Med/Surg Chapter 52
Primary hypertension typically appears between the ages of __ to __ years.
30 to 50 years
Strong research evidence has illustrated conclusively that ______ are effective in lowering blood pressure and reducing cardiovascular risk factors at little overall cost and with minimal risk.
Lifestyle modifications
Over _____, hypertension can develop
Time
The ultimate factors in evaluating whether the correct choice of treatment regimen has been made are as follows: the desired "______" blood pressure is reached, treatment choices are ____ and ____, and the client it willing to _____ to the regiment over the long term.
"control"; tolerated and safe; commit
People who are overweight, but carry most of the excess weight in the buttocks, hips, and thighs (giving them a "____" shape) are at far less risk for development of hypertension secondary to ____ alone.
"pear"; increased weight
There is ____ of ethanol in ___ of 100-proof whiskey, in ____ ounces of wine, or in ____ of beer.
1 ounce (30mL); 2 ounces (60mL); 10 ounces (300mL); 24 ounces (720 mL)
Advise clients who do drink alcohol to do so in moderation (i.e., no more than ____ of ____ per day for men and ____ for women).
1 ounce of ethanol; 0.5 ounce
The consumption of more than ____ of alcohol per day is associated with a higher prevalence of hypertension, poor adherence to antihypertensive therapy, and occasionally ______ hypertension. Carefully assess alcohol ____.
1 ounce; Refractory; intake
Excess body weight, exhibited by a body mass index of _____, correlates closely with elevated blood pressure.
27 or greater
Excess body fat accumulated in the torso with a waist circumference of ______ or greater for women and ____ or greater for men has been associated with an increased risk for hypertension (__/__ratio).
35 inches; 40 inches; waist/hip
At least ___% of clients who eventually develop hypertension are ____ and the excess ____ may be the precipitating cause of hypertension in these individuals.
40%; salt-sensitive; salt
Blood pressure is monitored frequently (ever __ to __ minutes, depending on the drug and the rout of administration used) and medications are _____ to manage the course of blood pressure reduction.
5-15 minutes; titrated
A report from the American Institute of Stress stimulates that __% to __% of all primary care visits involve stress-related complaints. Because stress is a matter of ____, people's interpretations of events are what create most stressors and stress responses.
60% to 90%; perception
For clients with diabetes or progressive renal disease, the goal is ____mmHg (or ____mmHg for clients with renal disease and proteinuria >1g/24 hour).
<130/80mmHg; 125/75mmHg
_____ and _____ can lead to orthostatic hypertension, and positional blood pressure measurement may be warranted to reduce the risk of falls.
ACE inhibitors and calcium channel blockers
A regular program of _____ adequate to achieve at least a moderate level of _____ facilitates cardiovascular conditioning and can aid the ____ hypertensive client in weight reduction and reduce the risk for cardiovascular disease and all-cause mortality.
Aerobic exercise; physical fitness; obese
_____, simply state, is high blood pressure.
Arterial hypertension
_____ is defined as a persistent elevation of the systolic blood pressure (SBP) at a level of __mmHg or higher and diastolic blood pressure (DBP) at a level of __mmHg or higher.
Arterial hypertension; 140mmHg; 90mmHg
Diabetes accelerates _____ and leads to hypertension from to damage to the _____; therefore hypertension WILL become a ____ diagnosis in diabetics, even if diabetes is well controlled.
Atherosclerosis; large vessels; prevalent
Recent data have shown that the use of _____ before surgery has reduced mortality. Therefore you may be asked to administer these medications before surgery even in clients with no history of hypertension or who do not routinely take _____.
Beta-adrenergic blockers; beta blockers
What is weight in kilograms divided by height in meters squared?
Body mass index (BMI)
Although acute ingestion of _______may raise blood pressure, chronic moderate _____ ingestion may appear to have no significant effect on blood pressure.
