Class 13 & 14 Flashcards
What is the difference between arteriosclerosis and athlerosclerosis?
Arteriosclerosis: is a thickening or hardening of arterial wall
Athlerosclerosis: a type of arteriosclerosis w/ plaque in artery wall
Name some of the usual arteries affected by A&A.
Usually larger arteries like: coronary artery, aorta, cartoid, vertebral, renal, illiac & femeral; or any combo of these
What is the pathophysiology of atherosclerosis.
It’s not excatly known, but it’s thought to occur from blood vessel damage that causes an inflammatory response
Name main risk factors for atherosclerosis.
+low HDL +high LDL +increased triglyderides +genetic dispostion +DM +obesity +sedintary lifestyle +smoking +stress +Afro-American or Hispanic +elderly
True or False: Small plaques are almost always present in the arteries of young adults.
TRUE
What can occur when stable plaque ruptures?
thrombosis (blood clot) and constriction obstruct the vessel lumen, causing decreased tissue perfusion and oxygenation to distal tissues
What can occur when unstable plaque ruptures?
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.
How does diabetes mellitus contribute to atherosclerosis?
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.
Main points when assesing pt for atherosclerosis.
+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
Likley lab values for pt’s w/ increase risk for atherosclerosis?
cholesterol > 200
triglycerides > 150
LDL > 130
What is the function of cholesterol in the body?
+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.
Normal range for Cholesterol?
Adult/elderly < 200 mg/dL
What is the function of HDL in the body?
High-Density Lipoproteins — collect cholesterol from body’s tissue (and vascular endothelium) and brings it back to liver—reverse cholesterol transport “ Healthy Cholesterol”
Normal range for HDL?
Male > 45 mg/dL
Female > 55 mg/dL
Normal range for LDL?
Adults <130 mg/dL
What is the function of VLDL in the body & it’s range?
+Very Low-Density Lipoproteins — carries a small amount of cholesterol, mostly triglycerides
+Normal: 7-32mg/dL
What are the High/Low conditions of LDL & VLDL?
+Increased VLDL & LDL — familial, hypothyroidism, alcohol, chronic liver disease
+Decreased LDL & VLDL — familial, hypoproteinemia, hyperthyoridism
What is the normal range for Triglycerides?
Male 40-160
Female 35-135
What are the High/Low conditions of Triglycerides?
+Increased levels: Familial hypertriglyceridemia, High carbohydrate diet, Poorly controlled DM, Hypothyroidism
+Decreased levels: Malabsorption syndromes/malnutrition, Hyperthyroidism
What is Homocysteine, and when is it tested for?
+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.
Elevated levels of homocysteine are associated with what vitamin deficiency?
+Vitamin B12 or folate
- monitor for malnutrition
What are some preexisting factors that increase the risk for the development of atherosclerosis?
+DM w/o signs of vascular disease
+Pt’s w/ multiple metabolic risk factors
Name four modifiable risk factors that pt can controll or change, and which is one of the most important.
\+Smoking
\+Weight management
\+Exercise
\+Nutrition - one of the most important
- high fiber, ?3, nuts, olive oilAntilipemic: Lipitor (atorvastin)
- List the CLASS, ACTION, SIDE EFFECT, & CONTRAINDICATIONS
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
Antilipemic: Questran (cholestyramine)
- List the CLASS, ACTION, SIDE EFFECT, & CONTRAINDICATIONS
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
Antilipemic: Zetia (azetimibe)
- List the CLASS, ACTION, SIDE EFFECT, & CONTRAINDICATIONS
CLASS: Cholesterol absorption inhibitor
ACTION: Inhibits cholesterol absorption in small intestine
SIDE EFFECT: n/a
CONTRAINDICATIONS: Elevated LFT
Antilipemic: Lopid (gemfibrozil)
- List the CLASS, ACTION, SIDE EFFECT, & CONTRAINDICATIONS
CLASS: Fibric Acid
ACTION: Activate lipase to breakdown cholesterol
SIDE EFFECT: n/v
CONTRAINDICATIONS: Liver, kidney, gallbladder, cirrhosis
Antilipemic: Niacin /vitamin B3
- List the CLASS, ACTION, SIDE EFFECT, & CONTRAINDICATIONS
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
True or False: PVD only affects the lower extremities.
FALSE: It affects the legs much more frequently than the arms, but can affect the upper extremities.
What is pathophysiology of Peripheral vascular disease (PVD)?
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.
Obstructions are classified as?___flow & ____flow. Describe each.
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.
Which type of obstruction may casue significant tissue?
Gradual inflow occlusions maynot cause significant tissue damage.
GradualOUTFLOW occlusions typically DO.
True or False: Atherosclerosis is the most common cause of chronic aterial obstruction.
TRUE
What are the common risk factors for PVD?
Hypertension +Hyperlipidemia +DM +smoking +obesity +familial predispostion +advancing age
What group/culture is affected by PVD more often than any other group?
African-Americans
What additional risks do pt’s w/ PVD become suseptible todeveloping?
Chroinc angina +MI +Stroke
S/Sx of PAD?
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.
Relieving pain of PAD
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
Assessing for PAD
Palpate all pulses in both legs +Note early signs of ulcer formation
PVD Stage I - Asymptomatic
No claudication
Bruit or aneurysm my be present
Pedal Pulses are decreased or absent
PVD Stage II - Claudication
Muscle pain, cramping, or burning w/ exercise (relieved w/ rest)
Symptoms reproducable
PVD Stage III - Rest pain
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
PVD Stage IV - Necrosis/Gangrene
Ulcers and blackened tissue occur on the toes, forefoot and heel
Distinctive gangrenous odor is present
What are the diagnostic imaging options for PDV?
