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Exam 2 NURS 110


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Describe the difference between atherosclerosis and arteriosclerosis? (P640-642)
- Arteriosclerosis – Abnormal Thickening of Vessel Walls; Thickening of Tunica Intima;
- Atherosclerosis – Deposits of Fat and Fibrin Build on Vessel Walls; Stages of: Fatty Streak; Fibrous Plaque; and Complicated Lesion
Describe the Etiology of Atherosclerosis and Arteriosclerosis? (P.640)
- Arteriosclerosis – Part of Normal Aging Process
- Atherosclerosis – Endothelial Injury from Smoking, Hypertension, Diabetes
In Atherosclerosis at what % of Occlusion does Symptoms Generally Appear? (P.641)
- Typically No Symptoms Until 60% of Vessel is Occluded
Explain how Arteriosclerosis Raises Blood Pressure?
- Decreases Distencibility
- Decreases Lumen Diameter
Define Normal Blood Pressure for Adults Age 18 or Older? (P.646)
- Normal <120, <80
- Prehypertension <139, <89
- Stage 1 < 159, <99
- Stage 2 >159, >99
Differentiate Between Primary and Secondary Hypertension? (P.646)
- Primary Is Most Common Form
- Overactivity Sympathetic Nervous System
- Overavtivity Renin/Angiotensin/Aldosterone System
- Salt & Water Retention of Kidneys

- Secondary is Caused By Systemic Disease Process
- Tumors
- Contraceptives
- Corticosteriods
- Antihistamines
- Blood Pressure Returns to Normal If Treated Early
Describe the Mechanisms of Organ Damage Secondary to Sustained Hypertension? (P.649)
- Myocardium – Increased Work Load; Diminished Blood Flow in Coronary Arteries
- Coronary Arteries – Accelerated Atherosclerosis
- Kidneys – Renin Aldosterone Secretion Stimulation; Reduced Oxygen Supply

- Essentially a Reduce in Blood Flow is the Mechanism of Injury
Describe Etiology, Manifestations of Orthostatic Hypotension? (P.650)
- Decrease in Systolic & Diastolic on Standing
- Baroreceptor Mediates Increase in Heart Rate & Constricts Arterioles

- Acute - Normal Regulatory Mechanisms Become Sluggish
- Drugs, Starvation, Loss of Fluid
- Most Common in Elderly

- Chronic – Secondary to a Disease, Endocrine Disorders, Disease of CNS
Discuss Aneurysms; Including Location of Majority, Types Requiring Emergency Surgeries? (P.651)
- Most Occur in Lower Abdomial Aorta (75%)

- True Aneurysms (Fusiform Circumfrential, Fusiform Saccular)
- Involve All Three Layers

- False Extravascular Hematoma Communicates with Extravascular Space
- Typically Between Vascular Graft & Artery

- Dissecting Saccular – Weakness or Separation of Vascular Layers
- Requires Emergency Treatment
Explain the Difference Between a Thrombus, Embolus and Thromboembolus? (P.652)
- Thrombus – Blood Clot Remains Attached to a Vessel
- Thromboembolus – Detached Thrombus
- Embolus – Bolus of Matter Circulating in Blood Stream
- Embolism – Obstruction of a Blood Vessel by Embolus
Explain the Pathophysiology of Thrombus Formation? (P.652)
- Conditions Promote Coagulation or Clotting
- Roughening, Inflammation, Trauma, Pooling of Blood
Discuss Pulmonary Embolism; Including Etiology, S/S, Most Likely Originating Site? (P.652??)
- Venous Side (Typically Deep Veins of Legs)
- Dislodged Thrombus
-Dyspnea; Unexplained Anxiety
Discuss Raynauds Disease; Including Pathophysiology, Trigger Events, S/S? (P.653)
- Characterized by Attacks of Vasospam in Small Arteries
- Secondry to a Disease Such as Collagen Vascular Disease
- Caused By Long Term Exposure to Cold, Vibrating Machinery
- Effects Hands; Pale Skin, Numbness
Discuss Varicose Veins; Including Common Etiologies? (P.654)
- Vein in Blood Has Pooled Producing Tortuous, and Palpable Vessels
- Caused by Trauma to Saphenous Veins; Distention Caused By Standing for Long Periods
- Crossing Legs
Discuss Chronic Venous Insufficiency; Including Etiology and Manifestations? (P.654)
- Inadequate Venous Returns Over Long Periods
- Trauma or Pressure Can Lower Blood Supply Leading to Venous Stasis Ulcers
. Differentiate Between Myocardial Ischemia, Necrosis and Hypertrophy and Etiologies of All? (P.655, 663???)
- Ischemia – Local State When Cells are Temporarily Deprived of Blood Supply (Atherosclerosis)
- Hypertrophy – Angiotensin Released in Ischemia Promotes Growth of Smooth Muscle
- Necrosis – After 20 mins of Myocardial Ischemia
Describe Modifiable and Non-Modifiable Risk Factors for CAD?
- Hyperlipidemia
- Hypertension
- Cigarette Smoking
- Obesity
- Alcohol

