Atherosclerosis Overview and Pathophysiology

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Questions and Answers

Which dietary approach is recommended to prevent plaque buildup in arteries?

  • Paleo diet
  • DASH eating plan (correct)
  • Mediterranean diet
  • Keto diet

What proportionate effect does smoking have on the risk of developing CAD?

  • Decreases risk significantly
  • Increases risk modestly
  • Increases risk proportional to the number of cigarettes smoked (correct)
  • No effect on CAD

What are the immediate benefits of smoking cessation?

  • No significant change
  • Improvement in physical appearance primarily
  • Gradual improvement over a year
  • Dramatic and almost immediate improvement (correct)

What impact does increased physical activity have on insulin resistance?

<p>May lower insulin resistance (B)</p> Signup and view all the answers

What should patients do before starting an exercise program?

<p>Consult their health-care provider (C)</p> Signup and view all the answers

What condition is characterized by a chromosome 19 defect affecting LDL removal?

<p>Familial hypercholesterolemia (C)</p> Signup and view all the answers

What are statins primarily used for?

<p>Reducing LDL by lowering cholesterol synthesis (A)</p> Signup and view all the answers

Why should patients taking statins report muscle pain to their health-care provider?

<p>Muscle pain may indicate rhabdomyolysis (A)</p> Signup and view all the answers

What does the prefix 'hyper' indicate in the term hyperlipidemia?

<p>Above (B)</p> Signup and view all the answers

Which of the following is a primary goal in the nursing care plan for a patient with a peripheral arterial occlusive disorder?

<p>Enhance peripheral tissue perfusion (A)</p> Signup and view all the answers

What is a common risk factor for developing an aneurysm?

<p>Smoking (A)</p> Signup and view all the answers

Which nursing intervention helps improve peripheral blood flow in patients with a peripheral arterial occlusive disorder?

<p>Maintaining the extremities in a dependent position (D)</p> Signup and view all the answers

What is the significance of checking capillary refill in a patient's extremities?

<p>To assess tissue perfusion (C)</p> Signup and view all the answers

Which of the following statements is true regarding abdominal aortic aneurysm (AAA)?

<p>An AAA less than 4 cm is often silent (B)</p> Signup and view all the answers

In the evaluation of a patient with peripheral arterial occlusive disorder, what indicates effective interventions?

<p>Presence of strong peripheral pulses (B)</p> Signup and view all the answers

What imaging technique is covered by Medicare for certain individuals to screen for an abdominal aortic aneurysm (AAA)?

<p>Ultrasound (B)</p> Signup and view all the answers

What is a major goal of nursing care for patients with Buerger disease?

<p>To prevent complications such as ulceration and gangrene (D)</p> Signup and view all the answers

Which symptom is associated with distal extremity ischemia?

<p>Intermittent claudication (A)</p> Signup and view all the answers

Which nursing assessment finding should be reported immediately to prevent limb loss?

<p>Absent pulses in extremities (A)</p> Signup and view all the answers

What lifestyle change is emphasized for Buerger disease patients to promote circulation?

<p>Smoking cessation (A)</p> Signup and view all the answers

What should be included in daily foot care for patients at risk of PAD complications?

<p>Inspecting feet for sores or blisters (A)</p> Signup and view all the answers

Which conditions are identified by a serum glucose and lipid panel in the assessment for PAD?

<p>Diabetes and hyperlipidemia (C)</p> Signup and view all the answers

What physical characteristic of the skin might indicate chronic diminished blood flow?

<p>Shiny and hairless skin (D)</p> Signup and view all the answers

What is a risk factor for PAD that can be controlled through lifestyle changes?

<p>High-fat diet (A)</p> Signup and view all the answers

Which immediate action is necessary upon arrival in the emergency department when using thrombolytic therapy?

<p>Administer thrombolytic within 30 minutes (B)</p> Signup and view all the answers

Why should nitrates not be administered to a patient who has taken a phosphodiesterase inhibitor?

<p>Possibility of catastrophic hypotension (D)</p> Signup and view all the answers

What is the main purpose of giving antiplatelet medication during myocardial infarction?

<p>To reduce clot formation (B)</p> Signup and view all the answers

What should be monitored when administering heparin for myocardial infarction?

<p>Bleeding risk (C)</p> Signup and view all the answers

For which type of myocardial infarction is Low Molecular Weight Heparin (LMWH) used for antithrombotic prophylaxis?

<p>Non-ST-elevation myocardial infarction (B)</p> Signup and view all the answers

Which medication might worsen patient outcomes if given for ischemic pain unrelieved by other therapy?

<p>Morphine sulfate (D)</p> Signup and view all the answers

What action should nurses take when administering Low Molecular Weight Heparin (LMWH)?

<p>Give the injection deep subcutaneously (B)</p> Signup and view all the answers

What guides the administration of oxygen therapy in myocardial infarction?

