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56 Cards in this Set
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Stress response - generalized or systemic response to a change (stressor), internal or external, and may be modified in specific situations - Hans Selye defined general adaptation syndrome (GAS) or the fight or flight concept.Three stages in GAS: = alarm stage, resistance stage, and the stage of exhaustion. |
Stressor – defined as any factor that creates a significant change in the body or environment - May be physical or psychological or a combination of the two. - Stressors are normal parts of life and can be a positive influence or a negative influence = may stimulate growth and development = severe stressor Or negative influence or multiple factors effect change at one time = body systems become more disrupted, maladaptive (ignoring stressor or eating unwisely are likely to add problems)or inappropriate behavior occur and homeostasis not possible - factors such as aging, or pathologic disorders ma interfere with person's ability to respond adequately to a stressor - may be long-term or short-term or - may be real-life or anticipated factor Possible stressors include: - pain, exposure to cold temperatures, trauma, anxiety or fear, a new job, infection or indeed, even joyous occasion. = Stress considered to occur when an individual's status is ALTERED by his or her reaction to a stressor Ex: infection may initiate a fever ( may cause illness in persons) - If individual can COPE with stressor = body returns to normal status - If person cannot adapt = harmful effects may result from stress = "distress" |
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Homeostasis - Body’s compensation to minor changes in needs or environment - compensate for physiologic changes in fluid balance or blood pressure Stressor - Factor that creates significant change in body function Severe or prolonged stress can cause dysfunction: - Increased wear and tear on tissues - Exhaustion of resources - Exacerbation of chronic conditions |
TA 26-1 a) Stressors may include factors such as illness, trauma, fear, surgery, taking exams, change in family or friends, new experience, job hunting, and financial problems. b) coping mechanisms: Coping mechanisms may be improved by planning or preparation for events, talking with a friend or counselor, considering several alternative responses by making a list of pros and cons, trying to find a benefit or positive aspect, assessing a problem realistically, putting a problem aside for a short time and then reconsidering, and relaxing with a different activity or exercise. c) Mechanisms for coping with psychological stressors may include counseling and support services, relaxation techniques, biofeedback, art or music therapy, and antianxiety medications. |
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3 Stages in Stress Response GAS General Adaptation Syndrome 1. Alarm stage - Mobilization of defenses by activating = Hypothalamus = Sympathetic nervous system = Adrenal glands 2. Resistance stage - Elevation of hormone levels = Body systems operate at peak performance levels. 3. Final stage (stage of exhaustion) - Resolution or death - body is unable to respond further or is damaged by increased demands - Stress response involves integrated series of action - hypothalamus and pituitary gland, the SNS, the adrenal medulla, and adrenal cortex - the locus ceruleus (collection of norepinephrine-secreting cells in the brain stem) provides rapid response in the nervous system. - any type of stressor immediately initiates a marked INCREASE in ACTH secretion follow by INCREASE in CORTISOL secretion |
Significant Effects of the Stress Response include - Elevated blood pressure and increased heart rate - Bronchodilation and increased ventilation - Increased blood glucose levels - Arousal of the central nervous system - Decreased inflammatory and immune responses = these activities increase general level of function in critical areas of body (brain, heart, and skeletal muscles) by increasing oxygen levels, increasing circulation, and increasing rate of cell metabolism. - short-term stressors, mild or moderate, appear to enhance cognitive function and short-term memory. = stress response leads to increased release of endorphins (act as pain-blocking agents) |
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Most cases - body responds positively, the stressor is dealt with, stress response diminishes, body activity returns to normal - additional distress results if state of stress is severe/prolonged or if adaptive mechanisms are impaired - hospitalization or physiotherapy (extra stressors added that may overwhelm patient) - with major/prolonged stress = intellectual function and memory are frequently disrupted - one factor: large amount of glucocorticoids released because memory impairment has shown to occur in persons taking large doses of glucocorticoids |
TA 26-2 a) explain probable source of increased glucose level in blood with stress - Increased glucose levels in the blood with stress likely result from glycogenolysis (liver) and gluconeogenesis from protein and lipids caused by the release of glucocorticoids and epinephrine. b) name organs in which vasoconstriction occurs and blood flow diminishes during a stress response (name areas that have increased blood flow) = In a stress response, there is diminished blood flow in the kidneys, digestive tract, and skin and increased blood flow in skeletal muscle. c) state two ways which oxygen supplies to brain may increase during a stress response = Oxygen supply to the brain is increased through bronchodilation and increased blood flow to the brain. |
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d) list hormones released during stress response and 2 significant actions of each Norepinephrine—vasoconstriction, increased blood pressure Epinephrine—increased heart rate and force of contraction Vasoconstriction—cutaneous and visceral, increasing blood pressure Vasodilation— skeletal muscle, bronchodilation, pupil dilation, increased blood glucose, increased BMR Glucocorticoids—increased BMR, increased blood glucose level, increased CNS activity, anti-inflammatory effects, depressed immune response |
Stress and Disease Stress may cause: Headache - May develop during or after stress response (when stressor is relieved) Stomatitis (ulcers in the mouth) and necrotizing periodontal disease Prolonged vasoconstriction (more severe complication: if reduced blood supply is impaired) - Can impair function, or necrosis and inflammation in gastrointestinal tract or kidneys = that may result in stomatitis (ulcers in mouth) and necrotizing periodontal disease - in some with preexisting pathologic conditions (a stress response may become an additive or exacerbating factor creating acute complication or adding to severity of original) = Ex: elevation of blood pressure or cardiac dysrhythmia result from a stress response may seriously aggravate condition of individual with heart damage Precipitating factor - Chronic infections (herpes simplex = cold sores often erupt from person), (asthma attacks or seizures may occur) = onset of cancer or infection frequently follows serious life crisis (immune system depressed) Exacerbating factor - Physical and/or emotional distress Ex: multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, asthma, acne, ulcerative colitis, and eczema (become more acute when a stressor is present) = important for person with chronic illness to develop improved coping mechanisms and adequate support system to delay exacerbations or progressive degeneration in chronic illness. - Etiologic factors: hypertension, coronary artery disease, and diabetes mellitus - serum cholesterol increased during stress and reactive vasoconstriction affects blood pressure and blood vessels (when stress sustained) |
