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Adult Health 1 - exam 3 Questions And Answers Advanced Exam 2024
types of hypertension - Correct Answer->Primary (idiopathic) - unknown cause
Secondary (specific causes) - something else is causing the hypertension, cirrhosis, pregnancy, caffeine use, renal disease, stress, medications - meth, heroine, endocrine disorder, traumatic brain injury, OSA
BP classifications - Correct Answer->Normal systolic/diastolic: <120 & <
Elevated systolic/diastolic: 120-129 & <
Stage 1: systolic 130-139 or diastolic 80-
Stage 2: systolic great than or equal to 140, diastolic greater than or equal to 90
We dont stage just treat it
Not based on one blood pressure; look at trends over time and s/s, patient should report abnormal blood pressure to provider
risk factors for high BP - Correct Answer->older, male higher risk earlier in life, African American, Obesity, Sedentary lifestyle, Tobacco use, Stress, excess dietary sodium
How to take an accurate BP reading - Correct Answer->No caffeine, nicotine, or exercise 30 minutes before BP
Rest quietly for 5 minutes; relax; no talking
Proper placement & size of cuff important for accuracy
Position arm at heart level
Use auscultatory (oscillatory) method
Take in both arms; note differences
Use arm with highest BP for future
If can't use upper arm; use forearm and radial artery or doppler; document location/site
orthostatic hypotension - Correct Answer->Drop in BP and rise in HR with position changes
BP and HR after supine for 5 minutes
Assist to standing position
Measure BP and HR at 1 minute and 3 minutes of position change
Abnormal:
SBP decreased by 20 mm Hg or more
DBP decreased by 10 mm Hg or more
HR increased 20 beats/min or more
Report of lightheaded or dizzy
clinical manifestations of hypertension - Correct Answer->Fatigue
Dizziness
Palpitations (not usually)
Angina
Dyspnea
Headaches
HTN is often called - Correct Answer->silent killer bc normally no symptoms
Most diagnosed as incidental findings
target organ damage - Correct Answer->Heart: MI, HF, CAD, left ventricular hypertrophy - cant push as much blood out to body
Brain: cerebral vascular disease, TIA/stroke - one of first presenting symptoms, hypertensive encephalopathy - alteration in brain
Kidneys: damges kideny blood vessels - nephrosclerosis (hardening/shriveling), kidney disease
Eyes: blurry and loss of vision because blood vessels supplying retina get damaged
- Lowers HR and BP
- Check BP and apical pulse before giving
ACE inhibitors - always ends in 'pril' - Correct Answer->prevent conversion of angiotensin I to angiotensin II; reduce vasoconstriction and sodium and water retention: lisinopril
- Relax blood vessels
- Excrete more water and sodium
Angiotensin-II receptor blockers (ARB) - Correct Answer->prevent angiotensin II from binding to receptors in blood vessel walls: losartan
- Excrete more water and sodium
- Reduce vasoconstriction
Calcium channel blockers (CCB) - Correct Answer->increase Na+ excretion and cause arteriolar vasodilation by preventing the movement of extracellular Ca+ into cells: Norvasc
Arteriovasodilation
diuretics - Correct Answer->reduce plasma volume by increased sodium and water excretion and reduce vascular response to catecholamines: hydrochlorothiazide* - most common, furosemide
- Reduce circulating blood volume
education for diuretic use - Correct Answer->Importance of drug
Will pee more
Take in morning
s/s of low BP
Caution with position changes, slow and careful
Common side effect is dry mouth - sugar free candy, gum, good dental care
common s/e of hypertension drugs - Correct Answer->dry mouth, frequent voiding, sexual dysfunction, orthostatic hypotension
patient adherence - Correct Answer->major problem
Reasons for poor adherence - complex
- Inadequate teaching
- Unpleasant side effects
- Return to normal BP so they think they do not need it
- Social determinants of health
-- Low health literacy - do not understand
