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Adults > Heme > Flashcards

Heme Flashcards

1
Q

Bone marrow function

A

Produces WBC (T + B cells)

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2
Q

Lymphoid Tissues

A

Spleen and Lymph nodes

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3
Q

Lymph Nodes

A

stores for white blood cells. They release when your body is getting sick

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4
Q

Spleen

A

filters out old and injured RBC

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5
Q

Natural/innate immunity

A

Defense against and resistance to infection
Inflammatory response
Physical barriers
o Gastric Acid, skin
Chemical Barriers
Cellular defenses
Immunoregulation

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6
Q

Acquired Immunity

A

Learned immunity through exposure of vaccinations

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7
Q

Active Acquired Immunity

A

actively gotten the illness and have created your own antibodies. Usually, you have these for a long time.

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8
Q

Passive Immunity

A

temporary loan from a source outside of your body. This is an antibody from someone else that helps your body fight short term. It will not make its own antigens
Ex: Breast milk

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9
Q

Phagocytic immune response:

A

o Comes through and gobbles up the invaders
o First line defense.
o Phagocytes attack invaders when they are found
o Macrophages and -phils

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10
Q

Humoral or ANTIBODY response

A

o B-cells know who to call to fight it
o Second response
o Recognize something you have seen before
o Sees it and responds quickly
o Production of antibodies

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11
Q

IgG

A

75%. Most important. Most prevalent. Found in blood and tissue. Activates the compliment system and calls the immune system buddies that it needs help. This is the one that we have seen a genetic deficiency with and it is bad. ENHANCES PHAGOCYTOSIS

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12
Q

IgA

A

15%
Found in breast milk, salaiva, tears, and intestinal secretions

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13
Q

Cellular response (T-Cells)

A

o Call the T cells to come in and kill it
o Cell mediated immunity
o T-cells come up and attack the invader
o Mature in the THYMUS
o They circulate alone in the blood stream. They look for the invaders and attack the invaders
These do NOT produce antibodies

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14
Q

3 responses to invasions

A

Phagocytic immune response
Humoral or antibody immune response
Cellular immune response

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15
Q

Bodily Response to Humoral Immunity

A

anaphylaxis
Hay fever
immune complex disease
bacterial and viral infections

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16
Q

Bodily Response to Cellular immunity

A

Delayed hypersensitivity
Transplant surgery
graft vs. host disease
Tumor surveillance

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17
Q

Fighter T cells (CD4 cells)

A
  • Facilitates action of other types of T+B cells
  • Simulate immune system
  • Release cytokines
  • Stimulate the immune system
  • These get attacked by HIV
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18
Q

CD8 cells

A

Directly attack and destroy the antigen

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19
Q

Natural Killer Cells

A
  • Destroy infected and stressed cells
  • Secrete macrophage/cytokines
  • ***This will trigger the inflammatory response!
    o This is what gives us our signs and symptoms of infection
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20
Q

Cytokines

A

Produced by lymphocytes and mediate reaction between cells

Enhance of phagocyte activity
Regulate lymphocyte and production of function
Triggers inflammatory response
Lymphnodes production

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21
Q

Interleukins

A

type of cytokine that activates inflammation

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22
Q

Colony Stimulating Factor

A

type of cytokines that turn up production in the bone marrow

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23
Q

Interferons

A

Type of cytokine with antiviral properties

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24
Q

Monoclonal antibodies

A

Made in lab to stimulate immune system

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25
Q

Tumor Necrosis Factor

A

Type of cytokine that induces endotoxic shock, growth factor for fibroblasts, narcotizes tumor cells

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26
Q

Cancer

A

abnormal cell growth. Cells ignore the growth regulation signals

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27
Q

Benign

A

tumor that is not cancerous

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28
Q

Malignant neoplasms

A

cancer cell growth

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29
Q

Tumor

A

abnormal tissue growth. cancerous or not cancerous

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30
Q

Metastasis

A

Spread of the cancer from the original site to another site

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31
Q

Carcinogens

A

Factors associated with cancer causation

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32
Q

Most common forms of cancer

A

Prostate and Breast because there is not much blood flow to that area

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33
Q

Carcinogen Examples

A

Viruses
Genetics (BRACA 1 and BRACA )
Lifestyle factors
Hormones changing

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34
Q

Primary prevention of Cancer

A

Reduce the risk before getting cancer

Vaccines
Not smoking
not going to a tanning bed

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35
Q

Secondary Prevention of Cancer

A

early detection and screening

Mammogram
going for skin checks
prostate exams

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36
Q

Tertiary Prevention of Cancer

A

After the diagnosis

Prevents some complications
treatment considered therapeutic to eradicate or arrest disease and prevent further complications