- Gender
- Genetic Predisposition
- Age
Describe what is happening in the Heart that Causes Angina Pectoris? (P.658)
- Symptoms of Chest Pain, Myocardial Ischemia
- Caused by Gradual Luminal Narrowing & Hardening of Arterial Walls
- Vessels Cannot Dilate In Response to Increased Myocardial Demand
- Relieved by Rest and Nitrates
- Discomfort Lasts 3 to 5 Minutes
Differentiate Between Stable, Unstable and Prinzmetal Angina? (P.658)
- Lasts 3 to 5 Minutes
- Not Tissue Damage
- Relieved By Nitrates & Rest

- Transient Ischemia of Myocardium at Rest
- Vasospasms of One or More Coronary Arteries
- Occurs in REM Sleep Triggered by Sympathetic Nervous System

- Between Reversible Myocardial Ischemia and Infarction
- Atherosclerotic Plaque has become Complicated
- Occlusion Occurs for 10 to 20 Min With Return to Perfusion
How long can Cardiac Cells Withstand Ischemic Conditions Before Damage is Permanent? (P.663)
- Cardiac Cells Can Withstand 20 Minutes of Ischemic Conditions Before
Cellular Death Takes Place
Describe the Goal(s) of Therapy in Managing Myocardial Ischemia (P.661)
- Reduce Myocardial Oxygen Consumption
- Control Factors Such As: Blood Pressure, Heart Rate, Contractility, and Left Ventricular Volume
Describe how Myocardial Infarction can lead to Ventricular Impairment? (P.???)
- Scar Tissue Does Not Function Like Original Tissue
Explain why Fever Often Occurs soon after Myocardial Infarction? (P.664)
- Inflammatory Activity Within Myocardium
Discuss Pericarditis; Including Complications of Pericardial Effusion, Related Condtions? (P.667)
Pericarditis – Pericardial Response to Injury (Acute Pericarditis, Pericardial Effusion, Constrictive Percarditis)

- Accumulation of Fluid in Pericardial Cavity
- Indicates underlying disorder such as Lupus, Erythematosus
- Serious Condition can cause Tamponade (Fluid Can Cause Cardiac Compression)
- Can be Caused by Tuberculosis
Describe Complication that is Possibility in all forms of Heart Valve Dysfunction? (P.671)
- Myocardial Hypertrophy
Differentiate Between Valvular Regurgitation, Insufficiency, and Stenosis? (P.671)
- Valvular Stenosis – Orifice is Constricted So Blood Cannot Flow Forward; Pressure & Work Increase
- Valvular Regurgitation (Insufficiency) – Valve Fails to Close; Permitting Blood to Flow When Closed
Identify the Valve Disorder Commonly Resulting in R Sided Heart Failure? (P.673)
- Tricuspid Regurgitation
Identify the Most Common Cardiac Valve Disease Most Prevalent in Young Women? (P.703)
-Mitral Valve Prolapse
Describe the Etiology, Pathophysiology and S/S of Rheumatic Heart Disease? (P.674)
- Group A Streptococcus (B-Hemolytic)
- Typically Occurs in Children 5 – 15 years
Define the type of Microbe Most Often Responsible for Infective Endocarditis? (P.677)
- Endocarditis is Inflammation of Endocardium
- Staphylococcus Aureus
Describe how Chronic HTN can Lead to L Heart Failure? (P.684)
- Increased Afterload Leads To Hypertrophy
Describe how Decreased Perfusion to Kidneys from Heart Failure Can Aggravate the Problem? (P.687)
- Decreased Cardiac Output Decreases Renal Perfusion Activating Renin-Angiotesnion-Aldosterone System
In Heart Failure what is the Pathophysiology that Results in Pulmonary Symptoms? (P.687-688)
- Left Heart Failure
- Pulmonary Vascular Congestion & Inadequate Profusion of Systemic Circulation
Identify the Common Cause of R Heart Failure? (P.688)
- Left Heart Failure
- COPD, Cystic Fibrosis, ARDS (Adult Respiratory Distress Syndrome)
Differentiate Between the S/S of R and L Heart Failure? (Notes)
- Right: Edema, Asceitis, JVD, Fatigue, Liver/Spleen Engorgement
- Left: Active & Sleeping Dyspnea; Orthopnea, Cough, Bloody Speutum, Cyanonsis, Decereased Uringary Output; S3 Gallop
In Shock What Leads to the Impairment in Cellular Metabolism? (P.689, 691)
- Oxygen & Glucose Depletion
Differentiate Between the Etiology and Patho, S/S of Cardiogenic, Hypovolemic, Anaphylactic and Septic Shock? (P.691)
- Cardiogenic: Typically Myocardial Infarction, Pericardial Infections, Drug Toxicity
- Hypovolemic: Loss of Whole Blood
What Major Injury Can Result in 3rd Spacing. What Type of Shock is This? (P.109)
- Burns, Hypovolemic Shock
- Fluids Travel From Vessel to Interstitial Space
What is the Underlying Process Occurring that Results in the Pale Cool Skin that Often Occurs in Hypovolemic Shock?
- Blood Travels From Peripherals To Core
Describe the Etiology of Neurogenic Shock?
- Spinal Cord Injury
Describe the Most Common Cause of Multiple Organ Dysfunction Syndrome (MODS)? (P.698)
- Sepsis and Septic Shock (Most Common)
- Any Disease Process that Causes Systemic Inflammatory Response
- Trauma, Burns, Acute Pancreatitis
Which Organ of the Body is Often the First to Fail in MODS? (P.700)
- Lung (Resulting in Adult Respiratory Distress Syndrome)
- Liver and Kidney Failures Then Appear

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