1-13-17 Flashcards
What the patient/family states about the current/past illness.
Subjective Assessment (Symptoms)
Test Results
What is observed by the health care provider.
Objective Assessment (Signs)
Protecting healthy people from developing a disease or experiencing an injury. Ex: Eating healthy to avoid obesity.
Primary Prevention
Intervene after an illness occurs to halt or slow the progress of disease in early stages. Ex: Taking care of diabetes so it doesn’t progress to heart problems.
Secondary Prevention
Helps people manage complicated long-term health problems such as heart disease.
Tertiary Prevention
Parts of Medical Histories
Current and prior illness Allergies Hospitalizations Treatments Specific complaints Current therapy (drugs, herbs, speech, etc)
the nurse gives the patient an anti-anxiety medication and his anxiety is lowered.
therapeutic effect
the nurse gives the patient a sleeping pill and the patient gets nauseated
side effects
the nurse gives the patient a dose of penicillin for a bacterial infection and the patient develops itching and hives
hypersensitivity
the nurse gives the patient a sleeping pill and he sleeps for 2 days
idiosyncratic
the patient has been on pain medication for terminal cancer for one month and needs an increased dose to get the same effect
tolerance
lab results show that the level of medication is above therapeutic level.
toxic reaction
the patient complains of fatigue after he starts taking his medication to decrease depression.
side effect
the nurse gives the patient a medication to decrease anxiety and the patient becomes overly anxious.
idiosyncratic
The schedule controlled substance group that has the biggest risk for abuse and is used in patient care
Schedule II
the schedule controlled substance group that has the least risk for abuse
Schedule V
the schedule controlled substance group that is never used for medical purposes
schedule I
the pregnancy category of drugs that can never be given to pregnant women
X
the pregnancy category that is the safest for pregnant women to use
A
the route of drug administration that provides the slowest rate of absorption
oral
how much of a drug will be left in the body following two half lives if the original dosage was 500 mg?
125mg
what type of enteral drug takes the longest to absorb?
entericoated
What types of enteral drugs take the quickest to absorb?
liquids
powders
buccal tabs
wafers
What kind of route requires the medication to be given under the tongue?
sublingual
What kind of route requires the medication to be given between the cheek and gum?
buccal
where is the chief location of drug metabolism in the body
liver
if a know drug is classified as an “enzyme” inducer, will the patient need a bigger or smaller dose?
bigger
if a know drug is classified as an “enzyme” inhibitor, will the patient need a bigger or smaller dose?
smaller
what kind of drug receptor interaction is a drug antidote based on?
antagonistic
what is the key to keeping the elderly and the children safe from cumulative drug effects regarding dosage?
start low and go slow
what type of drugs require routine monitoring of blood serum levels to keep the patient safe?
narrow therapeutic index
patients with G6PD deficiency should avoid drugs that cause further…
hemolysis
the patient has end stage cancer and is receiving pain medications around the clock
palliative therapy
the patient is taking insulin for his diabetes
supplemental therapy
the patient is taking blood pressure medication to keep his blood pressure within range so that he doesn’t have a stroke
maintenance therapy
the patient is receiving medications in the intensive care unit to treat his heart dysrhythmias
acute therapy
a child receives a flu vaccine
prophylactic therapy
the patient comes into the ER after a car accident and is being given IV fluids and blood products while he wait for a surgical room to open up
supportive therapy
the nurse runs two different types of medication in an intravenous infusion line and notes that the medications have clumped together
incompatibility
the patient is taking two different types of BP meds so that together they can lower his BP better than either of them alone
additive
the patient revives and anti-anxiety med and a pain reliever med in one injection prior to surgery and is so relaxed he falls asleep even though that is not the typical reaction from either medication when given alone
synergistic
narcan is given to stop the heroin from interacting at receptor sites that the patient lives
antagonistic
Unknown cause of disease Ex. Seizures
Idiopathic
Cause of disease by treatment, procedure or error. Ex: medication adverse affects, chemo treatments lead to damaged nerve cells.
Latrogenic
Promotes the development of disease, not always. Ex: smoking leads to cancer, but not always.
Predisposing factors
Presever health and prevent spread of disease. Ex: taking blood sugars and blood pressures
Prophylaxis Measures
Look at etiology and predisposing factors. Ex: vaccinations and education. Smoking cessation.
Prevention
how a disease is started
pathogenesis
no manifestations because of the great reserve capacity of organs.
subclinical state
early in development of disease, client has non-specific signs
prodromal period
Clinical evidence that a disease is present. Local vs. systemic.
