Obesity, DM, Smoking & others....

What BMI indicates obese?

>30

What BMI indicates overweight?

25-29.9

What BMI is normal?

18.5-24.9

What BMI is underweight?

<18.5

T or F: BMI is an accurate portrayal of a pt's health status

False, doesn't account muscle mass

What causes increases in BMI?

-diet

-genetics

-hormones

-sedentary life

-medication

-metabolic medical conditions

Obesity is associated with what GI diseases?

-GERD

-gall stones

-nonalcoholic fatty liver

What are the best methods to use body measurements to predict CV disease?

wait circumference (or WH ratio) with BMI

What cancers are associated with obesity more than others?

breast, colon, prostate

What is class I obesity?

30-34.9

What is class II obesity?

35-39.9

What is class III obesity?

>40

Being overweight and having what wait circumference for men & women is considered high risk for CV disease?

M > 40in (102cm)

F >35in (88cm)

What location of obesity may be a better predictor of CVS & type 2 DM in comparison to BMI?

location of abdominal obesity (specifically intraabdominal and visceral)

How does visceral adipose tissue lead to insulin resistance?

increased release of fatty acids which enter the circulation and may become deposited as ectopic fat in the liver, heart, skeletal muscles, and pancreas

T or F: The accumulation of adipose tissue in the gluteal femoral areas is not associated with increased CVD risk

True

What are tx options for obesity?

-diet, increased PA, behavioral modifications

-bariatric surgery

Why is rapid extreme wt loss not good?

not good because it can be dangerous for metabolic changes that occur

What caloric deficit is required to lose 1 lb?

3500kcal

Reducing caloric intake by how much per day would result in 1lb wt loss per week?

500/day

What is a Roux-en-Y gastric bypass? what is the effect and complications?

-stapling the stomach into a small proximal gastric pouch that empties into section of jejunum

-pts lose 30% of actual BW in 2 years

-complications include: GI leak, staple line disruption, PE, infection, nutritional deficiencies

What is a laparoscopic adjustable gastric banding? What are the effects and complications?

-placement of an adjustable band around the upper part of the stomach; band is adjusted via a balloon

-on average, pt loses 25% of BW in 2 years

-complications less severe than gastric bypass: band slippage, band or port infection

What is metabolic syndrome?

-cluster of interrelated risk factors:

--increased waist circumference

--elevated triglycerides (or on meds for it)

--reduced HDLs (or on meds for it)

--HTN (or on meds for it)

--elevating fasting glucose (or on meds for it)

What is DM characterized by?

hyperglycemia resulting from defects in insulin production/action or both

What are the 4 types of DM?

type I: insulin dependent

types II: non-insulin dependent

-gestational DM

-genetic defects causing DM

What is type I DM?

insulin dependent DM

-auto-immune destruction of B-cells in the pancreas resulting in a complete lack of insulin secretion

What is type II DM?

non insulin dependent

-progressive declining in B cell function over time

What is gestational DM?

DM that develops during pregnancy and almost always resolved after parturition (giving birth)

What is the risk for getting type 2 DM after having gestational DM?

40-60% risk

T or F: Women who have gestational DM are more likely to get type 1 DM after giving birth

False

What types of genetic defects may cause DM?

-CF

-hormonal syndromes

-pancreatic disease

What are signs of DM?

-polyuria

-polydipsia

-diabetic keoacidosis

What is diabetic ketoacidosis? What are s&s?

-very serious condition that can develop quickly & lead to coma/death

s&s

-hyperglycemia

-n&v

-polydispia

-polyluria

-abdominal pain

-ketotic breath

-dry skin

-dry mouth

-weakness

-fatigue

-rapid & deep breathing

T or F: PA causes a reduction in insulin secretion

True

T or F: PA causes a reduction in secretion of glucagon

False; enhanced secretion of glycagon

During exercise, how is reduced insulin production compensated for?

compensated by a heightened sensitivity and responsiveness of the peripheral tissues to insulin, to allow for rapid uptake of glucose

How does exercise decrease blood glucose?

exercise causes a heightened sensitivity/responsiveness of peripheral tissues to insulin, allowing for rapid uptake of glucose from the blood and into the working muscles

T or F: Type I DM have to continuously monitor glucose levels to avoid hypo or hyperglycemia

True

What are s&s of hypoglycemia?

-confusion

-dizziness

-feeling shaky, hungry

-headache

-irritability

-pounding heart

-sweating

-anxiety

-weakness

What are s&s of hyperglycemia?

-restlessness

-polyuria

-polydipsia

-fatigue

-polyphagia

-blurred vision

-dry skin

-dry mouth

What is the goal in tx of DM?

control glucose levels in the blood and avoid long-term damage

When is it recommended to monitor blood glucose in regard to exercise?

-generally take before, after, and several hours after new patterns of exercise are undertaken

-specifically take 60 minutes AND 30 minutes prior to exercise to identify tread of blood glucose

-taken every 2 hours after exercise ends to avoid late-onset hypoglycemia

What should pts do if their blood glucose levels are 250-300mg/dL prior to PT?

check for ketosis via urine stick or meter that measure ketones

If no ketones are detected, but the pts blood glucose level is 250-300, what does this mean? can the pt do exercise?

