Download NR507/ NR 507 Midterm: Advanced Pathophysiology Study Guide with Questions and Answers and more Exams Nursing in PDF only on Docsity!
NR507/ NR 507 Midterm
Advanced Pathophysiology |
Complete Guide with Questions and Verified
Answers| 100% Correct |Grade A – Chamberlain
Innate immunity - ANSWER>> >>the immunity we are born with
Immune response: 3 levels/lines of protection - ANSWER>> >>1 st line: physical, mechanical, & biochemical barriers
2nd line: the inflammatory response
3rd line: lymphocyte production
most important immune defense - ANSWER>> >> intact skin and mucous membranes (impermeable barrier)
PAMP - ANSWER>> >>pathogen associated molecular pattern
surfaces of bacteria, viruses, and other microbes are covered with many foreign proteins
foreign
DAMP - ANSWER>> >>damage associated molecular pattern
many proteins are released from inside our cells when they are damaged
foreign
PRR - ANSWER>> >>pattern recognition receptors
surfaces of WBCs contain these receptor sites -continuously interact with any material they encounter to ID it as "self" or "non-self" (foreign; PAMP or DAMP)
Chemotaxis - ANSWER>> >> Cell movement that occurs in response to chemical stimulus
Phagocytosis - ANSWER>> >>"cell eating"
1. opsonization and adherence
2. engulfment - WBC surrounds and ingests Ag
3. Fusion of phagosome with lysosome
4. destruction - phagosome digested by lysozyme, H202, acids, and other toxic chemicals
inside the lysosomes
5. egestion
Hypersensitivity Type 1:_____ - ANSWER>> >>Allergic reaction
Hypersensitivity: Type 1 Mediated by ______ - ANSWER>> >>IgE
Hypersensitivity: Type 1 Inflammation due to _____________ - ANSWER>> >>mast cell degranulation
Hypersensitivity: Type 1 local symptoms - ANSWER>> >>itching, rash
Hypersensitivity: Type 1 systemic symptoms - ANSWER>> >>wheezing
Hypersensitivity: Type 1 most dangerous form - ANSWER>> >>anaphylactic reaction-systemic response- hypotension, severe bronchoconstriction
Hypersensitivity: Type 1 main treatment ___________ - ANSWER>> >>epinephrine
Hypersensitivity Type 2: _________________ - ANSWER>> >> Cytotoxic reaction; tissue specific (example: thyroid tissue) hapten causes mediation of IgE or IgM
Hypersensitivity: Type 2 Primary effector cells involved - ANSWER>> >>macrophages
(MHC) alleles or non-MHC genes
Alloimmunity - ANSWER>> >>AKA isoimmunity immune system of one individual produces a reaction against tissues of another individual
Alloimmunity examples - ANSWER>> >>Neonatal disease where the maternal immune system becomes sensitized against antigens expressed by the fetus -Transplant rejection -Transfusion reaction
Hypersensitivity: Type 4 - ANSWER>> >>Tcell mediated delayed response
Does not involve antigen/antibody complexes
Hypersensitivity: Type 4 typical reaction - ANSWER>> >>localized contact dermatitis (symptoms usually occur a few days later)
Differentiating between type 1 and type 4 rash reactions - ANSWER>> >> Type I: IMMEDIATE hypersensitivity reactions, termed atopic dermatitis, are usually characterized by widely distributed lesions
Type 4: contact dermatitis (DELAYED hypersensitivity) consists of lesions only at the site of contact with the allergen -Example: poison ivy
How to treat Type 4 hypersensitivity rash - ANSWER>> >>nonsevere case of contact dermatitis: tx with topical corticosteroid
How to treat emergent Type 1 anaphylactic reactions - ANSWER>> >>epinephrine
Antihistamines act on _____________ - ANSWER>> >>H1 receptors
Primary immune deficiency - ANSWER>> >>congenital -caused generally by a genetic abnormality 60% of cases, symptoms within first 2 years of life
most primary immune deficiencies are the result of ______________ - ANSWER>> >>single gene defects
one of the most severe forms of primary immunodeficiency - ANSWER>> >>B- lymphocyte deficiency
secondary immune deficiency - ANSWER>> >>acquired -caused by illness, such as cancer or viral infection -caused by normal physiological changes, such as aging -more common than congenital
most common cause of secondary immunodeficiency worldwide - ANSWER>> >>malnutrition
most common symptom of immune deficiencies - ANSWER>> >> recurrent severe infections
hematopoiesis - ANSWER>> >>blood cell formation
most of our body's iron stores come from ____________________________ - ANSWER>> >>the recycling of iron from old RBCs
erythropoiesis - ANSWER>> >>formation of red blood cells (7 day process)
lab values for: Iron Deficiency Anemia - ANSWER>> >>Serum ferritin level: Decreased RBC distribution width: Increased Serum iron level: Decreased Total iron-binding capacity: Increased Transferrin saturation: Decreased
