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NSG211 Exam 1 Study Guide (SP2022)
Pathophysiology (NSG 211)
Marian University
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PATHO/PHARM 2022Preview text
NSG 211
E XAM 1 STUDY GUIDE
“A GOOD RN IS ALWAYS LOOKING FOR TROUBLE” ~DR. BURNS
1. DEFINITIONS:
Pathophysiology: study of functional or physiological change that results in a disruption of normal biological function. This disruption may be hidden or obvious at the cellular level and can be present for years before knowing about it. Disease : a disruption, interruption, cessation, or disorder of bodily functions, systems, and organs; that prevent the body from maintaining a homeostatic status. Pathology : the directly observable laboratory study of cell and tissue changes associated with disease. : the worsening of symptoms or disease Idiopathic : arising spontaneously or from an obscure or unknown cause, “disease of itself,” that is, one of uncertain origin, apparently arising spontaneously. (e. Idiopathic pulmonary fibrosis (IPF)- a disease of aging that has long had a mysterious etiology and pathogenesis) Iatrogenic : a state of ill health or adverse effect caused by medical treatment; it usually results from a mistake made in diagnosis or treatment, and can also be the fault of any member of the healthcare team; induced in a patient by the treatment. Acute : disease/illness or symptom appears suddenly and lasts for a short amount of time (e heart attack, bronchitis, influenza, heartburn, headache etc.) Chronic : defined broadly as conditions that last 1 year or more (insidious) and require ongoing medical attention or limit activities of daily living or both. Chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death and disability in the United States. Nosocomial : originating in a hospital, also referred to as healthcare-associated infections (HAI), are infection(s) acquired during the process of receiving health care that was not present during the time of admission. Communicable : also known as infectious diseases or transmissible diseases, are illnesses that result from the infection, presence and growth of pathogenic (capable of causing disease) biologic agents in an individual human or other animal host. How these diseases spread depends on the specific disease or infectious agent. Some ways in which communicable diseases spread are by contact with blood and bodily fluids; breathing in an airborne virus; or by being bitten by an insect. (e. tuberculosis, measles, hepatitis A/B/C, influenza virus, etc.) Notifiable (or Reportable): diseases that must be brought to the attention of local/State/Federal healthcare agencies immediately, as soon as identified. (e. Cholera, Measles, Hepatitis A, Salmonellosis, gonorrhea, HIV, etc.) Predisposing Factors : the conditions and activities that can lead to the development of disease within a living organism. These may include genetics, life events, or temperament. Predisposing factors include predisposing characteristics and predisposing conditions. Predisposing characteristics are those factors that are based on the social and demographic factors of a public that have a major effect on their health, illnesses, and how they will accept treatment. The predisposing conditions are basically the same as the predisposing factors as they are those conditions that give way to the development of disease. (e. lifestyle habits, immune deficiency, stress, gene abnormalities, fatigue, age, environment, etc.) Precipitating Factors : refer to a specific event or trigger to the onset of the current problem. Perpetuating factors are those that maintain the problem once it has become established. (e blocked artery that leads to a heart attack) Manifestations : a perceptible, outward, or visible expression of the disease process or abnormal condition. Signs : a physical response linked to a medical condition or illness that is detected by a physician, nurse, or
medical device during the examination of a patient. Signs are objective and measurable data, and this measurement can be central to diagnosing a medical problem. Symptoms : a manifestation of the disease or illness, that is apparent to the patient; subjective input from the patient. Syndrome : a set of medical signs and symptoms which are correlated with each other and often associated with a particular disease or disorder. The word derives from the Greek σύνδρομον, meaning "concurrence". When a syndrome is paired with a definite cause this becomes a disease. (e Irritable Bowel Syndrome, Polycystic Ovary Syndrome, etc.) Diagnosis : the identification of a certain disease based on the patient’s medical history, signs/symptoms, and diagnostic tests Prognosis : the likelihood of recovery from an illness or disease Pathogenesis : the origination and development of a disease. Insights into disease etiology and progression, the two major aspects of pathogenesis, are paramount in the prevention, management and treatment of various diseases Negative Feedback Loop : also known as an inhibitory loop, is a type of self-regulating system. In a negative feedback loop, increased output from the system inhibits future production by the system; meaning that the output of the system acts to oppose changes from the input of the system with the desired result being a restoration of homeostasis (restoring balance). This is the most common type of feedback system in the human body. Positive Feedback Loop : which a change in a given direction causes additional change in the same direction; thus, the output is unable to accommodate an input change, which results in a net change of the system (imbalance and loss of homeostasis). (e temperature regulation, onset of contraction during childbirth/lactation during breast-feeding[examples of the body still in homeostasis during a positive feedback loop], breathing air that has very high carbon dioxide content. The amount of oxygen in blood decreases while the concentration of carbon-dioxide in blood increases. This is sensed by carbon dioxide receptors, which cause the breathing rate to increase. So the person breathes faster, taking in mor\e carbon dioxide, which stimulates the receptors even more, so they breathe faster and faster which ultimately results in death.)