Manifestation of Disease
Collection of signs and symptoms, affecting more than one organ, signs vs symptoms
Syndrome
Manifestations of disease subside, ex: chemo works well but does not cure.
Remission
Manifestations of disease increase.
Exacerbations
Conditions that triggers an acute episode. Ex: cardiac patient shovels snow and has heart palpitations.
Precipitating factors
Period of recovery and return to heathy state.
Convalescence or Rehabilitation
Probability of recovery or other outcomes. Ex: cancer has 85% chance of going into remission.
Prognosis
of people with the disease within a group
morbidity
of deaths due to disease
mortality
Infections that can be spread from person to person
Communicable disease
Decrease in size of cells, reduced tissue mass.
Atrophy
Increase in size of cells, enlargement of tissues.
Hypertrophy
Increase in number of cells. Enlarged tissue mass.
Hyperplasia
Mature cell type is replaced by different mature cell type. Lining of respiratory tract in smokers.
Metaplasia
Cells vary in size and shape within a tissue and rate of mitosis is increased. Ex: chronic infection, precancerous change
Dysplasia
New growth, commonly called a tumor.
Neoplasia
Decreased oxygen delivery to tissues due to circulatory problems. Leads to hypoxia (reduced oxygen in tissues)
Ischemia
Necrotic tissue invaded by bacteria
Gangrene
any chemical that affects the physiologic processes of a living organism. Includes: prescribed medications, alcohol, sunscreen, and herbal remedies.
Drug
Describes the drugs chemical composition and molecular structure.
Chemical name
Most official name, used in drug books, only one type of name per drug. Signified by using noncaps in first word.
Generic name
The drug has a registered trademark, created by manufacturer. Drug can have several names.
Trade name
3 categories of drugs
prescription
nonprescription
controlled substance
largest category of drugs, potentially harmful unless use is supervised
prescription drugs
Drugs that are designated as safe when taken as directed. no prescription needed.
over the counter drugs
over the counter drug labeling requirements
dose, adverse reactions, contraindications, and precautions
Controlled substance act of 1970
Regulated controlled substances. Established classification list (schedules)
phase of drug activity where the dosage is formed (pills, liquid, powder, etc…)
Pharmaceutical Phase
what the body does to the drug during drug activity (adsorption, distribution, metabolism, excretion)
pharmacokinetic phase
what the drug does to the body during drug activity. (effects)
Pharmacodynamic phase
Parenteral drugs
injectable forms
drugs that only treat a certain area (aerosols, ointments, patches, inhalers, suppositories)
topical drugs
All
Drugs
Must
Exit
Absorption
Distribution
Metabolism
Excretion
Movement of drug from site of administration to the bloodstream.
Absorption
reduces bioavailability of drug to less that 100%. Oral drugs are given in larger doses because of this effect. Only effects oral drugs that go through GI.
first-pass effect
do parenteral drugs need higher or lower doses?
lower. 100% of drug is being used, unlike oral meds where the GI and liver destroy some.
Has slower absorption and longer duration of action than parenteral and enteral.
Topical route
Adhesive patches, good for patients who can’t tolerate oral administration, use of alternating sites.
Transdermal route
Drug distributed to various body tissues and target sites- interacts with specific receptors in body.
Distribution
primary site of metabolism
liver
Drugs that increase or speed up drug-metabolism enzymes. Result: decreased pharmacological effects.
Enzyme Inducers
Drugs that decrease or delay drug-metabolism enzymes. Result: increased effect of drug.
Enzyme Inhibitors.
main organ os excretion
kidneys
about how many half-lives does it take for the body to completely eliminate the drug?
5
onset of action for oral drugs
one hour
onset of action for parenteral drugs
15-30 minutes
onset of action for intravenous drugs
immediate- 15 minutes
time it takes for a drug to reach its maximum therapeutic response
peak effect
length of time that a drug concentration is high enough to cause a therapeutic response.
duration of action
highest blood level of drug. if too high = toxicity
Peak
lowest blood level of drug. draw blood right before next dose. if too low = drug is non therapeutic
trough
side effect vs adverse reaction
mild vs severe and life threatening
swelling of face, lips and throat
angioedema
unusual, abnormal reaction to drug, different than expected reaction . Not a side effect or averse reaction, believed to be due to genetic deficiency. Ex. being sedated for long periods of time from sleeping pill.
Idiosyncratic reaction
Decreased response to a drug, requires increased dosage for desired effect. Ex: opioids used for terminally ill pain control.
