NUR 226 Exam 3 Flashcards
What are components of the upper respiratory tract
Nasal passages
Sinuses
Nasopharynx
Pharynx
Larynx
Tonsils
Glottis
What are the components of the lower respiratory tract
Lower trachea
Right and left bronchus
Bronchial tree
Lungs
Pleural membranes
Alveolar ducts
Alveoli
Mediastinum
What does the upper respiratory tract mucus do
Maintains temp
Humidification of inhaled gas
Traps and removes foreign particles, bacteria, and noxious gas
What does the cilia do
Propel mucous and entrapped particles toward oropharynx
What does alveolar macrophages do
Ingest and remove bacteria from alveoli via phagocytosis
Release inflammatory cytokines
Present antigens to adaptive immune system
Allergic Rhinitis
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
Histamines
Stored in mast cells (skin and soft tissue)
Basophils (blood)
When activated histamines can cause:
Hives and itching skin
Dilation of blood vessels
Erythema and hypotension
Bronchoconstriction
Effect sleep/wake cycles
Increase the secretion of acid in the stomach
What causes the majority of the symptoms associated with allergic reactions
Histamine
Bacterial infection
Swollen uvula
Whitish spots
Red swollen tonsils
Throat redness
Gray furry tongue
Viral infection
Red swollen tonsils
Throat redness
What are some examples of URI
Rhinitis
Sinusitis
Laryngitis
Larynogotracheobronchitis
Acute bronchitis
Influenza
Sinusitis
Inflammation and swelling of sinus mucosa
Secondary infection
Rhinitis
Inflammation of the mucus membranes of the nose
Allergy
Symptoms:
Low grade fever
Headache
Fatigue
Nasal congestion
Rhinorrhea
Cough
Rhinovirus
Early fall, spring, and summer
Lives up to 3 hours outside the body
Spreads by droplet contaminated objects
Pharyngitis
Palate
Tonsils
Uvula
CULTURES AND RAPID STREP TEST
Acute bronchitis
Sputum production
Clear to yellow
Influenza
Viral ABC
Types can mutate
Vaccine
Rapid onset
Fever
Chills
Body aches
Secondary pneumonia can be deadly
Epiglottitis
Inspirators strider and retractions
Rapid onset of fevers
Pain
Difficult swallowing
Drooling
Atelectasis
The loss of lung volume due to collapse of lung tissue
It can be partial or complete
Involves alveoli- deflate fill with fluid
What are the two components of blood
Plasma 55%
Formed elements 45%
What is in the plasma of blood
Proteins 7%
Water 92%
Other solutes 1%
What formed elements of blood?
Platelets
Leukocytes
Erythrocytes
Cell components of blood
Erythrocytes
Leukocytes
Neutrophils
Lymphocyte
Monocyte/macrophage
Eosinophil
Basophil
Natural killer cells
Platelet
Platelets
Not true cells
Contain cytoplasmic granules which can release adhesive proteins, coagulation, and growth factors when they sense a vessel injury.
Normal platelet count vs thrombocytopenia
150-000-400,000
<100,000
Where are platelets formed
Bone marrow
Additional platelets stored in the spleen
What is the function of platelets
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
Hemostasis
Stop blood loss after any injury
Multiple actions:
-blood vessels
-Circulating platelets
-coagulation cascade
Excessive hemostasis- clot formation excessive or inappropriate
Inadequate hemostasis-bleeding
Steps of hemostasis
Vascular spasm
Platelet plug formation
Blood clotting
Petechiae
Tiny spots of bleeding under the skin or in the mucous membrane
Purpura
Hemorrhages in the skin and mucous membranes that result in appearance of purplish sports or patches
Ecchymosis
Discoloration of skin from bleeding underneath, caused by bruising
Telanglectasia
Spider veins
Menorrhagia
Unusually heavy bleeding at menstruation
Epitaxis
Nosebleed
Thrombosis
Formation blood clot within a vessel
Hematoma
Localized collection of blood outside vessels
Hemarthrosis
Bleeding into a joint space that causes pain
Thrombocytosis
Increased platelet count
Increased risk of clot formation
Inflammation
Malignancy
Thrombocytosis
Increased platelet count
Increased risk of clot formation
Inflammation
Malignancy
Thrombocytopenia
Characterized by decreased platelet count
Risk of bleeding
Thrombosis
What is inappropriate clot formation
Embolus
A piece of thrombus that breaks free and travels
Fibrinolysis
Clot dissolution
Platelets
Primary activator in coagulation cascade
Fibrin
End product of coagulation cascade which stabilizes the blood clot
What are protein strands made of
Fibrin
Anti-thrombin III
What is a circulating inhibitor of thrombin
What is the coagulation cascade
Groups of proteins that when activated form a blood clot
Activated by tissue injury or infection
What is a blood clot
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
What is a tissue factor pathway inhibitor inhibits factor
Xa
What is the natural removal of the clot
