NUR326 Exam 4 Flashcards
1
Q
synovial/diathrodial joint
A
any joint that allows movement
2
Q
subchrondral bone plate
A
under the cartilage
bone just underneath the cartilage
3
Q
articular cartilage
A
covers the bone of the joint, provides a smooth, slippery surface that allows free movement of a joint
4
Q
synovium
A
space between two articulating bones
synovial membrane that is the inner lining of the cavity
secretes synovial fluid that lubricates the joint surfaces and removes debris
5
Q
joint capsule
A
surrounds the joint
unties articulating bones
6
Q
three phases of bone healing
A
- inflammatory - hematoma forms
- reparative - fibrous cartilage and ossification
- remodeling - healing is complete
7
Q
osteoarthritis
A
degeneration of joints caused by aging and stress
obesity and age increase risk
commonly effects: cervical spine, lumbar spine, hip, knee, hand, first metatarsal phalangeal joint, and spared joints
8
Q
RF of osteoarthritis
A
aging, obesity, history of playing sports, history of trauma, heavy occupational work, misalignment
9
Q
etiology of OA
A
stress is applied to joints, degeneration of cartilage, osteoblasts are activated which lead to bony spurs, narrows joint space, becomes a chronic disease
10
Q
osteophytes
A
small bony projections that develop on the rim of the bone adjacent to cartilage loss
hallmark in OA**
11
Q
OA symptoms
A
deep aching joint pain, relieved with rest
pain during cold weather
stiffness in the mornings
popping during motion
joint swelling
altered gait
limited ROM
12
Q
herbeden’s nodes
A
swellings at the distal interphalangeal joint (OA)
13
Q
bouchard’s nodes
A
proximal interphalangeal joint (OA)
14
Q
pharmacotherapy for OA
A
focus on pain management and reduce swelling
mild to moderate pain: tylenol, topical capsaicin, NSAIDS
moderate to severe pain: NSAIDS, tylenol + tramadol, opioids, steroid injections
15
Q
NSAID MOA
A
reduce the production of prostaglandin
causes an increase in ulcer development
contraindicated with a history of ulcers
16
Q
cautions with NSAIDS
A
may effect kidney function
risk for GI bleed - contraindicated with ulcers, use with caution for those with a history of GI bleeds or current anticoag therapy
17
Q
OA dietary supplements
A
glucosamine sulfate - maintains cartilage health
chondroitin sulfate - slows cartilage breakdown
18
Q
degenerative disk disease (DDD)
A
degeneration of the lumbar and cervical spine
causes pain, motor weakness, and neuropathy
19
Q
S/S of DDD
A
lumbar - pain in lower back that radiates to back of leg, pain in butt or thighs, pain worsens when sitting/bending/ lifting/twisting
numbness/tingling/ weakness in legs
foot drop
cervical - chronic neck pain that radiates to shoulders and down the arms, numbness or tingling in the arm or hand, weakness
20
Q
commonalities between rheumatoid arthritis and systemic lupus erythematous
A
inflammatory conditions that result in pain, limitation of movement, destruction or erosion of joints, ligaments, or muscles
autoimmune orgin
systemic, not local
21
Q
rheumatoid arthritis (RA)
A
systemic autoimmune disease that is type III hypersensitivity
inflammation of the synovium
22
Q
RA etiology
A
not fully understood, genetic link, women 40-60, and tobacco use
23
Q
RA pathogenesis
A
autoimmune attack against the synovial tissue
immune cells are activated and they produce rheumatic factor - attacks against the body, destroys cartilage
24
Q
pannus
A
type of vascularized scar tissue, able to get nutrients but also contains inflammatory cells
