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Questions and Answers
What is the primary determinant of blood pressure?
What is the primary determinant of blood pressure?
In adults, what range encompasses the majority of hypertension cases?
In adults, what range encompasses the majority of hypertension cases?
Which of the following conditions is NOT a contributing factor to secondary hypertension?
Which of the following conditions is NOT a contributing factor to secondary hypertension?
What is a direct consequence of hypertension?
What is a direct consequence of hypertension?
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Which physiological factor is most likely to lead to hypertension?
Which physiological factor is most likely to lead to hypertension?
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What is the primary purpose of monitoring blood pressure in a patient?
What is the primary purpose of monitoring blood pressure in a patient?
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Which of the following is a key focus of nursing care for patients with hypertension?
Which of the following is a key focus of nursing care for patients with hypertension?
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What should a nurse correlate to understand clinical manifestations of hypertension?
What should a nurse correlate to understand clinical manifestations of hypertension?
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What is the primary focus of psychosocial nursing interventions for patients with hypertension?
What is the primary focus of psychosocial nursing interventions for patients with hypertension?
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What should a nurse consider when evaluating a hypertensive patient?
What should a nurse consider when evaluating a hypertensive patient?
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What does interprofessional care for primary hypertension include?
What does interprofessional care for primary hypertension include?
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What is the purpose of teaching about antihypertensive medication for nurses?
What is the purpose of teaching about antihypertensive medication for nurses?
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What is a focus point for nurses when caring for a patient with a hypertensive crisis?
What is a focus point for nurses when caring for a patient with a hypertensive crisis?
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Why is hypertension often referred to as the 'silent killer'?
Why is hypertension often referred to as the 'silent killer'?
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Which of the following is NOT a common late symptom of hypertension related to organ damage?
Which of the following is NOT a common late symptom of hypertension related to organ damage?
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Which target organ disease is NOT a common complication of prolonged hypertension?
Which target organ disease is NOT a common complication of prolonged hypertension?
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Which of these is considered a significant risk factor for cardiovascular problems in hypertensive patients?
Which of these is considered a significant risk factor for cardiovascular problems in hypertensive patients?
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What is the recommended blood pressure goal for most people with hypertension?
What is the recommended blood pressure goal for most people with hypertension?
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What is the recommended blood pressure goal for individuals with diabetes or chronic kidney disease?
What is the recommended blood pressure goal for individuals with diabetes or chronic kidney disease?
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What is the earliest clinical sign of diabetic nephropathy that should be monitored in hypertensive patients?
What is the earliest clinical sign of diabetic nephropathy that should be monitored in hypertensive patients?
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Besides laboratory tests, which of the following is part of the patient assessment for hypertension?
Besides laboratory tests, which of the following is part of the patient assessment for hypertension?
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What is the threshold for blood pressure indicating a hypertensive emergency?
What is the threshold for blood pressure indicating a hypertensive emergency?
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Which medication is NOT typically used in the treatment of hypertensive emergencies?
Which medication is NOT typically used in the treatment of hypertensive emergencies?
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What should the initial therapeutic goal be in managing severe hypertension during a hypertensive emergency?
What should the initial therapeutic goal be in managing severe hypertension during a hypertensive emergency?
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Which condition is NOT associated with hypertensive emergencies?
Which condition is NOT associated with hypertensive emergencies?
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What characterizes hypertensive urgency?
What characterizes hypertensive urgency?
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What is the initial treatment approach for patients with hypertension?
What is the initial treatment approach for patients with hypertension?
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Which dietary recommendation is suggested for sodium intake in hypertension management?
Which dietary recommendation is suggested for sodium intake in hypertension management?
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What is the primary action of medications used to treat hypertension?
What is the primary action of medications used to treat hypertension?
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Which type of medication is typically the initial treatment for uncomplicated hypertension?
Which type of medication is typically the initial treatment for uncomplicated hypertension?
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What lifestyle change is recommended for managing hypertension?
What lifestyle change is recommended for managing hypertension?
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When should the gradual reduction of types and doses of medication be considered?
When should the gradual reduction of types and doses of medication be considered?
