ARTERIO AND ATHEROSCLEROSIS narrows/blocks an artery.

They usually
- Arteriosclerosis is the general depend on what tissue or organ is affected.
name for a group of conditions See the next paragraph:
that cause arteries to become
thick and stiff ATHEROSCLEROSIS MAY CAUSE THE
- Arteriosclerosis obliterans is an FOLLOWING:
occlusive arterial disease most 1. Ischemic diseases, like angina and
prominently affecting the abdominal claudication (pain in the arms and
aorta, as well as the smaller arteries legs when said limbs are used;
in the lower extremities. This indicates that these parts receive too
reduces the palpability of the little blood flow, thus, receiving too
following pulse sites: little oxygen)
- Dorsalis pedis 2. Acute infarction, like myocardial
- Posterior tibial infarction or stroke
- Popliteal 3. Aneurysms, like AAA
- Also affects coronary arteries and
carotid artery MANAGEMENT is mainly focused on the
- Atherosclerosis is caused by a modification of risk factors, including
fatty, waxy build up called a controlled exercise program, as well as
plaque, this clogs the arteries and medication therapy.
reduces blood flow. 1. Supervised exercise therapy/regular
- Chronic inflammatory exercise
disorder brought on by said 2. LSLF diet, low sugar diet
plaques 3. Keeping a healthy weight
- WHILE THEY DIFFER, one usually 4. Smoking cessation, alcohol
doesn’t happen without the other, consumption in moderation
and the terms are often used
interchangeably. SURGICAL TREATMENT
1. INFLOW PROCEDURES: improves
RISK FACTORS blood supply from the aorta into the
a. Modifiable femoral artery; for diseases involving
i. Hypertension the aorta.
ii. DM or hyperglycemia that 2. OUTFLOW PROCEDURES:
causes insulin resistance provides blood supply to vessels
iii. Smoking from the femoral artery; for
iv. Dyslipidemia (low in HDL, peripheral artery disease (PAD).
high in LDL)
b. Nonmodifiable MEDICAL TREATMENT
i. Age 1. Antiplatelet drugs like aspirin,
ii. Family history clopidogrel
iii. African-american descent 2. Antilipidemics like statins
3. Antihypertensive agents, like BBs,
S/Sx are ABSENT. They don’t cause CCBs, ARBs
symptoms unless it severely
 4. Endovascular this promotes arterial flow by
management/treatment preventing vasoconstriction
a. Angioplasty or percutaneous from chilling
transluminal angioplasty, b. Discourage the use of
which opens blockage to the nicotine products. Rationale:
coronary arteries without nicotine products cause
open Sx vasospasm, which impedes
b. Atherectomy circulation
c. A stent is used in order to c. Encourage avoidance of
prevent the occurrence of a constricting clothing.
restenosis Rationale: impedes
circulation and promotes
NURSING MANAGEMENT venous stasis
1. Improving peripheral arterial d. Encourage avoidance of
circulation crossing the legs. Rationale:
a. Elevating the head of the also causes venous stasis
patient’s bed or by having the e. Administer vasodilator
patient use a reclining chair, medications and
sitting with the feet resting on adrenergic-blocking agents
the floor for patients with as prescribed. Rationale:
PAD vasodilators relax smooth
b. Patients with venous muscles; ABs block response
insufficiencies need to sympathetic nerve
enhanced blood return to the impulses
heart, which is why it is 3. For chronic pain due to impaired
important to elevate the ability of vessels to supply tissues
lower extremities. with oxygen
c. Assist patients with walking a. Promote increased
or other moderate grade circulation through exercise.
isometric exercises that Rationale: increases oxygen
promote blood flow and supply to tissues and
circulation (exercise only as decreases the accumulation
tolerated!); SUPERVISED of metabolites that cause
EXERCISE THERAPY is muscle spasms
prescribed with patients with b. Administer analgesic agents.
claudication Rationale: helps reduce pain
i. Make sure that SET and allows patient to perform
is done under activities that can promote
supervision to prevent circulation
complications 4. Heat application
2. For promotion of vasodilation and a. Patients are instructed to test
prevention of vascular compression the temperature of bath
a. Maintain a warm temperature water and to avoid using
and avoid chilling. Rationale: hot-water bottle/heating pads
 on the extremities—HEAT - Alcoholism, consumption of nicotine
APPLICATION MUST BE and tobacco products
DONE ON THE ABDOMEN - Poor diet habits, especially if diet is
INSTEAD, AS THIS CAN high in sodium; stress; sedentary
CAUSE REFLEX lifestyle
VASODILATION IN THE - Gender-related
EXTREMITIES - Men have greater risk until
b. Heat must be used with great 64 years of age
caution! Excess heat may - Women have greater risk at
increase metabolic rate. > 65 years of age
When there's too much heat,
it can make your body's outer Primary HTN: or essential hypertension, is
parts (like hands and feet) diagnosed when there is no identifiable
work harder and need more cause
oxygen. However, if an artery
is blocked or damaged, less Secondary HTN: defined as elevated BP
oxygen-rich blood reaches due to an identifiable underlying cause.
those areas. So, using heat
can be risky because it might Pathophysiology
make the situation worse. - Blood pressure is the product of
5. Encourage dropping other stimulants cardiac output x peripheral
a. Use of any tobacco products resistance.
cause vasospasm and - Cardiac output is the product of
reduce circulation; heart rate x stroke volume.
encourage the patient to stop - Each time the heart contracts,
b. Emotional stress can pressure is transferred from the
stimulate the sympathetic contraction of the myocardium to the
nervous system and cause blood, and then the pressure is
peripheral vasoconstriction; exerted by the blood as it flows
