NUR 376
Week 2 Module 2
Fluids, Electrolytes, and Acid/Bases Outline
Applied Pathophysiology - Concordia St. Paul
Pass the Exam with Confidence
, lOMoARcPSD|51648332
NUR 376 Applied Pathophysiology
Week 2 Module 2: Fluids, Electrolytes, and Acid/Bases Outline
by Rhaeven Ortiz
Learning Objectives
● Describe basic cellular adaptations and injury.
o Ch. 2
o Understanding will be beneficial for most chapters to understand issues like cardiac, cancer.
o Adaptations on pages 9-12 (hypertrophy, atrophy, hyperplasia, metaplasia, dysplasia, neoplasia). Examples
of each.
▪ Atrophy is a cellular adaptation in which cells revert to a smaller size in response to changes in
metabolic requirements or their environment. Atrophy occurs when a cell’s environment cannot
support its metabolic requirements. The cell’s smaller size allows for less metabolic demand and
more efficient functioning that is compatible with survival.
‣ EX: shrinking of skeletal muscle cells in an individual with upper extremity
paralysis…Gradually, the size of skeletal muscle cells decreases and they undergo diminished
metabolic activity.
▪ Hypertrophy is an increase in individual cell size that results in an enlargement of functioning tissue
mass. In hypertrophy, each individual cell becomes larger. Hypertrophy increases the cell’s functional
components, which leads to greater metabolic demand and energy needs.
‣ In physiological hypertrophy, the enlarged muscle is adequately perfused and supplied with
blood flow, oxygen, and nutrients because of angiogenesis. In well-trained athletes, the heart
physiologically hypertrophies because of the enlargement of each individual myocardial cell.
There is a proportional increase in myocardial cell size and enhancement of coronary blood
supply of the myocardial cells. Therefore, the enlarged heart in an athlete is supplied with
abundant coronary artery blood flow, which delivers large amounts of oxygen and nutrients
‣ Pathological hypertrophy occurs when there is an increase in cellular size without an increase
in the supportive structures necessary for the enlarged cell’s increased metabolic needs.
Pathological hypertrophy of cells can occur in disease processes or may be a compensatory
maladaptation to changed environmental conditions.
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1
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, lOMoARcPSD|51648332
Clinical Concept: As a result of hypertension, the left ventricle undergoes pathological hypertrophy. During cardiovascular
physical assessment, left chest palpation locates the point of maximal impulse (PMI). The PMI’s location correlates with
the location of the heart’s apex, which is usually located just under the left nipple. However, with left ventricular
hypertrophy, the PMI is displaced to the left.
▪ Hyperplasia is the increase in the number of cells in a tissue or organ. It occurs only in tissues with
cells that are capable of mitotic division, such as the epithelium and glandular tissue. Hyperplasia is
stimulated by hormonal or compensatory cellular mechanisms. Hyperplasia can also occur as a
maladaptive mechanism when overcompensation causes the cell mass necessary for regeneration to
be exceeded. Excessive numbers of cells in a specific tissue or organ can have detrimental effects.
‣ An example of hormonal stimulation of hyperplasia occurs in pregnancy, when estrogen
stimulation results in mitotic division of breast gland cells.
‣ It is believed that human organs contain limited populations of self-renewing cells, called
stem cells. Stem cell research is demonstrating the regenerative power of stable cells and has
the potential to change previously held theory (see the section “Regenerative Medicine
Using Stem Cells”).
Clinical Concept: Hyperplasia caused by hormonal stimulation occurs in older adult males. As males age, prostate gland
cells increase in number because of testosterone stimulation. As a result, a condition known as benign prostatic
hyperplasia (BPH) occurs.
▪ Metaplasia is the replacement of one cell type by another cell type. It is likely a result of the cell’s
genetic reprogramming in response to a change in environmental conditions. Commonly, metaplasia
occurs in response to chronic inflammation, and the substitution of cells enables the tissue’s
survival.
Clinical Concept: One of the best examples of metaplasia can occur in gastroesophageal reflux disease (GERD). In GERD,
the lower esophageal sphincter is weakened and allows stomach acid to reflux into the lower esophagus. The acid irritates
the lower esophageal cells, causing inflammation of the esophagus. Without treatment, and if prolonged, these lower
esophageal cells, which are normally squamous epithelium–type cells, transform into columnar stomach-like cells. The
stomach-like cells have greater tolerance for the acid reflux.
