NR 283 PATHOPHYSIOLOGY EXAM 1 REVIEW CONCEPTS, Exams of Nursing

Download NR 283 PATHOPHYSIOLOGY EXAM 1 REVIEW CONCEPTS and more Exams Nursing in PDF only on Docsity!

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

NR 283 Pathophysiology Exam 1 Review Concepts Cellular Biology/Cellular Adaptation/Cellular Injury Chapter 1 o Cellular Adaptation o Atrophy – decrease in size of cells, resulting in reduced tissue mass (immobilized limb in a cast) o Hypertrophy – increase in size of cells, resulting in an enlarged tissue mass (enlarged heart muscle) o Hyperplasia – increase in number of cells, resulting in enlarged tissue mass (could be compensatory mechanism or hormonal imbalance, cancer) o Metaplasia – one mature cell type is replaced by a different mature cell type (could be compensatory mechanism) o Dysplasia – tissue in which the cell varies size & shape, large nuclei are frequently present, and the rate of mitosis is increased (precancerous - cervical cells) o Anaplasia – cells that are undifferentiated with variable nuclear and cell structures and numerous mitotic figures (in most malignant tumors; basis for grading aggressive tumors) o Neoplasia “new growth”; Neo - new, Plasm - growth o Benign – less serious, do not spread, non-life threatening unless found in certain locations (i.e. brain) o Malignant – undifferentiated & nonfunctional cells that do not appear organized; rapid production & abnormal mitotic figures; cancer o Vocabulary Terms at on page 6-8 (Under headings of “Characteristics of Disease” and “Disease Prognosis.”) Characteristic of Disease: o Pathogenesis: refers to the development of the disease or the sequence of the

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

events involved in the tissue changes related to the specific disease process o Acute disease: indicates a short-term illness that develops quickly with marked signs such as high fever or severe pain o Chronic disease: milder condition developing gradually, such as rheumatoid arthritis, but it persists for a long time and usually causes more permanent tissue damage. Usually marked by intermittent acute episodes. o Subclinical State: exist in some conditions in which pathological changes occur but the patient exhibits no obvious manifestations, perhaps because of the great reserve capacity of some organs. o Latent State: silent stage, in which no clinical signs are evident, o Incubation Period: which is the time between exposure to the microorganism and the onset of signs or symptoms. o Prodromal Period: period compromises the time the early development of a disease when one is aware of a change in the body, but the signs are nonspecific o Manifestations: of a disease are the clinical evidence or effects, the signs, and symptoms, of the disease

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

o Local: found at the site of the problem o Systemic: general indicators of illness o Signs: objective indicators of disease that are obvious to someone other than the affected individual. Can be local or systemic o Symptoms: subjective feelings, such as pain or nausea o Lesion: term used to describe a specific local change in the tissue. Can be microscopic o Syndrome: a collection of signs and symptoms, often affecting more than one organ, that usually occur together in response to a certain condition o Diagnostic tests: laboratory tests that assist in the diagnosis of a specific disease o Remission: is a period or condition in which the manifestations of the disease subside, either permanently or temporarily o Exacerbations: is a worsening in the severity of the disease or in its signs/symptoms o Precipitating Factor: condition that triggers an acute episode o Complications: are new secondary or additional problems that arise after the original disease begins o Therapy/ therapeutic interventions: treatment measures used to promote recovery or slow the progress of a disease. Ex: surgery, drugs, physiotherapy, therapies, behavior modifications o Sequelae: the potential unwanted outcomes of the primary condition, such as paralysis following recovery from stroke o Convalescence or rehabilitation: period of recovery and return to the normal healthy state, may last days or months Disease Prognosis: o Prognosis: probability or likelihood for recovery or other outcomes o Morbidity: indicates the disease rate within a group

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

o Mortality: indicate the relative number of deaths resulting from a particular disease o Autopsy: examination of all or part of the body by a pathologist o Epidemiology: science of tracking the pattern or occurrence of disease o Occurrence: tracked by two factors o Incidence: the number of new cases in a given population noted within a stated time frame. o Prevalence: number of new and old or existing cases within a specific population and time frame. o Epidemics: occur when there are a higher than expected number of cases of an infectious disease within a given area o Pandemics: higher numbers of cases in many regions of the globe o Communicable: disease or infections that can be spread from one person to another o Notifiable/ Reportable: disease must be reported by the physician to certain designated authorities. o Types of tissue necrosis o Liquefaction Necrosis – dead cells liquify due to certain cell enzymes (ex. brain tissue dies or cavity/ulcer development in affected area)