causes bone erosion, bone cysts, and fissure development
in RA
25
CM of RA
early - vague
late - bilateral pain, stiffness, motion, limitation, inflammation
advanced - deformity and disability, joint subluxation
26
RA systemic involvement
fatigue, malaise
rheumatoid nodules, sjogren's sydrome
27
systemic lupus erythematous (SLE)
autoimmune inflammatory disease that affects many organ systems, has acute flare ups, and is unpredictable
autoimmune attack against the body's own DNA
28
two types of lupus
discoid - targets skin
systemic - targets internal organs
29
SLE predisposing factors
genetics, female, age 20-40, African American, environmental triggers, allergies to antibiotics, hormonal factors, and tobacco use
30
SLE pathogenesis
b-lymphocytes are hyperactive and productive autoantibodies
antinuclear antibody*
forms immune complexes
inflammatory response destroys the tissue
31
SLE CM
fatigue, photosensitivity, butterfly rash, fever, weight changes, unusual hair loss, periorbital edema
nephritis*
the more organs involved, the more CM and the worse the prognosis
32
SLE Flares
exacerbations and remissions
warning signs of flares: fatigue, pain, headache
prevention: recognize warning signs and avoid triggers
33
sjogren syndrome
autoimmune destruction of any moisture producing gland
lacrimal gland
salivary gland
34
methotrexate
first line therapy for SLE and RA
immunosuppressive
SE - GI, bone marrow suppression, shortened life expectancy
11 BBW
folic acid supplementation is necessary*
teratogenic, no alcohol
contact HCP with signs of infection
35
hydrochroroquine
SLE RA
antiinflammatory
slows progression when used with another DMARD
rare SE - retinopathy
36
difference in RA and SLE
RA - focus on joints
SLE - multisystem
37
gouty arthritis
urate crystals in the synovial fluid
acute painful inflammation
38
chronic tophaceous gout
advanced stage
tophi - white nodules composed of urate crystals
39
uric acid
waste product of purine metabolism
contains nitrogen, excreted in urine
sources: red meat, organ meat, seafood
40
predisposing factors of gout
male, genetics, diet, obesity, diuretic therapy and kidney insufficiency
41
pathogenesis of gouty arthritis
elevated uric acid levels, uric acid accumulates in body fluids, forms urate crystals, deposition in or around joints, inflammation, gouty arthritis
42
CM of gouty arthritis
intense pain, commonly in big toe, worst in early morning
inflammation
fever
malaise
43
complication of gouty arthritis
urate kidney stones
44
pharmacotherapy for gouty arthritis
acute - NSAIDS, corticosteroid therapy, colchicine
prophylactic - allopurinol, colchicine, probenecid
45
allopurinol
antigout agent
inhibits the production of uric acid
used for prophylaxis
SE - rash
interacts with hypoglycemic agents and warfarin
take with food or milk if it causes GI irritation
monitor urine uric acid and serum glucose
takes 2-6 weeks to improve
monitor PT/INR if on warfarin
46
colchicine
anti gout agent
inhibits leukocyte infiltration and disrupts cell division
for gout flares and prophylaxis
SE - GI (if this happens stop administration**, could be the first sign of toxicity)
contraindicated in renal disease
avoid grapefruit, alcohol, and B12 vitamins
many other drug interactions
47
probenecid
uricosuric agent
inhibits the reabsorption of uric acid in the kidneys
treats hyperuricemia with gout
SE - GI, dizziness, headache, kidney/liver impairment
many drug interactions
48
what is the relationship between bone mass, age, and sex?
