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NURS 611 Advanced Pathophysiology Review Notes, Study Guides, Projects, Research of Pathophysiology

NURS 611 Advanced Pathophysiology Review Notes

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2024/2025

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NURS 611 Advanced Pathophysiology Review Notes
*Multiple choice only*
Key Points Exam 1:
Know Cell components and what they do:
Nucleus-
houses the genetic info
Ribosomes-
responsible for protein synthesis
Mitochond
ri a-
Produce
ATP
Golgi apparatus-
responsible for packaging and distribution
Lysosome-
degrades and recycles waste
Peroxisome-
has a byproduct of H2O2 which produces free radicals
What are Free Radicals or Reactive Oxygen Species? How do they cause damage?
-
Free radical:
unpaired molecule; steals an electron from a healthy molecule.
-
Causes cellular damage and in excess can cause disease
-
Antioxidants give an electron to an unpaired molecule
-
Reactive oxygen species:
highly reactive chemical molecules formed due to the electron receptivity of O
2
.
Example: peroxides
Cell membrane
What is the Plasma Membrane made up of?
o
Phospholipid bilayer:
hydrophilic heads on outside: phosphate functional group, hydrophobic
tails
on inside: glycerol
+
fatty acid chains
Why do we need a Cell membrane?
o
Main function is to keep ICF and ECF separate
How is Osmolality different between ICF and ECF?
o
Osmolality:measure of how much one substance has dissolved in another substance.
The greater the concentration of the substance dissolved, the higher the osmolality
o
Usually the same between ICF and ECF
What do proteins do for the cell (6)? How much of the Cell membrane is made up of protein?
o
Proteins make up 55% of the cell membrane.
o
Serve as channels, carrier, pumps and receptors
o
Enzymes
o
And are part of the cytoskeleton.
What is a protein?
o
made from a chain of amino acids known as polypeptides.
o
Proteins are the major workhorses of the cell.
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NURS 611 Advanced Pathophysiology Review Notes

Multiple choice only Key Points Exam 1: Know Cell components and what they do: ● Nucleus- houses the genetic info ● Ribosomes- responsible for protein synthesis ● Mitochond ri a- Produce ATP ● Golgi apparatus- responsible for packaging and distribution ● Lysosome- degrades and recycles waste ● Peroxisome- has a byproduct of H2O2 which produces free radicals What are Free Radicals or Reactive Oxygen Species? How do they cause damage?

  • Free radical: unpaired molecule; steals an electron from a healthy molecule. - Causes cellular damage and in excess can cause disease - Antioxidants give an electron to an unpaired molecule
  • Reactive oxygen species: highly reactive chemical molecules formed due to the electron receptivity of O 2. Example: (^) peroxides Cell membrane ● What is the Plasma Membrane made up of? o Phospholipid bilayer: hydrophilic heads on outside: phosphate functional group, hydrophobic tails on inside: glycerol + fatty acid chains ● Why do we need a Cell membrane? o Main function is to keep ICF and ECF separate ● How is Osmolality different between ICF and ECF? o Osmolality:measure of how much one substance has dissolved in another substance. The greater the concentration of the substance dissolved, the higher the osmolality o Usually the same between ICF and ECF ● What do proteins do for the cell (6)? How much of the Cell membrane is made up of protein? o Proteins make up 55% of the cell membrane. o Serve as channels, carrier, pumps and receptors o Enzymes o And are part of the cytoskeleton. ● What is a protein? o made from a chain of amino acids known as polypeptides. o Proteins are the major workhorses of the cell.

3 types of Cell junctions: ● Describe what Tight junctions are and why we need them? o barriers to diffusion

isotonic solution? NS Give an example of a hypertonic solution? 3% saline What part does albumin do with keeping fluid in blood vessels?

