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113 Cards in this Set

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Define Physiology
The study of NORMAL body function
Define Pathophysiology
The study of the body function in disease incorporating the structural and functional changes in cells and tissues and the mechanisms of the disease process
Define Disease
Deviation or interruption of normal structure or function of an organ or body system
What 5 things describe disease in nursing?
Etiology, pathogenesis, clinical manifestations, diagnosis and clinical course
Define Etiology
The cause of a disease
Define Pathogenesis
The evolution of a disease that includes everything that happens in the body from the initial stimulus to the ultimate expression of manifestations of the disease
What are the 5 Disease categories?
O-U-PIG
Obstructive
Inflammatory (infection)
Genetic/cellular dysfunction
Psychological/ Stress
Unknown etiology / Combination
What are the 3 phases in stress response?
Alarm
Resistance
Exhaustion
A-R-E
Define autocrine.
signaling that occurs when a cell releases a chemical into the extracellular fluid that affects its OWN activity
Define Paracrine
signals that have responses from nearby cells
Define Endocrine
signals that rely on hormones carried by the bloodstream to cells throughout the body
What are 3 purposes of the cell membrane?
1. Provide receptors for hormones
2. Participate in electrical events from nerve and muscle cells
3. Aids in cell growth and proliferation
Define cellular adaption
changes that occur based on internal environment and increased demands
Define apoptosis
Programmed cell death
Define necrosis
cell death in an organ or tissue that are still part of a living person
What are the 4 types of tissues?
Connective
Muscle
Epithelial
Nerve
C- ME - N
Define morphology
fundamental structure or form of cells or tissues
Define clinical manifestations
describes the presentation of changes accompanying disease
Differentiate between signs and symptoms.
Signs are something seen, smelt, heard (breath sounds), felt, etc. from an observer (objective)
Symptoms are manifestations described by the patient
Define positive feedback loop
When the monitored function or value decreases below set point of the system this feedback causes the function or value to increase
Define negative feedback loop
When the function or value is increased above the set point this feedback mechanism causes it to decrease
Define stress
a state manifested by symptoms that come from the coordinated activation of the neuroendocrine and immune systems in response to stimuli
Define adaptation
the body's ability to respond to challenges of physical or psychological homeostasis and to return to a balanced state
What are the stages of the general adaptation syndrome and a brief explanation of each?
A-R-E (GAS is the stress response)
Alarm stage - stimulation of the sympathetic nervous system and the HPA axis which results in the release of catecholamine and cortisol
Resistance stage - body selects the most effective and economical channels of defense (fight or flight)
Exhaustion stage - resources are gone and signs of wear and tear appear
Define physiologic reserve.
the ability of body systems to increase their function given the need to adapt (includes red blood cells and oxygen, liver cells and nutrient storage, and bone and calcium storage)
Define anatomic reserve.
paired organs of which both are not needed to ensure the continued existence and maintenance of the internal environment
List 5 non-pharmacologic methods of stress reduction.
-Relaxation techniques
-Guided imagery
-music therapy
-massage
-biofeedback
What are the 3 phases of response when our body tissues are damaged?
I-I-T
-Inflammatory reaction
-Immune response
-Tissue repair and wound healing
What are 6 causes of inflammation?
1. Immune response to infectious microorganisms
2. Trauma
3. Surgery
4. Caustic chemicals
5. Extremes of heat and cold
6. Ischemic damage to body tissues
What are 5 s/sx of inflammation?
1. redness
2. swelling
3. heat
4. pain
5. loss of function
What do vascular changes have to do with injury?
There is an increase in capillary permeability that happens 4-24 hours after the injury that allows for the release of vital inflammatory and immune cells as well as fluids
What is acute inflammation "marked" by?
by the movement of white blood cells into the area of injury which includes two types of leukocytes, granulocytes (neb) and monocytes
What are the inflammatory mediators?
Histamine
Cytokines
Arachidonic acid metabolites
Platelet-activating factor
Plasma proteins
What are the 4 products of arachidonic acid synthesis with cyclooxygenase?
