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

Download NR 507 Advanced Pathophysiology Midterm Exam Study Guide and more Exams Nursing in PDF only on Docsity! Page 1 of 15 1 NR 507 Advanced Pathophysiology (Spring 2024) NR 507 Advanced Pathophysiology Midterm Exam Study Guide Epigenetics 1. Defects IinItheIencoding Iof histone-modifying Iproteins I(Chp I6 IandI12IwkI1) 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 Iand (45)Iits role on Ihuman development. 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 Ito differentiate IintoIany Itype of Icell 50. IPrader-WilliIsyndrome and – missing the PATERNALLY imprinted copy of chromosome 15, Page 2 of 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 Temper tantrums Stubbornness Page 5 of 15 4 8. Inflammation Ias an IetiologyIforIcancer-note conditions in which IthisImay occur ✓ Chronic inflammation can result from many causes: -Solar irradiation -Asbestos exposure (mesothelioma) -Pancreatitis -Infection -GU tract -Prostate -Thyroid -Pancreas -Urinary bladder -Pleura -Skin ✓ In both inflammation and cancer, inflammatory cells (neutrophils, lymphocytes, and macrophages) migrate to the site of injury and release: Cytokines and growth and survival factors that stimulate local cell proliferation and new bloodvessel growth to promote wound healing by tissue remodeling. ✓ Factors combine in chronic inflammation to promote: Continued proliferation. ✓ Inflammatory and immune responses may create a local environment in which cells can: Develop into a malignant phenotype and may even benefit progression and spread of malignancies. ✓ Inflammatory response to malignancy is a detrimental: Condition that successful tumors have evolved methods of evading. Cancer 9. In terms IofIepigeneticImodifications, the roleIofIenvironmentalIstressors Iassociated IwithIdevelopment IofIcancer. ✓ Environmental stressors can markedly increase the risk of aberrant epigenetic modification and are strongly associated with some cancers. While genetics, lifestyle choices and coping skills can affect the development and management of cancer, they are not currently considered as being the primary factors in the epigenetic modification that occurs. ✓ Cancer is the second leading cause of death in the United States. It is well established that many major types of Icancer (e.g., breast, colon, prostate, ovarian) cluster strongly in families. This is caused by both shared genes and shared Ienvironmental factors. Although numerous cancer genes are being isolated,15environmental factors also play an important role in causing cancer. In particular, tobacco use is estimated to account for one third of all Icancer cases in the United States, making it the most important known cause of cancer ✓ epigenetic Iand Igenetic Ichanges,Iinflammatory e Iregulation, Iintrauterine Iand Ilifelong Ipatterns of health, Idecline Iin Icell renewal by adult stemIcells, Iand accumulated IcellIdamage Irelated to Icancer Iand Iaging. ✓ i ✓ What is HDFN? orn Destruction of red blood cells of the fetus and neonate by antibodies produced by the mother -neonate-infant up to 6 weeks old -D antigen is major cause ✓ 3 prerequisites for the Dz- 1. mom lacks antigen and is exposed to it by pregnancy or transfusion and/or mom lacks antigen and has naturally occurring antibody (ABO) 2. Mom produces IgG Ab to the Ag 3. fetus has the Ag that was inherited from the father and foreign to the mother and is well developed in utero ITheIemergingIfocus Iin ItheIbiologyIof Iaging Iincludes I response, I oxidative I stress, I metabolic I and I endocrin DefectsI in I Mechanism IofI Defense 10. Hemolytic I defects I n I the newb Page 6 of 15 5 ✓ What are 3 classes of HDN? Page 7 of 15 6 Rh, ABO, and other (anti-D, Jk, K, Fy, S) Page 10 of 15 9 ✓ Extremely thin membrane Permeable to both oxygen and carbon dioxide. Real work of respiration because of their relationship with vascular supply. Each contains 2000 capillaries. 20. ArterialIperfusion Ipressure Iin the Ilung Ibase I and (21)Ialveolar gas IpressureIinIthe lungIbase The relationship between arterial perfusion and alveolar gas pressure at the base of the lungs is best described as: arterial perfusion pressure exceeds alveolar gas pressure. the Ipartial Ipressure Iof oxygen Igiven Ithe percentage Iof Ioxygen Iin Ithe Iair Iand I(23) ✓ Barometric Ipressure (PB) (atmospheric Ipressure) is the Ipressure exerted by gas molecules in air at specific altitudes. At sea level, barometric pressure is 760 mmHg. This number is the sum Iof the Ipressure exerted by each gas in the air at sea level. The portion Iof the total pressure exerted by any individual gas is its partial Ipressure At sea level the air is made up of oxygen (20.9%), nitrogen (78.1%), and a few other trace gases. The partial Ipressure Iof Ioxygen is equal to the percentage Iof Ioxygen in the air (20.9%) times the total pressure (760 mmHg), or 159 mmHg (760 × 0.209 = 158.84). 