Test 1 Flashcards
Hematopoietic stem cell transplant (HSCT) types
autologous, syngeneic, allogenic
autologous HSCT
donating own stem cells
syngeneic HSCT
identical twin donates stem cells
allogenic HSCT
make a match from non-related donor for stem cell transplant that’s
hemrarthrosis management
- during bleeding episodes, elevate and immobilize the joint
- ice
- analgesics
- range-of-motion exercises after the bleeding stops will help to prevent contractures
- physical therapy
- avoid obesity to minimize joint stress
Hemophilia A: etiology and pathogenesis
- etiology: x-linked recessive gene
- pathogenesis: factor 8 deficiency (90%), defective factor 8 (10%)
Four types of sickle cell anemia crises
- vasoocclusive: obstruction, vasospasm, thrombosis, & infarction
- sequestration: large amounts of blood pool in liver and spleen (children)
- aplastic: profound anemia d/t diminished erythropoesis
- hyperhemolytic: unusual, occurs with certain drugs or infections
5 factors associated with sickling
- exposure to cold
- infection
- stress
- dehydration
- acidosis
idiopathic thrombocytopenia purpura has platelet count of less than
less than 100,000 platelet count, can be drug induced
aplastic anemia 3 differentiating assessment findings
- infection of skin/mucous membranes
- bleeding from gums, nose, vagina, rectum
- retinal hemorrhage
immune mediated atrophic gastritis–> destruction of parietal cells–> decreased production of intrinsic factors and binding of intrinsic factors B12–>decreased absorption in the ileum–>large, flimsy RBC’s
pernicious anemia pathogenisis
- low serum iron and ferritin
- elevated total iron binding capacity (TIBC)
- complete blood count: decreased RBC’s
- low HGB & HCT
diagnosis of iron deficiency anemia
2 types of hemoglobin
0-6 months of age: Hemoglobin F
6 months of age and up: Hemoglobin A
implement bleeding precautions if platelet count is…
-platelet count less than 50,000
spontaneous hemorrhage occurs when platelet count is less than…
-platelet count less than 20,000
types of radiation therapy
- external ration or “teletherapy”
- internal radiation or “brachytherapy”
brachytherapy radiation source
direct radiation source in continuous contact with tumor tissues for a specific time
- binds to target antigens (often specific cell surface membrane proteins)
- prevents protein from functioning, prevents cell division
- ex: Rituximab (Rituxan)
monoclonal antibodies
Target mammalian target of rapamycin (mTOR)
-ex: Torisel
Angiogenesis inhibitors
Prevent formation of a large complex of proteins into cells
-Bortezomib (Velcade)
Proteasome inhibitors
Inhibit activity of specific kinases in cancer cells and tumor blood vessels
-Sunitib (Sutent)
Multikinase inhibitors (MKI’s)
Bind to vascular endothelial growth factor (VEGF), prevent binding of VEGF with its receptors on surfaces of endothelial cells present in blood vessels
-ex: Bevacizumab (Avastin)
Vascular endothelial growth factor receptor inhibitors
Block epidermal growth factor from binding to cell surface receptor
-Trastuzumab (Herceptin)
Epidermal growth factor/receptor inhibitors
TNM staging classification TO, Tis, T1, T2, T3, T4
TO: no evidence
TIS: tumor insitu
T1, T2, T3, T4: ascending degrees of tumor size and involvement
TNM staging classification N0, N1, N2, N3, N4
N0: no abnormal lymph nodes
N1, N2, N3, N4: progressively more involvement
TNM staging classification
T= tumor N= lymph node involvement M= metastasis
TNM staging classification M0, M1, M2, M3
M0= no evidence
M1, M2, M3,= distant metastasis present
Tumor Marker: Cancer antigen CA 125
Ovarian, pancreas, breast, colon, lung, liver
Tumor Marker: Prostate-Specific antigen (PSA)
prostate
Tumor Marker: Carcinoembryonic antigen (CEA)
lung, GI, Breas, Pancreas
Tumor Marker: Alpha-fetoprotein (AFP)
testicular, choriocarcinoma, pancreas, colon, lung, stomach, liver
Tumor Marker: Bence Jones Protein
multiple myeloma
Tumor Markers
protein molecules that we can detect in serum or other body fluids. Can derive from tumor or immune response
4 stages of infection
incubation: pathogenesis is reproducing
without recognizeable symptoms
Prodromal: develops vague symptoms
Acute: lots of proliferation and disemination
of pathogen. Specific symptoms occur
& are more pronounced. Cell lysis,
response
Convalescent: Containment of pathogen
& ultimate elimination. Damaged tissues
undergoing repair. Resolution of
symptoms.
