Essentials of Pathophysiology - Final Exam Review Sheet, Exams of Nursing

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Be sure to look over review sheets from Exam #1 and #2 – all previous information is fair game for the Final exam

1. Review the difference between homeostasis and allostasis. Allostasis is the overall process of adaptive change necessary 2. What is epidemiology?. Epidemiology the branch of medicine that deals with the study of the causes, distribution, and control of disease in populations ….Review the different levels of disease

prevention such as primary-

preventionintermsofimprovednutrition,economy,

housing,andsanitation Secondary - prevention that lead to the early

diagnosis of disease and, in some cases, cure tertiary - prevention - once a disease becomes

established, treatment as well as examples for each. Epidemiology the branch of medicine that deals with the study of the causes, distribution, and control of disease in populations. Primary- preventionintermsofimprovednutrition,economy,h ousing,andsanitation… Secondary - prevention that lead to the early diagnosis of disease and, in some cases, cure … Tertiary prevention - once a disease becomes established, treatment

3. Review the differences between the sympathetic vs the parasympathetic nervous systems. What happens to the body during “fight-or-flight” response? Sympathetic- stressful stimulus and release of norepinephrine. Parasympathetic-rest/relax

4. Review the functions of the various organelles of the cell such as the nucleus , mitochondria,

ribosome, lysosome , endoplasmic reticulum - cytoplasm of a eukaryotic cell, has

ribosomes attached and is involved in protein and lipid synthesis. peroxisome-

breakdown of very long chain fatty acids through beta oxidation golgi apparatus - a

complex of vesicles and folded membranes within the cytoplasm of most eukaryotic cells, involved in secretion and intracellular transport.protein molecules in sacs called cisternae and the transport of synthesized proteins in vesicles to the

5. Review the difference between active and passive immunity, know examples for each type. Active immunity - va c ine o c urswhenindividualsareexposedtoantigen,whichconfersl ong-term protectionbut maytakeseveralw e kstodevelop.)and

( Passive immunity - Newborns receive IgA antibodies through breast milk. serotherapy, involves direct injection of antibodies into an unprotected person

,

What is edema? swelling Review the various factors that can contribute to edema-- heart

failure, kidney problems

7. What is a hypersensitivity? Review the four different types of hypersensitivities: Type I (Anaphylactic)- (IgE)immediate hypersensitivity, allergic reaction Type II (Cytotoxic)- ABO transfusion reactions, hemolytic disease of the newborn, myasthenia gravis, hyperacute graft rejection, and autoimmune hemolytic anemia, IgM or IgG. Type III (Immune complex)-- inflammatory reaction to the antibody–antigen complex, , IgM and IgG, Immune complex- example Systemic Lupus E, Type IV (Delayed cell-mediated)--- (Delayed cell-mediated- example tuberculin reaction. Know examples and mediating factors for each type. Type IVa – Allergic Contact Dermatitis, Type IVa - Tuberculin-Typ….. Know examples and mediating factors for each type. **8. Review the differences between benign and malignant tumors.

9. Review signs and symptoms of peptic ulcer disease**. epigastricburningpainthatisusua l yrelievedbythe intakeo f ood(especia l ydairyproducts)orantacids.GIbl e di ng,mayo c urinpatientswithnowarning burning stomach pain, bloating or belching, Heartburn 10. Review signs and symptoms of appendicitis. Generalized periumbilical pain accompanied by nausea and, & diarrhea. Pain-“migrating”orlocalizingtothelowerRIGHTabdomen // / How do we assess for this condition? Low fever, nausea, anorexia, RIGHT quad pain, elevate WBC, rebound pain or tenderness at McBurney point 11. Review signs and symptoms of liver disease. Bruising,increasedbl e dingJaundice, Hepatomegaly, Splenomegaly,Varices, Anemia,Weakness,fatigue,anorexia,weightlos s,muscle wasting,fever,Ascites / Review complications of liver disease such as ascites - a c umulationof fluidintheperitonealcavity. hepatic encephalopathy — Confusion, subtle behavioral changes, Drowsy, clear behavioral changes, flap present Stuporous, confusion, slurred speech, Coma TX. Osmotic diuretics or antibiotics .. esophageal varices-- result of cirrhosis attributable to alcoholism or viral hepatitis--- complication of portal hypertension… How are esophageal varices managed/treated? To lower blood pressure and decrease risk of bleeding(control bleeding) - Propranolol. Nadolol 12. What role does albumin play in the blood? 60% of the total protein in the blood, keep fliud from