Thromboxane (platelets), Prostaglandins (gastric mucosa), Prostaglandins (joints), Prostacyclin (endothelial cells)
What is the difference between chronic and acute inflammation?
Acute - self-limited and short duration includes infiltration of neutrophils and has exudate
Chronic - self-perpetuating and has longer duration from weeks to years includes infiltration of mononuclear cells (macrophages) and lymphocytes and has proliferation of fibroblasts (scar tissue)
What are the 4 steps in developing new capillary vessels?
1. degradation of the parent vessel basement membrane
2. migration of endothelial cells from original capillary to angiogenic stimuli
3. Proliferation of the endothelial cells behind the migrating cells edge
4. Maturing of the endothelial cells and proliferation of pericytes (for capillaries) and smooth muscle cells (for larger vessels)
What are the 3 stages of wound healing?
1. inflammatory phase
2. Proliferative phase
3. Maturational or remodeling phase
What are some things that we need to be aware of that can impair wound healing?
-malnutrition
-impaired blood flow/oxygen delivery
-infection
-impaired inflammatory and/or immune response
-wound separation
-foreign bodies
-age
Define immune response
The collective, coordinated response of the cells and the molecules of the immune system
What are the 2 types of the immune defense?
Innate and adaptive
What does innate immune response mean?
Innate or nonspecific immunity is the natural resistance that we are born with
What does adaptive immune response mean?
Adaptive or specific immunity is the second line of defense it is slower than innate but more effective
What is included in our innate immunity?
skin, phagocytic cells (neutrophils and macrophages), NKC, plasma proteins, induction of inflammatory response
What is included in our adaptive immunity?
Humoral immunity and cell-mediated immunity
What is an antigen?
foreign to the host that stimulates an immune response
What is an antibody?
they are receptors on immune cells or secreted proteins that recognize antigens to get rid of them
What is the function of the central lymphoid organs?
(bone marrow and the thymus) - provides the environment for all immune cell production and maturation
What is the function of the peripheral lymphoid organs?
trap and process antigens and promote interaction with the mature immune cells
What is the importance of MALT, SALT, and GALT?
What does that stand for?
Mucosa Associated Lymphoid tissue
Skin Associated Lymphoid tissue
Gut Associated Lymphoid tissue
It is special lymph tissue that has leukocytes that transport invader organisms from the surface (or lumen) to the underlying lymph tissue
What does humoral immunity mean?
it is a type of adaptive immune response that is mediated by molecules in the blood ;it is the principal defense against extracellular microbes and toxins
What does cell-mediated immunity mean?
It is a type of adaptive immune response that is mediated by specific T lymphocytes and it defends against intracellular microbes such as viruses
What are 6 types of antigens we need to be aware of?
1. Bacteria
2. Fungi
3. Viruses
4. Protozoa
5. Parasites
6. Nonmicrobes (prions)
What are 5 portals of entries for pathogens we need to be aware of?
1. Pathogen entry into the body
2. Penetration
3. Direct contact
4. Ingestion
5. Inhalation
What is the process of antigen presentation?
It is a 3 step process:
1. macrophages and dendritic cells process and present antigen peptides to the CD4+helper T cells
2. By doing this they (CD4+helper T cells) enable the T cells to recognize the antigens
3. This initiates the adaptive immune response
What are B cells and what are they involved in?
B cells are lymphocytes involved in humoral immunity and memory (so in the future the immune response is faster because the B cells recognize the antigens faster)
What are T cells and what are they involved in?
T cells are lymphocytes involved in cell-mediated immunity and memory
Define active immunity
It is specific protection introduced following exposure to antigens (vaccines)
Define passive immunity
Specific protection transferred through antibodies against an antigen (across the placenta, breast milk, or immunoglobulin injections)
Who produces immunoglobulins?
Immunoglobulins or antibodies are produced from B cells
What is the class and function of IgG?
it is an antibody
-displays antiviral, antitoxin and antibacterial properties
-responsible for protection of a newborn (crosses the placenta)
-activates the complement and binds to macrophages
What is the class and function of IgM?
antibody that
-forms natural antibodies
-prominent in early immune responses
-"new infection" fighter
-activates complement
What is the class and function of IgE?
