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04.02 Cholesterol

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Overview

  1. Cholesterol
    1. Normal Value Range
    2. Pathophysiology
    3. Any special considerations when drawing the lab (i.e. on ice, etc.)
    4. Too High: Causes, Symptoms, Treatments
    5. Too Low: Causes, Symptoms, Treatments

Nursing Points

General

  1. Normal values
    1. <200 mg/dL
  2. Pathophysiology
    1. Functions
      1. Essential in cell membrane formation
      2. Precursor to Vitamin D
      3. Precursor to hormone formation
      4. Synthesized in liver
    2. Lipoproteins
      1. High Density Lipoprotein (HDL)
        1. Removes excess levels of cholesterol
        2. Goal >60 mg/dL
      2. Low Density Lipoprotein (LDL)
        1. Contributes to plaque buildup
        2. Goal <100 mg/dL
    3. Excess cholesterol and lipid buildup
      1. Contributes to:
        1. Atherosclerosis
        2. Arteriosclerosis
  3. Special considerations
    1. Submit in green top tube
    2. Ensure patient fasts
      1. Food intake can alter results
  4. Elevated cholesterol levels
    1. Obesity
    2. Cushing’s Disease
    3. Hypothyroidism
    4. Ischemic heart disease
    5. Diabetes
    6. Liver disease
      1. Non-alcoholic Fatty Liver Disease
    7. Malabsorption
      1. For all patients, attempt to decrease cholesterol levels with diet/exercise;
      2. If no improvement, incorporate statins (unless immediate concern for impending disease (such as stroke or MI)
  5. Decreased cholesterol levels
    1. Burns
    2. Hyperthyroidism
    3. Chronic Myelocytic Leukemia
    4. Malnutrition
    5. Anorexia

Assessment

  1. Assess fitness/activity lifestyle and goals
  2. Assess nutritional status, goals and lifestyle

Therapeutic Management

  1. Incorporate low fat diet
  2. Incorporate fitness/activity increase as tolerated

Nursing Concepts

  1. Lab Values
  2. Nutrition

Patient Education

  1. Educate patient on utilizing a low fat/low cholesterol diet
  2. Educate patient on appropriate fitness or activity level increase dependent on tolerance

Reference Links

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Video Transcript

All right in this lesson we’re going to talk about cholesterol.

So the normal value for cholesterol is less than 200 mg per deciliter. And similar to other screening tests, this is also a test that we used to look for indications for risk for disease. Cholesterol is going to be an indication for things like heart disease, heart attack, and stroke, and we’re going to get into some of the ins-and-outs of those here in a few minutes.

Now the automatic response shouldn’t be that cholesterol is bad. Remember that cholesterol and lipids have a particular function. Their job is essential in having a cell membrane formation around cells, they’re precursors to vitamin D, and precursors to hormone formation. They’re also is synthesized in the liver.

Another important aspect of cholesterol is that they’re made up of subunits called lipoproteins. The two that we really are concerned with are called high-density lipoprotein or HDL, and low density lipoprotein, LDL. And just like with cholesterol, it’s an indicator of risk for certain diseases. With HDL, you want that that value to be higher. The normal goal for this as a screening tool is greater than 60 milligrams per deciliter, and for LDL, you want to keep that number low, with the goal being less than 100 mg per deciliter. The way I remember is that you want to keep the HDL high, so H for high, and with LDL you want to keep it low, so L for low.

The important thing is that with cholesterol, we want to keep the cholesterol value to a minimum because it contributes to disease. In particular, this lipid build up contributes to atherosclerosis and arteriosclerosis. So it hardens the vessels, which makes them less flexible, and it also deposits fat and plaques inside the cells, which impedes the blood flow and decreases the ability for the body to deliver oxygen to the tissues. This presents a problem when you have things like a stroke and heart attack occur. The reason these things happen is because there is this lipid buildup or plaque buildup that is keeping blood from getting to the tissue and causing tissue damage. So that’s why it’s really important that we use this test as a risk indicator, and also as a way to evaluate progress in terms of reducing risk.

There are really just a few special considerations that we need to think about when we’re submitting this lab test. The first is that in most cases you’re going to submit it in a green top tube, so that’s the one with Heparin. The other really important factor to this test is that your patients have to be fasting. If they’ve eaten, it’ll actually affect their fasting cholesterol, which is what we really are concerned about. It’s always make sure that your patients are fasting so that we can get a good baseline value of what their cholesterol is.

So when do you think that we would actually see abnormal lab values?

Well you are going to see elevated cholesterol in patients that have obesity, sometimes Cushing’s Disease and hypothyroidism. You will also see elevated cholesterol with certain types of heart disease, and certain types of liver disease. In particular, one of them is called non-alcoholic fatty liver disease and you’ll see increases in cholesterol there. Also if your patients aren’t absorbing nutrients correctly, then you can see elevations in cholesterol.

For the majority of patients that have elevated cholesterol, the most efficient way to decrease their baseline elevated cholesterol is to change their diet and have them increase exercise. With nutrition the aim is for a low fat, low cholesterol diet. The other thing is that providers will often recommend exercise that is both beneficial and tolerable to the patient. Sometimes providers will include the use of statins, which are drugs aimed at reducing blood cholesterol. But that’s a case-by-case basis, and it’s not always the first option.

The times that you’ll see decreased cholesterol are in situations like burns, hyperthyroidism, different types of leukemia, malnutrition and anorexia.

For today’s nursing concepts when we’re looking at cholesterol, we’re looking at lab values, and we’re also looking at our patients nutrition status.

So to recap, normal cholesterol values are less than 200 mg per deciliter.

Cholesterol is an indicator of risk, such as heart attack, heart disease and stroke.

Cholesterol is made up of lipoproteins, both high-density lipoprotein and low-density lipoprotein. Remember that we want to aim to keep the HDL High, and the LDL low.

Elevated values of cholesterol are going to be indicative of diseases like obesity, diabetes, liver disease, and malabsorption.

A decrease value of cholesterol is going to be seen in patients and have burns, hypothyroidism, and anorexia.
That’s our lesson on cholesterol. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!

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  • Question 1 of 5

A nurse is checking laboratory results for a client with TPN and lipids and notes the following: Sodium: 138 mEq/L Potassium: 4.1 mEq/L Calcium: 10.1 mg/dL Albumin: 5.4 g/dL Triglycerides: 426 mg/dL Alkaline Phosphatase: 100 IU/L Based on these laboratory results, which of the following actions is most appropriate?

  • Question 2 of 5

A 28-year-old client with no history of heart disease asks the nurse about whether to have cholesterol checks and how often this should be monitored. Which answer from the nurse is correct?

  • Question 3 of 5

A nurse is monitoring her client who is in the medical-surgical unit with a recent bowel resection. The client has an infusion of TPN with lipids running into a central line. Which of the following metabolic complications would the nurse most likely see with a client receiving TPN?

  • Question 4 of 5

A client in the healthcare clinic has an order for total cholesterol levels because of his history of heart disease. The nurse provides information to this client about the upcoming test. Which of the following is true information regarding the results of this type of test? Select all that apply.

  • Question 5 of 5

A healthy adult female who is not at increased risk of heart disease should have her blood cholesterol checked how often?

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