Like this study set? Create a free account to save it.

Sign up for an account

Already have a Quizlet account? .

Create an account

Overview of alterations in the vascular system

- Disorders of arterial circulation
- Disorders of venous circulation
- Disorders of blood flow due to extravascular forces.

Disorders of arterial circulation
H. A. V. A

- Decreased blood flow to tissues, impaired delivery of oxygen and nutrients
- Hyperlipidemia
- Atherosclerosis
- Vasculitis
- Arterial disease of the extremities.

Disorders of arterial circulation: Hyperlipidemia

- abnormally elevated levels of any or all lipids and/or lipoproteins in the blood.
- Triglycerides (the main storage from of lipids)
- Phospholipids
- Cholesterol

Disorders of arterial circulation: Atherosclerosis: word origin

- from Greek words
- Athero: fatty mush or paste
- Skleros: hard

Disorders of arterial circulation: Vasculitis

- Inflammatory injury and necrosis of blood vessel wall
can be caused by
- Direct injury to vessel
- infectious agents
- Immune process
- secondary to other diseases

Disorders of arterial circulation: Arterial disease of the extremities: Type

- Atherosclerotic occlusive disease
- Aortic aneurysms

Arterial disease of the extremities Atherosclerotic occlusive disease

- Superficial femoral and popliteal arteries most affected
- most common in men in 60s and 70s

Arterial disease of the extremities Aortic Aneurysms

- Localized dilation or outpouching of arterial vessel wall
- involves damaged media layer of vessel
2 most common causes
- atherosclerosis
- degeneration of vessel media

Disorders of the venous circulation
Vv. Vsu. Vt. E

- Varicose veins
- Venous stasis ulcers
- Venous thrombosis
- Embolus

Disorders of the venous circulation: Varicose veins

- Dilated, tortuous veins of lower extremities
common causes
- age (over 50)
- Obese
- Women
- Heredity

Disorders of the venous circulation: Venous stasis Ulcers

- Usually above medial malleolus
- poorly and slowly healing ulcer

Disorders of the venous circulation: Venous thrombosis (thrombophelebitis)

- Presence of thrombus (blood clot) in vein and inflammatory response in vessel wall
- Virchow's triade
- Can occlude artery causing ischemia
- Can be dislodged, becoming thromboembolus that travels through vascular system until occluding flow in a small vascular bed

Disorders of the venous circulation: Venous thrombosis (thrombophelebitis): virchow's triade

- The three main factors in the etiology of Venous thrombosis
- stasis of blood (impaired venous blood flow)
- Increased blood coagulability (Hypercoagulability)
- Vessel wall injury

Disorders of the venous circulation: Embolus

- Bolus of matter circulating in the bloodstream
- usually a complication of heart disease
may consist of:
- dislodged thrombus
- fat
- air bubble
- amniotic fluid
- foreign body

Disorders of blood flow due to extravascular forces
Cs. Pu. Ipr.

- Compartment syndrome
- Pressure ulcers
- Increase in peripheral resistance

Disorders of blood flow due to extravascular forces:
Compartment syndrome

- Increased pressure in limited anatomic space
- impairs circulation and produces ischemic tissue injury

Disorders of blood flow due to extravascular forces:
Pressure ulcers

- Ischemic lesions of skin and underlying structures
- caused by external pressure that impairs flow of blood and lymph

Disorders of blood flow due to extravascular forces:
Increase in peripheral resistance

- The heart has to pump harder leading to hypertrophy
- leads to decreased blood supply to an area.

Conditions associated with Increased Peripheral Resistance

- Hypertension
- Presence of renal or endocrine problems

Conditions associated with Increased PR:

- Elevation of systemic blood pressure

Conditions associated with Increased PR:
Presence of renal or endocrine problems

- Hormones control vasodilation and constriction
- Kidneys control sodium excretion and extracellular fluid volume

Atherosclerosis: Definition

- Formation of fibrofatty lesions in large and medium vessels
- Marked by cholesterol-lipid-calcium deposits
- arteries become narrowed and reduce the flow of blood through the arteries.
- Leading cause of coronary artery and cerebral vascular disease.