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Potential Effects of Prolonged or Severe Stress Renal failure - Prolonged severe vasoconstriction and reduced blood supply to kidney - reduced blood flow supply causes tubular necrosis, obstruction of filtrate flow , and cessation of glomerular filtration or shutdown (some cases permanent kidney damage results) - Ischemia (inadequate blood supply) causes cell damage. Stress ulcers - may develop when severe trauma (Curling's ulcers- associated with burns) - multiple gastric ulcers (often asymptomatic, but dangerous because they frequently manifest with gastric hemorrhage) - Vasoconstriction and glucocorticoids - Intense vasoconstriction (gastric mucosa) = Decrease in mucosal regeneration and mucus production = decreased motility causes stasis of chyme in stomach = catabolic effects of glucocorticoids delay tissue regeneration (all contribute to ulcer formation) - several factors in stress response contribute to ulcer formation Infection - Depression of the inflammatory and immune responses by increased cortisol secretion = because these body defense mechanisms are reduced, opportunistic infections may develop and person becomes susceptible to infection by unusual organisms that are not normally pathogenic - the lack of inflammatory response may mask signs of infection = lymphoid tissue atrophies, and circulating leukocytes are reduced in number and function = increased incidence and growth of malignant tumors associated with severe stress have been linked with decreased efficiency of the surveillance function of immune system |
Continued stress may impede healing of tissue following trauma or surgery Slowed healing 2 major factors involved - Increased secretion of glucocorticoid—reduction in protein synthesis and tissue regeneration - Increased catecholamine levels—vasoconstriction, reduced nutrients and oxygen to the tissue (reduced blood supply and reduced delivery of nutrients to the traumatized area) = lead to increased risk of infection and increased amounts of scar tissue at site of trauma or surgery |
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Continued stress may impede healing of tissue following trauma or surgery - Post-traumatic stress disorder = Serious consequence of major disaster or personal threat = Usually occurs within 3 months of event - May cause symptoms years later = High risk of developing dependence on drugs and/or alcohol 3 categories of symptoms may occur - revisiting or reliving the event, - avoidance of certain activities and lack of emotional response - and dissociative state in which the person is non-responsive - also high risk of person with PTSD developing a dependence on drugs and or alcohol |
TA 26-3 Explain how reduced blood flow in area can interfere with healing and increase the risk of infection = Reduced blood flow in an area decreases the supply of nutrients and oxygen to the site for cell regeneration and repair. In addition, decreased WBCs, phagocytes, and antibodies are present to destroy microbes. |
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Coping with Stress - Ensure adequate rest and a healthy diet. - change in lifestyle in order to adapt to new situation - Use creative solutions to minimize stressors and adapt quickly to stressor. - Regular moderate exercise = aerobic exercise (release muscle tension and improve circulation - provide distraction) = during aerobic exercise: body uses more fats for energy and blood sugar levels remain stable) - Engage in distracting activities (and assess problem more objectively) - Counseling and support services - Relaxation techniques, imagery, biofeedback therapy, music and art therapy - using anti-anxiety medications (minor tranquilizers such as lorazepam [Ativan] for short period of time) must be used with caution because even LOW DOSES can have ADVERSE EFFECTS (drowsiness, memory loss, impaired judgment, confusion, nausea, and lack of energy - undertaking methodical approach, assessing options or goals and making immediate decisions - avoid sleep, eating junk food, drinking too much coffee and smoking constantly are behaviors that are more likely to add stress than to alleviate it |
Coping with Stress - to prevent stress from becoming a negative influence on the body - fatigue, age, inadequate nutrition, insufficient knowledge, or lack of emotional support are amount the factors that may interfere with an appropriate response |
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List the factors or mechanisms in stress response that contribute to increased oxygen supplies for the cells and explain how each factor contributes to stress response - Bronchodilation promotes increased oxygen flow to the lungs and increased diffusion. Increased heart rate and contractility improve cardiac output, transporting oxygenated blood to cells in vital organs such as the brain. Although vasoconstriction reduces blood flow into some tissues, it also shunts blood quickly back to the lungs to be reoxygenated and to vital organs. |
Describe recent stressor in life and stress response that followed it = For example, trauma, such as a dislocated shoulder, may be cited as a stressor. The response might be heart palpitations, sweating, and greater awareness of surroundings. In this case, the pain of the injury caused shock, and the blood pressure was slightly low. The stress response prevented the blood pressure from dropping more. |
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List some disorders that are stress related = Rheumatoid arthritis, eczema, asthma, herpes simplex, Crohn’s disease, and peptic ulcer are exacerbated by stress. Describe 2 potential complications of severe stress = Potential complications of severe stress include multiple stress ulcers in the stomach that frequently bleed and infection if stress is prolonged; renal failure is seen with severe stress. |
Why are maladaptive coping mechanisms such as excessive eating or alcohol intake not helpful? = Maladaptive coping mechanisms frequently cause additional stress such as obesity, hypertension, malnutrition, and/or alcoholism. Stress related disorders – review box 26-1; include Asthma, Acne, ARF, Infection, Ulcerative colitis, CHF, and angina. |
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Chapter 27 Substance Abuse and Associated problems |
Substance Abuse Substance abuse or chemical dependency Abuse of chemicals, prescribed or illicit, leads to: - Changes in behavior - Changes in sleep patterns - Changes in interpersonal relationships - Problems with employment - Serious health problems - Possibly even death most of these chemicals cause serious health problems or death if abuse is not addressed Ex: alcoholism leads to cirrhosis of liver and brain damage - cocaine causes damage to heart and brain - anabolic steroids cause heart disease - people using intravenous drugs contract hepatitis or HIV. - children born to substance abusers are directly and indirectly affected as a result of patient's substance abuse |
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Terminology Substance abuse or chemical dependency - Broad term refers to inappropriate or unnecessary use of drugs or chemicals - Impairs function in some way or extent - May cause euphoria (“high”)- sense of pleasure or may alter one's perception of reality or decrease one's awareness of people and the environment Habit - Practice (often involuntary) of using drugs or substances at regular and frequent intervals Dependence - Physiological and psychological craving for substance |
Terminology: Physiological dependence - Discontinuance of substance leads to withdrawal Psychological dependence - body has adapted to presence of drug or chemical so that discontinuing drug results in withdrawal signs (tremors, or abdominal cramps) - Continuing desire to take substance to function Tolerance - Body has adapted to substance - the amount of substance taken must be increased to achieve same effect - person has tolerance will experience withdrawal if discontinued substance Addiction—older term - Used for the most serious form of substance abuse - the uncontrollable compulsion to use a substance, often with serious consequences for the individual, family, society. - substance abuse at this level often involves increased use of substance, loss of control over use, leading to multidimensional issues, including health, social, psychological, occupational and legal problems. |
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TA 27-1 Define the terms tolerance and physiologic dependance = Tolerance is the need for increased amounts of a substance to achieve the same effect; physiological dependence is incorporation of the substance, with metabolic effects resulting in physical withdrawal signs, such as tremors or vomiting when the substance is not available. |
Abused substances may be classified in many ways: mode of action and source.
