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NUR 120 > Unit 2 > Flashcards

Unit 2 Flashcards

1
Q

What does bone marrow consist of?

A

Red blood cells, white blood cells, stem cells, platelets

Lymphocytes (B and T)are generated from stem cells ( undifferentiated cells).

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2
Q

What does the spleen consist of, and what is the action of those locations?

A

Filters (lymphocytes, macro phages, antigens.)

Red pulp: old and injured red blood cells are destroyed.
White pulp: lymphocytes.

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3
Q

What is the purpose of lymph nodes?

A

Remove foreign material, and immune cell proliferation.

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4
Q

What are the two types of immunity? Explain.

A

Natural nonspecific innate: present at birth, first line of defense. Monocytes, macro phages, dendrite cells, NK cells, basophil’s, Eosinophils, granulocytes.
Inflammatory response. Chemical physical barriers (sweat glands, tears, saliva, skin)

Acquired adaptive: results of prior exposure through immunization, disease contraction.
B and T cells.
2 types:
Active: immune response developed by own body.
Passive: temporary immunity transmitted from source other than body (developed immune either by immunization or previous disease.)

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5
Q

What are the four stages of immune response? Explain.

A

1: recognition-immune system finds foreign antigen. Lymphocytes circulating with help of macro phages/neutrophils (both have receptor sites for antibodies and complement, coating micro organism, enhancing phagocytosis.)
2: proliferation-T cell brings message to nearest lymph node. Activating T = cytotoxic and B=antibody production.
3. Response -T cells attack. Humoral or cell mediated
4. Effector-response works, antibody connecting to antigen, complement, or killer cell success.

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6
Q

Differentiate humoral vs cell mediated response.

A

Humoral: production of antibodies by B cells. And antigen/anti-body binding. Immunoglobulins:
IgG
IgA
IgM

Cell: T cells primarily responsible. Thymus. Attack invader directly, carry blueprint to lymph nodes.

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7
Q

What are the characteristics of the three major immunoglobulins?

A

IgG (75%): appears in serum,blood-borne, tissue infections. Activates complement, enhances phagocytosis, crosses placenta.
IgA (15%): appears in body fluids, protects against respiratory, G.I., GU infections. Prevents antigen absorption from food. Passes through breastmilk for protection.
IgM (10%): intravascular zero, in first immunoglobulin produced in response to bacterial/viral infections, activates complement.

  • takes all three to fight.
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8
Q

What are the three lines of defense?

A

Skin, inflammatory response and immune response.

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9
Q

What are four disorders and the immune system?

A

Hypersensitivities:
-Type one: allergic anaphylactic reaction: anaphylaxis
-Type two: cyto toxicity reaction: blood transfusion reaction
-Type III: immune complex mediated reaction: autoimmune disorder
-Type four: delayed reaction: transplant, rejection, contact dermatitis.
Immunodeficiencies
Gamopathies
immunosuppression

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10
Q

Discuss hypersensitivities ( type 1-4)

A

Type 1: anaphylaxis- IgE release histamine,
Basophils (mast cells)
Effects based on amount of exposure.
Treatment: airway, IV, steroid/diphenhydramine/epinephrine/prednisones. Lay patient flat elevate legs remove stinger
(local or systemic)
Type 2: blood transfusion reaction. Myasthenia gravis. Cell and tissue damage
Check ABO, RH, blood types
Type 3: immune complex. Auto immune disorders (RA, lupus) changes in vascular permeability and tissue integrity.
Type 4: delayed-transplants, contact dermatitis, nickel

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11
Q

Discuss immunodeficiencies.

A

Primary: typically genetic, rare

Secondary: underline disease condition, malnutrition, Burns

ID patients at risk.

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12
Q

Discuss gammopathies.

A

Overproduction of immunoglobulins.

B cells abnormally go into bone tissue breaking it down.

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13
Q

Discuss immunosuppression.

A

Poor immune function (chemo, radiation)

Neutra phenic precautions

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14
Q

What are the 2 defining conditions of HIV?

A

Pneumocystis pneumonia

Skin ca-kaposis sarcoma

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15
Q

What is HIV? AIDS?

A

Human immunodeficiency virus
Acquired immunodeficiency syndrome

Bloodeborne dz, retrovirus (Carry genetic material as RNA)
Obligate parasite (can't live unless in a living cell)
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16
Q

What are the major symptoms ofHIV?

A

candidiasis:
Thrush
Recurrent vag. Yeast infections

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17
Q

How is hiv transmitted?

