CHAPTER 1: INTRODUCTION TO PATHOPHYSIOLOGY AND PATHOPHYSIOLOGY TERMINOLOGY, Exams of Nursing

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AND PATHOPHYSIOLOGY TERMINOLOGY

Absorb- take in or soak up Ccute- has relatively severe manifestations but runs short course measured in hours, days, or a few weeks. Adverse- preventing successes or development; harmful Chronic- lasts for months to years. Clinical- relating to the observation and treatment of actual patients rather than theoretical or laboratory studies Manifestations- are observed as signs of diseases, both objective and subjective Compensate-to give something in recognition of loss/injury cyanosis- a bluish discoloration of the skin resulting from poor circulation or inadequate oxygen to the blood. Cytology- the branch of biology surrounding the structure of plant and animal cells Detrimental- tending to cause harm Disseminate- spread widely Diagnosis- the identification of the nature of an illness by examination of symptoms Endemic- a disease or condition regularly found among a particular people in a certain area Epidemic- a disease is disseminated to many individuals at the same time Epidemiology- the study and analysis of the distribution and patterns of health and disease conditions in defined populations Etiology- the study of causes or reasons for a phenomena Exacerbate- to make worse Excrete- to separate and expel as waste Histology- the study of microscopic structure of tissues Hypoxemia- poor oxygenation of blood Hypoxia- a condition in which the body is deprived of adequate oxygen supply Iatrogenic- the cause is a result of an unintended or unwanted medical intervention Idiopathic- the cause is unknown Incidence- the occurrence, rate, or frequency of a crime incubation period- the interval between exposure of a tissue to an injurious agent and the first appearance of symptoms in the case of infectious diseases. Infarction- death tissue due to inadequate blood supply to the affected area Inhibit- to hold in/hold back, restrain Insidious- proceeding a gradual, subtle way, but with harmful effects Intermittent- occurring at irregular cycles Ischemia- inadequate delivery of blood to cells Latent period- the interval between exposure to a tissue to an injurious agent and the first appearance of symptoms

CHAPTER 1: INTRODUCTION TO PATHOPHYSIOLOGY

AND PATHOPHYSIOLOGY TERMINOLOGY

Maladaptive- dysfunctional Morbidity- the condition of being diseased Mortality- the state of being subject to death Multifactorial- involving or dependent on a number of factors or causes Occlusion- the blockage or closing of a blood vessel or hollow organ Occurrence- an event/incident Pallor- an unhealthy appearance Pandemic- are epidemics that affect large regions and perhaps spreading worldwide Pathogenesis- refers to the development or evolution of a disease Pathology- the study and diagnosis of disease through examination of organs, tissues, cells, and bodily fluids Pathophysiology- the disordered physiological processes associated with disease/injury Perfusion- the passage of blood through the blood vessels or other natural channels Physiology- the branch of biology that deals with live organisms and their parts Prevalence- commonness Prodromal period- the appearance of the first signs and symptoms indicating the onset of disease Prognosis- the forecast of what is likely to come of the disease Prolonged- extend the duration of Remission- a temporary recovery Risk factor- when the link between an etiologic factor and development of disease is less than certain but the probability is increases when the factor is present Secrete- produced and discharged Sensitivity- the ability of an organism to respond to external stimuli Sequelae- a condition that is the consequence of a previous disease/injury Signs- abnormalities that signify a potential medical condition Specificity- the range of a function in which the antibody is effective Subclinical stage- during which the patient functions normally, although the disease processes are well established Symptoms- abnormalities that signify a potential medical condition Syndrome- a set of medical signs that correlate with each other and associates with a particular disease Transient- lasting only for a short time CHAPTER 2: HOMEOSTASIS AND ADAPTIVE RESPONSES TO STRESSORS

CHAPTER 1: INTRODUCTION TO PATHOPHYSIOLOGY

AND PATHOPHYSIOLOGY TERMINOLOGY

Increased secretion of epinephrine from adrenal Normalization of epinephrine secretion Loss of resistance of stressor; medulla possible death of organism Fight or flight: the hypothalamus senses the need to activate the GAS response to a stressor risking homeostasis Resolution of fight of flight manifestations Reduces resistance to stressors Increased resistance to stressor

