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BEACON MedSurg/Peds > Test 1 > Flashcards

Test 1 Flashcards

1
Q

Hematopoietic stem cell transplant (HSCT) types

A

autologous, syngeneic, allogenic

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2
Q

autologous HSCT

A

donating own stem cells

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3
Q

syngeneic HSCT

A

identical twin donates stem cells

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4
Q

allogenic HSCT

A

make a match from non-related donor for stem cell transplant that’s

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5
Q

hemrarthrosis management

A
  • 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
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6
Q

Hemophilia A: etiology and pathogenesis

A
  • etiology: x-linked recessive gene

- pathogenesis: factor 8 deficiency (90%), defective factor 8 (10%)

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7
Q

Four types of sickle cell anemia crises

A
  • 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
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8
Q

5 factors associated with sickling

A
  • exposure to cold
  • infection
  • stress
  • dehydration
  • acidosis
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9
Q

idiopathic thrombocytopenia purpura has platelet count of less than

A

less than 100,000 platelet count, can be drug induced

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10
Q

aplastic anemia 3 differentiating assessment findings

A
  • infection of skin/mucous membranes
  • bleeding from gums, nose, vagina, rectum
  • retinal hemorrhage
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11
Q

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

A

pernicious anemia pathogenisis

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12
Q
  • low serum iron and ferritin
  • elevated total iron binding capacity (TIBC)
  • complete blood count: decreased RBC’s
    - low HGB & HCT
A

diagnosis of iron deficiency anemia

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13
Q

2 types of hemoglobin

A

0-6 months of age: Hemoglobin F

6 months of age and up: Hemoglobin A

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14
Q

implement bleeding precautions if platelet count is…

A

-platelet count less than 50,000

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15
Q

spontaneous hemorrhage occurs when platelet count is less than…

A

-platelet count less than 20,000

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16
Q

types of radiation therapy

A
  • external ration or “teletherapy”

- internal radiation or “brachytherapy”

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17
Q

brachytherapy radiation source

A

direct radiation source in continuous contact with tumor tissues for a specific time

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18
Q
  • binds to target antigens (often specific cell surface membrane proteins)
  • prevents protein from functioning, prevents cell division
    • ex: Rituximab (Rituxan)
A

monoclonal antibodies

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19
Q

Target mammalian target of rapamycin (mTOR)

-ex: Torisel

A

Angiogenesis inhibitors

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20
Q

Prevent formation of a large complex of proteins into cells

-Bortezomib (Velcade)

A

Proteasome inhibitors

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21
Q

Inhibit activity of specific kinases in cancer cells and tumor blood vessels
-Sunitib (Sutent)

A

Multikinase inhibitors (MKI’s)

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22
Q

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)

A

Vascular endothelial growth factor receptor inhibitors

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23
Q

Block epidermal growth factor from binding to cell surface receptor
-Trastuzumab (Herceptin)

A

Epidermal growth factor/receptor inhibitors

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24
Q

TNM staging classification TO, Tis, T1, T2, T3, T4

A

TO: no evidence
TIS: tumor insitu
T1, T2, T3, T4: ascending degrees of tumor size and involvement

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25
Q

TNM staging classification N0, N1, N2, N3, N4

A

N0: no abnormal lymph nodes

N1, N2, N3, N4: progressively more involvement

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26
Q

TNM staging classification

A 
T= tumor
N= lymph node involvement
M= metastasis
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27
Q

TNM staging classification M0, M1, M2, M3

A

M0= no evidence

M1, M2, M3,= distant metastasis present

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28
Q

Tumor Marker: Cancer antigen CA 125

A

Ovarian, pancreas, breast, colon, lung, liver

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29
Q

Tumor Marker: Prostate-Specific antigen (PSA)

A

prostate

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30
Q

Tumor Marker: Carcinoembryonic antigen (CEA)

A

lung, GI, Breas, Pancreas

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31
Q

Tumor Marker: Alpha-fetoprotein (AFP)

A

testicular, choriocarcinoma, pancreas, colon, lung, stomach, liver

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32
Q

Tumor Marker: Bence Jones Protein

A

multiple myeloma

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33
Q

Tumor Markers

A

protein molecules that we can detect in serum or other body fluids. Can derive from tumor or immune response

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34
Q

4 stages of infection

A

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.

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35
Q

Gram (+) vs. Gram (-) bacteria

A 
Gram (+): do NOT retain violet dye
     -many medically relevant bacilli
     & cocci
     -endotoxin/lipopolysacharide walls
Gram (-): DO retain violet dye in gram 
     staining
     -staph, strep, enteroccocus
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36
Q

prions

A

protein particles with NO DNA or RNA

ex: mad cow disease

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37
Q

viruses

A
  • tend to be intracellular pathogens
  • require living cell to replicate
  • ex: HIV
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38
Q

bacteria

A
  • large groups of unicellular procaryotes
  • no nucleus
  • have both RNA & DNA
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39
Q

Rickettsiae & Chlamydiaceac

A
  • intracellular pathogens

- need direct conatct

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40
Q

Fungi

A

-yeast, mold, mushrooms

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41
Q

parasites

A
  • protozoa etc.

