Exam 2 in Med/Surg Nursing
Terms
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__________ Acquired Immunity: Results from invasion of the body by foreign substances:
Natural acquired: Clinical infection of chickenpox, measles etc.
Artificial acquired: Immunization with antigen such as live or killed vaccines - Active Acquired Immunity
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__________ Acquired Immunity: Results from receiving antibodies to an antigen
Natural: Transplacental and colostrums transfer form mother to child
Artificial: Injection of serum from immune human (globulin)
____________: substance -
Passive Acquired Immunity
Antigens: - _______________Phagocytes: responsible for capturing, processing, and presenting the antigen to the lymphocyte
- Mononuclear
- ___ lymphocytes: Originate in bone marrow, differentiates into plasma cells: produce antibodies
- B lymphocytes
- ___ lymphocytes: Migrate from bone marrow to thymus and differentiate into T-cells; 70-80% of circulating lymphocytes
- T lymphocytes
- ____ cytotoxic cells: attack antigens at the cell membrane level.
- T cytotoxic cells:
- ____________ and __________: involved in the regulation of cell mediated and humoral antibody response. Referred to as immunoregulatory cells
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T helper(CD4)
T suppressor(CD8) cells - ___________ killer cells: not T or B cells, they are large lymphocytes; involved in cell mediated immunity
- Natural killer cells
- soluble factors released by WBC’s and a variety of other cells in the body; act as messengers between cell types; instruct cells to alter their proliferation, differentiation, secretion or activity.
- Cytokines
- A virus invades the body through a break in the skin or another portal of entry. The virus must make its way _______ a cell in order to replicate itself.
- inside
- A ____________ recognizes the antigens on the surface of the virus. The _____________ digests the virus and displays pieces of the virus (antigens) on its surface.
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macrophage
macrophage - A ________________ cell recognizes the antigen displayed and binds to the macrophage. This binding stimulates the production of cytokines (interleukin-1 [IL-1] and tumor necrosis factor [TNF]) by the macrophage and interleukin-2 (IL-2) and -interferon (
- T helper cell
- _________ instructs other T helper cells and T cytotoxic cells to proliferate (multiply). T helper cells release cytokines, causing B cells to multiply and produce antibodies.
- IL-2
- T cytotoxic cells and natural killer cells _________ infected body cells.
- Destroy
- The antibodies bind to the virus and mark it for ____________ destruction
- macrophage
- Once the virus is gone, activated T and B cells are turned off by suppressor T cells. ___________ B and T cells remain behind to respond quickly if the same virus attacks again.
- Activated
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Humoral Immunity: B lymphocytes produce antibodies, result in B memory cells; protect against bacteria, viruses (________cellular),
Examples :
Anaphylactic shock
Atopic diseases
Transfusion reaction
< - extracellular
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Cell-Mediated Immunity: T lymphocytes, macrophages, produces sensitized T cells, lymphokines, results in T memory cells, protects against fungus, viruses (________cellular), chronic infectious agents, tumor cells
Examples:
Tuberculo - intracellular
- Immune System: __________ in immune system, more susceptible to cancerous tumors and infections
- deline
- Anaphylaxis is the ______ severe Type I reaction and can be fatal if not treated promptly. Persons with previous allergic reactions to medications, bee stings, foods, etc. are advised to wear Medic Alert bracelets & may need teaching regarding Epi pe
- most
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________ reactions: inherited tendency to become sensitive to environmental allergens. Examples: allergic rhinitis, asthma, atopic dermatitis, and urticaria.
Allergy testing may be necessary to determine the antigen causing the reaction. Pers - Atopic reactions
- The body makes special antibodies to _____ the tissues with foreign protein attached. The antibody binds to the self cell and triggers the cell’s destruction.
- kill
- Hemolytic transfusion reactions: receives ________ blood type
- wrong
- ___________________ syndrome: rare disease involving lungs and kidneys can result in pulmonary hemorrhage of glomerulonephritis.
