Final Exam Flashcards
Atrophy
a decrease in the size of a tissue or organ due to cellular shrinkage; the decrease in cell size is caused by the loss of organelles, cytoplasm and proteins.
* caused by mutations, poor nourishment, poor circulation, loss of hormonal support, loss of nerve supply to the target organ, excessive amount of apoptosis of cells, and disuse or lack of exercise or disease intrinsic to the tissue itself
Dysplasia
the abnormal growth or development of a tissue or organ
Hyperplasia
an enlargement of an organ or tissue caused by an increase in the amount of organic tissue that results from cell proliferation
* refers to increase in number
Hypertrophy
an increase and growth/thickening of muscle cells
* refers to increase in size
Metaplasia
the replacement of a mature, differentiated cell type by another mature, differentiated cell type that does not typically occur in the tissue in which it is found
* occurs in tissues constantly exposed to environmental agents, which are often injurious in nature
Iron Deficiency Anemia
Patho
* The body lacks adequate RBCs (Red Blood Cells) to carry oxygen around the body to perfuse the tissues.
Causes
* Lack of iron, B12 & other building blocks
* Diet low in: meat, fish, & poultry
* Pregnancy: fetus stores iron
* Pica: * LOW hematocrit and hemoglobin levels
* Gastric Bipass Surgery
S/S
* tired, fatigued & pale skin, with shortness of breath and dizziness
* Stomatitis - inflammation of mouth & lips
* Glossitis - inflammation of the tongue
Treatment
* Meat, Fish, Poultry
* Spinach “green leafy, veg” & whole grains
* Foods high in Vit C
Hemolytic Anemia
Patho
* a disorder in which red blood cells are destroyed faster than they can be made
Causes
* inheriting genetic conditions that cause anemia
* certain infections
* certain medications
S/S
* Jaundice
* SOB
* Fatigue
* Tachycardia
* Hypotension
Treatment
* blood transfusions
* bone marrow stem cell transplant
* lifestyle changes
Aplastic Anemia
Patho
* a condition that occurs when your body stops producing enough new blood cells
Causes
* Bone Marrow damage - The damage may be present at birth or occur after exposure to radiation, chemotherapy, toxic chemicals, some drugs, or infection.
S/S
* Fatigue, frequent infections, rapid heart rate, and uncontrolled bleeding
Treatment
* medications, blood transfusions, and stem-cell transplants
Sickle Cell Anemia
Patho
* The RBCs have a distorted shape, transforming from a nice round plump shape to a skinny sucked in sickle shape. These misshapen RBCs die quicker than normal RBCs, carry less oxygen to the body & get clogged in tiny blood vessels - blocking or occluding the blood supply causing ischemia to the organs.
* A vaso-occlusive crisis or“sickle cell crisis” can occur, causing extreme pain from the lack of oxygen.
S/S
* Blood clot manifestations: One-sided arm weakness, Swelling of the feet and hands (Dactylitis), sudden inability to be aroused
Complication
* Splenic sequestration crisis: rapidly enlarging spleen, low BP
Treatment
* Hydration: IV fluids
* Bed rest
* Pt control analgesia pump
Pernicious Anemia
Patho
* The body cannot absorb B12, which is a vital building block to
create RBCs. Clients lack intrinsic factor in the GI tract, which
helps the body take in B12.
Cause
* An autoimmune condition in which the body’s immune system attacks the actual intrinsic factor protein or the cells in the lining of your stomach that make it.
S/S
* Glossitis: inflammed smooth red tongue
* extreme weakness
* Jaundice
Treatment
* B12 injections IV or IM
Cell Lines
- A defined population of cells that can be maintained in culture for an extended period of time, retaining stability of certain phenotypes and functions.
- Cell lines are usually clonal, meaning that the entire population originated from a single common ancestor cell.
Deep Vein Thrombosis
Patho
* clot in deep vein
Causes
* being sedentary
* OCP
* pregnancy
* age
* injury
* obesity
S/S
* Calf pain and cramping
* One sided swelling
* Warm and red from blood pooling
* SOB and chest pain - alert HCP
Treatment
* anticoagulants: heparin and warfarin
* compression socks
Leukemia
Patho
* A type of cancer that affects the blood cells & bone marrow. Bone marrow is responsible for making blood cells: WBCs, RBCs, platelets. In Leukemia there is an overproduction of white blood cells (WBCs) that crowd out the production of normal cells, leading to low RBCs & low platelets.