A 
Body fluids (blood, seminal fluid, vaginal secretions, amniotic fluid, breastmilk)
That contain free virions an infected CD4 T cells.

1-attachment: glycoprotein (envelope coating HIV) binds with CD4 (t cells, mono, dend, microglia).
2-Uncoating: viral core (two RNA strand, and three enzymes: reverse transcriptase, integrase, and protease) enter host cell.
3-DNA synthesis: HIV changes to DNA (using reverse transcriptase) carrying instruction for viral replication.
4-integration- viral DNA enters nucleus (integrase)
5-transcription-DNA forms RNA building new virus.

Replication process occurs, losing CD4 count and integrity of own body

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18
Q

What are the two lab techniques to determine the presence of antibodies to HIV?

A

EIA/ELISA: (first)

Western blot: (second) supplemental for a positive result. More sensitive.

CD4: (measures damage) markers on lymphocytes in which HIV kills. Normal 700 to 1000. (Major determinant of initiating a RT and prophylaxis for opportunistic infections.

Viral load:(measures activity) measures plasma HIV RNA levels

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19
Q

What is HAART? And classifications based on MOA?

A

Highly active antiretrovirals therapy

Reduce plasma HIV RNA to lowest level possible

NRTI
NNRTI
Protease inhibitor
Entry inhibitor
Integrase inhibitor
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20
Q

What factors effect human emotional reactions to cancer?

A

Personality
Education
Culture

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21
Q

What is the emotional reaction to learning of ca dx, and the effects on the body?

A

Intense fear (mostly)
GES-generalized stress reaction
Inc. thoughts, HR, BP, insomnia, anxiety

Prolonged and episodic (SNS)
Inc infection risks

Anger-spiritual distress-denial

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22
Q

What are the patterns of occurrence of cancer?

A

Gender-male
Age-elder
Site-glandular
Geograph-industrial nations

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23
Q

DIff the 3 levels of nursing care.

A

Primary-actually preventing-vaccination
Secondary-screening, genetic testing
Tertiary-limit spread, control symptoms

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24
Q

What are the associated viruses and bacteria r/t ca?

A

CMV, EBV, HPV, HIV, Hep b and c

H. Pylori-stomach ca

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25
Q

What are the 7 warning signs to instruct the clients to watch for in ca detection?

A 
CAUTION:
Change in bowel/bladder habits
A sore that doesn't heal
Unusual bleeding or d/c
Thickening or lump in the break or elsewhere
Indigestion or diff swallowing
Obvious changes in warts or moles
Nagging cough or hoarseness
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26
Q

Normal cell growth and proliferation is? And controlled by?

A

Orderly, limited cell division, specific, adhere tightly together, non-migratory, euphloid

Proteins

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27
Q

What are the different types of abnormal cell growth r/t cancer?

A

Hyperplasia-rapid growth, inc number of cells
Dysplasia-become tougher, displaced
Anaplasia-growth when cells lack characteristics and differ in shape/organization, reconvert (malignant).
Neoplasia-uncontrolled cell growth not following physiologic demand. (Malignant neoplasm)
Metaplasia-enlarged cell, lose function, convert. (Chronic exposure)

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28
Q

What are host and environmental risk factors r/t ca?

A

Host: genetics, hormonal, immunologic

Environ:

  • physical/chem-tobacco, alcohol, exposure
  • radiation-UV
  • lifestyle-occupation hazard, obesity, nutrition (red meats, charred food, processed food)
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29
Q

What are the 3 phases of carcinogenesis?

A

Initiation-carcinogens cause mutation in cell DNA
Promotion-repeated exposure cause proliferation/expansion (benign lesion)
Progression -altered cell increase in malignant behavior (angiogenesis, metastasis)

30
Q

What are oncogenes? What can over expression cause?

A

Direct vital cell function, growth/differentiation

Malignant cell growth

(Tumors suppression genes turn off unneeded cell growth)

31
Q

What is growth factor and doubling time?

A

Gf- ratio of dividing cell vs resting cells in tissue mass

Doubling-time it takes for the total mass of cells in tumor to double

32
Q

What are the grades of tumors?

A 
gX-cannot be assessed
g1-well diff
g2-mod diff
g3-poor diff
g4-very poor diff
33
Q

Define the TNM staging.

A

T-tumor size (0-4)
N-nodes effected (0-4)
M-metastasis (X, 0, 1)-cannot be determine, no metas, dist. Metas.

34
Q

What are the steps of metastasis?