- Goodpasture syndrome
- Type III: Immune-Complex Reactions: Immune complex reactions occur when immune complexes are formed because of ____________ antigens. The complexes are deposited in the small blood vessel walls of various organs and cause tissue damage. This is seen in m
- excess
- Type IV: Delayed Hypersensitivity Reactions: Cause the T lymphocyte to release lymphokines and destroy the antigen. The process usually takes _______ days. Are examples of type IV reactions. It is important to find out the cause of the reaction and remov
- 2-3 days
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Types of transplant rejection:
Hyperacute: begins _____________ after transplantation. An antibody mediated response (antigen-antibody complexes form) because the body recognizes the transplant organ as non-self & begins coagulation, occlusion, - immediately
- Acute: begins __ week – 3 months after transplant and causes organ damage due to antibody mediated vasculitis and cell mediated cell lysis. Organ damage occurs but the client may not lose the transplanted organ if medications are successful at controll
- 1 week
- ___________: occurs over time. ________ inflammation causes fibrotic scarring with non-functional tissue replacing organ tissue. Known as AGA (accelerated graft atherosclerosis) in heart transplant recipients, this is the major cause of death in clients
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Chronic
Chronic -
Skin Tests
Procedure:
_____________ scratch or prick
_____________ injection -
Cutaneous
Intracutaneous - ___________ response is an immediate immune response which helps the body fight against acute bacterial or viral infections..
- Humoral
- The body's delayed hypersensitivity response which involves autoimmunity and allergic reactions is called the_____________ response.
- cellular
- _______________ immunity is present at birth and is also referred to as innate immunity.
- Natural
- _____________ acquired immunity is transferred from mother to baby via antibodies in the placenta & breast milk or by injections with animal serum containing antibodies.
- Passively
- _______________ acquired immunity occurs when the body produces its own antibodies to protect against a disease producing antigen.
- Actively
- _____________ T Cells (also known as CD4 cells) stimulate the activity of other leukocytes by secreting lymphokines which stimulate immune function. These cell counts are lowered in H.I.V. disease.
- Helper
- _____________ T cells prevent continuous overreaction (hypersensitivity reactions) to antigens by secreting lymphokines which have an inhibitory action on the immune system cells.
- Suppressor
- _________________ T cells exert cytotoxic effects without undergoing a period of sensitization.
- Cytotoxic
- ______________________ cells bind with an infected cell's antigen and causes the death of the infected cell to prevent the spread of the infection.
- Natural Killer
- ______________ rejection occurs immediately after transplantation and is unstoppable. Caused by an antigen-antibody response, it is seen mainly in people with donated transplant organs with different ABO blood types, multiple blood transfusions during li
- Hyperacute
- _________________ rejection occurs most commonly with kidney transplants and begins within one week to three months after transplant. Antibodies may cause organ vasculitis or cytotoxic T cells and NK cells may enter the organ and cause damage. The reject
- Acute graft
- ______________ rejection leads to organ destruction by causing atherosclerosis, fibrosis, and scar tissue in the organ. This rejection is the major cause of death in heart clients. The cause is not clear but it is thought to be a chronic inflammatory res
- Chronic
- ________________ skin testing is the most sensitive form of allergy skin testing involving injecting a small amount of the antigen under the skin. It is more painful than other test methods and must be performed over several sessions if many allergens ar
- Intradermal
- ________________ skin testing involves scratching the surface of the skin then applying a drop of the suspected allergen on the area of the scratch.
- Scratch
- Physical barriers, chemical barriers, interferon, inflammation, and phagocytosis are components of the body's ______________ immune response.
- non specific
- The nurse understands that a positive skin test reaction to an allergen stimulates __________ antibodies which are responsible for hypersensitivity type I reactions and are also elevated in intestinal parasite infections.
- IgE
- Capable of neutralizing viruses and inhibiting bacterial attachment,____ is found in external body secretions.
