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FINAL REVIEWNURS 1111FALL 2015
ATHEROSCLEROSIS CH 27
AssessmentGeneral appearance: cool skin/diaphoresis=low cardiac output, pallor=decreased perfusion, edema, paresthesia, ulcers, zanthelasmaPalpate pulses (some changes related to medications)Assess for temperature differences in extremitiesCapillary RefillAssess for BruitObtain BP in BOTH arms (Differences of >15 mm Hg could mean CAD. Use the higher systolic when reporting. Always note a difference of > 5 mm Hg).Labs: Lipid profile, C-Reactive Protein, Homocysteine
Risk Factors LABSChart 27-1 Family HistoryAge GenderPost-menopausal in estrogen risk> 65 risks are equalRaceHyperlipidemiaTobacco useHypertensionDiabetesObesityInactivityCholesterol – below 200LDL - LDL (bad- want low) should be <less than 100 HDL - HDL (good-want high) should be greater than 40 Triglycerides – below 150on
Life Style ChangesTable 27-1Dietary ChangesTotal Fat (25-35%)Saturated Fat – 7-10% total caloriesPolyunsaturated Fat - up to 10% of total caloriesMonounsaturated Fat - up to 25% of total caloriesCarbohydrates (50-60%)Fiber (20-30 grams)Protein (15%)Cholesterol (Less than 200mg)Other ChangesCholesterol controlPhysical ActivityTobacco CessationManaging HTNControlling DM
Cholesterol MedicationsTable 27-2 Six types of lipid-lowering agents: affect the lipid components somewhat differentlyHMG-CoA (or statins) [Inhibits enzyme that synthesizes cholesterol]Nicotinic acidsFibric acids (or fibrates)Bile acid sequestrants (or resins)Cholesterol absorption inhibitorsOmega-3 acid-ethyl estersKnow how they workSide effects that are OKSide effects to reportPatient teaching on how to take
HYPERTENSION CH31Those with an elevation in BP are associated with increased risk of stroke, heart attack (MI), heart failure and CV death.
Blood pressure monitoringChart 31-2Size and placement of cuff is very importantKnow how patient should be positioned to take BPObtain blood pressure reading in both armsKnow how to obtain Orthostatic BPs: What the results meanS/Sp to monitor for (complaints made by the patient How to prevent falls
Major Risk Factors Chart 31-1Family HistorySmokingObesityPhysical inactivityDyslipidemiaDiabetes mellitusOlder ageRenal Impairment
Types of HTN Primary hypertension (“Essential HTN”)Secondary hypertensionIsolated Systolic hypertension (ISH)Hypertensive Urgency/CrisisKnow for each: Who it affectsSigns/SymptomsCausesHow to treatWhat to report