RUHS, Jaipur, M.Sc Nursing Entrance Exam-2015
Medical & Surgical Nursing
Hard
Cardiovascular insufficiency is caused due to atherosclerotic plague/thrombosis and?
Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2015
Explanation
- Atherosclerotic plaque or thrombosis in cerebral arteries causes focal cerebral ischemia, which is a reduction or cessation of blood flow to a part of the brain.
- This ischemia leads to tissue hypoxia, meaning the partial pressure of oxygen (PO2) in the affected brain tissue decreases.
- Simultaneously, the impaired blood flow prevents the clearance of metabolic waste products, causing an accumulation of carbon dioxide, which increases the partial pressure of CO2 (PCO2).
- The combination of hypoxia and hypercapnia (high PCO2) leads to cerebral vasodilation and cytotoxic edema (swelling of brain cells), both of which contribute to a dangerous increase in intracranial pressure (ICP).
Why Other Options Were Wrong
- Option A: This option incorrectly states that ICP and PCO2 decrease while PO2 increases. This is the opposite of what occurs during cerebral ischemia.
- Option B: This option incorrectly suggests that ICP decreases and PO2 increases. Cerebral edema from ischemia causes ICP to rise, and lack of blood flow causes PO2 to fall.
- Option D: This option correctly identifies that ICP and PCO2 increase but incorrectly states that PO2 also increases. Ischemia, by definition, is a lack of blood flow and oxygen, which causes PO2 to decrease.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pathophysiological changes in cerebral ischemia as background academic context rather than a clinical decision trigger.
- In patients with acute ischemic stroke, managing intracranial pressure is a critical nursing priority to prevent secondary brain injury.
- Hypercapnia (high PCO2) is a potent cerebral vasodilator. Nurses must monitor respiratory status closely, as even slight increases in PCO2 can dangerously elevate ICP in an already injured brain.
- Nursing interventions for patients with increased ICP include elevating the head of the bed, maintaining a neutral head position, and managing fever and agitation to decrease the metabolic demands of the brain.
How to Approach the Question
- First, identify the core event described in the question: 'Cardiovascular insufficiency... due to atherosclerotic plague/thrombosis'. This points to an occlusion of a blood vessel, likely in the brain, causing an ischemic stroke.
- Next, analyze the consequences of this occlusion step-by-step. What happens when blood flow to the brain is blocked?
- Consider oxygen (PO2): Blocked blood flow means no new oxygen arrives. Therefore, PO2 must decrease.
- Consider carbon dioxide (PCO2): Blocked blood flow means waste products like CO2 cannot be removed. Therefore, PCO2 must increase.
- Consider intracranial pressure (ICP): The brain tissue injury (ischemia) causes swelling (edema). Swelling inside the fixed skull increases pressure. Therefore, ICP must increase.
- Finally, match your derived consequences (↑ICP, ↑PCO2, ↓PO2) with the given options to find the correct answer.
Concept Tested & Keywords
- Concept Tested: Pathophysiological changes in cerebral ischemia
- Stem keywords: Cardiovascular insufficiency, atherosclerotic plague, thrombosis
- Lead-in keywords: caused due to
Question ID
QSLYhRkc61eEPkcXEnhwQp
Reference Book
E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 1251-1253
E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 p. 53-55
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