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Patho RDR 1

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clinically considered alkalosis when blood pH is

>7.45

Free radicals damage cells by: A) Destroying phospholipids in the cell membrane B) Altering the immune response of the cell C) Disrupting calcium storage in the cell D) Inactivation of enzymes and mitochondria

Which of the following processes associated with cellular injury is most likely to be reversible? A) Cell damage resulting from accumulation of fat in the cytoplasm B) Cellular changes as a result of ionizing radiation C) Cell damage resulting from accumulation of free radicals D) Apoptosis

One of the breakdown products of fats and proteins is ketones: What are the bad characteristics of ketones?

(1) they are acids-- over time there is a danger of acidosis (2) they can't be used by brain cells—brain cells MUST have glucose for energy.

the solutes that most affect fluid shifts by their loss are

1) Na+, which can be lost via excess sweating or certain disease processes, and/or 2) proteins (protein loss in the blood - hypoproteinemia)

S&S caused by B-to-T fluid shifts

1) fluid volume overload or excess 2) edema: peripheral, pitting, pulmonary 3) acute CNS changes related to swelling of brain cells--restlessness, confusion, unconsciousness, convulsions

the most common mechanism for an increase in blood osmolality LOSS OF WATER. This can occur via:

1) inadequate intake (ex—patient too sick to drink fluids). 2) increased output; ex: a) vomiting. b) diarrhea c)increased urination

examples of tumor markers?

1) may be a hormone, enzyme, antigen, antibody, gene 2) example of blood test-- PSA—prostate specific antigen a) glycoprotein found in prostate gland cells that are released into the blood when cancer invades the prostate b)can help to detect prostate cancer very early

S&S of hyperpolarization

1) pathologic hyperpolarization of cells manifests clinically as muscles that are less sensitive than usual- ie, hypoactive. 2) they contract more slowly, often resulting in patients complaining of fatigue, lethargy, mental slowness.

typical generators of these free-radical-producing reactions are:

1) simple aging 2) environmental pollutants 3) certain drugs, & alcohol abuse 4) various types of radiation damage, including too much sun 5) certain foods such as those high in preservatives and charred meat.

later, if you don't eat and / or the availability of glucose is LESS than cellular energy needs, a state of _____usually exists.

1. hypoglycemia (low blood sugar)

How do the lungs compensate for metabolic acidosis?

1. the lungs try to decrease the acid gang in the body by increasing the amount of CO2 that is exhaled 2. they do this by increasing the rate & / or depth of respirations. 3. end result is that the pH is increased back to normal.

Which mechanism causes the body to "hang on" to water when vascular volume decreases excessively--the natriuretic peptides system or the RAAS & ADH

RAAS & ADH

How do we stage a tumor?

T-size pf tumor N-extent of lymph nodes M-metastasis

increased renin is secreted by the kidneys in the following situations

a) when blood osmolality is high (usually because of water loss) and/or b) when fluid volume in the circulation is low due to blood loss and /or c) BP is low

risk factors

a. factors that or contribute to and/or increase probability that a dz will occur ..."setting the stage" b. ex-- heredity, age, ethnicity, lifestyle (smoking, eating habits, etc), environment

examples of chronic ischemia causes of this gradual ischemia

a. gradual narrowing of arteries from atherosclerosis. b. slow-developing clot (thrombus) in leg artery or coronary artery.

single-gene disorders are inherited in recognizable patterns:

autosomal recessive, autosomal dominant sex-linked

A 28-year-old man presents with a low blood pressure due to blood loss from a gunshot wound. The regulatory action that will best compensate for this patient's fluid volume deficit is: a. increased action of the natriuretic peptide system. b. increased action of the RAAS. c. inhibition of renin secretion. d. conversion of aldosterone into angiotensin II.

A busy student, with very few financial resources, has body aches, a fever, cough and nasal congestions and difficulty breathing through their nose. The precipitating factors related to the illness include all options EXCEPT a. having few financial resources. b. having a cough and nasal congestion. c. has poor hand hygiene. d. is sleep deprived.

