Exam 2 Lewis Ch 11 and 13

  1. The inflammatory response is a _____ reaction to cell injury. It neutralizes and dilutes the inflammatory agent, removes necrotic materials, and establishes an environment suitable for healing and repair.
  2. The mechanism of ______ is basically the same regardless of the injuring agent. The intensity of the response depends on the extent and severity of injury and on the reactive capacity of the injured person.
  3. The inflammatory response can be divided into
    • a vascular response
    • a cellular response
    • formation of exudate
    • healing.
  4. The vascular response results in:
    vasodilation causing hyperemia (increased blood flow in the area) and increased capillary permeability. These actions result in redness, heat, and swelling at the site.
  5. During the cellular response
    neutrophils and monocytes move to the inner surface of the capillaries (margination) and then through the capillary wall (diapedesis) to the site of injury.
  6. Exudate consists of:
    fluid and leukocytes that move from the circulation to the site of injury. The nature and quantity of exudate depend on the type and severity of the injury and the tissues involved.
  7. A number of ______ assist in the inflammatory process.
    chemical mediators
  8. The complement system is a(n) ______ consisting of pathways to mediate inflammation and destroy invading pathogens.
    enzyme cascade
  9. Major functions of the complement system are:
    enhanced phagocytosis, increased vascular permeability, chemotaxis, and cellular lysis.
  10. Prostaglandins are
    generally considered proinflammatory and are potent vasodilators contributing to increased blood flow and edema formation. Prostaglandins also perform a role in sensitizing pain receptors to stimuli that would normally be painless.
  11. The local response to inflammation includes the manifestations of:
    • redness (rubor)
    • heat (calor)
    • pain (dolor)
    • swelling (tumor)
    • loss of function (functio laesa)
  12. Systemic manifestations of inflammation include
    an increased WBC count with a shift to the left, malaise, nausea and anorexia, increased pulse and respiratory rate, and fever.
  13. The basic types of inflammation are
    acute, subacute, and chronic.
  14. In acute inflammation, the healing occurs in
    2 to 3 weeks and usually leaves no residual damage.
  15. A subacute inflammation has the features of the acute process but
    lasts longer.
  16. Chronic inflammation lasts for
    weeks, months, or even years.
  17. The best management of inflammation is
    the prevention of infection, trauma, surgery, and contact with potentially harmful agents.
  18. The ability to recognize the clinical manifestations of inflammation is important so that appropriate treatment can begin. Treatment may include:
    fever management, rest, drug therapy, or specific treatment of the injured site. Immediate treatment may prevent the extension and complications of inflammation.
  19. Drug therapy to decrease the inflammatory response and lower the body temperature involves the use of
    aspirin, acetaminophen, some nonsteroidal antiinflammatory drugs (NSAIDs), antihistamines, and corticosteroids.
  20. Healing includes the two major components:
    regeneration and repair.
  21. Regeneration is
    the replacement of lost cells and tissues with cells of the same type.
  22. Repair is
    the more common type of healing and usually results in scar formation. Repair occurs by primary, secondary, and tertiary intention.
  23. Primary intention
    takes place when wound margins are neatly approximated, such as in a surgical incision or a paper cut.
  24. What are the three phases of the continuum for primary intention?
    initial, granulation, and maturation.
  25. Secondary intention wounds occur from
    trauma, ulceration, and infection and have large amounts of exudate and wide, irregular wound margins with extensive tissue loss. These wounds may have edges that cannot be brought together.
  26. Tertiary intention
    occurs with delayed suturing of a wound in which two layers of granulation tissue are sutured together.
  27. Wounds can be classified by their cause and depth of tissue affected, what are the causes and depths?
    • Cause: surgical or nonsurgical; acute or chronic
    • Depth of tissue affected: superficial, partial thickness, or full thickness
  28. The purposes of wound management include:
    • (1) cleaning a wound to remove any dirt and debris from the wound bed
    • (2) treating infection to prepare the wound for healing
    • (3) protecting a clean wound from trauma so that it can heal normally
  29. A thorough assessment of wounds should be performed _________, with observation and recording of wound characteristics being an essential task.
    on admission and on a regular basis
  30. Nursing and interprofessional care for the patient with a tissue injury is highly variable. It depends on:
    the causative agent, the degree of injury, and the patient’s condition.
  31. The type of wound management and dressings required depend on
    the type, extent, and characteristics of the wound and the phase of healing
  32. A variety of adjunctive therapies may be used to assist in wound healing:
    • Negative-pressure wound therapy: (vacuum-assisted wound closure) uses suction to remove drainage and speed wound healing.