- organisms requiring host

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42
Q

apoptosis

A

programmed cell death

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43
Q

physiological apoptosis

A

development of body tissue in normal embryonic development

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44
Q

pathologic apoptosis

A

result of intracellular events or disease

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45
Q

lipid peroxidation

A

destruction of lipids leading to membrane damage & increased permeability. Caused by free radicals.

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46
Q

electrically uncharged atom or groups of atoms that has an unpaired electron

A

free radicals

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47
Q

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

A

depletion of ATP sequence

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48
Q

metaplasia vs. displasia

A 
metaplasia= reversible
displasia= potentially reversible
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49
Q

-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

A

chronic pain

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50
Q

unrelieved pain—> activation of the autonomic nervous system

A

acute pain

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51
Q

cutaneous somatic pain

A

skin, sub Q, localized

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52
Q

deep somatic pain

A

bone, muscles, tendons, joints, blood vessels, locally diffuse

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53
Q

pain pathways 1st order

A

periphery–> spinal cord

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54
Q

pain pathways 2nd order

A

spinal cord—>thalamus

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55
Q

pain pathways 3rd order

A

thalamus—>primary sensory cortex

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56
Q

noxious stimuli (chemical, mechanical, orthermal)—>nociceptor stimulation—>type A and C fibers—>neospinothalamic tract (A), paleospinalthalamic tract (C)—>somatosensory cortex

A

pain mechanism

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57
Q

fibroblast synthesis and lysis of collagen—> increased tissue strength

A

maturation phase

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58
Q

excess scar tissue

A

Keloid formation

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59
Q

keloid formation occurs during which phase?

A

maturation phase

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60
Q
  • macrophages release:
    • transforming growth factor beta (TGFB)
    • angiogenesis factor (VEGF)
    • matrix metalloproteinases (MMPs)
  • granulation tissue
  • wound contraction
A

reconstructive phase

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61
Q

epithelialization, fibroblast and collagen

A

granulation tissue

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62
Q

myofibroblasts

A

wound contraction

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63
Q

3 components of plasma protein synthesis complement system

A

opsonins, chemotatic factors, anaphylatoxins

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64
Q

3 components of plasma protein synthesis pathway to activation

A

classical, lectin, alternative

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65
Q

immediate release of histamine and chemotatic factors

A

mast cell degranulation

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66
Q

later release of leukotienes, prostoglandins, and platelet activating factor

A

mast cell synthesis

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67
Q

4 cardinal signs of vascular response/stage

A

erythema, warmth, edema, pain

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68
Q

includes vascular response, cellular mediators, plasma protein system

A

acute inflammation

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69
Q

5 cardinal manifestations of inflammation

A

warmth, redness, swelling, pain, decreased function

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70
Q

who discharges the patient from pacu?

A

anesthesiologist

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71
Q

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
A

ambulatory surgery criteria for discharge

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72
Q

On the aldrete score ___ or more points are required for confired recovery

A

9 or more points are required for confirmed recovery

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73
Q

Aldrete score categories

A

activity, respirations, circulation, conciousness, 02 saturation

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74
Q

nursing PACU interventions for HTN (4)

A

analegsics, assistance w/ voiding, correction of respiratory problems, antihypertensives

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75
Q

nursing PACU interventions for hypotension (3)

A

administer oxygen, IV bolus fluids, antiarrhythmics

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76
Q

classification of surgery

A

risk factor, urgency, purpose, setting

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77
Q

poor understanding of right and wrong

A

newborn/infant values and beliefs

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78
Q

punishment and reward guides behaviors

A

toddlers/preschooler’s values and beliefs

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79
Q

moral judgements that are situation specific leading to a choice or decisions. Question faith and challenge religion

A

adolescent’s values and beliefs

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80
Q

values and morals developed. Are at high level with autonomous devisions, moral reasoning, spirituality evolves and is applied, health and spiritual harmony

A

adults/older adults values and beliefs

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81
Q

stable physical structure, maturation complete, peak efficiency, peak reproductive function

A

young adults 21-40 years old physical development

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82
Q

rapid growth, puberty, growth spurts

A

11-18 years adolescent physical development

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83
Q

search for identity, independence, challenge value systems

A

11-18 years adolescent psychological development

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84
Q

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

A

school age physical development, 6-11 years

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85
Q

friendships very intense, start to master skills, vocab increases dramatically, can classify and order objects, concept of time

A

school age psychological development, 6-11 years

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86
Q

school failure, lack of friends, social isolation, aggressive behavior

A

school age 6-11 years red flags for development

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87
Q

inability to perform self-care tasks, lack socialization, unable to play with other children, unable to follow directions

