Test 1 Flashcards
1
Q
Chronic inflammatory disorder of the airways
Causes airway hyper-responsiveness leading to sneezing, breathlessness, chest tightness, and cough.
A
Asthma
2
Q
Major precipitating factor of an acute asthma attack:
↑ inflammation hyper-responsiveness of the tracheo-bronchial system
Can last 2–8 weeks
vaccines are recommended for children 6 months and older and adults with asthma
A
Influenza
3
Q
Allergens
Exercise
Respiratory infections
Nose and sinus problems
Drugs and food additives
GERD (Gastro-esophageal reflux disease)
Air Pollutants
Emotional Stress
are all examples of
A
Asthma triggers
4
Q
Unpredictable and variable
Expiration may be prolonged
Wheezing is unreliable to gauge severity
Cough variant asthma
Cough may be non productive
Difficulty w airmovement
A
Clinical manifestations of Asthma
5
Q
Cough is the only symptom.
Bronchospasm is not severe enough to cause airflow obstruction
A
Cough variant asthma
6
Q
Particularly at night or early morning
Could be abrupt or gradual
Could last minutes to hours
A
Coughing w asthma
7
Q
Inspiration – expiration ratio of 1:2 to 1:3 or 1:4
Bronchospasm, edema, and mucus in bronchioles narrow the airways
Air takes longer to move out
A
Prolonged expiration (asthma)
8
Q
An ___________ attack usually reveals signs of hypoxemia:
Restlessness
↑ anxiety
Inappropriate behaviour
A
acute athma
9
Q
↑ pulse and blood pressure
Pulsus paradoxus (drop in systolic BP during inspiratory cycle >10 mm Hg)
Respiratory rate > 30 breaths/minute
A
Signs of hypoxemia (asthma)
10
Q
Life threatening asthma: Clinical manifestations are similar to those of non-severe asthma but are more ________ and _________.
A
Serious; prolonged
11
Q
May include pneumothorax, pneumomediastinum, acute cor pulmonale with right ventricular failure, and severe respiratory muscle fatigue that leads to
A
respiratory arrest
12
Q
Restlessness
↑ anxiety
Inappropriate behaviour
↑ pulse and blood pressure
Pulsus paradoxus
Respiratory rate > 30 breaths/minute
A
signs of hypoxemia
13
Q
Detailed history and physical exam
Symptoms – because wheezing and cough are seen with a variety of disorders, this complicates the diagnosis
Pulmonary function tests – variable airflow obstruction
Peak flow monitoring
CXR
ABGs
Oximetry
Allergy testing
Blood levels of eosinophils
Sputum culture and sensitivity
A
Diagnostic studies in asthma
14
Q
Stimulates sympathetic nervous system
Effects on respiratory tract
Carbon monoxide
Passive smoking (secondhand smoke)
A
Effects of nicotine
15
Q
Increases HR
Causes peripheral vasoconstriction
Increases BP and cardiac workload
Compounds problems in CAD
A
Nicotine: Stimulates sympathetic nervous system
16
Q
Increased production of mucus
Hyperplasia of goblet cells
Lost or decreased ciliary activity
A
Nicotine: Effects on respiratory tract
17
Q
↓ O2 carrying capacity
↑ Heart rate
Impaired psychomotor performance and judgement
Nicotine can have these effects because of ________:
A
Carbon monoxide
18
Q
↓ Pulmonary function
↑ Risk of lung cancer
↑ Rates of mortality from ischemic heart disease
A
Nicotine: Passive smoking COPD (second-hand smoke)
19
Q
COPD can develop with intense or prolonged exposure to:
dusts, vapours, irritants, or fumes.
high levels of air pollution.
These are examples of ______ chemicals
A
Occupational chemicals and dust COPD (risk factors)
20
Q
Recurring infections impair normal defense mechanisms.
