NURS 611 Advanced Pathophysiology Exam 1 Study Guide

Nurs 611 Advanced Pathophysiology Key Points Exam 1: Know Cell components and what they do: · Nucleus- Located in the center of the cell and contains the nucleolus which is composed of DNA, RNA, histones, and chromosomes. Primary functions are cell division, replication and repair of DNA, and transcription of RNA. · Ribosomes- Protein making factory (nucleoproteins). Goes into the nucleus, gets the “recipe”, transcribes the DNA, brings it out of the nucleus and releases the protein into the cytoplasm. · Lysosome- “garbage disposal”. filled with enzymes that digest organic molecules within the cell. They use hydrolase to break down the molecules. · Peroxisome- “garbage disposal”. Contain oxidative enzymes catalase and urate oxidase. Larger than lysosomes. Detoxifies compounds and fatty acids that contain hydrogen. What are Free Radicals or Reactive Oxygen Species? How do they cause damage? Free radicals are unstable electrically uncharged molecular species that roam free and will steal electrons from other cell membranes thus destroying that cell. Cell membrane · What is the Plasma Membrane made up of? The membrane is made up of lipids and proteins (lipid bilayer) · Why do we need a Cell membrane? The cell membrane acts as a “filter”. They provide protection, transport material, allow cell to cell interaction. · How is Osmolality different between ICF and ECF? Body osmolality is 280-294 and ICF and ECF are equal. · What do proteins do for the cell? How much of the Cell membrane is made up of protein? Proteins perform most of the membrane's tasks. They are the cell's workhorses. They transport things across the cell membrane and act as receptors, enzymes, or transporters. · What is a protein? Made from a chain of amino acids called polypeptides. There are 20 types. 3 types of Cell junctions: · Describe what Tight junctions are and why we need them? Barriers to diffusion. Prevent movement of substances. Prevent leakage. · Describe what Gap junctions are and why we need them? Clusters of communicating tunnels. They allow small ions and molecules to pass from inside one cell into the inside of another cell.· Describe what Desmosomes are and why we need them? They unite cells. They unite cells by forming continuous bands of epithelial sheets or by developing button-like points of contact. Energy · What is Oxidative phosphorylation? Occurs in the mitochondria. Mechanism in which energy produced from carbs, fats, and proteins is transferred to ATP. · What is the Inside of cell main Cation? Potassium · What is the outside of cell main Cation? Sodium · Is the inside of the cell positively or negatively charged? Negative. The Resting membrane potential= -70 to -85 millivolts · Is the outside of the cell positively or negatively charged? Postive Transport: · Describe what diffusion is? Is it active or passive? Give an example? Movement of solutes from an area of greater concentration to lower concentration (move with the concentration gradient). This is a passive process. Example: putting blue dye in a cup of water. The dye will spread out until evenly distributed. · Describe what Facilitated diffusion is? Is it active or passive? Give an example of facilitated diffusion? The process of passive transport (move with the concentration gradient) of molecules or ions across a membrane via specific transport proteins. Ex: glucose needs a transport protein because it is too big to pass through the lipid bilayer on its own. · Describe Active Transport? Is it active or passive? Give an example? Requires energy to move molecules against a concentration gradient through transport pumps. Ex. sodium/potassium dependent adenosine triphosphate pump. This is an active process. Tonicity · What does the cell do in a Hypotonic solution? Swells · What does the cell do in a Isotonic solution? Stay the same · What does the cell do in a Hypertonic solution? Shrinks Give an example of a hypotonic solution? Water Give an example of an isotonic solution? 0.9 %Normal saline and 5% dextrose Give an example of a hypertonic solution? 