1. Central nervous system (CNS) depressants or Tranquilizers such as alcohol, cannabis 2. Narcotics (also CNS depressants) - or Painkillers: which cause euphoria and drowsiness 3. Stimulants such as Coffee or Amphetamines 4. Psychedelics or hallucinogens: which alter a person's perception and awareness and produce illusions some chemicals actually manifest both stimulant and depressant effects. Ex: alcohol is really a CNS depressant, although initially appears to be a stimulant because it first depresses the higher brain centers used for judgment or the inability neurons |
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Abused drugs are classified by Source - include legally prescribed medications Legally prescribed medications - Tranquilizers or sedatives (prescribed and used long after the need for them has passed) - Medication shared with others - Prescriptions obtained from several sources - Medications combined with other substances (such as alcohol or nonprescription drugs to achieve the desired effect) the surge in drug deaths has recently been fueled by increased availability and abuse of prescription painkillers (OxyContin) and antianxiety drugs. - Heroin and Morphine (and stimulants prescribed for attention deficit hyperactivity disorder ADHD) regulated by (restricted by) government and research or with signed written prescription without refill provisions (considered more addictive and dangerous) |
Many psychoactive substances are readily available without restrictions Readily available without restrictions - Sleep-inducing or wake-up pills - Cough syrups and decongestants - Examples: spray paint, alcohol-based hair lotions, glue, nail polish remover, aerosols, solvents for sniffing or inhaling. = these generally provide a short "high" followed by depression and disorientation - such substances frequently misused and responsible for number of suicides and accidental deaths = substances of this type are kept behind counter in stores and MUST BE REQUESTED.
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Illegal or Street Drugs are widely available and are both costly and more dangerous for the use because their content is unpredictable Illegal or street drugs - Costly and dangerous for user (content unpredictable) - Use often leads to overdose or toxic effects (caused by adulterating substances) - Better known by their common names rather than by their medical or chemical names ("speed" or "Uppers" is term for amphetamines, "angel dust" for phencyclidine (PCP), and "snow" or "powder" for cocaine. Methamphetamine is highly addictive, easily manufactured stimulant "crank," "ice," or "crystal" - can be sniffed, injected, smoked or taken orally. = stimulates body by increasing dopamine levels in the brain but subsequently damages dopamine-producing neurons in brain = high dose causes elevated body temp and seizures. Heroin is commonly known on street as "blow". "Ecstasy" or MDMA a stimulant is a designer drug, chemically modified to provide special effects and avoid legal restrictions- imparts a feeling of euphoria and energy. I high dose leads to hyperthermia and heart failure. (commonly known as "X, "K or Special K" - Can be sniffed, injected, smoked, or taken orally - Increased criminal activity and violence associated with drug trafficking - Many manufactured from inexpensive chemicals - Often diluted with contaminants (may be toxic) |
Market for illegal drugs matter of concern both economically and socially because of increased criminal activity and violence associated with drug trafficking - many are easily manufactured from inexpensive chemicals in simple "laboratories" - regulations to restrict access to the precursor chemicals required to produce popular street drugs - some street drugs are diluted with contaminants that may be toxic; practice is done to increase profits and or to make substance more marketable on street |
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Medical Benefits compared with abuse potential and legal vs illegal status of marijuana - active ingredient: dronabinol (Marinol) or delta-9-tetrahydrocannabinol is available for the controlled treatment of nausea, vomiting, and wasting associated with cancer chemotherapy or AIDS - not effective in ALL patients - other less definitive areas involve tobacco smoking and social use of alcohol in which concepts of addiction and health risks are not well defined |
Individuals who abuse substances such as - alcohol often crave risk or excitement and participate in activities that are inherently dangerous - driving under the influence or in an impaired state is ex of behavior - 40% traffic accident are related deaths to alcohol use/abuse |
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TA 27-2 Differentiate the effects of stimulants from those of psychedelic drugs = Stimulants increase the activity of the brain and body systems; psychedelics distort the sensory perceptions and cause illusions. |
Predisposing Factors to Abuse (focus on psychological imbalances, personality deficits, biologic abnormalities, dysfunctional interpersonal relationships or a combo of these factors) - Heredity and/or genetics - Family systems and practices - Disease Increased availability of drugs - Stress Increased medical use of mood-altering and analgesic agents - Acceptance of alcohol or marijuana as a recreational tool in all age groups |
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Environmental and Behavioral Risk Factors - substance abuse more common in young adolescents - this aura of glamor and excitement influences young people to respond to peer pressure and need to express independence among their contemporaries -Substance abuse is becoming more common in young adolescents. - Parents’ medicine cabinet (M and M parties) = Prescription drugs - Mixture of drugs = Without knowledge what was consumed - Change in the complexity of society = Family breakdown, economic factors handful mixture of drugs taken without knowledge of what is consumed increases risk of behavior and challenging for health care workers because combined effects make treatment very difficult |
Evidence: increased stress and increased substance abuse and return to addiction after a period of withdrawal - people who take narcotic analgesics for prolonged periods of time risk becoming dependent because the drugs are addictive, creating state of euphoria while relieving pain. - narcotics helpful when medically treating severe pain, particularly in patients with terminal illnesses - heroin rarely used medically because of strong tendency to produce dependence |
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Anabolic steroids (similar to testosterones) - Abused by some athletes and body builders (build muscle mass and enhance performance) - these drugs have mood disorders, high blood pressure, serious cardiac damage, and liver cancer. - affects sexual function, fertility and appearance = Especially in competitive sports - Includes females |
Date rape drugs - form of substance abuse (person administer drug gets a rush from illicit behavior and the abused may experience physical and psychological trauma) - Illegal and premeditated assault - (Flunitrazepam (Rohypnol); gamma-hydroxybutyrate (easy drug to manufacture) or lorazepam (sedative, treat epilepsy/seizure disorders) = (depressing CNS and rapidly causing deep sleep) Mixed with alcohol cause CNS depression and deep sleep - No memory of events after administration - Difficult to bring charges against abuser |
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Indications/Recognition of Abuse Recognition is difficult. - Pattern of consumption varies = Frequently or consistently = Large amounts periodically, such a binge drinking - Some individuals are affected by small amounts. - Other individuals can function well with high intake. - Combinations of chemicals usually exert more marked effect (and exert a more marked effect than one substance) - Depressants decrease level of CNS function and social inhibitions. - Stimulants increase CNS activity. |
