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N302 > Class 13 & 14 > Flashcards

Class 13 & 14 Flashcards

1
Q

What is the difference between arteriosclerosis and athlerosclerosis?

A

Arteriosclerosis: is a thickening or hardening of arterial wall
Athlerosclerosis: a type of arteriosclerosis w/ plaque in artery wall

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2
Q

Name some of the usual arteries affected by A&A.

A

Usually larger arteries like: coronary artery, aorta, cartoid, vertebral, renal, illiac & femeral; or any combo of these

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3
Q

What is the pathophysiology of atherosclerosis.

A

It’s not excatly known, but it’s thought to occur from blood vessel damage that causes an inflammatory response

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4
Q

Name main risk factors for atherosclerosis.

A

+low HDL +high LDL +increased triglyderides +genetic dispostion +DM +obesity +sedintary lifestyle +smoking +stress +Afro-American or Hispanic +elderly

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5
Q

True or False: Small plaques are almost always present in the arteries of young adults.

A

TRUE

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6
Q

What can occur when stable plaque ruptures?

A

thrombosis (blood clot) and constriction obstruct the vessel lumen, causing decreased tissue perfusion and oxygenation to distal tissues

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7
Q

What can occur when unstable plaque ruptures?

A

causes severe damage. after rupture, underlying tissue causes platelet adhesion and rapid thrombus formation. the thrombus formation may suddenly block a blood vessel, resulting in ischemia & infarction.

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8
Q

How does diabetes mellitus contribute to atherosclerosis?

A

Adult pt’s w/ severe DM frequently have premature and severe atheroclerosis from microvascular damage. This occurs b/c dM promotes in increase in LDL and triglycerides in plasma. Also aterial damage may result from the effect of hyperglycemia.

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9
Q

Main points when assesing pt for atherosclerosis.

A

+Complete CV assessment +If pt has hx of HTN, take BP in both arms +Palpate pulses at all major sites, =? +Feel for temp diff in extremities +Cap refill +Auscultate for bruit

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10
Q

Likley lab values for pt’s w/ increase risk for atherosclerosis?

A

cholesterol > 200
triglycerides > 150
LDL > 130

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11
Q

What is the function of cholesterol in the body?

A

+Required for production of: Steroids, sex hormones, bile acids, & cellular metabolism.
+Most comes from foods we eat of animal origin.
+Main lipid associated with atherosclerotic vascular disease.

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12
Q

Normal range for Cholesterol?

A

Adult/elderly < 200 mg/dL

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13
Q

What is the function of HDL in the body?

A

High-Density Lipoproteins — collect cholesterol from body’s tissue (and vascular endothelium) and brings it back to liver—reverse cholesterol transport “ Healthy Cholesterol”

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14
Q

Normal range for HDL?

A

Male > 45 mg/dL

Female > 55 mg/dL

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15
Q

Normal range for LDL?

A

Adults <130 mg/dL

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16
Q

What is the function of VLDL in the body & it’s range?

A

+Very Low-Density Lipoproteins — carries a small amount of cholesterol, mostly triglycerides
+Normal: 7-32mg/dL

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17
Q

What are the High/Low conditions of LDL & VLDL?

A

+Increased VLDL & LDL — familial, hypothyroidism, alcohol, chronic liver disease
+Decreased LDL & VLDL — familial, hypoproteinemia, hyperthyoridism

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18
Q

What is the normal range for Triglycerides?

A

Male 40-160

Female 35-135

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19
Q

What are the High/Low conditions of Triglycerides?

A

+Increased levels: Familial hypertriglyceridemia, High carbohydrate diet, Poorly controlled DM, Hypothyroidism
+Decreased levels: Malabsorption syndromes/malnutrition, Hyperthyroidism

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20
Q

What is Homocysteine, and when is it tested for?

A

+Important predictor of coronary, cerebral, & peripheral vascular disease
+When strong familial predisposition or early-onset disease is noted, homocysteine testing should be performed to determine if genetic/acquired homocysteine levels exist.

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21
Q

Elevated levels of homocysteine are associated with what vitamin deficiency?

A

+Vitamin B12 or folate

- monitor for malnutrition

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22
Q

What are some preexisting factors that increase the risk for the development of atherosclerosis?

