Cardio-Vascular & Peripheral Vascular Nursing Crash-Notes

Hypertensive Urgency (BP > 180/120 w/o acute‐organ damage)

• Give rapid-acting PO agents: β–blocker, ACE-I, or central \alpha_2 agonist (clonidine)
• Goals – ↓ BP to safe range within 24–48 h, monitor vitals q15–30 min then qh
• Possible symptoms: severe HA, epistaxis, anxiety, sympathetic overdrive
• Nursing care: frequent VS, neuro/cardiac checks, treat symptoms (acetaminophen for HA, etc.)

Abdominal Aortic Aneurysm (AAA)

Pathophysiology & Epidemiology

• Localized dilation of aortic media; atherosclerosis = #1 cause
• 4 : 1 male > female, age > 65, “vacationing elderly man” prototype
• Risk factors: genetics, smoking, HTN, hyperlipidemia
• Natural course ⇒ progressive enlargement → rupture → exsanguination

Clinical Manifestations

• Often asymptomatic (≤ 40 % symptomatic)
• Possible pulsatile abdominal mass, bruit (swish); do not palpate forcefully
• Symptoms from compression: cough, hoarseness (laryngeal nerve), epigastric pain (esophagus/stomach)

Diagnostic / Surveillance

• Abdominal US, CT (gold standard)
• Monitor q6 mo if diameter < 5.5\,\text{cm} • Elective repair if ≥ 5.5\,\text{cm} or rapid growth (> 0.5 cm/6 mo)

Pre-op Medical Mgmt

• Tight BP control: target SBP 100\text{–}120\,\text{mmHg} (β-blocker, nitroprusside drip)
• Teach S/S impending rupture: sudden severe back/abd pain, syncope

Rupture = Emergency

• Triad: constant tearing pain + hypotension (BP < 90) + tachycardia ↓H/H
• Activate code, large-bore IV, fluid bolus, type & cross, immediate OR

Surgical Options

1. Open repair – midline laparotomy; sew Dacron graft inside aorta
2. EVAR (endovascular graft) – femoral groin puncture, stent-graft deployed

Post-op Nursing

• VS q15 min → q30 → qh; watch for bleeding/hematoma at incision (abdomen or groin)
• Assess distal pulses, color, temp, CMS, urine O/P ≥ 30 mL h⁻¹
• Supine 6 h (EVAR) & log-roll; no hip flex > 45°, no leg crossing
• Manage pain, advance diet, pulmonary hygiene

Heart Failure Primer

Left-sided (pulmonary)

• Dyspnea, crackles, frothy sputum, S₃ gallop, ↓SpO₂, AMS, fatigue

Right-sided (systemic)

• JVD, peripheral edema, ascites, hepatomegaly, weight gain (> 2–3 lb/d or 5 lb/wk)

Key Labs/Tests

• BNP normal 0–100 pg mL⁻¹ – HF often > 1000
• Echocardiogram → ejection fraction (normal 55–65 %). Systolic HF EF < 40 %; diastolic HF EF normal

Core Management

• Na⁺ ≤ 2 g d⁻¹, fluid ≈ ≤ 2 L (down to 1 L severe). Daily weights 7 AM after void.
• O₂ PRN, high-Fowler
• Drugs:
– ACE-I / ARB, β-blocker (↓mortality)
– Loop diuretic, spironolactone
– Digoxin (2nd line): check apical 1 min; hold < 60 bpm; toxicity → N/V, halos; monitor K^+; antidote = digoxin Fab
– Hydralazine + nitrate alternative

Test-Taking / Delegation Pearls

• RN never delegates assessment or teaching
• Clarify “first / priority / initial” & pre- vs post-op wording

Peripheral Arterial Disease (PAD)

Definition & Risk

• Atherosclerotic narrowing of neck, abd, or extremity arteries; age 60–80; ↑ in women
• Risks: smoking (biggest), DM, HTN, ↑LDL, obesity, sedentary

Classic Symptoms

• Intermittent claudication – ischemic calf pain relieved by rest (anaerobic ↑lactate)
• Paresthesia, thin shiny skin, hair loss, brittle nails
• Pallor on elevation → dependent rubor (reactive hyperemia)
• Rest pain (critical ischemia) esp. night; worse with elevation

Complications

• Arterial ulcers (tips of toes), gangrene, amputation

Diagnostics

• ABI = ankle SBP / brachial SBP; PAD if < 1.0 (severe < 0.5)
• Duplex Doppler, CTA/MRA, angiography

Risk-Factor Targets

• LDL < 100 (ideal < 70), HDL > 40 M / 50 F, TG < 150, HbA₁c < 7 %, BP < 130/80

Drug Therapy

• Antiplatelet: ASA 81–325 mg, clopidogrel 75 mg (watch GI bleed)
• ACE-I (ramipril): ↑ABI, ↑walk distance
• Claudication: cilostazol (1st), pentoxifylline (2nd) – no in HF

