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312 Cards in this Set
- Front
- Back
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3 Phases of tissue healing
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Inflammatory
Proliferative Maturation |
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Inflammation is a complex and coordinated series of events that involves what 4 responses?
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Vascular
Humoral Neurologic Cellular |
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5 Cardinal Signs of Inflammation?
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Calor - heat
Rubor - redness Tumor - swelling Dolor - pain Functio Laesa - Loss of function |
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Vasoconstriction leads to
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Clot formation
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Vasodilation leads to
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Leakage of fluid, plasma protein and whole cells
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2 Types of Leukocytes
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Phagocytes
Immunocytes |
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4 Types of Phagocytes
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Neutrophils
Eosinophils Basophils Macrophages (monocytes) |
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A Type of Immunocyte
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Lymphocyte
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The "first responder" or chief of inflammation is?
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Neutrophils
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Referred to as the "garbage man"?
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Macrophages (monocytes)
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The "Chief of Immunity"?
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Lymphocytes
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3 Types of Chemical Mediators?
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Mast Cells
Cytokines Arachidonic Acid |
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____ immediately releases histamine and chemotactic factors for ____.
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Mast Cell, Leukocyte
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____ long-term, synthesizes chemical mediators for tissue repair.
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Mast cell
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Produced by leukocytes
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Cytokines
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WBC exudate, coagulation, stimulates chemical mediators, stimulates connective tissue repair.
A. Local B. Systemic |
A. Local
Cytokines |
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Fever, metabolism, sleep, WBC production, immune responses.
A. Local B. Systemic |
B. Systemic
Cytokines |
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Comes from the Cell Membrane
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Arachidonic Acids
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Arachidonic Acids break into:
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Cyclooxygnease
Lipooxygenase |
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Cyclooxygenase breaks into:
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Prostaglandins
Thrombanes |
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Lipooxygenase breaks into:
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Leukotrienes
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Proliferative Phase begins within:
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24 hours
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Proliferative process works concurrently with what other processes?
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Inflammatory
Maturation |
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4 types of proliferative factors:
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Fibroblasts
Neovascularization Growth Factors Myofibroblasts |
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4 Types of Fibroblasts
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Fibronectins
Elastin Proteoglycans Collagen |
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Any cell that develops connective tissue:
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Fibroblast
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Earliest repairing agent:
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Fibroblast
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Proliferates, Synthesizes, and Secretes
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Fibroblast
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Fibronectins are form:
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protein chains
scaffolding & glue |
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Fibronectins provide a framework for:
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Collagen and proteoglycans to follow
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_______ are chemotactic for macrophages
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Fibronectins
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______ is a protein fiber that forms sheets or cross links and has elastic / recoil properties.
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Elastin
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______ form carbohydrate chains, are hydrophilic, and maintain hydration of healing tissue.
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Proteoglycans
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Three chains of amino acids form:
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Collagen
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There are ____ types of collagen.
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18
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________ collagen is in early repair.
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Type III
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________ collagen is primarily for scar tissue
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Type I
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________ is when cytokines in the wound and in the circulation cause nearby capillaries to proliferate.
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Neovascularization
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Neovascularization initially is ______ and _______ developed.
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Leaky, poorly
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_________ eventually degrade to normal network.
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Neovascularization
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4 Types of Healing Factors
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Cytokines
Growth Factors (GH, IGF1, etc.) Vitamins: C & E Minerals: Zinc |
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2 Parts of Maturation Phase
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Regeneration
Repair |
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Normal structure and function of a tissue:
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Regeneration
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- Regeneration and replacement of tissue (scar)
- Structure is abnormal, function maybe adequate |
Repair
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Types of Tissue Healing
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Primary intention
Secondary Intention Tertiary Intention |
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_______: tissues have minimal debris and minimal granulation tissue
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Primary intention
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_______: larger defect that requires scar tissue to fill the void left by the injury.
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Secondary intention
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_______: secondary intention with persisting agent or infection.
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Tertiary intention
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Persisting injury agent / longer than normal healing
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Chronic inflammation
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The body's ability to recognize materials as foreign or self
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Immunology
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The physiologic mechanisms of immunology are_____ and_____.
