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What formula determines blood pressure?

Blood pressure = Cardiac output × Peripheral resistance

What is cardiac output?

The amount of blood pumped by the heart.

What is peripheral resistance?

The resistance created by the blood vessels against blood flow.

How does the sympathetic nervous system affect blood pressure?

It causes vasoconstriction, which increases peripheral resistance and raises blood pressure.

How does the parasympathetic nervous system affect blood pressure?

It causes vasodilation, which lowers blood pressure.

What do baroreceptors and chemoreceptors detect?

Changes in blood pressure, oxygen, carbon dioxide, and pH.

What three systems regulate arterial pressure?

Autonomic nervous system, Kidneys, Endocrine glands.

What does systolic blood pressure represent?

The pressure produced when the ventricles contract and eject blood.

What does diastolic blood pressure represent?

Arterial pressure during ventricular relaxation.

Why does systolic blood pressure commonly increase in older adults?

Loss of arterial elasticity increases resistance to blood flow.

What happens to blood pressure when blood vessels narrow?

Peripheral resistance increases, causing blood pressure to rise.

What is central aortic systolic pressure?

The pressure at the root of the aorta as blood is pumped from the left ventricle.

How may central aortic systolic pressure compare with brachial systolic pressure?

It may be as much as 30 mm Hg lower than the brachial arm pressure.

When is renin released?

The kidneys release renin when renal perfusion or blood pressure decreases.

What is the correct RAAS sequence?

Renin → Angiotensin I → Angiotensin II → Aldosterone.

What does renin do to angiotensinogen?

Renin converts angiotensinogen into angiotensin I.

Where is angiotensinogen produced?

The liver.

What does angiotensin-converting enzyme do?

It converts angiotensin I into angiotensin II.

Where is angiotensin-converting enzyme primarily found?

In the lungs.

What are the major effects of angiotensin II?

Powerful vasoconstriction, Increased peripheral resistance, Increased blood pressure, Stimulation of aldosterone release.

What does aldosterone cause?

Sodium and water retention, increasing blood volume and blood pressure.

How do natriuretic peptides lower blood pressure?

They cause vasodilation and promote sodium and water excretion.

What may happen when natriuretic factor is deficient?

Sodium and water retention increase, causing blood pressure to rise.

How does hypernatremia contribute to hypertension?

Sodium retention increases blood volume, which raises blood pressure.

How may low potassium contribute to hypertension?

The kidneys may retain sodium to maintain electrolyte balance, increasing blood volume and blood pressure.

What is essential hypertension?

Sustained high blood pressure with no identifiable cause.

Approximately what percentage of hypertension cases are essential hypertension?

Approximately 95%.

What is secondary hypertension?

High blood pressure caused by another disorder, medication, or substance.

What conditions can cause secondary hypertension?

Kidney disease, Pheochromocytoma, Hyperaldosteronism, Atherosclerosis, Cocaine or stimulant use, Oral contraceptives.

What is pheochromocytoma?

A benign tumor of the adrenal medulla that releases excessive catecholamines, causing vasoconstriction, increased heart rate, and hypertension.

Which test may identify pheochromocytoma?

A 24-hour urine collection showing elevated catecholamines.

What lifestyle factors increase hypertension risk?

Obesity, Physical inactivity, Smoking, Excessive alcohol intake, Poor stress management.

Which groups have a high risk for hypertension?

Older adults, African Americans, Clients with diabetes mellitus.

What is white coat hypertension?

Blood pressure that is elevated in a healthcare setting because of anxiety but normal outside the healthcare setting.

What causes white coat hypertension?

Anxiety increases epinephrine and norepinephrine, causing vasoconstriction and elevated blood pressure.

What is masked hypertension?

Blood pressure is normal in the healthcare setting but elevated at home or during ambulatory monitoring.

Which is more easily missed: white coat or masked hypertension?

Masked hypertension, because office readings appear normal.

Which monitoring methods help distinguish white coat and masked hypertension?

Home blood pressure monitoring, Ambulatory blood pressure monitoring.

Why is hypertension called the 'silent killer'?

Clients may have no symptoms for years until serious organ damage occurs.

What are the four major target organs damaged by hypertension?

Eyes, Brain, Heart, Kidneys.

How can hypertension lead to heart failure?

High blood pressure → increased resistance → increased cardiac workload → left ventricular hypertrophy → heart failure.

How can hypertension cause angina?

Cardiac hypertrophy increases oxygen demand, leading to myocardial ischemia and angina.

What eye complications may result from hypertension?

Retinal vascular damage, Retinal hemorrhage, Blurred vision, Papilledema, Blindness.

What brain complications may result from hypertension?

Stroke, Intracranial hemorrhage, Cognitive decline.

What cardiac complications may result from hypertension?

Angina, Myocardial infarction, Left ventricular hypertrophy, Heart failure, Pulmonary edema.

What renal complication may result from long-term hypertension?

Reduced renal blood flow can cause kidney disease and renal failure.

What is the most obvious assessment finding in hypertension?

Sustained elevation of systolic, diastolic, or both blood pressure measurements.

What symptoms may occur as blood pressure rises?

Headache, Dizziness, Fatigue, Insomnia, Nervousness, Nosebleeds, Blurred vision.

What may angina or dyspnea indicate in a client with hypertension?

Development of hypertensive heart disease.

What pulse characteristic may be present in hypertension?

A full, bounding pulse.

What may peripheral edema indicate in a hypertensive client?