A

+DM w/o signs of vascular disease

+Pt’s w/ multiple metabolic risk factors

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23
Q

Name four modifiable risk factors that pt can controll or change, and which is one of the most important.

A 
\+Smoking
\+Weight management
\+Exercise
\+Nutrition - one of the most important
    - high fiber, ?3, nuts, olive oil
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24
Q

Antilipemic: Lipitor (atorvastin)

- List the CLASS, ACTION, SIDE EFFECT, & CONTRAINDICATIONS

A

CLASS: HMG-CoA reductase inhibitor, “statins”
ACTION: Decrease cholesterol & LDL production
SIDE EFFECT: HA, rash, mild GI - change med!
CONTRAINDICATIONS: Check LFT,report muscle pain, renal disease

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25
Q

Antilipemic: Questran (cholestyramine)

- List the CLASS, ACTION, SIDE EFFECT, & CONTRAINDICATIONS

A

CLASS:Bile Acid sequestrants
ACTION: Prevents resorption of bile acids.Lower LDL & increase HDL
SIDE EFFECT: Constipating, nausea, bloating, burping
CONTRAINDICATIONS: Biliary or bowel obstruction

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26
Q

Antilipemic: Zetia (azetimibe)

- List the CLASS, ACTION, SIDE EFFECT, & CONTRAINDICATIONS

A

CLASS: Cholesterol absorption inhibitor
ACTION: Inhibits cholesterol absorption in small intestine
SIDE EFFECT: n/a
CONTRAINDICATIONS: Elevated LFT

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27
Q

Antilipemic: Lopid (gemfibrozil)

- List the CLASS, ACTION, SIDE EFFECT, & CONTRAINDICATIONS

A

CLASS: Fibric Acid
ACTION: Activate lipase to breakdown cholesterol
SIDE EFFECT: n/v
CONTRAINDICATIONS: Liver, kidney, gallbladder, cirrhosis

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28
Q

Antilipemic: Niacin /vitamin B3

- List the CLASS, ACTION, SIDE EFFECT, & CONTRAINDICATIONS

A

CLASS: vitamin/supplement
ACTION: ?? Ability to inhibit lipolysis in adipose tissue:
decrease triglycerides, cholestrol, increase HDL’s
SIDE EFFECT: GI discomfort, flushing, pruritis
CONTRAINDICATIONS: HTN, peptic ulcer, active bleeding

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29
Q

True or False: PVD only affects the lower extremities.

A

FALSE: It affects the legs much more frequently than the arms, but can affect the upper extremities.

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30
Q

What is pathophysiology of Peripheral vascular disease (PVD)?

A

PVD is a result of system atherosclerosis. A chronic condition w/ partial or total arterial occlusion which deprives the lower extremities of oxygen and nutrients.

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31
Q

Obstructions are classified as?___flow & ____flow. Describe each.

A

Inflow: includes the distal end of aorta, common, internal, & external iliac arteries. They are located above the inguinal ligament.
Outflow: involves femoral, popliteal, and tivial arteries and are below the superficial femoral artery.

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32
Q

Which type of obstruction may casue significant tissue?

A

Gradual inflow occlusions maynot cause significant tissue damage.
GradualOUTFLOW occlusions typically DO.

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33
Q

True or False: Atherosclerosis is the most common cause of chronic aterial obstruction.

A

TRUE

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34
Q

What are the common risk factors for PVD?

A

Hypertension +Hyperlipidemia +DM +smoking +obesity +familial predispostion +advancing age

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35
Q

What group/culture is affected by PVD more often than any other group?

A

African-Americans

36
Q

What additional risks do pt’s w/ PVD become suseptible todeveloping?

A

Chroinc angina +MI +Stroke

37
Q

S/Sx of PAD?

A

Intermitten claudication - a type of limp
Rest pain - numbness or buring
Inflow disease - pain in lower back, butt, or thighs after walking about 2 blocks
Outflow disease - burning/cramping in calves, ankles, feet and toes after walking about 5 blocks
Physical manifestation - hair loss below knee, dry, scaly, dusky, pale, thick nails. In severe cases the extremities are cold and gray-blue.

