NUR 3010 - Week 8 Content (Hypertension)

ACE inhibitors 1.) What are their action? 2.) Possible side effects 3.) Important considerations

1.) Block conversion of angiotensin I to angiotensin II (powerful vasoconstrictor), help reduce blood pressure by vasodilation. Lower total peripheral resistance. (which helps decrease BP) 2.) Angioedema and dry hacking cough 3.) Monitor for hyperkalemia and should not be taken with a potassium-sparing diuretic or to patients that are pregnant or have renal artery stenosis.

Angiotensin Receptor Blockers (ARBS) 1.) What are their action? 2.) Possible side effects 3.) Important considerations

1.) Block vasoconstriction and aldosterone-producing effects of angiotensin II at various receptor sites. Reduce peripheral resistance. (which helps decrease BP). 2.) Minimal side effects, but can cause angioedema if the patient had the same reaction to ACE 3.) Monitor for hyperkalemia and should not be taken with a potassium-sparing diuretic or to patients who are pregnant or have renal artery stenosis.

Direct Vasodilators Ex, Hydralazine (Apresoline), Minoxidil (Loniten or Rogaine) 1.) What is their action? 2.) Side effects 3.) Important considerations

1.) Direct vasodilatory action on smooth muscle of blood vessels. 2.) Sodium and fluid retention and reflex tachycardia are common effect 3.) Can be given for pregnancy-induced hypertension and helps hair loss. Do not give to patients with angina, coronary disease, or heart failure.

Thiazide or Thiazide-Type Diuretics Ex, Hydrochlorothiazide (HCTZ, HydroDiuril), metolazone, chlorthalidone 1.) What is their action? 2.) Side effects 3.) Important considerations

1.) Increase excretion of sodium chloride, water, and potassium. Decrease of blood volume. 2.) GI disturbances, Orthostatic hypotension 3.) Relatively inexpensive. Mild hypokalemia may occur, so have potassium present in the diet. Take in the morning, and take with meals to avoid GI upset.

Loop Diuretics Ex Bumetanide, Furosemide (Lasix) 1.) What is their action? 2.) Side effects 3.) Important considerations

1.) Inhibit sodium and water reabsorption in the Loop of Henle. Volume depletion 2.) Hypokalemia, electrolyte imbalance, orthostatic hypotension. 3.) Preferred diuretics for patients with symptomatic HF. Never push this medication fast as it can cause auto-toxicity. Take in the morning to avoid peeing at night.

Calcium Channel Blockers—Dihydropyridines Ex, Amlodipine (Norvasc), felodipine, isradipine 1.) Does this effect the heart rate? 2.) What are their action? 3.) Side effects 4.) Important considerations

1.) No 2.) Inhibit calcium ion influx across membranes, which allow for vasodilatory effects on coronary arteries 3.) Can cause pedal edema. Also constipation, dizziness, facial flushing. 4.) No tendency to slow SA nodal activity. Do not give medication to patients with HFrEF

Aldosterone Antagonists (Diuretics) Ex, Spironolactone (Aldactone), eplerenone 1.) What is their action? 2.) Side effects 3.) Important considerations

1.) Nonselective blocker, blocks aldosterone and indirectly affects the sodium uptake and potassium secretion. Competitive inhibitors of aldosterone binding. 2.) Diarrhea and other GI symptoms. Hyperkalemia, drowsiness, and lethargy. 3.) Indicated for patients with primary aldosteronism. Monitor for hyperkalemia. Take after meals to avoid GI upset, take in the morning.

Beta-Blockers—Noncardioselective Ex, Propranolol (Inderal), Sotalol (Betaspace), Nadolol, Timolol 1.) What is their action? 2.) Side effects 3.) Important considerations

1.) Slowing the heart rate and lowering the blood pressure by non-selectively blocking beta-adrenergic receptors. 2.) Insomnia, lassitude, weakness, fatigue, and N/V. Mask hypoglycemia (weak, dizziness, confusion, clams, sweaty, tired, etc.) Bronchospasms. 3.) Avoid sudden discontinuation. (Rebound tach). Do not give to patients with asthma, COPD, or reactive airway disease since it can cause bronchospasms.

