HTN/PAD/DVT | NURS230

what are the 2017 AHA/ACC blood pressure categories?

1. normal: <120 / <80

2. elevated: 120-129 / <80

3. stage 1 HTN: 130-139 / 80-89

4. stage 2 HTN: 140+ / 90+

what are the populations that are at higher risk for hypertension?

1. older individual (60 years or older)

2. individual with family history of heart issues

3. those who are consuming high-sodium diet on a regular basis

4. individual who is physically inactive

5. individual with diabetes

6. individual with kidney disease

7. those of African American ethnicity

what lifestyle changes help manage hypertension?

1. low-sodium DASH diet

2. lose weight (lower than 25 BMI)

3. exercise (equal to or more than 150 minutes a week of moderate exercises)

4. quit smoking

5. limit alcohol

6. manage stress

what are the first line medications classes for hypertension?

1. thiazide diuretics: reduce blood volume by increasing urine output

2. ACE inhibitors: block angiotensin II formation → vasodilation, decrease blood pressure

3. Angiotensin II receptor blocker (ARBs): block angiotensin II receptors

4. calcium channel blockers: relax the blood vessels and decrease the heart's general workload

why is hypertension called the “silent killer”?

it often has no symptoms in the early stages, but can cause serious complications like stroke, MI, kidney failure, and heart failure in the later stages, when diagnosis sometimes might be a little too late

what is PAD and what causes it?

peripheral artery disease - it is basically a condition characterized by atherosclerosis (plaque buildup), narrowing of arteries in the legs → reduced blood flow to the limbs

1. smoking → damages the lining of blood vessels and increases, making the artery stiff and promoting plaque buildup

2. diabetes → the high blood sugar damages blood vessel walls, increasing the chance for plaque formation and reducing circulation

3. high cholesterol → excess LDL builds up in the artery, forming plaque (even worse if there is a lot of damages that create space for this cholesterol to accumulate)

4. hypertension → constant high pressure damages artery walls, making them more prone to plaque build up -

what is the classic symptom of PAD?

intermittent claudication: cramping leg pain during walking/exercise that goes away with rest due to lack of oxygen to the leg muscles due to stiffen arteries

what are the assessment findings of PAD?

1. 6 P’s of arterial ischemia: pain, pallor, pulselessness, paresthesia (tingling, prickling, burning, numbness, or crawling feelings in the skin), paralysis, and poikilothermic ( “perishingly” cold skin)

2. shiny skin, hair loss

3. weak or absent pedal pulses

4. ulcers on toes and feet because PAD restricts the blood flow needed for the skin and tissues to survive and heal (dry, round, and very painful!)

what are the nursing interventions for patient with PAD?

1. promote blood flow by keeping the leg dependent (hanging down), not elevated

2. encourage walking to build collateral circulation

3. no smoking because that can damage the arterial wall further and causes vasoconstriction

4. no caffeine because that causes vasoconstriction

5. foot care by inspecting the feet daily to detect early signs of complications like slow-healing wounds, ulcers, or infections

6. making sure the patient is taking medications like anti-platelets (aspirin, etc) and statin on time

what is Virchow’s Triad in DVT development?

they are the three main factors that contribute to the formation of a blood clot in deep vein thrombosis

1. venous stasis - immobility, long flights, surgery

2. endothelial damage - trauma, central lines

3. hyper-coagulability: cancer, pregnancy, birth control, smoking, clotting disorders

what are signs and symptoms of DVT?

1. unilateral leg swelling and warmth

2. redness or discoloration

3. pain or tenderness in calf (especially in dorsiflexion) - Homan’s sign not recommended clinically but tested in school

4. veins that appear enlarged or bulging

what are the priority nursing intervention for DVT?

1. DO NOT message the leg as that may dislodge the clot and causes further problem

2. bed rest with leg elevated to help with the swelling and pain but they are generally should be be on prolonged bed rest as physical inactivity is one of the main cause of DVT

3. anticoagulant: heparin, enoxaparin (lovenox), warfarin

4. monitor aPTT

5. use SCDs only on the unaffected leg

what is the most serious complications of DVT and its symptoms?

pulmonary embolism (PE) - due to dislodgment of a blood clot that forms in a deep vein

1. sudden shortness of breath

2. chest pain

3. tachycardia

4. coughing up blood (hemotypsis)

5. drop in oxygen saturation

what are the two factors that determine the blood pressure

1. cardiac output

2. systemic vascular resistance

BP = CO x SVR

what are the differences between arteriosclerosis and atherosclerosis?

1. arteriosclerosis: thickening or hardening of the arterial wall

2. atherosclerosis: type of arteriosclerosis involving the formation of plaque within the arterial wall

what is the differences between primary (AKA essential) and secondary hypertension?

1. primary: not the result of another disease process (e.g., CKD, diabetes, dyslipidemia, etc)

2. secondary; the result of another disease (e.g., gender, increased age, psychological stress, smoking, overweight

review the deitary and non-dietary causes of hypertension…

dietary

1. higher sodium intake

2. lower potassium intake

3. lower calcium/magnesium intake

4. lower diet quality 

5. alcohol intake

non-dietary

1. genetics variants

2. overweight/obesity

3. lower physical activity/fitness

4. sleep disturbances

5. psychological stressors

6. air pollution