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Ignatavicius: Medical-Surgical Nursing, 7th Edition
Chapter 38: Care of Patients with Vascular Problems
Key Points - Print
ARTERIOSCLEROSIS AND ATHEROSCLEROSIS
 With peripheral blood vessel disease or damage, arterial blood flow is impaired, resulting in
ischemia and necrosis, or cell death.
 Arteriosclerosis is a thickening, or hardening, of the arterial wall that is often associated with
aging.
 Atherosclerosis involves the formation of plaque within the arterial wall and is the leading
contributor to cardiovascular disease.
o Through the process of cellular proliferation, collagen migrates over the fatty
streak forming a fibrous plaque.
o Plaques are either stable or unstable. Unstable plaques are prone to rupture and
are often clinically silent until they rupture.
 Factors such as abnormal lipid levels, injuries from toxins, genetic predisposition, and
diabetes have a major effect on the development of atherosclerosis.
 The assessment of a patient with atherosclerosis includes a complete cardiovascular
assessment because associated heart disease is often present.
 People with multiple risk factors are grouped into high-risk patient categories termed
“coronary heart disease equivalents.” These groups include:
o Patients with diabetes but without signs of vascular disease
o Patients with a Framingham Heart Study 10-year absolute risk score of over 20%
for coronary heart disease events
o Patients identified with multiple metabolic risk factors
o People within these groups are at the same risk level as those who already have
vascular disease.
 Interventions for patients with atherosclerosis or those at high risk for the disease focus on
lifestyle changes of avoiding or minimizing modifiable risk factors.
 Assess the patient for modifiable and nonmodifiable risk factors for vascular disease, and
teach health promotion behaviors to the patient and family.
o Pay particular attention to the patient with a family history of cardiovascular
disease.
 Modifiable risk factors are those that can be changed or controlled by the patient, such as
smoking, weight management, and exercise.
 Remember that risk factors such as smoking increase the pathophysiologic process of
atherosclerosis.
 In collaboration with the nutritionist, patients should be taught to incorporate healthy eating to
lower cholesterol and saturated fats, and increase fresh fruits, vegetables, and fiber in the diet.
 Those that do not respond adequately to dietary intervention may be prescribed one or more
lipid-lowering agents depending on serum lipid levels.
HYPERTENSION
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Key Points - Print
38-2
 Hypertension is a systolic blood pressure greater than or equal to 140 mm Hg and/or a
diastolic blood pressure greater than or equal to 90 mm Hg.
 Essential hypertension is called primary hypertension and is not caused by another health
problem or drug.
 Secondary, or nonessential, hypertension is caused by other health problems or drug therapy.
 The classification for “normal” adult blood pressure is less than 120 mm Hg systolic and
less than 80 mm Hg diastolic.
 Adults with a blood pressure of 120 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic are
now classified as pre-hypertensive.
 Recall the classifications for hypertension to identify patients who are prehypertensive and
those that need referral to a health care provider.
 Malignant hypertension is severe elevated blood pressure that rapidly progresses.
 A person with this health problem usually has symptoms such as morning headaches, blurred
vision, and dyspnea and/or symptoms of uremia.
 Delayed treatment may lead to renal failure, left ventricular failure, or stroke.
 Hypertension is essential or primary most of the time.
 Isolated systolic hypertension is a major health threat, especially for older adults.
o As people age, the systolic blood pressure becomes more significant because it is
a better indicator than the diastolic blood pressure for risk of heart disease and
stroke.
o Diastolic blood pressure rises until age 55 years and then declines, whereas
systolic blood pressure continues to rise.
o Isolated systolic hypertension is defined as a systolic blood pressure reading at or
above 140 with a diastolic blood pressure below 90.
o Research demonstrates a significant association between isolated systolic
hypertension and peripheral vascular disease.
 Risk factors include age greater than 60, family history, excessive calorie consumption,
physical inactivity, excessive alcohol intake, hyperlipidemia, African-American ethnicity,
high intake of salt or caffeine, obesity, smoking, and stress.
 The higher the patient’s blood pressure is, the greater the chance for coronary, cerebral, renal,
and peripheral vascular disease.
 Control of hypertension has resulted in major decreases in cardiovascular morbidity and
mortality.
 The proposed Healthy People 2020 campaign includes a number of objectives related to
hypertension to decrease cardiovascular mortality.
 Specific disease states and medications, such as renal disease, can increase a person’s
susceptibility to hypertension. This is called secondary hypertension.
 Lifestyle changes are the foundation of hypertension control, but if unsuccessful,
antihypertensive drugs are used.
 Diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin II
receptor antagonists, and aldosterone receptor antagonists are used.
 A newer calcium channel blocker, clevidipine butyrate, is available only in IV form and must
be administered using an infusion pump.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Key Points - Print
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o This drug is indicated when oral therapy is not possible, and is most commonly
used for hypertensive urgency or severe hypertension.
Patients who are prehypertensive may also benefit from low-dose daily aspirin.
Once-a-day drug therapy is best, especially for the older adult, because the more doses
required each day, the higher the risk that a patient will not follow the treatment regimen.
Some patients have also had success with biofeedback, meditation, and acupuncture as part of
their overall management plan.
To reduce the risk of injury, caution patients about sudden movement or position changes
when taking antihypertensive drugs.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.