S/S
* Frequent infections
* Fatigue, Unsteady Gait, Pale “Pallor”
* Bruising, Petechiae, & Easy Bleeding
* Weight Loss & Anorexia
* Bone pain
Diagnostic
* Bone marrow biopsy from posterior iliac crest
Treatment
* Radiation & Chemotherapy to kill the cancer.
Lymphoma
Patho
* Lymphoma is cancer within the lymphatic system, the body’s disease fighting
network including:
* Lymph nodes - the drainage tubes that help to empty the waste
* Spleen - houses the white blood cells (WBCs), which help to defend the body
against infection
* Thymus gland & bone marrow
Diagnostics
* Hodgkin’s = Reed-Sternberg
* Non-Hodgkin = NOT Reed-Sternberg
Cause
* Epstein-Barr Virus
S/S
* Painless Bumps & “Lumps under arm”
* Enlarged lymph glands
* Fever (no chills or feeling bad)
* Weight Loss
* Infections
* Night sweats (changing sheets)
Treatment
* chemotherapy or radiation
Multiple Myeloma
Patho
* Cancer of plasma cells
* The disease can damage the bones, immune system, kidneys, and red blood cell count.
S/S
* Fatigue and weakness due to anemia
* Easy bruising or bleeding
* Paleness
* Tingling or numbness in the fingers or toes
* Frequent infections and poor healing from infection
* Bone pain, usually in the back and ribs
* Broken bones, often in the spine
* Feeling very thirsty
* Weight loss
* Nausea or constipation
* Frequent urination, or no urination at all over a longer period of time
Treament
* chemo
* stem cell or bone marrow transplant
Neutropenia
Patho
* An abnormally low count of a type of white blood cell (neutrophils)
Cause
* It can be caused by diseases that damage the bone marrow, infections, or certain medications.
S/S
* fever, mouth ulcer, sore throat, or susceptibility to infection
Treatment
* avoid those with infections
* bone marrow stimulants
Anaphylaxis
Patho
* Severe allergic reaction
S/S
* Tachycardia
* Palpitations
* Dizziness
* Hives
Treatment
* Epi-Pen
Candidiasis
Patho
* a fungal infection caused by a yeast (a type of fungus) called Candida
Causes
* antibiotics
* pregnancy
* uncontrolled diabetes
* impared immune system
S/S
* itching
* rash
Treatment
* anti-fungal medications
Fever Treatment
- rest
- fluids
- antipyretic - acetaminophen
Histamine Release and Side Effects
- Released from cells in response to an antibody called immunoglobulin E (IgE). This antibody may be secreted in response to an invading pathogen such as a virus, bacteria, or an allergenic substance such as pollen.
- Histamine can also be released in response to injury caused by toxins.
- Side Effects: itching, throat closing, NVD, anaphylaxis
Inflammatory Response
The inflammatory process, or simply inflammation, is a defensive mechanism that helps protect the body against infections and injuries. It can be caused by external triggers, such as pathogens and environmental substances; and internal triggers, like cellular injury. The vascular response includes transient vasoconstriction, followed by and vasodilation; while the cellular response includes the mobilization of immune cells and an outpouring of chemical mediators. During the inflammatory process, fluid that leaks from blood vessels and accumulates in the tissue, which is called an inflammatory exudate. Finally, local signs of inflammation include heat, pain, redness, swelling, and loss of function; while systemic signs include fever, malaise, nausea, anorexia, tachycardia, and tachypnea.
https://www.osmosis.org/learn/Inflammatory_process:_Nursing
MRSA
Patho
Methicillin-resistant Staphylococcus aureus
* A staph infection that is difficult to treat because of resistance to some antibiotics. Staph infections—including those caused by MRSA—can spread in hospitals, other healthcare facilities, and in the community where you live, work, and go to school.
S/S
* Swollen, painful red bumps
* Full of pus or other drainage
* Accompanied by a fever
Treatment
* antibiotics
Parasympathetic Response to Infection
modulates inflammation by acting as an anti-inflammatory neural circuit
Sympathetic Response to Infection
Protection of body tissues against challenges arising from the environment as well as from within the body. This function includes the modulation of inflammation, nociceptors and above all the immune system
Type 1 Hypersensivity
Type I hypersensitivity reactions are also called immediate reactions because they are the fastest out of the 4 different hypersensitivity types. This is because mast cells and basophils are primed by antigen specific IgE antibodies during the initial exposure to the antigen, so when the body is exposed to the antigen in the future, the mast cells are ready to attach to the antigen and release proinflammatory molecules.