A

Malignant transformation
Tumor revascularization
Blood vessel penetrations
Arrest and invasion

(Most common sites:lymph nodes, liver, lungs, bone, brain)

35
Q

What is carcinoma in situ?

A

Malignant but caught before metastasis. (Stage Tis)

36
Q

Define these conditions:

leukocytosis, leukopenia, thrombocytopenia, pancytopenia.

A

Leukocytosis-inc wbc (infection)
Leukopenia-dec wbc (dz)
Thrombocytopenia-dec platelets
Pancytopenia- dec in all 3

37
Q

What are the paraneoplastic syndromes?

A

Endocrinologic-SIADH (ADH keeping NA/Water), cushings (ACTH), hyper calcemia (
Hematologic-thrombosis, endocarditis (prod of procoag factors)
Neurological-autoimmune prod of antibod
Dermatological-skin changes

38
Q

What are the 3 types of tissue bx’s?

A

Excisional(punch, shave)
Incisional (bigger)
Needle

39
Q 
What are the purposes of the following labs for ca?
PSA
CA-125
AFP CEA
Hmg hmt
A

Tumor marker ID:
PSA-prostate ca
CA-125-ovarian ca
AFP and CEA-fetal antigens expressed by liver ca.
Hgb-o2 carrying rbcs Hmt-percent of rbcs
Leukocytosis-immune response, infection
Platelets-protect against bleed, indicate bleed

40
Q 
What are the purposes of the following labs? 
Hormone-calcitonin
Electrolyte-calcium
Enzyme-gastrin, alt, ast
ALP
A
  1. Controls calcium, potassium. Elev. w/ some ca’s
  2. when CA cells die, released calcium
  3. stim secretion of gastric acid. AST/Alt-detect liver injury.
  4. elev. w/ new bone growth, bone/liver metastatic dz
41
Q

Diff the 3 therapies of CA tx

A

Radiotherapy-localized tx, kill tumors, dec size (DNA damage)
Immunotherapy-tissue typing, enhance put immune sys. Tumors assoc. antigen
Chemotherapy-whole body tx to target tumor cells spread, done in cycles

42
Q

What are the standard radiation se?

A

Anorexia/nausea
Diarrhea
Fatigue

43
Q

What are some types of chemotherapy agents?

A

Alkylating agent-lymphoma, brca, multiple myeloma
Anti metabolic agent-leukemia, colon, lymphoma
Natural product
Anti tumor antibiotic-leukemia, testicular ca
Hormone-mon Cbc, blood glucose, give w/food, leukopenia precaution

44
Q

What are the common se of chemo?

A

Extreme fatigue, n/v, alopecia, cardiotoxicity, neutropenia, dec rbcs wbc and platelets.

45
Q

What is the benefit of stem cell transplantation? And the 3 types?

A

Boost immune and replace unhealthy tissue

  1. Allegenic-from donor
  2. autologous-save own plasma for later use
  3. syngeneic-twin.
46
Q

What are the 4 oncologic emergencies?

A

Superior vena cava syndrome
Spinal cord compression
Hypercalcemia
Tumor lysis syndrome

47
Q

What occurs in SVCS, manifestations and nurse management?

A

Compression/invasion of SVC (assoc. w/lung pan liver ca)
Sob, cough, edema face neck arms hands thorax, Jvd

Mon. Cardiopulm, fluid volume

48
Q

What occurs in spinal cord compression, manifestations, and management?

A

Metastatic paravertebral tumor extending into epidural space.

Local inflammation, radicular back/neck pain, spasms, usually thoracic level, numbness/tingling, coldness, paralysis, loss of B and B

49
Q

What occurs in hyper calcemia, manifestations and management?

A

Metabolic abnormality, ca released from bone more than kidney can excrete or bone can reabsorb.

Fatigue, confusion, dysrhythmia, s/p chemo/ rad

50
Q

What occurs in tumor lysis syndrome, manifestations and management?

A

Potentially fatal, s/p radiation/chemo cell destruction, big tumor Intracellular release. Massive effects on myocardium, kidneys, CNS.
Aggressive fluid hydration before and after therapy

51
Q

What results from radiation toxicity?

A 
Skin:alopecia, derm 
Mucosa:stomatitis, dry mouth
Anemia, Thrombocytopenia, leukopenia
Sys:Fatigue, malaise, anorexia
Late effects:loss of vascularity (ulceration, fibrosis, atrophy, necrosis)
52
Q

What are important focused assessments for the oncology patient?

