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