rrd 5 Flashcards
infection (277 cards)
1
Q
infectious diseases (IDs)
A
disorders in which tissue damage or dysfunction is produced by a microorganism
2
Q
endemic
A
used to describe a disease that exists all the time in certain communities
3
Q
epidemic
A
an outbreak of a disease that spreads within a certain time frame to people of one or several communities
4
Q
pandemic
A
the disease outbreak spreads from being epidemic (a few communities) to being worldwide
5
Q
example of endemic
A
malaria is endemic to parts of Africa
6
Q
example of epidemic
A
there is often a yearly flu epidemic in some U.S. communities
7
Q
example of pandemic
A
the Spanish flu of 1918 began as an epidemic amongst soldiers at U.S. army bases, then became pandemic when they went to Europe during WW1
8
Q
infection
A
- presence & multiplication of a living organism on or in the host
9
Q
invading organism is a ?
A
pathogen - an organism that causes harm
10
Q
types of pathogens
A
- viruses
- bacteria
- fungi
- protozoan
- nematodes
- microsporidia
11
Q
factors determining whether a host will be infected and how it will be infected
A
- immunocompetence of the host
- virulence factors of infecting organism
- its portal of entry
12
Q
immunocompetence of the host are?
A
its defense mechanisms adequate, non-defective, fully functional, etc.?
13
Q
virulence factors of the infecting organism include
A
- toxins
- adhesion factors
- invasion factors
- evasive factors
14
Q
portal of entry questions
A
how does microbe enter host?
15
Q
the portal of entry usually involves ______. the CDC divides infection risks into 4 _______ precautions that should guide every healthcare workers’ interactions with the public. what are they?
A
- breach of 1st line of defense
- transmission-based
- standard, contact, droplet, airborne precaution
16
Q
standard precautions
A
basic infection prevention measures used during every patient interaction whether a known/suspected infection is present
17
Q
standard precaution measures include
A
- hand hygiene
- use of PPE
- resp hygiene and cough etiquette
- safe injection practices
- disinfect soiled surfaces and equipment
18
Q
example of hand hygiene
A
wash hands
- before/after every patient contact
- before/after every meal
- after using toilet
19
Q
use of PPE includes
A
- gowns
- gloves
- face mask
when anticipating exposure to infectious material
20
Q
example of when to use PPE
A
always wear gloves when coming into contact with any blood or body fluids
21
Q
example of resp hygiene and cough etiquette
A
cover cough or sneeze w/ arm, not hand
22
Q
example of safe injection practices
A
dispose used needles in a special container
23
Q
example of disinfect soiled surfaces and equipment
A
disinfect shared equipment, such as BP cuffs, btw each patient use
24
Q
contact precautions
A
use when any patient has
- diarrhea
- stool incontinence
- draining wounds or sores
- uncontrolled secretions
- vomiting
- draining body fluids
- skin rashes or sores
to invade the host by direct contact or by contact w. an infected object
(contact with bodily fluids)
25
examples of when to use contact precautions
- salmonella
- hepatitis
- HIV
- ebola
- MRSA
- VRE
26
PPE for contact precautions
hand-washing, gown and gloves
27
droplet cautions
droplets can be generated by an individual during
- coughing
- sneezing or talking (saliva)
28
droplets contain ____ that travel no more than ____ form the infected individual. can invade the hosts ____, _____, _____.
- microorganism
- 3 ft
- nasal mucosa, conjunctiva, mouth
29
examples of when to use droplet precautions
- pertussis
- influenza
- diphtheria
- meningitis
- pneumonia
30
PPE for droplet precautions
hand washing, facemask once in the room
31
airborne precautions
use when any individual has a suspected or known infection that is transmitted by the airborne route
32
examples of when to use airborne precautions
- TB
- measles
- chicken pox
- small pox
33
PPE for airborne precautions
hand washing, N95 face mask prior to entering the room
34
course of a disease
stages that are pathogen-specific and affected by various factors
35
what are the stages of the course of a disease?