    • Hyperbaric O2 therapy: accelerates granulation tissue formation and wound healing.
    • Platelet-derived growth factor: stimulates wound healing by promoting cell proliferation and migration.
    • Special nutritional measures: facilitate wound healing. A high fluid intake is needed to replace fluid loss from perspiration and exudate formation. A diet high in protein, carbohydrate, and vitamins with moderate fat intake is necessary to promote healing.
  33. It is important that the patient, the family, or both know how to
    care for the wound and perform dressing changes.
  34. A pressure ulcer is
    a localized area (usually over a bony prominence) of tissue necrosis caused by unrelieved pressure that occludes blood flow to the tissues.
  35. Pressure ulcers generally fall under the category of healing by
    secondary intention
  36. The clinical manifestations of pressure ulcers depend on
    the extent of the tissue that is involved.
  37. Assess patients for pressure ulcer risk _______ based on the patient’s condition and care setting.
    initially on admission and at periodic intervals
  38. Care of a patient with a pressure ulcer requires
    local care of the wound and support measures of the whole person such as adequate nutrition, pain management, control of other medical conditions, and pressure relief.
  39. Local care of the pressure ulcer may involve
    debridement, wound cleaning, application of a dressing, and relief of pressure.
  40. The maintenance of adequate nutrition is
    an important nursing responsibility and involves the identification and correction of malnutrition states.
  41. Pressure ulcers affect the ______ of patients and their caregivers. It is important that the nurse support __________ through the added responsibility of pressure ulcer treatment.
    • quality of life
    • the caregiver
  42. Stage I pressure ulcers
    have intact skin with nonblanchable redness of a local area with a change in skin temperature, tissue consistency, or sensation.
  43. Stage II pressure ulcers
    are partial thickness with a red-pink wound bed.
  44. Stage III pressure ulcers
    are defined as full-thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia.
  45. Stage IV pressure ulcers
    involve extensive destruction of tissue with exposed bone, tendon, or muscle.
  46. Immunity is the body’s ability to ______. It is a state of responsiveness to foreign substances such as microorganisms and tumor proteins.
    resist disease
  47. Immune responses serve three functions:
    defense, homeostasis, and surveillance.
  48. Immunity is classified as
    innate or acquired.
  49. Acquired immunity is
    the development of immunity, either active or passive.
  50. An ____ is a substance that elicits an immune response.
  51. The immune response involves complex interactions of
    T cells, B cells, monocytes, and neutrophils.
  52. The immune response interactions depend on
    cytokines (soluble factors secreted by white blood cells [WBCs] and a variety of other cells in the body) that act as messengers among the cell types.
  53. Humoral immunity consists of
    antibody-mediated immunity.
  54. Immune responses that are initiated through specific antigen recognition by T cells are termed
    cell-mediated immunity.
  55. Humoral and cell-mediated immunity are needed to
    remain healthy.
  56. There is a ______ of the immune response with advancing age.
    decline in function
  57. Anergy
    an immunodeficient condition characterized by lack of or diminished reaction to an antigen or a group of antigens, is common with advancing age.
  58. ___________ exists when the body’s immune system can identify and inactivate or destroy foreign substances.
  59. A __________ reaction occurs when the immune response is overreactive against foreign antigens or fails to maintain self-tolerance.
    • hypersensitivity
    • This results in tissue damage.
  60. When the immune system is incompetent or underresponsive
    severe infections, immunodeficiency diseases, and malignancies may occur.
  61. Classification of hypersensitivity reactions may be done according to
    • the source of the antigen
    • the time sequence (immediate or delayed)
    • the basic immunologic mechanisms causing the injury.
  62. Four types of hypersensitivity reactions exist:
    • Anaphylactic reactions and atopic reactions are type I, or IgE-mediated, states that occur in susceptible persons who are highly sensitized to specific allergens.
    • Tissue damage in type II disorders is usually rapid. Common disorders include ABO incompatibility transfusion reaction, Rh incompatibility reactions, and autoimmune and drug-related hemolytic anemias.
    • Type III reactions are associated with autoimmune disorders such as systemic lupus erythematosus and rheumatoid arthritis.
    • Type IV, or delayed hypersensitivity reactions, include contact dermatitis; some drug sensitivity reactions; hypersensitivity reactions to bacterial, fungal, and viral infections; and transplant rejections.
  63. Although an alteration of the immune system may be manifested in many ways, allergies or type I hypersensitivity reactions are
    seen most frequently.
  64. Common allergic reactions include:
    anaphylaxis and atopic reactions.
