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408 Cards in this Set
- Front
- Back
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What are the five rights of medication administration?
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1)right drug
2) right dose 3) right time 4) right route 5) right patient |
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What legal aspect of the drug administration develops standards of care and practice
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Nurse practice act
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Name 6 changes in body composition in the elderly client
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Decreases in
1) total body mass 2) H2O 3) lean body mass 4) muscle mass 5)sub q tissue increases 6) proportion of body fat |
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Name two changes in cardiac function that occur do to aging. and their extent
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1) Cardiac output decreases by 50%
2) Cardiac absorption and distribution lowered 35% |
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Name 4 changes in GI function
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1) increased PH
2) delayed gastric emptying 3) decrease in small bowel surface area 4) decrease in intestinal blood flow |
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Name the 2 changes in hepatic function its effects in the elderly client.
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1) decrease liver blood flow
2) decrease in metabolism leads to increased blood levels of drug |
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Name 2 changes in the kidneys that occur in elderly client and how they effect drug processes
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changes in renal function- decrease in renal blood flow and rate of excretion
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In an elderly client topical medication can create what kind of effects
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Systemic
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What effects do sensory and perceptual changes have in a client
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1) affects drug safety effectiveness and compliance
2)may alter teaching 3)decreases manual dexterity |
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What are some considerations when doing IM injections to an elderly client
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1) IM needs to be in large muscle
2)never inject into immobile limb |
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What is the biggest source of adverse reactions in the elderly and by how much
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70-80% are dose related.
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How is distribution different in an elderly client
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1) decrease in serum albumin
2) more erratic delayed onset of action 3) prolonged effects or toxic effects |
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what changes in metabolism would you expect to see in an elderly client
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decreased- leading to prolonged pharm effects of drugs and increase in reactions
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How is Excretion different in an elderly client
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decreased
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What are 3 considerations when managing medication in an elderly client.
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1) need complete drug/ health history and allergies
2) give water before and after 3) monitor lab and nutritional status. |
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Identify 6 teaching needs in elderly clients
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1) accurate and understandable print
2) large print 3) consult dr. before making changes 4) inform Dr. of side effects 5) use one pharmacy 6) include family in teaching |
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Name 5 maternal changes during pregnancy that effect pharmodynamics
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1) Blood volume increases 35-50%
2) Cardiac Output-increases30-40% 3) gastric emptying time- delayd 4) increased gastric acid secretion 5) minor enzyme changes |
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By what percent is blood volume increased in pregnant women
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35%-50%
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By What percent is Cardiac output increased
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30-40%
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What does an FDA pregnancy category of A describe
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No risk of fetal harm
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An FDA pregnancy category of B means that
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Studies show no risk to animal fetus, and that info in humans not available
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FDA pregnancy category of C means
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Adverse effects are reported on animal fetus.
info on humans mia |
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FDA pregnancy category of D describes
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Possible fetal risk reported.
consider risk vs benefit |
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Category x of the FDA pregnancy categories relates what kind of information
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Fetal abnormalities reported and positive evidence of fetal risk noted. these drugs should not be used in pregnant women
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What are the 4 effects drugs can have on fetus's
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1) lethal
2) Teratogenic 3) mutagenic 4) Carcinogenic |
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A drug that is said to be teratogenic results in what effects to who? When do most of these effects manifest
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Results in structural defects to child
(3 weeks to manifest) |
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How does a carcinogenic effect effect a child
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Causes cancer
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Which drug effect is said to cause permanent changes in genetic composition
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mutanogenic effect
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What are 3 different manifestations of mutagenic effects
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1) changes to chromosome structure
2) Changes in the number of Chromosomes 3) DNA genetic code changes |
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What are some effects of Fetal Alcohol syndrome
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Teratanogenic effects
craniofacial, CNS dysfunction growth retardation |
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What trimester is the most dangerous to the fetus when it comes to drug effects
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first trimester
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what trimester is the most likely drug transfer will take place
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last trimester.
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what % of drug is transfered through the placenta
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50%-100%
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What drugs get transfered through breastmilk
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nearly all
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To minimalize the effects of drug in a must have senario when should a mother take her meds before during or after breast-feeding
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give her meds after breastfeeding
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Name 4 reasons variable drug actions occur in a neonate
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1) small body mass
2) low body fat 3) body H20 4) increased permeability of blood brain barrier |
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Name 3 traits of newborns that effect absorbion
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1) increase in peristalic action
2) variable gastric PH 3) variable gastric emptying time |
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Name 2 things that effect distribution in a newborn
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1) decrease in albumin binding sites
2) H20-Body fat is altered |
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metabolism in newborns is altered due to
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immature liver
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excretion is altered in a newborn due to
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immature kidneys
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How is Clarks rule calculated
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BSAadult/BSAchild x adult dose= estimated child dose
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When giving a child oral medication in a syringe
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make sure child knows no needle.
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Should one administer medication in a bottle
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no
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When giving IM injections to children what age is appropriate to administer medication to the deltoid
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age 5
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What is the site of choice for all ages including children under 3
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Vastus Lateralis
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What site should never be used due to location of the sciatic nerve
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dorsogluteal site
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what site is not used if the child has not been walking for a year
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ventrogluteal
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how are eardrops administered to a child under 3 (which way do you pull the ear)
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down and back
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How long should the period be between explanation and administration be
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brief
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What are non-self substances?