1). incubation period
2). prodromal stage
3). acute stage
4). convalescent period
5). resolution
36
incubation period
- phase during which the pathogen begins active replication but doesn't produce S&S
- varies in length
37
examples of incubation periods of diseases
- salmonella: 6 to 8 hrs
- hep B: 50-180 days
38
prodromal stage
- initial appearance of S&Ss
- may be mild
39
acute stage
- maximum impact
- very pronounced and specific S&Ss
40
convalescent period
containment of infection and resolution of S&Ss
41
resolution
total elimination of pathogen w/o remaining S&Ss
42
exceptions to classic stages of course of a disease
- may become chronic dz; protracted & irregular course
- some dzs progress in subclinical/subacute from start-finish w/o many clinical S&S or less severe S&S
- fulminant/fulminating illness: abrupt onset w/ little or no prodrome
43
since development of ______ medications, infectious disease in developed countries has lessened.
antibiotic/anti-infective
44
despite antibiotic/anti-infective, ______ are adept at _____ and now many are _____ to the anti-infective drugs that used to kill or disable them.
microorganisms, changing, resistant
45
examples of antibiotic (anti-bacterial) resistance
- beta lactam antibiotics
- vancomycin
46
penicillin and its derivatives are called?
beta-lactam antibiotics
47
why are penicillin and its derivatives called beta-lactam antibiotics?
they all have a molecular structure called beta-lactam ring
48
example of penicillins
- methicillin
- amoxicillin
49
beta lactams _____ to be effective against a wide spectrum of microbe. then certain microbes _____ and developed an enzyme called _______.
used, mutated, beta-lactamase
50
what does beta-lactamase do?
destroy beta-lactam antibiotics by dismantling the beta lactam ring
51
specific beta-lactamase microbes
MRSA and resistant Streptococcus pneumoniae
52
MRSA
methicillin- resistant Staphylococcus aureas
53
fomite
an inanimate vector
54
staphylococcus aureus is a ____ skin flora and occasionally, can cause infections such as _____ and ____ in ______ people.
- normal
- boils and cellulitis
- immunocompetent
55
MRSA developed in 1960s in hospitalized patients that had been on _____ so long that one strain of the _____ bacteria _____ and became ______.
- methicillin
- staph
- mutated
- resistant
56
MRSA is now rampant in?
- some hospital settings
- nursing homes
57
MRSA is generally known as a ?
nosocomial disease
58
how is MRSA spread?
- direct patient to hands to patient contact
- colonization of nares of healthcare workers
- occasionally fomites such as stethoscopes
59
MRSA usually invades ____ but "likes" ______ such as ? which can take it to a site to _____ such as?
- wounds
- fomites
- urinary catheters, IV catheters
- colonize
- bladder, blood
60
community-acquired MRSA
found in wounds of people who haven't been in a hospital setting
61
what drug is now one of the few that will destroy MRSA?
vancomycin
62
resistant Streptococcus pneumoniae
most common microbe causing otitis media (inner ear infection)
63
resistant Streptococcus pneumonia used to be easily treated with _____ until ear infections became?
- penicillin
- overtreated or treated inappropriately (antibiotics don't cure viral ear infections)
64
new strain of strep developed that makes _____ and now many ear infections are?
- beta lactamase
- much harder to get rid of
65
VRE
vancomycin-resistant enterococcus
66
VRE is another _____ infection
hospital associated
67
enterococci faecalis is a normal _____ flora, but in hospitalized people/nursing home residents, it will often migrate to ______ and other areas.
bowel, urinary tract
68
VRE used to be easily dealt with using _____, but then ______ developed due to mutated gene that changed one small part of a _____ on the enterococcus cell wall. now ____ won't ____ to the microbe cell wall to destroy it.
- vancomycin
- resistance
- protein
- vancomycin
- bind
69
what is used to treat VRE?
only very heavy-duty alternative antibx are effective now
70
example of infectious diseases whose portal of entry is breach of skin and/or mucous membranes integrity
- cellulitis
- botulism
- tetanus
- rabies
- malaria
- zika
71
cellulitis
infection of the dermis and subcutaneous tissue
72
pathogenesis of cellulitis
- organisms (like Staphylococcus aureus) that normally dwells on TOP of skin (epidermis) gains deeper entry after injury (laceration, puncture, microscopic breach, etc.)
OR
- cellulitis follows milder staph infection of skin like impetigo: blister eruption around nose/mouth that are itchy, crusty, contagious
73
cellulitis infected area is
erythematous, swollen, painful
74
tx for cellulitis
abx (antibiotics)
75
botulism
caused by toxin of Clostridium botulinum, bacillus that can invade body via food or soil (dirt to wound)
76
toxin of Clostridium botulinum heads for _________ nerve synapses and blocks _________ receptor cells.
neuromuscular, ACh muscle
77
typical S&S for botulism
- descending, symmetric paralysis including resp
- floppy baby syndrome in kids that eat honey contaminated w/ C. botulinum
78
botulism is considered what?
top candidates for bioterrorism use
79
tx for botulism
- temporary mechanical ventilation
- other supportive tx
80
tetanus vaccination as part of ____ (______) but immunity ____. so must?
