Pathophysiology EXAM 1

Von Willebrand Disease treatment

-*avoid aspirin because it causes bleeding and decreases platelet aggregation*, -desmopressin acetate, -form of vasopressin given intranasal to constrict blood vessels, also causes endothelium to release stored vWF and plasminogen activator.

Arteriovenous Malformation

-*developmental vascular anomalies* that result from failure of the embryonic vascular network to develop properly -tangled bed.

Megaloblastic

-*malshapened* and large -large cell means diseased cell

Nociceptive pain

-*stimuli* may cause *tissue damage* and include pressure, sharp objects, electric current or heat/cold applied to the skin. -Pain stimulus that causes tissue damage. Ex. Finger prick cause tissue damage and causes release of *mediators* that actually make you feel the pain. -NOCICEPTIVE pathways are composed of first, second, third order neurons.

Hemorrhagic Stroke

-13% of strokes -Most frequently fatal stroke. most fatal but less common -Spontaneous rupture of an intracerebral vessel -Creates hematoma -Could have burst aneurysm causing subarachnoid hemorrhage or torn artery causing intracerebral hemorrhage. -Vomiting and sudden headache at onset:"Worst headache of my life"

Chronic daily headache

-15 days or more in a month, could be due to medication overuse, caffeine, etc.

_____ of adults report recurrent headaches

-25%

Concussions

-30 million children in US at risk from playing sports -Many don't report symptoms right away -Prevention and early recognition are key

Ischemic Stroke

-87% of strokes - results from obstruction of cerebral blood flow by *thrombosis or emboli* -clot causing embolic stroke or plaque causing thrombotic stroke. Multiple types -thrombotic and embolic

Leukopenia and multiple etiologies

-A lower-than-normal white blood cell count is called leukopenia. A decreased WBC may be due to: *etiology:* -Autoimmune/ collagen-vascular diseases (such as *lupus erythematosus*), -Bone marrow failure (for example, due to infection, tumor, radiation, or fibrosis), -Disease of the liver or spleen

Cerebral aneurysms

-A saccular outpouching of a cerebral artery (accounts for most of cerebral vascular anomalies)

Adaptive immunity

-AKA specific or acquired -Second line of defense -Slower, more effective -Recognition, plan, attack (very methodical) Two types of responses: -Humoral: B lymphocytes create antibodies to halt progression into tissue -Cell-mediated: T lymphocytes activate phagocytes or kill host cells

Focal seizures WITHOUT Impairment of consciousness

-Limited to one hemisphere of the brain -Symptoms include: involuntary motor movements, somatosensory disturbances, or sensory disturbances. *Autonomic nervous system* may be affected (sweating, tachycardia, hypo/hypertension, pupillary changes) -Can be preceded by an aura

Iron deficieny anemia labs

-Low Hgb and Hct, decreased iron stores, low serum iron, low ferritin levels -microcytic: small cell -hypochromic low red color

Anemia

-Low numbers of RBCS, low hemoglobin, or low hematocrit indicates anemia, which can result from multiple etiologies. -not really disease but symptom

Alzheimer's diagnostic testing

-MRIs show widespread atrophy of the cerebral cortex and enlargement of the ventricles -Microscopic exam show neuritic (senile) *plaques*, degenerated nerve terminals and fibrillary *tangles*-proteins wound around each other. *Characterized by plaques and tangles*. Tangles keep neurons from communicating and causes cell or tissue death.

Treating Seizures non pharmacological

-MRIs, EEGs help diagnose *EEG's are gold standard* -Surgical options if medications fail -Neurostimulation (Kind of like pacemaker for the brain/Vagal nerve for focal seizures) -Diet (Ketogenic) more for pediatric patient.

Hemophilia A etiology and patho

-May be a family history, 30% of cases are new mutation in the Factor VIII gene -Patho: Expression of the effects vary with some producing almost no Factor VIII and others only having mild symptoms

Adhesion factors

-Microorganism's ability to attach and colonize host.

Nursing considerations for the post-stroke patient

-Mobile within 24 hours. Up and moving. -Assessment of ADL's. -Consult with PT/Nutrition/Social Work -Orient yourself to the non-affected side in order to ensure the patient can hear/see/interact with you more effectively -Help develop short and long-term goals. Wont be able to move or do what they could before. Need to help patient stay motivated* instead of focusing on what they cant do now. -Include family in education plans

Thalassemias Anemia

-Most common in the Mediterranean populations of Italy and Greece; also more common in Asians, Africans, Americans of African descent.

Most common leukemia in children

-Most common leukemia in children (2-4 yrs of age): acute lymphocytic leukemia

Ischemic stroke, thrombotic

-Most common type of stroke -*Artherosclerotic plaque* in brain near vessel bifurcations(divison of something into 2 division or parts) -Damage to the vessel wall from hypertension and diabetes results in clot formation...

Risk of Ischemic stroke

-Multiple risk factors including family history, HTN, obesity, smoking, a fib, chronic kidney disease

Prophalxis

-Necessary if migraines are disabling, occur more than 2-3 times a month, taken daily for months to years. -Beta-adrenergic blockers and anti seizure meds (stop overactive electrical signals) are *1st line* -taken daily so they dont occur

Prophylaxis

-Necessary if migraines are disabling, occur more than 2-3 times a month, taken daily for months to years. prevents migraines from occuring - Beta-adrenergic blockers and antiseizure meds are *1st line*. they stop overactive electrical signals in the brain. Medicine are 1st line. -helps migraines from not occuring. -taken daily

Infectious disease

-the process of *sustaining* injury or pathologic damage in response to an infection. Severity can range from mild to life-threatening

If hemoglobin molecule is fully saturated then that means...

-theres 4 chains and oxygen molecule is attached to each chain. -If blood is 100% saturated then everything is there that should be there. If 75% then that means *1 oxygen molecule is missing*. -Which is showed by STO value

hypochromic

-too little color -less heme

Hemoglobin molecule

-transports oxygen to various tissues. Main source of transport of oxygen. -iron attaches to hemoglobin molecule. -4 different chains. 4 hemes. 4 iron or Fé. -adds red to the cell (oxygen)

Antihistamines

-treatment for systemic anaphylaxis •Antihistamines block histamine release and treat symptoms such as edema, rhinitis, hives, etc. •Examples: diphenhydramine (benadryl), loratadine (Claritin), cetirizine (Zyrtec) -caution pts about drowsiness

Concussion diagnosis

Diagnosis made when any of the following signs/symptoms reported following head trauma: -Mental status change (amnesia or confusion) -Physical signs (fatigue, blurred vision, headache) -Behavioral effects (irritability or personality changes)

Stages of Alzheimer's

Early: •Short-term memory loss •Denied by the person •Random detail loss •Mild personality change •2-4 years Moderate: •Can last several years • Broader cognitive & higher cortical impairment •Language deficit, struggle w/ spatial relationships and problem solving •Depression • Unable to care for themselves •2-10 years Severe: •Loss of ability to respond to the environment •Total care •Bedridden •Death •1-3 years

Diagnosed for MS by

MRI(plaque in brain in body's attempt to making more myelin) and neuro exam

MCH

Mean corpusular hemoglobin

Caution for treatment of ischemic stroke

Need blood work bc tPA(see if candidate) is basically a clot buster**....need to make sure they aren't on blood thinners, having a hemorrhagic stroke, have good platelet levels, etc.

Diagnostic tools for seizure

Neurological deficit confirmed by: -Head CT without contrast -Neurological exam

Pain management interventions

Nonpharmacologic ◦Cognitive behavioral interventions. Used a lot for chronic pain. ◦Physical agents. Hot or cold treatments with sprained ankle. ◦Electroanalgesia ◦Acupuncture -try to use nonopioids first Pharmacologic ◦Use of drugs in the management of pain ◦Combination of narcotic and nonnarcotic analgesics as well as adjuvant medications ◦Analgesics help decrease/eliminate pain without causing unconsciousness, but *do not cure underlying cause* ◦Analgesics help make *pain tolerable. does not eliminate pain. ◦Long term use may cause a need for increase in dosage (tolerance) -most cases will not use opioids unless right after surgery or right before death or chemo.

NSAID

Nonsteroidal anti-inflammatory drug -inhibits COX enzymes

Internal Association for the Study of Pain def

Pain is an "unpleasant sensory and emotional experience associated with actual and potential tissue damage. " (2017).

Healing

Primary Intention ◦Sutured surgical incision. No tissue lost. Secondary Intention ◦Larger wounds (greater loss of tissue & contamination). Needs to be cleaned out and takes longer to heal because of tissue missing and then wound can be brought together.

Treatment of neutropenia

RX: Stop drug; give WBC transfusions (one day life for neutrophils

Seizure symptoms...

Symptoms depend on the neurons that are overfiring Sensory, motor (convulsion), autonomic, and psychic

symptoms of hodgkin's disease

Symptoms: Stage A- few sx: Stage B: Weight loss, fever, night sweats, fatigue

MS Treatment goals

Three goals: 1.Treat acute attacks 2.Modify the course of the disease 3.Treat symptoms Acute attacks-corticosteroids. Helps quiet immune system down. Disease-modifying- *Interferon B* as an immune booster and *glatiramer acetate* acts a myelin decoy. Says attack decoy and not the actual myelin.

Tissue healing

Tissue type: ◦Labile (continuously-dividing) -Readily regenerate if stem cell pool preserved (skin cells) ◦Stable (restricted dividing) -Capable of regeneration if proper stimuli (kidney cells) ◦Fixed (non-dividing) -Incapable of regeneration, fibrous scar switch (nerves)

Treating dementia

Treat any underlying cause that may reverse the dementia: -B 12 deficiency -Hypothyroidism -Drug toxicity -Brain tumors Recognize and treat problematic behaviors: -Agitation -Sleep disorder -Wandering

Disorders of Hemostasis and 2 main problems

Two main Problems: 1. Inappropriate blood clotting (thrombotic events). Thrombocytes 2. Inappropriate bleeding.