One of these is histamine and it could cause vasodilation, increase vessel permeability, and cause smooth muscle contractions. Other proinflammatory molecules like interleukin and prostaglandin attract more immune cells to the area which ramps up the immune response. The antigens that trigger a type 1 hypersensitivity reaction are called allergens and common ones include bee venom, foods like peanuts, shell-fish, airborne particles like pollen or animal dander, or contact based allergens like latex or animal hair.
Disease caused by type 1 hypersensitivity include Asthma, allergic rhinitis, contact dermatitis, and eczema. The most dangerous perhaps is anaphylaxis, which is a systemic condition that could cause anaphylactic shock and even death.
Type 2 Hypersensitivity
Type II hypersensitivity reactions are mediated by autoantibodies against the body’s own cells, which activate cellular toxicity mechanisms. The main risk factor is having a blood transfusion, as well as a personal or family history of type II hypersensitivity reactions. Common types of type II reactions include immune thrombocytic purpura, autoimmune hemolytic anemia, pernicious anemia, rheumatic fever, Goodpasture syndrome, and transfusion reactions.
Type II hypersensitivity begins when the body is exposed to an antigen and IgM or IgG antibodies are produced. These antibodies can be directed against a foreign antigen, like a medication or a red blood cell from a transfusion; or against self antigens. Autoantibodies can cause damage to self cells, which is the case with Goodpasture syndrome, a condition associated with kidney and lung damage; or disrupt the normal function of cells, like with myasthenia gravis and Graves disease. Additional manifestations depend on the particular type of reaction.
Type 3 Hypersensitivity
With type III hypersensitivity reactions, IgM or IgG antibodies bind to soluble antigens, forming immune complexes that precipitate in small blood vessels in the skin, kidneys, lungs and joints. Here, they activate the complement system, and cause tissue damage.
Important risk factors include positive family history; genetic predisposition; infections, like hepatitis B; vaccines, antitoxins, and antivenins; and using some medications, like penicillins and cephalosporins. Some common types of type III hypersensitivity reactions include those associated with systemic lupus erythematosus, rheumatoid arthritis, serum sickness, post-streptococcal glomerulonephritis and hypersensitivity pneumonitis. Clinical manifestations vary depending on the specific condition.
Type 4 Hypersensitivity
A type IV or delayed T cell mediated hypersensitivity reaction is when T cells overreact to an antigen, most commonly viruses, bacteria, fungi, some medications like antibiotics or anticonvulsants, or plant oils like in poison ivy. Pathology-wise, type IV reactions occur when T helper cells or killer T cells overreact to exogenous or endogenous antigens and over proliferate. So if the antigen is encountered again, a larger than normal immune response occurs.The end result in inflammation and destruction of surrounding tissue.
Some common types of type IV reactions include allergic contact dermatitis, the PPD test, endocrine conditions like type I diabetes and Hashimoto’s thyroiditis; multiple sclerosis, sarcoidosis, Crohn disease, Stevens-Johnson syndrome, transplant rejections, and drug induced hypersensitivity syndrome. Clinical manifestations vary depending on the specific disorder.
Appendicitis
Patho: Inflammation of the vermiform appendix
* Inflammation accompanies the ulceration and temporarily obstructs the appendix
* Obstruction, if present, is usually caused by stool
* Mucus outflow is blocked, which distends the organs
* Pressure within appendix increases and appendix contracts
* Bacteria multiply and inflammation and pressure continue to increase, affecting blood flow to the organ and causing severe abdominal pain
S/S
* Periumbilical pain with progression and radiation to **RLQ **
* With rebound tenderness
* Pain between right hip area and belly button
* Low-grade fever
Complication
* Rupture is life threatening, appendectomy is only treatment
* Perforation: peritonitis
* High fever
* Tachycardia and pnea
* Rigid board like abdomen
Treatment
* Watch and wait
* Antibiotics
* Surgery
* No heating pads
* No laxatives and enemas: no added pressure to bowels
Need CT scan for diagnosis
AST/ALT
Liver Enzyme Tests
* enzyme released from hepatic cells when there is cell lysis - pancreatitis, cirrosis, hepatitis.