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1)Any microorganism capable of invading body
2)exogenous proteins 3)Body's own unhealthy cells |
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Is inflamation specific or non specific
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nonspecific
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is immunity specific or non specific
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specific
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What are the three ways that immunity works in the body
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1)produces antibodies (humoral)
2)mobilizes lymphocytes that directly attack invaders (cell mediated response) 3)works with inflamatory response |
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What is an antigen?
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An Antigen is an endogenous or exogenous substance which the body recognizes as foreign or “non-self.” May stimulate an immune response.
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Define Immunogenicity? what furthurs this process
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Immunogenicity is the ability of a substance to stimulate the immune system. It is a process. Immunogenicity is furthered by
1)foreigness,” 2)size, 3)complexity and quantity of an antigen |
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What cell do body cells recognize on the surface to determine if antigens are nonself
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HLA present = self
HLA absent=nonself |
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What is autoimmunity?
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when the body begins to recognize self-antigens (HLA) as foreign.
SLE |
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What is Iso immunity?
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when the immune system reacts against the antigens of a donor’s tissue.
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What are two examples of Iso Immunity
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Rejection of transplanted organs
ABO compatibility |
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Name two of the bodies first lines of defense
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1)skin mucous membrane
2)chemical barriers |
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What are the two second lines of defense
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1)inflamation response
2) phagocytosis |
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What are the two third lines of defense
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1) specific immune response
2) natural killer cells |
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what are the 5 purposes of the immune system and the inflammatory process working together
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1. seek out nonself
2. confine inactivate or destroy non self cells 3. eliminate debris from dead or damage 4. stimulate actions to promote healing 5. initiate reexposure protection |
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What is the speed of the inflammatory response
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fast seconds after
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what are the four goals of the inflammatory response.
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1) surround
2) Issolate 3) destroy 4) remove |
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What are the 6 ways antibodies destroy antigens
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1) agglutination (clumping of cells)
2)Precipitation (causing to fall out of solution) 3)neutralization (inactivation) 4) Opsonization (enhances phagocytosis) 5) complement fixation or activiation (complement is a normal substance in the serum that when added to the antibody/andtigen complex, causes lysis of non-self cell). Formation of an antigen-antibody complex. |
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What method of antibody destruction consists of clumping cells together
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agglutination
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What method of antibody destruction consists of causing them to fall out of solutions
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precipitation
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what is it called when an antibody deactivates an antigen
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neutralization
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What method of antibody destruction enhances phagocytosis
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opsonization
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The immune response has the ability to be suppressed or accentuated by such things as
11 things |
1)Trauma
2)disease 3)nutritional status 4)drugs 5)radiation 6)pollutants 7)age 8)genetic background 9)reproductive status 10)gender 11)organ transplant |
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What are two features of natural immunity.
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1) acquired at birth
2) Species specific |
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What are some features of active acquired immunity
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gained through natural exposure or vaccination antigens
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what are some features of passive acquired immunity
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temporary
between mother and fetus |
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what are the two functions of pariferal lymph organs
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1) to trap and process antigen
2)promote antigen with mature immune cells |
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What connects lymph organs
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lymph channels blood channels and capillaries
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What are the primary cells of the immune system
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primary cells are lymphocytes
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what percent of leukocytes are lymphocytes
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25%-30%
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What percents of lymphocytes are t cells (cell mediated)
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60-70%
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What percent of lymphocytes turn into b cells (humoral)
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10-20%
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In what kind of immunity involves antibodies
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humoral
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what do b cells produce
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antibodies
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Which antibody is present in majority of B cells
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IgG
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Which antibody contains anti-viral, antitoxin, and antibacterial antibodies
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IgG
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Which antibody only immunoglobulin that crosses the placenta
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IgG
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Which antibody is only immunoglobulin that crosses the placenta; responsible for protection of newborn
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IgG
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Which antibody is 75% of total
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IgG
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Which antibody is Predominant immunoglobulin in body secretions, such as saliva, nasal and respiratory secretions, breast milk;
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IgA
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What is the purpose of IgA
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protects mucous membranes
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Which antibody Forms the natural antibodies such as those for ABO blood antigens
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IgM
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Which antibody prominent in early immune responses
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IgM
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Which antibodies activate the compliment
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IgG and IgM
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Which antibody's Action is not known; may affect B-cell maturation.
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IgD
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Which antibody Binds to mast cells
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IgE
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Which antibody binds to macrophages.
