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62 Cards in this Set

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What is the most prominent cellular injury, cause?
Hypoxia!
no air!
whats the diff b/t sublethal and lethal?
sublethal alters cell function w/o causing cell death.
lethal is irreversible process that causes cell death
how do cells adapt to sublethal injury?
adaptations are common
its part of the disease physiologic process
whats an example of how cells adapt to sublethal injury?
sunburns and suntans. sublethal cell injury can be like your muscles when your leg is in a cast, musclulr atropy
what is hypertrophy?
increase in the size of a cell. NOT cell division. hypertrophy is NOT cell division but INCREASE in the size of the cell.Ex. remove a kidney, the OTHER kidney grows bigger
********************
The enlargement or overgrowth of an organ or part due to an increase in size of its constituent cells.
again?
increase in size of a cell, ex is a kidney that grows
what is hyperplasia?
increase in # of cells
Ex. reversible when the stimulus removed. ex. Liver is removed, it regenerates itself.
******************
breast or uterus in pregnancy. we see BOTH tropy (bigger cells & phasia (more cells))
what is cell atropy?
rduced size of tissue or organ (the cells itself)
Ex. aging process causes decrease in size of cells
Ex. lack of mobility like in a cast. also from decreased nutrition
what is meta plasia?
reversible change of a cell type into another!!!
Ex. smokers lining in lungs changing in bronki to epitherial to squamous cells.
this is an abnormal change too. A normal change is like monocytes rushing in and change to macrophages.
Dysplasia:

abnormal Ex. ?
Ex = cancer cells

Abnormality of development, in pathology, alteration in size, shape and organisation of adult cells.
cause of lethal cell death?
ischaemia =
A low oxygen state usually due to obstruction of the arterial blood supply or inadequate blood flow leading to hypoxia in the tissue.
heat
cold
radiaton
mechanical trauma
chemical injury
microbial injury
ischemic injury
neoplasitc growth
normal substances
Ex. gastric abcesses like esphophasius, uric acid
what is cell necrosis
death of cells w/in a living organism
What is Anaplasia
Anaplasia is:

<pathology, oncology> Characteristics of a cell (structure and orientation) that make it identifiable as a cancer cell and malignant.

There is lack of differentiation, which is characteristic of some tumour cells.
whats the most commmon cause of cell damage?
hypoxia

the lack of oxygen
how do cells adapt to injury

some adaptations are common to adapt to injury? whats an example?
sunburn or a even a suntan

↑ in melon

another ex. is muscle atrophy
what is the difference b/t hypertophy and hyperplasia?
trophy is the size of the cell like a kidney that grows larger

plasia is the # of cells increase like breasts during pregnancy. another ex. is like a cardiac cell when heart is in a certain amount of hypertension, an enlarged heart, is a result from the cells growing larger, larger cells, NOT # of cells. Ex.kidneys do this too.
what are some examples of hyperplasia?
liver regeneration
breast tissue
Atrophy is a decrease in BOTH cells size and # of cells!
from what?
lack of blood supply
aging process. both # and size
what about an arm in a cast?
immobility causes what? a ↓ in size of cell from ↓ in blood and nutrition
Metaplasia is a cell ▲ from one type of cell to another type of cell. ex is?
smokers lungs that ▲ from epithelial to squamous cells
Ex. when monocyctes rush to an injury site and ▲ to phagocytes.
what is an example of NORMAL changes of cells like metaplasia?
monocytes ▲ to phagocyctes is a normal change, ex of metaplasia
****************************
what is a cell that ▲ from a normal cell into an abnormal cell, what is this called?
Dysplasia

is a change from a healthy cell to a unhealthy cell
what is anaplasia?
a cell that ▲ from a mature cell to an immature cell.
So, seeing immature cells is seeing a cancer develop, a malignancy.
what cells indicate a precursor to cancer? what type of cell?
a Dysplasia cell is an indication or precursor to cancer
there are other things other than hypoxia that causes cell death. like heat or burns kills cells, so does cold too. Chemical or mechanical (stabbings, shootings. What natural things can cause cell death are
a gastric absess. where cells are not where they should be which causes cell death. gastric disturbances, or uric acid in the wrong place. What about Uric acid? Gout and Kidney stones...uric acid is normal in the body but too much can cause trauma like gout
Cell necrosis, a term we give to cells that die that are part of a living organism. A pressure ulcer is an example of cell necrosis so we debreed it.
no response
we talked about the inflammatory response.
****************************
the reaction of our body to injury.
it is not the infection.
******************************
all infection has inflammation BUT
not all inflammation has infection.
**************************
Teacher made a point of neutropenia patients...Tabers says...the presence of abnormalily small # of neutrophils in the blood. what does this make a patient exposed to? (Neutrophiles are the most common form of WBCs)
a predisposition to infection!
a neurtrophile is the first to arrive to some kind of cell damage. They are not going to be able to mount a good inflammatory response to help protect their body.
the inflammatory response: 4 parts:
vascular response
cellular response
exudate being formed (fluids)
and what else
the healing response!