women have later bone mass in early postmenopausal years
women don't start with as much bone mass
women lose more bone mass than men
49
osteopenia vs osteoporosis
osteopenia - low bone mass
osteoporosis - porous bone
50
osteopenia
thinning of trabecular matrix of the bone before osteoporosis
51
osteoporosis
bone mineral density of 2.5 SD below peak bone mass
measured with DEXA scan
low bone mass, micro-architectural deterioration, increased bone fragility, susceptible to fracture
52
osteoporosis RF
age, female, history of fractures as an adult, family history, low body weight, smoking, alcoholism, steroid therapy and immune suppressive drugs
thin and small frame, lack of weight bearing exercises, lacking vitamin D and calcium, eating disorders, gastric bypass, lack of estrogen and testosterone, excess caffeine
53
FRAX
prediction tool for assessing individual risk of fracture
used to provide treatment guidelines
calculates a 10 year risk score of a hip fracture
54
osteoporosis patho
bone resorption from osteoclasts
bone formation from osteoblasts
failure to make new bone or increased resorption or BOTH
55
osteoporosis CM
early - none
late - fractures, pain, loss of height, stooped posture
56
3 most common fractures caused by osteoporosis
hip
wrist
vertebrae
57
hip fracture complications
death
high lifetime risk
requires hospitalization
mortality up to 40%
may cause them to need a caretaker
58
hip fx RF
age >65, female, hx osteoporosis or falls
59
clinical presentation of a hip fx
sudden onset of hip pain before or after a fall
inability to walk
severe groin pain
tenderness
externally rotated effected leg
shortened extremity
60
osteoporosis prevention pharm
calcium supplement
vitamin D supplement
exercise
61
alendronate
prevention and treatment of osteoporosis
binds permanently to surfaces of bones and inhibits osteoclasts
SE - GI, n/d, esophageal ulceration*
take with water
do not lie down after taking
no food, drink, calcium or vitamins for 2 hours after taking
may take a drug holiday
62
raloxifene
"Rail"
mimics estrogen
prevents and treats osteoporosis
reduces risk of spinal fractures by 50%
AE - hot flashes, leg cramps
take adequate calcium and vitamin D
discontinue 72 hours before prolonged immobilization
no tobacco or alcohol
teratogenic
BBW - stroke
63
calcitonin-salmon
bone resorption inhibitor
inhibits bone removal by osteoclasts (calcitonin)
treatment of osteoporosis
reduces spinal fractures by 30%
slows down bone loss, increases spinal bone density
can cause nasal irritation (salmon smells weird)
64
causes of fractures
traumatic, fatigue, pathologic
65
open vs closed fracture
open - penetrates skin
closed - does not break skin
66
transverse fracture
straight line across bone
67
spiral fracture
twisting break along bone
68
longitudinal fracture
up and down the bone
69
oblique fracture
diagonal fracture
70
comminuted fracture
more than one fracture line and more than two fragments
71
impacted fracture
crushed
caused by jumping from height
72
greenstick fracture
thinning of bone and breaking off
more likely in kids
73
stress fracture
small break due to repeated stressor on the bone
74
avulsion
fracture of the patella
75
PED CM of fractures
Pain
Edema
Deformity
76
complications of fractures
delayed healing
bone growth impairment
compartment syndrome
fat embolism syndrome
77
RF for delayed bone healing
infection
smoking
malnutrition
78
malunion
improper alignment
79
nounion
no healing for 4-6 months post-fracture
80
compartment syndrome
seen with crushing injuries, too tight of casts, long bone injuries, severe thermal burns. and animal bites
results from increased pressure within a limited amount of space
creates a "tourniquet effect"
81
CM of compartment syndrome
extreme pain
very quick process
check for pulse distal to the cast*
82
fat embolism syndrome
fat molecules in the lung after long bone fracture or major trauma that forms within 24-48 hours after injury
fat molecules from the bone marrow or traumatized tissue are released into the bloodstream, ending up in the lungs
83
osteomyelitis
an acute or chronic pus producing (pyogenic) infection of a bone
usually from bacteria (staphylococcus aureus)
84
RF for osteomyelitis
recent trauma
DM (poor circulation)
hemodialysis
IV drug use
splenectomy
PVD
85
direct osteomyelitis contamination
open wound from open fracture, gunshot, puncture, surgery, or insertion of metal plates
86
hematogenous (indirect) contamination of osteomyelitis
from the bloodstream, usually in the long bones, those under 16 have the highest risk
*most common type
87
hematogenous contamination patho
arterial bloodflow brings bacteria to bone
infection causes inflammation, bone destruction, and pus and edema
pressure increases
ischemia/necrosis
osteoblasts lay new bone around the old bone
infection becomes isolated
88
what is the problem when pressure within the bone increases to that of arterial blood flow?
local arteries collapse
no oxygen, nutrition, immune cell, or antibiotics supply
results in impaired healing
89
CM osteomyelitis
local - tenderness, warmth, redness, wound drainage, restricted movement
spontaneous fractures
systemic - spiking fevers, positive blood culture, leukocytosis
90
pharm for osteomyellitis
obtain a culture
give a broad spectrum abx (naficillin, cefazolin, vancomycin)
start bacteria specific therapy when culture returns
91
complications of osteomyelitis
chronic osteomyelitis
local spread of infection
reduced limb or joint function
92
4 phases of the cell cycle
G1 - cell prepares to make DNA
S - 2 separate chromosomes arise
G2 - DNA synthesis ceases
M - cell divides
Go - resting phase
93
what is an example of a non-cancerous cell that divides rapidly?
