FA Davis Atherosclerosis and Other Arterial Diseases

Which of the following conditions refers to a weakened, bulging arterial wall?

- Aneurysm

Can you differentiate the various arterial disorders? For each disorder, drag and drop the statements that apply to the disorder to the box. Peripheral Arterial Disease (PAD) Ankle-brachial index used for assessment C-reactive protein and homocysteine levels used for assessment Weak arterial wall resulting in bulging of the artery 33% of patients die within first 24 hours Intermittent claudication Decreased peripheral pulses Presents with ripping or tearing sound

- Ankle-brachial index used for assessment - Intermittent claudication - Decreased peripheral pulses CORRECT. Peripheral artery disease results in decreased blood flow to the extremities. Most commonly, the arteries of the legs are affected. Depending on the extent of the blockage, peripheral pulses may be diminished in one limb compared with the other. The ankle-brachial index (ABI) compares the blood pressure in the ankles with the blood pressure in the arms and may be reduced with peripheral arterial disease in the lower extremities. When blood flow through the narrowed arteries cannot match the metabolic demands of the tissues, intermittent claudication results.

Which of the following is an immediate, life-threatening condition?

- Aortic dissection

Which of the following statements about aortic dissection are true? Select all that apply. Aortic dissection requires surgical repair. In aortic dissection, cardiac tamponade may develop. Females are more commonly affected than males. In aortic dissection, layers of the aortic wall split, allowing blood to flow between them. When left untreated, 33% of patients die within 24 hours.

- Aortic dissection requires surgical repair. - In aortic dissection, layers of the aortic wall split, allowing blood to flow between them. - When left untreated, 33% of patients die within 24 hours.

Can you differentiate the various arterial disorders? For each disorder, drag and drop the statements that apply to the disorder to the box. Vasculitis Ankle-brachial index used for assessment Sudden onset of symptoms including chest pain and tearing sound Associated with autoimmune process Immune complexes deposited in arterial walls Basic physiological change that results in cardiovascular disease Takayasu arteritis is an example Classified based on vessel size affected

- Associated with autoimmune process - Immune complexes deposited in arterial walls - Takayasu arteritis an example - Classified based on vessel size affected CORRECT. Vasculitis is inflammation of the vessels and is classified according to the size of the vessels affected. The disease may be systemic or affect one area or tissue of the body. Several forms of vasculitis exist, and an autoimmune component, with immune complexes deposited in the arterial walls, has been found to play a role. Signs and symptoms of vasculitis vary, depending on the tissues involved. Takayasu arteritis is one example of vasculitis; it affects the aorta and pulmonary arteries.

What basic physiological change underlies most cardiovascular diseases?

- Atherosclerosis

Can you differentiate the various arterial disorders? For each disorder, drag and drop the statements that apply to the disorder to the box. Atherosclerosis Basic physiological change that results in cardiovascular disease Blood pressure differential between right and left arm Foam cell formation Associated with autoimmune process Uncommon disorder C-reactive protein and homocysteine levels are used for assessment Hyperlipidemia

- Basic physiological change that results in cardiovascular disease - Foam cell formation - C-reactive protein and homocysteine levels are used for assessment Hyperlipidemia CORRECT. Atherosclerosis, a common disease, is form of arteriosclerosis in which the lumen of arterial wall becomes occluded with plaques. The plaques are formed from cholesterol and white blood cells forming foam cells. Although white blood cells are involved, formation of the plaques is not caused by an autoimmune response. Elevated C-reactive protein (an inflammation marker), homocysteine levels, and hyperlipemia are associated with atherosclerosis.

Can you differentiate the various arterial disorders? For each disorder, drag and drop the statements that apply to the disorder to the box. Raynaud's phenomenon Affects coronary arteries of children most commonly Warmth and flushing of the extremities occur Commonly associated with autoimmune diseases Calcium channel blockers may be effective treatment Exaggerated sympathetic response causes vessel constriction Symptoms relieved with the stopping of exercise

- Commonly associated with autoimmune diseases - Calcium channel blockers may be effective treatment - Exaggerated sympathetic response causes vessel constriction CORRECT. Raynaud's phenomenon occurs with an exaggerated sympathetic response causing vasoconstriction resulting in numbness, coolness, and tingling of the extremities. Raynaud's phenomenon is associated with certain autoimmune conditions, such as lupus. Calcium channel blockers can be an effective treatment. Kawasaki's disease, not Raynaud's phenomenon, is a disease that affects the coronary arteries of children.