lab values for: Thalassemia - ANSWER>> >>Serum ferritin level: Increased RBC distribution width: Normal to incrased Serum iron level: Normal to increased Total iron-binding capacity: Normal Transferrin saturation: Normal to increased
lab values for: Anemia of Chronic Disease - ANSWER>> >> Serum ferritin level: Normal to increased RBC distribution width: Normal Serum iron level: Normal to decreased Total iron-binding capacity: Slightly decreased
Major lab marker for anemia - ANSWER>> >> Increased RBC distribution width (RDW) is one of the earliest lab markers in developing microcytic or macrocytic anemia
Folate deficiency can cause a _______________ - ANSWER>> >> megaloblastic anemia
megaloblastic anemia - ANSWER>> >>a blood disorde r characterized by anemia in which the red blood cells are larger than normal
who is at risk for folate deficiency - ANSWER>> >>alcoholics
Symptoms of Vit B12 deficiency - ANSWER>> >>Fatigue Dyspnea Peripheral neuropathy in BLE
Vit B12 deficiency risk factors - ANSWER>> >>older adults H-pylori infection vegan (its in meat, fish, poultry, dairy)
Hemolytic anemia - ANSWER>> >>anemia caused by the destruction of red blood cells -mismatched blood types-destroys RBCs (cytotoxic type 2) -autoimmune hemolytic anemia due to autoantibodies against erythrocytes the immune system perceives as an antigen and attacks -Allergic reaction to a drug
Trauma victims who are losing blood are at risk for what type of anemia? - ANSWER>> >>Acute blood loss anemia
a normocytic-normochromic type of anemia
Aplastic anemia is characterized by: __________ Dx: ___ - ANSWER>> >>failure of bone marrow to produce red blood cells Dx made by blood tests and bone marrow biopsy -granulocyte count < -platelet count <20,
- absolute reticulocyte count ≤ 40x109/L
Aplastic anemia is a __________-__________ type of anemia - ANSWER>> >>
Sickle Cell Anemia - ANSWER>> >>Hemoglobinopathy Inherited autosomal recessive genetic disorder Inherit 2 abnormal genes, one from each parent, if only one abnormal Hb gene inherited then person has sickle cell trait
Sickle cell anemia pathophysiology: _______________________ - ANSWER>> >>single amino acid change on beta-chain (valine replaces glutamic acid)
Sickle cell anemia increases the risk for: - ANSWER>> >>stroke and splenic damage
Thalassemia - ANSWER>> >>Hemoglobinopathy Inherited autosomal recessive genetic disorder that causes decreased circulating hemoglobin -abnormal gene from both parents
Thalassemia has __________genetic mutations - ANSWER>> >>many possible
Thalassemia relation to malaria - ANSWER>> >> abnormal RBCs are more resistant to infection by parasite that causes malaria, shortened life span doesn't allow malaria parasite to complete life cycle *more prevalent in Africa
Anatomy of Heart: Flow through heart (Valves in order) - ANSWER>> >>. Tricuspid valve
2. Pulmonary valve
3. Mitral valve (Bicuspid)
4. Aortic valve
Blood flow through the heart: - ANSWER>> >>1-Superior & Inferior Vena Cava 2-Rt Atrium 3-Tricuspid Valve 4- Rt Ventricle 5-Pulmonary Valve 6-Pulmonary Artery 7- Lungs-pick up oxygen 8-Pulmonary Veins
9- Lt Atrium
10- Mitral Valve (Bicuspid)
Hemorrhage can ___________ afterload due to decreased volume - ANSWER>> >>decrease
Increased preload __________ stroke volume (in the healthy heart)-the heart is able to __________ to the extra volume. - ANSWER>> >>increases, compensate
__________ preload caused by hemorrhage, dehydration-anything that reduces blood volume - ANSWER>> >>Decreased
Types of heart failure - ANSWER>> >>Left heart failure (CHF) Right heart failure (Cor Pulmonale) High-output failure
Left heart failure - ANSWER>> >>Inability of left ventricl e to provide adequate blood flow into systemic circulation
Causes of left heart failure - ANSWER>> >>systemic hypertension (most common) LV MI LV hypertrophy (often secondary to cardiac damage) Aortic semilunar or bicuspid valve damage Secondary to right heart failure
Left heart failure process - ANSWER>> >>1. high systemic vasular pressure
2. increase LV contraction force (increase afterload)
3. LV unable to eject normal amount of blood
4. increase LV preload
5. LA unable to eject normal amount of blood
6. Increase LA preload
7. Increase blood volume and pressure in pulmonary veins
8. fluid forced out into pulmonary tissues -pulmonary edema, dyspnea
-right heart failure=biventricular heart failure
underlying pathophysiology of heart failure - ANSWER>> >> less cardiac output to meet bodys oxygen demands
