Term
|
Definition
Release interleukins and tumor necrosis factor.
-Affect thermoregulatory center- fever
-Affect central nervous system- Lethargy
-Skeletal muscle breakdown |
|
|
Term
| What does the liver produce as a systemic response in the acute phast of the defense response? |
|
Definition
| Fibrinogen and c-reactive protein |
|
|
Term
| What is the function of fibrinogen and C-reactive protein produced by the liver during the acute phase of inflammatory response? |
|
Definition
-Facilitates clotting
-Binds to pathogens
-Moderate inflammatory responses |
|
|
Term
| Describe the 1st 3 steps in the white blood cell response. |
|
Definition
-Inflammatory mediators cause WBC production
-WBC count rises
-Immature neutrophils (bands) released into the blood. |
|
|
Term
|
Definition
| Increase in white blood cells common in inflammatory responses, especially with bacterial infections. Immature neutrophils (bands) are released from bone marrow (called a shift to the left in a WBC count). |
|
|
Term
| What is the main component of WBC that increases with bacterial infection. |
|
Definition
|
|
Term
| Name the component of WBC that increases with Allergic reaction or paracitic infection. |
|
Definition
|
|
Term
| What component of WBC does viral infection reduce? |
|
Definition
|
|
Term
| What component of WBC does a viral infection increase? |
|
Definition
|
|
Term
| What component of WBC will be elevated usually with chronic inflammation? |
|
Definition
| Usually lymphocytes instead of neutrophils. |
|
|
Term
| What is the cause of chronic inflammation in most cases? |
|
Definition
| Persistant irritants/foreign bodies. |
|
|
Term
| What happens to macrophages during chronic inflammations? |
|
Definition
| They accumulate in the damaged area and keep releasing inflammatory mediators. |
|
|
Term
| What forms and proliferates during nonspecific chronic inflammation? |
|
Definition
-Fibroblasts proliferate
-Scar tissue forms |
|
|
Term
| Explain the relationship b/w macrophages and connective tissue during granulomatous inflammation. |
|
Definition
-Macrophages mass together around foreign bodies (splinter)
-Connective tissue surrounds and isolates the mass. |
|
|
Term
| What are 3 steps in tissue repair? |
|
Definition
-Growth factor stimulates local cells to divide.
-Tissue organization is controled by the extracellular matrix.
-New cells are laid down on the extracellular matrix. |
|
|
Term
| Define: issue regeneration |
|
Definition
| Injured tissue is replaced by the same kind of cells. |
|
|
Term
| Define: Fibrous tissue repair |
|
Definition
| Injured tissue is replaced by connective tissue. |
|
|
Term
| What is another name for granulation tissue? |
|
Definition
|
|
Term
| When does the inflamatory phase begin? |
|
Definition
| It begins at the time of the injury. |
|
|
Term
| What do neutrophils and macrophages do during the inflammatory phase of wound healing? |
|
Definition
| Neutrophils ingest bacteria and debris, then macrophages stimulate epithelial cell growth! |
|
|
Term
| When does the proliferative phase of wound healing begin? |
|
Definition
| -It begins 2-3 days after injury |
|
|
Term
| What occurs during the proliferative phase? |
|
Definition
| The body focuses on building new tissue. Epithelialization occurs. |
|
|
Term
| When does the remodeling phase begin? |
|
Definition
|
|
Term
| Describe: Epithelialization |
|
Definition
| Migration, proliferation and differentiation of the epithelial cells at the wound edges. |
|
|
Term
| Describe a wound surface conducive to wound healing. |
|
Definition
|
|
Term
| Why does malnutrition hinder wound healing? |
|
Definition
| Protein deficiency prolongs the inflammatory phase, and Vitamins A and C are essential for healing. |
|
|
Term
| What is the effect of blood-flow arterial disease on wound healing? |
|
Definition
| It causes impaired healing. |
|
|
Term
| Why might a patient be put in a hyperbaric chamber after an accident? |
|
Definition
| Hyperbaric Oxygen helps in wound healing. |
|
|
Term
| What is the effect of diabetes mellitus on wound healing? |
|
Definition
| It impairs wound healing. Hyperglycemia also diminishes the action of neutrophils. DM is actually a risk factor for developing infections. |
|
|
Term
| List 7 factors that affect wound healing. |
|
Definition
1. mal-nutrition
2. Impaired blood flow and oxygen delivery