High Iron Diet

red meat, green leafy vegetables, fortified iron foods such as cereals;

Etiology

the cause of a disease

Patho

the process or what happens

passive immunity

we give antibodies to you. You didn't have to do any work. Momma gave it to you. Or direct injection of antibiodies. Ex. Hep B

Someone with kidney failure...

will be give erythropoietin via IV.

paleospinothalamic tract

ºAffects arousal, mood, attention ºAssociated with the mood-altering and attention-narrowing effect of pain ºActivates the *reticular activating system* (controls sleep/wake cycles) (RAS) -anterolateral pathway -paleo means slower (opposite of neo)

Patho of sickle cell

-*What occurs in the gene* -There is a *one point mutation in the hemoglobin molecule* with the substitution of *valine* for *glutamic acid* resulting in the abnormal *S* shape of the hemoglobin molecule

Inflammatory exudates

(various types of drainage. Mix of WBC and celluar debris exiting body) -Serous: clear, watery fluid. Usually just plasma. -Fibrinous: bloody, sticky meshwork. -Membranous: develops on mucous membranes, necrotic cells enmeshed in fibropurulent exudate -Purulent: yellow/greenish, contains pus which is composed of degraded WBCs, proteins, and tissue debris. -Sanguineous: red, leakage of red blood cells from capillaries. -Serosanguineous: pink (combination of serous and sanguineous)

Treating Seizures pharmacological

*Act by suppressing the over-firing of isolated neurons or inhibiting the transmission of electrical impulses* -Treat with benzodiazepine during seizure -More than 20 anti-epileptic drugs, *whenever possible only use 1* -*Can interact with OCPs, affect fertility, and cause birth defects* -65% don't fully respond to AED

Non Narcotic analgesics

*Aspirin, ibprofin and other NSAIDS* ◦Antipyretic and anti-inflammatory effect ◦Inhibition of COX-enzymes(cause swelling) to decrease pain. ◦Decrease sensitivity of blood vessels to bradykinin, histamine, decrease release of inflammatory mediators. -*asprin in adult (325 mg is 1 tablet) and usually give 2 tablets.* *Acetaminophen (Tylenol)* ◦Equal to aspirin and other NSAIDS but not anti-inflammatory response ◦Not an NSAIDS. ◦Not as useful for pain that has antifinfallmmtory characteriics.

WBC for innate

*Leukocytes* -macrophages, granulocytes aka neutrophils (most important cell in innate), eosinophils, basophils, and dendritic cells) -others are antigen-presenting (macs, dendritic) or related to parasite defence (eos and basos) -NK cells-first line of defense against viruses, can recognize tumor cells, abnormal body cells, intracellular pathogens -Cooperate together! -Innate fills in adaptive on what's going on, where it's happening, etc and stimulates a response from the adaptive lymphocytes

Treatment of hemorrhagic stroke

*Limit the spread of hematoma and manage intracranial pressure*. -As pressure goes up then occlusion to blood vessel and lack of blood to brain Surgery -Resection of AVM -Clipping of aneurysm IR (Interventional Radiology) -Endovascular Coiling- Copper coils induce clotting of an aneurysm, which prevents blood from getting into it.

Factors affecting immune response

*Newborn* -Thymus full-sized and fully functional at birth, *transfer of maternal antibodies* (IgG cross the placenta), infant protected by those and starts producing IgM antibodies after birth, takes about a year to get to adult level *Elderly* - decreased immune function, more susceptible to infection, autoimmune and immune disorders, cancer, etc. Possibly due to *decrease size of thymus (affecting t-cells)*, decreased amount of t cells, lymphocytes become unresponsive. *Nutritional status:* •Malnutrition-decrease in immune cells; •Excess adipose tissue-chronic inflammatory response (obesity) *Stress*: Prolonged can *suppress immune response* (HSV, flu, etc)

Tonic- Clonic SE can lead to...

*respiratory failure and death*

Reversible dementia

- 10-20% are reversible -drugs, endocrine disorders, metabolic, emotional, nutritional, toxic, tumor, trauma, alcohol.

How much oxygen is carried with hemoglobin.

- 97% -remaining 3% is carried in plasma in dissolved state. This dissolves across cell membraines and produces PÓ which drives diffusion.

___% of patients will have anemia

- 99.9% look at blood work first day of clinical to get all information. Don't just walk in and think anemic or not anemic. Need to look at paper work and come up with it.

Clonic

- Contract/relax -Accompanied by hyperventilation

Unprovoked epileptic seizures

- Focal seizures WITHOUT Impairment of consciousness -Focal seizures WITH impairment of consciousness

Pale Skin

- Hemoglobin is bright red when oxygenated and less red when deoxygenated. Because the redness of skin is due to the redness of blood, the skin of an anemic person (who has less oxygen in the blood) will be less red (paler) than the average person. -cyanotic: if cyanotic (not pink) then not oxygenated. Pink means oxygenated. Look at palms of hands, not feet because dont get good circulation to feet.

Iron deficiency anemia

- Impaired oxygen transport due to lack of hemoglobin, tissue hypoxia, microcytic hypochromic anemia -Also called Blood Loss Anemia if etiology is blood loss

Hemolytic anemia patho

- RBC are destroyed faster than can be made. - retention of iron (holding on to too much iron) -compensatory increase in erythropoiesis

Pernicous Anemia and patho

- Vitamin B12 deficiency -very common in elderly and can be very severe -Occurs in women mainly over 50. -Patho: B12 is bound to INTRINSIC FACTOR which protects B12 from autodigestion. If have gastrectomy then will end up with pernicious anemia. Would need supplemnataion. -autoimmune happens with women over 50.

Anti-inflammatory medications

- acetaminophen (affects liver. limit to how many you take a day) Tylenol - acetylsalicylic acid (asprin). more in blood -both used for inflammatory and given orally and rectally

Type IV

- immune reactant: Th1, Th2, CTL -Antigen: soluble anitgen, soluble antigen, cell associated angiten -Effector mechansisms: Macrophage activation, Eosinophil activation, cytotoxicity - examples: contact dermitits, tuberculin reaction ; chronic asthma, chronic allerigic rhinitis; contact dermitis

Visceral Pain

- in the visceral organs, nosicpetors respond to mechanical stimulation such as pressure, tissue damage, and chemical stimulation -nicoetors in skin and also in visceral organ and they respond to multiple sensations such as *pressure tissue damage and chemical stimuatlion*.

hemorrhagic stroke etiology

-Can be caused by trauma, aneurysm, drugs, erosion of blood vessels due to tumors, coagulation disorders, AVM etc.

Transfusion allergic reactions occur during...

- within 4 hours of cessation of transfusion) - Edema of eyes, lips, tongue, uvula, generalized flusing, hypotension, localized angioedema, maculopapular rash, pruritus, respiratory distress (bronchospasm), hives (urticarial).

Atonic

-"drop attacks" -sudden loss of muscle tone and fall to floor.

neospinothalamic tract

-(faster) ºAllows for *localization*, identification of pain -anterolateral pathway

Toxins

-*Alter or destroy the normal function of host cells*; *mostly produced by bacteria*; cause certain characteristic symptoms of disease -Endotoxins: lipopolysaccharides in *gram negative bacteria* that can lead to septic shock, DIC, acute respiratory distress syndrome -Exotoxins: proteins released from bacteria during cell growth that *inactivate or change important host cell structure/function*

Etiologies or causes of Anemia.

-*Autoimmune:* body is attacking itself. Collagen vascular diseases such as lupus erythematosus or rheumatoid arthritis. -Blood loss (hemmorrhage, heavy menstrual cycles. Acute blood loss is trauma such as being shot. Chronic blood loss is more common and happens over time. -*Bone marrow failure* (for example, from radiation, infection, or tumors). Occurs especially in cancers and can happen through radiation therapy. *Infection* can cause or *tumors* can cause. People are cured with leukemia and then get another tumor which causes bone marrow failure and death. Will die from 2nd tumor even though leukemia cured first time. -Erythropoietin deficiency (secondary to kidney disease). -Hemolysis (red blood cell destruction) -Leukemia: can cause anemia from bone marrow being so busy making abnormal WBC that it doesn't have time to make adequate numbers of RBC -Malnutrition (nutritional deficiencies of iron, Folate, Vitamin B12 or B6). Lots of minerals required to make RBC. Lack of minerals will cause anemia.

RBC Structure

-*Bi concave* shape so can wiggle through small capillaries easily and this is why clots wont form. -life span of 4 months or 120 days. -More hemoglobin on outter rim of RBC than middle (color)

Nursing considerations for alzheimer's/dementia

-*Biopyschosocial disorder*. Focus on what they can do, not what they cant do. -Support caregivers -Know your resources

Leukemia etiology

-*Cause unknown*, but *associated* with risk factors like exposure to high levels of radiation, benzene, use of antitumor drugs, secondary cancer after chemo for other cancers; may also be a genetic link since Down's Syndrome has a higher incidence, leukemia can "run in families"

Leukemia classified according to...

-*Classified according to their predominant cell type*; e.g. lymphocytic leukemia

Iron Deficiency Anemia Etiology

-*Dietary Deficiency. Most common* -*Bleeding* (2nd common), either acute or chronic (most common cause is chronic loss of blood); Menstruation; GI bleeding due to aspirin, peptic ulcers, polyps in intestines cause bleeding, or cancer especially next to blood vessel; hemorrhoids another cause of bleeding. Certain medications casue bleeding esp aspirn, anticoagulants and anitplatate agulators .... -*Increased demands*- in pregnancy; in infancy due to only cow's milk intake which is low in iron; Adolescents, due to growth spurts, diet deficiency, and menstrual loss; increased iron requirements in children, elderly.

Provoked seizures etiology

-*Febrile*- Occur between 6 months and 5 years of age, temperature above 100.4 not as the result of a CNS infection or metabolic disorder , 2-5% of *healthy infants experience one* -Electrolyte imbalances -Hypoxia -Hypoglycemia -Eclampsia. Disorder or high BP in pregnancy. -Tumors -Meningitis

Factors that cause bacterial growth

-*Humidity*-growth higher in higher humidity -*Biofilm*- structured community of bacteria that grows on surfaces. Ex phone, computer -*Oxygenation*- anaerobic(cant grow in oxygenated enironmentes) vs aerobic(need Ó for growth and metabolism) as well as facultatively anaerobic. -*Adaptability*: bacteria and adapt to environment to grow. -*Growth parameters* of bacteria determined by nutrition, temperature, light, humidity, atmosphere

Portals of Entry and their defense mechanisms

-*Intact skin and mucosa* : provides a physical multilayer barrier. bodie's first line of defense. -*Oral cavity and GI tract*: pH levels and enzyme activity of gastric secretions, peristalsis of intestines, normal bacterial flora, saliva -*Respiratory tract:* nasal hair, cilliae, humidification, cough mechanism, secretions, and phagocytes.

