Vascular Disorders

• These notes pertain to vascular disorders.

Objectives

• Describe the epidemiology of vascular disorders.
• Relate clinical manifestations to the pathophysiology of atherosclerosis/arteriosclerosis, hypertension, peripheral arterial disease, carotid artery disease, aortic artery disease (aneurysms), deep vein thrombosis, and chronic venous insufficiency.
• Characterize diagnostic results confirming diagnoses of vascular disorders.
• Discuss interprofessional management of atherosclerosis/arteriosclerosis, hypertension, peripheral arterial disease, carotid artery disease, aortic artery disease (aneurysms), deep vein thrombosis, and chronic venous insufficiency.
• Develop comprehensive nursing care plans for patients with vascular disorders
• Design teaching plans including pharmacological, dietary, and lifestyle considerations for patients.

Vascular System Function

• Ensures proper blood flow throughout the body.
• Allows capillary exchange between plasma, interstitial fluid, and tissue cells.
• Provides sufficient blood flow to support metabolic functions and waste removal
• Vascular disorders may affect oxygen and nutrient delivery to tissues.

Atherosclerosis vs. Arteriosclerosis

• Arteriosclerosis and atherosclerosis are often used interchangeably, but they have different meanings
• Arteriosclerosis involves thickening and hardening of arterial walls, which reduces elasticity.
• Arteriosclerosis occurs with aging and involves:
  • Medial calcific sclerosis which causes calcium deposits in arteries
  • Arteriolar sclerosis which causes thickening in small arterioles
  • Atherosclerosis causes LDL cholesterol buildup in arteries
• Atherosclerosis is a type of arteriosclerosis in which plaque buildup narrows arteries, thus increasing the overall risk of vascular disease

Atherosclerosis Epidemiology

• Atherosclerosis often begins in childhood and progressively worsens with age
• Linked to conditions like coronary artery disease, carotid artery disease, hypertension, and abdominal aortic aneurysm (AAA).
• Risk factors include:
  • Lipid abnormalities like, cholesterol mismanagement, and peripheral arterial disease (PAD).
  • Hypertension causes arterial wall damage
  • Diabetes where arterial damage stems from LDL activity and hyperglycemia
  • Smoking, which causes vasoconstriction and hypertension
  • Family history, obesity, and inactivity are all risk factors that further contribute to vascular issues and health decline
• Demographics: affects men earlier than women.

Atherosclerosis Pathophysiology

• Atherosclerosis is a chronic condition involving LDL cholesterol buildup in arterial walls, leading to inflammation and plaque formation.
• Key processes include:
  • Vessel damage and inflammation where Injury to the arterial wall triggers an inflammatory response.
  • Fatty streak formation where lipids deposit on the artery's inner lining and are oxidized by macrophages, worsening inflammation.
  • Plaque development causes the artery to thicken, thereby narrowing the vessel, and reducing blood flow, limiting oxygen supply.
  • Plaque rupture occurs when unstable plaques break open, leading to blood clots that may block arteries or travel elsewhere, causing severe complications.

Atherosclerosis Clinical Manifestations

• Atherosclerosis may be asymptomatic until significant arterial narrowing leads to an emergency.
• Symptoms depend on the affected artery:
  • Coronary arteries: may cause chest pain (angina), shortness of breath, fatigue, arrhythmias, myocardial infarction (MI), or sudden cardiac death.
  • Carotid arteries: may lead to stroke, with symptoms like sudden weakness (often one-sided), dizziness, loss of coordination, speech difficulty, facial droop, vision problems, or severe headache.
  • Peripheral arteries: reduced blood flow to the limbs can cause pain, difficulty walking, and, in severe cases, tissue death (gangrene), most commonly in the toes, fingers, hands, and feet.

Atherosclerosis Management

• Medical management focuses on gaining control of risk factors, mainly lowering LDL cholesterol levels.
• Medications include:
  • Lipid-lowering medications, such as atorvastatin and simvastatin.
  • Anticoagulation with apixaban or enoxaparin.
• Lifestyle modifications include:
  • Healthy diet
  • Smoking cessation
  • Exercise
  • Stress management
  • Diabetes control (if applicable)
• Surgical management is reserved for severe cases marked by irreversible manifestations like intractable chest pain which may be related to coronary artery disease, possibly requiring coronary revascularization
• In severe cases of gangrene, amputation might be necessary.