- DPT (diphtheria, pertussis, tetanus)
- weakens
- boosters every 10 years
81
pathogenesis of tetanus disease
- caused by Clostridium tetanii, bacillus which can live in soil as a spore
- when deposited in would, germinate as becomes active, release tetanospasmin
- block inhibitory NTs
- cause uninterrupted nerve impulses to muscle cells
82
uninterrupted nerve impulses to muscle cells due to Clostridium tetanii causes? (S&S)
- trismus/lockjaw (jaw musc tightening)
- severe tetany: muscle twitch, cramps, convulsions
83
tx of tetanus
antibx + TIG
84
what grps most likely to not have been fully vax?
- very elderly (vaccinations not around til 1950s)
- immigrants
- home-schooled kids
85
rabies
virus transmitted in saliva of infected host, usually by bit to skin (most common vector is bat)
86
vector-borne disease
transmitted via bite/sting/puncture of a host creature that then transmit microscopic disease - causing organism into new body
87
examples of vectors
- mosquitos
- ticks
- fleas
- rats
- bats
- dogs
88
rabies virus travels via ______ to the brain and spinal cord (___) can causes _________.
PNS, CNS, brain inflammation
89
S&S of rabies
- anxiety
- agitation
- confusion
- convulsions
^ caused by brain inflammation
- production of large amt saliva
- dysphagia (foam at mouth)
- hydrophobia (can't swallow water)
90
tx of rabies
- tx needs to begin w/in first 14 days post-exposure prophylaxis (PEP)
- 1 dose of rabies immunoglobulin + 4 doses of rabies vax
91
if rabies not treated w/in first 14 days, rabies virus will _____ its trip all way up to ____ - once _____ infected.....
- continue
- CNS
- CNS, no cure
- no tx = almost always fatal
92
malaria
- resp for 2 mil deaths in world yearly
- caused by protozoa that is transmitted via mosquito vector
93
protozoa of malaria reproduces in _______ (____) and then is released into blood, where it infects ____ and caused them to _____ (______). as _______ ____, they trigger ___ ___ ___ into blood and cause S&S.
- liver cells (hepatocytes)
- RBCs
- rupture (hemolysis)
- RBCs rupture
- acute phase reactants
94
S&s of rabies
- high fever
- chills
- arthralgia
- anemia
- splenomegaly
- cerebral ischemia
- heart failure
95
tx of malaria
- prevention w/ malaria vax in children or with quinine-based drugs
- mosquito nests
- use of iscent repellant that contains DEET
- antiparasitic or IV antimalaria drugs once diagnosed
96
Zika
cased by Zika virus, spread to people primarily through bite of infected mosquito
97
S&S for Zika
- may be mild and similar to S/S seen with flu
- usually don't get sick enuf to go to hospital
- rarely die from Zika
98
Zika infection during pregnancy can cause birth defects such as?
microcephaly (brain and head smaller than normal)
99
transmission of Zika occurs from?
- mosquito bites or person-to-mosquito-to-person
- pregnant woman to fetus
- sexual transmission
100
prevent Zika by?
- use insect repellants w/ DEET
- light-colored clothing when outdoors
- window/door screens + mosquito nets
- remove standing water where mosquitos reproduce
- sex abstinence or condom use considered for 8 wks to 6 months
- preg. women or prospective should avoid areas w/ known Zika outbreaks
101
diagnosis of Zika
blood or urine test can confirm diagnosis
102
tx of Zika
supportive care = fluids, rest, acetaminophen
103
examples of infectious diseases whose portal of entry is invasion of respiratory tract
- strep throat
- diphtheria
- pertussis
- mumps
- measles
- "pox" diseases
- influenza or flu
104
respiratory tract includes
- nose
- pharynx
- larynx
- trachea
- bronchi
- alveoli
105
strep throat
- caused by streptococcus pyogenes
- invades via coughing, sneezing
106
S&S strep throat
- red, sore throat
- white patches on tonsils
107
with certain strains of strep, can get ______ (______) along with usual S&S. what is that?
- scarlet fever "scarlatina"
- fever and rash that can cover whole body
108
with strep throat, important for infected person to get _____ early on. why?
