Med-Surg - Cardiovascular System, part 16: Atherosclerosis and Hypertension

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In this article, we cover atherosclerosis and hypertension, which are critical topics to know for nursing school, for the NCLEX, and for your Med-Surg exams. The Med-Surg Nursing video series follows along with our Medical-Surgical Nursing Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

Atherosclerosis

Atherosclerosis is the buildup of plaque on the walls of the arteries. These plaque deposits can become so large that they can block or partially block blood flow.

Atherosclerosis plaques can rupture, which can cause a thrombus or embolus—a blood clot that can cause a myocardial infarction or a stroke.

Risk factors for atherosclerosis

Risk factors associated with atherosclerosis include older age (because of the decrease in heart muscle efficacy and heart strength associated with increased age), immobility, smoking, increased cholesterol numbers, obesity, diabetes, as well as stress. A patient with atherosclerosis may have hypertension, because if there are plaques in the arterial walls, it narrows the lumen (opening) of those arteries, which increases blood pressure.

Labs for atherosclerosis

When assessing a patient with atherosclerosis, you may hear bruits (swishing or whooshing sounds) because of the turbulent blood flow. See:

Health Assessment, part 5: Assessing Pulse

Health Assessment, part 8: Assessing Blood Pressure

In terms of labs, a patient with a patient with atherosclerosis will often have elevated LDL levels as well as elevated triglycerides.

Treatment for atherosclerosis

A key treatment for atherosclerosis is the administration of cholesterol-lowering medications, like statins, ezetimibe, bile acid sequestrants (colesevelam, cholestyramine), antilipemics (gemfibrozil, fenofibrate) and niacin.

Patient teaching for atherosclerosis

Patient teaching for atherosclerosis includes informing the patient that they should quit smoking if they smoke, lose weight if applicable, make sure to exercise, and consume a heart-healthy diet.

Hypertension

Hypertension is high blood pressure. The pathophysiology behind hypertension is increased peripheral resistance and/or increased cardiac output that elevates blood pressure. Increased peripheral resistance may be due to atherosclerosis, described above. Atherosclerosis is a contributing factor in many cases of hypertension.

With hypertension, the force of the blood against the arterial walls is too high, so the heart has to work harder to pump blood. Over time, hypertension can cause damage to the heart and blood vessels, which places the patient at an increased risk of a myocardial infarction (heart attack) or stroke.

Primary hypertension vs. secondary hypertension

The difference between primary hypertension and secondary hypertension is the cause or risk factors.

Risk factors of hypertension

The risk factors for hypertension are different based on whether it is primary or secondary hypertension

Primary hypertension

Primary hypertension, also called essential hypertension, is the most common type of hypertension. It is idiopathic, meaning it arises spontaneously or from an unknown cause. It may be helpful to think of primary hypertension as just high blood pressure by itself, rather than high blood pressure being caused by another disease. Risk factors for primary hypertension are a family history of hypertension, high sodium intake, obesity, smoking, stress, and hyperlipidemia (high cholesterol).

Secondary hypertension

Secondary hypertension is when a disease or a medication causes a patient to have hypertension. Potential causes of secondary hypertension can include kidney disease, hypothyroidism, Cushing's syndrome, and pheochromocytoma.

See below for a list of medications that can cause hypertension

Signs and symptoms of hypertension

Usually, patients with hypertension are asymptomatic, so they will not have any signs and symptoms. However, if the patient's blood pressure is high enough, they may end up in a hypertensive crisis, which is a complication of hypertension.

Nursing care for hypertension

As a nurse, you definitely want to monitor your patient for the signs and symptoms of a hypertensive crisis. Signs and symptoms of a hypertensive crisis include a headache, chest pain, shortness of breath, and dizziness.

Diagnosis of hypertension

The threshold for diagnosing hypertension depends on which source you are following.

The American Heart Association states that a patient has stage 1 hypertension if their systolic blood pressure is over 130 or their diastolic blood pressure is over 80.

The Joint National Committee says that a patient has stage 1 hypertension if their systolic blood pressure is over 140 or their diastolic blood pressure is over 90.

As a nursing student, you need to find out which of these sources your school uses and what source you'll need to use on your nursing exams.

Treatments for hypertension

Treatment for hypertension includes diuretics, and antihypertensive agents, like calcium channel blockers, beta-blockers, and ACE inhibitors.

Diuretics for hypertension

Diuretics can help lower blood pressure. Diuretics lower blood pressure by removing excess fluid which helps to decrease cardiac output.

Why does removing excess fluid decrease blood pressure? Think of a garden hose. If a garden hose (your arteries) is turned up to maximum flow (maximum fluid), it feels harder in your hand—because the water is pushing up firmly against the inside walls of the hose. A lot of fluid is trying to get through the hose. If a garden hose is only trickling out (less fluid), it feels more limp in your hand—because there is less water pressure inside the hose.

