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health disease determinants > Exam 2 Review > Flashcards

Exam 2 Review Flashcards

1
Q

fibrillation

A

irregular fast heart rate, can lead to blood clots

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2
Q

thrombus

A

stationary clot attached to vessel wall

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3
Q

coronary thrombus

A

thrombus in blood vessel of the heart

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4
Q

embolus

A

moving clot

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5
Q

can thrombus go to embolus?

A

yes from the pressure of blood

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6
Q

congestive heart failure

A

heart muscles don’t pump as well as they should - inadequate blood to organs

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7
Q

stable angina

A

chest pain, stress or exercise

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8
Q

embolism

A

obstruction of artery

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9
Q

arteriosclerosis

A

stiffening or hardening of blood vessels

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10
Q

atherosclerosis

A

narrowing from plaque build up

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11
Q

metabolic syndrome

A

waist circumference - 31 in Asian Americans
high triglyceride
how HDL
elevated BP
elevated fasting glucose

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12
Q

unstable angina

A

no pattern of pain or at rest, lasts longer, rest and medication don’t relieve
sign of heart attack

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13
Q

variant angina

A

pain at rest, temporary artery spasm, younger women under 50, smaller lumen

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14
Q

management for Angina drugs

A

nitrate
beta blocker
Calcium channel blocker
anti platelet drugs

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15
Q

what do you look for patient evaluation

A

co-morbidity (2 or more diseases at same time), company atherosclerosis - diabetes, high lipid, hypothyroid, vascular disease

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16
Q

reduce risk of angina

A

lower LDL to less than 100

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17
Q

ischemia

A

no tissue death - causes reduction of blood flow

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18
Q

infarction

A

prolonged cessation of blood flow (blood flow reaches zero) causes tissue death

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19
Q

why is presence of cardiac enzymes a major sign of infarction

A

when the cells are dying they can’t hold the structure and release content to other areas - cells are dying if you can detect them

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20
Q

heart attack in men

A

pain in chest
lightheadedness, nausea, vomiting
jaw, neck, back pain
discomfort or pain in arm or shoulder
shortness of breath

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21
Q

heart attack in women

A

flu like
pressure, squeezing, fullness or pain in chest
pain or discomfort in arms, back, jaw, stomach
shortness of breath
cold sweat, nausea, vomit, lightheaded
chest pain or discomfort

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22
Q

male patterns of heart attack

A

obstruction in coronary vessel

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23
Q

male heart attack diagnostic

A

stress test, coronary angiography

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24
Q

male heart attack treatment

A

angioplasty, bypass surgery, statins

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25
Q

female heart attack patterns

A

microvascular coronary dysfunction, inflammation

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26
Q

female heart attack diagnostic

A

stress test, functional vascular imaging, cardiac MR, IVUS

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27
Q

female heart attack treatment

A

anti-hypertensive, anti inflammatory, statins

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28
Q

women ____ men ___

A

women erode, men explode

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29
Q

most common area for infarction and most lethal

A

left anterior descending artery
widow maker - kills

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30
Q

Clotting process

A
  • monocytes go to area of injury in blood vessel
  • covered to macrophages that engulf fat and turn to foam cells
  • foam cells die and deposit under endothelium
    smooth muscles go to top to form fibrous cap
  • when cap ruptures it exposes atheroma and stimulate coagulation forming coronary thrombus
  • can obstruct artery that lead to AMI
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31
Q

million hearts initiative

A

focus, coordinate, enhance cardiovascular disease prevention activities

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32
Q

life’s simple 7

A

get active
control cholesterol
eat better
manage blood pressure
lose weight
reduce blood sugar
stop smoking

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33
Q

go red for women

A

raise awareness about heart disease and stroke in women. take charge of heart, red as symbol to untie women

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34
Q

transmural

A

death tissue on layers of the heart

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35
Q

sub endocardial

A

death of tissue is located just underneath the endocardial layer

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36
Q

AMI complications - 7

A
  • Arrhythmias - AF, VF, heart block
  • heart failure
  • intracardiac thrombi
  • pericarditis
  • papillary muscle dysfunction
  • ventricular aneurysm
  • cardiac rupture - worst
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37
Q

hypertension nickname

A

silent killer because you don’t know it’s going to happen until it happens

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38
Q

diagnostic of hypertension?