A

preschool red flags for development

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88
Q

mini adult form, permanent teeth begin, attend to ADL’s, visual acuity 20/20

A

3-6 years preschoolers physical development

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89
Q

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

A

3-6 years psychological development

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90
Q

large heads, pot bellied, slower growth rate, all deciduous teeth present, visual acuity 20/30

A

toddler 1-3 years physical development

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91
Q

separation anxiety is highest during this period, can express fear, parallel playing, developing preferences

A

toddler 1-3 years psychological development

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92
Q

copy circle and cross, build using small clocks

A

fine motor 3 years

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93
Q

use scissors, color within borders

A

fine motor 4 years

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94
Q

write some letters and draw a person with body parts

A

5 years fine motor skills

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95
Q

developmental assessment domains (5)

A

cognitive, motor, language, social/behavioral, adaptive

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96
Q

stages of development across the lifespan

A
  • 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)
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97
Q

onlooker play

A

child just watching

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98
Q

solitary play

A

child entertains themselves

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99
Q

parallel playing

A

playing in the same room next to each other but not engaging with one another

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100
Q

associative playing

A

play interacting with one another

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101
Q

cooperative play

A

can share, have a common goal in play

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102
Q

sociological activity theory

A

-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

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103
Q

sociologic disengagement theory

A

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

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104
Q

endocrine theory

A

hormones control the rate of aging

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105
Q

immunity theory

A

functioning of the immune system diminishes with age. Fewer defenses against foreign organisms.

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106
Q

cross-linkage theory

A

cross linking agent attaches to DNo, damage results and accumulates due to failure of defense and repair mechanisms

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107
Q

spiritual development stages

A
  • stage 0: undifferentiated
  • stage 1: intuitive-projective
  • stage 2: mythical-literal
  • stage 3: synthetic-convention
  • stage 4: Individuating-reflexive
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108
Q

rapid periods of growth

A

infancy and puberty

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109
Q

slow periods of growth

A

preschool-puberty, post puberty is slow decelleration

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110
Q

barely able to lift head

A

newborn

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111
Q

easily lifts head, chest, and upper abdomen and can bear weight on arms

A

6 month old

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112
Q

ambulation milestones

A
  • 9 months: crawl
  • 1 year: stand independently from crawl position
  • 13 months: walk and toddle quickly
  • 15 months: can run
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113
Q

BAER test

A

done at birth for hearing

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114
Q

normal lab values for potassium

A

3.5-5

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115
Q

preop-med, decreases probability of emesis and aspiration
-ex: metoclopramide HCL (reglan), and
ondansetron (Zofran)

A

anti-emetics

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116
Q
  • 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
A

stage 4 general anesthesia

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117
Q
  • 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
A

stage 3 general anesthesia

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118
Q
  • 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
A

stage 2 general anesthesia

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119
Q
  • 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
A

stage 1 general anesthesia

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120
Q

malignant hyperthermia caused _________ and leads to __________

A
  • causes: increased metabolism and calcium levels in muscle cells
  • leads to: acidosis, high temps, dysrhythmias
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121
Q

hypnotics, opiod analgesics, neuromuscular blocking agents

A

adjuncts to general anesthesia agents

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122
Q

stages of general anesthesia

A
  • 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
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123
Q

definition of major risk classification in surgery

A

extended area of involvement with increased time in surgery and high degree of risk

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124
Q

definition of minor risk classification in surgery

A

limited to a body area with a short surgery time, minimal risk

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125
Q

attachment, interaction between them and caregiver

A

newborn/infant roles and relationships

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126
Q

sense of loss, separation anxiety and protest

A

toddlers and preschoolers roles and relationships

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127
Q

sexual development and pier group influence, less time with family

A

school age/adolescent roles and relationships

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128
Q

multiple roles, deferred parenting, multiple losses

A

adults/older adults roles and relationships

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129
Q

self perception stems from primary caregivers

A

newborn/infants

130
Q

self perception is egocentric

A

toddlers/preschoolers

131
Q

self perception in based on piers and positive groups

A

school age/adolescents

132
Q

self perception is individualized, depression

A

adult, older adult

133
Q

sensory stimulation, overstimulation, pain ID, physical sensory stimulation, environmental stimulation

A

cognition/perception newborn/infant

134
Q

hearing and vision problems, play even with pain, pain face scale

A

toddlers/preschoolers cognition/perception

135
Q

different with school, work, physiologic, emotional, environmental problems, drug use

A

school age/adolescent cognition/perception

136
Q

declining sensory function, pain perception varies, confusion, dementia

A

adult/older adult cognition/perception

137
Q

sleep/rest for newborn/infant

A

sleep thru night by 3-4 months

138
Q

sleep/rest toddler/preschool

A

1-2 naps, majority sleep at night, nightmares

139
Q

sleep/rest school age

A

continuation of nightmares and nighttime awakening, bed wetting

140
Q

adolescent sleep/rest

A

increased need of sleep, teach time management activities

141
Q

adult/older adult sleep/rest

A

stress related insomnia, sleep apnea, poor sleep habits

142
Q
  • decreased physiological systems functioning
  • decreased stamina, strength, recovery time, elimination control
  • degenerative change in bones
  • sensory changes
A

