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Med Surg Lecture <3 > Exam #2 Study Guide > Flashcards

Exam #2 Study Guide Flashcards

1
Q

What is the pathophysiology for Kaposi Sarcoma?

A
  • It is caused by human herpes virus 8 (HHv8)*
  • Involves epithelial layer of blood and lymphatic vessels
  • Involves lesions involving multiple organ systems
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2
Q

What are the clinical manifestations of Kaposi Sarcoma?

A
  • Cutaneous lesions are the first clinical manifestation
  • Lesions can affect lymph nodes, GI tract, and lungs
  • May lead to organ failure, hemorrhage, infection, or death
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3
Q

What is the ART therapy - medication compliance?

A
  • Antiretroviral therapy*
  • Overarching goal to suppress HIV replication
  • Prolong duration and quality of life
  • Prevent transmission of HIV
  • Medication compliance*
  • Monitor CD4+ counts as a measure of compliance
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4
Q

What are the HIV test indicators for health status?

A

1) HIV 1 and HIV 2 immunoassay: checks for antibodies (can get results as quickly as 5-30 mins)

2) HIV 1 and HIV 2 antigen/antibody immunoassay: checks for both antigen and antibody for the virus

3) HIV 1 differentiation assay: differentiates HIV 1 from HIV 2

4) HIV 1 nucleic acid amplification test: test directly for the virus

5) HIV 1 p24 antigen: test directly for virus

For health status

  • Viral load tests- quantifies HIV RNA for DNA in Plasma
  • PCR (polymerase chain reaction)
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5
Q

What are the types of immunities?

A

1) Natural (Innate)
2) Acquired passive
3) Acquired active

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6
Q

What is natural (innate) immunity?

A
  • Nonspecific response to a foreign invader
  • FIRST line of defense; WBC, skin, Gastric secretions, chemical barriers, and saliva
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7
Q

What is Acquired passive immunity?

A
  • Temporary, results from transfer source outside the body like previous disease or immunization

EX. breastfeeding, flu shot

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8
Q

What is Acquired active immunity?

A
  • Immunological defenses acquired by ones own body, lasts many years, may last a lifetime.

(getting sick)

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9
Q

What is the pathophysiology for HIV encephalopathy?

A
  • CD4+ cells found a CSF can release toxins of lymphokines that cause cellular dysfunction, inflammation, or interfere with neurotransmitters
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10
Q

What is the clinical manifestations of HIV encephalopathy?

A
  • It is characterized by progressive decline in cognitive, behavioral, and motor function
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11
Q

What is the Early VS. Late signs of HIV encephalopathy?

A

Early signs:

1) Memory deficits
2) Headache
3) Difficulty concentrating
4) Psychomotor slowing
5) Progressive confusion
6) Atoxia
7) Apathy

Late signs:

1) Global cognitive impairments
2) Vacant stare
3) Psychosis
4) Seizure
5) Spastic paraparesis
6) Hallucination
7) Mutism
8) Death
9) Delay in verbal responses
10) Hyperreflexia
11) Incontinence

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12
Q

What is the pathophysiology for Pneumocystis pneumonia (PCP)?

A
  • Opportunistic infection caused by P.jirovecii
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13
Q

What is the treatment for Pneumocystis pneumonia (PCP)?

A
  • Trimethropin- sulfamethoxazole (TMP-SMX) Bactrim
  • Adjunct corticosteriods (Prednisone) are indicated as quickly as possible (within 72h)
  • Treatment is usually 21 days long
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14
Q

What are the gynecological complications with AIDs?

A

1) Geneital ulcers
2) Persistent, recurrent vaginal candidiasis
3) Pelvic inflammatory disease
4) Menstral abnormalities

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15
Q

What is Megestrol acetate?

A
  • Synthetic oral progesterone preparation

*Promotes significant weight gain and increases body weight/fat stores

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16
Q

What is Dronabinol?

A
  • Synthetic tetrahydrocannabinol (THC)
  • Active ingredient in marijuana, used to relieve nausea, vomiting, associated with cancer chemotherapy
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17
Q

What are the risk factors for HIV/AIDs?

A

1) Unprotected sex
2) People who receive organ transmission
3) Mother to child (Amniotic fluid, Breast milk)
4) Multiple sexual partners
5) Drug abuse (Shared needles)
6) Shared razors and/or toothbrushes

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18
Q

What is the education regarding preventative measures?

