Med-surg test 2 Flashcards
1
Q
What is a serious of action by the body to protect itself against a pathological organism by the destruction or neutralization of the organism
A
Immunity
2
Q
What are harmful, different, abnormal substances?
A
Antigens
3
Q
What are the smallest particle in the body?
A
Haptens
4
Q
Haptens are not ______ on their own, but if it binds with a _______________ it can cause an allergic reaction
A
ANTIGENS; CARRIER PROTEIN
5
Q
What are the roles of mononuclear phagocytes?
A
Engulf antigens
6
Q
What are the lymphocytes that are involved in the immune response and create antibodies? (humoral response)
A
B cells
7
Q
What are cellular killing cells?
A
Cytotoxic T cells (CD8)
8
Q
Whar are cells that produce antibidoes?
A
HElper T cells
9
Q
What is the immunity you are born with?
A
Natural
10
Q
What immunity exits without formeter contact with antigen?
A
Natural
11
Q
What is the immunity that produces antibodies?
A
Actibe acquired immunity
12
Q
What is the immunity that receives antibodies to an antigen?
A
Passive acquired immunity
13
Q
Vaccines is an example of what immunity?
A
Active acquired
14
Q
Immunoglobin fed to a baby through breast milk is ________ immunity
A
passive
15
Q
What immunity is quick and does not last long?
A
PASSIVE
16
Q
Antivenom is an example of _______ immunity
A
Active
17
Q
What immunity takes a long time to develop but lasts a long time?
A
Active
18
Q
What antigen invades and causes B cells to divide and become plama cells- antibodies and to the blood stream?
A
Humoral immunity
19
Q
What Ig crosses placenta nad is the secondary immune response and takes longer
A
IGG
20
Q
What Ig lines the mucous membranes and protects body surfaces and is secreted in breast milk
A
IGA
21
Q
What is the primary immune response and antibodies to ABO blood antigens
A
IGM
22
Q
Cell mediated incolved what cells
A
CD8 (t cells)
23
Q
Immune system ______ with age
A
declines
24
Q
As people get older, there is an increased susceptibility to __________ and ______ incidences?
A
infection and tumor
25
What occurs in an IgE mediated reaction?
Asthma, runny nose, itchiness
26
Mast cells are where?
Everywhere
27
In an IgE reaction, what is the biggest chemical mediators are released from mast cells
HISTAMINE
28
Anaphylaxis is a ________ emergency
medical
29
The first step of an anaphalytic xn is________ the ______
REMOVE the CAUSE
30
What are the steps of anaphalytic rxn
Secure airway
High flow oxygen
IV access
EPI
Albuterol
31
Cytotoxic reactions involve what Ig's
IgG and IgM
32
Target cells for a cytotoxic reaction?
RBC, WBC, and Platelets
33
IgG and IgM reactions are normlaly with
blood transfucison, Rh factors and drugs
34
If a patient is transfused with incompatable blood, what should you do?
STOP
35
Delayed Hypersensitive Reactions can be with what material?
LATEX
36
An autoimmune disease is caused when....
Immune system cannor decide self from non self
37
What is the treatment for autoimmunity?
Apheresis: blood is separated
Plasmapheresis: plasma is taken
38
An immunodeficieny occurs when....
immune system is not doing its job
39
What is a primary immunodeficiency disorder?
Absent immune cells
40
Secondary immunodeficiency disorders are caused by?
Radiation, chemo, etc.
41
Unattenuated vaccines are_____
dead
42
Attenutated vaccines are ____
alive ; but genetically tweaked
43
Immunocompromised patient and pregnant cannot get what kind of shot?
ATTENUATED
44
What are the three functions of the immune system?
Homeostasis
Defense
Surveillance
45
What natural killer cells are similar to mononuclear phagocytes and marks for memory?
Dendritic cells
46
What are the cellular communication system?
Cytokines
47
What is the Ig that deals with lymphoyte surfaces and differentiation of B cells?
IgD
48
What is the Ig that is involved in allergic reactions and parasitic infections?
IgE
49
Cell mediated immunity protects primarily against cancer cells, viral infections, and fungal infections?
