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Hypersensitivity Reactions, Hematologic Disorders, and Cardiovascular Physiology, Exams of Pathophysiology

Chamberlain College of NursingPathophysiology

A comprehensive overview of hypersensitivity reactions, including their types, mechanisms, and clinical manifestations. It delves into various hematologic disorders, such as iron deficiency anemia, folate deficiency, and sickle cell anemia, outlining their causes, symptoms, and laboratory findings. Additionally, it explores key aspects of cardiovascular physiology, including blood flow through the heart, cardiac output, preload, afterload, and heart failure. The document also discusses specific valvular heart diseases, such as aortic stenosis and mitral regurgitation, highlighting their clinical features and associated murmurs.

Typology: Exams

2024/2025

Available from 02/22/2025

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NR507 Midterm Exam
Type 1 Hypersensitivity Reaction - - "Allergic reaction"
- Mediated by IgE.
- Inflammation d/t mast cell degranulation.
- Hay fever, hives (uticaria).
- Local s/s: itching, rash.
- Systemic: wheezing.
- Severe, systemic reaction: anaphylaxis: hypotension, severe bronchoconstriction.
- Main tx: epinephrine.
Type 2 Hypersensitivity Reaction - - Cytotoxic reaction; tissue specific
- Macrophages are the primary effectors cells involved
- Causes tissue damage or alters function
- Examples: 1) Grave's disease- example of altering thyroid function, doesn't destroy thyroid tissue. 2)
ABO incompatibility- example of cell/tissue damage; severe transfusion reaction occurs & the transfused
erythrocytes are destroyed by agglutination or complement-mediated lysis.
Difference between type 2 & 3 hypersensitivity reactions - - Type 2: organ specific; antibody binds to the
antigen on the cell surface.
- Type 3: not organ specific; antibody binds to soluble antigen outside the cell surface that was released
into the blood or body fluids, and the complex is then deposited in the tissues.
Type 3 Hypersensitivity Reaction - - Immune complex
- Antigen-antibody complex deposited in the tissues
- Neutrophils are the primary effector cell
- Causes autoimmune diseases
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NR507 Midterm Exam

Type 1 Hypersensitivity Reaction - - "Allergic reaction"

  • Mediated by IgE.
  • Inflammation d/t mast cell degranulation.
  • Hay fever, hives (uticaria).
  • Local s/s: itching, rash.
  • Systemic: wheezing.
  • Severe, systemic reaction: anaphylaxis: hypotension, severe bronchoconstriction.
  • Main tx: epinephrine. Type 2 Hypersensitivity Reaction - - Cytotoxic reaction; tissue specific
  • Macrophages are the primary effectors cells involved
  • Causes tissue damage or alters function
  • Examples: 1) Grave's disease- example of altering thyroid function, doesn't destroy thyroid tissue. 2) ABO incompatibility- example of cell/tissue damage; severe transfusion reaction occurs & the transfused erythrocytes are destroyed by agglutination or complement-mediated lysis. Difference between type 2 & 3 hypersensitivity reactions - - Type 2: organ specific; antibody binds to the antigen on the cell surface.
  • Type 3: not organ specific; antibody binds to soluble antigen outside the cell surface that was released into the blood or body fluids, and the complex is then deposited in the tissues. Type 3 Hypersensitivity Reaction - - Immune complex
  • Antigen-antibody complex deposited in the tissues
  • Neutrophils are the primary effector cell
  • Causes autoimmune diseases
  • Examples: rheumatoid arthritis (joints), systemic lupus erythematosus (SLE, organs) Systemic Lupus Erythematosus (SLE) - - Facial rash confined to the cheeks (malar rash)
  • Discoid rash (raised patches, scaling)
  • Photosensitivity (skin rash d/t sunlight exposure)
  • Oral or nasopharyngeal ulcers
  • Hematologic disorders (hemolytic anemia, leukopenia, lymphopenia, thrombocytopenia)
  • Immunologic disorders
  • Non-erosive arthritis of at least two peripheral joints
  • Serositis (pleurisy, pericarditis)
  • Renal disorder
  • Neurologic disorders (seizures, psychosis)
  • Presence of antinuclear antibody (ANA) Autoimmunity - - Can be familial: Affected family members may not all develop the same disease, but several members may have different disorders characterized by a variety of hypersensitivity reactions (autoimmune and allergic reactions). Alloimmunity - - General term used to describe when an individual's immune system reacts against antigens on the tissues of other members of the same species.
  • Examples: Neonatal disease where the maternal immune system becomes sensitized against antigens expressed by the fetus, Transplant rejection, Transfusion reaction. Type 4 Hypersensitivity Reaction - - T-cell mediated
  • Lymphocytes
  • Does not involve antigen/antibody complexes
  • Delayed response
  • High (hyperchromic): hereditary spherocytosis, liver disease, hyperthyroidism, sickle cell disease. Iron Deficiency Anemia - - Microcytic & hypochromic
  • Caused by disorders of hemoglobin synthesis
  • Lab: ferritin (reflects the body's total iron stores -> low reflects anemia, but does not tell you what type) Increased ____ ________ ______ is one of the earliest lab markers in developing macrocytic anemia. - RBC distribution width (RDW) Folate Deficiency - - Megaloblastic anemia
  • Alcoholism, malnutrition
  • Lab values: folate (low), MCV (high- macrocytic), MCHC (normal- normochromic), reticulocyte (normal or high), serum iron (normal or low). Vitamin B-12 Deficiency - - Pernicious anemia
  • S/S: fatigue, dyspnea, peripheral neuropathy (numbness & tingling) in bilateral lower extremities (BLE)
  • Risk factor: older adults, H. Pylori infection, d/o affecting b-12 absorption, vegetarian/vegan
  • Lab values: low B-12, high MCV (macrocytic), normal MCHC (normochromic), low reticulocyte, and normal or high iron Hemolytic Anemia - - Destruction/lysis of red blood cells.
  • Causes: transfusion reaction (cytotoxic type 2), autoimmune reaction, drug-induced (allergic reaction) Acute blood loss anemia - - Trauma victims who are losing blood

