ATI Medical Surgery A+ Graded 2023 QUIZLET

Describe COPD Chronic airflow limitation, progressive, systemic effects COPD includes: Chronic bronchitis Chronic cough for 3 mos in 2 consecutive yrs Emphysema Abnormal, permanent enlargement of air spaces Bronchospasm COPD stats 4th cause of death in US More in women and whites COPD risk factors Cigarette smoking Occupational chemicals & dust Air pollution Infection Genetics Aging Medical Surgery COPD What happens? Inability to expire air Loss of elastic recoil Air trapping Breathing with "over-inflated" lungs Air trapping worsens and alveoli destroyed Hypoxia and hypercarbia Bullae and blebs Excess mucus production Pulmonary hypertension Vasoconstriction from hypoxia Cor pulmonale Right ventricle hypertrophy COPD - s/s Dyspnea Chronic cough Sputum production Wheezing/chest tightness Tripod-ing Clubbed nails Prolongued expiration Barrel chest "Pursed lip" breathing Hypoxemia Hypercapnia Polycythemia COPD - diagnostic studies PFTs - to confirm diagnosis FEV1 - obstruction CXR ABGs - show hypoxemia, hypercarbia, acidosis, ↑ bicarbonate BMI -1/3 of COPD patients are underweight COPD - complications Cor pulmonale RHF COPD exacerbations Acute respiratory failure *DC bronchodilators/corticosteroids Medical Surgery COPD - tx smoking cessation vaccination Bronchodilators Β2 adrenergic agonists Anticholinergic agents Methylxanthines Corticosteroids ICS O2 therapy Coronary Artery Disease - stats CV is #1 cause of death in US Def: heart disease from impaired coronary blood flow by atherosclerosis Mortality rate decreasing Medical Surgery Describe the steps involved in the development of artherosclerosis what is it: deposits of fat lining coronary arteries Fatty streaks start at age 15 By 30, fibrous plaque appears 1. Inflammation or injury occurs (smoking, HTN, DM, high cholesterol) C-reactive protein will be elevtated 2. Immune response to injury. Platelets attach, smooth muscle cells migrate in, lipids accumulate, 3. Fibrous plaque forms, can lead to complicated lesions ( dangerous, unstable and can rupture) Two types of plaque: Stable - obstructs blood flow, angina when lesion >75% Unstable - gel-like lipid rich core covered w/fibrous cap - if ruptures leads to platelet aggregation and acute MI or unstable angina **CAD - lipids (atheromas) and cholesterol deposit in the intimal wall of coronary arteries = localized inflammatory response that develops into a fibrous plaque = endothelial injury as the plaque bulges into the lumen of the artery. Ongoing growth of the fibrous plaque plus continued inflammation = plaque instability, ulceration, and ultimately rupture. Once the endothelial layer is damaged, platelet aggregation leads to thrombus formation from receptor binding of fibrinogen. What is collateral circluation? Body's defense mechanism to prevent ischemia If given enough time, vessels will grow around the blockage and blood supply will continue CAD - risk factors unmodifiable vs modifiable Unmodifiable: Age (>65), gender (men), race (white), genetics Modifiable: #1 Hyperlipedemia #1!!!!! #2 Hypertension #3 Tobacco #4 Physical Inactivity Medical Surgery Why is smoking so bad to heart?? Increases LDL, decreases HDL, nicotine stimulates release of catecholamines which increases HR and BP which increases cardiac workload and demand, When heart needs more O2 supply, O2 extraction is decreased due to carbon monoxide in smoke, stimulates polycythemia = vessel inflammation and thrombosis Cholesterol Produced in liver. Building block in estrogen, steroidal hormones. Decribe lipoproteins - HDL - LDL - Triglycerides 1. LDL "bad" < 130 desirable < 100 mg/dL optimal carry cholesterol to tissue sites 2. HDL "good" > 30 desirable- higher HDL = less CAD > 50 mg/dL (females); > 40 mg/dL (males) optimal carry cholesterol from arteries to the liver for removal 3. Triglycerides: < 150 mg/dL optimal