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IgG
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Which antibody Binds to basophils
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IgE
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Which antibody causes the allergic response
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IgE
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What are the five classificaitons of T cells (cell mediated)
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1)T4CD4 Helper cells
2)T8CD8 Supressor T cells 3)Cytotoxic and cytolitic killer cells 4)Natural killer cells 5)memory cells |
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What are the two functions of cytoxic cytolitic t cells
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1)binds to nonself using anti antigen complex
2) lysis of nonself cells |
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Which T cell does not need to be sensitized to act
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Natural Killer cells
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How do natural killer cells kill
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secretes a lytic substance detaches and autolyses
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What kind of cells are natural killer cells experts at killing
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recognization of unhealthy self cells
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What are the two functions of suppressor T cells also called T8 Cells or CD8 cells
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1) regulate the immune and inflammatory response
2) oppose the activity of helper t cells |
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Which T Cell is the leader of the leukocyte army
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T4 CD4 Helper cell
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Which T cell interacts with both the inflammatory and the immune systems
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T4 CD4 helper cells
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Which lymphocyte secretes cytokines
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t4 cd4 helper cells
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What is the optimal ratio of T4 to T8 cells
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2:1 "1.9"
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What does an increase of T4 to T8 Cells manifest in the body and what happens to immune responses
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Hypersensitivity and the inflammatory response becomes exaggerated
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What happens when there are more T8 than T4 Cells
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immunosuppression example aids
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What are monocytes what do the mature into
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monocytes orginate in the bone marrow and become macrophages after they circulate
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are macrophages specific or non specific
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non specific
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what are the two purposes of macrophages
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1) contain infections until immunity occurs
2) also act in the inflamatory response |
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what kind of regulatory proteins are involved in the communication among macrophages and lymphocytes
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cytokines
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what are cytokines produced by lymph
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lymphokines
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what are cytokines produced by macrophages
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monokines
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what does the macrophage activating factor do
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speeds maturation of monocyts into macrophages, and increases the phagocyic action of macrophages
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What do Interluken 1 interluken 6 and the tumor necrosis factor all do
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mediates inflammation
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what does interluken 2 do
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causes the growth and maturation of T lymphocytes
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What does an interferon do
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limits viral replication
activates macrophages nuetrophils and natural killer cells |
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What are 3 common characteristics among leukocytes
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1) protect the body from non self substances
2) protect body via inflamation or immunity 3) distinguish self from non self "self tollerence" |
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Which leukocyte arrives 6-12 hours after infection and what is its main mechanism of action
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neutrophils caus phagocytosis
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which leukocyte works longer neutrophils or macrophages
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macrophages
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what is the definition of inflammation
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a vascular reaction whose net result is the delivery of fluid dissolved substances and cells from the circulating blood into the intestitial tissues to an area of injury
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what is the difference between inflammation and infection
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infection involves the invasion of a microogranism
inflamation can be initiated by that and other means such as surgery or trauma |
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what are the 4 purposes of inflammation
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1) destroy and eliminate agents causing inflammation
2) isolation or wall off area of injury 3) demolition of injured and necrotic tissue 4) promote healing |
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What cannot occur w/o inflammation
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Healing
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What are the 5 hallmarks of inflammation
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1) redness
2) edema 3) heat 4) pain 5) loss of function |
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What do mast cells do
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release histamine granules which vasodilate arterioles
reale leukotrienes which increase vascular permeability |
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What do bradykinins do
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Maintain vascular permeability and induces pain at site of injury using prostaglandins
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What two chemicals stimulate nerve endings causing pain
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prostaglandins and bradykinins
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Name 3 systemic manifestations which occur with acute inflammation
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1) fever
2) leukocytes 3) increase in circulation of plasma proteins |
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what type of inflammation is characterized by pus suppuration and incomplete wound healing
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chronic inflammation
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what kind of bacteria can survive inside macrophages
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TB
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What are 3 common characteristics among leukocytes
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1) protect the body from non self substances
2) protect body via inflamation or immunity 3) distinguish self from non self "self tollerence" |
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Which leukocyte arrives 6-12 hours after infection and what is its main mechanism of action
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neutrophils caus phagocytosis
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which leukocyte works longer neutrophils or macrophages
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macrophages
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what is the definition of inflammation
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a vascular reaction whose net result is the delivery of fluid dissolved substances and cells from the circulating blood into the intestitial tissues to an area of injury
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what is the difference between inflammation and infection
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infection involves the invasion of a microogranism
inflamation can be initiated by that and other means such as surgery or trauma |
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what are the 4 purposes of inflammation
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1) destroy and eliminate agents causing inflammation
2) isolation or wall off area of injury 3) demolition of injured and necrotic tissue 4) promote healing |
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What cannot occur w/o inflammation
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Healing
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What are the 5 hallmarks of inflammation
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1) redness
2) edema 3) heat 4) pain 5) loss of function |
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What do mast cells do
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release histamine granules which vasodilate arterioles
reale leukotrienes which increase vascular permeability |
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What do bradykinins do
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Maintain vascular permeability and induces pain at site of injury using prostaglandins
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What are 4 common mechanisms of action within antibiotics
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1) interference with cell wall synthesis
2) Interference with protein synthesis 3) Interference with replication of bacterial DNA and RNA 4) Disruption of metabolic reactions within the cell 3) 4) |
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Define Antibiotic resistance
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Occurs when one antibiotic cannot work on a specific bacteria
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Amoxicillin, ampicillin, augmentin are all types of what category of antibiotics
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Penicillins
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What is the most common adverse reaction of penicillin is located in what body system
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GI system
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Are Penicillins bacterio static or bacteriocidal
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bacteriocidal
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what type of bacteria are immune to penicillins?
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Bacteria without cell walls are
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The vast majority of antibiotics used today fall into which two antibiotic categories
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Penicillins and cephalosporins
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Drugs in the penicillin class have a cross allergy to which antibiotic
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cephalosporins
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Both Cephalosporins and penicillins are what kind of antibiotics
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beta lactams
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Name some common cephalosporins
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Cephalosporins: 1st, 2nd, 3rd, & 4th generations: Cephalexin, Cefazolin, Cefoxitin, Cefuroxime sodium, Ceftriaxone, Ceftazidime, Cefepime 5th generation Ceftobiprole in FDA approval process.
