more than 2 drinks/day
o Women: no more than 1 drink/day
o Physical activity
Regular physical activity; 30+ mins most days of the week
o Avoidance of tobacco
o Psychosocial risk factors
Most patients with HTN still require drug therapy
o Thiazide diuretic is often first drug choice
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