Caffeine; caffeine
___, heavy ____ consumption, and some ____ use all are risk factors for hypertension.
Cigarette smoking, heavy alcohol consumption, and some illicit drug
The goal of hypertensive therapy to ______ with a minimum of side effects.
Control blood pressure
In addition to the usual recommendations for sensible eating following the food pyramid is the ______ diet.
Dietary Approaches to Stop Hypertension (DASH)
Before _____ begins, assess the client's patterns of food intake, lifestyle, food preferences, and ethnic, social, cultural, and financial influences.
Dietary intervention
_____ and _____ has emerged as the most essential element in reducing morbidity and mortality rates associated with hypertension.
Long-term compliance and adherence
_____ quickly reduce potassium levels, and _____ can lead to elevations in potassium levels. Further, aldosterone blocking agents, such as ____ and ____, can also lead to hyperkalemia.
Loop sparing diuretics; potassium sparing diuretics; ACE inhibitors and angiotensin receptor blockers
Before administering antihypertensive medications, make not of the ______.
Most recent potassium level
If syncope develops, it usually can be managed by having the client _____ and _____ before standing.
Move slowly to a sitting position and res a moment before standing
A high-salt diet may induce excessive release of _____, which may indirectly increase blood pressure.
Natriuretic hormone
The _____ in cigarette smoke and drugs such as ____ cause an immediate rise in blood pressure that is dose dependent; however ____ use of these substances has been implicated in an increase incidence of hypertension over time.
Nicotine; cocaine; babitual
In the early stages of development of hypertension, ______ clinical manifestations are noted by clients or practitioners.
No
_____, especially in the upper body (giving an "____" shape), with increased amounts of fat about the midriff, waist, and abdomen is associated with subsequent development of hypertension.
Obesity; "apple"
What are some medication treatments for hypertension used for treatment of those with compelling indicaitons?
Other antihypertensive drugs (diuretics), Angiotensin-converting enzyme inhibitor (ACEI), Angiotensin receptor blocker (ARB), beta-blocker (BB), or calcium channel blocker (CCB) as needed
Blood pressure can be reduced with moderate-intensity (as low as 40% to 60% of maximum _____) physical activity, such as a _____ (about 2.5 to 3 mph) for 30 to 45 minutes most days of the week.
Oxygen consumption; brisk walk
The blood pressure remains elevated and continues to rise over time because of a persistent, progressive increase in _____ resistance.
Peripheral arterial resistance
If the condition of hypertension is left undiagnosed, the blood pressure will continue to rise, clinical manifestation will become apparent, and clients will eventually report to a provider's office with complaints of ____, ____, ____, _____, ____, ____ or ____, or ____.
Persistent headaches, fatigue, dizziness, palpitations, flushing, blurred or double vision, or epistaxis
Once a decision has been made to use _____, any one of several drugs from seven major drug classes can be used.
Pharmacologic interventions
Moderate sodium restriction may reduce the degree of ______ depletion that often accompanies ____ therapy.
Potassium; diuretic
Most clients with a combination of systolic and diastolic blood pressure elevation are diagnosed with _____, also known as "essential" or "idiopathic hypertension".
Primary hypertension
The exact pathologic underpinnings of ____ remain to be established. Any factor that produces an alteration in ____, ____, or ____ affects systemic arterial blood pressure.
Primary hypertension; peripheral vascular resistance, heart rate, or stroke volume
The stressor "noxious" stimuli are perceived by a person as a threat or as capable of causing harm; subsequently, a ______ "___ or ____" response is initiated by the body.
Psychophysiologic; "fight or flight"
A variety of ____ therapies, including transcendental mediation, yoga, biofeedback, progressive muscle relaxation, and psychotherapy, can reduce blood pressure in hypertensive clients, at least transiently.
Relaxation therapies
The DASH diet it rich in ___, ____, ____, and low-fat ____ foods with reduced saturated and total fats, should be recommended for clients who need a more structured, fat-limited dietary intervention.
Rich in fruits, vegetables, nuts, and low-fat dairy foods
Clients who develop hypertension form an identifiable cause are diagnosed with _____, and in many cases the underlying cause is _____.
