NR 283 Pathophysiology Exam 1
Concepts to Review
NR 283 Pathophysiology Exam 1
Concepts to Review
Cellular Biology/Cellular Adaptation/Cellular
... [Show More] Injury Chapter 1 and 3
8 functions of cells
o Movement – muscle cells generate force to produce motion
o Conductivity – As a response to a stimulus. This is the chief function of nerve cells
o Metabolic Absorption – take in and use nutrients
o Secretion – with mucous gland cells – absorb substances to be secreted elsewhere
o Excretion – Rid themselves of waste products
o Respiration – Absorb oxygen to transform nutrients to energy
o Reproduction – New cells produced to replace those lost
o Communication – vital for cells to survive as a society (think Osmosis Jones movie)
ATP
• ATP or adenosine triphosphate plays a major role in that
• ATP is a molecule that stores and transfers energy for the functioning of our cells
• Specifically it is used in the synthesis (creation) of molecules, muscle contractions, and active transport
Mitochondria the main job of the mitochondria is that it produces most of the cell’s ATP or energy.
Cellular metabolism
There are 2 parts to metabolism:
• Anabolism
• The energy using process
• Catabolism
• The energy releasing process
Ribosomes
Ways of cellular communication
Cellular respiration
Anaerobic and aerobic
Sodium/Potassium pump-function, what happens when it fails?, need ATP for this…
Cellular adaptation-hypertrophy, atrophy, hyperplasia, metaplasia, dysplasia (know examples, pathologic, physiologic, hormonal, compensatory)
Reversible/irreversible injury
Apoptosis vs. Necrosis
Apoptosis (“dropping off”) is an important distinct type of cell death that differs from necrosis in several ways. Apoptosis is an active process of cellular self-destruction called programmed cell death and is implicated in both normal and pathologic tissue changes
Necrosis--Cellular death eventually leads to cellular dissolution, or necrosis. Necrosis is the sum of cellular changes after local cell death and the process of cellular self-digestion, known as autodigestion or autolysis
Types of Necrosis (liquefactive, coagulative, fat, gas gangrene, dry gangrene, wet gangrene caseous)
Dry gangrene: Slow spreading, tissue becomes dry, brown or black, it shrinks and wrinkles.
Wet gangrene: Area is cold, swollen, pulseless, moist, black and a foul odor production
Coagulative necrosis. Occurs primarily in the kidneys, heart, and adrenal glands; commonly results from hypoxia caused by severe 103ischemia or hypoxia caused by chemical injury, especially ingestion of mercuric chloride. Coagulation is a result of protein denaturation, which causes the protein albumin to change from a gelatinous, transparent state to a firm, opaque state .The area of coagulative necrosis is called an infarct.
Types of cells
Cellular Injury (Chemical, Ischemia, Free Radicals, Reperfusion, Infectious, etc.)
Ischemia: lack of blood flow
Types of Injury (Blunt force, sharp, asphyxiation, gunshot wound, etc.)
Bruising-hemosiderin
Steps in cellular injury
Aging
Somatic Death-stages after death of body (livor mortis, algor mortis, rigor mortis)
2 Death-stages
1) Somatic death, which is the cessation of the vital process, and (2) molecular death, which is the progressive disintegration of the body
Changes that occur within the first 12 hours of death
i. Algor mortis (Cooling of the body)
ii. Livor mortis/Post-mortem hypostasis (Lividity) the blood will tend to flow downward. Consequently they will accumulate in capillaries and small veins in dependent parts of the body, and this is manifest as a purple or reddish-purple colour on the skin. This is known as lividity, and it is usually apparent within half an hour to two hours after death, fully developing within 12 hours
iii. Rigor mortis (Stiffening of the body)
Genetics Chapter 2
DNA- in the nucleus
• GENES ARE COMPOSED OF DNA WHICH HAS 3 BASIC COMPONENTS:
• A 5 CARBON MONOSACCHARIDE (DEOXYRIBOSE)
• A PHOSPHATE MOLECULE
• 4 NITROGENOUS BASES
• 2 ARE PYRIMADINES: CYTOSINE AND THYMINE
• 2 ARE PURINES: ADENINE AND GUANINE
• THE IMPORTANCE OF DNA IS THAT IT DIRECTS THE SYNTHESIS OF ALL THE BODY’S PROTEINS
• DNA REPLICATION CONSISTS OF BREAKING THE WEAK HYDROGEN BONDS BETWEEN THE BASES, LEAVING A SINGLE STRAND WITH EACH BASE UNPAIRED
• THE CONSISTENT PAIRING OF A TO T AND C TO G IS CALLED COMPLEMENTARY BASE PAIRING.