Risk factor for COPD
Intensify pathological destruction of lung tissue
HIV infection
TB is a risk factor
A
Infection COPD (risk factors)
21
Q
α-Antitrypsin (AAT) deficiency
Genetic risk factor for COPD
Severe AAT deficiency occurs in 1 in 5000–1 in 5500 of Canadian and North American population
A
Herdity COPD (risk factors)
22
Q
Some degree of the same symptoms of emphysema is common because of physiological changes of aging lung tissue.
A
Aging COPD (risk factors)
23
Q
Develops slowly
Diagnosis is considered with
cough.
sputum production.
dyspnea.
Underweight w/ adequate calories
Anorexia
Chronic fatigue
Polycythemia & cyanosis
A
COPD Clinical Manifestations
24
Q
Prolonged expiratory phase
Wheezes
Decreased breath sounds
↑ Anterior–posterior diameter
A
Physical examination findings (COPD)
25
COPD long term ______ therapy improves:
prognosis.
mental acuity.
exercise tolerance.
sleep
oxygen
26
An autosomal recessive, multisystem disease characterized by altered function of the exocrine glands of the lungs, pancreas, and sweat glands
Abnormally thick, abundant secretions from mucous glands lead to a chronic, diffuse, obstructive pulmonary disorder in almost all clients.
Cystic fibrosis
27
Exocrine pancreatic insufficiency
Sweat glands excrete increased amounts of sodium and chloride.
Mutations on chromosome 7 - alters transport of sodium & chloride in the sweat
Cystic fibrosis
28
Chronic fatal respiratory disease
The most common genetic disease among White people in Canada
cystic fibrosis
29
Etiology and pathophysiology
Obstruction of ducts of the exocrine system is caused by thick, viscous secretions – these adhere to lumen of the ducts which eventually undergo fibrosis
URTI may present and include chronic sinusitis, and nasal polyposis
Thick secretions obstruct bronchioles, leading to air trapping and hyperinflation.
cystic fibrosis
30
pseudomonas aeruginosa
Most common organisms cultured in Cystic fibrosis
31
Progressive loss of lung tissue from inflammation and scarring which results in chronic hypoxia that leads to pulmonary hypertension and cor pulmonale.
cystic fibrosis
32
Blebs and large cysts in lungs are severe manifestations of _______ in CF
destruction
33
Nursing diagnoses
Ineffective airway clearance
Ineffective breathing pattern
Impaired gas exchange
Imbalanced nutrition: less than body requirements
Ineffective coping
Cystic fibrosis
34
Past definitions of COPD included the terms chronic bronchitis and _______
emphysema
35
a progressive lung disease caused by over-inflation of the alveoli (air sacs in the lungs)
emphysema
36
an umbrella term used to describe a group of lung conditions (emphysema is one of them)
COPD (Chronic Obstructive Pulmonary Disease)
37
Received blood transfusion or clotting factors before 1985?
Shared needles, syringes, or other injection equipment with another person?
Had a sexual experience with your penis, vagina, rectum, or mouth in contact with these areas of another person?
Had a sexually transmitted infection (STI)?
Questions to ask someone at high risk for HIV
38
↓ Autoantibodies
↓ Cell-mediated immunity
↓ Delayed hypersensitivity response
↓ Expression of IL-2 receptors
↓ IL-1 and IL-2 synthesis
↓ Primary and secondary antibody
responses
↓ Proliferative response of T and B
cells
Thymic involution
Effects of Aging on the Immune System
39
________ are lined with smooth muscle that controls the amount of air entering the lungs.
Bronchioles
40
Dilation and constriction of the airways are controlled by the ___________ nervous system
autonomic
41
produce a fine mist to be inhaled by mask or a handheld device.
Nebulizers
42
inhaler that delivers a fine powder
Dry powder inhaler (DPI)
43
use of a propellant to deliver a measured dose of drugs to the lungs during a breath.