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complex, coordinated
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First line of defense. Non specific. Preventative.
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Innate Immunity
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Specific and Adaptive.
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Acquired Immunity
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Phagocytes, Inflammatory Mediators, Natural Killer Cells, and Pathogen-recognition receptors make up__________.
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Innate Immunity
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Active acquired immunity is:
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permanent
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Passive acquired immunity is:
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temporary
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Contact with antigen is ___________ active acquired immunity
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Naturally
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Vaccination is an example of ____________ active acquired immunity
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Artificially
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Mother to fetus/baby is an example of _________ passive acquired immunity
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Natural
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Antitoxin, serum globulin is an example of _________ passive acquired immunity
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Artificial
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5 Structures related to Acquired Immunity
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Bone Marrow
Lymph Nodes Thymus Spleen Tonsils |
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T & B Cells are ______________
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Lymphocytes
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Bone marrow produces _______ and _______
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Lymphocytes, Stem Cells
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_________ produces T-Cells
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Thymus
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_________ produces B-Cells
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Bone Marrow
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__________ = Ab in blood, saliva, and secretions
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Humoral
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___________ = Ag within a human cell
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Cell-mediated
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B cells (lymphocytes) activate after ____________
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Innate Immunity
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T Cells take ___ to ___ days
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3 to 5
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Plasma cells lead to ___________
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protein production
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IgM, IgG, IgA, IgE, and IgD are examples of:
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Immunoglobulins
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Bloodstream, first response
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IgM
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Bloodstream, newborns (80%)
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IgG
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Mucous membranes
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IgA
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GI tract, Allergic Rx
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IgE
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Activation / Suppression
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IgD
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When viruses or bacteria invade a cell:
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Cell mediated immunity
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2 types of T lymphocytes
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Regulators: Helper T, Suppressor T
Effectors: Cytotoxic T |
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Helper T cells are:
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Most numerous and example of Cell mediated immunity
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To become "sensitized" occurs when a helper T cell ________.
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Detects an antigen
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__________ produce lymphokines / cytokines, interferons, and tumor necrosis factor
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Helper T Cells
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Helper T Cells help:
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B Cells
Macrophages NK Cells |
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Helper T Cells activate
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CD8 T Cells
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Regulator T Cells are also known as:
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Suppressor T Cells
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_______ prevent self-reactivity and autoimmune diseases
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Regulator T Cells
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Primary immunodeficiency
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inherited conditions
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Secondary immunodeficiency
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iatrogenic (hospital acquired)
Diseases: leukemia, diabetes Drugs: Corticosteroids, cyclosporine Radiation Splenectomy Aging Alcoholism |
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The study of drugs:
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Pharmacology
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Treatment of disease through the use of drugs:
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pharmacotherapy
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Preparation and dispensing of drugs.
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Pharmacy
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N-Acetyl-p-aminophenol is an example of:
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A drug's chemical name
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Acetominophen is an example of:
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A drug's generic (official) name
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Generic drugs have the same amount of active ingredient (bioequivalent) as name brand drugs:
T / F |
T
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Generic and brand-name drugs have identical effects.
T / F |
F - They are similar but not identical
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Organization responsible for monitoring the use and approval of new drugs:
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FDA
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Safe means that there are no side effects.
T / F |
F - 'reasonably safe compared to benefits of the drug'
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A measure of what a drug is supposed to do:
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Efficacy
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Margin of Safety refers to the:
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Space between the minimum amount required to create a response and the curve indicating side effects.
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Dose at which 50% will respond in a specific, positive manner
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Median Effective Dose
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Dose at which 50% will have adverse, negative effect
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Median Toxic Dose
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Toxic Dose 50 / Effective Dose 50 =
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Therapeutic Index - estimate of safety. The greater the TI, the safer the drug
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How drugs are absorbed, distributed, metabolized (or not), and excreted from the body
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Pharmacokinetics
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The effects of the drug, biochemical and physical, on the body
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Pharmacodynamics
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How do drugs get absorbed by the body?