2. DEFINE EPIDEMIOLOGY, MORBIDITY, MORTALITY, PREVALENCE, INCIDENCE AND HOMEOSTASIS:
Etiology : cause or set of causes of a disease or illness Epidemiology : the study (scientific, systematic, and data-driven) of the distribution (frequency, pattern) and determinants (causes, risk factors) of health-related states and events (not just diseases) in specified populations (neighborhood, school, city, state, country, global). Mortality : the number of deaths in a population during a given time or place; a mortality rate is the number of deaths due to a disease divided by the total population. Morbidity : any decrease or departure, whether subjective or objective, from a state of physiological or psychological well-being or quality of life due to illness or disease. Prevalence : a measure of the total number of people in a specific group who have (or had) a certain disease, condition, or risk factor at a specific point in time or during a given period of time. A “snap-shot” of the disease data. Incidence : a measure of disease that allows us to determine a person's probability of being diagnosed with a disease during a given period of time. Therefore, incidence is the number of newly diagnosed cases of a disease. Homeostasis : from the Greek words for "same" and "steady," refers to any process that living things use to actively maintain fairly stable conditions necessary for survival. Primary Prevention of Disease : main focus is to avoid the development of the disease and to focus on interventions to maintain a healthy life. Primary prevention also involves two further subdivisions that include health promotion and health protection. Health promotion includes educating a patient on their health or on nutrition; and includes any type of education that would promote a healthy lifestyle. Health protection is anything that would protect the patient from developing a disease or illness; health protection can include administering immunizations, requiring mask wearing, etc. Secondary Prevention of Disease : refers to activities like screening and early diagnosis that aid in treatment of
Gangrenous Necrosis : an area of necrotic tissue that has been infected by bacteria Fat Necrosis : occurs when a person experiences an injury to an area of fatty tissue. This can result in the fat being replaced with the oily contents of fat cells. The term “necrosis” means the cells have die Coagulative Necrosis : a type of accidental cell death typically caused by ischemia or infarction. The heart, kidney, adrenal glands or spleen are good examples of coagulative necrosis. Cells that undergo coagulative necrosis can become dry, hard, and white. What is interesting is that gel-like appearance occurs in dead tissues, but the architecture of the cells is maintained for at least several days. Liquefaction Necrosis : also known as colliquative necrosis , is characterized by partial or complete dissolution of dead tissue and transformation into a liquid, viscous mass. The loss of tissue and cellular profile occurs within hours in liquefactive necrosis. Caseous Necrosis : A type of tissue death in which all cellular outline is lost and tissue appears crumbly and cheese-like, usually seen in tuberculosis. Fibroid Necrosis : a form of cellular death that results in the formation of a fibrous tissue, usually occurring in the blood vessels throughout the body. Fibrinoid necrosis is often a result of very high blood pressure that damages the cells in the blood vessels, eventually leading to cell death.
