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pathophysiology midterm

Terms in this set (100)

What portion of the brain controls gate/ movement? Cerebellum, if there is a lesion in the cerebellum what might be a problem?
If cerebellum is injured, running, walking, typing will be difficult even if paralysis doesn't ensue.
A patient comes in with carpal pedal spasms and a respiratory rate 28, what does that blood gas look like?
Respiratory alkalosis, with a low PCO2-below 35, and high pH above 7.45
What molecules induce endothelial cell retraction?
Leukocytes
true/false: cellular regeneration- what cells regenerate?
Labile cells can regenerate,
Stable cells: can regenerate circumstantially
Permanent: can't regenerate
What promotes wound healing?
Cytokines & Growth Factors
rapid homeostasis
1: Inflammatory phase
cell differentiation
2: proliferative phase
angiogenesis
3: Wound Contraction and Remodeling phase (epithelialization)
What pathogens do not fit the typical description of an organism?
Viruses
what symptoms of an infection are ALWAYS apparent/ obvious
-fever
-myalgia
-headache
-lethargy
-increased white blood cell count
a systemic manifestation in an infection to an acute phase response includes? what does it not include?
-changes in concentrations of plasma proteins
-skeletal muscle catabolism
-negative nitrogen balance
-elevated ESR
-Increased numbers of leukocytes
-anorexia
-somnolence
-malaise
-hypotension
-increased hr
-fever
(all of this is generated by cytokines)
What are the systemic manifestations of inflammation that may be present in an infection?
-acute phase response
-alterations in wbc count
-fever
-may resort to lymph nodes
Be able to define the correct manifestation response pattern isolated in acute inflammation.
systemic manifestation: acute-phase response.
-Vascular phase
-Cellular phase: Leukocyte margination, Adhesion, and transmigration
-Leukocyte Activation and Phagocytosis
What are the inflammatory mediators?
fever
inflammation
clotting/ fibrolyntic system
kinin system
activation of complement system
histamine
serotonin
lysosomal enzymes
PGs
Leukotrienes
Platelet activating factor
Nitric Oxide
Oxygen derived free radicals
cytokines
what does the term Mutualism mean?
Both the microorganism and host derive benefits from the interaction
Does viral replication occur inside or outside of the living cell?
inside the living cell
How is hepatitis B acquired?
oral/ sexual contact
drug users
different sex partners
if your gay
adults or adolescents acquire this disease
What is the function of MHC molecules?
-encode human leukocyte antigens
-encode proteins that play an important role in antigen presentation
-displays protein fragments
-The function of MHC molecules is to bind peptide fragments derived from pathogens and display them on the cell surface for recognition by the appropriate T cells.
What is a eukaryote?
A cell that has a nucleus and organelles, so it compartmentalizes cellular tasks and operations.
Fill in the blank: epidemiology refers to what in regards to infectious disease.
Epidemiology focuses on the incidence and prevalence of infectious disease.
Except question: The defense mechanism of the respiratory tract includes all of the following except:
coughing/sneezing, cilia also helps remove mucus, epithelial cells
Fill in: Culture, isolation, and identification is an example of what in an infection
diagnosis in an infection
Identify the correct way in which to use antibiotics
-nature of disease
-person's immune system
-side effects
Cytokines that effect hematopoiesis in bone marrow are called colony stimulating factors based on their ability to do _______?
regulate blood cells
Which hematopoietic growth factor has been cloned to produce a protein to treat anemia in kidney disease in cancer?
Epogen
Identify the various leukocytes and what each one does? eosinophil? attached to? lymphocyte? basophil? monocyte?
eosinophil: can build up and cause inflammation, allergic and parasitic
lymphocyte: antibodies (viral infections)
basophil: prevent blood clotting (parasitic infections)
monocyte: regulates cellular homeostasis (severe infections by pahgocytosis) through macrophages and dendritic cells
what happens to CT lymphocytes in the thymus? what do they differentiate into?
they differentiate into cd4+ helper t cells and CD8 cytotoxic cells (NK cells)
neutropenia definition and how as a nurse would respond to someone who has it
decrease number of neutrophils causing patient to be at high risk for infection
antibiotics
using G-CSF
change in meds
what pathogen causes infectious mono
Epstein bar virus EBV
what happens to the immune system with aging?
declines
higher risk for auto immune disease
less t cells as thymus shrinks
decrease rate is synthesis of cytokines
IL-2 IL4 IL-12 decrease
B-cell function is compromised but the antigens they recognize do not change
differentiate the response to an antigen
acquired immunity
how do immunodeficiency disorders arise?
