1
Q
What are the clincial implications of erthrocytosis?
increasing RBC
A
- monitor for fatiue
- screen for venous thromboembolism
- monitor for signs and symptoms of venous thromboembolism
–
2
Q
What is erthrocytosis?
A
increase in RBC
3
Q
What is Anemia?
A
decrease in RBC
symptom not a disease
4
Q
What causes and are clinical implications of anemia?
A
causes: hemmorhage, chronic/inflammatory disease, bone marrow suppresion, **sickle cell disease, **oncologic conditions, renal disease, pregnancy, iron deficiency, overhydration
clinical implications: monitor vital signs and cardiac rhythm, monitor for fatigue, monitor for leg cramps, assess/monitor for cognitive impairment, provide fall prevention, monitor for signs and smptoms of orthostatic hypotension
5
Q
what is hemoglobin?
definition, norms, test, low level indication
A
definition: a red protein responsible for transporting oxygen in the blood
test: measures the amount of hemoglobin per unit of volume blood
low level indication: anemia
norms: 14-18 for males and 12-16 g/dl for females
6
Q
What is hematocrit?
definition, norms, test, low level implication
A
definition: ratio of the volume of RBC to the total volume of blood
norms: 40-54% for men, 36-46% for women
test: measures the volume of RBC with respect to total blood volume
Low level implication: not enough RBC or loosing to acute bleeding
7
Q
What are thrombocytes?
include critical values\
A
- important for coagulation
- critical values: <50,000 (increased bleeding risk) or > 1 million ( extremes can be counter productive for PT intervention)
8
Q
What is thrombocytopenia?
definition and clinical implications
A
- Low amount of platelets in blood
- clinical implications: educate patients regarding risks and strategies to prevent falls and monitor for fatigue
9
Q
What is thrombocytosis?
A
increase platelets
10
Q
What are clinical implications of thrombocytosis?
A
screen for venous thromboembolism, montor for signs and symptoms of VTE, and consider referral, collaborate with interprofessional
11
Q
What is the function and some examples of platelet inhibitors?
antiplatelet drugs/fibrinolytics
A
- stop a clot from forming
- aspirin, ADP receptor inhibitors, glycoprotein platelet inhibitors, phosphodiesterase inhibitors
12
Q
What are fibrinolytics?
action, examples, adverse events
A
- drug that facilitates clot dissolution to repoen occluded vessels in arterial and venous thrombosis
- alterplase, recombinant t-PA, tenacteplase, urokinase
- adverse events: excessive bleeding
13
Q
Von willebrand’s disease
A
has 3 different types that get worse as the number increases
14
Q
What is hemophilia?
A
bleeing disorder
15
Q
What is virchow’s triad?
A
- contributes to thrombosis (clot formation)
- conages in vessel wall, blood composition and blood flow
- D-Dimer test: look for thrombin, activated factor XIII, and plasmin in blood to see if clot is present
16
Q
what do direct rhrombin inhibitors do and what are some examples?
anticoagulation medication
A
- bind direclty to thrombin and impair ability to activate fibrin (can’t make clot)
- ex. argroban, diabigatran, bivalirudin
17
Q
What are factor Xa inibitors, examples, and side effects?
anticoagulation medication
A
- directly inhibits the active form of clotting X factor through comman pathway (so more stable)
- ex. herapin, coumarin/warfarin
- side effects: hemorrhage, heparin induced thrombocytopenia and GI distress
18
Q
what is heparin?
A
- inhibits synthesis and function of clotting factors, primary prevents acute venous thromboembolism
anticoagulation medication
19
Q
What is coumarin?
A
- warfarin/coumadin inhibits synthesis of specific clotting factors by imparing vitamin K function, used for long-term prevention of venous thromboembolism
- international normalized ratio (INR) monitors how well anticoagulatino meidcal warfarin (coumadin) is working. Normal is >8-1.1, >3.6 is at high range for bleeding
20
Q
what is an antifactor Xa herapin assay?
A
- test to measure plasma herapin
- clinical implications: increased risk of bleeding, educate patients on trauma induced bleeding, collaboration with interprofessional team
21
Q
What is an activated partial thromboplastin time assay?
