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Pathopharmacology > NUR 226 Exam 3 > Flashcards

NUR 226 Exam 3 Flashcards

1
Q

What are components of the upper respiratory tract

A

Nasal passages
Sinuses
Nasopharynx
Pharynx
Larynx
Tonsils
Glottis

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2
Q

What are the components of the lower respiratory tract

A

Lower trachea
Right and left bronchus
Bronchial tree
Lungs
Pleural membranes
Alveolar ducts
Alveoli
Mediastinum

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3
Q

What does the upper respiratory tract mucus do

A

Maintains temp
Humidification of inhaled gas
Traps and removes foreign particles, bacteria, and noxious gas

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4
Q

What does the cilia do

A

Propel mucous and entrapped particles toward oropharynx

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5
Q

What does alveolar macrophages do

A

Ingest and remove bacteria from alveoli via phagocytosis
Release inflammatory cytokines
Present antigens to adaptive immune system

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6
Q

Allergic Rhinitis

A

Inflammatory disorder
Upper and lower airway and eyes
Triggered by allergens- bind to IgE antibodies on mast cells- release inflammatory mediators

Sneezing, rhinorrhea, pruritus, nasal congestion, watery, itchy eyes

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7
Q

Histamines

A

Stored in mast cells (skin and soft tissue)
Basophils (blood)

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8
Q

When activated histamines can cause:

A

Hives and itching skin
Dilation of blood vessels
Erythema and hypotension
Bronchoconstriction
Effect sleep/wake cycles
Increase the secretion of acid in the stomach

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9
Q

What causes the majority of the symptoms associated with allergic reactions

A

Histamine

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10
Q

Bacterial infection

A

Swollen uvula
Whitish spots
Red swollen tonsils
Throat redness
Gray furry tongue

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11
Q

Viral infection

A

Red swollen tonsils
Throat redness

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12
Q

What are some examples of URI

A

Rhinitis
Sinusitis
Laryngitis
Larynogotracheobronchitis
Acute bronchitis
Influenza

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13
Q

Sinusitis

A

Inflammation and swelling of sinus mucosa
Secondary infection

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14
Q

Rhinitis

A

Inflammation of the mucus membranes of the nose
Allergy
Symptoms:
Low grade fever
Headache
Fatigue
Nasal congestion
Rhinorrhea
Cough

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15
Q

Rhinovirus

A

Early fall, spring, and summer
Lives up to 3 hours outside the body
Spreads by droplet contaminated objects

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16
Q

Pharyngitis

A

Palate
Tonsils
Uvula
CULTURES AND RAPID STREP TEST

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17
Q

Acute bronchitis

A

Sputum production
Clear to yellow

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18
Q

Influenza

A

Viral ABC
Types can mutate
Vaccine
Rapid onset
Fever
Chills
Body aches
Secondary pneumonia can be deadly

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19
Q

Epiglottitis

A

Inspirators strider and retractions
Rapid onset of fevers
Pain
Difficult swallowing
Drooling

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20
Q

Atelectasis

A

The loss of lung volume due to collapse of lung tissue
It can be partial or complete
Involves alveoli- deflate fill with fluid

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21
Q

What are the two components of blood

A

Plasma 55%
Formed elements 45%

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22
Q

What is in the plasma of blood

A

Proteins 7%
Water 92%
Other solutes 1%

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23
Q

What formed elements of blood?

A

Platelets
Leukocytes
Erythrocytes

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24
Q

Cell components of blood

A

Erythrocytes
Leukocytes
Neutrophils
Lymphocyte
Monocyte/macrophage
Eosinophil
Basophil
Natural killer cells
Platelet

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25
Q

Platelets

A

Not true cells
Contain cytoplasmic granules which can release adhesive proteins, coagulation, and growth factors when they sense a vessel injury.

