Week 1 Flashcards
Inflammatory Response
- __________ response to cell injury
-Establishes an environment for healing and repair
-Inflammation is ______________________________ , but infection is not always present with inflammation – (think sprained ankle)
-Sequential response to cell injury
-Establishes an environment for healing and repair
-Inflammation is always present with infection, but infection is not always present with inflammation – (think sprained ankle)
Inflammatory Response
Cellular Response
-Neutrophils & monocytes
- _____________ first to arrive – phagocytize bacteria and other foreign objects
-Dead neutrophils and bacteria are ____
- Monocytes transform into _____________ and clean the area for healing…
-_______________ arrive later – humoral and cell mediated immunity
-Neutrophils & monocytes
- Neutrophils first to arrive – phagocytize bacteria and other foreign objects
-Dead neutrophils and bacteria are pus
- Monocytes transform into macrophages and clean the area for healing…
-Lymphocytes arrive later – humoral and cell mediated immunity
Inflammatory Response
Vascular Response
-Initial vascular ____________ followed by chemical mediated (histamine)
_____________ /capillary permeability (redness, swelling, heat)
-Initial vascular constriction followed by chemical mediated (histamine)
vasodilation/capillary permeability (redness, swelling, heat)
Chemical mediators
- Complement system – ___________ ___________ mediates inflammation
-______________ & Leukotrienes – (think of meds used to treat inflammation – leukotriene inhibitors)
- Complement system – enzyme cascade mediates inflammation
-Prostaglandins & Leukotrienes – (think of meds used to treat inflammation – leukotriene inhibitors)
Clinical manifestations of inflammation
See table 11-3 (Local Manifestations of Inflammation)
-______, redness, ______, swelling, loss of function (due to pain & swelling)
-Increase and “shift to the left” (______)
-Fever!
-Fever may not be present in ___________________ individuals (Cancer or those receiving chemo, HIV/AIDS, transplant recipients on immunosuppressant medications, older adults)
-Even small increases in ______ in compromised individuals should be a “red flag” to investigate and be concerned about
-Heat, redness, pain, swelling, loss of function (due to pain & swelling)
-Increase and “shift to the left” (WBCs)
-Fever!
-Fever may not be present in immunocompromised individuals (Cancer or those receiving chemo, HIV/AIDS, transplant recipients on immunosuppressant medications, older adults)
-Even small increases in temp in compromised individuals should be a “red flag” to investigate and be concerned about
Inflammation treatment
-RICE
_______
_______
____________________________
_____________
-Drug therapy
_________
__________
-RICE
Rest
Ice
Compression & immobilization
Elevation
-Drug therapy
NSAIDS
Tylenol
WOUND HEALING
Regeneration - ___________ of lost cells and tissues with the same type
Repair - Lost cells replaced with _____________________ – scar formation
Primary, secondary, tertiary - intention healing
Regeneration - Replacement of lost cells and tissues with the same type
Repair - Lost cells replaced with connective tissue – scar formation
Primary, secondary, tertiary - intention healing
WOUND HEALING COMPLICATIONS
Review Table: 11-7 (Complications of Wound Healing)
Adhesions
Contractions
Dehiscence
Evisceration
Fistula
Infection
Hemorrhage
Hypertrophic scars
Keloid
Adhesions
Contractions
Dehiscence
Evisceration
Fistula
Infection
Hemorrhage
Hypertrophic scars
Keloid
________________________ is the most common acute hyperglycaemic emergency in people with diabetes mellitus
Diabetic ketoacidosis (DKA)
Diabetic Ketoacidosis (DKA) results from ____________ deficiency, leading to hyperglycemia, metabolic acidosis, and ketosis.
It commonly occurs in uncontrolled type 1 diabetes (T1DM) but can also affect poorly controlled type 2 diabetes (T2DM) under stressful conditions.
insulin
Rights of Delegation:
Right task, circumstance, person, directions and communication, and supervision and evaluation
Why do you ice? (RICE) for inflammation
Causes vasoconstriction
Why do you elevate for inflammation?
Stops pooling/ fluid accumulation
Tylenol does what?
reduces:
fever & pain
NSAIDS like ibuprofen
they reduce:
inflammation, pain, & fever
Inflammation = primary
__________ is a separation of an incision
___________ is protrusion of abdominal viscera through an incision.
Dehiscence is a separation of an incision
Evisceration is protrusion of abdominal viscera through an incision.
Immunity is the body’s ability to:
resist disease.