3% saline solutionWhat are Oncotic pressure verses Hydrostatic pressure? Oncotic pressure= overall osmotic effect of colloids; Hydrostatic pressure= the mechanical force of water pushing against cellular membranes. What part does albumin do with keeping fluid in blood vessels? maintains intravascular colloid osmotic pressure What is happening in edema or third spacing if albumin is low? The fluid is leaking outside of the vascular system into the interstitial spaces. What happens to calcium if albumin is low? Calcium decreases Electrical Impulses and Membrane potential Define: Resting Membrane Potential? This is the difference in electrical charge between the outside of the cell and the inside of the cell. This is approx. -70 to -85 millivolts. Action Potential? When the nerve/muscle cells receives a stimulus that exceeds the membrane threshold value causing a rapid change in the resting membrane potential Depolarization? Movement of sodium into the cell which causes the membrane potential to move from a negative value to 0. Polarity is neutralized. Repolarization? The negative polarity of the resting membrane potential is reestablished. What is the difference between the relative refractory and Absolute refractory period? Relative refractory= when permeability to K+ increases, a stronger than normal stimulus can occur and evoke an action potential Absolute refractory period= the time in which the plasma membrane cannot respond to additional stimulus. Key Points WEEK 2: Altered Cell metabolism and Genetics Altered Tissue Define and give examples of each Condition Define Example Atrophy Decrease or shrinkage in cellular size When the muscles shrink due to inactivityHypertrophy Increase in the size of cells Muscles that grow larger due to heavy work Hyperplasia Increase in the number of cells When organs regenerate (i.e. The liver after a partial removal) Metaplasia The reversible replacement of one mature cell type by another. When the squamous cells of the esophagus are repeatedly damaged by acid reflux so the body adapts and replaces the squamous cells w/ granular cells Is Dysplasia considered a true adaptive process? No What is the difference between physiological change and a pathological change? Physiological change is natural and normal Pathological change is caused by damage or disease Cell injury 1.- Define Ischemia- Reduced blood supply 2.- Define Necrosis- type of cell death that involves swelling and the breakdown of organelles, rapid loss of plasma membrane, and mitochondria dysfunction. 3. – Define Infarction- area of coagulated necrosis What is the most common CAUSE of cell injury? Hypoxia Which is worse Hypoxia or Ischemia? Why? What is the difference between necrosis and apoptosis? Necrosis is irreversible damage and destruction of cells (always pathological) Apoptosis is an active process of cellular self destruction. This type of cell death can be natural (physiological) Ex: RBCs get old and they break down and get recycled. Necrosis: explain the difference · Dry gangrene – Coagulative necrosis resulting in dry skin that shrinks and the color changes to dark brown or black· Wet Gangrene- develops when neutrophils invade the site causing liquefactive necrosis. Usually occurs in internal organs. Cells and Aging: What happens to cells as we age? Cells undergo atrophy, decreased function, and loss of cells. What is somatic death? Death of the entire person Free Radical Injury– Explain what happens with ROS ? When there is a disturbance between ROS and antioxidant defenses this is called oxidative stress. This causes cell injury, cancer, and certain degenerative diseases. Chemical Injury List common types of chemical injuries and what happens in the body? Arsenic, cyanide, air pollutants, insecticides, carbon monoxide, alcohol, opioids, acetaminophen, lead, and mercury. - Genetics · What is Genotype give example? Composition of genes at a given locus · What is Phenotype give example? Outward appearance of a person (result of both genotype and environment) · DNA has 4 nitrogenous bases what are they? Adenine, cytosine, guanine, thymine · Mutation: ( what does this mean)- any inherited alteration of genetic material · Base Pair substitution also called mis-sense mutation: when one base pair is replaced by another (sometimes there is no consequence) · Frameshift mutation: the insertion or deletion of one or more base pairs to the DNA molecule. · What is a Mutagens? Give an example: mutagens are an agent that can increase the frequency of a mutation. Ex: radiation. · Which part of the cell can be damaged the most by radiation? The nucleus Explain the process of how we make a Protein? What is translation? The process by which RNA directs the synthesis of a polypeptide. What is transcription? The process by which RNA is synthesized from a DNA template. Where does protein synthesis occur? Protein synthesis occurs within the ribosomes which are located in the endoplasmic reticulum.CHROMOSOMES: · How many pairs chromosomes do we have? 23 · What is a Gamete cell ? sperm and egg cells · What is a Somatic cell ? all other cells · What is a Karyotype? An ordered display of chromosomes Genetic Diseases: DEFINE THE FOLLOWING · Aneuploidy: cells that do not contain a multiple of 23 chromosomes · Penetrance: the percentage of individuals with a specific genotype who also exhibit the expected phenotype. · Expressivity: the extent of variation in a phenotype associated with a particular genotype. Alleles · What is a Dominant allele? The allele whose effects are observable · What