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37
Q

Oncogenes

A

Cells change into oncogenes and increase a persons risk of getting cancer

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38
Q

G0

A

Resting phase, no proliferation occurring

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39
Q

G1

A

RNA and protein synthesized

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40
Q

S

A

Synthesis of DNA and proteins of new chromosomes

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41
Q

G2

A

Preparation for cell division

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42
Q

M

A

Actual cell division (mitosis), producing 2 daughter cells

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43
Q

Cancer Pathophys

A

Go through the cell cycle much quicker and are less likely to enter into the G0 phase

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44
Q

Helpful tools to Diagnose Cancer

A

**Tissue biopsy

◦ Cytology results
◦ Lab results (hematological malignancies)
◦ CT, X-rays, MRI

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45
Q

Cancer Staging

A

determines the size, invasion, lymph node involvement, metastasis

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46
Q

Cancer Grading

A

Looking at the cell and determining how different the cells look compared to other cells. Higher the grade, poorer the prognosis

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47
Q

Stage 0

A

in situ: a bump that they can cut out. Very early

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48
Q

Stage 1

A

early invasion. No metastasis, no Lymph nodes involved

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49
Q

Stage 2

A

some spreading of the tumor and a LITTLE bit of lymph involvement (deeper in one spot)

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50
Q

Stage 3

A

Extensive local and lymphnode involvement

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51
Q

Stage 4

A

distant metastasis is the defining characteristic

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52
Q

Grade 1-2

A

well defined and don’t look crazy

53
Q

Grade 3-4

A

very different than how they should. Poorly differentiated because you might not know where they came from if you didn’t have a comparison.

54
Q

Prophylactic Surgery

A

preventing the chance (getting a mastectomy before you have the chance to get cancer)

55
Q

Radiation

A

kills the rapidly dividing cells. It cannot decipher what is a good or bad cell, so it gets all of the rapidly dividing cells

We do these intermittently to catch the cells at different stages of the cells cycle life

56
Q

Cells commonly affected by radiation

A

 Bone marrow
 Lymphatic tissue
 Epithelium of GI
 Hair follicles
 Gonads

57
Q

How to know how much radiation

A

BSA: body surface area when treating

Specific to the type of patient and the size of your patient

Ask patient to keep the same weight so that the chemo works accurately

58
Q

External beam Radiation

A

source outside of the body. Shot with a laserbeam. Gets a direct hit for local tx. They make an individual garment for you that will allow the laser to target exactly where they need to

All tissue in pathway is affected
People can live their life

59
Q

Internal radiation/Brachytherapy

A

the use of implants at treatment site. Pt.s have seeds that plug right into the tumor that releases radiation right to the tumor. Sealed source so it does not make the pt. radioactive.

Pt. is able to continue on with life

60
Q

Common Tissues for internal radiation

A

Lung, thyroid, and prostate. Typically a more fibrous tissue.

61
Q

Radioactive Isotope Radiation

A

liquid radiation that is injected or swallowed that is considered an UNSEALED source so that you are literally radioactive. Fluid is radioactive. Be careful when taking care of the patient

62
Q

Radioactive Isotope Considerations

A

 Patient is typically in the hospital
 Visitors are restricted in visitation because of exposure
 We see these in advance cases. This is a systemic treatment. Your entire body is radiating
 Body fluid precautions
 Itolation precautions

63
Q

External Beam adverse Effects/considerations

A

burn where the laser is hitting the body at the entrance and the exit

No powder
no soap
no ointments or deodorant or perfumes
no shaving with razorblades
DONT WASH OFF THE MARKINGS

64
Q

Radiation adverse effects

A

attacks bone marrow
fatigue
GI tract involvement (stomatitis and mucositis)

65
Q

Radiation considerations

A

Watch CBC, bone marrow suppression, maintain nutrition

66
Q

Antineoplastic Drugs

A

Work on rapidly dividing cells but they cannot distinguish between the good and the bad ones

67
Q

Principles of Chemo

A

Disrupts reproduction of cells by altering biochemical processes

Destroys malignant cells without excess destruction of normal cells

Given in repeated doses or cycles

Functional assessment and other clearance tests done before drugs begin

WE want to catch the cells in the different phases that they are dividing

We need cardiac clearance, pulmonary clearance, etc.