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26
Q

Normal platelet count vs thrombocytopenia

A

150-000-400,000
<100,000

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27
Q

Where are platelets formed

A

Bone marrow
Additional platelets stored in the spleen

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28
Q

What is the function of platelets

A

Initially circulate foreleg in inactivated state
Damage to the blood vessel initiates platelet activation:
-increased platelet adhesion
-activation leading to platelet degranulation
- aggregation as platelet-vascular wall and platelet-platelet adherence increases
-activation of the clotting system

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29
Q

Hemostasis

A

Stop blood loss after any injury
Multiple actions:
-blood vessels
-Circulating platelets
-coagulation cascade
Excessive hemostasis- clot formation excessive or inappropriate
Inadequate hemostasis-bleeding

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30
Q

Steps of hemostasis

A

Vascular spasm
Platelet plug formation
Blood clotting

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31
Q

Petechiae

A

Tiny spots of bleeding under the skin or in the mucous membrane

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32
Q

Purpura

A

Hemorrhages in the skin and mucous membranes that result in appearance of purplish sports or patches

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33
Q

Ecchymosis

A

Discoloration of skin from bleeding underneath, caused by bruising

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34
Q

Telanglectasia

A

Spider veins

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35
Q

Menorrhagia

A

Unusually heavy bleeding at menstruation

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36
Q

Epitaxis

A

Nosebleed

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37
Q

Thrombosis

A

Formation blood clot within a vessel

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38
Q

Hematoma

A

Localized collection of blood outside vessels

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39
Q

Hemarthrosis

A

Bleeding into a joint space that causes pain

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40
Q

Thrombocytosis

A

Increased platelet count
Increased risk of clot formation
Inflammation
Malignancy

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41
Q

Thrombocytosis

A

Increased platelet count
Increased risk of clot formation
Inflammation
Malignancy

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42
Q

Thrombocytopenia

A

Characterized by decreased platelet count
Risk of bleeding

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43
Q

Thrombosis

A

What is inappropriate clot formation

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44
Q

Embolus

A

A piece of thrombus that breaks free and travels

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45
Q

Fibrinolysis

A

Clot dissolution

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46
Q

Platelets

A

Primary activator in coagulation cascade

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47
Q

Fibrin

A

End product of coagulation cascade which stabilizes the blood clot

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48
Q

What are protein strands made of

A

Fibrin

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49
Q

Anti-thrombin III

A

What is a circulating inhibitor of thrombin

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50
Q

What is the coagulation cascade

A

Groups of proteins that when activated form a blood clot
Activated by tissue injury or infection

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51
Q

What is a blood clot

A

Mesh work of fibrin strands and platelets
Platelets are the primary activator
Clot plugs the damaged vessel and stops bleeding
Fibrin which stabilizes the blood clot

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52
Q

What is a tissue factor pathway inhibitor inhibits factor

A

Xa

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53
Q

What is the natural removal of the clot

A

Lysis-breakdown
Breakdown carried out by the fibrinolytic system

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54
Q

Thrombosis

A

Formation of a clot in the blood vessel

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55
Q

Hemorrhage

A

Excessive bleeding due to inadequate clot formation

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56
Q

Arterial thrombosis

A

Adhesion of platelets to the arterial wall
Continued aggregation
Occlusion of the artery- blood flow reduced or stopped/localized tissue injury due to the lack of perfusion

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57
Q

Venous thrombosis

A

At sites where blood flow is slow
Stagnation of blood initiates the coagulation cascade
Results in fibrin- clot formation and expansion
Embolism-thrombus breaks away and travels

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58
Q

What are the goals of coagulation therapy

A

Prevent a clot formation
Break apart existing clots
Increase circulation and perfusion
Decrease pain
Prevent further tissue damage

59
Q

Hemophilias

A

Inherited bleeding

60
Q

Von Willebrand disease

A

Deficiency of von Wille brand factor (factor VIII)
Coagulation disorder affecting platelets
Symptoms: recurrent/excessive bruising, prolonged bleeding with minor skin trauma, prolonged bleeding of mouth, nose and menstruation
Treatment depends on how much VWF is missing

61
Q

Immune thrombocytopenia

A

Most common platelet disorder
Autoimmune disorder that causes distraction of platelets
Usually occurs after viral illness
75% of kids recover
Treatment: steroids

62
Q

Anticoagulants

A

Disrupt coagulation cascade and thus production of fibrin-venous clots

63
Q

Anti-platelets

A

Inhibit platelet aggregation-arterial clot

64
Q

Thrombolytics

A

Dissolve clots by breaking down fibrin

65
Q

Heparin

A

Prevents clotting by activating antithrombin
Indirectly activates thrombin
Activated factor X
Activated factor IX
***LMWH ONLY inactivates factor XA

