Title: Care of Patients with Hypertension and Peripheral Vascular Disease
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Markdown Content:
Care of
# Patients with
# Hypertension
# and
# Peripheral
# Vascular
# Disease
> DeWits: Ch. 18
> ATI: Ch. 30, 31, 32
## Unit Objectives
Recognize components of focused assessment that should be
included when collecting data on adults who have an alteration in
cardiac output and tissue perfusion
Apply knowledge of anatomy, physiology, basic pathophysiology,
nutrition, and developmental variations when helping to plan care
for adults who have an alteration in cardiac output and tissue
perfusion.
Identify priority actions for adults who have alteration in cardiac
output and tissue perfusion.
Apply knowledge of the actions, potential side effects, and nursing
implications when administering medications to adults who have an
alteration in cardiac output and tissue perfusion. Unit Objectives
Discuss the correct use of functioning of therapeutic devices that
support cardiac output and tissue perfusion.
Describe the role of the nurse in providing quality care to adults
who have an alteration in cardiac output and tissue perfusion.
Identify health care education and safety needs for adults how
have an alteration in cardiac output and tissue perfusion.
Discuss health alterations/structural abnormalities included venous
stasis, emboli, aneurysms, peripheral vascular disease, and
peripheral artery disease.
Discuss health alterations/arterial pressure disorders including
hypertension, shock (hemodynamic, septic, hypovolemic, and
anaphylactic) Hypertension (TB: 407, ATI :201)
Persistently high blood pressure
Systolic: _____________
Diastolic: _____________
Causes
Types
Primary/Essential
Secondary
Pathophysiology
Smaller vessels
Increased volume
Increased viscosity
Stress
Renin
Risk factors
> https://www.health.harvard.edu/blog/high -blood -pressure -why -me -201605029288
Concept Map 18.1 pg. Hypertension (Cont.) (TB: 407, ATI: 201)
Signs/Symptoms
Silent killer
Damage to organs
Diagnosis
Treatment
Goals (2)
Target: _______________
Individualized
Smoking cessation
Weight reduction, exercise
Sodium and alcohol restriction
Low fat diet
Control stress
Meds
Medications
Decrease blood volume, cardiac
output, or peripheral resistance -
table 18.3 pg. 411
Diuretics 1st line (ATI)
May need combination
Lab Values
None for HTN
Can identify causes
Elevated BUN/Creatinine
> This Photo by Unknown Author is
> licensed under CC BY -SA
## Hypertension Medications (TB: 412, ATI: 202)
Diuretics
Thiazide: (hydrochlorothiazide)
Loop (furosemide, bumetanide)
Potassium sparing (spironolactone)
Antihypertensives
Beta blockers
metoprolol
atenolol
carvedilol
labetolol
propanolol
Alpha Blocker: (doxazosin, terazosin,
prazosin)
ACE Inhibitor: (enalapril, lisinopril,
captopril, quinapril)
Antihypertensives (cont.)