- role of hypothalamus and function of corticotropin releasing hormone - Hypothalamus o Monitors internal and external environment o Secretes CRH to activate Sympathetic system o Secretes CRH to stimulate ACTH - CRH o Activates the SNS which in return stimulates the adrenal medulla to release epinephrine and norepinephrine - role of anterior pituitary and function of adrenocorticotropic hormone (ACTH) - Anterior pituitary then secretes ACTH o Found in the head also known as master gland o Influence growth, sexual development, skin pigmentation, thyroid function

CHAPTER 1: INTRODUCTION TO PATHOPHYSIOLOGY

AND PATHOPHYSIOLOGY TERMINOLOGY

• ACTH causes adrenal cortex to release glucocorticoids o Regulate steroid hormone cortisol by releasing it o Produced in the pituitary gland in the brain - role of posterior pituitary and function of antidiuretic hormone/vasopressin (ADH) - role of adrenal glands and functions of:
• Posterior pituitary o The back portion of the master gland o Secretes oxytocin which increase uterine contractions and ADH
• ADH o Increases reabsorption of water by tubules in the kidney - catecholamines – epinephrine, norepinephrine
• Catecholamines o Release of is imitated through the activation of the hypothalamus gland
• Epinephrine o Increases glycogenolysis (release of glucose from the liver and inhibits insulin secretion, elevating blood glucose levels) o Enhanced myocardial contractility and increases heart and cardiac output
• Norepinephrine o The primary constrictor of smooth muscle in blood cells and regulate blood flow through tissues and its distribution to organs, maintaining blood pressure o Reduces gastric secretion, inhibits secretion, and innervates muscles of the eyes, dilating pupils and increasing night and far vision - corticosteroids – cortisol, aldosterone
• Corticosteroids/glucocorticoids o Lipid-soluble hormones; practically every tissue in body has receptors

CHAPTER 1: INTRODUCTION TO PATHOPHYSIOLOGY

AND PATHOPHYSIOLOGY TERMINOLOGY

- Elevated BP - Increased muscle tension - Sweaty palms - Tension headache - Anxiety - Depression - Increases use of substances - Changes in eating/sleeping - explain the difference between homeostasis and allostasis - Homeostasis o The state of balance of the persons biopsychosocial systems; maintain all internal parameters to be constant - Allostasis o Refers to the overall process of adaptive change needed to maintain survival and well-being - explain what occurs during allostatic overload

• When adaption mechanisms are inadequate or the total amount is excessive, overwhelming allostasis - explain why each of the following can occur due to stress: hypertension, stroke, coronary artery disease
• Hypertension: can cause through repeated blood pressure elevations as well as stimulation on the NS to produce large amounts of vasoconstriction which increase blood pressure
• Stroke: High levels of cortisol causes salt retention which will increase blood pressure, causing stress on blood vessels making blood clotting more likely
• Coronary artery disease: high levels of cortisol from long time stress can increase blood cholesterol, blood sugar and pressure. It can promote buildup of plaque deposits in the arteries - gastrointestinal problems, immune suppression, diabetes mellitus - define glycolysis, gluconeogenesis, glycogenolysis, glycogenesis

CHAPTER 1: INTRODUCTION TO PATHOPHYSIOLOGY

AND PATHOPHYSIOLOGY TERMINOLOGY

• Glycolysis o The most fundamental system for sugar metabolism in the body; contributes the production of energy o The breakdown of glucose by enzymes, releasing energy
• Gluconeogenesis o A metabolic pathway that results in the generation of glucose from certain non- carbohydrate carbon substances o Allows the body to store needed energy for the brain in the form of glucose
• Glycogenolysis o The release of glucose from the liver and inhibits insulin secretion further elevating blood glucose levels
• Glycogenesis o The transformation of glycogen from sugar to store and provide energy CHAPTER 4: CELL INJURY, AGING, AND DEATH - list and describe the mechanisms associated with reversible (hydropic swelling,

