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Blood Vessel & Blood Pressure Pathophysiology

NRS 232 - Pathophysiology I

Katrina Dielman

on 9 February 2016

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Transcript of Blood Vessel & Blood Pressure Pathophysiology

Blood Vessel & Blood Pressure Pathophysiology
Virchow's Triad
1. Stasis of blood
2. Rough endothelium/endothelial damage
Chronic hypertension
3. Hypercoagulability
Oral contraceptives
Alterations in Arterial Flow

Endothelial dysfunction
- Inhibition of
nitric oxide
/other chemicals release results in increased resistance, smooth muscle proliferation, platelet aggregation, WBC adherence to endothelium

Fatty streak formation
- Macrophages filled with lipid/
Foam cells

Fibrous plaque development
- Narrows lumen; core becomes necrotic

Plaque rupture or ulceration
- Thrombus formation & possible acute occlusion
True Aneurysms
All 3 layers of the
arterial tunica
Alterations in Blood Pressure
Orthostatic Hypotension
Alterations in Venous Flow
Deep vs. Superficial
Other Venous Disorders
Valvular incompetence
- Do not shut properly
Varicose veins
- Raised, ugly veins due to incompetence
Chronic venous insufficiency
- Incompetence of the deep veins of the legs
NRS 232 - Pathophysiology I
Principles of Flow
Resistance vs. Reservoir/Capacitance
Laminar vs. Turbulent Flow
Blood flow is
proportional to resistance and area
Risk factors:
Virchow's Triad!
Pulmonary embolus!

Pneumatic compression devices
Prophylactic anticoagulation
Arterial Insufficiency
Acute Arterial Occlusion

ischemia of the lower extremities
Atrophy of tissue
Thick nails
Thin, shiny skin
Decreased hair growth
Ulceration & gangrene
Postural color changes
Cool to touch
Intermittent Claudication

ischemia in a lower extremity
Signs & symptoms
- "The 6 Ps"
A medical emergency!
Local arterial dilations
Cerebral > thoracic/abdominal aorta
(one sided) vs.
Hypertension & Atherosclerosis
Copstead, L. & Banasik, J. (2013).
(5th ed.). St. Louis, MO: Elsevier.

Felver, L. (2013). Online Materials:
PROP- Pathophysiology online.
Retrieved from https://evolve.elsevier.com/

Lehne, R. (2013).
Pharmacology for nursing care
(8th ed.). St. Louis, MO: Saunders Elsevier.
Ms. Planephobia
, age 57, embarked on her dream vacation and flew from Indianapolis, Indiana to Sydney, Australia, in spite of her fear of flying. This was her present to herself after feeling significantly better once she started hormone therapy for severe perimenopausal symptoms. She still had goals of dealing with her weight (BMI 31) and increasing her daily activity level, so she planned to do some walking tours on her vacation to signal her change in lifestyle. The flight to Sydney lasted 19 hours. Ms. Planephobia’s plan to deal with her fear of flying was to stay asleep as much as possible, and try not to unbuckle her belt. In order to minimize the need to leave her seat to use the rest room, she drank very little fluid on the flight. By the time she arrived in Sydney, her mouth was dry and sticky, and she was very thirsty.

By the sixth day of her vacation, Ms. Planephobia noticed that her right lower leg was sore and slightly swollen, more so than her left leg. After participating in the free walking tour of an historic part of the city in the morning, Ms. Planephobia was sitting at a sidewalk café when she developed pain in her chest, began to cough, and felt as though she could not breathe well.

Ms. Roosevelt
is a short-order cook and stands for long hours at the grill six days per week. She stopped wearing short skirts because her leg veins became visibly swollen and twisted. By the end of the day her ankles are puffy.

As spring is heading into summer, Ms. Roosevelt has put in her garden seeds, and spent quite a bit of time squatting in the garden thinning her seedlings and weeding by hand. Ms. Roosevelt has gradually noticed that she is developing increasing and localized pain over the inside of her right ankle where she has noticed some brownish colored spots. Now she notices that underneath one of those spots there appears to be a small, open, reddish sore developing.

Mr. Sport
presented to the emergency room Saturday after being hit from the side while playing on the men’s soccer team, injuring his knee. X-rays demonstrated a tibial fracture of his right leg. The orthopedic surgeon was contacted who remotely reviewed the X-Ray results and then scheduled a visit to the OR for surgical fixation of the fracture on Monday; until Monday, Mr. Sport was to go home with his leg immobilized in a splint, with instructions for application of ice, elevation of the leg, and use of analgesic medication.

The ER nurse and physician applied the splint to Mr. Sport’s leg, and applied ice, and administered an IV analgesic for complaints of moderately severe pain. Upon reevaluation prior to discharge, Mr. Sport reported increasing pain that seemed out of sync with his injury. Evaluation of his foot reveals a diminished pulse.
Mr. Roosevelt
, an African American aged 54, smokes two packs of cigarettes per day. He used to play basketball with his grandson, until he began getting cramping pains in his calves during their games. He stopped wearing shorts when the hair on his legs disappeared halfway up his calves. His blood pressure is 158/88 but he is not aware of it.
First we will look at Mr. Roosevelt’s arterial symptoms.
Then we will look at his blood pressure.
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