Exercise Prescription

• Walk until moderate pain, rest, resume; 30–60 min, 3–5 d wk⁻¹ × 3–6 mo

Interventions

• PTA/Stent, atherectomy
• Surgical bypass, endarterectomy, patch angioplasty
• Amputation last resort

Nursing Care

• Check peripheral pulses with Doppler marking; absent pulse = emergency
• Keep legs dependent for comfort, avoid knee flexion; NO heating pads (↓sensation)
• Warm blankets ok, inspect feet daily, roomy shoes, no tight garments

Raynaud Phenomenon

• Young women 15–40, episodic vasospasm fingers/toes/ears/nose
• Triphasic color: white (ischemia) → blue (cyanosis) → red (hyperemia)
• Triggers: cold, stress, tobacco, caffeine, sympathomimetics
• Care: gloves, avoid extremes, warm water soak, stop smoking; CCB (nifedipine), sympathectomy if severe

Venous Thrombo-Embolic Disease

Virchow Triad

1. Venous stasis (immobile, obese, pregnancy, postop)
2. Endothelial damage (IVs, trauma)
3. Hypercoagulability (smoke, OC, cancer, sepsis)

Superficial Vein Thrombosis (SVT)

• Palpable cord, redness, warmth along vein (often IV site)
• Remove IV, elevate, warm compress, NSAID or low-dose anticoagulant – not both

Deep Vein Thrombosis (DVT) / VTE

• Unilateral leg edema, pain, erythema, warmth, +Homan sign unreliable
• Diagnostics: duplex US, +D-dimer (> 250 ng mL⁻¹), venography
• Major complications: PE, chronic venous insufficiency, phlegmasia cerulea dolens

Prevention

• Early ambulation q2–4 h, leg exercises, chair for meals, reposition q2 h
• Graduated compression stockings & SCD – contraindicated if DVT present
• Low-dose anticoag (SQ heparin 5 000 U q8–12 h or enoxaparin 40 mg q24 h)

Anticoagulant Treatment

• Heparin protocol: adjust drip per aPTT; hold 1 h if > 110 s
• NEVER mix NSAID/ASA with anticoag unless ordered
• Patient teaching: MedAlert bracelet, consistent Vit-K intake (green veg), report bleeding, no razors/IM shots, soft toothbrush

Thrombolysis / Surgery

• Catheter-directed tPA for massive DVT
• Venous thrombectomy (open)
• IVC filter (Greenfield) via femoral vein to catch emboli; risks – migration, perforation, DVT; removed when clot risk passes

Pulmonary Embolism Recognition & First Aid

• Sudden dyspnea, pleuritic chest pain, hemoptysis, tachypnea
• Action: High-Fowler, O₂ 2 L nc, stay with pt, call Rapid / HCP, maintain IV, prepare antico-thrombolytic

Varicose Veins

• Dilated tortuous superficial veins from valve failure; risks: female, age, pregnancy, obesity, standing jobs, genetics
• S/S: aching heaviness, itching, ankle edema; complications → SVT, rupture, ulcers
• Dx: visual while standing, duplex US for reflux
• Mgmt: avoid prolonged standing, elevate legs, thigh-high compression hose, daily walking
• Procedures:
– Sclerotherapy (inject agent) – wear stockings 3–5 days; hyperpigmentation common
– Endovenous laser / IPL – multiple sessions 6 wk apart
– High ligation & vein stripping surgery – post-op elevate, stockings, CMS checks

Chronic Venous Insufficiency & Venous Ulcers

• Long-standing valve incompetence ± post-DVT
• Manifestations: pitting edema ↑end-day, brown hemosiderin staining, leathery skin, eczema, warm ankles, painful medial-malleolus ulcer w irregular edges & exudate

Care Plan

• Leg elevation 15–20 min 4× day & sleeping with feet ↑6 in
• Lifelong compression (apply before rising), SCDs prn, no crossing legs, loose clothing
• Daily moisturizing; avoid trauma/heat
• Balanced diet: ↑protein, calories, Vit A/C & Zinc; consult dietitian for DM/obesity
• Ulcer dressing: moist saline gauze, hydrocolloid; change q3–5 d or prn drainage
• Culture @ first infection sign → topical/systemic ABX per C&S
• Monitor for cellulitis, osteomyelitis, sepsis, amputation risk

Electrolytes & Other Reminders

• Know S/S & nursing actions for Na⁺, K⁺, Ca²⁺, Cl⁻ high/low (Adult I review)
• “Heating pad vs warm blanket” – avoid electrical pad (burn risk in PAD neuropathy); warm non-electric blanket OK
• Assess pulses: if non-palpable → Doppler then mark; true absent pulse = emergency call