jcmendiola_Achievers2013

Care of Clients with Problems In Oxygenation,

Fluids and Electrolytes, Metabolism and Endocrine
(NCM103)
Cardiovascular System: Hypertension, Peripheral Disorders

Hypertension (HTN)
Persistent elevation of Blood Pressure
To be considered HTN:
Has to be taken twice from initial up to 3
rd
week
Has to be taken by a health care provider
Systolic Pressure > 140 mm Hg; Diastolic Pressure > 90 mm Hg

Classification of Blood Pressure for Adults
Classification Systolic BP (mm Hg) Diastolic BP (mm Hg)
Normal < 120 < 80
Prehypertension 120 139 80 89
Stage 1 Hypertension 140 159 90 99
Stage 2 Hypertension > 160 > 100

Diagnostic Procedure
For Prehypertension Get a Check Up once every 6 months

Types of Hypertension
1. Primary Hypertension
o 90% - 95%
o Unknown cause
NOT CURABLE, But CONTROLLABLE
Not associated with any possible cause! (Idiopathic)
2. Secondary Hypertension
o 5% - 10%
o Related to known cause
1. Pregnancy Induced Hypertension (PIH)
2. Kidney Disorders
3. Liver Disorders

Risk Factors (Vasoconstriction!!)
1. Dyslipidemia (Abnormal blood fat levels)
2. Obesity Associated with
Atherosclerosis
3. Diabetes Mellitus
4. Sedentary Lifestyle
Causes:
1. Sympathetic Nervous System Activity
2. Renal Reabsorption of Na, Cl and H
2
O
3. Activity of Renin-Angiotensin-Aldosterone
4. Vasodilation
5. Resistance to insulin action

Topics Discussed Here Are:
1. Hypertension
2. Buergers Disease
3. Raynauds Disease
4. Aneurysm
Thoracic
Abdominal
5. Phlebitis
6. Thrombophlebitis/Phlebothrombosis
7. Varicose Veins
LOOKY
HERE
Most Important is the DIASTOLIC Reading
Because it is the ventricular relaxation

Rule of Thumb!
Age + 100 = Systole!
NONE = Diastole XD
Caused by STIMULATION of
Sympathetic Nervous System usually by STRESS!!

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Clinical Manifestation
SILENT KILLER
They dont present clinical manifestations!
ONLY BP
Nuxial pain / rigidity
Morning frontal lobe head ache
Dizziness
Chest pain

Management
Non-Pharmacologic Management
Lifestyle Changes
1. Weight Reduction Maintain normal body weight
2. Adopt DASH (Dietary Approaches to Stop Hypertension)
Diet rich in fruits, vegetables, low at dairy products and reduced saturated and total fat
3. Dietary Sodium Reduction
2.4 g 6 g Na
4. Physical Activity
Regulates aerobic physical activity as brisk walking (30 mins)
5. Moderation of alcohol intake
No more than 2 drinks per day (24 oz beer, 10 oz wine, 3 oz 80% whisky)

Pharmacologic Management
Initial medications
Diuretics, Beta Blockers / Both
Initially LOW DOSE
If BP does not fall to less than 140/90 mm Hg
Dose gradually increased and additional medications are given
If diuretics are discontinued
Can cause REBOUND HYPERTENSION ( BP MUCH HIGHER THAN BEFORE)
So, drugs SHOULD be GRADUALLY decreased
Side Effect of Anti Hypertension
ORTHOSTATIC HYPOTENSION / POSTURAL HYPOTENSION
To Prevent Orthostatic Hypotension
Take medications at NIGHT (Before Sleep)
Take in the morning (Lie in bed for 20 30 mins before continuing ADLs)
Dont stay too long under the SUN!
Dont take a bath with WARM water, but with LUKEWARM water

Peripheral Disorders
1. Buergers Disease
- Thromboangitis Obliterans (Other name XD)
Presence of Blood Clot + Inflammation of Artery
Affected: Blood Vessels of LOWER EXTREMITIES
- More common among males
- Cause:
SMOKING Most common
` Nicotine causes VASOCONSTRICTION and VISCOSITY of Blood
O Can cause CLOT FORMATION
O Blood FLOW to LOWER EXTREMITIES
- Manifestations:
1. Temperature
2. Paleness / Pallor
3. Cyanosis (Peripheral)