Gram (+) vs. Gram (-) bacteria
Gram (+): do NOT retain violet dye
-many medically relevant bacilli
& cocci
-endotoxin/lipopolysacharide walls
Gram (-): DO retain violet dye in gram
staining
-staph, strep, enteroccocusprions
protein particles with NO DNA or RNA
ex: mad cow disease
viruses
- tend to be intracellular pathogens
- require living cell to replicate
- ex: HIV
bacteria
- large groups of unicellular procaryotes
- no nucleus
- have both RNA & DNA
Rickettsiae & Chlamydiaceac
- intracellular pathogens
- need direct conatct
Fungi
-yeast, mold, mushrooms
parasites
- protozoa etc.
- organisms requiring host
apoptosis
programmed cell death
physiological apoptosis
development of body tissue in normal embryonic development
pathologic apoptosis
result of intracellular events or disease
lipid peroxidation
destruction of lipids leading to membrane damage & increased permeability. Caused by free radicals.
electrically uncharged atom or groups of atoms that has an unpaired electron
free radicals
tissue hypoxia or chemical injury–> decreased cellular intracellular ATP—>Na+ K+ ATPAse pump failure—> altered cell permeability—> sets up inflammatory response, cell fluids leak out causing edema, interferes with cell functioning and causes cell to die
depletion of ATP sequence
metaplasia vs. displasia
metaplasia= reversible displasia= potentially reversible
-persistant paint that serves no useful
function.
-predominance of C fiber stimulation
-neural changes: increased sensitivity—>
decreased threshold
-loss of inhibition at the spinal column
-reorganization of nociceptors at the
dorsal root ganglion
chronic pain
unrelieved pain—> activation of the autonomic nervous system
acute pain
cutaneous somatic pain
skin, sub Q, localized
deep somatic pain
bone, muscles, tendons, joints, blood vessels, locally diffuse
pain pathways 1st order
periphery–> spinal cord
pain pathways 2nd order
spinal cord—>thalamus
pain pathways 3rd order
thalamus—>primary sensory cortex
noxious stimuli (chemical, mechanical, orthermal)—>nociceptor stimulation—>type A and C fibers—>neospinothalamic tract (A), paleospinalthalamic tract (C)—>somatosensory cortex
pain mechanism
fibroblast synthesis and lysis of collagen—> increased tissue strength
maturation phase
excess scar tissue
Keloid formation
keloid formation occurs during which phase?
maturation phase
- macrophages release:
- transforming growth factor beta (TGFB)
- angiogenesis factor (VEGF)
- matrix metalloproteinases (MMPs)
- granulation tissue
- wound contraction
reconstructive phase
epithelialization, fibroblast and collagen
granulation tissue
myofibroblasts
wound contraction
3 components of plasma protein synthesis complement system
opsonins, chemotatic factors, anaphylatoxins
3 components of plasma protein synthesis pathway to activation
classical, lectin, alternative
immediate release of histamine and chemotatic factors
mast cell degranulation
later release of leukotienes, prostoglandins, and platelet activating factor
mast cell synthesis
4 cardinal signs of vascular response/stage
erythema, warmth, edema, pain
includes vascular response, cellular mediators, plasma protein system
acute inflammation
5 cardinal manifestations of inflammation
warmth, redness, swelling, pain, decreased function
who discharges the patient from pacu?
anesthesiologist
Requires:
- no IV narcotic for last 30 min.
- minimal nausea & vomiting
- voided
- able to ambulate
- responsible adult present to accompany pt.
- discharge instructions given and understood
ambulatory surgery criteria for discharge
On the aldrete score ___ or more points are required for confired recovery
9 or more points are required for confirmed recovery
Aldrete score categories
activity, respirations, circulation, conciousness, 02 saturation
nursing PACU interventions for HTN (4)
analegsics, assistance w/ voiding, correction of respiratory problems, antihypertensives
nursing PACU interventions for hypotension (3)
administer oxygen, IV bolus fluids, antiarrhythmics
classification of surgery
risk factor, urgency, purpose, setting
poor understanding of right and wrong
newborn/infant values and beliefs
punishment and reward guides behaviors
toddlers/preschooler’s values and beliefs
moral judgements that are situation specific leading to a choice or decisions. Question faith and challenge religion
adolescent’s values and beliefs
values and morals developed. Are at high level with autonomous devisions, moral reasoning, spirituality evolves and is applied, health and spiritual harmony
adults/older adults values and beliefs
stable physical structure, maturation complete, peak efficiency, peak reproductive function
young adults 21-40 years old physical development
rapid growth, puberty, growth spurts
11-18 years adolescent physical development
search for identity, independence, challenge value systems
11-18 years adolescent psychological development
taller and thinner, 2-3 inches per year, 6.5 lbs per year, redistribution of fat and muscle, facial changes, loose/gain four teeth per year, large and small muscle activities
school age physical development, 6-11 years
friendships very intense, start to master skills, vocab increases dramatically, can classify and order objects, concept of time
school age psychological development, 6-11 years
school failure, lack of friends, social isolation, aggressive behavior