Aplastic Anemia - - Characterized by an absence of all formed blood elements caused by the failure of blood cell production in the bone marrow.

  • Diagnosis is made by blood tests and bone marrow biopsy.
  • Suspected if levels of circulating erythrocytes, leukocytes, and platelets are diminished. Sickle Cell Anemia - - Have sickle cell trait; caused by a mutation in the HBB gene that leads to the production of abnormal hemoglobin.
  • Autosomal recessive disorder; both parents must contribute an abnormal gene for a child to have the disorder. Thalassemia - - Inherited blood disorder that causes decreased circulating hemoglobin.
  • Many possible genetic mutations. Aortic Valve - - Valve located between the left ventricle and the aorta. Mitral Valve - - The valve between the left atrium and the left ventricle of the heart. Pulmonary Valve - - Valve positioned between the right ventricle and the pulmonary artery. Normal Blood Flow Through the Heart - Superior & Inferior vena cava -> Right atrium -> Tricuspid valve -

Right ventricle -> Pulmonary valve -> Pulmonary artery -> Lungs -> Left atrium -> Mitral valve -> Left ventricle -> Aortic valve -> Aorta -> Body. Tricuspid Valve - - Valve between the right atrium and the right ventricle. Cardiac Output (CO) - - The volume of blood pumped by each ventricle per minute.