A

blood pressure measurements

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39
Q

primary hypertension

A

no known cause

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40
Q

secondary hypertension

A

there is a known cause

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41
Q

isolated systolic hypertension

A

same effects as primary and secondary
rise in systolic
lower diastolic

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42
Q

what percentage of people will develop hypertension in the next 4 years with a BP of 120-139/80-89

A

50%

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43
Q

hypertension urgency

A

asymptomatic for signs

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44
Q

hypertensive emergency

A

shows signs and symptoms

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45
Q

complications of hypertension

A

CVD mortality and morbidity
increase systolic and diastolic BP
older than 50 have increase in systolic and pulse pressure - predictor of complications than diastolic

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46
Q

inaccurate BP readings-7

A

talking or active listening - adds 10
full bladder - adds 10
unsupported back and feet -adds 6
crossed legs - addes 2-8
unsupported arm - adds 10
cuff over clothing - add 5-50
cuff too small - add 2-10

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47
Q

lifestyle modifications

A

reduce weight - highest BP reduction
increase aerobic physical activity - average SBP reduction 4-9
moderation in alcohol, 2 for men, 1 women
restrict sodium 1.5-2.4 g/day 2 if with CHF and kidney disease
modify eating plan - dash 8-14 SBP reduction

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48
Q

dash diet

A

high fruit, vegetable, low fat dairy
low total fat, saturated, cholesterol

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49
Q

stroke risk factors

A

age
gender
family history
high blood cholesterol
high blood pressure
physical inactivity
obesity and overweight
smoking
diabetes

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50
Q

TIA (transient ischemic attack)

A

less than 24 hour stroke, symptoms resolve, not permanent damage

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51
Q

s/s of TIA

A

loss of sensation in arm or leg, opposite side of body
temporary reduction of brain supply
think or speaking
short speech
partial loss of vision

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52
Q

causes of TIA

A

platelets, blood clot, fatty material calcium on carotid artery

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53
Q

ischemic stroke

A

blockage of blood vessel supplying Brian by embolus or thrombus
- clot from fatty deposit
- can cause cerebral thrombosis
- cerebral embolism

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54
Q

cerebral embolism

A

blood clot in another part of the circulatory system which breaks loose from an artery or the heart and travels to the brain where the blood vessels are too small to pass it
- causes obstruction of blood flow in brain - lack of oxygen

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55
Q

hemorrhagic stroke

A

rupture of blood vessel with bleeding into or around the brain
- causes by weak vessels that rupture
- compression on brain tissue where blood is
- pressure damage to brain cells inhibits proper function of brain tissue
- 20% of strokes are more serious and frequently fatal, extensive damage to brain tissue, pre-existing hypertension
- both last more than 24 Hours

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56
Q

strokes in right hemisphere of brain -7

A

impair judgement
short term memory
one-sided neglect
spatial and perceptual abilities
loss of sensation, reflex changes
controlling emotions
dysarthria

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57
Q

stroke in left hemisphere of brain

A

aphasia - partial loss or total loss of ability to communicate verbally or writing
highly specific problems
difficulty learning new information, login, problem solving

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58
Q

prevention treatment

A

reduce risk factors

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59
Q

immediate treatment after stroke

A

acute or while stroke is evolving - dissolve blood clot or stop bleeding

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60
Q

post - stroke rehabilitation

A

reduce stroke damage
overcome disabilities

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61
Q

how to prevent stroke

A

lifestyle modifications
treat risk factors
stress
drugs
surgery - carotid endarterectomy - 50% narrowing

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62
Q

FAST

A

face drooping
arm weakness
speech difficulties
time to call 911

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63
Q

BEFAST

A

balance
eyesight changes
facial drooping
arm weakness
speech difficulty
time to call 911

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64
Q

dementia

A

neurocognitive disorder that impairs intellectual function, interfere with daily activity

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65
Q

dementia is NOT..