-- High cost of medication
-- Lack of insurance
measures to enhance compliance - Correct Answer->Individualize the plan of care
Active patient participation
Involve family or support people
Continued patient teaching
Lifestyle modifications for HTN - Correct Answer->Eat better, smoking cessation, increase activity, weight loss
overall goals of BP control - Correct Answer->preserve organ function and protect the heart
evaluation of treatment for HTN - Correct Answer->Take BP because want to achieve and maintain goal BP
Understand and agrees with treatment plan
- Decreased renal function, narrowing and stiffer blood vessels and heart gets smaller and stiffer, baroreceptors do not function well
Assess for: orthostatic hypotension, acute kidney injury, and postprandial hypotension (after large meal BP decreases because blood goes to stomach to help digest)
coronary artery disease - Correct Answer->atherosclerosis of the coronary arteries that reduces the blood supply to the heart muscle
atherosclerosis - Correct Answer->hardening of arteries with a collection of cholesterol-like plaque
Lipid deposits, endothelial injury, inflammation play a key role in the development
common causes for endothelial injury - Correct Answer->Smoking
Hypertension
Hyperlipidemia (high fat - cholesterol - LDL)
Diabetes
Non-modifiable risk factors for CAD - Correct Answer->Increasing age
Gender - more in younger men
Ethnicity - more common in caucasian
Genetics
Modifiable risk factors for CAD - Correct Answer->High serum lipid
HTN over 120/
Diabetes control
Tobacco use
Physical activity
Obesity - fat around the waist is more dangerous to cardiac well-being
peripheral arterial disease (PAD) - Correct Answer->Definition: thickening of artery walls and middle space gets smaller
Leading cause: atherosclerosis - usually advanced systemic
Can involve more than one artery and multiple locations within the artery
Femoral and popliteal are two most likely locations
Pts with diabetes tend to develop it below the knee
risk factors of PAD - Correct Answer->Smoking
Alcohol use
Lifestyle - activity
Diabetes
Hypertension
High cholesterol
Age over 60
60-70% of blood flow has to be blocked before we see symptoms
clinical manifestations of PAD - Correct Answer->Severity depends on site and extent of blockage - any blood vessels around to pick up the slack
The classic symptom is: intermittent claudication (blockage)
Pain is caused by tissue ischemia
Due to decreased circulation
- Pulse weakened, decreased or absent
-- Common to need a doppler
- Cap refill increases - longer for blood to be restored
- Loss of hair on legs, feet, and toes
post intervention PAD care - Correct Answer->VS and assessment every 15 mins when back on the floor
Check Puncture site for bleeding, rock hard hematoma - put lotss of pressure
Neurovascular check (compare bilaterally)
- Temperature
- Cap refill
- Pulse
- Sensation
- Movement
If lose pulse after surgery - occlusion or hemorrhage - notify provider
chronic venous insufficiency (CVI) - Correct Answer->Improper functioning of the vein valves in the leg
Blood flow backs up in the vessels
risk factors for CVI - Correct Answer->Prolonged standing or sitting
Obesity
History of DVT bc they cause damage and trauma to the veins
Pregnancy
PAD
Extremely tall with long legs
Females - hormones
Age
family history
clinical manifestations of CVI - Correct Answer->Pulse is harder to find due to edema but probably still have a good pulse
Leg hair no change
Nails normal to thickened
Skin color brown
Skin temp normal, no temp gradient
Skin gets dry, thickened, hardened, flaky
Full ached or heaviness in calf or thigh - d/t fluid build up
Visible varicose veins
Ulcer - painful
venous ulcers - Correct Answer->medial and lower part of legs, medial ankle
Swollen, lots of drainage, tissue very granulated - pink, edges irregular, and wound more shallow
arterial ulcers - Correct Answer->toes and top of feet, lateral side of ankle, little to no drainage, pale or necrotic, circular with clear margins and edges, slightly deeper
