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rrd 5 Flashcards

infection

1
Q

infectious diseases (IDs)

A

disorders in which tissue damage or dysfunction is produced by a microorganism

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2
Q

endemic

A

used to describe a disease that exists all the time in certain communities

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3
Q

epidemic

A

an outbreak of a disease that spreads within a certain time frame to people of one or several communities

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4
Q

pandemic

A

the disease outbreak spreads from being epidemic (a few communities) to being worldwide

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5
Q

example of endemic

A

malaria is endemic to parts of Africa

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6
Q

example of epidemic

A

there is often a yearly flu epidemic in some U.S. communities

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7
Q

example of pandemic

A

the Spanish flu of 1918 began as an epidemic amongst soldiers at U.S. army bases, then became pandemic when they went to Europe during WW1

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8
Q

infection

A
  • presence & multiplication of a living organism on or in the host
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9
Q

invading organism is a ?

A

pathogen - an organism that causes harm

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10
Q

types of pathogens

A
  • viruses
  • bacteria
  • fungi
  • protozoan
  • nematodes
  • microsporidia
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11
Q

factors determining whether a host will be infected and how it will be infected

A
  • immunocompetence of the host
  • virulence factors of infecting organism
  • its portal of entry
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12
Q

immunocompetence of the host are?

A

its defense mechanisms adequate, non-defective, fully functional, etc.?

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13
Q

virulence factors of the infecting organism include

A
  • toxins
  • adhesion factors
  • invasion factors
  • evasive factors
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14
Q

portal of entry questions

A

how does microbe enter host?

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15
Q

the portal of entry usually involves ______. the CDC divides infection risks into 4 _______ precautions that should guide every healthcare workers’ interactions with the public. what are they?

A
  • breach of 1st line of defense
  • transmission-based
  • standard, contact, droplet, airborne precaution
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16
Q

standard precautions

A

basic infection prevention measures used during every patient interaction whether a known/suspected infection is present

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17
Q

standard precaution measures include

A
  • hand hygiene
  • use of PPE
  • resp hygiene and cough etiquette
  • safe injection practices
  • disinfect soiled surfaces and equipment
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18
Q

example of hand hygiene

A

wash hands
- before/after every patient contact
- before/after every meal
- after using toilet

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19
Q

use of PPE includes

A
  • gowns
  • gloves
  • face mask
    when anticipating exposure to infectious material
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20
Q

example of when to use PPE

A

always wear gloves when coming into contact with any blood or body fluids

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21
Q

example of resp hygiene and cough etiquette

A

cover cough or sneeze w/ arm, not hand

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22
Q

example of safe injection practices

A

dispose used needles in a special container

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23
Q

example of disinfect soiled surfaces and equipment

A

disinfect shared equipment, such as BP cuffs, btw each patient use

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24
Q

contact precautions

A

use when any patient has
- diarrhea
- stool incontinence
- draining wounds or sores
- uncontrolled secretions
- vomiting
- draining body fluids
- skin rashes or sores
to invade the host by direct contact or by contact w. an infected object
(contact with bodily fluids)

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25
Q

examples of when to use contact precautions

A
  • salmonella
  • hepatitis
  • HIV
  • ebola
  • MRSA
  • VRE
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26
Q

PPE for contact precautions

A

hand-washing, gown and gloves

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27
Q

droplet cautions

A

droplets can be generated by an individual during
- coughing
- sneezing or talking (saliva)

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28
Q

droplets contain ____ that travel no more than ____ form the infected individual. can invade the hosts ____, _____, _____.

A
  • microorganism
  • 3 ft
  • nasal mucosa, conjunctiva, mouth
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29
Q

examples of when to use droplet precautions

A
  • pertussis
  • influenza
  • diphtheria
  • meningitis
  • pneumonia
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30
Q

PPE for droplet precautions

A

hand washing, facemask once in the room

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31
Q

airborne precautions

A

use when any individual has a suspected or known infection that is transmitted by the airborne route

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32
Q

examples of when to use airborne precautions

A
  • TB
  • measles
  • chicken pox
  • small pox
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33
Q

PPE for airborne precautions

A

hand washing, N95 face mask prior to entering the room

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34
Q

course of a disease

A

stages that are pathogen-specific and affected by various factors

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35
Q

what are the stages of the course of a disease?

A

1). incubation period
2). prodromal stage
3). acute stage
4). convalescent period
5). resolution

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36
Q

incubation period

A
  • phase during which the pathogen begins active replication but doesn’t produce S&S
  • varies in length
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37
Q

examples of incubation periods of diseases

A
  • salmonella: 6 to 8 hrs
  • hep B: 50-180 days
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38
Q

prodromal stage

A
  • initial appearance of S&Ss
  • may be mild
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39
Q

acute stage

A
  • maximum impact
  • very pronounced and specific S&Ss
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40
Q

convalescent period

A

containment of infection and resolution of S&Ss

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41
Q

resolution

A

total elimination of pathogen w/o remaining S&Ss

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42
Q

exceptions to classic stages of course of a disease

A
  • may become chronic dz; protracted & irregular course
  • some dzs progress in subclinical/subacute from start-finish w/o many clinical S&S or less severe S&S
  • fulminant/fulminating illness: abrupt onset w/ little or no prodrome
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43
Q

since development of ______ medications, infectious disease in developed countries has lessened.