inherited, being sick for a long time, drugs, can be primary or secondary (later in life)
what hormone is responsible to clot development and control of blood flow in a laceration
thromboxane A2
what is nitric oxides physiological effect on the body, can be inhaled, decreases stemic vascular resistance on mechanical ventilators but it can also be taken orally in nitroglycerin. what does nitric oxide cause? what is its physiological effect of nitric oxide
smooth muscle relaxation, antagonism of platelet adhesion, aggregation, degranulation, leukocyte recruiter
vasodilation, which decreases venous return and arterial blood pressure reducing oxygen consumption
you need to be able to identify a hypersensitivity reaction. what defines type 1, 2, 3?
type 1:immediate, dependent on IgE-mediated activation of mast cells and basophils and the subsequent release of chemical mediators of the inflammatory response
type II: antibody mediated IgG or IgM
type III: immune complex, hypersensitivity caused by antigen-antibody immune complexes
type IV- t cell
select all that apply? what are the clinical manifestations common in a hypersensitivity response to the environment
contact dermatitis, asthma, life threatening anaphylaxis rash
edema
bronchospasm
mucus secretion
epithelial damage
select all that apply: drug reaction, a lytic drug reaction does what? how would you measure one????????
a lytic drug reaction is red blood cells (erythrocytes) breaking down which you would see on a blood test (hemoglobin would be low) (attack on platelets or thrombocytopenia) (increase bleeding response because of decrease of platelets.)Hypersentivity type II reaction
how does immunotherapy or allergy shots achieve a therapeutic effect?
they stimulate production of high levels of IgG antibodies, which are capable of combing with the antigen and preventing activation of cell bound IgE antibodies
what causes the reaction from contact dermatities, specifically poison ivy? what is the pathophysiological reaction from touching poison ivy, the path of response behind the clinical manifestation
sensitization: haptens captured by dendritic cells which migrate to lymph nodes and cause tcell production . keratinocytes amplify the reaction and t memory cells activate causing rapid symptoms
symptoms specifically of rejection of an organ, liver, what would show as a graft rejection, what types of elevation in labs indicatate acute graph rejection
activation cytotoxic t lymphocytes that attack and kills cells
activated b cells producing donor mhc- specific ab
-antibody mediated cytoxicity toward donor cells
what is the definitive diagnosis of AIDS and how is it made based on lab data? what do we use to determine if the HIV client had developed aids?
ELISA
HIV antibody test (seroconversion)
If EIA or ELISA is positive, Western blot assay needs to confirm results
taking care of population of HIV clients as nurses, what is the leading cause of death in that populations
tuberculosis
know the function or physiological principles of the somatic nervous system
our conscience perception of the environment
carries sensory info to nerves to cns
carries motor info from cns to muscles for movement
you need to know the pathophysiologic effects of spina bifida
neural arch does not form correctly in embryo or neural tube fails to form
which of the following messages is most likely to be carried by general somatic afferent neurons
Somatic afferent neurons are sensory neurons that conduct impulses initiated in receptors in the skin, skeletal muscles, tendons, & joints. Receptors in the skin are responsible for sensing such things as touch, temperature, pressure, & pain and are called exteroceptors
which area in the brain is responsible for respiration
medulla oblongata
if i were to remove part of the prefrontal cortex (seizure disorder) which of the following effects can be anticipated after surgery. know what the pre frontal cortex controls
helps one take information from other parts of the brain to achieve and obtain goals (look up what pre frontal cortex does)
emotional experiences come from what part of the brain
limbic system
if he gave us alcohol and told us to drive and make us do an obstacle course, what is it going to alter in your brain to make u suck ass at driving
cerebellum
parasympathetic nervous system functions
rest and digest
connects the cns to limbs and organs
conservation of energy
resource replenishment and storage
maintenance of organ function
know about reflex circuitry produced by the autonomic nervous system, what does it do when it is stimulated?
visceral reflex functions, efferent branch has two neurons making the reaction quicker, causes coughing, sneezing, vomiting, and swallowing
somatosensory system has sensory neurons, the somatic type has afferent receptors that sense what? somatic afferent sensory neurons sense what?