Metered dose inhalers (MDI)
44
______ and ______ are medications that dilate bronchi
Beta-adrenergic agonists; anticholinergics
45
drugs of choice in the treatment of acute bronchoconstriction
Beta-adrenergic agonists
46
Used to prevent and treat wheezing, difficulty breathing, chest tightness caused by lung diseases such as asthma, and COPD
Beta-adrenergic agonists
47
Respiratory drug:
Ultra short acting
Immediate effect but lasts only 2-3 hours
(Isuprel)
Isoproterenol
48
Anticholinergic (muscarinic antagonist), causes bronchodilation by blocking cholinergic receptors in bronchial smooth muscle.
Atrovent (ipotropium)
49
Inhaled ________ used for the long term prevention of long term management.
Glucocorticoids
50
Inhaled
Beclomethasone
Pulmicorte
Flovent
Orally
Methylprednisolone
Prednisone
Glucocorticoids
51
For asthma or as a nasal spray for allergic rhinitis.
Reduces inflammation – not a bronchodilator.
Minimal systemic absorption of inhaled medication
Half life of 1.5 hours
Local effects may include voice hoarseness
A large percentage of long term beclomethasone users will develop candidiasis.
Beclomethasone (QVAR)
52
Inhibit the release of histamine from mast cells
Prophylactic use for asthma – ineffective for bronchospasm.
Maximum effect may take several weeks so must be taken on a regular daily basis.
Mast cell stabilizers
53
Newer drugs approved in the 1990s
They modify the action of leuotrienes, so they reduce inflammation and ease bronchoconstriction.
Asthma prophylaxis by reducing inflammatory component of asthma.
Leukotrines are mediators of the immune response that promote airway edema, inflammation, and bronchoconstriction.
Singular and Accolate – taken orally
Leukotriene Modifiers
54
______ for relieving cough due to colds:
They dampen the cough reflex when treating coughs related to allergies or colds.
Good for dry hacking non productive coughs.
We don’t want to suppress the cough in emphysema and bronchitis.
Can be classified as Opioids or Non Opioids.
Opioids can cause significant respiratory depression.
Opioids can be combines with other agents such as antihistamines, decongestants and non opioids antitussives in cold and flu symptoms.
Codeine or Hydrocodone
Antitussives
55
Most common non opioids is ___________.
In a variety of cold and flu preparations.
Available in a variety of formulations.
It acts in the medulla.
Non drowsy and non dependent.
Rapidly absorbed in the GI tract.
Onset with in 15 to 30 minutes – half life is unknown.
Crosses the blood-brain barrier.
Metabolites are excreted in urine.
(Non Opioid antitussive) Dextromethorphan
56
_______ - Benylyn, Balminil
Expectorants increase bronchial secretions by reducing the thickness, or viscosity of bronchial secretion – this increases mucus flow which makes it easier to cough up.
Guaifenesin – Benylyn, Balminil
57
Includes asthma, chronic bronchitis and emphysema.
A progressive disease with the terminal stage being emphysema (from years of chronic inflammation) – no cure!
The goals of treatment are to treat infections, control cough and relieve bronchospasms
Pharmacotherapy includes, bronchodilators, and sometimes mucolytics, expectorants, antibiotics and oxygen.
Opioids are avoided because of the risk of respiratory depression.
COPD
58
Involves two main processes. Ventilation moves air into and out of the lungs and perfusion allows for gas exchange across the capillaries.
Physiology of respiration
59
Pharmacotherapy focuses either on the bronchial constriction and or the inflammation component of _____
Asthma
60
a rapidly acting bronchodilator and is the first line medication in rescue inhalers that reverses airway narrowing in acute asthma attacks
Beta2-adrenergic agonist that causes dilation of the bronchioles.
MDI, 1-2 inhalations tid-qid/day (max 8 inhalations/day)
Can be given every 30 – 60 minutes until relief is obtained.
Nebulizer solution, 2.5mg tid-qid PRN
Salbutamol
61
Acts by selectively binding to beta2 - adrenergic receptors in bronchial muscle to cause bronchodilations.
When taken 30 to 60 minutes prior to physical activity – helps to prevent exercise induced bronchospasm.
