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week 19 > the patient > Flashcards

the patient Flashcards

1
Q

What are the functions of the cardiovascular system?

A

to transport an exchange gases
Transports nutrients
Transport metabolic waste
Transport hormones
Distribution of metabolic heart and maintenance of body temperature

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2
Q

what are the main components of the cardiovascular system?

A

heart pump L1/2
Blood vessels L2/3
Arteries and arterioles
Veins and venules
Capillaries

Blood

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3
Q

the heart beat

A

measured by an electrocardio gram [ECG]

Cardiac muscle contraction
Pacemakers and cardiac muscle action potentials

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4
Q

What happens in depolarization of a cardiac muscle cell

A

calcium ions enter the cell
Via a pump/channel
There is an increase of calcium ions in the cytoplasm

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5
Q

what happens during contraction of a cardiac muscle cell

A

calcium ions, enter the satcoplasmic reticulum

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6
Q

what is a pacemaker

A

(sinoatrial node)

It is a specialized structure that sends electrical impulses that caused both atria and ventricles to contract

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7
Q

what heart cells allow intrinsic automaticity

A

SA
AV node
purkinje

shows the ability to generate a heartbeat. Consequently, the heart does not require nerve input to beat.

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8
Q

which cells have the fastest pacemaker potential

A

Sinoatrial mode SA node

This is the primary pacemaker
The fastest pacemaker normally drives the heart and suppresses other peacemakers

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9
Q

which node has the second fastest rhythm

A

atrioventricular node has the next fastest rhythm

Followed by the bundle of His

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10
Q

what myocytes have no peacemaker activity

A

Atrial and ventricular myocytes

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11
Q

What is not included in coordinating the pump: electrical signal flow?

A

synapse and neurotransmitters

depolarization of autorhuthmic cells rapidly spread to adjacent contractile cells through gap junctions

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12
Q

what do auto rhythmic cells do

A

generate that an action potential’s

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13
Q

What does an electronic signals conduction system do?

A

Sends signals by a gap junctions

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14
Q

explain in detail contraction

A

Sino, atrial node activity and atrial activation begins

Stimulus spreads across the atrial surfaces and reaches the atrioventricular node

There is a delay at the atrioventricular node. Atrial contraction begins.

The impulse travels along the interventricular septum within the atrioventricular bundle, and the bundle branches to the purkinje fibers. Via the moderator band, to the papillary muscles of the right ventricle.

The impulse is distributed by the purkinje fibers and relayed throughout the ventricular myocardium. Atrial contraction is completed, and ventricular contraction begins.

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15
Q

Describe the sinoatrial node action potentials

A

there is a slow calcium ion dependent upstroke

That is potassium, dependent repolarization

There is no resting potential

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16
Q

Describe the atrioventricular node action potential’s

A

there is a latent pacemaker

There’s a slow calcium ion dependent upstroke
There is slow conduction. [delay.]

There is potassium ion dependent, repolarization

Very similar to the sinoatrial node

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17
Q

Describe the ventricular muscle action potential

A

resting potential sits between -80 to -90 mV
There is a rapid sodium ion dependent upstroke

There is a calcium ion influx, then plateau

There is potassium ion dependent repolarization

And then contraction

prolonged calcium ion entry causes myocytes contraction

Long refractory period work to prevent cardiac muscle tetanus

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18
Q

What is the adaptability of the heartbeat?

A

40-200 bpm

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19
Q

how does the sympathetic nervous system modulate the heart rate?

A

Speeds up the heart rate by increasing calcium ion concentration

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20
Q

How does the parasympathetic nervous system modulate the heart rate?

A

It slows the heart rate by an increase of potassium ions and decreasing the calcium ion influx

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21
Q

What does the shape of the action potential depend on?

A

It depends on the cell type, and its function in the conduction pathway

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22
Q

How does the nervous system control heart rate?

A

Buy modulating the pacemaker cells

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23
Q

How can the electrical activity of the heart be detected?

A

It can be detected noninvasively with an ECG. This can give specific information about heart defects.

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24
Q

Give a general summary of the heart, and it autorhythmic cells

A

The heart has autorhythmic cells which can initiate the heartbeat, providing the electrical stimulus for muscle contraction.

These signals propagate through the conduction system via gap junctions

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25
Q

what is systole

A

Repetitive contraction

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26
Q

what is diastole

A

Relaxation of a heart chambers

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27
Q

How does blood move through the circulatory system?

