NUR 114 Exam 2 Study Questions and
Correct Answers
Concept of perfusion ✅If we don't have enough perfusion to vessels and organs
people usually experience pain
It can effect bowels if there is not enough perfusion to the gut
It can cause confusion if there is not enough perfusion to the brain
Perfusion and circulation ✅Your body was designed for movement, we start to see
issues with this lack of flow when people do not move or are immobile
If there is an obstruction in the vessels it can slow things down
Atherosclerosis ✅Disease in which plaque builds up inside arteries.
Plaque or atheromas are made up of fat, cholesterol, calcium
Causes arteries to narrow restricting blood flow....limits flow of oxygen rich blood to
tissue......effects perfusion
Major cause of Coronary Artery Disease (CAD)
Arteriosclerosis: "Hardening of the Arteries"
Why is it a problem if arteries harden?
Arteriosclerosis occurs when the blood vessels that carry oxygen and nutrients from
your heart to the rest of your body (arteries) become thick and stiff — sometimes
restricting blood flow to your organs and tissues.
It is all about the effect of the vessels
Your vessels need to be able to vasodilate and vasoconstrict in order to compensate
and are used in the sympathetic system. It effects the whole body and perfusion if the
vessels harden or are unable to expand and contract
Pathogenesis of atherosclerosis ✅LDL deposits cholesterol in artery wall
Macrophages sent as an immune response to engulf invading cholesterol
Foam cells are macrophages full of cholesterol....forms a fatty streak
Fatty streak turns into fibrous plaque pushing intima into the lumen, narrowing blood
flow
Pathogenesis of atherosclerosis. A, Damaged endothelium. B, Fatty streak and lipid
core formation. C, Fibrous plaque. Raised plaques are visible: some are yellow; others
are white. D, Complicated lesion: thrombus is red; collagen is blue. Plaque is
complicated by red thrombus deposition.
On the inside of the vessel it should be smooth. If it gets rough it starts to catch things.
The very inside of the blood vessels can release substances that can affect vasodilation
so if there is injury to the inside of the vessel wall there might be inflammation and we
might lose the body's ability to compensate when it needs to
If there is a roughening of the inside of the vessel or there is too much fat or LDL lipids
then they can seep to the inside of the vessel lining and the body detects that as an
,invader and the body sends macrophages out to swallow it and then they eat it up and
get too fat and are called foam cells when they get big and those cells cause a fatty
streak which becomes fibrous plaque which can then narrow the vessel and harden
which causes the vessel not to be able to vasodilate and vasoconstrict
There is also an inflammatory part and it can weaken the cap which can cause the
plaque to break away which tears the tissue and can cause platelets to aggregate which
can cause a blood clot to try and heal what the body considers an "injury" which can
occlude the vessel. This is a problem
There are several things that can cause injury to vessels including: nicotine (is caustic
to the vessel), tobacco, other toxins, infection, diabetes (having too
Risk factors for CAD (Impaired perfusion) ✅Modifiable:
Hyperlipidemia
Tobacco use
Hypertension
Diabetes
Metabolic syndrome
Obesity
Physical Inactivity
Nonmodifiable:
ge: Increases with age
Genetics: Family history
Gender
Ethnicity/Race
Metabolic syndrome is a syndrome where someone is a cluster of risk factors for
someone who has an increased waist circumference, hypertension, abnormal serum
lipids, elevated blood glucose
Metabolic Syndrome ✅Metabolic syndrome is a syndrome where someone is a cluster
of risk factors for someone who has an increased waist circumference, hypertension,
abnormal serum lipids, elevated blood glucose
Contributing Risk Factors to CAD ✅Diabetes
Psychological States
Homocysteine & C-reactive Protein
Substance Abuse
Metabolic syndrome (includes 3 of the following conditions):
Insulin resistance
Central obesity
Dyslipidemia
BP persistently greater than 130/85 mm Hg
Proinflammatory state