A family nurse practitioner (FNP) tells a patient that her biopsy shows leiomyosarcoma staged at T2N2M0. This patient has a a. benign tumor of the endometrium. b. smooth muscle malignancy that has spread to the lymph nodes. c. a malignancy of the uterus that has spread to distant sites. d. muscle cell tumor that is a carcinoma.

first part of name is usually the tissue involved usually end in "oma," meaning "tumor"

benign tumors' a) lipoma-- benign fatty growth b)leiomyoma: ("leio" = smooth, "myo" = muscle)benign tumor of smooth muscle

thiamine deficiency

beriberi and sequelae include neuro problems

lack of thiamine

beriberi— probs w/ memory, paresthesia; one type is Wernicke Korsakoff associated w/ alcoholism.

chronic ischemia

better tolerated because tissues can adapt to some degree over time; examples of causes of this gradual ischemia:

acidosis exists when?

blood pH is <7.35

respiratory acidosis compensation

by the kidneys: HCO3 production by the kidneys will be increased to buffer the situation, ie, to counteract the acid (CO2) that has accumulated from poor ventilation

A 28-year-old man presents with a low blood pressure due to blood loss from a gunshot wound. Which aspect, from expected compensatory mechanisms, will NOT occur? a. the patient's body will "hang on" to water. b. Na+ will be retained by the kidneys. c. water excretion into the urine will increase. d. arterial vasoconstriction is present.

A diabetic patient has pathological changes to his arteries that result in narrowing and blockage. He is diagnosed with gangrene of the toes (gangrene is when LOTS of cells die).. Lab work is drawn and shows an elevated CK. Which pathological process accurately explains this type of occurrence? a. necrosisàgangreneàischemiaà creatine kinase spillage into blood. b. infarctà cellular differentiationà release of urea. c. ischemiaà cell injuryàswellingàspillage of cellular enzymes into blood. d. metastasisà superoxide dismutaseà release of free radicals.

T= size of tumor T1-T3=

cancerous tumor size; increasing severity & poorer prognosis with higher #.

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

characterized by abnormally high levels of ADH: you "hold onto" water too much by abnormally decreasing urination --> results in increased vascular fluid volume (essentially means that water has been added to the blood = diluted plasma compartment).

Which mini-concept map correctly describes cancer genesis? a. angiogenesis->cachexia->lack of nutrition->cellular starvation->cancerous changes b. growth factor signals->increased cellular differentiation->anaplasia->cancer. c. oncogene->clonal proliferation->increased cellular differentiation->cancer. d. oncogene->clonal proliferation->anaplasia->cancer cells.

Glucose

important energy source

Hyperplasia

increase in reproduction rate of cells

How do we treat gout?

medications, plus a diet low in food that is high in purines, such as red meat, cream sauces, red wine.

types of acidosis are based generally on what caused the acidosis: the two types are?

metabolic and respiratory

respiratory acidosis

state of low pH caused by a ventilation problem such as diminished effectiveness of breathing or decreased respiratory rate---> results in the rentention of CO2

Metaplasia

transformation of one differentiated cell type to another differentiated cell type

angiogenesis

tumor cells leech nutrition from normal cells by diverting blood supply

uric acid is breakdown product of purine, an organic compound found in all our cells; normally we excrete excess uric acid in urine. .people with gout are unable to do what?

unable to process uric acid effectively, so uric acid crystals accumulate and settle in joints, causing inflammation, swelling, and pain. d. most often settles in first metatarsal joint of the big toe or in the ankle joint.

Lab work for a T-B (loss of water)

we would see a high serum osmolality (we would consider this patient's blood to be hyperosmolar)

malignant tumors involving neural tissue a)usually have specific nerve type plus

"blastoma" ("blast" refers to any cell that is very early in its development); b) ex—malignant tumor of nerve cell—neuroblastoma (benign nerve cell tumor would be: neuroma)

malignancies involving epithelial tissue usually have

"carcinoma" plus organ of origin: a) surface epithelium—carcinoma; ex-- hepatocellular carcinoma; basal cell skin carcinoma. b) glandular tissue—add "adeno"-- adenocarcinoma (benign tumor of gland would be adenoma)