- antibx
- getting an early/thorough treatment of antibx lessen chance of autoimmune disease like rheumatic fever
109
diphtheria
very contagious URI caused by bacterium transmitted by cough, sneeze, etc.
110
S&S of diphtheria
- sore throat
- fever
- pseudo membrane across tonsils and throat
111
pertussis
highly contagious disease that is leading cause of vaccine-preventable deaths in underdeveloped countries
112
pertussis is also known as? why?
- whooping cough
- S/S include horrible, violent coughing fits that can be bad to the point person cannot eat, becomes malnourished
113
DPT vaccine includes vax for?
diphtheria, pertussis, tetanus
114
mumps
- virus that invades parotid glands - swelling + fever
- main complication is infertility in males
- vaccine MMR - rarely seen in developed countries
115
measles nickname
- rubeola (2 wk or just measles)
- rubella (3 day or german measles)
116
rubeola and S/S
- virus passed by coughing and sneezing
- dense red maculopapular rash starting on head and going down body
- fever, cough, runny nose, conjunctivitis
117
rubeola can have serious complications such as?
encephalitis (brain inflammation from microorganism)
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rubeola is _____ seen in developed counties except in? still endemic in certain ______ areas.
- rarely
- immunocompromised or those not vax w/ MMR
- underdeveloped
119
rubella
milder virus and mild S/S include fever, rash, swollen glands
120
main concern w/ rubella is when?
woman contracts disease in early pregnancy
121
why is a woman contracting rubella during early pregnancy a concern?
- can cause baby to be born w/ problems like mental retardation, hearing problems, eye problems, etc.
122
child-bearing age women should always have a _____ titer done and if low, need to be _______
titer, vaccinated
123
titer
- done to measure level of antibodies to specific diseases
- high titer = lots of antibodies = had disease b4 or vaccinated
124
vaccine _____ has eradicated rubella in US and certain other countries.
MMR
125
pox diseases are also _____ diseases.
herpetic
126
herpetic diseases are all caused by some version of the?
herpes virus
127
a ______ virus, once in the body, ______ leaves the body.
- herpes, never
- hides out in the nerves and doesn't come back out most of the time
128
herpes viruses that DO come back out (the exceptions)
- genital and oral herpes
- shingles
129
varicella (chicken pox)
- very contagious - spread via direct inhalation of virus from infected person exhaling, sneezing, etc.
130
varicella manifests as _______ (______) that begin on _____ and move ____ and have diff stages of development. they appear, break, and crust in _____ at _____ times.
- vesicles (fluid-filled blisters)
- trunk, outward
- clusters
- different
131
person is contagious with varicella until?
the last lesion crusts
132
mortality in varicella
very low unless immunocompromised
133
_____ vaccine for varicella now part of?
chicken pox, normal immunization schedule
134
pox and pox diseases developed because?
they leave pockmarks - scars from pustular lesions
135
variola (small pox)
very contagious, inhaled virus, manifests as vesicles but diff look/pattern than chicken pox
136
variola/small pox lesions are _______ that are all _____ stage, start in ______ and _____ and move toward _____.
- dense clusters
- the same
- face and extremities
- trunk
137
depending on type of small pox virus, a person may get?
- high fever
- severe flu-like S&S
- painful pustules in moth and esophagus
- sometimes hemorrhage from virulence of variola virus toxin
138
variola state in world
eradicated (except in certain labs - possible bioterrorist use)
139
after having chicken pox, varicella virus remains in system _____, becoming _____ in nervous system like _____.
- for life
- dormant
- herpes simplex
140
zoster (herpes zoster, shingles)
in some people, especially elderly and/or immunocompromised peeps, varicella virus will pop out as painful lesions of skin along a dermatome
- single episode
141
tx of zoster
antiviral meds and creams
142
arthralgia
joint soreness
143
myalgia
muscle soreness
144
influenza (flu)
acute viral illness of upper/lower resp system w/ S/S of fever, chills, myalgia, malaise, dry cough, headaches
145
flu is _____ and usually ___ serious except in certain people of ______, who are?
- self-limiting
- not
- high-risk
- very young, elderly, chronically ill and debilitated, immunocompromised persons
146
epidemiology of flu (transmission and time of occurrence)
- transmitted airborne resp droplets + occurs primarily in winter months
147
epidemiology of flu - type A
- circulates yearly
- epidemics every 3-5 yrs
- major pandemics every 25-35 yrs due to major mutations
148
epidemiology: _____ flu outbreaks almost always being in ____ countries that have ____ of people that live close to _____, such _____ such as pigs/birds are the _______ _____ for the flu.