Cell mediated Immunity
50
What are sympathomimetic/decongestants?
Epinepherine (Adrenalin)
Pseudoephedrine (Sudafed)
51
What are mast cell stabilizing drugs?
Coats the mast cells and prevents inflammatory response
Cromolyn and Nedocromil
52
What is true about latex allergies?
The longer you are exposed the more increased chance of allerfic reactions
53
What are the two types of latex allergies?
Type IV: contact dermatitis (delayed)
Type I: reaction within minutes
54
What are symptoms of latex allergy:
Rash
HIVES
Itching
Flushing
Asthma
Shock
55
What are examples of autoimmune disease?
Lupus
RA
Glomerulonephritis
56
Where is type I HIV present?
US
Canada
Europe
57
Where is type II HIV present?
third world countries
58
What HIV type responds well to meds>
Type 1
59
What is the mode of transmission for HIV?
Sexual contact, blood product, perinatal transmission
60
HIV is a retrovirus meaning it has ____ but no ___ and needs host to duplicate?
RNA no DNA
61
HIV attaches to ____ receptors
CD4
62
Once HIV is in the body ______ makes the viral _____ with reverse transcriptase
RNA; DNA
63
In HIV enters the body, viral ____ enters the cell's DNA and alters the cell's ______
DNA; genome
64
What is the phase of HIV that is when HIV develops specific antibodies and is a short period with active replicating?
Acute infection
65
What are teh s/sx of the acute infection in HIV?
Headahce
Body aches
DIarrhea
Pharyngitis
Rash
66
What stage of HIV infection occurs 1-3 weeks after infection and lasts 1-2 weeks?
Acute infection
67
What levels drop temporarily in the acute phase?
CD4; they then return to baseline
68
What rises quickly in the acute phase of HIV?
Viral load
69
What is the phase in HIV that lasts from a few months to a few years?
The asymptomatic infection/ latent phase
70
What is the viral load of the latent phase?
200-500
71
What is the CD4 count during the latent phase?
above 500
72
What are teh symptoms during the latent phase of HIV?
fatigue
headache
diarrhea
low grade fever
night sweats
73
What is the phase of HIV that lasts for like 8-10 years?
Symptomatic
74
What is the CD4 count during the symptomatic phase?
200-500
75
What are the HIV symptoms during the symptomatic infection?
Night sweats
Fever
Chronic diarrhea
HA
Fatigue
increased infection
76
What are worsening symptoms of HIV?
Persistent night sweats and fever, Candidiasis, Kaposi Sarcoma, Oral Hairy Leukoplakia
77
What part of the chronic HIV infection begins at year 10+ and the CD4 count is below 200
AIDS
78
What are some opportunistic infections that occur with AIDS
Pneumocystis Jiroveci Pneumonia
Cryptococcal meningitis
Cytomegalovirus retinitis
Opportunistic cancer
Wasting syndrome
Dementia
79
What are the screening for HIV?
Orasure testing- gumline
Oraquick- blood drop
These are 20 minute screens for ANITBODIES if a positive then get tested
80
What are the testing for HIV?
Risk factors
4th generation testing for antigens and antibodies
Need to wait past 10 day eclipse window period
81
What are normal CD4 cells with no disease?
800-1200
82
What is the normal viral load with no disease?
0
83
What is the viral load for early chronic phase that is stable?
200-500
84
What is the viral load as the disease progresses?
5000-10000
85
what is the treatment goal for HIV?
Stop replication and stay in the asymptomatic stage
86
What are at risk populations for HIV?
Blood transfusion before 1985
Shares needles
Sexual contact with person
Patient with STD
87
What is the diagnosis of HIV?
Prevention
Ongoing infection
Dying
88
was are pre-exposure prophylaxis drugs?
prescribed to at risk populations
Integration into CD4
89
What are post exposure prophylaxis drugs?
Prevents HIV
within 72 hours of exposure
emergency situation
combo of 3 ART for 28 days
90
What are the goals of treating HIV?