60 years and older physical development

143
Q
  • redistribution of body tissue
  • hair changes
  • decreased vision, muscular strength, hormones
  • increased fatigue
  • empty nest syndrome
  • maladaptive coping skills can be present
  • death of a spouse
A

40-60 years, middle adult physical development

144
Q
  • buttoning clothing
  • holding crayon/pencil
  • building with small blocks
  • using scissors
  • playing a board game
  • have child draw pic of self
A

3-6 year fine motor and cognitive abilities

145
Q

stranger anxiety in toddlers should disappear by age___

A

should disappear at 3 years of age

146
Q

temper tantrums in toddler should occur _____, peak at ____, and disappear by___

A
  • occur: weekly
  • peak: 18 months
  • disappear: by age 3
147
Q

sibling rivalry peaks_____

A

-peaks around 1-2 years of age

148
Q

toilet training is accomplished by ____ years of age

A

-accomplished by age 3

149
Q
  • fast growth
  • voluntary motor skills
  • visual acuity
  • motor ability increases
  • pincer grasp
  • eruption of deciduous teeth
A

1 month to 1 year development

150
Q

birth to 1 month height and weight

A

7lb, 1oz, 19.3 inches

151
Q

most widely used developmental screening tool

152
Q

interrelationship of personal competence and environment determine successful aging

A

person-environment fit theory

153
Q

best way to predict how a person will adjust to being old is to examine how that person has adjusted to changes throughout life. Stability of personality is a rule rather than an exception.

A

continuity theory

154
Q
  • lifespan predetermines by genetic program/biological clock
  • in humans, biological programming is about 100-110 years
  • based on observation that human cells reproduce a set number of times
A

programmed theory

155
Q

organisms are like machines and they eventually wear out, even with care and maintenance and replacement of parts

A

wear and tear theory

156
Q

molecules capable of attacking other molecules because they posses an extra electron
-in aging, free radical production increases and/or protective mechanisms decrease

A

free radical theory

157
Q

psychosexual, id, ego

158
Q

sensitive periods

A

susceptibility is based on a positive or negative influence when interacting with the environment

159
Q

progression of behavioral changes that involve cognitive, linguistic, and psychosocial skills

A

development

160
Q

physiological development of a living being measured by body size

161
Q

diagnostic

A

to diagnose something, ex; removing mass to test

162
Q

ablative

A

remove diseased item ex: tonsilectomy, appendectomy

163
Q

constructive

A

restore function and or build tissue to connect something that’s missing, ex: cleft lip

164
Q

reconstructive

A

trying to rebuild something that has been damaged, ex: broken bone, skin grafts

165
Q

palliative

A

relieve intensity of symptoms or reduce, NOT curative, ex: ascites, remove fluid

166
Q

degree of risk in surgery is affected by

A

age, nutritional status, fluid and electrolyte status, general health, use of meds, mental attitude

167
Q

who can sign for informed consent?

A

-18 and older
-legal parents/legal guardians
-emancipated minors
-minors living without parent or
guardian, providing own financial
support
-married
-pregnant
-active duty in US military

168
Q

implied emergency consent

A
  • immediate threat to life
  • experts agree that an emergency exists
  • client unable to consent
  • legally authorized person cannot be reached
169
Q

3 classifications of anesthesia

A

general, regional, concious

170
Q

type of anesthesia?

  • loss of consciousness
  • amnesia
  • analgesia
  • loss of reflexes
  • muscle relaxation
A

general anesthesia

171
Q
  • tachycardia
  • skin mottling
  • cyanosis
  • myoglobinemia
  • rise in end tidal CO2
  • elevated temp
A

malignant hyperthermia clinical manifestations

172
Q

briefly disrupts sensory nerve impulse transmission from specific body area/region

A

local anesthesia

173
Q

regional anesthesia

A

analgesia, loss of reflexes, muscle relaxation

174
Q

regional anesthesia classifications

A
  • surface or topical
  • local nerve infiltration
  • nerve blocks
  • epidural blocks
  • spinal anesthesia
175
Q

local or regional anesthesia complications

A
  • anaphylaxis
  • incorrect delivery technique
  • systematic absorption
  • overdose
  • local complications
176
Q

nursing interventions to manage respiratory functions in PACU

A
  • side-lying position
  • extend jaw
  • administer 02 as needed
  • assist client with turning, coughing, deep breathing every 30 minutes until fully awake
  • monitor RR, breath sounds, pulse OX
  • suction as necessary
177
Q

PACU discharge criteria

A
  • client awake
  • vital signs stable
  • no excess bleeding or drainage
  • no respiratory depression
  • O2 sat great than 90
  • report called/given to post op until
178
Q