66
Q

Hepairin induced thrombocytopenia (HIT)

A

Low platelet count
Nursing considerations for HIT:
-monitor platelet counts
-stop heparin immediately if platelet count is <100,000
Lepirduin and argatorban are indicated to treat HIT

67
Q

Motility

A

Movement of the food through the GI tract

68
Q

Ingestion

A

Taking food into the mouth

69
Q

Mastication

A

Chewing the food and mixing it with saliva

70
Q

Deglutition

A

Swallowing the food

71
Q

Peristalsis

A

Rhythmic wave like contractions that move food through the GI tract

72
Q

Exocrine

A

Go directly into the GI tract
HCL
H20
HCO3-
bile
Lipase
Pepsin
Amylase
Trypsin
Elastase
Histamine

73
Q

Endocrine

A

Stomach and small intestine secrete hormones to help regulate the GI system
Gastrin
Secretin
CCK
GIP
GLP-1
Guanylin
VIP
Somatostatin

74
Q

GI tract divided into

A

Alimentary canal
30 ft long
Extends from mouth to anus

75
Q

Accessory digestive organs

A

Liver
Pancreas
Gallbladder
Salivary glands
Spleen has some indirect action on digestion

76
Q

Esophagus

A

Connects pharynx to the stomach
-upper third contains skeletal muscle
-middle third contains a mixture of skeletal and smooth muscle
-terminal portion contains only smooth muscle

77
Q

Stomach

A

Most dispensable part of the GI tract
-empties into the duodenum

78
Q

What are the functions of the stomach

A

Stores food
Initiates digestion of proteins
Kills bacteria
Moves food (chyme) into intestine

79
Q

Digestion and absorption in the stomach

A

Proteins partially digested by pepisin
Carbohydrate digestion by salivary amylase is soon inactivated by acidity
Mucosa is protected by the mucosal barrier

80
Q

Small intestine

A

5-6 meters long
-duodenum, jejunum, ilium
Absorption occurs by villi
2 layers of smooth muscle

81
Q

Large intestine

A

1.5 meters long
-cecum, appendix, colon, rectum, anal canal
Very little absorptive function: remaining water, vitamins, and electrolyte
Lining is called rugae
Extrinsic parasympathetic innervention occurs through the vagus nerve

82
Q

Small intestine

A

Most of the fluid and electrolytes are absorbed by small intestine - 90%
Absorption of water occurs passively as a result of the osmotic gradient created by active transport
Aldosterone stimulates NaCl and H20 absorption in the ileum

83
Q

Large intestine

A

Material entering colon is largely water
Absorption is by diffusion and active transport
Aldosterone increases membrane permeability to sodium
Increasing both diffusion of Na and into the cell and the active transport of Na to the interstitial fluid
After water is reabsorbed, feces remains for disposal

84
Q

Defecation

A

Waste material passes to the rectum
Occurs when rectal pressure rises and external and anal sphincter relaxes

85
Q

What is the defecation reflex

A

Longitudinal rectal muscles contract to increase rectal pressure
-relaxation of internal anal sphincter
Excretion is aided by contractions of abdominal and pelvic skeletal muscles
-pushes feces from the rectum

86
Q

Constipation

A

Small, infrequent, or difficult BM
Fewer than 3 BM a week

87
Q

Impact ion

A

Unrelieved constipation
May lead to obstruction
-firm immovable mass of stool obstructs the lower GI
S/S:
-may have continuous oozing or diarrhea
-loss of appetite
-N/V
-Abdominal distention
-cramping and pain

88
Q

Diarrhea

A

Increase in frequency and fluidity of bowel movements

89
Q

Osmotic diarrhea

A

Magnesium sulfate

90
Q

Secretory diarrhea

A

Vibrio cholera and staphylococcus aureus

91
Q

Secretory diarrhea

A

Vibrio cholera and staphylococcus aureus

92
Q

Exudative diarrhea

A

Chrohn disease and ulcerative colitis

93
Q

Related to motility disturbances

A

Dumping Syndrom and IBS

94
Q

Clostridium difficile

A

A secretory-type diarrhea
An overgrowth of bacteria

Causes: antibiotics, chemotherapy, or invasive bowel surgery
Healthcare workers or direct contact with contaminated surfaces