A

antibiotic/anti-infective

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44
Q

despite antibiotic/anti-infective, ______ are adept at _____ and now many are _____ to the anti-infective drugs that used to kill or disable them.

A

microorganisms, changing, resistant

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45
Q

examples of antibiotic (anti-bacterial) resistance

A
  • beta lactam antibiotics
  • vancomycin
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46
Q

penicillin and its derivatives are called?

A

beta-lactam antibiotics

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47
Q

why are penicillin and its derivatives called beta-lactam antibiotics?

A

they all have a molecular structure called beta-lactam ring

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48
Q

example of penicillins

A
  • methicillin
  • amoxicillin
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49
Q

beta lactams _____ to be effective against a wide spectrum of microbe. then certain microbes _____ and developed an enzyme called _______.

A

used, mutated, beta-lactamase

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50
Q

what does beta-lactamase do?

A

destroy beta-lactam antibiotics by dismantling the beta lactam ring

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51
Q

specific beta-lactamase microbes

A

MRSA and resistant Streptococcus pneumoniae

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52
Q

MRSA

A

methicillin- resistant Staphylococcus aureas

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53
Q

fomite

A

an inanimate vector

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54
Q

staphylococcus aureus is a ____ skin flora and occasionally, can cause infections such as _____ and ____ in ______ people.

A
  • normal
  • boils and cellulitis
  • immunocompetent
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55
Q

MRSA developed in 1960s in hospitalized patients that had been on _____ so long that one strain of the _____ bacteria _____ and became ______.

A
  • methicillin
  • staph
  • mutated
  • resistant
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56
Q

MRSA is now rampant in?

A
  • some hospital settings
  • nursing homes
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57
Q

MRSA is generally known as a ?

A

nosocomial disease

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58
Q

how is MRSA spread?

A
  • direct patient to hands to patient contact
  • colonization of nares of healthcare workers
  • occasionally fomites such as stethoscopes
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59
Q

MRSA usually invades ____ but “likes” ______ such as ? which can take it to a site to _____ such as?

A
  • wounds
  • fomites
  • urinary catheters, IV catheters
  • colonize
  • bladder, blood
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60
Q

community-acquired MRSA

A

found in wounds of people who haven’t been in a hospital setting

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61
Q

what drug is now one of the few that will destroy MRSA?

A

vancomycin

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62
Q

resistant Streptococcus pneumoniae

A

most common microbe causing otitis media (inner ear infection)

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63
Q

resistant Streptococcus pneumonia used to be easily treated with _____ until ear infections became?

A
  • penicillin
  • overtreated or treated inappropriately (antibiotics don’t cure viral ear infections)
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64
Q

new strain of strep developed that makes _____ and now many ear infections are?

A
  • beta lactamase
  • much harder to get rid of
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65
Q

VRE

A

vancomycin-resistant enterococcus

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66
Q

VRE is another _____ infection

A

hospital associated

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67
Q

enterococci faecalis is a normal _____ flora, but in hospitalized people/nursing home residents, it will often migrate to ______ and other areas.

A

bowel, urinary tract

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68
Q

VRE used to be easily dealt with using _____, but then ______ developed due to mutated gene that changed one small part of a _____ on the enterococcus cell wall. now ____ won’t ____ to the microbe cell wall to destroy it.

A
  • vancomycin
  • resistance
  • protein
  • vancomycin
  • bind
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69
Q

what is used to treat VRE?

A

only very heavy-duty alternative antibx are effective now

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70
Q

example of infectious diseases whose portal of entry is breach of skin and/or mucous membranes integrity

A
  • cellulitis
  • botulism
  • tetanus
  • rabies
  • malaria
  • zika
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71
Q

cellulitis

A

infection of the dermis and subcutaneous tissue

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72
Q

pathogenesis of cellulitis

A
  • organisms (like Staphylococcus aureus) that normally dwells on TOP of skin (epidermis) gains deeper entry after injury (laceration, puncture, microscopic breach, etc.)
    OR
  • cellulitis follows milder staph infection of skin like impetigo: blister eruption around nose/mouth that are itchy, crusty, contagious
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73
Q

cellulitis infected area is

A

erythematous, swollen, painful

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74
Q

tx for cellulitis

A

abx (antibiotics)

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75
Q

botulism

A

caused by toxin of Clostridium botulinum, bacillus that can invade body via food or soil (dirt to wound)

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76
Q

toxin of Clostridium botulinum heads for _________ nerve synapses and blocks _________ receptor cells.

A

neuromuscular, ACh muscle

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77
Q

typical S&S for botulism

A
  • descending, symmetric paralysis including resp
  • floppy baby syndrome in kids that eat honey contaminated w/ C. botulinum
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78
Q

botulism is considered what?

