HYPERTENSION
PATHOPHYSIOLOGY
• Multi-factorial etiology
BP= CO (SV X HR) x TPR
Any increase in the above parameters will
increase BP
HYPERTENSION
Risk factors for Cardiovascular Problems in
Hypertensive patients
Major Risk factors
• 1. Smoking
• 2. Hyperlipidemia
• 3. DM
• 4. Age older than 60
• 5. Gender- Male and post menopausal
women
• 6. Family History
HYPERTENSION
PATHOPHYSIOLOGY
Any increase in the above parameters will
increase BP
• 1. Increased sympathetic activity
• 2. Increased absorption of Sodium, and
water in the kidney
HYPERTENSION
PATHOPHYSIOLOGY
Any increase in the above parameters will
increase BP
• 3. Increased activity of the RAAS
• 4. Increased vasoconstriction of the
peripheral vessels
• 5. Insulin resistance
HYPERTENSION
ASSESSMENT FINDINGS
• 1. Headache
• 2. Visual changes
• 3. chest pain
• 4. dizziness
• 5. N/V
HYPERTENSION
DIAGNOSTIC STUDIES
• 1. Health history and PE
• 2. Routine laboratory- urinalysis, ECG,
lipid profile, BUN, serum creatinine ,
FBS
• 3. Other lab- CXR, creatinine
clearance, 24-huour urine protein
HYPERTENSION
MEDICAL MANAGEMENT
• 1. Lifestyle modification
• 2. Diet therapy
• 3. Drug therapy
HYPERTENSION
MEDICAL MANAGEMENT
Drug therapy
• Diuretics
• Beta blockers
• Calcium channel blockers
• ACE inhibitors
• A2 Receptor blockers
• Vasodilators
HYPERTENSION
NURSING INTERVENTIONS
1. Provide health teaching to patient
• Teach about the disease process
• Elaborate on lifestyle changes
• Assist in meal planning to lose
weight
HYPERTENSION
NURSING INTERVENTIONS
1. Provide health teaching to the
patient
• Provide list of LOW fat , LOW sodium
diet of less than 2-3 grams of Na/day
• Limit alcohol intake to 30 ml/day
• Regular aerobic exercise
• Advise to completely stop smoking
HYPERTENSION
Nursing Interventions
2. Provide information about anti-
hypertensive drugs
• Instruct proper compliance and not abrupt
cessation of drugs even if pt becomes
asymptomatic/ improved condition
• Instruct to avoid over-the-counter drugs
that may interfere with the current
medication
HYPERTENSION
Nursing Intervention
3. Promote Home care management
• Instruct regular monitoring of BP
• Involve family members in care
• Instruct regular follow-up
HYPERTENSION
Nursing Intervention
4. Manage hypertensive emergency and
urgency properly
ANEURYSM
• Dilation involving an artery
formed at a weak point in the
vessel wall
ANEURYSM
• Saccular= when one side of the vessel is
affected
• Fusiform= when the entire segment
becomes dilated
ANEURYSM
RISK FACTORS
1. Atherosclerosis
2. Infection= syphilis
3. Connective tissue disorder
4. Genetic disorder= Marfan’s
Syndrome
ANEURYSM
PATHOPHYSIOLOGY
Damage to the intima and media
weakness outpouching of vessel wall
Dissecting aneurysm tear in the intima
and media with dissection of blood
through the layers
ANEURYSM
ASSESSMENT
1. Asymptomatic
2. Pulsatile sensation on the
abdomen
3. Palpable bruit
ANEURYSM
LABORATORY:
• CT scan
• Ultrasound
• X-ray
• Aortography
ANEURYSM
Medical Management:
• Anti-hypertensives
• Synthetic graft
ANEURYSM
Nursing Management:
• Administer medications
• Emphasize the need to avoid increased
abdominal pressure
• No deep abdominal palpation
• Remind patient the need for serial
ultrasound to detect diameter changes
PERIPHERAL ARTERIAL OCCLUSIVE DISEASE
• Refers to arterial insufficiency of the
extremities usually secondary to
peripheral atherosclerosis.
• Usually found in males age 50 and
above
• The legs are most often affected
ARTERIOSCLEROSIS
OF THE
EXTREMITIES
Arteriosclerosis of the extremities is a disease of the peripheral blood vessels that is
characterized by narrowing and hardening of the arteries that supply the legs and feet.
The narrowing of the arteries causes a decrease in blood flow. Symptoms include leg
pain, numbness, cold legs or feet and muscle pain in the thighs, calves or feet.