A

1) Wear condoms (Protected sex)
2) Get tested frequently (especially past risky behavior)
3) Dont share needles, razors, toothbrush

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19
Q

What is the pathophysiology for Tubercolosis?

A
  • It is transmitted airborne. Infectious agent is M.tuberculosis affects the lungs
  • It is transmitted from the airway to the aveoli then through the blood tot he rest of the body
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20
Q

What are the clinical manifestations of Tuberculosis?

A

1) Low grade fever
2) Cough
3) Night sweats
4) Fatigue
5) Weight loss
6) Productive or nonproductive cough
7) Hemoptysis (coughing up blood)

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21
Q

What is the treatment for Tuberculosis?

A
  • It is treated with Anti-TB agents for 6-12 months
  • Isoniazid
  • Weight monitoring*
  • Goal is to maintain and increase ideal weight
    -Appetite stimulants
  • Oral supplements- high calorie, easily digestible protein, low fat , palatable
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22
Q

What are the stages of immune response?

A

1) Recognition
2) Proliferation
3) Response
4) Effector

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23
Q

What is the recognition stage?

A
  • Involves the use of lymph nodes and
    lymphocytes for surveillance.
    Macrophages and neutrophils have receptors for antibodies and compliment.
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24
Q

-What is the Proliferation stage?

A
  • Lymphocytes go to nearest lymph node and stimulate T & B cells.

-T-Lymphocytes become cytotoxic T cells
and B cells create and release antibodies.

  • Enlargement of the lymph nodes and
    sore throat.
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25
Q

What is the Response stage?

A
  • The differentiated lymphocytes begin their jobs (T cells killing B cells spreading antibodies)
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26
Q

What is the effector stage?

A
  • The lymphocytes (T cell/ B cell) connect with the antigen and it either kills it or uses the antibodies on it
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27
Q

What is the cellular function?**

A
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28
Q

What is the pathophysiology, function of B Lymphocytes?

A
  • Mature in the bone marrow in proliferation phase 2 they mature from lymphocytes to produce and release antibodies
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29
Q

What is the pathophysiology, function of T Lymphocytes?

A
  • Mature in the thymus in proliferation phase 2 they mature from lymphocyre into cytotoxic T cells or Killer T cells

** Attacks microbes **

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30
Q

What are the immune defender-cells that assist with fighting off antigens?***

A

B lymphocytes respond to antigens by triggering antibody formation

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31
Q

What is the Humoral response?

A

1) Bacterial phagocytosis & lysis
2) Anaphylaxsis
3) Allergic hay fever and Asthma
4) Immune complex disease
5) Bacterial and some viral infections

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32
Q

What is the cellular response?

A

1) Transplant rejection
2) Delayed hypersensitivity
3) Graft v. host disease
4) Intracellular infections
5) Viral, fungal, and parasitic infections

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33
Q

What are the kinds of T-cells?

A

1) Effector T cells (Helper and Cytotoxic T cells)
2) Suppressor T cells
3) Memory T cells

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34
Q

What is a Helper T Cell?

A
  • Are activated on recognition of antigens and stimulate the rest of the immune system.
  • When activated, helper T cells secrete cytokines, which attract and activate B cells, cytotoxic T cells, NK cells, macrophages, and other cells of the immune system*
  • ALSO help produce lymphokines
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35
Q

What are are Cytotoxic T cells (Killer T cells)?

A

-They attack the antigen directly by altering the cell membrane, causing cell lysis (disintegration), and releasing cytolytic enzymes and cytokines.

36
Q

What are Suppressor T cells?

A
  • Have the ability to decrease B-cell production, thereby keeping the immune response at a level that is compatible with health (e.g., sufficient to fight infection adequately without attacking the body’s healthy tissues).
37
Q

What are Memory T cells?

A

Remembers contact with an antigen and on subsequent exposures mounts an immune response

38
Q

What is an IgG?

A

IgG (75% of Total Immunoglobulin)

*Appears in serum and tissues (interstitial fluid)

*Assumes a major role in bloodborne and tissue infections

*Activates the complement system

*Enhances phagocytosis

*Crosses the placenta

39
Q

What is an IgA?

A

IgA (15% of Total Immunoglobulin)

*Appears in body fluids (blood, saliva, tears, and breast milk, as well as pulmonary, gastrointestinal, prostatic, and vaginal secretions)

*Protects against respiratory, gastrointestinal, and genitourinary infections

*Prevents absorption of antigens from food

*Passes to neonate in breast milk for protection

40
Q

What is an IgM?