A

top candidates for bioterrorism use

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79
Q

tx for botulism

A
  • temporary mechanical ventilation
  • other supportive tx
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80
Q

tetanus vaccination as part of ____ (______) but immunity ____. so must?

A
  • DPT (diphtheria, pertussis, tetanus)
  • weakens
  • boosters every 10 years
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81
Q

pathogenesis of tetanus disease

A
  • caused by Clostridium tetanii, bacillus which can live in soil as a spore
  • when deposited in would, germinate as becomes active, release tetanospasmin
  • block inhibitory NTs
  • cause uninterrupted nerve impulses to muscle cells
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82
Q

uninterrupted nerve impulses to muscle cells due to Clostridium tetanii causes? (S&S)

A
  • trismus/lockjaw (jaw musc tightening)
  • severe tetany: muscle twitch, cramps, convulsions
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83
Q

tx of tetanus

A

antibx + TIG

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84
Q

what grps most likely to not have been fully vax?

A
  • very elderly (vaccinations not around til 1950s)
  • immigrants
  • home-schooled kids
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85
Q

rabies

A

virus transmitted in saliva of infected host, usually by bit to skin (most common vector is bat)

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86
Q

vector-borne disease

A

transmitted via bite/sting/puncture of a host creature that then transmit microscopic disease - causing organism into new body

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87
Q

examples of vectors

A
  • mosquitos
  • ticks
  • fleas
  • rats
  • bats
  • dogs
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88
Q

rabies virus travels via ______ to the brain and spinal cord (___) can causes _________.

A

PNS, CNS, brain inflammation

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89
Q

S&S of rabies

A
  • anxiety
  • agitation
  • confusion
  • convulsions
    ^ caused by brain inflammation
  • production of large amt saliva
  • dysphagia (foam at mouth)
  • hydrophobia (can’t swallow water)
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90
Q

tx of rabies

A
  • tx needs to begin w/in first 14 days post-exposure prophylaxis (PEP)
  • 1 dose of rabies immunoglobulin + 4 doses of rabies vax
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91
Q

if rabies not treated w/in first 14 days, rabies virus will _____ its trip all way up to ____ - once _____ infected…..

A
  • continue
  • CNS
  • CNS, no cure
  • no tx = almost always fatal
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92
Q

malaria

A
  • resp for 2 mil deaths in world yearly
  • caused by protozoa that is transmitted via mosquito vector
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93
Q

protozoa of malaria reproduces in _______ (____) and then is released into blood, where it infects ____ and caused them to _____ (______). as _______ ____, they trigger ___ ___ ___ into blood and cause S&S.

A
  • liver cells (hepatocytes)
  • RBCs
  • rupture (hemolysis)
  • RBCs rupture
  • acute phase reactants
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94
Q

S&s of rabies

A
  • high fever
  • chills
  • arthralgia
  • anemia
  • splenomegaly
  • cerebral ischemia
  • heart failure
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95
Q

tx of malaria

A
  • prevention w/ malaria vax in children or with quinine-based drugs
  • mosquito nests
  • use of iscent repellant that contains DEET
  • antiparasitic or IV antimalaria drugs once diagnosed
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96
Q

Zika

A

cased by Zika virus, spread to people primarily through bite of infected mosquito

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97
Q

S&S for Zika

A
  • may be mild and similar to S/S seen with flu
  • usually don’t get sick enuf to go to hospital
  • rarely die from Zika
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98
Q

Zika infection during pregnancy can cause birth defects such as?

A

microcephaly (brain and head smaller than normal)

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99
Q

transmission of Zika occurs from?

A
  • mosquito bites or person-to-mosquito-to-person
  • pregnant woman to fetus
  • sexual transmission
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100
Q

prevent Zika by?

A
  • use insect repellants w/ DEET
  • light-colored clothing when outdoors
  • window/door screens + mosquito nets
  • remove standing water where mosquitos reproduce
  • sex abstinence or condom use considered for 8 wks to 6 months
  • preg. women or prospective should avoid areas w/ known Zika outbreaks
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101
Q

diagnosis of Zika

A

blood or urine test can confirm diagnosis

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102
Q

tx of Zika

A

supportive care = fluids, rest, acetaminophen

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103
Q

examples of infectious diseases whose portal of entry is invasion of respiratory tract

A
  • strep throat
  • diphtheria
  • pertussis
  • mumps
  • measles
  • “pox” diseases
  • influenza or flu
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104
Q

respiratory tract includes

A
  • nose
  • pharynx
  • larynx
  • trachea
  • bronchi
  • alveoli
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105
Q

strep throat

A
  • caused by streptococcus pyogenes
  • invades via coughing, sneezing
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106
Q

S&S strep throat

A
  • red, sore throat
  • white patches on tonsils
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107
Q

with certain strains of strep, can get ______ (______) along with usual S&S. what is that?

A
  • scarlet fever “scarlatina”
  • fever and rash that can cover whole body
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108
Q

with strep throat, important for infected person to get _____ early on. why?

