Adult Health I Valencia Community College

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Adult Health IValencia Community College

• Cardiovascular System
• Atherosclerosis
• Hypertension
• Developed by
• Leslie S. Lorette, RN, MSN

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Atherosclerosis

• Arteriosclerosis thickening or hardening of the
  arterial wall
• Atherosclerosis a type of arteriosclerosis,
  involves plaque formation within the arterial
  wall
• Most common cause of arterial obstruction
• High incidence of Hypertension

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Pathophysiology

• Etiology unknown
• Theories
• Platelet aggregation
• Lipid hypothesis
• Combination of both theories

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Factors Causing Arterial Injury

• Intimal Injury
• Mechanical injury
• Hypertension
• Chemical injury
• ? levels of low density lipoproteins (LDL)
• ? levels of high density lipoproteins (HDL)
• ? levels toxins in bloodstream

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Incidence Prevalence

• Peripheral Atherosclerosis
• 5 of Americans gt 60 YOA
• 25 of Americans gt 75 YOA
• Men vs. Women
• CAD less common in premenopausal women,
  postmenopausal, equal with men
• ? incidence in U.S. than other industrialized
  nations

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Assessment

• Vital Signs
• BP in both arms
• Palpate pulses
• Skin temperature, capillary refill
• Auscultate for bruits in larger arteries

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Laboratory

• Cholesterol
• lt 200 mg/dL
• High density lipoprotein (HDL)
• Low or normal level indicates ? risk for
  atherosclerosis
• Desirable level gt 35 mg/dL
• Low density lipoprotein (LDL)
• ? indicates increased risk for atherosclerosis
• Desirable level lt 100 mg/dL

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• Triglycerides
• ? with atherosclerosis
• gt 200 mg/dL indicates hypertriglyceridema
• Homocysteine
• Essential sulfur containing amino acid derived
  from dietary protein
• ? levels indicates ? risk for premature
  development of PVD and CAD (gt 15 µmo/L)
• Folic acid 1 mg/day can ? level ? risk

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Complications
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Interventions

• Diet Therapy
• ? fat cholesterol intake
• ? fruits, vegetables, whole grains, unsaturated
  fats
• Smoking Cessation
• Exercise
• Drug Therapy
• Lipitor, Zocor, Mevacor
• Questran
• Niacin

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Hypertension
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• Blood Pressure
• Tension or pressure exerted by blood against
  arterial walls
• Hypertension (HTN or HTP)
• Excess pressure in arterial portion of systemic
  circulation

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Types of Hypertension

• Essential HTN
• 90 of all cases
• No known cause
• Factors associated
• Family history
• ? Na intake
• ? calorie intake
• ? alcohol intake
• ? K intake

• Secondary HTN
• Renal Disease
• Primary aldosteronism
• Pheochromocytoma
• Cushings Disease
• Coarctation of Aorta
• Brain Tumors
• Pregnancy
• Medication

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Regulation of Blood Pressure

• Renin-Angiotensin- Aldosterone System
• Vasoconstrictor
• Inhibit Sodium excretion
• ? PVR (Essential HTN)
• Atrial Natriuretic Peptide
• Vasodilation
• Salt water excretion
• Epinephrine Norepinephrine

• Arterial Baroreceptors
• Carotid Sinus
• Mean Arterial Pressure
• Regulation of Body Fluid Volume
• Vasopressin
• Antidiuretic hormone
• Salt water excretion

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Incidence/Prevalence

• 50 million Americans, 1 in 4 adults
• ? incidence in African Americans
• ? incidence in southeastern US
• ? mortality with ? age

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Assessment

• Manifestations
• Early no symptoms
• Later vague symptoms
• headache near back of head and neck
• nocturia, confusion, nausea, vomiting, visual
  disturbances
• Eye Examination
• narrowed arterioles, hemorrhages, papilledema

• Laboratory
• None for essential HTN
• Radiographic
• None for diagnosis
• CXR, IVP, arteriogram
• EKG

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Complications of HTN

• Myocardial Infarction
• Stroke (CVA)
• Peripheral Vascular Disease
• Renal Failure
• Malignant HTN