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Name a 5th generation cephalosporin
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cefeprime
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can one prescribe cefeprime
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no its in fda approval process
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Name 3 macrolides
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Erythromycin, Azithromycin, Clarithromycin
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Name 2 Sulfamides
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Gantrisin, Bactrim
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Name 3 Carbapenems
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Imipenem/Cilastatin Aztreonam
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Name 3 Aminoglycosides
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Gentamycin, Tobramycin, Neomycin
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Name 3 Tetracyclines
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Clinimycin, Minocin, Vibramycin
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Name 2 Quinoles
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Cipro, Levofloxacin
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What is the most common side effect of macrolides
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Stomatitis
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Name 3 important facts to know about Sulfa antibiotics
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1) avoid sun exposure
2) Taken w/ food 3) Force fluids 2000-3000ml |
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where do sulfa drugs accumulate
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kidney
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what are sulfa drugs used to treat usually
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UTI
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Sulfamethoxazole is usually combined with what to be used in clinical practice
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trimethoprim
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When are sulfa drugs prescribed for non antibiotic therapy
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rheumatoid arthritis
ulcerative colitis |
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are sulfa drugs bacteriocidal or bactreriostatic
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bacteriastatic
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which was the first man made antibiotic
|
Sulfamides
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Which drug messes with the DNA of the Cell wall and prevents bacteria from producing new dna and is often combined with erythromycin and trimipen
|
Sulfamides
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What kinds of bacteria do Sula's workon
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gram positive and gram negative bacteria
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Which drug category is bactericidal inhibits cell wall synthesis and can cause drug induced seizure activity
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Carbapenem
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Are Carbapenems bacteriocidal or bacteriastatic
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bacteriocidal
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What kind of bacterial action does Carbapenems have Gram + Gram - or broad spectrum
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broad spectrum
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what kind of reaction will a person taking carbapenems have if he has an allergy penicillins
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allergic reaction
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How are Carbapenems prescribed
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IV infusion over 60 minutes
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How long should an IV infusion of Carbapenems be administered over
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60 minutes
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Aztreonam has the special advantage of doing what
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preserving gram + and anerobic flora
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What special nursing consideration should be noted with Aminoglycosides (hint route)
What should be monitored |
Check peak trough levels through blood
They cannot be given orally |
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which antibiotic cannot be given orally
|
Aminoglycosides
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What are two possible adverse effects of aminoglycosides
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cranial nerve 8 damage and or nephrotoxicity
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damage to cranial nerve eight causes what condition
|
ototoxicity
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What aminoglycoside is used prophylactically prior to surgical procedures involvin the GI tract
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Neomycin
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What category of drugs are given in eyedrop form to treat conjunctivitis
|
Aminoglycosides
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What is the mechanism of actions for aminoglycosides
|
interference with protein synthesis
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what antibiotic must be monitored for peak trough levels to prevent toxicity
|
aminoglycosides
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What is a trough level when is the best time to check for one
|
a trough level shows the lowest amount of drug in your system. it is drawn an hour before your next dose of medication
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What is a peak level when is the best time to check for one
|
a peak level shows the highest amount of drug in your system it is drawn an hour after your next dose of medication
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How do you know a patient has cranial nerve 8 damage
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ringing in ears or tinitus
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what lab values do you need to monitor to check for nephrotoxicity
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BUN and creatine
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Are Tetracyclines bacteriostatic or bacteriocidal
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Bacteriostatic
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What is the method of action for tetracyclines
|
Block DNA replication
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What antibiotic when taken with milk antacids or iron salts will decrease the oral absorption of the drug
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Tetracyclines
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What specific antibiotic and its category is often effective in treating STD's such as chlamydia and gnorrhea
|
Doxycycline a tetracycline
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What drug treats Rocky mountain spotted fever?
|
Doxycycline
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what drug is used in the prevention and treatment of malaria
|
doxycline the tetracycline
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A patient has anthrax what class of antibiotics will treat such a disease
|
tetracycline doxycline
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What are some 3 contraindications in patients taking tetracyclines
|
1) not given in children under 8
2) cause esophageal erosion if taken at bedtime 3) can cause fetal development problems if taken during pregnancy |
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Why are tetracyclines not used with children under the age of 8
|
teeth discoloration
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What is the best known drug in the category of quinoles
|
Ciproflaxin (Cipro)
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What drug category can possibly lead to cartilage damage or cause prolonged QT interval on the EKG leading to a tye of ventricular tachycardia Torsades de Pointe
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Quinoles
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Name two possible adverse effects of quinoles
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1) cartalidge damage
2) Torsades de pointe Prolonged QT interval on the EKG |
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What is the mechanism of action for Quinoles
|
Prevent cell replication by messing with dna synthesis
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What kind of bacteria are sensitive to quinoles
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Gram+ and Gram -
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Which antiobiotic is specifically contraindicated in patients with ulcerative colitis or enteritis
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clindamycin (cleocin)
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What should be monitored with the administration of linezolid (Zylvox)
|
Platlet count
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What drug is used to treat VRE and less commonly MRSA
|
Linezolid (Zyvox)
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What drug class is Linezolid (Zyvox)
|
oxazolidinones
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Which drug is used to treat anaerobic organisms in the abdominal and gyn infections also protozoan infections
|
metronidazole (flagyl)
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What drug may cause kidney stones
|
Sulfa's
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What blood dyscrasias
|
trimethoprim
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what drug can cause abnormal blood clotting
|
cephalosporins
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what is another caution to be aware of with tetracyclines
|
avoid sun exposure
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What are three things to be taken into consideration when taking antibiotics
|
history of liver and kidney disease
take full course all current meds listed |
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What are some facors thta need to be taken into consideration when determining a course of antibiotics
|
type of infection
health of patient |
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|
Most severe fungal infections tend to affec persons who are
|
immunocompromised
|
|
|
name 3 primary types of antifungals
|
Nystatin
Azoles Ampjhotericin B |
|
|
What should be avoided with metronidazole
|
alcohol
|
|
|
What are some things that should be taken into account when determining the course of antibiotics
|
type of infection and general healht of individual
|
|
|
What drug is administered in the treatment of thrush
|
nystatin
|
|
|
what drug is administered to treat severe fungal infections
|
amphotericicin B
|
|
|
Are there broad spectrum antivirals
|
no very specific
|
|
|
what are 3 diseases people are vaccinated for
|
hepatitis polio and small pox
|
|
|
How does Acyclivir work
|
Slows down virus's reproduction and multiplicaiton so immune system can catch up
|
|
|
What drug therapy is effective in treating varicell and herpes virus's
|
acyclovir
|
|
|
what are two different antivirals that help with hiv and aids what is the difference
|
1) AZT which inhibit reverse transcriptase
2) protease inhibitors which stop penetration of cell |
|
|
What is the amount of blood in the body of an adult
|
between 5-6 L
|
|
|
What is teh site from which blood cells develop?
