Chapter 33: Concepts of Care for Patients With Vascular Problems

Hypertension, the most prevalent primary care condition, requires a dual approach combining lifestyle interventions such as the DASH diet, sodium reduction, and regular physical activity with pharmacological management to prevent serious complications including stroke and renal dysfunction. Hypertensive crisis demands rapid assessment and immediate intervention including postural positioning and controlled blood pressure reduction. The chapter extensively addresses atherosclerosis as a progressive disease involving plaque accumulation within arterial walls, leading to peripheral arterial disease that often develops silently before manifesting as intermittent claudication and potentially advancing to rest pain, tissue necrosis, and gangrene. Peripheral arterial disease management emphasizes promoting collateral vessel development through exercise, addressing modifiable risk factors particularly smoking cessation, utilizing medications like statins and antiplatelet agents, and employing advanced interventions including arterial revascularization and percutaneous endovascular procedures. Acute peripheral arterial occlusion represents a vascular emergency characterized by the classic six signs of acute limb ischemia, necessitating urgent anticoagulation or surgical intervention. Central vessel pathology including aneurysms as localized arterial dilations and aortic dissection as a life-threatening emergency are discussed with emphasis on blood pressure regulation and surgical repair. The clotting exemplar addresses venous thromboembolism through the Virchow triad framework examining blood stasis, vessel injury, and hypercoagulable states. Deep vein thrombosis nursing care centers on prevention strategies, symptom recognition including unilateral edema and localized warmth, and administration of anticoagulant therapy with rigorous laboratory monitoring of activated partial thromboplastin time and international normalized ratio values. Chronic venous insufficiency, characterized by stasis dermatitis and recurrent stasis ulcerations, requires comprehensive management focused on edema reduction, venous return optimization through elevation, and compression modalities including graduated compression stockings and specialized bandaging systems.