diagnostics for CVI - Correct Answer->based on physical assessment and possibly duplex ultrasound, can see more visual changes
treatment for CVI - Correct Answer->Vein surgery
Lifestyle changes
- Compression stockings - make sure no wrinkles
- Skin checks/care - moisturizing
- Elevation of extremity
- Avoid sitting or standing for long periods
- Lose weight
- Regular exercise
- similar to left sided
- Cough, wheezing, dizziness, dysrhythmias, SOB
Left sided HF - Correct Answer->blood/fluid accumulation (left atrium/lungs)
Increased pulmonary hydrostatic pressure
Results in pulmonary congestion
*think Left -> Lung
Can quick go to respiratory failure
Want to manage disease
complications of left sided HF - Correct Answer->Extremely SOB when lay flat
LV hypertrophy
RT sided HF
Decreased cardiac output
RAAS
MI
Dysthymias
Pulmonary edema
Plural effusion
right sided HF - Correct Answer->right ventricle does not pump effectively
Fluid backs up into right atrium and then venous system
Fluid moves into tissues and organs
complications of right sided HF - Correct Answer->Splenomegaly (spleen enlargement)
Hepatomegaly (liver enlargement)
Pulmonary hypertension
labs for heart failure - Correct Answer->BNP - brain naturetic peptide (same family as ANP): causes blood vessels to dialate and tells kidneys to excret more salt; when in HF the chambers are stressed and overworked so they release extra BNP
- High: over 100, elderly over 300
- Gives overall fluid status of body
ABGs - arterial blood gases: how good is gas exchange in lungs and how are lungs functioning
BMET/CMET - electrolyte imbalances, low K+ from diuretics, hyponaturimia from excess water
Creatinine - kidney function, ACE inhibitors, diuretics will slightly increase
- High is a dysfunction
- Cardiorenal syndrome - heart is overloaded and not pumping correctly, kidneys are not getting enough blood and oxygen - start to fail, diuertics increase workload of kidneys and increase kidney failure, if give fluids to treat failing kidneys - worsening HF - goal is just to manage symptoms
BUN - blood urea nitrogen - should be filtered by kindeys
- Increase
- Rly diuerising will go up
Urinalysis - proteinuria - kidney issues
diagnostics for HF - Correct Answer->Chest x-ray - see fluid build up in lungs or around heart
ECG/EKG - arrhythmias, can see hypertrophy
Echocardiogram - cardiac output, ejection fraction (normal is 50-70%), valves, measure diameters
- Most important diagnostic tools, checked frequently
nursing interventions for HF - Correct Answer->Monitor VS
Apply oxygen PRN
Raise head of bed (semi fowlers or higher)
Auscultate lungs
Daily weight
- Gain of 2-3lbs in one day or 5lbs in a week
- They're holding fluid
input/output
Alternate rest w/ activity
Low salt (cardiac) diet DASH
Fluid restriction
Collaborate with PT/OT/cardiac rehab
Administer medications
interprofessional care - main treatment for HF - Correct Answer->Maximize cardiac output
- This perfuses organs and tissues
Improve ventricular function
Improve quality of life
Preserve target organ function
Optimize volume status
- Always tweaking diuretics
Support oxygenation & ventilation
- Gas exchange and work of breathing, want it to feel easier
Symptom management / relief
Identify and treat underlying causes
risk factors for HF - Correct Answer->Advanced age
Hypertension
MI
Cardiomyopathy
Congenital heart defects
Coronary artery disease / post bypass
Valvular disorders/disease
Hyperlipidemia / hyperthyroidism
Myocarditis
Pulmonary hypertension
Rheumatic heart disease - not as common anymore
precipitating causes of HF - Correct Answer->Anemia - body has decrease in O2 so heart is working harder and faster, too much strain
Hypervolemia - excess fluid volume, rly increases preload pressure
Not taking cardiac medications
prevention of HF exacerbations is key to - Correct Answer->preserving target organ function and prolonging life
