Module 2 Flashcards
Definition of subclinical
usually present with vague or no symptoms
Definition of virulent
the capacity to cause diseases
Definition of incubation
from time of infection to time of start of symptoms
A person arrives at the clinic and reports mild tiredness and discomfort after an exposure to a family member with the flu. The nurse suspects the person is in the ______ stage.
Prodromal period
Which information is correct regarding parasitic infections
Malaria is a common parasitic infection.
A person who is HIV positive is hospitalized with pneumonia caused by Pneumocystis jiroveci. The nurse understands that the development indicates the person
has progressed from HIV to AIDS
A nurse is asked how antibiotics work. How should the nurse reply ?
inhibition of protein synthesis
The stage of resistance in Selye’s general adaptation syndrome includes
mobilization that contributes to the fight or flight response
Which information indicates the nurse has a good understanding of epinephrine. Epinephrine actions include
increase of serum glucose concentration (so you will have the energy for the fight or flight response)
A patient has stress and releases cortisol. The nurse realizes that cortisol
increases the rate of protein synthesis in the liver
A patient has stress. The nurse realizes some changes in the immune system might include :
decrease natural killer cells
The woman has type O negative blood, which means
she is a universal donor
O negative
universal donor blood
What type of immunologic response is the woman experiencing during the blood transfusion? (she has fever, back pain, & flushing)
alloimmunity
The woman experiences a sudden drop in blood pressure, difficulty breathing, and a red itchy rash after taking the antibiotics. The woman is most likely experiencing
anaphylaxis
The mechanism of action of most antibiotic agents include:
blocking DNA replication
Prodromal stage
starts with the initial symptoms is often very mild with feelings of discomfort and tiredness
Invasion stage
invasion is farther and affects other body tissues, symptoms of illness are at their worse
Convalescence stage
recovery occurs and symptoms decline, or the disease is fatal, or has a period of latency
what is the hallmark of infection
fever
Virulence is
the capacity to cause severity of disease; potency
Endemic
disease with relative high but constant rates of infection in a particular population
Examples of endemic
prison or school system
epidemic
greatly exceeds the number usually observed
spreads over a large area such as a continent or worldwide
pandemic
____ infection is treated with antibiotics
bacterial
Gram ____ is above the diaphragm
positive
Gram ____ is generally located below the diaphragm
negative
Gram +/- tip, hint
Positive thoughts above the diaphragm because it is coming from the brain.
enzymes released during growth
exotoxins
contained in cell walls
endotoxins
Antibiotics work by prohibiting
protein synthesis
____ is the major cause of hospital-acquired infecctions and antibiotic resistance
Staphylococcus aureus
nosocomial infection
hospital-acquired
____ are large microorganisms
fungus
How to treat fungal infections
anti-fungals
Examples of fungus (2)
molds and yeast
Fungal infections are ____
systemic
Fungal infections are usually from
immunosuppression
Fungal infections are toxic to humans because
fungus have similar cell compositions to human cells
____ is the most fungal infection
Candida albicans
Candida albicans - where is it located (4)
resides in skin, GI, mouth, & vagina
If immune system is intact, candida albicans
remains localized
If immune system is compromised, candida albicans
can become systemic
Tissue damage caused by parasites is _____
secondary to release of enzymes that destroy surrounding extracellular matrix and tissue
What is the most common parasitic infection worldwide
malaria
What is the most common affliction of humans
viral diseases
Examples of viral diseases (5)
common cold, cold sores, hepatitis, HIV, and several types of cancers
Viruses are
intracellular parasites
Virus life cycle is completely
intracellular
Describe virus life cycle (3 steps)
Attaches and binds to the host cell.
Penetrates the host cell.
