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Questions and Answers
Which of the following is considered a modifiable risk factor for hypertension?
What is a common misconception about hypertension's clinical manifestations?
Which population has the highest prevalence of hypertension worldwide?
Which of these conditions is a potential complication of hypertension?
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Which diagnostic test is NOT typically used to assess hypertension?
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What dietary change is recommended to help manage hypertension?
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Which of the following medications primarily affects stroke volume?
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Which lifestyle change is NOT recommended for hypertension management?
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What should be monitored before administering antihypertensive medications?
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How should older adults be approached when treating hypertension?
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What is classified as a hypertensive emergency?
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Which of the following symptoms is NOT a manifestation of hypertensive encephalopathy?
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What is the primary goal of treatment in high-risk clients regarding LDL cholesterol levels?
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Which medication is most commonly prescribed for managing hyperlipidemia?
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What condition may result from severely elevated blood pressure if not managed properly?
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What is the primary characteristic of left-sided heart failure?
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Which of the following is a common risk factor for ischemic strokes?
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Which symptom is typically associated with a transient ischemic attack (TIA)?
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What dietary restriction is recommended for heart failure patients?
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During a neurological assessment, which sign indicates a potential stroke?
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Which statement describes a thrombotic stroke?
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What does the acronym FAST stand for in relation to stroke recognition?
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Which cardiac condition is known to be one of the causes of an embolic stroke?
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What is the maximum recommended door-to-needle time for stroke treatment in the emergency department?
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Which of the following medications is commonly used in addition to aspirin for ischemic stroke treatment?
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Which intervention is NOT recommended for patients recovering from a stroke during oral intake?
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What precaution should be taken with antiplatelet medications in patients who are scheduled for surgery?
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Which of the following is NOT a primary prevention strategy for ischemic stroke?
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Study Notes
Hypertension: Risk Factors
- Modifiable risk factors are those that can be changed, examples include alcohol/tobacco use, diabetes, obesity, high levels of low-density lipoprotein (LDL) cholesterol, sedentary lifestyle, stress, and salt intake.
- Nonmodifiable risk factors are those that cannot be changed, such as ethnicity, gender, age, and family history.
- Black populations have the highest prevalence of hypertension worldwide, and develop hypertension at a younger age.
- Women have a higher incidence of hypertension than men, especially after menopause.
- Hispanic populations are less likely to receive treatment for hypertension and have lower rates of blood pressure control.
Hypertension: Clinical Manifestations
- Hypertension is often referred to as the "silent killer" because it can be asymptomatic until it causes severe damage to organs.
- Common symptoms of hypertension include fatigue, dizziness, palpitations, angina (chest pain), and dyspnea (shortness of breath).
- Hypertension can affect target organs such as the brain, kidneys, eyes, and heart.
Hypertension: Complications
- Complications of hypertension include coronary artery disease (CAD), left ventricular hypertrophy (LVH), heart failure (HF), atherosclerosis, stroke, peripheral vascular disease (PVD), and chronic kidney disease (CKD).
Hypertension: Diagnostics
- Diagnostics for hypertension aim to rule out other underlying causes.
- Commonly performed diagnostic tests include a comprehensive history and physical examination, urinalysis (to assess renal function), blood sugar levels, complete blood count (CBC) and basic metabolic panel (BMP), lipid profile, and electrocardiogram (ECG).
Hypertension: Interprofessional Care
- The primary nursing goal for hypertension is health promotion across all populations.
- DASH diet (Dietary Approaches to Stop Hypertension) is a recommended dietary approach that emphasizes low-fat foods, whole grains, fish, poultry, beans, and reduced sodium intake (less than 2,300 mg/day).
- Physical activity is recommended for 30 minutes per day, five days a week.
- Lifestyle modifications for hypertension include quitting tobacco and alcohol, managing stress, maintaining a healthy weight, and managing blood sugar and cholesterol levels.
Hypertension: Pharmacology
- Medications for hypertension target either cardiac output or systemic vascular resistance.
- Diuretics reduce blood volume and lower blood pressure by affecting stroke volume. They can cause frequent urination as a side effect.
- ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors) and ARBs (Angiotensin II Receptor Blockers) lower blood pressure by reducing cardiac output. Common examples include drugs ending in "-pril" and "-sartan", respectively.
- Beta Blockers lower blood pressure by reducing heart rate. They may also affect libido and cause erectile dysfunction.
- Calcium Channel Blockers lower blood pressure by affecting systemic vascular resistance. Common examples include drugs ending in "-dipine".
- Combination medications are common for managing hypertension.
- Nursing considerations include monitoring blood pressure and heart rate before administering medications, monitoring for orthostatic hypotension, understanding medication parameters and routes of administration, and promoting medication adherence.
- Older adults are more sensitive to side effects, especially hypotension.
Hypertensive Crisis
- Hypertensive crisis occurs when blood pressure is significantly elevated, with systolic blood pressure greater than 180 mmHg and/or diastolic blood pressure greater than 120 mmHg.
- Hypertensive urgency refers to a hypertensive crisis without target organ damage.
