Lipids Part 2: Abnormal Lipid Levels PDF

Cholesterol and Lipid Disorders SLIDESMANIA.CO REVIEW! SLIDESMANIA.CO  What happens to the lipids if not used by the body? SLIDESMANIA.CO  Lipid Storage Fat is stored in the body in diffe...

Cholesterol and Lipid Disorders SLIDESMANIA.CO REVIEW! SLIDESMANIA.CO  What happens to the lipids if not used by the body? SLIDESMANIA.CO  Lipid Storage Fat is stored in the body in different compartments. The two main compartments are subcutaneous (under the skin) and visceral or abdominal (around the internal organs). SLIDESMANIA.CO  Lipid Storage Lipids are aggregated into lipoproteins through the action of a microsomal triglyceride transfer protein (MTP). SLIDESMANIA.CO  What are lipoproteins? SLIDESMANIA.CO Lipoproteins SLIDESMANIA.CO SLIDESMANIA.CO  What happens to lipids once inside the cell? SLIDESMANIA.CO  Formation Process Once inside the adipose cells, the fatty acids and glycerol are reassembled into triglycerides(triacylglycerol) and stored for later use. Muscle cells may also take up the fatty acids and use them for muscular work and SLIDESMANIA.CO generating energy.  How will the fatty acids and neutral fats be stored? SLIDESMANIA.CO  After transport through the circulation, triglycerides are hydrolyzed yet again to fatty acids in the adipose tissue. There they are transported into adipose cells, where once again they are resynthesized into triglycerides and stored as droplets. SLIDESMANIA.CO  Additional Notes: CHOLESTEROL Some cholesterol is required in for the synthesis of bile acids (Bile acid is derived from fatty acid) Cholesterol keeps the membrane fluid Key regulatory enzyme in cholesterol synthesis is HMG Co-A reductase SLIDESMANIA.CO  Additional Notes: METABOLISM Liver converts glucose via Acetyl CoA into fatty acids ○ This process, called lipogenesis, creates lipids (fat) from the acetyl CoA and takes place in the cytoplasm of adipocytes (fat cells) and hepatocytes (liver cells). When you eat more glucose or carbohydrates than your body needs, your system uses acetyl CoA to turn the excess into fat. What is lecithin? ○ is a mixture of fats that are essential to cells in the human body. It can be found in many foods, including soybeans and egg yolks. ○ These data suggest that dietary lecithin is particularly effective SLIDESMANIA.CO in increasing the HDLC/total cholesterol ratio in plasma. _____ SLIDESMANIA.CO _____ SLIDESMANIA.CO _____ SLIDESMANIA.CO ______ SLIDESMANIA.CO ____ SLIDESMANIA.CO  Did you know? Did you know that there is a term “ectopic fat? SLIDESMANIA.CO  Cholesterol and Lipid Disorders SLIDESMANIA.CO  Learning Outcomes Explain the implications of elevated or decreased blood triglyceride levels. Plan some basic nursing interventions on patients with elevated or decreased blood triglyceride levels (e.g. ischemic heart disease) SLIDESMANIA.CO  CONTENT 01 02 HYPERLIPIDEMIA HYPOLIPIDEMIA 03 04 ATHEROSCLEROSIS COMPLICATIONS SLIDESMANIA.CO  Hypolipidemia 01 total cholesterol (TC) < 120 mg/dL (< 3.1 mmol/L) or low-density lipoprotein cholesterol (LDL- C) < 50 mg/dL (< 1.3 mmol/L) SLIDESMANIA.CO  Hypolipidemia CAUSES: Hypolipidemia is a decrease in plasma lipoprotein caused by primary (genetic) or secondary factors. It is usually asymptomatic and diagnosed incidentally on routine lipid screening. Secondary Causes: Chronic infections (including hepatitis C infection) and other inflammatory states Hematologic and other cancers Hyperthyroidism SLIDESMANIA.CO Malabsorption Undernutrition (including that accompanying chronic alcohol use)  Hypolipidemia There are 3 primary disorders in which single or multiple genetic mutations result in underproduction or increased clearance of LDL: Abetalipoproteinemia (Bassen-Kornzweig syndrome) Chylomicron retention disease (Anderson disease) Hypobetalipoproteinemia SLIDESMANIA.CO  Hypolipidemia TREATMENT: Treatment of secondary hypolipidemia involves treating underlying disorders. Treatment of primary hypolipidemia is often unnecessary, but patients with some genetic disorders require high- dose vitamin E and dietary supplementation of fats and other fat-soluble vitamins. SLIDESMANIA.CO  Hypolipidemia Nursing Interventions: SLIDESMANIA.CO  Hypolipidemia Nursing Interventions: 1. Encourage the patient to become more active. 