Vascular Disorders Overview

Vascular Disorders

• Vascular disorders impact the body’s circulatory system.

Objectives

• Understand vascular disorder epidemiology.
• Correlate clinical occurrences with pathophysiological processes of conditions, like atherosclerosis/arteriosclerosis, hypertension, and peripheral arterial disease.
• Other correlated conditions include, carotid artery disease, aortic artery disease (aneurysms), deep vein thrombosis, and chronic venous insufficiency.
• Describe the diagnostic procedures for vascular disorders.
• Discuss interprofessional management for atherosclerosis/arteriosclerosis, hypertension, and peripheral arterial disease.
• Management also includes carotid artery disease, aortic artery disease (aneurysms), deep vein thrombosis, and chronic venous insufficiency.
• Create a comprehensive nursing care plan for vascular disorder patients.
• Establish a teaching plan with pharmacology, diet, and lifestyle considerations.

Vascular System Functions

• It ensures adequate blood circulation to body tissues.
• It facilitates capillary exchange between plasma, interstitial fluid, and tissue cells.
• It provides minimum blood flow per minute to support metabolic activities and waste removal.
• Vascular system disorders can impair oxygen and nutrient delivery.

Atherosclerosis vs. Arteriosclerosis

• Arteriosclerosis and arteriosclerosis are often used as interchangeable, but are unique conditions.
• Arteriosclerosis involves arterial walls thickening and hardening.
  • This includes a reduction in arterial elasticity.
  • Occurs with aging.
  • Includes medial calcific sclerosis (calcium deposits in arteries).
  • It includes also an arteriolar sclerosis (thickening of small arterioles).
  • Occurs in atherosclerosis (LDL cholesterol buildup in arteries).
• Atherosclerosis is a type of arteriosclerosis.
  • Plaque buildup narrows, causing vascular disease risk.

Atherosclerosis Epidemiology

• Atherosclerosis commonly begins in childhood and worsens with age.
• Atherosclerosis is linked to conditions, such as:
  • Coronary artery disease.
  • Carotid artery disease.
  • Hypertension.
  • Abdominal Aortic Aneurysm (AAA).
• Risk factors include:
  • Lipid abnormalities.
  • Cholesterol mismanagement.
  • Peripheral Arterial Disease (PAD).
  • Hypertension, causing arterial wall damage.
  • Diabetes causes arterial damage from LDL and hyperglycemia.
  • Smoking causes vasoconstriction, and HTN.
  • Family history, obesity, and inactivity.
  • High cholesterol causes poor vascular health.
• It is demographic, affecting men earlier than women.

Atherosclerosis - Pathophysiology

• Atherosclerosis is a chronic disease.
  • LDL cholesterol builds up in arterial walls, leading to inflammation/plaque.
• Key processes:
  • Vessel damage & inflammation: Arterial wall injury triggers an inflammatory response.
  • Fatty streak formation: Lipids deposit on artery's inner lining and oxidized by Macrophages worsens inflammation.
  • Plaque development: The artery thickens, narrowing vessel and limiting blood flow/oxygen.
  • Plaque rupture: Unstable plaques may break, leading to clots blocking arteries/traveling elsewhere, creating complications.

Atherosclerosis - Clinical Manifestations

• Atherosclerosis is asymptomatic until a significant artery narrows to an emergency.
• Symptoms depend on the affected artery:
  • Coronary arteries cause chest pain (angina), shortness of breath, fatigue, arrhythmias, MI, or sudden cardiac death.
  • Carotid arteries lead to stroke, with sudden weakness(one-sided), dizziness, loss of coordination, speech difficulity, facial droop, vision problems, or severe headache.
  • Peripheral arteries limit blood flow to limbs, causing pain, difficulty to walk, and tissue death (gangrene), mostly in toes, fingers, hands, and feet.

Atherosclerosis - Management

• Medical management:
  • Focus on gaining control of risk factors.
  • Primary focus is lowering LDL cholesterol levels.
• Medications include lipid-lowering medications and anticoagulation medications.
  • Lipid-lowering types includes Atorvastatin, Simvastatin
  • Examples of anticoagulation are Apixaban, Enoxaparin.
• Lifestyle modifications involve healthy diet, smoking cessation, exercise and stress management.
• Control of diabetes is included if applicable.

Atherosclerosis - Surgical Management

• Surgical management is reserved for severe cases and irreversible manifestations. intractable chest pain, r/t coronary artery disease, requiring coronary revascularization.
• Gangrene occur, may require amputation.