Atherosclerosis Nursing Management

• Assessments: Symptoms depend on the affected arteries.
• Patient History & Cardiovascular Exam: Identifies genetic and environmental risk factors.
• Blood Pressure (BP) in Both Arms: Hypertension is a key risk factor.
• Palpation of Pulses: Weak pulses suggest poor circulation.
• Auscultation for Bruits: Indicates narrowed arteries but not severity.
• Fasting Lipid Profile:
  • LDL-C (>100 mg/dL = Risk)
  • HDL-C (<40 mg/dL = Risk)
  • Triglycerides (>150 mg/dL = Risk)
• Homocysteine Levels: High levels may promote plaque buildup.
• Hemoglobin A1c: >7% may indicate poor diabetes control, increasing risk.
• Actions:
  • Administer prescribed medications per order, including antihypertensives and lipid-lowering therapy (e.g., statins).
  • Patient Teaching: Blood pressure management, take medications as prescribed.
• Lifestyle Modifications:
  • Healthy diet that is low-fat, low-cholesterol, and high in B-complex vitamins.
  • Smoking cessation, which reduces LDL-C and prevents endothelial damage.
  • Exercise lowers LDL-C, raises HDL-C, and improves BP, diabetes, obesity, and stress.

Hypertension

• Common chronic condition: 47% of adults in U.S. have hypertension.
• Risk Factors:
  • Age: BP increases with age.
  • Sex-related: Before age 45, more common in males, after age 65, more common in females.
  • Race: Black adults have the highest prevalence, morbidity, and mortality from hypertension.
  • Socioeconomic Status: More common in low-income populations.

Hypertension Types

• Primary (Essential) Hypertension has no identifiable medical cause, with risk factors like obesity, salt sensitivity, renin elevation and insulin resistance, vitamin D deficiency, and smoking.
• Secondary Hypertension is caused by an identifiable factor, such as renal parenchymal disease (most common), renovascular disease, endocrine disorders, congenital conditions, or substance use.

Hypertension Clinical Manifestations

• Hypertension is often silent until it causes target organ damage.
• Symptoms may include:
  • Headaches, dizziness, vision changes
  • Chest pain, shortness of breath
  • Fatigue and nosebleeds
  • Kidney dysfunction, indicated by elevated creatinine and decreased urine output
  • Secondary hypertension symptoms depend on underlying cause, such as kidney disease or hormonal disorders.

Hypertension Diagnosis

• Diagnosed after two or more high BP readings across separate visits.
• Treatments may start immediately if BP is extremely high on one visit.
• Testing to identify target organ damage includes assessing the heart, kidneys, and eyes.

Hypertension Treatment

• Includes lifestyle changes and medications.
• Lifestyle changes include:
  • Weight control
  • A healthy diet
  • Limiting alcohol
  • Regular exercise
  • Stress management
• Medications:
  • Antihypertensives
  • Diuretics

Hypertension Complications

• Heart Damage:"The silent killer.” Arterial pressure that leads to Left Ventricular Hypertrophy (LVH) can also ultimately lead to Heart Failure.
• Kidney Damage: Reduced renal blood flow triggers the renin-angiotensin system, increasing BP and causing kidney cell death.
• Stroke & Aneurysms: High BP can cause vessel rupture (hemorrhagic stroke) or aneurysm formation and potential rupture.
• Hypertensive Crisis: a severe BP spike that can be categorized as: Hypertensive Urgency: BP ≥120 mm Hg diastolic without acute organ damage. Hypertensive Emergency: high BP, with target organ damage such as stroke, heart failure, or aortic dissection. Requiring immediate intervention, this condition is more common in older adults, Black individuals, and males. It is often due to medication withdrawal or uncontrolled chronic hypertension.

Hypertension Nursing Management

• Assess for "silent disease," there are no formal symptoms until organ damage occurs. Perform a physical exam that includes BP monitoring.
• Nursing Assessment:
  • Neurological assessment to detect signs/symptoms of stroke or aneurysm.
  • B/P monitoring-Blood Pressure is Key
  • Check heart rate, increased heart rate, compensates for increased peripheral vascular resistance
  • Check auscultation of bruits r/t narrowed vessels
• Nursing Management : Extemities
• Includes Early detection and lifestyle changes
• Early signs are Palpitations of Edema/ Weak pulses
• Check Kidney Disease or HF
• Perform Tests for renal functions
• Check Creatinine Levels, GFR, and kidney levels
• Check BMI and waist to indicate hypertension relating to increased Obesity/Bodyweight
• Management will be through administration of antihypertensives in addition to lifestyle alterations

PAD (Peripheral Artery Disease) Epidemiology

• Globally affects over 230 million people with a primary cause of Atherosclerosis that is Modifiable versus Non-Modifiable. The Modifiable risk factors consist of of Stress Management/ Smoking/ and Hypertension, Diabetes plus Lipidemia and Obesity with physical inactivity. Unlike the Modifiable the Non-modifiable is more family, hereditary related, Consisting of Age/ Sex/ Ethnicity- with a family history of Peripheral or Coronary Disease.