A 
S/s infection
S/s bleeding
Skin problems
Alopecia
S/s nutritional problems
Pain
Fatigue
Psychosocial issues
Body image
53
Q

How can the nurse prevent infection in the oncology patient?

A 
Neutropenia precautions
Hand washing
Antibiotics admin timely 
Adequate nutrition and hydration
Daily hygiene
54
Q

How can the nurse decrease n/v in the oncology patient?

A

Avoid noxious stimuli (unpleasant sites,odors, sounds)
Admin antiemetics (odansetron), premed prior to chemo, stay ahead of nausea PRN
Small frequent meals, hydrate well pre/post chemo
Admin softeners/anti diarrheal meds

55
Q

What is myelosuppression and what is the nurses role in safe keeping this pt?

A

Bone marrow deppression by chemotherapy. Results in Dec wbc(leukopenia), RBC(anemia), platelets(thrombocytopenia), granulocytes(neutropenia) increasing risk for infection/bleeding.

Hand washing, bleed precautions
Avoid infections
Mon wbc, temp, RBC, Hgb, hmt., platelets
Use antibiotics, admin granulocytes, RBCs, Epoetin Alfa, platelets, plasma

56
Q

What are the uncontrollable risk factors for breast cancer?

A 
Age
Personal/family hx
Certain breast changes
Genetic alterations
Menstrual hx, late/no pregnancy
Race
Radiation, des exposure
57
Q

What are the controllable risk factors for breast cancer?

A 
Smoking/alcohol use
Exercising
Weight, nutrition
Estrogen exposure
Pregnancy earlier, breastfeed 6 months
58
Q

What are physical indications of breast cancer tumor?

A

Lump-Nontender, fixed, hard w/ irregular border
Skin dimpling, nipple retraction, skin ulceration
Upper outer quadrant typical
D/c from nipple

59
Q

What are 2 types of malignant breast changes?

A

Carcinoma in situ (non invasive)
Ductal and lobular

Invasive carcinoma
Infiltrating ductal and lobular

60
Q

What are 2 types of cervical cancers?

A

Squamous cell

Adenocarcinoma

61
Q

What are the risk factors for cervical cancer?

A 
Smoking (#1), diet, low socioeconomic status
mult. Partners
HPV exposure, HIV, chlamydia infections
mult. Pregnancies
Family hx
DES
62
Q

What are the RED flags in cervical cancer indication?

A

Abnormal vaginal bleeding
Unusual d/c
Bleeding post intercourse, douching, or pelvic exam
Pain during intercourse

63
Q

What are the 2 types of uterine cancers?

A

Endometrial

Uterine sarcoma

64
Q

What are the risk factors of uterine cancer? And additional risk for endometrial ca?

A 
(More common in the elderly)
Prior pelvic radiation therapy
Race
Hormone changes
At least 55 y.o 
ENDO:obesity, nulliparity, late menopause, tamoxifen use
65
Q

What are s/s of uterine cancer?

A 
Bleeding/spotting
D/c
Pelvic pain/mass
Irreg heavy bleed during menopause
Low abd pain
Back pain
66
Q

What are the 3 types of ovarian cancer?

A

Germ cell tumor
Stromal cells
Epithelial cells

67
Q

What are the risk factors for ovarian cancer?

A 
Family hx (epithelial, brca, colorectal, ovarian) person h/o brca
Age 40
Obesity
Menstrual before 12
No preg, infertility
1st preg after 30
Meno after 50
1 in 70 risk lifetime
Fert. Drugs
Talc powder use
Smoking/alcohol
Estrogen/HRT
68
Q

What are the RED flags for ovarian cancer to be aware of ?

A 
Back pain
Fatigue
Bloating
Constipation
Abd pain/cramping
Urinary urgency
Prolonged abd swelling
Pelvic pressure
Vag. Bleeding
Leg pain-(not good)
69
Q

What are the proper assessment for skin lesions?

A 
Color
Redness/heat/pain
Swellin
Location, size, pattern of eruption
Distribution
70
Q 
Diff between the following:
Macule/patch
Papule
Nodules
Tumors
Vesicle
Bulla
Wheal
A

Macule-non palp flat darkened Patch=>1cm
Papule-elevated palpable 1cm
Wheal-elev mass, serous into dermis (insect bite/hives)

71
Q

What type of dz is psoriasis?

A

Chronic
Non infectious
Inflammatory

72
Q

What is impetigo?

A

Superficial bacterial infection, 2ndary to staphylococci, streptococci, or mult bacteria.
Common in children.
Contagious!

NUR 120 (6 decks)

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