3. Impaired inflammatory and immune responses
4. Infection
5. Wound separation
6. Foreign bodies
7. Age |
|
|
Term
| Describe hypersensitivity |
|
Definition
| An excessive or inappropriate activation of the immune response. The body becomes damaged by the immune response, rather than by the antigen (allergen). |
|
|
Term
| What is another name for type I hypersensitivity mediated by IgE 1? |
|
Definition
|
|
Term
| How are local or atopic reactions acquired? |
|
Definition
|
|
Term
| What type of allergic reaction is hay fever? |
|
Definition
|
|
Term
| What type of allergic reaction is a food allergy? |
|
Definition
|
|
Term
| What type of allergic reaction is bronchial asthma and hives? |
|
Definition
|
|
Term
| Describe: allergic rhinitis |
|
Definition
| Sneezing, itching, watery discharge from eyes and nose. Associated with sinusitis and bronchial asthma. Fever is absent. Typical allergens are pollens, grasses, trees, weeds, fungal spores, dust mites, animal dander and feathers. It is perennial and seasonal. |
|
|
Term
|
Definition
| The most common causes in children are eggs, milk, peanuts, soy, tree nuts, fish and shellfish. In adults, it's peanuts, shellfish, and fish. |
|
|
Term
| Describe: type I hypersensitivity. |
|
Definition
Occurs when IgE is produced after exposure to an antigen (usually a protein that enters from the environment).
-After IgE is produced by the B lymphocytes, it is ready to respond to subsequent exposure.
-Degranulation of mast cells cause a release of histamine (vasodilation, edema, bronchoconstriction), prostaglandins, leukotriens and cytokines.
-It's familial! |
|
|
Term
|
Definition
A systemic response to the inflammatory mediators released in type I hypersensitivity.
-histamine, acetylcholine, kinins, leukotreines, and prostaglandins all cause vasodilation. Arteries throughout the entire body are dilated.
-Acetylcholine, kinins, leukotrienes, and prostaglandins all can cause bronchoconstriction. |
|
|
Term
| Describe what happens to blood vessels during anaphylaxis. |
|
Definition
| Vasodilation causes a ridiculous fall in blood pressure. There's also airway constriction and obstruction of the upper airway. It's basically bad. |
|
|
Term
| Describe type II hypersensitivity |
|
Definition
-Tissue specific
-Cytotoxic
-IgG or IgM attack antigens on cell surfaces
-Usually involves antigens on red or white blood cells.
-Transfusion reactions
-Rh & ABO incompatibility
-Drug reactions-causes hemolysis of RBC. |
|
|
Term
| Examples of type II hypersensitivity are?? |
|
Definition
| Mismatched blood transfusion reactions, hemolytic disease, and certain drug reactions. |
|
|
Term
| Describe type III hypersensitivity |
|
Definition
-Antigen-antibody complexes circulate and produce damage when they come in contact with the vessel lining.
-Damage occurs primarily because of compliment activation (proteins that cause lysis when activated)
-The body responds with inflammatory mediators (DAMAGE RESULTS) |
|
|
Term
| What type of hypersensitivity is Autoimmune vasculitis? |
|
Definition
| Type III hypersensitivity. Example: Systemic lupus erythematous. |
|
|
Term
| What type of hypersensitivity is glomerulonephritis? |
|
Definition
| Type III Hypersensitivity. |
|
|
Term
| What type of hypersensitivity is serum sickness? |
|
Definition
| Type III hypersensitivity. |
|
|
Term
| When does serum sickness normally happen? |
|
Definition
| Occurs after IV antibiotics, foods, drugs, and insect venoms. |
|
|
Term
| What are the signs and symptoms of serum sickness? |
|
Definition
| Urticaria, Rash, edema and fever |
|
|
Term
| What type of sensitivity is an arthus reaction? |
|
Definition
| Type III hypersensitivity. |
|
|
Term
|
Definition
| Localized tissue necrosis |
|
|
Term
| What is an arthus reaction |
|
Definition
| Localized tissue necrosis. |
|
|
Term
| Describe type IV hypersensitivity |
|
Definition
-Cell-mediated: sensitized T cells attack the antigen
-Direct cell-mediated cytotoxicity
-viral reactions
-Delated-type hypersensitivity
-Tuberculin test |
|
|
Term
| What type of hypersensitivity is direct cell-mediated cytotoxicity? |
|
Definition
| Type IV hypersensitivity. |
|
|
Term
| Describe autoimmune diseases. |
|
Definition
-Immune system attacks self-antigens
-Normally, self-reactive immune cells are killed in the lymphoid organs or suppressed by regulatory T cells.