A
  • antibx
  • getting an early/thorough treatment of antibx lessen chance of autoimmune disease like rheumatic fever
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109
Q

diphtheria

A

very contagious URI caused by bacterium transmitted by cough, sneeze, etc.

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110
Q

S&S of diphtheria

A
  • sore throat
  • fever
  • pseudo membrane across tonsils and throat
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111
Q

pertussis

A

highly contagious disease that is leading cause of vaccine-preventable deaths in underdeveloped countries

112
Q

pertussis is also known as? why?

A
  • whooping cough
  • S/S include horrible, violent coughing fits that can be bad to the point person cannot eat, becomes malnourished
113
Q

DPT vaccine includes vax for?

A

diphtheria, pertussis, tetanus

114
Q

mumps

A
  • virus that invades parotid glands - swelling + fever
  • main complication is infertility in males
  • vaccine MMR - rarely seen in developed countries
115
Q

measles nickname

A
  • rubeola (2 wk or just measles)
  • rubella (3 day or german measles)
116
Q

rubeola and S/S

A
  • virus passed by coughing and sneezing
  • dense red maculopapular rash starting on head and going down body
  • fever, cough, runny nose, conjunctivitis
117
Q

rubeola can have serious complications such as?

A

encephalitis (brain inflammation from microorganism)

118
Q

rubeola is _____ seen in developed counties except in? still endemic in certain ______ areas.

A
  • rarely
  • immunocompromised or those not vax w/ MMR
  • underdeveloped
119
Q

rubella

A

milder virus and mild S/S include fever, rash, swollen glands

120
Q

main concern w/ rubella is when?

A

woman contracts disease in early pregnancy

121
Q

why is a woman contracting rubella during early pregnancy a concern?

A
  • can cause baby to be born w/ problems like mental retardation, hearing problems, eye problems, etc.
122
Q

child-bearing age women should always have a _____ titer done and if low, need to be _______

A

titer, vaccinated

123
Q

titer

A
  • done to measure level of antibodies to specific diseases
  • high titer = lots of antibodies = had disease b4 or vaccinated
124
Q

vaccine _____ has eradicated rubella in US and certain other countries.

A

MMR

125
Q

pox diseases are also _____ diseases.

A

herpetic

126
Q

herpetic diseases are all caused by some version of the?

A

herpes virus

127
Q

a ______ virus, once in the body, ______ leaves the body.

A
  • herpes, never
  • hides out in the nerves and doesn’t come back out most of the time
128
Q

herpes viruses that DO come back out (the exceptions)

A
  • genital and oral herpes
  • shingles
129
Q

varicella (chicken pox)

A
  • very contagious - spread via direct inhalation of virus from infected person exhaling, sneezing, etc.
130
Q

varicella manifests as _______ (______) that begin on _____ and move ____ and have diff stages of development. they appear, break, and crust in _____ at _____ times.

A
  • vesicles (fluid-filled blisters)
  • trunk, outward
  • clusters
  • different
131
Q

person is contagious with varicella until?

A

the last lesion crusts

132
Q

mortality in varicella

A

very low unless immunocompromised

133
Q

_____ vaccine for varicella now part of?

A

chicken pox, normal immunization schedule

134
Q

pox and pox diseases developed because?

A

they leave pockmarks - scars from pustular lesions

135
Q

variola (small pox)

A

very contagious, inhaled virus, manifests as vesicles but diff look/pattern than chicken pox

136
Q

variola/small pox lesions are _______ that are all _____ stage, start in ______ and _____ and move toward _____.

A
  • dense clusters
  • the same
  • face and extremities
  • trunk
137
Q

depending on type of small pox virus, a person may get?

A
  • high fever
  • severe flu-like S&S
  • painful pustules in moth and esophagus
  • sometimes hemorrhage from virulence of variola virus toxin
138
Q

variola state in world

A

eradicated (except in certain labs - possible bioterrorist use)

139
Q

after having chicken pox, varicella virus remains in system _____, becoming _____ in nervous system like _____.

A
  • for life
  • dormant
  • herpes simplex
140
Q

zoster (herpes zoster, shingles)

A

in some people, especially elderly and/or immunocompromised peeps, varicella virus will pop out as painful lesions of skin along a dermatome
- single episode

141
Q

tx of zoster

A

antiviral meds and creams

142
Q

arthralgia

A

joint soreness

143
Q

myalgia

A

muscle soreness

144
Q

influenza (flu)

A

acute viral illness of upper/lower resp system w/ S/S of fever, chills, myalgia, malaise, dry cough, headaches

145
Q

flu is _____ and usually ___ serious except in certain people of ______, who are?

A
  • self-limiting
  • not
  • high-risk
  • very young, elderly, chronically ill and debilitated, immunocompromised persons
146
Q

epidemiology of flu (transmission and time of occurrence)

A
  • transmitted airborne resp droplets + occurs primarily in winter months
147
Q

epidemiology of flu - type A

A
  • circulates yearly
  • epidemics every 3-5 yrs
  • major pandemics every 25-35 yrs due to major mutations
148
Q

epidemiology: _____ flu outbreaks almost always being in ____ countries that have ____ of people that live close to _____, such _____ such as pigs/birds are the _______ _____ for the flu.

