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HypertensionMedical Surgical Nursing

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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
What factors are linked with a salt sensitivity (and therefore tendency to develop primary hypertension)? (3)
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African American, diabetes, chronic kidney disease
There are lots of risk factors for the development of primary hypertension. Name as many as you can (there's 13).
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Age (over 50), alcohol, smoking, diabetes mellitus, elevated serum lipids, excess dietary sodium, gender, family history, obesity, ethnicity (African American), sedentary lifestyle, socioeconomic status, stress.
You have two people in a room. A 40 year old woman and a 25 year old man. Which is more at risk for hypertension?
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The man, men up to age 55 are at higher risk for hypertension. When women are 55 and up, they become the higher risk.
What is target organ disease?
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The impact that primary hypertension has on certain targeted organs in the body: heart, brain, peripheral vascular, kidneys and eyes (essentially any system with small, delicate vessels).
What impact can hypertension have on the cardiac system?
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Development of CAD, MI, cardiac revascularization, left ventricular hypertrophy (from increased work of pushing against higher pressures)
What impact can hypertension have on the cerebrovascular system? What gender is most at risk?
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TIAs or stroke, women are most at risk
What impact can hypertension have on the peripheral vascular system?
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Aneurysms, aortic or carotid bruits/thrills, decreased/diminished pulses (except dorsalis pedis), and intermittent claudication (usually calf pain relieved with rest)
What impact can hypertension have on the renal system?
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Nephrosclerosis (hardening of the nephrons) leading to creatinine over 1.5 mg, proteinuria, and microalbuminemia
Where do the atherosclerotic plaques form that are thought to be responsible for TIAs/strokes?
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At the bifurcation of the common carotid artery into the internal and external carotids (hence, why we listen for a bruit there)
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What is hypertensive encephalopathy and what causes it?
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It develops when arterial pressure exceeds the body's ability to autoregulate. It causes the cerebral vessels to suddenly dilate leading to cerebral edema. Patient can die quickly from the increased cranial pressure and resultant brain damage.
What is the classic symptom of PAD?
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Intermittent claudication...muscle pain caused by activity and relieved with rest (usually the calf muscle)
T/F Some degree of renal dysfunction is usually present, even in patients with mild hypertension.
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TRUE
What is usually the first symptom of renal disease?
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Nocturia
What is usually the first symptom of renal disease?
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Nocturia
What are the common laboratory indicators of renal dysfunction?
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Microalbuminuria, proteinuria, hematuria, elevated BUN and creatinine.
______ is the lab test that reflects the glomerular filtration rate.
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Creatinine clearance
What lab test can be used to detect hyperaldosteronism, a secondary cause of hypertension?
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Serum electrolytes, especially potassium
What is white coat hypertension?
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The phenomenon of elevated BP levels while in a clinical setting, must normal values otherwise
What is ABPM?
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Ambulatory Blood Pressure Monitoring. A fully automated cuff is set at specific intervals to monitor BP within a 24 hour period.
What does a patient being monitored with an Ambulatory Blood Pressure Monitor (ABPM) need to do?
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Place their arm by their side during measurement periods and keep an activity diary to correspond with the measurements
  
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