PERIPHERAL ARTERIAL OCCLUSIVE DISEASE
Risk factors for Peripheral Arterial
occlusive disease
Non-Modifiable
• 1. Age
• 2. gender
• 3. family predisposition
PERIPHERAL ARTERIAL OCCLUSIVE DISEASE
Risk factors for Peripheral Arterial occlusive
disease
Modifiable
• 1. Smoking
• 2. HPN
• 3. Obesity
• 4. Sedentary lifestyle
• 5. DM
• 6. Stress
PERIPHERAL ARTERIAL OCCLUSIVE DISEASE
ASSESSMENT FINDINGS
• 1. INTERMITTENT CLAUDICATION- the
hallmark of PAOD
• This is PAIN described as aching,
cramping or fatiguing discomfort
consistently reproduced with the
same degree of exercise or activity
PERIPHERAL ARTERIAL OCCLUSIVE DISEASE
ASSESSMENT FINDINGS
• 1. INTERMITTENT CLAUDICATION- the
hallmark of PAOD
• This pain is RELIEVED by REST
• This commonly affects the muscle
group below the arterial occlusion
PERIPHERAL ARTERIAL OCCLUSIVE DISEASE
Assessment Findings
• 2. Progressive pain on the extremity
as the disease advances
• 3. Sensation of cold and numbness
of the extremities
ARTERIOSCLEROSIS OF
THE EXTREMITIES
PERIPHERAL ARTERIAL OCCLUSIVE DISEASE
Assessment Findings
• 4. Skin is pale when elevated and
cyanotic and ruddy when placed on a
dependent position
• 5. Muscle atrophy, leg ulceration and
gangrene
PERIPHERAL ARTERIAL OCCLUSIVE DISEASE
Diagnostic Findings
• 1. Unequal pulses between the
extremities
• 2. Duplex ultrasonography
• 3. Doppler flow studies
PAOD
Medical Management
1. Drug therapy
• Pentoxyfylline (Trental) reduces blood
viscosity and improves supply of O2
blood to muscles
• Cilostazol (Pletaal) inhibits platelet
aggregation and increases vasodilatation
2. Surgery- Bypass graft and anastomoses
PERIPHERAL ARTERIAL OCCLUSIVE DISEASE
Nursing Interventions
1. Maintain Circulation to the extremity
• Evaluate regularly peripheral pulses,
temperature, sensation, motor function and
capillary refill time
• Administer post-operative care to patient who
underwent surgery
• Administer heat modalities to the leg
cautiously to promote vasodilatation
PERIPHERAL ARTERIAL OCCLUSIVE DISEASE
Nursing Interventions
2. Monitor and manage complications
• Note for bleeding, hematoma, and decreased
urine output
• Elevate the legs to diminish edema
• Encourage exercise of the extremity while on
bed
• Teach patient to avoid leg-crossing
PERIPHERAL ARTERIAL OCCLUSIVE DISEASE
Nursing Interventions
3. Promote Home management
• Encourage lifestyle changes
• Instruct to AVOID smoking
• Instruct to avoid leg crossing
BUERGER’S DISEASE
Thromboangiitis obliterans
• A disease characterized by recurring
inflammation of the medium and
small arteries and veins of the lower
extremities
BUERGER’S DISEASE
Thromboangiitis obliterans
• Occurs in MEN ages 20-35
• RISK FACTOR: SMOKING!
