questions for exam 3
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| How do you distinguish healthy from non-healthy immune cells? | Immune cells are the only cells capable of determining self from nonself.
Self-tolerance is possible because of the different proteins present on all cell membranes.
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| Cardinal Signs of Inflammation | Redness
Warmth
Swelling
Pain
Loss of Function
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| Three Stages of Inflammation | 1. Vasoconstriction
2. Cellular
3. Healing
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| VASOCONSTRICTION: Phase of Inflammation | due to trauma (vascular)
Injury produces histamine and kinins
Causes constriction of veins and dilates arterioles
Redness and Warmth
Fluid leaks out of cap into intestinal spaces of tissue
Pain r/t prostaglandin release
Edema protects from further i
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| CELLULAR: Phase of Inflammation | mil-serious (dead WBCs)
moderate - sangiounous/serosanguinous
severe - purulent RBCs, dead and living bacteria
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| HEALING: Phase of Inflammation | Healthy neutrophils
Healing or Infection
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| Specific Inflammatory Response | Involves antibody-mediated immune response and cell-mediated immunity
Self recognize
Has a memory
Long lasting, generalized
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| Non-Specific Inflammatory Response | rapid, short term, protective responses
Bring fluid, dissolved substances and blood cells
Occurs only in vascularized tissue
helps start of the specific immune response
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| Which cells provide protective responses during inflammation | Macrophages - protect and stimulate of longer lasting immune response
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| Example of non-inflammatory health condition (osteo) | Auto-Immune (Lupus, RA, Psoriasis)
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| What is phagocytosis? | Engulf and destroy invaders
Rid body of debris after tissue injury
MATURE NEUTRO ONLY
Attraction - macros come into contact with target
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| Importance of Spleen in Immunity | destroys old and imperfect RBCs
Breaks down hemoglobin released from destroyed cells
Stores platelets
Filters antigens
Produces Antibodies
REMOVED- less able to remove disease-causing organisms
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| CBC Left Shift Bandemia | Bands are NOT MATURE
SHOULD NOT be in blood
Sepsis
Marrow can't produce mature neutros to keep up w/infection
NEUTROPENIC REVERSE ISOLATION
NEW LEFT SHIFT-TELL DR
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| What is Human Leukocyte Antigen | Test that detects antigens on WBC- determines tissue type
Used to test compatibility of donors
Unique per person
Not on leukocytes
IN ANOTHER BODY-become antigens
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| Neutrophils | segs/polyps-MATURE
bands-IMMATURE
Small energy supply
Higher number - greater resistance
Provide protection
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| Macrophages | play many roles in protection
Immediate inflammatory response
long life and can renew energy
Liver, spleen, intestinal tract
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| Basophils | Heparin, histamine, serotonin, kinins, leukotrienes
Released in blood - act on smooth muscle
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| Eosinophils | Act against infestations of parasitic larvae
Increased number circulating during an allergic response
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| Natural Passive Immunity | antibodies passed from mother to fetus/baby
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| Always have what when administering vaccines? | Epinephrine
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| Negative Antibody Titer in varicella zoster indicates what? | Never had it, not immune
Get a booster shot!
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| What type of immune protection can be transferred to another person? | Natural Passive Immunity
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| What cells are responsible for organ transplant rejections? | Natural Killer Cells
Cytotoxic T cells - transplant organs
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| Organ Transplant Precautions | Rescue Therapy - antilymphocyte globulin Alg
Cycolosporins - IMURAN
CellCept - Corticosteroids
IV within first two hours before surgery, first few days after also
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| Top nursing concerns with immunosuppressed clients? | RISK FOR INFECTION
Imbalanced Nutrition, Skin Integrity, Ineffective Coping, Diarrhea, Pain, Injury
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| HIV is most commonly found with what test? And confirmed with what test? | Elise
Western blot antibody test
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| How is HIV transmitted? | bodily fluids, sexual, parenteral, perinatal, needles
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| Who is at greater risk for HIV? Why? | WOMEN. Vagina has moist mucous membrane surface areas, more non-intact skin than a penis
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| How to help prevent HIV? | Sharing needles, abstinence, condoms
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| What and when to assess for opportunistic infections with HIV patients? | assess for symptoms every 2-6 months based on disease progression. meningitis from cyptococcus.
FEVER, HA, BLURRED VISION, N, STIFF NECK, CONFUSION, MENTAL CHANGES, MALAISE
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| HAART | Helps raise levels of CD4
Combo of 3+ HIV drugs to reduce virus levels
Start when CD4 falls below 350
Ritonavir - small doses
Antiretroviral - combo is zidovudine and lamivudine
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| Post exposure Prophylaxis of HIV | Combo of 3 approved ARVs for four weeks. PEP should be started as soon as possible after exposure!!!
