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NSG 123 Exam 3 latest updated 2024
What is hypertension? - correct answerhigh blood pressure What are HTN clinical manifestation? - correct answer"Silent killer" (no warning or s/s) But when they do show it's:
- Retinal Changes such as hemorrhages Exudates (fluid accumulation) Cotton wool spots (small infarction) Papilledema (swelling of the optic disc in severe HTN)
- Coronary artery disease with angina and myocardial infraction
- LVH
- Cerebral vascular disease What are the stages of HTN? - correct answerNormal: <120 & < Prehypertension: 120-129 & < Stage 1: 130-139 & 80- Stage 2: 140-159 & 90- HTN CRISIS: greater or equal to 180 and greater or equal to 120 diastole. Nursing Intervention for Normal B/P - correct answerAfter having the BP measured to screen for hypertension, a patient not previously diagnosed with hypertension and with a normal BP (i.e., SBP less than 120 mm Hg and DBP less than 80 mm Hg) can be advised to have the BP reevaluated in 1 year. Prehypertension Nursing Intervention - correct answerA patient without a prior diagnosis of hypertension with an elevated BP (i.e., SBP 120 to 129 mm Hg and DBP less than 80 mm Hg) should be advised to follow up with additional BP readings within 3 to 6 months. Hypertension Nursing Intervention - correct answerA patient with a BP that could be consistent with hypertension; that is, with an SBP greater than or equal to 130 mm Hg or a DBP greater than or equal to 80 mm Hg should follow-up with additional BP readings within 1 month's time to either confirm or rule out the diagnosis What B/P measurements are used to accurately diagnose someone with HTN? And why? - correct answerHome Blood Pressure Measurements (HBPM) Ambulatory Blood Pressure Measurements (ABPM) Because of masked hypertension and white coat hypertension. What patients should not to be instructed to a follow up B/P measurements? - correct answerPatients not instructed to follow up with additional BP readings to confirm a diagnosis of hypertension are patients with average BP readings greater than or equal to 160/100 mm Hg on one occasion; these patients are diagnosed with hypertension and begin treatment with antihypertensive medications
Sleep apnea and Hypertension - correct answerHaving obstructive sleep apnea increases your risk of high blood pressure (hypertension). Obstructive sleep apnea might also increase your risk of recurrent heart attack, stroke and abnormal heartbeats, such as atrial fibrillation. (Google searched) Primary hypertension - correct answerHigh blood pressure, the cause of which is unknown; also known as essential hypertension Secondary hypertension - correct answerhigh blood pressure caused by the effects of another disease Primary hypertension Nursing Management - correct answercombination of lifestyle changes: weight loss in overweight persons; increased physical activity; moderation of alcohol intake; and consumption of a diet that is higher in fruits, vegetables, and low-fat dairy products and lower in sodium content or the DASH diet. Secondary Hypertension Nursing intervention - correct answerPatients suspected to have secondary hypertension must be accurately screened and the disorder that caused the high blood pressure must be properly treated in order to bring the patient's blood pressure into normal parameters Discuss what is Target Organ damage (TOD) and how you assess a pt with suspected TOD - correct answerTarget organ damage is the consequences of hypertension. Long term exposure to HTN that leads to different organs in your body becoming damaged Assess TOD by laboratory testing and a physical assessment. Discuss labs required for screening a pt w suspected TOD - correct answerurinalysis, blood chemistry (i.e., analysis of sodium, potassium, creatinine, fasting glucose, cholesterol levels), and a 12-lead electrocardiogram Discuss why each lab is significant (what is tells us ) - correct answerLVH can be assessed by echocardiography. Renal damage may be suggested by elevations in BUN and creatinine levels or by microalbuminuria or macroalbuminuria. Additional studies, such as creatinine clearance, renin level, urine tests, and 24-hour urine protein, may be performed. Optional testing may include uric acid and urine albumin to creatinine ratio DASH diet (what is it? How is it beneficial? How do we educate our pt about this diet?) - correct answerDietary Approach to Stop Hypertension. It is an effective diet in lowering BP. If used in conjunction with weight loss, this diet can lower SBP by 11-16 mm Hg. In addition to this dietary advice, patients should be counseled to incorporate a low sodium (less than 2 g/day), high potassium (3500 to 5000 mg/day) diet; this dietary combination is more effective than following either a lone low sodium or high potassium diet (Perez & Chang, 2014). A high potassium diet must be avoided in patients with CKD, however.