A
  • yearly
  • Asian
  • animals, animals
  • natural reservoir
149
Q

pathogenesis of Type A flu

A

1). single stranded RNA virus w/ proteins on viral cell envelope called neuraminidase + hemagglutinin
2). proteins catalyze process of viral invasion of resp cells, replication, and release of new viral progeny
3). each time new progeny released, host cell dies
4). necrosis of superficial resp cells and inflammation
5). S/S and host susceptible to bacterial pneumonia

150
Q

it is the _____ and ____ viral proteins that mutate and cause yearly changes in Type A viral makeup - what is this change called?

A
  • neuraminidase and hemagglutinin
  • antigenic drift or shift, depending on how major the change is
151
Q

usually, an ____ designation is given according to the type of mutation. give example of nomenclature based on mutation.

A
  • HN
  • H5N1: avian flu
152
Q

each year, _____ _____ is made according to the new designation.

A

new vaccine

153
Q

infectious diseases of GI tract also called? why?

A
  • infectious enterocolitis or infectious diarrhea
  • microbe causes varied degrees of diarrhea and sometimes inflammation and ulcerations of the intestines
154
Q

in developed countries, GI infectious diseases usually _________ except in?

A
  • mild, self-limiting
  • young, elderly, immunocompromised patientsG
155
Q

GI infectious diarrhea transmitted by?

A
  • oral/fecal route
  • pathogens excreted from infected person’s gut and enter GI tract of another person through mouth
156
Q

example of transmission of infectious diarrhea

A

ingesting contaminated food or by touching contaminated surfaces and then touching mouth

157
Q

tx of infectious diarrhea

A

abx and fluid replacement

158
Q

viral etiology of infectious diarrhea

A
  • mild S/S of vomiting + watery diarrhea
  • sometimes “stomach flu” but is not true influenza
159
Q

bacterial etiology of infectious diarrhea

A
  • causing non-bloody (watery) diarrhea
  • spectrum of severity
160
Q

examples of organisms causing bacterial enteritis

A
  • E. coli
  • salmonella
161
Q

E. coli

A
  • certain strains can be ingested in undercooked meats and other foods
  • certain forms normally found in intestines do not cause diarrhea
162
Q

salmonella

A
  • cows/chickens reservoir and carry it in guts - spread in their stool
  • transmitted thru feces-contaminated beef or chicken that is not cooked properly (milk and eggs also)
163
Q

dysentery

A

infectious diarrhea when it is bloody and severe

164
Q

types of dysentery

A
  • bacillary dysentery
  • amoebic dysentery
165
Q

bacillary dysentery

A

etiology is bacillus - most common is shigella

166
Q

amoebic dysentery

A

etiology is protozoa found in water

167
Q

patho/S&S of dysentery

A
  • microbes cause damage to mucosal surface of the gut
  • diarrhea has blood + mucous and pain w/ bowel movements bc infection/inflammation of intestinal lining
168
Q

other S/S of dysentery

A

fever and dehydration

169
Q

giardiasis transmission

A
  • caused by giardia protozoa
  • usually contacted by drinking contaminated water (well-water, river water, etc.)
  • can be transmitted person to person by oral/fecal route
170
Q

patho and S/S of giardia infection

A

after ingestion, giardia adheres to intestinal wall and interferes w/ fat absorption - fat goes to stool

171
Q

giardiasis diarrhea is?

A

greasy, frothy, full of fat, foul smelling, but NAWT bloody (no blood bc doesn’t invade intestinal wall)

172
Q

giardiasis can last _____ to ____, but once identified, what tx?

A
  • months to years
  • easily fixable w/ antibx
173
Q

antibiotic-associated diarrhea also called

A

pseudomembranous colitis

174
Q

colitis

A

inflammation of colon

175
Q

pseudomembranous

A

as part of infection, causes internal lining of intestines to develop yellowish membrane-like debris

176
Q

antibx-associated diarrhea caused by?

A
  • long-term antibiotics
  • wipes out normal gut flora -> Clostridium difficile (C-diff) moves in and cause inflamed intestines
177
Q

antibx associated diarrhea most common cause of?

A

iatrogenic/nosocomial diarrhea

178
Q

tx for antibx associated diarrhea

A
  • stop antibiotics
  • IV fluids
  • put on other c-diff specific antibx
179
Q

antibx associated diarrhea: infection can _____, no _____

A

reoccur, prevention

180
Q

leukemia

A

type of cancer of hematopoietic system in which there is uncontrolled proliferation of leukocytes, causing over-crowding of bone marrow and decreased production of normal hematopoietic cells

181
Q

S/S of leukemia

A
  • leukocytosis: WBC count high (50000 when norm is 6 to 10000)
  • thrombocytopenia: easy bleeding + bruising
  • anemia: fatigue, SOB
  • ease of infection bc WBC immunocyte fxn impaired
182
Q

leukemia is classified according to _______ (____ vs ____) and the _____ (either ____ or ____).

