Anti-atherosclerotic And Endothelial Protective Effects Discussion

Anti-atherosclerotic And Endothelial Protective Effects Discussion

Question 1

According to the CDC, HDL is regarded as the good cholesterol as it takes up cholesterol in the blood and transports it back to the liver and is removed from the body. HDL also plays a role in anti-inflammatory anti-atherosclerotic and endothelial protective effects. It promotes RCT which is an anti-atherogenic outcome of HDL which promotes the breakdown of atherosclerotic lesions (Kosmas et al., 2018)Anti-atherosclerotic And Endothelial Protective Effects Discussion. HDL also prevents endothelial dysfunction and cell death by tumor necrosis factor-alpha and ox-LDL. Therefore high levels of HDL reduce the risk of stroke or heart disease.

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Question 2

Atherosclerosis primarily occurs via a repeated process of arterial wall lesions secondary to lipid retention in the intima layer by a matrix that includes proteoglycans leading to modification which as a result aggravates chronic inflammation at the vulnerable sites in the artery and plays a crucial role in the atherogenic progression phases (Pahwa & Ishwarlal Jialal, 2021)Anti-atherosclerotic And Endothelial Protective Effects Discussion. The immune and non-immune cells cause plague formation via the interplay of inflammatory mediators. Without removal of the underlying risk factor, the inflammatory process persists leading to chronic non-resolving inflammation.

Question 3

Pleural friction rub is often brought about by the pleural disease which is as a result of the movement of roughened and inflamed pleural surfaces against each other during movement of the chest wall. The pleural friction rub described as a grating sound and is heard on both inspiration and expiration (Adderley & Sharma, 2021)Anti-atherosclerotic And Endothelial Protective Effects Discussion. On palpation, the examiner might pick up a sandpaper-rubbing type of sensation. It is often accompanied by sudden, sharp intense pain that worsens with inspiration.

 

Question 4

The risk factors of DVT are classified under Virchow’s triad which consists of; hypercoagulability, stasis, and endothelial injury. If a patient has either of the mentioned risks there is an activation of the clotting cascade together with aggregation of blood cells particularly the platelets to form a thrombus (Waheed et al., 2021)Anti-atherosclerotic And Endothelial Protective Effects Discussion. As a result, there is partial or complete occlusion of the vein resulting in venous stasis lymphedema, and likely ischemia to the surrounding tissue. Some of the risk factors the patient has include; recent surgery intervention dehydration from nausea and vomiting and being obese.

Question 5

Emphysema is a disease that primarily involves the air spaces to the terminal bronchiole. It is caused by chronic and significant exposure to noxious gases from cigarettes biomass fuels, sulfur dioxide, and others. The inhalation of noxious substances results in the accumulation of inflammatory cells including cytokines and proteases which is directly responsible for tissue remodeling and destruction which eventually complicates to COPD (Parul Pahal et al., 2022). Chronic obstructive lung disease is characterized by limitation of airflow due to exposure to harmful substances. It is associated with structural changes in the lung secondary to chronic inflammation which leads to narrowing of the airway and reduced lung recoil Anti-atherosclerotic And Endothelial Protective Effects Discussion

References

‌Adderley, N., & Sharma, S. (2021, July 31). Pleural Friction Rub. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537118/

Kosmas, C. E., Martinez, I., Sourlas, A., Bouza, K. V., Campos, F. N., Torres, V., Montan, P. D., & Guzman, E. (2018). High-density lipoprotein (HDL) functionality and its relevance to atherosclerotic cardiovascular disease. Drugs in Context, 7, 1–9. https://doi.org/10.7573/dic.212525

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‌ Pahwa, R., & Ishwarlal Jialal. (2021, September 28). Atherosclerosis. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK507799/

‌ Parul Pahal, Akshay Avula, & Sharma, S. (2022, May 8). Emphysema. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482217/

Waheed, S. M., Pujitha Kudaravalli, & Hotwagner, D. T. (2021, August 11). Deep Vein Thrombosis. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK507708/ Anti-atherosclerotic And Endothelial Protective Effects Discussion

QUESTION 1

Scenario 1: Myocardial Infarction

CC: “I woke up this morning at 6 a.m. with numbness in my left arm and pain in my chest. It feels tight right here (mid-sternal).” “My dad had a heart attack when he was 56-years-old and I am scared because I am 56-years-old.”

