Colegio de San Antonio de Padua

De la salle supervised school

College of nursing
Guinsay, Danao City,Cebu

College
of
nursing
case study in
pleural effusion

submitted by:
rhea liza Comendador-tjernmoen

submitted to:
mrs. Herminia o. Fernandez rn, rm, man
ARTERIOSCLEROSIS/ATHEROSCLEROSIS
DEFINITION:
Arteriosclerosis is the most common disease of the arteries; the
term means hardening of the arteries. It is a diffuse process whereby the
muscle fibers and the endothelial lining of the walls of small arteries and
arterioles become thickened. Atherosclerosis in which fatty substances,
including cholesterol build up inside artery walls. These deposits, called
plaque, cause the artery walls to thicken and narrow
It is the usual cause of heart attacks , strokes, and peripheral vascular
disease -- what together are called cardiovascular disease.
CAUSES:
Arteries are blood vessels that carry blood from the heart throughout the
body. They're lined by a thin layer of cells called the endothelium. The
endothelium works to keep the inside of arteries toned and smooth, which
keeps blood flowing.
Atherosclerosis begins with damage to the endothelium. It’s caused by high
blood pressure, smoking, or high cholesterol. That damage leads to the
formation of plaque.
When bad cholesterol, or LDL, crosses the damaged endothelium,
the cholesterol enters the wall of the artery. That causes your white blood
cells to stream in to digest the LDL. Over years, cholesterol and cells become
plaque in the wall of the artery.
Plaque creates a bump on the artery wall. As atherosclerosis progresses,
that bump gets bigger. When it gets big enough, it can create a blockage.
That process goes on throughout your entire body. As a result, not only is
your heart at risk, but you are also at risk for stroke and other health
problems.
Atherosclerosis usually doesn’t cause symptoms until middle or older age.
But as the narrowing becomes severe, it can choke off blood flow and cause
pain. Blockages can also rupture suddenly. That’ll cause blood to clot inside
an artery at the site of the rupture.
SIGNS AND SYMPTOMS:
The clinical signs and symptoms resulting from atherosclerosis depend on
the organ or tissue affected. The plaques of atherosclerosis cause the three
main kinds of cardiovascular disease:
Coronary artery disease : Stable plaques in the heart's arteries
cause angina (chest pain). A sudden plaque rupture and clotting cause heart
muscle to die. This is a heart attack.
Cerebrovascular disease: Ruptured plaques in the brain's arteries cause
strokes with the potential for permanent brain damage. Temporary
blockages in an artery can also cause something called transient ischemic
attacks (TIAs), which are warning signs of stroke. However, there is
no brain injury.
Peripheral artery disease : Narrowing in the arteries of the legs from
plaque causes poor circulation. This makes it painful for you to walk. It’ll also
cause wounds not to heal as well. Severe disease may lead to amputations.
RISK FACTORS:
MODIFIABLE:
 Nicotine use (i.e., tobacco smoking or chewing)
 Diet (contributing to hyperlipidemia)
 Hypertension
 Diabetes (speeds the atherosclerotic process by thickening the
basement membranes of both large and small vessels)
 Hyperlipidemia
 Stress
 Sedentary lifestyle
 Hyperchromocysteinemia
NONMODIFIABLE:
 Increasing age
 Female gender
 Familial predisposition/ genetics
PATHOPHYSIOLOGY:
The most common direct results of atherosclerosis in arteries include
narrowing (stenosis) of the lumen, obstruction by thrombosis, aneurysm,
ulceration, and rupture. Its indirect results are malnutrition and the
subsequent fibrosis of the organs that the sclerotic arteries supply with
blood. All actively functioning tissue cells require an abundant supply of
nutrients and oxygen and are sensitive to any reduction in the supply of
these nutrients. If such reductions are severe and permanent, the cells
undergo ischemic necrosis (death of cells due to deficient blood flow) and
are replaced by fibrous tissue, which requires much less blood flow.
Atherosclerosis can develop at any point in the body, but certain sites are
more vulnerable, such as regions where arteries bifurcate or branch into
smaller vessels, with males having more below-the-knee pathology than
females (Ortmann, Nuesch, Traupe, et al., 2012). In the proximal lower
extremity, these include the distal abdominal aorta, the common iliac
arteries, the orifice of the superficial femoral and profunda femoris arteries,
and the superficial femoral artery in the adductor canal, which is particularly
narrow. Distal to the knee, atherosclerosis can occur anywhere along the
artery. Although many theories exist about the development of
atherosclerosis, no single theory explains the pathogenesis completely;
however, tenets of several theories are incorporated into the reaction-to-
injury theory. According to this theory, vascular endothelial cell injury results
from prolonged hemodynamic forces, such as shearing stresses and
turbulent flow, irradiation, chemical exposure, or chronic hyperlipidemia.
Injury to the endothelium increases the aggregation of platelets and
monocytes at the site of the injury. Smooth muscle cells migrate and
proliferate, allowing a matrix of collagen and elastic fibers to form
(Cronenwett & Johnston, 2010).
Atherosclerotic lesions are of two types: fatty streaks and fibrous
plaque:
• Fatty streaks are yellow and smooth, protrude slightly into the lumen of
the artery, and are composed of lipids and elongated smooth muscle cells.
These lesions have been found in the arteries of people of all age groups,
including infants. It is not clear whether fatty streaks predispose a person to
the formation of fibrous plaques or whether they are reversible. They do not
usually cause clinical symptoms.
• Fibrous plaques are composed of smooth muscle cells, collagen fibers,
plasma components, and lipids. They are white to white-yellow and protrude
in various degrees into the arterial lumen, sometimes completely obstructing
it. These plaques are found predominantly in the abdominal aorta and the
coronary, popliteal, and internal carotid arteries, and they are believed to be
progressive lesions.