this doens't have to be an open wound. It can be a sprain or strain. Doesn't have to be an open wound
the vascular response.

any tissue damage, either lethal or sublethal we will see histomines released. We see vessals dialating. We see increase of blood flow so we have more pressure so the cell wall becomes more permeable, and what?
the fluid contains proteins and ononic pressure...large molecules that will pull fluids into tissue which causes edema. moving from low to high (i think) the vascular response
***************************
the idea here is increased cell permiablility, KEY TERM
***************************
with vascular respones
w/ increased blood supply to injury, remember neutrophils have a short life like 24-48 hours, they die so what then?
dead neutrophils is left. this and other debri from the damage is what forms the exudate.
any damaged area has a ↑ neutrophil count so we see our bone marrow increasing blood production and we can tell this by the ↑ in WBC b/c the marrow is putting so much out some are immature & we can see that and this means ...
a bacterial infection. the bone marrow neutrophils are sometimes are immature and when we do a LAB and count immature neutrophils indicates a bacterial infection. So think a ↑ WBC think infection
**************************
a scab is a form of eschar. (dead matter cast off from surface of the skin)

something over a wound for protection and falls off by itself. Called Eschar. Back to cellular response...
whats second guys get to cell damage?
monocytes are 2 guys to get there. we see phagocytes change into macrophages and have a longer life cycle, like a whole week and hang around longer, part of your immunity.
She brought up something about what kind of pathogens would get inside our cells themselves?
Viruses. Also fungal infection. Incress with allergy, increase with tuberance. Also increase with paracyctes.
Exudate formation.

made up of fluids, leukocytes dead or alive, etc. We need to talk about the manifestation of inflammation. Know the 5 cardnal signs of inflammation are...
heat
swelling
redness
pain
loss of function
touch with back of hand and feel that heat. Loss of function, pain and swelling at the site. What would be systemic response to an injury?
fever
leucoyctosis at the site (WBCs)
nausia
malaise
↑ pulse and fever, and resp.
Regeneration.

some cells are able and some cells are not! what are Labile cells?
cells that regenerate constantly. like nails, hair, GI tract, bone marrow, skin, all regenerate
Then there are cells that divide ONLY when they are damaged. what are some examples?
STABLE CELLS
kidney
pancrease
bone cells
liver
don't do it on a regular basis but if injured will try
**************************
Ex. liver cells in alcoholics
some cells NEVER regenerate!
like what?
cardiac cells
nervous system

never regenerate so if we have a MI (myocardial infarction) those cells will never regenerate
**************************
The Healing Process:

the regeneration of the raw material that was damaged.
rmember we had
cell death or damage
the inflammatory response
the cell response
formation of exudate
cell regeneration (some do some dont)
then the ???
healing process!

2 parts:

regeneration of the tissues
repair where damaged or lost cells being replaced which causes scar tissue.
*************************
scar tissue (connective tissue) that tissue after it heals is never as strong as the orginal tissue. So this is why we never do reverse staging w/ pressure ulcer.
A stage 4 pressure ulcer never becomes a stage 3 or stage 2 pressure ulcer sore or a stage one. A stage 4 is a healed stage 4, but never as strong.
NOW repair and more complex thing. This is about connective tissue repair. there are 3 intentions. what are they?
primary intention
secondary intention
tertiary intention
what is primary intention?

the wound is nice...neatly approximated like a surgical wound. min. scarring. like a paper cut. what is being well approximated mean?
healed well. apporximated means it comes together well. scars are minimun. Its not jagged. this is a primary intention!
neat edges
what are secondary intentions?
jagged edges
wounds from truama
edges not approximated
more debris
scars and pus and scabs
what do we not want with a wound ?
the top to heal b/f the bottom heals. this is why we might have to debri wounds.
what is a tertiary intention?
a delayed primary healing
an old wound. maybe purposely left open on purpose to delay the healing to control infection. This is about packing a wound to get it to heal from bottom up. A badly shaped wound is this. Debriding a wound is this. If a wound is shaped to allow it to close ok but a crater wound cant be closed very well so it has to close from bottom up.
NOW complications related to healing

hypertropic scars:
are sometimes called
proud flesh a lay term
large not neat scars large hard suture lines. b/c less noticable over time. regresses over time
Keloid formation scar