When you are given test questions having to do with potassium (hypo- or hyperkalemia) or calcium (hypo- or hypercalcemia), think

"electrical issues," such as hyper vs hypo polarization

When you are given test questions having to do with sodium, water, protein, and/or osmolality issues, think

"fluid shifts" such as edema & fluid deficit problems

malignant tumor

"malignancy;" interchangeable with "cancer" 1) key characteristics—very rapid growth rate of cells that are poorly differentiated

malignancies involving muscle tissue usually have specific muscle type plus

"sarcoma" plus "myo" a) smooth-- leiomyosarcoma b) striated ("rhabdo"), AKA skeletal muscle-- rhabdomyosarcoma

malignancies involving connective tissue usually have

"sarcoma" plus organ of origin a) bone -- osteosarcoma (osteo = bone) (benign bone tumor would be osteoma) b) cartilage (chondro = cartilage) —chondrosarcoma c) blood vessels - hemangiosarcoma (hemangio = blood vessel-related)

examples of neurologic issues associated with thiamine deficiency:

(1) Wernicke-Korsakoff syndrome - classically associated with alcoholism and manifested as memory loss and ataxia (staggering, uncoordinated gait) (2)paresthesia--numbness & tingling or other unusual sensations, usually in legs (this is seen in B12 deficiency too).

serum lab measurements of these intracellular substances are sometimes used as diagnostic & prognostic tools—the higher the serum measurement, the worse the damage.

(1) creatine kinase (CK)-- an enzyme found in most muscle cells (including the heart) that catalyzes transference of phosphate groups back & forth between ADP & ATP (2) myoglobin (myo = muscle, globin= a type of protein) -- found in most muscle cells. (3) troponin -a type of protein molecule only found in heart muscle

benign tumors

(means "nice," so medically it means NOT cancer) 1) key characteristics: a) slower growth than malignant cells b) area of growth well-encapsulated & non-metastasizing c) cells in the area of growth are fairly well-differentiated & usually closely resemble the tissue they arose from.

what should we think of when we see metaboilc acidosis?

(think of the word metabolic in the ABGs context as meaning that the acid/ base imbalance is related to a problem in the kidneys and/or any other disorder/body system EXCEPT the lungs (respiratory system).

hyperketonemia is manifested by:

-blood test showing high serum ketones. -blood test showing LOW (<7.35) blood pH—this would be called ketoacidosis—a form of acidosis; -urine test which shows ketonuria (ketones spill into urine); S&S such as acetone breath (excretion via lungs).

What is an example of chromosomal disorders: alterations to STRUCTURE of chromosomes?

-some types of chromosomal aberrations are caused by alterations in chromosomal structure, such as deletion, duplication, or rearrangement of gene sites (translocation) on the chromosome 2) an example of this is the Philadelphia chromosome, which results from translocation

the normal tonicity (salinity) of the blood is

0.9% -- that means the saline concentration, ie amount of NaCl, in the blood is 0.9%

· Can you identify some disruptions to ATP Manufacturing?

1 hypoxia 2 nutritional problems 3 changes in acid/base balance 4 changes in balance of electrolytes and other solutes 5 changes in fluid distribution

A 70-year-old male client has been admitted to a hospital for the treatment of a recent hemorrhagic stroke that has left him with numerous motor and sensory deficits. These deficits are most likely the result of which of the following mechanisms of cell injury? A) Free radical injury B) Hypoxia and ATP depletion C) Interference with DNA synthesis D) Impaired calcium homeostasis

A client diagnosed with schizophrenia has been admitted to the emergency department (ED) after ingesting more than 2 gallons of water in one sitting. Which of the following pathophysiologic processes may result from the sudden water gain? A) Hypernatremia B) Water movement from the extracellular to the intracellular compartment C) Syndrome of inappropriate secretion of ADH (SIADH) D) Isotonic fluid excess in the extracellular fluid compartment

A client is brought to the emergency department semicomatose and a blood glucose reading of 673. He is diagnosed with diabetic ketoacidosis (DKA). Blood gas results are as follows: serum pH 7.29 and HCO3- level 19 mEq/dL; PCO2 level 32 mm Hg. The nurse should anticipate that which of the following orders may correct this diabetic ketosis? A) Administration of potassium chloride B) Initiating an insulin IV infusion along with fluid replacement C) Administering supplemental oxygen and rebreathing from a paper bag D) Instituting a cough and deep breathing schedule for every hour while awake to improve ventilation

