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Nurs 312 Exam 1
1-3L supplemental O2 - ansNo humidifier 2 major parts of nutrition that promote wound healing - ansVitamin C, zinc Acquired conditions - anscaused by events that occur AFTER birth Acute protein phase (liver synthesis proteins) in inflammatory response - ansErythrocyte sedimentation rate increases causing inflammation Acute stage - ansRapid multiplication of pathogen, symptomatic (illness) Adaptive immunity - ans- specific
- latent response
- humoral immune response (B-lymphocytes)
- cell mediated immunity (cytotoxic T-lymphocytes) acquired through previous exposure Adaptive immunity - ansResponse time: dependent upon exposure, 1st is delayed, 2nd is immediate bc antibody memory Diversity: wide range Microbe recognition: specific Non self recognition: yes Response: memory, more rapid/efficient with repeated exposure Defense: cell killing, antibodies tag antigen Cellular components: dendrite cells, NK, T&B lymphocytes, macrophages Molecular components: cytokines/chemokines, complement system, antibodies Adrenal gland - ansMedulla secretes epinephrine and norepinephrine; cortex produces and secretes cortisol, aldosterone, estrogen, testosterone Affinity hypoxia - ansFailure of hemoglobin to release oxygen to tissues; blood bank transfusions AIDS retrovirus - ansEtiology: caused by HIV Characteristics: enveloped ribonucleic acid; carries its genetic material in RNA Alarm - ansPerceived threat, stimulates SYMPATHETIC and hypothalamic pituitary adrenal axis, releases adrenaline and cortisol Aldosterone - ansProduced AND secreted by: adrenal cortex
- reabsorption of sodium
Aldosterone - ansProduced by: adrenal cortex Secreted by: adrenal cortex Action: reabsorption of sodium Anaphylaxis symptoms - ansSwelling, closing airway, hives Androgens - ansProduced by: adrenal cortex Secreted by: adrenal cortex Action: bone density, puberty, sexual function Anemic hypoxia - ansdue to anemia resulting from the inability of the blood to carry adequate oxygen; hemorrhage Angiotensin II - ans1. Stimulates sympathetic
- activates renin angiotensin aldosterone system
- peripheral vascular tone
- Retention of sodium and water by kidneys
- stimulates anterior pituitary gland
- secretes ACTH
- Stimulates posterior pituitary gland
- secretes vasopressin (Antidiuretic)
- vasoconstrictor antidiuretic hormone (ADH) - ansproduced by: hypothalamus secreted by: posterior pituitary gland
- retain water antidiuretic hormone (ADH) AKA vasopressin - ansProduced by: hypothalamus Secreted by: *posterior pituitary Action: retain water, increase peripheral vasoconstriction Apoptosis - ansNormal and programmed
- part of aging process
- leads to cell death Approximation of wound edges - ansDo NOT overlap (would lead to keloid) Arachidonic acid - ansinitiates a series of complex reactions
- production of eicosanoid inflammatory mediators
- corticosteroid works between cell membrane artificial active immunity - ansMechanism: vaccine is injected into the body; no illness results but antibodies form Memory: yes Ex: measles vaccines
Clinical manifestation of acute phase inflammatory response - ansfever from hypothalamus Clinical Manifestations - anssigns (objective) and symptoms (subjective) Clinical manifestations of lung cancer - ansHoarseness, shortness of breath, chronic reproductive cough, retrosternal chest pain Clinical manifestations of plural effusion - ansDiminished or absent breath sounds; dull percussion sounds; hypoxemia and tachycardia Clinical manifestations of primary pulmonary arterial hypertension - ansRight sided heart failure* Clinical manifestations of pulmonary embolism - ansBlood frothy sputum, tachycardia Color blindness (XX) - ansRed-green Color blindness (XY or XX) - ansBlue-green; very rare Complications - ansPossible adverse events from disease OR outcomes from treatments Congenital conditions - ansdefects that are present at birth Contraction and remodeling phase - ansSynthesis of collagenase enzymes, scar contracts and becomes smaller, possible keloid Contusion - ansBruise
