Module 13 Material Flashcards
Arteriosclerosis
Hardening of the arteries
Diffuse process whereby the muscle fibers and the endothelial lining of the walls of small arteries and arterioles become thickened
Atherosclerosis
Accumulation of lipids, calcium, blood
components, carbohydrates, and fibrous tissue on the intimal layer of the artery
Atheromas or plaques
Atherosclerosis
Accumulation of lipids, calcium, blood
components, carbohydrates, and fibrous tissue on the intimal layer of the artery
Atheromas or plaques
Peripheral Artery Disease (PAD)
Hallmark symptom is intermittent claudication
described as aching, cramping, or inducing
fatigue or weakness
Occurs with some degree of exercise or activity
Relieved with rest
Pain is associated with critical ischemia of the distal extremity and is described as persistent, aching, or boring (rest pain)
Ischemic rest pain is usually worse at night and often wakes the patient
intermittent claudication
muscle pain that happens when you’re active and stops when you rest. It’s usually a symptom of blood flow problems like peripheral artery disease.
The nurse is teaching a patient diagnosed with peripheral arterial disease (PAD). What should be included in the teaching plan?
A. Elevate the lower extremities
B. Exercise is discouraged
C. Keep the lower extremities in a neutral or dependent position
D. PAD should not cause pain
C. Keep the lower extremities in a neutral or dependent position
Rationale: For patients with PAD, blood flow to the lower extremities needs to be enhanced; therefore, the nurse encourages keeping the lower extremities in a neutral or dependent position. In contrast, for patients with venous insufficiency, blood return to the heart needs to be enhanced, so the lower extremities are elevated. Exercise can be prescribed to aid in the development of collateral circulation. Some pain is associated with PAD.
Raynaud’s Phenomenon
a condition that causes the blood vessels in the extremities to narrow, restricting blood flow. The episodes or “attacks” usually affect the fingers and toes. In rare cases, attacks occur in other areas such as the ears or nose.
Venous Thromboembolism
a condition that occurs when a blood clot forms in a vein. VTE includes deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT occurs when a blood clot forms in a deep vein, usually in the lower leg, thigh, or pelvis.
Which patient is at highest risk for venous thromboembolism?
A. A 50-year-old postoperative patient
B. A 25-year-old patient with a central venous catheter in place to treat septicemia
C. A 71-year-old otherwise healthy older adult
D. A pregnant 30-year-old woman due in 2 weeks
A 25-year-old patient with a central venous catheter in place to treat septicemia
Rationale: Some risk factors for venous thromboembolism include but are not limited to age older than 65 years, patients undergoing surgery, central venous catheter placement, septicemia, and pregnancy. The client in this question with two risk factors is the 25-year-old with a central venous catheter in place to treat septicemia. All other patients only have one risk factor.
dry gangrene
where the blood flow to an area of the body becomes blocked
wet gangrene
caused by a combination of an injury and bacterial infection. gas gangrene – where an infection develops deep inside the body and the bacteria responsible begin releasing gas.
Varicose Veins Prevention
Avoid activities that cause venous stasis (wearing socks that are too tight at the top or that leave marks on the skin, crossing the legs at the thighs, and sitting or standing for long periods)
Elevate the legs 3 to 6 inches higher than heart level
Encourage to walk 30 minutes each day if there are no contraindications
Wear graduated compression stockings
Overweight patients should be encouraged to begin weight reduction plans
Lymphangitis
inflammation or infection of the lymphatic channels
Lymphadenitis
inflammation or infection of the lymph nodes
Lymphedema
tissue swelling related to obstruction of lymphatic flow
Primary: congenital
Secondary: acquired obstruction
Which of the following is an effective strategy used to promote lymphatic drainage and prevent edema in clients with lymphedema?
A. Antibiotic therapy for 14 days
B. Constant elevation of the affected extremity
C. Application of heat therapy twice per day
D. Daily exposure to the sun
B. Constant elevation of the affected extremity
Rationale: Constant elevation of the affected extremity and observation for complications are essential. After surgery, antibiotics may be prescribed for 3 to 7 days. The patient is instructed to avoid the application of heating pads or exposure to sun to prevent burns or trauma to the area.
Cellulitis Nursing Intervention
Elevate affected area 3 to 6 inches above heart level
Warm, moist packs to site every 2 to 4 hours
Educate regarding prevention of recurrence
Reinforce education about skin and foot care
For patients with uncomplicated hypertension and no specific indications for another medication, what is the recommended initial medication?
A. Thiazide diuretic
B. Calcium channel blockers
C. Vasodilators
D. Angiotensin-converting enzyme (ACE) inhibitors
A. Thiazide diuretic
Rationale: For patients with uncomplicated hypertension and no specific indications for another medication, the recommended initial medication is thiazide diuretics for most patients. If blood pressure does not fall to less than 140/90 mm Hg, the dose is increased gradually, and additional medications are included as necessary to achieve control.
