Immune, Musculoskeletal, and Oncology Review Flashcards

Flashcards about immunity, HIV, musculoskeletal disorders, fractures, SLE, gout, Lyme disease, fibromyalgia, RA, and cancer

What are the manifestations of inflammation?

Redness, heat, pain, swelling, loss of function, increased WBC, malaise, nausea/anorexia, increased pulse/RR, fever

What is innate immunity?

Present at birth and is the first line defense against pathogens

What type of immunity produces antibodies against specific antigens (B and T cells)?

Adaptive immunity or acquired immunity

What is natural active immunity?

Exposed to a live pathogen, develops the disease, and becomes immune as a result of the primary immune response

What is artificial active immunity?

Induced by a vaccine, a substance that contains the antigen

What is natural passive immunity?

Occurs during pregnancy, in which certain antibodies are passed from the maternal into the fetal bloodstream

What is artificial passive immunity?

Short-term immunization by the injection of antibodies that are not produced by the recipient's cells

What cells does HIV target?

Targets CD4 lymphocytes, increases risk of opportunistic infection

How is HIV transmitted?

Blood, semen, vaginal secretions, breast milk

What is the most common mode of HIV transmission?

Unprotected sex with HIV infected partner

How does contact with blood increase risk of HIV transmission?

Sharing drug paraphernalia such as needles

How can perinatal transmission of HIV occur?

During pregnancy, delivery, and/or breastfeeding

What type of virus is HIV and why?

Retrovirus because they replicate backwards from RNA to DNA

At what CD4+ T cell count do immune problems start with HIV?

Less than 500 cells/microliter

What are the manifestations of acute HIV infection?

Mononucleosis-like symptoms: fever, swollen lymph nodes, sore throat, headache, malaise, n/v, muscle/joint pain, diarrhea, rash

What are the manifestations of symptomatic HIV infection?

Shingles, persistent vaginal candida infections, oral/genital herpes, bacterial infections

What are the complications of AIDS?

Infections, malignancies, wasting, cognitive changes

What labs are used to detect HIV?

ELISA test, confirmed by Western blot

What labs are monitored to determine HIV progression?

CD4 cell count and viral load

What medication reduces chance of getting HIV infection for those at risk?

Pre-Exposure Prophylaxis (PrEP)

What lab values would be ordered when testing for musculoskeletal disorders?

Calcium (decreased means osteomalacia, renal disease), Phosphorus (low-osteomalacia, high-healing fracture), Alkaline phosphatase (break down proteins & mineralize bone)

Which serum muscle enzyme has the highest concentration in skeletal muscle?

Creatinine kinase (CK)

What type of nursing interventions are associated with arthroscopy.

Monitor for neurovascular status of affected limb frequently, analgesics prescribed

After an arthroscopic procedure, what type of dressing will be applied?

Compression dressings

What is the pathophysiology of Rheumatoid Arthritis?

Autoantibodies attack the synovium, swelling, inflammation, destruction of bone

What are the manifestations of Rheumatoid Arthritis?

Synovitis, pain, stiffness, limited motion, symptoms are symmetrical

Where does rheumatoid arthritis typically manifest?

Small joints, tenosynovitis, deformity and disability, subluxation

What diagnostic studies are performted for Rheumatoid Arthritis?

Rheumatoid factor, erythrocyte sedimentation rate, C-reactive protein, antinuclear antibody, anti-citrullinated protein antibody, synovial fluid analysis, X ray, bone scan

What are the goals for Rheumatoid Arthritis?

Decrease inflammation and pain; maintain joint function, prevent joint deformity

What are the interventions for Rheumatoid Arthritis?

Heat or cold; balance rest & activity; pain; nutrition, safe environment, coping strategies, meds, OT/PT

What is Gout characterized by?

Hyperuricemia and uric crystals in joints

What is the pathophysiology of Gout?

Uric acid is end product of purine; excreted by kidneys

When does Gout occur?

If kidneys cannot excrete enough/too much uric acid is being made

What are the manifestations of Gout?

Acute: joint inflammation; elevated uric acid; crystals in synovial fluid Chronic: tophi- visible deposits of crystals

What medications are prescribed in the management of Gout?

Oral colchicine - decreases pain, NSAID-pain Corticosteroids: oral or intra articular

What type of diet is prescribed in the management of Gout?