US doppler - measures blood flow & pressure through leg
Arteriography w/ stenting - radiologic dye into extremities. Reveals occlusions
What is the invasive nonsurgical procedure for PVD?
Invasive non-surg: PTA - Percutaneous Transluminal Angioplasy. In through groin, dilate arteries w/ ballon. Can use stents TKO
What is the surgical procedure for PVD?
Arterial Revascularization - bypasses occlusion.
What is an arterial vascular occlusion?
An embolis (piece of clot travels and occludes)
Most commonly originiates in heart.
MI or afib occurs within previous weeks
S/Sx of ischemia r/t AVO aka the six P’s
Pain Pallor Pulselessness Paresthesia (pins and needles) Paralysis Poikilothermy
Emergency treatment of arterial occlusion
Anticoagulant
Thromectomy and/or
Thrombolytic therapy w/ Alteplase or t-PA (dissolves clot)
Teaching plan for PAD
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.
What are S/Sx ofDVT?
Clot in leg - can be asymptomatic, or unilateral swelling, sudden pain in limb.
How is a DVT diagnosed?
Doppler blood flow - checks blood flow through veins
Treating DVT
not much research - rest and warm compress
DO NOT massage
Anticoagulants - Heparin gtt or Lovenox
Number 1 priority to preventing DVT
Walking - exercise
- Hydration
- Lovenox
Name the three types of cells found in blood.
Red Blood Cells (RBC)
White Blook Cells (WBC)
Platelets (PLT)
This cell has the highest concentration in Blood. What is it’s normal range and life span?
- RBC’s aka erythrocytes
- 4.2 - 6.1 w/ a life span of 120 day
This growth factor is released by the kidney, what is it?
erythropietin
What condition causes erythropietin to be relased, and what effect does it have?
- hypoxia r/t cell desctruction or loss of RBCs
- it causes bone marrow to increase production of stem cells, which are immature erthyrocytes
Besides iron, what other substances are needed to form hemoglobin?
- B12
- Folic acid, copper, pyrdoxine, cobalt, nickle
The most definitive sign ot assessing hematologic function is?
- Complete Blood Count (CBC) Lab values
What values does a complete blood count include?
- 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
Define anemia
- 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
What are the most common causes of anemia?
~ 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)
What are some common causes of polycythemia (increased/over production of RBC’s)?
~ Polycythemia vera
~ COPD
~ Severe dehydration (relational polycythemia)
~ Athletes training at high elevations
A CBC also measures features of RBC’s (indices), what are these measurements?
~ 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.
What does an increased or decreased MCV indicate?
~ Increased = macrocytic indicates megaloblastic anemia
~ Dedcreased = microcytic indicates iron deficiency anemia
What does an increased or decreased MCHC indicate?
~ Increased = impossible to have hyperchromatic
~ Decreased = hypochromic (RBC Hgb deficiency) indicates iron deficiendy anemia
Cause(s) of Normocytic, normochromic anemia
Acute blood loss, chronic illness, iron deficiency, aplastic enemia, acquired hemolytic anemias
Cause(s) of Microcytic, hypochromic anemia
Iron deficiency, thalassemia, chronic illness
Cause(s) of Microcytic, normochromic anemia
renal disease
Cause(s) of Macrocytic normochromic anemia
~ Vitamin B12/Folic acid deficiency - most common cause
~ Chemotherapy, thyroid dysfunction, myeloid leukemia, ETOH toxicity…
Explain pernicious anemia
The lack of intrinsic factor to absorb Vitamin B12. Deficiendy casued by chronic gastritis, bowel resection, dietary deficiency of B12. Macrocytic.
Explain iron deficiency anemia
Most common worldwide. A microcytic anemia caused by low iron in diet or chronic blood loss (menses). Important to check ferririn levels.
Explain folic acid anemia
Macrocytic anemia caused by lack of folic acid in diet secondary to meds, malnutrition, chronic ETOH use. Given to pregnant women for fetal development.
What is a reticulocyte count used for?
~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
What does the red blood cell distribution width (RDW) indicate?
~ RDW indicates the variation in RBC size.
- Anisocytosis is a blood condition characterized by RBC’s of variable and abnormal size
What diagnoses does ESR help assess for?
~ Acute inflammation
~ Acute or chronic infection
~ Autoimmune diseases
~ Monitors inflammatory and malignant diseases
Lab Values for: RBC count
Male: 4.7 - 6.1
Female: 4.2 - 5 .4
Lab Values for: Hgb
Male: 14 - 18
Female: 12 - 16
Lab Values for: Hct
Male: 42 - 52
Female: 37 - 47
Lab Values for: ESR
Male: 0 - 15
Female: 0 - 20
S/Sx of inadequate oxygenation
Tachy, activity intol, cyanosis, increased RR (usually >20), low O2 sat, SOB, hypoxic, ALOC, dizzy, acid-base imbalance
Assessing pt w/ inadequate oxy.
distressed, sweaty, thready pulse
Pt intervention for inadequate oxy.
PRBC, supplements, IV fluids, O2, pace activities, monitor VS and labs, pt teaching, Meds
What is Thrombophlebitis
The presence of a thrombus associated with inflammation; usually occurs in the deep veins of the lower extremities.
What is Phlebothrombosis
Presence of a thrombus in a vein without inflammation.