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| Pathogenic Organisms | have the ability to cause disease, produce disease, caused by viral organisms, occur even in people with normal immune system
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| Opportunistic Organisms | Does not cause disease but becomes pathogenic when body's immune system is impaired and unable to fight off infection such as AIDs, Immunocompromised
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| How does Chemotherapy affect Bone Marrow? | Suppresses bone marrow, myelosuppression
RBC, WBC, Platelets DECREASE
Reduces replacement of these cells by suppressing bone marrow function
Neutropenia
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| Non-Cancerous Tumor Characteristics | Benign
Continuous Ceell Division, small nucleus, diploid chromosomes
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| Cancerous Tumor Characteristics | Rapid continuous cell division, large nucleus, adheres poorly, metastasizes, chromosomes lost/gained
MALIGNANT - multiply by mitosis
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| What is metastasis? | Cancerous ability to spread. Major Cause of Death.
Common Places: lungs, lymph tissues
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| Normal Cell Characteristics | limited cell division, apoptosis, distinct/recognizable specific response, small nucleus, well-regulated growth
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| What is grading? | system of classifying cellular aspects of a cancerous tumor, some are more malignant than others.
Find appropriate therapy.
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| Goals of Cancer Treatment | Pain relief
Prevent infection
Prevent metastasis
Grade 1-looks normal
Grade 4-no resemblance to tissue or origin
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| Why would a benign tumor be removed? | They can expand, but not invade.
Circulation issues.
Prophylactic therapy
Discomfort
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| Theory of Carcinogenesis: | Cancer Development.
exposure to carcinogens, genetic predisposition, immune function, damage occurs, cancer cells reenter cell cycle quicker than normal cells.
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| Greatest chance for cure of cancer: | SURGERY
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| How does Radiation Treatment work? | treats cancers that are confined to one area. Prevents destruction of normal tissue. Radioactive element breaks down, radiation energy released. Purpose is to destroy cancer cells and have minimal damaging effects on normal cells.
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| S/S Prostate Cancer | slowest growing, hesitancy, change in size or urine stream, back pain, leg, pain, history of UTI, blood in urine, swelling legs, bone pain
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| Leading Cause of Cancer Death in Men | Lung Cancer
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| TNM | Size of Tumor, Involvement of Nodes, Distance of Metastasis
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| Cancer Prevention | Early detection, vaccines, smoking cessation, environmental exposure, healthy diet, changes in bowel habits, unusual bleeding, unusual discharge, difficulty swallowing
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| Suppressor Genes in Cancer Development | tell the gene what the job is, and does it when it's supposed to
Proteins that control cell division
Limits cell division
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| What type of cancer is associated with Reed-Sternberg cells? (Hodgkins) | develops from a single lymph node or chain, and spreads the adjoining nodes
Involved nodes contain Reed-Sternberg cells
NON HODGKINS-doesn't contain Reed-Sternberg
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| Most Significant factor for risk of cancer? | ADVANCING AGE
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| Rehabilitation Surgery for Cancer | increases function, enhances appearance
Breast Surgery
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| Palliation Surgery for Cancer | Improves quality of life and survival time, not focused on the cure though
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| Prophylactic Surgery for Cancer | removal at risk tissue to prevent cancer
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| Curative Surgery for Cancer | Removal of all cancerous tissues
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| Diagnostic Surgery for Cancer | removal of all or part of a lesion for testing purposes
Biopsy
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| Second Look Surgery | Re-diagnosis after treatment
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| Cancer Control/Cytoreductive | removing part of the tumor, but not all.
Decrease cancer cells, increases the success of other therapies
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| What type of cancers are more susceptible to radiation therapy? | Treats cancer that is refined to one area/tissue of the body
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| Radiation Principles | Time, Distance, Shielding
Purpose is to destroy cancer cells with minimal exposure of the normal cells to the damaging actions of radiation.
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| Health Problems for patients with history of radiation therapy? | Infection, Fractures, Sun Problems, Fatigue, Skin Breakdown, Dry Mouth, Altered taste sensations, hair loss
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| What factors would prevent patients from participating in radiation therapy? | Side effects, infections, immunocompromised, metastasized
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| What type of cancer is chemotherapy most effective in? | Tumors with rapid growth.
Tumors that have metastasized cancer.
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| What is Neumega used for? | Prevention of platelet reduction, used in chemotherapy.
Protein.
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| Why would chemo be administered intrathecal? | Cancer can be undetected in the spinal cord, and can reach nervous system. Systemic, can kill bad cells.
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| Side Effects of Hormones for Cancer treatments? | Hypercalcemia, Liver Dysphunction, Gynecomastia, Masculinizing effects in women, hormonal manipulation
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| Which lab result is associated with SIADH? | SODIUM! Most commonly found in carcinoma of the lung, tumors also present in the brain.
Hypernatremia.
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| What do Interleukins do? | Induce fever and stimulation of prostaglandins.
modify patients biological response to tumor cells.
Increases growth of CD4 and T cells.
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| Bands vs Segs | Bands - IMMATURE neutrophils
Segs - MATURE neutrophils
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| Tumor Lysis Syndrome | large number of tumor cells are destroyed rapidly resulting in intracellular contents being released into bloodstream faster than the body can eliminate them.
