NURSE-UN 240 A&E I– FINAL EXAM STUDY GUIDE WEEK 9 – HYPERTENSION & STROKE HYPERTENSION,100% CORRECT
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NURSE-UN 240 A&E I– FINAL EXAM STUDY GUIDE WEEK 9 – HYPERTENSION & STROKE HYPERTENSION
- Hypertension –
o Some Disparities:
▪ Incidence is highest among African-Americans
▪ Incidence is higher among men compared to women until age 45
▪ Incidence is higher among women compared to m...
nurse un 240 aampe i– final exam study guide week 9 – hypertension amp stroke hypertension
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NURSE-UN 240 A&E I– FINAL EXAM STUDY GUIDE WEEK 9 – HYPERTENSION & STROK
HYPERTENSION
- Hypertension –
o Some Disparities:
▪ Incidence is highest among African-Americans
▪ Incidence is higher among men compared to women until age 45
▪ Incidence is higher among women compared to men after age 45,
especially after age 54 (cause unknown)
▪ 1 in every 3 Americans has HTN
• 46% do not have it under control
• 2 out of 3 have HTN after 65 years old
▪ Uncontrolled BP increases the risk of co-morbidities:
• A 20mmHg (systolic)/10 mmHg diastolic increase in BP
doubles the risk of cardiovascular disease (CVD)
o For example, a person with BP of 140/90 mmHg has twice the
risk as a person with BP of 120/80 mmHg
o BP = CO x PVR (systemic arterial blood pressure is a product of cardiac
output and total peripheral vascular resistance).
o CO – determined by the stroke volume
(SV) multiplied by the heart rate (HR); SV
is influenced by preload, afterload, and
contractility:
▪ The greater the preload the
greater the SV, the greater the CO,
the greater the BP
• Diuretics – decreases preload
▪ The greater the afterload the
greater the SV, the greater the CO,
the greater the BP.
• Vasodilators – decreases afterload
▪ The greater the contractility the
greater the SV, the greater the CO,
the greater the BP
• Calcium channel blockers –
decreases contractility
o PVR – influenced by sympathetic
nervous system activity and
angiotensin II.
, ▪ In the renin-angiotensin-aldosterone system (RAAS), the kidney produces
renin (an enzyme that acts on angiotensinogen to split off angiotensin I)
angiotensin I converted by enzyme in lung to angiotensin II
• Angiotensin II – strong vasoconstrictor action on blood vessels
and is the controlling mechanism for aldosterone release
• Aldosterone then works on the collecting tubules in the kidneys to
reabsorb sodium, which will inhibit fluid loss, thus increasing
blood volume and subsequent blood pressure.
Hypertension can be classified as essential (primary) or secondary:
- Essential hypertension is the most common type (approximately 95% of cases) and is
not caused by an existing health problem. However, a number of risk factors can
increase a person’s likelihood of becoming hypertensive:
o Family history of hypertension
o African-American ethnicity
o Hyperlipidemia
o Smoker
o Older than 60 years old or postmenopausal
o Excessive sodium and caffeine intake
o Overweight/obesity
o Physical inactivity
o Excessive alcohol intake
o Low potassium, calcium, or magnesium intake
o Excessive and continuous stress
- Specific disease states and drugs can increase a person’s susceptibility to secondary
hypertension:
o Kidney disease
o Primary aldosteronism
o Pheochromocytoma (tumor in the adrenal cortex)
o Cushing’s disease
o Brain tumor
o Encephalitis
o Pregnancy
o Drugs: estrogen (birth control pills), steroids (glucocorticoids, mineralocorticoids),
NSAIDs, and cold and flu medications
Systolic BP Diastolic BP
Normal < 120 and < 80
Elevated 120-129 and < 80
Stage I 130-139 or 80-89
hypertension
Stage II > 140 or > 90
hypertension
Hypertensive > 180 and/ > 120
crisis o
r
Nursing Assessment: subjective data, risk factors, objective data
Subjective PMHx, Risk factors Objective data Clinical Manifestations
meds, SHx, FHx,
ROS
, PMHx/Meds: - FHX of HTN - BP readings - Essential/Pri
HTN, CV (PAD, - Ethnicity (African- - Heart mary HTN:
American) sounds
PVD), - Hyperlipidemia - Pulses Usually
cerebrovascular, - Smoking - Edema asymptomati
renal, thyroid dx, - Age > 60 yo or post- - Body c (“Silent
DM, pituitary menopausal measurem Killer”),
disorders, obesity, - Excessive Na and caffeine ents (waist idiopathic
intake
dyslipidemia, - Overweight/obesity and air - Secondary
menopause or - Sedentary lifestyle circumfere HTN: resulting
hormone (physical nce from renal
replacement diseases, sleep
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