, e , leaking out of blood vessels, nourishes tissues, and transports hormones, vitamins, drugs throughout the body. What happens to albumin production with liver failure? Serum albumin is low in liver failure

13. What are the function of the kidneys? drainexce s interstitialfluidandproteinsregulat ebl o d su p lyandreninreleas filtrationofwater- solublesubstances; ( 2 )reabsorptionoffilterednutrients,

. water,andelectrolytes( 3 )secretionofwastesorex ce s substances… How do we assess for renal disorders?? BUN levels are used to monitor the progression of renal disease or to screen for occult renal insufficiency. Creatinineclearanceisfrequentlyusedtoa s e s GFR BUNandcreatininearemeasured together,andtheratioisdetermined.Acutechanges inGFRarereflectedinahigherBUN-to-creatinine ratio,usuallygreaterthan 20 : 1

14. What is cystic kidney disease? polycystic kidney disease, where cysts form in the kidneys. Genes code for proteins associated with the primary cilium 2 types- autosomal- rece s ive(infant)andautosomal- dominant(adult)commonlyfoundinmen…. What causes this condition? end stage renal **disease

15. Review the following terms: nephrons** - performingallfiltration,reabsorption,andsecreto ryfunctions hematuria-- proteinuria- for biopsy, renal disease check.. nephrolithiasis-- - (stone) crystal a g regatescomposedoforganicandinorganicmaterials 20 and 30 years,loweramongAfrican AmericansandMexican….. pyelonephritis- -Chronic : smallatrophiedkidneyswithdiffusesca r ing andblunting.obstruction or ureteral reflux that allows contaminated urine to enter the kidney… cystitis-- inflammation of the bladder lining, may result from bacterial, fungal, or parasitic infections 16. Review signs and symptoms of acute kidney injury (AKI). Review causes of AKI including prerenal - S/S- fluid volume overload, oliguria, low urinary sodium.. Intrinsic - S/S: declining urine output. postrenal. - Obstruction of the normal outflow of urine, more common in the elderly.Know examples of each type of injury. 17. What is compartment syndrome? trauma to soft tissue caused Why does it occur and what are the signs? decreased compartment size, increased compartment content, or externally applied pressure…. Remember the 5 P’s -- Pain. Pressure. **Paresthesia (numbness). Paralysis. Pulselessness
16. What are pressure ulcers? bedsores** , are localized damage to the skin

and/or underlying tissue.. How are the staged and how can we prevent them? Stage I :The skin is intact, Stage II : An open wound, Stage III : A deep wound- Deep damage may expose a fat layer, Stage IV : Large scale tissue loss- exposes bone, muscle or tendons.

19. What are electrolyte reservoirs? Electrolytes come from the food and liquids you consume. What electrolytes are found stored in bones? Ca

s - . . a

. s ( , e r ) 20. Review diseases of the bone including: Osteomyeliti- isaninfectioninabone…Osteosarcoma isa typeofbonecancerfoundinlongbonesOsteomalaci referstoamarkedsofteningofyourbones, mostoftencausedbyseverevitaminDdeficiency… Osteoporosi causesbonestobecomeweak andbrittle

21. Review disorders of the joints including: (Rheumatoid arthritis —CAUSE:Age, Family history,

Environment, Gender, Obesity, Smoking. Pain. Inflammation, Stiffness ) ( Osteoarthritis - Heredity , Pain after overuse or after long periods of inactivity ,Stiffness after periods of rest,Bony enlargements in the middle and end joints of the fingers (which may or may not be painful) ( Psoriatic arthritis - is a skin disease that causes a red, scaly rash, most often on your elbows, knees, ankles, feet, hands welling) (Gout -- caused due to accumulation of uric acid crystals, called urate, in the joints. Excess consumption of meat and seafood, 50 years of age Certain medications. Know causes and signs/symptoms for each. (done!)