Beta-Blockers—Cardioselective Ex, Metoprolol (Lopressor & Toprol), Atenolol (Tenormin), Bisoprolol, Betaxolol 1.) What is their action? 2.) Side effects 3.) Important considerations

1.) Slowing the heart rate and lowering the blood pressure by selectively blocking beta-1 adrenergic receptors 2.) Insomnia, lassitude, weakness, fatigue, erectile dysfunction and N/V. Mask hypoglycemia (weak, dizziness, confusion, clams, sweaty, tired, etc.) 3.) Can be given to patients with HF or CAD. Avoid sudden discontinuation. (Rebound tach)

Calcium Channel Blockers—Nondihydropyridines Ex, Nifedipine (Procardia), Diltiazem (Carizem), and Verapamil (Calan, Isoptin) 1.) Does this effect the heart rate? 2.) What are their action? 3.) Side effects 4.) Important considerations

1.) Yes 2.) Inhibit calcium ion influx. Reduce cardiac afterload. Slow velocity of conduction. 3.) Dizziness, hypotension, edema, bradycardia 4.) Can cause rebound tachycardia if you suddenly stop. Do not give medication to patients with HFrEF.

Fill in the blank: Clonidine (Catapres) is a Central Alpha2-Agonists. The exact mode of action is not understood, but acts through the central nervous system. Strong drugs, not considered ______1.______ hypertension medication. It is important to monitor for rebound ______2.______ for patients on this medication.

1.) first line 2.) hypertension

What type of beta blocker is Carvedilol (Coreg)? A. Combined Alpha- and Beta-Receptor Blockers B. Noncardioselective C. Cardioselective

A. Combined Alpha- and Beta-Receptor Blockers Note: Works stronger and more effective because more vasodilation

How would you classify a blood pressure of 110/79? A. Normal B. Elevated C. Hypertension Stage 1 D. Hypertension Stage 2 E. Hypertensive Crisis

A. Normal

Match the blood pressure category with their corresponding range? A. Normal B. Elevated C. Hypertension Stage 1 D. Hypertension Stage 2 E. Hypertensive Crisis 1. Systolic: 120-129 Diastolic: Less than 80 2. Systolic: 140 or higher Diastolic: 90 or higher 3. Systolic: Less than 120 Diastolic: Less than 80 4. Systolic: Higher than 180 Diastolic: Higher than 120 5. Systolic: 130-139 Diastolic: 80-89

A. Normal w/ 3. Systolic: Less than 120 Diastolic: Less than 80 B. Elevated w/ 1. Systolic: 120-129 Diastolic: Less than 80 C. Hypertension Stage 1 w/ 5. Systolic: 130-139 Diastolic: 80-89 D. Hypertension Stage 2 w/ 2. Systolic: 140 or higher Diastolic: 90 or higher E. Hypertensive Crisis w/ 4. Systolic: Higher than 180 Diastolic: Higher than 120

Determine whether the risk factor is for primary hypertension (P) or secondary hypertension (S) A. Sympathomimetics drug usage B. Dyslipidemia C. Obesity D. SSRI and MAOI usage E. Older age F. Smoking G. Diabetes mellitus H. Physical inactivity I. Sleep apnea J. Oral contraceptives K. Older age L. Family history

A. Sympathomimetics drug usage (S) B. Dyslipidemia (P) C. Obesity (P) D. SSRI and MAOI usage (S) E. Older age (P) F. Smoking (P) G. Diabetes mellitus (P) H. Physical inactivity (P) I. Sleep apnea (S) J. Oral contraceptives (S) K. Older age (P) L. Family history (P)

A patient has come into the ER since they are experiencing a hypertensive emergency. Which of the following nurse managements would be implemented for this patient? Select all that apply A. The nurse will make sure to frequent monitor the patient's BP and cardiovascular status B. The nurse will focus on reducing the patient BP very slowly, hopefully reduce blood pressure 20% to 25% in the first hour. C. The nurse will make sure the patient stays on bed rest for 2-6 hours D. The nurse will reduce

A. The nurse will make sure to frequent monitor the patient's BP and cardiovascular status B. The nurse will focus on reducing the patient BP very slowly, hopefully reduce blood pressure 20% to 25% in the first hour. D. The nurse will reduce to 160/100 mm Hg over 6 hours with gradual normalization occurring in 24-48 hours E. The nurse will impliment IV vasodilations to help reduce blood pressure. Those include sodium nitroprusside, nicardipine, and fenoldopam.