- fresh: red/purple
- old: yellowish convalescent stage - ansHost recovers with tissue repair Corticotropin-releasing factor (CRF) - anssecreted from hypothalamus
- stimulates anterior pituitary gland
- secretes adrenocorticotropic hormone (ACTH)
- stimulates adrenal gland (cortex)
- secretes glucocorticoid hormone (cortisol) Cortisol - ansProduced by: adrenal cortex Secreted by: adrenal cortex Action: inhibits immune system; reduced inflammation stimulated by ACTH
Cranial Nerve V: Trigeminal - ansSuperficial and deep regions of face, interior 2/3 of tongue; swallowing speech, and soft palate Cranial Nerve VI: Abducens - ansPupils fixed/dilate Cranial Nerve VII: Facial - ansInnervates anterior 2/3 of tongue cyclooxygenase pathway - anspathway that creates prostaglandins and thromboxane A2 that functions in vasodilation/vasoconstriction, pain and fever cystic fibrosis - ansToo much fluid secretion
- disorder of membrane transporting chloride ions in exocrine glands
- causing lung and pancreatic diseases Developing an infection/illness AFTER the first 48 hours at the hospital stay is - ansNosocomial; HAI Developing an infection/illness within the first 48 hours at the hospital stay is a - ansCommunity acquired infection Diagnosis - ansNature of health alignment causes Diagnosis differences for hemothorax vs pneumothorax - ansHemo: whitish fluid in pleural space Pneumo: air on effected side Difference between anaphylaxis and asthma - ansHives only with anaphylaxis Do cat bites or dog bites result in more infections? - anscat Do sequential compression devices treat deep vein thrombosis? - ansNO Do you suture bite or puncture wounds? - ansNO* Down syndrome - ansCause: non disjunction or error in cell division during meiosis
- trisomy of chromosome 21
- *increase risk if maternal age is above 35 Dysplasia - ansabnormal development or growth of cells, tissues, or organs
- precursor to cancer
- ex: Dr. Marklunds lip Dysplasia - ansDeranged cell growth
- precursor of cancer
- pap smears
Hemophilia A - ansBleeding disorder (bleed out); mutation of factor VIII protein Hemophilia B - ansMutation of factor IX protein Hemostasis Phase - ans1st: construction of injured blood vessels (slow bleeding) 2nd: blood vessels dilate (brings in neutrophils and platelets) Hemothorax - ansLarge amount of blood in the pleural cavity hemothorax vs. pneumothorax percussion - ansHemo: dull Pneumo: hyperresonance (sounds like drum bc of all the air) Histamines - ans1st RELEASES during acute inflammatory reaction
- dilates blood vessels
- stimulated by trauma, inflammatory response, immune reaction Histologic hypoxia - ansimpaired utilization of oxygen by tissues; cyanide, carbon monoxide, methemoglobin poisoning Histology - ansThe study of the cells and extracellular matrix of body tissues HIV Type 1 - ansCommon in USA, Europe, Central Africa, T cells are less than 200 cells/mm3; DEVELOPS INTO AIDS HIV Type 2 - ansCommon in West Africa, T cell count is more than 200 cells/mm3, tends to NOT develop into AIDS How do wounds heal? - ansBottom to top, outside to inside How does blood flow and oxygen delivery promote wound healing? - ansmacrophages require aerobic environment, blood supplies nutrients and oxygen How is health defined now - ansNo longer only physical, includes mental, spiritual, and social dimensions How is HIV transmitted? - ansExchange of blood or bodily fluids; must contain HIV or HIV infected cells How many known strains of HIV are there? - ans Human genome 2003 - ansHaplotype* Hyperplasia - ansincrease in number of cells (ex: warts)
Hyperplasia - ansincrease in the number of the cells in a tissue or organ (mitotic division)
- breast and uterus during pregnancy