22. Review endocrine disorders of the pituitary gland including: (Gigantism - over-production of

growth hormone, estradiol,produced)( Dwarfism-

Inadequatesecretionofthyroxinebythethyroidgla ndor insufficientgrowthhormonesecretionfrom thepituitarygland Acromegaly- GH excess is called acromegaly, frequencyinmen)( Diabetes insipidus - deficientantidiuretichormoneverydiluteurine andexce s iv thirst)( SIADH-- isa s ociatedwithpulmonarytumors,centralnervoussystem disease,Exce s ADH)

23. Review which organisms/viruses contribute to the following conditions: (Pelvic inflammatory disease-, cause gonorrhea or chlamydia infections) ( Cervical cancer - main cause HPV-Verrucae, or warts (Fig. 53.4), are common benign papillomas caused by DNA-containing papillomaviruses) ( UTI--) ( Herpes 1. Kissing, 2 sexual contact )- (Syphilis -- Treponema pallidum, an anaerobic spirochete, sexual contact) 24. What is parathyroid hormone (PTH)-- fou parathyroid glands,Adecreaseinserum calcium level causesareleaseofPTH,calcium leve l eadstosu p re s ionofPTHsecretion) ( Which electrolyte is primarily affected by PTH disorders - Serum calcium 25. Review differences between Cushings syndrome (hypercortisolism)-- adrenocortical hyperfunction is caused by disease of the adrenal cortex,

moonface,hirsutism, demineralizationofthebones (osteoporosis, Cortisolincreases(adrenal adenoma ( Addison’s disease (adrenocortical insufficiency)--- destructionoftheadrenalcortexthroughidiopath icorautoimmunemechanismstuberculosis, trauma,Hyperpigmentation

Review the differences between hypothyroidism--- intrinsic dysfunction of the thyroid gland, Congenital hypothyroidism, developmentmayberefe r edtoas cretinism and hyperthyroidism — increasedsynthesis andsecretionofT 4 andT 3 , , Gravesdisease .What labs can be drawn to determine if an individual is suffering from a thyroid disorder? TSH

27. Review the difference between Type 1 diabetes characterizedbydestructionoftheβcellsofthe pancreas-,verproductionofglucagonbypancreati cαcellsstimulatesglycogenolysis ( type II - need insulin, 2 diabetesme l itusareresistan t otheactionofinsulinonpe ripheralti s ues 28. What are signs and symptoms of hyperglycemia - Blurred vision. Fatigue. Weight loss. Poor or delayed wound healing. ( hypoglycemia-- hunger,visualdisturbance,weakne s ,paresthesi as, confusion,agitation,coma,anddeath ( What are the three Ps? **polyuria, polydipsia and polyphagia

29. Review the difference between primary and secondary brain injury**. TBI, primary injuries result immediately from the initial trauma…Secondary injury is an indirect result of the injury. It results from processes initiated by the trauma.. What is a reperfusion injury? Ce l deathresultingfrom ischemia occurs and blood supply to the tissues has been restored called reperfusion injury

30.Review causes of intracranial pressure; how does it lead to impaired neurological function?

LOC, decrease motor function, speech issues, sbp ^ & pulse down, headache…(cause

Aneurysm rupture , Encephalitis, Hydrocephalus (increased fluid around the brain)

31. What are signs or increased ICP? The signs of increased ICP include:

headache, increased blood pressure, confusion , double vision, pupils that don’t respond to changes in light, loss of consciousness, coma

32. Review the Glasgow coma scale, what is it used to assess? checks for impairment of conscious level

in response to defined stimulus. Eye opening, Verbal response, Motor response,

Review the different types of stroke : ischemic -- blood vessel carrying blood to the brain is blocked or restricted versus hemorrhagic - blood vessel in the brain ruptures or breaks. How is stroke diagnosed? CT or MRI 1 st^ step, blood test, ECG-EKG

34. Review the difference between meningitis-- infection to the outer layer of the

brain, cause Bacteria, Viruses,Fungi, rash, DX blood. versus

encephalitis - acute inflammation to the brain itself cause Virus, no

rash, DX mri ct.

35. Review the different types of seizures - tonic-clonic or convulsive seizures or grand mal) absence seizures or petit mal, atonic seizures or drop attacks) ( How are seizures diagnosed? Electroencephalogram (EEG), blood testing to check for electrolyte imbalances , a spinal tap rule out infection, a toxicology screening 36. Review the etiology of cerebral palsy -- disorder of movement, muscle tone or posture that is caused by damage that occurs to the immature, developing brain, most often before birth ) (Is cerebral palsy reversable? No,Lifelong condition, caused by a static, non- progressive lesion in the brain. 37. What causes Parkinson’s disease?Unknown toxic, genetic, head trauma, drug induced What does this condition affect? speech to your gait to your cognitive abilities, progressive nervous system disorder that affects movement

38. What are the major mechanisms of spinal cord injury? Impact, Laceration of the

spinal cord How do we treat if we suspect someone has a spinal cord injury? To stabilize

the spine. Traction, Analgesics: To relieve pain. Codeine. Hydrocodone. Oxycodone. Methadone

39. What happens with oxygen and carbon dioxide levels with hypoventilation? decreased

levels of oxygen , increased levels of carbon dioxide Hyperventilation?