they sense pain, heat, pressure, touch etc
if you were to have a spinal injury, and changes in distal forearm and fourth and fifth fingers. where would that injury be, look at the dermatome chart
injury on C8
select all that apply: What is involved in the final processing in the somatosensory information
awareness of stimuli
localization
discrimination of characteristics
interpretation of meaning
know the pain theories, what pain theory proposes receptors share the same pathway with other modalities
pattern theory
nociceptors are activated by what
detect stimuli that threatens an innervated tissue, mechanical thermal chemical stimuli
opioid receptors are concentrated in which region of the CNS
peripheral processes of primary afferent neurons
(cortex, brain stem, limbic)
what was emphasized on the presentation of pain that might indicate a myocardial infarction
pain in chest
what are the accesive components when accessing a clients pain in bone metastisis
ask where the pain is
severity of pain
history of pain
personal reaction to the pain
anything that relieves or exacerbates it
know about nonpharmacologic methods of pain control
cognitive-behavioral interventions: relaxation, distraction, cognitive reappraisal, imagery, meditation, biofeedback
physical agents: hot and cold
electroanalgesia: TENS, electrical acupuncture, neurostimulation
who is most likely to develop neuropathic pain
older people, diabetes mellitus, alcoholics, hypothyroidism
select all that apply: what types of triggers set off trigeminal neuralgia
demyelination of axons in ganglion, root, and nerve
eating, shaving, touching ur face, drinking, brushing your teeth
select all that apply: how is phantom limb pain treated
sympathetic blocks, TENS of the large myelinated afferents inverting the area, hypnosis, relaxation training
what characteristics would treat a migraine with or without an ora
avoidannce of triggers: food or smells
quiet, dark room
abortive therapy
preventative therapy
acetylsalicylic acid
acetimetaphin
caffeine NSAIDS
what principles should you choose when addressing pain control strategies in a child who was diagnosed cancer
management: pharmacologic (must consider GFR, liver function) and non-
pharmacologic (distraction, positive self-imagery, play therapy).
disorders of the pyramidal tracts such as a stroke are characterized by what
paralysis
what are early signs for presentation of Duchenne's muscular dystrophy
muscle weakness from falling, hips and postural muscles first affected, pseudohypertrophy of calf muscles
scoliosis
imbalances
how do botox work
blocks signals from the nerves to muscles, muscles can't contract which typically causes wrinkles
myasthenia gravis how does it present? what does the patient complain about
weakness, fatigue, eye muscles effected, difficulty chewing and swallowing, speech impairment
if i was assessing guillain barre syndrome, what would be the most important finding that i could identify or concerned with
most people report having an acute- flu like symptoms before
-progressive weakness of limbs, producing a symmetric flaccid paralysis, characterizes the disorder
-numbness
how would a vestibular cerebellar disorder present? clinical manifestations? what is something you might see with that region of the brain?
-unable to fix eyes or steady posture
-unsteadiness of trunk (truncal ataxia)
-cerebellum is damaged
what are some common physical findings in Parkinson's disease presentation
-tremor in hands, face, feet, head neck, lips, tongue, jaw
when you're intervening with a patient that has ALS, what would be the priority intervention for the client
-multidisciplinary team
-managing symptoms, nutrition, respiratory muscle weakness
-clinical trials focus on exercise programs, nutritional interventions, transplanted stem cells, antisense therapy
know the pathology behind the development of multiple sclerosis
-MS lesions of demyelinated patches that are visible in white matter and gray
-lesions/plaques are from acute myelin breakdown
-first stage: sequential development of small inflammatory lesions
second stage: lesions extend and consolidate and when demyelination and gliosis (scar formation) occur
know the treatments for multiple sclerosis: specifically meds in book
corticosteroids are the main treatment by reducing inflammation
interferon beta
glatiramer acetate
mitoxantrone
meds for chronic: dantrolene, baclofen, diazepam, antidepressants
what a complete transection of spinal chord injury: what happens below the site of trauma with complete transection of the spine?