  65. Common type I hypersensitivity reactions are:
    Allergic rhinitis, atopic dermatitis, urticaria, and angioedema
  66. For a thorough assessment of a patient with allergies, obtain a complete database. This consists of
    a comprehensive patient history, physical examination, diagnostic workup, and skin testing for allergens.
  67. Many specialized immunologic techniques can be performed to detect abnormalities of
    lymphocytes, eosinophils, and immunoglobulins.
  68. Skin testing can be used
    to identify the specific allergens that are causing the allergy symptoms.
  69. After an allergic disorder is diagnosed, the therapeutic treatment is aimed at
    • reducing exposure to the offending allergen,
    • treating the symptoms,
    • and if necessary, desensitizing the person through immunotherapy.
  70. Anaphylactic reactions can
    occur suddenly in hypersensitive patients after exposure to the offending allergen. They may occur following parenteral injection of drugs (especially antibiotics), blood products, and insect stings.
  71. Most allergic reactions are
    chronic and are characterized by remissions and exacerbations of symptoms.
  72. The major categories of drugs used for symptomatic relief of chronic allergic disorders include
    antihistamines, sympathomimetic/decongestant drugs, corticosteroids, antipruritic drugs, and mast cell–stabilizing drugs.
  73. Immunotherapy is the recommended treatment for
    control of allergic symptoms when the allergen cannot be avoided and drug therapy is not effective.
  74. Two types of latex allergies can occur:
    type IV allergic contact dermatitis and type I allergic reactions.
  75. What foods should a person avoid if they have a latex allergy?
    Foods to avoid include banana, avocado, chestnut, kiwi, tomato, water chestnuts, guava, hazelnuts, potatoes, peaches, grapes, and apricots.
  76. Multiple chemical sensitivities (MCS)
    is an acquired disorder in which certain people exposed to various chemicals and food in the environment have many symptoms related to multiple body systems.
  77. Autoimmunity is an immune response
    against self that occurs when the immune system no longer differentiates self from nonself.
  78. The cause of autoimmune diseases is
    unknown. They are grouped according to organ-specific and systemic diseases.
  79. apheresis
    • the use of a procedure to separate components of the blood followed by the removal of one or more of these components
    • various types have been effectively used to treat autoimmune diseases
  80. Plasmapheresis
    is the removal of plasma-containing components causing or thought to cause disease. It can also be used to obtain plasma from healthy donors to administer to patients as replacement therapy.
  81. Peripheral stem cell collection
    is used to collect stem cells from peripheral blood. These stem cells can then be used to repopulate a person’s bone marrow after high-dose chemotherapy.
  82. Immunodeficiency disorders
    • involve an impairment of one or more immune mechanisms,
    • which include: phagocytosis, humoral response, cell-mediated response, complement, and a combined humoral and cell-mediated deficiency.
  83. Immunodeficiency disorders are primary
    if the immune cells are improperly developed or absent
  84. Immunodeficiency disorders are secondary
    if the deficiency is caused by illnesses or treatment
  85. The human leukocyte antigen (HLA) system is
    responsible for rejection of genetically unlike tissues. It consists of a series of linked genes that occur together on the sixth chromosome in humans.
  86. Because of its importance in the study of tissue matching, the chromosomal region incorporating the HLA genes is termed
    the major histocompatibility complex.
  87. Commonly transplanted organs and tissues include
    corneas, kidneys, skin, bone marrow, heart valves, bone, and connective tissues.
  88. The degree of HLA matching required or deemed suitable for successful solid organ transplantation is
    dependent on the type of organ and the transplant center at which the transplant is being performed.
  89. Rejection of organs occurs if
    the donor organ does not perfectly match the recipient’s HLAs. The rejection can be prevented by closely matching ABO and HLAs between donor and recipient.
  90. The three types of rejection can be classified as
    hyperacute, acute, and chronic
  91. The goal of immunosuppressive therapy is
    to adequately suppress the immune response to prevent rejection of the transplanted organ while maintaining sufficient immunity to prevent overwhelming infection.
  92. Commonly used immunosuppressive drugs include
    corticosteroids, cyclosporine, tacrolimus (Prograf), and mycophenolate mofetil (CellCept).
  93. In graft-versus-host disease (GVHD)
    • the immunocompetent cells in a transplant graft attack or destroy vulnerable host or recipient tissue.
    • Examples include blood transfusions or the transplantation of bone marrow, fetal thymus, or fetal liver.
  94. In graft-versus-host disease, once the reaction is started, little can be done to modify its course. The target organs for the GVHD phenomenon are
    the skin, liver, and gastrointestinal tract; the biggest issue is infection.
Card Set
Exam 2 Lewis Ch 11 and 13
Key Points from Lewis Ch 11 and 13 for Exam 2