Exam 1 study checklist main points Flashcards
Actions of Chemical Mediators
-Histamine, Serotonin, Cytokines
a. Causing MORE vasodilation
b. Causing capillary permeability (“leaky capillary syndrome”) (contributes to swelling).
c. Causing blood flow to slow down so clotting can begin
d. Chemical mediators signal WBCs to congregate in the area of damage (contributes to
swelling).
Atrophy
REDUCED SIZE of cell due to disuse, decreased blood flow, malnutrition, etc.
Dysplasia
Abnormal cell growth of specific tissue resulting in abnormal SIZE, SHAPE, or APPEARANCE. Often precedes cancerous changes.
*NOTE: Hyperplasia and Hypertrophy often often precedes cancerous changes
Hypertrophy
INCREASED SIZE of cell due to increased workload (weight training to build muscle) or a pathological condition (cardiomyopathy = enlarged heart). Most common in cardiac and skeletal muscle tissue
Metaplasia
REPLACEMENT of one cell type with another that can better endure the stress (but usually
doesn’t work as well as the original tissue). Caused by chronic inflammation or irritation, i.e., a callous or scar tissue.
Endothelial cells produce chemicals that
a. vasodilates or vasoconstrict
b. cause blood thinning/prevent clotting (to keep vein open)
c. allows entrance/exit into and out of the blood vessel (vessel wall permeability)
d. control inflammatory response chemical mediators
Fever/chills
HYPERTHERMIA the most common objective sign of systemic inflammation, especially during the acute response phase.
chills do not indicate getting better
Reversible cell injuries
Water: Na K pump breaks, sodium builds up, water follows, intracellular swelling.
Lipids: Lipid collects, impairs cell functions, FATTY LIVER, MOR OMINOUS SIGN, can be reverse with dietary changes
Calcium: Ca Mg pump breaks, Ca builds up, inappropriate activation of cellular enzymes
Irreversible cell injurys
Apoptosis: controlled cell death
Necrosis: uncontrolled cell death (explosion, causes inflammatory response)
Telomeres
Outermost tails of the chromosome arms that are shortened during each replication of a cell. When the telomere is too short to replicate, the cell dies because it cannot reproduce itself any more = “Replicative Senescence.”
WBC lab value range
5,000 - 10,000
Acute vs Chronic
Acute: short period of time, heals itslef, doesn’t come back: neutrophils
Chronic: last for many weeks or years, permanent damage recurrent and persistent exacerbations and remissions: lymphocytes
Local vs Systemic
Local: one area, SHARP
Systemic: body wide, system wide, heightened CRP, Fever, Heightened WBC
cellular aging:
- Decrease in elasticity of blood vessels→atherosclerosis (“hardening of the arteries”] and high blood pressure
- Loss of bowel motility due to aging or medications→Chronic constipation
- Loss of muscle mass due to aging, malnutrition, eating disorders, etc.→muscle weakness, problems with balance
- Loss of subcutaneous fat due to aging or extreme dieting, cancer, malnutrition, etc.→problems regulating
temperature, and skin breakdown over bony areas especially if bed-bound
Benign
-Well differentiated
-stays together
-expands and pushes surrounding tissue
-encapsulated
-generally slow
-does not metastasize
-movable
Malignant
-poorly differentiated
-breaks apart
-infiltrates into tissue
-usually rapid
-eventually metastasizes
-fixed
Blood Dyscrasias
Blood component disorders. Can be caused by the primary tumor but is usually caused by bone marrow damage from various cancer treatments.
Types of blood dyscrasias
Anemia: Low RBC: fatigue and low O2
Leukopenia: Low WBC: prone to infections
Thrombocytopenia: Low platelet count: bleeding disorders
Leukocytosis: High WBC: common indicator of infections
Fetal alcohol syndrome effects and causes
Effects:
#1 cause of mental retardation in children
Irreversible defects
developmental delays
physical defects
seizures- withdrawal
behavioral problems
intellectual impairment
brain malformation
Causes:
one drink = 10 for baby
no safe amount to drink during pregnancy
Healing intentions
Primary: Wound margins are brought together by any means, low infection risk ex. incisions, cuts, and puncture wounds
secondary: Missing tissue requires margins to contract, and then fills-in, resulting in a large scar. Cannot be sutured closed because too much tissue is missing. High infection potential. ex. bike crash, and pressure ulcers.
tertiary: Wound margins either separate after
being closed (surgery incision dehisces) or are intentionally
left open (to allow infection to drain out of the wound), then
brought together (and closed with stitches) after granulation
tissue appears ex. dog bites, and wound dehiscence
Metastasis by circulation
(through blood and/or lymph) – a secondary tumor develops in a site distant from the primary tumor.
metastasis by direct contact/ extension
tumor cells spreads to tissues adjacent to the primary tumor by sending out projections (tentacles) into the surrounding tissue or growing pseudopodia to “walk” to the nearest cells.