It is an antibody that
-binds to mast cells and basophils
-involved in parasitic infection
-involved in allergic and hypersensitivity reactions
What is the class and function of IgD?
It is an antibody that
-is found on B lymphocytes
-needed to mature B cells
What is the class and function of IgA?
It is an antibody that
-found in body secretions
-protects mucous membranes
-high levels found in breast milk
What are the 2 classifications of immunodeficiency states?
1. Primary (congenital or inherited)
2. Secondary (acquired later in life)
Why would secondary immunodeficiency happen?-
-malnutrition
-infection (example AIDS)
-neoplastic disease (example lymphoma)
-immunosuppressive therapy (example corticosteroids)
What are the 4 major categories of immune mechanisms?
1. Humoral or antibody-mediated immunity (B lymphocytes)
2. Cell-mediated immunity (T lymphocytes)
3. Complement system
4. Phagocytosis (neutrophils and macrophages)
What is the definition and types of hypersensitivity disorders?
Hypersensitivity disorders are excessive or inappropriate activation of the immune system in 4 types:
Type I, Ig-E- mediated disorders (allergic fastest response)
Type II, antibody-mediated disorders
Type III, complement-mediated immune disorders
Type IV, T-cell mediated disorders
What are Type I allergic reactions divided into?
It can be divided into atopic and nonatopic disorders
What is Type I atopic disorders?
It is a hereditary predisposition and production of a local reaction to IgE antibodies produced in response to common environmental agents
Includes:
Urticaria (hives), allergic rhinitis (hay fever), atopic dermatitis, food allergies, some forms of asthma
What is Type I nonatopic disorders?
It is an allergic reaction that lacks the genetic component and organ specificity of atopic disorders
What are type II (Cytotoxic) hypersensitivity reactions mediated by?
They are mediated by IgG or IgM antibodies that are directed against target antigens on the surface of cells or other tissue components
(examples include mismatched blood transfusion, hemolytic disease of newborn, and certain drug reactions)
What are type III hypersensitivity reaction mediated by?
They are mediated by the formation of insoluble antigen-antibody complexes that activate complement they cause tissue damage by - alterations in blood flow, increased vascular permeability, and destructive action of inflammatory cells (RA)
What are type IV hypersensitivity reactions mediated by and what are the basic types?
It is a cell-mediated immune response which means it is the principal mechanism of response to a variety of microorganisms including intracellular pathogens and extracellular agents. This reaction can lead to cell death and tissue injury in response to chemical antigens or self-antigens. There are 2 basic types : direct cell-mediated cytoxicity (hepatitis) and delayed-type hypersensitivity (allergic contact dermatitis)
What is the MCH and how does it control immune response?
It is the Major histocompatibility complex and it is a set of molecules displayed on cell surfaces for lymphocyte recognition and antigen presentation. It controls the immune response through recognition of self and nonself
What are the 3 principal systems of the nervous system?
1. CNS
2. PNS
3. ANS
What are the primary functions of the CNS?
-receiving and processing sensory info
-create appropriate responses to send to muscles and glands
-Coordinate emotion, memory, cognition and learning
What is the BBB?
The blood brain barrier is the chemically stable environment protecting the brain from anything getting through except water, carbon dioxide and oxygen easily. Transportation of other substances across it is slower and very controlled
What are the 4 principal structures of the brain?
1. cerebrum
2. diecenphalon
3. cerebellum
4. brainstem
What would we possibly see if someone had damage to their frontal lobe?
Difficulty with
:abstract vs. concrete reasoning
:motivation
:decision making and concentration
: memory
:making meaning to language including speech organization and production
What could we expect to see if someone had brain damage to their temporal lobe?
Problems with:
-visual-spatial recognition
-attention
-motivation
-emotional modulation and interpretation
-impulse control
-interpretation and meaning of social contact
-sexual actions and associated meanings
What could we expect to see if someone had brain damage to their parietal lobe(s)
Problems associated with:
-body awareness
-filtration of background stimulus
-personality factors and symptom denial
-memory and nonverbal memory
-concept formation
What could we expect to see if someone had brain damage to their occipital lobe?