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

o Coagulative Necrosis – cell proteins are altered or denatured (ex. MI due to lack of oxygen) o Fat Necrosis – fatty tissue breaks down into fatty acids in the presence of infection or certain enzymes o Caseous Necrosis – form of coagulation necrosis; thick, yellowish, “cheesy” substance (ex. Tuberculosis) o Infarction - area of dead cells resulting from lack of oxygen (ex. MI) o Gangrene – necrotic tissue due to lack or loss of blood supply followed by invasion of bacteria o Seven Steps for Health

1. Be a nonsmoker and avoid second-hand smoke.
2. Eat 5 to 10 servings of vegetables and fruit a day. Choose high-fiber, lower-fat foods. If you drink alcohol, limit your intake to one to two drinks a day.
3. Be physically active on a regular basis. This will also help you to maintain a healthy body weight.
4. Protect yourself and your family from the sun.
5. Follow cancer screening guidelines.
6. Visit your doctor or dentist if you notice any change in your normal state of health.
7. Follow health and safety instructions at home and at work when using, storing, and disposing of hazardous materials. Genetics Chapter 21

• Congenital: Meaning o Genetic & inherited disorders present at birth
• Teratogens: Meaning and types o Agents that cause damage during embryonic or fetal development o Types:

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

▪ Physical agents ▪ Metabolic conditions ▪ Infections ▪ Drugs & Chemicals

• Genetic Diseases - know where these examples fall under inheritance; chance of inheritance as it applies to X-linked, autosomal dominant, and autosomal recessive, characteristics, and risk factors if applicable. o Down syndrome: Chromosomal Disorder (Trisomy 21) ▪ Inheritance? - No ▪ Characteristics: - Small head, round face, flat facial profile - Slanted eyes and epicanthic fold - Large tongue, high-arched palate - Small hands, single palmar crease

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

• Short stature
• Muscles tend to be hypotonic; loose joints
• Delayed developmental stages
• Cognitive impairment ranges from mild to major
• Delayed or incomplete sexual development
• Males infertile
• Females have lower rate of conception ▪ Risk factors?
• Maternal age o Turner’s Syndrome or Monosomy Occurs when only one sex chromosome, the x chromosome is present. This person has only 45 chromosomes, resulting in a variety of physical abnormalities and lack of ovaries. ▪ Inheritance?
• Most cases are not inherited ▪ Chance of Inheritance?
• Women with syndrome who conceive naturally have 30% chance of having a fetus with Turner Syndrome ▪ Characteristics
• Short stature and webbed neck
• Delayed puberty
• Infertility
• Heart defects
• Certain learning disabilities ▪ Risk Factors o Marfan’s: Autosomal Dominant Disorder ▪ Inheritance?
• Yes

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

▪ Chance of inheritance?

• Affected parent has a 50% probability of passing the disorder on to each child regardless of gender ▪ Characteristics:
• Skeletal deformities like pectus excavatum and abnormal curvature of the thoracic spine
• Aorta is wider and more fragile leading to leakage of the aortic valve or tears to the aortic wall ▪ Risk factors?

o Huntington’s: Autosomal Dominant Disorder

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

▪ Inheritance?

• Yes ▪ Chance of inheritance?
• Affected parent has a 50% probability of passing the disorder on to each child regardless of gender ▪ Characteristics:
• Difficulty swallowing
• Strange and uncontrolled movements that are either slow or wild and jerking ▪ Risk factors?
• Developed later in life (30-40 y.o.) o Color Blindness: X-Linked Recessive Disorders ▪ Inheritance?
• Yes, may appear to skip generations ▪ Chance of inheritance?
• Carrier females have a 50% chance of producing an affected male child and an equal chance of producing a carrier female child in each pregnancy ▪ Characteristics:

▪ Risk factors?

