Vascular Disorders Overview

• The presentation provides an overview of vascular disorders.

Objectives

• Describe the epidemiology of vascular disorders.
• Correlate clinical manifestations to pathophysiological processes of:
  • Atherosclerosis/arteriosclerosis
  • Hypertension
  • Peripheral arterial disease
  • Carotid artery disease
  • Aortic artery disease (aneurysms)
  • Deep vein thrombosis
  • Chronic venous insufficiency
• Describe diagnostic results used to confirm vascular disorder diagnoses.
• Discuss the interprofessional management of the above conditions.
• Develop a nursing care plan for patients with vascular disorders.
• Design a teaching plan of care that includes pharmacological, dietary, and lifestyle considerations for vascular disorder patients.

Function of the Vascular System

• Ensures adequate blood circulation to all body tissues.
• Facilitates capillary exchange between plasma, interstitial fluid, and tissue cells.
• Provides minimum blood flow per minute to support metabolic activities and waste removal.
• Disorders of the vascular system can impair tissue oxygen and nutrient delivery.

Atherosclerosis vs. Arteriosclerosis

• Arteriosclerosis and atherosclerosis are often used interchangeably but are distinct conditions.
• Arteriosclerosis refers to the thickening and hardening of arterial walls, reducing elasticity.
  • It occurs with aging and includes: Medial calcific sclerosis (calcium deposits in arteries)
  • Arteriolar sclerosis (thickening of small arterioles)
  • Atherosclerosis (LDL cholesterol buildup in arteries)
• Atherosclerosis is a type of arteriosclerosis where plaque buildup narrows arteries, increasing vascular disease risk.

Atherosclerosis Epidemiology

• Atherosclerosis often begins in childhood and worsens with age.
• Linked to conditions such as:
  • Coronary artery disease
  • Carotid artery disease
  • Hypertension
  • Abdominal aortic aneurysm (AAA)
• Risk factors include:
  • Lipid abnormalities like cholesterol mismanagement and peripheral arterial disease (PAD).
  • Hypertension causing arterial wall damage.
  • Diabetes causing arterial damage from LDL and hyperglycemia.
  • Smoking causing vasoconstriction and hypertension (HTN).
  • Family history, obesity, and inactivity affecting vascular health.
• Demographics affect men earlier than women.

Atherosclerosis Pathophysiology

• Atherosclerosis is a chronic disease where LDL cholesterol builds up in the arterial walls, leading to inflammation and plaque formation.
• The key processes are:
  • Vessel damage & inflammation: Injury to the arterial wall triggers an inflammatory response.
  • Fatty streak formation: Lipids deposit on the artery's inner lining and are oxidized by macrophages, worsening inflammation.
  • Plaque development: The artery thickens, narrowing the vessel and reducing blood flow, limiting oxygen supply.
  • Plaque rupture: Unstable plaques can break open, leading to blood clots that may block arteries or travel elsewhere, causing severe complications.

Atherosclerosis Clinical Manifestations

• Atherosclerosis may be asymptomatic until a significant artery narrowing leads to an emergency.
• Symptoms depend on the affected artery: Coronary arteries: Can 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 and lowering LDL cholesterol levels.
  • Medications:
    • Lipid-lowering medications include atorvastatin and simvastatin.
    • Anticoagulation includes apixaban and enoxaparin.
  • Lifestyle modifications:
    • Healthy diet
    • Smoking cessation
    • Exercise
    • Stress management
    • Diabetes control if applicable.
• Surgical management is reserved for severe cases (irreversible manifestations):
  • Intractable chest pain may require coronary revascularization.
  • Gangrene may require amputation.

Atherosclerosis Nursing Management

• Assessments include:
  • Dependent upon 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 identifying: LDL-C (>100 mg/dL = risk), HDL-C (<40 mg/dL = risk), and triglycerides (>150 mg/dL = risk)
  • Homocysteine levels: High levels may promote plaque buildup.
  • Hemoglobin A1c: >7% may indicate poor diabetes control, increasing risk
• Actions include:
• Administering prescribed medications per order:
  • Antihypertensives
  • 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: Reduces LDL-C, prevents endothelial damage.
  • Exercise: Lowers LDL-C, raises HDL-C, improves BP, diabetes, obesity, and stress.

