Exam #1 Flashcards

1
Q

What are three processes needed for immunity?

A
  1. Inflammation
  2. Cell mediated immunity- T cells
  3. Humoral immunity- Antibodies
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2
Q

Which immune process is lost in HIV?

A

Cell mediated immunity

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3
Q

Why is HIV a retrovirus?

A

-It replicates in a “backward” manner going from RNA to DNA.

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4
Q

What is the target cell for HIV?

A

-CD-4 T cell

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5
Q

What turns HIV RNA into HIV DNA?

A

-Reverse transcriptase

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6
Q

What enzyme matures the virus?

A

-Protease

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7
Q

What ways is HIV transmitted?

A

-Male to male sexual contact
-Heterosexual contact
-Injection drug use
-Perinatal

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8
Q

Contact with what bodily fluids can transmit HIV?

A

-Blood
-Semen
-Vaginal secretions
-Breastmilk
-Pregnancy
-US Blood supply
-Drug paraphernalia

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9
Q

What is PrEP?

A

-Pre exposure prophylaxis
-Strategy to reduce risk of sexually-acquired infection in high risk adults.

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10
Q

What drug is administered as PrEP?

A

-Truvada

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11
Q

What are 2 ways an RN can be exposed to HIV?

A

-Needlesticks
-Mucous membranes or no-intact skin
-Use standard precautions with all patients.

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12
Q

When should Post-Exposure Prophylaxis (PEP) be administered?

A

-As soon possible.
-Ideally within 2-36 hrs after exposure.
-Adhere to the full 28 day course.

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13
Q

What drugs are administered as PEP?

A

-Tenofovir combined with lamivudine or emtricitabine.

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14
Q

What are the different types of HIV tests?

A

-At- home test
-ELISA (enzyme-linked immunosorbent assay)
-Western blot
-Antigen/antibody test- Current gold standard
-Nucleic acid test (NATs)- tests for genetic material. Expensive

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15
Q

HIV progression is also monitored by?

A

-Viral load
-The lower the viral load the less active the disease

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16
Q

What is U=U?

A

-Undetectable=Untransmittable
-Undetectable for 6 months
-Teach to still use barriers

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17
Q

What is a normal CD4 T+?

A

-800-1200 cells/uL
-Stage 1

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18
Q

What is the CD4 count when immune problems arise?

A

-<500 cells/uL.
-Stage 2

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19
Q

What is the CD4 when symptoms worsen, viral load increases, and the is symptomatic infection?

A

-<200 cells/uL
-When a diagnosis of AIDS is made.

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20
Q

What does an Acute HIV infection (Stage 1) look like?

A

-Non specific- like mono
-Fever
-Nausea
-Malaise
-Swollen lymph nodes
-Headache
-Sore throat
-Muscle and joint pain
-Diarrhea
-Diffuse rash

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21
Q

When do these symptoms occur?

A

-2-3 weeks after infection
-Highly infectious

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22
Q

What is cART?

A

-Combination anti-retrovirus therapy

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23
Q

What is the example of cART discussed?

A

-BIKTARVY

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24
Q

What are the three drugs that make up BIKTARVY?

A

-Bectegravir
-Tenofovir Alafenamide
-Emtricitabine
-Taken at the same time everyday. 1 tablet a day regimen.

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25
Q

What are the goals of drug therapy?

A

-Decrease viral load
-Maintain/increase CD4 T counts
-Prevent HIV related symptoms and opportunistic diseases
-Delay disease progression
-Prevent HIV transmission

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26
Q

What are benefits of drug therapy adherence?

A

-Reduce viral load
-Prevent opportunistic disease
-Decreases/helps prevent resistance

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27
Q

What are challenges of drug therapy adherence?

A

-Lifelong commitment
-Schedule/ time/ memory
-Side effects/ interactions
-Decreased WBC count
-Low platelet counts
-Anemia

28
Q

What are some examples of opportunistic infections?

A

-Cytomegalovirus retinitis
-Herpes simplex virus
-Varicella zoster virus- shingles
-Epstein-Barr virus
-Oral hairy leukoplakia
-Oral thrush
-Pneumocystis jiroveci pneumonia
-Kaposi’s sarcoma- Reddish brown lesions
-NHL B cell

29
Q

What are clinical manifestations of wasting syndrome?

A

-Weight loss >10%
-Fever
-Chronic weakness
-Diarrhea
-Lasts longer than 30 days

30
Q

What is some patient teaching related to infection prevention?

A

-Avoid crowds
-Stay away from undercooked eggs, meats
-Don’t handle litter boxes, turtles, snakes, or garden
-Use antimicrobial soaps
-Report if temp >100 F/ cough/ drainage/ cloudy urine

31
Q

CANCER

A
32
Q

What are some characteristics of benign tumors

A

-Slow growth
-Encapsulated
-Well differentiated
-No metastasis
-Lipoma

33
Q

What are characteristics of malignant tumors

A

-Rapid, uncontrolled growth
-Loosely adhered
-Undifferentiated in structure, size, shape
-Divide indiscriminately
-Loss of contact inhibition- Disregard cell boundaries
-Divides continuously
-Metastasis (Invades tissue)

34
Q

Proto-oncogenes

A

-Regulate normal cellular processes such as promoting growth.
-Genetic locks that keep cells functioning normally
-Mutations that alter their expression can activate to function as oncogenes
-With cancer protocol-oncogenes get turned into oncogenes.

