In this article, we cover atherosclerosis and hypertension, which are critical topics to know for nursing school, for the NCLEX, and for your Med-Surg exams. The Med-Surg Nursing video series follows along with our Medical-Surgical Nursing Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
Atherosclerosis
Atherosclerosis is the buildup of plaque on the walls of the arteries. These plaque deposits can become so large that they can block or partially block blood flow.
Atherosclerosis plaques can rupture, which can cause a thrombus or embolus—a blood clot that can cause a myocardial infarction or a stroke.
Risk factors for atherosclerosis
Risk factors associated with atherosclerosis include older age (because of the decrease in heart muscle efficacy and heart strength associated with increased age), immobility, smoking, increased cholesterol numbers, obesity, diabetes, as well as stress. A patient with atherosclerosis may have hypertension, because if there are plaques in the arterial walls, it narrows the lumen (opening) of those arteries, which increases blood pressure.
Labs for atherosclerosis
When assessing a patient with atherosclerosis, you may hear bruits (swishing or whooshing sounds) because of the turbulent blood flow. See:
Health Assessment, part 5: Assessing Pulse
Health Assessment, part 8: Assessing Blood Pressure
In terms of labs, a patient with a patient with atherosclerosis will often have elevated LDL levels as well as elevated triglycerides.
Treatment for atherosclerosis
A key treatment for atherosclerosis is the administration of cholesterol-lowering medications, like statins, ezetimibe, bile acid sequestrants (colesevelam, cholestyramine), antilipemics (gemfibrozil, fenofibrate) and niacin.
Patient teaching for atherosclerosis
Patient teaching for atherosclerosis includes informing the patient that they should quit smoking if they smoke, lose weight if applicable, make sure to exercise, and consume a heart-healthy diet.
Hypertension
Hypertension is high blood pressure. The pathophysiology behind hypertension is increased peripheral resistance and/or increased cardiac output that elevates blood pressure. Increased peripheral resistance may be due to atherosclerosis, described above. Atherosclerosis is a contributing factor in many cases of hypertension.
With hypertension, the force of the blood against the arterial walls is too high, so the heart has to work harder to pump blood. Over time, hypertension can cause damage to the heart and blood vessels, which places the patient at an increased risk of a myocardial infarction (heart attack) or stroke.
Primary hypertension vs. secondary hypertension
The difference between primary hypertension and secondary hypertension is the cause or risk factors.
Risk factors of hypertension
The risk factors for hypertension are different based on whether it is primary or secondary hypertension
Primary hypertension
Primary hypertension, also called essential hypertension, is the most common type of hypertension. It is idiopathic, meaning it arises spontaneously or from an unknown cause. It may be helpful to think of primary hypertension as just high blood pressure by itself, rather than high blood pressure being caused by another disease. Risk factors for primary hypertension are a family history of hypertension, high sodium intake, obesity, smoking, stress, and hyperlipidemia (high cholesterol).
Secondary hypertension
Secondary hypertension is when a disease or a medication causes a patient to have hypertension. Potential causes of secondary hypertension can include kidney disease, hypothyroidism, Cushing's syndrome, and pheochromocytoma.
See below for a list of medications that can cause hypertension
Signs and symptoms of hypertension
Usually, patients with hypertension are asymptomatic, so they will not have any signs and symptoms. However, if the patient's blood pressure is high enough, they may end up in a hypertensive crisis, which is a complication of hypertension.
Nursing care for hypertension
As a nurse, you definitely want to monitor your patient for the signs and symptoms of a hypertensive crisis. Signs and symptoms of a hypertensive crisis include a headache, chest pain, shortness of breath, and dizziness.
Diagnosis of hypertension
The threshold for diagnosing hypertension depends on which source you are following.
The American Heart Association states that a patient has stage 1 hypertension if their systolic blood pressure is over 130 or their diastolic blood pressure is over 80.
The Joint National Committee says that a patient has stage 1 hypertension if their systolic blood pressure is over 140 or their diastolic blood pressure is over 90.
As a nursing student, you need to find out which of these sources your school uses and what source you'll need to use on your nursing exams.
Treatments for hypertension
Treatment for hypertension includes diuretics, and antihypertensive agents, like calcium channel blockers, beta-blockers, and ACE inhibitors.
Diuretics for hypertension
Diuretics can help lower blood pressure. Diuretics lower blood pressure by removing excess fluid which helps to decrease cardiac output.
Why does removing excess fluid decrease blood pressure? Think of a garden hose. If a garden hose (your arteries) is turned up to maximum flow (maximum fluid), it feels harder in your hand—because the water is pushing up firmly against the inside walls of the hose. A lot of fluid is trying to get through the hose. If a garden hose is only trickling out (less fluid), it feels more limp in your hand—because there is less water pressure inside the hose.
Blood pressure is the force of blood exerted against the arterial walls. Diuretics remove fluid from your blood vessels, so if there is less fluid flowing through the blood vessels, there is less force exerted against the arterial walls—the pressure is lower.
Diuretics covered in our pharmacology flashcards include:
- Loop diuretics - furosemide (Lasix)
- Thiazide diuretic - hydrochlorothiazide (Microzide)
- Potassium-sparing diuretic - spironolactone (Aldactone)
These diuretics differ in the method they use to decrease fluid, and which electrolytes they cause you to lose or retain.
Antihypertensive agents that act on the RAAS system
Some antihypertensive agents act on the Renin-Angiotensin-Aldosterone System (RAAS), which is a hormone system within the body that regulates blood pressure and fluid balance. Check out our Med-Surg A&P review within the endocrine system playlist to learn more about the RAAS system. The RAAS system’s job is primarily to prevent hypotension by increasing blood pressure. Antihypertensives that act on the RAAS system block or inhibit renin, angiotensin-converting enzyme (ACE), angiotensin II, or aldosterone.