  • Albumin is main plasma protein and if it is low it will allow fluid to leak out into the interstitial space
  • Eat more protein What is happening in edema or third spacing if albumin is low?
  • is the plasma protein that is primarily responsible for the plasma oncotic pressure because it has the highest concentration
  • causes edema as a result of a reduction in plasma oncotic pressure. What happens to calcium if albumin is low?
  • Calcium in serum is bound to proteins, principally albumin. As a result, the total serum calcium concentration in patients with low or high serum albumin levels may not accurately reflect the physiologically important ionized (or free) calcium concentration Electrical Impulses and Membrane potential Define: Resting Membrane Potential:
  • Cell is like a capacitor; it stores electrical charge
  • The difference in charge between the inside and outside.
  • -70 to -85 mV Action Potential:
  • When a nerve or muscle cell receives a stimulus that exceeds the membrane threshold value, there is a rapid change in the resting membrane potential Depolarization: net movement of sodium into the cell, and the membrane potential decreases, or “moves forward,” from a negative value (in millivolts) to zero Repolarization: the negative polarity of the resting membrane potential is reestablished What is the difference between the relative refractory and Absolute refractory period?
  • Relative: During the latter phase of the action potential, when permeability to potassium increases, a stronger-than- normal stimulus can evoke an action potential - Absolute: During most of the action potential, the plasma membrane cannot respond to an additional stimulus Key Points WEEK 2: Altered Cell metabolism and Genetics Altered Tissue Define and give examples of each

nonuse Hypertrophy increase in cell size Muscle growth from exercise Pathologic from HTN: CHF Hyperplasia increase in NUMBER of cells (^) Liver cell regeneration after surgery; endometrial hyperplasia Metaplasia (^) reversible replacement of one mature cell type by another cell type Barrett’s esophagus Bronchial changes from smoking Is Dysplasia considered a true adaptive process?

  • Abnormal changes in size, shape, and organization of mature cells.
  • NOT a true adaptive process
  • Mostly found in epithelia What is the difference between physiological change and a pathological change?
  • Physiologic: happens with early development
  • Pathologic: occurs as a result of decreases in workload, use, pressure, blood supply, nutrition, hormonal stimulation, and nervous stimulation Cell injury 1.- Define Ischemia:
  • reduced blood flow to tissue
  • Injured but can recover. 2.- Define Necrosis
  • type of cell death with severe cell swelling and breakdown of organelles
  1. – Define Infarction: deprivation of oxygen caused by cessation of blood flow What is the most common CAUSE of cell injury?
  • Hypoxia Which is worse Hypoxia or Ischemia? Why?
  • Ischemia. What happens to a cell that is hypoxic-explain the steps.
  • ATP pump fails, Sodium enters the cell, Fluid enters the cell, organelles begin to malfunction with eventual mitochondrial damage or cell wall damage If a person is hypoxic and you check the lactic acid, what does that mean for the cell?
  • Cell death has occurred and the enzymes inside that cell have spilled into the ECF Up to what point is the damage to a cell reversible?
  • “Point of no return” structurally when severe vacuolization of mitochondria occurs and Ca++ moves into the cell, including mitochondrial membrane damage
  • The injury is reversible if it is mild or transient, How do you know if irreversible damage has occurred?
  • You check the enzymes in the bloodstream??? What is the difference between necrosis and apoptosis?
  • Apoptosis is programmed cell death characterized by the “dropping off” of cellular fragments called apoptotic bodies
  • Necrosis: characterized by rapid loss of the plasma membrane structure, organelle swelling, mitochondrial dysfunction, and the lack of typical features of apoptosis
  • With hypoxia and subsequent bacterial invasion, the tissues can undergo necrosis Necrosis: explain the difference ● Dry gangrene – result of coagulative necrosis: skin becomes dry and shrinks, results in wrinkles, and color changes to dark brown or black ● Wet Gangrene – develops when neutrophils invade the site, causing liquefactive necrosis. o This usually occurs in internal organs, causing the site to become cold, swollen, and black. A foul odor is present, produced by pus, and if systemic symptoms become severe, death can ensue. Feature Necrosis Apoptosis Cell size Swells Shrinks Plasma membrane Disrupted Intact Cellular contents Leaks out of cell Intact Inflammation Frequent No Physiologic or pathologic Pathologic Most of the time physiologic Cells and Aging: What happens to cells as we age?
  • atrophy
  • decreased function
  • loss of cells, possibly by apoptosis
  • Loss of cellular function from any of these causes initiates the compensatory mechanisms of hypertrophy and hyperplasia of remaining cells, which can lead to metaplasia, dysplasia, and neoplasia
  • Caused by repeat blood transfusions or prolonged parenteral administration of iron Genetics ● What is Genotype give example?

