NUR 2063 / NUR2063 Exam 1 Blueprint (Latest 2022 / 2023): Essentials of Pathophysiology -, Study Guides, Projects, Research of Nursing

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1. Pathophysiology basics a. Homeostasis i. What is it? equilibrium, balance, consistency, and stability. vital signs such as blood pressure, pulse, and temperature. ii. Why do we have this? self-regulating, give-and-take system that responds to minor changes in the body through compensation mechanisms. Compensation mechanisms attempt to counteract those changes and return the body to its normal state b. Adaptation to stress and illness i. Resilience: How one bounces back from sickness or illness ii. Adaptation: How one adapts to sickness iii. Maladaptation: Not adapting correctly c. Cellular structures & functions i. Ribosomes: make proteins, protein synthesis ii. Mitochondria: cell power plant, ATP is made iii. Lysosomes: breakdown cell products & foreign bodies iv. Cell membrane: semipermeable membrane surrounding the cytoplasm of a cell
2. Receptors: Ion channels, protein-linked signals, Enzyme-linked cell funtion
3. Passing ions/nutrients across membrane v. Atrophy vs. hypertrophy: Atrophy: cell decrease in size and function. Hypertrophy: overworked cells (heart disease), increase size vi. Hyperplasia vs. metaplasia vs dysplasia: Hyperplasia: overgrowth of tissues, increase workload. Metaplasia: change in cells, abnormal cells. Dysplasia: mutated abnormal size vii. Apoptosis: planned cell death-90 days then die viii. Cell death d/t necrosis: Necrotic: dead tissue (coagulative, liquefactive, caseous, fatty) ix. Gangrene—what it is & the presentation: dead tissue caused by an infection or lack of blood flow. Dry: coagulative Wet: liquefactive Gas: release of gas from decomposition into tissue
4. Fluids and electrolytes a. Fluid regulation & distribution: Fluid regulation: intracellular 2/3 of fluid volume & extracellular 1/3of fluid volume. Water & sodium go together. Distribution: interstitial fluid=between cells, intravascular=inside blood vessels, transcellular= third space-a space it doesn’t belong b. Osmosis: movement of fluid. Molecules of a solvent pass through a semipermeable membrane from a less concentrated solution into a more concentrated one, equalizing the concentrations on each side c. Tonicity: Isotonic: equal concentrations between intracellular and extracellular Hypotonic: lower solute concentration. Hypertonic: higher solute concentration d. Sodium/water relationship: where sodium goes water goes e. Alterations in electrolytes

f. Fluid movement through body – basic principles: fluid intake, absorption, Distribution between vascular and interstitial, excretion g. Antidiuretic hormone (ADH): tells kidneys to hold onto water, promotes reabsorption of water in the kidneys h. Aldosterone: Hold on to water and sodium i. Sensible vs. insensible fluid losses: Sensible fluid loss: measurable (pee, diarrhea, blood). Insensible fluid losses: cannot be measured (sweat, fluid loss while talking/breathing) j. Abnormal fluid loss: Emesis(vomitus), Hemorrhage, wounds k. Fluid balance control: Antidiuretic Hormone (ADH): “tap water”, kidneys reabsorb plain water. Aldosterone: “salt water” hormone, cause kidney to reabsorb sodium and water. l. Fluid excess causes/presentation: Excessive sodium or water intake, High sodium diet, hypertonic fluid administered. Difficulty breathing(dyspnea), bouncing pulse, fast heart rate (tachycardia), polyuria, rapid weight gain. i. Third spacing – what is this? Fluid leaks into interstitial tissues m. Fluid deficit causes/presentation: inadequate sodium or water elimination, hyperaldosteronism, Cushing’s syndrome, renal failure, liver failure, heart failure. Dehydration

3. Normal electrolyte levels (table below) a. Sodium and associated disorders Normal range 135- i. Implications of sodium imbalances: Hypernatremia: excess sodium ingested, hypertonic saline administered, deficient water, excessive sweating, prolonged hyperventilation. Hyponatremia: deficient sodium, excessive water intake b. Potassium and associated disorders 3.5- i. Implications of potassium imbalances: hyperkalemia: deficient excretion; renal failure, excessive intake, increase release from cells. Hypokalemia: excessive loss, deficient intake, increased shift into cell c. Calcium 9- i. Chvostek’s signs: the healthcare practitioner taps the patient’s facial nerve in front of the ear. A spasm or brief contraction of the corner of the mouth, nose, eye, and muscles in the cheek is considered a positive sign and indicates increased neuromuscular irritability ii. Trousseau’s signs: The inflated cuff is left in place for approximately 3 minutes. The test is considered positive for increased neuromuscular irritability if it elicits a carpal spasm d. Phosphorus 2.5-4. i. Lab relationship with calcium: phosphorus has an inverse relationship with calcium. Absorption of phosphorus is decreased when it is ingested with foods containing calcium, magnesium, and aluminum—all of which bind with phosphorus. e. Magnesium 1.8-2.
4. Acid-base balance a. Normal pH & what it means: 7.35-7.45. pH indicates hydrogen ions. Hydrogens=acid. More hydrogen ions=lower pH b. Buffers (video): Carbonic acid (H2CO3), Phosphate (PO4), Hemoglobin, Protein