A

from areas of higher pressure to low pressure

Contraction of the heart produces the pressure

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28
Q

Explain in detail how blood is pumped around the body

A

late diastole: both sets of chambers are relaxed and ventricles fill passively

Atrial systole: atrial contraction forces, a small amount of additional blood into the ventricles

Isovolumic ventricular contraction: first phase of ventricular contraction, pushes atrioventricular valves closed, but does not create enough pressure to open semilunar valves.

Ventricular ejection: as the ventricular pressure rises and exceeds the pressure in the arteries, the semi lunar valves open, and blood is ejected

Isovolumic ventricular, relaxation: as the ventricles relax, pressure in the ventricles falls. Blood flows back into cups of semi lunar valves and snaps them closed

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29
Q

what is the 1st dub heart sound

A

is due to the closing of the atrioventricular bicuspid valve

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30
Q

what is the 2nd dub sound

A

Is due to the closing of the aortic valve

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31
Q

What is cardiac output used to measure?

A

The heart performance

The amount of blood pumped in one minute

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32
Q

How do you calculate, cardiac output?

A

Stroke, volume multiplied by heart rate

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33
Q

what is defined by the stroke volume?

A

The amount of blood ejected from a ventricle during a single heartbeat

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34
Q

How do you calculate stroke, volume?

A

end diastolic volume - end systolic volume

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35
Q

Control of cardiac output: intrinsic regulation

A

The response of ventricular muscles to EDV changes

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36
Q

Control of cardiac output: extrinsic regulation

A

The effects of a hearts nerve supply on the hearts activity

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37
Q

out is

A

SV

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38
Q

in is

A

EDV

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39
Q

what are frank starling ventricular function Curves

A

experimentally varied EDV and measured by SV

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40
Q

What are ventricular function Curves

A

A biological property of cardiac muscle

Increases in resting length causes an increase in development of tension

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41
Q

Extrinsic regulation
What does the sympathetic nervous system release?

A

Noradrenaline

depolarizes the autorhythmic cell, and speeds up the depolarization rate, increasing heart rate

It’s also increases the force of cardiac muscle contraction

Sinoatrial node

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42
Q

extrinsic regulation
What does the parasympathetic nervous system release?

A

Acetylcholine

Hyper polarizes the membrane potential of the autorhythmic cells and slows depolarization, slowing down the heart rate

Sino atrial node

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43
Q

what do valves ensure

A

One-way flow of blood in the cardiovascular system

44
Q

What are the arteries?

A

they have lots of smooth muscle, and are very elastic, this is important for maintaining an initial high-pressure to allow circulation

45
Q

What are capillaries

A

they have no smooth muscle and function as exchange vessel gases, soulutes

46
Q

What are veins?

A

they have smooth muscle, and hold 65 to 70% of the total blood volume. smooth muscle allows veins to alter their capacity, and thus the filling pressure of a heart – therefore contribute to stroke volume

47
Q

Why do veins have valves?

A

to ensure one-way flow of blood, muscle contraction

Contributes to Venus return

48
Q

What is blood pressure generated by?

A

Ventricular contraction

49
Q

What happens in ventricular contraction?

A

ventricle contracts
Semilunar valve opens
Aorta and arteries, expand and store pressure in elastic walls

50
Q

What happens in ventricular relaxation?

A

Isovolumic ventricular, relaxation
semilunar valve shuts
Elastic recoil of arteries, send blood forward into rest of the circulatory system

51
Q

where is blood pressure highest

A

arteries then falls throughout circulation

52
Q

what is MAP mean arterial blood pressure

A

the driving force for blood flow

53
Q

what does elastic rebound do

A

evens and mentains pressure

54
Q

what is mean arterial pressure determined by

A

cardiac output and peripheral resistance

arterioles are the main site for variable resistance, in the systemic circulation eg: main control point

55
Q

what is mean arterial blood pressure determined by (MAP)

A

blood volume
Cardiac output
Resistance of the system to blood flow
Relative distribution of blood between arterial and venous blood vessels

56
Q

What can blood pressure be affected by and be compensated by?

A

changes in blood volume: blood loss decreases blood pressure

Varying cardiac output

Varying, peripheral resistance colon hypertension, usually thought to increase peripheral resistance

Redistributing blood within a system: 60% of the blood in veins are constricted by sympathetic stimulation, and will cause an increase in blood pressure

57
Q

what is dynamic control of MAP
Maintenance of a stable blood pressure
How?

A

Central nervous system mechanisms

58
Q

What does the central nervous system control?