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4. Heaviness (Numbness) Due to poor healing process, lack of blood supply
5. Pain at the calf muscles
` Intermittent Claudication (WARNING)
O Pain is experienced while walking or standing for a long time
O Pain is relieved by rest
6. Trophic Changes
` Skin is STRETCHABLE / SHINY
` Decrease growth of hair
` Sole of patient is very THICK
` Clubbing of toenails
- Plan of Care
1. Preventive Measures
^ STOP SMOKING
^ DO NOT SMOKE
2. Perform Leg Exercises
^ Buerger-Allen Exercise
; Fix on bed, lower extremities elevate 45 (for 30 60 secs)
; Sit on edge of the bed, dangle legs (for 30 60 secs)
; Go back to bed, but legs are now flat (for 30 60 secs)
^ To improve the circulation on the lower extremities
^ To further enhance blood flow, ask patient to WIGGLE the toes
^ Put blanket / top sheet on top of legs to promote vasodilation
3. Care of the Foot (Podiatrist)
^ Dont walk BAREFOOT to prevent wound formation and gangrene
formation
^ PUT ON SOCKS
^ Buy a pair of shoes on the afternoon, because feet are LARGER in the
afternoon
^ Buy 1 size bigger
^ Get a basin with lukewarm water, liquid soap/baby oil then immerse
feet for 15 30 mins, get pumice stone / face towel / loofa then wipe
off outer layers of the skin
^ If Gangrene has formed AMPUTATION

2. Raynauds Disease
o Counterpart of Buergers Disease
The UPPER EXTREMITIES are AFFECTED
o Not common in the Philippines
o Brought about by:
STRESS and COLD

3. Aneurysm
- A localized sac / dilatation formed at weak points on the wall of the arteries

Types of Aneurysms
a. Thoracic Aortic Aneurysm
a. Incidence = More in men (40 70 y/o)
b. Cause 85% due to atherosclerosis
c. Clinical Manifestations: Some may be ASYMPTOMATIC
1. Pain
- Constant and Boring
- Occurs when patient is SUPINE
2. Dyspnea (SOB)
3. Coughing
4. Stridor

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5. Compression on Larynx
- Changes in voice, absence of or total absence of
voice
6. Compression on Esophagus: Dysphagia~
d. Diagnostic Tests
Chest X-Rays
TEE
Management:
; SURGERY
b. Abdominal Aortic Aneurysm
Cause:
Atherosclerosis
Congenital Weakness
Trauma
Clinical Manifestations:
40% have symptoms
Feels their heart beat in the abdomen when lying or abdominal
mass / throbbing
Assessment Findings
Palpate abdomen, can feel a PULSATING mass
Pulsating mass at the MIDDLE and UPPER ABDOMEN
Systemic bruit over the mass THRU AUSCULTATION
Diagnostic Findings:
Ultrasonography
CT Scan
Management:
Pharmacologic Therapy
a. Anti-Hypertensive Drugs
b. Diuretics
c. Beta Blockers
d. ACE Inhibitors
e. Ca
+
Channel Blockers
Prevent RUPTURE OF ANEURYSM!!
- Surgery
o Treatment of Choice
For more than 5.5 cm big (2 inches)
Involves:
Resection of vessel
Endovascular grafting Transluminal placement and
attachment of sutureless aortic graft prostheses

Phlebitis, Thrombophlebitis, Phlebothrombosis

Phlebitis
Definition: Inflammation of the vein
Causes:
1. Prolonged intravenous therapy (2 3 weeks)
2. Prolonged intravenous therapy of HIGHLY IRRITATING drugs
Local Manifestations:
Redness (Rubor)
Heat (Calor)
Pain (Dolor)
Swelling (Tumor)
Systemic Manifestations:
Fever
Level of WBC

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Lower Extremity
Heart
Congestion
Stretch/Dilate
Varicosities
Will turn into
REDDISH or
BLUISH color
Heart
Legs
Artery
Vein
(Valves)
VEIN YAN NA
MAY VALVE LOL
Brought About By:
1. Needle out of place
2. Inflamed Vein
a. Notify Physician
b. Remove IV
c. Apply PRESSURE with COLD COMPRESS!

Thrombophlebitis / Phlebothrombosis
Common cause: Blood Clot (Thrombus)
Definition:
o Thrombophlebitis Blood Clot + Inflammation of Veins
o Phlebothrombosis Blood Clot + with or without inflammation of veins
Important Nursing Responsibilities
1. NEVER Massage affected part
a. Embolus Moving Blood Clot
b. Thrombus Non-moving Blood Clot
2. NEVER Apply HOT Compress
- Deep Vein Thrombosis (DVT)
Legs are swollen
Pain
Keep patient on rest
Apply elastic bandage
Anti-coagulants

Varicose Veins
- Dilation of veins
- Saphenous Vein Most common to dilate
At the Lower Extremities




- Causes: Prolonged standing
- Presence of:
Bluish/Reddish
Heat
Heaviness / Numbness
Cramping sensation
- Diagnostic Test
Trendelenburg Test
+ Draining of blood on lower extremities
+ Then stand, observe Saphenous veins how they fill up
1. Gradually = (-) Trendelenburg Test; (-) Varicose Veins
2. Abruptly = (+) Trendelenburg Test (+) Varicose Veins

- Management:
1. Use Support Stockings
2. When resting, elevate lower extremities
3. DONT CROSS LEGS
- Surgery
1. Vein Stripping Ligation of Saphenous Veins
2. Sclerotherapy Injecting of solution at site of varicosities, formation of hematoma