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GI Tract
Sublingual - under the tongue Rectal / Vaginal - through mucosa. Can cause irritation. |
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Disadvantage of a "First Pass Effect"
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Goes to liver first where it may be metabolized or destroyed before reaching its target destination.
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Defined as anything other than GI tract
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Parenteral
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Anesthetics and asthma meds are absorbed via
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Inhalation
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IV is an example of:
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Injection
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Antibiotics and corticosteroids applied to the skin surface is a __________ application.
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Topical
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Patches, iontophroesis and phonophoresis are examples of:
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Transdermal
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Percentage of drug that reaches the blood stream:
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bioavailability
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Bioavailability is dependent on:
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Tissue permeability
Blood Supply (more blood supply = more drug delivery) |
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The body prevents toxic buildup of drugs by _________ the drugs from the body or by ________ the drugs into an inactive form.
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Eliminating or biotransforming
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Primary site for drug excretion
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Kidneys
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Primary site of biotransformation
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Liver
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Other sites of biotransformation
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lungs
kidneys GI skin |
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The duration of a drug's activity depends on the drug's ________.
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Half-life
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To get the ideal effect, your want to maintain the ___________ of the drug, which is easier with an IV than orally.
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Plasma concentration
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Individual responses to drugs depend on:
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genetic factors, age, diseases, drug interactions, diet, gender, body composition, alcohol, exercise, etc.
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Acute drug therapy is typically for:
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Pain relief
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Empiric drug therapy means:
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You start drug before diagnosis.
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Maintenance Therapy
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Take drug ongoing to keep cancer in remission
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Doesn't improve disease but increases comfort or controls symptoms
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Supportive Therapy
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Relieve suffering in serious, life-threatening or fatal disease
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Palliative Therapy
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A patient who is hypersensitive or who has an anaphylactic reaction to the drug is said to have:
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drug allergies
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Process of an organism establishing a parasitic relationship to a host organism
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Infection
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5 Transmission Methods
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Contact
Airborne Droplet Vehicle Vector Borne |
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Incubation, period of communicability (pre-syndrome), latent period, and innate & acquired immunity refers to:
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Infectious State
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Bloodborne viral infections:
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Hep B, C and HIV
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Liver inflammation, jaundice, dark urine, RUQ, and Cirrhosis are symptoms of:
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Hepatitis B (aka HepB, HBV)
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Hep B Common transmission method:
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needlestick
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3 dose series over 6 months, serology test 2 months
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Hep B Vaccine
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No vaccine, no post-exposure prophylaxis, 6-week incubation, mild acute infection
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Hep C
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Hep C is ___ chronic hepatitis and ___ cirrhosis
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75%, 25%
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Transmitted via blood or body fluids
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HIV
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Gloves are worn only in the event of ___________
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fluid exposure
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Incidence rate of needlestick for HIV
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<0.5%
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_____ post-exposure protocol:
Anti-septic soap and rinse with water Report incident Baseline and follow-up test Antiretroviral drugs |
HIV
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Mouth Sores, herpetic whitlow
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Type 1 Herpes
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Genital Herpes
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Type 2 Herpes
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_______ enters through peripheral sensory nerves and travels to the sensory nerve ganglia
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Herpes type I and 2
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Varicella-zoster: aka ________________
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Chicken pox
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Infectious Mononucleosis
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Epstein-Barr
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Lung, liver, Gi inflammation
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Cytomegalovirus
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Tick-borne Spirochete.
36 hour window: engorgement & injection Erythema Migrans: "Bulls-eye" rash |
Lyme Disease
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Lyme Disease Stage 1:
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Rash and flu
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Lyme Disease Stage 2:
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Aseptic meningitis
Transient Arthritis: Swelling Joints Tendinitis, muscle aches |
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Lyme Disease Stage 3:
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Chronic neurological and arthritic complications
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Lyme Disease Treatment:
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Antibiotics
NSAID Anti-rheumatics (DMARDs) Fibromyalgia treatments Chronic Fatigue Syndrome |
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The big nosocomial "no no!"