is a Recessive allele? The allele whose effects are hidden · What is a Carrier? Is an individual who has a disease causing allele but is phenotypically normal. Relative Risk What is relative risk mean? Measure of the effect of a specific risk factor= increased rate of the disease among individuals who are exposed divided by incident rate of the disease among those who are not exposed to the risk factor What is incidence? How do you calculate it? The number of new cases of a disease reported during a specific period (typically 1 yr) divided by the number of individuals in the population. What is prevalence? How do you calculate it? The proportion of the population affected by the disease at a specific point in time. (determined by both the incidence rate and the length of survival period in affected individuals. Epigenetics What is epigenetics? The process that modulate how a given set of genomic information gives rise to phenotype. How does environmental factors affect epigenetics? Maternal nutrition and maternal care can affect epigenetics in offspring. Lack of nutrition in pregnancy has shown that the offspring are more likely to develop obesity and diabetes. Can epigenetic modifications be reversed? If so how? They are reversible because they do not change the DNA. The can be reversed by DNA methylation, histone modifications, and alteration in microRNA. What is hypermethylation associated with? CancerPediatric considerations: What is Downs syndrome? What are typical characteristics? Trisomy of the 21st chromosomelow nasal bridge, epicanthal folds, protruding tongue, flat/low set ears, and IQ score between 25-70, poor muscle tone, and short stature. Can also have congenital defects. What is Turners syndrome? What are typical characteristics? Presence of one x chromosome and No homologous x or y chromosome which results in 45 chromosomes- always female, sterile, and have gonadal streaks instead of ovaries. Short stature, webbing of the neck, widely spaced nipples, narrowing of the aorta, and sparse body hair. What is Klinefelter’s syndrome? What are typical characteristics? Individuals with at least two x chromosomes and a Y chromosome. Usually male appearance. Sterile, develop female like breasts, testes are small, sparse body hair, tall stature, high pitched voice, and a moderate degree of mental impairment. What is a congenital disease? Diseases that are present at birth Key Points Chapter 3: Fluid and Electrolytes: Review how Aging affects the Distribution of water in the body? The percentage of TBW decreases with age due to an increase in fat, decrease in muscle, and the reduced ability to regulate sodium and water balance. Kidneys become less efficient in conserving sodium. Increased water loss through the skin and decreased thirst perception. How does have a normal, lean or obese frame affect TBW? Lean body mass carries much more body water than body fat. How does water move between ICF and ECF? Osmotic forces and passive transport (diffusion). What drives hydrostatic pressure? Driven by the blood pressure generated in the blood vessels by the contraction of the heart. What drives oncotic pressure? Osmotic effects of colloids such as plasma proteins (albumin).What are 4 causes of edema? ● Increased capillary hydrostatic pressure ● Decreased capillary oncotic pressure ● Increased capillary membrane permeability ● Lymphatic obstruction How does sodium and chloride and bicarb affect water balance? What does aldosterone do? ● Main hormone released to increase perfusion ● Released by adrenals ● Holds onto Na+= holds onto water ● Opposite of peptides What are natriuretic peptides? Why does an elevated BNP indicate CHF? ● Hormones released when there is an increase in intraatrial volume (HF) ● Leads to increase in Na and water excretion by kidneys= decrease blood volume and pressure ● BNP (produced by ventricles) when the body sense increased volume What initiates osmoreceptors? ● A rise ini serum osmolality= causes thirst and signal to pituitary to release ADH What does the Antidiuretic hormone (ADH) do? Think water ● Released by the pituitary gland when the body senses decreases in blood pressure/ volume Normal Pathophysiology Clinical manifestation s Evaluation and treatment Hypernatremia Think brain Greater than 145 Intracellular dehydration, inadequate water intake, sweating, too much aldosterone Weakness lethargy, confusion, sz Eval-urine specific gravity (will be greater than 1.03), hematocrit and plasma protein will be elevated treatment-or al fluids, 5% dextroseHyponatremia Less than 135 Too much water, not enough sodium N/V, headache, lethargy, confusion Eval- history labs/urine (specific gravity will be less than 1.01 Hyperchloremia Greater than 105 Occurs with hypernatremia No specific symptoms Treat underlying cause Hypochloremia Less than 97 