A
- monitors patients on heparin
- clinical implicaitons: increased risk of bleeding, education on trauma, induced bleeding, collaboration w.interprofessionals
22
Q
What are clinical implcations for prothrombin time assay?
A
- prothrombin is protein for clotting blood
- clincal implication:fall prevention, bruising, educate patient on fall risk, collaborate with interprofessionals
23
Q
WBC are…
A
non-specific indicators
24
Q
what causes an increase and decrease in neutrophils?
A
- increase: acute infection
- trending down: radiation, chemo, infection
25
what are leukocytes?
* increased in number of neutrocytes (WBC) in the blood
* caused by tissue necorisis, malignancies and inflamation
* clinical manifestations: fever, headache, shortness of breath, symptoms of localized or systemic infections and inflammation
26
What is leukopenia?
reduction of leukocytes
27
What are acute and chronic leukemia?
acute: accumulation of immature lymphoid or myeloid cells in bone marrow and peripheral blood
chronic: accumulation of mature lympoid or myeloid cells
28
What are 4 symptoms of leukemia?
bone pain, anemia, infection, bleeding
29
Who gets adult myeloid leukemia?
adults above 45
30
Who gets acute lymphoblast leukemia?
frequently children
31
What is chronic myeloid leukemia charactorized by?
philadelphia chromosome
32
What is chronic lymphocytic leukemia?
* common type of adult leukemia
* caused by environmental factors
* B cells affected
33
What is hodgkin's lymphoma characterized by?
reed sternberg cells
34
What is multiple myeloma?
cancer of bone cells so shows up first as bone pain
35
What is humoral acquired immunity?
**B cells** are made and mature in bone: helps to form memory of bacteria and pathologies in body - takes a couple of weeks
36
what is cell mediated immunity?
mediated by **T-lymphocytes**: bone in thymus, work 2/ b-lymphocytes and tell B-lympocytes to begin
* dynamic in killing virus cells
37
What is one factor that affects immunity?
**surgery and anesthesia**: can result in immune system prepression of 1 mo (B and T cell function)
38
what is a big characteristic of systemic lupus erythematosus?
**butterfly rash** if exposed to fun
39
What is chronic fatigue and immune dysfunction syndrome?
unexplained fatigue for greater than or equal to 6 mo
40
What is fibromyalgia?
syndrome w/ 11 to 18 tender points
41
What is an HIV and how is it treated?
* retrovirus
* attacks CD4 (t4-helper) lymphcytes
* antiretroviral is **most common treatment (antiretroviral theory)**
* managing HIV also means **treating opportunistic infections**
42
What are nukes and nonnkes, and what are their side-effects?
| aniretroviral drugs
*** stop HIV changing from single strand of RNA into double strand of DNA
* Side effects:** periopheral neuropathy, myalgia, myopathy, joint pain, fever, chills, rash, pancreatitis, anemia
43
What does a protase inhibitor do and what are its side effects?
| aniretroviral drug
* **blocks new HIV from being cut into the right size proteins which prevents new virus from being infectious**
* keeps viral load down
* common side effects:** lipdystrophy syndrome**
44
What is a primary skin lesion?
* present at birth/acquired during a person's lifetime
* bulla, vesicle, pustule, macule, patch, plaque, wheal, nodule,papule
45
What is a bulla?
circular, fluid filled, >1cm, blister
46
What is a vesicle?
circular, fluid filled, up to 1 cm
47
what is a pustule?
circular, collection or leukocytes, fluid filled, size varies
48
What is a macule?
a change in color of skin, circular flat discoloration, <1cm, freckle
49
What is a patch?
same as macule but > 1cm, circular, flat discolaration (brown, blue, red, or hypopigmented)
50
What is plaque?
superifical, elevated, solid, flat topped lesion, > 1cm
51
What is a wheal?
firm, edematous plaque, infiltration of dermis, may last a few hours
52
What is a nodule?
circular, elevated, solid, > 1cm
53
What is a papule?
superficial, solid, <1cm, color varies
54
What is a secoundary lesion?
changes in skin resulting from primary lesions
* natural progression or personal manipulation
* excoriation, denuded
55
what is excoriation?
loss of epidermis, linear, erosion, destruction by mechanical means (scratch, abrasion)
| secoundary lesion
56
What is denuded?
loss of epidermis (urine, feces, body fluids, wound exudate or friction
| secoundary lesion
57
what is a common characterisitic of psoriasis?
covered with** silvery scale**
58
What is a common characteristic of impetigo?