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C-diff
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C-diff transmission
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Fecal-oral
food poisoning diarrhea |
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C-diff Risk factors
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Reduced Gastric Acids
Antibiotic Therapy |
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The nosocomial leader
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Staph
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Staph Transmission
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nose, mouth, skin, inanimate surfaces, open wounds
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Fluids, inflammatory substances, WBC
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Pus
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Pus producing
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Pyogenic
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Pus forming
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Suppurative
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Collection of pus
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Abscess
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Staph Treatment:
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Wound care
Ab: Vancomysin MRSA: Methicillin-Resistant |
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3 Types of Strep
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Strep Throat
Scarlet Fever Cellulitis |
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4 Types of Musculoskeletal Infections
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Osteomyelitis - staph A, viral, fungal
Septic Arthritis - bacterial, viral, fungal Myositis - bacterial, viral, parasitic agent Skeletal tuberculosis - tuberculosis mycobacteria |
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Bone inflammation: secondary to infection. Staph A: bind to collagen and produce a glycocalyx and release endotoxins. Exogenous. Hematogenous.
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Osteomyelitis
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Fever (99-101), wound drainage, constant deep pain, and limited WB/function, night sweats, are clinical manifestations of ____________.
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Osteomyelitis
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Osteomyelitis Treatment:
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IV / high-dose Ab
Surgical resection / prosthetic removal Ab bead chains |
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Staph A, N gonorrhea, Hematogenous / Direct inoculation
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Septic Arthritis
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Reactive Septic Arthritis
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Aseptic inflammation, secondary to remote infection
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Pathogenesis of Septic Arthritis
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Synovial lining
Acute inflammation Necrosis leads synovial proliferation Pannus = inflammatory 'exudate' Joint Capsule and articular cartilage |
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___________ presentation:
Acute onset Dramatic pain, swelling, warmth, loss of motion systemic signs |
Septic Arthritis
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____________ treatment:
joint aspiration blood draw IV |
Septic Arthritis
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____________ implications
immunodeficiency Immobilize & refer to the ER Slow return to motion and WB Early detection = good recovery |
Septic Arthritis
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Inflammation of muscle
Infectious sources Auto-immune responses: Malignancy Rheumatic disease |
Myositis
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Myositis Treatment
|
Medical work-up
CK Statins Muscle biopsy Corticosteroids & immunosuppressive drugs |
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Extrapulmonary TB is spread through the body via:
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hematogenous / lymphatic spread, 2 - 3 years after exposure
Pott's Disease = T&L spine Vertebral body IV disc |
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________________ presents with joint pain, stiffness, pain at rest, neurological signs, non-resolution of symptoms, systemic (fever, wt. loss, fatigue)
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Extrapulmonary TB
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_________________ is treated with Ab, Surgical excision & correction, post-op rehab.
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Extrapulmonary TB
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Hormone Regulatory System
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Endocrine System
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Homeostasis is a balance of which two systems
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Nervous and Endocrine
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Thyroid Gland produces what 3 substances:
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Thyroxine (T4)
Triiodothyronine (T3) Calcitonin: Ca & Ph |
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Grave's Disease
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Hyperthyroidism
Women 4:1 20-40 y/o Auto-immune Nodules or adenoma "stressors" start or increase symptoms |
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Nervousness