Indications/Recognition of Abuse - Effects of an individual drug depend on the classification of drug - depressants usually decrease the level of CNS function - stimulants increase CNS activity - Generally drugs impair neurologic function in some way (ex: slowing reflexes, reducing coordination and judgment, or impair sensitivity and perception - info on specific drugs can be found in reference texts on substance abuse or pharmacology. |
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General indications of substance abuse include - changes in behavior, appearance (e.g. eyes), personality, daily living patterns, or work habits - in adolescents: may include change in friends, academic achievement, interest in sports or increase in risk-taking behaviors - frequently: this person may be defensive, angry, or embarrassed if he or she is questioned about drug intake - pattern of behavior is that any stress will immediately require a "helpful" pill or a drink - often cycle develops in which person takes a depressantt o relax or sleep and then needs a stimulant to wake up. - as need for drug increases, more secretive behavior may ensue; may be less personal care of clothes and appearance, more excuses for time and performance lapses, stronger efforts to acquire substitute drugs and eventually criminal activity - some may become malnourished or may develop anemia or infection and ignore normal health needs - healthcare workers to be sensitive when strangers request specific drugs for pain relief; for ex in dental office - drugs including samples and prescription order forms should not be visible or readily available to clients |
Potential Complications of Substance Abuse Overdose: common acute problem - Common and acute problem - Relatively small safety margin for some drugs - Street drugs may be contaminated and dosage not known accurately - Synergism (drug combinations)—stronger reaction (ex: combination of drugs often including alcohol) - barbiturates which induce sleep, and narcotics morphine and heroin depress the CNS and compromise the respiratory function (may depress respiratory effort to a critical level (very slow and shallow respirations) leading to respiratory failure or cardiac arrest. - antidotes (naloxone (Narcan) which is given for narcotic overdose can stimulate the respiratory drive. - although antianxiety drugs (diazepam) do not cause respiratory depression when used alone, they may cause brain damage and coma when combined with alcohol. - Other stimulants: Ecstasy, cause marked elevations in blood pressure that frequently result in brain damage |
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Potential Complications of Substance Abuse Withdrawal - Discontinuation of drug use (body has become physically dependent results in withdrawal symptoms) - Withdrawal symptoms caused by physiological dependency - Signs of withdrawal May be mild to severe, depending on drug (use and amount of drug to which body cells have adapted) - common signs of withdrawal = irritability, tremors, nausea, vomiting, and stomach cramps, high blood pressure, psychotic episodes, and convulsions |
TA 27-3 Differentiate between overdose and withdrawal and include their causes and effects = Overdose is an excessive amount of the substance in the blood and body tissues, usually caused by the administration of a very high dose or a combination of substances present in the blood, causing a synergistic effect. Overdose causes toxicity and damage to tissues, with loss of function or life-threatening effects. Withdrawal is a syndrome that occurs when one is physically dependent on a substance and that substance is suddenly discontinued. Possible effects include tremors or convulsions, abdominal pain, and excessive diaphoresis. |
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Effects on Pregnancy Pattern of neglect of health and nutrition established in female substance abusers usually continues during pregnancy, creating serious prenatal concerns for both the women and her fetus - Abusers often do not seek prenatal care. = Fear of detection - Many substances affect the fetus. = Result in congenital defects, respiratory depression at birth, and/or dependency in the baby - Fetal alcohol syndrome = No safe alcohol consumption during pregnancy - newborn child of a women who has abused alcohol during pregnancy has characteristic physical and facial abnormalities and cognitively delayed - alcohol consumption late in pregnancy is likely to cause cognitive and behavioral abnormalities more commonly than physical defects in child - encouraged to restrict consumption - Cigarette smoking and second-hand smoke = Increased rate of stillbirth and spontaneous miscarriage = decrease blood flow through the placenta = Low birth weight for gestational age babies = increased irritability in infant after birth - some drugs such as cocaine and barbiturates lead to addiction in new born, who then must undergo withdrawal therapy after birth - cocaine causes maternal hypertension, decreasing placental blood supply to fetus, result in developmental defects or premature birth. |
Cardiovascular Problems - Cocaine and other stimulants (amphetamines) affect the cardiovascular system = causing irregular heartbeat and increased blood pressure - may lead to heart attacks, strokes, or heart failure at young age |
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Infection - Malnutrition reduces host resistance. - Systemic infections: = Common in drug users who share needles and other materials (when injecting drugs) - Hepatitis B - HIV infection - Local lesions can occur because of repeated use of local injection sites. = these lesions can later become gangrenous leading to potential systemic infections |
Neurological/Psychological Effects - Hallucinogenic drugs/ psychedelic drugs (lysergic acid diethylamide and PCP) lead to = Increased, unreal, distorted interpretation of sensory inputs, with little control over experience - use hopes for pleasant, euphoric experience (a "high") but may have an unpleasant episode with a combination of acute fear, panic and depression, increasing risk of suicide - May have unpleasant episode with combinations of: = Acute fear, panic, depression, increased risk of suicide - Physical effects = Increased blood pressure, nausea, tremors = Drug called Ecstasy (MDMA) increase basal metabolism and body temperature and associated with dehydration and electrolyte imbalances that can lead to cardiac arrest or death because of dehydration - These drugs also Memory impairment, distorted judgment, high-risk behavior (esp to those who operate machinery or drive automobile while under influence of drug. |
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Alcohol Cirrhosis (Laennec's Cirrhosis) Alcohol is a hepatotoxin: irritant that causes metabolic changes in liver cells, leading first to lipid accumulation in cells (fatty liver) then to inflammation and necrosis (alcoholic hepatitis) and finally fibrosis or scar tissue formation - destruction of the liver takes place insidiously with only mild signs and symptoms until the condition is well advanced and irreversible. - Occurs in chronic alcoholics - Long-term or acute excessive alcohol intake = Lipid accumulation = Alcoholic hepatitis and fibrosis Nervous system damage Chronic alcoholism may cause serious nerve damage in the brain owing to a combination of neurotoxicity and malnutrition - Wernicke’s syndrome = Confusion, disorientation, loss of motor coordination - Korsakoff psychosis = Altered personality and amnesia (can occur with long-term abuse) |
Treatment for Substance Abuse Overdose or toxic effect - Treat immediately in emergency room Withdrawal - Should be handled in medical facility (e.g. drug detoxification center) Supportive care - Required to prevent complications Clients benefit from psychiatric intervention Family support services and follow-up are beneficial - Therapy - Counseling and behavior modifications - Support groups (e.g., AA) |