GI epithelial cells lining the GI tract
94
undifferentiated stem cells
can be triggered to enter the cell cycle and produce parent cells
95
parent cells
continue to divide and reproduce (blood, skin, liver cells)
96
well-differentiated cells
do not normally divide and reproduce (neurons of skeletal and cardiac muscle)
97
what are the 3 basic properties of cell proliferation?
1. intracellular control of proliferation
2. contact inhibition
3. rate of cell proliferation
98
cell differentiation
the process in which proliferating cells are transformed into different and more specialized types of cells
99
apoptosis
cell begins to die and molecules on the cell's surface change
100
fertilized ovum
where all types of cells originate from
101
stem cells
"reserve unit"
exist in a dormant state
when triggered by some event, they jump into the cell cycle and begin proliferation and differentiation
102
what is the connection between stem cells and cancer cells?
mutations of cells at some point in the differentiation process from a stem cell to an adult cell that cancer cells are formed
103
benign vs malignant
benign - glow slowly, have a well defined-capsule, non-invasive, looks like tissues from when it irises, have a low mitotic index, dividing cells are rare
malignant - grow rapidly, are not encapsulated, invade local structures and tissues, poorly differentiated (may not be able to tell what tissue it arose from), have many dividing cells, can spread distantly through blood and lymph system
104
what 3 things does the origin of cancer depend on?
genes, carcinogens, and promoters
105
what are the 4 phases of carcinogenesis?
1. initiation
2. promotion
3. progression
4. metastasis
106
oncogen and gas pedal analogy
mutated proto-oncogens cause the growth signal to be permanently "on" while tumor suppressor genes are inactivated "brake"
107
tumor supressor genes
normally function to restrain cell growth
can become effective and lose the ability to inhibit cell growth and division, allowing cancer formation
108
proto-oncogens
"good genes"
stimulate and regulate a cell's movement through the cell cycle, results in cellular growth and proliferation
when mutated, they become oncogens and stimulate constant cellular proliferation and cycling
109
carcinogens
substances that cause the development of cancer
promoters - diet, alcohol, tobacco, hormones
110
viral induced cancer
always involve the activation of growth promoting pathways or inhibition of tumor suppressors in infected cells
111
endothelial growth factor
substance that gives cancer cells the ability to develop new blood vessels
112
primary vs secondary tumor
primary - where it originated
secondary - due to the primary
113
seeding vs implantation
seeding - erodes and sheds into body cavities and implants somewhere else (seed falls off the tree and starts growing where it lands)
implantation - direct exposure of a tumor to surrounding tissue, from one organ to the next (tree has roots)
114
lymphatic spread of cancer
cells become trapped in the lymph nodes
cells either die, go dormant, or proliferate
if they survive, they work their way through the lymph system
115
vascular spread of cancer
spreads by vascular drainage - penetrates local veins and goes through the body
first stop is often the liver because it receives blood through portal circulation before general circulation (why the liver is commonly a secondary cancer site)
116
angiogenesis
tumor creates its own blood supply
117
common sites for secondary tumors
lungs
bones
liver
brain
118
lung cancer
normally diagnosed late
early diagnosis is key
most prevalent in those >65 and African Americans
*cigarette smoking is the main etiology (risk increases with more smoking)
cilia are paralyzed which activates oncogens
119
non small cell lung cancer vs small cell lung cancer
NSCLC - slow growing, majority of lung cancers
SCLC - rapidly growing tumor that metastasizes quickly
120
S/S of lung cancer
cough, hemoptysis, wheeze, chest pain, dyspnea, weight loss, excessive fatigue, weakness, hoarseness, may appear as pneumonia
paraneoplastic syndrome
121
paraneoplastic syndrome and lung cancer
lungs secrete an excess of ACTH (cortisol)
gives the patient a tanned appearance
122
breast cancer: RF, S/S
RF - age >50, prolonged reproductive life, hormone replacement therapy, obesity, late childbirth, nulliparous (no pregnancies), Jewish women, and genetic mutations
S/S - single tumor, nontender tumor, firm tumor, irregular borders, commonly in the upper outer quadrant
123
BRCA genes
familial gene that increases the likelihood of developing breast cancer
many women choose an elective mastectomy
124
cervical cancer
promote screening*
RF - smoking, STD history, *HPV infection, more than two lifetime sexual partners, immunosuppression, genetics
125
colorectal cancer- RF, S/S
usually starts as a polyp (can be hereditary)
RF - obesity, tobacco, inactivity, insulin resistance, low fiber, high amount of animal fat, diet low in a, c, and e, ulcerative colitis, and heavy alcohol use
S/S - fatigue, weakness, weight loss, iron deficiency anemia, changes in bowel habits, melena, diarrhea, constipation, and rectal bleeding
126
consequences to late detection of cancer
1. metastasis
2. less responsive to treatment
3. more debilitated by the disease
127
what are the strategies for success of chemo?