Keep viral load low
Maintain immune function
Improve QOL
Prevent opportunistic infection
Reduce disability
91
What are the interventions for HIV?
Adhere to drug regimen
Promote healthy lifestyle
prevent transmission
Supportive relationships
92
What precautions apply to HIV patients?
Standard
93
What is the blood flow through the heart?
Vena cava
RA
thru the tricuspid valve
RV
Pulmonic valve
pulmonary arteries
lung
Pulmonary veins
LA
Mitral valve
LV
aortic valve
aorta ------> BODY
94
What are the two semilunar valves of the heart?
Pulmonic and aortic
95
What are the two a/v valves of the heart?
Tricuspid and mitral
96
What coronary artery supplies the R.A and the R.V and part of the posterior L.V?
The right coronary artery
97
What coronary artery branches into the left arterior descending and the left circumflex artery that supplies the LA and LV?
L. Coronary Artery
98
What is the part of the conduction system that is a specialized nerve tissue that serves as the pacemaker?
SA node
99
What is an electrical impulse that travels trhough the heart and leads to contraction?
Action potential
100
Contraction of the heart muscle occurs when ____ flows into cardiac cells after ______________
Calcium; depolarization
101
What part of the heart picks up the impulse and spreads it over the ventricles by way of purjunkie fibers?
Bundle of His
102
What part of the heart cycle occurs when cells return to former state?
Repolarization
103
What is an absolute refractory period?
Systole
104
What part of the EKG signifies the depolarization of atria?
P wave
105
What part of the EKG signifies the time required for the impulse to travel from the SA node?
PR segment
106
What part of the EKG signifies the ventricular depolarization?
QRS segment
107
What part of the EKG signifies the repolarization of ventricles?
T wave
108
What part of the EKG signifies possible hyperkalemia?
U wave
109
Atrial _________ occurs during the QRS complex?
Repolarization
110
What determines the rate of an EKG?
Number of QRS complexes
111
What does one p wave for every QRS?
Sinus versus not sinus
112
What cardiac rhythym has a very high atrial rate (250-400)
A flutter
113
What cardiac rhythym looks like "sawtooth"?
A flutter
114
A flutter can be summarized by multiple places competing to be the SA node?
A flutter
115
The ventricular rhythym is A flutter can be __________ or _____
Normal; tachy
116
A flutter is not _____
sinus (not one p wave for every QRS)
117
A flutter is _________ irregular; it will either be that or completely ________
Regularly; Irregular
118
When you look at at the second lead in A fib you see the ____________ rhythym
Ventricular
119
When you look at the first lead in A fib you see ________ rhythym and rate
Atrial
120
In A fib, there is no discertation of the ___ wave
P
121
Is A fib sinus?
No; there are many many p waves for every QRS
122
In A fib, the rate is always __________
irregular
123
In A fib. there are ________ of places competing to be the ____ node so there is rapid and irregular p waves and atrial depolarization
A TON; SA
124
In V tach, you cannot count the _________ rate
Atrial (no p waves)
125
In V tachy, there is a ______ ventricular rate
HIGH
126
In V tachy, what are two characteristics that make it stand out?
No PR interval
Widened and weird QRS
127
Is the rhthym in V tachy regular?
Yes
128
V tachy menas that they are not ________ well and happens during a ____
perfusing; MI
129
Is V tachy a shockable rhythm?
YES
130
During V-Fib the rate is way too _____ and the rhythm is ________?
Fast; irregular
131
____ waves are absent in V-Fib
P
132
During V fib, there is no ________, _____, and no ___
perfusion
CO
BP
133
Think of V fib as ventricular __________
quivering
134
What is the equation for CO?
CO = HR x SV
135
What is the volume or the stretch of the heart muscle?
Preload
136
What are reasons for increased preload?
Hypervolemia, valve regurgitation and congestive heart failure
137
What are reasons for decreased preload?
Hypovolemia and bleeding
138
What is the resistance of the heart; going out of the chambers of the heart?
Afterload?
139
What are reasons for increased afterload?
Vasoconstriction
HTN
Meds
140
What are reasons for decreased afterload?