* normal range: 8-20
Cholecysitis
Patho
* Inflammation of the gallbladder caused by gallstones
* Block ducts, creates backup of bile and inflammation
Risk Factors
* Obesity and high calorie, high cholesterol diet
* Increased estrogen levels
* Use of clofibrate
* Age over 40
* Diabetes mellitus, ileal disease, blood disorders, liver disease, or pancreatitis
S/S
* RUQ pain that radiates to right shoulder
* N/V
* high WBC
* Fevers with chills
* Tachycardia
* High bilirubin: jaundice, dark urine, light colored stools
* Lack of enzymes from pancreas can make steatorrhea
Treatment
* Dietary modification
* Lifestyle modifications
* NPO, IVF, antibiotics
* Surgical removal
* Gallbladder removal
* Choledochotomy
* Exploration of common bile duct
Constipation
Patho
* Infrequent bowel moments
* Less than 3 stools per week
* Lumpy, hard stools
* Straining to have a bowel movement
Causes
* stress
* low fluid and fiber
* lack of exercise
Treatment
* high fluid and fiber
* ambulation
* laxatives
Complications
* Fecal incontinence (encopresis): leakage of stool
* laxative overdose: NVD, abdominal cramping from dehydration and electrolyte
Crohn’s Disease
Patho
* Inflammation of any part of the GI tract
* Mouth to anus
* Skip lesions that do not bleed
* Good tissue mixed with bad tissue
* Inflamed tissue with fistulas, fissures, and abscesses
* Granulomas: bumps and lumps all over the small intestine
* Malabsorption of nutrients
* Inflammatory Bowel Disease, autoimmune
Types
* Regional enteritis
* Of the colon
Causes
* Stress, smoking, sepsis
* Lymphatic obstruction
* Infection
* Allergies
* Immune disorders
* Genetic factors: Nod2 mutation
S/S
* 5 loose stools per day with no blood
* Steatorrhea
* Abdominal pain
* Diarrhea
* Possible constipation
Complication
* Clotting disorders
* Jaundice
* Edema
* Metabolic disorders
* Toxic megacolon: becomes too big and spill of feces into cavity
* Rapid death from peritonitis: report to HCP
* Fever over 100.3
* Rebound tenderness
* Rigid board like abdomen
* Restlessness
* Tachycardia and pnea
Treatment
* Drugs
* Sulfasalazine: inflammation
* Steroids: for swelling
* Antidiarrheal: loperamide “low bowel movements”, dicyclomine “dry cycle”
* Diet
* Surgical: ostomies
Diarrhea
Patho
* loose, watery and possibly more-frequent bowel movements
* may be an indicator of IBS, IBD, celiac, C-diff
Causes
* viruses, bacteria, parasites
* meds
* lactose intolerance
* digestive disorders
S/S
* abdominal cramping and bloating
* NV
* vomiting
* fever
* blood or mucus in stool
Treatment
* IV fluids
* check electrolytes
* add antidiarrheals when no infections are present
Diverticulitis
Patho
* small, bulging pouches (diverticula) develop in your digestive tract and become inflammed
Causes
* constipation, withholding stool
S/S
* diarrhea
* abdominal pain
* feeling need to defecate and cannot
Complication
* perforation
Treatment
* diet modifications, exercise
* fluid replacement
* meds: antibiotics, analgesics, antispasmodics
* colon resection, temporary colostomy
Gastritis
Patho
* inflammation of the lining of the stomach
* acute or chronic
Acute
* Inflammation of gastric mucosa (stomach lining)
Causes
* Alcohol & spicy food
* Aspirin
* NSAIDs
Manifestations:
* Hematemesis (vomiting blood)
* Epigastric pain (heartburn) & cramps
Chronic
* Atrophy of gastric mucosa
Cause
* H. Pylori infection
Complications:
* Increased risk for peptic ulcers & gastric cancer
GERD
Patho
* Backflow of gastric or duodenal contents into esophagus and past lower esophageal sphincter
* Heartburn
* Can lead to inflammation and even cancer
Causes
* Weakened lower esophageal sphincter
* Increased abdominal pressure
* Hiatal hernia: upper part of the stomach bulges, and acid gets stuck
* Medications
* Food or alcohol ingestion or cigarette smoking
* Nasogastric intubation for more than 4 days
S/S
* NV
* Burning sensation in throat, chest
* Epigastric pain following a meal
* Radiating pain to the arm and chest
Treatment
* diet therapy: small meals
* positioning: lie down 3 hours after a meal
* increased fluid intake
* stop smoking
* surgery: tighten LES
* Upper gastrointestinal endoscopy: see if the lower esophageal sphincter is closing properly
* Meds: antacids, H2 blockers, PPI
GI Bleed
Causes
* Upper: gastritis, GERD, peptic ulcer, esophageal varcies from cirrhosis
* Lower: hemorrhoids, colorectal cancer, diverticulosis, UC
S/S
* Upper: vomiting “coffee ground emesis” - blood that has been digested
* Melena stool: blood from upper and made it through digestion
Complications
* Hypovolemic shock - hemorrhagic shock
* Low CBC: H&H
IBD
Inflammatory bowel disease (IBD) is a term for two conditions (Crohn’s disease and ulcerative colitis) that are characterized by chronic inflammation of the gastrointestinal (GI) tract.