PAD (Peripheral Artery Disease) Pathophysiology

• PAD begins as progressive condition -in the Large Arteries
• Arteries can become Obstructed via tissue damage, then Ischemia takes over The Causes can be from Atherosclerosis and thrombus Ischemic resulting in Necrosis = Reduce oxygen to nutrient delivery/supple

PAD (Peripheral Artery Disease) Clinical Manifestations & Treatment

• It ranges from being Asymptomatic/Intermitted with Claudication and or Atypical leg pain
• Diagnosed best via Treadmill to identify claudication with Ankle Brachial(ABI)> where <0.5 is indicitive PAD The Treatment aims to Revasculize -or Nonsurgical intervention Surgical- Angioplasty or Bypass Graft -to save the limb

Peripheral Artery Disease(PAD)- Complications & Nursing Interventions

• Leads to Critical Limb Ischemia- causing risk and Loss of limb. Results in Sudden(ALI)& Chronic limb Pain and reduction if blood Flow- requiring emergent intervention. Check Pulps -Temperatures with a Pain Assessment plus S/S (Signs/Symptoms ) to infection and look or assess for ulcers. To Promote Blood flow -Positioning legs up higher where indicated, as well as limb assessment and Med Administration

Carotid Artery Disease

• Non-Modifiable Risk is mostly AGE. Commonly found found found in aging individuals with occlusion by 50% in those > 75 Y/O Stroke + Carotid Bruct are present/ noted- so physical is important Diagnosis best by physical exam as we assess pulse and ultrasound(duplex) for CTA/MBA. The aim with interventions is to increase tissue perfusion within brain - so assess patient and give proper education for s/s and risk after procedure. Surgical is the treatment- via extraction or stent placement. Post surgery monitor neurologic signs with B/P especially for contrast-dyes used Remember s/s post surgery and risk for stroke/hemorrhage is High

Aortic Artery Disease (Aneurysms)

• Aortic disease can be deadly if ruptured due to increased pressure via weakened arterial walls.
• Aneurysm can present in 3 main section of the aorta (Ascending Arch and Abdominal sections) and can either be TRUE if affecting 3 layers or False- if less than 3 layers - that also affect each other. As a result there can be massive blood loss or death. Risks include H. Cholesterol/ HTN and some genetics may promote- so know your risk in advance. There are 15 K DEATHS annually with individuals <75 Treatments Monitor- Vitals S/S with special note to neurologically Educate how to avoid/Recognize s/s of ruptured or distention to protect themselves Intervention- is to mediate and stabilize the area. Provide calm environment to decrease any increase with BP. Surgery may be needed

Deep Vein Thrombosis (DVT)

• Blood clot that blocks flow and may travel to lungs- where one out of the 1,000 may get/develop 1 Occurs in the Legs, where clot travels and blocks lungs- which is dangerous There are more individuals/ instances where individuals who are admitted into hospitals due to increase risk from risk factors. Risks include Age/Cancer/Surgery/ Immobility plus Pregnancy and birth control.

Deep Vein Thrombosis Pathophysiology

• As a result of having DVT- the s/ s (Virchow triad are stasis/bloodclots injuries and hypercoagulation)
• Signs can look to some degree as swelling with calf area in addition to being warm to touch or red color. Homans calf test is no longer indicator But to diagnose- with ultrasound and test the D-dimer test for for FDP which is good test but not 100 to test risk Interventions can include medications- and or prophylaxis. Elevate limbs and use -compression therapy- while in bed. Anticoagulant/Thrombolytic meds given

DVT Complications Pt Education

• After DVT- watch, assess and prevent pulmonary embolism in these clients. Watch + assess for -PE PTS- watch for post thrombolytic syndromes and damage in these patients Teach well patient -To s/s -of PE that may develop post

Chronic Venous Insufficiency (CVI)

• Progressive condition from venous disease - Affects approximately 6-7 million in U.S . From venous hypertension Results from damage from Veins in Legs and or valves do not function leading to pooling blood Signs include blood pooling increased pressure and poor circulation because of leg volume Can lead to more issues to leg- and possibly -necrosis Treatments - Compression is key, Skin / Wounds. Surgeries depending on situation. - Elevation is vital Encourage walking and education to increase healthy habits.