2. Guide the patient in lifestyle modifications. 3. Recommend to eat a diet rich in omega-3 fatty acids 4. Advise to avoid tobacco and alcohol consumption SLIDESMANIA.CO  02 Hyperlipidemia/dyslipidemia Hyperlipidemia is the medical term for elevated lipids (cholesterol and triglycerides) in the blood. Cholesterol causes plaque formation in the arteries reducing blood flow and oxygen throughout the body. Plaque buildup and hardening of the arteries (atherosclerosis) can cause chest pain, heart attack, stroke, blood clots, and peripheral vascular disease. SLIDESMANIA.CO  Hyperlipidemia refers to increased plasma levels of cholesterol (hypercholesterolemia) and triacylglycerols (hypertriacylglycerolemia or hypertriglyceridemia). SLIDESMANIA.CO  Hyperlipidemia/dyslipidemia Causes: Factors that cause dyslipidemia are categorized into Primary causes: Genetic (hereditary) causes Secondary causes: Lifestyle and other causes SLIDESMANIA.CO  Hyperlipidemia/dyslipidemia The most important secondary cause of dyslipidemia is A sedentary lifestyle with excessive dietary intake of total calories, saturated fat, cholesterol, and trans fats (see sidebar Types of Fat) SLIDESMANIA.CO  Hyperlipidemia/dyslipidemia Some other common secondary causes include the following: Having diabetes mellitus Consuming large amounts of alcohol Having chronic kidney disease Having hypothyroidism Having primary biliary cirrhosis Using certain medications SLIDESMANIA.CO  Symptoms High lipid levels in the blood usually cause no symptoms. SLIDESMANIA.CO  Symptoms Achilles Tendon Xanthomas (familial hypercholesterolemia) - fat is deposited in the skin and tendons and forms bumps SLIDESMANIA.CO  Symptoms Tendon Xanthomas (familial hypercholesterolemia) - fat is deposited in the skin and tendons and forms bumps SLIDESMANIA.CO  Symptoms Eruptive Xanthoma - People who have severe elevations of triglycerides can have eruptive xanthomas over the trunk, back, elbows, buttocks, knees, hands, and feet. SLIDESMANIA.CO  Symptoms Xanthelasma of the Eyelid - Xanthelasma are yellow-white plaques on the eyelids and corners of the eye. SLIDESMANIA.CO  Diagnosis Blood tests to measure cholesterol levels SLIDESMANIA.CO  Risk Factors Diet high in saturated and Obesity Lack of physical activity trans fat Smoking Alcohol Diabetes Diabetes increases the risk of hyperlipidemia by lowering “good” cholesterol and raising SLIDESMANIA.CO triglycerides and “bad” cholesterol levels.  Hyperlipidemia Nursing Interventions: SLIDESMANIA.CO SLIDESMANIA.CO  03 Atherosclerosis SLIDESMANIA.CO  Atherosclerosis Atherosclerosis thickening or hardening of the arteries. It is caused by a buildup of plaque in the inner lining of an artery. Plaque is made up of deposits of fatty substances, cholesterol, cellular waste products, calcium, and fibrin. As it builds up in the arteries, the artery walls become thickened and stiff. SLIDESMANIA.CO SLIDESMANIA.CO  Atherosclerosis It is the buildup of fats, cholesterol and other substances in and on the artery walls SLIDESMANIA.CO SLIDESMANIA.CO SLIDESMANIA.CO SLIDESMANIA.CO  General Symptoms Chest pain Shortness of breath (dyspnea) both at rest and during activity Rapid breathing (tachypnea) Difficulty of breathing while lying or sitting (orthopnea) Fainting (syncope) Palpitations Lower extremity edema Pain in the lower