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Treatment for addiction - must be individualized and include a holistic approach to all of individual's problems - long-term therapy and support are usually required to maintain abstinence or a significant decrease in use Therapy may include: - methadone maintenance programs for heroin dependency - Methadone: synthetic opioid that prevents withdrawal symptoms, improves function, and lessens the craving for narcotics in dependent persons. - Methadone is administered in prescribed doses in a controlled situation - Methadone programs have been successful in reducing crimes associated with heroin abuse - new treatment for opiate addiction: may be administered in oral tablets that can be used without daily clinic attendance (such program include monthly monitoring of treatment) |
Disulfiram (Antabuse) - deterrent (discourage) to alcohol use (AVOID ALCOHOL - very serious interactions) - drug is taken on a daily basis and causes unpleasant reactions (severe headache, vomiting, difficulty in breathing and visual problems) when patient ingests in a small amount of alcohol -In persons requiring treatment for substance abuse, malnutrition, particularly protein and vitamin B deficits, is a problem that requires treatment - counseling and behavior modification therapy are ongoing requirements - Narcotics anonymous are available for those with dependency problems |
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Chapter 28 Environmental Hazards and Associated Problems |
Agents in the environment can cause damage to cells and organs of the human body at the time of exposure or after repeated exposures. - Safe levels of agents must be calculated based on total life exposure. |
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Often, damage becomes apparent as aging reduces the physiological reserves of tissues. - Increase in childhood cancers and hypersensitivities - Hypersensitivities to new chemical substances have increased. = Chemicals in food processing = Synthetic materials in buildings and furnishings = Cosmetics and toiletries = Microbes in water and food supply |
Many agents in the environment can cause damage to cells and organs in the human body - frequently damage occurs silently as the agent accumulates ini the body - substantial increase in childhood cancers and hypersensitivities (asthma and anaphylaxis) cause for serious concern about the environment - hypersensitivities to new chemical substances in the environment have greatly increased - increased number of chemicals in food processing, synthetic materials in buildings and furnishings, and cosmetics and - many chemicals cannot be metabolized in body, increasing level of toxins in cells - physical factors play a role in environmental disease; awareness of role of sun exposure in combination with chemical exposure is increasing |
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OSHA: Occupational Safety and Health Administration (in the United States) and similar international agencies establish protocols for: - Safety procedures in workplace - Safety procedures in the environment - Infection control - Protective equipment - Exposure to harmful substances and hazardous material additional safety procedures been instituted in the workplace and environment to protect individuals from some hazards Ex: improved ventilation systems may be required for factories or soil in certain areas (may be tested for contaminants) before new housing is constructed. Additional information can be found in toxicology texts or environmental references |
Workplace Hazardous Materials Information System (WHMIS) - in canada to increase awareness of the role of these agents in pathologic processes, Ex: diseases arising from environmental references - every workers should feel free to question potential risk factors in the workplace or living environment |
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Chemicals Unwanted chemicals may be ingested in contaminated food or water, inhaled into lungs or absorbed through the skin - exposure may occur through skin - food and water may have been contaminated by industrial wastes - in contaminated food, water, toys, household objects (farmed salmon may contain toxic chemicals in feed, fresh water fish may absorb mercury in lakes and rivers) - some water processing plants test for over 300 chemicals (PCBs, DDT, and dioxin, as well as lead and mercury) - Inhaled - Absorbed through the skin - Chemical wastes may undergo transformation into more toxic materials or breakdown into harmless substances Ex: pesticides may remain in environment for a long time, such as DDT (do not break down into harmless chemicals and there fore high levels gradually accumulate in environment) |
Chemicals Many ecosystems are disturbed by the use of pesticides including those of microorganisms (some which may become pathogenic or disease causing) - organic foods provided opportunity for consumers to reduce their exposure to chemicals ingested in food - tissue damage may result from large dose in a single incident or more often damage results from repeated exposure to small amounts of unwanted material - chemical may cause damage at the site of entry or may enter the blood and circulate to other sites in body - frequently this process occurs without knowledge of individual = normally liver responsible for detoxification (inactivation and removal of foreign chemicals from body) - in many cases, these chemicals bypass liver and are stored in certain tissues, gradually accumulating to dangerous levels over years of exposure (usually no obvious signs of accumulation) |
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Examples of Chemicals Hexachlorophene - Was once widely used in hospitals and homes as an aseptic in soaps and powders - Until it was Absorbed through the skin (particularly broken skin) - (eventually leads to brain damage) - Use now restricted Exposure to plastics - Phthalates used to soften plastics and prevent shattering - children's exposure to plastic in environment - Toys, bottle nipples, soothers and others—withdrawn from U.S. and Canadian markets - but products produced overseas may still contain the banned product - Bisphenol A (BPA) hardening agent used in plastic baby bottles and water bottles - recently classified as toxin in Canadian Government - plastic and their ability to mimic hormones such as estrogen and act physiologically within the tissues = it is thought that such endocrine disrupters can lead to infertility and promote the growth of endocrine-sensitive cancers - also increasing concern about chemicals and regulation of menstrual cycle and reproduction in women - link exposure to solvents to increased risk in women for altered menstrual cycles, spontaneous abortions (miscarriages) and stillbirths |
Chemicals - chemicals may affect body in different ways - chemical substances often injure cells directly by damaging the cell membrane and causing swelling and eventual rupture of cell = results in inflammation and necrosis in tissue - some chemicals alter metabolic pathways in cells leading to degenerative changes - many chemicals are carcinogenic (cause mutations of cell and lead to onset of cancers such as Leukemia) |
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Dangerous Chemicals Heavy Metals - Lead and mercury = Can accumulate in tissues with long-term exposure Lead = Can be ingested in food or water = Inhaled = Found in lead pipes and batteries = Lead-based paint (toys, furniture) = Common childhood poison (children tend to chew on items covered with lead-based paint = toys, furniture and ingest paint flakes from walls or woodwork) - recent recall on common toy manufactured offshore of use of lead paints - Individuals with pica (craving for nonfood substances such as clay) may also develop high blood levels of lead. |
