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NUR 120 > Unit 2 > Flashcards

Unit 2 Flashcards

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1
Q

What does bone marrow consist of?

A

Red blood cells, white blood cells, stem cells, platelets

Lymphocytes (B and T)are generated from stem cells ( undifferentiated cells).

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2
Q

What does the spleen consist of, and what is the action of those locations?

A

Filters (lymphocytes, macro phages, antigens.)

Red pulp: old and injured red blood cells are destroyed.
White pulp: lymphocytes.

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3
Q

What is the purpose of lymph nodes?

A

Remove foreign material, and immune cell proliferation.

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4
Q

What are the two types of immunity? Explain.

A

Natural nonspecific innate: present at birth, first line of defense. Monocytes, macro phages, dendrite cells, NK cells, basophil’s, Eosinophils, granulocytes.
Inflammatory response. Chemical physical barriers (sweat glands, tears, saliva, skin)

Acquired adaptive: results of prior exposure through immunization, disease contraction.
B and T cells.
2 types:
Active: immune response developed by own body.
Passive: temporary immunity transmitted from source other than body (developed immune either by immunization or previous disease.)

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5
Q

What are the four stages of immune response? Explain.

A

1: recognition-immune system finds foreign antigen. Lymphocytes circulating with help of macro phages/neutrophils (both have receptor sites for antibodies and complement, coating micro organism, enhancing phagocytosis.)
2: proliferation-T cell brings message to nearest lymph node. Activating T = cytotoxic and B=antibody production.
3. Response -T cells attack. Humoral or cell mediated
4. Effector-response works, antibody connecting to antigen, complement, or killer cell success.

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6
Q

Differentiate humoral vs cell mediated response.

A

Humoral: production of antibodies by B cells. And antigen/anti-body binding. Immunoglobulins:
IgG
IgA
IgM

Cell: T cells primarily responsible. Thymus. Attack invader directly, carry blueprint to lymph nodes.

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7
Q

What are the characteristics of the three major immunoglobulins?

A

IgG (75%): appears in serum,blood-borne, tissue infections. Activates complement, enhances phagocytosis, crosses placenta.
IgA (15%): appears in body fluids, protects against respiratory, G.I., GU infections. Prevents antigen absorption from food. Passes through breastmilk for protection.
IgM (10%): intravascular zero, in first immunoglobulin produced in response to bacterial/viral infections, activates complement.

  • takes all three to fight.
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8
Q

What are the three lines of defense?

A

Skin, inflammatory response and immune response.

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9
Q

What are four disorders and the immune system?

A

Hypersensitivities:
-Type one: allergic anaphylactic reaction: anaphylaxis
-Type two: cyto toxicity reaction: blood transfusion reaction
-Type III: immune complex mediated reaction: autoimmune disorder
-Type four: delayed reaction: transplant, rejection, contact dermatitis.
Immunodeficiencies
Gamopathies
immunosuppression

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10
Q

Discuss hypersensitivities ( type 1-4)

A

Type 1: anaphylaxis- IgE release histamine,
Basophils (mast cells)
Effects based on amount of exposure.
Treatment: airway, IV, steroid/diphenhydramine/epinephrine/prednisones. Lay patient flat elevate legs remove stinger
(local or systemic)
Type 2: blood transfusion reaction. Myasthenia gravis. Cell and tissue damage
Check ABO, RH, blood types
Type 3: immune complex. Auto immune disorders (RA, lupus) changes in vascular permeability and tissue integrity.
Type 4: delayed-transplants, contact dermatitis, nickel

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11
Q

Discuss immunodeficiencies.

A

Primary: typically genetic, rare

Secondary: underline disease condition, malnutrition, Burns

ID patients at risk.

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12
Q

Discuss gammopathies.

A

Overproduction of immunoglobulins.

B cells abnormally go into bone tissue breaking it down.

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13
Q

Discuss immunosuppression.

A

Poor immune function (chemo, radiation)

Neutra phenic precautions

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14
Q

What are the 2 defining conditions of HIV?

A

Pneumocystis pneumonia

Skin ca-kaposis sarcoma

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15
Q

What is HIV? AIDS?

A

Human immunodeficiency virus
Acquired immunodeficiency syndrome

Bloodeborne dz, retrovirus (Carry genetic material as RNA)
Obligate parasite (can't live unless in a living cell)
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16
Q

What are the major symptoms ofHIV?

