NURS 620 Maryville Exam 2
Risk factors for hypertension - ANSWER 1. age & sex- women older than 55 & men older
than 45
2.Obesity
3.Excessive dietary intake of salt
4.cigarette smoking
5.chronic alcohol consumption
6.Family history of high blood pressure and/or cardiovascular disease
7.African American race
8.Stress
9.Sedentary lifestyle
Blood pressure goals for JNC8 - ANSWER Healthy patients over 60 years of age is ok if it
is below 150/90
For healthy patients less than 60 years of age, the blood pressure is okay if less than
140/90.
Patients with a dx of DM or CKD regardless of age, goal BP is less than 140/90
Lifestyle modifications for - ANSWER Weight reduction (BMI 18.5-24.9)
DASH diet
less than 2.4g a day of sodium
Increase Pysical activity to 30min most days of the week
Stop smoking
Alcohol less than 2 drinks a day
,JNC8 preferred agents: - ANSWER -general population:
thiazide
CCB
ACEI
ARB
-black: (without CKD)
CCB or thiazide
-DM:
thiazide
CCB
ACEI
ARB
-CKD:
ACE
ARB
Which medications for HTN should not be used together - ANSWER ACE and ARBS
HTN therapy for patients over 75years old with impaired kidney function - ANSWER CCB
Thiazides
Classification of HTN per AHA - ANSWER Normal BP: less than 120 Systolic, diastolic
less than 80
,Elevated: 120-129 systolic, less than 80 diastolic
Stage 1 HTN: 130-139/80-89
Stage 2 HTN: 140+/90+
Hypertensive crisis: 180+/120+
If goal not met for HTN in a month of treatment then what? - ANSWER Increase the intital
dose of drug or add a second agent, if goal not achieved with 2 agents consider a 3rd
agent.
When HTN treatment is initiated or dose changed when should patient follow up -
ANSWER 2-4 weeks, then once goal has achieved every 3-6 months.
Diagnostic workup for HTN - ANSWER History- any symptoms?
Physical examination
What are their risk factors? - family history, smoking, drinking, sedentary lifestyle.
Labs: BMP, CBC, UA, CMP, TSH, Lipid profile, ECG
need to know kidney function, electrolytes, are they spilling protein in their urine.
Work up for secondary causes of HTN - ANSWER Cushings- need a 24 hour urine
Coarctation of the aorta- CXR
Pheochromocytoma- 24 hour urine
Primary hyperaldosteronism
Renovascular hypertension- Renal arterogram, ultrasound of kidneys
Resistant Hypertension - ANSWER failure to achieve goal BP on patients taking full
doses of an appropriate three-drug regimen that includes a diuretic
, needs referral to cardiologist
Causes of resistant HTN - ANSWER 1) Improper BP measurement
2) Excess Na+ intake
3) Inadequate diuretic Tx
4) Drug issues such as inadequate doses, drug actions and interaction (e.g. NSAIDs,
illicit drugs, sympathomimetics, OCPs), or OTC drugs and herbals
5) Excess EtOH intake
6) Underlying ID causes of HTN (2ndary)
7) White coat hypertension
Complications of HTN - ANSWER Left ventricular hypertrophy
Heart failure
Ischemic Stroke
Intracerebral hemmorage
Ischemic heart disease
CKD, ESRD
Signs of target organ damage in Hypertension - ANSWER Headaches
vision changes
papillary edema
change in mental status
s/s heart failure
hematuria, proteinuria, elevated creatinine
Dyslipidemia-->
Desirable/optimal serum lipid levels ****** - ANSWER Total cholesterol: less than
200mg/dl
Risk factors for hypertension - ANSWER 1. age & sex- women older than 55 & men older
than 45
2.Obesity
3.Excessive dietary intake of salt
4.cigarette smoking
5.chronic alcohol consumption
6.Family history of high blood pressure and/or cardiovascular disease
7.African American race
8.Stress
9.Sedentary lifestyle
Blood pressure goals for JNC8 - ANSWER Healthy patients over 60 years of age is ok if it
is below 150/90
For healthy patients less than 60 years of age, the blood pressure is okay if less than
140/90.
Patients with a dx of DM or CKD regardless of age, goal BP is less than 140/90
Lifestyle modifications for - ANSWER Weight reduction (BMI 18.5-24.9)
DASH diet
less than 2.4g a day of sodium
Increase Pysical activity to 30min most days of the week
Stop smoking
Alcohol less than 2 drinks a day
,JNC8 preferred agents: - ANSWER -general population:
thiazide
CCB
ACEI
ARB
-black: (without CKD)
CCB or thiazide
-DM:
thiazide
CCB
ACEI
ARB
-CKD:
ACE
ARB
Which medications for HTN should not be used together - ANSWER ACE and ARBS
HTN therapy for patients over 75years old with impaired kidney function - ANSWER CCB
Thiazides
Classification of HTN per AHA - ANSWER Normal BP: less than 120 Systolic, diastolic
less than 80
,Elevated: 120-129 systolic, less than 80 diastolic
Stage 1 HTN: 130-139/80-89
Stage 2 HTN: 140+/90+
Hypertensive crisis: 180+/120+
If goal not met for HTN in a month of treatment then what? - ANSWER Increase the intital
dose of drug or add a second agent, if goal not achieved with 2 agents consider a 3rd
agent.
When HTN treatment is initiated or dose changed when should patient follow up -
ANSWER 2-4 weeks, then once goal has achieved every 3-6 months.
Diagnostic workup for HTN - ANSWER History- any symptoms?
Physical examination
What are their risk factors? - family history, smoking, drinking, sedentary lifestyle.
Labs: BMP, CBC, UA, CMP, TSH, Lipid profile, ECG
need to know kidney function, electrolytes, are they spilling protein in their urine.
Work up for secondary causes of HTN - ANSWER Cushings- need a 24 hour urine
Coarctation of the aorta- CXR
Pheochromocytoma- 24 hour urine
Primary hyperaldosteronism
Renovascular hypertension- Renal arterogram, ultrasound of kidneys
Resistant Hypertension - ANSWER failure to achieve goal BP on patients taking full
doses of an appropriate three-drug regimen that includes a diuretic
, needs referral to cardiologist
Causes of resistant HTN - ANSWER 1) Improper BP measurement
2) Excess Na+ intake
3) Inadequate diuretic Tx
4) Drug issues such as inadequate doses, drug actions and interaction (e.g. NSAIDs,
illicit drugs, sympathomimetics, OCPs), or OTC drugs and herbals
5) Excess EtOH intake
6) Underlying ID causes of HTN (2ndary)
7) White coat hypertension
Complications of HTN - ANSWER Left ventricular hypertrophy
Heart failure
Ischemic Stroke
Intracerebral hemmorage
Ischemic heart disease
CKD, ESRD
Signs of target organ damage in Hypertension - ANSWER Headaches
vision changes
papillary edema
change in mental status
s/s heart failure
hematuria, proteinuria, elevated creatinine
Dyslipidemia-->
Desirable/optimal serum lipid levels ****** - ANSWER Total cholesterol: less than
200mg/dl
