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NUR 2063 / NUR2063: Essentials of Pathophysiology Exam 1 Review Study Guide (Latest 2021) Rasmussen

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NUR2603 Essentials of Pathophysiology Exam 1 Focused Review • What is pathophysiology? o the study of abnormalities in physiologic functioning of living beings. It is studies in terms of common... , or classic, presentations of disorders. • Stress response o body’s attempt to try to restore the balance; is helpful but can become damaging when repeatedly activated or does not cease. • Flight or flight o The alarm stage; because it provides a surge of energy and physical alterations to either evade or confront danger. (when the hypothalamus senses a need to activate the GAS in response to a stimulus, a stressors placing the balance of homeostasis at risk) • Epidemiology and the treatment of disease o the study of health events and patterns of disease involving aggregates of people, their distribution, and associated causative factors in a defined population • Hans Selye’s General Adaptation Syndrome o Alarm (fight or flight), resistance (adaptation; move beyond the alarm stage), exhaustion (no longer able to effect a return to homeostasis) stages • What is homeostasis? Allostasis? o Maintaining internal conditions in a stable state by keeping things relatively the same, or balanced o ability to successfully adapt to challenges to maintain survival and well-being (i.e. BP, HR, glucose levels) o Allostatic overload- when adaptation mechanisms are inadequate or total amount of allostatic load is excessive; homeostasis cannot be obtained • Osmosis vs passive transport vs filtration o Movement of water across a semipermeable membrane to equalize the particle concentration of the fluid on both sides of the membrane. o Called facilitated diffusion; particles move through the cell membrane from an area of higher concentration to an area of low concentration w/o the use of energy o Particles move through the cell membrane from an area of low concentration to high concentration; requires the use of energy; ATP • Edema o Excess of fluid in interstitial compartment; may be localized or generalized; stages +1, +2, +3, +4 • Osteoporosis o Most common metabolic bone disease in which reduction in bone mass results from bone resorption proceeding at a rate faster than that of new bone formation. (s/s: shortened stature, muscle wasting, back muscle spasms, difficulty bending over) • Transmission of infections o An unbroken chain of events must occur to allow one human to infect another. o Direct transmission: body fluids-droplet, animal bites/soil, placenta transfer o Indirect transmission: vehicle-borne (infectious agent is transported to the host), vector-borne (mechanical or biological transfer), airborne (with aerosols) o Most effective ways to break the chain of transmission: handwashing • Myasthenia Gravis o Chronic autoimmune disease; affects neuromuscular function of voluntary muscles o Acetylcholine receptor antibodies destroy or block acetylcholine receptors of muscle end- plate of the neuromuscular junction. o Manifestations: profound muscle weakness and fatigability o Can lead to respiratory depression from weakness o Mind to head • Osteoarthritis o A common, local degenerative joint disease, associated with aging, characterized by progressive loss of articular cartilage, cartilage calcifies, wear of underlying bone, and by formation of new bone from subchondral bone at joint margins. • Pressure ulcers o Localized areas of cellular necrosis resulting from prolonged pressure between any bony prominence and an external object such as a bed or wheelchair o Prevention: turn Q2HR, keep areas clean and dry o Stages I, II, III, & IV • Histamine o An early mediator of the inflammatory response; causes bronchial constriction and mucus production. o Receptor-blocking agents are widely used in allergic reactions, such as skin reactions and hay fever to suppress the inflammatory actions. • Herpes simplex o Two types: HSV-1: occurs above the waist; lips, mouth, face; HSV-2: infections in the genital area o Vesicles and erythema; crusts before healing; no cure • Endotoxins o Integral part of the cell wall which is released upon cell death and sometimes during cell growth o Can lead to septic shock, intravascular coagulation, and respiratory failure • Herpes zoster o Inflamed disease that follows a dermatone o Shingles: acute localized inflammatory disease of a dermatomal segment of the skin caused by varicella zoster (chickenpox) o Results from reactivation of the latent virus; eruption of painful vesicles with eryrhematous bases typically unilateral; paresthesias • Significant ions o most significant ions are sodium, potassium, calcium, magnesium, chloride, bicarbonate, and phosphate • Epidemiology o Endemic: fairly constant presence in a community and changes little from year to year o Epidemic: significant increase in new infections in a certain population o Pandemic: epidemic that has spread to a large geographic area • Components of bone marrow o WBCs, RBCs, platelets o Red- Hematopoiesis occurs in red bone marrow (poiesis means formation and hema means RBCs) o Produces erythrocytes (RBCs), leukocytes, and platelets o Yellow (fatty)- does not contribute to hematopoiesis & can be recruited to become red marrow again when increased need for hematopoiesis • Muscular dystrophy o Group of genetically determined