|
bone marrow
|
|
|
Stems cells are said to be non commited what does this mean
|
they can form any type of blood cell
|
|
|
What is the PH range for blood
|
7.35 and 7.45
|
|
|
What is the the temperature of blood
|
slightly higher than body temperature 100.4
|
|
|
What percent of body weight is blood
|
8%
|
|
|
What are three types of functions of blood
|
1) distribution functions
2) regulatory functions 3) protective functions |
|
|
Name 3 destribution functions of blood
|
1)carry oxygen from lungs to cells
2) carry hormones 3) remove nitrogen form kidneys |
|
|
Name 3 regulatory functions of blood
|
1)Regulates body temperature
2)Regulates PH via buffer and proteins 3) Regulates fluid volume via proteins and NA+ |
|
|
Name some protective functions of blood
|
Prevention of blood loss via clotting
helps prevent infection with wbc antibodies |
|
|
What is meant by pluripotential
|
Stem cells are pluripotential in that they can choose what cell to become erythropoitin, leukopoitin, throbopoitin
|
|
|
what is meant by unipotent
|
unipotent refers to the fact that they are locked into a particular blood cells
|
|
|
what kind of blood cells do erythropoietin mature into
|
red blood cells
|
|
|
what kind of blood cells do leukopoetin mature into
|
white blood cells
|
|
|
what kind of blood cells do throbopoietin mature into
|
platelets
|
|
|
What are Reticulocytes and where do they reside
|
they are premature red blood cells they mature in the bone marrow and are released as erythrocytes
|
|
|
what percent of reticolocytes may be released into circulation
|
1%
|
|
|
What indicates how fast RBCs are forming
|
Reticulocytes
|
|
|
Name 5 nutritional requirements for adequate rbc formation
|
1) Iron
2)protein 3) Amino Acids 4) B12 5) folate |
|
|
where are red blood cells destroyed by macrophages
|
in the spleen
|
|
|
What is the lifespan of a red blood cell
|
80-120 days
|
|
|
what happens to the heme portion of the blood cell
|
converted into bilrubin and is transported to the live excreted as bile
|
|
|
what is the the function of red blood cells
|
heme molecule transports 02
carbamino hme transports carbo 02 |
|
|
What lab values are associated with red blood cells
and what does ieach mean |
1) hemoglobin- measures iron pigment
2) hemocrit- rbc in volume 100ml of blood 3) Red blood cell count per micro l 4) MCV microns |
|
|
What is a normal Hemoglobin count for men and women
|
14-17.4 for Male
12-16 for Females |
|
|
What is a normal hatocrit for women
|
42-52% for men and
36-48% in women |
|
|
What is a normal red blood cell count
|
4.2-5.4 in men
3.6-5 in women |
|
|
what is the range for size of a red blood cell
|
82-98
|
|
|
What is the normal range of thrombocytes
|
150000-400000
|
|
|
How do platetes form a clot
|
agreggate
|
|
|
what do platlets form to stop bleeding
|
a clot
|
|
|
What is one thing that would increase the produciton of leukocytes
|
infection
|
|
|
what happens to the reserves in bone marrow when an infection occurs
|
they drop
|
|
|
What 3 things do agranulocytes consist of
|
lymphocytes monocytes and macrophages
|
|
|
what do granulocytes consist of
|
esinophils neutrophils and basophils
|
|
|
What do Esinophils do
|
antibody formation against parsites and participates in allergic reactions
|
|
|
Do granulocytes offer specific or non specific responses
|
non specific responses
|
|
|
What is the definition of anemia
|
a condition which there are too few erythrocytes too little hemoglobin or both.
|
|
|
Is anemia a disease
|
no it is a process
|
|
|
What are 4 causes of anemia
|
1)excessive blood loss
2) destruction or hemolysis of RBC at a faster than normal rate 3) deficient RBC production due to lack of iron or other nutrition 4) Bone marrow failure |
|
|
Name how anemia is classified
|
Based on two characeristics size and hemoglobin
macrocytic normocromic |
|
|
what are 2 clinical manifestation of anemia
|
decreased oxygen transport hypoxia.