68
Q

Goals for Chemo

A

Cure
Control
Palliative

69
Q

Routes for Chemo

A

IV, Tompical, Intra-arterial, intracavitary, intraperitoneal, intrachial, IM, SQ, PO

70
Q

Chemo Adverse Effects on Blood

A

Leukemia
Anemia
Thrombocytopenia
May interrupt treatment schedules if levels are too low and blood needs to catch up

71
Q

Chemo Adverse Effect Mucositis/Stomatitis

A

Oral, rectal, vaginal

These tissues get irritated and painful

Ulcers in the mouth

Ulcers in rectum or GI tract

Can effect entire GI tract: severe diarrhea

72
Q

Doxorubicin

A

Cancer drug that is horrible for the heart (only once in a lifetime) and it needs to be preceded by Dexrazoxane to protect the heart

73
Q

Cisplatin
Cytoxan

A

Horrible for the kidney–we need to rehydrate

74
Q

5-FU (fluorouraci)

A

horrible chemo med for the liver

75
Q

Nonspecific Biologic Response Modifiers

A

Stimulate the immune system generally

76
Q

Monoclonal Antibodies

A

ex. trastuzumab

Destroy specific malignant cells and spare normal cells

77
Q

Gene Therapy

A

Targeted therapies to make it so you only have a son or so that your daughter wont have the BRACA gene

78
Q

What to watch with Chemo

A

Precautions r/t neutropenia, anemia, thrombocytopenia

79
Q

What pt. should expect on chemo

A

fatigue
pain
nausea
(promote bland non-acidic foods)

80
Q

Neutropenia

A

huge risk for infection
Fever is cardinal symptom!!! (38 is when we start getting worried)
Handwashing is crucial. Don’t touch anything
Staff wears a mask in the room and place on patient when patient is leaving the room
No fresh flowers or fruit or veggies, yogurt with active cultures

81
Q

Med to help with neutropenia

A

Filgrastim (colony stimulating factor)

we will expect bone pain so give ACETAMINOPHEN

82
Q

Thrombocytopenia

A

Common with Chemo
 WE are looking for bruising or bleeding
 WE don’t have many platelets
 Don’t use razors or sharp toothbrushes. Avoid IM injections
 May require platelet transfusion

83
Q

Risk Factors for HIV

A

Health care workers
Geriatric population (55-64 years of age)
Drug abuse (with needles)
Mother to baby

84
Q

HIV

A

retrovirus that attacks:
*Target cell - CD4 T lymphocytes
Monocytes
Dendritic cells
Brain microglia

85
Q

Enzyme Immunoassay (ELISA)

A

Positive results indicate HIV virus because it tests for positive antibodies but that takes 2+weeks to show up

86
Q

Antigen /Antibody Differentiation Tests

A

Used to confirm ELISA
Detects HIV virus right away

87
Q

CD4+ T cells

A

Count measures overall immune function
Used in HIV Staging

88
Q

HIV stage 0

A
  • Period when the person becomes infected and when those antibodies are made
  • First two weeks
     Highly infectious during this period
  • Fever
  • Fatigue
  • Lymphadenopathy
     High viral load
89
Q

HIV Stage 1

A

greater than 500 CD4 count

90
Q

HIV stage 2

A

200-499 CD4 count

91
Q

HIV stage 3

A

less than 200 CD4 count

92
Q

Symptoms of HIV

A

 Lack of energy
 Weight loss
 Fevers
 N/V
 Headache
 Truncal rash
 Ulcers of mouth, genitals, or both
 Thrush

93
Q

AIDS

A

Most advanced stage of HIV infection

94
Q

AIDS Definition

A

low CD4 count (less than 200) AND an AIDS defining illness

95
Q

AIDS defining illnesses

A

Pneumocystis Pneumonia
Mycobacterium avium complex
TB
Candidiasis (thrush)
Cancers
HIV encephalopathy
HIV wasting syndrome

96
Q

Medical Prevention of PrEP

A

pre-exposure prophylaxis
Limits spread

Ex. Tenofovir and emtricitabine

97
Q

Medical treatment of HIV

A

Mutates really rapidly so we have to use multiple drugs at the same time to combat the virus