Vasodilation, shock, and hypotension
141
What is how "in shape" the heart is?
Contractability
142
What are reasons for increased contractability?
SNS, ionatropes, and digoxins
143
What are reasons for decreased contractability?
Age and heart failure
144
What is the law that states the more the fibers are stretched the greater the force of contractability?
Starling's law
145
During the SNS response, the HR and contractability ________
INCREASE
146
During the PNS response, the HR and contractability ________
DECREASE
147
What is the normal systolic BP?
120
148
What is the normal diastolic BP?
80
149
What is the systolic BP- diastolic BP?
Pulse pressure
150
What does a narrowing pulse pressure mean?
Hypovolemia and bleeding
151
What does a widening pulse pressure mean?
ISH, ICP, and neuro issues
152
What is the equation for MAP?
SBP + (2 x DBP) / 3
153
MAP is a meaure of __________
PERFUSION
154
What are the four cardiovascular effects on the elderly?
Increased collagen
Valves require lipid and collagen
Decrease response of the heart to exercise
Decrease in number of pacemaker cells and beta receptors
155
What are diagnostic test of the regulation of the CV system?
Chest X ray
EKG
ECHO
Nuclear cardiology
CT scoring and CT scan
Cardiac Cath
156
What is a cardiac marker that is an inflammatory marker in the body and is released when an MI occurs?
CRP (should be less than 1.0)
157
What is the gold standard cardiac marker?
Troponin
158
What is the normal levels for troponin?
less than 0.4
159
If troponin is greater than 0.4, it is likely that what has occured?
MI
160
Troponin is ____________
highly specific
161
Troponin levels rise in _______ hours after the MI
4-6
162
Troponin levels peak ________ hours
10-24
163
Troponin levels return to normal ________ days after the MI?
4
164
Total cholesterol should be less than _____ mg/dL
200
165
What is the ideal LDL levels?
less than 100
166
What is the ideal HDL for women?
greater than 50
167
What is the ideal HDL for men?
Greater than 40
168
What are the most common meds for hyperlipidemia
Statins
Niacin
Fibric acid derivities
169
What is the cardiac cath that goes through the venous right side of the heart?
Right cardiac cath
170
A right cardiac cath is done on what kind of patients?
Pulmonary
171
What does a right cardiac cath measure?
pressure and volume
172
What is the cardiac cath that goes thru the artery to the LV?
Left sided cardiac cath
173
What does a left cardiac cath measure?
evaluates chamber pressure and 02 content
174
What is the procedure that injects dye into the vessel to visualize arteries on screen during cath?
Coronary angiography
175
What are Pre-Cath considerations?
Takes 2-3 hours
Permission and consent
NPO for 6-12 hours before
176
What are Post-Cath considerations?
Peripheral pulses
Warmth
Color
Q 15 vitals then every hours
Assess for bleeding, RR, signs of PE, and arrthymias
177
What are the 4 phases of CAD?
Early/endothelial stage
Fatty streaks
Raised fibrous plaque
Complicated lesion
178
What age can the fatty streaks stage start?
age 15
179
What stage of CAD is reversible?
Fatty streak
180
What age can the raised fibrous plaque stage start?
age 30
181
What stage of CAD can lipids become calcified?
Raised fibrous plaque
182
What stage of CAD leads to dangerous hemorhage?
Complicated lesions.
183
What is the demand for O2 is greater than the supply and is bc of artherosclerosis?
Angina Pectoris
184
What is a stable angina?
Classic
185
What is an unstable angina?
Progressive
186
What is the vasospams angina?
Prinzmetal Variant
187
What are other considerations for Prinzmetal Variant Angina?
Rare
Migraines and Reynaud's
W/O CAD
After period of physical demand
Happens at rest
May follow stress, EPI, and histamine
188
What are the signs and symptoms of angina?
Chest pain
Vague pressure
Indigestion and burning
189
What are complications of Angina?
Arythmias and MI
190
What are diagnostics of angina?
History
Lipid panel
Treadmill and nuclear imaging
Angiography
191
What is teh management of CAD?
Nitro
Antiplatelts
Betablockers
CCB