Metastasis by seeding
tumor cells slough off from primary tumor and develop into more tumors.
Example #1 – during surgery to remove a tumor, some tumor cells remain in the tissue after the main tumor is removed and provide the “seed” for more tumor cells to grow. Example #2: Tumors erode and shed cells into body cavities.
Sentinel node
is the initial lymph node to which the primary tumor drains. Once the sentinel node is identified, it is examined to determine the presence or absence of cancer cells which indicates how far the cancer has spread.
Summary staging system
Stage 1
In situ:
Abnormal cells are present only in the layer of cells in which they developed
Stage 2
Localized:
Cancer is limited to the organ in which it began – no evidence of spread
Stage 3
Regional:
Cancer has spread beyond the primary site to nearby lymph nodes or tissues and organs
Stage 4
Distant/ Metastatic:
Cancer has spread from the primary site to distant tissues or organs or to distant lymph nodes
Unk
Unknown:
There is not enough information to determine the stage
Teratogens
chemical, biological or physical factors that might cause an abnormal development of a fetus in the mother’s womb
three to eight weeks of pregnancy is considered to be the most critical.
Tumor grading system
NOT THE SAME AS THE STAGE OF CANCER.
GX: Grade cannot be assessed (undetermined grade)
❖ Grade I: Well differentiated, least aggressive
❖ Grade II: Moderately differentiated
❖ Grade III: Poorly differentiated
❖ Grade IV: Very poorly differentiated. More likely to progress quickly, highly malignant
Teratogens examples
Diseases (Maternal illness): Chicken pox, Herpes virus, German measles, Cytomegaly Virus,
HIV, AIDS (see T.O.R.C.H. Infections (see below)
❖ Drugs/chemicals: Tetracycline, acne medication, aspirin, antacids, diet pills, alcohol*,
tobacco, marijuana, cocaine, methamphetamine, heroin.
❖ Environmental: Mercury (even small amounts in fish), lead, radiation (like x-rays)
TORCH
- Toxoplasmosis (avoid
undercooked meat & kitty litter) - Other (syphilis, varicella-zoster,
parvovirus B19) - Rubella (German Measles)
- Cytomegalovirus (CMV)
- Herpes
TNM staging system
Tumor (T) size of tumor
Lymph nodes (N) node involvement
Metastasis (M) metastatic spread
Primary Tumor (T) staging
TX: Primary tumor cannot be evaluated
T0: No evidence of primary tumor
Tis: Carcinoma in situ
T1, T2, T3, T4: Size and/or extent of the primary tumor
Regional Lymph Nodes (N)
NX: Regional lymph nodes cannot be evaluated
N0: No regional lymph node involvement
N1, N2, N3: Degree of regional lymph node involvement
(number and location of lymph nodes)
Distant Metastasis (M)
oMX:Distant metastasis can not be evaluated
oM0:No distant metastasis
o M1: Distant metastasis is present
affects on wound healing
- Nutritional Status -
- Blood Flow/O2 delivery -
- Impaired Inflammatory/Immune Response 4. Infection -
- Wound Separation -
- Foreign Bodies -
How Respiratory regulates
First response is by lungs
Acidotic: raises pH by “blowing off” CO2 (which makes a weak acid in the body – carbonic acid). This results in a KUSSMAUL breathing pattern - deep rapid breathing).
Alkalotic: The body will try to compensate by reducing ventilations to conserve CO2.
How metabolic regulates
slower response
acidotic: he kidneys will excrete hydrogen ions [H+] to get rid of acid and retain Bicarbonate (a base) to neutralize acid.
Alkalosis:The kidneys will retain H+ excrete bicarb.
Causes of acid/ base imbalances Respiratory
~ Acidosis – RETAINED CO2 (lung insult/illness/injury – infection, COPD, trauma to lungs, etc.)