Heat intolerant Weight loss Atrial fibrillation "Thyroid storm" |
Grave's disease (hyper) clinical manifestations
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Periarthritis
Calcific Tendinitis Proximal muscle weakness balance & coordination dyspnea Periodic paralysis |
Grave's disease neuromuscular manifestations
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Elevated HR
Swelling in throat TSH lowered (T3/T4) Radioactive Iodine uptake |
Grave's disease diagnosis
|
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Radioactive iodine
Partial or subtotal thyroidectomy Creates hypothyroidism Thyroid Replacement Therapy |
Grave's disease treatment
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Type 1 hypothyroidism
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hormone deficient
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Type 2 hypothyroidism
|
hormone resistant
hypothalamus / pituitary dysfunction females 30-60 y/o |
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CM Hypothyroidism
|
bradycardia
Slowed GI Low heat production (get cold easy) High serum cholesterol Anemia |
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Dx Hypothyroidism
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Elevated TSH levels
T3 / T4 levels - blood tests |
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Tx Hypothyroidism
|
Thyroid replacement (synthroid)
Cholesterol management |
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Hypothyroidism implications
|
Heart disease
Pseudogout: calcium pyrophosphate deposits Fibromyalgia Exercise intolerant Exercise-induced Myalgia Rhabdomyolysis |
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Parathyroid regulates ____ and ____ metabolism, bone resorption of ____, and activates vitamin _____
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Ca, Ph, Ca+, D
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Hyperparathyroidism:
Primary _______ Secondary_______ Tertiary ________ |
Primary: enlarged gland, adenoma, post-menopausal females
Secondary: renal failure, hypocalcemia Tertiary: dialysis patients |
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CM hyperparathyroidism
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Bone decalcification
blood hypercalcemia calcium phosphate deposits in renal tubules |
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Tx hyperparathyroidism
|
Diuretics
Bisphosphonates & Calcitonin Removal |
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Hyperparathyroidism implications
|
osteoporosis
muscle weakness balance & mobility inflammatory erosive polyarthritis |
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Hypoparathryoidism
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Hypocalcemia
High phosphate levels Muscle Irritability Cardiac Arrhythmia QT interval |
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HPT Dx
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Serum Ca and Phosphate levels
|
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HPT Tx
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Acute: IV calcium
Vitamin D and Calcium |
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Adrenal Cortex
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mineralcorticoids
glucocorticoids androgens |
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Adrenal Medulla
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Epinephrine and Norepinephrine
|
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Adrenal insufficiency characteristics
|
Addison's disease
Females > Males Widespread metabolic disturbances |
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AI CM
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Nausea, ab pain
Anorexia, weakness and weight loss Hypovolemic Addisonian Crisis |
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AI Dx
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Serum Cortisol levels
Hormonal levels in blood and urine |
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AI Tx
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Acute: replace fluids and electrolytes
Corticosteroids & mineralocorticoids |
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Adrenocortical hyperfunction
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Cushing's Syndrome - excessive cortisol levels in blood stream
|
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ACH CM
|
Weakened elastic and muscle tissues
Bone demineralization Moon face |
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ACH Dx
|
Serum Cortisol level
Dexamethasone = shut down ACTH production MRI - pituitary gland CT scan - adrenal glands |
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ACH Tx
|
Radiation, surgery, meds for tumors
|
|
|
Type 1 DM
|
Insulin production & secretion problem
Genetic Auto-immune Beta-cells in pancreas Associated diseases: graves, and thyroiditis |
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Type 2 DM
|
cellular resistance to insulin
|
|
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Gestational DM
|
24 weeks
|
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Insipidous DM
|
Anti-diuretic hormone difficiency
|
|
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Type 1 DM Dx
|
Childhood
Poly phagia, dipsia, uria Weight loss |
|
|
Type 2 DM prevalence
|
18.8 million diagnosed in US
25.8 total in US |
|
|
Type 2 Risk Factors
|
Family Hx
Ethnic origin: african american, native american, hispanic Inactivity Smoking High stress Hypertension Low HDL High LDL |
|
|
Insulin Resistance Syndrome
|
Prediabetes - cells insensitive to insulin. Increased BG. Related to metabolic syndrome.