Which of the following medications are considered first-line for African Americans and patients >60 yr? Select all that apply A. Thiazide diuretic B. ACE-I C. Beta blocker D. ARB E. Calcium channel blocker F. Loop diuretic

A. Thiazide diuretic E. Calcium channel blocker

Which of the following patient's with comorbid disease would not be given any ACE-I or ARB? A. A patient with a history of CKD B. A patient who is experiencing hypertension while pregnant C. A patient who has a history of heart failure with reduced ejection fraction (HFrEF) D. A patient with a history of type two diabetes E. A patient with a history of atrial fibrillation

B. A patient who is experiencing hypertension while pregnant

A nurse see the following medication in a patient chart, lisinopril, benazepril, captopril, and enalapril. Which of the following drug class would these medications be under? A. Potassium sparing diuretic B. ACE Inhibitors C. Calcium channel blocker D. ARBs

B. ACE Inhibitors

Which of the following medications are considered first-line for Non-African American and patients <60 yr? Select all that apply A. Thiazide diuretic B. ACE-I C. Beta blocker D. ARB E. Calcium channel blocker F. Loop diuretic

B. ACE-I D. ARB

A patient with heart failure with preserved ejection fraction (HFpEF) is experiencing hypertension. What first-line antihypertensive would they most likely be given? A. ACE-I B. Diuretic C. ARBs D. Beta blocker

B. Diuretic

How would you classify a blood pressure of 126/78? A. Normal B. Elevated C. Hypertension Stage 1 D. Hypertension Stage 2 E. Hypertensive Crisis

B. Elevated

A patient is being assessed for hypertension after exhibiting two BP readings above 120/80. Which of the following would be included during the focused assessment? Select all that apply A. Signs/symptoms of CHF B. History and risk factors C. Symptoms of organ failure D. Neuropathy assessment E. Personal, social, and financial factors F. Signs/symptoms of kidney stones G. Cardiovascular assessment that includes apical pulse and peripheral pulses

B. History and risk factors C. Symptoms of organ failure E. Personal, social, and financial factors G. Cardiovascular assessment that includes apical pulse and peripheral pulses

A patient is asking the nurse how they can improve their blood pressure via diet. Which of the following nursing responses the most correct? A. "I am not sure, let me talk to my supervisor before I give you an answer" B. "It is highly recommended that the patient implement a Keto diet as it can help reduce blood pressure" C. "It is highly recommended that the patients implement a DASH diet as it can help reduce blood pressure. I would also generally decrease sodium intake and alcohol consumption

C. "It is highly recommended that the patients implement a DASH diet as it can help reduce blood pressure. I would also generally decrease sodium intake and alcohol consumption as well." Note: Other lifestyle changes includes weight reduction and regular physical activity

A nursing student is asked how primary hypertension is different from secondary hypertension. Which of the following responses would indicate that the student nurse requires more education? A. "Primary hypertension occurs in the majority of hypertension cases, about 95% of patients have primary." B. "Secondary hypertension occurs significantly less then primary. Specifically, 5% of patients have secondary." C. "Primary hypertension occurs as a result of heart failure, hyperlipidemia, and heart attacks." D. "Secondary hypertension occurs as a result of renal disease, sleep apnea, and pregnancy"

C. "Primary hypertension occurs as a result of heart failure, hyperlipidemia, and heart attacks." Primary is multifactorial and has no exact cause

Which of the following is not a potential antecedents to primary HTN? A. Increased renal resorption of Na and H2O in the absence of renin B. Increased RAAS activity leading to Na and H2O rentention. This results in increases systemic resistance, vasoconstriction, and more volume C. Inappropriate activation of parasympathetic pathway D. Increased SNS activity leading to more epi/norepi. This results in increased vasoconstriction and BP E. Inappropriate activation of inflammatory pathways

C. Inappropriate activation of parasympathetic pathway

A patient is being assessed for hypertension after exhibiting two BP readings above 120/80. Which of the following physical examination/diagnostic tests would be included during the assessment? Select all that apply A. BNP level B. Troponin level C. Urinalysis D. Echo E. ECG F. Lipid level G. Blood pressure and retinal exam H. Electrolyte levels I. GFR J. BUN/Creatinine

C. Urinalysis E. ECG F. Lipid level G. Blood pressure and retinal exam H. Electrolyte levels I. GFR J. BUN/Creatinine

Which of the following responses would indicate the student requires more education in regard to blood pressure check education? A. "Sit comfortably with back supported, forearm at heart level, and both feet on ground" B. "Patients should avoid caffience, nicotine, and activity 30 min prior to blood pressure check" C. "Sit for 5 min before blood pressure check" D. "The patient should empty their bladder after their blood pressure check"