-In autoimmunity, this self-tolerance breaks down.
-Immune system destroys body tissues
-anti-tissue antibodies appear in blood (e.g. anti-thyroid antibodies) |
|
|
Term
| Name the two mechanisms of autoimmune disease. |
|
Definition
1. Genetic
2. Environmental |
|
|
Term
| Define: Autoimmune disease. |
|
Definition
| A breakdown in the ability of the immune system to differentiate between self and non-self antigens. |
|
|
Term
| What type of pathological process is graft vs host disease? |
|
Definition
|
|
Term
| Describe graft vs host disease. |
|
Definition
| Immunologically competent cells are transplanted into recipients who are compromised. Can result in accute, Hyperacute or chronic GVHD. |
|
|
Term
| Describe Hyperacute GVHD. |
|
Definition
| Circulating antibodies react with the graft. |
|
|
Term
| Describe acute graft vs host disease. |
|
Definition
| Exposure to transplant causes activation of immune system, expecially T-cells. |
|
|
Term
| Describe Chronic Graft vs Host disease. |
|
Definition
-Blood vessels in transplant gradually damaged.
-Occurs more than 100 days after transplant. |
|
|
Term
| What are 4 types of primary immunodeficiency? |
|
Definition
-B-cell deficiencies
-Ig deficiencies
-t cell deficiencies
-Combined immunodeficiencies |
|
|
Term
| What might a patient with b-cell deficiencies expect to experience in terms of illness? |
|
Definition
| Frequent pyrogenic infections (strep pneumonia and haemophilus influenza) |
|
|
Term
| What might a patient with Ig Deficiencies expect to experience in terms of illness? |
|
Definition
| Repeated respiratory and GI Infections, asthma. |
|
|
Term
| What is the life expectancy for someone with T cell deficiency? |
|
Definition
| They rarely survive past infancy or childhood. |
|
|
Term
| What are the effects of B cell immunodeficiency? |
|
Definition
| Defects in humoral immunity. Impaired ability to produce antibodies and defend against |
|
|
Term
| What is the most common type of Ig deficiency? |
|
Definition
|
|
Term
| What are the characteristic signs of IgA deficiency? |
|
Definition
| 2/3 are asymptomatic. If low levels of IgA, may have repeated respiratory and GI infections, increased incidence of allergic manifestations (asthma, autoimmune disorders). |
|
|
Term
| What are the characteristics of a child with combined immunodeficiency? |
|
Definition
| They will have disease characteristics that resemble aids. |
|
|
Term
| When did screening for HIV in blood donors begin? |
|
Definition
| 1985. The year WhiteSnake was on top of the world. |
|
|
Term
|
Definition
| The point of Negative HIV result to positive result. |
|
|
Term
| Describe the signs of the primary infection phase of HIV. |
|
Definition
-Signs of systemic infection
-Seroconversion: immune system responds and antibodies against HIV appear (1-6 months) |
|
|
Term
| Describe the processes of the latent period of HIV infection. |
|
Definition
-Virus is replicating, TH cell count gradually falls.
-May last 10-11 years or longer. |
|
|
Term
| Describe the clinical sign of Overt AIDS! |
|
Definition
| TH cell count <200 cells/microliter |
|
|
Term
| What are some of the main AIDS associated illnesses? |
|
Definition
Opportunistic infections such as respiratory, gastrointestinal, and nervous system infections.
-AIDs dementia complex
-Malignancies
-Wasting syndrome. |
|
|
Term
| What are the most common causes of opportunistic respiratory infection in AIDS patients? |
|
Definition
| Most common causes are pneumonia and TB. |
|
|
Term
|
Definition
| An automatic response that neutralizes harmful agents and removes dead tissue. |
|
|
Term
| What happens during the vascular stage of acute inflammation? |
|
Definition
-Prostaglandins and leukotriens affect blood vessels.