a certain kind of person like blacks and you do a surgical procedure and the flesh what?
(Scars that are thick, raised and discolored, usually dark brown, red or purple, are known as hypertrophic scars)
becomes a huge scar and you cannot fix it even if you try to remove it, so blacks are prone to Keyloid scaring
The contracture scarring
what are some examples?
scarring from burns
scarring around joints
Another example of proud flesh is excessive granulation and sometimes needs to be cleaned or debrided to heal. like an abdominal wound. when sutures are removed and the edges don't stay together. Its important to teach these people what?
how to breath correctly so they don't split these wounds open.
Disheisence is a seperation of the wound.*******************
should learn to cougha and breath correctly
anti medic are medicines to stop someone from vomiting and retching w/h puts a huge stress on abdominal wounds. This is also an issue w/ obese patients. Why is obese an issue here?
There is no blood supply in adipose tissue so healing is harder.
Adhesion is where healing is around abdominal organs that heal together and b/c of this there is a connection made and this is real bad from the surgical manipulation. This is why some people have surgery just for this.
Now black people again. We can not see what in their skin?
redness in black people skin.
so you look for natural light to get on the skin to check for temperature or a feeling of the tissue, wheither its firm or foggy. Damaged skin has a soft boggy texture that says its not the same as other tissue around it. Blacks are hard to assess with this kind of injury
the aging and injury.
our immune response isn't 100% they will not have a fever, they may not get vocal, but we will see what?
confusion. This is a symption of infection.
Factors that affect healing and psycosocial issues.

what about nutrition?
we need nutrition in place, we said obese won't heal well, smoking makes it hard to heal b/c of the constriction of vessels so MDs try to make pts stop smoking b/c smoking cuts down of circulation!
*************************
what about drugs that have an adverse effect on healing. like what?
cotizon will affect healing
diabetes have bad healing abilities
nausea / vomiting hinders healing b/c of stress
there are some huge things here like people who have huge huge wounds that take years to heal! so there are psycosocial problems like how they feel about themselves. Like what?
Keyloid formatins
signs and symptoms review again:

Heat, pain, swelling is
fever, malaise, etc is
for geriatrics may not see typical signs but will display what?
GERIs will display:
decreased pain
might not have fever
increased irritablility
increased incontenence
increased adjitation
**************************
b/c we have talked about response to injury, now our body's natural defense mechanism. like what?
cilia in the lungs which sweeps
up and not down into our lungs

normal flora get the bad guys down

tears and sweat protect us by cleaing and pH action

our skin is moist and keeps mold from growing on it

intake muccous membrane like our skin is intact, keeps everything in

sneezing

vaginal pH

eyelashes eyebrows now hairs

stomach acid

lots of natural protection
Urinary tract has a natural defense system? yes gravity washing! thats it for natural defense. On thing our skin does is constantly shedding which also what?
is shedding bacteria away with it.
The chain of infection. KNOW THIS. THE CHAIN OF INFECTION.
Why we break the chain of infection at the resoivor. where do we break that chain of infection?
at the portal and resivor

by doing what? washing our hands.
chain of infection Potter pp 774
host
→ infectous agent (bacteria,viruses,etc. Washing hands will break the chain here)
→ reservoir (human body)
→ portal of exit(resp, Urinary, GI, Repro, blood)
→ mode of transmission(direct(touching),indirect(sharps, dressings),(droplet, air)
→ portal of entry(same as exit)
→ back to host. so what?
book says:
the presence of pathogen doesn't mean an infection will begin. But development of an infection occurs ina cycle that depends on the presence of all of these following things:
an infectious agent present
a reservoir or source for growth
a portal of exit from reservoir
a mode of transmission
a portal of entry to a host
a susceptible host
an infection will develop if this chain remains intact! Nureses follow infection prevention and control to break this chain so that infection will not develop
Urinary tract has a natural defense system? yes gravity washing! thats it for natural defense. On thing our skin does is constantly shedding which also what?
is shedding bacteria away with it.
The chain of infection. KNOW THIS. THE CHAIN OF INFECTION.
Why we break the chain of infection at the resoivor. where do we break that chain of infection?
at the portal and resivor

by doing what? washing our hands.
chain of infection Potter pp 774
host → infectous agent → reservoir → portal of exit → mode of transmission → portal of entry → back to host. so what?
book says:
the presence of pathogen doesn't mean an infection will begin. But development of an infection occurs ina cycle that depends on the presence of all of these following things:
an infectious agent present
a reservoir or source for growth
a portal of exit from reservoir
a mode of transmission
a portal of entry to a host
a susceptible host
an infection will develop if this chain remains intact! Nureses follow infection prevention and control to break this chain so that infection will not develop