Toxic Effects of Lead Hemolytic anemia (destruction of erythrocytes leading to low hemoglobin levels) Inflammation and ulceration of the digestive tract (lead colic) Inflammation of the kidney tubules Damage to the nervous system: - Neuritis (inflammation and demyelination of peripheral nerves) - Encephalopathy (edema and degeneration of neurons in brain) - Seizures or convulsions (children manifest lead toxicity) - Delayed development and intellectual impairment (even low doses can lead to irreversible brain damage) |
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Lead poisoning can be detected by bone defects or "lead lines" in bone as well as on the gingiva or gums adjacent to teeth) |
Acids / Bases - can cause corrosive damage to living tissue (classified as a chemical burn) - classification of type follows same standard system as thermal burns - acids and bases can be found in numerous household products as well as labs and manufacturing facilities - strong oxidizers, reducing agents and solvents can also cause chemical burns - Treatment depend on specific chemical causing burn - general: first aid involves rinsing off chemical with water or with neutralizing solution - some cases involving lipophilic chemicals such as hydrofluoric acid) = burn symptoms may not be immediately obvious but may appear hours later |
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Inhalants - can be classified as particulate (abestos and silica, or gaseous (sulfur dioxide and ozone) or arise from solvents (carbontetrachloride) - although local irritation of the eyes and nose is often noticeable when exposure occurs, inflammation of respiratory tract and effect on CNS are not immediately apparent - some inhaled or aspirated solvents such as carbontetrachloride diffuse into circulation and cause inflammation of liver cells and irreversible hepatic damage as well as pneumonitis - other inhalants affect lung tissues directly Particulates - Asbestos - Silica Pesticides - Illness depends on type of pesticide, amount and duration of exposure Gases - Sulfur dioxide - Ozone Solvents - Benzene - Acetone |
Sources of Toxic Inhalants - Factories, laboratories, mines, artists’ workshops - Insecticides, aerosols - Paints, glues - Furniture, floor coverings (supply irritants at home) - Poorly maintained heating systems - Smog (visible air pollution contains noxious gases = Hydrogen sulfide = Particles from dust and smoke = Carbon monoxide Iron oxide and silica are examples of inhaled particles that frequently cause lung damage in workers in mines and other industries using these substances - can cause episodes of acute inflammation or may lead to low-grade chronic inflammation = result in fibrosis in lung - chronic cough and frequent infections results from irritation and inflammation of respiratory mucosa and may lead to additional damage - geographical locations with heavy pollution demonstrate increased incidence of chronic lung disease (many are carcinogenic and increase risk of lung cancer) |
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Examples of Toxic Inhalants Asbestos, iron oxide, silica = Inhaled particles = Lung damage in mine workers and other industries (NOTE: Family members may also be exposed when clothing transfers toxins in the home environment.) = Asbestos: fibrosis of the lungs Cigarette smoking predisposes smoker to - Lung disease, including cancer, emphysema, bronchitis and lung cancer - smoking impairs fertility and during pregnancy affects fetal development (stillbirth or low birth weight infants and increase risk for complications) - Bladder cancer - Cardiovascular disease - Predisposition to numerous other diseases |
Many gases such as - sulfur dioxide also cause inflammation to lungs - carbon monoxide results from incomplete combustion (e.g. automobile exhaust) is not a threat in small amounts for healthy people- but displaces oxygen from hemoglobin, can be dangerous for individuals with cardiovascular or respiratory disease |
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Asbestos - found in older buildings (used for insulation) - exposure of lungs to asbestos can cause severe acute inflammation and subsequent scarring (could lead to chronic problems such as mesothelioma) = malignant mesothelioma is a rare form of lung cancer that develops in the mesothelium and often caused by exposure to asbestos - other asbestos related disease include asbestosis, pleural plaques and pleural thickening - chronic asbestos related disease often take a long time to manifest which leads to delayed diagnosis and poor prognosis for recovery |
Pesticides - illness is a grouping of diseases and complications that can be caused by some type of exposure to pesticides - depending on type of pesticide and amount of exposure these chemicals can cause a variety of both acute and chronic adverse health effects - children and infants are especially sensitive (organs and body systems are still in process of development) to health risks that can arise due to pesticide exposure - signs of acute exposure problems: diarrhea, nausea, vomiting, pinpoint pupils, rashes, headaches, irritation of eyes, skin, or throat. - chronic exposure with some chemicals lead to aggravation of asthma problems, cause damage to immune system and increase risk of certain cancers and birth defects = treatment of pesticide illness will usually depend on specific chemicals involved. |
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TA 28-1 a) explain why chronic lung disease (bronchitis) occurs more frequently in highly industrialized regions = Chronic lung disease occurs more often in those living in industrialized regions because more irritants, both gases and particles, are in the environment and constantly inhaled, causing chronic irritation in the lungs and frequent infections. |
b) Describe 2 possible effects of chemical toxicity in body giving example of each = Effects of chemical toxicity include liver damage and cirrhosis caused by absorption of organic solvents, lung cancer resulting from inhalation of asbestos, and lead ingestion or inhalation, causing damage to the nervous system |
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c) Explain why young children are at greater risk of pathologic changes resulting from exposure to hazardous chemicals such as pesticide = A young child’s body systems and tissues are just developing, and any damage can have catastrophic effects on their small, developing organs. Any damage at a young age can create problems in the future. Dose–to–body weight ratios are much higher. Liver and kidney function may not be completely developed before the age of 2 years. |
Physical Agents: Temperature Hazards: Hyperthermia Excessive elevation of body temperature (can occur when environmental temperature is usually high, preventing effective cooling of body) - also strenuous activity generates excessive body heat on a hot day or inadequate replacement of fluid and salt lost in perspiration may lead to hyperthermia Syndromes include: - Heat cramps with skeletal muscle spasms = Caused by loss of electrolytes - Heat exhaustion = Sweating, headache, nausea, dizziness, dizziness or syncope (fainting) most common problem, result from loss of water and sodium leading to hypovolemia - Heat stroke = Shock = Coma = Very high core body temperature (most serious complication) - heat stroke occurs commonly in elderly, infants, or debilitated persons - early signs: red, dry skin, headache, dizziness, and rapid weak pulse = caused by general vasodilation (marked decrease in circulating blood volume) and damage to heart - prompt cooling and fluid and electrolyte replacement in persons with these syndromes are essential to prevent brain damage or cardiac failure. - because of less effective physiologic compensation mechanism, Older people, Infants and Cardiac Patients are most at risk for Overheating |