Secondary hypertension; correctable
Although ____ has not been statistically linked to the development of hypertension, ___ definitely increases the heart rate and produces peripheral vasoconstriction which does raise arterial blood pressure for a short time during and after ____.
Smoking; nicotine; smoking
_____ assumption can be an important factor in the development of essential hypertension.
Sodium
____ increases peripheral vascular resistance and cardiac output and stimulates _____ activity.
Stress; sympathetic nervous system
_____ can be many things, and noise, infection, inflammation, pain, decreased oxygen supply, heat, cold, trauma, prolonged exertion, responses to life events, obesity, old age, drugs, disease, surgery, and medical treatment can elicit the ____ response.
Stressors; stress
_____ is defined as generalized muscle weakness and an inability to stand erect accompanied by loss of consciousness.
Syncope (fainting)
The goal of management for clients with hypertension is to lower ____ below 140mmHg (goal of less than or equal to 120mmHg) and ____ below 90mmHg (goal of less than or equal to 80mmHg) while modifying and controlling _____.
Systolic blood pressure; diastolic blood pressure; risk factors
What are some medication treatments for stage 1 hypertension?
Thiazide-type diuretics for most. May consider Angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), beta-blocker (BB), calcium channel blocker (CCB) or combination
What are some medication treatments for stage 2 hypertension?
Two-drug combination for most, usually thiazide-type diuretic and Angiotensin-converting enzyme inhibitor (ACEI), Angiotensin receptor blocker (ARB), Beta-blocker (BB), or calcium channel blocker (CCB)
Poor compliance or adherence is the reason that more than ______ of clients with hypertension do not have adequate control of their blood pressure. For example, clients may choose not to have the initial ______ filled; successfully initiate therapy only to abandon it after a few weeks or months; or comply with only _____ of the regimen
Two-thirds; prescription; part
_____ using _____ is a positive addition to any exercise regimen; however, lifting ____ can be harmful because blood pressure rises, sometimes to high levels, with the ____ response that occurs during an intense ____ muscle contraction
Weight training; light weights; light weights vasovagal response; isometric muscle contraction
Know what your ____ should be and keep it at that level or ____.
Weight; below
Mortality statistics indicate that the death rate for adults with hypertension is lowest for ___ women at 4.7%; ___ men have the next lowest rate at 6.3%; and ___ men have the next lowest at 22.5%; the death rate is highest for ____ women at 29.3%.
White; white; black; black
What is the definition of an "identifiable cause"?
a specific disease state or problem
Unfortunately, poor compliance with or adherence to _____ therapy persist as one of the most frustrating blocks to effective therapeutic management and is often due to clients' belief systems and values.
antihypertensive therapy
Early in the course of development of hypertension, no obvious pathologic changes in the ____ and organs may be seen other than ____ elevations of blood pressure (_____).
blood vessels; intermittent; labile hypertension
Without treatment persistent severe hypertension results in a 90% _____ within 1 year secondary to renal or heart failure, stroke, myocardial infarction, or aortic dissection.
death rate
Modifiable risk factors of hypertension include what 5 things?
diabetes, stress, obesity, nutrients, and substance abuse
Hypertension has shown to be more than twice prevalent in ____ clients according to several recent research studies.
diabetic
Discuss the prescribed ____ with the household members who ____.
diet; prepare food
If possible, enlist the aid of a ____ to provide detailed _____.
dietitian; dietary instructions
Hypertensive crisis clinical manifestations include those of hypertensive _____ evidenced by restlessness, changes in ______, ____, blurred _____, dizziness, headache, ____, and vomiting.
encephalopathy; level of consciousness; seizures, blurred vision, nausea
It is essential to avoid excessive ____ in blood pressure, which can precipitate ____, ____, or _____ ischemia.
falls; renal, cerebral, or coronary
Non-modifiable risk factors of hypertension include what 4 things?