Types of Exudate: (interstitial fluid formed in the inflamed area) Serous : clear or light yellow, thin fluid Fibrinous : high about of fibrin (clotting factor), sticky Purulent : “pus” like fluid, contains many dead neutrophils (WBC), suggestive of a bacterial infection Abscess : fluid is “walled off”, protected purulent exudate, usually requires drainage via an incision Hemorrhagic : injury causes artery or vein compromise resulting in blood collecting
Types of Tissue Healing and Tissue Healing Abnormalities 1 st Intention Healing : also termed primary healing, is the healing that occurs when a clean laceration or a surgical incision is closed primarily with sutures, Steri-Strips, or skin adhesive. 2 nd Intention Healing : also termed secondary healing, is the healing that occurs when a wound is left open to heal by granulation , contraction , and epithelialization. Keloid : caused by an excess protein (collagen) in the skin during healing. Keloids often are lumpy or ridged. The scar rises after an injury or condition has healed, such as a surgical incision or acne. Keloids aren't harmful and don't need treatment. If a person finds them unattractive, a doctor can sometimes minimize the scars. Contracture : a condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints. Loss of Function : especially is the scar is along a flexor or extensor surface Adhesions : gut, intestines, have netting effects, bowel obstructions Ulcerations : occur if the GI tract is continually irritated during the healing process
Types of Cellular Healing:
Regeneration : tissue is regenerated by new cells (mitosis generates daughter cells to replace identical cells); only occurs if the cell type is able to regenerate after damage. Replacement : original cell cannot regenerate thus non-mitotic cells are replaced by another type of cell (usually scar tissue, which often results in a decrease function (e. cardiac tissues after a myocardial infarction; CNS nerve tissue after a spinal injury or cerebrovascular accident). Factors Affecting Healing :
1.) Promoting Healing : youth, good nutrition (protein, vitamin c, vitamin d), adequate hemoglobin (effective circulation), a clean, undisturbed would (first intention/ less granular tissue)
2.) Inhibiting Healing : advanced age (reduced mitosis ability), poor nutrition, dehydration, anemia, circulatory problems, irritation or excessive mobility of the area of injury, infection/foreign body, prolonged use of glucocorticoids (steroids).
5. INFLAMMATION PROCESS (INNATE IMMUNITY : TYPICAL MANIFESTATIONS, COMPLICATIONS):
Major chemical mediators of inflammation: Histamine: “early bird”, released from mast cells and monocytes; known for vasodilation, increased vascular permeability, and causing the vascular response of the non-specific inflammation immune response Prostaglandins: mast cells, DO NOT present early because they are made from arachidonic acid; 10 types of prostaglandins, functions include vasodilation, increased capillary permeability, fever, platelet adhesion, induce pain, and potentiate (increase the effect of) histamine. Bradykinin : a peptide that promotes inflammation. It causes arterioles to dilate via the release of prostacyclin, nitric oxide, and endothelium-derived hyperpolarizing factor Leukotriene : cause tightening of airway muscles and the production of excess mucus and fluid. These chemicals play a key role in allergies, allergic rhinitis, and asthma, also causing a tightening of your airways, making it difficult to breathe. Tumor Necrosis Factor (TNF) : is an inflammatory cytokine produced by macrophages/monocytes during acute inflammation and is responsible for a diverse range of signaling events within cells, leading to necrosis or apoptosis. The protein is also important for resistance to infection and cancers. Acute Inflammation : the immediate response, characterized by the increased movement of plasma and leukocytes (such as neutrophils and macrophages) from the blood into the injured site/tissues; the four cardinal signs of inflammation—redness (Latin rubor), heat (calor), swelling (tumor), and pain (dolor) Chronic Inflammation : an ongoing, long-term response to endogenous or exogenous inflammatory stimuli and is characterized by continued accumulation of mononuclear leukocytes (macrophages and lymphocytes), accompanied by tissue injury due to the prolonged inflammatory response. Chronic inflammation is associated with heart disease, diabetes, cancer, arthritis, and bowel diseases like Crohn's disease and ulcerative colitis
Manifestations (signs & symptoms) of Inflammation:
Acute Inflammation: comes on quickly, swelling, redness, heat, can result in ulcers, infections, and skeletal muscle spasms (from swelling). ● redness (rubor) ● warmth/heat (callor) ● swelling (edema) ● pain and tingling (nerve fiber compression) ● loss of function (from joints swelling)