A

disease itself but group of symptoms
causes damage to brain cells

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66
Q

types of dementia

A

Alzheimer’s disease - MC in U.S
vascular dementia
Lewy body dementia
frontotemporal dementia
parkinson’s

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67
Q

Lewy body dementia

A

rigidity and bradykinesia
visual - bizarre hallucinations
tremor - rarely

68
Q

frontotemporal dementia

A

personality change
compulsive behavior
preserved visuospatial function

69
Q

s/s dementia

A

clinical picture varies greatly
2 core mental functions significantly impaired

70
Q

impairments

A

memory impairment
aphasia - language
fluent/receptive aphasia - comprehension, word meaning
PPA - primary progressive aphasia
apraxia - motor disorder, purposeful movement
agnosia - perceptual disorder, identifying
impaired executive function

71
Q

Is Alzheimer’s characterized by early loss of long term memory and one other cognitive function

A

No
just 2 cognitive functions being impaired

72
Q

6 R’s

A

reassess
reconsider
re-channel/re-direct
reassure
review
restrict

73
Q

reassess

A

situation needs, interventions

74
Q

reconsider

A

strategies based on condition

75
Q

re-channel/re-direct

A

negative energy or action, guide behavior

76
Q

reassure

A

support and comfort

77
Q

review

A

care plan and interventions

78
Q

restrict

A

limit actives

79
Q

guidelines for caretakers-8

A

safety first
music brings joy
routines are good
speak simply
understand feelings not words
don’t urge to correct
communicate w/ touch
ask for support

80
Q

agitation

A

respond simply, reasonable, kind statement - don’t be angry

81
Q

aggression

A

underlying reason, agreeable, feelings and validate

82
Q

apathy- lack of interest

A

keep them engaged

83
Q

apraxia

A

remember it’s not stubbornness or willfulness

84
Q

repetition/perseveration

A

be patient and repeat back

85
Q

confusion/disorientation/ memory loss

A

don’t remind them they’re losing their memory

86
Q

hallucination/delusion

A

no action necessary if not harmful,
medication, validation, social contact

87
Q

suspicions, delusions, paranoia

A

validate feelings

88
Q

sundowning

A

reduce stimulation, good lighting

89
Q

wandering

A

constant supervision
lock, gate, alarm

90
Q

alzheimer’s is a type of…

A

dementia
specific brain disease that accounts fro 60-80% of dementia cases

91
Q

dementia

A

general term for symptoms like decline in memory, reasoning, other thinking skills

92
Q

Alzheimers disease and senile dementia

A

○ Acquired, persistent, progressive impairment of intellectual function
○ Cortex of brain shrivels and damages area that involve thinking, remembering, and planning
○ Cerebrospinal fluid fill ventricle
○ Hippocampus shrink a lot
○ #7 cause of death in U.S. and only top 10 cause of death we can’t prevent, slow, or cure
Increased 146% from 2000 to 2018

93
Q

signs of Alzheimer’s

A

poor judgement and decision making
can’t manage budget
losing track of date or season
difficulty having conversation
misplacing things and not able to retrace steps

94
Q

pre-clinical Alzheimer’s

A

plaques and tangles spread in cortex in brain areas - learning, memory, thinking, planning

95
Q

MCI mild cognitive impairment

A

more plaque and tangle
serious thinking/memory problems that interfere with work or social
change in personality or behavior
trouble recognizing friends and family

96
Q

dementia

A

may last 1-5 years..?
most of the cortex seriously damaged, brain shrinks dramatically because of widespread cell death
loss of speech, appetite, weight, bladder, bowel control
total dependance

97
Q

dementia risk factors

A

age
family
lack of social engagement
low educational level (apolipoprotein E detected in late AD)
MCI
traumatic brain injury
CVD risk factors

98
Q

dementia diagnosis

A

medical history
mental status testing - mini cog (clock test)
physical and neurological exam
lab test - blood test and brain imaging
brain scan - CT or MRI to tule out stroke or tumor and PET scan
biopsy/autopsy

99
Q

diagnosis to REALLY remember

A

mental status testing - mini cog (clock test)
biopsy/autopsy - only way to be 100% certain of AD

100
Q

perfectly hidden depression - 10 things

A
  • perfectionist
  • excessive sense of responsibility
  • worry a lot, avoid situations where control isn’t possible
  • focus on task, accomplishment to have value
  • sincere concern about others, allow few to world
  • dismiss hurt or abuse from past
  • accompanying mental health issue - anxiety
  • count blessing as foundation
  • emotional difficulty in personal relationships
  • professional success
101
Q

s/s of depression
SIGECAPS

A

○ S- sleep changes - increase day, decrease night
○ I- interest loss (apathy)
○ G- guilt
○ E- energy loss
○ C- cognition/concentration reduced
○ A- appetite, decreased usually
○ P- psychomotor agitation (anxiety)/retardation (lethargic)
S- suicide preoccupation

