NR283 Exam 1 Review Notes, Exams of Nursing

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NR283 Exam 1

 Cellular Regulation

o S

 Cancer

o Cause – alteration in cellular regulation that leads to neoplasm

o Pathology – Normal cellular organization, inhibition of growth,

contact controls, and cell-to-cell communication do not occur

because the cells are immature.

o Common Sites of Metastasis

 Neurological, respiratory, liver, skeletal, lymph nodes, and

spinal

o Benign vs Malignant

 Benign – differentiated, slow reproduction rate,

encapsulated, expands but does NOT spread, not life-

threatening

 Malignant – undifferentiated/unorganized, nonfunctional

cells, rapid reproduction rate, tumor cells spread into

surrounding tissue, quickly metastasizes and breaks away

to spread into other organs/tissues

o Staging Tumors (TNM)

 Tumors are staged from 1-4 and are based on tumor size,

spread to lymph nodes , and metastasis.

o Seven Warning Signs of Cancer (CHANGE)

 Change in bowel/bladder function

 A sore that doesn’t heal

 Unusual bleeding

 Thickening or lump

 Indigestion/difficulty swallowing

 Obvious change in wart/mole

 Nagging cough

o Breast Cancer

 Risk Factors

 Female, age (40+), white, middle/upper class,

genetics, family history, age at pregnancy (30+),

women who are not sexually active, obesity,

experiencing other cancers

 Treatments

 Surgery, radiation, chemo, hormonal therapy,

targeted therapy, immunotherapy

 Mammogram is the most reliable method for diagnosing

breast cancer because it can detect it before it becomes

palpable.

 Primary ways to prevent breast cancer

 Limiting dose and duration of hormonal therapy,

exercise, controlling your weight, and limiting

radiation exposure

o Leukemia

 Group of blood cancers that usually begin in the bone

marrow and results in many abnormal blood cells

o Naming Tumors

 -oma is benign

 -carcinoma involves malignant epithelial tissue

 -sarcoma involves malignant connective tissue

o Testing & Diagnosing Cancer

 Testing – lab and imaging testing (CT, PET Scan, MRI)

 Diagnosing - biopsy

 Needle biopsy – withdraws tissue or fluid from the

tumor location

 Endoscopic Biopsy – uses a camera to examine

internal structures

o Cellular Threats – traumatic injury, lack of oxygen, lack of

nutrients, genetic variations, and pollution

o Early Signs of Lung Cancer – persistent cough, bloody sputum,

wheezing, and fatigue

 Cellular Adaptation

o Definition- refers to the protective mechanism allowing cells to

change in response to internal and external environmental

threats

 Immunity

o When suspicious cells are identified in the blood stream, B Cells

are activated first.

o Immune System Components include: tonsils, lymph nodes, bone

marrow, thymus, and spleen.

o Immunoglobins – antibody proteins that are present in different

body fluids.

 Consists of 5 classes

 IgG – Provides passive immunity for the newborn

and is able to cross the placenta

 IgM – Blood type incompatibility reactions

 IgE – releases histamines and other chemicals in

response to allergic reactions

 IgD – activates B Cells

 IgA – located in the colostrum (related to

breastfeeding) and provides antibody protection for

the newborn

 May be administered to decrease the severity of a snake

bite

o Diagnostic testing for HIV: Enzyme-linked immunosorbent assay

(ELISA)

o Acquired Natural Active Immunity Example – having chickenpox

as a child, so you are protected from future outbreaks.

o Immune Responses

 Headache – caused by increased dilation of blood vessels

to the brain that alerts us to a problem

 Rhinitis – infection within mucous membranes of the nose

 Fever – hypothalamus makes an adjustment to increase

blood flow and vessel sizes for faster transport of immune

and inflammatory mediators

 Infection – main cause of immune system and

inflammatory response

 Pharyngitis – another name for sore throat and

inflammation of the tonsils and other lymphoid tissue

 Cough – inflammatory response causes an explosive,

forceful movement of anything in the respiratory tract

o Reasons to use Antibody Testing

 Hep B Diagnosis

 An individual with German measles

 To determine Rh incompatibility

 Tissue matching prior to organ transplant

 To identify the number of lymphocytes

o Antigens – activate the immune system to produce specific

antibodies produced by the B Lymphocytes

o Antibodies – binds to the specific matching antigen to destroy it

o Macrophage – cells critical to the initiation of the immune

response

o Complement system – initiates an inflammatory response

o Lymphocytes – primary cells in the immune response that

recognize and react with antigens and the body

o Chemical mediators – signal a cellular response or cause cellular

damage

o A primary immune response occurs when an individual is

exposed to an antigen for the first time and it generally can take

up to two weeks to develop antibodies.

o Only active immunity creates lifelong immunity or immune

memory because antibody copies are maintained for a faster

response to the next encounter with the antigen.

o Adaptive Immunity (Naturally and Artificially Acquired)

 Natural Active – antigens enter the body naturally in

response to infection (body induces antibodies and

lymphocytes)

 Natural Passive – antibodies pass from mother to fetus

through placenta or breastfeeding.

 Artificial Active – antigens are introduced through

vaccines. (the body produces antibodies)

 Artificial Passive – preformed antibodies in the immune

serum are introduced by injection.

o Nonspecific and Specific Line of Defenses

 Nonspecific – response is the same to any challenge

encountered.