Releases genetic information into the host cytoplasm
RNA viruses enter
the host nucleus
DNA virus enter
the host nucleus
DNA viruses may
integrate the host DNA
DNA virus may make
mRNA
_____ surface proteins undergo changes each year
influenza
HIV - what percentage are infected but don’t know they are infected/need testing
13%
Estimated new HIV infections declined ___% 2017-2021
12%
Diagnosis for AIDS is
CD4+ T-cell numbers are at or below 200 cells/uL
Natural products of fungus, bacteria, and organisms to kill or inhibit the growth of other microorganisms
antimicrobials
They prevent growth or directly kill microorganisms
antimicrobials
prevent growth
bacteriostatic
directly kill
bactericidal
Antimicrobials inhibit
production and function of the cell wall
Antimicrobials block
DNA replication
Antimicrobials inhibit ______
protein synthesis
Antimicrobials also interfere
with folic acid metabolism
Antivirals are sometimes less successful because
viruses use host enzymes
Witnessed changes from outside forces are called
stressors
GAS 3 stages
alarm stage
resistance/adaptation stage
exhaustion stage
Alarm stage description
triggers the hypothalamic-pituitary-adrenal (HPA) axis (which activates the SNS)
Resistance/adaptation stage description
begins with actions of adrenal hormones (cortisol, epi, norepi)
Exhaustion stage is also called the
allostatic overload
Exhaustion stage description
occurs only if stress continues and adaptation is not successful
The anterior pituitary gland secretes 4 hormones. Name them.
Prolactin
Endorphins
Growth hormone (GH)
Adrenocorticotropic hormone (ACTH)
ACTH stimulates what
the adrenal gland cortex to release cortisol
Cortisol is a key indicator of
stress
What does cortisol do ?
elevates blood sugar
Cortisol contributes to the (2)
development of metabolic syndrome and the pathogenesis of obesity
Development of diabetes is secondary to
cortisol-induced obesity
What does chronic cortisol induce ?
(3 areas)
lipogenesis in the abdomen, trunk, and face
What does chronic cortisol result in
obesity
Proteins found in the brain that have pain-relieving capabilities are
(2)
endorphins and enkephalins
stress-age syndrome: Excitability changes in the (2 places)
limbic system & hypothalamus
Stress-age syndrome: catecholamines, ADH, ACTH, and cortisol
Increases or decreases
Increase
what decreases in stress-age syndrome
(3)
testosterone, thyroxine, and other hormones
stress age syndrome effects of opioids
alterations of opioid peptides that bind opioids in the brain
stress-age syndrome on immune system
immunodepression and alteration in lipoproteins
stress-age syndrome on the blood
hypercoagulation of the blood
stress-age syndrome on free radicals
free radical damage of cells destroying cell membranes
Stress-age syndrome
lower adaptive reserve and coping mechanisms
An individual has primary hypertension & recurrent strokes. Which drug should the nurse be prepared to administer?
ACE inhibitors
A person has atherosclerosis. Which pathophysiologic process has occured?
Macrophages release enzymes and toxic oxygen radicals that create oxidative stress.
A person with an MI is releasing angiotensin II. How should the nurse interpret this finding?
Counterproductive. It causes the heart to work harder.
A person has been diagnosed with valvular regurgitation. What pathophysiologic process is the person experiencing. The valves…
fail to close completely, causing the blood to backflow
systolic heart failure is associated with the activation of
renin-angiotensin-aldosterone system (RAAS)
The fetus receives oxygenated blood and nutrients through the
umbilical vein
Agonists binds to receptors &
prolongs the response
Antagonists binds to receptors &
shortens the response
A child is admitted with acute hypoxia. The nurse anticipates the child will exhibit
clubbing of the nail beds
In a child with a ventricular septal defect (VSD), blood flow is shunted from the
left ventricle to the right ventricle
A nurse is assessing a child with coarctation of the heart. What will the nurse find?