The nurse is preparing an education plan for a patient newly diagnosed with hypertension. Which of the following should be included in the education plan?
A. Engage in regular aerobic physical activity such as brisk walking (at least 30 min/day most days of the week)
B. Eliminate alcoholic beverages from the diet
C. Reduce sodium intake to no more than 200 mmol/day
D. Maintain a normal body weight with BMI between 18 and 30 kg/m2
Engage in regular aerobic physical activity such as brisk walking (at least 30 min/day most days of the week).
Rationale: The nurse assists the patient to develop and adhere to an appropriate exercise regimen (as described above), because regular activity is a significant factor in reducing blood pressure. Alcoholic beverages can be consumed in moderation. Sodium should be reduced to no more than 100 mmol/day, and the patient should maintain a normal body weight with a BMI between 18.5 and 24.9 kg/m2
Which of the following is a priority nursing assessment when caring for the patient in a hypertensive crisis receiving intravenous vasodilators?
A. Pain
B. I&O
C. Vision
D. Family history
B. I&O
Rationale: Assessing the individual’s fluid volume status is recommended because if there is volume depletion secondary to natriuresis caused by the elevated blood pressure, then volume replacement with normal saline can prevent large sudden drops in blood pressure when antihypertensive medications are administered.
Immunity
the body’s specific protective response to foreign agent or organism; resistance to a disease, specifically infectious disease
Immunopathology
the study of diseases that results from dysfunction within the immune system
Is the following statement true or false?
Immunity refers to the body’s nonspecific protective response to an invading foreign agent or organism.
False
Immunity refers to the body’s specific protective response to an invading foreign agent or organism.
Where do B lymphocytes mature?
in the bone marrow
Where do T lymphocytes mature?
in the thymus, where they also differentiate into cells with various functions
Phagocytosis
monocytes responsible for engulfing and destroying foreign bodies and toxins
Natural immunity
nonspecific response to any foreign invader
White blood cell action: release cell mediators such as histamine, bradykinin, and prostaglandins and engulf (phagocytize) foreign substances
Inflammatory response
Physical barriers, such as intact skin, chemical barriers, and acidic gastric secretions or enzymes in tars and saliva
Acquired immunity
specific against a foreign antigen
Result of prior exposure to an antigen
Active or passive
Active Immunity
Immunologic defenses developed by person’s own body
Lasts many years; may last a lifetime
Passive Immunity
Temporary
Results from transfer of a source outside of the body that has developed immunity through previous disease or immunization
Examples: transfer of antibodies from mother to infant through breast feeding; receiving immune globulin through injections
Which leukocytes are associated with inflammation?
A. Basophils
B. Eosinophils
C. Monocytes
D. Neutrophils
D. Neutrophils
Neutrophils (polymorphonuclear leukocytes) are the first cells to arrive at the site where inflammation occurs.
Four Stages in Immune Response
Recognition
Proliferation
Response
Effector
Recognition Stage
Recognition of antigens as foreign
Use of lymph nodes and lymphocytes for surveillance
Lymphocytes recirculate from the blood to lymph nodes and from the lymph nodes back into the bloodstream in a continuous circuit
Proliferation Stage
Circulating lymphocytes containing the antigenic message return to the nearest lymph node
Stimulate some of the resident T and B lymphocytes to enlarge, divide, and proliferate
T lymphocytes differentiate into cytotoxic (or killer) T cells
B lymphocytes produce and release antibodies
Response Stage
Begins with the production of antibodies by the B lymphocytes in response to a specific antigen
Cellular response stimulates the resident lymphocytes to become cells that attack microbes; (killer) T cells
Viral rather than bacterial antigens induce a cellular response
Most immune responses to antigens involve both humoral and cellular responses, although one usually predominates
Effector Stage
Humoral immunity
Interplay of antibodies
Cellular immunity
Action by cytotoxic T cells
Humoral or antibody response
Antibody response; B lymphocytes transform themselves into plasma cells that manufacture antibodies
Cellular immune response
T lymphocytes; cytotoxic killer cells that can attack pathogens
IgM
M is for miserable
FIRST response to both bacterial and viral infections
IgG
G is for GONE
eliminated most, lab results change
IgE
ALLERGY
allergic/parasitic results
T lymphocytes: cellular immunity
Attack invaders directly, secrete cytokines, and stimulate immune system responses
Helper T cells
Cytotoxic T cells
Memory cells
Suppressor T cells (suppress immune response)
Null cells
Destroy antigen coated with antibody
Natural killer cells
Defend against microorganisms and some malignant cells
Complement System Functions
Defend the body against bacterial infection
Bridge natural and acquired immunity
Dispose of immune complexes and the by-products
Is the following statement true or false?