A

The baroreceptors reflex

It’s major role is to keep arterial blood pressure within narrow limits and to be able to initiate changes within seconds

carotid sinus is thinner than other parts of the carotid artery

Therefore, it stretches more in response to pulse pressure

59
Q

how does the central nervous system controls the baroreceptor reflex

A

if peripheral vasodilation, because, arterial blood pressure will tend to fall

This fall is detected by baroreceptors in the carotid sinus and aortic arch

A rise in blood pressure causes an increase in firing the nerves signaling to the brain

The cardiovascular center in the medulla responds by either: increasing parasympathetic turn to the heart or by decreasing sympathetic tone to the heart. [Arterioles and veins]

60
Q

what is the Renin Angiotestin Aldosterone System

A

Renin-a hormone enzyme released from the kidney: by low arterial pressure [low sodium] now a low blood volume

renin releases results in the production of angiotensin II in the blood

61
Q

what does Angiotensin II do

A

stimulates the thirst center in the hypothalamus

directly constricts blood vessels

Causes the increased sodium and water reabsorption by the kidney

These effects lead to increased blood volume and increased peripheral resistance

62
Q

and the mechanisms, modulating, blood, pressure ensure:

A

The circulation wax effectively via blood flow and capillary exchange efficient

Blood supply to the tissues is related to metabolic need – Allows for large variations

63
Q

what is intrinsic auto regulation

A

it is the local control of resistance to enable changes in flow or to Keep flow or pressure constant.

64
Q

what is active hyperemia

A

Metabolic, a decrease in local oxygen levels, raised levels of carbon dioxide, low pH, slightly raised potassium, concentration - all cause vasodilation

65
Q

what is flow auto regulation

A

it increases in the flow release.

There is no release from the endothelium causing vasodilation

Other vasodilator paracrine hormones include histamine and bradykinin

66
Q

how is blood pressure and flow controlled overall

A

by local and systemic control

67
Q

what is active immunization

A

The deliberate induction of an immune response

To use the natural immune defense to provide long-term protection against infection

Sometimes known as vaccination

68
Q

what are the four main courses of an infection?

A

establishment of infection
Induction of adaptive response
Adaptive immune response
Immunological memory

69
Q

What does adaptive immunity prevent?

A

reinfection

Immunization removes the need for infection to obtain memory

70
Q

what does vaccination do

A

stimulate our bodies to develop a specific immunity

Protection and memory

When we encounter a pathogen, we respond:
Rapidly
Effectively
Via secondary immune response

71
Q

what is immune conversion to vaccine

A

not all people respond strongly
No vaccine is 100% effective

72
Q

what is herd immunity

A

chance of an infected person contacting a non-immune person

73
Q

what is the risk – benefit assessment

A

Successful vaccination programs rely upon engagement/compliance

If people perceive a low disease risk [they are unlikely to get it/not so bad they do] then they won’t worry about risk

Risk of adverse reaction perceived worse than risk from the disease

74
Q

What are features of an effective vaccine?

A

safe: The vaccine must not itself cause illness, or death

protective: vaccine must protect against illness, resulting from exposure to the live pathogen

gifts sustained protection: the protection against an illness must last for several years

Induces neutralizing antibody

Induces protective T cells

Practical considerations: low cost per dose, biological stability, ease of administration, few side effects

75
Q

give examples of vaccine types

A

Live attenuated vaccines
inactivated vaccines
Toxoids
Subunit vaccines

76
Q

what is live attenuated

A

attenuation:
to weaken
reduce pathogenicity of microbe

Grow an organism under abnormal culture conditions:
Grows virus in nonhuman cell

generic modifiction
more rapid and reliable than above

77
Q

give an example of natural attenuation

A

edward jenner smallpox

78
Q

1967 WHO global campaign to eradicate smallpox

A

A freeze dried vaccine was employed
Storable without refrigeration
One month stability

This was delivered with a bifurcated needle
Low-dose, and could be sterilized

79
Q

What do most antiviral vaccines do?

A

promote, lifelong immunity
Induce, strong immune responses
Can include more effector mechanisms

80
Q

what are some disadvantages with live attenuated

A

risk of reversion
Can cause disease
Vaccinated people can transmit the attenuated vaccine organism
Storage problems

81
Q

what are some advantages of inactivated killed vaccines

A

no risk of reversion
Easily stored
Highly stable

82
Q

what are some disadvantages of inactivated/ killed vaccines

A

variable efficiency
Generate weaker responses
boosters needed

83
Q

what is a toxoid

A

for disease is caused by exotoxins
diphtheria
tetanus

Toxin is purified and inactivated
by physical or chemical means
Complete detox is needed without the loss of epitope structure

They can still neutralize antibodies

84
Q

what are subunit vaccines

A

They avoid the use of whole pathogens

they immunized with key components of the pathogen
Because they can’t cause disease alone
The response to them protects

85
Q

What are peptide vaccines?

