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HypertensionMedical Surgical Nursing

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Question Answer
Which SNS receptors, when stimulated, cause vasoconstriction?
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Alpha 1, Alpha 2, and Beta 1
_______ sense the rise and fall of blood pressure and suppresses or initiates SNS activity in response.
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Baroreceptors
_______ is a potent vasoconstrictor produced by the vascular endothelium.
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Endothelin (three subclasses, ET-1-ET-3)
_____ is the subclass of endothelin that is the most potent vasoconstrictor and also causes adhesion and aggregation of neutrophils and stimulates smooth muscle growth.
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ET-1
______ is produced by the vascular endothelium and helps maintain low arterial tone at rest, inhibits growth of the smooth muscle layer and inhibits platelet aggregation.
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Nitric oxide (an endothelium-derived relaxing factor/EDRF)
What events trigger the secretion of renin from the kidneys? (3)
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SNS stimulation, decreased bloodflow to the kidneys or low serum sodium
How does Angiotensin II work locally on the heart?
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It vasoconstricts the heart and causes tissue growth that results in remodeling of the vessel walls (this is bad)
How do the kidneys decrease blood pressure?
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The renal medulla secretes prostaglandins (PGE1 & PGE2) causing vasodilation
How does the heart decrease blood pressure?
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The cardiac cells secrete ANP and BNP which antagonizes ADH and Aldosterone causing the kidneys to eliminate sodium and water
What areas of the body vasoconstrict in response to the release of epinephrine? Why?
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The kidneys and skin, they only have alpha 1 adrenergic receptors
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Which subtype of hypertension? Average SBP of 140 or more/ DBP less than 90 Common in older adults, caused by loss of elasticity in the large arteries from atherosclerosis
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Isolated hypertension
Which is a more significant risk factor for heart disease, an elevated systolic BP or an elevated Diastolic BP?
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Systolic (especially in people over 50)
Which subtype of hypertension? Occurs with advanced arteriosclerosis, arteries feel rigid and few retinal/cardiac signs are found relative to the pressure measured
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Pseudohypertension
What is the only accurate way to measure blood pressure in a patient with pseudohypertension?
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With an intra-arterial catheter
Which type of hypertension, primary or secondary, cannot be attributed to any specific cause?
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Primary (Idiopathic)
When should a secondary cause of hypertension be suspected?
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When it occurs in a person under 20, or develops suddenly in a person over 50
What are the signs and symptoms of secondary hypertension? (6)
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Unprovoked hypokalemia, abdominal bruit over the renal arteries, variable BPs with a history of tachycardia, sweating, tremor, or a family history of renal disease
There are lots of conditions that can cause secondary hypertension. List the 7 most common.
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-coarctation or congenital narrowing of the aorta, -renal diseases like parenchymal disease or renal artery stenosis, -endocrine disorders like pheochromocytoma/Cushing's/Hyperaldosteronism, -Neurological disorders like tetraplegia, tumors, head injury
What are types of medications that have linked to the development of secondary hypertension?
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Sympathetic stimulants (medications and things like cocaine), MAOI's taking with tyramine containing foods (some beers, Chianti, vermouth, aged cheese, soy, etc.), Estrogen Replacement therapy/contraceptives, and NSAIDS.
Hypertension is caused by either increased cardiac output or increased stroke volume. Which one typically is present in pre-hypertensive/borderline hypertensive persons?
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Increased Cardiac output occurs first, as the body adjusts, increased Stroke Volume develops. At this point, CO returns to normal.
What are the major contributors to the development of primary hypertension? (6)
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Heredity, excessive sodium intake leading to sodium and water retention, altered Renin-Angiotensin mechanism, stress and increased SNS activity, insulin resistance/hyperinsulinemia, endothelial cell dysfunction
  
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