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CARE OF PTS WITH VASCULAR PROBLEMS (ARTERIOSCLEROSIS/ATHEROSCLEROSIS…

- - - - ASSESS
        
        BP (right and left arm) with hypertension
        
        detect differences seen
        
        history/diagnosis o HTN
        
        check pulses in major sites (radial, femoral, carotid, pedis) bilat.
        
        if pulse is not symmetic, may have athero-
        
        cool extremities/ tissue damage, ischemia/necrosis
        
        will be evident distal location of injury
        
        bruits - abnormal turbulent blood flow heard in arteries)
        
        heard in carotids, temporals, subclavian, abdominal aorta, iliacs, femorals, radials
    - - Lipid panel
        
        pt will need to fast for this lab (12 hrs)
        
        cholesterol
        
        recommended: <200 mg/dL
        
        borderline: 200-239
        
        high risk: >240
        
        LDLs
        
        recommended: <130
        
        moderate risk: 130-159
        
        high risk: 160-189
        
        VERY high risk: >190
        
        HDLs
        
        the GOOD protein
        
        increased levels are assoc. with decreased risk of CVD
        
        major risk factor: M (<45) F (<55)
        
        negative risk factor: M (>45) F(>55)
        
        triglycerides
        
        recommended: M(<160) F(<135)
        
        listen to recording for example of pts
      - CRP (C-reactive protein (LOOK @ NOTES)
      - Homocystiene
        
        normal value: 0.54-2.3 mg/L
        
        2.3 indications inflammatory response in vessels
        
        lack of B12, B6, folic acid causes increased values
        
        these vitamins break down homocystiene, and when they don't, homocystiene causes vessels to become inflamed
  - - - provide them with the necessary tools for success!
    - - nicotine is HIGHLY ADDICTIVE
        
        causes lung damage, vasoconstriction, leading to damaged vessels
        
        smoking LOWERS HDL levels
      - replacements available
        
        patches
        
        gum
        
        COLD TURKEY! seems to be the best
    - - obesity increases CHOLESTEROL levels
      - talk to them about exercise and diet
        
        weight loss
        
        exercise help build collateral circulation in pt with atherosclerosis
        
        can be a lifesaver
        
        start low and slow then build on it
    - - DIETS DONT WORK! changing your lifestyle works
        
        change your diet (dont go ON A DIET)
        
        Mediterranean Diet Pyramid
        
        Low fat Low cholesterol diet
        
        LISTEN TO RECORDING
        
        step 1: foods and calories will consist of 30% fats with <10% saturated fats
        
        AHA: cholesterol intake should be <300/day
        
        step 2: less than 7% sat fat, total cholesterol <200/day, increase fiber daily
    - - no improvement
  - - - can be genetic
      - non-compliant pts
- - - - not life threatening, just annoying
        
        doctor may advise to take 325 mg aspirin 30-60 mnutes before eating
      - caused by prostaglandins
        
        aspirin is effective inhibitor of prostaglandin synthesis
    - - take an antihistamine to help with itching