- liver regeneration Hypertrophy - ansIncrease in size and volume of cell, number is unchanged Hypothalamus - ansEndocrine and ANS Hypothalamus * - ansCoordinates responses of endocrine and autonomic nervous system Hypoxemic hypoxia - ansInsufficient oxygen, reaching the blood; high altitudes, strangulation Hypoxia - ansLow oxygen saturation of the body, not enough oxygen in the blood Hypoxia and ischemia result in - ansPremature cell death; tissue death Impaired wound healing factors - ansDiabetic mellitus, corticosteroids, ischemia/hypoxia In situ hybridization studies* - ansTwo somatic cells from different species (human/animal)
- fuse to form new hybrid cell In what phase of wound healing do macrophages enter the tissue area - ansInflammation Incidence - ansNumber of NEW cases incubation period - ansPathogen replicates, asymptomatic but can be infectious Indirect ionization - ansbrachytherapy Infectious agents - ansTORCH (toxoplasmosis, other, rubella, cytomegalovirus, herpes Inflammation phase - ansmacrophages enter tissue area*, platelets clot, migration of phagocytic WBC, phagocytosis inflammatory response - ansTriggered by infection
- redness (rubor)
- swelling (tumor)
- heat (calor)
- pain (dolor)
- loss of function
Ischemia - ansLack of blood supply cannot have without also having hypoxia Klinefelter Syndrome (XXY) - ansCause: presence of 1 or more extra X chromosome
- abnormal testicular development
- affects MEN
- men can develop breasts
- very long limbs Lactic acid range - ans<2 is good
2 is bad 4 is really bad Laserstion - ansDeep cut or tear; increased infection risk Legionnaire's disease - anssevere, often fatal bacterial infection characterized by pneumonia and liver and kidney damage; caused confusion; crackles in breath sounds Leukocytosis - ans>10, Leukocytosis - ansAbnormally high WBC count; >10, Leukopenia - ans<4, Leukopenia - ansAbnormally low white blood cell count; <4, Limbie System - ansInvolved with emotions (fear, anxiety, excitement) Linkage studies - ansCloser genes that are together on same chromosome have a greater chance of passing on to offspring Lipoxygenase pathway - ansconverts arachidonic acid to leukotrienes; leukotrienes complement histamine actions Lysosome - ansCellular digestive system Macrophages - anscan move out of blood vessels and into tissue Marfan Syndrome - ansAffects all body systems
- connective tissue disorder
- abnormal skeletal system
- abnormal ocular
- abnormal cardio system Mast cells - anssecretes histamine Metaplasia - ansOne mature cell type is replaced by a different mature cell type
- trachea of chronic cig smokers
- predisposed to pre cancerous transformation of metaplastic epithelium milieu interieur - ansThe internal environment of a cell or organism; concept developed by Claude Bernard
- body fluids surrounding cells (extracellular fluids) and organ systems
- provide the means for exchange between external and internal environments
- cells receive nourishment and excrete waste in same internal fluid
- strive for homeostasis Mitochondria - ansPowerhouse of the cell Morbidity - ansEffects of a disease on peoples lives Morphology - ansGross anatomic/microscopic changes characteristic of disease Mortality - ansStatistical information about cause of DEATH natural active immunity - ansMechanism: pathogens invade & cause illness, antibodies form Memory: yes Ex: person has rubella once natural passive immunity - ansMechanism: antibodies pass from mom to fetus or baby Memory: no Ex: through placenta or breast milk Necrosis - ansPremature cell death due to injury or infection
- nose collapse from cocaine use
- promotes systemic inflammatory response syndrome
- hyperkalemia & cardiac dysthymias Negative feedback loop - ansStable; common; requires a set point; works like a thermostat Neoplasm cellular growth diagnosis gold standards - ansPET with CT scan, tissue biopsy Neurofibromatosis (NF) - ansNeuro tumors
- fibromatous skin tumors
- pigmented skin lesions Neutrophils - ans1st to ARRIVE
- seg= mature
- band= immature (released from bone marrow)
- *generates hydrogen peroxide and nitrogen oxide (both bad; free radicals)