Hypertension

• Hypertension is a common chronic condition affecting 47% of U.S. adults.

Hypertension Risk Factors

• Age increases BP.
• Sex shows before age 45, more common in males with, after age 65 - more common in females.

Hypertension Race

• Black adults have the highest prevalence, morbidity, and mortality from HTN.
• Socioeconomic status is more common in low-income populations.

Hypertension Types

• Primary (essential) hypertension has no identifiable medical cause.
  • Risk factors: Obesity, salt sensitivity, renin elevation and insulin resistance, Vitamin D deficiency, Smoking
• Secondary hypertension is due to an identifiable cause.
  • Renal parenchymal disease (most common), renovascular disease
  • Endocrine disorders, congenital conditions, substance related cause.

Clinical Manifestations of Hypertension

• Hypertension is often silent until it causes target organ damage.
• Symptoms may include headaches, dizziness, vision changes, chest pain, shortness of breath, fatigue, nosebleeds, and kidney dysfunction (elevated creatinine, decreased urine output).
• Secondary hypertension symptoms depend on the underlying cause like kidney disease or hormonal disorders.

Diagnosing Hypertension

• Diagnosis of hypertension occurs after two or more high BP readings across separate visits.
• Treatments may start immediately if BP is extremely high during one visit. Testing can identify target organ damage to heart, kidneys, eyes.

Hypertension Treatment

• Lifestyle changes:
  • Weight control
  • Diet
  • Alcohol limit
  • Exercise
  • Stress management
• Medications such as antihypertensives and diuretics.

Hypertension Complications

• Heart damage includes "the silent killer".
• Arterial pressure leads to left ventricular hypertrophy then heart failure.
• Kidney damage: Reduced renal blood flow leads to renin then BP then kidney cell death.
• Stroke and aneurysms can occur with high BP. High BP can lead to vessel rupture resulting in Hemorrhagic stroke and lead to aneurysm formation and potencial rupture

Hypertensive Crisis

• A severe BP spike categorized as: Hypertensive urgency: BP > 120 mm Hg diastolic without acute organ damage. Hypertensive emergency: High BP with target organ damage, this requires immediate intervention

Hypertensive Emergency Characteristics

• Hypertensive emergencies are more common in: Older adults, black individuals, and males Often due to medication withdrawal or uncontrolled chronic hypertension.

Hypertension Nursing Management

• Hypertension is a silent disease with no formal symptoms until organ damage occurs.

Hypertension Assessments:

• Physical exam includes BP monitoring. Nursing assessment includes:Neurological assessment of,S/S of stroke or aneurysm
• Blood pressure monitoring, heart rate and auscultation for bruits.

Hypertension Diagnostic Tests:

• Edema, Palpitations of extremities , and renal function tests

Hypertension Nursing Management

• Actions include: Administering antihypertensive drugs as prescribed and providing Dash Diet advice Patient Education: including Medication adherence and Lifestyle changes such as; moderate exercise Recognize signs of total organ death, and stroke

Peripheral Artery Disease Epidemiology

• Affects over 230 million people globally. Caused by Atherosclerosis Modifiable Risk Factors Include
• Stress Management
• Smoking Non Modifiable Risk Factors Include
• Age
• Sex Family History
• Ethnicity

Peripheral Artery Disease Clinical Presentation:

Often a progressive condition where large peripheral arteries become obstructed Ischemia/Tissue damage can be caused by Atherosclerosis, Inflammation, Thrombosis,Resulting in Necrosis & Reduce Oxygen /Nutrient delivery

Peripheral Artery Disease Symptoms:

Symptoms include: Asymptomatic Atypical Leg Pain: - Joint Pain Joint Pain, Gold Extremities Limitation in Mobility Decreased quality of Life

Peripheral Artery Disease Diagnosis:

Includes : - Ankle-Brachial Index using the ankle vs arm ratio to asses blood flow -- Plethysmography: Detects changes in blood flow Volume to Assess How

• Treadmill Test: is used to identify the severity of claudication -Imaging techniques also: like duplex ultra sound, CTA and MRA & Angiography used for severe Cases

Peripheral Artery Disease Treatments Include

Include Non Surgical options like smoking secession & surgical options like revacularization

Peripheral Artery Disease Complications include

• Can result Severe pad and ulcers, Critical Limb Ischemia and Acute Limb Ischemia.

