FINAL PP Fall 2015 (1) - FINAL REVIEW NURS 1111 FALL 2015 ATHEROSCLEROSIS CH 27 The abnormal accumulation of lipid deposits and fibrous tissue within

FINAL PP Fall 2015 (1) - FINAL REVIEW NURS 1111 FALL 2015...

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FINAL REVIEW NURS 1111 FALL 2015
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ATHEROSCLEROSIS CH 27
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Assessment General appearance: cool skin/diaphoresis=low cardiac output, pallor=decreased perfusion, edema, paresthesia, ulcers, zanthelasma Palpate pulses (some changes related to medications) Assess for temperature differences in extremities Capillary Refill Assess for Bruit Obtain 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
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Risk Factors LABS Chart 27-1 Family History Age Gender Post-menopausal  in estrogen  risk > 65 risks are equal Race Hyperlipidemia Tobacco use Hypertension Diabetes Obesity Inactivity Cholesterol – below 200 LDL - L DL ( bad - want low ) should be <less than 100 HDL - H DL ( good - want high ) should be greater than 40 Triglycerides – below 150 on
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Life Style Changes Table 27-1 Dietary Changes Total Fat (25-35%) Saturated Fat – 7-10% total calories Polyunsaturated Fat - up to 10% of total calories Monounsaturated Fat - up to 25% of total calories Carbohydrates (50-60%) Fiber (20-30 grams) Protein (15%) Cholesterol (Less than 200mg) Other Changes Cholesterol control Physical Activity Tobacco Cessation Managing HTN Controlling DM
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Cholesterol Medications Table 27-2 Six types of lipid-lowering agents: affect the lipid components somewhat differently HMG-CoA (or statins) [Inhibits enzyme that synthesizes cholesterol] Nicotinic acids Fibric acids (or fibrates) Bile acid sequestrants (or resins) Cholesterol absorption inhibitors Omega-3 acid-ethyl esters Know how they work Side effects that are OK Side effects to report Patient teaching on how to take
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HYPERTENSION CH31 Those with an elevation in BP are associated with increased risk of stroke, heart attack (MI), heart failure and CV death.
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Blood pressure monitoring Chart 31-2 Size and placement of cuff is very important Know how patient should be positioned to take BP Obtain blood pressure reading in both arms Know how to obtain Orthostatic BPs: What the results mean S/Sp to monitor for (complaints made by the patient How to prevent falls
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Major Risk Factors Chart 31-1 Family History Smoking Obesity Physical inactivity Dyslipidemia Diabetes mellitus Older age Renal Impairment
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Types of HTN Primary hypertension (“Essential HTN”) Secondary hypertension Isolated Systolic hypertension (ISH) Hypertensive Urgency/Crisis Know for each : Who it affects Signs/Symptoms Causes How to treat What to report
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Patient Assessment H&P, Exam Lab tests Urinalysis Blood chemistry Cholesterol levels
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