Exam 1 Flashcards
Arthritis
Inflammation of one or more joints
Non-inflammatory arthritis (osteoarthritis)
Not systemic or an autoimmune disease that develops from overuse of the joint, most common type
Osteophytes
Bone spurs that form as cartilage and the bone beneath it begins to erode
Synovitis
Inflammation of the synovial tissue
Subluxation
Partial joint dislocation
Herberdens nodes
Swelling at the distal fingers
Bouchards nodes
Swelling of the proximal fingers
Joint effusions
Excessive joint fluid, ballottement
Joint involvement
Joint tenderness upon palpation or range of motion
Total joint arthroplasty or total joint replacement
Surgical creation of a joint or total knee replacement
Arthroscopy
Procedure to remove damaged cartilage
Osteotomy
Bone resection to correct a joint deformity
Rheumatoid arthritis
Chronic, progressive, systemic inflammatory Auto immune disease of musculoskeletal system involving many joints and connective tissue, characterized by remissions and exacerbations
Stages of rheumatoid arthritis
Body’s immune system begins to attack cells at synovial joints.
Causes inflammation in the synovial membrane,
synovial thickening,
cartilage and bone damage (calcification, bony ankylosis)
Systemic disease
Affects other organs in the body including many joints and other tissues
Vasculitis
Inflammation of the blood vessels
Subcutaneous nodules
On the on their surface of the arm, fingers, along the Achilles tendon
Pulmonary complications
Inflammation of lung lining, interstitial fibrosis
Periungal lesions
Brown spots around the nailbed, ischemic lesions
Paresthesias
Burning and tingling sensation in the extremities
Rheumatic disease
Any disease or condition involving the musculoskeletal system
Sjögren’s syndrome
Dry eyes, mouth and vagina
Feltys syndrome
Hepatospleenomegaly
Caplan’s syndrome
RA nodules in the lungs and pneumonia coniosis
Rheumatoid factor
Measures the presence of unusual antibodies of IGM
Anti-nuclear antibody titer
Measures the titer of unusual antibodies that destroys cells and cause tissue death not always accurate
Erythro site sedimentation rate
Measures inflammation
Serum complement
Measures the serum proteins C3 and C4 which are usually low in patients with autoimmune disease
C reactive serum protein
Also used to measure inflammation
NSAIDs
Usually the initial drug of choice to relieve pain and inflammation
Disease modifying antirheumatic drugs (DMARDS)
Slows the progression before it worsens
Methotrexate
Slow acting immunosuppressive medications
Leflunomide
Help diminish information such as joint swelling, stiffness, and improve mobility
Biological response modifiers (BRM)
Newest drug neutralize the biological activity of tumor in a crisis factor by binding with the TNF receptors
Glucocorticosteroids
Fast acting, anti-inflammatory and immunosuppressive effects can be given in high dose for short duration or as low chronic dose
Lots of complications
Plasmapheresis
Process which of the fluid part of the blood plasma is removed from blood cells by a cell separator. The blood plasma, which contains the antibodies, is discarded and replaced with other fluids
Autoimmune process
Where antinuclear antibodies affect the DNA of the cell nucleus, resulting in inflammation and damage to organs directly or cause vasculitis, compromising blood flow and oxygenation
Discoid lupus erythematosus
Chronic skin condition of sores with inflammation and scarring favoring the face ears and scalp and at times on other body areas only affects the skin
Systemic lupus erythematosus
Chronic progressive inflammatory connective tissue disorder that causes major body organs and systems to fail (kidneys and lungs)
–dry scaly butterfly rash on face, skin lesions, alopecia, mouth ulcers
Osteonecrosis
Bone necrosis due to prolonged steroid use causing constriction of blood vessels, hip commonly affected
Muscle atrophy
From disuse, steroid use, or immune complex invasion
Fever and fatigue
Very common finding with lupus erythematosus
Renal involvement
Common with lupus nephritis has the most common cause of death
Pleural effusions/pneumonia
Found in almost half of all cases of SLE
Drug therapy for a systemic lupus
Topical drugs like Cortizone cream, anti-malaria medication, Tylenol or NSAIDs, chronic steroid therapy, immunosuppressive agents like methotrexate
scleroderma (systemic sclerosis)
Chronic inflammatory autoimmune connective tissue disease that is not always progressive, hardening of the skin, has a higher mortality rate than SLE
Filtration
The movement of fluid through a cell or blood vessel because of hydrostatic pressure differences
Diffusion
Solutes move from higher concentration to lower concentration with no energy; important in transfer of most electrolytes and particles through cell membranes
Osmosis
Movement of water only through a selectively permeable membrane; thirst mechanism
