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Mary's Tests - Spring 2016 > Mary's Patho Test - Jan 2016 - Study Guide Review > Flashcards

Mary's Patho Test - Jan 2016 - Study Guide Review Flashcards

1
Q

What is a long-term response in relation to Adaptation?

A

 Long-term responses– maladaptive response, changes to ventricle which can hypertrophy, edema, problems breathing, activation of RAAS

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2
Q

What are maladaptive responses to stress?

A

disease–GI issues, anxiety, depression, infections, headaches, hypertension, fluid retention

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3
Q

Adaptive responses to stress?

A

beneficial response for the body.. EX: exercise,

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4
Q

What is a short-term response in relation to Adaptation?

A

 Short-term responses- ability it increase output to meet need, if you get startled- body returns back to normal levels

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5
Q

What is decreased in the REsistance stage?

A

 Decreased lymphocytes and sharply decreased T Lymphocytes

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6
Q

This describes what stage?
 Body tries to level off and return to normal, patients in hospitals are in this stage, time period varies. Symptoms in alarm stage should be leveling off such as cortisol and epinephrine/norepinephrine.

A

REsistance stage

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7
Q

In the CNS, what modulates alertness, ANS activity, skeletal muscle tone

A

RAS

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8
Q

In the CNS, what controls and coordinates ANS & endocrine response?

A

Hypothalamus

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9
Q

In the CNS, what is the relay center?

A

relay center

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10
Q

In the CNS, what is responsible for vigilance, focus, awareness, cognition?

A

Cerebral cortex

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11
Q

What does the Locus Ceruleus do?

A

causes release of norepinephrine and activation & regulation of SNS

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12
Q

Where is the Locus Ceruleus located?

A

In the brain stem

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13
Q

What hornmone does the pituitary gland release?

A

pituitary to release ACTH (adrenocorticotropic hormone)

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14
Q

What hormone mediates and modulates other stress hormones and helps terminate stress by exerting negative feedback at HPA axis.?

A

Cortisol

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15
Q

What stress is: designed to be acute and self-limited and controlled by negative feedback, but pathological changes can occur?

A

Chronic stress

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16
Q

What key stress hormone promotes diuresis?

A

ADH

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17
Q

What has direct nerve link to posterior pituitary– causes release of ADH (vasopressin)?

A

Hypothalamus

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18
Q

What does Beta 2 Effect do?

A

dilates bronchioles

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19
Q

What 4 meds promote SNS Stimulation?

A

SYMPATHOMIMETIC, ADRENERGIC, ALPHA AGONISTS, BETA ADRENERGIC AGONISTS

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20
Q

What 4 meds promote SNS Inhibition?

A

ANTI-ADRENERGIC, ALPHA ADRENERGIC BLOCKER, BETA BLOCKER

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21
Q

What 3 meds promote PNS Stimulation?

A

: PARASYMPATHOMIMETIC, CHOLINOMIMETIC, CHOLINERGIC

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22
Q

What 3 meds promote PNS Inhibition

A

PARASYMPATHOLYTIC, ANTI-CHOLINERGIC, CHOLINERGIC BLOCKER

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23
Q

What med:
 Nonspecific (alpha1 with higher doses and beta with lower doses)
 Use: to treat anaphylaxis, shock (increase BP), cardiac arrest, bronchoconstriction
 AEs: dysrhythmias, HTN, excess CNS stimulation
 Eg: Epi-pen

A

Epinephrine (Adrenaline)

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24
Q

What med :

 Stimulates alpha receptors—vasoconstriction and increased BP. Used to treat severe hypotension, works by causing vasoconstriction. Nursing considerations: check cap refill, pulses, temp and all peripheral things.
 AE: severe decrease in blood flow to periphery

A

Norepinephrine (Levophed)—IV drip

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25
Q

What does low dose dopamine do?

A

 Low Dose: stimulates dopaminergic receptors and increases renal blood.

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26
Q

What does medium dose dopamine do?

A

 Medium dose: beta- increase heart rate & CO (positive inotropic)

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27
Q

What does high dose dopamine do?