Aplastic Anemia Patho

-*Patho*: Reduction of all cell lines including RBC's, WBC's and platelets -Worse anemia of all. -*Onset can be insidious (slow) or acute (quick)*

Thrombocytopenia symptoms

-*Petechiae* (looks like ink dots usually on trunk of body ), bleeding in various body cavities, nose, eyes, stool, easy bruising,

Process of cell injury and death

-*Reversible*: cellular swelling and fatty change; fatty change more severe. If fatty changes present in the cell then more severe. -*Apoptosis*: programmed cell death to eliminate injured or aged cells; also aids in immune cell function. Normal. Fetal development (when in the womb we have webbed fingers and toes but apoptosis happens to get rid of webbed feet and hands. Can get rid of certain T cells... ● Extrinsic pathway - death receptor dependent ● Intrinsic pathway- death receptor independent -Necrosis: cell death in an organ or tissue that is part of a living organism, *interferes with cell replacement/regeneration* ●Liquefaction. ●Coagulation-turns in a gray, firm mass w/ acidosis ●Infarction-no blood supply to area. ●Caseous necrosis- dead cells persist indefinitely. Forms cheese subsbatnce where cells persist indefinelty. - Gangrene- large mass of tissue undergoes necrosis. Most is internal and dry is extremeties. Gas gangrene- caused by clostridium bacteria and can be fatal if not treated. Can result in amputation of infected limb -*Necrosis and apopotis both result in cell death but have different mechanisms.*

Acute pain continued

-ATP , acetylcholine, and platelets sensitize nociceptors through agents such as prostaglandins. ASA and NSAIDS *block prostaglandin* secretion and control pain. ◦Short duration, lasts no longer than 6 months (usually days only) ◦Remits when underlying process is resolved ◦Should be aggressively managed ◦Give preemptive and multimodal therapy. Ex. Distraction. White noise. Music therapy ◦Give pain medication before the pain becomes severe ◦Management helps with mobility and respiratory movements -once damge is resolved then acute pain will go away and will be aggresviely managed( want to tell patient to let you know when they are having pain "tell us when you first experience pain and don't let it go for hours thinking you can bare it")

Migraine without aura

-About 85% of migraines -Pulsatile, throbbing, unilateral moderate to severe pain -Lasts 4-72 hours -Aggravated by physical activity -Can be accompanied by nausea/vomiting, sensitivity to light, sounds, or smells, and visual disturbances

Seizures and type of seizures

-Abrupt and transient occurrence of signs and symptoms resulting from an *abnormal, excessive firing from a group of neurons* in the brain -*Provoked* (secondary in nature, from infection, brain injury, drug abuse) vs. *unprovoked* which is not cause from medical condition (primary, idiopathic, epilpetic, focal) -***Alteration in the permeability or *distribution of ions*, *neurotransmitter imbalances*, *genetic mutations*/ psychic=feelings of déjà vu/anxiety

Underlying causes of Status Epilepticus that need to be treated....

-Abrupt d/c of AED's (anti-epileptic drugs) -Alcohol withdrawal -Acute neurological illness -Metabolic disorders -Stroke

Secondary immunodeficiency

-Acquired (AIDS is the most common) (not born with it) -Etiology: pathogen, aging, malignancies, malnutrition, drugs -Pathophysiology: IgG loss, T cell deficit (viral/fungal/ opportunistic) , white blood cell dysfunction -Clinical Consequences: No cure, immunosuppressed (immune system doesnot function so susceptible to many illnesses), congenital transmission is possible( can be transferred through vagina at birth)

Symptoms of Aplasitc Anemia

-Affects all systems because all blood lines affected. -With WBC count is decreased or increased then will have increased susceptibility to infection which wont be able to go in as nurses and do our thing. -We would have to wear gown and mask to protect patient for organisms we are carrying (reverse isolation) -Symptoms: weakness, fatigue, pallor, petechieae, ecchymosis, bleeding from any orifice, increased susceptibility to infection

Multiple Sclerosis

-Affects women twice as much as men, presents ages 18-45 -progressive and degenerative -characterized by demyleization •Characterized by periods of relapse and remission Depression in 30-50% -Charcot's neurologic triad. - mostly happens in low sun light areas. -low risk in high sunlight areas.

Antifungals

-All Anti-cytoplasm -Polyenes (ampho-B, nystatin)- *puts holes in the cell membrane* -Imidazoles (fluconazole, itraconazole)-damage the cell membrane -Echinocandins (caspofungin, micafungin)- cause cell wall to become unstable

Shortness of breath

-An anemic person may feel short of breath and then breath faster to alleviate the feeling. -compensation for the poor delivery of oxygen to the tissues -subjective sign (how the person is feeling). Cant look at someone and see it.

Sick Cell Diagnosis

-Analysis of DNA by amniocentesis (amniotic fluid using a hollow needle inserted into the uterus, to screen for developmental abnormalities in a fetus.) -Hemoglobin electrophoresis- confirmation -Screenings

Antivirals

-Anti-DNA/RNA (acyclovir). Some antivirals that attacks DNA and helps no more Virus replication

Most common NSAIDS

-Aspirin and ibuprofen that act as antipyretic (fever reducer) and antiinflammatory

Types of Cellular Adaptation

-Atrophy: decrease in cell size to become more efficient. ex. decrease in work demand due to disuse, inadequate nutrition, ischemia, etc -Hypertrophy: increase in cell size and tissue mass. ex. muscle increase d/t exercise or left ventricular hypertrophy d/t HTN, or compensatory (kidney removal-other gets bigger) -Hyperplasia: increase in number of cells in an organ or tissue in cells capable of mitotic division (epidermis, GI tract, etc). ex. breast changes in pregnancy due to estrogen; warts due to HPV -Metaplasia: reversible change in which one adult cell type is replaced by another adult cell type. cervical cells change during puberty d/t hormal changes; usually due to chronic inflammation or irritation -Dysplasia: deranged cell growth of a specific tissue that results in cells that vary in size, shape, and organization. Can be precursor to cancer.

Hemophilia A treatment

-Avoid ASA, NSAIDS. Give recombinant Factor VIII, pt may develop antibodies. May be cured in the future by gene replacement therapy.

Humoral

-B lymphocytes -*Defend in blood and mucous* (aka humors!) -B lymphocytes *produce antibodies* -B cells *recognize antigen, differentiate into plasma cells, then secrete antibodies* -Antibodies bind to microbes before they invade tissue and mark microbe for destruction

Pernicious Anemia Diagnostic / Lab values

-B12 def shows abnormally low serum B12 level. -indicated by detection of parietal cell and intrinsic factor antibodies.

Lasting effects of concussions

-Brain damage may not show up on MRI/CT -"May result in impaired neurotransmission, loss of ion regulation, deregulation of energy use and cellular metabolism, and reduced cerebral blood flow" (Granitto and Norton, 2018, p. 17) -Emerging research on accumulation of tau protein determining when an athlete can return to play -Can lead to chronic traumatic encephalopathy (CTE)

Transient Ischemic Attack

-Brief episodes of *ischemia* (compromised blood flow), no infarction (no cell death or permanet death) -"Mini-strokes" -No set time limit, important *factor is no infarction* -Same causes as ischemic strokes. Such as diabetes, genetics, etc -Could serve as a warning sign for a future stroke. risk for stroke is 15% in the next 3 months.

Myoclonic

-Brief, involuntary muscle contractions generalized or limited to the face, trunk, or 1 or more extremities

Dementia

-Broad term used to describe abnormal cognitive decline caused by damage to the areas of the brain that affect cognition and memory

Mechanisms of Cell Injury

-Can be direct (heat) or indirect (genetic causes of metabolic disturbances) -Most are caused by 1. *Free radical formation* (disrupt/damage cells and tissue). Damage cell membranes and inactivated certain enzymes and deactivate DNA. 2.*Hypoxia and ATP depletion* (time differs depending on type of cell). Ex. Brain tissue is very sensitive to hypoxia. brain tissue is permanent damage within 4 to 6 min of deprivation. 3.*Disruption of homeostasis of intracellular calcium* (causes accumulation). Cells already have low levels of calcium but if have radiation an acucmation of calcium will occur in cells which can damage cell.

Types of unprovoked epileptic seizures

-Can be followed by *Todd's paralysis* (temporary paresis, aphasia, or hemianopia lasting up to 24hrs) -Symptoms: unconsciousness, bilateral and symmetric motor response -most common types of seizures in children. -Tonic-Clonic (Grand Mal) -Absence (Petit Mal) -Myoclonic -Tonic -Clonic -Atonic

Risk factors for embolic stroke

-Cardiac risk factors such as a fib, MI, bacterial endocarditis

Ischemic stroke, embolic

-Caused by a moving blood clot that migrates to the brain -Most commonly affects the *middle cerebral artery* -*Sudden and severe onset*

Alzheimer's disease patho

-Caused by accumulation of *amyloid beta peptide* in the brain that starts a chain reaction of physical changes -Neurons within the brain develop abnormal amyloid plaques and their axons become tangled, preventing communication and eventually leading to the death of these cells.

Leukemia treatment

-Chemotherapy -CNS irradiation since chemo can't cross the blood brain barrier. -if spread to brain will use radiation -Bone marrow transplantation. used successfully but many people will get lymphoma after bone marrow transplant. -Leukemia is one of the few cancers that have had long term cures made (>20 years). -For adults, leukemia may end up being a chronic disease but not in all cases. -exact count varies if chronic or acute. Will have low WBC count after initial treatment. Initially most people will have elevated WBC

which leukemia is 15-20% of leukemias in adults (30-50)

-Chronic myelogenous leukemia. chronic means you will have it for awhile.

Lab Tests for Suspected Infection

-Complete blood count (CBC): Leukocytes (including different types) -Urinalysis (UA): Test for leukocytes and nitrate -Serology: Antibody detection for viruses (IgG vs IgM). If somebody is exposed to antibody for first time you will have IgM. IgG present when have some infection you have had before. -Specimen culture: sample from host is grown outside the body (agar plate or broth) through incubation in a controlled environment until growth is detectable; use microscopic appearance, Gram stain reaction, shape, texture, and color to identify bacteria -do blood culture before give antibiotics. Culture is trying to see what is growing. Need to give antibiotics to specific antibiotics.

Primary immunodeficiency

-Congenital/inherited (rare, over 180 identified). Usually born with -Etiology: Genetic (*recessive, X-linked* or autosomal mutations) -Pathophysiology: Mutations *affect signaling pathways* that dictate immune cell development/symptoms of autoimmune disorders. Stops immune cell development -Clinical Consequences: Early detection is critical; recurrent, persistent, or unusual infection is a clue; types of infection help diagnose; family trees are important, can be fatal in early childhood

Non-pharmacological

-Control risk factors and triggers -Migraine diary. What they were doing before, what they have eaten. Tracks triggers and risk factors. -Behavior interventions- stress management, relaxation therapy, biofeedback, cognitive therapy etc. -Avoiding aggravating factors

Risk factors for thrombotic stroke

-DM (diabetes) and HTN are risk factors

Opportunistic infections

-Decreased levels of CD4 T Cells create susceptibility to various conditions that would not infect a "healthy" person •*Respiratory*: bacterial pneumonia, P. jiroveci (PCP) pneumonia, TB •*GI* : esophageal candidiasis, gastroenteritis, C.Diff, E.Coli, etc. •*Nervous system*: HANDS, toxoplasmosis, PML •*Malignancies*: Kaposi sarcoma, non-Hodgkin lymphoma, noninvasive cervical carcinoma secondary to impaired cell-mediated immunity •*Metabolic*:Wasting Syndrome, insulin resistance, lipodystrophy -HIV associated neurocognitive disorders can manifest as cognitive impairment with motor dysfunction, behavioral/psychosocial symptoms, dementia, etc -Progressive multifocal leukoencephalopathy- demyelinating disease of white matter

Symptoms of Sickle Cell Disease

-Decreased life span of RBCs (20 days) -*Chronic hemolytic*(lytic means dissolving or destroying) anemia and Blood vessel red blood cell occlusion(clotting), causing very severe pain, tissue ischemia to almost any part of the body. RBC is biconcave but sickle cell is S shape and they stick together easily. This causes clot or occlusion. Causes lactic acid build up causing pain. Tissue ischemia (Lack of blood flow/ oxygen to body limbs) -Factors leading to Sickle Cell Crisis include cold, stress, physical exertion, infection, hypoxia, dehydration, acidosis -Other major complications include Myocardial infarction, stroke, infections, pneumonia, bone crises, splenic ischemia, infarctions to eyes/kidneys, liver etc (brain is most common place)

Treating infection with antibiotics

-Different antibiotics that target bacteria is different ways. -Broad-spectrum (cephalosporins) -Anti-bacterial cell wall (penicillin) -Anti-DNA (fluoroquinolones, nalidixic acid) -Anti-metabolism (sulfonamides, trimethoprim) -Anti-bacterial protein synthesis (aminoglycosides, tetracyclins)

Dermatome Map for sensory impulses

-Discuss in terms of paralysis. -Can tell exactly where level of sensation is occurring at the spinal cord by the dermatone map. Going to test each of these areas. -feeling doesn't all return after 2 years after a major accident

Tension headache

-Dull, aching, diffuse, "hat-band", usually not severe enough to limit activity

Megaloblastic Anemia Etiology and two main causes

-Enlarged RBCS -Etiology: **Impaired DNA synthesis* that results in enlarged RBCs (MCV >100)* - Vitamin B 12 and Folic Acid deficiency

When should ergotamines not be used???