- IgA
- _____________ is the major antibody in the body and is capable of crossing the placenta with its antibacterial, antiviral and antitoxin properties.
- IgG
- The first antibody produced when exposed to an antigen is _____________.
- IgM
- The function of ____________ is unknown but it is thought to function only on the surface of B cells for regulation.
- IgD
- Human Immunodeficiency Virus (H.I.V.) is a secondary immunodeficiency disease which attacks the T ________ lymphocytes
- Helper
- _________ immunodeficiencies are present at birth and include DiGeorge syndrome and severe combined immune deficiency (SCID).
- Primary
- All secondary immunodeficiencies are caused by H.I.V.(true/false).
- False
- ____________ occurs about one to three weeks after exposure to H.I.V. Flu like symptoms with a reddened, diffuse rash are the only symptoms at this stage of H.I.V. infection.
- Acute retroviral infection
- Symptoms of H.I.V. disease, including fever, fatigue, night sweats, headache, diarrhea, and oral infections, do not begin to occur until the CD4 count dips below _______.
- 500
- ___________ H.I.V. disease occurs when the CD4 count falls below 50. CNS symptoms increase and mortality is high at this point.
- Advanced
- _____________ sarcoma and other dermatologic symptoms present in the client with late symptomatic H.I.V. disease.
- Kaposi's
- The most sensitive test for H.I.V. antibodies is the _________________.
- Western Blot
- Routine H.I.V. screening measures test for the virus in the blood (true/false).
- False
- H.I.V. transmission can be prevented by ______________.
- education
- "Cocktail therapy" (several antiretrovirals taken concurrently) can decrease the viral load in the client with H.I.V. infection. This treatment is called highly activated antiretroviral therapy or ______________.
- HARRT
- The time from exposure to H.I.V. to antibody production in the body is called the _____________ time.
- seroconversion
- _________ is a life threatening hypersensitivity reaction that rapidly and systemically affects multiple organs.
- anaphylaxis
- In ____________ disorders, antibodies and/or lymphocytes are directed against healthy normal cells and tissues..
- autoimmune
- ___________ is a medication which competes for histamine at the histamine receptor site.
- antihistamine
- A drug which cuases vasoconstriction and reduces edema to increase comfort is a _________________.
- decogestant
- ________________ decrease inflammation and immune response in a short time.
- Corticosteriods
- Immediate hypersensitivity reactions occur within minutes after an antigen combines with ______________.
- IgE
- _________________ include hemolytic transfusion reactions, and drug induced hemolytic anemias. Cell damage and destruction occur
- Type II cytotoxic reactions
- Penicillin, cephalosporins, and antitoxin from animal sera are the main causes of __________________.
- serum sickness
- __________ hypersensitivity reactions take at least 24 hours to manifest and include contact dermatitis, PPD testing for TB, and graft rejections.
- Cell mediated
- A __________ rash is a typical manifestation of systemic lupus erythematosus.
- butterfly
- Clients with systemic lupus erythematosus are advised to avoid ___________ to prevent symptom exacerbation.
- ultraviolet light
- Chronic fatigue syndrome has shown some improvement with the intravenous administration of __________.
- immunoglobulin G
- The cause of autoimmune hemolytic anemia is ________.
- unknown
- Diffuse scleroderma, an autoimmune collagen disorder, usually begins with _______________ of the fingertips.
- Raynauds's phenomenon
- Reducing or decreasing an aspect of the immune system's ability to respond to an antigen is called ________________.
- immunosuppression
- __________ immunosuppression uses repeated exposure to an antigen to help the body suppress the antibody response, as in allergy testing.
- Antigen specific
- Side effects of __________ administration include febrile reactions, serum sickness, and occasionally anaphylaxis.
- Antilymphocyte serum
- ____________ affects both B cells & T cells to suppress the immune system. The mechanism of action is not understood.
- Corticosteriods
- A treatment which uses identical copies of an antibody reacting with a single, specific part of the antigen, _______ antibodies may be useful in the treatment of cancers.