A
  • predominant cell (myeloid vs lymphoid)
  • onset (acute or chronic)
183
Q

multiple myeloma

A

type of cancer that is mostly idiopathic etiologically, but may also have genetic component

184
Q

multiple myeloma: predominant cell involved in becoming cancerous is?

A

B-lymphocytes, specifically plasma cells

185
Q

normally, plasma cells (__________) selectively produce immunoglobulins on ___________.

A
  • cells that develop from B-cells and secrete immunoglobulins
  • as-needed basis
186
Q

multiple myeloma pathogenesis

A

1). some plasma cells become malignant and begin overproducing immunoglobulins
2). immunoglob. infiltrate bones mainly
3). cause multiple malignant tumors that increase osteoclastic activity

187
Q

osteoclasts are ____ cells that normally migrate along _______ walls and _____ bone cells when _____ is needed in the body.

A
  • hematopoietic
  • bone capillary
  • chew up
  • calcium
188
Q

in multiple myeloma, osteoclasts go into _____ and chew up _____ bone cells than normal.

A

overdrive, more

189
Q

w/ multiple myeloma, bones get ____ and pathologically _____ amt of calcium in the blood (_____).

A

weaker, high, hypercalcemia

190
Q

S/S of multiple myeloma

A
  • osteoporosis
  • hypercalcemia
191
Q

osteoporosis

A

pathological fractures (bone breakage from minimal stimulus)

192
Q

hypercalcemia

A

s/s of confusion, lethargy, weakness, kidney stones + failure

193
Q

tx of multiple myeloma

A
  • chemotherapy
  • radiation
  • bone marrow transplantation
194
Q

problems with erythrocyte fxn can be _____ or _____, or both.

A
  • quantitative (alterations in numbers)
  • qualitative (defect in quality of fxn)
195
Q

general causes of alterations and defects of erythrocyte

A
  • qualitative: genetic abnormalities like sickle cell
  • quantitative: too few vs too many
196
Q

anemias

A

disorder due to pathologically decreased number of RBCs (too few)

197
Q

anemia definition

A

less than normal # of total circulating erythrocytes and/or decreased in quality/quantity of Hgb

198
Q

anemia is the ____ of a disease process; ____ or ____ and/or can be considered a ____ of a disease. only certain cases it is considered a _________.

A
  • RESULT
  • state or condition
  • SIGN
  • disease process in itself
199
Q

general etiologies of anemia

A
  • decrease in erythropoiesis (bone marrow dysfxn, leukemias, hypersplenism)
  • loss of RBCs (via hemorrhage and/or pathologic hemolysis)
200
Q

classification of anemias are according to changes in?

A
  • shape
  • substance
  • size
    of RBCs
201
Q

shape of RBCs anemia class

A

several anemia disorders which are caused by abnormalities in shape
ex: sickle cell anemia

202
Q

substance of RBCs anemia class

A

reduced hemoglobin content - hypochromic anemia (less color)

203
Q

size of RBCs anemia class

A

microcytic, normocytic, macrocytic anemias

204
Q

diagnosis of an anemia and its classification by what test?

A

CBC (complete blood count)

205
Q

CBC:
1). look at ____ count, norm is _______ in males. patient has anemia when ___ count is?
2). to name anemia, next look at ______ (____) which is the _____ of the RBC, normal range is?

A

1). RBC, 4-6 mil/L, <4 mil
2). MCV (mean corpuscular volume), size, 80-95

206
Q

MCV count for
1). microcytic anemia
2). normocytic anemia
3). macrocytic anemia

A

1). MCV <80
2). MCV in norm range of 80-95
3). MCV >95

207
Q

other #s you might see in anemic person’s CBC

A
  • low Hgb is <14 (norm is 14-18 gm/L)
  • low hematocrit (Hct) is <42% (percentage of RBCs in blood) (norm is 42-52%)
208
Q

polycythemias

A
  • disorders due to pathologically increased number of RBCs (too many)
  • disorder in which more than norm number of total circulating RBCs (erythrocytosis)
  • 2 forms: primary and secondary
209
Q

primary polycythemia

A
  • aka: polycythemia vera
  • rare condition in which there is slow development of hyperproliferation of bone marrow stem cells
210
Q

tx of primary polycythemia

A

removal of 300 to 500 mL of blood 3-4 times per month

211
Q

secondary polycythemia

A

compensatory increase in RBCs in resp to hypoxic conditions

212
Q

hypoxic conditions that cause secondary polycythemia

A
  • living in higher altitudes (>10000 feet)
  • smoking (increased CO2 level)
  • chronic low-O2 conditions (COPD)
213
Q

mechanism of compensation of secondary polycythemia

A

1). low O2
2). body increases erythropoietin secretion
3). more RBCs made

214
Q

on CBC, polycythemia is characterized by

A

1). RBCs > 6 million
2). hematocrit > 52%

215
Q

problems related to over proliferation of RBCS most often are due to?