- Hypertensive emergency refers to a hypertensive crisis with evidence of target organ damage.
- Manifestations of hypertensive crisis include encephalopathy, brain hemorrhage, myocardial infarction (MI), heart failure (HF), acute renal failure (ARF), aortic aneurysm.
- Management of hypertensive crisis includes hospitalization, intravenous antihypertensive medications, monitoring blood pressure, and assessing urine output hourly.
Hyperlipidemia
- Hyperlipidemia refers to elevated total cholesterol levels, commonly assessed through a lipid profile.
- Screening recommendations include assessment every five years for those over 20 years old, and every one to two years for people with coronary artery disease, a family history of hyperlipidemia, or diabetes.
- Treatment for hyperlipidemia aims to lower low-density lipoprotein (LDL, "bad" cholesterol) levels below 70 mg/dL in high-risk patients and below 130 mg/dL in low-risk patients.
- Medications for hyperlipidemia include statins such as atorvastatin, niacin, simvastatin (Zocor), and rosuvastatin (Crestor). Statins inhibit cholesterol synthesis in the liver and increase the number of LDL receptors.
- Lifestyle modifications are important for improving lipid profiles.
Heart Failure
- Definition: Heart failure is the inability of the heart to provide sufficient blood to meet the oxygenation needs of the body.
- Left-sided heart failure is the most common type.
- Systolic (LV) failure refers to a weakened left ventricle with reduced ejection fraction (less than 40%).
- Ejection fraction is a measurement of how much blood the left ventricle pumps out with each beat.
- Nursing assessments focus on changes in lung sounds, skin vital signs, dyspnea, orthopnea, sputum amount and characteristics, and mental status.
Stroke
- Ischemic stroke occurs as a result of a blockage in an artery supplying blood to the brain.
- Embolic stroke is caused by a traveling blood clot from the heart or body. Atrial fibrillation is a common cause of embolic strokes.
- Thrombotic stroke occurs when a blood clot forms in an artery in the brain.
- Transient ischemic attack (TIA) is a temporary blockage of blood flow to the brain.
Ischemic Stroke Causes
- Major risk factors for ischemic stroke include high blood pressure, cardiac abnormalities (atrial fibrillation, heart defects), high cholesterol, diabetes mellitus, obesity, alcohol use disorder, genetic predisposition.
CVA Signs and Symptoms
- Stroke symptoms include numbness or weakness in the face, arm, or leg, particularly on one side of the body; confusion or trouble speaking or understanding speech; disturbances in vision; difficulty walking, dizziness, or balance problems; and sudden, severe headache with no known cause.
FAST (Face, Arm, Speech, Time)
- FAST is a mnemonic for remembering the key signs of stroke.
- Time is critical for managing strokes and preventing complications.
Stroke Protocol and Treatment
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Emergency room care: Treatment for stroke aims to restore blood flow to the affected area of the brain. This includes:
- Performing a non-contrast computed tomography (CT) scan of the head immediately.
- Administering intravenous thrombolysis (tPA) if eligible within 60 minutes of arrival.
- Managing blood pressure.
- Avoiding heparin therapy to prevent bleeding.
Ischemic Stroke Medications
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Antiplatelet medications prevent blood clots from forming. Common antiplatelet medications include:
- Aspirin 81 mg (Aggrenox).
- Dipyridamole (Persantine)
- Ticlopidine or Clopidogrel (Plavix)
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Anticoagulants are used for patients with atrial fibrillation. Common anticoagulants include:
- Warfarin (Coumadin)
- Rivaroxaban (Xarelto)
- Dabigatran (Pradaxa)
- Apixaban (Eliquis)
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Statins are used to lower cholesterol levels. Examples include:
- Simvastatin (Zocor)
- Lovastatin (Mevacor)
Interventions for Stroke
- The primary intervention for ischemic stroke is thrombolysis (either intravenous or intra-arterial).
- Other interventions include transluminal angioplasty, balloon and stenting to improve blood flow, carotid endarterectomy to remove atherosclerotic lesions.
Safe Oral Intake
- Nursing care after stroke includes evaluation for food and fluid intake.
- Swallowing and gag reflex should be assessed by a nurse or speech therapist.
- Feeding strategies include sitting upright during meals, feeding on the non-affected side, placing food in line of vision, tucking the chin slightly, no distractions while eating, double swallows, oral hygiene after meals, and a modified diet based on individual needs.
Prevention of Ischemic Stroke
- Primary prevention aims to prevent the first stroke. It focuses on modifiable risk factors such as hypertension, diabetes, high cholesterol, smoking, and obesity.
- Secondary prevention aims to prevent recurrent strokes in individuals who have already experienced a stroke.
- Tertiary prevention focuses on minimizing long-term disabilities associated with stroke.
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Description
Explore the critical risk factors associated with hypertension, including both modifiable and nonmodifiable types. This quiz also delves into the clinical manifestations of hypertension, emphasizing the importance of early detection and understanding symptoms. Test your knowledge on this significant health issue.