1/4-1/3 usual dose of pain medication is given and might be prescribed every 10-15 minutes

A

PACU pain meds

179
Q

Any natural protective feature of a person

-ex: inflammation

A

innate (native) immunity

180
Q
  • Non-specific complex response
  • protective process
  • stimulates healing and prevents further damage
  • types: acute and chronic
A

inflammation

181
Q

immature undifferentiated cells produced by bone marrow

A

stem cells

182
Q

protect body from effects of invasion by organisms

A

leukocytes (WBC’s)

183
Q
  • macrophage and lymphocyte infiltration
  • fibroblast proliferation
  • greater scaring and deformity
A

chronic, non-specific inflammation

184
Q

stitches (type of wound healing)

A

primary intention wound healing example

185
Q

open sore on foot (type of wound healing)

A

second intention wound healing example

186
Q

inflammatory, reconstructive, maturation

A

stages of wound healing

187
Q
  • nutritional state
  • perfusion
  • immune status
  • infection
A

factors impacting wound healing

188
Q

the point at which a stimulus is perceived as painful

A

pain threshold

189
Q
  • tachycardia
  • increased stroke volume
  • hypertension
  • pupil dilation
  • increased muscle tension
  • dry mouth
  • decreased gut motility
A

manifestations of prolonged unrelieved acute pain

190
Q
  • trigeminal neuralgia
  • complex regional pain syndrome
  • phantom limb pain
A

neuropathic pain syndromes

191
Q

non-pharm. pain management of infants (4)

A
  • containment
  • non-nutrative sucking
  • kangaroo care
  • positioning
192
Q

drug therapy for pain, 3 groups

A
  • non-opiods: acetaminophen, NSAIDS
  • opiods: morphine, oxycodone, methadone, codeine
  • adjuvants: SSRI’s, anti-epileptic drugs, muscle relaxants/antispasmotics, Alpha-2 adrenergics, local anesthetics/analgesics, NMDA antagonists, cannabinoids (cannabis extracts)
193
Q

gerentological pain med considerations

A
  • “start low, go slow”

- initially no more than half of recommended dose

194
Q

Level one WHO pain rating

A

1-3: non-opiods are recommended

195
Q

Level 2 WHO pain rating

A

4-6 rating: weak opioid alone or with adjuvant drug recommended

196
Q

Level 3 WHO pain rating

A

7-10: use strong opioids

197
Q

nerve blocks and spinal cord stimulation are _____ techniques for ______

A

invasive techniques for chronic pain

198
Q

Decrease in number or cell size

199
Q

atrophy causes

A

disuse, paralysis, hormonal changes, ischemia

200
Q

cell increase in size, occurs frequently in cardiac and skeletal muscles

A

hypertrophy

201
Q

what helps neutralize free radicals?

A

antioxidants: donate free electron to help neutralize them

202
Q
  • attack of critical proteins affecting ion pumps and transport mechanisms
  • fragmenting DNA decreasing protein synthesis
  • damage to mitochondria allowing influx of cellular calcium
A

damaging effects of free radicals

203
Q

4 broad classifications of genetic disorders

A
  • autosomal dominant disorders
  • autosomal recessive disorders
  • x-linked disorders
  • chromosomal disorders
204
Q

heterozygous vs. homozygous

A

heterozygous: 1 mutated gene in pain
homozygous: both genes in pair are mutated

205
Q
  • Ex: Huntington’s disease
  • 50% will have disease
  • only 1 parent has to have dominant gene mutation
A

autosomal dominant disorders

206
Q
  • Ex: Cystic fibrosis, sickle cell anemia
  • 50% of people will be carriers
  • 25% will have disease
  • 25% normal
  • both parents must be carriers for the child to have the disease
A

autosomal recessive

207
Q
  • Ex: Duchenere’s muscle dystrophy
  • mothers are carriers and pass disease to their sons 50% of the time
  • mothers are carriers and 50% girls can be carrier
  • sex-linked recessive disorder
208
Q

Aneuploidy

A

abnormal number of chromosomes

209
Q

monosomy

A

1 copy of chromosome only

-ex: Turner syndrome

210
Q

Trisomy

A

3 copies of chromosome

-downs syndrome

211
Q

endotoxins vs exotoxins

A

exotoxins: proteins/enzymes released during bacterial growth
- antitoxins: tetanus, diptheria, pertussis
- endotoxins: cell wall of gram-bacteria and released during lysis of the cell

212
Q

4 portals of entry

A

-penetration, direct contact, ingestion, inhalation

213
Q

symptomology (5)

A
  • all cause the symptoms of infection/illness
  • biological response mediators
  • endotoxins
  • exotoxins
  • antigen-antibody complexes
  • intracellular
214
Q

malignant vs benign tumors (neoplasm)

A

benign: not cancer, only locally and cannot spread by invasion or metastasis, slow growing, cohesive
Malignant: cancer, cells invade neighboring tissues, enter clood vessels, and metastasize to different sites, relatively undifferentiated, grow rapidly, un-encapsulated