Drug tolerance
Patients with liver and kidney disease: body is unable to metabolize and excrete one dose of drugs before next dose is given. Start low and go slow.
Cumulative drug effect
hereditary disease where certain drugs cause hemolysis of RBC’s. Causes low RBC count.
G6PD Deficiency
drug is administered in large dosages, blood concentration levels exceed therapeutic levels.
toxic reactions
genetically determined abnormal response to normal dose of drug. Inherited traits cause abnormal metabolism of drugs.
Pharmacogenetic disorder
combined effect of two drugs is equal to sum of each drug given alone. 1+1=2
additive effect
drugs interact with each other and produce a sum greater than the sum of the separate actions. 1+1 > 2
synergistic effect
one drug interferes with action of another: Neutralization/decrease in effect of one drug. 1+1 < 2
antagonistic effect
some meds are incompatible and cannot be rain in the same line (IV).
incompatibility
detects changes in cell membranes from viruses to cancer. essential role in activation of immune response.
Major histocompatibility complex
group of proteins that flow freely in the blood. first part of the immune system that greets invaders.
complement system
Triggers inflammation
Attracts phagocytes by coating invading cells with proteins (antibodies)
next step is antigen presentation
Complement system
Directly kills invading antigens
Helper T cells, Memory T cells, suppressor t cells, cytotoxic t cells
T Lymphocytes
Main regulators of the immune response
Activates B cells and Killer T cells after a phagocyte
Helper T cells
Produced at every encounter and have long memory. Mounts faster and stronger immune response each time encounters a specific antigen.
Memory T cells
Produces antibodies - not directly kills
B lymphocytes
produces specific protein called antibody
plasma cells
Bind to specific antigen to destroy it
Immunoglobulins
Significant in development of immunity to various diseases
Antibodies
most common antibody in the blood
major antibacterial, antiviral, and anti toxin antibody
IgG
first to increase immune response
involved in blood incompatibilities
IgM
found in secretions
defends on body surfaces
IgA
binds to mast cells in skin and mucous membranes
Causes release of histamine
Hypersensitivity/allergic reactions
IgE
attached to and activates B cells
antigen receptor
IgD
tissue matching for transplant
Extensive HLA (MHC) typing
occurs when person first exposed to an antigen. antigen recognized and processed. takes 1-2 weeks for the process to complete.
primary response
repeat exposure to same antigen. more rapid response.
secondary response
venom antidote
antivenins
provides long lasting or permanent immunity
herd immunity
active immunity
provides quick immunity such as in case of exposure to hep. B or rabid dogs.
Passive immunity
people allergic to MMR are sensitive to…?
egg or neomycin
people allergic to yeast could be sensitive to which vaccine?
Papillomavirus Vaccine (Guardisil)
Vaccine used for whooping cough
Diptheria, Tetanus toxoid, and Pertussis Vaccine (DTap)
Vaccine thats good against 23 strains that cause pneumonia. Used primarily in adults. Given to elderly, high risk children, smokers, and immunocompromised.
Pneumococcal Vaccine
Live virus (attenuated)
flumist
vaccine for prevention of shingles (chicken pox)
Herpes Zoster Vaccine
The immunity that is conducted by T lymphocytes
Cell-Mediated Immunity
the type of immunity acquired after an individual gets a disease
active immunity
antibody that is responsible for hypersensitivity reactions
IgE
antibody that is the most common in the blood
IgG
the immunity that is conducted by a B lymphocytes
humoral immunity
the type of response led by memory cells in the acquirement of immunity
secondary response
the vaccine given to protect the elderly and high risk individuals against pneumonia
pneumovax
antibody found in secretions
IgA
the immune cells that engulf antigens
phagocytes (dendritic cells, macrophages)
type of vaccine you can’t give to individuals allergic to neomycin
MMR
the t-cell that specializes in bacteria, viruses and cancer cells
Killer-T cells (cytotoxic)
another name for antibodies
immunoglobulins
the type of vaccine in which the antigen is somewhat alive
attenuated vaccine
they type of T call that activates both B and T cells after antigen presentation
helper T cells
The type of vaccine in which the antigen (virus) is somewhat alive
attenuated vaccine
another name for antibodies
immunoglobulins
antibody that is responsible for hypersensitivity reactions
IgE
the vaccine given to protect individuals from the flu each year
influenza vaccine
antibody that is the first to increase in immune response
IgM
type of protection that includes the skin and mucous membranes
innate immunity
first part of the immune system that greets invaders
complement system
first step of the complement system when encountering a foreign invader.
