NR 507 Advanced Pathophysiology Midterm Exam Study Guide Epigenetics, Exams of Nursing

Download NR 507 Advanced Pathophysiology Midterm Exam Study Guide Epigenetics and more Exams Nursing in PDF only on Docsity! 1 NR 507 Advanced Pathophysiology Midterm Exam Study Guide Epigenetics 1. Defects Iin ItheIencoding Iof Ihistone-modifying Iproteins I(Chp I6 IandI12 IwkI1) Histone modification (e.g., Ihistone acetylation and deacetylation, alterations in chromatin): Chromatin compaction and organization help to regulate gene expression, determining and maintaining cell identity. Chromatin structure must be controlled in self-renewing and differentiated cells in cell renewal systems. For example, there are differences in chromatin structure in stem cells and terminally differentiated cells ✓ are chemical modifications of DNA sequences that alter the expression of genes, resulting in disease and phenotypical variations (upon genetics) ✓ types of epigenetic modifications ✓ > DNA modification > histone modification > Microribonucleic acids (miRNAs) or mature miRNAs > specific environmental or non-genetic factors, such as diet and exposure to certain chemicals can affect epigenetic ✓ Histone modifications- in diverse biological processes such as transcriptional activation/inactivation, chromosome packaging, and DNA damage/repair. ✓ Histone modifications (e.g. histone acetylation and deacetylation, chromatin alterations)- Chromatin compaction and organization help to regulate gene expression, determining and maintaining cell identity ✓ quantitative detection of various histone modifications- would provide useful information for a better understanding of epigenetic regulation of cellular processes and the development of histone modifying enzyme-targeted drugs. ✓ Histone Modification- Results: > Histone acetylation and deacetylation > alterations in chromatin 2. Epigenetics IandI(45)Iits Irole Ion Ihuman Idevelopment. I(chp I6) ✓ the study of influences on gene expression that occur without a DNA change. ✓ diseases and other phenotypic variation are caused by mechanisms other than changes in the DNA sequences—termed Iepigenetics (“upon genetics”).1Epigenetics is the study of heritable changes in gene expression or phenotype caused by mechanisms other than changes in DNA sequences. Epigenetic modifications can cause individuals with the same DNA sequences (such as identical twins) to have different disease profiles 3. TotipotentIcells ✓ the zygote and early embryonic cells ✓ Totipotent stem cells mean that they can produce an entire organism like fertilized oocyte ✓ What are totipotent stem cell ✓ They are stem cell that can give rise to any and all cell of the human body. They can give rise to a entire organism. They cells are found on the first round of replication when the sperm and egg unite or at the very earliest stage of development++. and I(49)Iits Iability ItoIdifferentiate IintoIany ItypeIof Icell 50.IPrader-WilliIsyndrome and – missing the PATERNALLY imprinted copy of chromosome 15, ✓ Prader-Willi syndrome-features include short stature, hypotonia, small hands and feet, obesity, mild to moderate mental retardation, and hypogonadism ✓ behavioral characteristics of prader willi 2 Temper tantrums Stubbornness 5 Rh, ABO, and other (anti-D, Jk, K, Fy, S) 6 ✓ What is Rh incompatibility? Occurs when mother is Rh-negative and becomes pregnant with Rh positive baby inherited from father. anti-D is stimulated in mother in response to D antigens on fetal RBCs. anti-D is igG and can cross the placenta ✓ What is the most common form of HDN? - anti-D, more rare is anti-E, c, e, C ✓ What is ABO incompatability? mother with blood type O becomes pregnant with fetus of different types, A, B, or AB. ✓ What is erythroblastosis fetalis? fetal anemia as a results of maternal antibodies destroying fetal RBCs, will stimulate BM to produce moreRBC including immature ones. ✓ What happens to the baby as a result for compensating the anemia? hepatosplengomegaly, immature RBCs cannot compensate anemia, RBCs breakdown and baby cannot getrid of cells so bilirubin increases causing jaundice ✓ What is Hydrops fetalis? baby's organs are unable to handle the anemia so heart begins to fail and large amounts of fluid build upin baby's tissues and organs. ✓ What is Kernicterus? kernicterus or bilirubin encephalopathy results from high levels of unconjugated bilirubin in fetus blood. Unconjugated bilirubin is lipid soluble and toxic, crosses BBB and penetrates neuronal and glial membrane causing neurotoxicity. ✓ What are some sxs of surviving kernicterus? choreoathetosis, spasticity, muscular rigidity, ataxia, deafness, mental retardation ✓ What must be done to monitor risk of kernicterus? measure bilirubin in cord blood and at least every 4 hours for the first 12-24 hours. ✓ What is a new procedure done to monitor bilirubin? - trans cutaneous bilirubinometry ✓ What are lab findings of