215
Q

4 types of metastasis

A
  • hematogenous: through the bloodstream
  • lymphatic
  • direct invasion: finger like projections that invade surrounding tissue
  • surgical seeding: they undergo surgery, minute cells break off into body cavity
216
Q

2d screening test

217
Q

3d screening test

218
Q

screening and follow up

219
Q

detect abnormalities in structure, needle biopsies done with this

A

ultrasound

220
Q

glucose and tissue metabolism

221
Q

detect metastases, especially to bones and other types of organ tissues

A

nuclear imaging

222
Q

invasive diagnostic techniques in cancer

A
  • give definitive diagnosis*
  • biopsy: needle, incisional, excisional
  • endoscopy: helps to provide direct visualization of the are of concern
223
Q

used to diagnose, stage, and treat cancer

224
Q

masculanizing effects in women

  • feminizing effects in men
  • risk for venous thromboembolism
  • acne
  • hypercalcemia
  • liver dysfunction
  • Bone loss
A

side effects of hormone therapy

225
Q
  • selective destruction of cancer of cancer cells via chemical reaction triggered by different types of laser light
  • sensitive to light up to 12 weeks*
A

-photodynamic therapy

226
Q

immunotherapy biological response modifiers (BRMs)

A
  • modify patient’s biological response to tumor cells

- side effects: generalized, sometimes severe inflammatory response, peripheral neuropathy, skin rashes

227
Q

tyrosine kinase inhibitors

A
  • inhibit activation of tyrosine kinases

- side effects: fluid retention, electrolyte imbalances, bone marrow suppression

228
Q

-decreased WBCs, platelets, hemoglobin

A

bone marrow suppression

229
Q

type or radiation when client does not pose risk for radiation exposure to others

A

external radiation

230
Q

Brachytherapy

A

internal therapy
-radiation source is sealed in needle, seed, or wire, implanted for hours to several days
-client emits radiation while implant in place but excreta are not radioactive
-client remains hospitalized during treatment
client does not pose risk for radiation
exposure to others
-unsealed: by mouth or IV, client emits radiation, excreta ARE radioactive
*poses risk to others

231
Q

re-growth of hair after chemo/radiation

A

chemo: hair grows back 1 month after completion. Texture/color different
- radiation to head: hair loss is permanent

232
Q

neutropenic precautions for WBC less than?

A

WBC less than 2,000

233
Q

HgbS and low oxygen tension (PO2 aggregation and polymerization of HgbS—>Change in shape and rigidity of RBCs—>Hemolysis of sickled cells vascular occlusion

A

sickle cell disease pathogenesis

234
Q

3 sicle shape causes of RBCs

A

HgbS RBCs move through microcirculation more slowly

  • more time for de-oxygenation
  • adherence to the vascular endothelium further inhibiting blood flow
235
Q
  • usually fatal by middle age from renal and pulmonary failure
  • prone to infection; pneumonia most common
  • gradual involvement of all body systems
A

sickle cell complications

236
Q
  • increased blood volume and impaired tissue oxygenation
  • puritis
  • erythromyalgia
  • splenomegaly
  • epitaxis, Gi bleeding
  • CBC: increased RBCs, AGBs, HCT, WBCs, Platelets
A

polycythemia clinical manifestations

237
Q

polycythemia nursing actions

A
  • assist in therapeutic phlebotomy

- prevent thrombotic events

238
Q
  • etiology: genetic, latent mutation, factor V

- acquired: incresed platelet function, stasis of blood, hyperestrogenic states

A

hypercoagulability disorders

239
Q

-increased estrogen levels—> increased synthesis of coagulation factors and decreased synthesis of antithrombin III

A

hyperestrogenic states

240
Q

Clot location in artery or vein?: impaired perfusion, tissue ischemia

A

clot in artery

241
Q

Clot location in artery or vein?: back up of blood behind clot, swelling

A

clot in vein

242
Q
  • decreased platelet function
  • decreased platelets in circulation
  • impaired coagulation
A

bleeding disorders manifestation

243
Q

-decreased number of platelets (

A

thrombocytopenia

244
Q

idiopathic thrombocytopenia purpura is what kind of disorder? And etiology

A
  • autoimmune disorder

- etiology: unknown, possible viral illness

245
Q
  • etiology: deficiency or defect in vWF, autosomal dominant disorder
    patho: decreased platelet adherence, impaired clot formation
    dx: low levels of vWF
A

Von Willebrands disease & dx

246
Q

types of leukemia

A
  • non-lymphocytic
  • lymphocytic
  • acute
  • chronic
247
Q
  • uncontrolled production of immature WBC’s in the bone marrow
    etiology: unknown, ionizing radiation, certain chemicals and drugs, genetic factors, immunologic factors
248
Q
  • 80% of adult leukemias