38
Q

Relieving pain of PAD

A

Intermitten claudication - pain stops after rest
Rest pain - sometimes pain relief by keeping limb in dependent position, below hear
Inflow pain - eases with rest most of the time
Outflow pain - relieved by rest, in severe cases pt will hang foot off

39
Q

Assessing for PAD

A

Palpate all pulses in both legs +Note early signs of ulcer formation

40
Q

PVD Stage I - Asymptomatic

A

No claudication
Bruit or aneurysm my be present
Pedal Pulses are decreased or absent

41
Q

PVD Stage II - Claudication

A

Muscle pain, cramping, or burning w/ exercise (relieved w/ rest)
Symptoms reproducable

42
Q

PVD Stage III - Rest pain

A

Pain awakens pt at night
Toothache like pain
Pain usually occurs in the distal portion of extremity, rarely in calf & ankle
Pain reduced by placing limb in dependent position

43
Q

PVD Stage IV - Necrosis/Gangrene

A

Ulcers and blackened tissue occur on the toes, forefoot and heel
Distinctive gangrenous odor is present

44
Q

What are the diagnostic imaging options for PDV?

A

US doppler - measures blood flow & pressure through leg

Arteriography w/ stenting - radiologic dye into extremities. Reveals occlusions

45
Q

What is the invasive nonsurgical procedure for PVD?

A

Invasive non-surg: PTA - Percutaneous Transluminal Angioplasy. In through groin, dilate arteries w/ ballon. Can use stents TKO

46
Q

What is the surgical procedure for PVD?

A

Arterial Revascularization - bypasses occlusion.

47
Q

What is an arterial vascular occlusion?

A

An embolis (piece of clot travels and occludes)
Most commonly originiates in heart.
MI or afib occurs within previous weeks

48
Q

S/Sx of ischemia r/t AVO aka the six P’s

A 
Pain
Pallor
Pulselessness
Paresthesia (pins and needles)
Paralysis
Poikilothermy
49
Q

Emergency treatment of arterial occlusion

A

Anticoagulant
Thromectomy and/or
Thrombolytic therapy w/ Alteplase or t-PA (dissolves clot)

50
Q

Teaching plan for PAD

A

Assess effected foot/leg - report six P’s
Foot Care: monitor cold, tight clothing, dressings, injury
Quit smoking
Diet
Meds
If needed: surg procedure and d/c teaching.

51
Q

What are S/Sx ofDVT?

A

Clot in leg - can be asymptomatic, or unilateral swelling, sudden pain in limb.

52
Q

How is a DVT diagnosed?

A

Doppler blood flow - checks blood flow through veins

53
Q

Treating DVT

A

not much research - rest and warm compress
DO NOT massage
Anticoagulants - Heparin gtt or Lovenox

54
Q

Number 1 priority to preventing DVT

A

Walking - exercise

  • Hydration
  • Lovenox
55
Q

Name the three types of cells found in blood.

A

Red Blood Cells (RBC)
White Blook Cells (WBC)
Platelets (PLT)

56
Q

This cell has the highest concentration in Blood. What is it’s normal range and life span?

A
  • RBC’s aka erythrocytes

- 4.2 - 6.1 w/ a life span of 120 day

57
Q

This growth factor is released by the kidney, what is it?

A

erythropietin

58
Q

What condition causes erythropietin to be relased, and what effect does it have?

A
  • hypoxia r/t cell desctruction or loss of RBCs

- it causes bone marrow to increase production of stem cells, which are immature erthyrocytes

59
Q

Besides iron, what other substances are needed to form hemoglobin?

A
  • B12

- Folic acid, copper, pyrdoxine, cobalt, nickle

60
Q

The most definitive sign ot assessing hematologic function is?

A
  • Complete Blood Count (CBC) Lab values
61
Q

What values does a complete blood count include?

A
  • RCB; count in 1mm^3 of blood
  • WBC; all leukocytes in 1mm^3 of blood
  • HCT; calculated as % of RBC in total blood vol
  • Hgb; the total amount in the blood
62
Q

Define anemia

A
  • Any problem that reduces the function or number of RBC’s to the point that tissue oxygenation needs are not completely met.
  • Classified as low H&H
63
Q

What are the most common causes of anemia?