HDN? anemia, hyperbilirubinemia, reticulocytosis, increase nucleated RBC count, thrombocytopenia, leukopenia, positive DAT, hypoalbuminemia, Rh negative blood type ✓ What does the blood smear show in HDN polychromasia, anisocytosis, no spherocytes, increase nucleated RBCs 11. Understand ItheImeaning Iof Iinfectivity ( chap 10 ) ✓ quantitative measure of a pathogen's ability to infect another susceptible host ✓ Infectivity: The ability of the pathogen to invade and multiply in the host Mechanism of action: How the microorganism damages tissue Pathogenicity: The ability of an agent to produce disease—success depends on communicability, Iinfectivity, extent of tissue damage, and virulence 12. MostIeffectiveItreatmentIforIHIV- ✓ TheIcurrent Itreatment IforIHIVIinfection Iis IaIcombinationIofIdrugsIcalled IantiretroviralItherapy I(ART). 13. Defected Icells IofIHIV 14. SignsIofIT-LymphocyteIdeficiency Pulmonary I Alterations 15. Pulmonary Ifunction Itests ✓ reveals signs of obstructive airway disease, low normal or decreased vital capacity and increased total lung and residual capacities. Can be used only after child is 5 to 6 years of age. 16. RelationshipIofIlung Icompliance IandI(46)IresidualIvolume ✓ Lung Icomplianceis Iensured Iby Iadequate Iproduction Iof Isurfactant; Ichest Iwall Iexpansion Idepends Ion Iflexibility.ITheImeasureIofIlungIandIchestIwallIdistensibility IcomplianceIis IthereforeItheIreciprocalIof Ielasticity. ✓ A. Pneumothorax B. Pressure - Volume relationship of the chest 7 17. Shifts IinItheIoxyhemoglobin Idissociation- (chap 3, 17, 34) ✓ TheIoxyhemoglobin curve is shifted to the left, decreasing the Idissociation ofIoxyhemoglobin and increasing the risk of dysrhythmias. ✓ When hemoglobin saturation and desaturated are plotted on a graph, the result is distinctive S- shaped curve. ✓ percentage of hemoglobin that is chemically bound to oxygen at each oxygen pressure ✓ The flat portion of the oxygen dissociation curve is significant because it illustrates that Increasing the oxygen pressure beyond 100torr adds very little additional oxygen to the blood, the hemoglobin has an excellent safety zone for loading of oxygen in the lungs and the diffusion is in the alveolar capillary system is enhanced. ✓ The steep portion of the oxyhemoglobin dissociation curve is significant because it illustrates that Oxygen pressure reduction below 60torr indicates a rapid decrease in the amount of oxygen bound to hemoglobin and a large amount of oxygen is released from the hemoglobin for only a small decrease in oxygen pressure. ✓ The 50 Pressure represents the partial pressure at which the hemoglobin is 50% saturated with oxygen. That is when there are two oxygen molecules on each hemoglobin molecule. ✓ When the oxyhemoglobin dissociation curve shifts to the right, the 50 pressures increases ✓ When the oxyhemoglobin dissociation curve shifts to the left the 50 pressures decreases ✓ Factors that shift the oxyhemoglobin dissociation curve to the left increased pH, decreased carbon dioxide pressure, decreased temperature, decreased BPG, and fetal hemoglobin ✓ Factors that shift the oxyhemoglobin dissociation curve to the right decreased pH, increased carbon dioxide pressure, increased temperature, and increased DPG ✓ When the oxyhemoglobin dissociation cure shifts to the right the loading of oxygen in the lungs at any given oxygen pressure decreases ✓ When the oxyhemoglobin dissociation cure shifts to the right the plasma oxygen pressure reduction necessary to unload oxygen at the tissue sites is less than normal ✓ When the oxyhemoglobin dissociation curve shifts to the left the loading of oxygen in the lungs at any given oxygen pressure ✓ increases ✓ When the oxyhemoglobin dissociation curve shifts to the left the plasma oxygen pressure reduction necessary to unload oxygen at the tissue site is ✓ greater than normal 18. CO2Itransport IinIthe Iblood ( chap 34) ✓ CO2 can be transported in the blood via... • dissolved CO2 in plasma • bound to Hb ( Carbamino compounds) • as bicarbonate ion from carbonic anhydrase (in RBC & plasma) 19. Characteristics IofIalveoli- ✓ Primary area of gas exchange ✓ Chief unit structure of gas exchange ✓ Have over 300 million in our lungs 3I 3. IActivation Iof Ithe Irenin-angiotensin Isystem 10 ✓ thick ascending limb of loop of henle Na+ permeable ✓ Capillary bed function in the loop of henle transports water and salt but doesn't remove the salt interstitum ✓ Distal Convoluted Tubule -Functions in secretion of K+ with aldosterone (4th part of nephron) - increases BP and Na+ ions into the blood stream -Na+ in, K+ out, peeing away k+ ✓ Collecting Duct - where final water reabsorption occurs (5th part of nephron) - permeable to water and urea ✓ Water reabsorption with ADH in collecting duct ADH is produced by supraoptic nuclei of hypothalamus which is stored and released in the posterior pituitary 31. OverallIrenalIphysiology- ✓ I