Risk factors associated with development of atherosclerosis that cannot be changed
H. G. A. E

- Heredity
- Gender
- Age
- Ethnicity

Risk factors associated with development of atherosclerosis that can be changed
Cs. Hbp. Esl. Pi. O

- cigarette smoke
- High blood pressure
- Elevated serum levels
- Physical inactivity
- Obesity

Atherosclerosis contributing factors
D. S. Crp. H. L

- Diabetes
- Stressful lifestyle
- C-reactive protein (Protein produced by the liver)
- Homocysteine (Amino acid produced in protein catabolism)
- Lipoprotein

Atherosclerosis pathogenesis
Fs. Fap. Cl

- Fatty streaks
- Fibrous atheromatous plaque
- Complicated lesions

Atherosclerosis pathogenesis:
Fatty streaks

- Flat, yellow, lipid-filled smooth muscle cells
- enlarges by becoming thicker and slightly elevated.
- Macrophages and smooth muscle cells become distended and form foam cells
- immunologic and inflammatory changes result in progressive damage to the wall
- can be reversible

Atherosclerosis pathogenesis:
Fibrous atheromatous plaque

- Lesions of advancing atherosclerosis
- arterial wall changes initiated by chronic endothelial injury of many factors
- lesion is gray/white, elevated and protrudes into lumen of artery
- after endothelial injury, lipoproteins transport cholesterol and other lipids into arterial intima (innermost layer of the artery)

Atherosclerosis pathogenesis:
Complicated lesion

- Most dangerous
- Plaque consists of lipids within area of dead tissue
- Rigidity and hardening
- may totally or partially occlude artery

atherosclerosis: Theories of the mechanisms of development

- endothelial cell injury
- Migration of inflammatory cells
- smooth muscle cell proliferation and lipid deposition
- gradual development of the atheromatous plaque with a lipid core.

Atherosclerosis: Clinical manifestations

- Depends on vessel involved and extent of vessel obstruction
- Ischemia
- Infarction: tissue that undergoes necrosis following cessation of blood supply
- Necrosis: death of an area due to insufficient blood supply

Atherosclerosis: management
D. Dt. Sc. E. Dt

- Diagnostic
- Diet Therapy
- Smoking cessation
- Exercise
- Drug Therapy

Atherosclerosis: management:
Diagnostic: Serum lipid tests

- Cholesterol is manufactured by liver but also present in many foods
- used in synthesis of steroid hormones and to form bile salts
- Transported by combining with proteins called lipoproteins

Hd. Ld. Vld

- High-density Lipoproteins
- Low-density Lipoproteins
- Very-low-density Lipoproteins

High-density Lipoproteins (HDL)

- Carries fat away from cells to be degraded in the liver
- protects against atherosclerosis
- "good" cholesterol

Low-density Lipoproteins (LDL)

- Carries fat to cells of body
- Has an affinity for arterial walls
- "bad" cholesterol

Very-Low-density Lipoproteins (VLDL)

- Contains mostly triglycerides
- Direct correlation with heart disease is uncertain

Serum Lipid tests types
Tc. Cf. T. A. A

- Total cholesterol
- Cholesterol fractionation
- Apolipoprotein A-1
- Apolipoprotein B

Serum Lipid tests: Total Cholesterol

- Measures serum cholesterol
- normal range is 140-200mg/dl
- Considered a risk if more then 200

Serum Lipid tests:
Cholesterol Fractionation

- Measures types of cholesterol
- HDL desirable above 60mg/dl
- LDL desirable if less then 130mg

Types of fatty acids

- Saturated fats: the amount in diet is most significant factor in raising blood cholesterol
Unsaturated fats
- Monounsaturated fats lower LDL
- Polyunsaturated fats lower both LDL and HDL

Serum Lipid tests: Triglycerides

- Provides an early ID of hyperlipidemia and risk of Coronary artery disease.