Atherosclerosis - Nursing Management

• Assessments includes symptoms depending on arteries affected Patient history & cardiovascular exam identifies genetic and environmental risk factors.
• Blood pressure in both arms: Hypertension is a key risk factor. Palpation of pulses: weak pulses suggest poor circulation. Auscultation for bruit: 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 Alc: >7% may indicate poor diabetes control, increasing risk.
• Actions: Administer prescribed medications per order: anti-hypertensives or lipid lowering therapy (e.g., statins).
• Patient teaching is vital for blood pressure management: take medications as prescribed. Life style Modifications: –Healthy diet: low-fat, low-cholesterol, 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

• Common chronic condition.
• 47% of U.S. adults have HTN Risk factors include: Age, Sex, Race

Hypertension - Types and Causes

• Primary (Essential) Hypertension:
  • No identifiable medical cause.
  • Risk factors include obesity, salt sensitivity, renin elevation, resistance to insulin, Vitamin D deficiency, and smoking.
• Secondary Hypertension:
  • Due to identifiable medical causes.
    • Renal parenchymal disease.
    • Renovascular disease.
    • Endocrine disorder.
    • Congenital conditions.
    • Or substance-related causes.

Hypertension – Clinical Manifestations

• Hypertension is often silent until it causes target organ damage. Symptoms include headaches, Dizziness, and Vision Changes. Additional signs include chest pain, shortness of breath, fatigue, and nosebleeds. Renal disfunction is involved when hypertension is present, and is characterized by elevated creatinine, and decreased urine output.
• Secondary hypertension symptoms depend on the underlying cause (e.g., kidney disease, hormonal disorders).

Hypertension - Diagnosis

• Diagnosis is preformed after two or more high blood pressure readings across separate visits.
• Treatments may start immediately if blood pressure is extremely high during one visit.
• Testing can be done to identify target organ damage.
• Examinations of, heart, kidneys, and eyes are common.

Hypertension - Treatment

• Treatment includes lifestyle changes,
  • Weight control.
  • Diet.
  • Limiting alcohol.
  • Exercise.
  • Stress management.
    • Medications.
    • Antihypertensive drug table
    • Use of Diuretics

Hypertension – Complications

• Heart damage is a complication.
  • Known as the "silent killer”.
• Arterial pressure becomes Left Ventricular Hypertrophy, which later results in Heart Failure (HFREF).
• Kidney Damage results as reduced renal blood flow causes Renin, and ultimately Kidney Cell Death
• Stroke & Aneurysms are results, indicated by the risk of high blood pressure leading to Vesel Rupture (Hemorrhagic Stroke) or Aneurysm formation- leading to potential rupture.
• Hypertensive Crisis a severe BP spike categorized as:
• Hypertensive Urgency Blood pressure > 120 mm Hg diastolic without acute organ damage.
• Hypertensive Emergency. High BP with target organ damage(e.g., stroke, heart failure, or aortic dissection). Requires, immediate intervention.
• This condition is more common in:, Older adults
• Black individuals, Males, often due to medication withdrawal or uncontrolled chronic hypertension.

Hypertension – Nursing Management

• Silent disease with no formal symptoms until organ damage occurs
• Physical exam – BP monitoring
• Nursing assessment –Neurological assessment: -S/S of stroke or aneurism, -B/P Monitoring, Heart Rate increase HR to compensate for increased peripheral vascular resistance. Evaluation of auscultation and/or bruites r/t narrowed vessels.
• Palpitations of extremities
• Testing for edema/ weak pulses, kidney disease, or renal disfunction. Renal function tests are preformed with analysis of Creatinine, BUN, GFR, and 24 HR Creatinine Clearance
• Albumin Excretion Rate is performed and can be determined as early signs of cardiac conditions of the renal and/or retinal.
• BMI and waist circumference is commonly measured to evaluate obese related hypertension.
• Nursing Intervention; Administer anti-hypertensive as prescribed and educate the dietary requirements. Low in sodium and high in fruits, vegetables and low-fat dairy.
• Patient Education includes medication adherence and teaching of life style change. Encourage moderate exercise and the limit intake or stoppage of alcohol. Stress management and home B/P monitoring is essential. In addition to teaching patient to recognize signs of total organ death, stroke, and aneurysms.