- yearly
- Asian
- animals, animals
- natural reservoir
149
pathogenesis of Type A flu
1). single stranded RNA virus w/ proteins on viral cell envelope called neuraminidase + hemagglutinin
2). proteins catalyze process of viral invasion of resp cells, replication, and release of new viral progeny
3). each time new progeny released, host cell dies
4). necrosis of superficial resp cells and inflammation
5). S/S and host susceptible to bacterial pneumonia
150
it is the _____ and ____ viral proteins that mutate and cause yearly changes in Type A viral makeup - what is this change called?
- neuraminidase and hemagglutinin
- antigenic drift or shift, depending on how major the change is
151
usually, an ____ designation is given according to the type of mutation. give example of nomenclature based on mutation.
- HN
- H5N1: avian flu
152
each year, _____ _____ is made according to the new designation.
new vaccine
153
infectious diseases of GI tract also called? why?
- infectious enterocolitis or infectious diarrhea
- microbe causes varied degrees of diarrhea and sometimes inflammation and ulcerations of the intestines
154
in developed countries, GI infectious diseases usually _________ except in?
- mild, self-limiting
- young, elderly, immunocompromised patientsG
155
GI infectious diarrhea transmitted by?
- oral/fecal route
- pathogens excreted from infected person's gut and enter GI tract of another person through mouth
156
example of transmission of infectious diarrhea
ingesting contaminated food or by touching contaminated surfaces and then touching mouth
157
tx of infectious diarrhea
abx and fluid replacement
158
viral etiology of infectious diarrhea
- mild S/S of vomiting + watery diarrhea
- sometimes "stomach flu" but is not true influenza
159
bacterial etiology of infectious diarrhea
- causing non-bloody (watery) diarrhea
- spectrum of severity
160
examples of organisms causing bacterial enteritis
- E. coli
- salmonella
161
E. coli
- certain strains can be ingested in undercooked meats and other foods
- certain forms normally found in intestines do not cause diarrhea
162
salmonella
- cows/chickens reservoir and carry it in guts - spread in their stool
- transmitted thru feces-contaminated beef or chicken that is not cooked properly (milk and eggs also)
163
dysentery
infectious diarrhea when it is bloody and severe
164
types of dysentery
- bacillary dysentery
- amoebic dysentery
165
bacillary dysentery
etiology is bacillus - most common is shigella
166
amoebic dysentery
etiology is protozoa found in water
167
patho/S&S of dysentery
- microbes cause damage to mucosal surface of the gut
- diarrhea has blood + mucous and pain w/ bowel movements bc infection/inflammation of intestinal lining
168
other S/S of dysentery
fever and dehydration
169
giardiasis transmission
- caused by giardia protozoa
- usually contacted by drinking contaminated water (well-water, river water, etc.)
- can be transmitted person to person by oral/fecal route
170
patho and S/S of giardia infection
after ingestion, giardia adheres to intestinal wall and interferes w/ fat absorption - fat goes to stool
171
giardiasis diarrhea is?
greasy, frothy, full of fat, foul smelling, but NAWT bloody (no blood bc doesn't invade intestinal wall)
172
giardiasis can last _____ to ____, but once identified, what tx?
- months to years
- easily fixable w/ antibx
173
antibiotic-associated diarrhea also called
pseudomembranous colitis
174
colitis
inflammation of colon
175
pseudomembranous
as part of infection, causes internal lining of intestines to develop yellowish membrane-like debris
176
antibx-associated diarrhea caused by?
- long-term antibiotics
- wipes out normal gut flora -> Clostridium difficile (C-diff) moves in and cause inflamed intestines
177
antibx associated diarrhea most common cause of?
iatrogenic/nosocomial diarrhea
178
tx for antibx associated diarrhea
- stop antibiotics
- IV fluids
- put on other c-diff specific antibx
179
antibx associated diarrhea: infection can _____, no _____
reoccur, prevention
180
leukemia
type of cancer of hematopoietic system in which there is uncontrolled proliferation of leukocytes, causing over-crowding of bone marrow and decreased production of normal hematopoietic cells
181
S/S of leukemia
- leukocytosis: WBC count high (50000 when norm is 6 to 10000)
- thrombocytopenia: easy bleeding + bruising
- anemia: fatigue, SOB
- ease of infection bc WBC immunocyte fxn impaired
182
leukemia is classified according to _______ (____ vs ____) and the _____ (either ____ or ____).