A

candidiasis:
Thrush
Recurrent vag. Yeast infections

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17
Q

How is hiv transmitted?

A 
Body fluids (blood, seminal fluid, vaginal secretions, amniotic fluid, breastmilk)
That contain free virions an infected CD4 T cells.

1-attachment: glycoprotein (envelope coating HIV) binds with CD4 (t cells, mono, dend, microglia).
2-Uncoating: viral core (two RNA strand, and three enzymes: reverse transcriptase, integrase, and protease) enter host cell.
3-DNA synthesis: HIV changes to DNA (using reverse transcriptase) carrying instruction for viral replication.
4-integration- viral DNA enters nucleus (integrase)
5-transcription-DNA forms RNA building new virus.

Replication process occurs, losing CD4 count and integrity of own body

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18
Q

What are the two lab techniques to determine the presence of antibodies to HIV?

A

EIA/ELISA: (first)

Western blot: (second) supplemental for a positive result. More sensitive.

CD4: (measures damage) markers on lymphocytes in which HIV kills. Normal 700 to 1000. (Major determinant of initiating a RT and prophylaxis for opportunistic infections.

Viral load:(measures activity) measures plasma HIV RNA levels

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19
Q

What is HAART? And classifications based on MOA?

A

Highly active antiretrovirals therapy

Reduce plasma HIV RNA to lowest level possible

NRTI
NNRTI
Protease inhibitor
Entry inhibitor
Integrase inhibitor
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20
Q

What factors effect human emotional reactions to cancer?

A

Personality
Education
Culture

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21
Q

What is the emotional reaction to learning of ca dx, and the effects on the body?

A

Intense fear (mostly)
GES-generalized stress reaction
Inc. thoughts, HR, BP, insomnia, anxiety

Prolonged and episodic (SNS)
Inc infection risks

Anger-spiritual distress-denial

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22
Q

What are the patterns of occurrence of cancer?

A

Gender-male
Age-elder
Site-glandular
Geograph-industrial nations

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23
Q

DIff the 3 levels of nursing care.

A

Primary-actually preventing-vaccination
Secondary-screening, genetic testing
Tertiary-limit spread, control symptoms

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24
Q

What are the associated viruses and bacteria r/t ca?