Pancreatitis
Patho:
* Inflammation of the pancreas
* Autodigestion of own enzymes: protease, lipase, amylase
Cause
* Biliary tract disease
* Alcoholism
* Gallbladder disease
* CF
* Surgery that causes trauma: ERCP procedure, clears gallstones
Diagnostics
* Elevated enzymes - amylase, lipase
* Elevated glucose, lack of insulin
* Elevated WBC over 10k: fever
* Elevated coagulation time: PT and aPTT
* Elevated bili
S/S
* LUQ pain, may have epigastric pain or pain radiating to the back
* Bruising: Turner’s sign - on side of body, Cullen’s - on abdomen near bellybutton
* Liver disease symptoms: jaundice, HTN
Treatment
* maintain circulation, fluid volume, and pain relief
* NPO because eating stim more enzymes
* IV pain meds: hydromorphone
* meds: antacids, PPI, H2 blockers
* diet low in fat and sugars, enzymes with meals
Peptic Ulcer Disease
Patho
* Open sores in mucosal membrane of upper GI tract - stomach
* Erosions in lining of stomach and adjacent areas of the GI tract from the gastric acid
Types
* duodenal
* gastric
* stress: from traumatic event
Cause: Gastric
* gastric pain
* Gnawing, dyspepsia: burning pain to the back, often occurring after meals
* weight loss
* vomiting blood
Duodenal
* Pain decreased with food, 2-3 hours after meals
* Worst at night
* Weight gain
* Blood in stool “melena” dark tarry stool
Complication
* GI bleed
Treatment
* drugs and surgery
Ulcerative Colitis
Patho
* Inflammation of the mucosa in the colon that causes ulcerations
* Bleeding colon, sores
* Inflammatory Bowel Disease, autoimmune
Causes
* Related to abnormal immune response to GI tract
* Stress, smoking, sepsis
S/S
* Lower quadrant pain
* Cramping
* 15-20 Bloody stools per day
* Cause anemia and decrease in H&H
* Rebound tenderness – must be reported
Complication
* GI bleed
Treatment
* Diet mod
* Drugs
* Surgery
Hepatitis
Patho
* most common infection that leads to liver failure
Cause
* Post viral infection
* Alcohol
* Autoimmune diseases
* Unprotected sex
* Sharing blood and body fluids
S/S
* Three or more liquid stool/day for more than 2 days
* Flu like symptoms
* NV
* Elevated liver enzymes: ALT and AST, bili: jaundice
* Pruritus: itching
* Dark colored urine
* Clay colored stools
* Elevated PT and aPTT: bruising
* Low albumin: edema, cannot attact water
Treatment
* New drugs vs interferon alpha
* Post-viral infection commonly resolves within a few weeks
* Apply moisturizer and use cold compresses, stay out of sun
BPH
Patho
* prostate enlargement that compresses the urethra & surrounding bladder causing difficulty urinating
S/S
* Urinary retention
* Urinary frequency
* Nocturia
* Straining to void
Complications
* UTI S/S
Treatment
* avoid caffeine and bladder training
* Finasteride
BUN
Blood, urea, nitrogen
* 6 to 24 mg/dL
* How are the kidneys working
* Can fluctuate with protein intake
* Indicator of hydration
Creatinine
A waste product that comes from the normal wear and tear on muscles of the body.
* Over 1.3 = damaged kidney