family history, age, gender, and ethnicity
When a client reports dizziness or is at risk of syncope because of medication use or prolonged bed rest, assess _____ and check the _____ for irregularities.
fluid volume status; pulse
In clients with hypertension, there is a risk for imbalanced nutrition: More than body requirements related to ____, ___, and total _____.
high sodium, fat, and total calorie intake
When a diabetic client is diagnosed with hypertension, treatment decisions and follow-up care must be totally ____ and ____.
individualized and aggressive
In secondary hypertension, many renal, vascular, neurologic, endocrine, and drug and food induced problems that directly or indirectly negatively affect the ____ can result in serious insult to these organs that interferes with ____ excretion, ____ perfusion, or the ____ mechanism, leading to an elevation in blood pressure over time.
kidneys; sodium; renal; renin-angiotensin-aldosterone
Many events during a hospitalization can ____ blood pressure, such as ____ with surgery and _____ with analgesics.
lower; blood loss; pain control
The overall incidence of hypertension is higher in ___ than ____ until about the age of ___ years.
men than women until about the age of 55 years
The etiology of primary hypertension is ____, with no identifiable cause, but several interacting ____ forces are generally involved.
multifactorial; homeostatic
The goal of management for clients with hypertension is to ____ blood pressure and reduce risk factors in order to control the ____ of the hypertension.
normalize; progression
Reducing the _____ and _____ of antihypertensive medications should be considered once a client's blood pressure has been controlled effectively for at least 1 year.
number and amounts
If the stress responses become excessive or prolonged, target ____ or ____ will result.
organ dysfunction or disease
Caution the client to avoid _____ because these preparations often contain sympathomimetic agents, which elevate blood pressure.
over-the-counter appetite suppressants
Hypertension is thought to be ____ and _____- that is, if any person with a family history of hypertension, several genes may interact with each other and the environment to cause the blood pressure to elevate over time.
polygenic and multifactorial
What constitutes more than 90% of all cases of hypertension?
primary hypertension
For patients with hypertension there is a risk for ineffective health maintenance related to a lack of ____.
regular exercise regimen.
For clients with secondary hypertension t is important to isolate the _____ so that the most appropriate treatment regimen can be prescribed.
root of the problem
Eventually the blood pressure will rise, and if it is not "found" during _____ screening, clients will remain unaware that their blood pressure is elevated.
routine
The persistent rise in arterial resistance is due to inappropriate renal retention of ____ and ____ or abnormalities of or within the ______.
salt and water; vessel wall
Advise the client with hypertension to eat a diet low in ____, ___, ___, and ____.
salt, calories, cholesterol, and saturated fat
Do not use too much ____ in cooking or at meals and avoid ____ foods.
salt; salty
Fewer than 5% to 8% of adult hypertensive clients have _____; however, hypertension, regardless of type, results from an array of ____ and _____ factors.
secondary hypertension; genetic and environmental factors
For patients at risk for imbalanced nutrition: more than body requirements restrict ___ and reduce ____ and ____.
sodium, fat, and cholesterol
The high ratio of ____ and ____ in the modern diet has been held responsible for the development of hypertension; however, even though ____ supplements may lower blood pressure, they are too costly and potentially too hazardous for routine use.
sodium; potassium; potassium
A moderate restriction of _____ intake to 2 or 3g of ____ can be used to lower blood pressure. The amount of medication otherwise needed may be decreased if ____ intake is lowered.
sodium; sodium; sodium
Before administering antihypertensives, be certain that you are aware of _______.
the most recent blood pressure
Hypertension is characterized by ___, ____, and ___.
type, cause, and severity
The most common cause of persistent sever hypertension is ______. Other causes include _____, dissecting _____, _____, sudden _____ release (as from a _____), drug or toxic substance ingestion or exposure, and food and drug interactions
untreated hypertension
The two most important aspects of dietary intervention for hypertension are _____ (for overweight clients) and ____.
weight reduction and mild to moderate sodium restriction