HPI: Patient is a 56-year-old Caucasian male who presents to Express Hospital Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states this started this morning and has been getting worse, pointing to the mid-sternal area, “it feels like an elephant is sitting on my chest and having a hard time breathing”. He rates the pain as 9/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, or lightheadedness. Nitroglycerin 0.4 mg tablet sublingual x 1 which decreased pain to 7/10.

Lipid panel reveals Total Cholesterol 424 mg/dl, high density lipoprotein (HDL) 26 mg/dl, Low Density Lipoprotein (LDL) 166 mg/dl, Triglycerides 702 mg/dl, Very Low-Density Lipoprotein (VLDL) 64 mg/dl

His diagnosis is an acute inferior wall myocardial infarction.

Question: Which cholesterol is considered the “good” cholesterol and what does it do? Anti-atherosclerotic And Endothelial Protective Effects Discussion

QUESTION 2

Scenario 1: Myocardial Infarction

 

CC: “I woke up this morning at 6 a.m. with numbness in my left arm and pain in my chest. It feels tight right here (mid-sternal).” “My dad had a heart attack when he was 56-years-old and I am scared because I am 56-years-old.”

HPI: Patient is a 56-year-old Caucasian male who presents to Express Hospital Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states this started this morning and has been getting worse, pointing to the mid-sternal area, “it feels like an elephant is sitting on my chest and having a hard time breathing”. He rates the pain as 9/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, or lightheadedness. Nitroglycerin 0.4 mg tablet sublingual x 1 which decreased pain to 7/10.

Lipid panel reveals Total Cholesterol 424 mg/dl, high density lipoprotein (HDL) 26 mg/dl, Low Density Lipoprotein (LDL) 166 mg/dl, Triglycerides 702 mg/dl, Very Low-Density Lipoprotein (VLDL) 64 mg/dl

His diagnosis is an acute inferior wall myocardial infarction.

Question: How does inflammation contribute to the development of atherosclerosis? Anti-atherosclerotic And Endothelial Protective Effects Discussion

QUESTION 3

Scenario 2: Pleural Friction Rub

A 35-year-old female with a positive history of systemic lupus erythematosus (SLE) presents to the Emergency Room (ER) with complaints of sharp retrosternal chest pain that worsens with deep breathing or lying down. She reports a 5-day history of low-grade fever, listlessness and says she feels like she had the flu. Physical exam reveals tachycardia and a pleural friction rub. She was diagnosed with acute pericarditis.

Question: Because of the result of a pleural friction rub, what does the APRN recognize?

QUESTION 4

Scenario 4: Deep Venous Thrombosis (DVT)

A 81-year-old obese female patient who 48 hours post-op left total hip replacement. The patient has had severe nausea and vomiting and has been unable to go to physical therapy. Her mucus membranes are dry. The patient says the skin on her left leg is too tight. Exam reveals a swollen, tense, and red colored calf. The patient has a duplex ultrasound which reveals the presence of a deep venous thrombosis (DVT).

Question: Given the history of the patient explain what contributed to the development of a deep venous thrombosis (DVT)

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QUESTION 5

Scenario 5: COPD

A 66-year-old female with a 50 pack/year history of cigarette smoking had a CT scan and was diagnosed with emphysema. He asks if this means he has chronic obstructive pulmonary disease (COPD).

Question: There is a clear relationship between emphysema and COPD, explain the pathophysiology of emphysema and the relationship to COPD.

**Please cite course resources, as well as outside resources to answer the questions. Each question should have at least one source cited Anti-atherosclerotic And Endothelial Protective Effects Discussion