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95 Cards in this Set
- Front
- Back
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Circulatory Congestion
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too much blood in a given area; excess blood within the circulation of a given area. circulatory congestion is classified by either active or passive cause.
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Active Circulatory Congestion
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there in an increase of blood to an area in the body. this happens because arterioles are dilated. it can be the result of:
inflammatory response nervous system response (blushing) inc. of blood to muscle because of metabolic demands (exercise) heat being applied **active is a NORMAL response; it is short lived and blood flow returns to normal when stimulus is removed. |
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Passive Circulatory Congestion
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drainage of blood is impaired by something compressing the veins.
local causes: tourniquet, tumor, tight bandage, blood clot, legs crossed. |
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Systemic causes of circulatory congestion
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if heart is failing to pump efficiently, venous congestion results. example:
the left side of the heart is failing, so blood returning to the heart from the lungs will back up into lungs, resulting in pulmonary circ. example: if the right side of the heart is weak, blood will back up into the systemic (peripheral) circ. causing congestion. this condition is known as CONGESTIVE HEART FAILURE. |
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What is it called when veins are damaged by chronic congestion?
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Varicose veins
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Edema
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Excess fluid outside of the circulaiton; it may be between cells, intracellular, or with body cavities. (effusion - pleural effision, pericardial effusion)
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Anasarca & Ascites
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massive generalized edema
edema in abdominal cavity |
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What causes edema?
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imbalance between forces that keep fluid within the circulatory system and forces that allow fluid to leave the circulatory system. Basically, it's the result of pressure and permeability changes.
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what happens when there is an increase of hydrostatic pressure?
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the pushing pressure will push fluid out of the capillaries and into the interstitial spaces. You many see this when venous drainage is obstructed. examples: high blood pressure, tourniquet, blot clot in venous circulation
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what happens when there is an increase in capillary permeability?
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this will allow protein molecules to escape from the blood into the interstitual spaces. proteins carry fluid with them. this happens as part of the inflammatory response.
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what happens when there is a decrease in proteins in the circulatory system?
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if there is a decrease of proteins then the oncotic pressure in decreased. protein molecules hold fluid so if there are too few protein molecules in the ciculation, fluid will leak out into the insterstitual spaces causing edema. (there is nothing there to pull the fluid back in)
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why would there be a decrease in circulating proteins?
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in cases of malnutrition, kidney damage that results in an excess loss of proteins, liver disease that results in a decrease of albumin production.
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hypoproteinemia
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decreased circulation of proteins. hydrostatic pressure is greater than oncotic pressure. when the blood gets to the venous side there are no proteins to pull fluid back in. this is seen a lot in cases of severe starvation.
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dependent edema
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the result of gravity
example: feet swelling hot weather to treat: elevate feet |
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hemorrhage
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escape of blood from the cardiovascular system into tissues, spaces, or outside the body
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hematoma
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bleeding into tissues; blood clots in tissue.
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hemothorax
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blood in pleural space (lungs/resp)
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petechiae
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little capillary leaks; look like purple/red dots; indicates a bleeding disorder
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Ecchymosis
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large bruises
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Purpura
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wide spread bruises; means they have A LOT of bruises.
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what causes a hemorrhage?
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1. damage to vascular wall (disruption of vessel wall)
2. disruption of clotting mechanisms - hemophilia: hereditary disorder, body doesn't manufacture clotting factors. - decreased platelets: platelets initiate clotting. - liver disease |
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what are the effects of bleeding?
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local bruising
seriousness depends on location: cerebral hem is fatal (in brain) pericardial sac (heart) will affect the heart pump. |
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what are signs/symptoms of internal bleeding?
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signs: decrease blood pressure; increase in pulse and respiration; decreased urine output; restlessness and confusion
symptoms: anxiety, feeling of impending doom. *may also have chronic, slow blood loss (from GI tract) as a result the patient becomes anemic and seeks help for fatigue. |
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Thrombosis
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inappropriate formation of a clot
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what cause thrombosis?