Primary Functions of the Kidneys ✓ Excrete metabolic waste products and foreign substances ✓ Fluid and electrolyte balance ✓ Regulation of acid -base balance ✓ Circulatory control ✓ Synthesize glucose ✓ Metabolize polypeptide hormones ✓ Control endocrine functions ✓ Glomerular filtration ✓ Tubular reabsorption ✓ Tubular secretion ✓ Excretion of waste products ✓ Endocrine function 32. Substances Ithat IareIactivelyIsecretedIby ItheIrenalItubules I(Chap39) ✓ hydrogen or bicarbonate and potassium ✓ The renin-angiotensin system will be activated by: decreased blood pressure in the afferent arterioles 11 ✓ Renin -Angiotensin-Aldosterone System. Activation of tubuloglomerular feedback mechanisms stimulates the release of renin with activation of the renin- angiotensin-aldosterone system. Plasma volume and blood pressure are increased with the reabsorption of sodium chloride and water from the renal tubules. The restoration of plasma volume and blood pressure then decrease the release of renin, forming a negative feedback loop. ADH, Antidiuretic hormone. ✓ Renal juxtaglomerular cells sense decrease in BP & release renin-->renin activates angiotensinogen to angiotensin I-->angiotensin I is converted to angiotensin II via angiotensin - converting enzyme ACE in the lung capillaries --> angiotensin II promotes vasoconstriction & stimulates aldosterone secretion from adrenal cortex resulting in renal sodium & H2O retention, potassium excretion, & an increase in BP --> aldosterone causes increased reabsorption of sodium & H2O retention 34. GlomerularIfiltrationIrate- clearance ✓ The amount of glomerular filtrate (plasma ultra-filtered across the glomerular capillaries) in the nephrons of the kidneys per minute ✓ -A measure of the functionality of the kidneys to filter fluids and solutes ✓ -Measured by creatinine clearance or indirectly/ constant value is 140 ✓ * Calculate (140-age) x wt.(Kg)x 0.85 ✓ (If female)/serum creatinine x 72 ✓ Normal value is 80-120mL/min--------(age influences GFR, wt., and gender) 35. Mesangial Icells- ✓ Mesangial Icells and the Imesangial matrix, secreted by Imesangial Icells, lie between and support the glomerular capillaries. Different ImesangialIcells contract like smooth muscleIcells to regulate glomerular capillary blood flow. 36. RenalIsystemIanatomy ✓ Structures of the kidneys ✓ Renal cortex- glomerulus and convoluted tubules ✓ Renal medulla –is the whole collection of loop of Henley – Renal Pyramids ✓ Nephron is the functional unit of the kidney – after urine is formed and is drained into the pelvis ✓ Renal pelvis – into the Renal calyces – then urine all drains to the ureters by the way of the bladder 37. WhyIplasma Iproteins IshouldIbeIabsent IfromIthe Iurine- 12 ✓ Normally the Iplasma level and filtered glucose load are not high enough to saturate the carrier mechanism. When the plasma glucose concentration reaches 180 mg/dl, however, as occurs in the individual with uncontrolled diabetes mellitus, the renal threshold for glucose is achieved 38. EffectsIofIurinaryItractIobstruction-IhydronephrosisIandIaI(39)IdecreasedIglomerularIfiltrationIrate 40. IEffect Iof Iurinary Iretention ✓ Urinary Retention Pathophysiology -Inability to empty bladder -Leads to bladder distention, poor contractility of detrusor muscle, further inability to urinate ✓ Causes of Urinary Retention -Benign prostatic hypertrophy -Prostate ca, other pelvic malignancies -Congenital urethral valve abnormalities -Detrusor muscle dyssynergia (d/t surgery) -Circumcision -Damage to the bladder -Obstructed urethra -Paruresis "shy bladder syndrome" -Consumption of some psychoactive substances (ecstasy) -Use of drugs w/ anticholinergic properties ✓ Clinical Manifestations of Urinary Retention -Firm, distended bladder -Overflow voiding or incontinence -Susceptible to UTIs -Poor urinary stream w/ intermittence, straining -May see incontinence, nocturia, and high frequency Most Icommon ItypeIof IrenalIstone ✓ most common Istone types include calcium oxalate or phosphate (70% to 80%), struvite (magnesium, ammonium, and phosphate) (15%), and uric acid (7%). 41. Epispadias ✓ An abnormal urethral opening on the dorsal or top of the penis. ✓ signs and symptoms opening urethra on the bottom of the penisIincomplete foreskin curvature of the penis on erection abnormal position of the scrotum opening on the top of the penis curvature of penis urinary incontinence ✓ medial surgical management to enable the child to void in standing position with straight streamimprove physical appearance of genitalia produce a sexually adequate organ surgical procedure usually 6 -12 months reconstruction of urethral opening 42. Glomerulonephritis- ( chap 38) ✓ Glomerulonephritis is an inflammation of the glomerulus caused by primary glomerular injury, including immunologic responses, ischemia, free radicals, drugs, toxins, vascular disorders, and infection. 43. Nephrotic Isyndrome- ( chap 38)