Autoimmune disorders are more common in women than men.
True
Many autoimmune diseases have a higher incidence in females than in males, a phenomenon believed to be correlated with sex hormones. Research has revealed that sex hormones are integral signaling modulators of the immune system. Sex hormones play definitive roles in lymphocyte maturation, activation, and synthesis of antibodies and cytokines. In autoimmune disease, expression of sex hormones is altered, and this change contributes to immune dysregulation
Stem cells
basic building blocks
Primary Immune Deficiency Disorders (PIDD)
Genetic
Majority diagnosed in infancy; some may be diagnosed during adolescence
Male-to-female ratio of 5 to 1
Occasionally, adults may present with persistent, recurrent, or resistant infections
Prevent body from developing normal immune responses
May affect phagocytic function, B cells or T cells, or the complement system
Is the following statement true or false?
Primary immune deficiency disorders result from external factors such as infection.
False
Rationale: Primary immune deficiency disorders are genetic.
PLWHA
persons living with HIV/AIDS
HIV: Modes of Transmission
Blood and blood products
Seminal fluid
Vaginal secretions
Mother-to-child: Amniotic fluid, breast milk
Not through casual contact
Postexposure prophylaxis (PEP)
Antiretroviral medications within 72 hours of exposure
2 to 3 drugs prescribed for 28 days
Antiretroviral medications as postexposure prophylaxis for health care workers are started within how many hours of exposure?
A. 24 hours
B. 12 hours
C. 36 hours
D. 72 hours
D. 72 hours
Rationale: Antiretroviral medications are started as soon as possible, but no more than 72 hours (3 days) after possible HIV exposure.
HIV: Pathophysiology
HIV is in the subfamily of lentiviruses and is a retrovirus because it carries its genetic material in the form of ribonucleic acid (RNA) rather than deoxyribonucleic acid (DNA)
HIV targets cells with CD4+ receptors, which are expressed on the surface of T lymphocytes, monocytes, dendritic cells, and brain microglia
HIV: Stage 0
Early HIV infection; inferred from laboratory testing
HIV: Stage 1
Primary/acute
Period from infection with HIV to the development of HIV-specific antibodies
Dramatic drops in CD4+ T-cell counts normally 500 to 1500 cells/mm3 of blood
HIV: Stage 2
Occurs when T-lymphocyte cells are between 200 and 499 cells/mm3
HIV: Stage 3
CD4+count drops below 200 cells/mm3 of blood
Considered to have AIDS for surveillance purposes
HIV: Unknown stage
No information on CD4+ T-lymphocyte count or percentage
Antiretroviral therapy: ART
Treatment
Overarching goal to suppress HIV replication
Reduce HIV-associated morbidity and prolong duration and quality of life
Restore and preserve immunologic function
Maximally and durably suppress plasma HIV viral load
Prevent HIV transmission
Which of the following is a clinical syndrome that is characterized by a progressive decline in cognitive, behavioral, and motor functions as a direct result of HIV infection?
A. Cryptococcal meningitis
B. Neuropathy
C. Progressive multifocal leukoencephalopathy
D. HIV encephalopathy
D. HIV encephalopathy
Rationale: Formerly referred to as AIDS dementia complex, HIV encephalopathy is a clinical syndrome that is characterized by a progressive decline in cognitive, behavioral, and motor functions as a direct result of HIV infection.
Pneumocystis pneumonia (PCP)
caused by P. jirovecii (formerly P. carinii) (Panel on Opportunistic Infections in Adults and Adolescents with HIV [OI-Panel], 2019) and is associated with CD4+ T-lymphocyte (CD4+) cell counts less than 200 cells/mm3. The most common manifestations of PCP are subacute onset of progressive dyspnea, fever, nonproductive cough, and chest discomfort that worsens within days to weeks.
PEP-In-Your-Pocket (PIP)
is a good fit for people who may find themselves at increased risk of HIV transmission.
Telangiectasia
Vascular lesions caused by dilated blood vessels
A nurse is monitoring the client’s progression of human immunodeficiency virus (HIV). What debilitating gastrointestinal condition found in up to 90% of all AIDS clients should the nurse be aware of?
Chronic diarrhea
Ataxia
uncoordinated muscle movement.
A client that is HIV+ has been diagnosed with Pneumocystis pneumonia caused by P. jiroveci. What medication does the nurse expect that the client will take for the treatment of this infection?
Trimethoprim-sulfamethoxazole
(TMS)
Which statement best explains the goal of HAART (highly active antiretroviral therapy) when used for HIV/AIDS?
This answer is correct because HAART utilizes several different classes of drugs that prevent the virus from entering the body’s CD4 cells, as well as disabling proteins required for the virus to replicate. This results in decreasing the viral load and restoring the CD4 level to help immune function. HAART therapy reduces the complications from HIV, as well as transmissions to others.
