Blood Pressure Basics
What is considered normal BP and elevated blood pressure per the categories.
Normal: less than 120 over less than 80
Elevated is 120-129 over less than 80
What are modifiable risk factors for hypertension?
Obesity
Smoking
Stress
Excessive alcohol
Hyperlipidemia
Increased intake of salt or caffeine
What is the first goal for a hypertensive crisis!
Reduce MAP by 25% (maintain DBP > or equal to 100 mm Hg)
What are some symptoms of hypertensice crisis?
Extremely High BP
Headache
Drowsiness and confusion
Blurred Vision
Changes in neurological status
Tachycardia and tachypnea
Dyspnea
Cyanosis
Seizures
How often should BP be minitored during a hypertensive crisis?
Every 5 minutes
A patient has a blood pressure of 135/85 mmHg. How is this classified?
Stage 1 Hypertension
What are non-modifiable risk factors of hypertension?
Aging
Family History
African American Race
If a patients BP is 210/120, what is their map and what would their reduction be within the first hour?
210 + 2(120) =450
Divided by 3 = 150
150 is their map, we want to reduce by 25% so
150 x 0.25 =37.5
- Or you can do 150 x .75 =112.5 or 113 (shortens the math for you)
150 - 37.5 =112.5 or 113
We want their map to be 112.5 or 113 in the first hour
Which symptoms are a hypertensive emergency?
Chest pain, SOB, back pain, numbness, weakness, change in vision, or difficulty speaking
What paient positioning is recommended? How about if they become hypotensive?
HOB elevated 45 degrees unless they become hypotensive, then lay them flat.
What BP reading defines Stage 2 Hypertension?
SBP: greater than or equal to 140
DBP: Greater than of equal to 90
What are ways we can educate patients at risk for hypertension?
Educate on impotance of compliance
Teach them how to check their blood pressure
Educate on diet and exercise regimen
Relaxation techniques and ways to reduce stress
Educate on medication compliance and side effects
Regular follow up care
If a patients BP is 163/93, what is their map and what would their reduction be within the first hour? If their BP in 10 minutes is 160/91, what percent was it reduced to?
Math step by step is in the answer, please text me if something isn't correct.
2(93) + 163 =349
349 / 3 =116.333 or 116 (old map)
116 x .75 = 87 or you can do it this way 116 x .25 = 29 then 116 - 29 = 87
if their BP in 10 min is 160/91 we do 2(91) + 160 =342 divided by 3 = 114 (new map)
116 - 114 = 2 divided by 116 = 0.0172 (convert to a percentage by moving the decimal to the right twice) = 1.72% or 2%
BP decreased by 2%
If we do it the other way take new / by old 114/116 =0.983 take this number, make it a percent and subtract it from 100
100 - 98% = 2% decrease
This way is easier in my brain lol
What organs can be impacted by hypertension and what diseases can come from hypertension that can lead to death?
Brain, heart, kidney, and Retina of the eyes
Death can be caused by stroke, kidney failure, or cardiac diseases.
What do Calcium channel blockers do? Name at least two, What do we montior for and S/S we can see?
Nifedipine, Amlodpine
These are our "Pines" - They help lower BP and HR
We would monitor BP and HR and hold for BP less than 110 and HR less than 60
S/S: Dizziness and orthostatic hypotension
SBP > 180 or DBP > 120
What is one risk factor that can be adjusted with medication and which medication can a patient take to lower this risk factor?
Cholesterol medicaition (Statins) for hyperlipidemia
They can take simvastatin, lovastatins, atorvastatin
If a patients BP is 198/102, what is their map and what would their reduction be within the first hour? If their BP in 30 minutes is 158/92, what percent was it reduced to?
Math step by step is in the answer, please text me if something isn't correct.
2(102) + 198 =402
402 / 3 = 134 (old map)
What we want in the first hour: 134 x .75 =100.5 or 101 or you can do it this way 134 x .25 =33.5 or then 134 - 33.5 =100.5 or 101
If their BP in 30 min is 158/92 we do 2(92) + 158 =342 divided by 3 = 114 (new map)
134 - 114 = 20 divided by 134 = 0.1492 (convert to a percentage by moving the decimal to the right twice) = 14.92% or 15%
BP decreased by 15%
If we do it the other way take new / by old 114/134 =0.8507 take this number, make it a percent and subtract it from 100
100 - 85% = 15% decrease
This way is easier in my brain lol
If a patient has a blood pressure of 190/130 but has no symptoms, what should you tell them?
Tell them if they have symptoms please call 911, but for now call their health care provider for additional information.
What are our ace inhibitors and our ARBS and what do they do?
What do we monitor for and signs and symptoms for each?
Which one is considered the first line?
Ace inhibitors are our first lines
They reduce BP, we hold for a systolic less than 110
S/S" Dizziness, orthostatic hypotension for both and angioedema and dry cough for lisinopril
Losartan and Valsartan
Lisinopril, benazepril, enalapril etc. (just wanted to give us more names lol)
What is the difference between severe hypertension and hypertensive emergency?
Severe hypertension has a BP of over 180/120 without symptoms, while hypertensive emergency has symptoms like chest pain, shortness of breath, back pain, numbness, weakness, change in vision, or difficulty speaking.
A nurse is assessing a patient with newly diagnosied hypertension. What demographic and lifestyle factors in a patient's history would increase their risk for developing hypertension? Give me 4 different ones
Tell me some education you would give too.
Can't change: Aging, Family history, and African American
Change:
Obesity - Impliment a better diet and exercise regimen
Smoking and excessive alcohol- Cessation
Stress - Find ways to cope with stress and work on ways to reduce it if you can
Hyperlipidemia - diet and medications if applicable
Increased intake of salt or caffeine - teach to read labels on foods, decrease salt and caffeine intake.
If a patients BP is 156/57, what is their map and what would their reduction be within the first hour? If their BP in 10 minutes is 153/53, what percent was it reduced to?
Math step by step is in the answer, please text me if something isn't correct.
156 + 2(57) = 270
270 / 3 = 90 (old map)
What we want in the first hour: 90 x .75 = 67.5 or 68 or you can do it this way 90 x .25 =22.5 or then 90 - 22.5 = 67.5 or 68
If their BP in 10 min is 153/53 we do 2(53) + 153 = 259 divided by 3 = 86.3 or 86 (new map)
90 - 86 = 4 divided by 90 = 0.0444 (convert to a percentage by moving the decimal to the right twice) = 4.44% or 4%
BP decreased by 4%
If we do it the other way take new / by old 86/90 =0.955 take this number, make it a percent and subtract it from 100
100 - 96% = 4% decrease
This way is easier in my brain lol
What are hypertensive Crisis interventions? When administering an antihypertensive and a patient becomes hypotensive, what can we do if a patient gets hypotensive?
Maintain patent airway
Administer antihypoertensive medications as prescribed
- Hypotension can occur, if it does, lay the patient flat
Monitor vital signs with BP every 5 minutes
Maintain bedrest with HOB elevated 45 degrees
Assess for hypotension
Have emergency medication and resuscitation equipment ready
Monitor IV therapy, assess for fluid overload
Monitor I/O's carefully
What do beta blockers do? Name at least two, What do we montior for and S/S we can see?
These medications lower our BP and HR, hold for systolic less than 110 and HR less than 60
S/S: Dizziness, orthostatic hypotension, bradycardia
Metoprolol, Carvedilol, and atenolol