Asthma maintenace therapy drug because of long effect
Takes 15 to 25 minute to act so not good for acute symptoms.
Half life of 3 – 4 hours
Salmeterol (Serevent)
62
Loosen mucus
Mucolytics
63
Produce thinner mucus
Expectorants
64
Suppress inflammation
Glucocorticoids
65
Inhibit histamine release
Mast cell stabilizers
66
Suppress cough
Antitussives
67
Side effects – irritability, nervousness, tachycardia, insomnia and anxiety are common side effects of __________ bronchodilators that result from sympathetic nervous system stimulation.
Beta-adrenergic agonists
68
An older alternative to beta agonist for the treatment of asthma
Methylxanthines and anticholinergics
69
are older established drugs (Aminophylline, theophyline).
Side effects include nausea and vomiting, and CNS stimulation and dysrythmias.
methylxanthines
70
One _________ (Atrovent) has widespread use.
anticholinergic
71
help to loosen thick bronchial secretions by breaking down the chemical structure of mucus molecules - cause thick secretions to become thinner.
(Acetylcysteine – Mucomyst)
Mucolytics
72
relax bronchial smooth muscles resulting in lower airway resistance
easier breathing for patients.
Inhaled produce little systemic toxicity because only small amounts of the drugs are absorbed.
Beta-adrenergic agonists
73
Respiratory drug:
Medication acts quickly but last 5-6 hours
(Alupent, Orciprenaline)
Metaproterenol
74
Respiratory drug:
Medication acts quickly but last 5-6 hours
(Bricanyl)
Terbutaline
75
Respiratory drug:
Medication acts quickly but last 5-6 hours
MAXAIR
pirbuterol
76
Respiratory drug:
Med acts intermediate (not instant relief)
8 hours
Salbutamol (Ventolin)
77
Respiratory drug:
Lasts Up to 12 hours
Salmeterol
78
Given via inhalation with effects peaking in 1 – 2 hours and continue up to 6 hours.
Half life of 2 hours.
Less effective then the beta2 agonist –or glucocorticoids for an additive effect.
Sometimes used for nasal congenstion and chronic bronchitis.
Atrovent (ipotropium)
79
Oral ________ may be used to the short term management of acute asthma.
glucocorticoids
80
Inhaled___________ are first line therapy for asthma – they suppress airway inflammation without major side effects and help to prevent acute asthma attacks. (Evidence-based therapy for asthma)
glucocorticoids
81
the first mast cell stabilizer discovered. It is a safe alternative to glucocorticoids.
has a short half life of 80 minutes so must be inhaled 4 – 6 times aday.
Cromolyn
82
The 3 most widely used are:
beta-2 agonists – like salbutamol, salmeterol, formoterol and vilanterol.
anticholinergics – like ipratropium, tiotropium, aclidinium and glycopyrronium.
Types of bronchodilators
83
Genetic locks that keep cells functioning normally
Mutations that alter their expression can activate them to function as oncogenes
Proto-oncogenes
84
Regulate normal cellular processes such as promoting growth
Proto-oncogenes
85
Suppress growth of tumors
Tumour suppressor genes
86
Function to regulate cell growth
Suppress growth of tumours
Are rendered inactive by mutations
Result in loss of suppression of tumour growth
Tumour suppressor genes
87
Well differentiated
Usually encapsulated
Expansive mode of growth
Characteristics similar to parent cell
Metastasis is absent.
Rarely recur
Benign
88
Usually undifferentiated
Able to metastasize
Infiltrative and expansive growth
Frequent recurrence
Moderate to marked vascularity
Rarely encapsulated
Becomes less like parent cell
Malignant
89
Once ________, mutation is irreversible.
Not all mutated cells form a tumour.
