final Flashcards
In 2016, what percentage of the population lived with a disability?
25% or 1 in 4 people
What is the difference between primary, secondary, and tertiary prevention?
Primary- removing or reducing the risk factor
Secondary- to promote early detection of the disease
Tertiary- rehabilitation
What is epigenetics?
The study of how biology and environmental signals determine gene expression
What is pharamacology?
What is toxicology?
the use of specific drugs to prevent, treat, or diagnose a disease
the study of the harmful effects of chemicals
Brand Names for Acetaminophen, Aspirin, Ibuprofen, and Naproxen
Acetaminophen- tylenol
Aspirin- Bufferin, Aspirin
Ibuprofen-advil, motrin
Naproxen- aleve
Drug development and approval process: subjects and time period
Testing phases
Preclinical phase- initial testing, lab animals, and 1-2 years
Phase 1- determine effects, safe dosage, less than 100 healthy volunteers, less than 1 year
Phase 2- assess drugs effectiveness in treating a specific disease, 200-300 with disorder, 2 years
Phase 3- assess safety and effectiveness in large population, 1,000-3,000 people, 3 years
Phase 4- monitor any problems that occur after NDA approval, general patient population, indefinite
What is an orphan drug?
given small funding for small population with the rare disease
What is off label prescribing?
the use of a drug to treat conditions other than those that the drug was originally approved to treat
What are the enteral routes of drug administration?
What are the parenteral routes of drug administration?
Oral buccal rectal
Inhalation, injection, topical, transdermal
What is bioavailability?
the extent to which the drug reaches the systemic circulation
What is the primary site for drug excretion?
kidneys
Necrosis vs Apotosis
Cell size
Plasma membrane
Cellular contents
Adjacent inflammation
Cell size
necrosis is enlarged and apoptosis is reduced
Membrane
necrosis is disrupted and apoptosis is intact
Contents
Necrosis may leak out of cell and apoptosis is intact
Adjacent inflammation
Necrosis is frequent and apoptosis is no inflammation
What are the 4 cardinal signs of inflammation?
erythmea
heat
edema
pain
Inflammatory Exudates
Sanguineous
Serosanguineous
Serous
Purulent
Catarrhal
bright red or bloody; presence of RBC
blood tinged yellow or pink, RBC
thin, clear yellow or straw colored, contains albumins and immunoglobins
viscous cloudy pus cloudy debris from necrotic cells
thin, clear mucus
What is the lifespan of neutrophils?
What replaces neutrophils to clean up cellular debris?
24 hours
Macrophages
histamine is in what cells?
Important for?
Mast cells, basophils, and platelets
allows fluids and blood cells to exit into the interstitial spaces
What are the phases of healing?
Homeostasis and degeneration, inflammation, proliferation and migration, remodeling and maturation
Regeneration of what can only occur when the basement membrane is in tact?
The lung
Cortical bone is how much of skeletal tissue?
Cancellous bone is how much of skeletal tissue?
80 percent
20 percent
What is the reparative phase?
Begins during the next few weeks and includes the formation of the soft callus seen on x rays around 2 weeks after the injury, which is replaced by the hard callus
What part of the meniscus has blood supply?
Inner 2/3 has no blood supply
Outer 1/3 has blood supply
What is metaplasia?
What is anaplasia?
What is hyperplasia?
The first level of dysplasia, reversible but benign
Loss of cellular differentiation, advanced form of metaplasia
Increased number of cells in tissue
Stages of cancer?
Stage 0- carcinoma in situ
Stage 1-early stage local cancer
Stage 2- increased risk of spread because of tumor size
Stage 3- local cancer has spread
Stage 4- cancer has spread to distant sites
How does the TNM staging work?
T- primary tumor
N- lymph node
M- metastasis
T0, N0, M0- no metastasis
T1, N1, M1- increasing involvement of metastasis
What is the most prevalent cancer in the world?
For men and women?
Lung cancer and is the most deaths worldwide
Men prostate
Women breast
Abut what percentage of clients have newly diagnosed cancers with detectable metastases?
30 percent
Cancer pain occurs in approx.
1/4 adults with newly diagnosed malignancies
1/3 individuals undergoing treatment
3/4 with advanced disease
What may increase the person’s perception of cancer pain?
Depression and anxiety
Chemotherapy is most effective in what stage?
Cells are most sensitive to radiation therapy in what stage?
Stem cells in what phase are resistant to chemotherapy and radiation therapy?