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1. abnormality or injury in vessel wall
2. abnormality in the flow of blood (too turbulent or too slow) 3. increase in coaguability (dehydration, excess platelets (if you have more platelets blood clots easily) |
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what is the cause of a:
1. stroke 2. heart attack 3. venous congestion 4. death of tissue due to decrease in oxygen |
1. thrombus in brain
2. thrombus in heart valves if valve leaflets are roughened, stenosed, or infected. 3. thrombus in venous circulation 4. thrombus in arterial circulation |
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embolism
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movement of mass (blood cloth, gas bubble, tissue fragment, fat fragment) from one area of the body to another one where it lodges.
embolus: piece of blood clot that breaks loose from venous side. |
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thromboembolus
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most common: from a blood clot; usually from the venous circulation in legs or pelvis. breaks loose and moves to the right side of the heart disrupting pulmonary circulation. may cause death or damage lungs.
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what are the signs/symptoms of pulmonary embolus?
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sudden dyspnea (breathlessness), increase in respiration and pulse, coughing, chest pain. this can be diagnosed with a lung scan.
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Air embolus
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if air enters circulation through IV, arterial line, or during surgery. it's basically a gas bubble that doesn't get dissolved.
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fat embolus
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this usually follows trauma, especially fracture of the femur or other large bones. fat emboli from bone marrow will enter the circulation and travel to the lungs or the brain. usually occurs 24-48 hours after the trauma.
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what are signs/symptoms of fat embolus?
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restless, disoriented, dyspnea, petechia on skin (chest); fat embolus causes vessel necrosis at place where it lodges.
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arteriosclerosis/atherosclerosis
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hardening and thickening of arteries; formation of atheroma or plaque. plaque consists of fat and fibrous tissue and sometimes calcium salt deposits.
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what does too much plaque do to the blood vessels?
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plaque makes the vessel lining rough so that thrombus formation is more likely; plaque may also occlude the vessel. the vessel is unable to change sizes in response to the tissue demands for more or less blood.
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what causes plaque to build up in the tissue?
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genetics, diet, lipid levels, diabetes, cigarette smoking, elevated blood pressure
*effects of arteriosclerosis depends on size and location of the arteries involved. |
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aneurysm
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when there are large lesions (structural changes) the plaque weakens the vessel wall, causing the vessel to balloon out causing an aneurysm. it may also rupture.
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ischemia
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decreased blood flow to an area resulting in decrease of oxygen and nutrients and an increase of accumulation of waste products.
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what causes ischemia?
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anything that decrease blood flow; heart attack, blood clot, etc.
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what are signs and symptoms of ischemia?
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they vary with the size:
heart: chest pain (angina) leg muscle (leg pain) brain (confusion) **if ischemia is abrupt and severe it results in death of tissue (happens in a heart attack) the area is called infarct and the process is called infarction. |
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infarction
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death of tissue
infarction is dependent on the length or time and tissue demands; there is a better chance to recover if oxygen demand is increased, if ischemia occurs slowly and if if collateral circulation develops. *if patient has signs of ischemia, reduce work of muscles and increase oxygen before infarction sets in. |
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inflammation
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nonspecific defense; it is a beneficial defense mechanism that occurs when the body tissue is damaged.
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what causes inflammation?
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trauma, heat, cold, infection, surgical incision
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what are the 5 signs of inflammation?
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1. redness (due to increased blood flow - hyperemia. this is controlled by histamine.
2. heat: on surface of body; inflammed area feels warm to touch. 3. pain: this is caused by chemical changed at the site and by swelling. 4. swelling: local swelling at the site is caused by fluid and cells moving from the capillaries to the interstitual fluid. (exudate) 5. altered function of damaged site |
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describe the movement of fluids and cells in the inflammatory response.
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fluid: there is an increase in permeability of the capillaries and small vessel walls. This leads to protein and fluid leakage. It also increases the lymph fluid through the lymph system.