myopathies characterized by progressive muscle weakness and degeneration; muscle is replaced by fat and fibrous connective tissue; progressive loss of muscle tissues • Mitochondria o “powerhouses of the cell” o Convert energy to forms that can be used to drive cellular reactions o Each mitochondrion is bound by two specialized membrane, the matrix and the cristae o Essential to the process of oxidative phosphorylation which generates most of the cells adenosine triphosphate (ATP) o Cells with high energy needs, such as cardiac or skeletal muscle, have many mitochondria o Mitochondria also have important role in programmed cell death, called apoptosis • Cancer cells o Produce telomerase, allows immortality in cancer cells o Generally spread via circulatory or lymphatic systems o P53 gene- most common tumor-suppressor gene defect identified in cancer cells; cancer cells that lack functional p53 may be resistant to chemotherapy/radiation • Dehydration o Combination of ECV deficit and hypernatremia; too small a volume of fluid in the extracellular compartment and the body fluids are too concentrated (adults and infants are at higher risk); vomiting and diarrhea; do not know how to replace the salt and water that is exiting the body • Syphilis o STD from Treponema pallidum o Primary: single chancre on genitalia o Secondary: disseminated rash o Tertiary: permanent cardiac and CNS damage o Diagnosis: serum antibodies (VDRL); pustules for spirochete o Penicillin effective for eradicating primary and secondary syphilis • Atopic dermatitis o Most common in children; usually improves with age o Lesions pruritic, oozing, crusting, coalescent papule; thickening of the skin or lichenification occurs o Moisturization of skin; decrease frequency of bathing; topical steroids, antihistamines, etc. • Electrolyte pool o Bones act as an electrolyte pool and store calcium, magnesium, and phosphate ions o Shifts of electrolytes in electrolyte pools will decrease plasma electrolyte concentration and shift of electrolytes from an electrolyte pool into the extracellular fluid will increase the plasma electrolyte concentration • Components of extracellular fluid o Body fluid that is not inside the cells; includes vascular, interstitial, and transcellular fluids. o Vascular- fluid that is in blood vessels; a component of extracellular fluid. o Interstitial- fluid that lies between the cells o Transcellular- body fluid contained in special compartments, such as the synovial or cerebrospinal compartments. • Antimicrobial resistance o Usually develops from a chance mutation which can be passed to another microorganism during replication; caused by subtherapeutic dosing & excessive use of antibiotics o Give antibiotics only when needed for bacterial infections; not for vital infections. • Measurements of inflammation o Acute- short in duration, lasting less than 2 weeks o Chronic- more diffuse, extends over longer period of time, may result in scar tissue formation or deformity • Compartment syndrome o Dangerous complication of soft tissue injury (trauma); results from swelling of injured tissue within a restrictive fascia o Causes: decreased compartment size, increased compartment content, or externally applied pressure (Ex: edema) • Carcinogenesis o A multi-step phenomenon: Initiation (DNA damage- mutation), promotion (proliferation-growth promoters), progression (development of cancerous phenotype) • Signs of inflammation o Redness, swelling, heat, pain, loss of function • Extracellular fluid volume o Imbalances of extracellular fluid are saline imbalances because they are disorders of isotonic salt water (isotonic saline is salt water in the same concentration as the normal plasma concentration) • Acute inflammation mediators o Bradykinin (primary mediators) & kallidin • Active vs passive immunity o A protected state owing to the body’s immune response as a result of active infection or immunization o Types: immunizations; vaccines o Transfer of preformed antibodies against specific antigen from a protected or immunized individual to an unprotected or nonimmunized individual; used for B-cell immunodeficiencies o Types: mother to fetus: IgG; mother to infant: IgA from breast milk; serotherapy- direct injection of antibodies (human or animal) • Hyponatremia o Serum sodium concentration lower than normal- hyponatremia o Extracellular fluid contains too much water for the amount of sodium ions present- more dilute than normal Causes o Factors that produce a relative excess of water in proportion to salt in the extracellular fluid o Also called hypotonic syndrome, hypoosmolality, and water intoxication o Circumstances that cause prolonged or excessive release of ADH cause kidneys to retain too much water, which dilutes the blood leading to hyponatremia o SIADH o small cell carcinoma, pain, nausea, and other stressors also increase ADH release o May also be caused by loss of more salt than water- depletional hyponatremia o Thiazide diuretics, excessive water intake Clinical Manifestations o Nonspecific central nervous system dysfunction- malaise, anorexia, nausea, vomiting, and headache to confusion, lethargy, seizures, and coma o Rapid decrease in osmolality produces more severe manifestations than a slow decline o Profound hyponatremia causes fatal cerebral herniation due to swelling of neurons and glial cells as result of decreased osmolality of ECV • Fibromyalgia o Cause remains unknown; possible central sensitization; characterized