Peripheral Artery Disease - Epidemiology

• PAD affects over 230 million people globally.
• Primary cause is atherosclerosis.
• Modifiable risk factors include stress, smoking, hypertension, diabetes, dyslipidemia, obesity, and physical inactivity.
• Non-modifiable risk factors include age, sex, ethnicity, and family history.
• Other risk factors, peripheral arterial disease and coronary artery disease.

Peripheral Artery Disease - Pathophysiology

• Progressive condition.
• Large peripheral arteries become obstructed, leading to ischemia/tissue damage.
• Cause by athereoclerosis, inflammation and thrombus.
• Can result in necrosis or reduced oxygen/nutrient delivery

Peripheral Arterial Disease - Clinical Manifestations

• Six Ps of ischemia is commonly related to, and includes pain, pulselessness, pallor, paralysis, paresthesia, and poikilothermia.
• Manifestation includes Asymptomatic condition, Intermittent Claudication in legs is characterized by pain, cramping during activity and relieved by rest.
• Additional manifestations of PAD may be atypical to leg pain, and include joint pain, cold extremities, limitation in movement, and decreased quality of life.

Peripheral Arterial Disease

• Diagnosis Ankle-brachial Index. ABI value of less 0.9 indicates PAD in measurement of the ankle vs. arm.
• Plethysmograph is used to measure changes of blood volume to assess blood flow Imaging.
• Treadmill test identifies the severity of claudication
• Duplex Ultrasound to measures blood flow velocity to detect lesions
• CTA scans for detailed imaging.
• Angiography is used in severe cases to decide if angioplasty and/or bypass is needed.

Peripheral Arterial Disease

• Treatment Nonsurgical
• -Weight loss, smoking cessation, and Exercise.
• Medications
• -Antihypertensives such as, Metoprolol, Losartan, and, Statins such as Atorvastatin, Simvastatin
• -Anti-pallets such as, Aspirin, Clopidogrel
• Surgical
• -Revascularization with Bypass Graft or Balloon Angioplasty.

Peripheral Arterial Disease - Complications

• Critical Limb Ischemia: Severe PAD causing ulcers, gangrene or risk of limb loss.
• Acute Limb Ischemia: Sudden loss of blood flow from an embolus or clot, requiring urgent intervention.

Nursing Management for PAD

• Assessment
• -Pulse, Temperature and Color. Review, pain, and sign of Symptoms of an infection as well as Ulcers especially in patients with diabetes.
• Interventions
• • Evaluate the need for medications. Provide limbs positioning assistance.
• Actions to improve blood flow:
• • Encourage exercise and educate on lifestyle changes.
• Teaching:
• • Foot care is essential. Instruct patient to inspect feet daily; avoid crossing legs.
• Educate patients to seek care for chest, or neurological symptoms, as soon as possible.

Carotid Artery Disease

• Carotid Artery Disease is common in aging individuals, men under 75Y/O and women over 75Y/P.
• Disease occures in 3-4% of individuals with Cardiac Arrest and are 50% or more occluded. Risk factors
• The following should monitored.
• Risk Factors
• --Smoking Hypertension Diabetes Dyslipidemia Obesity Sedentary Lifestyle

Pathophisiology of CAD

Non-Modifiable-Age, Sex, Family History and Ethnicity. The pathophysiologies: are plaque formation and narrowing arterial pathways with in the carotid arteries especially in bifurcation, with increased risk clots increases chances of stroke. The severity is dependent upon the percentage of arterial narrowing. CAD Clinical Manifestations:

• Asymptomatic until cerebral perfusion is impaired, bruit, stroke symptoms- Sudden weakness to one side, dizziness, loss of coordination, facial droop, difficulty speaking, vision problem and/or headache. Tests to diagnosis CAD:
• Physical Exam, look for bruit, non-invasion such as sonogram US in Duplex mode (Most common, can visualize in 3D views.
• CTA to measure or MRA. Invasion to examine for carotid angiography also is gold standards. Treatment to cure CAD:
• Patients who have asymptomatic disorder need lifestyle changes and drug such as asprin clopidogrel, anithypertensive is statins. Symptomatic needs medical management needs surgical intervention includes carotid endarterectomy, endarterectomy, revaculriazation and/or with higher Risk Stroke and complications.

