Vascular disease

• arteriosclerosis: thickening or hardening of the arterial wall that is often associated with age
• risk factors for arteriosclerosis: high cholesterol, high triglycerides, high LDLs, low HDLs, DM, smoking, HTN, obesity, sedentary lifestyle, vessel damage, inflammatory response, hard thick vessels, and formation of plaques
• consequences of arteriosclerosis: HTN, carotid artery disease, PVD, renal failure, CAD, CVA, PAD
• HTN: the silent killer - headaches, chest pain/myocardial hypertrophy, vision changes/blindness, SOB, renal dysfunction or failure, dizziness, fatigue, nosebleeds
• primary HTN (essential): no secondary cause for high blood pressure
• major risk factors for secondary HTN (something is causing it): cigarette smoking, obesity (BMI above 30), physical inactivity, excessive alcohol use, diet, stress, dyslipidemia, DM, age (older than 55 or men and 65 for females), family history of premature cardiovascular disease
• hypertensive crisis over 180 systolic and/or 120 diastolic sustained
• bring blood pressure down slowly due to risk of heart attack and stroke in a hypertensive crisis
• goal for HTN: patient will have a blood pressure of 120 systolic or less and 80 diastolic or less
• independent interventions: education (lifestyle modifications, smoking cessation, weight reduction, DASH diet , 1600mg sodium restriction, monitoring BP at home, stress reduction coping methods)
• DASH diet: 1600 mg sodium restriction, high in fruits and vegetables, high in potassium
• collaborative interventions: medications (HTZ, lisinopril)
• DVT risks: increased age, active cancer (cancer makes you hyper coagulable), varicose veins, prior venous thrombosis, pregnancy or postpartum, oral contraceptive or hormone therapy (estrogen), immobility
• DVT patho: virchow's triad - decreased flow rate of blood (stasis), damage to blood vessel wall (endothelial injury), and increased tendency to clot (hyper coagulability)
• assessment for DVT: pain, swelling, tenderness, discoloration, redness, warmth, positive homans sign (not definitive), vital signs, assess extremities, compare right and left extremity circumference, gentle palpation, signs of bleeding, sudden chest pain (PE), neuro assessment
• independent interventions for DVT: early ambulation (**), leg elevation, compression stockings (on both legs), AVOID SCDs on affected limb, encourage adequate fluid intake, administer medications as ordered
• collaborative interventions: lab testing, D-dimer (checking for clots), PT/INR (if on warfarin), PTT (if on heparin), medications (anticoagulants)
• priority for sudden sharp pain, SOB, and diaphoretic?

  sit patient up in a wheelchair, then assess oxygen level and apply oxygen (if below 88%), then take vital signs, THEN notify provider
• education interventions for DVT: prevention of reoccurrence, signs and symptoms of bleeding, compliance with regular lab monitoring, and safety precautions
• key points:

  if the patient has atherosclerosis in one area other areas are at a risk

  anticoagulants and antiplatelets put the patient at risk for bleeding
• atherosclerosis is the narrowing of an artery due to plaque build up and is a TYPE of arteriosclerosis