Limit alcohol and purine foods; adequate urine volume; weight reduction

What is the most common manifestation of Lyme Disease?

Erythema migrans - bull’s eye rash

What is the treatment for Lyme Disease?

Antibiotics: early treatment and prevention of progression

What type of disease is Systemic Lupus Erythematosus (SLE)?

Multisystem inflammatory autoimmune disease

How is Lupus diagnosed?

History, physical exam; antibodies ANA; CBC, urinalysis, x-rays, ECG,,,,,, anti dna something

What type of symptoms are associated with Fibromyalgia?

Widespread, nonarticular musculoskeletal pain and fatigue; multiple tender points

What type of tender points are assessed during an Fibromyalgia exam?

Tenderness in 11-18 points; pain throughout body

What are the interventions for Fibromyalgia?

Rest and muscle relaxants; relaxation techniques: imagery, meditation-cope w stress

How are fractures classified?

Based on direction or fracture line (linear, oblique, transverse, longitudinal, spiral, comminuted) and whether they are displaced or non displaced

What are the clinical manifestations of fractures?

Edema, swelling, pain, tenderness, muscle spasms, deformity, contusion, loss of function, crepitation, guarding

What is closed reduction?

Nonsurgical, manual alignment of bone fragments

What is open reduction - ORIF?

Surgical incision used to correct bone via wires, screws, pins, plates, rods, nails

What is the purpose of traction?

Prevent/reduce pain and muscle spasm, immobilize joint/body part, reduce fracture or dislocation, treat pathologic joint condition

What defines skin traction?

Short term (2-6 days), tape, boot, splint applied to skin to reduce muscle spasms

What is skeletal traction?

Align bones and joints or treat joint contractures and congenital hip dysplasia, long term pull to maintain alignment

How are casts used in fracture immobilization?

Temporary after closed reduction, allows pt to do ADLs, incorporated joint above and below fracture for stabilization during healing

What medications are used for fractures?

Central and peripheral muscle relaxants (Carisoprodol, Cyclobenzaprine, Methocarbamol), tetanus and diphtheria toxoid, bone-penetrating antibiotics (cephalosporins)

What is the recommended diet when treating a fracture?

Increase protein (1g/1kg weight), vitamin B,C,D, calcium, phosphorus, magnesium, 2-3k ml fluid; fiber

What are the direct complications of fractures?

Bone infection, bone nonunion or malunion, avascular necrosis

What are the indirect complications of fractures?

Compartment syndrome, VTE, fat embolism, hypovolemic shock

What is compartment syndrome?

Swelling and increased pressure in limited space

What are the 6 P's of compartment syndrome?

Pain, pressure, paresthesia, pallor, paralysis, pulselessness

Why is Venous Thromboembolism a complication of fractures?

Veins of lower extremities and pelvis susceptible to thrombus formation from venous stasis of inactivity

What is fat embolism?

Systemic fat globules from fracture that’re displaced into tissues and organs (lung/brain)

What are the clinical manifestations of Fat Embolism Syndrome (FES)?

Dyspnea, pallor to cyanosis; comatose, fat cells in blood, urine, sputum, decreased PaO2 to less than 60 mmHg, ST segment (ischemia/MI) and T wave changed, low platelet and hematocrit; increased ESR, X ray shows pulmonary infiltrates

What is the definition of Oncology?

Group of diseases characterized by uncontrolled and unregulated growth of cells

What are the two major dysfunctions present in the process of cancer development?

Defective cell proliferation and defective cell differentiation

How do you define a benign cell?

Normal cells growing in the wrong place or at the wrong time. Specific morphology

How do you define a malignant cell?

Abnormal cells that have no useful function and harm body tissues

What are the signs of malignant tumors?

Anaplasia: cells w poor differentiation (role of cell is botched). Rapid cell division & metastisizes

What term is used to define cancer development?

Carcinogenesis/oncogenesis

What are the stages of cancer development?

Initiation, promotion, progression, metastasis

How does metastasis of cancer occur?

Through blood and lymphatic spread

How is cancer classified?

Tumor classified by anatomic site, histology, extent of disease

How are carcinomas classified?

Carcinomas originate from embryonal ectoderm (skin, glands) and endoderm (mucous membrane, respiratory tract, GI/GU tracts)

How are sarcomas classified?

Sarcomas originate from embryonal mesoderm (connective tissue, muscle, bone, fat)

How are lymphomas and leukemias classified?