(CO2) levels to decreasere, and increasing O

40. Be able to identify normal versus abnormal ABG values— What is the normal pH range of blood? ph7.35-7.45 CO2 34-45 HCO3 23-30.

• Respiratory acidosis : low pH, high CO

Respiratory alkalosis : high pH, low CO 2

• (^) Metabolic acidosis : low pH, low HCO 3 -
• (^) Metabolic alkalosis : high pH, high HCO 3 -
• (^) Compensated respiratory acidosis : normal pH, high CO 2
• (^) Compensated metabolic acidosis : normal pH, low HCO 3 -
• (^) Compensated respiratory alkalosis : normal pH, low CO 2
• (^) Compensated metabolic alkalosis : normal pH, high HCO 3 - 41. Review conditions that affect the lungs such as: asthma - Asthma is a condition in which your airways narrow and swell and produce extra mucus…. mycobacterium tuberculosis-- tubercle bacillus bacteria, spread by droplets .. COPD - Chronic bronchitis and emphysema can clog the airways and damage lungs making It difficult to breath,

incurable disease.. cystic fibrosis

— Cystic fibrosis (CF) is an inherited disease of the mucus(Sticky) clogs the lungs, causing breathing problems and making it easy for bacteria to grow is a genetic disorder, which means you get if from your parents at birth. ARDS— Acute respiratory distress syndrome causes fluid to leak into your lungs, keeping oxygen from your organs life-threatening pneumonia — Pneumonia is an infection that inflames the air sacs in one or both lungs. Caused by Bacteria, viruses, or fungi

42. What are signs of ARDS? Breathing rate increase, cyanosis, Grunting on exhales, Nose flaring, Sweating, Wheezing

43. What is a tension pneumothorax, how is it treated? air escapes into the pleural

cavity, increasing air pressure in the pleural cavity causes

progressive collapse of the lung. TX-by Needle in chest remove

excess air

44. What is Virchow’s Triade? named for (Rudolf Virchow) contribute to

thrombosis, Hypercoagulability Hemodynamic changes (stasis, turbulence)

Endothelial injury/dysfunction How do these factors increase a patient’s risk for developing a pulmonary embolus? Beccuase thrombi occurring within the veins and migrate to the pulmonary vasculature

What are different causes/types of emboli? ( pulmonary embolism- deep vein thrombosis or DVT), lodges in one of the arteries of the lungs. Types-- brain embolism, fat embolism, air embolism. Causes-- smoking and heart disease-- cancer, previous surgery, a broken leg or hip

46. What are causes of anemia? blood loss, decreased production of RBC, and destruction of RBC. What are complications of anemia? tissue hypoxia. Shock , hypotension , or coronary and pulmonary insufficiency What is the goal in treating anemia? treated based on the cause 47. Review the following conditions of the blood including causes: (polycythemia- red cells are present in excess, increasing blood viscosity thrombocytopenia Caused by: lung and heart diseases, sleep apnea, tumors, dehydration,) (Disseminating intravascular coagulation (DIC)--- hemorrhagic syndrome in which both clotting and bleeding occur simultaneously. How do we treat DIC- Replacementofdepleted clo t ingfactorswithfreshfrozenplasma,packedre dbl o dcells,platelets,orcryoprecipitate 48. What hormone plays a role in RBC production? erythropoietin (EPO). What organ produces this hormone? Kidney(Formation in the bone marrow)

49. Review the difference between Hodgkin’s - dx’s Is early stages treatable, also begins in the upper body neck

, armpits chest vs Non-Hodgkin’s lymphoma -begins in lymph nodes dx’s Is later stages harder to treat.. How are these cancers diagnosed?