- predominant cell (myeloid vs lymphoid)
- onset (acute or chronic)
183
multiple myeloma
type of cancer that is mostly idiopathic etiologically, but may also have genetic component
184
multiple myeloma: predominant cell involved in becoming cancerous is?
B-lymphocytes, specifically plasma cells
185
normally, plasma cells (__________) selectively produce immunoglobulins on ___________.
- cells that develop from B-cells and secrete immunoglobulins
- as-needed basis
186
multiple myeloma pathogenesis
1). some plasma cells become malignant and begin overproducing immunoglobulins
2). immunoglob. infiltrate bones mainly
3). cause multiple malignant tumors that increase osteoclastic activity
187
osteoclasts are ____ cells that normally migrate along _______ walls and _____ bone cells when _____ is needed in the body.
- hematopoietic
- bone capillary
- chew up
- calcium
188
in multiple myeloma, osteoclasts go into _____ and chew up _____ bone cells than normal.
overdrive, more
189
w/ multiple myeloma, bones get ____ and pathologically _____ amt of calcium in the blood (_____).
weaker, high, hypercalcemia
190
S/S of multiple myeloma
- osteoporosis
- hypercalcemia
191
osteoporosis
pathological fractures (bone breakage from minimal stimulus)
192
hypercalcemia
s/s of confusion, lethargy, weakness, kidney stones + failure
193
tx of multiple myeloma
- chemotherapy
- radiation
- bone marrow transplantation
194
problems with erythrocyte fxn can be _____ or _____, or both.
- quantitative (alterations in numbers)
- qualitative (defect in quality of fxn)
195
general causes of alterations and defects of erythrocyte
- qualitative: genetic abnormalities like sickle cell
- quantitative: too few vs too many
196
anemias
disorder due to pathologically decreased number of RBCs (too few)
197
anemia definition
less than normal # of total circulating erythrocytes and/or decreased in quality/quantity of Hgb
198
anemia is the ____ of a disease process; ____ or ____ and/or can be considered a ____ of a disease. only certain cases it is considered a _________.
- RESULT
- state or condition
- SIGN
- disease process in itself
199
general etiologies of anemia
- decrease in erythropoiesis (bone marrow dysfxn, leukemias, hypersplenism)
- loss of RBCs (via hemorrhage and/or pathologic hemolysis)
200
classification of anemias are according to changes in?
- shape
- substance
- size
of RBCs
201
shape of RBCs anemia class
several anemia disorders which are caused by abnormalities in shape
ex: sickle cell anemia
202
substance of RBCs anemia class
reduced hemoglobin content - hypochromic anemia (less color)
203
size of RBCs anemia class
microcytic, normocytic, macrocytic anemias
204
diagnosis of an anemia and its classification by what test?
CBC (complete blood count)
205
CBC:
1). look at ____ count, norm is _______ in males. patient has anemia when ___ count is?
2). to name anemia, next look at ______ (____) which is the _____ of the RBC, normal range is?
1). RBC, 4-6 mil/L, <4 mil
2). MCV (mean corpuscular volume), size, 80-95
206
MCV count for
1). microcytic anemia
2). normocytic anemia
3). macrocytic anemia
1). MCV <80
2). MCV in norm range of 80-95
3). MCV >95
207
other #s you might see in anemic person's CBC
- low Hgb is <14 (norm is 14-18 gm/L)
- low hematocrit (Hct) is <42% (percentage of RBCs in blood) (norm is 42-52%)
208
polycythemias
- disorders due to pathologically increased number of RBCs (too many)
- disorder in which more than norm number of total circulating RBCs (erythrocytosis)
- 2 forms: primary and secondary
209
primary polycythemia
- aka: polycythemia vera
- rare condition in which there is slow development of hyperproliferation of bone marrow stem cells
210
tx of primary polycythemia
removal of 300 to 500 mL of blood 3-4 times per month
211
secondary polycythemia
compensatory increase in RBCs in resp to hypoxic conditions
212
hypoxic conditions that cause secondary polycythemia
- living in higher altitudes (>10000 feet)
- smoking (increased CO2 level)
- chronic low-O2 conditions (COPD)
213
mechanism of compensation of secondary polycythemia
1). low O2
2). body increases erythropoietin secretion
3). more RBCs made
214
on CBC, polycythemia is characterized by
1). RBCs > 6 million
2). hematocrit > 52%
215
problems related to over proliferation of RBCS most often are due to?
thickness of blood
- extra RBCs = sludge-like blood
216
sequelae of thick blood is?
high risk for distal tissue ischemia bc blood that is thick and slow moving (stasis) can increase chance of clots forming + blocking blood vessels
217
thickened blood can cause what on heart/lungs?
extra workload = higher risk for failure in these organs
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S/S polycythemia
- ischemic pain
- heart and lung failure related issues
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microcytic anemia
- anemia where size/MCV smaller than normal
- RBCs <4 mil and MCV <80
220
for microc. anemia, something causes body to ____, _____ ____ RBCs and being to ______ on material to make enough _____ replacement RBCs.