98
Q

ART

A

Antiretroviral therapy: treats HIV

99
Q

HIV therapy adverse effect

A

Hepatotoxicity, nephrotoxicity, osteopenia, and increased risk of CVD and MI

100
Q

Long term non-progressor

A

Person doing well and keeping the HIV under control

101
Q

Long-term survivor

A

progressed to AIDS but they have not gone further than that

102
Q

Nursing intervention for HIV

A

Only thing we can do is try to not let them progress
Increase caloric intake and fluids
Maintain comfort and safety
Prevent fatigue
Patient/family education on preventing further infections

103
Q

Autoimmune Disorders

A

Immune system mistakes part of your body, like your joints or skin, as foreign. It releases
autoantibodies that attack healthy cells

104
Q

Autoimmune Disorders Pathophys

A

B cells overproduce
◦ Systemic inflammation
◦ Can target 1 organ (DM1) or many organs (Lupus

105
Q

Symptoms of Autoimmune Disorders

A

fatigue
◦ achy muscles & joints
◦ low-grade fever
◦ trouble concentrating/ brain fog
◦ numbness and tingling in the hands and feet
◦ hair loss
◦ skin rashes

106
Q

Antinuclear antibodies

A

Lab testing autoantibodies that attack structures in the nucleus of cells. Different patterns
on the ANA are correlated with different disease

107
Q

Erythrocyte sedimentation rate (ESR)

A

detects nonspecific inflammation in your body. An elevated (abnormally high) sed rate does suggest that
there is an ongoing inflammatory process in your body but does not indicate where or why

108
Q

VDRL (Serum Syphilis test)

A

Systemic inflammation may cause false positive resu

109
Q

Kidney Biopsy

A

May show antibody-antigen clumps blocking glomerulu

110
Q

Lupus

A

Inflammatory autoimmune disease, multiple organ involvement
◦ Antibody-Antigen complexes trapped in capillaries
◦ Antibodies destroy host cell

111
Q

Manifestations of Lupus

A

Chronic or acute states
◦ Fever
◦ Malaise
◦ Butterfly rash
◦ Joint & muscle pain
◦ Pericarditis, CP
◦ Nephritis

112
Q

Medical Management of Lupus

A

Prevention of organ damage
◦ Prevent complications
◦ Renal failure
◦ CVA /MI
◦ Pain
◦ Life threatening in Acute stage

113
Q

Drugs for Lupus

A

Immunosuppression
Corticosteroids
◦ Monoclonal Antibodies (MABs)
◦ Belimumab
◦ NSAIDS

114
Q

Nursing Management for Lupus

A

Avoid sunlight
Infection prevention
Diet Restrictions

115
Q

Sjogren’s Syndrome

A

Systemic autoimmune disease affecting lacrimal and salivary glands

116
Q

Manifestations of Sjigren’s Syndrome

A

Dry eyes
◦ Dry mouth
◦ Thick mucus
◦ Difficulty swallowing
◦ Skin rash
◦ Raynaud’s phenomenon

117
Q

Drug Therapy for Sjigrens

A

Artificial tears
Biotene rinse

118
Q

Diagnosis of Sjigrens

A

Ocular tests
Elevated ANA

119
Q

General treatments for Autoimmune disorders

A
  • Celecoxib
  • Prednisone
  • Adalimumab
  • Methotrexate
120
Q

Transplant Contraindications

A

Active systemic infection
 Malignant disease
 Active peptic ulcer disease
 Active abuse of alcohol or other substances
 Severe damage to other organ system
 Severe psychiatric disease
 Demonstrated non-compliance
 Lack of support system
 Lack of financial resources

121
Q

Common problems with braindead people that we need to watch for in order to keep their organs verifiable

A

Hypotension
 Shock
 Electrolyte imbalances
 Disseminated intravascular coagulation (DIC)
 Loss of thermoregulation

122
Q

Organ Viability (time per organ)

A
  • Kidney 42-72 hours
  • Heart: 4-5 hours
  • Lung: 4-6 hours
123
Q

Immunosuppressants used in transplant patients

A

Tacrolimus, Mycophenolate, and prednisone

124
Q

Hyper acute rejection

A

right when they put the organ in the body the immune system attacks immediately

125
Q

Acute rejection

A

1-3 months after the transplant the body rejects it

126
Q

Chronic rejection

A

results from medication non-compliance. Cumulative damage over years

127
Q

Signs/symptoms of rejection

A

o Fever
o Tenderness at graft site
o Fatigue
o Abnormal labs

128
Q

Malignancy in Transplants

A

o Caused by the immune-deficient state
o We see a lot of blood cancers with transplants

Adults (6 decks)

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