**superficial,** caused by straphylococci or streptococci
59
What is cellulitis?
**rapidly spreading,** red streaking, medical emegency
60
What is Kaposi's sarcoma?
malignancy of vascular tissue
61
How do signs and symptoms of infectious diseases change with age?
immunocompromised, hospitalized or older adults may show tachypnea, confusion or hypotension prior to fever
62
what are integumentary system signs and symptoms of infectious disease?
purulent drainage, skin rash, red streaks, bleeding from gums or into joints
63
what are cardiovascular system signs and symptoms of infectious disease?
tachycardia, petechial lesions, hypotension, change in pulse rate
64
what are CNS signs and symptoms of infectious disease?
confusion, altered level of consciusness, seizures, headache, photophobia, memory loss, stiff neck, myalgia
65
what are GI system signs and symptoms of infectious disease?
nausea, vomiting, diarrhea
66
what are genitourinary system signs and symptoms of infectious disease?
dysuria or flank pain, hematuria, oliguria, urgency, frequency
67
what are upper respiratory system signs and symptoms of infectious disease?
trachypnea, cough, dyspnea, hoarseness, sore throat, nasal drainage, sputum production, oxygen desaturation, decreased exercise tolerance, prolonged ventilatory support
68
What are transmission-based precautions and preventions for standard, airborn, droplet and contact?
**standard:** handwashing and loves
**airborn:** private room
**droplet:** private room, surgical mask when within 3ft
**contact: **private room, gown and glove
69
what does sulfonamaide/fluoroquinolones do?
| infectious disease pharmacodynamics
*** inhibit DNA and RNA**
* also carry most of our allergies and cause a lot of adverse drug reactions
70
What can ciproflaxin/fluroquinolones cause?
tendon damage and neuropathies (numbness)
## Footnote
1. Penicillin and vancomycin inhibit cell wall membrane
2. Aminoglycosides inhibit protein synthesis
a. Nephrotoxity (bloody urine) and ototoxicity (dizziness)
---
71
What should PT's do about infections?
educate about signs and symptoms
72
what is the Varicella Zoster virus?
Singles = chicken pox = varicella zoister virus = herpesvirus type 3
73
What is heerpesvirus type 4, infectious mononucleosis caused by?
EBV
74
what are side effects of acyclovir/zovirax?
skin, GI, CNS (headaches and dizziness)
75
Amantadine/symadine side effects
CNS: confusion, mood changes, dizziness light-leadedness
overdoese: seizures
76
oseltamivir/tamiflu side effects
GI, CNS toxicity (confusion, seizures)
77
Foscarnet/fascavir side effects
nephrotoxicity, hematological disorders (anemia, leukopenia), gi, CNS toxicity
78
Ribavirn/Virazole side effects
rare, minor if inhaled - conjectivitis of eyes
if PO: anemia
79
why do you treat with antiviruls?
because it targets the cytokine and inflammatory phase: has specific age groups/stages -> very specific for pt/disease
80
What is the difference in bacteria vs. Virus?
bacteria is a single cell microorganism with rigid cell membrane, different ribosomes and different nucleic acid metabolism
a virus is surrounded by protein shell and needs a host to survive
81
What is ABCDE screening?
asymmetry, border, color, diameter, evolution
82
What is differentiation?
* No longer looks like tissue of origin
* undifferentiated, anaplastic and anaplasia all mean the same thing
83
What is dysplasia?
disorganization of cells in which adult cell varies from its normal size, shape or organization
* caused by chronic irritation
* may reverse itself early on or progress to cancer
84
What is hyperplasia?
increase in number of cells in tissue, resulting in increased tissue mass
85
What are tumors/neoplasma?
abnormal growth of new tissue that has no purpose and could be harmful
* primary: cells local to structure
* secoundary: results of metastasized cancer cells from primary site to other places in body
* carcinoma in situ: tumors of grandular or squamous cell origin that stay above basement membrane (have not spread to other tissues
--
86
What are benigna and malignant epithelial cells called?
**benign:** papilloma
**malignant:** squamous cell carcinoma
87
What are benigna and malignant connective tissue- bone cells called?