Pneumonia symptoms and diagnosis - ansCrackles in breath sounds; hyponatremia Pneumothorax - ansair in the pleural cavity then collapse polymerase chain reaction (PCR) - ansUsed to detect HIV's genetic material (RNA) Positive feedback loop - ansUnstable; NOT common Preclinical - ansnot yet clinically apparent; diagnostic tests are negative Prevalence - ansNumber of cases Primary Assessment - ansA: airway B: breathing C: circulation D: disabilities E: environment/expose
- also control bleeding Primary care - ansPreventative; handing out pamphlets, talking to kids about wearing helmets on their bikes Primary intention - ansSutures/staples Prodromal stage - ansInitial appearance of symptoms: malaise, fever, myalgia, headache, fatigue proloferative phase - ansscar tissue develops (hypoxia/poor perfusion worsens scarring), promote angiogenesis (to prevent hypoxia), requires moist vascular wound surface (reason for scab) Proteasomes - ansBreakdown proteins Pulmonary arterial hypertension - ansLife threatening; increased pulmonary artery pressure Pulmonary embolism - ansBlocking of a pulmonary artery due to a blood clot Purpose of feedback loop - ansBody manages homeostasis via compensatory mechanism and feedback control Radiation (DTD) - ansDistance, time, duration Resistance - ansResource management, decrease in cortisol and sympathetic nervous system
Resolution stage - anstotal elimination of a pathogen from the body without residual signs or symptoms of disease Reticular Activating System (RAS) - ansAlertness and arousal
- muscle tone and reflex circuit Revised classification system for AIDS - ans- positive for HIV
- T cell count is less than 200 cells/mm
- opportunistic diseases (immunocompromised) Ribosome - anssite of protein synthesis Right side pain and swelling = - ansLiver Risk factors - ansMultiple factors that predispose to a particular disease Sarcoma - ansBlood vessels Secondary Assessment - ansS: signs/symptoms A: allergies M: medications L: last oral intake/menstruation E: events leading to injury/illness
- head to toe assessment Secondary care - ansHospital; early detection and treatment measures Secondary intention - ansWound packing, fills gaps of injured tissue Selye's theory - ansGeneral adaptive syndrome (GAS) Sensitivity - ansDiseased patient with true POSITIVE test result Sepsis - anssuspected or proven infection
- treat with antibiotics EARLY w/o culture results Septic shock - ansHas everything SIRS and sepsis has; hypotension, associated with severe infection and SIRS with refractory hypotension
- treat with SPECIFIC antibiotic per culture results Sequelae - ansLesions or impairments following OR caused by disease Seroconversion of HIV - ansSymptomatic; POSITIVE antibody test, person IS infectious Sickle cell disease* - ansCrescent shaped blood cells
The pneumotaxic center of the UPPER pons - ansmodifies the rate and depth of breathing Thyroid Stimulating Hormone (TSH) - ansProduced by: *anterior pituitary Secreted by: anterior pituitary Action: affects metabolism (energy) stimulates thyroid Thyroid Stimulating Hormone (TSH) - ansProduced by: anterior pituitary
- stimulates secretion from thyroid gland (metabolism) Transmission modes of HIV - ans- unprotected sex
- blood transfusions
- sharing needles/syringes
- breast milk
- in utero or during birthing process Turner Syndrome - ansCause: absence of all or part of X chromosome
- affects WOMEN
- females lose oocytes by 2 years old
- no menstruation, no 2nd sex characteristics Type 1 Acute Respiratory Failure - ansWITHOUT hypercapnia Type 1 immediate - ansIgE (allergies, anaphylaxis, food, insect bite/sting) Type 1 Immediate Hypersensitivity - ansIgE Mechanism: allergens activate, T cell binding to mast cells during first exposure (IgE). Next exposure: allergen binds with IgE and inflammatory mediators Ex: allergies, anaphylaxis, food, insect bite/sting Type 2 antibody mediated hypersensitivity - ansIgG and IgM Mechanism: destruction of target cell; IgG or IgM reacts with antigen on cell Ex: blood transfusions, maternal antibody Type 2 antibody mediated hypersensitivity - ansIgG, IgM (blood transfusions, maternal antibody) Type 3 acute respiratory failure - ansWITH hypercapnia Type 3 immune complex - ansIgM, IgG, IgA (autoimmune disorders) type 3 immune complex hypersensitivity - ansIgM, IgG, IgA Mechanism: circulating antigen - antibody complexes, accumulate in tissues; triggered, complement, causes inflammation