- Direct renin inhibitor - aliskiren
- ACE inhibitors - captopril, lisinopril
- Angiotensin II receptor blockers - losartan, valsartan
- Aldosterone Antagonists - eplerenone
Other antihypertensive agents
Calcium channel blockers (verapamil, nifedipine, diltiazem) help hypertension because they block calcium channels in the heart and blood vessels, which leads to vasodilation, which is the blood vessels opening up. When the blood vessels are opened up, the same fluid has more room and is therefore exerting less pressure.
Centrally-acting alpha-2 agonists (clonidine) help hypertension by decreasing sympathetic outflow to the heart and blood vessels. This type of medication acts on the brain to change nerve impulses and get the blood vessels to relax. When the blood vessels are more relaxed, blood passes through them more easily.
Beta-1 blockers (metoprolol, atenolol) help hypertension by blocking the effects of epinephrine (adrenaline), which causes the heart to slow down, and the reduced cardiac output lowers blood pressure. Beta-1 blockers only act on the beta-1 receptors, which affect heart activity.
Non-selective beta-blockers (propranolol, labetalol, carvedilol) help hypertension in the same way that the Beta-1 blockers do, described above, but because they act on the remaining beta receptors (beta-2, beta-3) they are also able to relax the blood vessel smooth muscle. When the smooth muscle around blood vessels is more relaxed, the blood vessels themselves are more relaxed, and blood passes through them more easily.
Nitroprusside is a powerful vasodilator that immediately helps hypertension by relaxing blood vessel smooth muscle, which allows the blood vessels to dilate immediately which reduces pressure. Nitroprusside can be used in a hypertensive crisis.
Patient teaching for hypertension
Patient teaching for hypertension includes modifying their diet and other behaviors.
The diet that helps hypertension is called the DASH diet, which is an increased intake of fruits & vegetables, low fat dairy, decreased sodium and fat, particularly saturated fat and trans fat.
Other changes that can help hypertension are for the patient to lose weight (if applicable), reduce stress, quit smoking, limit alcohol consumption. Patients should also monitor their blood pressure on a regular basis at home.
A note on hypertension in your nursing studies
You will find hypertension everywhere you look in your nursing studies; as a symptom, as a risk factor, as a side effect, as a contraindication.
Fundamentals
When you are studying fundamentals, you will need to know:
- Hypertension is a sign/symptom of fluid volume excess, hypomagnesemia, and hypoxia
- Which vulnerable population is at risk for hypertension
Need help with fundamentals? Check out our Fundamentals of Nursing - Flashcards.
Health assessment
When you are studying health assessment, you will need to know the levels/stages of hypertension for adults.
Need help in health assessment? Check out our Health Assessment - Nursing Flashcards.
Medical-surgical
When you are studying med-surg, hypertension is a sign/symptom you need to know for:
- AKI
- autonomic dysreflexia
- circulatory overload
- CKD
- Cushing's syndrome
- fluid volume excess
- glomerulonephritis
- hyperaldosteronism
- hyperparathyroidism
- hyperthyroidism
- hypomagnesemia
- hypoxia
- IV fluid overload
- late cirrhosis
- pheochromocytoma
- PKD
- polycythemia
- scleroderma
- SIADH
- thyrotoxicosis
Hypertension is a risk factor you need to know for:
- aneurysm
- angina
- cardiomyopathy
- CKD
- diabetes
- esophageal varices
- glaucoma
- heart failure
- PAD
- stroke/CVA
- valvular heart disease
Need help in med-surg? Check out our Medical-Surgical Nursing - Flashcards.
Pharmacology
In addition to the antihypertensives described earlier in this article, hypertension comes up with a lot of other drugs you need to know in Pharmacology.
Hypertension is a side effect you need to know for:
- albumin
- cyclosporine
- dobutamine
- epinephrine
- epoetin alfa
- fludrocortisone
- MAOIs
- methylergonovine
- norepinephrine
Hypertension is a contraindication you need to know for:
- epoetin alfa
- ergotamine
- estrogens
- methylergonovine
- pseudoephedrine and phenylephrine
- sumatriptan
- thrombolytics
Need help in pharm? Check out our Pharmacology - Nursing Flashcards
Maternity
When you are studying for maternity, you will need to know the hypertensive disorders in pregnancy, including: gestational hypertension, preeclampsia, eclampsia, and HELLP syndrome.
Need help in maternity? Check out our Maternity Nursing - Flashcards
Pediatrics
When you are studying Pediatrics, hypertension is a sign/symptom you need to know for:
- Brain herniation
- Coarctation of Aorta
- Pediatric AGN
- Pediatric AKI
- Pediatric CKD
- Pediatric pheochromocytoma
- Pediatric SIADH
- Wilms tumor
Need help in pediatrics? Check out our Pediatric Nursing - Flashcards
Nutrition
When you are studying nutrition, you will need to know:
- Too little magnesium can cause hypomagnesemia, which hypertension is a symptom of
- Which diets are associated with a lower risk of hypertension
- Which diet is recommended for hypertension
- Cultural dietary considerations regarding hypertension
- Hypertension is a sign/symptom of metabolic syndrome
- The recommended sodium level for a hypertensive patient
Need help in nutrition? Check out our Nutrition Essentials - Nursing Flashcards.
Psychiatric mental health
When you are studying mental health, you will need to know:
- MAOIs can cause a hypertensive crisis
- Hypertension is a sign/symptom of stimulant use disorder
Need help studying for mental health? Check out our Psychiatric Mental Health - Nursing Flashcards.
Wound care
When you are studying wound care, you will need to know hypertension is a risk factor for LEAD wounds.
Need help in wound care? Check out our Wound Care - Nursing Flashcards.