i. H 2 CO 3

1. Bicarbonate/carbonic acid system: most significant in extracellular fluid ii. Phosphate iii. Hemoglobin iv. Protein c. Potassium + hydrogen ions: Potassium & Hydrogen move interchangeably into and out of the cell to balance pH. Potassium imbalance leads to pH imbalances. d. Respiratory system regulation (very basic): Manages pH by altering CO2 excretion. Faster respirations excrete more CO2, decreasing acidity. Slower respirations excrete less CO2, increasing acidity e. Renal regulation (very basic): kidneys alter the excretion or retention of hydrogen or bicarbonate. ^ potassium ^ acid= dialysis. If pH imbalance is in the lungs, the kidneys will initiate efforts to correct f. ABG values = know the NORMALS pH- 7.35-7.45 PaCO2- 45-35 HCO3- 22- g. Acidosis & alkalosis conditions (very basic info)

Respiratory Acidosis: CO2 retention, increasing carbonic acid, Hypoventilation, decreased gas exchange, asthma COPD, airway obstruction, pulmonary edema, drug overdose, respiratory failure, CNS depression

Respiratory Alkalosis: excessive exhalation of CO2 leading to carbonic acid deficits, anxiety, pain, fever, hypoxia, aspirin overdose, hypermetabolic state.

Metabolic Acidosis: deficient of bicarbonate (intestinal and renal loss) or excess of hydrogen ions (tissue hypoxia: lactic acid accumulation, ketoacidosis, renal retention)

Metabolic Alkalosis: excess bicarbonate (excess antacid use, hypochloremia) or deficit of acid (GI loss, hypokalemia, renal loss, hypovolemia hyperaldosteronism) or both

h. VERY BASIC ABG interpretation: pH- determines acid-base status, PaCO2- determines adequacy of pulmonary ventilation, HCO3- determines activity of kidneys to retain or excrete bicarbonate

5. Immune system components a. General Adaptation Syndrome – Stages and features: Stage 1: alarm (initial reaction, sympathetic nervous system), stage 2: resistance (adaptation, limit stressor), stage 3: Exhaustion (adaptation fails, disease develops) b. Fight or flight i. Epinephrine: Adrenaline produced by the adrenal glands, acts as a neurotransmitter involved in regulating visceral functions(respiratory) ii. Norepinephrine: produced in the adrenal glands, also called the adrenal medulla. Stress hormone and neurotransmitter. c. Coping: Ability to deal with a stressor. Influenced by age, genetics, gender, life experience, social support. or, the concepts of adaptation: physical activity, adequate sleep, relaxation, distraction. maladaptation: smoking, substance abuse, overeating d. Innate immunity : immediate line of protection, self from non-self, skin, mucous membranes, chemicals i. Cardinal signs of inflammation : Redness, swelling(edema), heat/warmth, pain, loss of function

ii. Inflammatory process & purpose: A vascular reaction triggered by mast cells iii. Pyrogens: fever-producing molecule, produced by macrophages, metabolic changes in hypothalamus. iv. Interferons: proteins released from virus infected cells, bind to uninfected cells, they release an enzyme to prevent viral replication v. Complement: plasma protein that enhances antibodies, activated by antigen, there to destroy cells e. Adaptive immunity: destroy invading pathogens i. T-cells  cellular immunity: cell-mediated immunity, attack infected cells ii. B-cells  humoral immunity: humeral immunity, attack invaders outside the cell f. Acquired immunity i. Active: acquired by having the disease, vaccination ii. Passive: receive antibodies from external source, maternal-fetal transfer, breastfeeding, short-lasting g. Alterations in immunity i. 4 types of hypersensitivity (Type I: lgE mediated, II: cytotoxic hypersensitivity, III: immune complex mediated, IV: delayed hypersensitivity reaction) & corresponding conditions