• Fam. Hx o Hemophilia: X-Linked Recessive Disorder ▪ Inheritance?
• Yes, may appear to skip generations ▪ Chance of inheritance?
• Carrier females have a 50% chance of producing an affected male child and an equal chance of producing a carrier female child in

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

each pregnancy ▪ Characteristics:

• Prolonged bruising ▪ Risk factors?

o Duchenne’s Muscular Dystrophy: X-Linked Recessive Disorder ▪ Inheritance?

• Yes, may appear to skip generations ▪ Chance of inheritance?
• Carrier females have a 50% chance of producing an affected male child and an equal chance of producing a carrier female child in each pregnancy

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

▪ Characteristics:

▪ Risk factors?

o Cystic Fibrosis: Autosomal Recessive Disorders ▪ Inheritance?

• Yes ▪ Chance of inheritance?
• 25% that the child will be born with the unaffected genotype
• 50% that the child will be born with the carrier genotype
• 25% that the child will be born with the affected or disease genotype ▪ Characteristics:

▪ Risk factors?

o Turner Syndrome: Chromosomal Disorder (Monosomy X) ▪ Inheritance?

• No ▪ Characteristics:
• Short stature
• Webbed neck ▪ Risk factors?

o Klinefelter’s Syndrome: Chromosomal Disorder (Polysomy X) ▪ Inheritance?

• No ▪ Characteristics:

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

• Small testes and do not produce sperm
• Develop breast tissue ▪ Risk factors?

Chapter 2

• What controls sodium balance o the sodium-potassium pump or active transport, resulting in sodium levels that are high in extracellular fluids and low inside the cell
• Causes of Edema

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

o Increased Capillary Hydrostatic Pressure o Loss of Plasma Proteins o Obstructions of the Lymphatic Circulation o Increased Capillary Permeability

• Electrolytes found in intracellular fluid and extracellular fluid o Intracellular: Potassium o Extracellular: Sodium Chloride
• Types of edema (localized, generalized, pitting) o Pitting edema – excess fluid moved aside when fingers pressed into tissue o Generalized – increase in body weight o Localized – central to one specific area
• Hypervolemia (S/S, causes) o Increase in blood volume
• Hypovolemia (Dehydration) (S/S, causes) o Fluid deficit in the excess vascular compartment o Dehydration – insufficient body fluid resulting from adequate intake or excessive loss of fluids or a combination of both ▪ S/S - Vomiting/ Diarrhea (Loss of electrolytes, nutrients, water) - Excessive sweating (Loss of sodium & water) - Diabetic ketoacidosis (Loss of fluid, electrolytes, glucose in urine) - Insufficient water intake in elderly or unconscious person - Use of concentrated formula (infant)
• Hypernatremia (S/S, causes) < 142 mEq/L o Ingestion of large amounts of sodium w/o proportionate water intake o Loss of water faster than the loss of water o Cause:

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

▪ Specific causes include the following:

• Insufficient ADH, which results in a large volume of dilute urine (diabetes insipidus)
• Loss of the thirst mechanism
• Watery diarrhea
• Prolonged periods of rapid respiration o S/S: ▪ Thirst: tongue & mucosa are dry & sticky ▪ Weakness ▪ Lethargy ▪ Agitation ▪ Edema

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

▪ Elevated blood pressure ▪ Decreased U/O due to ADH secretion

• Hyponatremia (S/S, causes) > 135 mEq/L o Direct loss of sodium from the body o An excess of water in the extracellular compartment resulting in dilution of sodium o Cause: ▪ Losses from excessive sweating, vomiting, and diarrhea ▪ Use of certain diuretic drugs combined with low-salt diets ▪ Hormonal imbalances such as insufficient aldosterone, adrenal insufficiency, and excess ADH secretion (SIADH or syndrome of inappropriate antidiuretic hormone secretion) ▪ Early chronic renal failure ▪ Excessive water intake o S/S: ▪ Anorexia, nausea, cramps ▪ Fatigue, lethargy, muscle weakness ▪ Headache, confusion, seizures ▪ Decreased blood pressure
• Hyperkalemia (S/S, causes) < 5 mEq/L o Causes: ▪ Renal failure ▪ Deficit of aldosterone ▪ Use of “potassium-sparing” diuretic drugs, which prevent potassium from being excreted in adequate amounts ▪ Leakage of intracellular potassium into the extracellular fluids in patients with extensive tissue damage such as traumatic crush injuries or burns