A

 High dose: alpha- vasoconstriction and increase in BP

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28
Q

With Dopamine,  IF an IV infiltrates: nexrosis with extravasation occurs. Give ?

A

Give Regitine (phentolamine) at site.

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29
Q

What drugs  disrupt function of SNS by blocking the impulse or receptor sites (alpha and beta)
 Work by blocking impulse transmission at adrenergic neurons or adrenergic receptor sites?

A

 Anti- adrenergics (sympatholytics):

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30
Q

Give 3 examples of  Anti- adrenergics (sympatholytics)?

A

Prazosin (Minipress), clonidine (Catapres), Tamsulosin HCI (Flomax)

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31
Q

What drug: treat hypertension, heart failure, migraines, angina, and glaucoma. It causes vasoconstriction. Decreases force of contraction. People may notice decrease in activity while on this drug. Adverse effects: orthostatic hypotension, blurred vision, bradycardia, low cardiac output. Teach patient to take their pulse while on this at least once a week. Vivid dreams may also be an adverse side effect as well as depression. ?

A

 Beta adrenergic antagonists (blockers):

32
Q

Why not use beta blockers with asthma?

A

Not used with asthma since it causes bronchoconstriction.

33
Q

What drugs:  Promotes action of neurotransmitter acetylcholine
 Initiates PNS
?

A

 Cholinergic Drugs (cholinomimetics, parasympathomimetics)

34
Q

Direct acting  Cholinergic Drugs (cholinomimetics, parasympathomimetics)

A

Bethanecol (Urecholine)

35
Q

Indirect acting:  Cholinergic Drugs (cholinomimetics, parasympathomimetics)?

A

 Neostigmine (prostigmin), pyridostigmine, edrophonium (Tensilon.
 Donepezil (Aricept) for Alzheimers since it increased Ach in the brain by inhibiting metabolism and can delay the progression of the disease.

36
Q

What do indirect  Cholinergic Drugs (cholinomimetics, parasympathomimetics) block?

A

acetylcholinesterase

37
Q

What treats bradycardia, asthma and parkinsons?

A

Anticholinergics

38
Q

What causes Myasthenic Crisis?

A

Exacerbation of MG due to insufficient anticholinesterase meds or to stress or trauma

39
Q

Does Tensilon improve Cholinergic crisis?

A

No, but it does with Myasth. crisis

40
Q

What is  Tumor of adrenal medulla that causes increased production of catecholamines

A

 Pheochromacytoma:

41
Q

What disease  Age onset 20-40

A

 Multiple Sclerosis:

42
Q

What disease has prognosis of 2-5 years life expectancy after dx?

A

ALS

43
Q

In what disease does swallowing, speech and respiration issues ultimately cause death?

A

ALS

44
Q

What is the prognosis of GBS?

A

treat early, 80-90% recover within 6-12 months

45
Q

What can cause bradycardia if it entered the systemic circulation. Both can also cause pupil constriction or miosis.

A

• Pilocarpine and Timolol

46
Q

What is a dec all blood cells?

A

• Pancytopenia

47
Q

What is the Hct levels for men and women?

A

• Hct- women 37-47% ..men 40-50%

48
Q

Hgb levels men and women?

A

• Hgb- women 12-15 g/dl ..men 14-16.5 g/dl

49
Q

Classification of Anemia: (3 areas)

A
  • Increased RBC loss
  • Decreased or defective RBC production (aplastic anemia, iron deficiency anemia, megaloblastic anemia like vitamin B-12 deficiency or folic acid deficiency)
  • Increased destruction of RBCs (Hemolytic anemias) like sickle cell or thalassemias.

Increased RBC loss: due to hemorrhage from acute trauma, chronic condition like ulcers, cancers, polyps, GI or GU bleeding.

50
Q

What • Stem cell disorder causes pancytopenia. ????

A

Aplastic Anemia:

51
Q

How is iron deficiency classified?

A

o Mild: hgb 10-12 gm/dl; vague fatigue, headache, palpitations, dyspnea, exercise intolerance
o Moderate: hgb 7-10; may be pale, paresthesias, SOB, palpitations, koilonychias (brittle nails)
o Severe:

52
Q

What causes Decreased RBC Production: Macrocytic Anemias (megaloblastic)?

