SV_Patients_With_Vascular_Problems

Patients With Vascular Problems

Hypertension

• Normal Blood Pressure (BP): < 130/80

• Mechanisms Influencing BP:

  • Cardiac Output control

  • Control systems

  • Arterial Baroreceptor System

  • Regulation of body fluid

  • Renin-angiotensin-aldosterone system

  • Vascular autoregulation

Hypertension Classifications

• Essential Hypertension: No identifiable cause

• Secondary Hypertension: Due to identifiable cause (e.g., kidney disease)

• Hypertensive Crisis: Malignant hypertension, rapidly progresses >200/130

Hypertension Classifications

Essential Hypertension (Risk Factors)

• Family history

• African-American ethnicity

• Hyperlipidemia

• Smoking

• Age: 60 years old or post-menopause

• Obesity/overweight

• Sedentary lifestyle

• Stress

Secondary Hypertension (Causes)

• Kidney disease

• Primary aldosteronism

• Cushing’s disease

• Brain tumors

• Encephalitis

• Pregnancy

• Certain medications (e.g., estrogen, glucocorticoids)

Hypertension "Fun Facts"

• Affects ~90 million worldwide

• Can shorten life expectancy

• High American obesity rates impact hypertension

Hypertension Assessment

• History: Focus on risk factors and subjective data (e.g., dizziness, headache, fainting)

• Physical Assessment:

  • Measure blood pressure

  • Cardiovascular assessment

  • Inquire about eye exams

Psychosocial Assessment

• Factors: Occupation, stress, economics

Diagnostic Assessment

• Essential Hypertension: No specific lab test

• Secondary Hypertension: Dependent on underlying conditions

Knowledge Deficit Interventions

• Lifestyle Changes (Foundational)

  • Smoking cessation

  • Avoid caffeine and sodium

  • Weight reduction

  • Moderate alcohol intake

  • Regular exercise

  • Stress management

Interventions (Medications)

• Diuretics

• Lipid lowering agents

• Antihypertensives (Beta blockers, ACE inhibitors, ARBs)

Medications Used For Hypertension

Medications - Diuretics

• Thiazide Diuretics:

  • Most commonly used for hypertension

  • Act on sodium and water balance in the distal convoluted tubule

  • Examples: Hydrochlorothiazide (HCTZ)

  • Uses: Edema, hypertension

  • Side Effects: Hypokalemia, hyperglycemia, increased uric acid levels

  • Contraindications: Gout, diabetes

  • Patient Education: Take in the morning; monitor BP/HR

Loop Diuretics

• Mechanism: Act directly on loop of Henle, inhibiting sodium and chloride reabsorption

• Examples: Furosemide (Lasix), Bumetanide (Bumex)

• Uses: Heart failure, edema, pulmonary edema

• Side Effects: Hypokalemia, orthostatic hypotension, hyperglycemia, dizziness

• Patient Teaching: Monitor vital signs, rise slowly, need for potassium supplements

Potassium Sparing Diuretics

• Action: Inhibit sodium reabsorption in exchange for potassium

• Example: Spironolactone (Aldactone)

• Side Effects: Weakness, hypotension, irregular heart rate

• Patient Teaching: Monitor BP/HR, decrease potassium intake

Calcium Channel Blockers

• Function: Counteracts arrhythmias by blocking calcium access, reduces contractility

• Examples: Amlodipine (Norvasc), Diltiazem (Cardizem)

• Side Effects: Bradycardia, hypotension

• Patient Teaching: Monitor HR/BP

ACE Inhibitors

• Mechanism: Blocks conversion of Angiotensin I to II, causing vasodilation

• Examples: Lisinopril, Benazepril

• Side Effects: Hypotension, nagging cough

• Patient Teaching: Monitor BP/HR

Angiotensin II Receptor Blockers (ARBs)