The blood pressure tended to drop in the standing position compared with the sitting, supine and supine with crossed legs. Systolic and diastolic blood pressure was the highest in supine position when compared the other positions. Modifiable risks associated with HTN vs Non-modifiable risks associated with HTN? - correct answerModifiable: Dieting, stress, socioeconomic status (can be both non- modifiable too), smoking, obesity, and sedentary lifestyle. Non-Modifiable: Family History, ethnicity, age, and gender. Thiazide or Thiazide-Type Diuretics chlorthalidonea hydrochlorothiazide indapamide metolazone - correct answerMOA: decrease of blood flow volume, renal blood flow, and cardiac output. Depletion of extracellular fluids, negative sodium balance, directly affect vascular smooth muscles. Advantages: inexpensive, effectively orally, and effective long term administration. Disadvantages: dry mouth, thirst, weakness, drowsiness, lethargy, muscles aches, tachy, GI disturbances and can enhance other antihypertensive meds. Orthostatic hypotension caused by alcohol, hot weather and other barbiturates. Because thiazides cause loss of sodium, potassium, and magnesium, and increase in uric acid and calcium, monitor for signs of electrolyte imbalance. Encourage intake of potassium-rich foods. Gerontologic considerations: Risk of orthostatic hypotension. ACE inhibitors: Benazepril Captopril Enalapril Fosinopril Lisinopril moexipril Basically "pril" - correct answerMOA: Inhibit conversion of angiotensin I to angiotensin II. Lower total peripheral resistance. (relax veins and arteries to lower BP) Contraindications: Concomitant use of an ARB or a renin inhibitor or a potassium- sparing diuretic or potassium supplements; bilateral renal artery stenosis, pregnancy; history of angioedema with prior use of an ACE inhibitor. N/C: Can cause hyperkalemia. Side effect can include cough. Gerontologic considerations: Require reduced dosages and the addition of loop diuretics when there is renal dysfunction.
May cause upregulation of ACE2 receptors, making patients more susceptible to infection with SARS-CoV-2; however, may also mitigate deleterious effects of COVID-
Angiotensin Receptor Blockers azilsartan candesartan eprosartan irbesartan losartan olmesartan telmisartan valsartan - correct answerMOA-Block the effects of angiotensin II at the receptor. Reduce peripheral resistance. Advantage: Minimal side effect Contraindications: Concomitant use of an ACE inhibitor or a renin inhibitor or a potassium-sparing diuretic or potassium supplements; bilateral renal artery stenosis; history of angioedema with prior use of an ARB; pregnancy, lactation, renovascular disease. N/C-Monitor for hyperkalemia. Can be prescribed for patients with a history of angioedema from ACE inhibitor; however, must wait 6 wks to take after ACE inhibitor stopped. May cause upregulation of ACE2 receptors, making patients more susceptible to infection with SARS-CoV-2; however, may also mitigate deleterious effects of COVID-
Calcium Channel Blockers—Dihydropyridines amlodipine felodipine isradipine nicardipine SR nifedipine LA nisoldipine - correct answerMOA: Inhibit calcium ion influx across membranes. Vasodilatory effects on coronary arteries and peripheral arterioles. Decrease cardiac work and energy consumption, increase delivery of oxygen to myocardium. Advantages: Rapid action. Effective by oral or sublingual route. No tendency to slow SA nodal activity or prolong AV node conduction. Useful drug in treating isolated systolic hypertension. Contraindication: HFrEF (but can use amlodipine or felodipine, if necessary). N/C: Can cause pedal edema, which is more common in women. Administer on empty stomach; recommend eating small, frequent meals if complaint of nausea. Use with caution in patients with diabetes. Muscle cramps, joint stiffness, sexual dysfunction may disappear if dose decreased.
muscle wasting unexplained weight loss resting tachycardia pallor/cyanosis dizziness Muscle wasting unexplained confusion daytime oliguria and recumbent nocturia Congestion (THINK BUILD UP): Dyspnea orthopnea PND cough pulmonary crackles weight gain dependent edema ascities JVD sleep disturbances fatigue Abdominal bloating Air hungry Diagnostics used to confirm heart failure and what each one tells us about the status of the pt - correct answerEchocardiogram Chest X-ray 12-lead electrocardiogram Lab studies serum electrolytes, BUN, creatinine, liver function tests, bnp, routine urinalysis, and CBC. Nursing management of HF and teaching pt self-management of their disease - correct answerLifestyle recommendations include restriction of dietary sodium; avoidance of smoking, including secondhand smoke; avoidance of excessive fluid and alcohol intake; weight reduction when indicated; and regular exercise. Medication adherence. The patient must also know how to recognize signs and symptoms that need to be reported to the primary provider. Clinical manifestations of Acute Decompensated HF and nursing management? - correct answeris directed toward reducing volume overload, improving ventricular function, and increasing oxygenation. These goals are accomplished through a combination of oxygen and ventilatory support, IV medication, and nursing assessment and interventions.