• IT IS THE KEY TO ACCURATE REPLICATION OF THE DNA
RNA (RIBONUCLEIC ACID)
• now remember, DNA is formed in the nucleus and the synthesis of the protein takes place in the cytoplasm
• the code or information from the DNA has to make it out of the nucleus so that the protein can be made
• this is done by RNA through the processes of transcription and translation
• RNA is very similar to DNA with a few exceptions:
• the sugar molecule is ribose instead of deoxyribose
• one of the nitrogenous bases is different, instead of thymine, RNA has uracil
• RNA is typically only a single strand, not a double
Mitosis/Meiosis for cellular replication
• Meiosis is the formation of new gamete cells
• Mitosis is the formation of new somatic cells
Chromosomes (normal number, abnormal numbers-aneuploidy, tetraploidy, etc, Monosomies, Trisomies, etc.)
• Triploidy is when a zygote has 3 sets of each chromosome for a total of 69 pairs (23 x 3)
• Tetraploidy is 4 sets of each chromosome for a total of 92 pairs (23 x 4)
• Trisomy
• A cell containing three copies of one chromosome
• Monosomy
• The presence of only one copy
of a given chromosome in a
diploid cell (somatic)
• Aneuploidy
• A somatic cell that does not contain 23 pairs of chromosomes
Genes: When talking about genetics and genetic inheritance, there are a few things we need to talk about
• Remember we get our genes from our parents
• The genotype is what your genetic material is or says.
• It is what you have
• The phenotype on the other hand is what you portray on the outside (your appearance)
• It is what you demonstrate
• When looking at your genes, we also look at which one is dominant versus recessive
• The gene that is portraying the observable effects (or your phenotype) is your dominant gene
• The characteristics or elements that are hidden are considered to be on your recessive gene
• It is the gene that is hiding and not portraying your characteristics
Mutations is an inherited alteration of genetic material.
Two types of Mutations
• Silent Mutation
• Where one base pair is exchanged or substituted for another
• This typically does not cause any consequences in the individual, hence it is called a silent mutation
• Frameshift mutations
• The insertion or deletion of 1 or more base pairs in the DNA molecule
• This will alter the amino acid and can cause serious consequences in the individual
• For example, a patient may be born with some type of deformity or mental retardation
Genetic Diseases-know where these examples fall under inheritance; chance of inheritance as it applies to X-linked, autosomal dominant, and autosomal recessive
An autosomal dominant disease is an inherited disease that is on a non-sex chromosome on a dominant gene, or the gene that portrays who or what you are.
An autosomal recessive disease is an inherited disease that is on a non-sex chromosome on the recessive gene that typically “hides”. Remember you don’t portray the characteristics of the recessive gene
X-linked: the sex chromosome diseases are typically called X Linked Inheritance because it is the X chromosome that is most likely affected.
PKU- which is a disorder when your body can’t digest is an example of autosomal recessive
Down Syndrome is the best known example of autosomal aneuploidy, which is a Trisomy of chromosome 21. Physical characteristics such as a low nasal bridge, epicanthal folds, protruding tongue, and poor muscle tone
Turner Syndrome (falls under aneuploidy) is seen in females, in which they have only 1 X chromosome
• So this individual only has 45 chromosomes instead of 46
• An individual with Turner Syndrome is underdeveloped and short, sterile, and can also have webbing of the neck
Kleinfelter’s Another type of sex chromosome aneuploidy is Klinefelter Syndrome
• This is a male who has 1 Y chromosome and 2 or more X chromosomes
• Characteristics of Klinefelter’s include:
• Long limbs
• Female like breasts
• Small testes
• Sparse body hair
Marfan’s autosomal dominant disease. physical appearance are, tall, large hands.
