# Study Notes: Vascular Disorders and Hypertension ## Hypertension (HTN) ### Types of Hypertension 1. **Primary Hypertension (Essential Hypertension)** - Accounts for 90-95% of cases. - No identifiable cause; develops gradually over time. - Risk factors include genetics, lifestyle, and environmental factors. 2. **Secondary Hypertension** - Caused by an identifiable underlying condition (e.g., kidney disease, sleep apnea, or certain medications like NSAIDs). - Can often be corrected if the root cause is treated. 3. **Elevated Hypertension** - Blood pressure (BP) readings: - Systolic: 120-129 mmHg - Diastolic: <80 mmHg - Not treated with medication but requires lifestyle changes to prevent progression. 4. **Hypertension Stage 1** - BP readings: - Systolic: 130-139 mmHg - Diastolic: 80-89 mmHg 5. **Hypertension Stage 2** - BP readings: - Systolic: ≥140 mmHg - Diastolic: ≥90 mmHg 6. **Hypertensive Crisis** - **Urgency**: BP rises over hours or days without target organ damage. - **Emergency**: Sudden, severe BP elevation with evidence of target organ damage (e.g., heart failure, renal failure, or stroke). - Symptoms: Confusion, headache, nausea, vomiting, seizures, coma, and papilledema (swelling around the eyes). Hypertensive emergencies require immediate medical intervention to prevent life-threatening complications. --- ### Symptoms of Hypertension - Often called the "silent killer" because it is asymptomatic until target organ damage occurs. - Common symptoms (if present): - Fatigue - Dizziness - Palpitations - Dyspnea (shortness of breath) - Angina (chest pain) Target organ damage includes damage to the heart, kidneys, eyes, and brain. --- ### Risk Factors for Hypertension - **Modifiable**: - Smoking - High sodium intake - Obesity - Sedentary lifestyle - Excessive alcohol consumption - Stress - **Non-Modifiable**: - Age - Family history - Gender (higher risk in men until age 65, then higher in women) --- ### Lifestyle Modifications for Hypertension - **Dietary Approaches to Stop Hypertension (DASH Diet)**: - High in fruits, vegetables, and whole grains. - Low in saturated fats, cholesterol, and sodium. - **Other Recommendations**: - Weight reduction. - Regular physical activity (30-45 minutes/day, 3-5 days a week). - Stress management techniques. - Avoid tobacco and limit alcohol intake. For a patient with hypertension, reducing sodium intake to less than 2,300 mg/day can significantly lower BP. --- ## Peripheral Artery Disease (PAD) ### Overview - Progressive narrowing and degeneration of arteries in the upper and lower extremities. - Most commonly caused by **atherosclerosis** (plaque buildup in arteries). --- ### Symptoms of PAD - **Intermittent Claudication**: - Cramping or aching pain in the calves, thighs, or buttocks during activity, relieved by rest. - **Other Signs**: - Shiny, tight skin on lower legs. - Hair loss on legs. - Diminished or absent pulses in the ankles and feet. - Cool, pale, or cyanotic extremities. Do not confuse PAD symptoms with general muscle fatigue or arthritis. PAD pain is activity-induced and relieved by rest. --- ### Risk Factors for PAD - **Major Risk Factors**: - Tobacco use - Uncontrolled hypertension - Hyperlipidemia - Diabetes - **Additional Risk Factors**: - Elevated C-reactive protein (CRP) - High triglycerides - Sedentary lifestyle - Family history - Stress --- ### Nursing Interventions for PAD - **Assessment**: - Check pulses, pain, color, temperature, and capillary refill every 4 hours. - Report any loss of pulses or changes in extremity color (e.g., pale or cyanotic). - **Positioning**: - Keep extremities dependent (dangling) to improve blood flow. - Avoid crossing legs or placing pillows under knees. - **Skin Care**: - Provide meticulous daily care to prevent ulcers. - Use light blankets to keep skin warm. - **Exercise Therapy**: - Encourage walking to the point of claudication, resting, and then resuming. NEVER apply direct heat to the affected extremity, as it can cause burns due to reduced sensation. --- ### Treatment Options for PAD 1. **Medications**: - Antiplatelet agents (e.g., aspirin, clopidogrel). - Statins to lower cholesterol. - Cilostazol or pentoxifylline for intermittent claudication. 2. **Procedures**: - Percutaneous transluminal balloon angioplasty. - Stent placement. - Atherectomy (plaque removal). - Cryoplasty (uses gases to cool the area). 3. **Surgical Interventions**: - Endarterectomy (removal of plaque). - Peripheral artery bypass. - Amputation (in severe cases). After a popliteal bypass, assess the extremity for color, temperature, capillary refill, and pulses. Report any increase in pain or numbness immediately. --- ## Hypertensive Crisis and Target Organ Damage ### Target Organ Damage - **Heart**: Heart failure, myocardial infarction (MI). - **Brain**: Stroke, hypertensive encephalopathy. - **Kidneys**: Chronic kidney disease, end-stage renal disease. - **Eyes**: Retinal damage, papilledema. Damage to the retina is often an early indicator of hypertension-related complications. --- ### Symptoms of Hypertensive Crisis - Severe headache. - Nausea and vomiting. - Confusion or altered mental status. - Seizures or coma (in severe cases). - Swelling around the eyes (papilledema). --- ## Venous Disorders ### Phlebitis - **Definition**: Inflammation of the walls of small veins, often due to IV catheter use. - **Symptoms**: Redness, pain, warmth, edema, and a palpable cord. - **Treatment**: - Remove the IV catheter. - Elevate the affected limb. - Apply heat. - Use oral or topical NSAIDs. --- ### Venous Thrombosis - **Definition**: Formation of a blood clot in a vein, which can lead to embolism if the clot detaches. - **Risk Factors**: - Immobility (e.g., long trips, bed rest). - Obesity. - Pregnancy. - Heart failure. Do not confuse venous thrombosis with superficial vein thrombosis, which occurs at the skin level and is less severe. --- ## Key Takeaways - Hypertension is often asymptomatic but can lead to severe complications if untreated. - Lifestyle changes, such as the DASH diet and regular exercise, are critical for managing hypertension. - PAD is primarily caused by atherosclerosis and requires a combination of lifestyle changes, medications, and possibly surgical interventions. - Hypertensive crises and venous disorders require prompt recognition and management to prevent life-threatening complications. Regular monitoring of BP and early intervention can significantly reduce the risk of target organ damage.