1. IgE reactions: hay fever, food allergy, anaphylaxis ii. Autoimmune
2. Self vs. non-self-concept and what it means: losses ability to recognize, defenses are directed at host, mechanism that trigger are unknown
3. SLE: systemic lupus erythematosus. Chronic inflammatory autoimmune, more common in women, Asians, African Americans. iii. Immunodeficiency: diminished/absent immune response, acute/chronic iv. HIV/AIDS: parasitic retrovirus that infects CD4 and macrophages. 2 types, transmission through blood/body fluid h. Promoting healthy immune system: increase fluid intake, eat well, adequate sleep, avoid caffeine/refine sugar, reduce stress
4. Neoplasms a. Warning signs of cancer – CAUTION acronym: Change in bowel/bladder habits, A sore that doesn’t heal, Unusual bleeding/discharge, Thickening or lump in breast or elsewhere, Indigestion/difficulty swallowing, Obvious changes in a wart/mole, Nagging couch/hoarseness b. Benign (slow, progressive, localized, well-defined, does not usually result in death) vs. malignant (rapid growing, spreads quickly, highly undifferentiated, fatal if not treated) c. Metastasis: development of secondary malignant growths at a distance from a primary site of cancer d. Grading (Stage I, II, III, IV, as stage increases, tumor is less differentiated) and staging (TNM system: Tumor, Node, Metastasis. Based on spread of disease) e. Steps to carcinogenesis i. Initiation: introduction of the cancer-causing agent ii. Promotion: initiation of uncontrolled growth iii. Progression: permanent malignant changes

f. Complications of cancer: Anemia, cachexia (wasted appearance), fatigue, infection, leukopenia, thrombocytopenia (low platelets=increase risk of bleeding), pain g. Cancer therapies: surgery, radiation, chemotherapy, hormone and antihormone therapy, biotherapy

7. Musculoskeletal disorders & injuries a. Kyphosis: curvature of thoracic spine outward, develop in adolescence, impair lung expansion lordosis: concave curve pf lumbar spine, obesity increases risk, develop in adolescence scoliosis: lateral deviation of the spine-may effect thoracic, lumbar, more common in females, pulmonary compromise, chronic pain b. Tissue injuries c. Bone fractures and injuries i. Healing process: Hematoma forms (clot), broken bone ends necrose (dissolve), fibroblasts invade clot and secrete collagen fibers to form a callus, callus protects and pulls broken ends together within 2-6 weeks, osteoblasts slowly convert callus to bone:3 weeks to several months ii. Stabilization: splint or cast d. Compartment syndrome: increased pressure in a compartment (muscle fascia) i. 5 Ps of compartment syndrome: Pain, Pallor, Paresthesia, Pulselessness, Paralysis e. Dislocations: separation of two bones at a joint. sprains: injury to a ligament that stretching or tearing of the ligament. Force joint into an unnatural position. Most common in ankle and knee. f. Herniated disks: protrusion of nucleus pulposus, may occur suddenly or gradually. g. Complications of bone injuries i. Fat embolism: can be fatal if travels to the brain, heart, lungs ii. Pulmonary embolism (overview): blood clot gets lodged in an artery in the lung, blocking blood flow to part of the lung. iii. DVT iv. Bone infections: Osteomyelitis h. Metabolic bone disorders i. Rickets: osteomalacia in adults, vitamin D, calcium, or phosphate defiency leading to weak soft bones. ii. Osteoporosis: metabolic condition results in loss of bone calcium, leaves bones brittle. Asymptomatic, bone pain iii. Paget’s disease: a disease that disrupts the replacement of old bone tissue with new bone tissue. i. Musculoskeletal diseases i. Idiopathic diseases: Any disease that is of uncertain or unknown origin. ii. Muscular dystrophies: most inherited, but some occur due to genetic mutation. j. Fibromyalgia k. Arthritis types i. Osteoarthritis/degenerative joint disease ii. Rheumatoid iii. Psoriatic

l. Bone tumors m. Gout

8. Integumentary patho a. Age-related issues b. Contact dermatitis c. Atopic dermatitis d. Psoriasis e. Infections i. Impetigo ii. Cellulitis iii. Necrotizing fasciitis iv. Viral infections
9. HSV
10. Shingles v. Parasites
11. Tinea
12. Scabies
13. Lice vi. Burns vii. Skin cancer
14. Sensory patho a. Pain b. Conjuntivitis c. Otitis media d. Eye/ear trauma e. Glaucoma f. Macular degeneration g. Meniere’s disease

Laboratory Values

Lab Normal values

Sodium 135 - 145 Potassium 3.5- 5 Magnesium 1.5-2. Phosphorus 2.5-4. Calcium 9 - 11 ABGs (^) pH = 7.35-7. PaCO 2 = 45 - 35 HCO 3 = 22 - 26 PaO 2 = 80 - 100

1 kg = 1-liter fluid