complete loss of motor, sensory, reflex, and autonomic function
what happens if someone has transection at C5, what would you expect to see as a nurse
full head and neck control, shoulder strength, elbow flexion, minimal assistance with dressing and eating, help with eliminating, electric or manual wheelchair, transfer assistance
what out of those is the most capable of compensating for increased ICP
cerebral spinal fluid
what is late indicator of increased ICP
hypertension, bradycardia, and widened pulse pressure
select all that apply: what are the clinical manifestations of an upward herniation from the midbrain infratentorial compartment
ischemia, hemorrhage, displacement and obstruction occurs quickly, leading to irreversible infarction and hemorrhage
how do we resolve hydrocephalus
shunting, provides an alternative route for CSF to return to the circulation
surgical decompression
What happens in a car accident to the brain with acute acceleration/ deceleration type forces
the brain hits the skull surface, contusions and hematomas occur from nerves, vessels, and brain tissue hitting the skull
What is the earliest sign of decreased level of consciousness
confusion/inattention
disorientation
blunted responsiveness
What metabolic factors cause vasodilatation of cerebral vessels
histamine, NO6, increased CO2, increased hydrogen, decrease ph, lactic acid
What is the rationale behind a stroke teams restoration of cerebral perfusion post stroke presentation?
most strokes are ischemic strokes which are caused by an interruption of flow in cerebral vessels. When it gets too low it causes a stroke so it is important to level it out
-there is a window of time right after a stroke where viable brain tissue can be salvaged
The pathophysiologic process of bacterial meningitis
the bacteria replicate and undergo lysis in the CSF, releasing endotoxins or cell wall fragments
-inflammatory mediators release which allows pathogens, neutrophils, and albumin to get into CSF
Know about the epidemiology of medulloblastoma
-most common malignant childhood brain tumor
-1.5-2 cases per 100,000
Status epilepticus results in death if it is not treated, so what are you concerned about if a patient is having uncontrolled seizures?
-if it is causes by neurologic or systemic disease, the cause needs to be identified and treated immediately, it can't heal if it isnt corrected
How a patient with Alzheimer's moves form the initial stage to a moderate stage? What is the criteria that identifies each one?
stage 1: no impairment
forgetfulness
memory effected
stage 2: mild decline
occasional short-term memory
occasional aphasia
memory and language effected
stage 3: mild decline, STM, name recall, occasional aphasia, concentration issues
memory, language, complex attention affected
stage 4: memory, language, complex attention, executive function affected, difficulty multitasking
A client with a long history of cigarette smoking and poorly controlled blood pressure and hypertension exhibits psychomotor deficits. This is a result of?
Vascular dementia
A client presents to the clinic a complaint of something in their eye. When questioned a client say scratching and burning sensations and light sensitivity. What type of a disease might indicate? Inflammatory eye disease section
blepharitis
Select all that apply: Who is at high risk for non ulcerative inflammation of the cornea.
welder with inadequate eye protection
A female who uses a tanning bed four to five times/week
A ski patrol who works 12 hours/day in bright, sunny mountain tops
-chemical exposure
-uv exposure
Which of the following vision deficits is clinician justified in attributing to normal aging process?
-presbyopia
-age-related macular degeneration
-glaucoma
-cataracts
Diabetic and hypertensive retinopathy are both characterized by the appearance of:
intraretinal hemorrhages
A 60 year old clients history of poorly controlled hypertension has culminated in a diagnosis of retinal detachment. What type of retinal detachment is this client most likely to have experienced?
exudative (serous) retinal detachment
A client has been diagnosed with open ankle glaucoma during a routine eye exam. The client has been prescribed topical beta adrenergic antagonists. As a nurse you teach the client about how this drug works. How do they?
Lower intraocular pressure by decreasing aqueous humor production
strabismus, how do you tell a mom of a kid the best / current treatment for strabismus (crossed eyes)
glasses
patching
surgery
botulinum toxic type A (botox)
Conductive hearing loss is caused by what?
impacted cerumen in outer ear
fluid in middle ear
cotton, insects impairing hearing
Paget disease or ostosclerosis
A female client with reumatory arthritis has been taking high doses of aspirin for several years to control inflammatory pain. What symtoms would this patient have if she became ototoxic? or developed ototoxicity? hearing issues? what symptoms would this patient have that would say she is having ototoxicity
light headedness
dizziness
tinnitus hearing loss
can occur in one or both ears (sensorineural)
signs and symptoms of menieres disease
fluctuating episodes of tinnitus
feelings of ear fullness
violent rotary vertigo (unable to sit or walk)
avoidance of head movement
pallor
sweating
vomiting
nausea
chalazion, blepharitis, hordeolum, ptosis which one is not inflammatory
ptosis
what drug effects pupillary reflexes?
opiate
miotic drugs
atropine drops
codeine.
fentanyl.
hydrocodone.
oxycodone.
morphine.
methadone.
heroin.
What is expressive aphasia?
inability to easily communicate spontaneously or translate thoughts or ideas into meaningful speech or writing
-comprehension is normal
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