-Ergotamines cannot be used during *pregnancy*(bc of fungus) or in people with *peripheral artery disease* (bc causes vasoconstriction)

Anemia symptoms

-Fatigue -increased heart rate -Shortness of breath -low blood pressure -Pale skin

Leukemia Symptomology

-Fatigue, low grade fever, night sweats -Weight loss -Bleeding due to thrombocytopenia, anemia -Bone pain and tenderness -Lymphadenopathy -Splenomegaly, hepatomegaly -CNS involvement, e.g. HA, N&V, cranial nerve palsies, papilledema, seizures, coma -Increased WBC (30-100,000); eventually a low WBC may occur due to "crowding" of the bone marrow. (exact count varies if chronic or acute. Will have low WBC count after initial treatment. Initially most people will have elevated WBC.)

Systemic Manifestations of inflammation

-Fever: Increases set point of hypothalamic thermoregulation center ◦To promote pathogen-hostile environment. Pathogens hates high temps -Leukocytosis: Increased leukocyte count to 15K-20K ◦To efficiently fight inflammation/infection ◦Release pyrogenic (fever-making) mediators. -Lethargy/fatigue: Metabolism change from energy-making to heat-making. ◦To maintain fever-induced pathogen-hostile environment *These signs /symptoms are classified as acute-phase response.*

Fatigue

-First and most common symptom - overwhelming lack of energy particularly with exercise. *Oxygen is required to metabolize fuel molecules (sugars, fats and proteins) to obtain energy.* A person with a low hematocrit cannot carry enough oxygen in the blood to meet their energy demands. -Not tiredness. Fatigue will lasts for days and days

Acute non responder care

-For those that don't respond to first-line treatment (20-25% do not), 10mg metoclopramide (Reglan) IV

Hodgkin's disease etiology and patho

-Form of Lymphoma which has an abnormal cell called *REED_STERNBERG CELL.* -Age range is 10-20 and then 50 and older. Not in between. -Cause unknown but exposure to *carcinogens, viruses, genetic and immune mechanisms are proposed.* -Patho: Painless, progressive enlargement of a single node or group of nodes, spreading throughout lymphatic system. Spleen, liver spread is commonly involved. Definitive dx based on presence of reed-sternberg cell;

Why you shouldn't keep using abortive medications...

-Frequent use of abortive (acute) therapies can cause rebound HA. Once medication wears off then pain comes back. Used during actual migraine. Not preventive. -NSAIDS and triptans

MS etiology

-Genetic and environmental (smoking, low vitamin D levels)

Chemical Mediators of inflammation

-Histamine -Platelet - Cytokines - Nitric oxide -Omega 3- polyunsaturated fatty acids

Chemical Mediators of Inflammation definitions

-Histamine: causes *vasodilation* -Platelet: *activating factor* - broad inflammatory effects, activates *neutrophils* and eventually activated platelets. -Cytokines: (proteins that *tell other cells what to do*) & chemokines(tells WBC exactly where to go) - mediate inflammation -Nitric oxide & oxygen-derived free radicals - *regulate & amplify inflammatory process*. Want inflammatory process to occur to fight off infection. -Omega-3 polyunsaturated fatty acid: anti-inflammatory effect on cell membranes. Chemical *mediator* on other side. Try to stop inflammation

Histamines

-Histamines are potent vasodilators ( that can cause shock) respond to antigen exposure within 5 to 30 minutes, *increasing capillary permeability and smooth muscle contraction and bronchoconstriction*

Antibiotic Resistant Organisms

-Huge issue in health care. -Bacteria has figured out a way to outsmart us. Bacteria can become resistant to medication by: -*producing enzymes* that inactivate antibiotics -genetically mutating to *alter antibiotic binding sites.* -developing *alternative metabolic pathways* to bypass antibiotic activity -*changes in the cell wall* that prevent antibiotics from crossing -MRSA-Methicillin-resistant Staphylococcus aureus. Running out of antibiotics to treat this. -Need for patient education. Need to be less diligent. -Overprescribing -Need for cultures/sensitivity . We have broad spectrum antibiotic and need to be specific to match bacteria to antibiotics. -Need to see if bacteria is sensitive to antibiotic. Sensitivity is testing bacteria growth.

Pernicious anemia etiology

-Immunologically induced, probably autoimmune *destruction of the gastric mucosa.* -Other causes of B12 deficiency are gastrectomy, surgery or tumors involving the ileum, malabsorption syndromes -Met Formin (diabetes medication) can cause deficiency. -gastrectomy, surgery or tumors involving the ileum, malabsorption syndromes then will need supplementation -Autoimmune disease.

treatment of iron deficiency anemia

-Increase dietary intake -Ferrous sulfate (oral supplementation) -Iron Dextran (given IM or IV); IV can cause fatal dysrhythmias -Erythropoietin (in some chronic disease states)

Stages of Infectious Disease

-Incubation: Pathogen begins active replication, but there are no symptoms in host, can last hours (salmonella) to months/years (HIV). -Prodromal: Appearance of symptoms in host, can be vague -Acute: Maximum impact of infection, symptoms peak and are more specific. -Convalescent: Containment, elimination of pathogen, repair damage. Beginning healing stages. -Resolution: Total elimination of pathogen

More etiology of leukopenia

-Infectious diseases -Inflammatory disease (such as rheumatoid arthritis or allergy) -Leukemia -Severe emotional or physical stress -Tissue damage (such as burns) -Low hemoglobin values may indicate: -Anemia (various types) -Blood loss

Thalassemias Anemia Etiology

-Inherited (Mendelian); *if heterozygous is mild; if homozygous is severe*.

Cell mediated

-Inside the cell where antibodies can't get to -T lymphocytes *recognize antigen-presenting cells* -Helper T Cells: Help out B cells with antibody production and phagocytes destroy their contents -Cytotoxic T Cells: Kill intracellular microbes. Kill cell antigen is present in.

Surgery

-Last option if anitbiotics done work. -Removal of tissue, limbs, or organs -Draining abscess -Debridement -Valve replacement (endocarditis)

Migraine with aura

-Less common -most common headache that people search medical help for. -Pulsatile, throbbing, unilateral moderate to severe pain -Lasts 4-72 hours -Aggravated by physical activity -Can be accompanied by nausea/vomiting, sensitivity to light, sounds, or smells, and visual disturbances **Preceded/accompanied by an aura-visual and sensory symptoms, speech disturbances, etc. Develops over 5-20 minutes, lasts up to an hour*** -aura is sensory or speech disturbances. Can be on days of irritabily or fatgiue. aura comes before the migraine. -genetic component to migraines and think the gentic componet is stronger for aura migraines.

Sickle Cell Diagnoses/ Treatments

-No cure -Supportive care, e.g. antibiotics, full immunization with influenza, Hepatitis B, *pneumococcal (prevents 23 strains of pneumonia) vaccine* for 2-6 mos old -main thing *Hydroxurea (medication)*, allows for synthesis of HbF and less HbS, decreasing sickling; recommended as standard of care. *Supportive care* such as antibiotics. -Blood transfusions, bone marrow transplantation, stem cell transplantation, other investigational drugs -No known cure but with better treatments, more are living to adulthood and passing on the disease to their offspring

Indirect transmission

-No direct contact between individuals; virus being shedded; can be ingested or inhaled. -Ex. Measles. Don't need to see child with measles to get measles.

Pharmacological

-Non-narcotics-Mild to moderate headaches; best if taken *early* in headaches. ex tylenol, ASA -NSAIDS- *Abortive* (stop headache in its tracks) and preventative; prevent prostaglandin (causes inflammation) synthesis -Triptans-1st line *abortive*; increases available serotonin/vasoconstriction. ex sumatriptan (Imitrex) -Narcotics-For severe headaches, addictive. ex hydrocondone. pain is 10/10. strong risk of addiction and should not be taken everyday for pain. -Isometheptene (Midrin): sympathomimetic acting as a vasoconstrictor and mild sedative -*ergotamines* (derived from *fungus*) combined with caffeine act as vasoconstrictors. Stops throbbing

Absence (Petit Mal)

-Nonconvulsive, only in children, brief, *unresponsive, blank stare*

Focal seizures WITH impairment of consciousness

-Occur in *temporal lobe*, can spread to both hemispheres *but initially starts in one(what makes this focal)* -Psychomotor symptoms like lip-smacking, patting, rubbing clothing, etc. -Confusion postictally is common -Patients report feelings of deja vu, fear, hallucinations, etc. -Can be confused with psychiatric disorders

Cell injury and repair

-Ongoing, balanced ◦Reversible: allows recovery ◦Irreversible: apoptosis/necrosis -Dependent on *cell condition & injury extent* as well as *blood supply and nutritional status* - Etiology of injury: (what causes cell damage) ◦Physical (mechanical/ fracture, temperature extremes, electrical burns) ◦Radiation (including UV) ◦Chemical (substances, drugs, lead, mercury) ◦Biologic (viruses, bacteria, parasites)can continue to cause harm unless treated. Can continue to replicate ◦Nutritional imbalance (deficits & excesses, including vitamins/minerals)

Endogenous Sources of Analgesia (opioid receptors)

-Opioid *Receptors* (Mu, delta and kappa) and *peptides* are found on the peripheral processes of *primary afferent neurons* and other CNS regions. -These families include enkephalins, endorphins, and dynorphins. -Morphine attaches to Mu receptors. -*Opioid peptides function as neurotransmitters* and work to control pain. -Opioid receptors are *highly concentrated in the gray area* of the midbrain and by stimulation of the PAG matter of the midbrain produce analgesia; this area is sometimes called the *analgesia system*. Opoiod receptors try to diminish the pain expereince and make it feel better. Innate. work as nuerotransmitters and going to help control pain.

