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Flashcards in Unit Exam 3 Deck (61):
1

Immunity

The normal physiological response to microorganisms and foreign proteins

2

Inflammation

An immunologic defense against tissue injury, infection, or allergy

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Altered immunity

Could refer to either immunocompromised or deficient, or hypersensitivity. Suppression or exaggeration

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Inflammation

The body perceives a threat from injury or invader, the immune system triggers this response. Provides immediate protection against tissue injury and foreign proteins. Causes visible symptoms and can rid body of harmful organisms. Too much can cause damage

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The five cardinal signs of inflammation

Warmth
Redness
Swelling
Pain
Decreased functioning

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Suppressed immunity

Primary or secondary
Causes infection or cancer

7

Primary immunodeficiency

Disease process, within patients own body. For example, a COPD patient is more susceptible to respiratory illness

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Secondary immunodeficiency

Intentional - prevention of organ rejection
Adverse effects of treatment - a radiation patient suffers from immunosuppressive unintentionally as a result of the therapy needed to help destroy the cancer.

9

Exaggerated immunity

Four types:
1. Anaphylaxis
2. Graves’ disease. Tissues effected
3. Slow, lupus
4. Delayed, contact dermatitis, transplant reaction

Can be localized or systemic.

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Consequences of exaggerated immune response

Acute hypersensitive reactions
Localized
Systemic

Chronic body-wide system disease
Tissue destruction
Abnormal organ growth
Change in function

11

Health promotion

The process of enabling people to increase control over and improve their health. Future focused on nutrition, exercise, wellness education, and stress management.

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Primary prevention

Eliminating (trying to) the risk of incidence of disease from EVER occurring. Wellness promotion

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Secondary prevention

Early detection, early treatment, focuses on screening, at risk individuals, and preventing decline into full blown illness when health disparities occur.

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Tertiary prevention

Restorative, achieve highest possible level of functioning possible. Management of disease and symptoms. Life quality.

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Preventative services

Patient and community centered. Motivation.

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Health promotion interventions

Education
Immunizations
Screenings
Nutritional health
Physical activity
Smoking cessation
Weight loss

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Patient education for health promotion

The process by which we assist people to learn health- related behaviors in order to incorporate them into everyday life with a purpose of achieving he goal of optimal health and independence in self care.

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Goals of teaching

Maintain and promote health
Prevent illness
Restore health
Facilitate coping
Reduce costs

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Barriers to health teaching

Limited hospital stays
Limited interactions
Limited resources
Limited ability of patients to learn

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C.O.P.E. Model of teaching

Creativity
Optimism
Planning
Expert information

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Learning domains

Cognitive
Thinking, remembering, understanding, applying, evaluation. Storing and recalling knowledge

psychomotor
Coordination, physical skills

Affective
Attaching worth and value to new knowledge changing attitudes and feelings

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Special considerations for the elderly in teaching

Identify learning barriers
Allow time
Plan short teaching sessions
Accommodate sensory deficits
Reduce environmental distraction

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Eschar

Necrotic and dead tissue, must be derided before healing can take place

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Slough

Soft yellow, white, stringy tissue attached to wound bed. Must be derided before healing begins.

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Granulation tissue

Red, moist, composed of new blood vessels. Healing.

26

Four types of wound drainage

Serous
Clear, watery plasma

Purulent
Yellow, green, tan, brown, very thick, foul

Serosanguineous
Pale, pink, watery mixture of clear and red

Sanguineous
Bright red, active bleeding

27

First aid for wound

Hemostasis - control bleeding
Allow puncture wounds to bleed, never remove a penetrating object. Bandage
Clean gently with normal saline
Protect

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Nasal metabolic rate

Energy needed at rest to maintain life sustaining activities for specific amounts of time

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Resting energy expenditure

Amount of energy needed to consume over a 24 hour period for the body to maintain internal working activities at rest.

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Nutrients

Energy needed for the normal function of numerous body processes

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Carbohydrates

Complex and simple saccharides that provide the main source of energy. Simple carbs are sugars, where complex carbs are more fibrous

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Proteins

Amino acids necessary for proper nitrogen balance

33

Fats

Lipids.
Very caloric dense
Linolenic acid is essential for metabolism

34

Water

Fluid intake should always equal output
Water is essential for cellular function.

35

Vitamins

Organic substances present in small amounts in food, essential to normal metabolism. They act as catalysts in metabolic reaction. When there is enough vitamin for the body, the excess vitamin remains a free chemical and is often toxic. The body cannot synthesize vits. Can be fat or water soluble. Fat soluble vits are stored in the body so it’s possible to consume toxic amounts, whereas water soluble is more difficult to achieve toxicity. We need more water soluble vitamins due to the fact they aren’t stored.

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Minerals

Inorganic elements act like catalysts. Macro minerals are those in which the daily requirement is 100mg or more and trace elements or micro minerals is less than 100 mg daily. These macro minerals aid in ph balance. The excess of one mineral can cause deficiency of another.

37

Digestion

Mechanical breakdown that results from chewing, churning, and mixing with fluid and chemical reactions in which food is reduced to its simplest form.

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Absorption

The small intestine is the primary absorption site for nutrients. Passive diffusion, osmosis, active transport. And Pinocytosis. Carbs, protein, minerals, and water soluble vits occurs in the small intestine.