- etiology: unknown, exposure to toxins, chromosome abnormalities ie: downs syndrome

A

acute non-lymphocytic leukemia (ANLL)

249
Q
  • all cell lines affected
  • etiology: philielphia chromosome, formation of abnormal gene: BCR-ABL
  • manifestation: NBC. 30,000, anemia, splenomegaly
A

chronic non-lymphocytic leukemia (CLL)

250
Q

phases of CLL

A

chronic
accelerated
hypermetabolism
terminal: blastcrisis

251
Q

-most common cancer among children ,15 years (Tcell, Bcell, Null)
Etiology: uknown
Patho: malignant transformation in lymphoblast line, CNS involvement
Presentation: CNS symptoms (headache, vomit, seizure, etc), lymphadenopathy, lethargy

A

acute lymphocytic leukemia presentation and etiology

252
Q
  • clotting factors, desmpopressin (DDAVP), transfusions (prompt intervention to decrese complications), exercise and physical therapy
  • are all collaborative management for
A

hemophilia A collaborative management

253
Q

-suppress autoimmune response
-corticosteroids, azathioprine (Imuran),
retuximab (Rituxan), immunoglobulins
-platelet growth factor (neumega)
*are all medications for ?

A

thrombocytopenia medications

254
Q
  • neuro changes
  • kidney failure
  • anemia
  • menorrhagia, hematuria, GI bleeding
  • epistaxis, gingival bleeding
  • petechiae & purpura
  • clinical manifestations for?*
A

thrombocytopenia clinical manifestations

255
Q

drug induced cytopenia

A
  • heparin, quinine, and sulfa based drugs
  • clinical course/dx: decreased platelets 2-3 days after starting new drug. Resolution when drug is stopped. Antiplatelet antibodies
256
Q

drug induced cytopenia “type” reaction

A

type 2 reaction

257
Q

clinical manifestations that differentiates pernicious anemia

A

neurological symptoms: symmetrical parasthesias, loss of vibratory sense, loss of proprioception

258
Q

refers to hemoglobin

259
Q

refers to cell size

260
Q

decreases with malnutrition and CA

A

hemoglobin

261
Q

increases and decreases with chemo, increases with multiple cancers

262
Q

prolonged with leukemia and mets in liver

A

bleeding times

263
Q

decreased with malnutrition and mets in liver

264
Q

increased liver and gallbladder cancer

A

bilibrubin

265
Q

increased with renal cancer

A

BUN and Creatinine

266
Q

increased in mets cancer

267
Q

positive gastric and colon cancer

A

occult blood

268
Q

range for RBC’s and hemoglobin Hct

A 
RBC's:
     -men: 4.2-5.4
     -women: 3.6-5.0
Hbg:
     -men: 13.4-17.6
     -women: 12.0-15.4
Hct
     -men: 42-53%
     -women: 38-46%
269
Q
  • increase in size due to increase in the number of cells
  • can be normal (ex: pregnancy, puberty) or abnormal
  • when you take away the stimulus, it stops
A

hyperplasia

270
Q

etiology: impingement of nerve root

unilateral manifestations: facial tics/grimacing, excruciating stabbing, distribution along the trigeminal nerve

A

Trigeminal nueralgia

271
Q
  • pain along a single peripheral nerve
  • etiology: peripheral nerve damage
  • clinical manifestations: allodynia, hyperalgesia, burnign pain, (early) vasodilation and edema, (late) vasoconstriction, cyanosis, tissue edema
A

complex regional pain syndrome (reflex sympathetic dystrophy)

272
Q

etiology: sensory nerve injury from trauma, DN, chronic alchohol use, neurotoxic drugs
Patho: degeneration, abnormal spontaneous discharge
Manifestation: burning, tingling, stabbing or shooting pain

A

neuropathic pain

273
Q
  • pain, histamine-like effects

- factor xIIa, bradykinin

A

kinin system

274
Q

fibrin vs. fibrinopeptides

A

Fibrin: clotting, factor X
FP: chemotactic factor, vascular permiability, factor X

275
Q

Piaget 4 stages

A

I: sensorimotor (0-2 yrs)
II: preoperational (2-7)
III: concrete operations (7-11)
IV: formal operations (11-adult)

276
Q

Psychosocial 8 stages guy

-ex: trust vs. mistrust

277
Q
  • preceeds the development of fine motor skills

- occurs in cephalocaudal fashion

A

gross motor skills

278
Q

5 stages Cognitive developmental theory guy

279
Q

5 piaget stages

A

oral, anal, phallic, latency, genital

280
Q

8 erikson stages

A
  • stage 1: trust vs. mistrust (1yr)
  • stage 2: autonomy vs. shame and doubt (1-3)
  • stage 3: initiative vs. guilt (3-6)
  • stage 4: industry vs. inferiority (6-11)
  • stage 5: identity vs. role confusion (puberty)
  • stage 6: intimacy vs. isolation (young adult)
  • stage 7: generative vs. self absorption and stagnation (middle age)
  • stage 8: integrity vs. dispair (old age)
281
Q