Cri du chat: Chromosomes that break and lose their DNA are called deletions
• The most often seen example is in a condition called Cri du Chat
• Cri du chat is deletion of the short arm of chromsome 5
• Cri du chat literally means cry of the cat which describes the cry of the child with this condition
• These children also have low birth weight, mental retardation, and microcephaly (smaller head size than normal)
Huntington’s: An autosomal dominant disease which is a Neurological disease that affects your movements. E.g spastic movement and dementia
Color Blindness X-linked diseases, happens more in males.
Hemophilia X-linked diseases, is a bleeding disease mostly in male, because females have 2 XX to cover each other in the case of blood cloth, but males only have 1 X
Duchenne’s Muscular Dystrophy
Cystic Fibrosis: autosomal reccessive
Chapter 4
What controls sodium balance
• Sodium is the primary positive ion found in the extracellular fluid.
• It regulates osmotic forces and helps to maintain acid base balance, chemical reactions, and membrane transport
• Natriuretic peptides are another type of hormone that help regulate sodium balance
• These peptides are ANTAGONISTS to aldosterone
• So when natriuretic peptides are secreted it will promote:
• Sodium and water excretion
• Decrease in blood volume
RAAS
Renin-Angiotensin Aldosterone System
• Aldosterone secretion is influenced by
o Circulating blood volume
o Blood pressure
o Serum concentrations of Na and K
• When aldosterone is secreted, it will promote
o Reabsorption of sodium and water
o Excretion of potassium
o Increase in blood volume
o Increase in BP
Causes of Edema
• 1. An increase in capillary hydrostatic pressure:
o Remember, hydrostatic pressure pushes water, so in edema the capillary is pushing a lot of fluid into the interstitial space
o This can happen if there is an obstruction in a vein
Pressure behind the obstruction (in the capillary) increases, causing more fluid to be pushed out
Seen in patients with prolonged standing (nurses!!)
o This can also happen if there is water retention, like in patient’s with CHF
• 2. A decrease in capillary oncotic pressure
o Remember, oncotic/osmotic pressure pulls water, so in this case, the capillary is not pulling all the fluid back like it is supposed to, leaving excess fluid in the tissue
o This is typically seen in someone who has a decreased production of plasma proteins, such as in someone with liver disease
• 3. Increases in capillary permeability can be another cause
o This will cause a loss of plasma proteins
o Which in turn will affect capillary oncotic pressure
• 4. An obstruction in the lymph system can cause edema
o This will cause proteins and fluid to accumulate in the interstitial space, because normally the lymph system carries out any extra fluid that should not be there
Types of edema (localized, generalized)
o Localized edema is limited to a site of trauma (think of a broken finger) or in a particular organ system.
o Generalized edema is a more uniform distribution of fluid in interstitial spaces (legs and feet).
Third spacing
• An important thing to remember about edema, is that the excess fluid gets trapped in what is called a 3rd space (think of when a doctor or nurse has used the word 3rd spacing)
Hypervolemia (S/S, causes)
• Isotonic fluid excess causes hypervolemia
• Causes include: excessive administration of IV fluid, or the effects of some drugs
Hypovolemia (S/S, causes)
• Isotonic alterations are total body water changes that have proportional changes between the electrolytes and water, so no change occurs to the cell
• Isotonic fluid loss causes hypovolemia.
• Causes include: hemorrhage, severe wound drainage, excessive sweating, and inadequate fluid intake
**Remember, when we are talking about hyper or hypo states, we are looking at what is occurring in the ECF or the serum (always, no matter what electrolyte we are talking about)**
Hypernatremia (S/S, causes)
• Hypernatremia occurs when the sodium levels are >145.
• Hypernatremia has many causes:
o Increased retention of sodium
From an increase in aldosterone secretion (remember it gets secreted to increase NA reabsorption)
o Ingestion of large amounts of sodium without taking in a proportionate amount of water as well
o Increased loss of water or water deficit
Such as could be seen with watery diarrhea
Insufficient secretion of ADH causing the body to fail to retain fluid
Water deficit
Hyponatremia (S/S, causes)
• Hyponatremia is when the sodium level is less than 135.