A

IgM (10% of Total Immunoglobulin)

*Appears mostly in intravascular serum

*Appears as the first immunoglobulin produced in response to bacterial and viral infections
*Activates the complement system

41
Q

What is Prep (pre exposure prophylaxsis)?

A
  • Clients take one pill containing 2 HIV medications (tenofovir disoproxil) furmate 300 mg and emtricitaldine 200 mg daily.
  • It used to prevent transmission of HIV
  • Prep does not prevent other sexually transmitted disease
42
Q

What is Post exposure prophylaxis?

A
  • Antiretroviral medication taken within 72 h of exposure
  • 2-3 drugs prescribed for 23 days

Both should be followed up with HIV testing

43
Q

What are HIV-Gerontological comorbidities?**

A
  • Comorbidities in older persons with HIV/AIDS include type 2 diabetes; non-AIDS cancerous diseases; cardiovascular disease; osteoporosis; and depression
  • Due to the high number of chronic illnesses, polypharmacy along with drug interactions becomes a major clinical challenge
44
Q

What is CMV Cytomegalovirus Retinitis?

A
  • CMV is the most common cause of retinal inflammation in patients with AIDS.
  • Pt may complain of floaters or decrease in peripheral vision
  • Some have paracentral or centrals cotoma, wheras others have fluctuations in vision from macular edema
45
Q

What are the 3 forms of CMV?

A

1) Hemorrhagic - large areas of white, necrotic retina may be associated with retinal hemorrhage.

2) Brushfire - a yellow-white margin begins at the edge of burned-out atrophic retina

3) Granular - white granular lesions in the periphery of the retina gradually expand. The white, feathery infiltration of the retina destroys sensory retina and leads to necrosis, optic atrophy, and retinal detachment.

46
Q

What is the pharmacological therapy for CMV?**

A
47
Q

What is Hypersensitivity?**

A

is an excessive or aberrant immune response to any type of stimulus

It usually does not occur with the first exposure to an allergen

48
Q

What are the types of Hypersensitivity?

A

1) Anaphylactic (Type 1) Hypersensitivity
2) Cytotoxic (Type II) Hypersensitivity
3) Immune Complex (Type III) Hypersensitivity
4) Delayed (Type IV) Hypersensitivity

49
Q

What is the Lifecycle of HIV?

A

1) Binding (also called Attachment)
2) Fusion
3) Reverse Transcription
4) Integration
5) Replication
6) Assembly
7) Budding

50
Q

What are physical barriers?

A

1) The skin
2) Mucous membranes
3) Cilia of resp. tract

Prevent pathogens from giving access to the body

51
Q

What are the chemical barriers?

A

1) Mucus
2) Acidic gastric secretions
3) Enzymes in saliva
4) Substances in sebaceous and sweat secretions

Act in a nonspecific way to destroy invading bacteria and fungi

52
Q

What is health promotion?

A
  • Common goal to encoruage achievement of a high level of wellness
  • Healthy people 2030
  • Promote wellness and prevent illness
  • It is the responsibility of the PT
  • It is for ALL ages across the lifespan
53
Q

What are the considerations for the elderly regarding health promotion?

A
  • Very health conscious
  • Benefit from activities that help them maintain their independence and achieve optimal health
54
Q

What does educating patients entail?

A
  • Self responsibility
  • Nutritional awareness
  • Stress reduction and management
  • Physical fitness
55
Q

What are some health promotion activities?

A

1) Churchs hold little events
2) Jobs
3) Social media

etc

56
Q

Procedure for donning PPE?

A

1) Wash hands
2) Gown
3) Mask
4) Goggles
5) Gloves

57
Q

Procedure for Doffing PPE?

A

1) Gloves
2) Gown
3) Goggles
4) Mask
5) Wash hands

58
Q

What are some complications associated with COVID-19?

A

1) VTE formation- venous thromboembolism

  • given enoxaparin as VTE prophylaxis

2) ARDS- acute respiratory distress syndrome

  • Can lead to shock and respiratory failure
  • S & S = tachypnea
    dyspnea
    retractions
    hypoxia
    tachycardia
    decreased pulmonary compliance

3) ARF- Acute respiratory failure

  • Rapid deterioration to hypoxemia, hypercapnia, and respiratory acidosis
  • Impaired ventilation of perfusion mechanisms

4) Septic shock

59
Q

What are some transmission precautions for COVID-19?