  • Cardiac output (mL/min) = stroke volume (mL/beat) x heart rate (beats/min)
  • Stage C: patient is symptomatic with alteration in their daily functions due to dyspnea, swelling, etc. This is where their NYHA functional classifications come into play.
  • Stage D: end-stage heart failure- have maximized medications to treat it- may need heart transplant or pacemaker NYHA Functional Classifications - - Stage I: mild; no limitation of physical activity; ordinary physical activity doesn't cause symptoms.
  • Stage II: mild; slight limitation of physical activity; comfortable at rest; ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain.
  • Stage III: moderate; marked decrease in physical activity; marked limitation of physical activity; comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea, or anginal pain.
  • Stage IV: severe; inability to carry on any physical activity w/out discomfort. Symptoms of HF or the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort increases. Aortic Stenosis - - Narrowing of the aorta.
  • S/S: syncope (fainting), chest pressure upon exercising, dyspnea, left ventricular hypertrophy, sustained laterally displaced apical pulse, S4 gallop.
  • Murmur: mid-systolic crescendo-decrescendo @ base and radiating to the neck. Aortic Regurgitation - - Flow of blood backward from the aorta into the heart (left ventricle); caused by a weak/"floppy" aortic valve.
  • S/S: SOB that progressively worsens, exercise intolerance, chest x-ray shows pulmonary edema & cardiomegaly
  • Murmur: diastolic rumbling sound @ apex; systolic crescendo-decrescendo @ left upper sternal border; high-pitched early diastolic murmur @ left lower sternal border. Mitral Regurgitation - - "Floppy" mitral valve. Blood goes back into the left atrium and into pulmonary system.
  • S/S: SOB, jugular vein distention, crackles in bilateral lung bases
  • Murmur: blowing, holosystolic/pansystolic murmur @ apex and radiates to the back & axilla Mitral Valve Prolapse - - Valve bulges into left atrium
  • S/S: asymptomatic, MVP syndrome (atypical chest pain, palpitations, SOB, dizziness/syncope)
  • Murmur: mid-systolic click Mitral Stenosis - - "tight" mitral valve; blood backs up into left atrium & lungs.
  • associated w/Hx of rheumatic heart disease.
  • S/S: SOB, exercise intolerance, pounding/racing heart, JVD, bilateral crackles in lung bases, atrial fibrillation, left ventricular hypertrophy.
  • Murmur: low-pitched murmur @ apex of the heart. Obstructive vs. Restrictive Lung Disease - - Obstructive: low or normal FVC, low FEV1, <70% FEV1/FVC ratio, high TLC. Ex- COPD & Asthma
  • Restrictive: low FVC, low FEV1, normal or >70% FEV1/FVC ratio, low TLC. Ex- interstitial lung disease. Asthma - - Constricted airways; chronic obstructive disease.
  • Intrinsic: triggered by non-allergic factors (chemicals, airborne irritants, infections, exercise, stress, chemicals), more common in adults.
  • Extrinsic: triggered by chronic allergic factors (pollen, dust mites, pet dander), elevated IgE, more common in children.
  • Mild/intermittent form: short-acting beta 2-agonist inhalers are prescribed.
  • Mild/persistent asthma will have night symptoms 3-4x/mo. Chronic obstructive pulmonary disease (COPD) - - Diagnosis is based on hx of symptoms, physical exam, chest imaging, pulmonary function tests, and blood gas analyses.
  • PFTs reveal airway obstruction (decreased FEV1) that is progressive and unresponsive to bronchodilators.

(Cell-mediated) What type of hypersensitivity reaction is: adult develops hemolysis after mismatched blood transfusion - Type II Hypersensitivity reaction (Tissue-specific) Folate deficiency anemia is associated with chronic malnourishment and chronic abuse of __________. - Alcohol When describing the appearance of erythrocytes, terms that end with _________ refer to the hemoglobin content and terms that end with ________ refer to cell size. - -chromic -cytic Appearance of erythrocytes: iron deficiency anemia - microcytic, hypochromic Appearance of erythrocytes: aplastic anemia - normocytic, normochromic Appearance of erythrocytes: pernicious anemia (b-12 deficiency) - Macrocytic, normochromic Appearance of erythrocytes: folate deficiency anemia - macrocytic, normochromic Serum ferritin levels are used to evaluate _______ status when diagnosing anemia. - Iron Clinical manifestations of left heart failure - - Orthopnea

  • Dyspnea
  • Coughing pink, frothy sputum
  • Crackles upon auscultation
  • Pulmonary edema Clinical manifestations of right heart failure - - Ankle edema
  • Jugular venous distention
  • Splenohepatomegaly People who have obstructive respiratory disorders have the most difficulty with inspiration or expiration? - Expiration The two disorders known as COPD are emphysema and ______ _______; this latter condition is characterized by persistent hypersecretion of ______ and chronic _________ cough - - Chronic bronchitis
  • Mucus
  • Productive Clinical manifestations of emphysema include _______ chest and _______ on exertion and eventually at rest. - - Barrel
  • Dyspnea Cor pulmonale is _______ ventricular enlargement caused by chronic pulmonary __________. - - Right
  • Hypertension