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Physical Agents: Hypothermia Exposure to cold temperatures (localized or systemic effects) - increased serious cases in colder climates as number of homeless individuals in these areas increase - children also vulnerable (may not understand the risks) Localized frostbite - Fingers, toes, ears, exposed part of face - wet clothing increases danger - vascular occlusion occurs quickly and may lead to necrosis and gangrene = usually sensation is lost early, and individual may not be aware of danger - close observation of exposed area for color changes (whitish or bluish spots) - gradual warming of area without rubbing can minimize damage Systemic exposure - Caused by submersion in cold water, lack of adequate clothing (in cold weather), wet clothing (on windy day) particularly if body movement is REDUCED. = low temp can affect many body tissues (depend of length of time of exposure and actual temperature) - shivering occurs initially in effort to generate more body heat and then body feels numb - lethargy and confusion become marked - pulse and respiration becomes slower, person becomes unresponsive - reflex vasoconstriction and increased blood viscosity = lead to ischemia and reduced metabolism - Core body temperature drops; capillaries and cell membranes are damaged. = Abnormal shift of fluid and sodium = Hypovolemic shock (low blood pressure) and cell necrosis - Rewarming must be done slowly and cautiously and must be accompanied by fluid replacement to maintain adequate circulation and minimize cell damage - often brain is protected against edema by administration of corticosteroid drug during return of normal body temperature |
TA 28-2 a) compare effects of hypothermia and hyperthermia on circulation = Hypothermia causes marked peripheral vasoconstriction, ischemia, and hypovolemia as a result of a fluid shift from damaged cells. Hyperthermia results in peripheral vasodilation and hypovolemia caused by excessive diaphoresis. b) Suggest some reasons why it would be difficult for a person submerged in an icy lake to continue swimming = Hypothermia causes decreased cell metabolism and function, leading to decreased sensory awareness, muscle weakness, and lethargy. c) How does hypothermia affect cell metabolism and oxygen requirements of the brain? = Hypothermia could cause a dramatic decrease in cellular metabolic reactions and may also disrupt cell integrity itself, because ice crystal formation in the cytoplasm could cause cells to rupture. Damage to capillaries leads to shifts in fluid and electrolyte levels, which could lead to low blood pressure and shock, thus reducing oxygen supply to the brain. (The diving reflex may be discussed here if appropriate.) |
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Radiation Hazards: Ionizing Radiation arriving from natural sources such as sun and radioactive minerals in soil (ongoing hazard) - increase concern in change in protective ozone layer in earth's atmosphere and resultant risk of more radiation - expanded exposure to radiation in homes (radon gas, byproduct of natural decay or uranium in earth, can seep into a house through soil or water), industry and defense systems, nuclear reactors for generation of electricity, and medicine for diagnostic procedures (x-ray and tracer studies, and treatment presents the primary risk of exposure for workers and clients) - workers must use lead shields and wear monitoring devices to check individual exposure) - Includes x-rays, gamma rays, protons, neutrons - Rays differ in energy levels and ability to penetrate body tissue, clothing, or lead - increased distance from the source lessens amount of radiation of exposure - Amount of radiation absorbed by the body is measured in rads (radiation-absorbed dose) - radiation emission measured in roentogens = radiation primarily affects cells that undergo mitosis (epithelial tissue, bone marrow, and gonads (ovaries and testes) = small doses of radiation, cells can sometimes repair the ruptured DNA strands - with larger doses: DNA is altered and often cross-linkages form, leading to mutations in cell and development of cancer (the cells may be destroyed) - exposure to large amounts or radiation leads to radiation sickness = damage to bone marrow, digestive tract, and CNS. = with intensive care and bone marrow replacement - Natural sources = Sun and radioactive materials in soil - Other sources = Radon gas (homes), industry, nuclear reactors, diagnostic procedures |
Radiation damage may occur with a single large exposure - usually accidental or may accumulate with repeated small exposures - the effects of repeated small doses of radiation have not been well studied and there is far less information about the resulting pathology than for massive exposure (occurred when atomic bombs were used against cities in japan and nuclear meltdown in Ukraine |
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Damage may occur with a single large exposure. May accumulate with repeated small exposures - Not been well studied Exposure to large doses - Leads to radiation sickness Cumulative damage - Skin cancers (sun exposure) - Radiation primarily affects actively dividing cells. = Epithelial tissue, bone marrow, gonads |
Light Energy - exposure to both visible light and UV ultraviolet rays = can damage skin and eyes - cumulative damage is manifested by development of skin cancers resulting from ultraviolet rays related to sun exposure (frequently in older individuals) - UV damages the nucleotides in the cell's DNA - reducing exposure and routine use of skin lotions that block damaging ultraviolet rays (UVA and UVB) is recommended to reduce the risk of skin cancer - exposure to eyes to strong UV radiation can cause permanent damage depending on specific wavelength involved = the shorter wavelength can cause corneal cell damage - UVA and UVB can cause lens damage - the longer wavelengths implicated in macular degeneration and retinal tissue damage - visible laser light can cause severe damage to eyes 2 types of eye damage that can be caused by laser beam are tissue thermal burns, affecting structures (cornea and photochemical damage to retina) - powerful lasers can also cause thermal damage to unprotected skin |
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TA 28-3 a) epithelial tissue is very sensitive to radiation. List specific structures that include epithelial tissue likely to be damaged by radiation = Epithelial tissue likely to be damaged by radiation includes the skin and lining of hair follicles, mucous membranes of the digestive tract or respiratory tract, lining of the renal tubules or glands, and lining of the blood vessels. Give several specific examples of radiation sources in your community and workplace = The sun, radioactive minerals in the ground (e.g., radon gas), nuclear generators (source of electricity), and x-ray machines are sources of radiation |
Noise Hazards - Hearing impairment may result from excessive noise Ex: a single loud noise (gunshot) or variety of noise intensities) can cause cumulative damage - sudden extreme loud noise may rupture the Tympanic Membrane (eardrum) or damage nerve cells in the inner ear. - Inner ear damage involving nerves is usually irreversible - cumulative damage caused by noise may result directly from noise in the workplace but is often associated with higher noise levels in urban areas and recreational sources such as rock music Noise in the workplace - Cumulative damage - Ear protection is now required in most noisy work environments. - Home or social environment may exceed safe levels for noise. - Because only soft or high-pitched sounds are lost initially, the effects of such trauma are often gradual and go unnoticed until they are well advanced - some cases, may notice tinnitus (ringing in ears) more obvious warning of problem |
