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HypertensionMedical Surgical Nursing

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Question Answer
_______ are usually the first type of medication prescribed to a patient with hypertension unless there are compelling indications for additional medicinal treatment.
Show Answer
Thiazide diuretics
________ should be used with caution when administering the initial dose, changing dosing, or adding another antihypertensive agent because patients have developed sudden syncope within 30-90 minutes post dose.
Show Answer
Doxazosin (Cardura)
What is the criteria for persistent hypertension?
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Failure to reach goal BP even while on 3 antihypertensive agents, including a diuretic
What are the age-related physical changes that play a role in the development of hypertension in an older adult? (7)
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-decreased tissue elasticity, -increased collagen content and stiffness of the myocardium -increased peripheral vascular resistance -decreased sensitivity of adrenergic receptors -baroreceptor reflex diminished -decreased renal function -decreased
What is the technique used to ensure an accurate blood pressure in an elderly client?
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Palpate the brachial pulse and inflate the cuff until it is no longer felt, then listen.
Older adults are sensitive to changes in BP. Reducing the blood pressure to _______ could cause inadequate cerebral blood flow in a patient with long standing hypertension.
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SBP below 120
T/F Older adults respond well to ACE inhibitors and ARBs.
Show Answer
False, they have decreased renin and therefore don't respond to them as well
Who is most likely to develop orthostatic hypotension?
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Elderly people with ISH
What is a hypertensive crisis?
Show Answer
A severe, sudden elevation in BP (arbitrarily defined as a DBP over 140). Suddenness is more important than value
What are the major differences between a hypertensive emergency and hypertensive urgency?
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Hypertensive emergency-develops over hours-days and involves target organ damage Hypertensive urgency-develops over days-weeks, no organ damage evidenced
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What are the clinical manifestations of hypertensive emergency and what causes them?
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Caused by hypertension encephalopathy: headache, n/v, seizures, confusion, stupor, coma, blurred vision, transient blindness
What is the major differentiation between a hypertensive emergency and a stroke (they present essentially the same)?
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Strokes present with lateralization or focal symptoms (i.e. loss of vision on one side, not both)
Why is it important to only decrease MAP by no more than 25% in a patient experiencing a Hypertensive Emergency?
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Rapid reduction in pressure may cause a stroke, acute MI, or renal failure from the sudden loss of perfusion
_______ is the most effective treatment for hypertensive emergencies.
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Sodium nitroprusside (Nitropress)
How often should BP be assessed in a patient with a hypertension emergency?
Show Answer
Every 2-3 minutes while medication is being administered
What should be monitored in a patient being treated for a hypertensive emergency?
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Monitor for resolution of the elevated blood pressure, changes in level of consciousness, signs and symptoms of pleural effusion (rhonchi, dyspnea), and seizures. These patients are at extremely high risk for strokes and heart attacks so you need to closely monitor for signs and symptoms of both.
How is a patient experiencing hypertensive urgency typically treated?
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Allowing them to sit for 20-30 minutes and then administering oral meds like Captopril (Capoten), Iabetalol (Normodyne), and Clonidine (Catapres) and If not hospitalized, the patient should be seen within 24 hours.
All thiazide diuretics end in -thiazide except which two?
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Chlorthalidone and Metolazone
How long does it take for thiazide diuretics to lower BP typically?
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2-4 weeks
What are some recommendations that should be made to patients on thiazide diuretics?
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Limit NSAIDS, they reduce the effectiveness Cautious use with digoxin, can lead to cardiotoxicity Each foods high in Potassium, low in salt
Furosemide is an example of a ______ diuretic.
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Loop
  
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