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Characteristics of Arteriosclerosis
- Thickening of arterial wall
- Loss of elasticity
- Hardening of artery walls (calcification)
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Atherosclerosis
- A type of arteriosclerosis
- Lipoprotein and fibrous tissue accumulate in the arterial wall
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Pathophysiology of Atherosclerosis
Vessel damage > vessel inflammation > fatty streak appears on inner lining of artery
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Increased risk of Atherosclerosis
- High levels of lipoproteins
- Low density lipoprotein (LDL) too high
- High density lipoprotein (HDL) too low
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LDL/HDL normal levels
- LDL - Want lower than 100
- HDL - Want higher than 40
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Treatment of Arteriosclerosis/Atherosclerosis
- Diet therapy - Fat content <30%, LDL low, HDL high, homocysteine levels low
- Stop smoking
- Exercise
- Drug therapy
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Peripheral Venous Disease disorders
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Causes of DVT
- Endothelial injury
- Venous stasis
- Hypercoagulability
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Greatest risk of DVT
Lead to PE
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DVT risk factors
- Hip surgery
- Knee surgery
- Open prostate surgery
- Immobility
- Phlebitis (vein inflammation)
- Pregnancy
- Heart failure
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Signs of DVT
- Groin tenderness and pain
- Sudden onset of unilateral swelling of leg
- Homan's sign only accurate 10%
- Diagnostic tests - Doppler studies, venogram, ultrasonography
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DVT nursing diagnoses
- Risk for ineffective tissue perfusion r/t interruption for venous blood flow
- Acute pain r/t physical injury agent (thrombus)
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DVT nursing interventions
- Prevention:
- -Client edu
- -Leg exercises
- -Early ambulation
- -Adequate hydration
- -SCDs or TED hose
- Rest and extremity evaluation
- Observe for signs and symptoms of PE
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Drug therapy for DVT
- Anticoagulants (Heparin, Warfarin)
- Thrombolytic Therapy to dissolve clot
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Function of hematologic system
- Transportation of:
- - Oxygen to cells
- - CO2 from cells
- - Hormones, electrolytes, and nutrients to cells
- - Waste products to the liver and kidneys
- Coagulation and clotting of blood
- Immune response
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Erythrocytes
- Concave disc
- Carry hemoglobin that transports O2 to body tissues
- Production in bone marrow = erythropoiesis
- Circulates 120 days
- Eliminated in liver and spleen
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Whole blood contains ___ grams of Hgb / 100 mls of blood
14-15
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Normal WBC count
5,000-10,000 / ml
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Platelets
- Primary function = Aid the body in clot formation
- Thrombocytes derived from megakarocytes in the bone marrow
- Life span in 8-12 days
- Stored in spleen and destroyed by phagocytosis
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Normal platelet count range
150,000 - 450,000
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Thrombin converts...
fibrinogen to fibrin for clotting
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Normal RBC range
- Men: 4.5-5.3 million/mm
- Women: 4.1-5.1 million/mm
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Normal Hct range
Hct is generally three times Hbg
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Normal Hbg range
- Men: 13-18g/100ml
- Women: 12-16g/100ml
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Erythropoiesis
- RBC production
- Begins in bone marrow of vertebrae, sternum, ribs, and pelvis
- Completed in the blood or spleen
- Stimulus for RBC production = hypoxia
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Required components for proper development of RBCs
- Iron necessary for hemoglobin synthesis
- Protein
- Vitamins b, b12, c, e
- Folate
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RBC destruction
- Life span of 120 days
- Old or damaged RBCs are lysed by phagocytes in the spleen, liver, bone marrow, lymph nodes
- Process of RBC destruction = hemolysis
- Phagocytes save and reuse amino acids and iron from the heme units of lysed RBCs
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Anemia results from:
- Decreased erythrocyte production
- Increased erythrocyte production
- Acute or chronic blood loss
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Causes of decreased erythrocyte production
- Altered hemoglobin synthesis
- Altered DNA synthesis
- Bone marrow failure
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Acute blood loss anemia
- All blood components are lost and nothing is recycled
- Loss can be any source: trauma, GI, surgical procedure, clotting disorder
- Blood may need to be replaced via transfusion
- Fluid shifts from interstitial to vascular to maintain BP
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Chronic blood loss anemia
- May be secondary to chronic GI bleeding or heavy menses
- As blood is lost the body's supply of iron that is normally recycled when old RBCs are destroyed is lost.
- Result = depletes iron stores as RBC production attempts to maintain supplies
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Nutritional anemias
- Iron Deficiency Anemia
- Vitamin B12 Deficiency Anemia
- Folic Acid Deficiency Anemia
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Iron deficiency anemia
- Caused by inadequate supply of iron
- Normally recycled, but need to renew with diet
- Can lose iron when blood is lost
- Most common type of anemia
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Vitamin B12 deficiency anemia
- Needed for DNA synthesis (result = large abnormal cells)
- Malabsorption of B12 secondary to many things (gastritis, partial/total gastrectomy, loss of pancreatic secretions)
- When loss is specifically due to loss of intrinsic factor, its called pernicious anemia
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Folic acid deficiency anemia
- Needed for DNA synthesis
- (result = large abnormal cells)
- Usually due to inadequate intake (alcoholics, elderly, drug addicted)
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Dietary sources of iron
- Beef
- Chicken
- Egg yolk
- Clams, oysters
- Pork loin
- Turkey
- Veal
- Bran flakes
- Brown rice
- Whole grain breads
- Dried beans
- Dried fruit
- Greens
- Oatmeal
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Dietary sources of folic acid
- Green leafy vegetables
- Broccoli
- Organ meats
- Eggs
- Wheat germ
- Asparagus
- Liver
- Milk
- Yeast
- Kidney beans
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Dietary sources of B12
- Liver
- Fresh shrimp and oysters
- Eggs
- Milk
- Kidney
- Meats (muscle)
- Cheese
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Hemolytic anemias
- Sickle cell
- Thalassemia
- Acquired hemolytic anemia
- Glucose-6-phosphate dehydrogenase (G6PD) anemia
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Sickle cell anemia
- Hereditary
- Primarily in african americans
- Result = an abnormal synthesis of hemoglobin that causes sickle-like appearance of RBCs
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Thalassemia
- Hereditary disorder
- Result = deficient production of hemoglobin and fragile RBCs
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Acquired Hemolytic anemia
- hemolysis occurs secondary to something outside the cell itself
- Trauma to cell from many factors including: prosthetic heart valves, severe burns, hemodialysis, radiation, certain infections, immune-mediated responses (transfusion reactions), drugs, venom
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Glucose-6-phosphate dehydrogenase (G6PD) anemia
- Hereditary disorder in RBC metabolism
- Result = direct oxidation of the Hgb which damages the RBC
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Aplastic anemia
- AKA Bone marrow failure
- Bone marrow fails to produce all three types of blood cells
- Leads to panocytopenia - everything is low
- Rare and cause is unknown in 50% of cases
- Can occur from exposure to certain chemicals, toxins, and infections
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