<p>Arterial blood gases (ABGs) (B)</p> Signup and view all the answers

What differentiates microvascular angina from other types of anginal pain?

<p>The pain is more severe and lasts longer (A)</p> Signup and view all the answers

Which symptom is considered atypical for women experiencing angina?

<p>Shortness of breath (D)</p> Signup and view all the answers

Which diagnostic test is NOT commonly used to diagnose coronary artery disease or anginal causes?

<p>Pulmonary function test (B)</p> Signup and view all the answers

Which statement best describes 'referred pain' in the context of angina?

<p>Pain in the shoulders, neck, jaw, arms, or back without chest pain (B)</p> Signup and view all the answers

Which medication class is NOT used for reducing angina?

<p>Antidepressants (A)</p> Signup and view all the answers

What is one recommended lifestyle change to prevent anginal attacks?

<p>Smoking cessation (B)</p> Signup and view all the answers

What characteristic is unlikely to describe anginal chest pain?

<p>Shooting pain (A)</p> Signup and view all the answers

Which method of nitroglycerine administration is intended for acute anginal attacks?

<p>Sublingual spray (C)</p> Signup and view all the answers

What is a common reason older adults may experience more medication toxicity during treatment for myocardial infarction?

<p>Reduced renal and hepatic function (C)</p> Signup and view all the answers

What vital sign change would require stopping a patient's activity during myocardial infarction management?

<p>Systolic blood pressure increases more than 20 mm Hg (B)</p> Signup and view all the answers

Which strategy helps to condition the myocardium and improve activity tolerance in myocardial infarction recovery?

<p>Progressive activity as tolerated (D)</p> Signup and view all the answers

Which symptom is typically not associated with acute myocardial infarction in older adults?

<p>Sharp localized pain (D)</p> Signup and view all the answers

Why should the pace of care be slowed for geriatric patients with myocardial infarction?

<p>To reduce cardiac demand and fatigue (B)</p> Signup and view all the answers

What is an expected outcome for a patient with decreased activity tolerance due to myocardial infarction?

<p>Tolerance of progressive activity as indicated by stable vital signs (B)</p> Signup and view all the answers

Why is it important to understand whether peripheral vascular disease is arterial or venous in origin?

<p>It helps prevent serious complications (A)</p> Signup and view all the answers

What activity should be cautious to implement progressively for a myocardial infarction patient according to their tolerance?

<p>Progressive activity like range-of-motion exercises (A)</p> Signup and view all the answers

Flashcards

Heart-Healthy Diet

A diet beneficial for reducing plaque in arteries, like the DASH eating plan.

Smoking and CAD Risk

Cigarette smoking increases the risk of coronary artery disease (CAD) proportionately to the number of cigarettes smoked.

HDL Loss from Smoking

Smoking contributes to a decrease in high-density lipoprotein (HDL) levels, which is protective for heart health.

Vasoconstriction Effects

Smoking causes blood vessels to constrict, leading to conditions like angina pectoris and cardiac arrhythmias.

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Thirdhand Smoke

Residual nicotine and toxic chemicals left on surfaces after tobacco smoke has cleared, posing health risks.

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Benefits of Exercise

Increased physical activity raises HDL levels, lowers insulin resistance, and facilitates weight loss.

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Medications for Lipid Levels

Statins and fibrates are medications used to lower lipid levels in patients at risk of atherosclerosis.

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Familial Hypercholesterolemia Treatment

For genetic high cholesterol, monoclonal antibodies like alirocumab and evolocumab help lower LDL levels.

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Cyclical Angina

Anginal pain that occurs at regular intervals, often daily.

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Microvascular Angina

Pain caused by spasms in small heart arteries, reducing blood flow.

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Referred Pain

Pain felt in areas other than the source, often seen in angina.

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Atypical Symptoms in Women

Women may experience non-standard symptoms like fatigue or jaw pain instead of classic chest pain.

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Diagnostic Tests for CAD

Tests like ECG, echocardiography, and stress tests used to diagnose coronary artery disease.

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Risk Factors for Angina

Factors like inactivity, poor diet, and smoking that increase the likelihood of angina attacks.

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Nitroglycerin

A vasodilator medication of choice for treating acute anginal attacks.

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Heart-Healthy Lifestyle

Lifestyle changes like weight loss and stress reduction that help manage angina.

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PCI

Percutaneous coronary intervention, a procedure to open narrowed coronary arteries.

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Thrombolytic Therapy

Uses medication to dissolve blood clots in coronary arteries.

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Oxygen Requirements

Arterial blood gases guide oxygen needs in patients.

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Antiplatelet Medication

Given to reduce platelet aggregation and clot formation.

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NTG (Nitroglycerin)

A medication used to relieve ischemic cardiac pain via vasodilation.

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Dual Antiplatelet Therapy

Long-term use of two antiplatelet drugs after myocardial infarction.