raized hr fatigue syncope angina palor circulatory collapse |
|
|
What are two results of rapidly developing anemia
|
circulatory collapse
shock |
|
|
What is an effect of sever rapidly developing anemia
|
peripheral vasoconstricition
|
|
|
What is the result of decreased hemoglobin to kidney
|
increased volum BP and organ profussion
|
|
|
What causes pernicious anemia and how is it categorized
|
macrocytic nromochromic anemia
malabsorbtion of B12 due to the absense of gastric mucosa secretions of intrinsic factor |
|
|
What are some of the etiologies of pernicious anemia
|
1) congenital difficiancy
2) autoimmune process or genetics 3) chronic gastitus 4 )indivuals who have a gastrectomy |
|
|
Name 4 diagnosis to determine if a patient suffers from pernicious anemia
|
1) low serum of vitamin B12 or folic acid
2) peripheral blood smear 3) complete blood count shows decreased hemoglobin and hemocrit levels 4 Schillings test |
|
|
what is one treatment of pernicious anemia
|
b 12 injections
|
|
|
What type of anemia is chronic microcytic and hypochromic
|
Iron deficiency anemia
|
|
|
name two causes of Iron deficiency anemia
|
1) slow bleeding
2) insufficient iron intake |
|
|
Name some clinical manifistations and when do symptoms occur
|
they occur when HGb is around 7 or 8
|
|
|
Besides MCV being low (which indicates Microcytic RBC) and hyperchromic blood smeers what indicators suggest iron defficiency anemia
|
Decreased ferritin levels
low serum iron history of iron defficiency |
|
|
after how long of taking iron suplimates will patient see results
|
3 weeks
|
|
|
what type of anemia is normocytic and normochromic
|
hemolytic anemia
|
|
|
when does hemolytic anemia occur
|
during a blood transfusion
|
|
|
What are some clinical manifestations of hemolytic anemia
|
increased numbers of reticulocytes
spleen may enlarge and jaundice |
|
|
how do you treat hematologic anemia
|
treat cause stop administration of wrong blood flush with plenty of fluids
|
|
|
what causes aplastic anemia
|
bone marrow failure
by drug therapy or hereditory |
|
|
What anemia results in pancytopenia
|
aplasia/ bone marrow hypoplasia
|
|
|
what genetic anemia is found in blacks and is noted by RBC sickle
|
sickle cell anemia
|
|
|
What causes hemolytic uremic syndrome
|
bacterial infection
|
|
|
what causes sideroblastic anemia
|
altered sythesis of heme in the bone marrow
|
|
|
Define polycythemia and how does it differ from anemia
|
anemia is underproduction of red blood cells and polycythemia is over production of red blood cells
|
|
|
what are the three categories of polycythemia and their causes
|
1) relative- dehydration
2) primary aka polythemia vera enlarged spleen 3) secondary (most common) due to high altitude and hypoxia |
|
|
What are some possible pathological risks that are associated with polycythemia
|
Risk of thrombosis formation
Elevated bp |
|
|
What are some ways beside a history and complete blood count that polycythemia is diagnosed
|
1) bone marrow aspiration
2) genetic analysis |
|
|
What are the treatments of polycthemia
|
1)relative- rehydrate
2) secondary relieve hypoxia 3) vera- reduce blood vascossaty and control platlet and WBC |
|
|
What is the definition of leukemia
|
Uncontrolled prolifferation of immature and inneffective leukocytes with overcrowding of bone marrow.
|
|
|
What is the result of leukemia
|
decreased production of erythrocyte and/or platelts.
|
|
|
What is the definition of leukemia
|
Uncontrolled proliferation of immature and innefective leukocytes with over crowding
|
|
|
Leukemia's overcroding of bonemarrow results in a decrease in what two cells
|
erythrocytes and platlets
|
|
|
What are the two most common causes of death
|
Infection and hemorrhages
|
|
|
In what two ways are leukemias named
|
cell type and chronicity
lymphocytic or Myelogenous or acute and chronic |
|
|
What kind of white blood cells are myeloid leukemias describe
|
granulocytes-
consist of neutrophils eosinophils Basophils |
|
|
What are the two types of blood cells involved with lymphoid
|
agranulocytes B cells, and T cells
|
|
|
What is the ratio of adults to children when it comes to leukemia
|
15 to 1
|
|
|
what is the most common childhood leukemia
|
Acute Lymphocytic leukemia
2/3 |
|
|
What two types of leukemia are the most common adult forms
|
Acute non lymphoblastic leukemia
chronic lymphocytic leukemia |
|
|
what is a common clinical manifestation of leukemia
|
pancytopenia- a reduction of all blood cells component
|
|
|
What is the onset and prognosis of acute leukemias
|
abrupt
poor |
|
|
What is the onset and prognosis of chronic leukemia
|
onset is gradual
prongosis is better |
|
|
name 3 classifications of acute leukemia
|
1) acute myelogenous leukemia (AML)
2) Acute lymphoblastic leukemia (ALL) 3) Acute lymphocytic leukemia. |
|
|
What direction do you pull the auricle to administer eardrops
|
down and back
|
|
|
What injection site is not used in a child under 3 who hasn't walked yet
|
ventrogluteal
|
|
|
What site is not used due to location of the sciatic nerve
|
dorsogluteal
|
|
|
For children under 3 what is the site of choice for injections
|
vastis lateralis
|
|
|
What site is not used in children under 5
|
deltoid
|
|
|
what changes to pregnant women alter absorption
|
1)increased blood volume: 35-50%
2)Increased cardiac output: 30-40% 3) Increased gastric empyting time 4) Increased GI acid secretion 5)minor enzyme changes |
|
|
What pregnancy category do fetal abnormalities with evidence present fall under