intermittent chemo
combo therapy
optimal dosing
regional therapy
128
intermittent chemo
gives chemo intermittently to allow normal cells to recover in between cycles
normal cells recover faster than cancer cells, so it strikes a balance
129
what is an important precaution with combination chemo therapy?
don't want to have drugs that have overlapping toxicities, could "knock out" one part of the body
130
what are the "usual toxicities" of chemo?
nausea and vomiting
decreased WBC, RBC, platelets
diarrhea, alopecia, and fatigue
131
3 major complications of chemo
neutropenia - risk for infection
thrombocytopenia - risk for bleeding
erythrocytopenia - anemia
132
magic mouthwash
prescription cocktail to assist in treating stomatitis
lidocaine, mylanta, diphenhydramine, prednisolone, distilled water
*not curative
133
what are 3 drugs to help with chemo toxicities?
ondansetron
dexamethasone
magic mouthwash
134
cytotoxic agents MOA
disrupts DNA synthesis, target rapidly producing cells
135
cyclophosphamide
alkylating agent
nonspecific cell phase
*bladder injury plus normal toxicities and discoloration of skin and nails
136
methotrexate
antimetabolites
S phase specific
resemble natural metabolites
usual toxicities plus nephrotoxicity, hepatotoxicity, and abnormaltities/fatal
137
doxorubicin
antitumor abx
nonspecific in cell cycle phase
originates from streptomyces
usual toxicities plus cardiotoxicity
138
vincristine
mitotic inhibitors
m phase specific
comes from periwinkle
almost all experience peripheral neuropathy*
no bone marrow suppression in some drugs
139
ondansetron
blocks seretonin receptors on vagal nerve and CTZ
efficacy is improved with steroids
AE - headache, diarrhea, dizziness
140
promethazine
blocks dopamine receptors in the CTZ
AE - respiratory depression, drowsiness, sedation
BBW - resp depression <2 and gangrenous extraversion
141
biologics therapy
uses body's immune system to kill cancer cells
many types
approved for leukemia, lymphoma, breast, bladder, brain, colon, lung, and pancreatic
142
biologics SE
pain, swelling soreness
flu-like
weight gain
diarrhea
risk of infection
143
non-self antigen
our immune system surveys the body for these foreign substances
144
differentiation
extent that neoplastic cells resemble normal cells both structurally and functionally
145
anaplasia
lack of differentiation
cellular disorganization
146
what types of substances are tumor markers and where can they be found?
hormones, enzymes, antigens, or genes
blood, urine, CSF, or tumor plasma membranes
*not always diagnostic of cancer
147
classifying cancer through the TNM system
T - tumor size
N - lymph node involvement
M - metastasis to distant organs
148
grades 1-3 of malignant cancers
grade 1 - cells are well differentiated
grade 2 - cells are moderately differentiated
grade 3 - poorly differentiated or anaplastic cells
149
4 stage cancer classification
stage 1 - confined to organ or origin
stage 2 - locally invasive
stage 3 - regional spread
stage 4 - spread to distant sites