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Heparin

An anticoagulant that prevents thrombus formation by inhibiting thrombin.

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Low Molecular Weight Heparin (LMWH)

Antithrombotic medication used to prevent ischemic complications.

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Intermittent Claudication

Pain or cramping in legs or arms during activity due to inadequate blood flow.

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Atypical MI Symptoms

Older adults may experience non-traditional symptoms of myocardial infarction, such as silent MI.

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Distal Extremity Ischemia

Reduced blood flow to the farthest parts of limbs, leading to pain and potential complications.

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Buerger Disease

A condition causing blood vessel inflammation and obstruction, often related to smoking.

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Medication Toxicity

Elderly patients may have increased risk of side effects due to reduced renal and hepatic function.

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Decreased Activity Tolerance

Inability to sustain physical activity due to imbalance between oxygen supply and demand, weakness, and fatigue.

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Peripheral Arterial Disorder (PAD)

A blood circulation disorder that narrows arteries, reducing blood flow to limbs.

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Vital Signs Monitoring

Regular observation of heart rate, blood pressure, and other vital signs to detect abnormal responses during physical activity.

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Nursing Care for PAD

Focus on preventing complications like ulceration, gangrene, and amputation in PAD patients.

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Skin Assessment

Evaluating skin condition, pulses, capillary refill, and temperature to identify PAD complications.

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Progressive Activity

Gradually increasing physical activities to condition the myocardium, starting with basic tasks.

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Foot Care Education

Teaching proper daily foot care to prevent complications in patients with PAD.

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Independence in Care

Allowing older patients to manage their activities at their own pace to reduce cardiac strain.

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Cardiac Rehabilitation Referral

Older adults should be referred to rehabilitation programs for strength and cardiovascular improvement.

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Health Literacy in PAD

Understanding the disease, treatment, and self-care necessary to manage PAD effectively.

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Peripheral Vascular Disease (PVD)

Condition marked by compromised blood flow, can be classified as either arterial or venous.

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Hyperlipidemia

A condition of elevated fats in the blood.

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Ineffective Peripheral Tissue Perfusion

Insufficient blood flow to arms and legs.

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Peripheral Pulses

Pulses felt in arms and legs indicating blood flow.

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Capillary Refill

Time taken for color to return to nailbeds after pressure.

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Aneurysm

A bulging or weakening in an arterial wall.

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Abdominal Aortic Aneurysm (AAA)

A specific aneurysm located in the abdominal aorta.

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Risk Factors for Aneurysm

Conditions increasing the likelihood of an aneurysm.

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Elective Repair

Planned surgery to fix an aneurysm before rupture.

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Study Notes

Atherosclerosis

  • Atherosclerosis is the thickening, loss of elasticity, and calcification of arterial walls, occurring with aging.
  • It involves plaque formation in arteries.
  • Early childhood onset is possible, with progression throughout adulthood.
  • Leading cause is coronary heart disease (CHD), also known as coronary artery disease (CAD).

Pathophysiology

  • Atherosclerosis is a multistep process affecting the inner lining of arteries.
  • Injury to endothelial cells initiates inflammation and immune response.
  • Smooth muscle cell growth is stimulated, secreting collagen and fibrous proteins.
  • Lipids, platelets, and clotting factors accumulate, forming plaque.
  • Plaque buildup narrows arteries (stenosis), potentially leading to complete blockage (occlusion).
  • Distal areas can become ischemic.

Etiology

  • Risk factors for atherosclerosis are categorized into modifiable and non-modifiable.
  • Non-modifiable: Age (men >50, women post-menopause), ethnicity (Black Americans), and genetics (hyperlipidemia).
  • Modifiable: Diabetes increases risk of hypertension, obesity, and high blood lipids.
  • Hypertension increases myocardial oxygen demand.
  • Elevated serum cholesterol (above 200 mg/dL) and high LDL levels are risk factors.
  • High homocysteine levels are linked to increased CAD risk. Foods with folic acid can reduce homocysteine level.
  • Excessive alcohol use raises blood pressure, increases triglycerides and causes irregular heartbeats.
  • Obesity increases risk of hypertension, diabetes, glucose intolerance, and hyperlipidemia.
  • Sedentary lifestyle contributes to these risk factors.
  • Emotional stress, tobacco use (including secondhand and thirdhand smoke) increases workload and myocardial oxygen demand.

Diagnostic Tests

  • Total cholesterol levels above 200 mg/dL increase risk of CAD and MI.
  • Elevated LDL and low HDL levels are associated with increased CAD risk; Lp(a) cholesterol is a genetic variation of LDL.
  • LDL particle number is an excellent predictor of MI risk.
  • High LDL particle number with low LDL levels still creates a high MI risk.
  • C-reactive protein (CRP) indicates low-grade inflammation and increased CAD risk.
  • Elevated blood glucose increases atherosclerosis risk.
  • Radiological studies can show narrowed or occluded vessels.

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