A

• Vit. B12 or Folate Deficiency

B12 often lacking in vegetarians

53
Q

Common Meds to treat Iron disorders:

A

Oral: Ferrous Sulfate, Ferrous Gluconate, Iron Polysaccharide

Parenteral: Iron Dextran, Imferon

54
Q

How much iron is absorbed?

A

10-15%

  • Absorption decreased if taken with antacids & certain foods (milk) DO NOT DRINK!
  • Absorption from oral sources in increased by 10% if taken with ascorbic acid
55
Q

When are blood transfusions indicated?

A

• Indicated for hgb

56
Q

What is Epoetin Alfa used for?

A

• To prevent and treat anemia in clients with hgb

57
Q

Causes of Polycythemia?

A

• Causes: hypoxia, tumors that secrete erythropoietin, kidney disease, genetic defects

58
Q

What sickle cell crisis is described as : massive spenomegaly, hypovolemic shock

A

• Splenic Sequestration

59
Q

How long are babies with sickle cell anemia asymptomatic?

A

• Babies asymptomatic until 5-6 months (HbF)

60
Q

What sickle cell crisis is characterized by markedly decreased RBCs, Hgb

A

• Aplastic crisis:

61
Q

• Major cause of Anemia is due to ? (5 answers)

A

low intake of iron, persistent blood loss during menses, decreased iron absorption in the duodenum or jejunum, pregnancy and lead exposure

62
Q

• Supply of iron is too low for optimal rbc formation–> leads to??

A

smaller microcytic cells

63
Q

Decreased RBC production: Microcytic Anemia—Iron Deficiency is very common in who??

A

Athletes and runners (common and often underdiagnosed)

64
Q

How do you reduce GI irritation with Oral: Ferrous Sulfate, Ferrous Gluconate, Iron Polysaccharide?

A

Give with meals

65
Q

When is Oral: Ferrous Sulfate, Ferrous Gluconate, Iron Polysaccharide contraindicated?

A

• Contraindicated w/ peptic ulcer disease or inflammatory bowel disease

66
Q

When is Parenteral: Iron Dextran, Imferon given?

A

• Given IM or IV for clients who cannot tolerate po iron or who need rapid replenishment

67
Q

How do you avoid skin staining with Parenteral: Iron Dextran, Imferon given?

A

• May stain skin when given IM, so give Z-Track to ventrogluteal w/ long needle

68
Q

Why must IV prep be given and diluted over several hours with Iron Dextran, Imferon?

A

To avoid anaphylaxis

69
Q

What side effects are associated with Parenteral: Iron Dextran, Imferon?

A

• may see tachycardia, hypotension, shock with IM or IV (risk for anaphylactic reaction)

70
Q

What is the most serious and often fatal complication with Sickele Cell Anemia?

A

Stroke

71
Q

Is sickling reversible in sickle cell anemia?

A

Yes, • Sickling is reversible, but after several episodes, cells are ____________ and break

• Hemolyzed and removed by Monocyte-Macrophage system!!!

72
Q

Sickle Cell Anemia reduces RBC lifespan by how many days?

A

Reduced by 10-15 days. (normal is 120 days)

73
Q

What will lab results be like for someone that has Sickle Cell Anemia?

A

decreased Hgb, Hct, RBC #, increased reticulocyte #, bilirubin, uric acid. May see erythroblasts, bone marrow hyperplastic

74
Q

What Sickle Cell crisis is most prevalent and causes above S/S

A

• Vaso-Occlusive crisis:

75
Q

What are the 5 types of blood transfusions?

A

packed red blood cells, whole blood, blood components, platelets, fresh frozen plasma

76
Q

What is the Black Box WARNING with Epoetin Alfa?

A

do not use in pts with Hgb > 12 and use at lowest dose possible (could be associated with serious or life-threatening AEs)
• Effectiveness monitored by _______ levels

Mary's Tests - Spring 2016 (10 decks)

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