o composition of genes at a given locus o Ex. Infant born with inability to metabolize phenylalanine ● What is Phenotype give example? : expression of the gene/disease: ex. PKU: can prevent expression of disease with dietary restriction o outward appearance of an individual, which is the result of both genotype and environment ● DNA has 4 nitrogenous bases what are they? o Guanine, Thymine (RNA Uracil), Cytosine, Adenine ● Mutation: o an inherited alteration of genetic material ● Base Pair substitution also called o mis-sense mutation ● Frameshift mutation: o involves the insertion or deletion of one or more base pairs to the DNA molecule ● What is a Mutagens? Give an example: something that can increase the frequency of mutations o Radiation o Nitrogen mustard ● Which part of the cell can be damaged the most by radiation? o Radiation can fragment the DNA molecule and it can cause chemical reactions that can alter a DNA base

  • Autosomal dominant: Big D. (7) what is the RR? o Breast CA o Marfan Syndrome o Polycystic kidney o Huntington (age expressed penetrance) o Hypertrophic obstructive cardiomyopathy o Retinoblastoma o Von Recklinghausen o 50% recurrence risk for each child
  • Autosomal Recessive (6 ex) o Abnormal allele must be homozygous to EXPRESS the disease o Many are carriers o Ex. CF, tay sachs, PKU, Wilson, hemochromatosis, thalassemia o 25% recurrence risk per offspring o Consanguinity is a factor o Disease usually seen in siblings of parents who do not express the disease
  • X-linked: located on sex chromosome o More often in MALES o Usually a carrier female with a male o Mother will transmit gene to half of daughters and half of sons o Ex Duchenne muscular dystrophy (duxxene) o Frameshift mutation 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 DNA specifies a sequence of mRNA Where does protein synthesis occur? Ribosomes CHROMOSOMES:

- DNA demethylation, histone modification, and miRNAs What is hypermethylation associated with? Tumorigenesis Pediatric considerations:

What is Downs syndrome? What are typical characteristics?

  • Trisomy of 21st chromosome
  • low nasal bridge, epicanthal folds, protruding tongue, and flat, low-set ears. Poor muscle tone (hypotonia) and short stature
  • Congenital heart defects, reduced ability to fight respiratory tract infections What is Turner syndrome? What are typical characteristics?
  • single X chromosome, always female
  • gonadal streaks rather than ovaries.
  • short stature, webbing of the neck in about half of cases, widely spaced nipples, coarctation (narrowing) of the aorta, edema of the feet in newborns, and sparse body hair What is Klinefelter’s syndrome? What are typical characteristics?
  • At least 2 Xs and a Y, sometimes XXXY, XXXXY.
  • Usually male appearance, sterile, gynecomastia, small testes, sparse body hair What is a congenital disease?
  • Diseases present at birth -------------------------------------------------------------------------------------------------------------------------------------------- Key Points Chapter 3: Fluid and Electrolytes: Review how aging affects the Distribution of water in the body?
  • Decrease in total body water with age
  • Dehydration can be severe/life threatening How does have a normal, lean or obese frame affect TBW?
  • The fatter you are, the lower total body water percentage How does water move between ICF and ECF?
  • Water moves freely by diffusion through the lipid bilayer cell membrane and through aquaporins, a family of water channel proteins that provide permeability to water
  • The osmolality of TBW is normally at equilibrium. What drives hydrostatic pressure?
  • Hydrostatic pressure is movement from capillary to interstitial space affected by pressure gradient. What drives oncotic pressure? - Plasma proteins - Oncotic pressure is keeping fluid IN the space. - The overall osmotic effect of colloids, such as plasma proteins

Ex. of increased capillary membrane permeability. How could you reverse it?