- monoclonal
- Antigen specific treatments, antilymphocyte serum, monoclonal antibodies, steroids, chemotherapy, radiation, and surgical removal of the lymphoid tissue all fall into the general category of _____ therapy.
- immunosupressive therapy
- ______________ is prescribed to relieve pain, fever and inflammation. It can cause gastrointestinal symptoms and ulceration if used for a prolonged period of time.
- ibuprofen
- Drugs used to prevent or treat infections caused by pathogenic microorganisms are called ______________ Monitoring of repsonse to treatment, toxicity, and side effects of this classification of drugs is very important.
- antibiotics
- ___________ (the trade name for low molecular weight heparin) works the same as heparin and is used to preven thrombosis and DVT in the client with musculoskeletal injury. It is not necessary to montitor the activated partial thromboplastin time (APTT) w
- lovenox
- _____________ relieve moderate to severe pain by reducing pain sensation, producing sedation, and decreasing the emotional upset often associated with pain. Often requiring additional nursing accountability procedures, this class of drug should be evalua
- narcotics
- _____________ or Zyloprim is a uric acid synthesis inhibitor used in the client with gout to reduce the amount of uric acid delivered to the kidneys by inhibiting uric acid production. Clients on this medication must drink at least 2000 mL of water per d
- allopurinol
- One drug used to decrease the bone reabsorption in women who have had ovaries removed or have undergone menopausal changes is ______________ . It is important to teach clients to perform breast self exams and undergo annual mammograms and pelvic exams du
- estrogen
- _____________ , the generic name for Fosamax, is a drug which inhibits bone resorption by osteoclasts. Erosive esophagitis is a problem with this medication and clients are instructed to take the drug with a full glass of water before breakfast and remai
- alendronate
- __________ is an intranasally or subcutaneously administered hormone used to inhibit osteoclastic bone resorption.
- calcitonin
- A simple, uncomplicated fracture which does not cause a break in the skin is called a __________ fracture.
- closed
- An ____________ or compound fracture involves trauma to surrounding tissue and breaks the skin.
- open
- An _____________ fracture is a partial, cross-sectional break with incomplete bone disruption.
- incomplete
- A _______________ fracture is a cross-sectional break of the bone, which severs the periosteum.
- complete
- ______________ fractures produce several breaks of the bone and cause bone splinters and fragments.
- comminuted
- _________________ fractures break one side of a bone and bend the other.
- greenstick
- ____________ fractures involve a fracture twisting around the shaft of the bone and are indicative of child abuse in the absence of a plausible history.
- spiral
- A fracture occuring straight across the bone is called ____________.
- transverse
- __________ fractures occur at an angle across the bone.
- oblique
- The acronym ___________ is used to describe the musculoskeletal care principles of rest, ice, compression, and elevation of the affected area.
- rice
- __________, a life-threatening systemic complication of a fracture usually occurs 24-72 hours after the fracture. Symptoms include personality changes, restlessness, dyspnea, crackles, white sputum, and petechiae over the chest and buccal membranes.
- fat embolus
- ____________________ occurs when increased pressure compresses nerves and blood vessels. Symptoms include deep unrelenting pain, hard edematous muscle, decreased tissue perfusion and impaired neurovascular checks. Treatments might include cast bivalve or
- compartment syndrome
- The ______________ makes up most of the bone's length and is composed of compact bone.
- diaphysis
- ______________ is a fibrous connective membrane that covers and protects the diaphysis.
- periosteum
- The ends of the long bone consisting of thin layers of compact bone enclosing an area filled with spongy bone is called the ______________.
- epiphysis
- ____________ is vascular tissue located in the medullary cavity of long bones and flat bones..
- bone marrow
- Fixed joints (eg., skull sutures) are called ________.
- synarthroses
- Slightly movable joints (eg., vertebral joints) are called _______________.
- amphiarthroses
- Freely moveable joints (eg., mandible, ear ossicles) are called ________________.