high blood pressure in the upper extremities with decreased pulses in feet
A child with Kawasaki in an acute phase is admitted to the hospital. The nurse understands the child will
be febrile
During pulmonary stenosis, resistance to blood flow causes
right ventricular hypertrophy
Primary hypertension is extremely complication
interaction of genetics and the environment mediated by neurohumoral effects
Also overactivity of
sympathetic nervous system, RAAS, and alterations in natriuretic peptides
Hypertension caused by 4 things :
caused by inflammation, endothelial dysfunction, obesity-related hormones, and insulin resistance
Secondary hypertension caused by
systemic disease that raises peripheral vascular resistance and/or cardiac output
Complicated hypertension
hypertrophy and hyperplasia with associated fibrosis of the tunica intima and media in a process called vascular remodeling
Malignant hypertension (hypertensive crisis); rapidly progressive hypertension
diastolic pressure is usually > 140 and can lead to encephalopathy
Clinical manifestations of early HTN
early stages of HTN have no clinical manifestations other than elevated blood pressure
HTN diagnosis
elevated readings on at least 2 occasions
HTN treatment
(non-pharm treatments, 4)
reducing/eliminating risk factors, dietary approaches to stop HTN (DASH), smoking cessation, exercise program that promotes endurance and relaxation
HTN pharmacologic therapies
ACE-inhibitors, ARBs, or aldosterone antagonists
ACE-inhibitors, ARBs, and aldosterone antagonists are effective in those with (3 things)
heart failure, chronic kidney disease, and after an MI or recurrent stroke
arterial thrombus formation is the activation of … & caused by …
activation of coagulation cascade and caused by roughening of the tunica intima by atherosclerosis
PVD - thromboangiitis obliterans is also known as
Buerger’s disease
Buergers disease
what is it, how does it present, and mainly occurs in whom ?
occurs mainly in smokers, inflammatory disease of the peripheral arteries, sluggish blood flow, rubor (redness), and cyanosis
Reynaud’s disease is
episodic vasospasm (ischemia) in the arteries and arterioles of the fingers
Clinical manifestations of Reynaud’s disease
changes in skin color and sensation caused by ischemia
Reynaud’s disease is a ____ ____ disorder
a primary vasospastic disorder
Difference between Reynauds & Buergers
reynauds is episodic vasospasm. Beurger’s is inflammatory disease of peripheral arteries.
Atherosclerosis is
the thickening and hardening caused by the accumulation of lipid-laden macrophages in the arterial wall
Main symptoms of atherosclerosis are the result of
inadequate perfusion of tissues
Coronary artery disease is any ____ disorder that ….
any vascular disorder that narrows or occludes the coronary arteries
CAD results in an imbalance between …..
coronary supply of blood and myocardial demand for oxygen and nutrients
CAD most common cause is
atherosclerosis
CAD non-modifiable risks (4)
advanced age, family history, male gender, or women after menopause
CAD modifiable risks (5)
dyslipidemia, smoking, diabetes/insulin resistance, obesity, sedentary lifestyle
CAD modifiable diet
atherogenic diet - high in salts, fats, transfats, and carbs
dyslipidemia meaning
dietary fat packaged into chylomicrons for absorption in the small intestines
Chylomicrons transports what to where
transports lipids eaten from the intestine to the liver and peripheral cells
Triglycerides may be
removed and either stored by adipose tissue or used by muscle as an energy source
LDLs are responsible for
the delivery of cholesterol to the tissues, important in atherogenesis
HDLs are responsible for
reverse cholesterol transport. they are the bulldozers !