DNA synthesis and mitosis
G2
G0
What are the two types of lymphocytes?
B lymphocutes
T lymphocytes
Helper T Cells
Cytotoxic T cells
What are the 3 different types of immunglobulins?
IgM- first secreted antibody, produced by B cell
IgG- secondary response
IgA- in serum and secretions
Mechanisms of Tissue Destruction
Rate of Development, Antibody Involved, Principal Cell, Disorders
Type 1 IgE
Type 2 Tissue Specific Reaction
Type 3 Immune Complex mediated reaction
Type 4 Cell mediated reaction
Type 1- immediate, IgE, Mast cells, Seasonal allergic rhitnis
Type 2- immediate, IgG and IgM, macrophages, graves disease
Type 3- immediate, IgG and IGM, neutrophils, systemic lupus erythematosus
Type 4- delayed, none, lymphocytes and macrophages, contact sensitivity
Elevated WBC count?
Decreased WBC count?
Most abundant WBC type?
Leukocytosis
Leukopenia
Neutrophil
Chain of transmission steps
- pathogen
- reservoir
- portal of exit
- mode of transmission
- portal of entry
- host susceptibility
What is the Varicella Zoster virus?
What type is mononucleosis?
Herpes virus type 3 and is very contagious also known as chicken pox or shingles
Type 4
Common patterns of pain referral?
Pancreas, liver spleen, gallbladder?
Shoulder?
Heart?
shoulder mid thoracic and low back
neck, upper back
Shoulder neck upper back and TMJ
What are the three major types of antigen presenting cells?
Macrophages, dendritic cells, and B cells
MHC class 1 vs class 2?
Class 1- can be recognized by Cytotoxic T cells CD8
Class 2- can be recognized by helper t cells CD4
What is the correct order for the HIV life cycle?
Bind, fusion, reverse transcription, integration, replication, assembly, budding
What virus is a DNA virus?
What virus is a herpes virus?
What virus is a respiratory infection?
Hep B and Hep C
Varicella-zoster virus
Flu and Covid 19
What is somatic mutation theory?
Early in the study of cancer, the concept that neoplasia originates in a single cell
What are carcinogens?
etiologic agents capable of malignant transformation of a cell
What is a clinical manifestation of cancer?
Most are asymptomatic
What is an example of adaptive immunity?
Vaccines
What is in the body’s third line of defense?
T cells and B cells
Cancer pain in hospice care how can It be treated?
Biophysical agents
Etiology and pathogenesis of cancer pain?
some pain is caused by pressure on nerves or by the displacement of nerves
What is the physiologic effect of cortisol?
increases output of glucose from liver
Most common site of diverticular disease?
sigmoid colon
What will likely refer pain to the left shoulder?
After rupture of the spleen
What is the appropriate action for a patient who comes in complaining of headache?
check patient’s vital signs and blood sugar level
What is the position to promote optimal respiratory function?
Semi fowler’s
Which islet cells produce somatostatin?
Delta cells
What is a clinical manifestation of metabolic syndrome?
atherogenic dyslipodemia
What % off BW does skin consist of?
15-20%
Aging contributes to what deficiency which can lead to what?
Vitamin D deficiency, Osteoperosis
Bacterial infections?
Viral infections?
Fungal infections?
Cellulitis, impetigo
Herpes zoster, warts
Athletes foot, ringworm, yeast
First vs Second vs Third Degree burn?
Superficial- EpidermisSunburn and UV exposure
Partial Thickness-dermis,scalding liquids
Full Thickness- sub cutaneous, prolonged exposure y]to flame
What kind of burns account for 75% of all burn center admissions?
Thermal burns
What is the most common and life threatening complication or burn injuries?
Infection
What are the 3 stages of medical management of severe burn?
- Emergent phase
- Acute phase
- Rehab phase
What are the different skin transplantations?
Autograft- persons own skin, treat full thickness burn
Allografts- homografts, cadaver skin
Xenografts- heterografts, typically pig skin
Bio synthetic grafts- combo of collagen and synthetics
Neuropathic ulcers may be classified using what system?
Wagner system
Pressure injuries usually occur over?
Heels sacrum ischial tuberosities greater trochanter, elbow and scapula
What are the stages of pressure injuries?
Stage 1- nonblanchable erythema of intact skin
Stage 2- partial thickness skin loss with exposed dermis
Stage 3- full thickness skin loss
Stage 4- full thickness skin and tissue loss
What scale is used to determine if someone will get a pressure ulcer?