|
Category X
|
|
|
What does stage 0 mean
|
carcinoma in situ (not invssive)
|
|
|
What does stage 1 mean
|
Tumor is limited to tissue of orgin
localized tumor |
|
|
Stage II
|
local spread
|
|
|
Stage III
|
extensive local and regional spread
|
|
|
Stage IV
|
metastisis
|
|
|
According to the TNM system what does TNM stand for
|
T primary size of tumor
N nodal involvement M metastasis present |
|
|
How does tumor structure different in benign and malignant tumors
|
Benign Tumors -resemble tissue of origin
Malignant tumors- Atyical Tissue of origin |
|
|
What is the rate of growth difference between benign and malignant tumors
|
Benign grow slow
malignant grow rapidly |
|
|
what is the difference in progression between benign and malignant
|
benign are slow progrssive may regress
malignant is progressive and almost always fatal if untreated |
|
|
what is the difference in mode of growth between malignant and benign tumors
|
benign grow by expansion in capsule
Malignant grow by local infiltration and metastasis to diferent sites |
|
|
what is the difference in tissue distruction between benign and malignant tumors
|
benign tumors have no tissue damage
malignant have ulcerationa nd necrosis of tissue |
|
|
What does stage 1 mean
|
Tumor is limited to tissue of orgin
localized tumor |
|
|
Stage II
|
local spread
|
|
|
Stage III
|
extensive local and regional spread
|
|
|
Stage IV
|
metastisis
|
|
|
According to the TNM system what does TNM stand for
|
T primary size of tumor
N nodal involvement M metastasis present |
|
|
How does tumor structure different in benign and malignant tumors
|
Benign Tumors -resemble tissue of origin
Malignant tumors- Atyical Tissue of origin |
|
|
What is the rate of growth difference between benign and malignant tumors
|
Benign grow slow
malignant grow rapidly |
|
|
what is the difference in progression between benign and malignant
|
benign are slow progrssive may regress
malignant is progressive and almost always fatal if untreated |
|
|
what is the difference in mode of growth between malignant and benign tumors
|
benign grow by expansion in capsule
Malignant grow by local infiltration and metastasis to diferent sites |
|
|
what is the difference in tissue distruction between benign and malignant tumors
|
benign tumors have no tissue damage
malignant have ulcerationa nd necrosis of tissue |
|
|
Do normal cells or cancer cells require fewer groth factors for survival
|
cancer cells
|
|
|
what does the secretion of tumor angiogenesis factor do
|
allows new blood vessels to grow within cell or tumor
|
|
|
Name the 6 steps of metastatic invasion
|
Invasion
Penetration of Blood Vessels Transportation to distant site extravasation Infiltration Proliferation |
|
|
name 4 common sites of metastasis
|
liver
brain lungs bones |
|
|
name 3 of the bodies defences against metastasis
|
platelets and fibrin
Some cancer cells are killed some cancer cells are immobilized as they adhere to vascular walls |
|
|
name 5 methods used to diagnose cancer
|
1) CBC and FOBT
2) Tumor cell markers in blood 3) imaging studies 4) biopsies 5) cytology pap smear |
|
|
name 3 ypes of srugical biopsies to diagnose cancer
|
excisiona- remove entire tumor with clean margins- outpatient
incisional- multiple surgery endoscopic- remove tumor from lumins |
|
|
what are the 2 types of needle biopsies to diagnose cancer
|
1) fine needle aspiration: aspiration fo individual cells through small bore needle
2)core needle biopsy |
|
|
What does caution stand for
|
C change in bowel or bladder
A a sore that will not heal u unusual bleeding or discharge t thickening or lump I indigestion o obvious change in wart or mole N nagging caugh or horseness |
|
|
What is the purpose of staging and grading cancer
|
teatment plan
giving prognosis evaluating treatments |
|
|
What does tumor grading check
|
degree of malignancy or level of differentiation
|
|
|
What does grad I cancer describe
|
Grade I means well defferentiated
resembles tissue of orgin and retains some specialized functions |
|
|
What does grade II cancer describe
|
Grade II means moderately differentiated - minimal resemblance to tissue or organ. variation in size and shape increased mitosis
|
|
|
Grade III cancer cells describe
|
cancer cells that are poorly differentiated minmal resemblance ot cells of orgin
|
|
|
What does grade IV describe
|
Tumor has no resemblance to tissue of orgin
|
|
|
What does staging describe
|
the measure or extent of cancer matasis
|
|
|
when is staging performed
|
at the time of diagnosis and subsequent intervals
|
|
|
What type of cancer is staged with the numerical staging system
|
cervical cancer and non hodgkins lymphoma
|
|
|
what is a neoplasm
|
abnormal mass of tissue with progressive and uncontrolled growth that serves no physiologic function aka tumor
|
|
|
what is a matastasis
|
process by which malignant cells leave original tumor site and spread to distant sites of the body
|
|
|
what is a carcinogen
|
a substance or agent that has potential to cause cancer
|
|
|
what is an oncogene
|
tumor inducing gene that results from mutations present in almost all cells but normally is inactive
|
|
|
What is atrophy
|
decreasre in cell size
|
|
|
what is hypertrophy
|
increase in cell size
|
|
|
what is dysplasia
|
disturbance in size shape and organization of cells and tissues
|
|
|
can dysplasia be reversed
|
yes
|
|
|
what is metaplasia
|
conversion of one mature cell type to another mature cell type.