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Malignant HTN

• Rapid ? in BP (syst. gt 200 diast. gt120)
• c/o morning HA, confusion, restlessness, blurred
  vision, papilledema, dyspnea
• Requires immediate treatment
• Treatment goal
• ? BP no gt 25 wining minutes to 2 hours, ?
  160/100 within 2-6 hours
• Sodium nitroprusside (Nipride)
• Continuous BP monitoring

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Treatment

• Education
• Life Style Modification
• Na restriction
• Weight reduction
• DASH diet
• Moderation in alcohol intake
• Exercise
• Relaxation Techniques
• Smoking Cessation

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Figure 33.2 Sites of antihypertensive drug action
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Drug Therapy

• Recommended initial therapy
• Single Drug, once-a-day
• Start with diuretic or beta-blocker
• ACE inhibitor for clients with diabetes or have
  HF or history of MI
• Considerations for selection
• Concurrent conditions
• Quality of life
• Cost
• Drug interactions

• After 1-3 months, if no chg in BP, ? dose or
  substitute for different class of
  antihypertensive
• After 1 yr of effective control ? ? dose or of
  medications

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Medications

• Diuretics
• Prevent tubular reabsorption of sodium ? H?O
  sodium excretion ? blood volume
• Thiazide (HCTZ)
• Loop (Lasix)
• K Sparing (Aldactone)
• Nursing Precautions
• Monitor K
• Hypovolemia
• Orthostatic hypotension
• Weights

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• Alpha Adrenergic Blockers
• Block alpha receptors in vascular smooth muscle
• ? vasomotor tone vasoconstriction
• Cardura, Minipress, Hytrin
• Give 1st dose at HS
• Assess BP apical pulse prior to administration

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• Beta-adrenergic Blocking Agents
• Prevent beta-receptor stimulation in the heart ?
  ? HR C.O.
• Tenormin, Corgard, Lopressor
• Not used with hx of asthma or bronchospasm
• Side Effects
• Fatigue, weakness, depression, sexual
  dysfunction, sleep disturbances
• Caution with Diabetes (? BS)
• Monitor HR for bradycardia

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• Calcium Channel Blocker
• Inhibit the flow of calcium ions across the cell
  membrane of vascular tissue cardiac cells ?
  relaxation of arterial smooth muscle, ? PVR
  through vasodilation
• Norvasc, Verapamil, Cardizem
• Give with caution if taking Digoxin or beta
  blocker
• Side Effects- ?BP, constipation
• Effective in older adults African Americans

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• ACE Inhibitors
• Prevent conversion of Angio I to Angio II
  preventing vasoconstriction water/Na retention
• Capoten, Vasotec, Prinivil, Zestril
• Assess BP WBC prior to 1st dose
• Give 1 hour prior to meal
• Side Effects
• Severe ? BP after 1st dose
• Orthostatic Hypotension
• Angioedema
• Monitor renal function
• Monitor K
• Effective in young Caucasians

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• Angiotensin II Receptor Antagonists
• Same effect as ACE inhibitor but act by blocking
  the effect of angio II on receptors
• Cozaar, Diovan, Atacand, Avapro
• Used alone or in combination
• Substitute for ACE Inhibitors or patients with
  ?K levels
• Orthostatic hypotension

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• Central Acting Sympatholytics
• Stimulate ?? receptors in CNS to suppress
  sympathetic outflow to heart blood vessels
• Catapres, Aldomet, Wytensin
• Administer at HS
• Convenient- 7 day patch (Catapres TTS)
• Contraindications
• Catapres in pregnancy
• Aldomet in clients with active liver disease

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• Vasodilators
• Relax vascular smooth muscle ? PVR
• Loniten, Apresoline,
• Used in combination with diuretic or beta-blocker
  
• Not used in mgmt of chronic HTN
• Side Effects
• Reflex tachycardia
• Fluid retention
• Orthostatic hypotension

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Nursing Diagnoses

• Ineffective Health Maintenance
• RF Noncompliance
• Imbalanced Nutrition gt body requirements
• Excess Fluid Volume

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Home Care

• Take active role in disease management
• BP monitoring
• Medication compliance
• Life style modifications
• Follow up appointments