NURS 6501 Knowledge Check: Module 2 Answer Key

NURS 6501 Knowledge Check: Module 2 Answer Key Why is HDL considered the "good" cholesterol? HDL is considered the good cholesterol because it collects excess cholesterol in the body cells and transports it to the liver where it is excreted in the body cells and transports it to the liver where it is excreted in the body. HDL carries 20-25% of total plasma cholesterol. Explain the role inflammation has in the development of atherosclerosis. Inflammation in the heart muscle caused by chronic inflammatory processes leads to mitochondrial damage that results in an increased free radical production that further activates the chronic inflammatory vicious cycle. What does the Advanced Practice Registered Nurse (APRN) recognize as the result of the pleural friction rub? The inflammation of the pericardium, due to either the underlying autoimmune disease or a post viral syndrome, causes roughening of the pericardium. The roughening of the pericardium causes the classic "rub" which can best be heard at the apex of the heart and left sternal border. Explain how a positive strep test has caused the patient's symptoms. Rheumatic Heart Disease (RHD) only develops after a pharyngeal infection with Group A beta hemolytic streptococcus. It is an abnormal response to humoral and cell-mediated response to M proteins on the microorganisms. The intense inflammation caused by these reactions cause proliferative and exudative lesions in connective tissue. This inflammation causes scarring of the valve tissue. The inflammation usually affects the endocardium which contains the valves. Endocardial inflammation causes swelling of leaflets in the valves the APRN sees a 74-year-old obese female patient who is 2 days post-op after undergoing left total hip replacement. The patient has had severe post op nausea and vomiting and has been unable to go to physical therapy. Her mucus membranes are dry. The patient says she feels like the skin on her left leg is too tight. Exam reveals a swollen, tense, and red colored calf. The patient has a duplex ultrasound which reveals the presence of a deep venous thrombosis (DVT). Question:Describe the factors that could have contributed to the development of a DVT in this patient explain how each of the factors could cause DVT. Virchow's Triad caused damage to the walls of the vessels. When there is injury to the intimal layer of the vessel, antiplatelet substances such as nitric oxide and prostacyclin, along with the expression of collagen on the vessel wall, causes adherence of the platelets to the vessel wall. The platelets become activated then aggregate forming clots. Venous stasis as a result of obesity, patient's advanced age and inability to go to physical therapy Explain why a large pulmonary embolus interferes with oxygenation. The embolus lodges somewhere in the pulmonary circulation and causes a ventilation/perfusion mismatch (V/Q). Ventilation Perfusion mismatch or "V/Q defects" are defects in total lung ventilation perfusion ratio. It is a condition in which one or more areas of the lung receive oxygen but no blood flow, or they receive blood flow but no oxygen due to obstruction somewhere in the pulmonary circulation. This causes a decreased area for oxygen exchange Explain why a large pulmonary embolism causes right ventricular strain. The V/Q mismatch causes release of neurohumeral substances and inflammatory mediators that cause vasoconstriction of the pulmonary vasculature further impeding oxygenation. Hemodynamically, this vasoconstriction results in pulmonary hypertension, making it difficult for the right ventricle to pump blood. The V/Q mismatch also causes decreased production of surfactant causing atelectasis that further decreases surface area available for oxygen exchange Explain early asthmatic responses and the cells responsible for the responses. When there is an initial airway exposure to an antigen, an innate and adaptive immune response is initiated. Cells that can initiate the inflammation of the bronchial mucosa and hyperresonance of the airways include dendritic cells, T helper 2 lymphocytes, B lymphocytes, mast cells, neutrophils, eosinophils, and basophils. Early asthmatic response is a phase of bronchospasm that peaks at about 30 minutes and usually resolves after about 3 hours. Explain late asthmatic responses and the cells responsible for the responses Late asthmatic responses are mediated by earlier exposure in early phase that causes a latent release of inflammatory mediators. These mediators, leukotrienes and prostaglandin D, cause bronchospasm, edema, and mucus secretions that obstruct airflow. Airway obstruction creates resistance to airflow and causes air trapping. Continued air trapping increases intrapleural and alveolar gas pressure, decreases ventilation and perfusion leading to uneven and variable ventilation/perfusion in the lung. Explain the pathophysiology of emphysema and how it relates to COPD Emphysema is a disease of the airways that causes permanent enlargement of the gas- exchange airways. It is accompanied by destruction of the alveolar walls do not appear to be fibrotic. Chronic exposure to irritants recruit neutrophils, macrophages, and lymphocytes to the lung resulting in progressive damage from inflammatory oxidative stress. Emphysema is characterized by destruction of alveoli leading to decreased surface area for gas exchange that causes significant ventilation/perfusion mismatch Explain the pathophysiology of chronic bronchitis and how it relates to COPD. Chronic bronchitis is caused by inhalation of irritants that promote bronchial inflammation. This inflammation causes bronchial edema, increase in the size and number of mucus glands and goblet cells, smooth muscle hypertrophy with fibrosis and narrowing of the airway. Increased secretions of thick mucus happen, and the patient cannot cough it up due to impairment of ciliary function. As the disease, progresses, the smaller airways are involved as well as the large airways. These airways, due to hypertrophy, cause narrowing of the smooth muscle and obstruct airflow, especially during expiration. The obstruction can lead to VQ mismatches Mr. Jones is a 78-year-old gentleman who presents to the clinic with a chief complaint of fever, chills and cough. He also reports some dyspnea. He has a history of right sided CVA, COPD, dyslipidemia, and HTN. Current medications include atorvastatin 40 mg po qhs, lisinopril, and fluticasone/salmeterol. He reports more use of his albuterol rescue inhaler. Vital signs Temp 101.8 F, pulse 108, respirations 21. PaO2 on room air 86% and on O2 4 L nasal canula 94%. CMP WNL, WBC 18.4. Physical exam reveals thin, anxious gentleman with mild hemiparesis on left side due to CVA. HEENT WNL except for diminished gag reflex and uneven elevation of the uvula, CV-HR 108 RRR without murmurs, rubs, or click, no bruits. Resp-coarse rhonchi throughout lung fields. CXR reveals consolidation in right lower lobe. He was diagnosed with community acquired pneumonia (CAP). Question:Patient was hypoxic as evidenced by the low PaO2. Explain the pathologic processes that caused this patient's hypoxemia. Arterial hypoxemia early in acute pneumococcal pneumonia is principally caused by persistence of pulmonary artery blood flow to be consolidated lung resulting in an intrapulmonary shunt, and by ventilation-perfusion mismatch later. Release of mediators cause widespread inflammation of the bronchial structures, especially the alveolar- capillary membrane. The alveoli collapse due to inactivation of surfactant and the alveoli fill with exudate, decreasing surface area for gas exchange. The APRN recognizes that COPD has a deleterious effect on patients. Explain why patients with COPD are at risk for malnutrition. Many of the patients with severe COPD are lean, and frequently in a malnourished or undernourished state, which is characterized by loss of fat-free body mass causing muscle wasting. The muscle wasting in COPD not only leads to decreased skeletal muscle function associated with reduced exercise capacity but is also a major determinant of mortality in COPD. Patients with COPD require a low carbohydrate diet as increased CHO can lead to hypercapnia as the end products of CHO metabolism are CO2 and H2O.