inflammation
type of vaccine is comprised of a weakened toxin
toxoid
the test that measures specific antibodies
Titers
gene coding used for tissue typing in transplants
HLA
the type of replacement therapy given to protect individuals who have weakened immune systems
gammaglobulin
HAART is designed to prevent this
Resistance
the type of infection caused by normal flora in an immunosuppressed individual
opportunistic infection
if this is suppressed too much, individuals have to wait to take Zidovudine (Retrovir)
bone marrow
GI effect seen in individuals with AIDS
malnutrition
A temporary state of immunosuppression in women
pregnancy
individuals need this injection ASAP when having an anaphylactic reaction
epinephrine
the type of reaction seen in a type 3 hypersensitivity reaction
autoimmune
low platelets in the blood
thrombocytopenia
individuals with SLE have this reaction in their blood vessels which eventually causes ischemia and necrosis
inflammation
Drug classification given to individuals with SLE to control the disease by decreasing immune response
corticosteroid
low leukocytes in blood
leukopenia
the adverse affects seen in people taking Ritonavir (Norvir)
hyperglycemia
an over-the-counter medication given ASAP when individuals begin to experience signs of an allergic reaction
antihistamine
the drug given to prevent organ rejection by suppressing T lymphocytes
cyclosporine
another name for hives
urticaria
another name for itching
pruritus
The type of lab test that signifies inflammation in the body
ESR
symptoms seen in patients with AIDS
lymphadenopathy
This type of drug should be given by mouth asap when individual starts to show signs of an allergic reaction
corticosteroids
another name for the swelling of the face lips and throat
angioedema
the typical butterfly mask seen in individuals with SLE is exacerbated with exposure to this
Sun
this type of reaction is seen in a type 2 cytotoxic hypersensitivity reaction
transfusion
the adverse affects of cyclosporine identified by increases in the BUN and creatine in the body
nephrotoxicity
the type of organ rejection that occurs months/years after the transplant is done
chronic
pneumocystitis carni is the #1 cause of what in individuals with AIDS
death
this drug therapy is used to treat cancer and causes immunosuppression in an individual
chemotherapy
low red blood cells in the blood
anemia
this gland shrinks in old age
thymus
the type of immune response seen in type I hypersensitivity reactions
allergic
the phase of HIV in which the individual is asymptomatic
latent
kidney damage has this type of course in SLE
progressive
Kaposis sarcoma is this type of disease specific to those with AIDS
cancer
shrinking of thymus gland
decreased antibody response to antigens
decreased circulating memory B cells (slow response)
increased autoantibodies (autoimmune problems, fighting own cells)
Elderly immunosuppression
Secondary deficiencies in immunodeficiency
loss of immune response from specific cause, may occur at any time of life
infections, splenectomy, malnutrition, immunosuppressant drugs, chemotherapy
Test to find HIV antibodies in blood
Western Blot Test
What cells does HIV destroy?
Helper T cells (CD4 lymphocytes)
Highly active antiretroviral therapy, includes at least three medications, used to treat AIDS.
HAART
adverse effects of Zidovudine (Retrovir, ZDV)
bone marrow suppression (you have to stop taking this medication if bone marrow blood cell counts are too low)
severe anemia and neutropenia
HAART medication
Adverse effects of Ritonavir (Norvir)
hyperglycemia
fat redistribution (buffalo hump)
increased cholesterol and triglyceride levels
HAART medication
GI effects of AIDS
chronic severe vomiting and diarrhea
ulcers in mouth -> severe weight loss-> malnutrition
Early antihistamine drugs
diphenhydramine (Benadryl)
Corticosteroids (prednisone)
IgG antibodies react to antigen located on cell membrane and cause lysis of cell in which stage of hypersensitivity. Ex: incompatible blood infusion
Type II cytotoxic hypersensitivity
Examples of Type III hypersensitivity
SLE
rheumatoid arthritis
scleroderma
Impaired blood supply to major organs, ischemia and necrosis of tissue
Erythrocyte sedimentation rate (ESR) is high
SLE
Signs: butterfly mask, joint inflammation, kidney damage, Pleurisy of lungs, Carditis of heart, raynauds phenomenon (white hands bc low circulation), anemia, leukopenia, thrombocytopenia, depression, and mood changes
SLE
SLE treatment
Corticosteroid
avoid sun exposure
avoid excessive fatigue
type of hypersensitivity characterized by a delayed response by sensitized T lymphocytes
Type IV hypersensitivity
vaccine for shingles
Herpes Zoster