A

CMV, EBV, HPV, HIV, Hep b and c

H. Pylori-stomach ca

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25
What are the 7 warning signs to instruct the clients to watch for in ca detection?
``` CAUTION: Change in bowel/bladder habits A sore that doesn't heal Unusual bleeding or d/c Thickening or lump in the break or elsewhere Indigestion or diff swallowing Obvious changes in warts or moles Nagging cough or hoarseness ```
26
Normal cell growth and proliferation is? And controlled by?
Orderly, limited cell division, specific, adhere tightly together, non-migratory, euphloid Proteins
27
What are the different types of abnormal cell growth r/t cancer?
Hyperplasia-rapid growth, inc number of cells Dysplasia-become tougher, displaced Anaplasia-growth when cells lack characteristics and differ in shape/organization, reconvert (malignant). Neoplasia-uncontrolled cell growth not following physiologic demand. (Malignant neoplasm) Metaplasia-enlarged cell, lose function, convert. (Chronic exposure)
28
What are host and environmental risk factors r/t ca?
Host: genetics, hormonal, immunologic Environ: - physical/chem-tobacco, alcohol, exposure - radiation-UV - lifestyle-occupation hazard, obesity, nutrition (red meats, charred food, processed food)
29
What are the 3 phases of carcinogenesis?
Initiation-carcinogens cause mutation in cell DNA Promotion-repeated exposure cause proliferation/expansion (benign lesion) Progression -altered cell increase in malignant behavior (angiogenesis, metastasis)
30
What are oncogenes? What can over expression cause?
Direct vital cell function, growth/differentiation Malignant cell growth (Tumors suppression genes turn off unneeded cell growth)
31
What is growth factor and doubling time?
Gf- ratio of dividing cell vs resting cells in tissue mass Doubling-time it takes for the total mass of cells in tumor to double
32
What are the grades of tumors?
``` gX-cannot be assessed g1-well diff g2-mod diff g3-poor diff g4-very poor diff ```
33
Define the TNM staging.
T-tumor size (0-4) N-nodes effected (0-4) M-metastasis (X, 0, 1)-cannot be determine, no metas, dist. Metas.
34
What are the steps of metastasis?
Malignant transformation Tumor revascularization Blood vessel penetrations Arrest and invasion (Most common sites:lymph nodes, liver, lungs, bone, brain)
35
What is carcinoma in situ?
Malignant but caught before metastasis. (Stage Tis)
36
Define these conditions: | leukocytosis, leukopenia, thrombocytopenia, pancytopenia.
Leukocytosis-inc wbc (infection) Leukopenia-dec wbc (dz) Thrombocytopenia-dec platelets Pancytopenia- dec in all 3
37
What are the paraneoplastic syndromes?
Endocrinologic-SIADH (ADH keeping NA/Water), cushings (ACTH), hyper calcemia ( Hematologic-thrombosis, endocarditis (prod of procoag factors) Neurological-autoimmune prod of antibod Dermatological-skin changes
38
What are the 3 types of tissue bx's?
Excisional(punch, shave) Incisional (bigger) Needle
39
``` What are the purposes of the following labs for ca? PSA CA-125 AFP CEA Hmg hmt ```
Tumor marker ID: PSA-prostate ca CA-125-ovarian ca AFP and CEA-fetal antigens expressed by liver ca. Hgb-o2 carrying rbcs Hmt-percent of rbcs Leukocytosis-immune response, infection Platelets-protect against bleed, indicate bleed
40
``` What are the purposes of the following labs? Hormone-calcitonin Electrolyte-calcium Enzyme-gastrin, alt, ast ALP ```
1. Controls calcium, potassium. Elev. w/ some ca's 2. when CA cells die, released calcium 3. stim secretion of gastric acid. AST/Alt-detect liver injury. 4. elev. w/ new bone growth, bone/liver metastatic dz
41
Diff the 3 therapies of CA tx
Radiotherapy-localized tx, kill tumors, dec size (DNA damage) Immunotherapy-tissue typing, enhance put immune sys. Tumors assoc. antigen Chemotherapy-whole body tx to target tumor cells spread, done in cycles
42
What are the standard radiation se?
Anorexia/nausea Diarrhea Fatigue
43
What are some types of chemotherapy agents?
Alkylating agent-lymphoma, brca, multiple myeloma Anti metabolic agent-leukemia, colon, lymphoma Natural product Anti tumor antibiotic-leukemia, testicular ca Hormone-mon Cbc, blood glucose, give w/food, leukopenia precaution
44
What are the common se of chemo?
Extreme fatigue, n/v, alopecia, cardiotoxicity, neutropenia, dec rbcs wbc and platelets.
45
What is the benefit of stem cell transplantation? And the 3 types?
Boost immune and replace unhealthy tissue 1. Allegenic-from donor 2. autologous-save own plasma for later use 3. syngeneic-twin.
46
What are the 4 oncologic emergencies?
Superior vena cava syndrome Spinal cord compression Hypercalcemia Tumor lysis syndrome
47
What occurs in SVCS, manifestations and nurse management?
Compression/invasion of SVC (assoc. w/lung pan liver ca) Sob, cough, edema face neck arms hands thorax, Jvd Mon. Cardiopulm, fluid volume
48
What occurs in spinal cord compression, manifestations, and management?