- slowly, chronically, lose
- run low
- full-sized
221
bc body runs low of materials to make full-sized RBCs in microc. anemia, the bone marrow tries to catch up by?
- churning out RBCs that are smaller/less mature
- compensatory resp not enough to bring up RBC #s, but better than nothing
222
examples of chronic, steady loss of RBCs
- women with heavy menses
- occult (hidden) GI bleeding
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sometimes, microc. anemia is called _____ because _____ is an essential part of _____ molecules which are lost w/ RBCs.
- iron deficiency anemia
- iron (Fe)
- Hgb
224
S/S microcytic anemia
- RBC <4 mil
- fatigue
- weakness
- sometimes SOB and dull mentation
^ common in most anemias
- specific to class: low MCV and low Hgb
225
tx of microcytic anemia
stop blood loss if possible and give iron supplements
226
normocytic anemia
- an anemia where size of RBC is normal
- RBC <4 mil and normal MCV
227
patho of normocytic anemia
- something cause RAPID blood blood loss, no time for compensatory resp of smaller RBCs (ex traumatic hemorrhage)
OR
- chronic dz cause slow-down production of RBCs - produced in norm size, but more slow and less in #s (ex AIDS, lupus, chronic renal failure)
228
S/S normocytic anemia
- common in most anemias: RBC <4 mil, fatigue, weakness, sometimes SOB and dull mentation
- specific to class: normal MCV
229
tx for normocytic anemia
- acute blood loss: stop loss if possible and give units of blood as needed to replace
- chronic disease: give GH erythropoietin to stimulate bone marrow to make more RBCs
230
macrocytic anemia
- aka megaloblastic anemias
- anemia where size larger than normal
- CBC: RBCs <4 mil, MCV >95
231
patho of macroc. anemia
- certain dz processes cause faulty DNA coding of RBC size
- RBCs larger than normal (don't fxn right)
- most common example if pernicious anemia
232
pernicious anemia
- most seen in elderly, patients w/ GI absorption disorders, ppl w/ inadequate nutrition (eg, alcoholics)
1). beings w/ diminished intrinsic factor (hormone made by parietal cell in stomach)
2). w/o intrinsic factor: vit. B12 cannot be adequately absorbed from digested food
3). w/o vit. B12: DNA malfxns and makes coding error in RBC creation
4). too few RBCs made + larger than normal
233
S/S of macrocytic anemia
- common: RBC <4 mil, fatigue, weakness, sometimes SOB and dull mentation
- class specific: MCV> 4mil, glossitis, neuropathies
234
glossitis
- tongue inflammation
- swollen, beefy red, smooth, painful tongue
235
neuropathies associated w/ macroc. anemia are most often seen in ____. example? caused by?
- legs
- paresthesia: pins/needles or burning
- lack of B12 as important nerve modulator
236
tx of macroc. anemia
usually B12 injection
237
fewer and/or deranged RBCs or Hgb means ____ in effectiveness of ____ getting to cells of tissues and organs for cellular metabolism.
disruption, O2
238
anemic patient will usually have S/S related to?
hypoxemia (lack of oxygen in blood)
239
type of S/S of anemic patient w/ hypoxemia
- slow/subtle if slow process and body able to compensate
OR
- immediate and severe if cause if sudden
240
reduced blood O2 (hypoxemia) causes ___ hypoxia, which can lead to?
- tissue
- SOB, weakness & fatigue, muscle cramps
- CNS effects: slow mentation, dizziness, lethargy, syncope (fainting)
- pallor of skin bc less RBCs traveling in skin capillaries - less pinkness
241
for any kind of bleeding deficiency, S/S will be similar, relating to ______, which can be ______ or _____.