Cells: the blood becomes more viscous as fluid leaks out of the injured area. The cellular portion of the blood: RBC and WBC attach to the lining of the vessels and WBC's begin to move out to the injured cell. |
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Chemotaxis
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chemical signal in the injured tissue that attracks WBC's.
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Mediation of Inflammatory Response
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Histamine is stored in mast cells throughout the body. when mast cells are injured, the histamine is released. when this happens it leads to vasodilation and increased vascular permeability.
various plasma factors are activated by the injury and become vasoactive. other plasma factors release histamine or become chemotactic agents. |
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What are the different types of WBC's and their actions in the inflammatory response
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A. GRANULOCYTES
1. neutrophils: (PMNs or polys)these are the first responders in inflammation. first 12-24 hours ;They appear early in exudate to engulf, kill and digest the causative agent through the release of enzymes. 2. Eosinophils: respond especially in allergic reactions and parasitic infections. 3. Basophils: contain histamine and heparin which are important in the immune response B. MONOCYTES: 2nd responders; finish what the neutrophils didn't; these are slow moving with longer life than PMNs. they move into an area of inflammation in the exudate where they are called macrophage, they can kill and digest various agents. macrophages are also found in sites other than inflammation. |
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what are examples of lymphoid tissues?
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lymph nodes
spleen thymus (production of T-lymph) tonsils liver bone marrow |
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what are the systemic aspects to inflammation?
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fever (then increased pulse and respiratory rate), leukocytosis (increased release of WBC's), malaise (don't feel well), anorexia (loss of appetite)
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Is the immune response specific or nonspecific and why?
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It is specific: when certain foreign materials (called antigens) are introduced into the body, they cause a change in the host so that subsequent responses to the foreign material cause a different reaction than seen on first exposure.. the altered resonse in called an immunological response. the immune response is a protective mechanism to rid the body quickly of foreign material.
note: antigens are usually Ig proteins |
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what are the two types of immune response?
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humoral: this involves immunoglobins (antibodies); immunoglobins in the blood are synthesized in response to an antigen. after the initial exposure to the antigen, the immunoglobins react and destroy the antigens.
cell-mediated: carried out by lymphocytes that react specifically with the antigen. |
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what is the immune system supposed to do/"rules of the intact immune system"?
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1. immune reaction is mounted only against foreign material; the body needs to be able to distinguish what is foreign and what is self.
2. response is more rapid with repeated exposure (memory); an immune system should have a memory. 3. response to antibodies is specific to the specific antigen. |
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lymphocytes
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this is the primary cell responsible in th immune response; there are a lot of variations in size and function; they are found everywhere in the body but mainly in the lymphoid tissue; they move through the blood and lymph; they are manufactured in bone marrow and migrate to different areas.
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where do t-lymphocytes migrate to after they are manufactored in the bone marrow?
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the thymus; as they migrate to other parts of the body they differentiate into helper cells, suppressor cells, and killer cells.
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what other lymphocytes are not under the influence of the thymus?
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B-lymphocytes; these can change into plasma cells which produce antibodies.
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nulls cells
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have receptors for immunoglobin G (IgG)
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NK cells
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natural killer cells can destroy some tumor cells.
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Hypersensitivity Reactions:
Type I: Anaphylactic-type reactions "allergic reaction".,l12o |
on first exposure to the antigen, IgE antibodies are made and attach to the mast cells. On second and subsequent exposure when the antigen and antibodies attached to the mast cells result in a rapid release of histamine. (histamine causes increased vasodilation(redness) and increased capillary permeability (swelling).
if the antigen amount is small and local, you will just experience swelling and redness. if there is a larger amount of antigen introduced and the subject is extremely sensitive, the release of histamine is massive and wide spread. this can result in bronchiolar constriction and suffoction. example: shellfish, bee stings, antibiotics. |
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type iV: cell mediated involving T lymphocytes (give examples)
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contact dermatitis (can occur if you're allergic to cheap jewelry or detergent) and rejection to foreign grafts (transplants) the T-lymphocytes see the transplanted object as foreign and attacks it.