Blood pressure is the force of blood exerted against the arterial walls. Diuretics remove fluid from your blood vessels, so if there is less fluid flowing through the blood vessels, there is less force exerted against the arterial walls—the pressure is lower.

Diuretics covered in our pharmacology flashcards include:

These diuretics differ in the method they use to decrease fluid, and which electrolytes they cause you to lose or retain.

Antihypertensive agents that act on the RAAS system

Some antihypertensive agents act on the Renin-Angiotensin-Aldosterone System (RAAS), which is a hormone system within the body that regulates blood pressure and fluid balance. Check out our Med-Surg A&P review within the endocrine system playlist to learn more about the RAAS system. The RAAS system’s job is primarily to prevent hypotension by increasing blood pressure. Antihypertensives that act on the RAAS system block or inhibit renin, angiotensin-converting enzyme (ACE), angiotensin II, or aldosterone.

Other antihypertensive agents

Calcium channel blockers (verapamil, nifedipine, diltiazem) help hypertension because they block calcium channels in the heart and blood vessels, which leads to vasodilation, which is the blood vessels opening up. When the blood vessels are opened up, the same fluid has more room and is therefore exerting less pressure.

Centrally-acting alpha-2 agonists (clonidine) help hypertension by decreasing sympathetic outflow to the heart and blood vessels. This type of medication acts on the brain to change nerve impulses and get the blood vessels to relax. When the blood vessels are more relaxed, blood passes through them more easily.

Beta-1 blockers (metoprolol, atenolol) help hypertension by blocking the effects of epinephrine (adrenaline), which causes the heart to slow down, and the reduced cardiac output lowers blood pressure. Beta-1 blockers only act on the beta-1 receptors, which affect heart activity.

Non-selective beta-blockers (propranolol, labetalol, carvedilol) help hypertension in the same way that the Beta-1 blockers do, described above, but because they act on the remaining beta receptors (beta-2, beta-3) they are also able to relax the blood vessel smooth muscle. When the smooth muscle around blood vessels is more relaxed, the blood vessels themselves are more relaxed, and blood passes through them more easily.

Nitroprusside is a powerful vasodilator that immediately helps hypertension by relaxing blood vessel smooth muscle, which allows the blood vessels to dilate immediately which reduces pressure. Nitroprusside can be used in a hypertensive crisis.

Patient teaching for hypertension

Patient teaching for hypertension includes modifying their diet and other behaviors.

The diet that helps hypertension is called the DASH diet, which is an increased intake of fruits & vegetables, low fat dairy, decreased sodium and fat, particularly saturated fat and trans fat.

Other changes that can help hypertension are for the patient to lose weight (if applicable), reduce stress, quit smoking, limit alcohol consumption. Patients should also monitor their blood pressure on a regular basis at home.

A note on hypertension in your nursing studies

You will find hypertension everywhere you look in your nursing studies; as a symptom, as a risk factor, as a side effect, as a contraindication.

Fundamentals

When you are studying fundamentals, you will need to know:

Need help with fundamentals? Check out our Fundamentals of Nursing - Flashcards.

Health assessment

When you are studying health assessment, you will need to know the levels/stages of hypertension for adults.

Need help in health assessment? Check out our Health Assessment - Nursing Flashcards.

Medical-surgical

When you are studying med-surg, hypertension is a sign/symptom you need to know for:

Hypertension is a risk factor you need to know for:

Need help in med-surg? Check out our Medical-Surgical Nursing - Flashcards.

Pharmacology

In addition to the antihypertensives described earlier in this article, hypertension comes up with a lot of other drugs you need to know in Pharmacology.

Hypertension is a side effect you need to know for:

Hypertension is a contraindication you need to know for:

Need help in pharm? Check out our Pharmacology - Nursing Flashcards

Maternity

When you are studying for maternity, you will need to know the hypertensive disorders in pregnancy, including: gestational hypertension, preeclampsia, eclampsia, and HELLP syndrome.

Need help in maternity? Check out our Maternity Nursing - Flashcards

Pediatrics

When you are studying Pediatrics, hypertension is a sign/symptom you need to know for:

Need help in pediatrics? Check out our Pediatric Nursing - Flashcards

Nutrition

When you are studying nutrition, you will need to know:

  • Too little magnesium can cause hypomagnesemia, which hypertension is a symptom of
  • Which diets are associated with a lower risk of hypertension
  • Which diet is recommended for hypertension
  • Cultural dietary considerations regarding hypertension
  • Hypertension is a sign/symptom of metabolic syndrome
  • The recommended sodium level for a hypertensive patient

Need help in nutrition? Check out our Nutrition Essentials - Nursing Flashcards.

Psychiatric mental health

When you are studying mental health, you will need to know:

Need help studying for mental health? Check out our Psychiatric Mental Health - Nursing Flashcards.

Wound care

When you are studying wound care, you will need to know hypertension is a risk factor for LEAD wounds.

Need help in wound care? Check out our Wound Care - Nursing Flashcards.

Quiz Questions

What is a buildup of plaque on arterial walls called?