CHAPTER 1: INTRODUCTION TO PATHOPHYSIOLOGY

AND PATHOPHYSIOLOGY TERMINOLOGY

Protein damage: Cellular stress Excessive glycogen Variety of inorganic particles Apoptosis Cell death resulting from activation of intracellular signaling cascades. Is tidy and normally not associates with inflammation. Requires energy in cell. Cell adaptions May be due to increased functional demand or reversible cellular injury

- describe and give causes and examples of each of the following cell adaptations: atrophy, hypertrophy, hyperplasia, metaplasia, dysplasia, anaplasia, neoplasia Atrophy When cells reduce in size Causes: 1) disuse 2) denervation 3) ischemia 4) nutrient starvation 5) interruption of endocrine signals 6) persistent cell injury Ex: immobilization in bed rest will cause shrinkage in skeletal muscles Hypertrophy Increase in cell size Caused by increase in pathophysiological/physiological demands Ex: organ enlargement may be a result of both in hypertrophy and hyperplasia

CHAPTER 1: INTRODUCTION TO PATHOPHYSIOLOGY

AND PATHOPHYSIOLOGY TERMINOLOGY

Hyperplasia by increasing the number of cells Cause: increased physiological demands or hormonal stimulations Ex: estrogen lease to increase in endometrial and uterine cells Metaplasia Replacement of one differentiated cell type with another. Fully reversible after injurious stimulation is removed Cause: persistent injury Ex: chronic irritation of bronchial mucosa by cigarette smoke, leads to metaplasia Dysplasia Refers to the disorganizes appearance of cells because of abnormal variations in size, shape, and arrangement. Involves complete thickness

CHAPTER 1: INTRODUCTION TO PATHOPHYSIOLOGY

AND PATHOPHYSIOLOGY TERMINOLOGY

- describe ischemia, hypoxia, and hypoxemia along with why/when each condition occurs - Hypoxia is an important cause of cell injury that results from poor oxygenation of blood (Hypoxemia) or inadequate delivery of blood to cells (ischemia) CHAPTER 7: NEOPLASIA - benign vs malignant tumors: terminology, appearance (gross and microscopic), growth, metastasis, necrosis, likelihood of recurrence, prognosis Characteristic Benign Malignant Histology Typical of tissue of origin Few mitoses Anaplastic, within abnormal cell size and shape Many mitoses Growth rate Slow Rapid Localization Strictly local Invasive Tumor necrosis Rare Common Recurrence Rare Common Prognosis Good, unless in critical area Poor if untreated - abnormal behavior of malignant cells

CHAPTER 1: INTRODUCTION TO PATHOPHYSIOLOGY

AND PATHOPHYSIOLOGY TERMINOLOGY

• Cells inhibit antisocial properties that allow them to ignore growth controlling signals from the environment. Cancer cells proliferate excessively, become immortal, invade locally, and may travel to distant sites to establish new colonies - risk factors/predisposing factors for carcinogenesis: tobacco, nutrition, genetics (proto- oncogenes, oncogenes, tumor suppressor genes), viruses
• Proto-oncogenes: a normal gene, when mutates becomes an oncogene that can contribute to cancer. Functions: 1) lead to division 2) regulate programmed death (apoptosis) - role of p53 and Rb
• P o The most common tumor suppressor gene o Inhibits cell cycling, very little found in cells; a transcription factor that binds to damaged DNA and regulates genes o Stalls cell division to allow DNA to repair o Accumulates in response to cellular DNA damage o In the face of excessive damage, it may signal apoptosis o Defect: allows genetically damaged and disabled cells to survive and continue replicating
• Rb o Codes for a large protein in cell pRB that is called the “master brake “of the cell cycle. o Blocks division by binding transcription factors inhibiting them from transcribing the genes that initiate cell cycle. o Defect: removes one of the major restraints on cell division o Is common in a number of different cancers - carcinogenesis: what is initiation, promotion, progression?
• Initiation: o The genetic mutations that inappropriately activate protooncogenes and inactivate tumor suppressor genes. o Proliferation is needed for cancer development, without it is unlikely to cause cancer
• Promotion o The stage where the mutating cell proliferates. May need activation of another oncogene or inactivation of tumor suppressor gene that has kept proliferation in check o Nutritional factors and infection may provide stimulus for cellular proliferation
• Progression