Aldosterone
Secreted by the adrenal cortex when the ECF sodium level is decreased
Antidiuretic hormone
Vasopressin produced in the brain and stored in the pituitary. released by control of the hypothalamus in response to changes in blood osmolarity
Natriuretic peptide
Hormones secreted by cells in the atria and ventricles of the heart causing affects opposite of aldosterone
Fluid loss
Minimum amount of urine needed to excrete toxic waste products is 400 to 600 mL
1+ pitting edema
Slight indentation of 2 mm, normal contours, associated with interstitial fluid volume 30% above normal
2+ pitting edema
Deeper pit after pressing 4 mm, last longer then one plus, fairly normal Contor
3+ pitting edema
Deep pit 6 mm, remains several seconds after pressing, skin swelling obvious by General inspection
4+ pitting edema
Deep pit 8 mm, remains for a prolonged time after pressing possibly minutes, Frank swelling
Brawny edema
Fluid can no longer be displaced. No pitting,
tissue palpates as firm
Or hard, skin surface shiny warm moist
Sodium
135 to 145; vital for skeletal muscle & cardiac contraction, nerve impulse transmission and normal osmolarity and volume of the ECF; positive and hangs with CL and opposes K
Potassium
3.5-5; most dominant cation in ICF; regulates cellular excitability, assist skeletal and cardiac muscle contraction, neuromuscular transmission
SUCTION
Occurs with hypokalemia; skeletal muscle changes, U wave, flattened T, depressed (ECG changes),
Constipation, toxicity of digoxin, irregular or weak pulses , orthostatic hypotension, numbness or Paresthesias
3 P danger signs
For hypokalemia; paralytic ileus, paralysis of muscles including respiratory, pulse craziness including cardiac arrest
Calcium
9.0-10.5; major cation in teeth and bones; Affects cell membrane permeability, acts as an enzyme activator within cells, aids coagulation
Phosphorus
3.0-4.5; needed for activating vitamins and enzymes, forming ATP, assisting in cell growth and metabolism.
Magnesium
1.3-2.1; critical for skeletal muscle contraction, carbohydrate metabolism, ATP formation, vitamin activation, cell growth
STARVED
For hypomagnesium; seizures, tetany, anorexia, rapid heart rate, vomiting, emotional lability, deep tendon reflex is increased
Chloride
98-106
pH
Balance of hydrogen atoms (H+) to bicarbonate (HCO3)atoms in the blood
Normal pH for arterial blood
7.35 to 7.45, arterial blood is alkaline
Normal pH for venous blood
7.31 to 7.41
Destruction of cells
Acids are released into the ECF
Incomplete breakdown of glucose
When cells metabolize under anaerobic conditions; forming lactic acid or incomplete breakdown of fatty acid forming ketoacids
Hyperventilation
When CO2 rises the respiration rate increases
Hypo ventilation
When the H+ in the ECF is low CO2 level is low causing a decrease in respiration rate
Kidney movement of bicarbonate
Renal mechanism where kidneys create bicarbonate as well as reabsorbed bicarbonate
Formation of acid
Renal mechanism where excretion of hydrogen ions occur and increases the reabsorption of bicarbonate back in the blood
Formation of ammonium
Renal mechanism which binds to the hydrogen ions for excretion in the urine
PaCO2
35-45 mmHg
PaO2
Greater than 70 mmHg
HCO3
22-26 mmHg
Base excess
Amount of H plus ions that would be required to return the pH of the blood to a normal limit if the PCO2 were adjusted to normal; +2 to -2
Kussmaul respiration
Deep rapid involuntary breathing
Normal serum osmolarity
270 to 300
Hypertonic: fluids greater than 300
Hypotonic: fluids less than 270
Iso tonic infusate
Water does not move into or out of the body cells with no net transfer of fluid.
Pts receiving this are at risk for fluid overload
240-340 concentration
Hypotonic infusate
Moves water into the cells and expands them which can cause swelling of the Venus pathway and inflammation
Hypertonic infusate
Moves water out of the body’s cells and into the bloodstream
Vascular access device (VAD)
Short peripheral catheters: superficial veins of the hand and forearm.
72-96 hours and then require removal and insertion into another site
Complains of tingling pins and needles and extremities or numbness can indicate nerve puncture
Midline catheter
6 to 8 inches long, inserted through veins of the antecubital fossa.
Used for therapies lasting 1 to 4 weeks
Should not be used for infusion of vesicant or blistering medications
Peripherally inserted central catheter (PICC)
40 to 65 cm, chest x-ray to determine placement the tip rest in the SVC
Nontunneled percutaneous central catheter
15 to 20 cm long, inserted through subclavian vein in the upper chest or jugular veins in the neck, tip resides in SVC, placement confirmed by chest x-ray
Tunneled.Central catheter
Used for infusion therapy that is frequent and long-term
Implanted port
Consists of portal body, then septum, catheter.