Serum Lipid tests: Apolipoprotein A-1

- Primarily found in HDL
- Assesses cholesterol clearing capacity

Serum Lipid tests: Apolipoprotein B

- Assesses cholesterol depositing capacity of blood

Atherosclerosis management:
Diet Therapy

- Decrease saturated fat (8-10% of calories) and cholesterol.
- Less than 30% of total calories from fat
- visible fat - 1 tsp per meal
- only unsaturated vegetable oils
- lean meats, skim milk, no more then 3 egg yolks/week
- avoid high fat food.

Atherosclerosis management:
Smoking cessation

- Cigarette smokers have 70% greater CAD death rate then nonsmokers

Atherosclerosis management:

- Tones muscles, stimulates circulation, helps prevent obesity, promotes general feeling of well-being
- Aerobic activities especially valuable
- may increase development of collateral vessels
- may reduce amount of circulating fat and increase HDL

Atherosclerosis management:
Drug therapy
Bas. N. Fad. Hcri. Cai

- Used only if serum lipoproteins are not reduced by reasonable trial of dietary modification.
- Bile acid sequestrants
- Niacin
- Fibric acid derivatives
- HMG CoA reductase inhibitors (statins)
- Cholesterol Absorption inhibitor

Atherosclerosis management:
Drug therapy: Bile Acid Sequestrants

- Binds with bile acids in intestines
- removes LDL
- Questran and Colestid

Atherosclerosis management:
Drug therapy: Niacin

- Inhibits synthesis of VLDL and LDL.
- Increases HDL
- Nicobid, Niarcor

Atherosclerosis management:
Drug therapy: Fibric acid derivatives

- Decreases hepatic synthesis of VLDL
- Increases HDL

Atherosclerosis management:
Drug therapy: HMG CoA reductase inhibitors (statins)

- Blocks synthesis of cholesterol
- Decreases LDL
- Increases HDL
- Zocor, lipitor

Atherosclerosis management:
Drug therapy: Cholesterol Absorption Inhibitor

- Inhibits intestinal absorption of cholesterol
- Zetia

Peripheral Arterial Disease:

- Interruption of blood supply
- Slow and painful healing process
- may be compounded by other medical problems
- May appear minor but disabling when healing
- recurrence is frequent

Peripheral Arterial Disease:
Risk Factors

- Same risk factors as atherosclerosis
- Controllable: tobacco use, HTN, Obesity, Sedentary lifestyle, stress, diabetes
- uncontrollable: Age, genetics, gender, ethnicity

Peripheral Arterial Disease:
Clinical manifestations

- Intermittent claudication (leg pain): severe cramp-like pain in affected extremity(ies), usually associated with activity
- Skin may become pale, mottled and shiny in appearance
- temperature of skin is cool to cold
- Diminished to absent pulses in extremity
- Pain, ischemia, impaired function, also may be infarction and tissue necrosis

Peripheral Arterial Disease:

- Decreased blood supply
- Increased healing time
- Infection
- gangrene

Peripheral Arterial Disease:
Dt. Dt. Ctm. I/sm

- Diagnostic tests
- Drug therapy
- Conservative therapeutic management
- Invasive/surgical management

Peripheral Arterial Disease:
Management: Diagnostic tests
Dus. Abi. A

- Doppler ultrasound studies
- Ankle-brachial index
- Angiography

Doppler ultrasound studies

- Noninvasive
- evaluates blood flow in major veins and arteries

Ankle-brachial index

- used to monitor patency of bypass grafts


- x-ray with contrast dye
- can visualize blood vessels

Peripheral Arterial Disease:
Management: Drug therapy

- Analgesics- variety of drugs help relieve pain
- Antiplatelet agents: Pentoxifylline, Pletal

Antiplatlet agents: Pentoxifylline (trental)

- Improves capillary blood flow by increasing RBC flexibility and lowering blood viscosity

Antiplatlet agents: Pletal

- Inhibits platelet aggregation
- Increases vasodilation
- inhibits smooth muscle cell proliferation.