DIAGNOSTIC TESTS
 Blood test
 Doppler ultrasound
 Ankle-brachial index
 Electrocardiogram (ECG)
 Stress test/ 2D Echo
 Cardiac catheterization and angiogram
 Other imaging test such as CT Scan Or Magnetic Resonance
Angiography
MEDICATION
Various drugs can slow — or even reverse — the effects of atherosclerosis.
Here are some common choices:
 Cholesterol medications. Aggressively lowering your low-density
lipoprotein (LDL) cholesterol, the "bad" cholesterol, can slow, stop or
even reverse the buildup of fatty deposits in your arteries. Boosting
your high-density lipoprotein (HDL) cholesterol, the "good" cholesterol,
 may help, too. Your doctor can choose from a range of cholesterol
medications, including drugs known as statins and fibrates. In addition
to lowering cholesterol, statins have additional effects that help
stabilize the lining of your heart arteries and prevent atherosclerosis.
 Anti-platelet medications. Your doctor may prescribe anti-platelet
medications, such as aspirin, to reduce the likelihood that platelets will
clump in narrowed arteries, form a blood clot and cause further
blockage.
 Beta blocker medications. These medications are commonly used for
coronary artery disease. They lower your heart rate and blood
pressure, reducing the demand on your heart and often relieve
symptoms of chest pain. Beta blockers reduce the risk of heart attacks
and some heart rhythm problems.
 Angiotensin-converting enzyme (ACE) inhibitors. These medications
may help slow the progression of atherosclerosis by lowering blood
pressure and producing other beneficial effects on the heart arteries.
ACE inhibitors can also reduce the risk of recurrent heart attacks.
 Calcium channel blockers. These medications lower blood pressure and
are sometimes used to treat angina.
 Water pills (diuretics). High blood pressure is a major risk factor for
atherosclerosis. Diuretics lower blood pressure.
 Other medications. the doctor may suggest certain medications to
control specific risk factors for atherosclerosis, such as diabetes.
Sometimes specific medications to treat symptoms of atherosclerosis,
such as leg pain during exercise, are prescribed.
SURGICAL PROCEDURES
Sometimes more aggressive treatment is needed to treat atherosclerosis. If
there are severe symptoms or a blockage that threatens muscle or skin
tissue survival, it is a candidate for one of the following surgical procedures:
 Angioplasty and stent placement. In this procedure, the doctor inserts
a long, thin tube (catheter) into the blocked or narrowed part of your
artery. A second catheter with a deflated balloon on its tip is then
passed through the catheter to the narrowed area. The balloon is then
inflated, compressing the deposits against your artery walls. A mesh
tube (stent) is usually left in the artery to help keep the artery open.
 Endarterectomy. In some cases, fatty deposits must be surgically
removed from the walls of a narrowed artery. When the procedure is
done on arteries in the neck (the carotid arteries), it's called a carotid
endarterectomy.
 Fibrinolytic therapy. If you have an artery that's blocked by a blood
clot, the doctor may use a clot-dissolving drug to break it apart.
 Bypass surgery. The doctor may create a graft bypass using a vessel
from another part of your body or a tube made of synthetic fabric. This
allows blood to flow around the blocked or narrowed artery.
TREATMENT
The management of atherosclerosis involves modification of risk factors, a
controlled exercise program to improve circulation and its functioning
capacity, medication therapy, and interventional or surgical graft
procedures.
HEALTH TEACHING
Lifestyle changes can help you prevent or slow the progression of
atherosclerosis.
 Stop smoking. Smoking damages your arteries. If you smoke or use
tobacco in any form, quitting is the best way to halt the progression of
atherosclerosis and reduce your risk of complications.
 Exercise most days of the week. Regular exercise can condition your
muscles to use oxygen more efficiently. Physical activity can also
improve circulation and promote development of new blood vessels
that form a natural bypass around obstructions (collateral vessels).
Exercise helps lower blood pressure and reduces your risk of diabetes.
Aim to exercise at least 30 minutes most days of the week. If you can't fit it
all into one session, try breaking it up into 10-minute intervals. You can take
the stairs instead of the elevator, walk around the block during your lunch
hour, or do some sit ups or pushups while watching television.
 Eat healthy foods. A heart-healthy diet based on fruits, vegetables and
whole grains — and low in refined carbohydrates, sugars, saturated fat
and sodium — can help you control your weight, blood pressure,
cholesterol and blood sugar. Try substituting whole-grain bread in
place of white bread; grabbing an apple, a banana or carrot sticks as a
snack; and reading nutrition labels as a guide to controlling the
amount of salt and fat you eat. Use monounsaturated fats, such as
olive oil, and reduce or eliminate sugar and sugar substitutes.
 Lose extra pounds and maintain a healthy weight. If you're
overweight, losing as few as 5 to 10 pounds (about 2.3 to 4.5
kilograms) can help reduce your risk of high blood pressure and high
cholesterol, two of the major risk factors for developing
atherosclerosis. Losing weight helps reduce your risk of diabetes or
control your condition if you already have diabetes.
 Manage stress. Reduce stress as much as possible. Practice healthy
techniques for managing stress, such as muscle relaxation and deep
breathing.
PROGNOSIS
This disease can be particularly dangerous because it can cause tissue
death. A lack of oxygen is called ischemia and will lead to tissue death if not
reversed quickly, Ischemia of a finger or earlobe is not life threatening.
However, tissue death of the heart or brain can become extremely
dangerous.