|
|
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DM pathogenesis
|
Gene mutation for insulin receptor substrate protein
Mutations of insulin receptors and glucose receptors Excess fat |
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DM Dx
|
Urine Dip: glucose levels, ketone levels
Blood test: fasting glucose levels ( >8 hours) Glucose Tolerance test: fasting --> test Ingest glucose: 2 & 4 hour re-test Monitoring: A1c (glycated hemoglobin) |
|
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Normal BG
|
A1c: < 5.7%
Fasting Glucose: <100 mg/dl Glucose Tolerance: <140 mg/dl |
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Pre-Diabetes BG
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A1c: 5.7% - 6.5%
Fasting Glucose: 100 - 126 Glucose Tolerance: 140 - 199 |
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Diabetes BG
|
A1c: > 6.5%
Fasting Glucose: >126 Glucose Tolerance: >200 |
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Type 2 Management ABC Goals
|
A1c
Blood Pressure Cholesterol |
|
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Type 2 DM Co-morbidities
|
Macrovascular: atherosclerosis of heart, brain, and lower extremities
Microvascular: retina, renal glomerulus, peripheral nerves |
|
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Atherosclerosis related to DM
|
Hyperglycemia - cause free-radicals (cell damage/death), reduced NO (vasoconstriction)
Capillaries: increased vascular permeability / extracellular matrix |
|
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Type 2 DM - leads to:
|
Heart Disease (CAD), left ventricular dysfunction, diabetic cardiomyopathy, PAD
Retinopathy - leads to ischemia Renal (diabetic nephropathy) - thickening of glomerular basement membrane, breakdown of filtration membranes, increased albumin levels |
|
|
Effects of Type 2 DM:
|
Hand and feet sensory neuropathy
Motor neuropathy Foot deformities: claw toes, arch collapse Autonomic Neuropathy: blood pressure, temp, and sweating Carpal Tunnel Syndrome Adhesive Capsulitis Dupuytren's Contracture Flexor Tenosynovitis Charcot Foot Diffuse Idiopathic Skeletal Hyperostosis (DISH) Osteoporosis Neurotropic Ulcerations |
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Kidney Functions
|
Filtration & Excretion
Regulation of Blood volume, pressure, and electrolytes Maintenance of Acid-base balance Production and secretion of hormone |
|
|
Basic Unit of Kidney
|
Nephron
|
|
|
Tubular structure 45-65 mm long and 0.5 mm wide
|
Nephron
|
|
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Glomerulus Anatomy
|
Renal corpuscle
Glomerulus - tuft of arterioles Surrounded by Bowman's capsule |
|
|
Basement Membrane charge
|
Net Negative Charge
|
|
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Glomerular Filtration Rate
|
120 ml/min = 180 L/day
< 1% is excreted as urine |
|
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Ion Flow Pattern
|
H+ flows into collecting duct and distal tubule
Na+ flows out of collecting duct, distal tubule, loop of Henle, and proximal tubule K+ flows into collecting duct and distal tubule Cl- flows out of loop of henle and proximal tubule H2O flows out of collecting duct and proximal tubule |
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Ion concentrations
|
Na+ > Cl- > Glucose > HCO3
|
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Blood-Urea Nitrogen (BUN) measurement
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General screen for abnormal renal function
Normal Range 10-20 mg/dL (>20 blood flow is decreased) |
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Glomerular Filtration Rate (GFR) decreases = BUN _____
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Increases
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End product of muscle metabolism
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Creatinine
Collect urine over 24 hours and blood sample to determine clearance of creatinine Can also do radioactive dye |
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___________ leads to production of angiotensin II
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Renin
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Renin leads to ____________ of salt and water
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Retention
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____________ is secreted by adrenal gland in response to angiotensin II
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Aldosterone
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Increase in Aldosterone leads to ________ salt and water retention and __________ in ADH
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Increased, increased
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_______ is secreted by posterior pituitary gland
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ADH - upregulates water resorption in collecting ducts of the nephrons in the kidneys.
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_________ water in blood stream = ____________ in Na+ concentration by dilution
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Increase, decrease
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_____________ stimulates red blood cell development in bone marrow.
