Med-Surg - Cardiovascular System, part 11: Atherosclerosis and Hypertension
by Cathy Parkes October 08, 2021 Updated: December 29, 2021 4 min read
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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