Posted: October 6th, 2022

Discussion: Development of atherosclerosis

Discussion: Development of atherosclerosis

1. CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”
HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.
Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl
His diagnosis is an acute inferior wall myocardial infarction.
1 of 2 Questions:
Why is HDL considered the “good” cholesterol?

QUESTION 2
1. CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”
HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.
Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl
His diagnosis is an acute inferior wall myocardial infarction. Discussion: Development of atherosclerosis
2 of 2 Questions:
Explain the role inflammation has in the development of atherosclerosis.

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QUESTION 3
1. A 45-year-old woman with a 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 3-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:

What does the Advanced Practice Registered Nurse (APRN) recognize as the result of the pleural friction rub?

1 points
QUESTION 4
1. A 15-year-old adolescent male comes to the clinic with his parents with a chief complaint of fever, nausea, vomiting, poorly localized abdominal pain, arthralgias, and “swollen lymph nodes”. States he has felt “lousy” for a couple weeks. The fevers have been as high as 102 F. His parents thought he had the flu and took him to an Urgent Care Center. He was given Tamiflu® and sent home. He says the Tamiflu didn’t seem to work. States had a slight sore throat a couple weeks ago and attributed it to the flu. Physical exam revealed thin young man who appears to be uncomfortable but not acutely ill. Posterior pharynx reddened and tonsils 3+ without exudate. + anterior and posterior cervical lymphadenopathy. Tachycardic and a new onset 2/6 high-pitched, crescendo-decrescendo systolic ejection murmur auscultated at the left sternal border. Rapid strep +. The patient was diagnosed with acute rheumatic heart disease (RHD).

Question:

Explain how a positive strep test has caused the patient’s symptoms.

QUESTION 5
1. The APRN sees a 74-year-old obese female patient who is 2 days post-op after undergoing left total hip replacement. The patient has had severe post op nausea and vomiting and has been unable to go to physical therapy. Her mucus membranes are dry. The patient says she feels like 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). Discussion: Development of atherosclerosis
Question:
Describe the factors that could have contributed to the development of a DVT in this patient explain how each of the factors could cause DVT.

QUESTION 6
1. A 45-year-old woman is 10 days status post partial small bowel resection for Crohn Disease and has been recuperating at home. She suddenly develops severe shortness of breath, becomes weak, and her blood pressure drops to 80/40 mmHg (previous readings ~130/80s mmHg). The pulse oximetry is 89% on room air. The APRN suspects the patient experienced a massive pulmonary embolus.

Question:

Explain why a large pulmonary embolus interferes with oxygenation.

QUESTION 7
1. A 45-year-old woman is 10 days status post partial small bowel resection for Crohn Disease and has been recuperating at home. She suddenly develops severe shortness of breath, becomes weak, and her blood pressure drops to 80/40 mmHg (previous readings ~130/80s mmHg). The pulse oximetry is 89% on room air. While waiting for the Emergency Medical Service (EMS) to arrive, the APRN places EKG leads and the EKG demonstrates right ventricular strain.

Question:

Explain why a large pulmonary embolism causes right ventricular strain.

— Fo

QUESTION 8
1. A 12-year-old girl is brought to the Emergency Room (ER) by her mother with complaints of shortness of breath, wheezing, tachypnea, tachycardia, and a non-productive cough. The mother states they had just come from a fall festival where the entire family enjoyed a hayride. The symptoms began shortly after they left the festival but got better a couple hours after they returned home. The symptoms began again about 6 hours later and seem to be worse. The mother states there is no history of allergies or frequent respiratory infections. The child is up to date on all vaccinations. The child was diagnosed with asthma. The nurse practitioner explained to the mother that her child was exhibiting symptoms of asthma, and probably had an early asthmatic response and a late asthmatic response.

Question 1 of 2:

Explain early asthmatic responses and the cells responsible for the responses.

QUESTION 9
1. A 12-year-old girl is brought to the Emergency Room (ER) by her mother with complaints of shortness of breath, wheezing, tachypnea, tachycardia, and a non-productive cough. The mother states they had just come from a fall festival where the entire family enjoyed a hayride. The symptoms began shortly after they left the festival but got better a couple hours after they returned home. The symptoms began again about 6 hours later and seem to be worse. The mother states there is no history of allergies or frequent respiratory infections. The child is up to date on all vaccinations. The child was diagnosed with asthma. The nurse practitioner explained to the mother that her child was exhibiting symptoms of asthma, and probably had an early asthmatic response and a late asthmatic response. Discussion: Development of atherosclerosis
Question 2 of 2:
Explain late asthmatic responses and the cells responsible for the responses.