heart failure: over time there is decreased _________, decreases __________, increased ____________________________. - ANSWER>> >> contractility, stroke volume, left ventricular end-diastolic volume (LVEDV)
When contractility is decreased, stroke volume falls, and left ventricular end-diastolic volume (LVEDV) increases. This causes dilation of the heart and an increase in __________ - ANSWER>> >>preload
Heart failure: major risk factor in its development - ANSWER>> >>longstanding hypertension Sometime right-sided heart failure can occur without there being left-sided heart failure; This usually occurs because the person has _________________________________. - ANSWER>> >>long-standing pulmonary issues (COPD)
Right heart failure - ANSWER>> >> Inability of RV to provide adequate blood flow into pulmonary circulation
Right heart failure causes - ANSWER>> >>pulmonary disease RV MI RV hypertrophy pulmonary semilunar valve or tricuspid valve damage Secondary to left heart failure
Characteristic of right heart failure - ANSWER>> >>JVD
Right heart failure process - ANSWER>> >>1. high pulmonary vascular pressure
2. increase RV contraction force (increase afterload)
3. RV unable to empty completely
4. increase RV preload
5. RA unable to empty completely
6. increase RA preload
7. increase vena cava and systemic venous volume and pressure
8. fluid forced out into peripheral tissues
-jugular distension, hepatosplenomegaly, peripheral edema -Left heart failure = biventricular heart failure
High-Output Failure (HOF) - ANSWER>> >> Inability of heart to pump sufficient amounts of blood to meet the circulatory needs of the body, despite the normal blood volume and cardiac contractility
High-output failure causes - ANSWER>> >>severe anemia nutritional deficiencies hyperthyroidism
NYHA Functional Classification - ANSWER>> >>Stage I: mild - no limitation of physical activity
Stage II: mild - slight limitation of physical activity Stage III: moderate - marked decrease in physical activity
Stage IV: severe - inability to carry on any physical activity without discomfort
Mitral stenosis murmur characteristics - ANSWER>> >>-rumbling, decrescendo diastolic murmur heard at apex of heart -low-pitched murmur auscultated at apex of heart -opening snap
mitral stenosis s/s - ANSWER>> >>As it progresses, symptoms of decreased CO occur: SOB exercise intolerance JVD crackles in bases pulmonary congestion/edema cough fatigue pounding/racing heart
mitral regurgitation murmur characteristic - ANSWER>> >>-blowing, holosystolic murmur -blowing pansystolic murmur heard best at the hearts apex and radiates to the back and axilla
Mitral regurgitation s/s - ANSWER>> >>SOB JVD crackles in bases
aortic stenosis murmur characteristic - ANSWER>> >>mid-systolic crescendo- decrescendo murmur heard loudest at the base and radiating to the neck
aortic regurgitation presents with - ANSWER>> >>-early, high pitched diastolic decrescendo murmur heard loudest at the left lower sternal border
aortic regurgitation s/s - ANSWER>> >>fatigue syncope SOB palpitations
wide pulse pressure (SBP-DBP) LV dilation -can have extra heart sound (S3) or displaced PMI
chest xray may show signs of pulmonary edema and cardiomegaly with what type of heart valve disorder? - ANSWER>> >>aortic regurgitation
mitral valve prolapse (MVP) s/s - ANSWER>> >>-many asymptomatic -atypical chest pain -palpitations -SOB -mid-systolic click certain arrhythmias mitral valve prolapse increases the risk for: - ANSWER>> >>infective endocarditis progression to mitral regurgitation
Fainting and chest pressure upon exercising are symptoms of ___________. - ANSWER>> >>aortic stenosis
Aortic stenosis has __________, laterally displaced ___________. - ANSWER>> >>sustained, apical pulse
what kind of heart valve disorder will have a S4 gallop present - ANSWER>> >> aortic stenosis
Spirometry that indicates obstructive pulmonary disease - ANSWER>> >> decreased FEV low FEV1/FEV ratio <70%
Spirometry that indicates restrictive pulmonary disease - ANSWER>> >> FEV1/FVC ratio above 70%
Asthma - ANSWER>> >>obstructive pulmonary disease airways are constricted two forms: intrinsic or extrinsic
asthma characterized by: - ANSWER>> >>airway inflammation bronchial hyperreactivity and smooth muscle spasm
Diagnostic PFT for COPD - ANSWER>> >> reveals airway obstruction (decreased FEV1) that is progressive and unresponsive to bronchodilators
COPD consists of _______ and _______ - ANSWER>> >> chronic bronchitis and emphysema