A nurse caring for a client with a diagnosis of diabetes insipidus (DI) should prioritize the close monitoring of which of the following electrolyte levels? A) Potassium B) Sodium C) Magnesium D) Calcium

Aerobic metabolism, also known as oxidative metabolism, provides energy to the body by: A) Removing the phosphate bonds from ATP B) Combining hydrogen and oxygen to form water C) Activating pyruvate stored in the cytoplasm D) Breaking down glucose to form lactic acid

An elderly client has experienced some hypoxia as a result of chronic respiratory problems. Knowing that oxygen -deprived cells result in an accumulation of lactic acid in the cells, physiologically, the client may experience: A) An increase in fat load B) Altered cell membrane permeability C) Retention of lysosomal enzymes D) Cellular shrinkage and dehydration

Fetal alcohol syndrome (FAS) is unlike other teratogens in that the harmful effects on the fetus: A) Directly result in liver damage B) Extend throughout the pregnancy C) Are most noticeable in adulthood D) Cause death in early childhood

The angiogenesis process, which allows tumors to develop new blood vessels, is triggered and regulated by tumor-secreted: A) Procoagulants B) Growth factors C) Attachment factors D) Proteolytic enzymes

cachexia

1) a syndrome that includes anorexia, early satiety, weight loss, weakness, altered cellular metabolism 2) patients have sunken features & generally malnourished appearance

some causes of hypoproteinemia

1) diminished protein production -such as certain types of liver diseases like cirrhosis (the liver produces many proteins such as albumin, so if liver is diseased, can't produce proteins) and 2) diminished protein intake- which cause certain protein malnutrition states such as kwashiorkor. 3) plasma protein loss- via certain kidney diseases such as glomerulonephritis

certain hormones called the counterregulatory hormones are triggered by low blood glucose:

1) epinephrine from the adrenal medulla 2) cortisol from the adrenal cortex 3) growth hormone (GH) from the pituitary 4) glucagon from the pancreas.

situations that can cause excess water in the blood & eventually in the tissues (water shifts from B to T):

1) excess in take of water: psychotic water drinking, too much IV fluid 2) low output: kidney failure 3)hormonal problems: SIADH

many events and/or triggers can cause injury to cells, upsetting homeostasis, causing some degree of cell dysfunction, and often resulting in some sort of disease or disorder. b. examples of types/causes of injury (more on these further on):

1) ischemia 2) carbon monoxide poisoning 3) free radicals 4) abnormal cellular accumulation such as uric acid & fat 5) abnormal cellular proliferation (cancer) 6) other: chemicals (cyanide), genetic, hypoxia, nutrition (already covered); infections, immunologic reactions

when substances accumulate in the cells pathologically they can interfere with normal cellular functions & ultimately cause cell injury; examples

1) lipids; ex-- fatty liver from dz processes such as alcoholism 2) urates (AKA uric acid) accumulation; ex—gout:

S&S of hypopolarization

1) pathologic hypopolarization of cells manifests clinically as muscles that are too sensitive - ie, hyperactive, "irritable" 2) they contract with smaller-than-normal stimulation, often resulting in muscle tics or spasms (example—positive Chvostek's sign) 3) if the spasms are severe and/or unrelenting, this is called tetany

the oncogene promotes clonal proliferation—a rapid increase in growth & development—by:

1)stimulating cells to "overreact" to growth factor signals—causes wild, rapid duplication but very little differentiation 2) overriding normal "braking" signals 3) stimulating the development of tumor cell's very own blood supply—angiogenesis (development of new blood vessels); this is partly why cancer kills—cancer cells divert nourishment from our other cells

Potential Complications of immobility;

1. Integumentary (skin): risk for the development of pressure ulcers (ischemia) and/or skin breakdown 2. Musculoskeletal: muscle cells will shrink when no longer stimulated to do "much" work. Known as disuse atrophy.