- easy bleeding
- frank bleeding (obvious)
- occult bleeding (hidden)
242
where frank bleeding can happen
- under the skin
- GI bleeding
- mucous membranes
243
under the skin frank bleeding
- petechiae: pinpoint red spots that don't blanche
- purpura: larger areas that look purplish
- ecchymosis: collection of blood under skin greater than 1cm
244
frank GI bleeding
stools can be blood or black/tarry
245
frank mucous membrane bleeds
nose bleeds
246
thrombocytopenia
platelets (thrombocytes) deficient in number
247
causes of thrombocytopenia
- congenital problems (rare)
- nutritional
- certain drugs and chronic diseases
- autoimmune
248
autoimmune cause of thrombocytopenia
- IgG attacks platelets, diminish their effectiveness
- idiopathic thrombocytopenia purpura (ITP)
249
S/S thrombocytopenia
- platelet count on CBC <100,000 (norm is 150,000-400,000)
- easy bleeding
250
diseases that causes clotting factors to be defective or deficient in amount
- hemophilia
- von Willebrand disease (vWD)
- liver disease (cirrhosis)
251
hemophilia
refers to several possible different hereditary deficiencies of coagulation factors, usually X-linked recessive problem
252
S/S hemophilia
- spontaneous bleeding or bleeding that is out of proportion to amt of trauma
253
txs of hemophilia
- transfuse plasma - plasma has clotting factors
- transfuse concentrates of whichever clotting factor is deficient
254
von Willebrand disease (vWD)
- inherited disorder and most common clotting disease
- every 1 in 10 person has variation of it
255
example of von Willebrand factor
a type of vWF released by injured tissue that calls platelets and binds to them + to fibrinogen to promote clotting (platelet plug)
256
von Willebrand Factor (vWF) is found in the ____ and in the _____in ___forms
blood, tissue, various
257
S/S von Willebrand disease
- various types causes varied severity of S/S
- mostly very mild clotting deficiency w/ mild incidences of easy bleeding
258
example of S/S of vWD
some women manifest very heavy periods due to type of vWD
259
tx of vWD
usually none needed, or symptomatic
- certain more severe forms receive vWF transfusions
260
liver disease (cirrhosis)
- liver is site of protein synthesis including coagulation factors
- liver disease -> coagulation factors -> decreased ability to clot -> easy bleeding
261
thrombocytosis
- platelet greater than 400,000
- can be genetic myeloproliferative disorder or from secondary cause (RA, cancer, or after splenectomy)
262
thrombocytosis causes ______, which can manifest as ______ disorder, which is?
- hypercoagulation
- thrombotic
- proliferation of blood clot formation
263
thromboembolic disorders
- any combination of thrombocytosis and clotting factor overactivity
- thrombus and embolus
264
thrombus
an arterial or venous clot attached to vessel wall
265
embolus
an arterial or venous thrombus that has broken loose and travels in the circulator system
266
splenomegaly
enlargement of spleen
267
splenomegaly causes can be categorized as?
- hematologic
- infectious
- malignancies
- physiologic
268
hematologic splenomegaly
any time there is increased hemolysis of RBCs, the spleen can enlarge bc more RBC debris to process
269
examples of when hematologic splenomegaly occurs
- Rh blood type incompatibility (erythroblastosis fetalis)
- ABO blood type incompatibility
- hemolytic problems from drug rxns/autoimmune diseases that trigger antibody attack on RBCs or infections in which RBCs are attacked (malaria)
270
infection/inflammation splenomegaly
- viral: hepatitis, mononucleosis (epstein-barr virus), CMV
- bacterial: TB
271
malignancies splenomegaly
- esp leukemia
- huge #s of WBCs come thru spleen, cause it to swell
272
physiologic splenomegaly
- usually individualistic quirk
- idiopathic etiology
- no S/S
273
S/S splenomegaly
- palpably large spleen (normally can't palpate)
- may have pain
- may have hypersplenism
274
spleen is part of ____________, which phagocytizes old, damaged, or dead blood cells so parts can be ________; also _______ come through and are _______ of blood.
- mononuclear phagocytic system (MPS)
- recycled
- microorganisms
- filtered out
275
hypersplenism
- condition that results from splenomegaly
- due to enlarged spleen, RBCs+ WBCs + thrombocytes trapped there (sequestered)
276
all the cells trapped in the spleen (hypersplenism) begin to be _______, _______ en masse. what are the two sequelae from this?
- chewed up, destroyed
- spleen more engorged and enlarged
- pancytopenia: low #s of all cells in blood
277
S/S hypersplenism
- anemia
- increased risk of infection
- easy bleeding