Immunity serves three functions
- __________ – prevents invasion of microorganisms and infection
- _______________ – damaged cellular substances are digested and removed
- ____________ – mutations continually arise, recognized as foreign
- Defense – prevents invasion of microorganisms and infection
- Homeostasis – damaged cellular substances are digested and removed
- Surveillance – mutations continually arise, recognized as foreign
Antigens are substances that elicit :
an immune response
Antigens are usually __________ , but also large polysaccharides, lipoprotiens, and nucleic acids
proteins
Innate immunity – ___________________ , primary role is against pathogens
-Non-specifi c response – not antigen specific
present at birth
Acquired Immunity - 2 types
Active
Passive
Active acquired immunity
- Results from __________________________ & development of antibodies & sensitized lymphocytes
- Naturally or through _____________
- Takes time to develop but lasts a long time
- Results from invasion of foreign bodies & development of antibodies & sensitized lymphocytes
- Naturally or through vaccinations
- Takes time to develop but lasts a long time
Passive acquired immunity
- Host ___________________ rather than making them
- From mother to fetus
- Injection of gamma globulin (serum antibodies) – think rabies …
- Benefits – ____________ immunity
- Drawback – ____________ immunity
- Host receives antibodies rather than making them
- From mother to fetus
- Injection of gamma globulin (serum antibodies) – think rabies …
- Benefits – immediate immunity
- Drawback – short lived immunity
B Lymphocytes - _____________ !
Antibodies
T Lymphocytes
-Primarily responsible for immunity to ____________________ , tumor cells (Cancer), fungi.
T-helper & T-Cytotoxic
- T-Helper – help identify and activate the cell and humoral mediated immune response
(think HIV and inability to mount immune response)
- T-cytotoxic – have antigen specificity and sensitized by exposure to antigens, release
chemicals to kill cells
intracellular viruses
T-helper & T-Cytotoxic
- T-Helper – help identify and activate the ________________________________ response
(think HIV and inability to mount immune response) - T-cytotoxic – have _____________________ and sensitized by exposure to antigens, release
chemicals to kill cells
- T-Helper – help identify and activate the cell and humoral mediated immune response
(think HIV and inability to mount immune response) - T-cytotoxic – have antigen specificity and sensitized by exposure to antigens, release
chemicals to kill cells
NK (Natural Killer) Cells
- Large ______________ with numerus granules
- No prior sensitization required
- Primarily kill _______________ cells, tumor cells, transplanted graft tissue
- Significant role in immune surveillance for _____________ cells
- Large lymphocytes with numerus granules
- No prior sensitization required
- Primarily kill virus infected cells, tumor cells, transplanted graft tissue
- Significant role in immune surveillance for malignant cells
Cytokines
-Soluble factors secreted by WBCs and other cells
-Immune cell interactions depend/rely on cytokines, which act as ____________
- _____ different known cytokines
-Proinflammatory, antiinflammatory
-Stimulate _______________
-Soluble factors secreted by WBCs and other cells
-Immune cell interactions depend/rely on cytokines, which act as messengers
-100 different known cytokines
-Proinflammatory, antiinflammatory
-Stimulate hematopoiesis
Hypersensitivity Reactions Type-I
_____________________
— Mast cells, basophils, histamine, leukotrienes, prostaglandins
- Immunoglobulin (IgE)
Drug Classes to Treat __________________
- Antihistamines, Sympathomimetic/decongestants, corticosteroids, antipruritic, mast cell-stabilizing, leukotriene receptor antagonists (inhibitors)
Allergic Disorders
Humoral Immunity
- ___cells
- Antibody mediated immunity (Immunoglobulins [IgM, IgG, etc…)
*Primary exposure (IgM) – ______________as the body is first encountering antigen
- B-cells differentiate into plasma cells when exposed to antigens & create/release antibodies
- Some stimulated B-cells remain and are called memory cells
- Memory cells allow for rapid production if antigen is encountered a second time
*Secondary exposure (IgG) – ________________ & more significant response due to previous exposure
- B-cells
- Antibody mediated immunity (Immunoglobulins [IgM, IgG, etc…)
*Primary exposure (IgM) – takes time as the body is first encountering antigen
- B-cells differentiate into plasma cells when exposed to antigens & create/release antibodies
- Some stimulated B-cells remain and are called memory cells
- Memory cells allow for rapid production if antigen is encountered a second time
*Secondary exposure (IgG) – much faster & more significant response due to previous exposure
Cell Mediated Immunity
- ___cells
- Response to specific __________
- Primary importance in: Intracellular antigens (virus), fungi, transplant rejections, tumor/cancer cell
- T-cells
- Response to specific antigens
- Primary importance in: Intracellular antigens (virus), fungi, transplant rejections, tumor/cancer cell
Autoimmunity
- Response against _________
-Immune system unable to recognize _________________
- Human Leukocyte Antigen System (HLA)
- Unique to each person
- Crucial to organ/tissue transplantation
- Goal is to get best match for transplant
- Response against oneself
-Immune system unable to recognize self from other (attacks self) - Human Leukocyte Antigen System (HLA)
- Unique to each person
- Crucial to organ/tissue transplantation
- Goal is to get best match for transplant
Treat autoimmune disorders by:
suppressing the immune system
ORGAN TRANSPLANT
Life saving procedure!