Which is the most common location for peripheral artery disease?

- Femoral artery

Can you differentiate the various arterial disorders? For each disorder, drag and drop the statements that apply to the disorder to the box. Aneurysm Fusiform and saccular shapes Takayasu arteritis is an example 33% of patients die within first 24 hours Abdominal aorta most commonly affected Weak arterial wall resulting in bulging of the artery Surgical repair required

- Fusiform and saccular - Abdominal aorta most commonly affected - Weak arterial wall resulting in bulging of the artery CORRECT. An aneurysm is a bulge in an arterial wall. The most common location for an aneurysm is the abdominal aorta. An aneurysm may present in different forms including fusiform and saccular. Surgical repair is not always necessary with an aneurysm, and death does not occur at a high rate within the first 24 hours of development. Takayasu arteritis is a form of vasculitis and is not a type of aneurysm.

Which of the following statements about atherosclerosis are true? Select all that apply. Many early warning signs and symptoms of atherosclerosis exist. Risk factors for atherosclerosis include obesity, tobacco use, and family history. Clinical manifestations of atherosclerosis include a point of maximal impulse displaced towards the midclavicular line. Diagnostic tests for atherosclerosis include those for hyperlipidemia. Diabetes mellitus accelerates the development of atherosclerosis.

- Many early warning signs and symptoms of atherosclerosis exist. - Diagnostic tests for atherosclerosis include those for hyperlipidemia. - Diabetes mellitus accelerates the development of atherosclerosis.

Can you differentiate the various arterial disorders? For each disorder, drag and drop the statements that apply to the disorder to the box. Abdominal Aortic Aneurysm One of the primary types of vasculitis Immediate surgical intervention needed on detection May be detected as a bulge in the abdominal aorta Most common type of aneurysm Referred to as a "berry aneurysm" May rupture, leading to internal bleeding

- May be detected as a bulge in the abdominal aorta - May rupture, leading to internal bleeding - Most common type of aneurysm CORRECT. Abdominal aortic aneurysms are the most common type of aneurysm and may present as a bulge along the abdominal aorta. On detection, monitoring over time for changes is the most common course of action. If an abdominal aortic aneurysm were to rupture, internal bleeding will result. A "berry aneurysm" refers to a cerebral aneurysm.

An outpatient in the clinic complains of leg pain while walking. However, the patient adds that the pain ceases when he is at rest. Which condition would the nurse suspect?

- Peripheral arterial disease

Can you differentiate the various arterial disorders? For each disorder, drag and drop the statements that apply to the disorder to the box. Aortic Dissection Foam cell formation Sudden onset of symptoms including chest pain and tearing sound Antigen excess deposited in arterial walls Fusiform and saccular shapes 33% of patients die within first 24 hours Surgical repair required Blood pressure differential between right and left arm

- Sudden onset of symptoms including chest pain and tearing sound - 33% of patients die within the first 24 hours - Surgical repair required - Blood pressure differential between right and left arm CORRECT. Aortic dissection is a life-threatening condition in which a tear in the inner layer of the aortic wall appears. Blood pours into the tear, separating (dissecting) the inner layer from the middle layer. If the tear ruptures, death may result. Almost one-third of patients with aortic dissection die within the first 24 hours. Surgical repair of the tear is needed. Signs and symptoms include a sudden onset of severe chest pain. Depending on the location of the dissection, blood flow to either arm may be compromised, resulting in a difference in pressure between the arms.

Intermittent claudication ______________. Select all that apply. occurs most frequently in the legs. is pain that is alleviated by rest. is an unremitting, constant pain. is a tear in the aortic wall. radiates from the shoulder to the jaw.

- occurs most frequently in the legs. - is pain that is alleviated by rest.

A patient asks about heart disease and atherosclerosis because she is concerned about her family history. Which of the following does a nurse share as risk factors for atherosclerosis? Select all that apply. Age Diabetes mellitus Diet high in saturated fats Moderate active lifestyle Lower-than-normal blood lipid levels

-Age -Diabetes mellitus -Diet high in saturated fats

At what level of occlusion do the symptoms of peripheral arterial disease normally first begin to appear?

70%

A pulse pressure of 40 mmHg is recorded. Systolic blood pressure equals 130 mm Hg. What is diastolic blood pressure in mmHg? Enter numeral only.