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

▪ Displacement of potassium from cells by prolonged or severe acidosis o S/S: ▪ Arrhythmias, cardiac arrest ▪ Nausea, diarrhea ▪ Muscle weakness, paralysis beginning in the legs ▪ Paresthesias – fingers, toes, face, tongue ▪ Oliguria ▪ Acidosis – serum pH > 35

• Hypokalemia (S/S, causes) > 3.5 mEq/L o Causes: ▪ Excessive losses from the body due to diarrhea ▪ Diuresis associated with certain diuretic drugs; patients with heart disease who are being treated with certain diuretic drugs such as furosemide may

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

have to increase their intake of potassium in food or take a potassium supplement because hypokalemia may increase the toxicity of heart medications such as digitalis ▪ The presence of excessive aldosterone or glucocorticoids in the body (in Cushing syndrome, in which glucocorticoids have some mineralocorticoid activity, retaining sodium and excreting potassium) ▪ Decreased dietary intake, which may occur with alcoholism, eating disorders, or starvation ▪ Treatment of diabetic ketoacidosis with insulin o S/S: ▪ Cardiac arrhythmias, cardiac arrest ▪ Anorexia, nausea, constipation ▪ Fatigue, muscle twitch (tetany), weakness, leg cramps ▪ Shallow respirations, paresthesias ▪ Postural hypotension, polyuria, nocturia ▪ Alkalosis – serum pH < 7.

• Hypercalcemia (S/S, causes) < 10 mEq/L o Causes: ▪ Uncontrolled release of calcium ions from the bones due to neoplasms; malignant bone tumors may directly destroy the bone, and some tumors, such as bronchogenic carcinoma, may secrete PTH in excess of body needs ▪ Hyperparathyroidism ▪ Immobility, which may decrease stress on the bone, leading to demineralization ▪ Increased intake of calcium due either to excessive vitamin D or to excess dietary calcium ▪ Milk-alkali syndrome, associated with increased milk and antacid intake,

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

which may also elevate serum calcium levels o S/S: ▪ Apathy, lethargy ▪ Anorexia, nausea, constipation ▪ Polyuria, thirst ▪ Kidney stones ▪ Arrhythmias, prolonged strong cardiac contractions, increased blood pressure

• Hypocalcemia (S/S, causes) > 8 mEq/L o Causes: ▪ Hypoparathyroidism—decreased parathyroid hormone results in decreased intestinal calcium absorption

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

▪ Malabsorption syndrome—resulting in decreased intestinal absorption of vitamin D or calcium ▪ Deficient serum albumin ▪ Increased serum pH—resulting in alkalosis o S/S: ▪ Tetany—involuntary skeletal muscle spasm, carpopedal spasm, laryngospasm ▪ Tingling fingers ▪ Mental confusion, irritability ▪ Arrhythmias, weak heart contractions

- Sodium imbalances o Found in Neuro - Potassium imbalances o Found in Heart

• Acid/base balance o Essential to homeostasis o Normal serum pH range 7.35 – 7.
• High Risk Population for dehydration o Elderly & Infants
• Insensible fluid loss o Urine o Feces o Skin (perspiration) o Exhaled air
• Causes for Dehydration in the elderly o Decrease water intake
• Fluid regulation (Hydrostatic Pressure, Osmotic Pressure)

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

o Hydrostatic Pressure pushes fluid o Osmotic Pressure pulls fluid

• Normal level for pH o Normal serum pH 7.35 – 7. Chapter 5, 6 and 7
• Anaphylaxis o Severe, life-threatening, systemic hypersensitivity reaction resulting in decreased blood pressure, airway obstruction, and severe hypoxia.
• Erythrocyte sedimentation rate (ESR) o Elevated plasma proteins increase the rate at which red blood cells settle in a sample

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

o General indicator of inflammation (along with C-reactive protein)