Atherosclerosis

Individuals with hypertension are typically asymptomatic. True or false?

True

An individual with a history of hypertension complains of a headache, chest pain, and shortness of breath. What complication does the nurse suspect?

A hypertensive crisis

Full Transcript: Med-Surg - Cardiovascular System, part 16: Atherosclerosis and Hypertension

Hi, I'm Cathy with Level Up RN. In this video, I'm going to talk about atherosclerosis as well as hypertension. And at the end of the video, I'll give you guys a quick little quiz to test your understanding of some of the key information I'll be covering in this video. So definitely stay tuned for that. And if you have our medical surgical nursing flashcards, definitely pull those out so you can follow along with me.

First up, we have atherosclerosis which is the buildup of plaque on the arterial walls, and these plaque deposits can become so large that they impair blood flow.

In addition, these plaques can rupture causing a thrombus or embolus. So a blood clot which in turn can cause a myocardial infarction or a stroke.

So risk factors associated with atherosclerosis include older age, immobility, smoking, increased cholesterol numbers, obesity, diabetes, as well as stress. So a patient with atherosclerosis may have hypertension. And that makes sense, right? Because if we have these plaques in the arterial walls, then we are narrowing the lumen of those arteries which increases blood pressure.

Also upon assessment, we may hear bruits because of that turbulent blood flow.

In terms of labs, a patient with atherosclerosis will often have elevated LDL levels as well as triglycerides.

So one key treatment for this condition would be the administration of cholesterol-lowering medications such as statins.

We also want to provide teaching to the patient, they should quit smoking if they smoke, they should lose weight if applicable, and make sure they exercise and consume a heart-healthy diet.

Now let's talk about hypertension which is high blood pressure.

So the pathophysiology behind hypertension is that we have increased peripheral resistance and/or increased cardiac output such that we end up with an elevation in blood pressure. So that increased peripheral resistance may be due to atherosclerosis which we just talked about, so that's definitely a contributing factor in many cases for hypertension. Over time, hypertension can cause damage to the heart and the blood vessels which places the patient at increased risk for an MI or stroke.

So there are two types of hypertension. We have primary and secondary.

So with primary hypertension which is also called essential hypertension, we have risk factors such as a family history, increased sodium intake, as well as obesity, smoking, stress and hyperlipidemia, so increased LDL or triglyceride numbers.

With secondary hypertension, we have a medication or disease that is causing an increase in blood pressure.

So risk factors include kidney disease, hypothyroidism, Cushing's syndrome, as well pheochromocytoma which is a tumor on the adrenal gland that causes an increase in blood pressure.

In terms of the signs and symptoms of hypertension. In most cases, patients are asymptomatic, so they will not have any signs and symptoms. However, if their blood pressure gets high enough, then they may end up in a hypertensive crisis which is a complication of hypertension and they may complain of a headache, chest pain, shortness of breath, and dizziness. So as a nurse, you're definitely going to want to monitor your patient for those types of signs and symptoms which can indicate a hypertensive crisis.

In terms of diagnosis. We would diagnose a patient with hypertension if their blood pressure is elevated during two or more visits. And the level though, however, the threshold for diagnosing hypertension, really varies depending on the source. So the American Heart Association says that a patient has stage 1 hypertension if their systolic blood pressure is over 130 or their diastolic blood pressure is over 80. However, the Joint National Committee says that a patient will have stage 1 hypertension if their systolic blood pressure is over 140 or their diastolic blood pressure is over 90. So as a nursing student, you need to find out which of these sources your school uses and what source you'll be responsible for on your nursing exams.

In terms of treatment, we can provide the patient with diuretics to try to get rid of that excess fluid which will help to decrease that cardiac output. We can also provide the patient with antihypertensive agents such as calcium channel blockers, beta-blockers, and ace inhibitors. And I go over all of those medications in detail in my pharmacology playlist, so definitely check that out.

We also need to provide the patient with teaching. In terms of diet, we want the patient to consume a DASH diet which is highly recommended for hypertension. So with a DASH diet, we encourage an increased intake of vegetables and fruits as well as low-fat dairy. And we encourage a decreased consumption of sodium and fats, particularly saturated fats and trans fats. We also want to encourage our patients to lose weight if that's applicable, reduce their stress, quit smoking, limit alcohol consumption, and they also need to monitor their blood pressure on a regular basis at home.

Okay. It's time for a quiz. I have three questions for you. The first question is a fill-in-the-blank question. A buildup of plaque on the arterial walls is called blank. The answer is atherosclerosis. Question number two is a true-false question. Individuals with hypertension are typically asymptomatic. True or false? The answer is true. Question number three. An individual with a history of hypertension complains of a headache, chest pain, and shortness of breath. What complication does the nurse suspect? The answer is a hypertensive crisis.

Okay. That's it for this video. I hope it's been helpful for you. If so, be sure to like this video, subscribe to our channel, and tell your friends and classmates about our channel as well. Take care.

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