CHAPTER 1: INTRODUCTION TO PATHOPHYSIOLOGY

AND PATHOPHYSIOLOGY TERMINOLOGY

o Done to predict tumor behavior and guide therapy o Grading- histologic characterization of tumor cells o Staging- location and pattern of tumor spread within the host

- most common organs where metastasis occurs; what is the first place of metastasis for many cancers? o Liver, brain, lungs, bones o Nearby lymph nodes

• **- TNM system: what does each letter represent, are low or high number more severe?
• generalized effects of cancer on the body** System used extensively as a general framework for staging tumor - generalized effects of cancer on the body
• The development of many cancers is related to lifestyle, especially tobacco and nutrition
• Smoking cessation is considered important to reducing risk of cancer
• Avoid excessive weight gain and alcohol intake, try to eat veggies an fruit -leukopenia vs leukocytosis, thrombocytopenia vs thrombocytosis
• Leukopenia: decrease in circulating white blood cells o Malignant invasion of bone is primary cause, with malnutrition and chemotherapy as contributing factors o Major cause of morbidity in cancer patients, organism become opportunistic
• Thrombocytopenia is a deficiency in the number of circulating platelets, which are important for mediating blood clots o Less than 20,000 can be associated with a spontaneous hemorrhage
• thrombocytopenia: decrease in the number of platelets
• thrombocytosis: increase in the number of platelets - general warning signs of cancer
• Change in bowl/bladder habits
• A sore that does not heal
• Unusual bleeding/discharge
• Thickening or lump in breast somewhere
• Indigestion of difficulty swallowing
• Obvious change in wart/mole
• Nagging cough or hoarseness -effects of cancer therapies on the body: surgery, radiation, chemotherapy, immune therapy, gene/molecular therapy, stem cell therapy
• Surgery o Majority of patients with sold tumors are treated surgically o Main benefit: removal of tumor with minor damage o Commonly accompanied with radiation therapy or chemotherapy
• Radiation o Initiated apoptosis; kills tumor cell by damaging nuclear DNA

CHAPTER 1: INTRODUCTION TO PATHOPHYSIOLOGY

AND PATHOPHYSIOLOGY TERMINOLOGY

o Some normal cells killers, small does of radiation o Kills what surgery might have left over

• Chemotherapy o Drug therapy, finds and kills cells, may kill some normal cells o Most effective on rapid dividing cells o Side effect: bone marrow suppression
• Immunotherapy o Interferons- glycoproteins produced by immune cells in response to infection o Interleukins- peptides produced and secreted by WBC o Monoclonal antibodies- specific structures that bind to specific organs o Used with surgery, radiation and chemotherapy
• Gene/Molecular Therapy o May replenish missing tumor suppression function o Genetic alteration of tumor cells to make them more susceptible to immune system; alteration of immune cells to make more efficient killers
• Stem Transplant o Provides a method to restore bone marrow function after high dose radiation/therapy o Need a donor! ▪ Matched to patient: allogenic ▪ Identical twin: syngeneic ; Patients own: autologous CHAPTER 10: ALTERATIONS IN IMMUNE FUNCTION
• autoimmunity: describe what is going wrong with the immune system and give examples
• Immune system attacks own tissues, immune system recognizes its own cells are foreign and mounts a response that injuries self-tissues. No single theory to explain, would be multifactorial.
• Cause: abnormal excessive immune responses towards own tissues
• Example: in rheumatic heart disease, the body forms antibodies against the streptococcus organism and also reacts with heart valve tissue.