Subcutaneous pocket is surgically created and the poor is placed in the upper chest or upper extremity
Port needs to be flushed after every use and at least once a month between courses of therapy
Dialysis catheter
Used to accommodate the hemodialysis procedure or a pheresis procedure that harvest specific blood cells
Should not be used for administration of other fluids and medications
Phlebitis and post infusion phlebitis
Inflammation of the vein after devices removed like a cord
Thrombosis
Blood clot inside the vein
Thrombophlebitis
Clot with the vein information
Nerve damage
Transection of nerve
Communicable pathogen
Ability to transfer disease to someone else can be infectious or contagious
Pathogenicity
Ability to cause disease in someone
Virulence
Degree in severity of the disease
Colonization
Micro organism is present in the tissue but not yet causing symptomatic disease
Gram-positive cocci
Staphylococcus aureus, skin infections, food poisoning, pharyngitis
Gram-positive bacilli
Clostridium tetani (tetanus), clostridium botulism
Gram-negative bacilli
Salmonella urinary tract infections, burn infections
Spirilla
Acute enterititis, diarrhea, gastritis, peptic ulcer
Contact transmission
Direct or indirect contact with items in the environment
c diff, mrsa, lice, scabies, VRE
Droplet transmission
Organisms that can be in air and may travel up to 3 feet but is not suspended;
influenza, mumps, meningitis, h1n1
Airborne transmission
Organisms that can be suspended in the air for prolonged periods of time;
Use negative airflow room and hepafilters
TB, varicella, measles
Vector borne transmission
Involves insect or animal carrier; lyme disease, West Nile
Inflammation
She’s become damaged, releasing neutrophils that are attracted to the affected side from the bloodstream
Antibody mediated immune system (humoral immunity)
involves antigen to antibody interactions that neutralize, eliminate, or destroy foreign bodies
Produced by sensitized b-lymphocytes or B cells
Fluid immunity
Circulating antibody
Cell mediated immunity (cellular immunity)
Involves many white blood cell actions and interactions, which are supplied by lymphocytes themselves that mature in the thymus and lymphoid tissues
Helps protect the body through the ability to differentiate self from nonself
Important in preventing the development of cancer and Mehta stasis after exposure to carcinogens
Nosocomial or healthcare infection
Associated infections are infections acquired in the inpatient healthcare setting which were not present at admission
Endogenous infection
Infection from clients Flora
Exogenous infection
Infection is from outside the client, often from the hands of healthcare workers
Sterilization
Kills all organisms
Disinfection
Reduces the numbers of disease causing bacteria but does not kill spores
Multi-drug-resistant organisms
Process where some infectious microorganisms have become resistant to previously effective antibiotics, becoming more difficult to treat
MRSA
Multi-drug-resistant organisms that is commonly found on skin, perineum, nose;
Susceptible to vancomycin and linezolid
Community associate MRSA (prison, schools, dorms)
Inflammation and immunity
To meet human needs protection by the neutralizing, eliminating, destroying organisms that invade the internal environment
Human leukocyte antigen
Unique universal product code for each person, it is key for recognition and self tolerance
Infection
Occurs in response to tissue injury and to the invasion of organisms;
Usually accompanied by inflammation
Sequence of inflammatory responses
Warmth, redness, swelling, pain, decreased function
Sequence of inflammatory responses (stages)
Stage one (vascular): change in blood vessels Phase 1: constriction Phase 2: hyperemia and edema
Stage 2 (cellular exudate): neutrophilia, pus
Stage 3: tissue repair and replacement
Innate native immunity
Natural immunity
Adaptive active immunity
Natural active immunity (chicken pox)
Artificial active immunity (immunization)
Passive immunity
Natural passive immunity (breast milk)
Artificial passive immunity (antibody injections)
Hyper acute transplant rejection
Immediate response
ACute transplant rejection
1 to 3 months after
Chronic transplant rejection
When you get a chance plants, it’s reduced and function because of scar tissue, won’t work at 100%
Treatment of transplant rejection
Maintenance is used after organ transplant, rescue therapy is used to treat acute rejection
Polyarthritis
Early join changes similar to rheumatoid arthritis, small joints and knees are commonly involved
CREST
Symptoms of scleroderma
Calcinosis (calcium deposits in the skin)
Raynaud’s phenomenon: spasm of blood vessels in response to cold or stress
Esophageal dysfunction: acid reflex and decrease in motility of esophagus
Sclerodactyly: thickening and tightening of the skin on the fingers and hands
Telangiectasias: dilation of capillaries causing red marks on surface of skin
Arthralgia
Scleroderma manifestation: joint pain without inflammation or deformities