Mutated cells become tumours only when they establish the ability to self-replicate and grow.
initiated
90
_____ may be
Chemical
Radiation
Viral
Carcinogens
91
Carcinogen effects in the stage of initiation are usually ________ and additive.
irreversible
92
Initiation
Promotion
Progression
Cancer development
93
Anatomical
Histological
Extent
are ways that ______ can be classified
Tumours
94
carcinomas
sarcomas
lymphomas
Anatomical classification
95
Grade 1
Grade 2
Grade 3
Grade 4
Histological classification
96
Stage 0
Stage 1
Stage 2
Stage 3
Stage 4
Extent classification
97
grading and severity
Histological analysis
98
Extent of disease (cancer)
staging
99
Change in bowel or bladder habits.
A sore that does not heal.
Unusual bleeding or discharge.
Thickening or lump in breast or elsewhere.
Indigestion or difficulty in swallowing.
Obvious change in wart or mole.
Nagging cough or hoarseness.
CAUTION - 7 Warning Signs of Cancer
100
Superior Vena Cava syndrome
Spinal Cord Compression
Third Space Syndrome
Intestinal Obstruction
Obstructive oncological emergency
101
SIADH
Hypercalcemia
Tumor Lysis Syndrome
Septic Shock
Disseminated Intravascular Coagulation
Metabolic oncological emergency
102
Cardiac Tamponade
Carotid Artery Rupture
Infiltrative oncological emergency
103
Common fears experienced by the patient with ________ include disfigurement, dependency, unrelieved pain, financial depletion, abandonment, and death.
cancer
104
CD4+ counts of 800–to 1,200 cells/μL are generally considered _________.
normal
105
Main goals for ____ drug therapy:
Decrease viral load
Maintain/raise CD4+ counts
Delay related symptoms and opportunistic infections
Prevent transmission
HIV
106
Nebulizers
Dry powder inhaler (DPI)
Metered dose inhaler (MDI)
Devices for Delivering Drugs via Inhalation
107
presence of two or more chronic illness that are not directly related to each other in a person at the same time.
Comorbidity
108
simultaneous occurrence of several chronic medical conditions in the same person, may or may not be related to each other.
Multimorbidity
109
Dose of one analgesic equivalent in pain-relieving effects compared with another analgesic
Equianalgesic dose
110
Fast-acting drugs for breakthrough
Long-acting drugs for constant pain
Scheduling analgesics
111
Dose adjustment based on assessment of the analgesic effect versus adverse effects
Use the smallest dose to provide effective pain control with fewest adverse effects
Titration
112
Transduction
Transmission
Perception
Modulation
Pain process
113
noxious stimuli cause cell damage with the release of sensitizing chemicals (prostaglandins, bradykinin, serotonin, substance P, histamine) - these substances activate nociceptors and lead to generation of action potential
Transduction
114
action potential continues from: site of injury to spinal cord, spinal cord to brain stem and thalamus, thalamus to cortex for processing.
Transmission
115
conscious experience of pain
Perception
116
neurons originating in the brain stem descend to the spinal cord and release substances (e.g. endogenous opioids) that inhibit nociceptive impulses
Modulation
117
Cardio
Respiratory
Sensory
Urinary system
Gastric Intestinal
Musculoskeletal system
Skin
Are all systems impacted when someone is at the _______
end of life
118
Gradual decrease in urinary output
Incontinent of urine
Unable to urinate
Physical manifestations of end of life (urinary system)
119
______ is a normal reaction to loss
Anger, guilt, anxiety, sadness, depression, despair, or a combination of these
Disruption in sleep, changes in appetite, physical symptoms, and illness
Grief
120
takes place before the actual death
Anticipatory grief
121
BE SENSITIVE
NO REPEATED UNNECESSARY ASSESSMENTS
PAIN AND RESPIRATORY STATUS
End of life
122
Can occur with difficulty breathing or diaphoresis at end of life
Anxiety
123
Jerking or twitching
Can occur with high dose of opioids
MYOCLONUS
124
At end of life
Related to dry skin, nutritional deficits, anemia, friction, immobility, shearing forces, incontinence
Skin becomes mottled, cool cyanotic as circulation decreases.