• Action: Blocks binding of Angiotensin II, leading to vasodilation

• Examples: Candesartan, Losartan, Valsartan

• Side Effects: Hypotension

Beta-adrenergic Blockers

• Mechanism: Inhibits adrenergic receptors, decreasing heart rate

• Examples: Atenolol, Carvedilol

• Side Effects: Hypotension, bradycardia, fatigue, sexual dysfunction

• Patient Teaching: Monitor HR/BP, caution for orthostatic hypotension

Hypertension Compliance

• Importance of medication compliance, often lifelong

• Educate on potential side effects and consequences of noncompliance

• Encourage home monitoring of BP/HR, lifestyle adjustments

Peripheral Arterial Disease

Arteriosclerosis and Atherosclerosis

• Definitions:

  • Arteriosclerosis: Thickening/hardening of arterial walls

  • Atherosclerosis: Formation of plaque within artery walls

Pathophysiology

• Fatty streak formation due to inflammation, calcification, hemorrhage

• Can lead to partial or complete blood flow occlusion

Causes of Atherosclerosis

• Genetics, age, hypertension, abnormal lipid levels, diabetes, smoking, obesity, sedentary lifestyle

Assessment

• Evaluate blood pressure, carotid pulses, and capillary refill

• Perform lipid panel tests for LDL, HDL, cholesterol levels

Interventions

• Slow progression through lifestyle changes—smoking cessation, exercise, healthy nutrition

• Medications:

  • Statins to lower LDL (e.g., Mevacor, Zocor)

  • Side effects: muscle tenderness, possible liver enzyme issues

  • Fibrates (e.g., Lopid, Tricor) to take with meals, avoid fatty foods

Peripheral Vascular Disease (PVD)

• Defines altered blood flow; also known as Lower Extremity Arterial Disease (LEAD)

• Risk: Increased likelihood of angina, myocardial infarction, stroke; more prevalent in older adults, especially African-Americans and women post-menopause

Assessment of PVD

• Stages:

  1. Asymptomatic; may have absent pulses

  2. Intermittent claudication (muscle pain, cramping relieved by rest)

  3. Rest pain (pain in toes/feet)

  4. Ulcers and gangrenous tissue

Diagnostic Assessments

• Include exercise tolerance testing and imaging (e.g., arteriography)

Interventions

• Routine exercise, manage positioning, and promote vasodilation

• Avoid tight clothing, caffeine, nicotine, and stress

• Medications include angioplasty, stent placements, or surgical revascularization as needed

Home Care Management

• Chronic condition requires ongoing care

• Education to promote vasodilation and minimize risk factors

Acute Peripheral Arterial Occlusion

• Common Cause: Embolus, sometimes thrombus

• Assessment: Sudden severe pain, cold, and pulselessness in extremity

• 6 P’s of Ischemia:

  1. Pain

  2. Pallor

  3. Pulselessness

  4. Paresthesia

  5. Paralysis

  6. Poikilothermia

Interventions for Occlusion

• Thrombolytics, noting possible bleeding complications

Aneurysms of Central Arteries

Pathophysiology

• Dilation (ballooning) of an artery; most commonly caused by atherosclerosis

Types of Aneurysms

• Dissecting aneurysm, thoracic aneurysm, abdominal aortic aneurysm (AAA)

Assessment

• Often discovered incidentally; possible pulsations or pain present

Buerger’s Disease

• Smoking as primary cause; assessment includes claudication and neuropathy

• Interventions: Total tobacco abstinence, medication to promote vasodilation

Raynaud’s Phenomenon

• Condition involving vasospasms; managed through patient education (avoid cold and stress)

Venous Thromboembolism (VTE)

• DVT: Thrombus that poses risk for pulmonary embolism

• Prevention: Avoid certain contraceptives, stay hydrated, mobilize during prolonged inactivity

DVT Assessment

• Calf/groin pain, unilateral leg swelling, localized edema; diagnostic assessments include venography and duplex ultrasonography

Interventions for DVT

• Rest with limb elevation, drug therapies including heparin or warfarin; monitor INR

• Possible surgical management (thrombectomy, IVC filter)

Venous Insufficiency

• Result from prolonged venous hypertension; symptoms include edema and stasis ulcers

• Management:

  • Use elastic compression stockings, elevate legs regularly, and follow proper skin care protocols

  • Surgical Options: Debridement only for severe ulcers

  • Community-Based Care: Positioning, weight management, and mild exercise encouraged

Varicose Veins

• Characterized by protruding, darkened veins; management includes compression and potential surgical options.