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What class of drugs primarily works by inhibiting catecholamines at adrenergic receptors?
What class of drugs primarily works by inhibiting catecholamines at adrenergic receptors?
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Which of the following is a recommendation for dietary approaches to stop hypertension?
Which of the following is a recommendation for dietary approaches to stop hypertension?
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Which class of diuretics is chlorothiazide (Diuril)?
Which class of diuretics is chlorothiazide (Diuril)?
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What is the primary goal of the nursing process for a patient with hypertension?
What is the primary goal of the nursing process for a patient with hypertension?
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Which medication is classified as a beta-blocker?
Which medication is classified as a beta-blocker?
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What intervention should be emphasized for a patient on antihypertensive medication?
What intervention should be emphasized for a patient on antihypertensive medication?
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Which of the following is a potential symptom of target organ damage from hypertension?
Which of the following is a potential symptom of target organ damage from hypertension?
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What should patients be cautioned about when taking antihypertensive medications?
What should patients be cautioned about when taking antihypertensive medications?
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Which type of anti-hypertensive crisis is characterized by severely elevated blood pressure requiring immediate intervention?
Which type of anti-hypertensive crisis is characterized by severely elevated blood pressure requiring immediate intervention?
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What nursing diagnosis is commonly associated with patients undergoing treatment for hypertension?
What nursing diagnosis is commonly associated with patients undergoing treatment for hypertension?
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Study Notes
Hypertension
- Hypertension is referred to as a "silent killer"
- Patients are often asymptomatic until target organ disease occurs
- Usually no symptoms other than elevated blood pressure
- Symptoms related to organ damage appear late and are serious, including retinal and other eye changes, renal damage, myocardial infarction (MI), angina, and cardiac hypertrophy.
Hypertension Symptoms
- Symptoms often secondary to target organ disease, including fatigue and reduced activity tolerance, dizziness, palpitations, angina, and dyspnea
Hypertension Complications
- Prolonged high blood pressure damages blood vessels throughout the body
- Target organ diseases occur most frequently in the heart (coronary artery disease (CAD), myocardial infarction (MI), heart failure (HF), left ventricular hypertrophy), brain (stroke), peripheral vascular systems, kidneys (renal failure), and eyes (impaired vision)
Etiology of Hypertension
- Primary (Essential or Idiopathic): Elevated blood pressure without a specific cause. Accounts for 90-95% of cases
- Secondary: Elevated blood pressure with a specific cause. Accounts for 5-10% of cases in adults. Often occurs in children greater than 80%
Risk Factors for Primary Hypertension
- Diabetes Mellitus (DM): Elevated serum lipids
- Dyslipidemia: Elevated serum lipids
- Obesity
- Family history/heredity
- Ethnicity
- Sedentary lifestyle
- Socioeconomic status
- Stress
Risk Factors for Hypertension in Cardiovascular Patients
- Smoking
- Obesity
- Physical inactivity
- Dyslipidemia
- Diabetes mellitus (DM)
- Microalbuminuria (MA): A value above 30 mg/day can indicate high albumin excretion
- Older age
- Family history
Risk Factors for Secondary Hypertension
- Congenital narrowing of the aorta
- Renal disease
- Endocrine disorders (e.g., pheochromocytoma)
- Neurological disorders
- Cirrhosis
- Medications (e.g., NSAIDs)
- Pregnancy-induced hypertension
Blood Pressure
- Blood Pressure (BP) is the force exerted against artery walls
- BP = Cardiac Output x Peripheral Resistance
- High BP results from changes in either cardiac output (CO) or peripheral resistance (PR), or both
- CO = Heart Rate (HR) x Stroke Volume (SV)
- Cardiac output is usually expressed in liters/minute
- BP is a significant sign used to monitor patient clinical status, risk factor for atherosclerotic cardiovascular disease, and a sign of high disease
Blood Pressure Classification for Adults 18 Years and Older
- Based on average of two or more, properly measured, seated readings taken on two or more office visits
- Table 32-1 outlines the classifications of normal, prehypertension, stage 1 hypertension, and stage 2 hypertension.