transfer objects from hand to hand

A

fine motor 1 yr old

282
Q

can hold crayon and color verticle strokes

A

fine motor 2 yr old

283
Q

-unable to sit alone by __months

A

9 months, red flag for development

284
Q

unable to transfer object from hand to hand by __

A

1 year, red flag for development

285
Q

abnormal pincer at ___

A

15 months, red flag for development

286
Q

unable to walk alone by ___

A

18 months, red flag for development

287
Q

failure to speak recognizeable words by age ___

A

2 years, red flag for development

288
Q

cooing milestone

A

1-2 months speech

289
Q

laughs and squeals milestone

A

2-6 months speech milestone

290
Q

babbles, mama/dada milestone

A

8-9 months speech milestone

291
Q

20-30 words, 50% understood by strangers milestone

A

18-20 months speech milestone

292
Q

2 word sentances, > 50 words, 75% understood by strangers milestone

A

22-24 months speech milestone

293
Q

almost all speech understood by strangers

A

30-36 months speech milestone

294
Q

palmer grasp age

295
Q

pincer grasp age

296
Q

needs assistance sitting up

297
Q

can sit alone in tripod position

298
Q

can sit w/o support and engage in play

299
Q
  • preop med
  • reduces anxiety and induces sedation and amnesia
    ex: idazolam (Versed), diazepam (Valium), Lorazepam (ativan)
A

benzodiazepines

300
Q
  • preop med
  • reduces amount of anesthetic needed
  • provides analgesia
  • decrease anxiety
    ex: morphine sulfate, fentanyl (Sublimaze)
301
Q
  • reduce gastric acidity and decrease gastric volume

ex: famotidine (pepcid), ranitidine (zantac)

A

H2 receptor antagonists

302
Q
  • preop med*
  • decreased oral and respiratory secretions
    ex: atropine sulfate, scopolamine (transderm-Scop)
A

anti-cholinergics

303
Q

caution model

A
  • american cancer society 7 warning signs*
  • Change in bowel/bladder habits
  • A sore that does not heal
  • Unusual bleeding or discharge from any body oraface
  • Thickening or lump in breast or elsewhere
  • Indigestion or difficulty swallowing
  • Obvious change in wart or mole
  • Nagging cough or horseness
304
Q

mechanisms of cell injury (3)

A
  • Depletion of ATP
  • Free radicals
  • Impaired calcium homeostasis
305
Q
  • iron defieciency
  • megaloblastic anemias
  • aplastic anemias
A

deficiencies in production of RBC’s

306
Q
  • weakness
  • pallow
  • fatigue
  • dyspnea
  • heart murmurs
  • palpitations
  • angina
  • tachycardia
  • epithelial atrophy
  • overweight “milk baby”
A

clinical manifestations of iron deficiency anemia

307
Q

RBC’s assuming various shapes

A

polkilocytosis

308
Q

RBC’s assuming various sizes

A

anistocytosis

309
Q
  • production of large, oval shaped RBCs
    etiology: folic acid or Vit. B12 deficiency
  • Risk Factors: malnutrition, malabsorption, parasitic infestations (tapeworm)
A

megaloblastic anemia

310
Q

etiology: hereditary atrophic gastritis, abscence of intrinsic factor

A

pernicious anemia

311
Q

Vit B12 important for what 3 things related to anemia?

A

DNA synthesis, maturation of RBC’s, facilitates metabolism of folic acid

312
Q

a state of too many RBC’s, can be primary or secondary

A

polycythemia

313
Q
  • hemolytic anemia
  • autosomal recessive
  • synthesis of HgbS
A

sickle cell disease

314
Q

-decreased production of all 3 types of bone marrow elements

A

pancytopenia

315
Q
  • pancytopenia
  • classification: autosomal recessive chromosomal defect (congenital) or radiation, chemo, viral infections, pregnancy (acquired)
A

aplastic anemia

316
Q

polycythemia vera: too many RBC’s, WBCs, Platelets
etiology: unknown
Patho: increased number of cells, increased blood viscocity

A

primary polycythemia

317
Q

-an adaptive mechanism to chronic hypoxemia
Etiology: chronic heart and lung disease, living at high altitudes
Patho: increased erythropoeitin

A

secondary polycythemia

318
Q

causes of increased platelet function

A
  • atherosclerosis
  • diabetes
  • smoking
  • malignancy and chronic inflammation
319
Q

<200 cells

A

agranulocytosis

320
Q

-<1500 cells

A

neutropenia

321
Q

An increased band cell count, decreased WBC, and signs and symptoms of infection are signs of?

A

neutropenia

322
Q

lymphoproliferative
-age >60, 2:1 male
-B cell line
Presentation: painless lymphadenopathy, splenomegaly

A

Chronic Lymphocytic Leukemia

BEACON MedSurg/Peds (21 decks)

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