A

~ Hemorrhage
-bleeding
~ Reduced levels of EPO r/t kidney diseae
~ As bone marrow compensates for chronic low leukocytes w/ WBC, chronic illness, & autoimmune disease.
~ Hematologic CA (i.e. leukemia)

64
Q

What are some common causes of polycythemia (increased/over production of RBC’s)?

A

~ Polycythemia vera
~ COPD
~ Severe dehydration (relational polycythemia)
~ Athletes training at high elevations

65
Q

A CBC also measures features of RBC’s (indices), what are these measurements?

A

~ Mean corpuscular volume (MCV) is avg. volume or size of a single RBC
~ Mean corpuscular Hgb (MCH) is avg. amount of Hgb by weight for a single RBC
~ Mean corpuscular Hgb concentration (MCHC) ave. amount of Hgb by % for a single RBC.

66
Q

What does an increased or decreased MCV indicate?

A

~ Increased = macrocytic indicates megaloblastic anemia

~ Dedcreased = microcytic indicates iron deficiency anemia

67
Q

What does an increased or decreased MCHC indicate?

A

~ Increased = impossible to have hyperchromatic

~ Decreased = hypochromic (RBC Hgb deficiency) indicates iron deficiendy anemia

68
Q

Cause(s) of Normocytic, normochromic anemia

A

Acute blood loss, chronic illness, iron deficiency, aplastic enemia, acquired hemolytic anemias

69
Q

Cause(s) of Microcytic, hypochromic anemia

A

Iron deficiency, thalassemia, chronic illness

70
Q

Cause(s) of Microcytic, normochromic anemia

A

renal disease

71
Q

Cause(s) of Macrocytic normochromic anemia

A

~ Vitamin B12/Folic acid deficiency - most common cause

~ Chemotherapy, thyroid dysfunction, myeloid leukemia, ETOH toxicity…

72
Q

Explain pernicious anemia

A

The lack of intrinsic factor to absorb Vitamin B12. Deficiendy casued by chronic gastritis, bowel resection, dietary deficiency of B12. Macrocytic.

73
Q

Explain iron deficiency anemia

A

Most common worldwide. A microcytic anemia caused by low iron in diet or chronic blood loss (menses). Important to check ferririn levels.

74
Q

Explain folic acid anemia

A

Macrocytic anemia caused by lack of folic acid in diet secondary to meds, malnutrition, chronic ETOH use. Given to pregnant women for fetal development.

75
Q

What is a reticulocyte count used for?

A

~Helpful in determining bone marrow function.

  • an increased count indicates RBC’s are being produced and released by marrow too early or immature.
  • if there is no precipitation cause, may indicate polycythemia of bone marrow
76
Q

What does the red blood cell distribution width (RDW) indicate?

A

~ RDW indicates the variation in RBC size.

- Anisocytosis is a blood condition characterized by RBC’s of variable and abnormal size

77
Q

What diagnoses does ESR help assess for?

A

~ Acute inflammation
~ Acute or chronic infection
~ Autoimmune diseases
~ Monitors inflammatory and malignant diseases

78
Q

Lab Values for: RBC count

A

Male: 4.7 - 6.1
Female: 4.2 - 5 .4

79
Q

Lab Values for: Hgb

A

Male: 14 - 18
Female: 12 - 16

80
Q

Lab Values for: Hct

A

Male: 42 - 52
Female: 37 - 47

81
Q

Lab Values for: ESR

A

Male: 0 - 15
Female: 0 - 20

82
Q

S/Sx of inadequate oxygenation

A

Tachy, activity intol, cyanosis, increased RR (usually >20), low O2 sat, SOB, hypoxic, ALOC, dizzy, acid-base imbalance

83
Q

Assessing pt w/ inadequate oxy.

A

distressed, sweaty, thready pulse

84
Q

Pt intervention for inadequate oxy.

A

PRBC, supplements, IV fluids, O2, pace activities, monitor VS and labs, pt teaching, Meds

85
Q

What is Thrombophlebitis

A

The presence of a thrombus associated with inflammation; usually occurs in the deep veins of the lower extremities.

86
Q

What is Phlebothrombosis

A

Presence of a thrombus in a vein without inflammation.

N302 (5 decks)

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