95
Q

Complications of c diff

A

Dehydration
Kidney failure
Bowel perforation
Toxic mega colon
Death

96
Q

IBS

A

Diarrhea/constipation with cramps/mucous
Heightened response to stimulation
Causes: genetics, environment, diet
Pharmacotherapy: anti diarrheal, anticholinergic, laxatives

97
Q

Dumping syndrome

A

Impaired gastric emptying
External feedings given rapidly
Pathogenesis: impaired stomach function, hyper solar food gets dumped into small intestine, draws water into lumen and stimulates bowel mobility

98
Q

Homeostasis

A

Persons well being
Ideal “set point”
Where balance is achieved
Ph, temp, blood pressure

99
Q

Allostasis

A

Stability through the change
Addresses the need to alter “set points” based on certain situations- anticipation of increased demand
Involves altering multiple physiologic variables to match demands

100
Q

What is stress

A

Physical or psychological threat

101
Q

What is stressor

A

Internal or external challenge
Experiences that threaten ones since of security

102
Q

General Adaptation Syndrome

A

A similar response by the body no matter what the stressor
-Alarm- fight or flight
Resistance or adaptation
Exhaustion

103
Q

Alarm reaction

A

Increased secretion of cortisol, epinephrine, and norepinephrine

SNS activation:
-dilated pupil
-increased HR
-Bronchodilation
-increased glucose
Can be a psychological stressor or a physical stressor

104
Q

Allostasis

A

Short term adaptation to the stressor
Survival

105
Q

Allostatic load

A

Chronic stress
Long term dysregulation

106
Q

Allostatic overload

A

Exhaustion
Stress induced disease or disorder

107
Q

Adaptive ability

A

Coping mechanism

108
Q

What influences our response to stress?

A

Genetics
Culture
Prior experiences/environment
Pre-existing health status
Allostatic state
Ability to manage stress

109
Q

The stress system

A

Perception or anticipation of stress activates 3 physiologic systems
1. The hypothalamic-pituitary-adrenal axis HPA
2. The sympathetic nervous system SNS
3. Immune system IS

110
Q

Adrenal system

A

Organ that sits on top of kidney
2 parts:
Adrenal medulla- secretes epi + norepinephrine
Adrenal cortex- secrete glucocorticoids and mineralocorticoids

111
Q

Mineralcorticoids

A

Regulate electrolytes
Aldosterone
Blood pressure
Sodium and water resorption

112
Q

Glucocorticoids

A

Affect metabolism of carbs mainly but also fats and proteins
Cortisol
Anti inflammatory
Maintain normal BP
Stress effects

113
Q

Cortisol

A

-Promotes glucogenesis in the liver
-Increase protein metabolism use
-Suppress system inflammatory response
-Inhibit pro inflammatory activity of some growth factors and cytokines
-Increase local pro inflammatory effects

114
Q

Crushing Syndrome

A

-Over secretion
-redistribution of body fat and arms and legs to face, shoulders, trunk, and abdomen
-Hirsutism, bruising, hypokalemia, hypernatremia, abnormal glucose tolerance, and muscle atrophy
- caused by a tumor or excess administration of steroids

115
Q

Addisons disease

A

-under secretion
-decreased blood sodium and glucose levels
-increased potassium levels
-dehydration
-weight loss
-treated with mineralocorticoid and glucocorticoid

116
Q

Norepinephrine

A

Pupils-dilate
Gastric acid- decrease secretion
Pancreas- inhibit insulin secretion

117
Q

Epinephrine

A

Heart-increases contractability
Vascular smooth muscle- increase contractility
Lungs- bronchodilation
Brain- increase blood flow
Liver-increase glucose production

118
Q

Relaxation response

A

Decreased heart rate
Decreased BP
Decreased lactate levels
Increased immune system
Well being increases
Sleep improves
Increased normal
Decreased brain wave patterns
Increase digestion

119
Q

Stress response

A

Increased heart heart
Increased BP
Increased cholesterol
Decreased immune system
Increased anxiety
Increased depression
Increased libido
Irritability increases
Decreased digestion