by widespread pain in all quadrants of the body o s/s: hyperactivity, fatigue, insomnia, depression and concentration problems; tender/trigger points • Psoriatic arthritis o Inflammatory arthritis associated with psoriasis; peak age of onset 30 to 55 years o Genetic factors; T lymphocytes and macrophages infiltrate skin and joint tissue, producing inflammatory cytokines o Asymmetric oligoarthritis; combined soft-tissue and peripheral joint disease with enthesitis and dactylitis o Treatment: NSAIDs, corticosteroids, emollients, keratolytic agents, light therapy, or immunosuppressive therapy • Gout o Heterogeneous disorder in which disturbance of uric acid metabolism leads to deposition of uric acid crystals in joints; risk increases with age. o Characterized by hyperuricemia and urate crystal–induced arthritis o Recurrent attacks of articular and periarticular inflammation, accumulation of tophi, renal impairment, and uric acid calculi o 4 phases: asymptomatic hyperuricemia (no clinical signs, serum urate levels elevated), acute gouty arthritis (weight-bearing joints affected; warm, red, tender to palpation), intercritical gout (intervals between acute attacks; no symptoms), & chronic tophaceous gout (advanced deforming gout; tophi develops) o Hyperuricemia: usually asymptomatic without symptoms but on a routine blood draw you will see an elevated urate level. In men can be seen after puberty and in women after menopause. o Gouty arthritis: Where there is an inflamed, erythematous lesion, usually weight-bearing joints with urate crystals formed in synovial fluid. This stage lasts 1 to 2 days or up to 2 weeks. o Intercritical gout: This is the stage in between attacks and the patient is usually pain free. o Chronic Tophaceous gout: is a late sign usually around 10 years of increased uric acid levels. Tophi form in synovium, subchondral bone, olecranon bursa, and infrapatellar and Achilles tendons. Tophi can be found in soft tissue such as aorta, valves of heart, pinna of ear, cornea, sclera, and kidneys. This all leads to deforming arthritis. • Bone cancers o Neoplasms can be benign or malignant; malignant referred to as sarcomas; metastatic lesions spread to bone from primary carcinomas o Osteosarcoma- formation of bone or osteoid by tumor cells; extremely malignant; grows rapidly o Manifestations- pathologic fracture, metastasis to lungs is noted early in disease, pain becomes consistent and progressively more intense; joint function compromised o Chondrosarcoma- malignant cartilage-forming tumor that develops slowly; tends to develop in the pelvic and shoulder girdles and the proximal ends of long bones; characterized by formation of cartilage by tumor cells; occurs in 30 to 60 years old o Ewing Sarcoma- third most common primary sarcoma; rapidly growing malignant round cell tumor; composed of densely packed small cells with round nuclei, may metastasize to lungs o Multiple myeloma- slowly growing bone marrow malignancy with neoplastic proliferation of a single clone of plasma cells; homogeneous immunoglobin is present in urine and serum; affects kidneys, immune and circulatory systems • Difference between clinical manifestation, complication, sequela o Clinical manifestations- can either be objective (physician) or subjective (patient) information o Complication- a new or separate process that may arise secondarily b/c of some change produced by the original problem. o Sequela- a condition or conditions caused by and following a disease • Hormones that assist with electrolyte movement o Lipid-soluble hormones?- allow them to pass through cell membranes to initiate changes in cellular activities o Distribution of the electrolytes between the extracellular fluid and electrolyte pools is influenced by hormones: epinephrine (potassium), insulin (potassium and phosphate ions), parathyroid hormone (calcium ions). • Hypernatremia o Serum sodium concentration greater than 145mEq/L o Extracellular fluid contains too little water for the amount of sodium ions- too concentrated o Water deficit, hypertonic syndrome, and hyperosmolality o Causes o Gain of more salt than water or loss of more water than salt o Concentrated tube feedings without enough water, IVF with hypertonic saline, overuse of salt tables, no access to water, inability to respond to thirst, diabetes insipidus (deficient ADH), prolonged emesis, diarrhea, or diaphoresis without water replacement o Manifestations o Nonspecific manifestations of central nervous dysfunction- confusion and lethargy to seizures and coma o Thirst and oliguria (decreased urine output) o Can cause death if severe • Type I Hypersensitivity reactions o Reaction occurs 15 to 30 minutes after exposure to antigen/allergen o Mild: hives, seasonal allergic rhinitis, eczema o More problematic: throat constriction, localized edema, wheezing, tachycardia o Anaphylaxis: most life- threatening reaction • Rheumatoid arthritis o Systemic autoimmune inflammatory disease; inflammatory response in rheumatoid joint leads to accumulation of immune cells and infiltration of the synovium; granulation tissue forms over articular cartilage; leads to pannus formation; pannus can erode and destroy articular cartilage, resulting in bone erosion, bone cysts, and fissures o Classic presentation: bilateral symmetric polyarthritis involving smaller joints; malaise, fatigue, and diffuse musculoskeletal pain are common [Show More]

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