Peripheral Arterial Disease:
Management: Conservative therapeutic management

- Risk factor modification
- positioning (use gravity to your advantage)
- walking
- foot care
- nutritional therapy

Peripheral Arterial Disease:
Management: Invasive/surgical
Ptba. E. Abg. A

- Percutaneous transluminal balloon angioplasty
- Endarterectomy
- Aortofemoral bypass graft
- Amputation

Peripheral Arterial Disease:
Management: Invasive/surgical
Percutaneous transluminal balloon angioplasty

- Tries to improve blood flow by cracking plaque
- 50% chance of re-stenosis in 1 year

Peripheral Arterial Disease:
Management: Invasive/surgical

- Surgical removal of lining of the artery

Peripheral Arterial Disease:
Aortofemoral bypass graft

- replace diseased parts of arteries and veins

Peripheral Arterial Disease:

- removal of a limb or part

Essential (primary) hypertension

- Consistent elevation of systemic arterial blood pressure.
- Systolic over 140 and diastolic over 90

Essential (primary) hypertension: risk factors

- Family history
- Advancing age
- Race
- Insulin resistant and resultant hyperinsulinemia

Essential (primary) hypertension: lifestyle factors

- Contribute by interacting with risk factors
- High salt intake
- excessive calorie intake and obesity
- physical inactivity
- excessive alcohol consumption
- low intake of K
- Stress, smoking, diet high in saturated fats.

Essential (primary) hypertension: Possible pathogenesis

- several factors, hemodynamic, neural, humoral, and renal mechanisms, are thought to interact to produce long term elevations in BP.
- sympathetic nervous system activity
- kidney function (water and sodium retention)
- electrolyte composition
- cell membrane transport mechanisms
- Humoral influences

Factors influencing BP

Cardiac output
- Cardiac
- Renal fluid volume control
Systemic vascular resistance
- Sympathetic Nervous system
- Local regulation
- Humoral

Factors influencing BP: Cardiac

- Heart rate
- Inotropic state (muscle contraction strength)
- Neural
- humoral

Factors influencing BP: Renal Fluid Volume Control

- Renin-angiotensin
- Aldsterone
- Atrial natriuretic factor

Factors influencing BP: Sympathetic Nervous System

- Alpha-adrenergic receptors (vasoconstriction)
- Beta-adrenergic receptors (vasodilation)

Factors influencing BP: Local regulation

- Vasodilators: prostaglandins, EDRF
- vasoconstrictors: endothelin

Factors influencing BP: Humoral

- vasoconrictors: angiotensin, catecholamines

Essential (primary) hypertension: Clinical manifestations

- early stages often have none other than elevated BP
- Often called a "silent killer"
- symptoms secondary to effects on blood vessels or increased work of heart: fatigue, reduced activity tolerance, dizziness, palpitations, angina and dyspnea

Essential (primary) hypertension: Complications

- Cardiac complications
- CNS complications: higher risk of stroke
- renal complications: leading cause of end stage renal disease
- eye complications

Essential (primary) hypertension: Management: diagnostic studies
B. C. C. E

- BP Check
- Cholesterol levels
- Chest x-ray

Essential (primary) hypertension: Management: Pharmacologic therapy
D. A

- diuretics
- Antihypertensive medications

Essential (primary) hypertension: Management: Pharmacologic therapy:

- Enhance selective excretion of various electrolytes and water by affecting renal mechanisms for tubular secretion and reabsorption
- thiazides
- loop diuretics
- Potassium sparing diuretics

Essential (primary) hypertension: Management: Pharmacologic therapy:
Diuretics: Nursing interventions
Afs. Me. Mbp. Am. T

- Assess fluid status
- Monitor electrolytes
- Monitor BP and pulse
- Give in AM
- teach

Essential (primary) hypertension: Management: Pharmacologic therapy:
Diuretics: Thiazides