-Arterioles and venules dilate, increasing blood flow to the injured area, resulting in redness and warmth.
-Capillaries become more permeable, allowing exudate to excape into tissues, resulting in swelling and pain. |
|
|
Term
| What type of exudate consists of watery fluids low in protein? |
|
Definition
|
|
Term
| What type of exudate results from severe tissue injury causing damage to blood vessels? |
|
Definition
|
|
Term
| This type of exudate produces a thick and sticky meshwork. |
|
Definition
|
|
Term
| This type of exudate contains pus (WBCs, proteins, and debris) |
|
Definition
|
|
Term
| During this state, white blood cells enter the injured tissue. |
|
Definition
|
|
Term
| What is the function of white blood cells during the cellular stage? |
|
Definition
-Destroying infective organisms
-removing damaged cells
-releasing more inflammatory mediators to control further inflammation and healing. |
|
|
Term
| What is the primary phagocyte involved in inflammation and when does it arrive? |
|
Definition
| Neutrophils are the primary phagocyte involved in inflammation, and they arrive within 90 minutes. |
|
|
Term
| Which WBCs increase with allergic reactions and parasitic infections? |
|
Definition
|
|
Term
| These contain histamine and produce allergic symptoms. |
|
Definition
|
|
Term
| These contain histamine and produce symptoms of allergic reaction. |
|
Definition
|
|
Term
| These granulocytes originate in the bone marrow, and arrive within 24 hours. |
|
Definition
| Monocytes (they are macrophages) |
|
|
Term
| These WBCs express adhesive proteins. |
|
Definition
|
|
Term
| Name the inflammatory mediators that leukocytes release at the injured area |
|
Definition
-Histamine and serotonin
-Platelet-activating factor-potent vasodilator
-cytokines
-Colony-stimulating factors
-interleukins
-interferons
-tumor necrosis factor
-Nitric oxide
- |
|
|
Term
| What is the effect of nitric oxide release at the injured area? |
|
Definition
| Relaxes vascular smooth muscle, reduces platelet aggregation and adhesion, aids in the killing of microbial agents. |
|
|
Term
| What are the levels of anxiety? |
|
Definition
| Mild, moderate, severe, and panic. |
|
|
Term
| What are the physiological responses to anxiety? |
|
Definition
| Increased heart rate and blood pressure, rapid, shallow respirations, dry mouth/tight throat, tremors/muscle tension and urinary frequency. |
|
|
Term
| What are the steps in the nursing process? |
|
Definition
| ADPIE-Assessment, diagnosis, [problem (outcome) identification], planning, implementation, evaluation |
|
|
Term
| Identify the main benzodiazepines we've discussed. |
|
Definition
| alprazolam (xanax), clonazepam (klonopin), diazepam (valium), lorazepam (ativan) |
|
|
Term
| What are the side effects of benzodiazepines? |
|
Definition
-May cause physical and psychologic dependence
-Alcohol and other CNS depressants pay potentiate action, especially in elderly patients.
-Blood dyscrasias (fever, sore throat, bruising, rash, and jaundice) are rare.