A

1) Airborne precautions (Covid-19)

  • Faceshield/goggles
    -N95 or high respirator/can wear facemask if needed
  • One pair of clean non-sterile gloves
    -Isolation gown

2) Contact precautions

60
Q

Why is hand hygiene important?

A
  • It is important to perform hand hygiene before and after giving direct patient care
  • This protects you and your patient from spreading pathogens
61
Q

What is the importance against COVID-19?

A
  • To provide immunity
  • To help you fight it if you do catch it by reducing symptoms and severity
62
Q

What is the treatment for COVID-19?

A

1) Antiviral treatment
-Veklury/Remdesvir

2) Mostly conservatives outpatient management
- Rest
- Hydrate
- Antipyretic agents ie. ibuprofen

3) Hospitalization for severe illness with pneumonia
-Endotracheal intubation
- Mechanical ventilation

63
Q

What are the risk factors for COVID-19?

A

1) Elderly
2) Obese
3) Respiratory illness/ problems
4) Immunocompromised PTs

64
Q

What are the sign and symptoms of COIVD-19?

A

1) Fatigue
2) Myalgia
3) Congestion
4) Sore throat
5) Diarrhea
6) Anosmia
7) Ageusia

65
Q

What are the methods of measuring visual acuity?

A

1) Rosenbaum pocket screener (14 in away)
2) Snellen chart (120 ft away)
3) A tumbling “E”, “Illiterate E”, number or picture chart is used for a person who is illiterate or unable to read the english language
4) Finger count or hand

66
Q

What is the Amster Grid?

A

1) Used for PTs with macular problems, ex. Macular degeneration

2) Consists of a geometric grid of identical squares with a central fixation point

3) PT normally wearing regular reading glasses

4) Each of the eyes are tested separately

5) PT is to stare at the fixation point and report any distortion

67
Q

What is the pathophysiology for Glaucoma?

A
  • Group of ocular conditions in which damage to the optic nerve is caused by increase intraocular pressure caused by congestion of the aqueous humor
68
Q

What are the risk factors for Glaucoma?

A

1) Black or asian race
2) Cardiovascular disease
3) Diabetes
4) Family HX of glaucoma
5) Previous eye tramua
6) Prolonged use of topical or systemic corticaosteroids
7) Hypertension
8) Migraine syndromes
9) Myopia (near sightedness)
10) Obstructive sleep apnea
11) Older age
12) Thin cornea

69
Q

What are the clinical manifestations of Glaucoma?

A
  • Silent thief, unaware of condition until there is significant vision loss;

1) Peripheral vision loss
2) Blurring
3) Halos
4) Difficulty focusing
5) Difficulty adjusting eyes
6) To low lighting

TYPES OF GLAUCOMA:

1) Wide angle
2) Narrow angle
3) Congenital
4) Associated with other conditions
5) May be primary or secondary

70
Q

What is the post-op teaching for cataract removal?

A
  • Before discharge, the patient receives verbal and written education regarding eye protection, administration of medications, recognition of complications, activities to avoid, and obtaining emergency care
  • Eye shield is worn first night

-The nurse also explains that there should be minimal discomfort after surgery and educates the patient about taking a mild analgesic agent, such as acetaminophen, as needed. Antibiotic, anti-inflammatory, and corticosteroid eye drops or ointments are prescribed postoperatively. Patients prescribed anti-inflammatory or corticosteroid eye drops are monitored for possible increases in IOP

71
Q

What is the compliactions of cataract surgery?

A

1) Acute bacterial endophthalmitis;

-Characterized by marked visual loss, pain, lid edema, hypopyon, corneal haze, and chemosis

2) Toxic anterior segment syndrome;

  • noninfectious inflammation that is a complication of anterior chamber surgery; caused by a toxic agent such as an agent used to sterilize surgical instruments

3) Suture related problems;

  • Toxic reactions or mechanical injury from broken or loose sutures

4) Malposition of the iOL;

  • Results in astigmatism, sensitivity to glare, or appearance of halos

5) Opacification of the posterior capsule - most common late complication of extracapsular cataract extraction

  • Visual acuity is diminished
72
Q

What are the visual changes that come with aging?

A

1) Ptosis - drooping of the eyelid
2) Ectropion - turning out of the lower eyelid
3) Entropion - turning in of the lower eyelid
4) Diplopia - seeing one object as two (double vision)
5) Chemises - edema of the conjunctiva
6) Nystagmus - involuntary oscillation of the eyeball

73
Q

What are some communication techniques for the visually impaired?