Angiotensin II Receptor Blockers:
(losartan, valsartan)
Calcium Channel Blockers:
verapamil, nifedipine, diltiazem,
amlodipine)
Central - Acting Agents:
(methyldopa, clonidine)
Box 18.1 pg. 412 -413 Nursing
Interventions Hypertension (Cont.) (TB: 414, ATI: 204)
Complications
Hypertensive crisis
Life threatening, ICU status
BP: _________________
IV meds
Hypertensive urgency
ED, follow up with PCP
BP:__________________
Oral meds
Patient teaching box pg. 415
Nursing Management
Assessment
Nursing Diagnosis
Goals
Implementation
Evaluation
Atherosclerosis
Narrowing of arteries and plaque
grows
Arteriosclerosis
Hardening of arteries DASH Diet: Dietary Approaches to Stop
## Hypertension (ATI: 204)
DASH:
High in fruits/veggies
Avoid foods high in sodium, trans
fat, and saturated fat
Limit alcohol
Avoid high cholesterol foods
Eat foods high in magnesium and
calcium
Lean meat
Very similar to Mediterranean
diet
More strict on limiting red meats to
2x.month This Photo by Unknown Author is licensed under CC BY Peripheral Vascular Disease (TB: 416, ATI: 191)
Narrowing or obstruction of
peripheral blood vessels
Loss of function in arms, neck,
abdomen, lower extremities
Causes
Prevention
Types:
Peripheral Arterial Disease
> arteries
Peripheral Venous Disease
> veins
## Peripheral Arterial Disease (TB: 416, ATI: 191)
Restriction of arterial blood
flow
Peripheral artery or carotid arteries
Causes:
Atherosclerosis
Embolism
Can cause
Arterial ulcers
Ischemia
Tissue death
Risk Factors Peripheral Arterial Disease (TB: 416, ATI: 191)
Signs and Symptoms
Intermittent claudication
Pain at rest
Tightening pressure in
calves/buttocks
Ischemic changes
Bp in affected extremity lower -
ABI
Leg elevated = pallor
Leg dependent= rubor (dark red)
Tight and shiny skin, little to no hair
Diminished/absent pulses
Thickened toenails
Temp change distal to occlusion
Wounds painful and difficult to
heal
6 ps Peripheral Arterial Disease (TB: 418, ATI: 191)
Treatment
Goal of treatment:
Regular exercise
Wound care
Medications
Antiplatelets
aspirin, clopidogrel
Thrombolytic
Antilipemics
atorvastatin, simvastatin
Surgery
Re -establish blood flow
Complications
Graft occlusion
Wound or graft infection
Compartment syndrome
Nursing Management
Assessment
Diagnosis
Implementation
Evaluation Aneurysm (TB: 420, ATI: 207)
Weakness in section of artery causing ballooning in the wall
Aortic dissection
Causes
Genetic
Plaque formation (atherosclerosis) - most common
Hypertension
Weakened areas by trauma or surgery
Risk factors
Location
Abdominal (abdominal aneurysm)
Aorta (thoracic aneurysm)
Below kidneys (abdominal aortic aneurysm) AAA
Pathophysiology Aneurysm (TB: 420, ATI: 207)
Signs/Symptoms
No obvious symptoms
AAA:
Thoracic:
Dissection:
Diagnosis
Difficult
Chest radiograph, ultrasound, MRI, CT
Treatment
Goal:
Surgery if detected early or if AAA are 6 -
8cm and thoracic are 5.5 -6.5cm
Monitor via ultrasound
Antihypertensive drugs to control
pressure
Nursing Management
Assessment
Diagnosis
Implementation
Evaluation Lets Practice
A nurse is assisting with the care of a client who has a
possible dissecting abdominal aortic aneurysm. Which of the
following actions is the priority for the nurse to take?
1. Administer pain medication as prescribed
2. Provide a warm environment
3. Administer iv fluids as prescribed
4. Initiate a 12 lead ECG Carotid Artery Disease (TB: 423)
Narrowing of the carotid
arteries due to atherosclerosis
Prevention: Ch. 17
Signs/symptoms
Treatment
Goal:
Carotid endarterecomy
Carotid artery angioplasty with
stenting
Post op care:
Assess for bleeding
Monitor neuros
Assess for hoarseness
> https://www.templehealth.org/services/conditions/carotid -stenosis
## Buergers Disease (TB: 411)
Inflammation and thickening of
small and medium sized arteries
Occlusion of vessels in
hands/feet
Directly linked to
moderate/heavy smoking
Signs/Symptoms
Numbness/tingling of toes/fingers in
cold weather
Pain in feet
Intermittent claudication intensifies
Treatment
STOP SMOKING
Exercise for increased circulation Raynauds Disease (TB: 412)
Spasm of the arteries of the upper and