Chronic Inflammation: less swelling, less exudate, more fibroblast (connective tissue & collagen) being laid down; leads to thicker scar or granuloma. More Macrophages and Lymphocytes present ● fever (pyrexia) ● pyrogens (endogenous or bacteria exotoxins) ● malaise ● “unwell” feeling ● fatigue ● headache ● lack of appetite or desire to eat
Steps of Inflammation 1.) Injury or Cause : Ischemia, Hypoxia, Oxidative Stress, Free Radicals, Physical or Chemical Injury, Infection, etc. 2.) Release of Chemical Mediators (specifically histamine) 3.) Histamine activates vascular and cellular responses : inflammation is a 2 in 1 vascular and cellular response. a.) vascular response: vasodilation, increased capillary permeability, results in heat (callor), redness of the area (rubor), and tissue swelling (edema). Fibrin mesh is formed, platelet activating factor
allergies, specifically the Type I HS * IgE-llergic IgD* : bound to B-cells T-Cell : mature in the Thymus, seek out protein antigens on infected host cell’s surface, destroys all cells that express the target antigen via apoptosis, are effected against virus infected cells, fungal infections, protozoal infections, cancer cells, and transplanted tissues (Type IV HS). Cell-Mediated (T, B) : Cell-mediated immunity is an immune response that does not involve antibodies. Rather, cell-mediated immunity is the activation of phagocytes, antigen-specific cytotoxic T-lymphocytes, and the release of various cytokines in response to an antigen. CD4+ T-helper cell (architect of all immunity) : help coordinate the immune response by stimulating other immune cells, such as macrophages, B lymphocytes (B cells), and CD8 T lymphocytes (CD8 cells), to fight infection. HIV weakens the immune system by destroying CD4 cells. NK Natural Killer T-cells : “natural born killers” destroy foreign cells (cancer) T-Memory Cells : activated with 2nd exposure response Killer T-Cells : aka cytotoxic T-cells, destroys targets cells and releases enzymes or initiates Complement Bone Marrow : source of stem cells Thymus : location of T-cell maturation Lymph Nodes : “outposts” surveilling tissues for foreign antibodies Spleen : “filter” GALT : Gut Associated Lymphoid Tissues
Lines of Immunity Defense : Phagocytosis : a cellular process for ingesting and eliminating particles, including microorganisms, foreign substances, and apoptotic cells. Phagocytosis is found in many types of cells and it is, in consequence, an essential process for tissue homeostasis. Specific Immunity : also known as adaptive immunity, is specialized immunity for particular pathogens. Helper T-cells, cytotoxic T-cells, and B-cells are involved in specific immunity. The non-specific cells, like macrophages, tell the T- and B-cells that an intruder is present. Titer Test : Diagnostic test of antibodies in the blood, measuring Igm/IgG levels; primarily IgGto make sure there are adequate levels of Ig in the blood for a secondary response. The presence of IgM titers indicates that the patient is currently sick with the infection.
7. TYPES OF IMMUNE RESPONSE:
Primary Response : initial exposure, high IgM, pretty good response; IgG late to the party (has to be created by arachidonic acid). Secondary Response : secondary exposure, mostly IgG, gigantic response compared to the initial response Natural Immunity : Natural immunity is the antibody protection your body creates against a germ once you've been infected with it. Natural immunity varies according to the person and the germ. Artificial Immunity : is a means by which the body is given immunity to a disease by intentional exposure to small quantities of it. Natural Active Immunity : occurs when the person is exposed to a live pathogen, develops the disease, and becomes immune as a result of the primary immune response. Once a microbe penetrates the body's skin, mucous membranes, or other primary defenses, it interacts with the immune system. Artificial Active Immunity : a person can build a resistance to a disease following an immunization. An immunization is defined as the process by which someone becomes protected against a specific disease via the administration of a vaccine. Natural Passive Immunity : is immunity passed along from mother to child. Before the child is born, antibodies are passed through the placenta to protect the child from illness. After birth, an infant continues to receive passive immunity to disease from antibodies found in breast milk. Artificial Passive Immunity : comes from injected antibodies created within a different person or an animal. These antibody-containing preparations are termed antiserum. The rabies vaccine and snake antivenom are two examples of antiserums that yield passive immunity.
Autoimmunity : when you have a disturbance of the tolerance to “self-antigens” and your body begins making antibodies to proteins that are on your HLA/Active body.
AlloImmunity : one person’s immune system initiates a response against another person’s antigens; usually in a blood reaction (Type II HS) or an organ transplant (Type IV HS).