120
Q

Immune system

A

-Adaptive role to signal other organs
-Evokes HPA axis
-Chronic stress—>lower levels of NK cells and increased levels of pro inflammatory cytokines.
-Psychosocial stress-induced modulation of lymphoid and myeloid cells
-Chronic inflammation by cytokines are implicated in cancer progression, metastasis, and recurrence

121
Q

Exhaustion

A

Stressor is not relieved
Body can no longer achieve homeostasis
Depleted energy stores
Inability to sleep

122
Q

Chronic stress at an early age

A

Prenatal stress has the potential to adversely affect the early development of the child
Alter brain morphology

123
Q

Neurotransmitters

A

Chemicals that enable neurotransmission-communication between neurons and other cells
Travels across a synapse and either blocks or facilitates relay of stimulus

124
Q

Major neurotransmitters

A

Dopamine
Norepinephrine
Serotonin
GABA
-Any substance that inhibits or blocks the reuptake of a neurotransmitter make more neurotransmitter available

125
Q

Dopamine deficit

A

Parkinson-like symptoms
Slow reaction time
Anergie
ANHEDONIA
“Pleasure center” dysfunction

126
Q

Serotonin deficit

A

OCD like symptoms
Obsessive thoughts
Compulsive behavior
IMPULSIVITY
Suicide
Aggression
Susceptibility to “cue triggers”

127
Q

GABA

A

Principle inhibitory neurotransmitter
GABA dysfunction is associated with anxiety disorders-especially panic
Connected to major depressive disorder

128
Q

Norepinephrine

A

Excitatory neurotransmitter associated with fight or flight response
High levels associated with anxiety, stress, hyperactivity
Low levels associated with lack of energy, focus, and motivation

129
Q

Depression

A

> 17 million
Most commons in women, white, single
64%> risk of CAD
Leading cause of disability
High risk of suicide
Associated with family history and genetically linked

130
Q

Depressive symptoms

A

Loss of interest or pleasure
Fatigue
Restlessness
Irritability
Impaired concentration
Low self esteem
Negative thinking
Sleep disturbances
Appetite changes

131
Q

How to treat depression

A

Medication
Psychotherapy
Cognitive behavioral therapy
Psycho education and support groups
Brain stimulation therapy

132
Q

Types of anxiety

A

Panic
PTSD
GAD
Social anxiety disorder
OCD

133
Q

Panic disorder

A

Anticipatory anxiety: fearful expectation of panic anxiety onset
Avoidance anxiety: personal strategies used to increase feeling of control and decrease the risk of panic anxiety

Genetics, family history
Early childhood stress linked to adult onset anxiety disorder

134
Q

Panic

A

Unexpected episodes
Out of proportion to events going on around patient
Many patients with panic also have depression

135
Q

Panic attacks

A

Recurrent uncomfortable episodes with sudden onset with symptoms:
Heart palpitations
Chest pain
SOB
Dizziness
Nausea
Fear of losing control
Tingling in hands
Flushing or chills

136
Q

How to treat panic disorder

A

Cognitive behavioral therapy-reduce fearful thinking and cognitive/physical stress responses

Anti-depressants

137
Q

Generalized anxiety disorder

A

Chronic condition
Anxiety for more than 6 months
Excessive, uncontrolled, unrealistic worry
Accompanied by muscle tension, autonomic hyperactivity, exaggerated startle, difficulty concentrating

138
Q

How to treat GAD

A

Cognitive behavioral therapy
Antidepressants
Buspirone
Benzodiazepines

139
Q

PTSD

A

Hyper-arousal
Avoidance of reminders
Re-experiencing the events

Chronic activation of the stress response in relation to exposure to potentially life threatening event

140
Q

PTSD treatment

A

Psychotherapy
Medications

141
Q

Social anxiety disorder

A

Intense fear of being criticized by other
Persistent fear of humiliation
Negative evaluation of embarrassment in social situations
Withdraw from situations or experience intense discomfort

Causes:
Inherited traits
Brain structure
Environment

142
Q

How to treat social anxiety

A

Cognitive behavioral therapy
SSRI
Benzos
Propranolol

143
Q

OCD

A

Repetitive unwanted thoughts/obsessions
Repeated activities/rituals

144
Q

OCD treatment

A

VERY VERY difficult to treat
SSRI-first line
TCA-second line

Pathopharmacology (3 decks)

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