school age 6-11 years red flags for development
inability to perform self-care tasks, lack socialization, unable to play with other children, unable to follow directions
preschool red flags for development
mini adult form, permanent teeth begin, attend to ADL’s, visual acuity 20/20
3-6 years preschoolers physical development
associative play, like to question things, can think in the past as well as the present (not future), lots of make-believe play, talk constantly, count, colors, follow three step directions, read simple print
3-6 years psychological development
large heads, pot bellied, slower growth rate, all deciduous teeth present, visual acuity 20/30
toddler 1-3 years physical development
separation anxiety is highest during this period, can express fear, parallel playing, developing preferences
toddler 1-3 years psychological development
copy circle and cross, build using small clocks
fine motor 3 years
use scissors, color within borders
fine motor 4 years
write some letters and draw a person with body parts
5 years fine motor skills
developmental assessment domains (5)
cognitive, motor, language, social/behavioral, adaptive
stages of development across the lifespan
- infancy: neonate (0-1 month)
- early childhood: toddler (1m to 1 yr)
- preschool: (3-6 yrs)
- middle childhood: (7-12)
- late childhood: adolescent (13-19)
onlooker play
child just watching
solitary play
child entertains themselves
parallel playing
playing in the same room next to each other but not engaging with one another
associative playing
play interacting with one another
cooperative play
can share, have a common goal in play
sociological activity theory
-psychological and social fitness is maintained by social activity. Based on one’s self concept is affirmed through activities associated with various socially derived roles. Loss of roles in old age negatively affects life satisfaction
sociologic disengagement theory
social equilibrium is achieved by a process of withdrawal between society and the older person. Mutually beneficial, reciprocal, governed by society’s needs, not individuals needs or desires
endocrine theory
hormones control the rate of aging
immunity theory
functioning of the immune system diminishes with age. Fewer defenses against foreign organisms.
cross-linkage theory
cross linking agent attaches to DNo, damage results and accumulates due to failure of defense and repair mechanisms
spiritual development stages
- stage 0: undifferentiated
- stage 1: intuitive-projective
- stage 2: mythical-literal
- stage 3: synthetic-convention
- stage 4: Individuating-reflexive
rapid periods of growth
infancy and puberty
slow periods of growth
preschool-puberty, post puberty is slow decelleration
barely able to lift head
newborn
easily lifts head, chest, and upper abdomen and can bear weight on arms
6 month old
ambulation milestones
- 9 months: crawl
- 1 year: stand independently from crawl position
- 13 months: walk and toddle quickly
- 15 months: can run
BAER test
done at birth for hearing
normal lab values for potassium
3.5-5
preop-med, decreases probability of emesis and aspiration
-ex: metoclopramide HCL (reglan), and
ondansetron (Zofran)
anti-emetics
- DANGER STAGE*
- Begins with depression of vital functions and ends with respiratory failure, cardiac arrest, and possible death
- respiration muscles are paralyzed and apnea occurs
- pupils are fixed and dilated
stage 4 general anesthesia
- Surgical Anesthesia*
- begins with generalized muscle relaxation and ends with loss of reflexes and depression of vital functions
- jaw is relaxes and there is quiet, regular breathing
- client cannot hear
- sensations are lost
stage 3 general anesthesia
- Excitement, Delirium*
- begins with loss of consciousness and with relaxation, regular breathing, and loss of eyelid reflex
- client may have irregular breathing, increased muscle tone, and involuntary movement of extremities during this stage
- larygospasm and vomiting
- client susceptible to external stimuli
stage 2 general anesthesia
- analgesia and sedation relaxation*
- begins with induction and ends with loss of consciousness
- client feels drowsy and dizzy, has reduced sensation to pain, and is amnesic
- hearing exaggerated
stage 1 general anesthesia
malignant hyperthermia caused _________ and leads to __________
- causes: increased metabolism and calcium levels in muscle cells
- leads to: acidosis, high temps, dysrhythmias
hypnotics, opiod analgesics, neuromuscular blocking agents
adjuncts to general anesthesia agents
stages of general anesthesia
- stage 1: analgesia and sedation, relaxation
- stage 2: excitement, delirium
- stage 3: surgical anesthesia
- stage 4: danger not expected stage to go through
- emergence: recovery and wake up
definition of major risk classification in surgery
extended area of involvement with increased time in surgery and high degree of risk
definition of minor risk classification in surgery
limited to a body area with a short surgery time, minimal risk
attachment, interaction between them and caregiver
newborn/infant roles and relationships
sense of loss, separation anxiety and protest
toddlers and preschoolers roles and relationships
sexual development and pier group influence, less time with family
school age/adolescent roles and relationships
multiple roles, deferred parenting, multiple losses
adults/older adults roles and relationships