- diarthroses
- The ______________ is a tough, fibrous sheath surrounding the articulating bone.
- joint capsule
- Strong, fibrous connective tissue binding bone and providing joint stability are called ______________.
- ligaments
- Strong, fibrous, nonelastic connective tissue extending from a muscle sheath and binding muscles to bones is called ________________.
- tendons
- _______________ is a nonvascular, supporting connective tissue composed of various cells and fibers which absorbs weight, shock, stress and strain to protect bones, joints and tissues.
- cartilage
- A test using radiation or photographic images to detect musculoskeletal structure, integrity, texture, or density problems and can evaluate disease progression is called _________.
- roentgenography
- A ________ detects skeletal trauma and disease by determining the degree to which the matrix of the bone "takes up" a bone-seeking radioactive isotope.
- bone scan
- ____________ is injection of radiopaques substance or air into the joint cavity to identify acute or chronic tears of the joint capsule or supporting ligaments for the knee, shoulder, ankle, hip, or wrist.
- arthrography
- An ___________ allows analysis of synovial fluid, blood, or pus aspirated from ajoint cavity.
- arthrocentesis
- An injection of a contrast agent into the subarachnoid space of the spine to detect herniation, tumor, and congenital or degenerative conditions of the spinal canal is called a ___________.
- myelography
- ______________ measures muscle electrical impulses for diagnosis of muscle or nerve disease.
- electromyography
- A ___________.(aspiration, punch, needle or incision) studies bone, synovium, or muscle tissue
- biopsy
- _____________ shows soft tissue, bone, and the spinal cord in three-dimensional, cross-sectional images..
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computed tomography scan
CT scan - ____________ allows study of soft tissue in multiple planes of the body
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magnetic resonance imaging
MRI - _________ identifies anemias, hemorrhage, infections, neoplastic conditions, lupus, blood dyscrasias, allergies, stress, and other conditions.
- CBC
- _______ identifies increases in osteoblastic activity and inflammatory conditions.
- alkaline phosphatase
- ___________ elevation may identify skeletal muscle necrosis, atrophy, or trauma.
- creatinine phosphokinase
- _____________ elevation may identify skeletal muscle damage.
- lactate dehydrogenase
- ___________ helps identify problems with calcium availabilty, absorption, or distribution in the blood.
- serum calcium
- __________ is used to evaluate the severity and course of an inflammatory process such as a bacterial infection.
- (C) reactive protein
- A measurement of the antibody found in rheumatoid arthritis and connective tissue diseases is called _________________.
- rheumatoid factor
- The reduction and alignment of a fracture through a surgical opening is called an _________________.
- open reduction
- The stabilization of a reduced fracture using screws, plates, nails, or pins is known as __________.
- internal fixation
- A ___________ involves plaicing bone tissue in an area to facilitate healing, stabilization, or replacement.
- bone graft
- Joint repair through a small arthroscope to avoid a large incision is called _________.
- arthroplasty
- involves immobilizing a ___________ joint through fusion.
- arthrodesis
- ______________ is the replacement of a joint surface with a metal or plastic prosthetic.
- joint replacement
- ____________ is moving a tendon insertion site to improve joint function.
- tendon transfer
- ___________ is the cutting of a tendon.
- tenotomy
- ___________, the removal of muscle fascia, is performed to relieve constriction in the area.
- fasciotomy
- ______________ involves aligning bone by removing a wedge of the bone.
- osetotomy
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Osteoarthritis
lNoninflammatory disorder of the diarthrodial (synovial) joints
lSlowly progressive
lMore than ___________ of adults are affected by age 40
lBefore age _______, men are more often affected than -
90%
50
women -
Rheumatoid Arthritis (RA)
A chronic, ___________ disease characterized by ______________ of connective tissue in the diarthrodial (synovial) joints
Typically have periods of _________ and exacerbation
Affects all ethnic -
inflammation
systemic
remission
women
men
smoking