Possible problems with
-vision
-possibly information storage
What are the 2 types of cells the nervous system is composed of?
neurons (generate and transmit nerve impulses)
and
glial cells (provide supportive functions to neurons)
What are the 6 major classes of neurotransmitters?
1. Amines
2. Amino Acids
3. Polypeptides
4. Purines
5. Gases
6. Acetycholine
What causes seizure disorders?
An alteration in membrane potential which makes certain neurons abnormally hyperactive and hypersensitive to changes in their enviornment
What is dementia?
It is classified as impairment of short- and long-term memory associated with abstract thinking, impaired judgment, other higher cortical functions, or personality change
What causes dementia?
It is caused by any disorder that permanently damages large association areas serving memory and learning
What is included in the diagnosis of dementia?
-Assessment
-History
-Complete physical
-Cognition
-Functional status
-Laboratory and imaging studies
What are the 6 types of dementia?
1. Alzheimer disease
2. Vascular dementia
3. Frontotemporal dementia
4. Creutzfeldt-Jakob disease (mad cow)
5. Wernicke-Korsakoff syndrome (alcohol related dementia)
6. Huntington disease
What is cerebral palsy?
It is a diverse group of syndromes that appear during childhood and involve permanent, nonprogressive damage to motor control area of the brain, it is very broad spectrum on severity and impact of life of those who have it
How is Cerebral Palsy classified?
It is classified on the basis of neurologic signs and symptoms: spasticity, ataxia, dyskinesia, or a mix of the three
What is the etiology of Cerebral Palsy?
May include prenatal infections or diseases of the birth mother ; mechanical trauma to the head of the child before, during or after birth ; exposure to nerve-damaging poisons or reduced oxygen supply to the brain
What is the treatment of Cerebral Palsy?
Varies due to the wide spectrum of severity, can include muscle relaxants, anticonvulsant drugs, orthopedic surgery, casts, braces, and traction (the earlier the intervention the more usable function of the muscles)
What are the classifications of major depression?
unipolar (sad)
bipolar (alternating periods of mania and depression)
What are a few of the 9 characteristics of depression?
1. Depressed mood
2. Anhedonia
3. Feeling worthlessness (or excessive guilt)
4. Decreased concentration
5. Psychomotor agitation or retardation
6. Insomnia or hypersomnia
7. Decreased libido
8. Changes in weight or appetite
9. Thoughts of death or suicidal ideation
What is needed to diagnose depressive disorders?
5 or more of the symptoms lasting simultaneously for 2 weeks or more not associated with medication side effects, grief reactions, or sequealae of medical illness
What is the etiology of PTSD?
caused by major catastrophic events (weather-related disasters, airplane crashes, terrorist bombings, rape, child abuse, war)
What is the pathogenesis of PTSD?
It is the chronic activation of the stress response as a result of experiencing a potentially life-threatening event
What are the clinical manifestations of PTSD?
Intrusion : flashbacks during waking hours or nightmares where the event is relived over and over
Avoidance : emotional numbing that disrupts personal relationships
Hyperarousal : increased irritability difficulity concentrating, exaggerated startle reflex, and increased vigilance and concern for safety
What are the clinical manifestations of Rheumatoid Arthritis?
Signs: gait abnormalities, subcutaneous nodules, erosion of hand/wrist joints, physical deformities in finger joints, soft tissue swelling
Symptoms: pain in the am for at least 1 hour, malaise, fatigue, limited range of motion for affected joints and pain on palpation of the joints
What would you tell a patient with Rheumatoid Arthritis what is going on in their body? (pathogenesis)
The B cells which are apart of everyone's immune response is producing something called rheumatoid factor. This is an antibody that is against IgG another antibody in your body. Because of this white blood cells (T lymphocytes and B lymphocytes) start the immune response in the synovial tissue. This starts the cycle over again increasing this response. The synovial tissue grows in response to all the invaders on to the cartilage, tendons and ligaments. This can cause the nodules. All together this causes pain, disfiguration and decreased range of motion.