risk factors for COPD - ANSWER>> >>smoking airborne irritants -air pollutants, chemical fumes, dust anything that affects lung growth during gestation - smoking, antibiotic use, preterm, air pollution inherited mutation of alpha-antitrypsin gene -genetic cause of COPD
COPD has decreased _______ due to expiratory airway obstruction from ______________________ - ANSWER>> >> decreased FVC, mucus, edema, loss of elastic recoil
COPD causes air trapping in the lungs which leads to: - ANSWER>> >> chest to hyper expand causing increased work of breathing -hypoventilation -hypercapnia
COPD chest xray reveal - ANSWER>> >>flattened diaphragm distended lung fields increased thoracic diameter
COPD GOLD staging - ANSWER>> >> GOLD guidelines are based on the degree of airway limitation: Gold 1: Mild - FEV1 ≥ 80% predicted Gold 2: Moderate - 50% ≤ FEV1 < 80% predicted Gold 3: Severe - 30% ≤ FEV1 < 50% predicted Gold 4: Very Severe - < 30% predicted
perfusion - ANSWER>> >> the actual exchange of O2 and CO2 in the bloodstream -occurs via the alveoli and pulmonary capillaries
ventilation - ANSWER>> >>air movement in/out of the lung -critical to ensure sufficient perfusion
damage from Emphysema occurs in the ___________ - ANSWER>> >>alveoli
emphysema impairs _________ - ANSWER>> >>gas exchange
emphysema s/s - ANSWER>> >>air trapping pursed-lip breathing increased A&P diameter barrel chest prolonged expiration dyspnea
damage from chronic bronchitis occurs in the __________ - ANSWER>> >>airway dyspnea wheezing rhonchi chronic bronchitis s/s - ANSWER>> >>Productive cough with copious amount of sputum cyanosis of the skin and mucus membranes prolonged expiration
chronic bronchitis characterized by: - ANSWER>> >>chronic productive cough: -persisting for at least 3 consecutive months for at least 2 successive years bronchial inflammation hypersecretion of mucus
Chronic Granulomatous Disease (CGD) is what type of immunodificiency? - ANSWER>> >>Primary immunodeficiency
what is a predominant cause of secondary immune deficiency worldwide? - ANSWER>> >>malnutrition
Pneumocystis Carinii is what type of immunodeficiency? - ANSWER>> >> secondary immunodeficiency -caused by something external to immune system (yeast-like fungus)
contact dermatitis is an example of type ______ hypersensitivity reaction - ANSWER>> >>type 4
"first responders" of the innate immune system - ANSWER>> >>neutrophils -appear 1st in any immune response anaphylaxis is an example of a type ____ hypersensitivity reaction - ANSWER>> >> type 1
antigens
anemia types are classified by: - ANSWER>> >>size -normocytic, microcytic, macrocytic color -normochromic, hypochromic, hyperchromic variability -anisocytosis (size), poikilocytosis (shape) sideroblastic thalassemia microcytic-hypochromic anemias - ANSWER>> >>iron deficiency
microcytic-normochromic - ANSWER>> >>anemia of inflammation and chronic disease
microcytic-hyperchromic - ANSWER>> >>hereditary spherocytosis infection transfusion reaction causes of hemolytic anemia - ANSWER>> >>RBC's are destroyed: hemolytic disease of newborn (Rh incompatability) Autoimmune reaction drug-induced
aplastic anemia - ANSWER>> >>failure of blood cell production in the bone marrow
what valve disorder is associated with a hx of rheumatic heart disease - ANSWER>> >>mitral stenosis
an ECG may demonstrate atrial fibrillation and left ventricular hypertrophy in _______ - ANSWER>> >>mitral stenosis
4 main categories of interstitial lung diseases (ILD) - ANSWER>> >>ExposureRelated ILD Connective Tissue Disease Idiopathic Interstitial Pneumonias Other ILDs ILDs observed almost solely in current or past smokers - ANSWER>> >> Respiratory bronchiolitis-interstitial lung disease (RB-ILD) Desquamative interstitial pneumonia (DIP) Pulmonary Langerhans cell histiocytosis
Meds that can cause Medication-Induced ILD - ANSWER>> >>Amiodarone Nitrofurantoin Methotrexate
ILD s/s - ANSWER>> >>dyspnea non-productive cough hypoxemia fine (velcro-like) crackles fever clubbing extrapulmonary symptoms hemoptysis, chest pain, wheezing -relatively uncommon but can occur
interstitial lung disease (ILD) excludes: - ANSWER>> >> infectious and neoplastic diseases alterations of alveolar and airway architecture ILD characterized by: - ANSWER>> >>interstitial inflammation and fibrosis -scarring around alveolar sacs
ILD 4 diagnostic tests - ANSWER>> >>1. High resolution chest CT
2. PFT
3. Bronchoalveolar lavage
4. lung biopsy
What are the most diagnosed ILD's - ANSWER>> >>Radiation pneumonitis Pneumoconioses Hypersensitivity Pneumonitis