Occurs with hyponatremia, diuretics, vomiting, No specific symptoms ? Treat underlying cause Hyperkalemia Greater than 5 Renal failure, too much dietary intake, K+ sparing diuretics, Addison’s disease, trauma, insulin deficiencies Tingling, numbness, Calcium gluconate, give glucose/ glucose + insulin in diabetics, dialysis if in renal failure Hypokalemia Less than 3.5 Less K+ in the cell, decrease dietary intake, alcoholism, too much Vit B12/folate, DKA, Diarrhea Muscle weakness, cardiac dysrhythmia s, lethargy, confusion, bradycardia, Ileus Give potassium Hypercalcemia Greater than 10.5 Cancer, hyperparathyroidis m, Fatigue, lethargy, nausea, osteoporosis Oral phosphate, calcitonin, large amounts of NSHypocalcemia Less than 8.5 Decrease in PTH, decrease in Vit d, massive blood transfusion, no enough albumin Cardiac arrest, prolonged T waves, dysrhythmia s, confusion, muscle spasms Calcium gluconate, treat underlying causes Hyperphosphat emia Greater than 4.7 Renal failure, chemo, long term use of of laxatives, phosphorus released into the ECF Cardiac arrest, prolonged T waves, dysrhythmia s, muscle spasms Albumin Hypophosphate mia Less than 2 Antacids, Vit D deficiency, hyperparathyroidis m, resp alkalosis Hypoxia, bradycardia, confusion, muscle weakness Phosphoru sR eplaceme nt Hypermagnese mia Renal failure, antacids adrenal insufficiency Lethargy, cardiac arrest, bradycardia Dialysis, avoid magnesium containing substances Hypomagnesae mia Less than 1.5 Alcoholics, malnutrition, loop diuretics, Muscle cramps, tachycardia, hypotension, confusion Magnesium Electrolytes: ACID BASE: Review normal PH and the buffering system which tries to bring body back into balance ● As hydrogen (H+) increases pH decreases, H+ decreases pH increases ● The lungs and the kidney regulate excretion of acids● Most important extracellular buffer- bicarbonate–carbonic acid and hemoglobin. ● Phosphate and protein are the most important intracellular buffers and provide a first line of defense. Ammonia and phosphate can attach hydrogen ion and are important renal buffers. Pg. 122 in digital book Know common causes of and pathophysiology of the following and Understand how the renal and respiratory systems compensate for imbalances. Metabolic acidosis: ● Acid being dumped into the body ● Elevated anion gap ● Evaluate- electrolytes are better than repeat ABGs ○ K-Jetoacidosis ○ I-Ingestion ○ L-lactic acid ○ U- Uremic acid ● Resp- tries to compensate through hyperventilation ● Kidneys- trying to conserve base and rid of acid Respiratory acidosis ● Occurs with hypoventilation- common cause airway obstruction ● Hold onto CO2 ● kidneys - slow to help Metabolic alkalosis ● Bicarb is elevated, losing acid ● Diarrhea, vomiting, excessive NG suctioning, hypokalemia, hyperaldosteronism ● Resp- decreases resp rate to hold onto CO2 Respiratory alkalosis ● Occurs with hyperventilation ● Kidneys- conserve H+ and secrete bicarb How do you determine if compensation is occurring? What does compensation mean? ● HCO3 /= to 24 = renal compensation for resp acidosis ● PaCO2 40 = resp compensation for metabolic acidosis ● HCO3 /= 24= renal compensation for resp alkalosis ● PaCO2 40 = resp compensation for metabolic alkalosis Explain the neuronal discharge? · Communication from one neuron to another through a neurotransmitter.· Dendrites receive the impulse—excites or inhibits—signal sent to cell= excites = response, if inhibits= no response What do afferent, efferent and interneurons do? ● Peripheral nervous system= sensory and motor neurons ● Afferent neurons= sensory, send signals to CNS ● Efferent neurons= motor, receives signals from the CNS ● Interneurons= help connect the two signals together How is the CNS divided? · Brain and spinal cord How are the Parasympathetic and Sympathetic systems different? Parasympathetic Sympathetic Eyes Constriction Dilation Lungs Contraction Relaxation Cardiac response Decrease HR Increase HR Peripheral Blood vessel response Dilation Constriction GI tract response Increase motility, excretion Decrease motility, inhibition Which system controls DAY to DAY activity? · Parasympathetic o Main neurotransmitter= Ach o Activates the gut Which system does an anticholinergic work on? · Sympathetic o Main neurotransmitter= norepi/epi o Fight or flight o Elevates glucose for fuel How do excitatory and inhibitory NT work? · Excitatory neurons o Acetylcholine- most common cholinergic neurotransmittero Strored in the vesicles waiting to be activated—released into synaptic cleft—binds to a receptor—muscle contracts o Stimulates muscle contractions Memory, cognition, proper motor control · Inhibitory neurons o Glycine- released from interneurons in the spinal cord—binds w. psot synaptic receptor= opening of calcium channels = inhibits the action What is a seizure? · Excessive neuronal