24. Results IofIincreased Iwork ofIbreathing ✓ Hypoxemia, reduced oxygen levels in the blood, further contributes to cardiovascular dysfunction by causing dilation of arterioles, capillaries, and venules, thus leading to decreased vascular resistance and increased flow ✓ Tissue hypoxia creates additional demands and compensatory actions on the pulmonary and hematologic systems. The rate and depth of Ibreathing increase in an attempt to increase the availability of oxygen. ✓ If surfactant production is disrupted or surfactant is not produced in adequate quantities, alveolar surface tension increases, causing alveolar collapse, decreased lung expansion, increased work of breathing, and severe gas-exchange abnormalities ✓ diffuse or focal disturbances of ventilation, gas exchange, or ventilation-perfusion relationships can cause dyspnea, as can Iincreased work of Ibreathing or diseases that damage lung tissue (lung parenchyma). ✓ Labored breathing occurs whenever there is an increased work ofIbreathing, especially if the airways are obstructed, as in chronic obstructive pulmonary disease (COPD) ✓ Increased work ofIbreathing (emphysema, severe asthma) KnowIterms: ChapterI34 I25.VitalIcapacity I(VC), ✓ The maximum volume of air that a person can exhale after maximum inhalation VC = IRV + TV + ERV ✓ the amount of air that can be forcibly expired after a maximal inspiration and indicates, therefore, the largest amount of air that can enter and leave the lungs during respiration. 26. TotalIlungIcapacity ✓ VC + RV or IC+FRC ✓ The maximum volume to which the lungs can be expanded with the greatest possible inspiratory effort; it is equal to the vital capacity plus the residual volume and is approximately 5,800 mL. 27. FunctionalIcapacity- 28. ResidualIvolumeI(RV) ✓ Volume of gas remaining in the lungs after complete exhalation (under normal condition the lungs are 22. How I do I determine ItheIbarometric Ipressure Page 11 of 15 10 never completely emptied) ✓ RESIDUAL volume (air left in alveoli after VC) I29. IFunctional Iresidual Icapacity I(FRC) I– ✓ total amount of gas left in the lungs after resting expiration ✓ ERV+ RV RenalIAlterations 30. Types IofInephrons IandI(48)Itheir functions I(chap I37) ✓ what are the 4 sections of the nephron 1. proximal convoluted tubule 2. Loop of Henle 3. Distal convoluted tubule 4. Collecting tubule ✓ Superfical Cortical nephrons- located in the cortex – most numerous, which extend partially into the medulla (85 % of all nephrons) ✓ Midcortical nephrons- with short or long loops ✓ Juxtamedullary nephrons – concentrating urine- location extend from the cortex deep into the medulla and are important for all the process of concentrating urine ✓ Renal Corpuscle contains glomerulus and bowman's capsule (1st part of nephron) - intersection between the vascular system and glomerulus ✓ Glomerulus - functions in filtration - has fenestrated capillary exchange -podocytes - restrictive site - immune system cell -mesangial cell ✓ Afferent Arteriole -incoming flow into the glomerulus - smooth muscle resistant to angiotensin 2 ✓ Efferent Arteriole - outgoing flow from glomerulus - smooth muscle activated by angiotensin 2 -only kidneys has the capillaries drained by arteriole ✓ Bowman's Capsule collects fluid from the glomerulus ✓ Proximal Convoluted Tubule - functions in reabsorption (2nd part of nephron) - 85% of reabsorption of water, Na+, Amino Acid, and glucose(coupled with Na+) occurs here ✓ What is the normal Tm value for both men and women? Tm= 375mg/dl for men Tm = 300 mg/dl for woman ✓ What happens if blood glucose exceeds the normal Tm value? sugar gets excreted in urine leading to a test in diabetes (not normal) ✓ What do the microvilli on the proximal convoluted tubule do? they increase surface are and thus increase max reabsorption value (Tm) ✓ Loop of Henle -helps make concentrated urine by creating a salt interstitum (3rd part of nephron) -U-shaped --> 10% is not reabsorbed ✓ Thin decending limb of loop of henle water permeable Page 12 of 15 11 ✓ 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. Overall renal physiology- ✓ 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 Iare activelyIsecretedIby ItheIrenalItubules I(Chap39) ✓ hydrogen or bicarbonate and potassium I33.IActivation IofIthe Irenin-angiotensin Isystem ✓ The renin-angiotensin system will be activated by: decreased blood pressure in the afferent arterioles