- Action increases sodium and water excretion by inhibiting sodium and chloride reabsorption in distal tubule
- hydrochlorathiazaide

Essential (primary) hypertension: Management: Pharmacologic therapy:
Diuretics: Loop diuretics

- inhibits sodium and chloride reabsorption at proximal and distal tubules and ascending loop of henle.
- Lasix

Essential (primary) hypertension: Management: Pharmacologic therapy:
Diuretics: Potassium sparing diuretics

- Causes excretion of sodium and calcium while conserving potassium and hydrogen ions
- Aldactone

Essential (primary) hypertension: Management: Pharmacologic therapy:
Antihypertensive medication

- treatment of Hypertension
- Used to lower Bp to normal levels
- Classified into groups according to site of action

Essential (primary) hypertension: Management: Pharmacologic therapy:
Antihypertensive medication: Nursing intervention

- Monitor BP
- Monitor I & O
- Monitor Weight
- Teaching

Essential (primary) hypertension: Management: Pharmacologic therapy:
Antihypertensive medication: types
Baba. Ccb. Caa. ai. aara. dasmv

- Beta-adrenergic blocking agents
- calcium channel blockers
- Central alpha agonists
- ACE inhibitors
- Alpha-adrenergic receptor antagonists
- Direct acting smooth muscle vasodilators

Essential (primary) hypertension: Management: Pharmacologic therapy:
Antihypertensive medication:
Beta-adrenergic blocking agents

- Reduces BP by antagonizing beta-adrenergic effects.
- Decrease Cardiac output and reduces sympathetic vasoconstrictor tone.
- decreases renin secretion by kidney
- Ie Inderal (propanolol)

Essential (primary) hypertension: Management: Pharmacologic therapy:
Antihypertensive medication:
Calcium channel blockers

- Inhibits transport of calcium into myocardial and vascular smooth muscle cells.
- results in inhibition of excitation-contraction coupling and subsequent contraction
- calan (verapamil)
- Procardia (nifedipine)

Essential (primary) hypertension: Management: Pharmacologic therapy:
Antihypertensive medication:
ACE (angiotension converting enzyme) inhibitors

- Prevents production of angiotension II by blocking its conversion to the active form
- results in systemic vasodilation
- vasotec (enalapril)

Essential (primary) hypertension: Management: Pharmacologic therapy:
Antihypertensive medication:
Central alpha agonists

- reduces sympathetic outflow from the CNS.
- Reduces peripheral sympathetic tone, producing vasodilation
- catapres (clonidine)

Essential (primary) hypertension: Management: Pharmacologic therapy:
Antihypertensive medication:
Alpha-adrenergic receptor antagonists

- Blocks alpha adrenergic receptors
- Results in peripheral vascular dilation
- Cardura (doxazosin)

Essential (primary) hypertension: Management: Pharmacologic therapy:
Antihypertensive medication:
Direct acting smooth muscle vasodilators

- Produces relaxation of vascular smooth muscles
- works best in combo with other HTN drugs
- Apresoline (hydralazine)

Essential (primary) hypertension: Management: Supportive treatments

- Dietary management (restriction to sodium, DASH diet)
- Weight control
- Exercise
- stress reduction
- Monitoring of BP

Essential (primary) hypertension: Management: Nursing Management

- Primary prevention
- Interventions associated with oxygenation need area
- Patient teaching.

Please allow access to your computer’s microphone to use Voice Recording.

Having trouble? Click here for help.

We can’t access your microphone!

Click the icon above to update your browser permissions and try again


Reload the page to try again!


Press Cmd-0 to reset your zoom

Press Ctrl-0 to reset your zoom

It looks like your browser might be zoomed in or out. Your browser needs to be zoomed to a normal size to record audio.

Please upgrade Flash or install Chrome
to use Voice Recording.

For more help, see our troubleshooting page.

Your microphone is muted

For help fixing this issue, see this FAQ.

Star this term

You can study starred terms together

Voice Recording