extremity Difficulty in performing physical activities SLIDESMANIA.CO  Non-modifiable risk factors: Age Gender Family history of ischemic heart disease Race or ethnicity: Minority groups such as Hispanics and Blacks have a higher incidence of CAD. SLIDESMANIA.CO  Modifiable risk factors: Hypertension Hyperlipidemia/hypercholesterolemia Diabetes or insulin resistance Kidney disease Tobacco use Obesity Physical inactivity Diet Stress Alcohol use Lack of sleep SLIDESMANIA.CO  The patient with coronary artery Disease The Patient is a 40-year-old African American man with a history of hypertension. He is in for an annual physical and admits that he has experienced chest pain "a time or two" When he takes the stairs at work, so lately he has avoided the stairs. The chest pain subsided once he rested for a few minutes in his office. He smokes one pack of cigarettes per day. His diet includes fast foods four to five times a week. He is 5.8" and weighs 250 lbs. He takes hydrochlorothiazide and metoprolol (Lopressor) for his hypertension. His last serum cholesterol level was 220 mg/dl, with the HDL 35mg/dl and LDL 105mg/dl. His father died of an Ml at age 54, and his mother has hypertension. He works 50 hours a week as a lawyer and takes SLIDESMANIA.CO occasional walks on weekends.  NONMODIFIABLE MODIFIABLE SLIDESMANIA.CO  04 Atherosclerosis Complications SLIDESMANIA.CO  Coronary Artery Disease (CAD) Coronary artery disease (CAD) is a term used to describe conditions that affect the arteries that provide nutrients, blood, and oxygen to the heart. Atherosclerosis, a known cause of CAD, is characterized by lipid deposits within the walls of the arteries. SLIDESMANIA.CO  Carotid Artery Disease Carotid artery disease. When atherosclerosis narrows the arteries close to your brain, you may develop carotid artery disease. This can cause a transient ischemic attack (TIA) or stroke. SLIDESMANIA.CO  Peripheral Artery Disease Peripheral artery disease. When atherosclerosis narrows the arteries in your arms or legs, you may develop blood flow problems in your arms and legs called peripheral artery disease. SLIDESMANIA.CO  Aneurysms Aneurysms. Atherosclerosis can also cause aneurysms, a serious complication that can occur anywhere in the body. SLIDESMANIA.CO  Chronic Kidney Disease Chronic kidney disease. Atherosclerosis can cause the arteries leading to the kidneys to narrow. Narrowing of these arteries prevents enough oxygen- rich blood from reaching the kidneys. SLIDESMANIA.CO  Nursing Interventions SLIDESMANIA.CO  ACTIVITY (GROUP) CASE ANALYSIS (20 minutes) - Analyze the case scenario. - Identify the signs and symptoms exhibited by the patient then prioritize. 1. 2. 3….. - Choose one of the signs and symptoms then create a nursing care plan focusing on the nursing interventions and rationale. - Present. (2-3 minutes per group) SYMPTOM: __________ Nursing Intervention Rationale SLIDESMANIA.CO  CRITERIA: Content 5 Organization 5 TOTAL 10 POINTS SLIDESMANIA.CO  A 58 year old male client has recently been diagnosed with coronary artery disease and hypertension. The physical examination reveals BP of 150/90. pulse of 80, respiratory rate of 22, and oral temperature of 99.2°F. The client is coming in to the clinic for a follow up visit (one month into the treatment plan) for additional nutritional instruction regarding hypercholesterolemia because his lipid profile indicates HDL of SLIDESMANIA.CO 28. LDL of 280, and triglyceride level of 150.  Thank you! Do you have any questions? PREPARED BY: TRISHA T. TAN, RN, LPT SLIDESMANIA.CO  REFERENCES: https://www.msdmanuals.com/professional/endocrine-and-metabolic-disorders/lipid- disorders/hypolipidemia https://www.nursetogether.com/hyperlipidemia-nursing-diagnosis-care-plan/ Ma’am Phoebe B. Toyokan pPT SLIDESMANIA.CO SLIDESMANIA.CO