- 123,000 people on organ waiting list!
- Fewer than _______ receive transplants annually
_____________ is required
- HLA compatibility required or best match
- Identical twins only people who will perfect HLA compatibility
Life saving procedure!
- 123,000 people on organ waiting list!
- Fewer than 30,000 receive transplants annually
Tissue typing is required
- HLA compatibility required or best match
- Identical twins only people who will perfect HLA compatibility
Transplant/organ/tissue Rejection
Hyperacute rejection
- Occurs within ______
- ______________ are rapidly destroyed
- Preexisting antibodies to transplanted tissue
- Organ __________ necessary
- Rare – better testing
- Occurs within 24hrs
- Blood vessels are rapidly destroyed
- Preexisting antibodies to transplanted tissue
- Organ removal necessary
- Rare – better testing
Transplant/organ/tissue Rejection
Acute rejection
- occurs when? __________
- ______-mediated immunity
- _____________ with immunosuppressive medication
- Long-term use of immunosuppressive drugs
- Risk for infection!!! – teach patient to take precautions
- First 6-months
- Cell-mediated immunity
- Reversible with immunosuppressive medication
- Long-term use of immunosuppressive drugs
- Risk for infection!!! – teach patient to take precautions
Immunosuppressive therapy - [organ transplant]
- duration _________
- Many immunosuppressive drugs have side-eff ects
- Corticosteroids!
- Biggest complications from immunosuppression – _________________
- Life-long
- Many immunosuppressive drugs have side-eff ects
- Corticosteroids!
- Complications from immunosuppression – risk for infection
Transplant/organ/tissue Rejection
Chronic rejection
- Occurs when? ___________
- Organ is infiltrated with large numbers of __________ cells
- Results in scarring and fibrosis
- No definite therapy, difficult to manage, not associated w/ optimistic prognosis of acute rejection
- Months to years
- Organ is infiltrated with large numbers of T and B cells
- Results in scarring and fibrosis
- No definite therapy, difficult to manage, not associated w/ optimistic prognosis of acute rejection
Graft-versus-host disease
- Most commonly seen in ____________________ transplants
- Graft rejects host _______ days after transplant
- Little can be done – donor T-cells attack host cells
- Immunosuppression
- Most commonly seen in Hematopoietic stem cell transplants
- Graft rejects host (7-30) days after transplant
- Little can be done – donor T-cells attack host cells
- Immunosuppression
Pathogens - microorganism that causes _________
Major pathogens
- _________________________________
Pathogens - microorganism that causes disease
Major pathogens
-Bacteria, viruses, fungi, protozoa, prions
Infections can be:
- Local, disseminated, systemic
- Local, disseminated, systemic
____________ infections include Covid, Ebola
Emerging
Antibiotic _____________
- MRSA = Methicillin Resistant Staph Aureus
- VRE; VRSA = Vancomycin Resistant Enterococci & VR Staph Aureus
- CRE = Carbapenem Resistant enterococci
Resistance
Health care providers contribute to the problem [Abx resistance]
- abx for _______ infections
- prescribing abx unnecessarily
- inadequate drug regimens
- using ________________ abx when not needed
- abx for viral infections
- prescribing abx unnecessarily
- inadequate drug regimens
- using broad spectrum abx when not needed
Patient contribute to the problem [Abx resistance]
1. __________ doses
2. not taking medication for _______________ of treatment
3. saving ________ abx
- skipping doses
- not taking medication for full duration of treatment
- saving unused abx
hospital-acquired infections - HAIs - Acquired through exposure in a healthcare setting
_______
_______
_______
- c-Diff
- VRE
- MRSA
Fluid Compartments
Intracellular
- 2/3 of Decreases as we age
- body water is _____________
Extracellular
- Interstitial fluid – spaces between the cells
- Intravascular (plasma) – blood and vasculature
Intracellular
- 2/3 of Decreases as we age
- body water is INSIDE cells
Extracellular
- Interstitial fluid – spaces between the cells
- Intravascular (plasma) – blood and vasculature
Osmosis-
movement down a pressure gradient (From low to high conc.)