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Food and Waterborne Hazards - Contaminated food and water (common sources of gastroenteritis or vomiting and diarrhea) - E. Coli (part of normal flora) are transmitted by the oral-fecal route when personal hygiene or community sanitation is not up to standard = "so called Traveler's diarrhea" Antibiotic-resistant pathogens (originating from humans or animals treated with antibiotics) have also been found in lakes and rivers. - May be the result of heat-labile toxins produced in contaminated food = Botulism poisoning - May be the result of heat-stable toxins produced in contaminated food = Staphylococcal contamination - May be the result of infection with microbe = Most common outbreaks are caused by strains of Escherichia coli or Salmonella. E. Coli emerged and have continued to cause serious illness including deaths and kidney damage - hemolytic uremic syndrome develops when specific strains of E. Coli invade the bloodstream and cause damage to Renal Tubules. - many serious outbreaks have occurred in North America - imperative that any meat products (ground and processed) cooked thoroughly to recommended temperature - institutions have frequent outbreaks of - Salmonella infection associated with contaminated poultry products or with food handlers who are carriers (person who is a reservoir for the organism and can spread it but shows no clinical signs of infection) - occur in daycares, nurseries when careful hand-washing and other infection control techniques have not been maintained - stool cultures can be used to identify the responsible organism - in many cases, such infections are self-limiting, but infants and elderly people have increased risk and may become DEHYDRATED very quickly. - Other pathogens: Listeria and Shigella (food borne) = Listeria: common in processed meat products (sausage or ham common) - this makes control difficult = Shigella: causes dysentery (bloody diarrhea) extremely dangerous - Shigella is a bacterium that is transmitted through unwashed hands (only small loading dose of organism is needed to cause serious infection) |
Food and Waterborne Hazards - Melamine: plastic that has been added to food and milk in some areas of the world to allow dilution of the food with water - acts as a protein when tested and can go unnoticed in milk or other food unless specific testing is carried out - adulteration of food is done to increase profit margins = result of indigestion of melamine is acute renal failure and possibly death. |
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Biological Agents: Bites and Stings 1. Direct injection of animal toxin into the body - Neurotoxins by spiders or snakes (affect nervous system, causing paralysis and respiratory failure or seizures) - Vascular agents in jellyfish 2. Transmission of infectious agents through animal or insect vectors to humans - Rabies or hydrophobia (caused by an RNA virus), rabies caused primarily by bites of wild animals (raccoons or skunks) or bites from cats/dogs that have been bitten by infected wild animals) - following any bite, animal usually impounded and monitored for infection = Rabies lead to nerve paralysis and death if not treated quickly (certain regions, mosquitos are threats because they transmit infections (rickettsial Rocky Mountain spotted fever and lyme disease caused by spirochete also transmitted by ticks) - Malaria - Lyme disease 3. Allergic reaction to insect's secretion - Bee or wasp stings - an anaphylactic reaction: sudden and severe life-threatening hypersensitivity or circulatory allergic reaction - anaphylaxis is identifiable by respiratory difficulty and shock in someone who has just been bitten |
Study Questions 1. Explain the potential benefits of reducing the use of pesticides and insecticides = A reduction in the use of pesticides and insecticides would mean less contamination of food, water, and air, lower risk of toxic effects in humans or animals immediately and years later, less interference with ecosystems, and less risk of dangerous mutations of microbes or insects. 2. List examples of dangerous gaseous and particulate compounds of chemical inhalants - Inhaled particles include asbestos, aluminum, silica, or dust; gases include sulfur dioxide and hydrogen sulfide. 3. Describe potential effects of chemicals on respiratory tissue = Potential effects of chemicals on respiratory tissue are inflammation, congestion, damage to cilia, loss of elastic fibers, fibrosis, obstructions, and carcinogenesis. |
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4. Explain how skin cancer is linked to sun exposure = The sun is a source of UV radiation that causes cumulative mutations in the skin cells with repeated exposure. |
5. Give several examples of excessive noise in your environment = Machines, drills, and loud music are sources of excessive noise. 6. Name a biologic agent and associated problem for each of the following a) transmission of an infection through a bite b) hypersensitivity reaction c) injection of a toxin = a. Bite—animal saliva carrying the rabies virus causes nerve paralysis. = b. Hypersensitivity—bee or wasp stings cause anaphylaxis. = c. Injection of toxin—venom from a snake causes nerve paralysis. |
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7. Define a carrier: = A carrier is an asymptomatic person in whom the microorganism is present but produces no symptoms. The carrier can transmit the infection to others. 8. Define fecal-oral transmission of infection (give an example). = Disease is spread by the ingestion of food or water contaminated by microorganisms in the feces of an infected person (e.g., gastroenteritis caused by Salmonella or Escherichia coli). |
During the stress response, endorphins act as: = pain blockers |
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Possible complications caused by prolonged, severe stress include all of the following EXCEPT: = Blindness |
A serious consequence of a major disaster, first recognized in war veterans is: = PTSD |
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Which of the following may alter a person's perception of a stressor? = Presence of several stressors at the same time, past experiences, and lack of effective coping mechanisms |
Improved function of the heart and brain during a stress response results from:1. glycogenesis.2. bronchodilation.3. vasoconstriction in the skin and viscera.4. decreased metabolic rate. = 2,3 |
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Which of the following is/are NOT a common sign(s) of withdrawal? = Respiratory Depression |
What is physiological dependence? = Adaptation of the body to a drug, resulting in withdrawal signs after drug is continued |
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When an increased dosage of a drug causes toxic effects, it is called: = overdose |
Chronic alcoholism is likely to cause all of the following EXCEPT: = respiratory failure |
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Withdrawal from any drug is best accomplished: = with medical support |
Bites and stings cause disease in which three ways? = injection of toxins, transmission of infectious agents or allergic reactions |
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Illness in institutions may be traced back to food handlers who: = are carriers of pathogens, do not practice adequate hand-washing or sanitization, and bring in pathogens from home or the community. |
Which of the following is considered carcinogenic? = inhaled particulates |
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The term pica refers to: = the consumption of nonfood substances such as clay |
Two types of eye damage that can be caused by a laser beam are: = thermal burn and photochemical damge |
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Hans Selye defined his general adaptation syndrome concept, which is also known as: = fight or flight |
Which of the following may alter a person's perception of a stressor? = presence of several stressors at same time, past experiences and lack of effective coping mechanisms |
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Chemical dependency has been associated with all the following EXCEPT: = increased work productivity |
Which of the following applies to abuse of anabolic steroids? = they often cause permanent damage to cardiovascular system |
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Which of the following is likely to result from lead poisoning? = damage to brain and peripheral nerves |
20/20 on quiz |