Pain in children

-Pain begins in the neonatal period -Able to accurately and reliably report pain at 3 years of age -Children remember pain -Careful assessment is key. Usually with a picture. Are you happy or sad etc -Use numeric scales as well as picture scales -Pharmacologic and nonpharmacologic methods

Pain in older adults

-Pain increases in older adults (65+) -Unrelieved pain can led to immobility and falls -Impaired appetite, sleep disturbances, and cognitive dysfunction -Decreases quality of life -If patient is lucid , pain is easier to assess -Drug metabolism is different/older in older adults and medications should be taken into account when prescribing pharmacologic methods -Nonpharmacologic

Pain

-Pain is when a person reacts to a stimulus by removing the TRIGGER causing the noxious stimulation. (Guyton, 2016). early protection warning system. -Many factors including *anxiety, culture, and past experience* influence the actual pain reaction. -Culture: some cultures are stoic when it comes to pain. -past experiences: if you know something causes pain then will avoid that experience. -Both Acute and Chronic pain are major health problems.

Pain Threshold

-Pain threshold is the point at which a stimulus is *perceived as painful*. -tends to be pretty stable over various culture. -ex everyone is not going to want to put hand in the oven and they will remove quickly.

Pain tolerance

-Pain tolerance is the total pain experience and psychological, cultural and environmental factors influence the amount of pain a person can tolerate -varies, personal, gender differences

Hodgkin's disease patho

-Painless, progressive enlargement of a single node or group of nodes, spreading throughout lymphatic system. Spleen, liver spread is commonly involved. Definitive dx *based on presence of reed-sternberg cell*

Thalassemias patho

-Patho: Decreased synthesis of either the alpha and/or the beta chain of hemoglobin caused by deletion of the gene; -results in hypochromic, microcytic anemia with hemolysis -***Results in SEVERE blood transfusion anemia which causes iron overload with deposition of excess iron into heart, liver, etc.

Leukemias

-Patho: Malignant *proliferation* of WBC's - replacement of bone marrow with unregulated, proliferating *immature* neoplastic cells. -These cells are immature and cause irregulated growth and one of leading causes of death. -Leading cause of death in children -Acute leukemias have a quick onset that is overwhelming while chronic leukemias may be discovered in a routine checkup

Migraines

-Patho: interaction between *brain and serotonin* and *brain between and trigenail nerve*. Drops in serotonin can also affect migraines. -Migraine without aura -Migraine with aura -Affect women more than men, usually diminish after 50; -can last 1 to 2 days but longer than 72 hours is called status migrainosus; -Aura can be preceded by days of fatigue/irritability. Cause is unknown, possibly due to interaction between the brain and the trigeminal nerve, possibly due to serotonin drops; thought to have a genetic component-es

Von Willebrand Disease and etiology and path

-Usually *autosomal dominant disorder (20 variants of the disease)* -severe is autosomal recessive. autosomal refers to 22 pairs of autosomal chromosomes instead of sex chromosomes. -Etiology: Low level of vWF -Patho: Compound defect in both platelet function and coagulation pathway

Granulocytes

-Phagocytic (ingesting harmful foreign particles, bacteria, and dead or dying cells.) cells which contain cytoplasmic granules -Basophils- release histamine and heparin, main role is in *allergic diseases, 0-1.0 % of* total WBC count -Eosinophils- increase in # in allergies and parasitic diseases, 0-3.0 % of total WBC count. -Neutrophils (also called polymorphonuclear leukocytes)- 60-65% of total # of WBCs ◦ # rises in infectious diseases, shift to the right or shift to the left ◦Maintain normal host defense -if bacterial infection then neutrophils rise and shift left. Start reading cells on the left. If numbers rise then immature cells on the left then mature cells on the right. -If don't rise due to bacterial infection then will die. Pneumonia patients die within a couple days because neutrophils did not shift to the right or rise.

Direct Transmission

-Physical contact between infected individual (including bodily fluids) and susceptible individual -can be classified as *horizontal (sexual contact)* or *vertical (congenital/mom to baby)*. HIV can be horizontal and vertical.

Thrombocytopenia treatment

-Platelet transfusions, corticosteroids, IV immune globin, splenectomy, immunosuppressant therapy

Thrombocytes and bleeding disordesr

-Platelets are large fragments from the cytoplasm of bone marrow cells called megakaryocytes. They assist in controlling coagulation. Life span 8-9 days. -In stored blood, only last one day.

Stages of HIV

-Primary infection (first infected with the virus). lots of people dont get f but instead symptoms. if do symptoms feel so like flu. -Latency (chronic, asymptomatic). can stay in this stage indefinitely -AIDS (HIV, CD4 below 200 +/ opportunistic infection). HIV not death sentenced like it used to be in the 80s. Now have more medications and way to protect yourself. *Can take medications to suppress the cells. If have AIDS can go back to latency.*

Types of Headaches

-Primary: no organic cause or disease that causes this. 90% of headaches (migraine, cluster, tension, chronic daily HA) -secondary: due to a different medical condition (meningitis, tumor, aneurysm) neuralgias -cranial neuralgias and facial pain (random)

Cellular adaptation

-Protective to prevent cell/tissue harm -Cells undergo adaptation to *respond to stressors* -Cell injury/death when adaptation fails -Once stressor is removed, adaptation stops

RBCs Lab Values

-RBCs and erythrocyte values always different bw men and women based on size or menstrual cycle. Males have higher values than females. Based on size and menstruation but mainly size. -Males: 4.2 -5.4 million/uL -Females: 3.6-5.0 million/ uL

Thrombocytopenia Risk Factors

-Radiation exposure or treatment, cancer drugs, HIV

Inflammation

-Reaction of *vascularized tissues to cell injury* by attempting to *eliminate the cause, remove damaged tissue, and promote new tissue growth* -Characterized by the *elaboration of inflammatory mediators* and the movement of fluid and leukocytes from the vascular system into the extravascular tissues at site of injury -Common causes: burns, chemical irritants, frostbite, toxins, infection by pathogens, physical injury, hypersensitive immune reactions, ionizing radiation, foreign bodies, stress, and trauma.

Thrombocytopenia and etiology

-Reduction in platelets < 100,000 -bleeding and some clotting Etiology: -decrease in platelet production, -excessive pooling of platelets in spleen; reduced lifespan of platelets caused by immune or nonimmune mechanisms -E.g. Idiopathic thrombocytopenia purpura, also immune thrombocytopenia purpura

Diagnosing dementia

-Requires criteria in 2 categories as outlined by DSM IV (Diagnostic and Statistical Manual of Mental Disorders) 1.Decline in memory 2.Decline in at least one of the 4 following cognitive functions: -Coherent speech or understand spoken or written language -Plan, make sound judgment, abstract thought, complete complex tasks -Execute motor activities -Process and interpret visual information

Post stroke care

-Risk of recurrence is highest in the first week -*Antiplatelet agents*. Want clots to occur. Don't want more hemorrhaging or bleeding. -Reduce modifiable risk factors and treat underlying medical conditions -Motor, language, sensory, and cognitive deficits -Weakness, foot drop, difficulty with fine motor skills -Dysarthria (difficulty with speech) and aphasia (diffulty understading and expression language or themselves verbally)

Cardinal Signs of Inflammation

-Rubor (redness): occurs due to vasodilation in the vascular phase. Blood cells near site will dilate. -Swelling: occurs due to increased accumulation of fluid in tissue spaces in the vascular phase. *Fluid comes from vascular space to extra vascular space.* -Heat: occurs due to *vasodilation in the vascular phase.* -Pain: occurs due to increased *accumulation of fluid* in tissue spaces in the vascular phase. Pressure on nerve cells. -Loss of function/alteration in functio: also occurs due to increased accumulation of fluid in tissue spaces in the vascular phase. Loss of function where site is occurring.

Treatment for Ischemic stroke goals

-Salvage brain tissue -Prevent secondary stroke -Minimize long-term disability Drugs: *Tissue plasminogen activator (tPA)*- MUST RULE OUT HEMORRHAGIC STROKE BEFORE(don't want clot bluster if someone is already bleed in brain) -ADMINISTERING; usually given within 3 hours of symptom onset

Cluster headache

-Severe, unilateral pain that occurs in clusters. -Lasts from 15 minutes to 3 hours -*Hereditary*, -*circadian and neuroendocrine disturbances.* -can get them for weeks or months then go into remission for up to a few years

Hemolytic Anemia Etiology

-Sickle Cell Disease -Thalassemias - Inherited enzyme defects: e.g. G6PD (sex linked X chromosome), most common in AA men causing hemolysis as the result of oxidative stress from an infection or certain drugs. -Acquired through exposure: to various drugs, diseases such as Malaria, DIC, severe burns, venoms, etc -Transfusion Reactions

Tonic- Clonic (Grand Mal)

-Small focal seizure followed by tonic extension of extremities and LOC; loss of bladder and bowel control, clonic rhythmic contraction and relaxation of extremities

The more reticulocyte you see...

-the faster erythropoeises of production of RBC -in some anemias you will see rapid rate if compensating. However, Just because you have anemia does not mean you are compensating. People die because they can not compensate.

Factors associated with infection risk....

-Source: Who, what, where, when -Portal of entry where or how infection gets into host: ◦Transmission in direct proportion to pathogen quantity. Greater quanity more likely of infection.) ◦Penetration (step on nail), direct contact(kissing), ingestion(food poisoning), inhalation -Immune competence: ◦Intact immune system( less susceptible to certain pathogens, helps prevent colonization from occurring). You can be own source of infection such as overgrowth of bacteria or yeast.... Someone else sneezing in your place....hosptials can be sources of infection...animals...cat scratch fever.

MS symptom management

-Spasticity -Sensory symptoms/weakness -Bowel/bladder problems -Pain -Fatigue -Depression

Hemophilia A symptoms

-Spontaneous hemorrhage, with or without trauma, especially in the joints, soft tissues resulting in contractures, disability

treatments of Hodgkins

-Staging helps to determine treatments: irradiation, combo chemo, 70% cure rate. Helps see which side of diaphragm its on

Blood Cell Formation starts with...and ends with...

-Stem cell -erythrocyte

Regulation of erythropoiesis

-Stimulus: Hypoxia(absence of Ó in the tissues to sustain bodily functions) due to decreased RBC, decreased availability of Ó to blood, or increased tissue demands for Ó. -Reduced Ó levels -Kidney releases erythropoietin(hormone) which stimulated red bone marrow. -leads to enhanced erythropoiesis -More RBC which increases Ó carrying ability of blood.

Treatment of Aplastic Anemia

-Stop drug that's causing it. -Might need bone marrow transplant or immunosuppressive treatment, anibiotics, blood tranfusions, corticsteriods, removal offending agent.

Types of fever

-Sustained fever: doesn't get back to normal -Remittent fever: doesn't go back to normal but decrease and *still elevated base line.* -Relapsing fever: Has remission of fever for a couple days but spikes back up. -intermittent fever: constantly goes up and down. irregular intervals for several hours.