Metastatic paravertebral tumor extending into epidural space. Local inflammation, radicular back/neck pain, spasms, usually thoracic level, numbness/tingling, coldness, paralysis, loss of B and B
49
What occurs in hyper calcemia, manifestations and management?
Metabolic abnormality, ca released from bone more than kidney can excrete or bone can reabsorb. Fatigue, confusion, dysrhythmia, s/p chemo/ rad
50
What occurs in tumor lysis syndrome, manifestations and management?
Potentially fatal, s/p radiation/chemo cell destruction, big tumor Intracellular release. Massive effects on myocardium, kidneys, CNS. Aggressive fluid hydration before and after therapy
51
What results from radiation toxicity?
``` Skin:alopecia, derm Mucosa:stomatitis, dry mouth Anemia, Thrombocytopenia, leukopenia Sys:Fatigue, malaise, anorexia Late effects:loss of vascularity (ulceration, fibrosis, atrophy, necrosis) ```
52
What are important focused assessments for the oncology patient?
``` S/s infection S/s bleeding Skin problems Alopecia S/s nutritional problems Pain Fatigue Psychosocial issues Body image ```
53
How can the nurse prevent infection in the oncology patient?
``` Neutropenia precautions Hand washing Antibiotics admin timely Adequate nutrition and hydration Daily hygiene ```
54
How can the nurse decrease n/v in the oncology patient?
Avoid noxious stimuli (unpleasant sites,odors, sounds) Admin antiemetics (odansetron), premed prior to chemo, stay ahead of nausea PRN Small frequent meals, hydrate well pre/post chemo Admin softeners/anti diarrheal meds
55
What is myelosuppression and what is the nurses role in safe keeping this pt?
Bone marrow deppression by chemotherapy. Results in Dec wbc(leukopenia), RBC(anemia), platelets(thrombocytopenia), granulocytes(neutropenia) increasing risk for infection/bleeding. Hand washing, bleed precautions Avoid infections Mon wbc, temp, RBC, Hgb, hmt., platelets Use antibiotics, admin granulocytes, RBCs, Epoetin Alfa, platelets, plasma
56
What are the uncontrollable risk factors for breast cancer?
``` Age Personal/family hx Certain breast changes Genetic alterations Menstrual hx, late/no pregnancy Race Radiation, des exposure ```
57
What are the controllable risk factors for breast cancer?
``` Smoking/alcohol use Exercising Weight, nutrition Estrogen exposure Pregnancy earlier, breastfeed 6 months ```
58
What are physical indications of breast cancer tumor?
Lump-Nontender, fixed, hard w/ irregular border Skin dimpling, nipple retraction, skin ulceration Upper outer quadrant typical D/c from nipple
59
What are 2 types of malignant breast changes?
Carcinoma in situ (non invasive) Ductal and lobular Invasive carcinoma Infiltrating ductal and lobular
60
What are 2 types of cervical cancers?
Squamous cell Adenocarcinoma
61
What are the risk factors for cervical cancer?
``` Smoking (#1), diet, low socioeconomic status mult. Partners HPV exposure, HIV, chlamydia infections mult. Pregnancies Family hx DES ```
62
What are the RED flags in cervical cancer indication?
Abnormal vaginal bleeding Unusual d/c Bleeding post intercourse, douching, or pelvic exam Pain during intercourse
63
What are the 2 types of uterine cancers?
Endometrial Uterine sarcoma
64
What are the risk factors of uterine cancer? And additional risk for endometrial ca?
``` (More common in the elderly) Prior pelvic radiation therapy Race Hormone changes At least 55 y.o ENDO:obesity, nulliparity, late menopause, tamoxifen use ```
65
What are s/s of uterine cancer?
``` Bleeding/spotting D/c Pelvic pain/mass Irreg heavy bleed during menopause Low abd pain Back pain ```
66
What are the 3 types of ovarian cancer?
Germ cell tumor Stromal cells Epithelial cells
67
What are the risk factors for ovarian cancer?
``` Family hx (epithelial, brca, colorectal, ovarian) person h/o brca Age 40 Obesity Menstrual before 12 No preg, infertility 1st preg after 30 Meno after 50 1 in 70 risk lifetime Fert. Drugs Talc powder use Smoking/alcohol Estrogen/HRT ```
68
What are the RED flags for ovarian cancer to be aware of ?
``` Back pain Fatigue Bloating Constipation Abd pain/cramping Urinary urgency Prolonged abd swelling Pelvic pressure Vag. Bleeding Leg pain-(not good) ```
69
What are the proper assessment for skin lesions?
``` Color Redness/heat/pain Swellin Location, size, pattern of eruption Distribution ```
70
``` Diff between the following: Macule/patch Papule Nodules Tumors Vesicle Bulla Wheal ```
Macule-non palp flat darkened Patch=>1cm Papule-elevated palpable 1cm Wheal-elev mass, serous into dermis (insect bite/hives)
71
What type of dz is psoriasis?
Chronic Non infectious Inflammatory
72
What is impetigo?
Superficial bacterial infection, 2ndary to staphylococci, streptococci, or mult bacteria. Common in children. Contagious!

NUR 120 (6 decks)

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