NCLEX - Hyperlipidemia Pathophysiology

Here are key facts for NCLEX from the Hyperlipidemia Pathophysiology tutorial, as well as points of interest at the end that are not directly addressed in this tutorial but should help you prepare for the boards.

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1. Silent condition: Hyperlipidemia is often asymptomatic, but it significantly increases one's risk for cardiovascular diseases, especially atherosclerosis 2. Skin manifestations: These are created by lipid deposits in the skin associated with foam cells (macrophages that have ingested lipids) 3. Cardiovascular risk factor: Hyperlipidemia is often asymptomatic, but it significantly increases one's risk for cardiovascular diseases, especially atherosclerosis 1. Joint examination: Tuberous xanthomas form small to large bulges in the skin over the joints, particularly the elbows and knees 2. Skin assessment: Eruptive xanthomas are erythematous bumps that tend to appear on the buttocks, shoulders, and extensor surfaces 3. Periorbital assessment: Plane xanthomas are thin yellow plaques. Xanthelasma is characterized by plaques around the eyelids 4. Hand examination: Palmar xanthomas are characterized by yellow plaques that form along the creases of the palm of the hands 5. Tendon assessment: Tendinous xanthomas are bumps that form over the tendons or ligaments. The Achilles tendon at the posterior ankle is a common site for these xanthomas 1. Cholesterol levels: Hypercholesterolemia is often defined as: Total cholesterol > 200 mg/dL, Low-Density Lipoproteins > 130 mg/dL, High-Density Lipoproteins < 40 mg/dL 2. Triglyceride levels: Hypertriglyceridemia = levels above 150 mg/dL

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1. Type I (Hyperchylomicronemia): Occurs when there is a deficiency in lipoprotein lipase or an alteration in apolipoprotein C-II, which activates lipoprotein lipase. These deficiencies cause elevated chylomicrons and triglyceride levels exceeding 500 mg/dL. This disorder is associated with acute pancreatitis, eruptive xanthomas, and, when triglyceride levels are exceedingly high, lipemia retinalis 2. Type IIa (Hypercholesterinemia): Occurs when LDL receptors are deficient. Results in elevated Low-Density Lipoproteins and cholesterol. Patients are at increased risk of premature Atherosclerotic Cardiovascular Disease (ASCVD), tendinous xanthomas, and, corneal arcus, which is a whitish ring around the iris 3. Type IIb (Hyperlipidemia): Occurs when there is a reduction in LDL receptors or increased apolipoprotein B. Characterized by elevated Low Density Lipoproteins and Very Low Density Lipoproteins. Both triglycerides and cholesterol are also elevated. Patients are at increased risk of premature ASCVD and may have tendinous xanthomas. This is the most common inherited dyslipidemia 4. Type III (Dysbetalipoproteinemia): Occurs when apolipoprotein E-2 is defective. The disorder is characterized by elevated chylomicron remnants and Intermediate Density Lipoproteins. Both triglyceride and cholesterol levels are elevated. Patients are at increased risk of ASCVD, and may have palmar xanthoma and/or tuberoeruptive xanthomas of the elbows and knees 5. Type IV (Hypertriglyceridemia): Characterized by increased production and decreased secretion of Very Low Density Lipoproteins. Elevated levels of triglycerides. Patients are at increased risk for acute pancreatitis and ASCVD. Type IV is another relatively common inherited hyperlipidemia 6. Type V (Mixed hypertriglyceridemia): Associated with increased Very Low Density Lipoprotein production and decreased Low Density Lipoprotein production. Characterized by elevations in chylomicron remnants and VLDL. Increased triglyceride and cholesterol levels. Patients are at risk for acute pancreatitis, eruptive xanthomas, and ASCVD 1. Lifestyle modification teaching: The most significant contributors in the United States are diets high in saturated fats, cholesterol, and trans fats, coupled with sedentary lifestyles 2. Substance use assessment: High levels of alcohol consumption also elevate lipid levels 3. Associated conditions monitoring: Several other disorders may contribute to hyperlipidemia, including: diabetes mellitus, chronic kidney disease, nephrotic syndrome, hypothyroidism, cholestatic liver diseases, and Cushing syndrome 4. Medication review: Several drugs can cause hyperlipidemia, including oral contraceptives, diuretics, beta-blockers, and antiretroviral agents

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1. Patient education: Teaching about dietary modifications and exercise 2. Medication administration: Understanding lipid-lowering medications 3. Monitoring: Assessment for medication side effects and compliance 1. Risk for impaired cardiovascular function: Related to elevated lipid levels 2. Knowledge deficit: Related to diet and lifestyle modifications 3. Risk for non-adherence: Related to asymptomatic nature of condition 1. Acute pancreatitis assessment: In patients with severe hypertriglyceridemia 2. Cardiovascular assessment: In patients with known hyperlipidemia 3. Patient adherence support: Strategies to improve medication and lifestyle compliance