DKA = high serum osmolality! ↑ glucose concentration in serum → intracellular dehydration
high serum osmolality! ↑ glucose concentration in serum → intracellular dehydration
Hydrostatic pressure- __________________________________________
-Fluid pushed out through ‘leaky’ capillary blood vessel wall under high pressure
pressure exerted against the walls of the blood vessels/ capillaries
Colloidal oncotic pressure- caused by plasma proteins (mainly albumin)
-Cirrhosis – decreased intravascular oncotic pressure leads to ascites
Colloidal oncotic pressure- caused by plasma proteins (mainly albumin)
-Cirrhosis – decreased intravascular oncotic pressure leads to ascites
Fluid Spacing
Edema – Second spacing (fluid in the ___________ areas)
1+
2+
3+
4+
Third Spacing –______________________ of fluid
-Ascites, abdominal cavity
Edema – Second spacing (fluid in the interstitial areas)
1+
2+
3+
4+
Third Spacing – abnormal accumulation of fluid
-Ascites, abdominal cavity
Fluid volume regulation - Several mechanisms control fl uid volume deficits and excess
-Hypothalamic-Pituitary Regulation – ADH (anti-diuretic hormone)
- Renal/Kidneys – urination
- Adrenal – Cortical Regulation
>RAAS
- Cardiac (BNP) – Heart failure [MCA-2]
- Gastrointestinal (GI) – think Nausea/vomiting
-Hypothalamic-Pituitary Regulation – ADH (anti-diuretic hormone)
- Renal/Kidneys – urination
- Adrenal – Cortical Regulation
>RAAS
- Cardiac (BNP) – Heart failure [MCA-2]
- Gastrointestinal (GI) – think Nausea/vomiting
Fluid volume deficit / excess
-Nursing Actions: ______________
-IVs, PO, nausea, vomiting, excess urination, sweating (fever), weights!
-Monitor Lab values – _____
- Measure BP, tachycardia, CVP
-Nursing Actions: Track I’s & O’s
-IVs, PO, nausea, vomiting, excess urination, sweating (fever), weights!
-Monitor Lab values – BUN
- Measure BP, tachycardia, CVP
ELECTROLYTES
Sodium - Think ______
Potassium - Think ________
Calcium - Think ________
Phosphorus
Magnesium
Sodium - Think neuro
Potassium - Think cardiac
Calcium - Think muscle
Phosphorus
Magnesium
Fluid types
- Hypertonic – _____ NS
- Isotonic – _____ NS
- Hypotonic – _____ NS
- Hypertonic – 3.0% NS
- Isotonic – 0.9% NS
- Hypotonic – 0.45% NS
Electrolyte Replacement
____________________ . Usually best option [bananas]
IV
– Potassium
*NEVER EVER GIVE K+ _________ – CAN CAUSE CARDIAC ___________
*USUALLY THROUGH CENTRAL LINE
*RATE LIMITED
* Can cause peripheral irritation
* RATE LIMITED
PO – diet or supplements. Usually best option [bananas]
IV
– Potassium
*NEVER EVER GIVE K+ IV PUSH – CAN CAUSE CARDIAC ARYTHMIAS
*USUALLY THROUGH CENTRAL LINE
*RATE LIMITED
* Can cause peripheral irritation
* RATE LIMITED
Diabetes mellitus is a problem of:
glucose metabolism
Global cost of diabetes mellitus in 2015:
1.3 trillion
1 in 5 health care dollars is spent caring for people with : _______ in the US
Diabetes Mellitus
Insulin attaches to receptors on target cells, where it promotes ____________________________ through the cell membranes
Insulin attaches to receptors on target cells, where it promotes glucose transport into the cells through the cell membranes
Diabetes type 1
-_____________disease
-B cells ____________________
-Autoimmune disease
-B cells do not secrete insulin
While Type 1 diabetes cause is unknown/autoimmune and often occurs in children, type 2 diabetes:
is more common in adults; associated with lack of exercise/ poor diet
Symptoms in diabetes type 1 vs 2
type 1: quickly develop
type 2: gradual symptoms
Type 1 diabetics treatment:
daily insulin
Type 2 diabetics treatment:
often managed by exercise, healthy diet, or oral medications
If progresses, may be treated with insulin
Symptoms of type 1 + 2 diabetes
Thirst
weight loss
frequent urination
constant hunger
fatigue
blurry vision
Signs of hypoglycemia
headache
sweaty
hungry
shaky
confused
grumpy
Hyperglycemia signs
Tired
vomiting
stomach pain
rapid breathing, increased pulse
dry mouth
flushed face
fruity breath
Long term complications of Diabetes mellitus
- Retinopathy & PVD
- Peripheral neuropathy
- Coronary Artery Disease
- CVA & Nephropathy