D. "The patient should empty their bladder after their blood pressure check"

A nurse see the following medication in a patient chart, losartan, azilsartan, eprosartan, and candesartan. Which of the following drug class would these medications be under? A. Potassium sparing diuretic B. ACE Inhibitors C. Calcium channel blocker D. ARBs

D. ARBs

A patient comes into the ER with tearing pain present in their back. When gathering vitals, the nurse notices that the patient BP is elevated in upper extremities, but no no pulses in lower extremities. Given this information, what condition does this patient most likely have? A. Hypertension B. Heart failure C. Cariogenic shock D. Aortic Dissection

D. Aortic Dissection

What is this condition? Blood tears through the endothelium and into the arterial media to create a 'second lumen'. As volume enters the media, no resistance and it fills very easily, resulting it to bulge out and possibly rupture. A. Hypertension B. Heart failure C. Cariogenic shock D. Aortic Dissection

D. Aortic Dissection

A patient with stable coronary artery disease is experiencing hypertension and tachycardia. What first-line antihypertensive would they most likely be given? A. ACE-I B. Direct renin inhibitor C. ARBs D. Beta blocker

D. Beta blocker Note: ACE and ARBs can also be given, but since tach is present, beta blockers would be chosen first

A patient who is pregnant has been diagnosed with hypertension. What hypertensive medication would they most likely be given? A. ACE-I B. Direct renin inhibitor C. ARBs D. Beta blocker

D. Beta blocker (or Ca Channel Blocker) Note: Stop ACE inhibitors, ARBs, and/or direct renin inhibitors due to teratogenic effects.

How would you classify a blood pressure of 150/100? A. Normal B. Elevated C. Hypertension Stage 1 D. Hypertension Stage 2 E. Hypertensive Crisis

D. Hypertension Stage 2

How would you classify a blood pressure of 160/110? A. Normal B. Elevated C. Hypertension Stage 1 D. Hypertension Stage 2 E. Hypertensive Crisis

D. Hypertension Stage 2

How would you classify a blood pressure of 190/130? A. Normal B. Elevated C. Hypertension Stage 1 D. Hypertension Stage 2 E. Hypertensive Crisis

E. Hypertensive Crisis

What is the difference between hypertensive emergency vs hypertensive urgency?

Hypertensive emergency (Go to ER!!!) Blood pressure >180/120 mm Hg and signs of damage to target organs (chest pain, vision changes, pee blood, etc.) Hypertensive urgency Blood pressure is very elevated but no evidence of immediate or progressive target organ damage

A patient is suspected to be experiencing hypertensive emergency. Which of the following signs and symptoms could further indicate this issue? Select all that apply. A. Orthopnea B. Chest pain C. Seizures D. Decreased urinary output E. Vision changes/Blurred vision F. Numbness in fingertips G. Mental Status changes H. Tension headache I. Hematuria J. Vascular damage

KNOW THIS INFO B. Chest pain C. Seizures E. Vision changes/Blurred vision G. Mental Status changes I. Hematuria (blood in urine) J. Vascular damage

A patient comes into the clinic for an annual physical. When the patient had their vital done, the nurse found that the patient had a blood pressure of 130/88. If the patient were diagnosed with hypertension, how many blood pressure checks would they need? Is there a specific amount of time required between each blood pressure check?

Numbers are based on Average of 2 or more BPs taken 1 to 4 weeks apart by a health care provider

A patient has called their physical as they noticed their blood pressure is significantly elevated. When assessed for any symptoms of organ damage, none were present. Given this information, what treatment and goals would the physician most likely have the patient implement?

Oral agents can be administered with the goal of normalizing blood pressure within 24 to 48 hours Fast-acting oral agents: Beta-adrenergic blocker—labetalol Angiotensin-converting enzyme inhibitor—captopril Alpha2-agonist—clonidine Patient requires close monitoring of blood pressure and cardiovascular status. Assess for potential evidence of target organ damage.

True or False: Primary hypertension is usually occurs in earlier onset of patients (22-55 yrs). Secondary hypertension occurs later in life and typically has higher 'numbers' (Ex,180/100).

True

True or False: Usually no symptoms other than elevated blood pressure occur in those with hypertension. Symptoms related to organ damage are seen late and are serious. - Retinal and other eye changes (blindness), Renal damage, Myocardial infarction, Cardiac hypertrophy, and Stroke

True