REV -5/24
2
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, lOMoARcPSD|51648332
ALERT! The metaplastic change that occurs in GERD is a condition referred to as Barrett’s esophagus, which requires
periodic examination and aggressive treatment because it can deteriorate into cancer of the esophagus
▪ Dysplasia is deranged cellular growth within a specific tissue, often as a result of chronic
inflammation or a precancerous condition. On histological examination, dysplastic cells vary in size,
shape, and architectural organization compared with healthy cells. Cervical dysplasia, often detected
on a Papanicolaou (Pap) test, is a common example of this cellular change
▪ Neoplasia means new growth and usually refers to disorganized, uncoordinated, uncontrolled
proliferative cell growth that is cancerous. The words tumor and neoplasm are often used
interchangeably, and both indicate new cells growing within a specific tissue or organ.
Neoplasms can be classified as benign or malignant, depending on an important cell characteristic
called differentiation
o Make the connections: How does the body’s cells compensate for lack of blood flow/ischemia? What is this
called?
▪ See Figure 2.2 ABOVE
When the body’s cells experience a lack of blood flow, also known as ischemia, they adapt through several mechanisms to
mitigate damage and maintain function. This process is called ischemic preconditioning and involves several
compensatory strategies:
1. Metabolic Shifts: Cells may switch from aerobic respiration to anaerobic metabolism, using less oxygen but
producing energy through glycolysis. This helps them continue to produce ATP (energy) even with reduced oxygen
supply.
2. Vascular Changes: The body can induce vasodilation in nearby blood vessels to increase blood flow to the affected
area, a process often mediated by signaling molecules like nitric oxide.
3. Increased Oxygen Extraction: Cells can enhance their ability to extract oxygen from the blood, even if the blood
flow is reduced. This is done by increasing the efficiency of oxygen utilization at the cellular level.
4. Activation of Protective Pathways: Ischemic preconditioning involves the activation of various signaling pathways
that help protect cells from further damage. For example, cells might increase the production of antioxidant
molecules to combat oxidative stress or activate repair mechanisms to handle damage.
REV -5/24
3
Downloaded by Benjamin Luca ()
Week 2 Module 2
Fluids, Electrolytes, and Acid/Bases Outline
Applied Pathophysiology - Concordia St. Paul
Pass the Exam with Confidence
, lOMoARcPSD|51648332
NUR 376 Applied Pathophysiology
Week 2 Module 2: Fluids, Electrolytes, and Acid/Bases Outline
by Rhaeven Ortiz
Learning Objectives
● Describe basic cellular adaptations and injury.
o Ch. 2
o Understanding will be beneficial for most chapters to understand issues like cardiac, cancer.
o Adaptations on pages 9-12 (hypertrophy, atrophy, hyperplasia, metaplasia, dysplasia, neoplasia). Examples
of each.
▪ Atrophy is a cellular adaptation in which cells revert to a smaller size in response to changes in
metabolic requirements or their environment. Atrophy occurs when a cell’s environment cannot
support its metabolic requirements. The cell’s smaller size allows for less metabolic demand and
more efficient functioning that is compatible with survival.
‣ EX: shrinking of skeletal muscle cells in an individual with upper extremity
paralysis…Gradually, the size of skeletal muscle cells decreases and they undergo diminished
metabolic activity.
▪ Hypertrophy is an increase in individual cell size that results in an enlargement of functioning tissue
mass. In hypertrophy, each individual cell becomes larger. Hypertrophy increases the cell’s functional
components, which leads to greater metabolic demand and energy needs.
‣ In physiological hypertrophy, the enlarged muscle is adequately perfused and supplied with
blood flow, oxygen, and nutrients because of angiogenesis. In well-trained athletes, the heart
physiologically hypertrophies because of the enlargement of each individual myocardial cell.
There is a proportional increase in myocardial cell size and enhancement of coronary blood
supply of the myocardial cells. Therefore, the enlarged heart in an athlete is supplied with
abundant coronary artery blood flow, which delivers large amounts of oxygen and nutrients
‣ Pathological hypertrophy occurs when there is an increase in cellular size without an increase
in the supportive structures necessary for the enlarged cell’s increased metabolic needs.
Pathological hypertrophy of cells can occur in disease processes or may be a compensatory
maladaptation to changed environmental conditions.
