Cardiac- Med Surg.docx - Chapter 31 Hypertension Definition o Persistent elevation of Systolic BP >140 mm Hg AND\/OR Diastolic BP >90 mm Hg(140\/90(must

Cardiac- Med Surg.docx - Chapter 31 Hypertension Definition...

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Chapter 31: Hypertension DefinitionoPersistent elevationof: Systolic BP >140 mm Hg AND/OR Diastolic BP >90 mmHg (140/90) (must be persistent in two or more reading in two separate occasions by health care provider) oBlood Pressure= Cardiac Output x Peripheral Resistance Used to evaluate blood flow (perfusion) to peripheral tissues Increase in CO and Peripheral Resistance can cause HTNHR x Stroke Volume = COoPrehypertensionWarning sign that pt is on verge of HTN Systolic pressure = 120-139 mmHgDiastolic pressure= 80-89 mmHgOn 2 or more readings on 2 separate occasions Used to emphasize that people whose BP begins to rise above 120/80 mmHg are at risk to become hypertensiveTreatment: Lifestyle Modifications Exercise, Diet, Weight Loss Slight increases in BP increases the risk of stroke, heart attack, HF and CVdeath Blood Pressure ClassificationCategorySBP (mmHg)DBP (mmHg)Normal(keep normal so still teach diet, weight loss and exercise)< 120 and<80Prehypertension(start lifestyle modification treatment)120-139 or80-89Stage 1 hypertension(treated with lifestyle modifications ANDmeds)140-159 or 90-99Stage 2 hypertension (may start have s/s such as stroke and h/a)≥160 or≥ 100Factors Involved in the Control of Blood PressureoSilent KillerPt generally do not have any s/s of increased CO and peripheral resistance oThings that Affect CO Increased intake of sodium directly cases increase in BP. Fluid follows sodium, which increases cardiac output Increase fluid volume → increases preload Causing heart and vessels to work harderoRenal Function
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Can affect both CO and peripheral resistance. An increase in renin angiotensin causes you to hold onto sodium = increase in volumeIncreased renal reabsorption of sodium, chloride and water related to a genetic variation for the kidneys to handle sodiumIncreased activity if RAAS system Results in expansion of ECF volume and increased systemic vascular resistance Decreased filtration surface causes venous constriction Causes increased preload and contractility oMineralocorticoids (stress).When we get stressed we naturally release mineralocorticosteroids Which release sodium and causes vasoconstriction within the vessels Increasing CO and peripheral resistanceoOveractive Sympathetic Nervous System (pain stress, emotion)Increase in volume and vasoconstrictionDamage or narrowing of vessels cause BP to rise Increasing peripheral resistance (obesity, genetic cell membrane alterations causing hypertrophy of vessel walls) Decreased vasodilation of the arterioles r/t dysfunction of vascular endotheliumoResistance to Insulin Action (type two diabetes, structural hypertrophy)
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Activation of the innate and adaptive immune response contributing to renal inflammation and dysfunction Teaching in Prehypertension StateoWeight lossoSalt and alcohol reductionoExerciseoSmoking cessationTeaching in Stage 1 HTNoAdopt lifestyle changes while being treated with medicationso
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