JVD assessment - correct answerJVD is assessed with the patient sitting at a 45- degree angle; distention greater than 4 cm above the sternal angle is considered abnormal and indicative of right ventricular failure (Bickley, 2017). This is an estimate, not a precise measurement, of high central venous pressure. Iron deficiency: Causes, clinical manifestations. - correct answerIron deficiency anemia results when the intake of dietary iron is inadequate for synthesis of hemoglobin. They may also have a smooth, red tongue; brittle and ridged nails; and angular cheilosis. Iron deficiency: Nursing management, treatment, evaluation of treatment of goals. - correct answerThe definitive method of establishing the diagnosis of iron deficiency anemia is bone marrow aspiration. Oral iron supplementation is often the primary mode of treatment for iron deficiency anemia. Pernicious Anemia: Causes, clinical manifestations, assessment of ?: - correct answerType of B12 anemia Patients with pernicious anemia develop a smooth, sore, red tongue and mild diarrhea. They are extremely pale, particularly in the mucous membranes. They may become confused; more often, they have paresthesias in the extremities (particularly numbness and tingling in the feet and lower legs). They may have difficulty maintaining their balance because of damage to the spinal cord, and they also lose position sense (proprioception). An intrinsic factor antibody test is often more useful in determining the presence of pernicious anemia. A positive test indicates that antibodies are present that interfere with the binding of the intrinsic factor-vitamin B12 complex to receptors in the ileum, preventing absorption. pernicious anemia risk factors - correct answerDeficiency of vitamin B12 can occur in several ways. Inadequate dietary intake is unusual but sometimes can occur in people who follow a vegan diet and do not consume any meat or dairy products. Impaired absorption from the GI tract is more common, especially in older adults. Nearly 20% of older adults have low vitamin B12 levels; 5% to 10% have symptoms related to vitamin B12 deficiency (Langan & Goodbred, 2017). Vitamin B12 deficiency can occur in patients with disorders such as inflammatory bowel disease, or in patients who have had GI surgery such as ileal resection, bariatric surgery, or gastrectomy. Use of metformin for treatment of type 2 diabetes as well as chronic use of histamine blockers, antacids, and proton pump inhibitors to reduce gastric acid can also inhibit vitamin B absorption (Lanier et al., 2018). Thalassemia: Causes, clinical manifestations, risk factors, - correct answerThe thalassemias are a group of hereditary anemias characterized by hypochromia (an abnormal decrease in the hemoglobin content of erythrocytes), extreme microcytosis (smaller than normal size erythrocytes), hemolysis, and variable degrees of anemia. The thalassemias occur worldwide, but the highest prevalence is found in people of Mediterranean, African, and Southeast Asian ancestry
Treatments, expected medications? - correct answerThe best way to treat hemophilia is to replace the missing blood clotting factor so that the blood can clot properly. This is typically done by injecting treatment products, called clotting factor concentrates, into a person's vein. HEMOPHILIA AND VON WILLEBRAND DISEASE• DESMOPRESSIN (CLOTTING PROMOTER) Peripheral Artery Disease (PAD) Expected assessment findings - correct answerArterial insufficiency of the extremities occurs most often in men and is a common cause of disability. as aching, cramping, or inducing fatigue or weakness that occurs with some degree of activity or exercise, which is relieved with rest. As the disease progresses, the patient may have a decreased ability to walk the same distance as before or may notice increased pain with ambulation Elevating the legs increases the discomfort legs will appear ruddy and cyanotic when placed in a dependent position.Unequal pulses between extremities or the absence of a normally palpable pulse is a sign of PAD. PAD long term management Surgical interventions, Non-surgical/pharmacological interventions - correct answer a walking exercise program that can be done at home • walking program combined with weight reduction and cessation of tobacco use, patients often can further improve their activity tolerance Surgical is treated with severe pain. If endarterectomy is performed, an incision is made into the artery and the atheromatous obstruction is removed
