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Ignatavicius: Medical-Surgical Nursing, 7th Edition
Chapter 38: Care of Patients with Vascular Problems
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.
Key Points - Print
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HYPERTENSION
 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.
STUDENTS- beable to recognize secondary hypertension
 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. Reduce risk of injury by
cautioning patients about sudden movement or position changes with these meds