What assessments would you want to perform with a patient you suspect has Rheumatoid Arthritis?
-Vital Signs
-Pain level
-Onset of symptoms
-family health history
-lab values for RF
-examination of joints, including range of motion
-gait patterns
-what patient uses to relieve pain, what has worked what hasn't
What nursing interventions would you want to offer a patient who had diagnoses of Rheumatoid Arthritis?
-NSAID education
-recommendation for follow-up with a rheumatologist
-Education on disease progression/quality of life/affect on family
-Education on how physical therapists, occupational therapists can be helpful in keeping range of motion and learning how to work around disease
-education on alternative therapies, heat, tai chi, exercise and rest in moderation
-support system recommendations including support groups that connect patients with RA together
What would you explain to a patient who was diagnosed with MRSA as to what is happening to their body?
You have been diagnosed with Methicillin-resistant staphylococcus aureus. This is a microorganism that has developed the ability to become resistant to many of the antibiotics we use for treatment. It is commonly referred to as MRSA. Staphylococcus aureus is a common bacteria found in the body and has many important uses that help us, this strain however is what we call virulent or aggressive. It gets into places we don't want it and causes infections that are hard to treat. It does this by causing clusters that can cause damage to tissue and organs.
What clinical manifestations would you expect to see from MRSA?
Signs: red, swollen, heat at site of infection. Soft tissue damage may present in abbesses, boils, cellulitis, impetigo, and progress to necrotizing fasciitis. Fever may be present, increased heart rate and/or increased blood pressure.
Symptoms: pain at site of infections, joint pain, fatigue
What nursing assessments would you preform with a patient suspected of having MRSA?
-Head to toe assessment
-History of hospital stays, recent surgery's, nursing home visits (stays) in the past
-recent spider bite type wound in recent past (?)
-Suggest to provider: testing of site of infection, sputum, urine or blood
What interventions and care would you offer a patient diagnosed with MRSA?
-Monitor fluid and electrolyte balance
-Monitor effectiveness of medication by reduction of signs and symptoms
-educate patient on aseptic technique, contact precautions and help reduce stigma association
-educate patient on continuing care/prevention such as proper hand washing technique, showering after contact sports, cleaning frequently touched surfaces, keeping infected sites covered and not sharing towels or personal items
What would you say to a patient (or their family) if they wanted to know more about the pathogenesis of Alzheimer's Disease?
It is a disorder of the neurons of the central nervous system. Tau proteins which are normally supportive of brain function become entangled. Also there are another type of protein which makes something called B-amyloid which forms plaques. This damages the brain tissue especially the front part of the frontal lobe which is used for decision making and memory.
What clinical manifestations would you look for in Alzheimer's Disease?
Signs: positive snout reflex
Symptoms: (from patient or family) loss of smell, forgetfulness, memory loss on preforming everyday tasks, difficulty retaining new information, lack of concentration, depression, mood swings, combativeness, disorientation
What assessments would you want to do with someone you suspected has Alzheimer's Disease?
-Head to toe including snout reflex
-Information from family or caretaker on symptoms and family history
-Possible recommendation for PET, CT, MRI or Cerebral blood flow study to rule out other diagnosis
What interventions and care would you want to provide for a patient diagnosed with Alzheimer's Disease?
Educating the patient and family on
-medication side effects, proper administration, reason for use of medications
-signs of disease progression
-safety concerns and how to overcome those concerns
-resources on caretaker fatigue, change in roles and emotional supportive services
-when to seek treatment immediatly
What would you explain to a patient who has Bi-polar what is happening in their body?
We all have something called the hypothalamic-pituitary-adrenal axis which is responsible for regulating hormones in our body. Yours is unable to keep those hormones at the right levels and that leads to abnormal levels of neurotransmitters in the brain. Neurotransmitters are fancy words for gas that helps the neurons fire and go. You are also more sensitive to the neurotransmitters which can make the neurons fire even when you don't want it to. Because these levels are not stable this causes the grey matter or nervous tissue to decrease. This leads to less function in the prefrontal cortex which is what helps us all make choices. This is what bi-polar is.