Ex: autoimmune disorders (lupus) Type 4 cell mediated hypersensitivity - ansIntra/extracellular agents Mechanism: macrophages delay, antigen processing; release lymphokines Ex: organ transplant rejection Typical pneumonia - ansBacterial Western blotting technique - ansMore sensitivity assay; indirect test; looks for presence of HIV antibodies to specific viral antigens If negative: that means your ELISA was a false positive What are the HIV antibody tests? - ansELISA, western blotting technique What chemotherapy is most effective? - ansCombination What conditions can develop into acute respiratory disorders - ansFree base cocaine, heroin, multiple blood transfusions, open wounds, burn injuries, pulmonary embolism, oxygen toxicity What conditions can develop into acute respiratory failure - ansPulmonary edema What do arterioles and arteries do during hematogenous dissemination? - answall thickness prevents movement of cancer cells into tissue What do you treat methemoglobin toxicity with - ansMethylene blue and 100% oxygen What does central cyanosis indicate - ansCardio pulmonary or desaturation problem What does cyanide toxicity affect and how - ansMitochondria; cyanide inhibits oxidative phosphorylation in mitochondria What does methemoglobin affect - ansHemoglobin What does peripheral cyanosis indicate? - ansBlood flow issues What does pulse oximetry failed to detect - ansOxygen carrying hemoglobin versus carbon monoxide carrying hemoglobin What happens in the proliferative phase that can make scarring worse - ansHypoxia and poor perfusion What is adequate ventilation? - ans94%-98%* What is required in the proliferative phase - ansMoist vascular wound surface (under scab)
What two pathways are metastatic cancer cells disseminated by? - ans1. lymph channels (lymphatic spread)
- blood vessels (hematogenous spread; typical of sarcomas) What type of cells is chemotherapy most toxic to? - ansRapidly proliferating cells; cells that are dividing are potentially sensitive to chemo What vaccines must you get if you do not have your spleen? - ansPneumococcal & meningococcal vaccines When do you need a blood transfusion? - ansLess than 8 g/dL Where can cyanide be found - ansExtract from almonds and apple seeds Where is the spleen located - ansupper left quadrant of the abdomen Which side of the heart fails during 2nd pulmonary arterial hypertension - ansLeft Which type of pulmonary arterial hypertension is associated with disease process - ans2nd Why do corticosteroids impair wound healing? - ansSuppresses immune system Why do ischemia and hypoxia impair wound healing? - ansIncreased infection risk, decreased fibroblast growth, decreased collagen production, decreased angiogenesis Why do we give the lowest amount of oxygen possible? - ansTo minimize chance of free radicals Why does diabetic mellitus impair wound healing? - ansHyperglycemia; too much sugar; sugar is an energy source for pathogens Why does swelling occur during inflammation? - ansincrease in fluid that will escape from blood vessels into tissue (extravascular space) Why is the infection rate higher for adult bites compared to child bites? - ansDeeper/harder bite Why shouldn't you share your pen at clinicals? - ansShigella! Dr Marklund got this Why would radiation therapy be used as palliative care? - ansDecrease pain associated with bone metastasis Window period of HIV - ansAsymptomatic; NEGATIVE blood test for HIV antibodies, person IS infectious
X linked dominate (affect males and females) - ansFragile X syndrome X linked recessive (affects males) - ansHemophilia A