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Erythropoietin
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__________________: Calcium Homeostasis
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Vitamin D3
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Altered kidney function for ____ months = chronic kidney disease
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3
|
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Chronic Kidney Disease Causes:
1. 2. 3. 4. 5. |
Diabetes
Hypertension Glomerulonephritis Analgesic Nephropathy Substance Abuse |
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CKD Stage 1:
- Nephron ___________ - GFR ___________ - BUN and Creatinine: _______ - Reversible or ____________ |
Hypertrophy
Increased WNL Sustained |
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CKD Stage 2 & 3:
- Damaged ____________ - ___________ in urine - ___________ = elevated BUN and Creatinine - ___________ extremities |
Capillaries
Albumin Azotemia Edematous |
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CKD Stage 4:
- ____________ BUN and Creatinine and other toxins - ____________ = excessive serum protein in urine - ____________ production of renin |
Increased
Proteinuria Increased |
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CKD Stage 5:
- GFR < ____ ml/min - __________: elevated and abnormal levels in blood - __________lethargic, nausea, itching, pericarditis Need __________ or ____________ |
15
Uremia Uremic Dialysis, transplant |
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CKD CM
___________ erythropoietin = decreased RBC production and _______ absorption Risk for _____________ disease |
decreased
iron cardiovascular |
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CKD CM
Decreased GFR = ________________ cardiovascular risk |
increased
|
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CKD CM
_______tension: ACE inhibitors & beta blockers |
Hyper
|
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CKD CM
________ ventricular hypertrophy, CHF |
Left
|
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CKD CM
_________, arrythmias, Valve abnormalities |
Stroke
|
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CKD CM
Gastrointestinal __________ = Nausea, vomiting, anorexia Restricted diet - protein levels gastritis, pancreatitis |
Azotemia
|
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Fluid within abnormal organ
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Ascites
|
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CKD CM
Hypercalcemia: ______phosphate, ______ calcitriol (vit. D) |
increase, decrease
|
|
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CKD CM
Renal osteodystrophy |
bone pain upon WB
Fractures |
|
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CKD CM
Extra skeletal Calcification |
Coronary arteries, periarticular, retina
|
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CKD CM: Neurologic
|
Sleeping disturbance
Memory loss, confusion peripheral neuropathy: paresthesias |
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Primary Bacterial Infection, secondary to UTI
Chronic: ______________ Risk Factors: _______________ and _____________ mobility |
Pyelonephritis
Reflux nephropathy Immobilization, decreased |
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Pyelonephritis CM
|
Fever, chills, HA
Flank Pain Bladder Irritation Urinalysis: pyruia, bacteriuria |
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Renal Cystic Disease
Cysts: _______________________ |
Degenerating renal tissue
|
|
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Polycystic Kidney Disease:
____________ dominant or recessive Usually a _______ progression Leads to ________________ kidney disease |
autosomal
slow end-stage |
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RCD CM
Cyst Rupture: __________ _________ and hypertension __________ ____________ Initial Imaging: ____________ or CT Scan |
Hematuria
Fever Flank pain Ultrasound |
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|
Renal Calculi
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Urinary stone disease
Numerous causes Urinary obstruction and severe pain |
|
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RC Manifestations
|
Hematuria
Urinary urgency Flank or abdominal pain radiating to the groin Shifting positions Nausea |
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Progressive loss of normal liver tissue, replaced with fibrotic and nodular regeneration of tissues.
|
Liver disease
|
|
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Enlargement of the liver due to deposits of fat tissues
|
Fatty liver disease
|
|
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Swelling of the liver
|
Alcoholic Hepatitis
|
|
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Fibrotic changes and scarring of liver tissues, lobular changes
|
Cirrhosis
|