BUERGER’S DISEASE
PATHOPHYSIOLOGY
• Cause is UNKNOWN
• Probably an Autoimmune disease
• Inflammation of the arteries and
veins thrombus formation
occlusion of the vessels
BUERGER’S DISEASE
ASSESSMENT FINDINGS
1. Leg PAIN
• Foot cramps in the arch
(INSTEP CLAUDICATION) after exercise
• Relieved by rest
• Aggravated by smoking, emotional
disturbance and cold chilling
BUERGER’S DISEASE
ASSESSMENT FINDINGS
2. Digital rest pain not changed by
activity or rest
BUERGER’S DISEASE
ASSESSMENT FINDINGS
• 3. Intense RUBOR (reddish-blue
discoloration), progresses to
CYANOSIS as disease advances
• 4. Paresthesias
BUERGER’S DISEASE
Diagnostic Studies
• 1. Duplex ultrasonography
• 2. Contrast angiography
BUERGER’S DISEASE
Nursing Interventions
1. Assist in the medical and surgical
management
– Bypass graft
– amputation
2. Strongly advise to AVOID smoking
3. Manage complications appropriately
BUERGER’S DISEASE
Nursing Interventions
Post-operative care: after amputation
• Elevate stump for the FIRST 24 HOURS to
minimize edema and promote venous return
• Place patient on PRONE position after 24
hours several times a day
• Assess skin for bleeding and hematoma
• Wrap the extremity with elastic bandage
RAYNAUD’S DISEASE
• A form of intermittent arteriolar
VASOCONSTRICTION that results in
coldness, pain and pallor of the fingertips
or toes
RAYNAUD’S DISEASE
• Cause : UNKNOWN
• Most commonly affects WOMEN, 16- 40
years old
RAYNAUD’S DISEASE
ASSESSMENT FINDINGS
1. Raynaud’s phenomenon
• A localized episode of
vasoconstriction of the small
arteries of the hands and feet that
causes color and temperature
changes
RAYNAUD’S DISEASE
W-B-R is the acronym for the color change
• Pallor- due to vasoconstriction, then
• Blue- due to pooling of Deoxygenated
blood
• Red- due to exaggerated reflow or
hyperemia
RAYNAUD’S DISEASE
ASSESSMENT FINDINGS
2. Tingling sensation
3. Burning pain on the hands and feet
RAYNAUD’S DISEASE
Medical management
• Drug therapy with the use of
CALCIUM channel blockers
–To prevent vasospasms
RAYNAUD’S DISEASE
Nursing Interventions
• 1. instruct patient to avoid situations that may
be stressful
• 2. instruct to avoid exposure to cold and
remain indoors when the climate is cold
• 3. instruct to avoid all kinds of nicotine
• 4. instruct about safety. Careful handling of
sharp objects
VARICOSE VEINS
• THESE are dilated veins
usually in the lower
extremities
VARICOSE VEINS
• Predisposing Factors
–Pregnancy
–Prolonged standing or sitting
–Incompetent venous valves
VARICOSE VEINS
• Pathophysiology
–Factors venous stasis
increased hydrostatic
pressure edema
VARICOSE VEINS
• Assessment findings
–Tortuous superficial veins on
the legs
–Leg pain and Heaviness
–Dependent edema
VARICOSE VEINS
• Laboratory findings
–Venography
–Duplex scan pletysmography
VARICOSE VEINS
• Medical management
–Pharmacological therapy
–Leg vein stripping and ligation
–Anti-embolic stockings
•
VARICOSE VEINS
Nursing management
• 1. Advise patient to elevate the
legs with pillow to increase
venous return
• 2. Caution patient to avoid
prolonged standing or sitting
VARICOSE VEINS
Nursing management
• 3. Provide high-fiber foods to
prevent constipation
• 4. Teach simple exercise to
promote venous return
VARICOSE VEINS
Nursing management
• 5. Caution patient to avoid
constrictive clothing
VARICOSE VEINS
Nursing management
• 6. Apply anti-embolic
stockings as directed
• 7. Avoid massage on the
affected area
DVT- Deep Vein Thrombosis
• Inflammation of the deep veins
of the lower extremities and the
pelvic veins
• The inflammation results to
formation of blood clots in the
area
DVT- Deep Vein Thrombosis
• Predisposing factors
– Prolonged immobility
– Varicosities
– Traumatic procedures
– Increased age
– Malignancy
– Estrogen therapy
– Smoking
DVT- Deep Vein Thrombosis
• Complication
–PULMONARY
thromboembolism
DVT- Deep Vein Thrombosis
Assessment findings
• Leg tenderness
• Leg pain and edema
• Positive HOMAN’s SIGN
DVT- Deep Vein Thrombosis
HOMAN’s SIGN
• The foot is FLEXED upward
(dorsiflexed) , there is a sharp pain felt
in the calf of the leg indicative of
venous inflammation
DVT- Deep Vein Thrombosis
Laboratory findings
• Venography
• Duplex scan
DVT- Deep Vein Thrombosis
• Medical management
–Antiplatelets- aspirin
–Anticoagulants
–Vein stripping and grafting
–Anti-embolic stockings
DVT- Deep Vein Thrombosis
Nursing management
1. Provide measures to avoid
prolonged immobility
–Repositioning Q2
–Provide passive ROM
–Early ambulation
DVT- Deep Vein Thrombosis
Nursing management
2. Provide skin care to prevent
the complication of leg ulcers
3. Provide anti-embolic stockings
DVT- Deep Vein Thrombosis
Nursing management
4. Administer anticoagulants as
prescribed
5. Monitor for signs of pulmonary
embolism sudden respiratory
distress
The End
Thank You!