-this means that the blood glucose is stable or falling

-if pt is feeling good, low-mod exercise can be done for 10-15 minutes, followed by a re-check

If ketones are detected, but the pts blood glucose level is 250-300, what does this mean? can the pt do exercise?

unstable blood glucose; no exercise

After exercising, if a pt's blood glucose rises, what should be done?

stop exercising

A pt begins with 250mg/dL of blood glucose, and no ketones. After exercising for 12 minutes, pt's blood glucose decreases to 200. What does this indicate and what should be done?

appropriate response to exercise; exercise can continue for another 10-15 minutes before rechecking

T or F: It is abnormal for blood glucose to increase with exercise

True

What should be done of blood glucose levels are lower than 70mg/dL before exercise?

individual should eat a carb snack, wait 20-30minutes, and then check again; if within appropriate levels, do 10-15min of low-mod exercise and re-check

What blood glucose level for exercise?

>70

Where is the recommended spot for insulin injection prior to exercise?

abdomen or arm

What should a pt do if after 30 minutes of having a carb snack, the blood glucose is 68mg/mL?

do not do exercise

Impairment in glomerular filtration rate will result in what?

renal dysfunction or failure

What is the normal GFR?

90-120 mL/min

What are risks for chronic kidney disease?

-HTN

-DM

-CVD

-obesity

-glomerulonephritis

-lupus

-polycystic kidney disease

-overuse of aspirin/acetaminophen/coke

Describe stage 1 CKD and its GFR

-normal kidney; high functioning

-some s&S of CKD

-GRF is 90-120 OR greater than 120

Describe stage 2 CKD and its GFR

-kidney damage

-mildly decreased GFR = 60-89

Describe stage 3 CKD and its GFR

-moderately decreased GFR

-30-59

Describe stage 4 CKD and its GFR

-severely decreased GFR

-15-29

Describe stage 5 CKD and its GFR

-kidney failure

- <15; or requires dialysis

What is the primary goal of tx of CKD?

slow down the progression of the disease via medication, diet, lifestyle changes

What is the tx for kidney failure? Describe it and how it works

-hemodialysis

-replaces the excretory function of the kidneys; uses a rinsing solution and membrane to filter out toxic waste from blood

-controls the fluid imbalances, but doesn't control endocrine function that the kidneys are responsible for

What is the standard tx schedule for pts on hemodialysis?

3x per week, 3-4hr each tx

T or F: Pts do well on dialysis for up to 20 years

FAlse; 10 years

To what degree is exercise capacity reduced in those with end stage renal failure?

reduced to 50-60% of normal capacity

Why are pts with ESRD likely to have balance issues?

likely to have diabetic neuropathy

Why do CKD pts have muscle fatigue and/or atrohpy?

there is an impaired protein synthesis and impaired AA metabolism

What does ARD mean?

autoimmune rheumatic diseases

What defines ARD? How does it affect the cardiopulm system?

-systemic diseases characteriszed by inflammatory abnormalities of joints, muscles, CTs

-can affect all pulmonary & CV structures

What is the most common cardiac manifestation of ARD? What may occur as a result?

pericarditis; as a result, can induce dysrhythmias, pericardial effusion, and pericardial thickeing

T or F: RA is a type of ARD

True

What is the most common cardiopulm complication with RA?

pleural effusions

T or F: Lupus is not considered a type of ARD

False; yes it is

What is SLE? Describe its effect on the cardiopulm system

-systematic lupus erythematosus

-inflammation of all serous membranes (including heart)

-CVD is the most common cause of death

-pt will have butterfly rash

How does scleroderma affect the cardiopulm system?

-produces slowly progressive fibrosis and vascular obliteration of the skin, subcutaneous tissues, and often visceral organs

-known for its pulmonary complications (leading cause of morbidity)

How does PD affect the cardiopulm system?

-characterized by resting muscle tremors, rigidity, gait impairments and postural instability

-impaired ventilatory function in 50-87% of pts

What is Lou Gehrig's disease?

ALS

What is ALS and how does it affect the cardiopulm system?

-progresive neuro deterioration without remission due to loss of both upper and lower motor neurons

-hypoventilation results as a loss of intercostal & diaphragm muscle function

-4yr life expectancy after dx

What is MS and its common sx?

-autoimmune disease which causes demyelination of the CNS and is characterized by periods of remission & relapses (chronic & progressive or reversible)

-sx include motor weakness, ataxia, blurred/double vision

-commonly diagnosed between 20-29yo

What is GBS and how can it affect the cardiopulm system?

-acute inflammatory polyneuropathy leading to acute neuromuscular paralysis

-weakness, dyspnea, difficulty coughing, dysphagia

(slow progression)

What is Duchenne muscular dystrophy, its cause, and what its characterized by?

-caused by a lack of dystrophin (which allows muscles to rebuild after being damaged); build up of scar tissue in muscle cells instead

-characterized by delayed motor development and muscle weakness causing the lack of ability to ambulate by age 10 or 11

What is the cardiopulm indication with duchenne muscular dystrohpy?

-respiratory impairment manifests due to respiratory muscle weakness in the advanced stages of the disease

-poor coughing ability

-poor alveolar ventilation

What is sickle cell disease characterized by?

by structurally abnormal hemoglobin that causes RBCs to become less pliable and some, crescent shaped, thus causing an inability to carry O2

-overall less O2 in the body

What is anemia?

reduced amount of circulating RBC

What is the most common risk factor worldwide contributing to COPD?

smoking

15% of all deaths related to heart disease is a result of what?

cig smoking

T or F: Cig smoking is linked to atherosclerosis

True

How many cigs per day increases risk of developing CAD

4

In comparison to non-smokers, smokers have lower or higher HDL? lower or higher BP?

lower HDL

higher BP