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HypertensionMedical Surgical Nursing

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Question Answer
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
What conditions are an indication for the use of Ambulatory Blood Pressure Monitoring (ABPM)?
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-white coat hypertension, -Drug resistance, -hypotensive symptoms with hypertension medications, -episodic hypertension, -SNS dysfunction
For people active during the day, when would you expect to have the highest BP measurement?
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In the morning (lowest at night/sleeping)
What is a non-dipper with respect to blood pressure?
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A person with hypertension whose blood pressure doesn't dip at night while sleeping, increase the risk even further of cardiovascular complications
What is the BP goal for a people with hypertension?
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Less than 140/90 For diabetics or patients w/chronic kidney disease the goal is 130/80
What are the lifestyle modifications recommended to all pre-hypertensive and hypertension patients? (6)
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-weight reduction, -DASH eating plan, -reduce dietary sodium, -moderate consumption of alcohol, -regular aerobic activity, -no tobacco
At what point are patients typically prescribed medications to help manage hypertension?
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When the BP is 140-159/90-99 (usually a thiazide diuretic)
At what point are patients put on a two drug combination to treat hypertension?
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When their BP is over 160/100 (usually a thiazide diuretic and an ACE inhibitor)
What are considered compelling indications for hypertension medications?
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Heart failure, post MI, high cardiovascular risk, diabetes mellitus, kidney disease, history of stroke
What are the components of the DASH diet?
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Eating several servings of fish, fruits and vegetables, increasing fiber intake and drinking lots of water each week
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What is the recommended daily serving of salt? What is the average consumed?
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Recommended: 2.4-6 g of salt daily Current: 15 g
What are some hidden sources of sodium that a patient should be taught to be vigilant for?
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Toothpastes with baking soda, OTC meds, and packaged foods
Consumption of _______ alcoholic beverages daily is a risk factor for hypertension, heart disease and stroke.
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3 or more
What is the most frequent cause of secondary hypertension in the US?
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Cirrhosis caused by excessive alcohol consumption
What is the major nursing consideration related to use of Omega-3/Fish Oil supplements?
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3 g a day is the recommended dose, more than that may increase the risk of bleeding, and should be used with caution in patients with diabetes or who are pregnant/lactating
________ reduce BP by promoting sodium and water excretion, reducing plasma volume, decreasing sodium in the arteriolar walls, and reducing the vascular response to catecholamines.
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Diuretics
______ reduce BP by acting centrally on the vasomotor center and acting peripherally to inhibit norepinephrine release or by blocking receptors on blood vessels.
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Adrenergic Inhibitors
______ decrease BP by relaxing vascular smooth muscle and reducing SVR.
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Direct vasodilators
_______ reduce BP by increasing sodium excretion and causing arteriolar vasodilation.
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Calcium channel blockers (they block movement of extracellular calcium into cells, preventing the Na for Ca switch and leaving the Na to be excreted)
What is the difference between ACE inhibitors and ARBs and how they treat hypertension?
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ACE-prevents conversion of Angiotensin I to II ARBS-prevents Angiotensin II from binding with the receptors in the walls of blood vessels
_______ are usually the first type of medication prescribed to a patient with hypertension unless there are compelling indications for additional medicinal treatment.
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Thiazide diuretics
  
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