Hypersensitivities : an inappropriate immunological response to an antigen; four types listed below:
Type I HS : Allergic Reactions: IgE mediated via eosinophils and mast cell degranulation; histamine releases, vasodilation increases, increases capillary permeability, edema, can cause airway obstruction (anaphylaxis). (e. asthma, seasonal allergies, eczema, anaphylaxis). Type II HS : Tissue Specific Hypersensitivity: 2 major types, 1.) cytotoxicity (ABO Blood reaction); alloimmune reaction to a foreign HLA antigen (patient’s blood views the donor’s blood as a foreign antigen and causes hemolysis) 2.)ADCC Antibody-Dependent Cell Mediated autoimmune reaction, organ/tissue specific, antibody is created for “self” tissue, an intolerance to “self” (e. Graves Disease) Type III: Immune Complex Hypersensitivity: always involves an Ag-Ab complex and is systemic , meaning the immune complexes are widespread. 1.) if Ag-Ab complexes are not properly removed, remains in the blood and deposits through the body in various tissues; then the complex activates the complement cascade in these tissues. Once the Complement Cascade is started, these Ag-AB complexes are destroyed but so are the surrounding tissues that they were embedded in. (e. Acute Rheumatic Fever from improperly treated strep throat- leads to Rheumatic Heart Disease). 2.) if antigen-protein of the Ag-AB complex is auto-immunity, it tries to destroy its own host's tissues because the immune system loses “self tolerance” of one's own HLA antigens (e. systemic lupus erythematosus SLE). Type IV: T- Cell-Mediated or Delayed Hypersensitivity: does NOT have an Ag-Ab complex , instead T-cell lymphocytes become sensitized to antigens, causing cell destruction, which is mediated through cytokines, and macrophages. (ex. TB Skin Test, Contact Dermatitis, Rheumatoid Arthritis, Type I Diabetes)
8. PATHOPHYSIOLOGY OF ANAPHYLACTIC SHOCK
WHAT TYPE OF IMMUNE RESPONSE? EDEMA, EXTREME SWELLING
WHAT TWO MECHANISMS OF CONCERN? AIRWAY CONSTRICTION (LUNGS/BRONCHIAL EDEMA), HYPOTENSION (VASODILATION)
9. PATHOPHYSIOLOGY OF BURNS AND TREATMENT OF BURNS
Characteristics of Superficial Thickness: “1st Degree” : superficial, still hurts but lowest risk factor for infection, only affects the epidermis, no blisters resolves very quickly (e. a sunburn). Characteristics of Partial-Thickness : “2nd Degree”: partial thickness burn, complete epidermis and part of the dermis layers affected, blistering of the epidermis, blanches with pressure, may increase the risk of future cancer, heals but scar may remain. Characteristics of Full-Thickness : “3rd Degree”: damage through the entire epidermis and dermis layers extending into the connective tissues, nerves, and vasculature, Does not blanch with pressure and will often result in a permanent disability. Often less painful centrally because of the nerve damage; however, it is still extremely painful in the surrounding regions of the injury, as those burn injuries are likely 2nd degree burns.
Shock : loss of fluid due to extreme inflammation (and therefore edema) will drop blood pressure, leading to hypovolemia, and shock. Respiratory Problems : extensive edema can close off airways and G areas, causing compartment syndrome and restricting O2. Pain : Swelling from the edema, nerve damage, and infection cause a significant pain input
family history (genetics cannot be changed), among other factors.
Modes of Cancer Spread Invasion : local spread where the tumor grows into adjacent tissues and destroys normal cells; “crab-walk” Metastasis : “changing place” spreading to distant sites via the blood and lymph vessels. Seeding : movement of the neoplastic cells in body fluids or along membranes ; usually in a cavity; typically occurs as a result of a surgery or procedure as part of an unintended consequence.
Stage I: confined to the original organ Stage II: locally invasive to surrounding tissues Stage III: regionally-node spread Stage IV: metastasis to distant sites
Tumor Grading Scale : T: size of the primary tumor N: extent of the regional node involvement (number of nodes) M: signs of distant spread via metastatic spread
Laboratory Data Complete Blood Count with White Blood Count Differential (CBC with Diff) Normal total WBC Count 4,500 – 9,500/mm 3 >10,000 Leukocytosis <1,500 Neutropenia Normal Differential % : Neutrophils 57 – 70% “seg”, immature are “bands” or “stabs” Lymphocytes 20 – 25% T lymphocytes, B lymphocytes Eosinophils 2 – 4% Allergic, histamine releasers Monocytes 3 – 8% Suggest infection recovery Basophils 0 – 1% Involved in allergic conditions, along with eosinophils
NSG211 Exam 1 Study Guide (SP2022)
Course: Pathophysiology (NSG 211)
University: Marian University
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