50. Review modifiable- Dietary factors, Sedentary lifestyle, Obesity/weight gain// nomodifiable— Family history,Age,Ethnicity/Genetics risk factors for hypertension. How is hypertension managed/treated? What medications are often prescribed to manage HTN? What are complications

of hypertension if left unmanaged? Stroke, atherosclerosis, MI, organ damage

51. What is the role of renin-angiotensin-aldosterone system in managing blood pressure? restore blood volume, Angiotensin 1 not strong enough Instead, converted to angiotensin II, much more powerful hormone to change blood act directly on blood vessels. 52. What is coronary artery disease? major blood vessels that supply your heart with blood, oxygen

and nutrients (coronary arteries) become damaged or diseased

What is atherosclerosis? a disease of the arteries characterized by the deposition of plaques of fatty material on their inner wall ) How does plaque formation begin-- begins with damage to the endothelium and buildup of plague

54. Review the difference between ( stable - -- relieved by rest and nitroglycerin ,( unstable angina - Unstable angina, myocardial ischemia, myocardial necrosis includes ST-segment elevation myocardial infarction

55. (STEMI)-- ST-elevation myocardial infarction, prolonged,

part of the heart dies .. non-STEMI (NSTEMI )- partially blocked arteries are found within the heart

56. What diagnostic tool is used to identify acute coronary syndrome? Catheter based coronary **angiography

57. Review the following terms: afterload** - aortic impedance that the left ventricle must overcome to eject blood during systole, disease HTN) preload --- amount of blood in the ventricle at the end of diastole, happens HF ) ( ischemia- insufficiency of oxygen cardiac tissue damage and death.. contractility- inherent state of activation of cardiac muscle fibers) ( cardiac output- - **the amount of blood pumped out by each ventricle in 1 minute
58. Review the differences between left-sided** -- Left ventricular failure most common Pulmonary congestion and pulmonary edema Dyspnea, dyspnea on exertion, Cough, respiratory crackles (rales), hypoxemia, and cyanosis/// versus right-sided heart failure--- congestion in the systemic venous system, Dependent peripheral edema, Ascites, Jugular veinous distention (JVD), Impaired mental functioning Hepatomegaly, splenomegaly know signs/symptoms for each.

59. What medications are used to manage heart failure? Digoxin, Pacemaker

Angiotensin- converting enzyme (ACE) inhibitors:

Converting enzyme inhibitors (ACE inhibitors)helps to open

narrowed blood vessels. Benazepril. Captopril. Enalapril Beta

blockers: To reduce blood pressure and slow down heart rate.

Acebutolol. Atenolol. Bisoprolol Diuretics: Metolazone.

Indapamide. Hydrochlorothiazide

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Review the signs and symptoms of shock. Review the causes of different types of shock including: anaphylactic shock - Antibiotic therapy, Peanuts and tree nuts, Insect stings, Snake bites cardiogenic shock -- Loss of consciousness, Pallor of the skin hypovolemic shock -- elevated HR, vasoconstriction, increased contractility obstructive shock - Confusion or lack of alertness, Loss of ability to concentrate, Unconsciousness, Chest pain. septic shock--- Activation of clotting cascade, DIC, Hypotension, Cellular hypoxia, Increased capillary permeability with edema formation ( Distributive shock )--- abnormal distribution of blood flow, not enough oxygen-carrying blood Neurogenic shock massive vasodilation, spinal cord sympathetic nerves damage

61. What are complications of shock? They are Disseminated Intravascular Coagulation occurs in septic shock Immune activation of the clotting.. Acute Renal Failure - Kidneys undergo long periods of hypoperfusion. Vasoconstriction causes decreased glomerular blood flow.. Multiple Organ Dysfunction Syndrome (MODS) Occurs when 2 or more organ systems are affected 62. What are the stages of hemostasis?- initial , interaction between platelets and the endothelium of the injured blood vessel. The secondcomponentofprimar hemostasis isformationofaplateletplug-formationof afibrinclot,orcoagulation.Clot retraction, the final stage of clot formation, This stage takes approximately 1 hour 63. What medications can affect hemostasis? vascularpurpuraincludesremovalofcausativeagentifonei s identified(e.g.,penici l in).extensivebl e dingtocontrolth bleedingarenecessary. 64. What is hemophilia? most common severe inherited coagulation disorder. Excessive bleeding adevelop bleeding) Review the differences between Hemophilia A is a bleeding disorder associated with a deficiency of factor VIII, a protein necessary for blood clotting TX - administration of cryoprecipitate or other preparations of factor VIII concentrate desmopre s inandantifibrinolytic .. Hemophilia B- results from factor deficiency or the abnormal function of factor IX, TX-- administration of fresh or fresh frozen plasma or cryoprecipitate What is the treatment for each?