-kava kava and st john's wort may potentiate action. |
|
|
Term
|
Definition
| Discrete periods of intense fear or discomfort that may be incapacitating. Irrational fear of an external object, activity, or situation. |
|
|
Term
| What are the nursing interventions for panic disorder? |
|
Definition
-Trusting, calm, direct approach
-provide safe environment
-draw attention away
-decrease caffeine, nicotine
-discuss effective coping strategies |
|
|
Term
| What are effective nursing interventions for agoraphobia/social phobias? |
|
Definition
-Assist desensetizing strategies
AFTER trust has been established:
-Assist in recognizing precipitating factors
-thought substitutions/role playing
-expose progressively to feared stimuli
-provide positive reinforcement. |
|
|
Term
| What are effective nursing interventions for PTSD? |
|
Definition
-Listen actively (identify MOST troubling aspect of the event)
-Have client verbalize feelings
-Assess client for suicide
-encourage group therapy/support groups. |
|
|
Term
| What phenomena are especially important to assess for clients w/ PTSD? |
|
Definition
| Flashbacks, emotional detachment, shock, anger, denial, self-destructive behavior, substance abuse |
|
|
Term
| When is the best time to interact with an OCD patient? |
|
Definition
| After the completion of the performed ritual. |
|
|
Term
| W/OCD patients, what are the compulsions a response to? |
|
Definition
| They are a response to anxiety. It's the nurse's responsibility to reduce anxiety. |
|
|
Term
| How should the nurse respond to compulsions? |
|
Definition
| They should not be interfered with because this will increase anxiety. Allow them to act as long as they do not cause harm. |
|
|
Term
|
Definition
| Unconscious failure to acknowledge an even, thought, or feeling. |
|
|
Term
|
Definition
| The transference of feelings to another person. |
|
|
Term
| Describe intellectualization |
|
Definition
| Using reason to avoid emotional conflict |
|
|
Term
|
Definition
| Incorporating the values and qualities of an admired person into one's own ego structure. |
|
|
Term
|
Definition
| separation of an unacceptable feeling, idea, or impulse from one's thought process |
|
|
Term
| Describe passive-aggressiveness |
|
Definition
| Indirectly expressing aggression toward others. A facade of an unacceptable feeling, idea or impulse that masks resentment. |
|
|
Term
|
Definition
| Attributing one's own thoughts or impulses to another person. |
|
|
Term
|
Definition
| Offering an acceptable, logical explanation to make unacceptable behavior acceptable. |
|
|
Term
| Describe reaction formation |
|
Definition
| Development of conscious attitudes and behaviors which are opposite of what is really felt. |
|
|
Term
| When do somatoform disorders usually begin, and who are they most often seen in? |
|
Definition
| Often begin before age 30 and most often seen in women. |
|
|
Term
| What is a somatoform disorder often used by the patient for? |
|
Definition
| Secondary gain. ie attention from parents. |
|
|
Term
| In somatoform disorders, what are physical symptoms thought to be an expression of? |
|
Definition
|
|
Term
|
Definition
| Frequent somatic complaints for which no medical pathology is present (patient complains of chest pain, but has a normal EKG) |
|
|
Term
|
Definition
| A belief or fear of having a disease with misinterpretations of physical signs as "proof" of the presence of the disease (simple rash means lupus to these clients). |
|
|
Term
|
Definition
| Transferring mental conflict (psychological) into a physical disorder for which there is no organic cause (blindness, paralysis, false pregnancy) |
|
|
Term
| How should a nurse react to a patient who is suspected of having a somatoform disorder related to presenting with an illness? |
|
Definition
-Be aware of your own feelings and remember that the pain is "real" to these clients
-Acknowledge the symptom or comlaint
-reaffirm that the tests revealed no organic pathology
-determine the secondary gains acquired by the client. |
|
|
Term
| What is La Belle indifference? |
|
Definition
|
|
Term
|
Definition
| Decrease in anxiety from the ability to deal with a stressful situation. |
|
|
Term
|
Definition
| Rewards obtained from the sick role/freedom from certain responsibility. |
|
|
Term
| What is a dissociative disorder? |
|
Definition
| Alteration in the function of consciousness, personality, memory, or identity. |
|
|
Term
| What phenomena is characterized by "splitting" from a situation into a fantasy state? |
|
Definition
|
|
Term
| Describe psychogenic amnesia |
|
Definition
| a dissociative disorder usually trauma induced/sudden temporary loss of ability to recall extensive personal information. |
|
|
Term
| Describe psychogenic fugue |
|
Definition
| dissociative disorder characterized by sudden onset/inability recall identity and behavior. Can be ETOH related. |
|
|
Term
| Describe dissociative identity disorder |
|
Definition
| Dissociative disorder characterized by the presence of 2 or more distinct personalities that emerge during stress. |
|
|
Term
| Describe depersonalization |
|
Definition
| Dissociative disorder characterized by a temporary loss of one's reality and/or ability to feel and express emotions; sense of strangeness and fear of going crazy. |
|
|
Term
|
Definition
|
|
Term
| What must you always asses for in depressed clients? |
|
Definition
|
|
Term
| What change in mood must be observed for in depressed clients? |
|
Definition
|
|
Term
| If a client is non-talkative, how should you react? |
|
Definition
| Sit in silence with them. |
|
|
Term
| What are the neccessary interventions for clients with bipolar disorder? |
|
Definition
-reduce environmental stimuli
-maintain physical health
-assess nutrition, rest and hygeine
-provide small, frequent meals (finger foods)
-engage in non-competitive activities that use large muscle groups.