Angiotensin II systemic effects on MI :
peripheral vasoconstriction and fluid retention
Cardiomyopathies effects
neurohumoral responses to ischemic heart disease or hypertension on the heart muscle cause remodeling
Many cases of cardiomyopathies are
idiopathic
Hypertrophic cardiomyopathy can be (2 things)
obstructive (inherited thickness of septal wall) or valvular due to HTN
Hypertrophic obstructive cardiomyopathy treatment (4 things)
beta blockers or ACE inhibitors, surgical resection of the hypertrophied myocardium, septal ablation, prophylactic placement of an implantable cardioverter-defibrillators in high-risk individuals
Stenosis does not ____ correctly
open
Regurgitation does not ____ correctly
close
Valvular stenosis is usually (which valves)
aortic or mitral
Valvular regurgitation is usually (which valves)
aortic, mitral, tricuspid
What 3 things assist in determining which valve is abnormal
characteristic heart sounds, cardiac murmurs, and systemic complaints
Aortic regurgitation (does not close correctly) clinical manifestations
widened pulse pressure as a result of increased stroke volume and diastolic backflow
Mitral regurgitation (does not close correctly) most common causes (6)
mitral valve prolapse, rheumatic heart disease, infective endocarditis, MI, connective tissue disease, dilated cardiomyopathy
mitral valve prolapse syndrome clinical manifestations are
asymptomatic
Rheumatic fever (inflammatory disease) is caused by
infection strep throat
Rheumatic fever clinical manifestations (5)
carditis (murmur), polyarthritis, subcutaneous modules, chorea, erythema marginatum
heart failure definition is the inability to …
generate adequate cardiac output
Systolic heart failure is an EF under …. ?
EF<40, inability of the heart to generate adequate cardiac output
Diastolic heart failure is EF under…. ?
EF>40, heart failure with preserved ejection fraction
high output heart failure
inability of the heart to supply the body with bloodborne nutrients
endocardial cushions
instrumental in closing the atrial septum, dividing the atrioventricular (AV) canals into the right and left AV orifices, and closing the septum
Septum primum & septum secundum
atrial separation
Ostium primum
gap that closes by the endocardial cushions
Ostium secundum
fenestrations or openings that develop in the superior portion of the septum primum
Foramen ovale
nonfused septum secundum and ostium secundum result in the formation of a flapped orifice
bulbis cordis
separates the aorta from the pulmonary artery
truncus arteriosus
torsion occurs within the anterosuperior region of the loop
ductus arteriosus
communication exists between the aorta and the pulmonary artery
foramen ovale is the opening …
between the atria
Newborn HR
100-180
Newborns have a _____ oxygen demand (high or low)
high
HF/CHF in children
neurohumoral and hemodynamic changes create abnormal ventricular wall stress and cause the myocardium to hypertrophy
Hypoxemia due to congenital birth defects
heart defects that allow desaturated blood to enter the systemic system without passing through the lungs resulting in hypoxemia and cyanosis
hypoxemia
arterial oxygen tension is below normal
cyanosis
deoxygenated blood
defects that cause hypoxemia and cyanosis
obstruction & shunting, TOF, and mixing of saturated and unsaturated blood
mild hypoxemia
occasionally when stressed
severe hypoxemia (in babies)
feeding intolerance (can’t breathe and suck at the same time)
_____ that cause _____ obstruction and shunting from the right side of the heart to the left side as in TOF
Lesions;obstruction
Defects increasing pulmonary blood flow
Patent Ductus Ateriosus (PDA)
PDA is the failure of
the ductus ateriosus to close
PDA normally closes
within the 1st few hours of birth
PDA allows blood
to shunt from the pulmonary artery to the aorta
Clinical manifestations of PDA ( 2 descriptions of murmur)
continuous, machinery-type murmur
atrial septal defect clinical manifestations
often asymptomatic, diagnosed by murmur
defects decreasing pulmonary blood flow
TOF
Kawasaki disease causes
unknown, acute self-limiting vasculitis
Clinical manifestations of Kawasaki’s 3 stages
acute, subacute, and convalescent
Acute stage of Kawasaki’s (4)
fever, conjunctivitis, oral changes, rash
subacute stage of Kawasaki’s (3)
begins when fever ends, desquamation of palms & soles occurs, marked thrombocytosis
Convalescent stage of Kawasaki’s (3)
continued elevation of erythrocyte sedimentation rate and platelets, arthritis
diagnosis of Kawasaki’s disease
oral changes - strawberry tongue
Acquired HTN in children …
hypertension are commonly asymptomatic, blood pressure checks
Most common macrocytic anemia
pernicious anemia
Pernicious anemia lacks
intrinsic factor from gastric cells
What causes an increased risk of PA
gastrectomy or gastric bypass
Pernicious anemia is due to _ deficiency
B12 deficiency
pernicious anemia is common with what surgery
with gastric bypass surgery
Folate (folic acid) is an essential vitamin for
RNA & DNA synthesis
Where does folate absorption occur ?
