NUR 206 Exam 4: Disease System Template Overview
for Key Disorders
Suggested Diseases for making a Disease System Template
Powerpoint 1 (HTN)
● Hypertension
■ Normal BP 120/80
■ Elevated BP 120-129/80
■ Stage 1 hypertension 130-139/80-89
■ Stage 2 hypertension BP 140+/90
○ Primary
■ Elevated BP with no cause
■ Altered endothelial function, increased SNS activity,
increased Na+ intake, overproduction of Na+ retaining
hormones, overweight, diabetes, tobacco, excess
alcohol intake, age, family history, ethnicity
■ Increased CO or SVR = increased BP
■ Hemodynamic hallmark: persistently increased SVR
■ Risk factors
● Age, alcohol use, diabetes, elevated serum lipids,
excess dietary sodium, gender, family history,
obesity, ethnicity, sedentary lifestyle,
socioeconomic lifestyle, stress
■ Excess Na intake is linked to HTN
● Altered RAAS
○ High plasma renin activity (PRA)
■ Increased conversion of
angiotensin to angiotensin 2
■ Increased BP inhibits the release of
renin
● Stress and increased SNS activity
○ Anger, fear, and pain influence BP
○ Increase in SNS activity, prolonged SNS
activity
■ Increased vasoconstriction
■ Increased HR
■ Increased renin release
● Activation of RAAS
● Insulin resistance and hyperinsulinemia
○ Defects in glucose, insulin, and
lipoprotein metabolism are common
○ Insulin resistance is a risk factor
for the development of HTN and
CVD
○ High insulin levels
, ■ Stimulate SNS activity and impair
nitric oxide-mediated vasodilation
■ Vascular hypertrophy
■ Increased renal sodium reabsorption
● Endothelial dysfunction
, ○ Can manifest as a prolonged
vasoconstriction response or reduced
vasodilation response
○ Elevated endothelin leads to
prolonged vasoconstriction
○ Vasodilation effects can be altered by
oxygen free radicals
■ Impairs the bioavailability of NO
leading to cellular dysfunction and
an imbalance of vasodilation and
vasoconstriction mechanisms in the
endothelium
○ Secondary
■ Elevated BP with a specific cause, sudden development
■ Can become resistant if left untreated
■ Clinical findings
● Cirrhosis, aortic problems, drug-related,
endocrine, neurologic, or real problems,
pregnancy-induced or obstructive sleep
apnea
■ Tx is removing or treating the cause
■ Can be a contributing factor to hypertensive crisis
Powerpoint 2 (Arterial/Venous Disorders)
● Peripheral Artery Disease (PAD)
○ Involves thickening of artery walls and progressive narrowing of
arteries of upper and lower extremities
■ Symptomatic age 50-70, earlier with diabetes
○ Strongly related to other CVD and risk factors
○ Higher risk for mortality, major coronary events, and stroke
○ Marker for advanced systemic atherosclerosis
● Critical Limb Ischemia
○ Protect limb from trauma, decrease ischemic pain, prevent and
control infection, improve perfusion
○ Carefully inspect, cleanse, and lubricate feet (avoid lubricating
between the toes and soaking the feet), keep feet clean and dry
○ Cover ulcers with dry and sterile dressing
○ Wear soft, roomy, and protective footwear
○ Keep heels free from pressure - place heels on pillow
○ Give analgesics and place a bed in Trendelenburg- increases
perfusion to lower extremities
○ Avoid extreme heat/cold
● Acute Arterial Ischemic Disorders
○ Sudden interruption in blood supply to tissue, organ, or extremity
■ Can result in death if untreated
○ Causes of AAI
■ Embolism
for Key Disorders
Suggested Diseases for making a Disease System Template
Powerpoint 1 (HTN)
● Hypertension
■ Normal BP 120/80
■ Elevated BP 120-129/80
■ Stage 1 hypertension 130-139/80-89
■ Stage 2 hypertension BP 140+/90
○ Primary
■ Elevated BP with no cause
■ Altered endothelial function, increased SNS activity,
increased Na+ intake, overproduction of Na+ retaining
hormones, overweight, diabetes, tobacco, excess
alcohol intake, age, family history, ethnicity
■ Increased CO or SVR = increased BP
■ Hemodynamic hallmark: persistently increased SVR
■ Risk factors
● Age, alcohol use, diabetes, elevated serum lipids,
excess dietary sodium, gender, family history,
obesity, ethnicity, sedentary lifestyle,
socioeconomic lifestyle, stress
■ Excess Na intake is linked to HTN
● Altered RAAS
○ High plasma renin activity (PRA)
■ Increased conversion of
angiotensin to angiotensin 2
■ Increased BP inhibits the release of
renin
● Stress and increased SNS activity
○ Anger, fear, and pain influence BP
○ Increase in SNS activity, prolonged SNS
activity
■ Increased vasoconstriction
■ Increased HR
■ Increased renin release
● Activation of RAAS
● Insulin resistance and hyperinsulinemia
○ Defects in glucose, insulin, and
lipoprotein metabolism are common
○ Insulin resistance is a risk factor
for the development of HTN and
CVD
○ High insulin levels
, ■ Stimulate SNS activity and impair
nitric oxide-mediated vasodilation
■ Vascular hypertrophy
■ Increased renal sodium reabsorption
● Endothelial dysfunction
, ○ Can manifest as a prolonged
vasoconstriction response or reduced
vasodilation response
○ Elevated endothelin leads to
prolonged vasoconstriction
○ Vasodilation effects can be altered by
oxygen free radicals
■ Impairs the bioavailability of NO
leading to cellular dysfunction and
an imbalance of vasodilation and
vasoconstriction mechanisms in the
endothelium
○ Secondary
■ Elevated BP with a specific cause, sudden development
■ Can become resistant if left untreated
■ Clinical findings
● Cirrhosis, aortic problems, drug-related,
endocrine, neurologic, or real problems,
pregnancy-induced or obstructive sleep
apnea
■ Tx is removing or treating the cause
■ Can be a contributing factor to hypertensive crisis
Powerpoint 2 (Arterial/Venous Disorders)
● Peripheral Artery Disease (PAD)
○ Involves thickening of artery walls and progressive narrowing of
arteries of upper and lower extremities
■ Symptomatic age 50-70, earlier with diabetes
○ Strongly related to other CVD and risk factors
○ Higher risk for mortality, major coronary events, and stroke
○ Marker for advanced systemic atherosclerosis
● Critical Limb Ischemia
○ Protect limb from trauma, decrease ischemic pain, prevent and
control infection, improve perfusion
○ Carefully inspect, cleanse, and lubricate feet (avoid lubricating
between the toes and soaking the feet), keep feet clean and dry
○ Cover ulcers with dry and sterile dressing
○ Wear soft, roomy, and protective footwear
○ Keep heels free from pressure - place heels on pillow
○ Give analgesics and place a bed in Trendelenburg- increases
perfusion to lower extremities
○ Avoid extreme heat/cold
● Acute Arterial Ischemic Disorders
○ Sudden interruption in blood supply to tissue, organ, or extremity
■ Can result in death if untreated
○ Causes of AAI
■ Embolism