lower extremities (fingers and toes)
Due to exaggerated response to cold
and stress
Raynaud's phenomenon = 1 side of the
body
Signs/Symptoms:
Burning pain and throbbing when spasm
has subsided
Affected body part changes color (white,
red, blue)
Numbness, prickly sensation
Edema
Decreased sensory perception
Treatment
> This Photo by Unknown Author is licensed under CC BY -SA
# Venous Disorders (TB: 424) Peripheral Venous Disorders
Problems with the veins that inference with adequate blood
flow from the extremities to the heart
Can result in venous stasis
Types
Thrombophlebitis
Deep Vein Thrombosis (DVT)
Venous insufficiency
Varicose veins
Venous stasis ulcers Superficial Thrombophlebitis (TB: 424)
Thrombus and inflammation of the skin
Signs/Symptoms
Redness or tenderness along the vein
Swelling
Treatment
Depends on severity
Remove IV catheter if the cause
NSAIDs for tenderness
Elastic support
Elevation
Heat Deep Vein Thrombosis (TB: 425, ATI: 194)
Blood clot resulting from venous
stasis, endothelial injury,
hypercoagulability
Most often found in iliac and
femoral veins
Can dislodge and travel to the
lungs = pulmonary embolus
MEDICAL EMERGENCY
Risk Factors
Signs/Symptoms
Unilateral pain
Swelling
Redness
Warmth Deep Vein Thrombosis (TB: 425, ATI: 194)
Treatment
IV Heparin
Low molecular weight heparin
(enoxaparin) injection
Transition to oral for 3 -12 months
Thrombolytic
SCDs or elastic stockings
Early ambulation once
recommended
IVC
Nursing Management
Assessment
Documentation
Prevention Varicose Veins (TB: 429, ATI: 194)
Enlarged, tortuous veins
distorted in shape by
accumulated blood
Causes
Signs/Symptoms
Treatment
> https://www.centerforvein.com/blog/why -do -i-have -varicose -veins -in -only -
## Venous Insufficiency (TB: 430, ATI: 194)
Damaged or absent valves, leads
to pooling of blood in legs
Leads to lower extremity
swelling, venous ulcers, and
cellulitis
Risk Factors
Signs/Symptoms
Chronically swollen legs
Thick, brownish skin around ankles
Itchy, scaly skin
Stasis dermatitis
Infection or cellulitis can occur if
ulcer not treated
Treatment https://provascularmd.com/stages -of -venous -insufficiency/ Venous Stasis Ulcers (TB: 431)
Ulcers that occur in those with
venous insufficiency or
diabetic patients
Compromised circulation
Hard to heal, extend deep into
the tissue
Tissue congestion and
edema
Signs/Symptoms
Good foot and leg care is
important
Treatment
> This Photo by Unknown Author is licensed under CC BY
## Nursing Management (TB: 432)
Assessment (Box on pg. 432)
History
Subjective
Pain
Objective
Skin color, warmth, moisture,
pruritus, wounds, pulses
Nursing Diagnosis
Insomnia
Decreased self esteem
Implementation
Monitor condition and determine if
treatment is effective
Evaluation
Response to treatment
Evaluate pulses
Skin color, temperature, ulcers
Community Care
Outpatient treatment or home
health
Monitor progress and compliance
with treatment
Monitor blood pressure,
medications, diet, lab values for
those on coagulation medications Lets Review!
## ARTERIAL VENOUS
Affects veins, carrying blood to the heart
Includes varicose veins, DVT, and venous
insufficiency symptoms dependent on type
Edema, dark colored legs, ulcers common
Elevate legs above heart
Avoid crossing legs
Wear elastic compression stockings
Early ambulation
Moist heat
Do not massage
Affects arteries
Carrying blood AWAY from heart
Tight/shiny skin, decreased pulses, decrease
cap refill, hair loss on legs, cold extremities,
pallor with elevation
Exercise
Promote vasodilation and avoid
vasoconstriction
Warm environment
Insulated socks
NO direct heat (heating pad)
Avoid cold, stress, caffeine, nicotine
No crossing legs or elevating above level of
# VS Lets Practice
A nurse is caring for a client who has a new diagnosis of severe
peripheral arterial disease. Which of the following instructions
should the nurse include?
A. Wear tightly -fitted insulated socks with shoes when going
outside.
B. Elevate both legs above the heart when resting.
C. Apply a heating pad to both legs for comfort
D. Place both legs in dependent position while sleeping.