in the upper small intestine
Absorption of folate is NOT ….
dependent on any other facilitating factors
Folic acid/folate deficiency anemia clinical manifestations (4)
severe chelilosis (scales of lip/mouth), stomatitis (mouth inflammation), painful oral ulcerations, dysphagia
Microcytic-hypochromic anemia
IDA - iron deficiency anemia
Most common type of anemia worldwide
iron-deficient
What is the measure of iron in circulation
serum iron
What is the measure of iron in storage
serum ferritin
What is the reticulocyte count
the ability of bone marrow to produce RBCs
Lab finding of hemoglobin and hematocrit ?
HGB is 1/3 of HCT
Anemia of chronic disease (4 causes)
infections, cancer, inflammatory, or autoimmune diseases
Pathological mechanisms of anemia of chronic diseases
decreased erythrocyte life span, suppressed production of erythropoietin, ineffective bone marrow response to erythropoietin, and altered ion metabolism
Pancytopenia is the
reduction or absence of all 3 types of blood cells (anemia, neutropenia, thrombocytopenia)
Penia
low (penis is down south)
Philia
high (Philly is in the north)
Pathophysiology of aplastic anemia
hypocellular bone marrow that has been replaced with fat
hemolytic anemia
accelerated destruction of RBCs
polycythemia
overproduction of RBCs occur
relative polycythemia
result of dehydration
Polycythemia vera (PCV) is an
overproduction of RBCs
Leukocytosis is the
increased levels of WBCs
Polycythemia is coupled frequently with …
increased levels of WBC (leukocytosis) and platelets (thrombocytosis)
Thrombocytosis is the
increased levels of platelets
Death from ____ is increased 5x in polycythemia vera (PCV)
cerebral thrombosis
Polycythemia vera (PCV) is an acquired mutation
janus kinase 2 (JAK2)
Immune Thrombocytopenic Purpura (ITP) is a
low platelet disorder
Immune Thrombocytopenic Purpura is when
antibody coated platelets are sequestered and removed from circulation
ITP acute form develops
after viral infections
Thrombotic microangiopathy is
platelets aggregate and cause occlusion of arterioles and capillaries
pathognomonic pentad
ischemic signs & symptoms most often involve the CNS
Causes of disorders of coagulation (6)
defects or deficiencies of clotting factors,
vitamin K deficiency,
liver disease,
CV abnormalities, vasculitis,
and impaired hemostasis
Disseminated Intravascular Coagulation (DIC) is a
complex, acquired disorder where clotting and hemorrhage occur
Disseminated Intravascular Coagulation (DIC) is characterized by
a cycle of intravascular clotting followed by active bleeding
cytosis also means
high
Granulocytosis (neutrophilia) is the
premature release of immature leukocytes is termed a shift to the left
leukemoid reaction
Gun example - automatic spray vs a sharp shooter
eosinophilia - eosinophils are high or low
high
eosinophilia causes are
allergic, parasitic, and some cases of asthma.