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Acute and chronic liver disease
Levels of proteins and ammonia in bloodstream |
Hepatic Encephalopathy
|
|
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HE Stage ___
Personality changes, tremor, incoordination, numbness / tingling |
1
|
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HE Stage ___
Spasticity, Ataxia, Apraxia |
2
|
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HE Stage ___
Lethargy, muscle rigitity, hyperventilation |
3
|
|
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HE Stage ___
Comatose, decerebrate posturing |
4
|
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Screening
Diagnosis Monitoring Effects of medications Changes in pathology |
Lab tests
|
|
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Lab Values
|
Expected value
Reference range: adjust for age, gender, co-morbidities, drugs, etc. |
|
|
CBC
|
Complete Blood Count
|
|
|
Anemia
Dehydration Infections Clotting Problems |
CBC
|
|
|
Number of cells in a cubic millimeter
|
Erythrocyte count
|
|
|
RBC count:
_____ women _____ men |
4.1-5.1
4.5-5.3 |
|
|
Number of immature RBC
|
Reticulocyte Count
|
|
|
Percentage of RBC in the blood
|
Hematocrit
36-49% adults Erythrocyte Volume Fraction (EVF) |
|
|
O2 carrying capacity
|
Hemoglobin
13-18 men 12-16 women g / dL |
|
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ESR
|
Erythrocyte Sedimentation Rate - rate RBC sink in a test solution clumping cells = faster rate
|
|
|
Greater globulins and fibrinogen proteins = _____ rate
|
Faster
|
|
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Clumping is from _______________ conditions
|
inflammatory
|
|
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ESR
|
Non-specific Test
0-17 mm/hr: men 1-25 mm/hr: women |
|
|
WBC Total Counts
|
4500 - 11,000 cells / mm3
Neutrophils 50-60% Lymphocytes 30-40% Monocyte 1-9% Eosinophils 0-3% Basophils 0-1% |
|
|
Platlets Total Count
|
150,000 - 450,000 cells / mm3
|
|
|
Hemostasis
Coagulation Tests: ____________________ International Normalized Ratio (INR) __________ |
Blood plasma
0.9 - 1.1 |
|
|
Coagulation Factors
Factor I: _______________ Factor II: _______________ Factor VII: ______________ Factor IX: ______________ vonWillebrand factor |
Fibrinogen
Prothrombin Stable Factor Christmas Factor |
|
|
Basic Metabolic Panel (BMP), Chem Panel, Chem-7
|
Sodium
Potassium Chloride Calcium Blood Urea Nitrogen Creatinine Glucose Carbon Dioxide |
|
|
Na: hyper/hyponatremia
High Na: (4) ___ ___ ___ ___ Low Na: (5) ___ ___ ___ ___ ___ |
Dehyrdation
Diarrhea Edema Replace Fluids Excessive Fluids CHF Kidney and liver failure Neurological functions Medical emergency |
|
|
K+: hyper/hypokalemia (HR and Rhythm)
Buffer System: Acid-base balance Treatment: Assess _______________ _______ Levels Muscle ______________ and _______________ |
vital signs
O2 cramping and weakness |
|
|
Cl-
Buffering System - Bicarbonate (HCO3) - pH and PCO2 levels - Low ___________= Acidosis Respiratory: _____________, poor ventilation Metabolic: _______________, diabetes |
HCO3
COPD Renal failure |
|
|
Ca+: Tissue ______________
Hypercalcemia: ________________________, multiple fractures Dehydration - _______________ & ________________ Fatigue, ________________ arrhythmias Hypocalcemia: ____________ causes Tissue Excitability: Muscle __________ and tetany numbness & tingling: extremities / lips and mouth |
Excitability
Hypermarathyroidism Nausea & Vomiting Heart Numerous Spasms |
|
|
__________ BUN = ___________ Renal Function
Decreased renal blood flow Diuretic medications GI bleeds |
Increase, Decrease
|
|
|
___________ creatinine = ____________renal function
|
Increase, Decrease
|
|
|
Loss of __________ function = __________ filtration
|
nephron, glomerular
|
|
|
Normal Fasting Glucose:
|
70 - 100 mg/dL
|
|
|
Standard Precautions
1. _______________ 2. _______________ |
Nosocomial Infection
Health care-associated infection |
|
|
Universal Precautions
1. ____________ 2. ____________ 3. ____________ |
CDC
HICPAC "Joint Comission" |
|
|
Standard Precautions:
Risk Exposure to: 1. 2. 3. 4. |
Blood
Body fluids (except sweat) Non-intact skin Mucous membranes |
|
|
Standard Precaution Implementation:
1. 2. 3. 4. |
Education
Environmental Systems Monitorying Institutional priority and efficacy |
|
|
non-latex gloves
fluid-proof gowns |
Standard precautions
|
|
|
Food and drink
Lip balm / lipstick Handling contact lens Coughing and Sneezing |
Standard Precautions
|
|
|
Negative Airflow filtering system
|
Airborne Infection Isolation
|
|
|
Positive airflow:
|
Immune suppressed
|
|
|
Cleaning Equipment:
Cleaning: Wipe off dirt and ___________ Disinfecting: Use of ___________ agent and physical removal to eliminate common ____________, virus, fungi. ____________ ____________ ____________ Sterilize: Use of heat, chemicals, pressure to kill organisms, and spores |
dust
chemical bacteria germicide bleach-based alcohol-based |