**benign: **osteoma
**malignant:** osteosarcoma
88
What are benigna and malignant nervous tissue cells called?
**benign:** nerve cells-neuroma
**malignant:** glia - glioma or neuroglioma
89
What are malignant lymphoid tissue cells called?
lymphoma
90
What are malignant hematopoietic tissue - bone marrow cells called?
leukemia or myelodysplasia
91
What are the cancer stages?
0 is premalignant up to 4 which is extensive with little chance of survival
92
What are signs and symptoms of pulmonary metastases?
dry persistent cough, pleural pain, dyspnea, new onset of wheezing, hemoptysis (bloody cough)
93
What are signs and symptoms of hepatic metastases?
adbominal pain and tenderness, jaundice, ascites, peripheral edema, **right shoulder pain,** general malaise, bilateral carpal tunnel syndrome
94
What are signs and symptoms of integumentary metastases?
skin lesion, palpable changes in nail bed, bleeding, discharge, tenderness
95
What are signs and symptoms of musculoskeletal metastases?
deep localized bone pain, decreased tolerance of weight bearing, soft tissue swelling, pathologic fracture, back or rib pain
96
What are signs and symptoms of CNS metastases?
headaches w/nausea and vomiting, irritability, confusion, seizure, change in bowel and bladder, changes in DTR clonus and babinski, vision changes, changes in mental status, balance/coordination problems, numbness and tingling
97
What is a clinical symptom of cancer?
paraneoplastic syndrome: ectopic hormone production by tumor
98
What are early warning signs of cancer?
1. changes in bowel/bladder
2. a sore that does not heal in 6 weeks
3. unusual bleeding or discharge, thickened or lump
4. thickening or lumb in brest or elswhere
5. indigestion
6. obvious change in wart or mole
7. nagging caugh or hoarseness
8. supplemental signs and symptoms: weight loss, malaise etc.
99
What are the side effects for Anthrocycyline?
| anticancer antibiotics ADEs
cardiotoxicity (arrhythamias, heart failure)
100
what are the side effects for bleomycin?
| anticancer antibiotics ADE
pulmonary toxicity (interstitial pneumonitis)
101
what are the side effects for vinca alkaloids/taxanes?
| plant derivative cancer drugs
peripheral neuropathies
102
What are the side effects for iritonecan/toptecan?
| plant derivative cancer drugs
diarrhea
103
what are common side effects of platinum analogs?
| cancer drug
nausea and vomiting, nephrotoxicity (kidney damage)
104
What are the side effects of cisplatin/carboplatin?
| cancer drug
nephrotoxicity: kidney
105
what are common side effects of doxorubin?
| cancer drug
cardiotoxitity
106
What are common side effects of methotrexate and 5 fluroracil?
myelosuppresion (bone marrow supression)
107
What is a side effect of nitrosures (lomustine/carmustine)?
neurotoxitity
108
What is a common side effect of cylophospamide?
| cancer drug
hemorragic cystitis (bleeding of bladder)
109
What is starling's law?
fluid at the **arterial end **of the capillary will tend to **flow into the tissue space because plasma (blood) hydrostatic pressure**
110
what is lympatic?
**inflammation of the lymph vessel,** red streaking
111
What is lymphadenopathy?
enlargement of lymph nodes
112
what is lymphadenitis?
lymphadenopathy due to inflammation of one or more lymph nodes
113
What is lymphedema precox known as?
meig's disease
114
What is congenital lymphedema known as?
milroy disease
115
What is the 0/IA/latent stage of lympedema?
subclinical condition where swelling is not evident despite impaired lymph transport
116
what is the I stage of lympedema?
accumulation of fluid that subsides with limb elevation. pitting may occur
117
what is the II stage of lymphadema?
limb elevation alone rarely reduces tissue swelling. Pitting is present, expect in late stage 2 where more fibrosis occurs
118
What is stage III lympydema?
lympostatic elephantiasis where pitting is absent and trophic skin changes (acanthosis, fat deposits, warty overgrowths) develop
119
What is lipedema?
* hypertrophy and hyperplasia of fat cells
* thickened basement membrane
* fibrosis of arterials
* symmetrical swelling of both legs
system based pathology
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