Prothrombotic state
,Just having a higher level of blood glucose (hyperglycemia) causes an inflammatory
process that affects the endothelial function, also increases platelet aggregation, can
alter red blood cell function and puts people at a higher risk of developing clots
(thrombus)
Having a lot of stress has a lot of anxiety and there is a catecholamine released and
chronically causing them flowing through the body is caustic and can cause an
inflammatory process to occur inside the vessels
High Homocysteine levels is an amino acid and is linked to the development of
atherosclerosis and arteriosclerosis and can be caused if they
Also insufficient B vitamins lowers the levels of Homocysteine
C-reactive protein is a cardiac marker for high cardiac risk and it is created in response
to chronic endothelial injury (it is an expensive test so they do not test it very often)
Substance abuse (cocaine, amphetamines) really can put people at risk for coronary
artery disease (causes people to have more MIs), cocaine causes a coagulative affect
and can cause more blood clots, long term use can cause coronary spasm and
hypertension
Atherosclerosis-Related Diseases ✅Coronary Heart Disease
Carotid Artery Disease
Peripheral Artery Disease
Chronic Kidney Disease
Anywhere you have blood vessels you can have atherosclerosis
Cholesterol ✅Waxy, fat-like substance found in all cells
Used to make hormones, vitamin D, bile salts
Made in body & found in foods
Travels through bloodstream via lipoproteins (small packages made of fat on inside and
protein on outside)
Need healthy level of High Density Lipoproteins and Low Density Lipoproteins
HDL: Carries cholesterol from other parts of body back to liver. Liver then removes
cholesterol from body
LDL: travels through body carrying cholesterol, but can lead to cholesterol build up in
arteries
We make our own cholesterol, and every cell in the body can do so.
The liver is the most important organ for cholesterol production and removal. When the
liver fails to function properly, cholesterol numbers can be exceedingly high and
dangerous.
We also get it from food when we eat
If we break down cholesterol we can break it down into either HDL or LDL (HDL is
healthy, LDL is bad)
, LDL hangs out too long and that is where the cholesterol hangs out in the body and
builds up as plaque
Cholesterol levels (KNOW THESE) ✅Total cholesterol goal: less than 200mg/gL
LDL cholesterol goal: Less than 100mg/dL
HDL cholesterol goal: Males > 40mg/dl, females >50mg/dL, low risk for CAD, >
60mg/dL and higher
We need higher HDL than LDL
NEED TO KNOW THIS SLIDE
When you draw a lipid panel it will show you this
VDL is very low density
Lipid levels (KNOW THESE) ✅LDL cholesterol number is:
Optimal if it is less than 100
Near optimal/above optimal if it is 100-129
Borderline high if it is 130-159
High if it is 160-189
Very high if it is 190 or above
Triglyceride numbers are:
Normal if they are less than 150
Borderline high if they are 150-199
High if they are 200-499
Very high if they are 500 or higher
Triglycerides is another fat that is with cholesterol and it can be used as energy. The
problem is that if there is too much triglyceride because it is still a fat, a fatty substance.
The lower the better with Triglyceride
They break it down into levels to give the physician an idea of what needs to change
with getting the LDL into a better level to know if they need to go
Factors Affecting Lipid Levels ✅Cholesterol: Sedentary lifestyle with intake of
saturated fatty acids; familial hypercholesterolemia
LDL: Excessive intake of saturated fatty acids; dietary cholesterol intake and obesity;
familial hypercholesterolemia; hypothyroidism; diabetes.
Triglycerides: Obesity, excessive alcohol intake, diabetes mellitus, beta blockers,
familial hypertriglyceridemia
HDL: Cigarette smoking, obesity, lack of regular exercise, genetic disorders of HDL
metabolism, hypertriglyceridemia, and diabetes lowers HDL
LIFESTYLE
A Lipid Panel measures Cholesterol, triglycerides, LDL, HDL.
Familial Hypercholesterolemia ✅Genetic disorder
Familial: Heterozygous or Homozygous
Body unable to remove LDL from blood (begins at birth)