90 mm Hg

A nurse sees that an emergency surgery has been scheduled for an arterial disorder. Which of the following may most likely require this intervention?

Aortic dissection

Paramedics bring in a patient who has lost consciousness. Friends state that prior to losing consciousness, the patient complained of severe pain in the chest and hearing a ripping or tearing sound. What does the nurse likely suspect?

Aortic dissection

A woman working in an office in which the summer air conditioning keeps the temperature very low mentions that she has Raynaud's phenomenon. What manifestations does the woman experience because of this disorder?

Blanching and coolness at the fingertips

A nursing educator tells students that endothelial tissue is an active tissue secreting many factors, one being nitric oxide. Based on this information, the nurse educator asks students to relate why nitroglycerine may be used to treat angina pectoris. Which of the following is the correct response?

In angina pectoris, coronary arteries are occluded. Nitroglycerin serves to dilate these arteries.

A child presents with vasculitis following an infection. A nurse suspects which of the following?

Kawasaki disease

There are a number of disorders related to atherosclerosis.

Peripheral artery disease, P.A.D. for short, is an occlusive disorder of the peripheral arteries, most commonly occurring in the femoral artery. PAD typically develops gradually, with intermittent claudication as a classic symptom. As a person exercises, muscle requires increased oxygenated blood. This means the artery needs to be free and clear of congestion. In intermittent claudication, however, the artery is obstructed, and the oxygenated blood cannot reach the muscle, causing pain that is relieved by rest.

A nurse notices a pulsing mass in the abdomen of a thin elderly gentleman. What is an appropriate response?

Recognize that this is likely an abdominal aortic aneurysm, which will need to be monitored.

After age of 55 years, females experience an increased risk for cardiovascular disease. Which explanation is most likely?

Women benefit from the cardioprotective effect of endogenous estrogen. After menopause, this effect dissipates.

When considering atherosclerosis and other arterial diseases, think of the body's arterial system as a highway, with the body's blood standing in for normal traffic. When the arterial system is healthy,

blood moves through the body without delay. There are no red lights, accidents, or delays. Everything is getting where it needs to go on time and on schedule. However, when the arterial system experiences disease, this highway system becomes congested and the body's blood has trouble getting where it needs to go.

A patient with many risk factors for atherosclerosis is talking to a nurse. The nurse states that although atherosclerosis has many causes, the process of atherosclerosis is initiated with which of the following events?

endothelial damage

A patient has Raynaud's phenomenon. What area of the body does the clinician expect to be affected?

hands

An elderly gentleman who is obese and living a sedentary lifestyle has presented at the clinic complaining that after running after his grandchildren, he felt cramping pains in his calf area. When he stopped and rested, the pain went away. What type of pain is the patient likely experiencing?

intermittent claudication

A patient's chart reveals that she has peripheral arterial disease. Which area of the body does the nurse most closely inspect, as this is the most common location for this disease?

leg

Which of the following cell types form foam cells?

macrophages

Aortic dissection is a potentially lethal disorder of the aorta, involving, as the name implies,

tearing of the aorta. As a person ages, the aortic wall weakens. In aortic dissection, this weakness leads to a splitting of the layers between the inner lining and middle muscular wall. Blood takes this new exit ramp and flows between the layers, which traumatizes the region, causing the gap to widen. Eventually, this new traffic pattern causes a backup of blood in the newly opened region, leading to a hematoma that protrudes into the lumen. This reduces blood flow to the major arteries arising from the aorta.

An aneurysm is a different type of arterial damage. Usually the result of a

weakened arterial lining from atherosclerosis, aneurysms feature arterial wall bulges and an uneven interior surface. These malformations increase the risk for rupture. As blood flows against the wall, it grows weaker. This weakness can increase to the point of rupture, which itself can lead to internal hemorrhage.

Atherosclerosis is the basic physiological change that causes cardiovascular disease. The process of atherosclerosis begins

when endothelial cells of vessel walls are damaged, stimulating inflammation-similar to when a highway is damaged and requires repair. When this occurs, white blood cells-our highway's road crew—travel to the area of injury. These macrophages engulf low-density lipoprotein molecules in the blood stream and transform into foam cells. These foam cells act like the support structures that are meant to guide traffic around an area of repair. They collect, gather, multiply, and take up space. Foam cells form lipid deposits along the vessel wall, eventually resulting in plaque formation. These plaques occlude the vessel and may also break free and obstruct blood flow in other areas.