REV -5/24
1
Downloaded by Benjamin Luca ()
, lOMoARcPSD|51648332
Clinical Concept: As a result of hypertension, the left ventricle undergoes pathological hypertrophy. During cardiovascular
physical assessment, left chest palpation locates the point of maximal impulse (PMI). The PMI’s location correlates with
the location of the heart’s apex, which is usually located just under the left nipple. However, with left ventricular
hypertrophy, the PMI is displaced to the left.
▪ Hyperplasia is the increase in the number of cells in a tissue or organ. It occurs only in tissues with
cells that are capable of mitotic division, such as the epithelium and glandular tissue. Hyperplasia is
stimulated by hormonal or compensatory cellular mechanisms. Hyperplasia can also occur as a
maladaptive mechanism when overcompensation causes the cell mass necessary for regeneration to
be exceeded. Excessive numbers of cells in a specific tissue or organ can have detrimental effects.
‣ An example of hormonal stimulation of hyperplasia occurs in pregnancy, when estrogen
stimulation results in mitotic division of breast gland cells.
‣ It is believed that human organs contain limited populations of self-renewing cells, called
stem cells. Stem cell research is demonstrating the regenerative power of stable cells and has
the potential to change previously held theory (see the section “Regenerative Medicine
Using Stem Cells”).
Clinical Concept: Hyperplasia caused by hormonal stimulation occurs in older adult males. As males age, prostate gland
cells increase in number because of testosterone stimulation. As a result, a condition known as benign prostatic
hyperplasia (BPH) occurs.
▪ Metaplasia is the replacement of one cell type by another cell type. It is likely a result of the cell’s
genetic reprogramming in response to a change in environmental conditions. Commonly, metaplasia
occurs in response to chronic inflammation, and the substitution of cells enables the tissue’s
survival.
Clinical Concept: One of the best examples of metaplasia can occur in gastroesophageal reflux disease (GERD). In GERD,
the lower esophageal sphincter is weakened and allows stomach acid to reflux into the lower esophagus. The acid irritates
the lower esophageal cells, causing inflammation of the esophagus. Without treatment, and if prolonged, these lower
esophageal cells, which are normally squamous epithelium–type cells, transform into columnar stomach-like cells. The
stomach-like cells have greater tolerance for the acid reflux.
REV -5/24
2
Downloaded by Benjamin Luca ()
, lOMoARcPSD|51648332
ALERT! The metaplastic change that occurs in GERD is a condition referred to as Barrett’s esophagus, which requires
periodic examination and aggressive treatment because it can deteriorate into cancer of the esophagus
▪ Dysplasia is deranged cellular growth within a specific tissue, often as a result of chronic
inflammation or a precancerous condition. On histological examination, dysplastic cells vary in size,
shape, and architectural organization compared with healthy cells. Cervical dysplasia, often detected
on a Papanicolaou (Pap) test, is a common example of this cellular change
▪ Neoplasia means new growth and usually refers to disorganized, uncoordinated, uncontrolled
proliferative cell growth that is cancerous. The words tumor and neoplasm are often used
interchangeably, and both indicate new cells growing within a specific tissue or organ.
Neoplasms can be classified as benign or malignant, depending on an important cell characteristic
called differentiation
o Make the connections: How does the body’s cells compensate for lack of blood flow/ischemia? What is this
called?
▪ See Figure 2.2 ABOVE
When the body’s cells experience a lack of blood flow, also known as ischemia, they adapt through several mechanisms to
mitigate damage and maintain function. This process is called ischemic preconditioning and involves several
compensatory strategies:
1. Metabolic Shifts: Cells may switch from aerobic respiration to anaerobic metabolism, using less oxygen but
producing energy through glycolysis. This helps them continue to produce ATP (energy) even with reduced oxygen
supply.
2. Vascular Changes: The body can induce vasodilation in nearby blood vessels to increase blood flow to the affected
area, a process often mediated by signaling molecules like nitric oxide.
3. Increased Oxygen Extraction: Cells can enhance their ability to extract oxygen from the blood, even if the blood
flow is reduced. This is done by increasing the efficiency of oxygen utilization at the cellular level.
4. Activation of Protective Pathways: Ischemic preconditioning involves the activation of various signaling pathways
that help protect cells from further damage. For example, cells might increase the production of antioxidant
molecules to combat oxidative stress or activate repair mechanisms to handle damage.
REV -5/24
3
Downloaded by Benjamin Luca ()