Braden scale
Cardiovascular disease accounts for what % of death of people aged 65 and older?
80%
Optimal cholesterol levels?
BP? Waist Circumference?
HDL- 40 in men nd 50 in women
Total cholesterol- 150
LDL- about 100
Triglycerides- less than 150
BP- 130/85
Waist circumference- 40 in men and 35 in women
Categories of BP in adults?
Normal- <120/80
Elevated- 120-129/<80
Stage 1 HTN- 130-139/80-89
Stage 2 HTN- >140/90
Orthostatic hypotension
Decrease of 20 mmHg or greater in SBP or drop of 10 mmHg or more in systolic and diastolic
What is an aneurysm?
Most common type?
An abnormal stretching in the wall of an artery vein or heart by 50 %
Abdominal aortic aneurysm
Deep vein thrombosis and pulmonary embolism referred to as____
VTE is the most common reason for?
Venous thromboembolism VTE
Hospital readmission and death after total hip and knee arthroplasty
Primary hemostasis?
What is VWF?
Formation of platelet plug at the site of vascular injury normal number of platelets and VWF
Plasma proteins that mediates the Initial adhesion, Binds and stabilizes blood clotting 8 in circulation
What is thrombocytopenia?
Common causes?
Main symptom?
A decrease in platelet blood count below 150,000 of blood caused by inadequate platelet production
Medications or supplements are common causes
Main symptom is mucosal bleeding
What is hemophillia?
Hemophillia A?
Hemophillia B?
A bleeding disorder inherited as an x linked chromosome autosomal recessive trait
A- 80% lack of clotting factor 8
B- 15% Lack of clotting 4
Severe hemophillia?
60% of people
May bleed spontaneously or with slight trauma particularly into joints and deep muscle
What is starling law?
Fluid at the arterial end of the capillary will tend to flow into the tissue spaces
The lymphatic organs include»
Thymus, bone marrow, spleen, tonsils, Peter patches of small intestine
Right extremity and thoracic lymphotome drain into?
Left extremity left thoracic lymphotome drain into?
Right lymphatic duct
Left subclabian vein
Lymphangitis?
Lymphadenitis?
Lymphedema?
Lymphadenopathy?
Inflammation of lymphatic vessel
Inflammation of one or more lymph nodes
An increase amount of lymph fluid
Enlargement of the lymph nodes
Normal PaO2?
Normal SaO2?
PaO2- 80-100 mmHg
SaO2 and SpO2: 95-100%
Aspiration Pneumonia?
Viral Pneumonia?
Bacterial Pneumonia?
Fluids or other material from oral cavity is aspirated the Lower tract
Respiratory syncytial virus common in infants
Streptococcus pneumoniae the most preveoant bacterial pathogen
Acute bronchitis?
Caused by?
An inflammation of the trachea and bronchi that is short duration 1-3 weeks
Caused by viral infection
Chronic bronchitis?
Condition of productive cough lasting at least 3 months per year for 2 consecutive years
What is emphysema?
Main etiologic factor?
Enlargement of the air spaces beyond terminal bronchioles and is associated with loss of elasticity in the distal airways, airway collapse and gas trapping
Cigarette smoking
Pathogenesis of Asthma?
Mechanisms of airway obstruction by the immune system
T helper cells secrete cytokines which contributes to inflammation mediated by IgE
IgE is present on mast cells and other airway cells
What % of people with sleep apnea are obese?
70%
Drug Drug Interaction?
Drug-Disease interaction?
Overdosage toxicity?
Drug Drug- medication interact unfavorably
Drug Disease-medication causes an existing disease to worsen
Predictable toxic effect that occurs with dosages in excess of therapeutic range for persom
ADE is a national health problem… over ____ million people misuse opioid. more than ____ people dying each day from opioid overdose
!1.4 million
130 people
In developed countries approx ___ % of patients aged 65 or older are prescribed how many drugs?
30% and 5 drugs
Normal serum pH is….
7.35 to 7.45
Acidosis vs Alkalosis
Respiratory acidosis vs alkalosis?
Acidosis is when H+ increases and pH decreases
Alkalosis is when H+ decreases and pH increases
CO2 increases, pH decreases
CO2 decreases, pH increases
Peripheral nerve repair?
Rapidly undergoes myelin degeneration, within 2e hours new Asian, sprouts from central stump are observed