• Hyponatremia also has many causes:
• A loss of sodium
• This can be from excessive sweating, or fluid and electrolyte loss from vomiting or diarrhea
• It can also be caused by an imbalance of Aldosterone( regulates salt and water in the body)
• And certain diuretic medications can cause it as well
• A common cause of hyponatremia is an increase in water intake or water excess
• This will cause sodium levels to get diluted
• A decreased intake of sodium can also cause hyponatremia, but this cause is usually quite rare
• Sodium deficits cause intracellular over-hydration and cell swelling
• Because there is less sodium in the serum, the water wants to go where there is a greater concentration of sodium, inside the cell
• Common clinical manifestations are confusion, weakness, and muscle twitching. More severe CM’s are coma and seizures.
Hyperkalemia (S/S, causes)
• Hyperkalemia is when the potassium level is greater than 5.5
• Hyperkalemia is rare because an acute increase in potassium levels are dealt with by the kidneys excreting it
• Causes of hyperkalemia include :
• Increased potassium intake
• Shift of potassium from the cells to the ECF
• Seen with cellular trauma/Burns
• Decreased renal excretion
• Usually caused by renal failure
• Hormone deficit
• Specifically Aldosterone
• Clinical manifestations vary with the rate and severity of hyperkalemia. Restlessness, muscle weakness, decreased cardiac conduction, EKG changes and dysrhythmias are common.
Hypokalemia (S/S, causes)
• Hypokalemia is a potassium level less than 3.5
• Hypokalemia is caused by a
• Reduced intake of potassium
• Increased entry of potassium into the cells
• As would be seen with an ALKALOSIS (K moves into the cell to maintain equilibrium because of the lack of Hydrogen ions)
• Increased loss of body potassium
• Such as with the use of diuretics
• Diarrhea
• Excessive aldosterone secretion
Sodium imbalances think neuro,
potassium imbalances think heart
Potassium is the major intracellular electrolyte essential for cell function
• The concentration of potassium is maintained by the Na/K pump
• Potassium has an essential role in ICF osmolality, transmission of nerve impulses and cardiac rhythms, and muscle contraction
• The most efficient regulator of potassium balance is the kidneys
• Too high or too low potassium levels will have a significant effect on your heart and its ability to contract
• It can even lead to death
Hypovolemia- low vomiting of blood-monitor BP and resuscitate fluids with NS
Dehydration S/S
Vocabulary Terms
Hypotension (low blood pressure)
Hypertension (high blood pressure)
Bradycardia (low heart rate)
Tachycardia (high heart rate)
Anemia (low red blood cell count)
Leukopenia (low white blood cell count)
Thrombocytopenia (low platelet count)
Jaundice (yellowing of skin and mucous membranes usually due to liver failure or insufficiency)
Edema (swelling from fluid accumulation)
Cancer Chapter 9 & 10
Neoplasm
The term tumor is now referred to as a neoplasm or new growth. Not every tumor or neoplasm is cancer
Malignant tumors
Malignant tumors (or cancers) grow more rapidly and they lose the definition and organization of cells that are definitive of benign tumors
A hallmark sign of a cancer cell is anaplasia which is the loss of cellular differentiation
Malignant cells are also pleomorphic which means that the cells are markedly different in both size and shape
Malignant tumors lose their normal tissue structure, and they typically do not have a capsule enclosing it, so it is free to grow and invade nearby blood vessels, lymphatics, and tissue.
The most important part about malignant tumors is their ability to spread far beyond the original tissue where the cancer cells originated, this is known as metastasis
Just like with benign tumors, malignant cancers are named for the place at which they originate.
o Cancers in epithelial tissue are known as carcinomas
o Cancers of lymphatic tissue are called lymphomas
o Cancers of connective tissue, muscle or bone are called sarcomas
Benign tumors
Benign tumors are slow growing and are made up well differentiated cells, and they have a well defined capsule or stroma of connective tissue surrounding itself.