Lysis-breakdown
Breakdown carried out by the fibrinolytic system
Thrombosis
Formation of a clot in the blood vessel
Hemorrhage
Excessive bleeding due to inadequate clot formation
Arterial thrombosis
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
Venous thrombosis
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
What are the goals of coagulation therapy
Prevent a clot formation
Break apart existing clots
Increase circulation and perfusion
Decrease pain
Prevent further tissue damage
Hemophilias
Inherited bleeding
Von Willebrand disease
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
Immune thrombocytopenia
Most common platelet disorder
Autoimmune disorder that causes distraction of platelets
Usually occurs after viral illness
75% of kids recover
Treatment: steroids
Anticoagulants
Disrupt coagulation cascade and thus production of fibrin-venous clots
Anti-platelets
Inhibit platelet aggregation-arterial clot
Thrombolytics
Dissolve clots by breaking down fibrin
Heparin
Prevents clotting by activating antithrombin
Indirectly activates thrombin
Activated factor X
Activated factor IX
***LMWH ONLY inactivates factor XA
Hepairin induced thrombocytopenia (HIT)
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
Motility
Movement of the food through the GI tract
Ingestion
Taking food into the mouth
Mastication
Chewing the food and mixing it with saliva
Deglutition
Swallowing the food
Peristalsis
Rhythmic wave like contractions that move food through the GI tract
Exocrine
Go directly into the GI tract
HCL
H20
HCO3-
bile
Lipase
Pepsin
Amylase
Trypsin
Elastase
Histamine
Endocrine
Stomach and small intestine secrete hormones to help regulate the GI system
Gastrin
Secretin
CCK
GIP
GLP-1
Guanylin
VIP
Somatostatin
GI tract divided into
Alimentary canal
30 ft long
Extends from mouth to anus
Accessory digestive organs
Liver
Pancreas
Gallbladder
Salivary glands
Spleen has some indirect action on digestion
Esophagus
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
Stomach
Most dispensable part of the GI tract
-empties into the duodenum
What are the functions of the stomach
Stores food
Initiates digestion of proteins
Kills bacteria
Moves food (chyme) into intestine
Digestion and absorption in the stomach
Proteins partially digested by pepisin
Carbohydrate digestion by salivary amylase is soon inactivated by acidity
Mucosa is protected by the mucosal barrier
Small intestine
5-6 meters long
-duodenum, jejunum, ilium
Absorption occurs by villi
2 layers of smooth muscle
Large intestine
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
Small intestine
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
Large intestine
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
Defecation
Waste material passes to the rectum
Occurs when rectal pressure rises and external and anal sphincter relaxes
What is the defecation reflex
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
Constipation
Small, infrequent, or difficult BM
Fewer than 3 BM a week
Impact ion
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
Diarrhea
Increase in frequency and fluidity of bowel movements
Osmotic diarrhea
Magnesium sulfate
Secretory diarrhea
Vibrio cholera and staphylococcus aureus
Secretory diarrhea
Vibrio cholera and staphylococcus aureus
Exudative diarrhea
Chrohn disease and ulcerative colitis
Related to motility disturbances
Dumping Syndrom and IBS
Clostridium difficile
A secretory-type diarrhea
An overgrowth of bacteria
Causes: antibiotics, chemotherapy, or invasive bowel surgery
Healthcare workers or direct contact with contaminated surfaces
Complications of c diff
Dehydration
Kidney failure
Bowel perforation
Toxic mega colon
Death
IBS
Diarrhea/constipation with cramps/mucous
Heightened response to stimulation
Causes: genetics, environment, diet
Pharmacotherapy: anti diarrheal, anticholinergic, laxatives
Dumping syndrome
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
Homeostasis
Persons well being
Ideal “set point”
Where balance is achieved
Ph, temp, blood pressure
Allostasis
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
What is stress
Physical or psychological threat
What is stressor
Internal or external challenge
Experiences that threaten ones since of security
General Adaptation Syndrome
A similar response by the body no matter what the stressor
-Alarm- fight or flight
Resistance or adaptation
Exhaustion
Alarm reaction
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
Allostasis
Short term adaptation to the stressor
Survival
Allostatic load
Chronic stress
Long term dysregulation
Allostatic overload
Exhaustion
Stress induced disease or disorder
Adaptive ability
Coping mechanism
What influences our response to stress?