Prevention hydration, drug therapy
Pos sign that CA TX is effective
Dilutes K levels
DRINK
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| What is cytotoxic chemotherapy most effective in treating? | kills specific cancer cells
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| Mutliple Myeloma is most common in who? | BLACKS
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| Most common issues affecting toddlers and preschoolers? | Infection/Communicable Diseases
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| Fifth Disease | Erythema Infectiosum - Human Panovirus "slapped face" appearance, maculopapular rash on extremities in 3 days
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| Untreated Strep Throat can lead to what? | Scarlet fever
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| Failure to report abuse can result in what? | Prison, loss of license, civil action
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| End result of DIC | Exhaustion of available clotting
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| S/S of Panic Level Anxiety | Palpitations, SOB, Choking/Smothering sensation, chest pain, nausea, depersonalization, dear of dying, chills, hot flashes
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| Interventions for Panic Attacks | stay with client, speak quietly, provide safety and comfort, relaxation techniques
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| Splitting | From BPD- describes difficulty with the ability to hold opposing thoughts, feelings, or beliefts about oneself or others
Worst person in the world, I LOVE YOU
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| Nursing interventions for Histrionic personality disorder | emotional attention seeking behavior, the person needs to be the center of attention, often flirtatious, seductive, MAINTAIN professional boundaries and comm.
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| Side Effects of Electroconvulsive Therapy | useful for clients with depression
Alterations in bp, adverse se of anesthesia, skin burns, dental and oral trauma, pain, stroke, death
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| Tardive Dyskinesia in clients taking long term antipsychotics | involuntary movements, tongue thrusting, repetitive chewing,
MEDS-Haldol, Flunarizine
If noticed within first 2 yrs, REVERSIBLE
FLY CATCHING, WORM TONGUE, LIP SMACKING
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| Rape Trauma Syndrome | Acute Phase - lasts 2 weeks after rape. Expressed -emotional outbursts, crying, laughing, anger
Controlled -survivor may appear calm but confused. Difficulty making decisions, numb.
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| How to Avoid Reye's Syndrome? | Don't give kids under 12 aspirin especially during a viral illness
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| Symptoms of Schizophrenia | Hallucinations, Delusions, Disorganized speech, bizarre behavior, walking backwards
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| NOT POSITIVE SYMPTOMS OF Schizophrenia | Affect-blunt or flat expression
Alogia-poverty of though
Avolition-lack of motivation
Anhedonia-lack of pleasure/joy
Anergia-lack of energy
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| S/S of Panic Disorder | Papitations, SOB, Choking, Smothering Sensations, Chest Pain, N/ Fear of dying, chills, hot flashes
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| How to Combat eating problems with bipolar? | Monitor fluid intake, nutrition, provide portable nutritious food
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| During a severe psychotic break: | SEEK ADDITIONAL PERSONNEL
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| Abrupt Onset of Psychotic Disorder | Mania, paranoid, bizarre behavior, delusion, hallucinations
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| Underlying factors for depressed client considering suicides? | untreated depression, despair, hopelessness, changes in a job, history of suicide attempts
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| Seasonal affective disorder | occurs during the winter months and may be treated with light therapy
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| S/S Depression | difficulty sleeping or excessive sleeping, indecisiveness, decrease ability to concentrate, suicidal ideation, cincreased/decreased in motor activity, inability to feel pleasure, increase/decrease in weight
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| Interventions for major depressive disorder | Safety, Milieu therapty, self care, communication, counseling, psychotherapy, antidepressants, ECT
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| TMS | electromagnetic stimulation of the brain, exercise, St Johns Wort
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| Hobo Phobia | fear of homeless
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| Athazagoraphobia | fear of being ignored
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| Agoraphobia | fear of being on open spaces
impaired ability to work
avoid being outside
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| Schizotypal | odd beliefs leading to interpersonal difficulties, eccentric appearance, magical thinking that are not clear, delusions, hallucinations
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| Schizoid | emotional detachment, disinterest in close relationships, indifference to praise or criticism, uncooperative
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| Antisocial | disregard for others with exploitation, repeated unlawful actions, deceit, failure to accept personal responsibility
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| OCD Personality | perfectionism with a focus on orderliness, control to the extent that the person may not be able to accomplish a given task
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| OCD Disorder | Intruisive thoughts of unrealistic obsessions and tries to control these thoughts with compulsive behaviors, repetitive
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| Borderline Personality | Instability of affect, identity, relationships, fear of abandonment, splitting behaviors, manipulation, impulsiveness, tries self mutilation or suicide
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| Avoidant | social inhabitation, and avoidance of all situations that require interpersonal contact despite wanting close relationships due to extreme fear of rejections, often anxious and social situations
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| Histrionic | emotional attention seeking behavior
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| Schitzoid | Emotional detachment
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| Dependent | feels the need to find another close relationship when one ends, mostly seen in personality disorders
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| Generalized Anxiety Disorder | more than 6 months of uncontrollable excessive worry
Impairment of one or more functions
Fatigue, restlessness, irritability, sleep disturbances
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| PTSD | Exposure to a traumatic event, causing flashbacks, horror, fear, impairment for longer than 1 month after the event and may last for years
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| Social Phobias | fear of embarrassment, unable to perform in front of others, dreads social situations, believes others are judging negatively, impaired relationships
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| Panic | recurrent panic attacks
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