Clinical Manifestations of infection

-Symptoms ◦Specific - reflect the site of infection (e.g., diarrhea, hemorrhage, rash, etc.) ◦Nonspecific - can be shared by a number of infectious diseases (fever, ha,) ◦Obvious - chickenpox vesicles or measles ◦Covert - discreet/not observable (may require laboratory testing to determine such as increased WBCs)

Pernicious Anemia Symptoms

-Symptoms also include severe anemia, mild jaundice, pallor, fatigue, ataxia & paresthesias(numbness mainly in legs) due to spinal cord demyelination, dementia and other cognitive changes

MS symptoms

-Symptoms depend on location of the lesion or plaque that is formed by broken down myelin -Visual changes, speech deficit, muscle weakness, gait and coordination issues

Iron deficieny anemia symptoms

-Symptoms depend upon how severe the anemia is: -Easy fatigability, pallor, dyspnea, tachycardia, pallor, brittle hair and nails, smooth tongue, sores in corners of mouth, pica, in infants may affect cognitive function -short of breath if down to 4g to 6g. If 8 to 10g you would have lack of hemoglobin but wont necessarily have shortness of breath. -some religions wont want blood transfusions and this could cause short of breath or anemia symptoms.

Gum disease and anemia

-Systemic effects of disease must think further than outside of person. -People who have chronic disease might have long standing anemia which can cause gum disease. -Anemia can affect so much and affects whole body.

Phantom limb pain treatment

-TENS(overrides pain/electrical stimulus that overrides pain thats occurs and tends to reduce it/been used for decades), hypnosis, relaxation training, sympathetic blocks -can be difficult to treat and can last for months.

Neuromatrix theory (Malzach 1999)

-The *brain ( thalamus, limbic, spinal) identifies pain* and there are multiple dimensions and *determinants* of pain, including stress, attention, culture, expectation, personality, genetics. -More of what we look at today. -Attention is important. If laying in bed with nothing to do but think about pain will actually feel it. But if your attention is somewhere else then you wont feel it as much. Nurses use distraction to get their mind off of their pain.

Increased heart rate

-The body increases heart rate to *compensate* for the low oxygen carrying capacity of the blood. *If more blood is moved faster through the tissue then tissues get more oxygen per unit time.* -Tachycardia occurs as a compensatory mechanism. If blood isn't providing enough Ó to tissues then will have increase heart rate and could be tachycardia (anything above 100).

Phlembotomy risks

-There is very little risk involved with having your blood taken. Veins and arteries vary in size from one patient to another and from one side of the body to the other. *Taking blood from some people may be more difficult than from others.* -Other risks associated with having blood drawn are slight but may include: -Excessive bleeding -Fainting or feeling light-headed -Hematoma (blood accumulating under the skin) -Infection (a slight risk any time the skin is broken

Mechanisms of Disease Production

-Toxins -adhesion factors - evasion factors -invasion factors

Transfusion reactions

-Transfusion reactions will kill a patient. *Nurses are responsible because we give the blood.* -Identify patient and have *2 RNs*. Can't do anything as a student as far as identifying. -Most problems occur because lots of mistakes in identification. Always nurse error and will lose certification. -*The RN must stay with the patient the first 15-30 minutes*, monitoring vital signs including temperature every five minutes...... then monitor every 15-30 minutes therafter. -CDC has id'd 11 types of reactions (see textbook)

Two main causes for Megaloblastic Anemias

-Two main causes are Vitamin B12 (Pernicious Anemia) and Folic Acid deficiencies -Vitamin B12 is found in animal origin foods and *essential for DNA synthesis* and maturation, maturation of RBC's. -Folic acid is required for *DNA synthesis* and RBC maturation. It is found in leafy green vegetables, fruits, cereals. -Commonly associated with alcoholism, celiac disease and various drugs such as antiseizure drugs. -Folic acid anemia is mostly associated with *alcoholism*. Very malnourished because alcoholics don't eat just drink.

Stroke

-Vascular-induced disorders that injures brain tissue and causes acute focal neurological deficit that matches the cerebral vascular territory -somehwere in the brain, blood flow is cut off and that area of the brain dies. -One of the leading causes of morbidity and mortality (4th leading cause) -"Brain attack" -Two main types: ischemic and hemorrhagic(something bursted)

Hematocrit (Hct) Lab Values

-Volume of RBC packed by centrifuge in a given volume -Males: 42-52% -Females: 36-48%

Hemophilia A

-X linked recessive disease mainly affecting males

Status Epilepticus

-a dangerous condition in which epileptic seizures follow one another without recovery of consciousness between them -Does not stop spontaneously after 5 minutes or occur back-to-back with no recovery. -medical emergency when seizures dont stop after 5 min. these patients get admitted to the ICU -Life support measures and medication needed -As many types as there are generalized seizures -Occur most frequently in the *young and old populations.*

Infection

-aThe presence, multiplication, and subsequent injury within a host by another living organism.

There are 450 ____________ _________ and sickle cell is just one of them...

-abnormal hemoglobins

How are migraines treated?

-acute -acute non responder care - prophylaxis

Attack

-acute phase -pain of migraine. •Varies in location •Tends to feel throbbing (throbbing from vasodilation in cerebral blood vessels of the brain) •May throb worse during physical activity •Unusual sensitivity to light, sounds, and smells •Lightheadedness and fainting •Nausea and vomiting

Hemorrhagic stroke most common predisposing factors...

-age(cant control) and HTN(hypertension, can control)

Neutropenia etiology

-aplastic anemia, -bone marrow depression by chemotherapy, -radiation therapy, most cases caused by drugs; -idiosyncratic expression is a drug that causes neutropenia when in most persons it does not. E.g. chloramphenicol, sulfonamides, propylthiouracil

Type A fibers

-are myelinated -the largest size fiber -fastest rate of conduction -conveys cutaneous pressure, touch, cold, mechanical and heat pain. -Pain quality: well localized, sharp, stinging, pricking, referred to as "fast or first pain" -releases glutamate at the synapse with spinal nuerons

Type B fibers

-are myelinated -transmit from *cutaneous and subcutaneous receptors* and transmit to *thalamus*

Type C fibers

-are unmyelinated -have the smallest diameter -slowest rate of conduction; -warm-hot, mechanical chemical and heat/cold. (slow pain) -pain quality: diffuse, dull, burning, aching, reffered to as a slow or second pain. -release glutamate and substance P

Neuropathic pain

-arises from direct injury or dysfunction of the *sensory axons* of peripheral or central nerves. -*no direct stimulus* in that cause but blood glucose causing damage to nerve itself. Ex. Nerve entrapment. Long term alcohol use. -Patient with diabetes. -direct injury or dysfunction of central nerves and they are where damage is. -More widespread and covers broader area. -*Control is always more difficult than nociceptive pain*. Need specialist to control this type of pain.

Diagnosis of Dementia is based on....

-based on the presenting problem, history, physiological and neurological exam, labs, brain imaging, behavior, cognitive function, etc. -rule out reversible causes of memory loss/ cognitive decline.

Aura

-can last 5 to 60 min and develop over 5 to 20 min. •only 15% of migraines •Visual symptoms such as flickering lights •Sensory symptoms like pins and needles •Speech disturbances

3rd order neurons

-carry sensory pulse to *cortex* where it identifies sensation -Primary somatosensory cortex *identifies sensation* -Association cortex relates sensation to memories, other sensations, etc -cerebral cortex you are associating it with other things.

2nd order neurons

-carry sensory pulses to the *brain* -*Discriminative pathway* (feel right way) -From spinal nerve root to medulla -Crosses over to thalamus on other side of brain

DIC

-characterized by both clotting and bleeding at concurrently.

Multiple Sclerosis patho:

-characterized by demyelination -Autoimmune disorder characterized by the inflammation and selective destruction of myelin in the central nervous system (brain, spinal cord, optic nerve); possible viral cause as well -Myelin acts as an electrical insulator, allowing for normal conduction of signals

Erythropoiesis stimulated by...

-decreased Ó in circulation which is detected by kidneys which secrete hormone erythropoietin.

Polycythmia etiology

-dehydration (reversing itself) -Kidney disease with high erythropoietin production -Low oxygen level in the blood: ◦Congenital Heart Disease. Heart has to compensate. so causes heart problems ◦Cor Pulmonale ◦Pulmonary fibrosis -Smoking -Polycythemia vera: vera means true. Meaning true disease. Primary disease. Too many RBC and you clot and will cause necrosis to any tissue distal to that area. need to remove extra RBC -smoking

Sickle cell most common in what ethnicity...

-every baby is screened by law even though most common in African American. -Screening for all ethnicities is mandated in many states by hemoglobin solubility

What rises when you have infection

-ex. If have bacterial pneumonia, neutrophils should rise bc the body is starting to fight infection . If don't start rise the mature cells with ascending. -If numbers rise then immature cells on the left then mature cells on the right. If numbers don't rise due to bacterial infection then will die. Pneumonia patients die within a couple days because neutrophils did not shift to the right or rise to fight off infection.

Etiology of sickle cell

-the genetics -Inheritance of *HbS gene (abnormal hemoglobin)* -*Recessive gene* means that both parents have to have the trait passed on. one gene is sickle cell trait and virtually no symptoms (heterozygous)

Aplastic Anemia Etiology

-exposure to high dose radiation. If patient has blood cancer that want to get rid off then zap bone marrow ability to stop all making of blood then will have bone marrow transplant -chemicals and toxins that suppress hematopoiesis; -chemotherapy and radiation (usually for cancer) result in bone marrow depression; -agents such as benzene, chloramphenicol (antibiotic), some chemotherapy agents, -AIDS: MOST CASES are UNKNOWN ETIOLOGY -onset is very quick if drug related such as seizure medication. -nepraxin also seen associated with this

Symptoms of severe anemia

-fainting -chest pain -angina - heart attack

Common antigens in systemic anaphalxis

-food, insects, drugs, latex

Polycythmia treatment:

-goal is to reduce viscosity. -patient can come in every 2-3 weeks to get blood removed. -blood letting -asprin can control high blood control high platelet count -supporession of bone marrow meds (hydroxyurea) controls elevated WBC count

Nitrates

-gram positive: thick cell wall

Active immunity

-have to make antibiodies yourself. Ex. Given vaccine. Your body has to make own anitbiodies. Or if have chicken pox already and your body makes more antibodies.

Vasoconstrictor medications because...

-headaches are too much blood flow to the brain and wants to vasoconstrict to stop the blood flow.

Polycythemia symptoms

-hypertension, headaches, dizziness, inability to concentrate, difficulty with hearing and vision due to decreased cerebral blood flow. -most common in men about 60 years of age; Increased RBCs, blood volume, splenomegaly(spleen becomes enlarged), high viscosity, hypertension(high BP), venous stasis (slow blood flow), dusky redness of lips, fingernails,

Type 1 Reaction

-immune reactant: IgE -Antigen: Soluble antigen -Effector mechanisms: Mast-cell activation -example: allergic rhinitis, asthma, systemic anaphylaxis.