Carotid Artery Disease Nursing

• Assessment is extremely important, check vital signs, assess the Nero function by looking for s/s of a stroke. Check for carotid artery bruits. Check for complications after post- surgery;
• The nursing plans will focus maintaining respiratory status and cranial nerve function. It can be evaluated after endarterectomy a procedure or kidney function after stent insertion, due to contract dye will be used in test.
• Interventions with assessments- Check patient assessment of the medication administered such as anti hypersensitive to lower pt load an antiplatelets, with or with out lipid lowering medication.

Aortic Artery Disease (Aneurysms)

• Approximately 15,000 annual death in the USA from AAA. Men are higher risk than women
• More common in Caucasians that other groups. The most non-modifiable risk factors: Are family history and/or age. Risks
• The most prevalent is smoking -Hypertension and Atherosclerosis
• Other risks includes: high cholesterol. Coronary artery disease. Genetic conditions.

Aortic Artery Disease (Aneurysms)

• Atherosclerosis is found R/T hypertension
• It can occur in three areas ascending (arch or abdominal) and descending (thoracic).
• Clinical manifestations of Aortic artery Disease is the patient can be in asymptomatic while developing the aneurysm and it causes for a pulsating abdominal massive tumor AAA. Patients experience back or flank pain chest.

Aortic Artery Disease (Aneurysms)

• The patho True involve all artery layers, false can cause leak.
• Tests for diagnosis includes CT or gold standards; ultra sound echo cardiogram
• Medications will be antihypertensive is or stains
• Complications of aortic dissections can cause severe pain or rupture
• Surgical is done, for larger is more symptomatic aneurysm endovascular-aneurysm Repair is less invasive, Complications include blood loose for patients rupture the medical term in the

Aortic Artery Disease (Aneurysms) Nursing

• Nursing in Management: Assess neurological functions and watch vital signs especially. BP. Listen and follow the patient with the pain of peripheral pulses and make safety during interventions is monitor drug as hypertensive’s.
• Education include recognize and dissection avoid smoking and maintain the lifestyle with patient support the reduce stress promote calm environment.

Deep Vein Thrombosis

• Formation of a blood clot in the large vein of legs for pelvis
• Typical has 1 in 1000 people per year. can cause pulmonary embolism. Risk during hospitalization, Risk factor Surgery immobility cancer pregnancy oral contraceptive's COVID19. Virchow's triad. Clinical manifestation: pain swelling redness warm Homan's sign less likely.

Management/Diagnosis

• Tests include Wells score asses risk. Imaging sonogram/ ultra sound .Venography is test as a computer imaging and/or magnetic field imaging (MRI). D. dimer a test to detect breakdown Prevention- activity promote ambulation. Pharmaological- Mechanical VTE propylaxis

Management Actions

• Compression Stockings and venous foot pumps need of administrations with patients on Heparin and/or Molecular-Weight Heparin for acute or long-term and/Warfin-Xaraltox for outpatient settings for those long the management.

• Complications Occurs When PE Clot to the lungs- respiratory distress- chess pain shock Post Thrombotic syndrome =PTS

• --Chronic leg in Vein damage Occluded in 24% -50% of VT pts

Deep Vein Thrombosis – Nursing Management

Asses symptoms-VS: extremity- welling, pain, tenderness, a sings of bleeding which can lead to bruising or petechiae. The need for Administration includes ambulations and leg Elevations and/ or anti-coagulants. •Thrombolytcs.

DVT Teaching

•Education, Prevention: Acivity, Hydration, and Avoid Prolonged Sitting orStanding. •Signs and Symptoms:Bleeding,Importance of Testing, Therapy, Safety Precautions.

Chronic Venous Insufficiency (CVI)

• Epidemiology: Progressive Condition with chronic venous disesase or venouse hypertension.
• Affect 7 million + Americans.
• Primary issues are valves, secondary causes with DVT:
• Leg pain, Lower extremity, skin discolored and thickened, lacking oxygen. With possible Narosis

Pathophysiology and Symptoms

Causes incompetent leaking valve in the veins of Legs, With issues causing increase pressure and or poor circulation. Clinical assessment: leg pain and lower extremity skin which is Discolored and thickened is or lacking in oxygen.

Chronic Venous Insufficiency

Diagnose with test a test done using the above symptoms listed dilated in a test test done using the above symptoms listed and Skin Changes, Medics - Antibiotics is there’s infection a aspirin for the information Surgical options oblation and sclerosis and micro.

Complications and Diagnosis of CVI

Tests includes compression therapy skin care exercise leg elevated nutrition •CVI complications- edema leg pain ulcers

• Pulmanory embolism and cellutes