NURS617 EXAM 5 Questions And Answers Graded A.Latest Update 2024/2025

NURS617 EXAM 5 Questions And Answers Graded A.Latest Update 2024/2025 Atherosclerosis development: 3 stages - answers 1. Endothelial injury (smoking, obesity, htn); causes increase in adhesion of platelets + phagocytic monocytes Migration of inflammatory cells; macrophages engulf lipoproteins (ldls) and creates "foam-like" cells Fibrous plaque forms; central core=lipid-laden foam cells. Can result in hemmorhage into plaque or thrombotic occlusion Atherosclerosis vs arterial sclerosis - answers atherosclerosis=type of arterial sclerosis Arterial sclerosis=hardening/thickening of vessel wall; loss of elasticity Arterial vs venous disease - answers arterial=decreased blood flow to tissues Venous=decreased blood return + removal of waste products Arterial circulation: 3 diseases - answers 1. Atherosclerosis: progressive dx d/t formation of fibrofatty plaques in large or medium arteries. Risk factors=hyperlipidemia & inflammation 2. Vasculities: inflammation of blood vessels (arteries/veins/capillaries); d/t direct injury, infection, or immune process 3. Aneurysms: dilation of artery d/t weakness in vessel wall; as size increases, % of rupture increases Lipid levels + role: total, ldl, hdl - answers total: 200 (high risk=240+) Ldl: 100; carries cholesterol to peripheral tissues Hdl: 40+; protective; removes cholesterol from tissues to liver for disposal **liver=major role in ldl metabolism; poor liver function=increased ldls Atherosclerosis: risk factors + arteries effected - answers -htn, smoking, aa race, diabetes, age, genetic predisposition (low ldl receptors=increase risk d/t increased need for macrophages to digest lipids; forms foam cells) -birth control, hiv meds, beta-blockers, estrogens -arteries supplying heart, brain, kidneys, lower extremities, small intestine Athersclerosis: 3 types of lesions - answers 1. Fatty streak - yellow 2. Fibrous plaque - grey/pearly 3. Complicated lesion - scar tissue, ulceration, thrombosis risk Giant cell arteritis (temporal arteritis) - answers -granulomatous inflammation of aorta + its major branches (ex: carotid); autoimmune panarteritis d/o frequently affecting the temporal artery (lupus, ra) -s/s: blurred vision or diplopia, fever, myalgia, arthralgia. Increased crp & esr -risk for aortic aneurysm -tx: high dose corticosteroids Acute arterial occlusion - answers -sudden blockage of an artery, typically in the lower extremity (tibial, pedal, peroneal), in the patient with chronic peripheral arterial disease -50% narrowing of artery until s/s appear -s/s: intermittent claudication (pain w/ walking that resolves w/ rest), pallor, shiny skin w/o hair, weak pedal pulse, cool to touch, sores that wont heal -dx: lower systolic bp in ankle than brachial, doppler ultrasound -tx: aspirin, plavix; no nicotine of any kind Thrombroangitis obliterans/burger disease - answers -inflammatory arterial disorder that causes thrombus formation; effects medium sized arteries (femoral, digital, plantar) -s/s: pain distal to arterial ischemia, intermittent claudication in arch of foot + digits, malformed nails -extremities can turn gangrene & require amputation **no nicotine; triggers inflammatory response Raynaud disease vs phenomenon + tx - answers -intense vasospasm of arteries + arterioles in fingers, sometimes toes; ischemia causes pallor/cyanosis -disease=precipitated by cold or extreme emotions; not a secondary disorder, seldom causes tissue necrosis -phenomenon= can cause tissue necrosis; d/t previous tissue trauma (ex: frost bite, heavy vibratory tools, lupus/collagen dx) -tx: vasodilators; minipress, calcium channel blockers (nifidepine, diltiazem) Aneurysms: true vs false - answers true= bounded by a complete vessel wall; blood remains within vascular compartment False=local dissection or tear in inner wall of artery; forms extravascular hematoma and causes vascular enlargement; only bound by outer layers of vessel wall or supporting tissues Aneurysms: berry vs fusiform - answers -berry=small, spherical vessel dilation; usually in circle of willis -fusiform=gradual enlargement of aorta; usually abdominal or thoracic Aneurysms: causes - answers -abnormal dilation of blood vessel; can be in artery or vein -causes=trauma, infection, atherosclerosis Aortic aneurysms - answers -weakness in the wall of the aorta that makes it susceptible to rupture -involves any part of aorta; ascending, descending, and abdominal -abdominal=most common -usually asymptomatic; pulsing mass d/t calcification over time -risk factors: htn, atherosclerosis, male, smoker, 50+ Aortic dissection - answers -acute, life threatening hemmorhage into blood vessel wall w/ long tearing of vessel wall to form blood-filled channel -causes: htn, pregnancy, connective tissue disease (marfans) -s/s: abrupt excrutiating pain, syncope, pulse unattainable in one or both arms, paralysis of lower extremities -occurs w/o evidence of previous vessel dilation; usually thoracic or ascending aorta Factors in developing venous dx - answers 1. Level of activity in lower extremities - skeletal muscle contraction moves blood back to heart 2. # of valves in veins to prevent retrograde of blood - less=genetic predisposition to varicose veins 3. Changes in thoracic pressure when breathing - increase in pressure (exhtn)=increase risk of varicose veins Varicose veins - answers -abnormally swollen, twisted veins with defective valves; most often seen in the legs -most common cause=dvt -other causes: increase in abdominal pressure (htn, obesity), prolonged standing w/o use of leg muscles to pump blood back to the heart -tx: compression stockings, calf pumps Chronic venous insufficiency - answers -venous circulation is inadequate due to partial vein blockage or leakage of venous valves (or both); muscle pumps ineffective -effective blood flow & emptying of deep veins cannot occur -s/s: edema, brown pigmented skin on les, necrosis, tissue congestion, stiffening of ankle joint & loss of muscle mass + strength -secondary lymphatic insufficiency occurs Venous thrombosis - answers -formation of blood clot in vein d/t stasis of blood, increase coagulability, vessel wall injury -causes: best rest/immobility, pregnancy, birth control, cancer, stress/trauma, hyperlipidemia, htn, hip fracture, surgery -s/s: deep muscle tenderness, pain, hot to touch, fever, swelling -tests: doppler, d-dimer -tx: elevate legs 15-20 degrees, compression stockings, prophylactic anticoag (ld aspirin), heparin or warfarin 3-6mo after tx of thrombi to ensure dissolved Short vs long term bp regulation - answers -short=d/t exercise, stress, hemmorhage; regulated by medulla/reticular formation. Sns=increases hr and contractility of heart, constricts vessels. Pns=vagal nerve stimulated and decreases hr, dilates blood vessels