A

reductionist

vaccine with part of a protein

They provide relatively effective hepatitis B vaccines

Recombinant peptides can be used

86
Q

What are some disadvantages with peptide vaccines?

A

they are short and don’t fold

There is a reduced ability of antibodies to bind due to the loss of confirmation

Poor at humoral stimulation

87
Q

What is a DNA vaccination?

A

they insert cloned DNA for a gene

Animals respond to B & T cells to the encoded protein

DC dependant

88
Q

What are some things you have to consider with the administration of a vaccine?

A

The root can be crucial

The injection may not protect so well against infection at mucosal surfaces

You must induce protection at the relevant site

89
Q

what are adjuvants

A

they nonspecifically enhance the immune response to Ag with which it is mixed

They are used for nonliving vaccines

They must be:
Safe
Biodegradable
Stable
Chemically defined
Efficient

90
Q

what two ways do adjuvants act

A

they activate the responding of cells to the immune system

They alter the delivery by affecting the rate or route of delivery

91
Q

What are the five stages of vaccine? [explained.]

A

incubation
prodromal
illness
decline
convalescence

92
Q

what is fever defined by

A

an increase in body temperature

93
Q

what essential history do you ask about for children under 5 with a fever

A

duration, frequency and height of the fever
How temperatures are being measured
history of any recurrent infections
Rash
Exposure to illness in the family or community
History of recent immunizations
History of foreign travel

94
Q

describe what children under 5 have

A

developing body systems
developing immune systems
developing habitus
anatomically variant:
airway anatomy
breathing: nasal/abdominal breathers
low circulating volume

95
Q

how should fever and temperature be measured

A

using an electronic or chemical dot thermometer in axilla or infrared tympanic thermometer

96
Q

causes of fever in children less than 5

A

infection:
bacterial
viral

teething
post vaccination

97
Q

what are red flag and symptoms

A

less than 3 months >38°C
3-6 months >39°C
weak high pitched or continuous cry
fever lasting more than 5 days
rigor
reduced urine output

98
Q

what is kawasaki disease

A

cause: unknown
a leading cause of acquired heart disease in children
8 in 100,000 diagnosed each year but is increasing
72% of those affected are under 5

99
Q

what does NICE also provide

A

a traffic light system for identifying serious disease

100
Q

what are common childhood infections

A

measles
german measles
chicken pox
mumps
hand foot and mouth disease
viral and bacterial meningitis

101
Q

what is measles

A

respiratory disease with an all body rash
clear prodrome with symptoms
initially a macular rash
later becomes papular with coalescence with a distinctive appearance

102
Q

what is rubella (german measles)

A

not the same as measles

incubation period 15-20 days
prodromal symptoms vary with age
a child does not tend to feel too unwell
initial rash at 4 days is pink macules
later the rash spreads and there is some convergence

main complication is foetal damage in early pregnancy

103
Q

what is chicken pox

A

incubation period is 1-3 weeks
most infectious period is 1-2 days before the rash appears
continues until the rash has blistered over
prodrome for 1-2 days

ibuprofen should not be used with chicken pox

104
Q

What is shingles?

A

occurs in an individual who has had chickenpox
Can transmit has chickenpox, but not as shingles

Small blisters on red, swollen skin
Small area than chickenpox
Can be very painful and serious if it affects the eye

Virus remain dormant after infection in nerve roots

105
Q

What is hand foot and mouth disease

A

commonly caused by coxsackievirus

Transmitted in fluid drops
Most common in late summer and autumn

Low-grade fever, and sore throat

Painful blisters, similar to cold, sores, can appear in the mouth or tongue

Resolves after 7 to 10 days
Symptomatic treatment
analgesic/ antipyretic, calamine lotion, ice lollies

106
Q

what is meningitis

A

Viral meningitis is usually considered to be less dangerous and it’s fairly common complication of virus infections. there is no specific treatment.

headache and fever
May also be vomiting
Serious symptoms:
Neck and back stiffness
Over sensitivity to light
severe headache
Drowsines

in meningococcal meningitis diarrhea and or a Rash may occur

week 19 (3 decks)

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