overview / risk factors
what is blood pressure characterized by and increase in?
systemic vascular resistance (SVR)
how do you regulate HTN short term and long term?
- Short-term: SNS activation utilizing a1, a2, b1, and b2 receptors.
- Long-term: Renal and hormonal processes.
what is the criteria for HTN (what is the bp) and when does is most commonly occur?
180/120 and most commonly occurs in patients with a history of HTN who are noncompliant with medications or are undermedicated
what is gestational hypertension and when is it reclassified as chronic?
gestational hypertension is elevated BP occurring after 20 weeks of gestation in a patient without proteinuria. If the hypertension persists beyond 6 weeks postpartum, it is reclassified as chronic hypertension.
roughly how many adults meet diagnostic criteria for hypertension? (percentage)
45% of adults
what is primary/secondary HTN (% of adults this count for?)
what is the difference between HTN urgency and emergency?
what is chronic hypertension and what is the most common development risk?
hypertension that was present prior to pregnancy or diagnosed before 20 weeks of gestation.
the most common risk is the development of preeclampsia.
what population has the highest prevalence of HTN?
african americans
since HTN is a largely silent disease, what the most common complication of HTN?
target organ disease
clinical manifestations (4) and complications (2-3) of hypertensive emergency?
manifestations: Hypertensive encephalopathy, renal insufficiency, cardiac decompensation (chest pain, myocardial infarction, pulmonary edema), and dyspnea.
complications: Aortic dissection (marked by severe chest/back pain with reduced or absent extremity pulses) and intracranial or subarachnoid hemorrhage (SAH).
what is eclampsia? what is the treatment?
progression of preeclampsia to generalized seizures. treatment requires Magnesium Sulfate, continuous fetal monitoring during seizures, and immediate delivery of the fetus to treat the underlying disease.
name the risk factors of HTN (11)
Age, excessive alcohol intake, smoking, diabetes, excessive sodium intake, family history, gender (more common in males; more common in women after age 64), elevated lipid levels, obesity, sedentary lifestyle, and lower socioeconomic status.
diagnostics of HTN? (5)
Fasting blood glucose, urinalysis, 12-lead ECG, laboratory studies, and ambulatory blood pressure monitoring.
what does hypertensive emergency require? (4)
Requires hospitalization, continuous monitoring (vital signs and organ function), baseline laboratory studies, and IV antihypertensives.
what is HELLP syndrome? what is the hallmark symptom?
Hemolysis, Elevated Liver enzymes, and Low Platelets. A life-threatening complication occurring in 10% of severe hypertensive pregnancies.
hallmark symptom: right upper quadrant (RUQ), lower chest, or epigastric pain, alongside nausea, vomiting, and severe edema. requires intensive care.
what are lifestyle modifications for HTN? (health promotion) (7)
Weight loss, dietary and nutritional changes, sodium restriction, moderate alcohol consumption, regular physical activity, and avoiding tobacco products.
what is the initial MAP goal? what is important to remember when reducing blood pressure?
reduce MAP by 20% to 25% or decrease MAP to 110-115 mmHg.
Remember, BP must be reduced gradually over 24 hours once stable; reducing blood pressure too rapidly can trigger cerebral, coronary, or renal hypoperfusion.
what is preclampsia? describe patho, objective signs, subjective signs, mild management, and severe management
- a multisystem disorder affecting 5% to 8% of US pregnancies, causing intrauterine growth restriction and serving as a major cause of perinatal death. (hypertension w/ damage to another organ)
- Preeclampsia occurs when increased sensitivity to angiotensin II and decreased natural vasodilators cause generalized vasospasm, increasing PVR and decreasing blood flow to maternal organs.
- Key signs include BP >140/90, proteinuria, edema, hyperreflexia, and decreased urine output, while symptoms include headache, confusion, visual changes, and epigastric pain.
- Mild cases may be monitored at home if stable, while severe cases require hospitalization, antihypertensives, magnesium sulfate to prevent seizures, and possibly delivery.
nursing management for hypertensive pregnancy? (7)
Frequent assessments, strict Intake & Output (I/O) monitoring, checking urinalysis every 4 hours for protein, continuous fetal monitoring, seizure precautions, assessing for signs of impending seizures, and monitoring closely for Magnesium toxicity (monitoring deep tendon reflexes, respiratory rate, and kidney function).