~Alkalosis - CO2 is too low (caused by hyperventilation)
Causes of acid/ base imbalances metabolic
~Acidosis – Retained H+ or other acid (Chronic Renal Failure or Diabetic Ketoacidosis-DKA), crush injury that releases potassium into the blood stream (K+ becomes an acid), or in diarrhea (“base-out-the–butt”).
~Alkalosis – Loss of H+ or other acid as in vomiting
Effects of acid/ base imbalances Acidosis
Principal effect of ACIDOSIS is DEPRESSION of the Central Nervous System (decrease in synaptic transmission).
❑ Deranged CNS function is the greatest threat
❑ Generalized weakness
❑ Severe acidosis causes: Disorientation - Coma - Death
Effects of acid/ base imbalances Alkalosis
Principal effect of ALKALOSIS is EXCITATION of the Central Nervous System.
❑ S/s initially are numbness/lightheadedness
❑ Severe Alkalosis causes: Muscle spasms or tetany - Convulsions - Death
BP for low fluid balance
low bp
Bp for high fluid balance
high Bp
Sodium lab value and effects
135-145
Extracellular
Excites nervous syst
LOC and seizures
- lower Na+ same s/s as fluid overload
- higher Na+ same s/s as dehydration
Potassium lab value and effects
3.5-5.0
Intracellular
Excites Cardiac tissue and Gi tract when elevated
-lower K+ cause dysrhythmias, N/V, paresthesia, SZs.
-higher K+ causes diarrhea (excites GI)
- lower K+ causes constipation
(calms GI)
Calcium lab values and effects
8.5-10.5
extracellular
calms muscles and nerves
-lower Ca++ Causes tetany because muscle cannot calm down [positive Chvostek’s sign;
Severe lower Ca= laryngeal spasm.
-higher Ca++ →muscle weakness
Magnesium lab values and effects
1.5-3.0
intracellular
calms smooth muscle and DTRs
- Smooth muscle = lungs/ uterus/
heart/ intestines)
- lower Mg+ → hyperreflexia [DTRs cannot relax].
-higher Mg+ → Resp. failure.
- Milk of Magnesia =
laxative
ADH effect
Retains water and sodium in kidneys to raise bp
AND Vasoconstriction which helps to increase BP
Effects of prolonged stress
Cardiovascular: Hypertension
Immune system; prone to infections (decreased Tcell activity)
Gastrointestinal system: ulcers
Endocrine system: Hyperglycemia, obesity
CNS: insomnia
Cancer
Autoimmune disorders
General adaption syndrome
Alarm stage:aware of the stress, CNS aroused. Body defenses mobilized, cortisol response–> SNS or flight or fight phenomena. Release of catecholamine and cortisol.
Resistance/ adaption:full mobilization of all body resources allow the individual to cope (maintain homeostasis) despite being in a stressed condition.
Stage of exhaustion: continuous stress causes the progressive breakdown of compensatory mechanisms & homeostasis. This stage marks the onset of certain diseases.
Isotonic
MOST COMMONLY USED
use first if you aren’t specified otherwise
moves equally back and forth across a membrane without increasing or decreasing the cell size. Preferred for fluid replacement since the tonicity (sodium concentration) is similar to blood. When infused into the blood stream (by I.V.)
isotonic fluids “Stay where I put it.”
EX: 0.9% normal saline (NS) and lactated ringers (LR).
Hypertonic solutions
The “E” in hyper reminds you that fluid “ENTERS” the blood stream. Fluid is attracted from the tissue into the blood stream by the high concentration of solutes in hypertonic fluid.
molecules like Proteins and Glucose attract water
RAPID FLUID REPLACEMENT (emergency when lots of blood was lost or low bp)
TISSUE IS OVER HYDRATED
Examples: Albumin, D50, hetastarch, 3% saline, 6% saline, etc.
Hypotonic solution
The “O” in hyper reminds you that fluid “Goes OUT” of the blood stream. Fluid moves from an area of low solute concentration to an area of higher concentration
TISSUE IS DEHYRDATED
Diabetes ketoacidosis
Examples: 0.45% NS; 0.225% NS; or D5W (dextrose 5% and water).
D5W
isotonic in bag and then once in blood stream it is hypotonic
Kussmaul respirations
deep rapid breathing, caused by respiratory regulation trying to blow off CO2
Lab values of WBC
5,000-10,000
Normal PH
7.34-7.45
Normal PCO2
35-45
Normal HCO3
22-26
Normal Platelet count
150,000-400,000
RBC count
3.6-5.4