  • Bee sting or infection: give antihistamines or treat underlying cause What are 4 causes of edema?
  1. Increased capillary hydrostatic pressure
  2. Decreased capillary oncotic pressure
  3. Increased capillary membrane permeability
  4. Lymphatic obstruction How does sodium and chloride and bicarb affect water balance?
  • Na is major cation in ECF
  • Cl is major anion in ECF
  • HCO3 is major ECF anion
  • Cl concentration varies inversely with bicarb concentration What does aldosterone do (3)?
  • Mediates hormonal regulation of sodium balance
  • stimulates secretion (and therefore excretion) of potassium by the distal tubule of the kidney
  • reducing potassium concentrations in the ECF What are natriuretic peptides (3)? Why does an elevated BNP indicate CHF?
  • hormones that include ANP, BNP, and urodilatin synthesized within the kidney. - ANP and BNP are released when there is an increase in transmural atrial pressure caused by increased intra atrial volume as may occur with heart failure
  • ANP and BNP increase sodium and water excretion by the kidneys, which lowers blood volume and pressure (antagonist of RAAS) What initiates osmoreceptors?
  • activated by an increase in osmotic pressure of the plasma What does the Antidiuretic hormone (ADH) do?
  • secreted when plasma osmolality increases or circulating blood volume decreases and blood pressure drops
  • increases the permeability of distal renal tubular cells to water, increasing water reabsorption and therefore increasing blood volume and blood pressure Sodi u m Regulator of fluids, Maintenance of neuromuscular conduction of nerve impulses. (135-145 meq/L) Hypernatremia (greater than 147 meq/L) Cause: Inadequate free water intake Inappropriate administration of hypertonic saline solution Over secretion of aldosterone Clinical manifestations Confusion Convulsions Cerebral hemorrhage Coma

Hypernatremia - BRAIN:

Flattened-T waves;AV Hyperaldosteronism causes which fluid and

What are causes and manifestations of hypokalemia? Bradycardia Paralytic ileus electrolyte imbalances: Hypernatremia Fluid volume excess Calcium: bone, teeth, blood clotting, muscle contraction (heart) (8.6-10.3) CAUSES MANIFESTATIONS Hypocalcemia (<8.5 mg/dl) ● Inadequate intestinal absorption, massive blood administration ● Decreases in PTH and vitamin D levels ● Nutritional deficiencies: ● Malnutrition: o Alkalosis o Elevated calcitonin level o Pancreatitis; o hypoalbuminemia ● Increased neuromuscular excitability ● Tingling, muscle spasms (particularly in hands, feet, and facial muscles) ● Intestinal cramping ● Hyperactive bowel sounds ● Osteoporosis and fractures ● Severe cases show convulsions and tetany ● Prolonged QT interval, ● Cardiac arrest Hypercalcemia (>10-12 mg/dl) ● Hyperparathyroidism ● Bone metastases with calcium resorption from: ● Breast ● Prostate ● Renal ● Cervical cancer ● Sarcoidosis ● Excess vitamin D ● Many tumors that produce PTH ● Calcium-containing antacids ● Many nonspecific ● Fatigue ● Weakness ● Lethargy ● Anorexia ● Nausea ● Constipation ● impaired renal function ● kidney stones ● dysrhythmias ● bradycardia ● cardiac arrest ● bone pain ● osteoporosis ● fractures Phosphate (phosphorous): energy (ATP), 2,3 diphosphoglycerate (2.5-4.5) CAUSES MANIFESTATIONS Hypophosphatemia (<2.0 mg/dl) ● Intestinal malabsorption related to vitamin D deficiency ● Use of magnesium- and aluminum- containing antacids ● Long-term alcohol abuse ● Conditions related to reduced capacity for oxygen transport by red blood cells and disturbed energy metabolism; ● Leukocyte and platelet dysfunction ● Deranged nerve and muscle function