-set limits |
|
|
Term
| What is the most common side effect of antidepressants? |
|
Definition
| Anticholinergic effects: dry mouth, constipation, urinary retention, blurred vision, orthostatic hypotension, tachycardia. |
|
|
Term
| Name the 5 SSRIs we focused on in class. |
|
Definition
| Fluoxetine HCL (prozac), paroxefine (paxil), sertraline (zoloft), fluvoxamine (Luvox), citalopram (celexa) |
|
|
Term
| What are the 2 side effects of SSRIs discussed in class? |
|
Definition
| Sexual dysfunction and serotonin syndrome (medical emergency) |
|
|
Term
| What are the 5 tricyclics discussed in class? |
|
Definition
| Amitryptyline HCL (Elavil), Deslpramine HCL (norpramin), imipramine HCL (tophranil), nortryptyline HCL (aventyl), Protryptilline HCL (vivactil) |
|
|
Term
| Why are the tricyclics unsafe for suicidal clients? |
|
Definition
|
|
Term
| What are the 3 MAOIs talked about in class? |
|
Definition
| Isocarboxazid (marplan), Phenelzine sulfate (nardil), tranylcyprmine (parnate) |
|
|
Term
| What is the most detrimental side effect of MAOIs? |
|
Definition
| Hypertensive crisis. Limit foods with tyramine to avoid this. |
|
|
Term
| What are the 3 mood stabilizers mentioned in class? |
|
Definition
| Lithium (0.5-1.5), valproic acid (depakote)(50-125), carbamazepine (tegretol) (8-12) |
|
|
Term
| When should lithium be taken? |
|
Definition
| 12 hours after last dose (before morning dose) |
|
|
Term
| What are the signs of lithium toxicity? |
|
Definition
| Diarrhea, vomiting, drowsiness, muscle weakness, lack of coordination |
|
|
Term
| What are the risk factors for suicide? |
|
Definition
| Previous attempt, loss of significant other/parent (especially if it was to suicide) |
|
|
Term
| What are the risk factors for suicide? |
|
Definition
| Previous attempt, loss of significant other/parent (especially if it was to suicide) |
|
|
Term
| What are the warning signs that a client may attempt suicide? |
|
Definition
-Previously depressed client becomes happy
-Client begins giving away possessions |
|
|
Term
| What steps should be taken to ensure the safety of a suicidal client? |
|
Definition
-Determine intent, plan, method, and availbility of chosen method
-implement safety precautions ie 1:1, eliminating sharps, etc
-never leave a suicidal client alone |
|
|
Term
| Name the 3 cluster A (odd/eccentric) disorders. |
|
Definition
-Paranoid personality disorder
-schizoid personality
-schizptypal personality |
|
|
Term
| Name the 4 cluster B (dramatic emotional) disorders |
|
Definition
-Antisocial personality disorder
-Borderline personalirt disorder
-historionic personality disorder
-narcissistic personality disorder |
|
|
Term
| Name the 3 cluster c (anxious/fearful) personality disorders |
|
Definition
-Avoidant personality
-Dependent
-obsessive/compulsive disorder |
|
|
Term
| Discuss some of the interventions for personality disorder clients. |
|
Definition
| Limit setting, reinforcing positive behaviors, and focusing on client strengths. |
|
|
Term
| Describe delirium tremens |
|
Definition
They are life threatening and require immediate intervention. They usually occur 12-36 hours after the last drink.
The symptoms include tremors, confusion, diaphoresis, and possible seizures. |
|
|
Term
| Describe wenicke-korosoff syndrome. |
|
Definition
| It is associated with long term ETOH abuse and is the result of thiamin deficiency. It is manifested by severe cognitive deficits. |
|
|
Term
| Disulfram (antabuse) is used for what? |
|
Definition
| A deterent to ETOH abuse. If alcohol is consumed, pt will experience nausea, vomiting, headache, hypertension, rapid pulse, flushed face, confusion. |
|
|
Term
| What are the most commonly used defense mechanisms with substance abuse? |
|
Definition
| Denial and rationalization |
|
|
Term
| What must a patient be able to do before healing can take place? |
|
Definition
| Must be accountable and describe the impact that substance abuse has had on their lives. |
|
|