39

Metabolism

And umbrella term for all biochemical reactions within the body. Can be anabolic or catabolic, i.e. building or breaking down.

40

Anabolism

Is the building of more complex biochemical substances by synthesis of nutrients. For example, adding lean muscle through diet and exercise. Nutrients are anabolized into tissues, hormones, and enzymes. Normal metabolism and anabolism is physiologically possible in positive nitrogen balance.

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Catabolism

The breakdown of biochemical substances into simpler substances during physiological states of negative nitrogen balance. Starvation, for example, when wasting of body tissue occurs. The tissue is being catabolized into simpler forms to be used as energy.

42

The three main processes of nutrient metabolism

Catabolism of glycogen into glucose, carbon dioxide, and water (glycogenolysis)
Anabolism of glucose into glycogen for storage (glycogenesis)
Catabolism of amino acids and glycerol into glucose for energy (gluconeogenesis)

43

Developmental needs for nutrition

Infants need ALOT of protein, vits, minerals, and energy.

Just before adolescence, energy needs drop, but during adolescence, they rise again to compensate for growth, protein and calcium are keys here. Iron for girls especially. Iodine for thyroids b vits. Eating disorders crop up during this time.

Young and middle adults experience a reduction in nutrient needs, except during pregnancy and lactation. Protein and folic acid during pregnancy. B and c during lactation.

Older adults need less energy still because of decreased metabolism, but vits and mineral requirements stay unchanged throughout life. Older adults may have decreased sensation of thirst and hunger, reduced desire or ability to eat, or other factors that put them at risk for inadequate nutrient intake.

44

Gastric residual volumes

Should be measured every 4-6 hours in patients with continuous feedings, and immediately before feedings for patients receiving continuous feedings. Delayed gastric emptying is a concern if 250 ml or more remains in the patient’s stomach at two consecutive assessments (1 hr apart.) or a single grv measurement exceeds 500 ml.

45

Stopping enteral tube feedings

Lack of consensus
Should be stopped if patient is aspirating, withhold if grv is 500 ml or more, routinely evaluate for aspiration, pay special attention to aspiration risk if grv is between 250 and 500 ml.

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Parenteral nutrition

Nutrition given intravenously, usually though a central line.

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Pro kinetic meds

Increase gastric emptying, good for use during enteral tube feedings when feedings are not tolerated well.

48

Desiccation

Cells will dry out and die in a dry environment

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Mace ration

Overhydration

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Edema

Interferes with blood supply

51

Necrosis and dead tissue impairs wound healing

Yeah

52

Systemic factors affecting wound healing

Younger heals more rapidly than older

Nutrition, wound healing requires proteins, carbs, fats, vitamins, and minerals. Vits a,c, and zinc are essential for re-epithelialization and collagen synthesis.

Adequate blood flow to tissues is needed to deliver nutrients and oxygen as well as remove toxins, bacteria, and debris.

53

Obesity for wounds

Obesity causes tissues with more fat to have fewer blood vessels. Fat puts stress on the wound, fat makes suturing difficult, fat around wounds increases risk of infection and increases healing time. Contaminated wounds heal slowly.

54

The 6 anatomical landmarks for cardiac auscultation

Aortic is the 2ICSRight sternal border
Pulmonic is the 2ICS left sternal border
Erbs point is the 3ICS LSB
Tricuspid is 4ICS LSB
Mitral is 5ICS LSB

Epigastric

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Bruit

Narrowed blood vessels cause a blowing or whooshing

56

Jugular veins

Right internal has most direct path to right atrium. Supine position with distended jugulars signifies fluid volume overload.

57

Head of bed elevation for patients receiving enteral feedings

At least 30 degrees

58

Types of dressing for wounds

Gauze sponges are most common, absorbent and wick away exudate. 4x4 most common. Provides moisture while absorbing drainage. “Wet to dry”
Transparent film, good for small superficial, non infected, non draining wounds. Stage 1 pressure ulcer. Adheres to damaged skin, acts as barrier, permits viewing, no secondary dressing, autolytic debridement.
Hydrocolloid dressings, wound contact forms a gel as wound exudate is absorbed, maintains moisture, autoyltic debridement, 3-5 days, used in shallow to moderate dermal ulcers, leaves residue that is easy to confuse with purulent drainage.
Hydrogel gauze or sheet dressings impregnated with gel, Hydrates and absorbs exudate, for partial and full thickness wounds, do not adhere to wound bed.
Foam

59

Normal breath sounds

Bronchial: heard over trachea, expiration longer than inhalation, blowing and hollow

Bronchovesicular: heard 1-2 ICS between scapula, equal expiratory and inspiratory sounds, intermediate sounds.

Vesicular: heard in lung periphery, inspiration greater than expiration, soft and breezy sounds.

60

Adventitious breath sounds

Crackles or rales: heard in lower lungs caused by sudden reinflation of alveoli, high pitched.

Rhonchi: trachea, bronchi, lung fields chased by air flow obstruction, loud and low pitched.

Wheeze: heard in all lung fields caused by air flowing through narrow passages, high pitch continuous squeak.

Pleural friction rub: anterior lateral lung field, inflamed parietal pleura rubbing against visceral pleura, sounds graft,

61

Pulse measured

0-4

0 is not present, 2 is expected, and 4 is bounding