A

thickness of blood
- extra RBCs = sludge-like blood

216
Q

sequelae of thick blood is?

A

high risk for distal tissue ischemia bc blood that is thick and slow moving (stasis) can increase chance of clots forming + blocking blood vessels

217
Q

thickened blood can cause what on heart/lungs?

A

extra workload = higher risk for failure in these organs

218
Q

S/S polycythemia

A
  • ischemic pain
  • heart and lung failure related issues
219
Q

microcytic anemia

A
  • anemia where size/MCV smaller than normal
  • RBCs <4 mil and MCV <80
220
Q

for microc. anemia, something causes body to ____, _____ ____ RBCs and being to ______ on material to make enough _____ replacement RBCs.

A
  • slowly, chronically, lose
  • run low
  • full-sized
221
Q

bc body runs low of materials to make full-sized RBCs in microc. anemia, the bone marrow tries to catch up by?

A
  • churning out RBCs that are smaller/less mature
  • compensatory resp not enough to bring up RBC #s, but better than nothing
222
Q

examples of chronic, steady loss of RBCs

A
  • women with heavy menses
  • occult (hidden) GI bleeding
223
Q

sometimes, microc. anemia is called _____ because _____ is an essential part of _____ molecules which are lost w/ RBCs.

A
  • iron deficiency anemia
  • iron (Fe)
  • Hgb
224
Q

S/S microcytic anemia

A
  • RBC <4 mil
  • fatigue
  • weakness
  • sometimes SOB and dull mentation
    ^ common in most anemias
  • specific to class: low MCV and low Hgb
225
Q

tx of microcytic anemia

A

stop blood loss if possible and give iron supplements

226
Q

normocytic anemia

A
  • an anemia where size of RBC is normal
  • RBC <4 mil and normal MCV
227
Q

patho of normocytic anemia

A
  • something cause RAPID blood blood loss, no time for compensatory resp of smaller RBCs (ex traumatic hemorrhage)
    OR
  • chronic dz cause slow-down production of RBCs - produced in norm size, but more slow and less in #s (ex AIDS, lupus, chronic renal failure)
228
Q

S/S normocytic anemia

A
  • common in most anemias: RBC <4 mil, fatigue, weakness, sometimes SOB and dull mentation
  • specific to class: normal MCV
229
Q

tx for normocytic anemia

A
  • acute blood loss: stop loss if possible and give units of blood as needed to replace
  • chronic disease: give GH erythropoietin to stimulate bone marrow to make more RBCs
230
Q

macrocytic anemia

A
  • aka megaloblastic anemias
  • anemia where size larger than normal
  • CBC: RBCs <4 mil, MCV >95
231
Q

patho of macroc. anemia

A
  • certain dz processes cause faulty DNA coding of RBC size
  • RBCs larger than normal (don’t fxn right)
  • most common example if pernicious anemia
232
Q

pernicious anemia

A
  • most seen in elderly, patients w/ GI absorption disorders, ppl w/ inadequate nutrition (eg, alcoholics)
    1). beings w/ diminished intrinsic factor (hormone made by parietal cell in stomach)

2). w/o intrinsic factor: vit. B12 cannot be adequately absorbed from digested food

3). w/o vit. B12: DNA malfxns and makes coding error in RBC creation

4). too few RBCs made + larger than normal

233
Q

S/S of macrocytic anemia

A
  • common: RBC <4 mil, fatigue, weakness, sometimes SOB and dull mentation
  • class specific: MCV> 4mil, glossitis, neuropathies
234
Q

glossitis

A
  • tongue inflammation
  • swollen, beefy red, smooth, painful tongue
235
Q

neuropathies associated w/ macroc. anemia are most often seen in ____. example? caused by?

A
  • legs
  • paresthesia: pins/needles or burning
  • lack of B12 as important nerve modulator
236
Q

tx of macroc. anemia

A

usually B12 injection

237
Q

fewer and/or deranged RBCs or Hgb means ____ in effectiveness of ____ getting to cells of tissues and organs for cellular metabolism.

A

disruption, O2

238
Q

anemic patient will usually have S/S related to?

A

hypoxemia (lack of oxygen in blood)

239
Q

type of S/S of anemic patient w/ hypoxemia

A
  • slow/subtle if slow process and body able to compensate
    OR
  • immediate and severe if cause if sudden
240
Q

reduced blood O2 (hypoxemia) causes ___ hypoxia, which can lead to?

A
  • tissue
  • SOB, weakness & fatigue, muscle cramps
  • CNS effects: slow mentation, dizziness, lethargy, syncope (fainting)
  • pallor of skin bc less RBCs traveling in skin capillaries - less pinkness
241
Q

for any kind of bleeding deficiency, S/S will be similar, relating to ______, which can be ______ or _____.