stress should be minimized! through the blood vessels.
- Hypertension may be caused by an
HYPERTENSION increase in cardiac output (often
related to an expansion in vascular
volume), increase in peripheral
resistance (constriction of the blood
vessels), or both.
- The tendency to develop
hypertension can be inherited, but
genetic makeup alone cannot predict
Risk factors for HTN
whether someone will develop it.
- Advancing age
- African-American descent
PHYSIOLOGIC PRECEDENTS THAT CAN
- CKD, DM, hypercholesterolemia,
LEAD TO HTN
obesity, sleep apnea
 1. Increased sympathetic NS activity 6. TIA or stroke may manifest as
related to dysfunction of the alterations in vision/speech,
autonomic NS. dizziness, weakness, sudden fall,
2. Increased renal reabsorption of Na, transient or permanent hemiplegia
Cl, and H2O (paralysis on one side)
3. Increased activity of the RAAS
system, resulting in the expansion of RENIN-ANGIOTENSIN-ALDOSTERONE
ECF volume and increased systemic SYSTEM
vascular resistance 1. The kidney detects lowered blood
4. Decreased vasodilation of the pressure,
arterioles 2. This encourages liver to release
5. Resistance to insulin action, which angiotensinogen
links HTN to DMT2, obesity, and 3. Renin is produced by the kidneys in
glucose intolerance response to the angiotensinogen,
6. Activation of the innate and adaptive thereby converting it to Angiotensin
components of the immune I
response that contribute to vascular 4. Angiotensin I is converted into
inflammation and dysfunction Angiotensin II by the lungs, once
the lungs produce
Isolated systolic hypertension: the Angiotensin-converting enzyme
predominant form of hypertension in older 5. Angiotensin II will increase the blood
people pressure by two ways:
a. It may cause the vessels to
S/Sx: vasoconstrict
1. No abnormalities may be present b. It may cause the adrenal
except for elevated BP, which makes glands to produce
hypertension the so-called “silent aldosterone, which
killer”, because there is no warning promotes the reabsorption of
S/Sx. NaCl and water
2. When S/Sx do appear, they suggest
vascular/target organ damage.
3. In the case of severe HTN,
papilledema or swelling of the optic
disc may be seen.
4. Left ventricular hypertrophy may
also be caused by hypertension,
because it occurs in response to the
increased workload placed on the
ventricle
5. Changes in the kidneys, when
patients are tested for BUN and
CREATININE, may manifest as
nocturia
Assessment - Assessment is based on the
1. Measuring BP in a clinical setting is average of at least two readings.
considered less accurate than home - If two readings differ by more than 5
blood pressure measurement mm Hg, additional readings are
(HBPM) or ambulatory blood taken, and an average reading is
pressure management (ABPM). calculated with the results
They are used in diagnosis and
monitoring of effectivity of treatments
2. HBPM and ABPM recognize other MEDICAL MANAGEMENT
manifestations of blood pressure. 1. Goal is to maintain a BP lower than
a. Masked hypertension: 130/80 mm Hg.
exhibit elevated BP at levels 2. Lifestyle changes: weight loss,
typically consistent with dietary changes, physical activity
hypertension in settings modifications, decreased alcohol
outside the hospital/clinic, consumption, and smoking
while their BP is normal in cessation; incorporate LSLF diet
health care setting; may lead
to adverse cardiovascular Pharmacologic therapy
events like MI or CVA if left 1. Thiazide diuretics, is the preferred
untreated agent because of its long half life.
b. White coat hypertension: Decreases blood volume, CO, and
have high blood pressure renal blood flow; depletes ECF;
readings in clinical settings, negative Na balance; affects smooth
but within normal range in muscles
other settings; patients with a. S/E: not potassium sparing,
white coat hypertension may and may also cause
receive unwanted treatment hyponatremia,
hypomagnesemia,
WHAT IS ASSESSED FOR hyperuricemia, and
COMPLICATIONS? hypercalcemia
- Lipid profile b. Dry mouth, thirst, weakness,
- Kidney function panel lethargy, muscle aches,
- UA muscular fatigue
- ECG c. Tachycardia, GI disturbance
- Ophthalmic exam 2. ACE inhibitors (pril drugs), which
inhibits the conversion of
For conditions that cause HTN, the following Angiotension I to II, and lowers
may be checked: peripheral resistance
- CBC a. S/E angioedema is rare, but
- FBS may be life-threatening
- TSH b. Hyperkalemia, COUGH
- Kidney function panel 3. Angiotensin receptor blockers, or
ARBs (sartan drugs), which blocks
Interpretation of Results the effect of Angiotensin II at the
 receptors; can be prescribed for - Severe BP elevation in which BP is
patients with angioedema due to greater than 180/120 mm Hg
ACE-inhibitors - Without target organ damage, as
a. S/E: hyperkalemia evidenced by clinical examinations
4. Calcium channel blockers or CCBs and lab results
(dipine drugs), which inhibit calcium - Usually results from
ion influx across membranes and nonadherence to anti-HTN
cause vasodilatory effects in arteries therapy, resulting in rebound
and arterioles hypertension
a. Effective sublingually or
orally
b. No tendency to slow down
SA or AV node
c. S/E bipedal edema,
commonly in women; MUST
BE TAKEN ON AN EMPTY
STOMACH
i. Recommend frequent
meals if nausea is
being felt
d. Use with caution in pt with
DM
e. Anything that affects the
muscles, like muscle cramps
f. Irregular heartbeat,
constipation, SOB, edema
g. Dizziness

Patients are first prescribed low doses. If BP

Resistant hypertension is diagnosed when

HYPERTENSIVE EMERGENCY
- Severe BP elevation in which BP is
greater than 180/120 mm Hg
- New/worsening target organ
damage

HYPERTENSIVE URGENCY