• Roles of the types of White blood cells (Leukocytes) o Neutrophils – Phagocytosis; nonspecific defense; active in inflammatory process o Basophils – Bind IgE, releases histamine in anaphylaxis o Eosinophils – Participate in allergic responses and defense against parasites o Monocytes – Migrate from the blood into tissues to become macrophages o T lymphocytes – cell-mediated immunity
• Hypersensitivity o Allergic reactions are unusual and sometimes harmful immune responses to normally harmless substances
• Signs and Symptoms of inflammation o Local signs ▪ Pain, swelling, redness, & warmth - Bacterial: purulent exudate - Viral: serous, clear exudate o Systemic signs ▪ Fever (possible) ▪ Fatigue & weakness ▪ Headache ▪ Nausea
• Types of Hypersensitivity reactions (4 Types) o Allergic Reactions (immediate inflammation & pruritis) ▪ Hay fever; Anaphylaxis o Cytotoxic Hypersensitivity (cell lysis & phagocytosis) ▪ ABO blood incompatibility o Immune Complex Hypersensitivity (inflammation; vasculitis) ▪ Autoimmune disorders

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

• Systemic Lupus
• Erythematosus
• Glomerulonephritis o Cell-Mediated / Delayed Hypersensitivity (delayed inflammation) ▪ Contact dermatitis: transplant rejection
• Tests for immunity o Antigen identification o Antibody titer (measure levels of serum immunoglobulins) o Indirect Coomb’s Test (detects Rh blood incompatibility) o Elisa (detects HIV antibodies; used for several other diseases) o MHC typing (tissue matching before transplantation procedure)
• Opportunistic Infections

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

o Microbes that are not pathogenic under normal circumstances but may cause disease if they are transferred to another location in the body, if the balance among the species is not maintained or if the boy’s defenses are impaired.

• Systemic versus local signs and symptoms o Local S&S ▪ Inflammation (pain, tenderness, swelling, redness, & warmth) ▪ Bacterial: purulent exudate / pus ▪ Viral: serous, clear exudates o Systemic S&S ▪ Fever, fatigue & weakness, headache, nausea ▪ Severe infections: nervous system may be affected, confusion / disorientation, seizures (convulsions), or loss of consciousness
• Active vs Passive Immunity o Active Immunity: develops when the person’s own body develops antibodies or T cells in response to a specific antigen introduced into the body ▪ Takes a few weeks but lasts for years due to T & B Cells ▪ 2 forms - Active Natural (direct exposure to an antigen – chickenpox) - Active Artificial (vaccine injection – measles) o Passive Immunity: when antibodies are transferred from one person to another ▪ Effective immediately, but temporary protection ▪ 2 forms - Passive Natural (mother to fetus via placenta) - Passive Artificial (injection of antibodies from one person/animal into a second person)
• Innate Immunity o Gene specific and is related to ethnicity
• Humoral Immunity vs Cellular Immunity

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

o Humoral Immunity – antibodies are produced to protect the body o Cellular Immunity – lymphocytes are programmed to attack nonself cells to protect the body

• B cells o Responsible for production of antibodies o Humoral immunity o Mature in bone marrow ▪ Proceed to the spleen and lymphoid tissue o Plasma cells ▪ Produce antibodies o B memory cells ▪ Can quickly form clone of plasma cells

PATHOPHYSIOLOGY

EXAM 1 REVIEW

CONCEPTS

• T cells o From the bone marrow stem cells o Further differentiation in thymus o Cell-mediated immunity o Cytotoxic T killer cells o Helper T cells o Memory T cells
• Memory cells o Memory B cells o Memory T cells
• Autoimmune definition o The immune system no longer recognizes itself from nonself and begins to attack its own cells / structures or organs
• Most common cause of death in AIDS o Secondary infections ▪ Lungs – Pneumocystis carinii & Tuberculosis
• Blood Transfusion Reaction o A reaction that will destroy the RBC (hemolysis)
• Virus Replication o Trick the cells to create more
• Bacterial Replication o Binary Fission ▪ A division of the cell that produces 2 daughter cells identical to the parent bacterium
• Aerobic metabolism vs Anaerobic metabolism o Anaerobic metabolism – absence of oxygen o Aerobic metabolism – presence of oxygen