|
|
|
what occurs with chronic inflammation and irritation
|
metaplasia
|
|
|
is metaplasia reversiable
|
yes
|
|
|
what is hyper plasia
|
increase in the number of cells in a tissue or organ
|
|
|
what is anaplasia
|
loss in the usefulness of cell a cell w/ out form
|
|
|
is anaplasia reversable
|
no
|
|
|
what is the most common "invassive " cancer
|
lung cancer
|
|
|
What is the difference between benign and malignant tumros
|
benign tumors are self contained and have well defined perimeter
malignant tumors are not self contained and matastisize |
|
|
what is a common pathology with benign tumors
|
they are dangerous when they compress surrounding tissue ie a benign tumor near a blood vessel could restrict the flow of blood, in abdomin digestion is impared, in the brain it can cause paralysis
|
|
|
What are 5 internal factors associated with causing cancer
|
1)genetics
2) viruses 3)bacteria 4) hormones 5 Immunologic defects |
|
|
name 3 ecamples of genetics said to cause cancer
|
BRCA genes
retinoblastoma Multipe polyposis of colon |
|
|
Name 4 virus's and the type of cancer they cause
|
1)Hep BC- hepatocellular cancer
2) Epstein Barr virus- lymphoma 3) retro virus- T Cell leukemia 4) HPV and Herpes Simplex II and cervical cancer |
|
|
Name the bacteria that can lead to stomach cancer
|
heliobactar pylori
|
|
|
What hormone can cause cancer and what type of cancer does it cause
|
estrogen- breast cancer
|
|
|
what 3 immunologic defects lead to cancer
|
1) chemotherapy
2) aging 3) HIV (karposi's sarcoma) |
|
|
What are the 3 stages of cancer developement
|
1) initiation
2) promotion 3) proliferation |
|
|
what is different in cell structure and components of cancer cells compared to normal cells
|
enlarged nuclei
increased mitosis loss of contact inhibition |
|
|
What two most common leukemias in adults
|
CML AML
|
|
|
What are some results of thrombocytopenia
|
increased susceptability of to bleeding
|
|
|
wht defines thrombocytopedia
|
A platelet count of less than 100000 (normal is 140,000-400000
|
|
|
what can happen if platelet count drops below 50000
|
hemoraging may occur
|
|
|
At what Platlet count can thrombocytopenia be fatal
|
if platlets are less than 10000 Bleed can be fatal
GI CNS RS |
|
|
what are some causes of thrombocytopenia
|
1)congenital (rare)
2)Viral infections 3)Nutritional dificiencies B12 Folic acid and Iron 4) Bone marrow transplant/aplastic anemia 5) Drugs (heparin, chemo estrogen, and medicines that contain quinine) 6) Exposure to toxins (cocaine and ethanol) 7) platlet destruction |
|
|
at what platlet count does thrombocythemia occur
|
greater than 400000
|
|
|
Although assymptomatic, primary thrombocythemia can lead to
|
1) clots in the microvascular which affects fingers and toes
2) larger vessels in lower extremeties may lead to clot formation 3) can lead to hemmorhage |
|
|
What is the Red blood cell Count and what is the average for men
|
The actual number of RBC per microliter
3.6-5.0 |
|
|
What is the RBC for women
|
3.6-5.0
|
|
|
What is a HCT level
|
The % of RBC in 100 ml of blood. roughly 3 times HG levels
|
|
|
What is the hematocrit level for adult women
|
36-48 vol%
|
|
|
What is the hematocrit level for adult men
|
42-52 vol %
|
|
|
What is the mean cell volume
|
refers to the individual size of RBC 82-98 cubic microns
|
|
|
what is hgb
|
measures the iron containing pigment of red blood cells
|
|
|
what is the hgb of men
|
14-17.4
|
|
|
Adult Women
|
12.0-16g/dl
|
|
|
What is a shift to the left
|
Revealed when there is an increase in the number of bands accompanied by a slight increase in the number of mature neutrophils and a decrease in the pecentage of lymphocytes.
|
|
|
What does a shift to the left usually indicate
|
acute bacterioinfection
|
|
|
Name 6 things that normal healthy cells do as opposed to cancerous cells
|
Devid and fully differentiate"
Follow a genetic program Have a nonchaotic end point Lose ability to devide when mature Function as genetic Programmed die a natural death |
|
|
What shortens to cause a natural cell death
|
telomere
|
|
|
name 2 genetic control of cells
|
1) proto oncogenes
2) Tumor suppressor genes |
|
|
What is cancer
|
a disease of the cell characterized by uncontrolled growth, invasiveness, and the ability to develop new blood vessels
|
|
|
what are 2 major dysfunctions that are present in cancer
|
1) uncontrolled cell proliferation and growth
2) defective cellular differentatiation |
|
|
What are two basic traits of cancer cells
|
1)autonomy (unregulated growth
2) anaplasia (loss of normal cellular function) |
|
|
what are 4 types of leukemia's
|
1)ALL
2)AML 3)CLL 4)CML |
|
|
What type of leukemia is most common among children
|
ALL
|
|
|
What is the least common type of leukemia
|
ALL
|