They retain a typical tissue appearance and they do not spread beyond that stroma
Benign tumors are typically named according to the tissue that they arise from, and the suffix –oma is included.
For example, a benign tumor of the fat cells is a lipoma.
Malignant tumor characteristics (contact inhibition, anchorage independent, immortality)
Contact inhibition
o Normally when cells are dividing, the growth process will stop when 2 cells come into contact with one another. That is what contact inhibition is. Cancer cells do not have this, and will continue to divide and grow, often times piling up on each other.
Anchorage independent
Cancer cells are anchorage independent and can divide and grow even when suspended
Immortality
Cancer cells are considered immortal and will continue to divide and grow for years in a lab setting.
Metastasis forms (seeding, vascular system, lymph system)
• Seeding – which is when cancer cells penetrate the wall of a neighboring organ or body cavity, and spreads throughout that area
• Venous System – cancer cells may travel throughout the venous system
• During this time is when the cancer cells will overtake the immune/inflammatory cells to get throughout the body
• Lymphatic System – cancer cells moving through the lymphatic channels and lymph nodes
• This would be how people can get cancer of their lymph nodes/bone marrow, etc
Naming of malignant and benign tumors (adenoma, carcinoma, sarcoma, lipoma, etc)
Carcinoma-cancer arising in the epithelial tissue
Sarcoma- cancer arising in connective tissue, muscle, and bone
lipoma
Anaplasia is the loss of cellular differentiation in cancer cells
Angiogenesis This process, called angiogenesis, allows larger cancers to secrete factors to stimulate the growth of new blood vessels
Causes of cancer and their subsequent types (H. Pylori-stomach, EBV-Hodgkin’s lymphoma/b cell lymphoma, HIV/Aids- kaposi’s sarcoma, Hep. B, Hep. C, Epstein Barr
Risk factors for cancer: (cigarette smoking!!!!, alcohol, diet, environmental factors (e.g. radon, asbestos, rubber, etc), lack of hormones (estrogen), inflammatory processes, sun exposure, sexual behavior, etc.)
Effects of cancer on the body (malnutrition, leukopenia, anemia, thrombocytopenia)
Clinical manifestations of cancer (weight loss, fatigue, nausea/vomiting, etc.)
Staging of cancer
• Done using the TNM system (Tumor, Nodes, Metastases) to determine the extent to which a cancer has developed and/or spread
• Stages include 1-4, with 4 being the worst, which is usually a sign of distant cancer metastasis.
Carcinoma in situ (definition, three fates-progress, disappear, stable)
Are abnormal growths that have characteristics of malignant tumors, but because they have not invaded the basement layer of the tissue they are known as CIS)
These are commonly found in the cervix, skin, and esophagus
• Carcinomas in situ will do 1 of 3 things
o They can remain stable for a long time
o They can progress to invasive and metastatic cancers
o Regress and disappear
Tumor Markers and where they are found, examples (PSA, breast cancer gene, etc)
Tumor markers are substances produced by both benign and malignant cells that are in or on tumor cells or are found in blood, spinal fluid or urine.
Tumor markers are hormones, enzymes, genes, antigens, and antibodies
• Tumor markers can be used in 3 ways:
o To screen and identify people at high risk for cancer
o To help diagnose the specific type of cancer
o To follow the clinical course of the cancer
PSA or prostate specific antigen that identifies who is at risk for developing prostate cancer
Cancer treatment-surgery, chemotherapy, radiation
Dysplasia-precursor to cancer / an early stage in the development of cancer. E.g biopsy, pap smear
ABCDE for skin cancer detection
ABCDE rule: Asymmetry (one half of the mole doesn't match the other), Border irregularity, Color that is not uniform, Diameter greater than 6 mm — (about the size of a pencil eraser), and Evolving size, shape or color
Patient teaching for cancer prevention (diet, smoking cessation, exercise, protection during sex, reduce exposure to environmental risk factors, reduce alcohol consumption, inspect skin for suspicious lesions, use sunscreen and protective equipment, etc. [Show Less]