Nursing management of Peripheral Artery Disease includes

Assessment of Palpation of pulse, temperatures, Color, and S/S of infection Interventions involve Educated on lifestyles changes and medication management provide proper positioning

Carotid Artery Disease Epidemiology

Carotid Artery Disease is often found in aging individuals, Men typically under 75 y/o Women over 75 y/p 3% Individuals with CAD are often 50% or more Occluded

Risk Factors For Carotid Artery Disease:

Risk factors include smoking, hypertension, diabetes, dyslipidemia & sedentary lifestyle. Non-Modifiable risk factors are Age, Sex, Family History, Ethnicity often

Carotid Artery Disease Presentation:

Often occurs because PLAQUE FORMATION creating NARROWING leading to Cerebral damage

Clinical Manifestations:

Often caused by Plaque rupture or embolism is Asymptomatic until cerebral

Diagnoses Include

• The goal is to improve the cerebral perfusion that includes and Physical is a, Bruit in the Neck
• Common medication managements: antiplatelets Aspirin, STATINS Lifestyle

Treatments for Carotid Artery Disease Include:

• Include surgical options

Treatment Goals:

include and physical exam is a Bruit in the Nect

NURSING MANAGEMENT is focused of Post Operative care

Respiratory function cranial nerve function Also maintaining Blood Pressure

Aortic Artery Disease (Aneurysms) Epidemiology

• Men are at higher risk of approx. 15,000 deaths annually in the U.S. from AAA’s
• More common in Caucasians with high Cholesterol, genetic conditions and Marfans Syndrome

Aortic Aneurysm Pathophysiology:

An Aneurysm is a localized artery dilation caused by weakening of the arterial wall

• Can be identified by using Imaging Techniques in true of false cases Ascending (Arch), Descending, Abdominal Clinical Manifestation: Asymptomatic until Complication Pulsatile abdominal mass (AAA) Diagnostic- CT Scan

Aortic Aneurysm Treatment:

Can be used with Antihypertensive, STATINS

• S/S includes Chest or Flank Pain, a Surgical

Complications-

rupture sudden Tear in the walls Aortic dissection- immediate surgery is critical Nursing Management is based of Vital and Neuro checks

Deep Vein Thrombosis Epidemiology:

A Blood Clot found in a Large Vein that affects 1 in 1 in 100 people a year Risk Factors: include Oral Contraceptives, Covid19 surgery and Immobility Typically found in a Limb or in the Pelvis

• Can cause Clots to Travel

Clinical Manifestation include:

Pathophysiology-caused Virus’s Triad Diagnostic: include, Wells, A scores d-dimer

Deep Vein Thrombosis Treatments:

• Use Ambulation- mechanical and pharmacological Intervention
• Surgical: Vena Cava Filters, Compression socks or Pneumasock

Complications of Deep Vein Thrombosis-

Pulmonary embolisms post thrombotic and

NURSING MANAGEMENT for Deep Vein Thrombosis Includes::

• Early ambulation for extremity
• Anticoagulation
• Prevent skin Breakdown

CHRONIC VENOUS INSUFFICIENCY:(CVI)

Pathophysiology: caused by Valves Incompetence affecting The Skin

CVI Treatment:

is based with symptoms- medications

• Surgically-ablation
• Diagnostics: Based on Symptoms Compression Therapy

Complications include:

• Potential Sepsis and ULCERS Nursing Management : Includes: Amputation, Wound Care
• Goals would be : Education
• Lifestyle Management