Type III

-immune reactant: IgG -Antigen: Soluble antigen -Effector mechanisms: FcR cells complement -example: serum sickness, arthus reaction

Type II

-immune reactant: IgG -Antigen: cell or matrix associated antigen -Effector mechanisms: FcR+ cells such as phagocytes, NK cells -example: same drug allergies ex. penicillin

Polycythemia

-increased RBCS or a high hematocrit

Chain of infection

-infectious agent -reservoir (dirty surfaces) -portal of exit (mouth) - mode of transmission (contact or ingested) - portal of entry (broken skin or catheter) - susceptible host (someone that has portal of entry and can get infection)

Antiretrovirals

-inject these -Decrease the amount of virus in the body -5 classes- each class attempts to interrupt the life cycle of the virus at a different point -Combination therapy is ideal, usually at *least 3 drugs* (called HAART-Highly Active AntiRetroviral Therapy). Want varitey of different drugs bc each drug targets virus at each stage of its life. -Goal is undetectable viral load and increasing CD4 count

Hemoglobin (Hgb)lab values

-iron containing pigment of the red blood cells carrying oxygen to the tissues. -Males: 14-17.4 g/100mL -Females: 12-16 g/100mL -*roughly 3x value of hct*

Seizure precautions:

-keeping side rails up and padded, low bed to floor so dont fall. -have suction available so they cant hyperventilate or choke

Types of WBC

-know numbers of different WBC -WBCs are mediators of inflammation and the immune response. 4000-10,500 cells/mm 3 -Neutrophils (polymorphonuclear leukocytes) -Band cells (slightly immature neutrophils) -T-type lymphocytes -B-type lymphocytes -Monocytes -Eosinophils -Basophils

macrocytic

-large cell -macrocytic anemia: blood with *insufficient concentration of hemoglobin* in which RBC are larger than normal volume.

Chronic pain continued

-last longer than 6 months or longer than reasonably expected -Highly variable -Nociceptors(pain stimulus that causes tissue damage) are persistently stimulated all the time -Serves no useful purpose. -Causes psychological, physiological, family and economical stress -Management is complex and depends on the cause of the pain, the underlying health problem, and life expectancy of the individual -It is best managed by a multidisciplinary team but not necssaily at a pain clinic. pain clinics give out too much medication and contributing to opioid crisis.

Treatment of Perncious Anemia

-lifelong injections of B12 or large oral dosages

Lymphocytes

-lymphocytes 25-33% -more important with immunity -Subtypes: e.g. B lymphocytes and T cell lymphocytes

Non oral medications for migrain may....

-may help in sudden onset HA -also use for those with severe nausea/vomiting

MCHC

-mean corpuscular hemoglobin concentration

Von Willebrand Disease symptoms

-mild to moderate bleeding in Types 1 and 2, severe bleeding, life threatening in Type 3 which is autosomal negative.

acute inflammation

-minutes to hours after insult *Vascular Responses*: -causes cardinal signs - Characterized by increased blood flow followed by increased *vascular permeability* and leakage of protein-rich fluid into the extravascular tissues (cardinal signs!). Caused by vasodilation. *Cellular Responses* -Characterized by changes in the endothelial cells lining the vasculature and movement of *phagocytic leukocytes* from blood into the area of injury or infection. Delivery of leukocytes from blood stream to site: -The delivery and activation of leukocytes is divided into steps: ◦*Adhesion and margination*: line up on endothial surface of blood cells to get into site of infection. ◦*Transmigration*: transmigrate into intraextravsacual tissue. Helped migration by proteins ◦*Chemotaxis*: chemical gradient that attracts WBC and tells them exactly where to go. ◦*Activation and phagocytosis*: activated and phagocytosis occurs which releases certain chemicals and enzymes and start to eat the cells.

Monocytes

-monocytes 3-7 % -Monocytes are largest of the WBC's and play a major role in chronic inflammation. -Monocytes are referred to as *macrophages* when they enter the cells.

Chronic pain

-more likely to result in destructive drug seeking behaviors. (pain lasting >3-6 months). -Chronic pain *serves no purpose*, causes suffering while increases over time, appears out of proportion to any observable tissue injury. -does not teach avoidance causes theres nothing you can do to avoid it. -Appears out of proportion to the observable tissue damage that occurs.Ex. People with severe back pain with long duration. People don't look like they are in a lot of pain but are actually in a lot of pain just not telling you about it. -Can be constant or intermittent. Complete relief of pain usually not possible. if complete relief its for a short amount of time.

Acute Pain

-most often results from injury, surgery, or invasive medical procedures, infection. (less than 3 months duration; usually minutes to a few days); -acute pain is protective, promotes withdrawal from the painful stimuli, allows injured part to heal, and teaches avoidance of painful stimuli (e.g. hot stove). -Suffering decreases over time. Likelihood of eventual complete pain relief. -allow for rest which promotes healing.

Innate immunity

-natural system -first line of defense against pathogens/antigens/foreing substances that body doesn't like. Limited in what it can do. -early rapid -Recognizes self vs nonself and prevents establishment of infection. Quick to respond. -Uncordinnated to attack. First line of defense. Made up of: -Skin -Mucous membranes -stomach acid -Phagocytic leukocytes(eat other cells that don't belong there and help body get rid of them such as macrophages and neutrophils -Specialized lymphocytes (natural killer) first line of defense against viruses. -Plasma proteins (complement)

Normocytic

-normal cell -can have normacytic anemia which is normal RBC cell but low number of them

normochromic

-normal color. normal heme

how can nurse look for signs of anemia

-nurse should watch stools for signs of occult(hidden cant see red blood) blood loss -blood loss in stool looks black and tarry. Will not see red. -however will see red with hemmorroids.

Charcot's neurological triad

-nystagmus(when eyes dark back and fourth), intentional tremors(shaking), and staccato speech (abrupt and broken speech)

Symptoms

-outward expression of struggle between invading organism and the retaliatory inflammatory and immune responses of the host

The amount of ________ received by body tissues depends on the amount and functions of _________ and ___________.

-oxygen -RBC - hemoglobin

Pain mechanisms and Pathways

-pain is usually viewed in the context of injury (nocere is latin for "to injure) -nociceptive pain -neuropathic pain

Neurogenic inflammation

-pathway for neurogenic inflammation will track through naciocpetors and fibers.

Innate and adaptive bot use...

-phagocytes and complement system

Phases of a migraine

-prodromal -aura -attack -postdromal

IGM antibodies

-produced first. can only meet someone one time

Erythropoises

-production of RBC

Immunology

-protection from infectious disease by a collective, coordinated response of the cells and molecules of the immune system -innate and adaptive work together to coordinate immune response.

Sensory Unit

-refers to neurons. -*Somatosensory information* is sequentially transmitted: 1st order, 2nd order and 3rd order neurons. -Somatosensory info includes: touch, temperature, body position(close eyes and point figure up and down/ you can tell exactly what position your fingers are in with eyes closed.) and PAIN. -The sensory unit consists of the *cell body* of the *dorsal root ganglion neuron*, its *peripheral branch*, and its *central axon*. -Three types of nerve fibers transmitting somatsensory info: Type A, Type B, and Type C fibers.

Iron deficiency risk factors

-risk factors: makes person most likely to get a given disease. doesnt necessarily cause it. First chapter in the book -drinking cow's milk under 2 years of age. Need supplementation of iron. -Iron supplementation in breast fed infants younger than one year of age -In second year of life, give diet rich in iron and use of iron fortified vitamins -not eating enough iron in foods for children and adults.

Alzheimer's disease

-risk increases with age -subtle onset of memory loss followed by slowly progressive dementia

IGAs

-secreted in breast milk.

Erythropoietin

-senses normal blood oxygen levels by *partial pressure* Oxygen 80-100. - as long as over 80% you can function otherwise will be in ICU -when partial pressure oxygen normalizes then kidney will slow down release.

If your patient has a hemoglobin of 6.2 gms. patient could experience...

-shortness of breath -severe restless. If patient is nice and quiet and suddenly becomes restlessness then think oxygenation. -when have question about hemoglobin...think oxyegnation etc

microcytic

-small cell -microcytic anemia: presence of small often hypochromic rbc and is low MCV. *causes iron deficiency*.

Tonic

-stiffening of extremities

Migraine triggers

-stress -sleep deprivation -alcohol -foods (MSG, aged cheese, chocolate) -visual stimuli -estrogen (Coincide with periods, 75-80% go away with pregnancy. estrogen is why is this happens more in women. When reach menopauses and less estrogen then less migraines.)

Neutropenia (agranulocytosis)

-super low neutrophil count. -Neutrophil count less than 1500 cells/uL (normal 4500-6500) -Agranulocytosis: Count < 200 u/L -very serious. can die from neutropenia. -Patient cant tolerate chemothereapy if less than 1500 so will stop chemo.

acute treatment

-taking during -Aim is to alleviate or shorten symptoms

Colonization

-the act of establishing a presence in a host. Ex. Flora in gut.

Neuropathic pain syndromes

-trigeminal neuralgia (tic douloureux): severe pain and like a tick pain. herpes can cause this...get pain after herpes infection. shingles is herpes and very painful and pain may last from weeks to months. -postherpetic neuralgia -phantom limb pain : when person has amputation and the food may continue to itch or feel pain. limb still feels there. multiple theories including *neuromatrix*

Discriminative pathway

-used for the rapid transmission of sensory information such as discriminative touch. Feel right away

Polycythemia vera:

-vera means true. Meaning true disease. Primary disease. Too many RBC and you clot and will cause necrosis to any tissue distal to that area. need to remove extra RBC -primary -patient can come in every 2-3 weeks to get blood removed.

Low Blood Pressure

-viscosity of blood drops as hematocrit decreases. -A decrease in blood viscosity directly lowers total peripheral resistance (TPR) to the flow of blood, thus lowering mean arterial blood pressure (MAP). -cant define LBP because it varies from person to person.

MCV

-volume

IGG

-when body is again exposed. but can greet someone forever after that. -Crosses placenta and can pass to baby

Acute hemolytic transfusion reaction

-which is usually fatal but rare causing renal failure. Symptoms include back/flank pain, chills, DIC, nose bleeding, fever hematuria, hypotension, oliguria/anuria, pain/oozing at IV site, renal failure (watch for S&S up to 24 hours later)

5-HT1 receptor agonists (Triptans) shouldn't be used in people....

-with CAD (coronary artery disease) because of increased risk of coronary spasm

Treatments of autoimmune disorders

-•Corticosterioids (help with inflammation) and immunosuppresive drugs (can stop, slow down, or reverse symptoms but this also prevents fighting infections/ need to avoid people with flu cause get sick easier. ).

Lab Test for Inflammation

-↑ ESR (Erythrocyte Sedimentation Rate) When testing for inflammation this will be elevetated. Faster rate than normal. ◦RBCs rouleaux process: red blood cells stack up like pancakes. ↑ CRP (C-Reactive Protein) protein that's elevated during inflammation. If elevated it shows theirs a systemic inflammatory response occurring. ◦Target invaders for destruction Significance ◦↑ indicative of systemic inflammatory process

NEXT CHAPTER INFECTION

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NEXT CHAPTER IMMUNOLOGY

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Which tract allows for localization of chronic pain?