Fluid retention or cardiovascular dysfunction.

What is papilledema?

Swelling of the optic disc associated with severe or malignant hypertension.

What can an electrocardiogram detect in hypertension?

Cardiac enlargement, Cardiac strain, Dysrhythmias.

What does echocardiography evaluate in a hypertensive client?

Left ventricular hypertrophy, Heart enlargement, Heart function.

What may a chest radiograph show in long-standing hypertension?

An enlarged left ventricle.

What does a MUGA scan evaluate?

How efficiently the heart pumps and whether hypertension has caused heart failure.

Which laboratory values may indicate kidney damage from hypertension?

Elevated blood urea nitrogen, Elevated serum creatinine.

What may fluorescein angiography reveal?

Leaking retinal blood vessels caused by hypertensive damage.

What may renal arteriography identify?

Narrowing of a renal artery.

Why are lipid studies obtained in hypertension?

Elevated cholesterol and triglycerides may indicate atherosclerosis.

What should the client do before blood pressure measurement?

Sit quietly for at least 5 minutes.

What substances should be avoided for 30 minutes before measuring blood pressure?

Cigarettes or nicotine, Coffee or caffeine.

How should blood pressure initially be measured?

Measure it in both arms and assess the client supine, sitting, and standing.

What should the nurse do after identifying the arm used for follow-up readings?

Use the same arm and the same position for future measurements.

What effect does a blood pressure cuff that is too small have?

It produces a falsely elevated reading.

What effect does a cuff that is too large have?

It may produce a falsely low reading.

What factors can falsely elevate a blood pressure reading?

Anxiety, Caffeine, Smoking, Talking, Failure to rest, Improper cuff size, Arm not at heart level.

What is the primary goal of hypertension treatment?

Lower blood pressure and prevent stroke, myocardial infarction, heart failure, and kidney failure.

What does DASH stand for?

Dietary Approaches to Stop Hypertension.

Which foods are emphasized in the DASH diet?

Fruits, Vegetables, Whole grains, Poultry, Fish, Nuts, Low-fat dairy products.

Which foods are limited in the DASH diet?

Red meat, Fat, Sweets, Sugar-containing beverages.

What nutrients are high in the DASH diet?

Potassium, Magnesium, Calcium, Fiber, Protein.

What is the general daily sodium limit?

Less than 2,300 mg per day.

What is the daily sodium limit for high-risk clients?

Less than 1,500 mg per day.

Which clients are considered high risk for stricter sodium restriction?

Age 51 or older, African American, Hypertension, Diabetes, Chronic kidney disease.

Approximately how much sodium is contained in one teaspoon of table salt?

Approximately 2,300 mg.

What foods should a client with hypertension limit?

Processed meats, Canned soups, Packaged mixes, Pickles, Olives, Sauerkraut, Sauces, Salted snacks.

How should canned vegetables be prepared to reduce sodium?

Drain and rinse them before eating.

How much weight loss may significantly improve blood pressure?

Approximately 10% of body weight.

What is the ideal body mass index mentioned for hypertension prevention?

Less than 25 kg/m².

How do diuretics lower blood pressure?

They promote sodium and water excretion, reducing blood volume and cardiac workload.

What should the nurse monitor in a client taking a loop or thiazide diuretic?

Potassium level, Hydration status, Intake and output, Daily weight, Orthostatic hypotension.

What are common adverse effects of diuretics?

Dehydration, Hypokalemia, Polyuria, Nocturia, Dizziness, Orthostatic hypotension.

What drugs are examples of diuretics?

Furosemide, Chlorothiazide.

How do ACE inhibitors lower blood pressure?

They block conversion of angiotensin I into angiotensin II, decreasing vasoconstriction and aldosterone release.

What are the major adverse effects of ACE inhibitors?

Persistent dry cough, Hyperkalemia, First-dose hypotension, Dizziness, Renal impairment.

What is the major black-box warning for ACE inhibitors?

They are contraindicated during pregnancy because they can cause fetal injury or death.

What ending helps identify ACE inhibitors?

'-pril'.

A client taking lisinopril develops a persistent dry cough. What should the nurse recognize?

The cough is a common ACE inhibitor adverse effect and should be reported to the provider.

How do angiotensin receptor blockers differ from ACE inhibitors?

ARBs block angiotensin II receptors and usually do not cause the dry cough associated with ACE inhibitors.

What ending identifies most angiotensin receptor blockers?

'–sartan'.

What pregnancy teaching applies to ARBs?

Women who may become pregnant should use effective contraception.

How do calcium channel blockers lower blood pressure?

They block calcium movement into cardiac and vascular smooth muscle, causing vasodilation.

What should the nurse monitor when administering a calcium channel blocker?

Blood pressure, Heart rate, Bradycardia, Hypotension, ECG with intravenous administration.

What food interaction applies to calcium channel blockers?

Avoid grapefruit juice and grapefruit products because they may increase medication levels and toxicity.

What ending identifies many calcium channel blockers?

'-dipine'.

How do beta blockers lower blood pressure?

They decrease heart rate, cardiac contractility, and myocardial oxygen demand.

What assessment is required before administering a beta blocker?

Check the apical pulse and blood pressure.

When is a beta blocker commonly held?

When the heart rate is below the provider’s parameter, commonly below 60 beats/minute.

Why must beta blockers not be stopped abruptly?

Sudden withdrawal can cause rebound hypertension, angina, or myocardial infarction.