SKIN BREAKDOWN
125
an increase and growth of muscle cells
Hypertrophy
126
increased cell production in a normal tissue or organ
Hyperplasia
127
(of body tissue or an organ) waste away, especially as a result of the degeneration of cells, or become vestigial during evolution.
Atrophy
128
a process whereby one type of mature tissue is replaced by another type of mature tissue not indigenous to that organ or tissue
Metaplasia
129
the abnormal development of cells within tissues or organs
Dysplasia
130
Lack of cellular differentiation is considered a hallmark of cancer
Anaplasia
131
______ can cause cell damage from irreversible damage or altered function – without cell destruction.
injury
132
If the stimulus causing the damage is removed then altered function can be _________.
reversible
133
Hypoxia/ischemic injury
Heat and cold
Radiation
Electrothermal injury
Mechanical trauma
Chemical injury
Microbial injury
Immunological
Neoplastic growth
Normal substances
Causes of lethal cell injury
134
type of lethal cell injury
substances are released that injure or damage (antigen/antibody responses, inflammation)
Immunological
135
Type of lethal cell injury
cell destruction from the introduction of lethal toxins.
Bacterial
136
Type of lethal cell injury
viruses which can take over cell metabolism.
Microbial injury
137
This type of lethal cell injury can lead to cell death from altered cell metabolism.
Chemical Injury
138
Physical Injury which can damage cell and lead to cell ______
death
139
Apoptosis – the end of normal cell life.
Necrosis – everything else that causes an inflammatory response from the release of intracellular contents.
Two types of cell death
140
the end of normal cell life.
Apoptosis
141
Can occur from trauma, infection, ischemia, exposure etc.
Death of tissue
Necrosis
142
Programmed cell death
Apoptosis
143
Not normal in developed tissues; serious when many cells involved
Necrosis
144
Another form of necrosis is ____ which is necrosis of an appendage.
gangrene
145
There can be ___ or ___ gangrene.
dry; wet
146
____ action usually contributes to wet gangrene
dry gangrene can occur related to ____ diseases and the degenerative changes.
Bacterial; chronic
147
Is odorous and soft. When caused by trauma such as a crush injury or burn there is a sudden change in blood flow which can be fatal.
Wet gangrene
148
REMEMBER THAT ANY ODOR IS INDICATIVE OF ______ INFECTION.
BACTERIAL
149
The ________ cell action refers to the ability to protect itself.
protect by ingesting harmful foreign particles, bacteria and dead or dying cells.
phagocytic
150
monocytes, macrophages, neutrophils, tissue dendritic cells and mast cells.
The main types of phagocytes
151
______ from cell injury has either a:
Vascular response
Cellular response
Formation of exudate
Healing
Inflammation
152
______ of the inflammation depends on:
The extent or severity of the injury
The reactive capacity of the injured person
Intensity
153
Vascular response leads to vasoconstriction of the small arterioles.
↓
Injury site is sealed by platelets to form a fibrin platelet clot which then releases pro inflammatory mediators like histamine that causes dilation.
↓
With dilation there is increased blood flow to the area – hyperemia.
↓
Hyperemia causes increased capillary permeability causing fluid movement from
the capillaries into the tissue spaces – serous fluid.
↓
Serous fluid – inflammatory exudate which causes more pressure changes and more fluid to pull from blood vessels which is seen as edema.
↓
Serous fluid contains plasma fibrinogen that changes to fibrin that strengthens the blood clot that was originally formed by the platelets.
↓
The clot helps minimize blood loss and trap bacteria to help from spreading.
↓
WBC’s migrate to the site of inflammation – chemotaxis
Healing process
154
arrive to the site of inflammation in about 6 – 12 hours
*Short life span of 24 – 48 hours
*Bone marrow reproduces more
*Immature cells can be released to try and keep up with the demand - neutrophil bands)
Neutrophils
155
arrive 3 – 7 days after the onset of inflammation
*become macrophages when they enter the site
*They clean the area of debris before healing can occur.