- Data are values in millimeters of mercury (mmHg) for systolic and diastolic blood pressure
Pathophysiology of Hypertension
- A multifactorial condition caused by several factors interacting within the body
- Factors that influence the development of hypertension involve sympathetic nervous system activity, reabsorption of sodium chloride and water by kidneys, activity of the rennin-angiotensin system, vasodilation of arterioles, insulin resistance, and more.
Medical Management of Hypertension
-
Goals: Control blood pressure, reduce cardiovascular risk, prevent complications and/or death.
-
Treatment Goals:
- Most adults: Maintain blood pressure at or below 140/90 mm Hg.
- Adults with DM or chronic kidney disease: Maintain blood pressure at or below 130/80 mm Hg
-
Management Options: Treatment algorithm from the Joint National Committee (JNC 7).
-
Treatment Plan: Lifestyle modifications (e.g., weight reduction, alcohol intake, sodium intake) and medication
Lifestyle Modifications
- Weight reduction
- Reduce alcohol intake
- Reduce sodium intake (less than 2.4 g of sodium/day or 6 g sodium chloride)
- Diet high in fruits, vegetables, and low-fat dairy foods
- Avoid tobacco products
- Regular physical activity; at least 30 minutes most days of the week
Pharmacologic Therapy
-
Drug therapy to treat hypertension uses various mechanisms including:
- Reduction of systemic vascular resistance (SVR)
- Reduction of circulating blood volume
- Various classifications of drugs; commonly used drugs may include diuretics, adrenergic inhibitors, vasodilators, ACE inhibitors, calcium channel blockers and others
Medication Treatment
- Initial treatment starts with low doses, titrating gradually
- Additional medications may be necessary
- Lifestyle changes initiated to control BP must be maintained
- When BP is regularly below 140/90 mmHg for at least one year, medication types and dosage may be reduced gradually
Medication Therapy Classifications
- Diuretics
- Loop diuretics
- Potassium-sparing diuretics
- Aldosterone receptor blockers
- Beta-blockers
- Central alpha2-agonists
- Alpha1-blockers
Patient Assessment
- History and physical examination
- Laboratory tests: urinalysis, blood chemistry, cholesterol levels
- ECG
- Echocardiogram
Nursing Process Considerations for Hypertension
- Assessment: Obtain detailed history, identify risk factors, and assess for potential target organ damage symptoms (headaches, shortness of breath, etc.), and perform cardiovascular assessments
- Goals: Patient understanding of disease process, treatment regimen, self-care, and absence of complications.
- Nursing Diagnoses: Knowledge deficit related to the treatment regimen and control of disease process; noncompliance with therapeutic regimen related to side effects
- Interventions: Patient education, support of adherence, emphasize control, and long-term support.
- Nursing Alert: Cautions for use of antihypertensive medications, including reporting low BP, postural hypotension, teaching slow position changes, and use of supportive measures.
Hypertensive Crises
-
Hypertensive Emergency: BP above 180/120 mmHg with acute, life-threatening blood pressure elevations. Immediate blood pressure lowering is needed to prevent damage to target organs.
- Conditions associated with hypertensive emergency: Pregnancy-induced hypertension, acute myocardial infarction (MI), intracranial hemorrhage
- Hypertensive Urgency: Elevated BP without acute symptomatic target organ damage.
- Assessment and Monitoring: Continued monitoring of blood pressure closely and assess for potential organ damage is necessary for both emergency and urgency
Therapeutic Goals
- Hypertensive Emergency: Reduce blood pressure 25% in the first hour and 160/100 mmHg in 6 hours. Gradual reduction to normal levels over several days. IV vasodilators (e.g., sodium nitroprusside, nicardipine) and other medications such as ACE inhibitors, may be utilized.
- Hypertensive Urgency: Close monitoring of blood pressure, assess for organ damage. Oral medications such as beta-blockers, ACE inhibitors, or alpha2-agonists are used.
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Description
This quiz explores the critical aspects of hypertension, often known as the 'silent killer.' It covers the symptoms related to target organ disease, complications due to prolonged high blood pressure, and the underlying etiology. Understand how hypertension affects various organs and the serious health risks associated with it.