35
Q

Tumor suppressor genes

A

-Suppress growth
-Function to regulate cell growth
-Prevent cells from going through cell cycle
-Mutations make them inactive
-Result in loss of suppression of tumor growth

36
Q

What is the main contributing factor of cancer?

A

-Age

37
Q

What are carcinogens?

A

-Cancer-causing agents capable of producing cell mutation.
-Many are detoxified by protective enzymes and are excreted.
-Failure of protective mechanisms allows them to enter the cell’s nucleus and alter its DNA

38
Q

Chemical carcinogenes

A

-Benzene
-Arsenic
-Formaldehyde

39
Q

Radiation carcinogens

A

-Damage to DNA

40
Q

What is the main source of UV exposure?

A

-The sun

41
Q

Ultraviolet radiation

A

-Associated with melanoma, squamous and basal cell carcinoma.

42
Q

Promotion stage of mutation

A

-Reversible proliferation of altered cells

43
Q

Activities of promotion that are reversible

A

-Smoking
-Obesity
-Alcohol use
-Dietary fat

44
Q

Patient teaching for promotion stage

A

-Teach about a healthy lifestyle

45
Q

For disease to be clinically evident

A

-Tumor must reach a critical mass that can be detected
-Detectable= 1cm

46
Q

Progression stage of mutation

A

-Increased growth rate of tumor
-Invasiveness
-Metastasis
-Spreads through blood and lymph

47
Q

How does metastasis occur?

A

-Begins with rapid growth of primary tumor
-Develops its own blood supply
-Tumor cells can detach and invade surrounding tissue
-Most mobile cells do not survive
-Surviving tumor cells must create an environment conducive to growth and development.

48
Q

Tumor angiogenesis

A

-Tumor develops its own blood supply

49
Q

What are main sites of metastasis?

A

-Brain and cerebrospinal fluid
-Lung
-Liver
-Adrenals
-Bone- spine and femur

50
Q

Cancer prevention: Primary
(These people do not have cancer)

A

-Avoid or reduce exposure to know or suspected carcinogens
-Eat a balanced diet
-Limit alcohol intake
-Exercise regularly
-Maintain a healthy weight
-Get adequate rest
-Eliminate, reduce, or cope with stress
-Have a regular health exam
-Be familiar with family history

51
Q

Cancer prevention: secondary
(These people may have cancer. Trying to catch it early)

A

-Screening/Early detection
-Identify high risk groups
-Screening examinations
-Self-monitoring
-Diagnostics
-“CAUTION”

52
Q

7 Warning signs of cancer: “CAUTION”

A

-Change in bowel or bladder habits
-A sore that does not heal
-Unusual bleeding or discharge
-Thickening or lump in the breast, testicle, or elsewhere
-Indigestion or difficulty swallowing
-Obvious change in the size, color, shape, or thickness of a wart, mole, or mouth sore.
-Nagging cough or hoarseness

-These changes last for weeks or months

53
Q

Classification of cancer: Grading

A

-4 grades of abnormal cells

54
Q

Cancer grading: Grade 1

A

-Cells differ slightly from normal cells and are well differentiated

55
Q

Cancer grading: Grade II

A

-Cells are more abnormal and moderately different

56
Q

Cancer grading: Grade III

A

-Cells are very abnormal and poorly differentiated

57
Q

Cancer grading: Grade IV

A

-Cells are immature and primitive and undifferentiated.

58
Q

Clinical staging of cancer: Stage I

A

-Tumor is limited to tissue of origin; localized tumor growth

59
Q

Clinical staging of cancer: Stage II

A

-Limited to local spread

60
Q

Clinical staging of cancer: Stage III

A

-Extensive local and regional spread

61
Q

Clinical staging of cancer: Stage IV

A

-Metastasis

62
Q

Clinical staging of cancer: Stage 0

A

-Cancer in situ

63
Q

TNM staging of cancer

A

T=Tumor size
N=Lymph node status
M=Metastasis

64
Q

TNM staging: Tumor

A

T1: 0-2 cm
T2: 2-5 cm
T3: >5 cm
T4: tumor has broken through skin or attached to chest wall

65
Q

TNM staging: Nodes

A

N0: Surgeon can’t feel any nodes
N1: Surgeon can feel swollen nodes
N2: Nodes feel swollen and lumpy
N3: Swollen nodes located near collarbone

66
Q

TNM staging: Metastasis

A

M0: Tested nodes are cancer free
M1: Tested nodes show cancer cells or micro metastasis