*Long lifespan
*If the macrophages can not eat all the debris then they accumulate and encapsulate it by collagen leading to the formation of a granuloma. – we see this with TB
Monocytes
156
arrive later with their role being immunity.
Lymphocytes
157
– selective role in inflammation
-Released with allergic reactions
-Release chemicals that control the effects of histamine and serotonin
Eosinophils and basophils
158
Redness
Heat
Pain
Swelling
manifestations of inflammation
159
hyperaemia from vasodilation
Redness
160
increased metabolism at inflammatory site
Heat
161
change in pH; nerve stimulation by chemicals (e.g. histamine, prostaglandins); pressure from fluid exudate
Pain
162
fluid shift to interstitial space: fluid exudates accumulate
Swelling
163
a build-up of mucus in your nose and sinuses and phlegm in your throat.
Catarrh
164
______ exudate is a specialized type of inflammatory fluid that the body releases in response to tissue injury or inflammation
fibrinous
165
Redness, heat, swelling pain
Prodrome, chill, flush, defervescence
are things that happen when you have a _______
Fever
166
_______ – healing is done in 2 – 3 weeks with no residual damage
Subacute – Same as acute but lasts longer.
Chronic – injury persists and lasts weeks to years
Acute
167
Cytokines cause metabolic changes within the hypothalamus that is manifested as a _____.
Prostaglandin E2 (PGE2) increases temperature
Shivering, increased muscle tone, decreased perspiration from ANS increases temp.
Epinephrine increases the metabolic rate.
fever
168
-Increases phagocytosis by neutrophils
-Increase killing of microorganisms
-Increased proliferation of t cells
-Increases interferon activity ( body’s natural virus fighting substance)
Benefit of a fever
169
Prodrome
Chill
Flush
Defervescence
Stages of fever response
170
mild headache, fatigue, malaise, muscle aches
prodrome
171
“goose bumps” feel cold to increase the temperature
chill
172
vasodilation or a feeling of warmth
flush
173
sweating and a decrease in body temperature
defervescence
174
FINAL PHASE OF INFLAMMATION IS ________ WHICH CONSISTS OF
1.Regeneration
2.Repair – Healing
HEALING
175
replacement of lost cells and tissue
depends on the cell type
Regeneration
176
2. __________ Healing
Most common type of healing is when connective tissue replaces lost cells resulting in scar formation
Repair
177
A.PRIMARY
B. SECONDARY
C. TERTIARY
Types of wound healing
178
Margins like a paper cut
Margins can be approximated
A.PRIMARY
179
Margins cannot be approximated
Larger scar
Seen with chronic wounds, venous ulcers, trauma
B. SECONDARY
180
Delayed Primary
Wound need to stay open in order to heal.
May require surgical closure.
C. TERTIARY
181
Cause (surgical/nonsurgical)
Underlying pathology
Duration (acute or chronic)
Level of contamination
Depth of tissue (superficial; partial thickness; full thickness)
Wound classification
182
All of these things cause _______:
Nutrition (Deficiencies in Vit C, protein and Zinc)
Poor circulation
Smoking
Corticosteroids meds
Infection
Anemia
Obesity
Diabetes mellitus
Poor general health
Mechanical friction on wound
Cold tem
Excessive moisture
Delay of healing
183
- people at risk include people with malabsorption problems, have deficient intake, high energy demands
- Any with a 30% weight loss in the preceding 6 months is at risk
- Anyone with 10% weight loss in the preceding 2 months
NUTRITIONAL RISK
184
* Adhesions
* Contractures
* Dehiscence and evisceration
* Excess granulation tissue
* Fistula formation
* Infection
* Hemorrhage
* Formation of hypertrophic scars and keloids
* Collaborative care
* Drug therapy
* Nutritional therapy
Complications of healing
185
Initially cold for vasoconstriction
to decrease swelling, pain and congestion
After 24 – 48 hours heat to increase circulation to remove debris.