CHAPTER 1: INTRODUCTION TO PATHOPHYSIOLOGY

AND PATHOPHYSIOLOGY TERMINOLOGY

o More problematic symptoms: throat constriction, localized edema, wheezing, tachycardia o Anaphylaxis: more life threatening, occurs in small number of highly allergic people

• Anaphylactic shock: Anaphylaxis causes immune system to release a flood of chemicals that can cause you to go into shock- blood pressure suddenly drops and airways are narrow, blocking breathing. S/S: rapid weak pulse, skin rash, nausea and vomiting.
• why is anaphylaxis life-threatening? what needs to be administered immediately? why?
• Severe reaction. Causes your immune system to release a flood of chemical that can cause you to go into shock – your blood pressure drops suddenly and your airways, blocking breathing.
• An EpiPen needs to be administered immediately. It contains epinephrine, a chemical that narrows blood vessels and opens airways in the lungs. These effects can reverse sever low BP, wheezing, severe skin itching hives, etc
• Type II: describe hypersensitivity problem
• Antibodies attack antigens on surface of specific cells/tissues. May be mediated by activated complement fragments (membrane attack complex).
• Transfusion reaction: individual received blood from someone with a different blood group type.
• blood type that is universal donor? universal recipient? why?
• Universal red cell donor has type O negative
• The universal recipient AB
• erythroblastosis fetalis: common name, when/why does it occur, RhoGAM
• Common name: Hemolytic disease of the newborn
• When: occurs during pregnancy
• Why: Mothers IgG Rh positive antibodies cross the placental barrier and attack the fetus’ red blood cells, moms status is monitored o If negative, RhoGAM is administered
• Type III: describe hypersensitivity problem
• Immune and phagocytic systems fail to effectively remove antigen/antibody immune complexes, no specific tissue
• systemic lupus erythematosus (SLE): describe, systems/organs affected, lab results, why is it difficult to diagnose?

CHAPTER 1: INTRODUCTION TO PATHOPHYSIOLOGY

AND PATHOPHYSIOLOGY TERMINOLOGY

• Chronis disease with remissions and exacerbations
• Fever, joint pain, fatigue, “butterfly rash”, joint inflammation, kidney damage
• Diagnosis: Difficult to diagnose as etiology is unknown, may be genetic predisposition. Combination of clinical findings and laboratory evidence. o Rash, mouth sores, arthritis, lung/heart inflammation, kidney problems, neurological, abnormal blood tests.
• Organs affected: Kidney, lung/heart, neurological system
• Lab results: Presence of ANA in bloodstream, lows WBC/platelets
• Type IV: describe hypersensitivity problem, give examples
• Delayed hypersensitivity: tissue damage resulting from a delayed cellular reaction to an antigen
• Example: contact with poison ivy
• what is Mantoux skin test and how does it work? how long does it take to appear?
• What: confirms the diagnosis of Tuberculosis, it can only indicate if individual has had prior infection
• How: PPD is injected, after 48 hours, there should be no elevation/reaction. If so, a chest X-ray is required to check for active disease.
• immunodeficiency disorders: primary vs secondary, examples of each Primary Secondary Congenital, genetic, or acquired defects that directly affect immune cell function Rare, and often sex linked Predisposed to multiple deficiencies Example: Wiscott-Aldrich syndrome. Non-immune system disorders Treatments that secondarily affect immune system Excessive or defective neuroendocrine responses Excessive: increases corticosteroid increases susceptibility to infection Defective: low corticosteroid increases susceptibility to infection Factors: poor nutrition, stress, drugs, surgery Example: AIDS CHAPTER 11: MALIGNANT DISORDERS OF WHITE BLOOD CELLS
• overview of WBC cancers:
• leukemia vs lymphoma vs myeloma (in general)
• Common neoplastic disorders of the bone marrow and lymphoid tissues
• Leukemias: circulation tumors that primarily involve blood and bone marrow

CHAPTER 1: INTRODUCTION TO PATHOPHYSIOLOGY