A

When the person who is blind or has low vision is a patient in a health care facility:

*Make sure all objects the person will need are close at hand.

*Identify the location of objects that the person may need (e.g., “The call light is near your right hand”; “The telephone is on the table on the left side of your bed.”)

*Remove obstacles that may be in the person’s pathway and could cause a fall.

*Place all assistive devices that the person uses close at hand; let the person feel the devices so that they know their location.

*Do not distract a service animal unless the owner has given permission.

*Ask the person, “How can I help you?” At some times, the person needs help; at other times, help may not be needed.

74
Q

What is conductive hearing losss?

A

usually results from an external ear disorder, such as impacted cerumen, or a middle ear disorder, such as otitis media or otosclerosis. In such instances, the efficient transmission of sound by air to the inner ear is interrupted.

75
Q

What is Sensorineural hearing loss?

A
  • Involves damage to the cochlea or vestibulocochlear nerve.
76
Q

What is the Whisper test?

A
  • To exclude one ear from the testing, the examiner covers the untested ear with the palm of the hand. The examiner then whispers softly from a distance of 1 or 2 feet from the unoccluded ear and out of the patient’s sight. The patient with normal acuity can correctly repeat what was whispered.
  • Your gross hearing, the ability to hear, one of the first test we do. You do all these test together, do whisper then weber and Rinne, then refer to specialist
77
Q

How do you interpret the results from the Weber test?

A
  • A person with normal hearing hears the sound equally in both ears or describes the sound as centered in the middle of the head.
  • A person with conductive hearing loss, such as from otosclerosis or otitis media, hears the sound better in the affected ear.
  • A person with sensorineural hearing loss, resulting from damage to the cochlear or vestibulocochlear nerve, hears the sound in the better-hearing ear.

ON TOP OF HEAD

78
Q

How do you interpret the results of Rinne test?

A
  • A person with normal hearing reports that air-conducted sound is louder than bone-conducted sound.
  • A person with a conductive hearing loss hears bone-conducted sound as long as or longer than air-conducted sound.
  • A person with a sensorineural hearing loss hears air-conducted sound longer than bone-conducted sound.
79
Q

What is Serous otitis media?

A
  • Middle ear effusion, or serous otitis media, involves the presence of fluid, without evidence of active infection, in the middle ear.
80
Q

What causes Serous otitis media?

A
  • The fluid results from a negative pressure in the middle ear caused by eustachian tube obstruction. When this condition occurs in adults, an underlying cause for the eustachian tube dysfunction must be sought.
81
Q

What is Acute otitis media?

A
  • It is an acute infection of the middle ear, lasting less than 6 weeks. Pathogens that cause AOM are usually bacterial or viral and enter the middle ear after eustachian tube dysfunction caused by obstruction related to upper respiratory infections, inflammation of surrounding structures

Commonly seen in children

82
Q

What is the treatment for Acute otitis media?

A

The outcome of AOM depends on the efficacy of therapy (the prescribed dose of an oral antibiotic and the duration of therapy), the virulence of the bacteria, and the physical status of the patient.

83
Q

What are the risk factors for Acute otitis media?

A
  • Tobacco smoke exposure, day care attendance, family history of AOM, and atopy (such as eczema, asthma, and seasonal allergies)
84
Q

What is the Tympanic membrane (color & function)?

A
  • 1 cm diameter, very thin
  • Pearly gray, translucent
  • Protects the middle ear and conducts sound vibrations from the external canal to the ossicles *
85
Q

What is Meniere’s disease?

A
  • Abnormal inner ear fluid balance cause by malabsorption of the endolymphatic sac or blockage of the endolymphatic duct
86
Q

What are the clinical manifestations of Meniere’s disease?

A

1) Episodic vertigo
2) Tinnitus
3) Fluctuating sensorineural hearing loss
4) Feeling of pressure
5) Nausea
6) Vomiting

87
Q

What is the treatment of Meniere’s disease?

A
  • Low sodium diet; 1000 to 15000 mg/day
  • Meclizine; tranquilzers, valium, antiemtics
  • Diuretics
  • Surgical management to eliminate attacks of vertigo
  • Endolymphatic decompression
  • Middle and inner ear perfussion
  • Vestibular nerve sectioning

Med Surg Lecture <3 (2 decks)

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