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autoimmunity
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body loses tolerance to own tissue and begins to recognize own tissue as foreign. can't recognize self vs. foreign and begins to attack its own tissue in the body.
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what is an infection?
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an invasion of tissue by microorganisms
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prednisone
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makes you susceptible to infections, anti-inflammatory
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transmissibility
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2 types: direct and indirect
direct: coughing, sneezing, touching indirect: thru soil, inanimate objects, food, water, insects exudates and excreta, blood and body fluids. |
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invasiveness
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the microbial agent must establish self in or on the body in order to produce an infection.
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What are the defense mechanisms of the body against infectious agents?
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1. Intact skin and mucous membranes (major defense)
2. GI tract: IgA, stomach acids 3. Resp. tract: IgA, cough reflex, macrophages 4. Inflammatory response **if defenses and response are inadequate then an infection develops. it may be local or it may spread through lymphatics or through blood stream (bactermia) |
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Septicemia
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severe infection; wide spread microorganisms
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opportunistic infection
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organisms that don't normally produce a disease can do so if the host has a compromised defense mechanism. We see this most in patients whose immune systems are impaired due to disease such as those with leukemia, those on medications that affect immune system (steroids used to suppress inflammatory response or certain cancer meds) Antibiotics may also suppress some of the normal flora of the body and allow another type of flora to grow excessively.
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immunodeficiency
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may be inborn (born without immunity) or acquired (like HIV)
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What is the sequence of events Humoral - mediated immunity (Antibody mediated) B lymphocytes
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1. Antigen (bacteria or virus) enters the body.
2. Antigen is taken up by a macrophage (a monocyte or WBC) 3. Macrophages present the antigen to the B-lymphocyte in the lymph tissue 4. The B-lymphocyte changes into a plasma cell 5. The plasma cell produces an antibody(immunoglobin) specific to the antigen. the plasma cell also makes a memory cell that will remember the antigen and produce an antibody faster next time. 6. Antibody (immunoglobin) circulates in the blood and lymph fluid and kills the antigen. |
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What is the sequence of events in cell-mediated immunity, t-lymphocytes
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1. Antigen (fungus, parasite, virus, bacteria) enters the body.
2. the antigen is taken up by a macrophage. 3. the macrophage presents the antigen to the t-lymphocyte in the lymph tissue. 4. the t-lymphocyte becomes "sensitized" so the it recognizes the antigen. the t-lymp also makes a memory cell that will remember the antigen and produce a sensitized t-lymph fast for the next time. 5. the sensitized t-lymph circulates in the blood and lymph fluid and either kills the antigen or releases "lymphokines" which increase the number and efficiency of macrophages so that they can ill the antigen. |
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Fluids and Electrolytes: intro/facts
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the body has a lot of physiologic and chemical mechanisms for maintaining homeostasis of fluids and elect.
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what role does water play with maintaining homeostasis with fluids and elect.?
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it is the primary fluid in the body and acts as a solvent for nutrients and waste products. It is also important for temperature regulation.
*in adults: 60% of body weight is water. in elderly people it is less because they have a smaller fluid reserve. *in infants: 70-80% of weight is water. 40% of total body weight is from intracellular fluid (fluid within cells) |
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where is the extracellular fluid found?
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it's found in interstitual fluid, intravascular (plasma, circ volume), CSF, fluid in eyes and GI tract.
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What is fluid spacing and what are the 3 levels?
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it simply describes the location of fluid.
1st spacing: present in ICF and ECF in normal distribution 2nd spacing: excess interstitual fluid: edema 3rd spacing: fluid is present where there normally isn't any. example: abdominal cavity (ascites), bowel (peritonities). important note: this fluid is not available for the normal circulation, after it moves it, it doesn't move back in. |
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What are the positive and negative electrolytes called?