...Slower-conducting tract associated with chronic and visceral pain. Travels through C fibers. Neospinothalamic tract.

25 million...

...people experience pain on a daily bases and one common reason people go to their physicians.

Reticulocyte count Lab Value

1-1.5% (of the total RBC ct) -can be up to 10% if a lot of new RBCs are being made which represent the amount of new cells being produced. RBC have a lifespan of 120 days. -if ret cell is high then lots of new RBC are being made. Theres a reason for that...ex. If patient has a bleed out then they will form a lot of new RBC. -aplastic anemia. They wont have RBC or reticulated because they cant form any kind of cell and have an incapacity.

Hemostasis 5 Stages

1. Vessel spasm: *thromboxane Á* released from platelets leads to *vasoconstriction*; from endotheliun *Prostacyclin causing vasodialtion, another prostaglandin, released from the endothelium causes vasodilatation and prevents platelet aggregation. -*same process occurs no matter where damage is either inside or outside body*but...outside body want vasoconstriction but inside body want vasodialation because dont want platelets clotting in the heart. 2. Formation of the Platelet Plug preventing more bleeding: Immediately after vessel injury, von Willebrand factor, from the endothelium, is released binding platelets to exposed collagen fibers. -good on outside but bad on inside 3. Blood Coagulation: complex process with *two pathways*: intrinsic is activated by Factor XII and extrinsic is activated by tissue factor. Both pathways lead to activation of Factor X when activvated then, conversion of prothrombin to thrombin, & conversion of *fibrinogen to fiber*, holding the clot together. 4. Clot Retraction:In a few minutes after the clot is formed, the fibrin strands pull the serum out of the clot causing clot to start shrinking. 5. Clot Lysis (Dissolution): Large amts of plasminogen are trapped within the clot. TPA (tissue *plasminogen activator*) is released from the injured tissues and the endothelium converts plasminogen to plasmin, which digests the fibrin strands, causing the clot to dissolve. -theres drug that affects all of this such as asprin. KNow what drugs affects these processes and its in textbook.

Neurometer test

A NEUROMETER can test involvement of specific nerve fibers, allowing for a more comprehensive assessment of sensory function.

Evasion factors

Ability to evade the host's immune system. Can disguise themselves to look like something else.

Invasion factors

Ability to invade the anatomic barriers and host tissue

Infectious Agents

Everything has DNA except prions. Viruses have DNA and RNA -Prion (protein without a genome)= Mad Cow. No genetic material -Viruses(HIV, herpes): smallest, can cause infectious dx as well as cancer. DNA or RNA -mycoplasmas= pneumonia -rickettsiae (usually transmitted by fleas/ticks): Rocky Mtn Spotted Fever; -Chlaymdiea: causes chlamydia. -Fungi: yeasts and molds, most are skin/subcutaneous infxn. has nucleus. -protozoa/ parasites: malaria, dysentery, giardia. has nucleus -helminths: tapeworm. has nuclues.

True or False people who have sickle cell are not constantly in pain.

False: Rick factors: What leads to it is weather, lack of Ó, dehydration, *acidosis*, etc.

Alzheimer's disease etiology

Likely results from a variety of causes, including less choline acetyltransferase

Factors that impact wound healing

Local & Systemic (often overlap): ◦Blood flow & Ó delivery -supply nutrients, remove debris ◦Infection, wound separation, foreign bodies -Delay process (wound separation, infection, foreign bodies). ◦Nutrition -*Expedites overall process* ◦Inflammation & immune mechanisms -Prevent infection that impair wound healing. ◦Aging -Impairs process. Wounds don't heal as efficiently as they did when younger.

Complete Blood Count includes:

WBCs and Platelets, most common blood test

Time from reticulocyte to erythrocyte...

about a week.

Irreversible dementia

alzheiemer's, parkinsons disease, etc

Delayed hypersensitivity

•(type IV)- inflammatory response that takes 24-72 hours to develop in response to activated mononuclear lymphocytes; exemplified by the tuberculin skin test -ex. TB Test

Autoimmune disorders

•Breakdown in the body's ability to differentiate between self and non-self antigens •Specific cause is unknown, could be *genetic and/or environmental (includes infectious agents)*

Examples of autoimmune disorders

•Can affect almost any type of cell or tissue in the body -Systemic: Systemic lupus erythematosus, rheumatoid arthritis -Blood: autoimmune hemolytic anemia, idiopathic thrombocytic purpura -Other: Hashimoto thyroiditis, type 1 diabetes mellitus, Crohn's disease

Places where pain can originate from....

•Cutaneous- pain arises from superficial structures, sharp, burning e.g. paper cut •Deep somatic- originates in deep body structures, more diffuse in nature, e.g. sprained ankle •Visceral - severe pain usually deep and caused by disease such as cramping intestinal pain. •Referred- pain that is perceived at a site different from point of origin but *innervated by the same dorsal horn* projection neurons. -ex.Pain from a myocardial infarction is perceived as referred to the left arm, neck, and or chest. Usually originates in viscera. -*Referred pain is determined by embryology*. -Ex. Myocardial infarcation, you will not have heart pain or in heart area but will have arm pain... -ex. Pancreatic pain usually goes to left shoulder. Pain is referred to somewhere else.

Impact of stroke location

•Effects noted on OPPOSITE of stroke location •Right hemisphere= left-sided weakness, left facial droop etc. •Left hemisphere= right-sided weakness, right facial droop, etc.

Postdromal

•Extreme tiredness •Sluggishness •Confusion •Head pain that flares up when leaning over, moving quickly, or get a rush of blood to the head

Pattern theory

•Group of theories that propose that pain receptors *share pathways with other sensory receptors* but different patterns of activity signal *painful vs nonpainful stimuli*. -E.g. light touch produces low intensity firing vs intense pressure causes high frequency firing. When you scrape something with finger nail you feel hard touch and receptor differniates if its really painful or not.

prodromal

•Hours or days before •Either unusually energetic and excitable or depressed •Irritable •Thirsty •Cravings for specific foods •Fatigue •Increased urination -only 30% of people experience this. Not everyone goes through this phase. Before pain of migraine begins. days or hours before. Can be depressed.

HIV/ AIDS

•Human Immunodeficiency Virus develops into Acquired Immune Deficiency Syndrome in the presence of a *CD4 count below 200* and/or an opportunistic infection (doesnt normally pop up in regular population. •HIV transmitted through blood, semen, vaginal fluid, and breastmilk. Sexual contact is the most common method • PATHO: HIV is a retrovirus that *infects certain cells (CD4 T cells, macrophages, dendritic cells)*. The death of these types of cells create decreased immune response even if the person is asymptomatic, creating susceptibility to many illnesses (common and rare)

Altered pain sensitivity

•Hyperpathia: continued stimulation causes pain •Paresthesias: spontaneous, unpleasant sensations. numbness and tingly. •Hypalgesia: reduced pain sensation •Analgesia: absence of pain. most of the time not expected. when give pain meds expecting 50% reduction in pain and not expecting absence of pain. •Allodynia: pain after nonnoxious stimulus

Systemic anaphylaxis

•Life-threatening hypersensitivity manifested by widespread edema, bronchospasms, and vascular shock secondary to vasodilation (histamines). •Previous exposure to antigen creates *IgE*. at some point body will have enough antibodies and body will start attacking antibodies. Ex. Can eat shellfish your whole life and get so many IG antibodies that body what's to attack antigens when eat shellfish and that's when you swell up. •Level of severity dependent on level of *sensitization* to antigen •Antigen can be *ingested* (food allergy, medication), *injected* (bees, medication), or *absorbed* (either through the skin or GI tract) •Hives, itching, difficulty breathing, vomiting, cramps, diarrhea, edema and obstruction of the airway

Immunosuppressive Agents

•Most immunospressive drugs work by *preventing DNA synthesis in immune cells*, preventing replication and eventually causing cell death

Specificity theory

•Pain is a separate sensory modality and specific receptors (nociceptors) detect and then transmit info to the brain for interpretation.

Gate control theory (Melzach and Wall, 1965)

•Pain is carried by distinct fibers in the *spinal cord, small and large diameter fibers*; -local stimuli can block (close the gate) the pain experience. -If gate is closed will decrease experience and if open will increase experience. -Very famous theory.

Adapt to stressors by undergoing changes in size, number, or shape...

◦Atrophy ◦Hypertrophy ◦Hyperplasia ◦Metaplasia ◦Dysplasia

Steroids

•Work by suppressing inflammatory response that characterizes disorders such as rheumatoid arthritis and lupus •Can have severe side effects depending on *dosage and length of therapy* (weight gain, Cushing's syndrome, osteoporosis, pregnancy complications, glaucoma, etc)

Anterolateral pathway

•provides transmission of sensory information such as pain, thermal sensations, crude touch and pressure that *does not require discrete localization of signal source.* means it can be associated with chronic pain. -*slower* and going to transmit crude touch and pressure. -if you feel someone squeeze your hand too hard that is slower and doesn't require that discriminative pathway. -paleospinothalamic tract -neospinothalamic tract

Immediate Hypersensitivity

•rapid reaction to *exposure to antigen*, can be within minutes, range in severity from rhinitis(runny nose) to anaphylaxis

Chronic inflammation

◦*Monocytes and lymphocytes* predominant, can cause fibrosis. ◦May follow acute inflammation ◦Insidious onset, often asymptomatic to tissue damage ◦*Aimed at treating persistence*, because may lead to cancer -Risk of scarring and deformity is greater. Takes longer for cells to repair if at all.

Pain managment opioid analgesic

◦Group of medications with morphine-like actions ◦Morphine and codeine ◦Used for relief of short-term pain(after surgery) and for long-term conditions, as cancer pain ◦Helps to give routinely before pain starts or becomes strong is more effective than administering in a sporadic manner. Evidence suggests that people require fewer doses and are able to resume normal activities quicker. ◦Use only when absolutely necessary and for the shortest length of time; switch to nonnarcotic ASAP. No longer than 4 days. -switch to NSAID before they go home.

Healing phases

◦Inflammatory: blood clots occur and WBC are there. ◦Proliferative: new tissue is being built ◦Maturational/Remodeling: can take 3 weeks after injury has occurred and take up to 6 months. Delvopment of scar tissue or fibrous tissue that needs to be there

pain managment assessment

◦Pain is subjective and cannot be measured objectively ◦Want to *eliminate* the cause rather than treat symptoms ◦Take a careful history ◦Include onset, description, localization, radiation, intensity, quality, pattern of the pain, anything that relieves the pain, and individuals personal reaction to the pain (COLDSPA, character, onset, location, duration, severity, pattern, associated characteristics) ◦Use a numeric pain scale to measure intensity of pain

Acute inflammation

◦Vascular change, edema, *neutrophils predominant* ◦Cardinal signs & systemic manifestations(acute phase response) ◦Exudate production(when WBC do their job and combination of WBC and celluar debris exiting body) ◦*Aimed at assisting tissue repair* where damage occurred.