Hypertension, Atherosclerosis, and PVD

Primary Hypertension

no known medical cause; associated w family hx, age, hyperlipidemia, stress, obesity, smoking, etc

Secondary Hypertension

results from specific diseases; like renal, Cushing’s, hyperthyroidism, medications, etc

Malignant Hypertension

severe type where systolic is often >100 and diastolic >150 or >130 w pre-existing complications; sudden and progressive, BP rises quickly

Symptoms/Results of Malignant Hypertension

morning headaches, blurred vision. dyspnea, uremia; quickly leads to renal failure and stroke if not treated

DASH Diet for treating HTN

high potassium, high calcium, low sodium

Mediterranean Diet for HTN

emphasis on plant-based foods

Meds for HTN

diuretics (HCTZ, Lasix), beta blockers (reduce after load), calcium channel blockers (lower HR), ACEIs (dilate blood vessels and have dry cough as a side effect), ARBs

Peripheral Vascular Disease

group of diseases that alter the flow of blood through veins of peripheral circulation (venous insufficiency), can be caused by thrombus formation

Arteriosclerosis

thickening of arterial wall

Atherosclerosis

formation of plaque within arterial wall

Risk factors of atherosclerosis and arteriosclerosis

smoking, high fat diet, sedentary lifestyle, obesity, homocysteine levels, HTN, hyperlipidemia

Peripheral Arterial Disease (PAD)

insufficient circulation from aorta + occlusion of lower extremities that limits oxygenation; biggest risk factor is atherosclerosis; tissue damage occurs

Non-modifiable risk factors of PAD

age, gender (higher in males, race (higher in blacks), family hx

Stage 1 of PAD

asymptomatic!!!, pedal pulses can be decreased or absent and bruits may be present

Stage 2 of PAD

claudication (muscle pain/cramping/burning increased by exercise and relieved by rest)

Stage 3 of PAD

pain with rest and commonly awakens at night, pain can be more numb, usually occurs at distal portion of extremity, pain relieved by placing leg in dependent position

Stage 4 of PAD

necrosis or gangrene; ulcers and blackened tissue occurs on feet, gangrene odor is present

Diagnosis of PAD

Ankle-brachial index

Ankle-brachial index >1.30

non compressible arteries (RF for CVD)

Ankle-brachial index 1.0-1.29

normal

Ankle-brachial index 0.91-0.99

borderline disease

Ankle-brachial index 0.41-0.9

mild-moderate disease

Ankle-brachial index 0-0.4

severe disease

6 P’s for PAD

pain, pallor, pulselessness, paralysis, paresthesia, poikilothermic (cool)

Nursing Management of PAD

exercise/walking programs, weight loss, smoking cessation, lipid dietary control, control DM and HTN, foot care

PAD Medical Mangement

anti platelet therapy (ASA, clopidogrel, cilostazol), antihypertensives, statins, thrombolytics, angioplasty (removes clot), grafts and stents

Classifications of PVD

thrombus formation, thrombophlebitis, venous insufficiency, DVT

Thrombus formation

associated w stasis of blood flow

Thrombophlebitis

thrombus + inflammation of vein, varicose veins

Venous Insufficiency

damaged valves and stretched veins

DVT

occurs in deep veins of lower extremity, major risk for PE

PVD Diagnosis

Wells score, D-dimer testing, compression ultrasound, doppler flow studies, MRI venography

Assessment for Venous Insufficiency

discoloration of ankles/calf, arterial ulcers on toes and foot

Venous Insufficiency Care

avoid standing and sitting for a long time, elastic + compression socks for prevention, elevate legs for 20 min, SCD’s

Treatment of PVD once diagnosed

elevated extremity in bed, thrombolytic therapy, warm soaks and no SCDs, wear compression stockings, increase fluids, early ambulation

Treatment and Prevention of PVD

unfractioned heparin, warfarin, plavix, aspirin, factor Xa inhibitors

Symptoms of PVD

brown skin pigmentation, edema usually present, varicose veins, usually affects one leg (unilateral)

Symptoms of PAD

pale in color/dry/scaly, loss of hair on foot/calf, no edema, toenails thick and brittle, pain w elevation and exercise, sluggish cap refill

Arterial Ulcers

deep punched out wounds w well-defined edges, very painful, pale to grey/red/brown/black, dry w no bleeding, usually on ankle heels and toes

Venous Ulcers

large shallow irregular wounds, appear moist/weepy, can have yellow tissue, less painful, usually between knee and ankle