Lymphomas and leukemias originate from hematopoietic system

What is histologic classification?

Appearance of cells and degrees of differentiation are evaluated to see how close the cells resemble OG tissue

What is Grade 1 abnormal cells?

Grade 1 - cells differ slightly from normal cells and are well differentiated (low grade)

What is Grade II abnormal cells?

Grade II - cells are more abnormal (moderate dysplasia) and moderately differentiated (intermediate grade)

What is Grade III abnormal cells?

Grade III - cells are very abnormal (severe dysplasia) and poorly differentiated (high grade)

What is Grade IV abnormal cells?

Grade IV - cells are immature and primitive (anaplasia) and undifferentiated; cell of origin is hard to determine (high grade)

What are the stages of Clinical Staging?

0: cancer in situ I: tumor limited to tissue of origin; localized tumor growth II: limited local spread III: extensive local and regional spread IV: metastasis

What does the TNM classification system stand for?

Anatomic extent of disease based on 3 parameters: tumor size and invasiveness (T), spread to lymph nodes (N), metastasis (M)

What is primary cancer prevention?

Strategies to prevent occurrence - lifestyle, diet, sleep, exercise

What is secondary cancer prevention?

Screening strategies to detect cancer early

What are the lifestyle habits used in cancer prevention?

Practice recommended cancer screenings, self-exams, know “7 warning signs of cancer” CAUTION, ABCDE - skin cancer

What are the consequences of cancer?

Reduced immune and blood-producing function, altered GI structure and function, motor and sensory deficits, decreased respiratory function

What are the methods of cancer management?

Surgery, radiation, chemo, hormone therapy, photodynamic, immunotherapy, targeted therapy

What is Chemotherapy?

Treatment of cancer w chemical agents, kills cancer cells over normal cells, systemic effects

What normal cells are destroyed during chemotherapy?

Bone marrow, lining of GI tract, integument (skin, hair, nails)

What are the adverse effects of Chemotherapy?

Acute - anaphylaxis, extravasation, flare rxn, N/V, dysrhythmia Delayed - delayed N/V, mucositis, alopecia, skin rash, bone marrow suppression, diarrhea/constipation, neurotoxicities Chronic - heart, liver, kidney, lung damage

How does hormone therapy work?

Blocks effects of hormone and stops growth of cancer

What are the side effects of Hormone Therapy?

Masculinizing effects in women, feminizing effects in men, risk for venous thromboembolism - estrogen therapy in men, acne, hypercalcemia - stimulate breakdown of bone, liver dysfunction, bone loss

What is the Cancer Treatment: Radiation Therapy?

Emission of energy from a source and travels through space or some material with high energy beams or waves to Breaks chemical bonds in DNA, causing cell death

Which type of radiation is it important to limit pt near when healthcare professionals limit time spent near pt under tx and must organize care and wear film badge to monitor exposure

Internal radiation (brachytherapy)

What are the interventions for cancer fatigue?

Fatigue Rest before activity and w assistance; remain active during periods of feel better times; nutrition/hydration; assess reversible causes of fatigue

What are the interventions for GI issues in cancer?

Antiemetics, assess alkalosis, dehydration, low fiber, low residue, high cal/protein

In reference to patients undergoing chemotherapy, what actions should be taken when stomatitis is present?

Anesthetic gel to oral lesions before meals

What nursing interventions are associated with neutropenic precautions?

Monitor temperature, restrict visitors who are ill, no fresh plants/flowers

What nursing interventions are associated with thrombocytopenia?

Monitor for blood in its stool, urine, vomit, avoid IV's and injections whenever possible, encourage male pot to use electric razor instead of straight one, soft toothbrush, avoid blowing nose vigorously, avoid Nsaids (Ibuprofen), safety precautions (avoid falls

In reference to skin cancer, what does ABCDE stand for?

Asymmetry, border, color, diameter (>6mm), evolving

How can a patient limit exposure and apply prevention for skin cancer

Limit exposure to sunlight especially between 1000 and 1600, use sunscreen with SPF of 15, should apply 30 min before sun exposure and reapply every 2hr

How can a patient promote prevention of oropharyngeal cancer?

Dental visits 2x/yr, no UV, No tobacco, & limit alcohol

What are the signs associated with bladder cancer?

Hematuria but not painful, abd distended