QUESTION 10
1. A 64-year-old man with a 40 pack/year history of cigarette smoking has been diagnosed with emphysema. He asks the APRN if this means he has COPD.
Question 1 of 2:
Explain the pathophysiology of emphysema and how it relates to COPD
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Discussion about atherosclerosis

1. CC: “I have awful chest and arm pain and worry I am having a heart attack.”
Mr. Hammond, a 57-year-old African American male, goes to the ED with chest pain radiating down his left arm. He said the discomfort started some hours ago and “feels like an elephant is lying on my chest”. He gives it an 8/10. Nothing has helped or hurt. He denies any prior chest pain. He denies feeling sick or dizzy. It helped to reduce the pain, but not completely eliminate it.
Total Cholesterol 324 mg/dl, HDL 31 mg/dl, LDL 122 mg/dl, Triglycerides 402 mg/dl, VLDL 54 mg/dl
Acute inferior wall myocardial infarction.
2nd Question:
Why is HDL regarded as the “good” fat?

“I’ve had awful chest and arm pain for 2 hours and worry I’m suffering a heart attack.”
HPI: Mr. Hammond, a 57-year-old African American man, goes to the ED with chest pain radiating down his left arm. He said the discomfort started some hours ago and “feels like an elephant is lying on my chest”. He gives it an 8/10. Nothing has helped or hurt. He denies any prior chest pain. He denies feeling sick or dizzy. It helped to reduce the pain, but not completely eliminate it.
Total Cholesterol 324 mg/dl, HDL 31 mg/dl, LDL 122 mg/dl, Triglycerides 402 mg/dl, VLDL 54 mg/dl
Acute inferior wall myocardial infarction. Discussion about atherosclerosis
2 of 2 Questions: Describe how inflammation contributes to atherosclerosis.

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Q3 1. A 45-year-old woman with SLE presents to the ER with acute retrosternal chest discomfort that increases with deep breathing or lying down. Her symptoms include a 3-day low-grade temperature, listlessness, and a flu-like feeling. A tachycardia and pleural friction rub are found. Her pericarditis was acute.

Question:

What does the APRN see as a result of the pleural friction rub?

1 pt
QUESTION 4 1. A 15-year-old guy presents with fever, nausea, vomiting, poorly localized stomach pain, arthralgias, and “swollen lymph nodes”. He’s been feeling “lousy” for weeks. Fever up to 102 F. His parents feared he had the flu and rushed him to an ER. He was sent home with Tamiflu®. He says Tamiflu didn’t work. States had a sore throat a few weeks ago and blamed the flu. An examination revealed a skinny, unwell young guy. A reddish posterior pharynx with tonsils 3+. + cervical lymphadenopathy anterior and posterior Unusual beginning 2/6 high-pitched crescendo-decrescendo ejection murmur near left sternal boundary. Strep +. The patient had rheumatic heart disease (RHD).

Question:

Describe the symptoms induced by a positive strep test.

2 days postoperatively obese female patient with left complete hip replacement presented to the APRN. Acute post-operative nausea and vomiting prevented the patient from attending therapy. Her mucous is dry. The patient thinks her left leg’s skin is excessively tight. Calf is bloated, stiff, and red. A duplex ultrasound reveals a deep venous thrombosis in the patient (DVT). Discussion about atherosclerosis
Describe the variables that could have caused this patient’s DVT and explain how each factor could induce DVT.

7-day partial small bowel resection for Crohn’s disease: A 45-year-old lady is recovering at home. Her blood pressure lowers to 80/40 mmHg (formerly 130/80 mmHg). On room air, the pulse oximetry is 89%. The APRN detects a major pulmonary embolus.

Question:

Analyze how a big pulmonary embolus affects oxygenation

QUESTION 7 1. A 45-year-old woman is recovering at home after a partial small intestinal resection for Crohn’s Disease. Her blood pressure lowers to 80/40 mmHg (formerly 130/80 mmHg). On room air, the pulse oximetry is 89%. While waiting for EMS, the APRN puts EKG leads, which show right ventricular strain.

Question:

Define the right ventricular strain caused by a big PE.

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In the Emergency Room (ER), a 12-year-old girl complains of wheezing, a tachypneic tachycardic cough, and shortness of breath. The mother said they had just returned from a family hayride at a fall fair. Symptoms started soon after they left the festival and went away a few hours later. Symptoms returned 6 hours later, worsening. The mother says her son has never had allergies or respiratory illnesses. The child is fully vaccinated. The toddler had asthma. The nurse practitioner informed the mother that her child had early and late asthmatic symptoms.

Question 1:

Explain early asthmatic reactions and the cells that cause them.

1 year old girl with shortness of breath, wheezing, tachypnea, tachycardia and non-productive cough brought to Emergency Room by her mother. The mother said they had just returned from a family hayride at a fall fair. Symptoms started soon after they left the festival and went away a few hours later. Symptoms returned 6 hours later, worsening. The mother says her son has never had allergies or respiratory illnesses. The child is fully vaccinated. The toddler had asthma. The nurse practitioner informed the mother that her child had early and late asthmatic symptoms. Discussion about atherosclerosis
Question 2 of 2: Describe late asthmatic reactions and their cells.

QUESTION 10 1. A 64-year-old man with emphysema has smoked 40 packs a year for 40 years. Asks the APRN if he has COPD.
Question 1 of 2: Describe emphysema and its relationship to COPD.

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