Compression Counters vasodilation and the development of edema after an injury
Support
Ice and heat
186
Decreases tissue metabolic need
Immobilization
187
Increases venous and lymphatic return
decreases edema
Reduces pain from engorgement.
Elevation
188
* Surgical
* when large amounts of nonviable tissue and sepsis is present.
* Mechanical –
* wet to dry dressing (debris sticks to the dressing and then removed)
* Wound irrigation
* ultrasonic
* Autolytic
* Hydrogels – promote softening
* Enzymatic
* Proteolytic enzymes applied to necrotic tissue – Santyl collagenase
* Biosurgical
* Medical grade maggots to digest dead tissue.
Cleaning and debriding
Types of debridement
189
* Depend on the extent of the tissue involved.
* Staged according to the deepest level of tissue damage
* ______________ (NPUAP) guidelines
Pressure injuries
A good indicator of quality care
National Pressure Ulcer Advisory Panel
190
Invasion of body by _____ virus
↓
Enters a cell and starts to duplicate
↓
The antigens on the surface are recognized by a macrophage - it eats the virus and now the virus antigen is displayed on it surface.
↓
The antigen is recognized by the T helper
cells and now they bind to the macrophage causing cytokines to be released.
↓
T helper cells and T cytotoxic cells multiply.
and B cells multiply and produce antibodies
↓
T cytotoxic cells and natural killer cells
destroy infected body cells
↓
The virus is marked by binded antibodies
for macrophage destruction
HIV
191
*CD4+ counts of _____ to _______ cells/μL are generally considered normal.
800–to 1 200
192
*Main goals
*Decrease viral load
*Maintain/raise CD4+ counts
*Delay HIV-related symptoms and opportunistic infections
*Prevent transmission
HIV Drug therapy
193
Skin and connective tissue and smooth muscle ______
regenerate
194
Cardiac muscle and severely damaged skeletal muscle is replaced with ___________
connective tissue
195
________ do not replicate or replace themselves they are replaced with scar tissue
Neurons
196
A delay in healing may be caused by deficiencies in _____, _____, & ______
Vit C, protein, & Zinc
197
(smoking) nicotine is a _________ and results in delayed wound healing
vasoconstrictor
198
__________ meds – impairs phagocytosis
Corticosteroids
199
________ – decreased oxygen - longer time requires for epithelization of the skins, maybe altered immune responses and slowed collagen synthesis, or impaired circulation and results in delayed wound healing
Anemia
200
________ – adipose tissue has less blood supply and results in delayed wound healing
Obesity
201
____________ – hyperglycemia causes impaired phagocytosis – also there is reduced oxygen and nutrients as a result of vascular disease and results in delayed wound healing
Diabetes mellitus
202
Poor general health results in poor ______
wound healing
203
Mechanical friction on wound – destroys ___________ and results in delayed wound healing
granulation
204
Cold tem – decreases __________ activity and results in delayed wound healing
cellular
205
_____________ – causes hyper granulations and results in delayed wound healing
Excessive moisture
206
can destroy a parasite’s cell surface because they contain highly caustic chemicals
Eosinophils
207
contain histamine and heparin that are released during inflammation
Basophils
208
________ – increased inflammation and further destruction and results in delayed wound healing
Infection
209
Repair of cellular damage,
Redistribution of cells in the cell cycle
Repopulation with normal cells
Reoxygenation of hypoxic tumor area.
The 4 Rs
210
Albuterol
Ventolin
Proventil
Levalbuterol
Are all ______ acting bronchodilators
Short acting
211
Salmeterol
Formoterol
Aclidinium
Tiotropium
Are all ______ acting bronchodilators
Long acting
212
Low PaO2 is an indicator of this condition
hypoxaemia
213
High PaCO2 is an indicator of this condition
inadequate alveolar ventilation
214
Impairs heart & lungs -> impacting circulation -> retention of fluid
Pulmonary hypotension
COPD
215
CHR
Chest X Ray
216
air can't come out of the lungs indicates an ________ problem
Obstructive