102
Q

cognitive distortions - 8

A

○ Catastrophizing - assume the worst
○ Overgeneralization - what happened once to all experiences
○ Jump to conclusions
○ Label - self label
○ Should statement
○ Filter thinking - negative side of things
○ Black and white thinking - one way or another with no in between
○ Emotional reasoning - true based on how you feel
Personalization and blame - too personally and blame self

103
Q

cognitive reconstruction effects

A

lower BP
reduce risk of heart disease
strengthen immune system to resist infection and disease
lower stress level
calm down
avoid stomach problems, insomnia, back pain
happier and more optomistic about future

104
Q

strategies for cognitive reconstruction - 8

A

○ Remove should though
○ Acknowledge feelings
○ Thought diary
○ Recognize thought pattern and ANTS
○ Put thought on trial - challenge ANTS
○ Take break from ANTS
○ Focus on strengths, make small steps
- Coping with criticism and rejection

105
Q

more strategies

A

§ Eat well, sleep, active
§ Gratitude- count blessings
§ Social connections
§ do something nice for self
§ Mindfulness
§ Set self up for success - be realistic
§ Share feelings
- Seek professional support

106
Q

benign tumor

A

slow growth rate
growth character - expansion
tumor spread - localized
cell differentiation - well differentiated cells
- oma to cells of origin

107
Q

malignant tumor

A

rapid growth rate
growth character - infiltration
tumor spread - metastasis by bloodstream or lymphatic channels
cell differentiation - poorly differentiated cells
type of lump in breast - fibrocyst, fibroadenoma, malignant tumor

108
Q

gene mutations

A

BRCA 1 and BRCA 2

109
Q

BRCA 1

A

mutated tumor suppressor gene
60-80% chance of BC
45% chance of ovarian cancer
increase risk of uterine cancer

110
Q

BRCA 2

A

mutated tumor suppressor gene
50-70% chance of BC
10-20% chance of ovarian chancer

111
Q

s/s of breast cancer

A

lump, change in size/shape, duct discharge
lump painless, hard and uneven or soft and tender
spread through blood and lymphatics - tissue

112
Q

breast cancer locations

A

upper right - 60
lower right - 15
upper left - 15
lower left - 5
nipple -5

113
Q

staging

A

describes extent and spread from original site - size, location, spread
- prognosis and treatment options
different staging systems
AJCC

114
Q

TNM staging

A

tumor size
node involvement
metastasis

115
Q

in situ

A

localized
ductal carcinoma in situ
lobular carcinoma in situ

116
Q

infiltrating

A

invasive ductal carcinoma
50-75 hard tumor, irregular shape, abnormal cells in milk ducts
invasive lobular carcinoma - firm tumor likely ER+ and HER2 negative

117
Q

ER+

A

tumor uses estrogen to grow

118
Q

HER2

A

human epidermal growth factor, if negative, not a lot of protein HER - slower growth in contrast to positive, treated with Herceptin

119
Q

TNBC

A

10-15% of BC, cells don’t have estrogen or progesterone receptors

120
Q

breast cancer risk factors

A

age
race
biological susceptibility
personal and family history
early menarche, late menopause
not breastfeeding
poor diet
physical inactivity
alcohol
contraceptive
hormone therapy
reproductive history
DES - nonsteroidal estrogen med

121
Q

dense breast

A

has more fibrous and glandular tissue rather than fatty tissue
- hard to tell in mammogram if there is BC
- non-dense, fatty, low density, high density

122
Q

stage 0

A

noninvasive, carcinoma in situ

123
Q

stage 1

A

breast cancer
1-2 cm, no lymph nodes involved

124
Q

stage 2

A

invasive breast cancer
2-5 cm, axillary LN on same side as BC

125
Q

stage 3

A

locally advanced breast cancer
greater than 2 inches in diameter
extensive axillary LN, spread to other LN or tissue

126
Q

stage 4

A

metastatic breast cancer
recurrent

127
Q

breast surgery

A

simple/total mastectomy
halted radical mastectomy
modified radical mastectomy with axillary lymph node dissection
breast conserving surgery