 Type – Innate (fast response)

 Gene-specific and related to ethnicity

 Example(s) – skin and mucous membranes (prevent

external substances from entering the body)

 Specific – responses are specific based on specific

pathogens and antigen identification. (slow response)

 Type – Adaptive

 Example(s) -

 Complications of Stress

o Stress – generalized or systemic response to a change or stressor

o Stressor – any factor that causes a significant change in the body

or environment

o Complications of Stress (Based on body systems)

 Endocrine System – Diabetes Type II

 Gastrointestinal System – Heartburn

 Cardiovascular System – increased pulse

 Reproductive System – infertility

 Respiratory System – panting

 Musculoskeletal System – tension headaches

o Affects of Stress on the Body

 Norepinephrine causes nausea and pallor

 Epinephrine causes increased heart rate and force of

contraction

 Glucocorticoids decrease anti-inflammatory response and

depresses immune responses.

o Glucose levels in the body increase due to the release of

cortisol.

o Types of Stressors

 Physical – pain, surgical procedure, extreme cold, illness,

infection, accident, exercise

 Psychological – ending a friendship, taking a test, financial

trouble

o The Stress Response



 Stage 1 – Alarm

 CNS is activated

 Epinephrine and norepinephrine are released

 ADH and aldosterone increase the reabsorption of

water and sodium to increase blood pressure and

volume.

 Stage 2 – Resistance

 ACTH (Adrenocorticotropic hormone) from the

pituitary gland causes the adrenal cortex to release

cortisol.





 Stage 3 – Exhaustion

 The body is unable to continue to respond to the

stressor, so the stress response can last several days

and become chronic.

 Examples – unable to concentrate, difficulty sleeping

o Physical Effects of Stress – headaches, sleep loss, upset

stomach, higher blood pressure, constant muscle tension, and

chest pains.

o Mental Effects of Stress – mood changes, depression, anxiety

o Behavioral Effects of Stress – substance use,

personality/mood changes, social withdrawal, angry outbursts

o Hormone associated with stress – glucocorticoids

o General Adaptation Syndrome (GAS) – systemic response to

internal and external stressors (“fight or flight”)

 Physiological responses include headaches,

hypertension, and upset stomach.

 Inflammation

o Acute Inflammation

 Signs of Acute Inflammation: heat, pain, redness, and

swelling

 Causes: tissue injury or invasion of a pathogen

 Clinical Manifestations: Local

 Leukotrienes, Kinins, Histamine, and Prostaglandins

(proinflammatory hormones) contribute to the

swelling associated with acute inflammation.

 Increased blood flow – results in redness and warmth

 Increased blood flow and extravasation of white

blood cells and fluids – results in swelling, which

causes loss of function

 Pressure of swollen tissues that stimulate pain

receptors – results in pain

o Chronic Inflammation

 Causes of Chronic Inflammation: foreign material that

remains in the body

 Down Syndrome

o Physical Characteristics:

 cleft lip and palate

 large protruding tongue

 congenital heart defect

 widely spaced toes

 narrowed ear canals

 short, broad hands

 slanted eyes

 flattened nose and face

 small head at birth

o Type of Genetic Disorder: Chromosomal

o Other Names Associated: Trisomy 21

o Patient at risk for conceiving a child with Down Syndrome: 43yo

undergoing artificial insemination

o Types of Down Syndrome

 Complete/Trisomy 21: extra copy of chromosome 21 (most

common)

 Translocation: part of chromosome 21 breaks off during

cell division and attaches to another chromosome

 Mosaicism: mixture of two types of cells – some with 46

chromosomes and some with trisomy 47

o Screening: Alpha fetal protein analysis and nuchal (neck)

translucency (NT)

 Can be diagnosed by cells in the amniotic fluid and/or the

placenta

o Causes of Trisomy 21: biological mother’s ovum (egg), biological

father’s sperm, and after fertilization

o Risk Factors

 Individuals living with Down Syndrome have a high chance

of developing Alzheimer’s disease after 40 years of age.

 Sleep apnea

 Hearing loss

 Leukemia

 Immune deficiency

o Hypersensitivity

 Stimulates an inflammatory response

 Also known as an allergic reaction

 During an allergic reaction, histamines are released from

mast cells and basophils.

 A patient’s anxiousness is an early manifestation of their

airway becoming constricted.

 When a patient is hypersensitive, excessive amounts of

immune mediators, B Lymphocytes, and

inflammatory mediators are produced.

 Clinical Manifestations of Atopic Dermatitis

 Skin rash with no signs of respiratory distress

 Inflammatory Components – cytokines, prostaglandins,

histamine

 Immunity Components – antigen, antibody, lymphatic

tissues

 Antibodies bind to antigens.

 Types of Hypersensitivity

 Type I – Food allergies(IgE)

o Local Effect – inflammation

o Systemic Effect – anaphylaxis (severe,

systemic allergic reaction characterized by

swelling of the face, throat, tongue, or airway)

o Clinical Manifestations – diarrhea, nausea,

vomiting, respiratory distress, and skin rash

o Treatment - EpiPen

 Type II – Incompatible blood transfusion and Rh

factor (IgG)

o Mechanism – IgG or IgM reacts with the

antigen on the cell and complement is

activated

o Effect – causes red blood cell lysis and

phagocytosis

 Type III – Autoimmune Disorders(IgG)

o Mechanism: antigen-antibody complex deposits

in the tissue and complement is activated

o Effect: inflammation, tissue necrosis, vasculitis

 Type IV – Organ transplant rejection, contact

dermatitis, positive tuberculin skin test (TH1, TH2,

CTL)

o Mechanism – antigen binds to T Lymphocytes

and the sensitized lymphocyte releases

lymphokines

o Effect – delayed inflammation and issue

destruction

o Example – latex allergies