Worms, wheezes and weird diseases
infectious mononucleosis is caused by this virus
Epstein-Barre virus (EBV)
Most common childhood leukemia
ALL (acute lymphoblastic leukemia)
Lymphomas make up a diverse groups of
neoplasms that develop from the proliferation of malignant lymphocytes in the lymphoid system
Primary lymphoid tissue is located in
the thymus, bone marrow
Secondary lymphoid tissue is located in
lymph nodes, spleen, tonsils, intestinal lymphoid tissue
Non-hodgkins lymphoma is linked to
chromosome translocations
non-hodgkins lymphoma changes in
proto-oncogenes (turn-on switch) and tumor-suppressor (turn-off switch) genes contribute to cell immortality thus an increase in malignant cells
Waldenstrom macroglobulinemia
also called lymphoplamacytic lymphoma is rare
a majority of blood disorders (in children) revolves around
erythrocytes/anemia
Acquired disorders of erythrocytes are
hemolytic disease of the fetus and newborn (HDFN)
HDFN (hemolytic disease of the fetus and newborn) is
maternal blood and fetal blood are antigenically incompatible
HDFN (hemolytic disease of the fetus and newborn) means
maternal antibody is directed against fetal antigens
Glucose-6-phospate dehydrogenase deficiency (G6PD) is a deficiency
that shortens red blood cells life span
Sickle cell disease is characterized by the presence of
abnormal hemoglobin
Sickle cell disease’s 2 prominent attributes
deoxygenation and dehydration
4 types of sickle cell crisis
Vasoocclusive
Aplastic
Sequestration
Hyperhemolytic
Vasocclusive crisis
pain crisis, sickling is in microcirculation, extremely painful and symmetric.
Hands and feet exhibit painful swelling (hand-foot syndrome)
Acute chest syndrome
Hemophilias
serious bleeding disorders
leukemia is the most common ____
malignancy of childhood
mechanisms of hormonal alterations
too much or too little hormone
SIADH
levels of anti-diuretic hormone (ADH) are abnormally high
SIADH action :
water retention, action of ADH on renal collecting ducts increases their permeability to water, thus increasing water reabsorption by the kidneys
Hyponatremia is sodium less than
135
Diabetes insipidus
insufficiency of ADH, polyuria, and polydipsia, partial or total inability to concentrate the urine
DI clinical manifestations
polyuria, nocturia, continual thirst, low-urine specific gravity <1.010, low urine osmolality (<200), hypernatremia, diuresis
3 clinical manifestation of Graves’ disease
ophthalmopathy, diplopia, and pretibial myxedema
Ophthalmopathy
exophthalmos - increased secretion of hyaluronic acid, orbital fat accumulation, inflammation, and edema of the orbital contents
diplopia
double vision
pretibial myxedema
(Graves’ dermopathy) leg swelling
Secondary hyperparathyroidism
hypercalcemia does NOT occur
hypoparathyroidism clinical manifestations
hypocalcemia
Diabetes mellitus affects metabolism of
fat, protein, and carbohydrates
DM is characterized by
hyperglycemia, resulting from defects in insulin secretion, insulin action, or both
DM categories
DM1
DM2
other specific types
gestational diabetes
DM type 1 is
pancreatic atrophy and loss of beta cells resulting in a deficit of insulin and amylin and an increase in glucagon
DM type 2 risk factors
age, obesity, HTN, physical inactivity, and family history, and metabolic syndrome
metabolic syndrome
central obesity, dyslipidemia, prehypertension, and elevated fasting blood glucose level
DM type 2 is characterized by 2 mechanisms
insulin resistance and decreased insulin secretion by beta cells
DM2 alterations in the production of
adipokines by adipose tissue: leptin resistance
DM2 - elevated
serum fatty acids and intracellular lipid deposits
DM2 release of
inflammatory cytokines from adipose tissue
DM2 reduced
insulin-stimulated mitochondrial activity
DM2 is ____ - associated insulin resistance
obesity-associated
Cushings clinical manifestations
truncal obesity
moon face
buffalo hump
sodium retention
renal stones
purple striae
brown/bronze skin
Addison’s disease clinical manifestations
hypercortisolism
hypoaldosteronism
weakness
hyperpigmentation (very tan)
vitiligo
Addison’s abrupt discontinuation
of steroids can cause Addison’s crisis
Obesity - WAT (white adipose tissue)
stores energy
tend to hypertrophy in obesity releasing adipokines
increasing vascularity
increasing insulin resistance
increase inflammation resulting in dysregulation of food intake and energy metabolism
Brown Adipose Tissue (BAT)
burns energy
can be protective against obesity as increases metabolism but is decreased in obesity
Anorexia of aging
due to reduced energy needs
waning hunger
diminished sense of tast and smell
decreased saliva production
altered GI satiety mechanisms
co-morbities
meds