discharge · In children o Around puberty · 2 witnessed sz to diagnose · Ct to rule OUT a lesion or tumor · EEG to rule IN diagnosis Can a brain injury cause a seizure? Yes Could low blood sugar cause a seizure? Yes Could withdrawal cause a seizure? How? · ???? Ischemic stroke · Obstruction of arterial blood flow to the brain = inadequate cellular oxygenation= infarction · Thrombotic- clot in an artery, common from atherosclerosis · Embolic – fragment that broke off from a thrombus and traveled to the brain, originates outside of the brain. From the heart · Hemodynamic- hypoperfusion, cardiac arrest Hemorrhagic · Bleeding in to the brain · Can occur within brain tissue, subarachnoid, subdural · Hypertension- takes years to develop, causes thickening of the walls What is the most common cause? · HTN/ Smoking ? What is a TIA? · Signs of a stroke last no longer than 1 hr.· Penumbra- area around that surrounds the damage, if oxygen is restored before permanent damage occurs= no lasting effects · Risk of stroke in the next 3 months = 15% Explain the difference between Multiple Sclerosis and Guillain- Barre? Multiple Sclerosis · Chronic inflammatory disease · Involves the CNS · Destroys Myelin sheath · Genetically predisposed Guillain-Barre · Autoimmune trigger by an infection or possibly immunization · Involves the peripheral nervous system · Progresses upwards · Damaged myelin usually resolves Explain Myasthenia Gravis? · Leads to muscle fatigue · Acetylcholine receptors are blocked · Dysphagia is a late sign Why does physical therapy not help with Myasthenia Gravis? · Because it a communication problem between the nerves and the muscles and physical therapy is unable to improve that communication Explain Parkinson’s? What is the NT involved? How does the body respond to this deficit? · Neuromuscular disorder · There is not enough dopamine (inhibitory) in the basal ganglia = poor connections to the thalamus and motor cortex · Affects the pathway with GABA (inhibitory) and glutamate (excitatory) = symptoms of Parkinson’s · Substantia nigra- Main are where dopamine is depleted Explain Pain Acute pain (type A) · Follows an injury, heals when the body heals · Sharp, prickling, electric, can point to it, not felt in deeper tissues · Fast pain Chronic pain (type C)· Can’t see the symptoms- body no longer responds with sympathetic nervous system · Can be linked to an acute injury · Slow pain- increases slowly, burning, aching, throbbing, can’t point to it, can’t sleep through it Deafferented pain- nerve pain, gabapentin settles nerve signals Migraine- with and without aura · One sided, throbbing, light/noise sensitivity, typically in women · Aura- visual, auditory, sensory Tension · Band-like across the eyes Cluster · Around the eye, rapid onset causes stuffiness, typical in men Temporal · Headache in the temple Brain injury: What is the difference between a focal or a diffuse brain injury? Focal- effects on area of the brain, can be caused by closed or open injuries Diffuse- effects multiple areas of the brain, involves neurons throughout the brain What happens in a concussion? 556 What is TBI? · Alteration in brain function caused by an external force · Causes- falls, blunt trauma, MVAs Mental issues Explain what happens in schizophrenia? · Emerges late teens/early twenties · Thought disorder- creating a split between cognitive side and emotional side of personality · positive and negative symptoms including auditory hallucinations, paranoid delusions, and cognitive deficits · genetic but environmental factors play a role in disease development· enlargement of the ventricles, too much dopamine, not enough glutamate Explain the difference between dementia and delirium? Dementia · Deterioration and progressive failure of cerebral functions · May have no other associated conditions · Chronic, slow decline Delirium · Acute confused state caused by something else · associated with autonomic nervous system hyperactivity and typically develops over 2 to 3 days. · Disruptions takes place in the upper brainstem · Can be caused by UTI, hospitalization, trauma, multiple meds... · Disrupted sleep, impaired Pediatric points What is anencephaly? · Missing the soft bony part of the skull and brain · Typically causes a still birth or they die within days after birth What is a Chiari Malformation and how might it present? · Malformation of the brainstem and cerebellum · Can be caused by hydrocephalus o Creates pressure that blocks the flow of cerebrospinal fluid and syringomyelia, an abnormality causing cysts at multiple levels within the spinal canal What is Cerebral Palsy and what population is it most common in? · Disorder of movement, muscle tone or posture · Caused by an injury or abnormal brain development before, during or after birth up to 1 year· More common in African Americans