A
  • easy bleeding
  • frank bleeding (obvious)
  • occult bleeding (hidden)
242
Q

where frank bleeding can happen

A
  • under the skin
  • GI bleeding
  • mucous membranes
243
Q

under the skin frank bleeding

A
  • petechiae: pinpoint red spots that don’t blanche
  • purpura: larger areas that look purplish
  • ecchymosis: collection of blood under skin greater than 1cm
244
Q

frank GI bleeding

A

stools can be blood or black/tarry

245
Q

frank mucous membrane bleeds

A

nose bleeds

246
Q

thrombocytopenia

A

platelets (thrombocytes) deficient in number

247
Q

causes of thrombocytopenia

A
  • congenital problems (rare)
  • nutritional
  • certain drugs and chronic diseases
  • autoimmune
248
Q

autoimmune cause of thrombocytopenia

A
  • IgG attacks platelets, diminish their effectiveness
  • idiopathic thrombocytopenia purpura (ITP)
249
Q

S/S thrombocytopenia

A
  • platelet count on CBC <100,000 (norm is 150,000-400,000)
  • easy bleeding
250
Q

diseases that causes clotting factors to be defective or deficient in amount

A
  • hemophilia
  • von Willebrand disease (vWD)
  • liver disease (cirrhosis)
251
Q

hemophilia

A

refers to several possible different hereditary deficiencies of coagulation factors, usually X-linked recessive problem

252
Q

S/S hemophilia

A
  • spontaneous bleeding or bleeding that is out of proportion to amt of trauma
253
Q

txs of hemophilia

A
  • transfuse plasma - plasma has clotting factors
  • transfuse concentrates of whichever clotting factor is deficient
254
Q

von Willebrand disease (vWD)

A
  • inherited disorder and most common clotting disease
  • every 1 in 10 person has variation of it
255
Q

example of von Willebrand factor

A

a type of vWF released by injured tissue that calls platelets and binds to them + to fibrinogen to promote clotting (platelet plug)

256
Q

von Willebrand Factor (vWF) is found in the ____ and in the _____in ___forms

A

blood, tissue, various

257
Q

S/S von Willebrand disease

A
  • various types causes varied severity of S/S
  • mostly very mild clotting deficiency w/ mild incidences of easy bleeding
258
Q

example of S/S of vWD

A

some women manifest very heavy periods due to type of vWD

259
Q

tx of vWD

A

usually none needed, or symptomatic
- certain more severe forms receive vWF transfusions

260
Q

liver disease (cirrhosis)

A
  • liver is site of protein synthesis including coagulation factors
  • liver disease -> coagulation factors -> decreased ability to clot -> easy bleeding
261
Q

thrombocytosis

A
  • platelet greater than 400,000
  • can be genetic myeloproliferative disorder or from secondary cause (RA, cancer, or after splenectomy)
262
Q

thrombocytosis causes ______, which can manifest as ______ disorder, which is?

A
  • hypercoagulation
  • thrombotic
  • proliferation of blood clot formation
263
Q

thromboembolic disorders

A
  • any combination of thrombocytosis and clotting factor overactivity
  • thrombus and embolus
264
Q

thrombus

A

an arterial or venous clot attached to vessel wall

265
Q

embolus

A

an arterial or venous thrombus that has broken loose and travels in the circulator system

266
Q

splenomegaly

A

enlargement of spleen

267
Q

splenomegaly causes can be categorized as?

A
  • hematologic
  • infectious
  • malignancies
  • physiologic
268
Q

hematologic splenomegaly

A

any time there is increased hemolysis of RBCs, the spleen can enlarge bc more RBC debris to process

269
Q

examples of when hematologic splenomegaly occurs

A
  • Rh blood type incompatibility (erythroblastosis fetalis)
  • ABO blood type incompatibility
  • hemolytic problems from drug rxns/autoimmune diseases that trigger antibody attack on RBCs or infections in which RBCs are attacked (malaria)
270
Q

infection/inflammation splenomegaly

A
  • viral: hepatitis, mononucleosis (epstein-barr virus), CMV
  • bacterial: TB
271
Q

malignancies splenomegaly

A
  • esp leukemia
  • huge #s of WBCs come thru spleen, cause it to swell
272
Q

physiologic splenomegaly

A
  • usually individualistic quirk
  • idiopathic etiology
  • no S/S
273
Q

S/S splenomegaly

A
  • palpably large spleen (normally can’t palpate)
  • may have pain
  • may have hypersplenism
274
Q

spleen is part of ____________, which phagocytizes old, damaged, or dead blood cells so parts can be ________; also _______ come through and are _______ of blood.

A
  • mononuclear phagocytic system (MPS)
  • recycled
  • microorganisms
  • filtered out
275
Q

hypersplenism

A
  • condition that results from splenomegaly
  • due to enlarged spleen, RBCs+ WBCs + thrombocytes trapped there (sequestered)
276
Q

all the cells trapped in the spleen (hypersplenism) begin to be _______, _______ en masse. what are the two sequelae from this?

A
  • chewed up, destroyed
  • spleen more engorged and enlarged
  • pancytopenia: low #s of all cells in blood
277
Q

S/S hypersplenism

A
  • anemia
  • increased risk of infection
  • easy bleeding

nurs pathophysiology (13 decks)

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