Genetics
Culture
Prior experiences/environment
Pre-existing health status
Allostatic state
Ability to manage stress
The stress system
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
Adrenal system
Organ that sits on top of kidney
2 parts:
Adrenal medulla- secretes epi + norepinephrine
Adrenal cortex- secrete glucocorticoids and mineralocorticoids
Mineralcorticoids
Regulate electrolytes
Aldosterone
Blood pressure
Sodium and water resorption
Glucocorticoids
Affect metabolism of carbs mainly but also fats and proteins
Cortisol
Anti inflammatory
Maintain normal BP
Stress effects
Cortisol
-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
Crushing Syndrome
-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
Addisons disease
-under secretion
-decreased blood sodium and glucose levels
-increased potassium levels
-dehydration
-weight loss
-treated with mineralocorticoid and glucocorticoid
Norepinephrine
Pupils-dilate
Gastric acid- decrease secretion
Pancreas- inhibit insulin secretion
Epinephrine
Heart-increases contractability
Vascular smooth muscle- increase contractility
Lungs- bronchodilation
Brain- increase blood flow
Liver-increase glucose production
Relaxation response
Decreased heart rate
Decreased BP
Decreased lactate levels
Increased immune system
Well being increases
Sleep improves
Increased normal
Decreased brain wave patterns
Increase digestion
Stress response
Increased heart heart
Increased BP
Increased cholesterol
Decreased immune system
Increased anxiety
Increased depression
Increased libido
Irritability increases
Decreased digestion
Immune system
-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
Exhaustion
Stressor is not relieved
Body can no longer achieve homeostasis
Depleted energy stores
Inability to sleep
Chronic stress at an early age
Prenatal stress has the potential to adversely affect the early development of the child
Alter brain morphology
Neurotransmitters
Chemicals that enable neurotransmission-communication between neurons and other cells
Travels across a synapse and either blocks or facilitates relay of stimulus
Major neurotransmitters
Dopamine
Norepinephrine
Serotonin
GABA
-Any substance that inhibits or blocks the reuptake of a neurotransmitter make more neurotransmitter available
Dopamine deficit
Parkinson-like symptoms
Slow reaction time
Anergie
ANHEDONIA
“Pleasure center” dysfunction
Serotonin deficit
OCD like symptoms
Obsessive thoughts
Compulsive behavior
IMPULSIVITY
Suicide
Aggression
Susceptibility to “cue triggers”
GABA
Principle inhibitory neurotransmitter
GABA dysfunction is associated with anxiety disorders-especially panic
Connected to major depressive disorder
Norepinephrine
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
Depression
> 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
Depressive symptoms
Loss of interest or pleasure
Fatigue
Restlessness
Irritability
Impaired concentration
Low self esteem
Negative thinking
Sleep disturbances
Appetite changes
How to treat depression
Medication
Psychotherapy
Cognitive behavioral therapy
Psycho education and support groups
Brain stimulation therapy
Types of anxiety
Panic
PTSD
GAD
Social anxiety disorder
OCD
Panic disorder
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
Panic
Unexpected episodes
Out of proportion to events going on around patient
Many patients with panic also have depression
Panic attacks
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
How to treat panic disorder
Cognitive behavioral therapy-reduce fearful thinking and cognitive/physical stress responses
Anti-depressants
Generalized anxiety disorder
Chronic condition
Anxiety for more than 6 months
Excessive, uncontrolled, unrealistic worry
Accompanied by muscle tension, autonomic hyperactivity, exaggerated startle, difficulty concentrating
How to treat GAD
Cognitive behavioral therapy
Antidepressants
Buspirone
Benzodiazepines
PTSD
Hyper-arousal
Avoidance of reminders
Re-experiencing the events
Chronic activation of the stress response in relation to exposure to potentially life threatening event
PTSD treatment
Psychotherapy
Medications
Social anxiety disorder
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
How to treat social anxiety
Cognitive behavioral therapy
SSRI
Benzos
Propranolol
OCD
Repetitive unwanted thoughts/obsessions
Repeated activities/rituals
OCD treatment
VERY VERY difficult to treat
SSRI-first line
TCA-second line