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pos: cation
neg: anion |
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Fluids and Electrolytes: intro/facts
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the body has a lot of physiologic and chemical mechanisms for maintaining homeostasis of fluids and elect.
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what role does water play with maintaining homeostasis with fluids and elect.?
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it is the primary fluid in the body and acts as a solvent for nutrients and waste products. It is also important for temperature regulation.
*in adults: 60% of body weight is water. in elderly people it is less because they have a smaller fluid reserve. *in infants: 70-80% of weight is water. 40% of total body weight is from intracellular fluid (fluid within cells) |
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where is the extracellular fluid found?
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it's found in interstitual fluid, intravascular (plasma, circ volume), CSF, fluid in eyes and GI tract.
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What is fluid spacing and what are the 3 levels?
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it simply describes the location of fluid.
1st spacing: present in ICF and ECF in normal distribution 2nd spacing: excess interstitual fluid: edema 3rd spacing: fluid is present where there normally isn't any. example: abdominal cavity (ascites), bowel (peritonities). important note: this fluid is not available for the normal circulation, after it moves it, it doesn't move back in. |
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What are the positive and negative electrolytes called?
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pos: cation
neg: anion |
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what are the major extracellular and intracellular electrolytes?
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ECF: sodium, chloride, bicarb
ICF: potassium, magnessium note: there should be no proteins in the interstitual space. |
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Why are electrolytes important?
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1. they regulate the movement of water (especially sodium and proteins)
2. they play an important role nerve impulses and muscle contractions (by concentration gradients) 3. blood clotting 4. acid base balance |
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Diffusion
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the movement of particles from an area of higher concentration to an area of low concentration. movement stops when the concentration is equal. membrane must be permeable to the substance diffusing.
example: capillary membrane is not permeable to proteins under normal circumstances so proteins shouldn't move out of capillaries into the interstitual space. |
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Facilitated Diffusion
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a substance combines with a carrier for a more rapid transport.
example: glucose carried across cell membrane by insulin |
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Active Transport
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substance moves from an area of low concentration to an area of high concentration. it moves against a concentration gradient. it requires energy to do so: ATP.
example: sodium/potassium pump. |
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Osmosis
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movement of water across a permeable to water but not to a solute. water moves from an area of less solute to an area of more solute (from more dilute to less dilute)
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Osmolality
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solutes/solvents in body fluids.
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Hydrostatic Pressure
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this is generated by the heart; it is the pressure exerted by blood against vessel walls, moves water out of circulation into the capillaries
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Oncotic Pressure
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"collidal pressure"/ "holding pressure" exerted by proteins; the proteins attract or hold water
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Describe the fluid movement at the capillary level: how is the amount and direction of the movement of fluid determined?
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1. capillary hydrostatic pressure
2. plasma oncotic pressure 3. interstitual hydrostatic pressure 4. interstitual oncontic pressure |
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what is the sequence of NORMAL fluid movement?
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at the arterial end of the capillary, the capillary hydrostatic pressure exceeds plasma oncotic pressure. at the venous end of the capillary, the capillary hydrostatic pressure is lower than the oncotic pressure so fluid is drawn back into the capillary by the plasma proteins.
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what happens if there is an abnormal fluid shift?
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if pressures are altered, fluid will shift from plasma to interstitual spaces or from interstitual spaces into plasma.
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What happens if there is a shift of plasma into the interstitual fluid?
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there is an accumulation of fluid in the interstitual area (edema).
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shifts of plasma to interstitual fluid
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1. elevation of venous hydrostatic pressure from fluid overload, results from congestive heart failure or obstruction of venous return to heart.
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decrease in plasma oncotic pressure
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this occurs if the protein level of the plasma is decrease, the plasma oncotic pressure will be too low to hold fluid in the circulation and fluid from the blood will leak into the interstitual fluid.
example: anerxia, starvation, loosing proteins in urine *they have no pulling pressure |