128
Q

simple or total mastectomy

A

remove entire breast -
leave behind axillary lymph node and chest muscle

128
Q

Halsted radical mastectomy

A

entire breast, all LN, chest muscles, and additional fat and skin

129
Q

modified radical mastectomy with axillary lymph node dissection

A

entire breast and all ALN dissection but leave chest muscles

130
Q

breast conserving surgery

A

*Lumpectomy - remove only tumor and small rim of normal tissue around, most of breast left in place
partial mastectomy
lymph node dissection

131
Q

mammogram

A

up to 2 years can detect breast cancer - 2 years earlier than manual

132
Q

infectious agent

A

micro-organism capable of causing disease or illness
bacteria, fungi, parasite, prions

133
Q

reservoir

A

place where infectious agents live, grow, reproduce
- people, water, food

134
Q

portal of exit

A

agent leaves reservoir
- blood, secretion, excretion, skin

135
Q

mode of transmission

A

spread from reservoir to host
- physical contact, droplet, airborne

136
Q

portal of entry

A

how it enter susceptible host
- mucous membrane, respiratory system, digestive system, broken skin

137
Q

susceptible host

A

have traits that affect susceptibility and severity
- immune deficiency, diabetes, burn, surgery, age

138
Q

direct contact

A

body to body
transmission: personal contact
prevention: wash hand, mask, condom

139
Q

indirect contact

A

object or surface
○ Transmission: not washing handing between patients, instruments contaminated
- Prevention: sterilizing instruments, disinfect surfaces

140
Q

droplet

A

large >5 um projected up to 5 feet
○ Transmission - air, sneezing, cough, talk
- Prevention: cover mouth, mask, physical distance

141
Q

airborne

A

airborne particle
○ Transmission - ventilation
- Prevention - masks, PPE, hospital negative pressure room

142
Q

vehicle

A

single contaminated source to multiple
○ Transmission: point source - food borne
○ Common source - E. coli outbreak in meat facility
- Prevention: safety and disinfection standards

143
Q

vector

A

born by insect or animal
○ Transmission: animal or insect bite
- Prevention: barriers, sprays

144
Q

CDC guidelines on hand washing

A

alcohol based preferred to soap when not dirty
20 seconds
miss the thumbs, fingertips, between fingers

145
Q

hand washing

A

alcohol based hand sanitizers do not cause antibiotic resistance
- alcohol based contain 60-95% alcohol that are most effective at denaturing proteins

146
Q

mean arterial pressure

A

2x diastolic + systolic / 3

147
Q

normal MAP

A

70-110

148
Q

what is MAP

A

average pressure in the arteries during one cardiac cycle
better indicator of perfusion to vital organs than systolic pressure

149
Q

stroke

A

clot block or vessel rupture

150
Q

stroke belt

A

southeast United States

151
Q

arb

A

block angiotensin II receptors
decrease SVR,SV

151
Q

ace inhibitors

A

inhibits ace
decrease SVR, SV

152
Q

alpha blockers

A

block alpha receptors
decrease SVR

153
Q

beta blockers

A

block beta receptors
decrease HR, SV

154
Q

Calcium channel blockers

A

block calcium channels, decrease SVR

155
Q

diuretics

A

facilitate diuretics
decrease SV

156
Q

Renin -angiotensin - aldosterone system (picture) - regulates BP

A

○ Angiotensinogen released from the liver to blood
○ Enzyme reaction from renin in kidney to turn to angiotensin 1
○ Enzyme reaction from ACE to Angiotensin 2
○ Stimulate to adrenal cortex to aldosterone
○ Stimulate salt uptake
Drug block - ACE inhibitors

157
Q

WISE study

A

women, ischemia, symptom, evaluation
- understand heart disease in women
- address the gender gap
- different symptoms

158
Q

angina & AMI sensation

A

both not pain but tightness, squeezing, burning, pressing, choking, aching, bursting, gas indigestion, discomfort

159
Q

angina and AMI location

A

80-90% behind mid sternum, precordial

160
Q

angina and AMI radiation

A

left shoulder and upper arm, elbow, forearm, wrist, 4-5 fingers

161
Q

angina duration

A

less than 30 min

162
Q

AMI duration

A

more than 30 min

163
Q

angina and AMI timing

A

most common is lifting that strains thoracic or arm muscle, rapid walk uphill, morning or after strong emotion, sexual activity, vasospasm

health disease determinants (4 decks)

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