S&S: cancer can be in many body systems, and S&S will vary according to site, but there are certain clinical manifestations that can be generalized:

1. Pain 2.fatigue due to angiogenesis 3. cachexia 4. hematologic alterations such as anemia, leukopenia & thrombocytopenia

What causes an alteration in cell RMP?

1. anytime more cations go into a cell, its RMP changes from usual -90mV to a more positive state & cell becomes hypopolarized 2. anytime cations are reduced inside a cell its RMP changes from the usual -90mV to a less positive state & cell becomes hyperpolarized

· Identify the inheritance pattern, S&S and patho (as it relates to the sequela) of Polycystic Kidney disease (PKD).

1. autosomal dominant (Dd, DD)-the normal allele is recessive & the abnormal allele is dominant 2. mutated ("bad") gene codes for malfunction in development of kidneys-> cysts throughout kidney tissue-> S&S of hematuria, proteinuria, pain, kidney stones, kidney failure.

Identify the inheritance pattern, S&S and patho (as it relates to the sequela) of Sickle Cell Disease (SSD).

1. autosomal recessive (ss) -the normal allele is dominant & the abnormal allele is recessive 2. mutated ("bad") gene codes for malfunctioning Hgb, leading to sickled RBCs which: -cannot carry O2 well-> S&S of SOB, fatigue -get stuck in capillaries-> ischemic pain. 3. less than normal RBCs -> anemia

Explain the basics of cellular injury. How do you know when your patient has suffered from a cellular injury?

1. continuum of injury ranging from reversible changes to necrosis 2. with cell swelling often comes cell leakage of substances such as certain enzymes —CK, troponin and myoglobin; serum levels of these can be measured—the more cellular injury there is, the higher the amount of intracellular substances that will "leak" from damaged tissue into blood

two main sequela result from hypoxia:

1. deficiency of ATP for cellular functions 2.altered acid/ base balance: especially acidosis; significance: acidosis from something like hypoxia or reliance on gluconeogenesis (more on this in next section) can dangerously tip body pH out of its narrow, desirable range fairly quickly

S&S caused by T-to-B fluid shift

1. dehydration "fluid volume deficit" a. dry mucus membranes b. poor skin turgor c. sunken eyes d. sunken fontanels in babies e. diminished urinary output (oliguria) also urine concentration increases. f. sometimes low BP (blood pressure) if dehydration bad enough g. acute CNS (central nervous system) changes related to dehydrated brain cells-- restlessness, confusion, unconsciousness, convulsions.

Immobility Treatment/Nursing Interventions

1. frequent repositioning / turning of bedbound patients 2. encourage early activity and ambulation 3. check skin for breakdown 4. use of protective devices for the skin, feet/heels/elbows 5. ensure adequate nutrition and hydration 6. educate patients and their families on the risks of immobility

if intake of food / glucose is greater than immediate cellular energy needs, insulin directs the excess glucose to be stored as _____ in the liver. This is called ___?

1. glycogen 2. gycogenesis

Name two diseases related to cellular metabolism back up plans.

1. glycogen storage diseases; ex—McCardle's->can't use glycogenolysis as back-up plan so has exercise intolerance. 2. prolonged gluconeogenesis (as in Type I diabetes)-> fatty acids-> ketones- ketonemia ->ketoacidosis, ketonuria, acetone breath

sequelae of hypoxia

1. not enough ATP (only 2 are made in anaerobic glycolysis) 2. lots of pyruvic acid made -----> lactic acid builds up

angiotensin II has two important duties:

1. stimulates peripheral vasoconstriction: less blood into constricted blood vessels in periphery, will stay in central circulation 2. increases secretion of aldosterone from the adrenal gland: aldosterone causes kidney tubules to "hold on" to Na+--> water follows Na+ back into circulation instead of going out with urine--> urine output decreases--> water in blood and general circulatory volume increases

negative side to anaerobic glycolysis:

2 molecule of ATP is not enough to keep going for a long time. b. also, every time the metabolic process must "recycle" through glycolysis, multiple molecules of pyruvate (pyruvic acid) accumulate, resulting in acidosis.

ABG value HCO3

22-28

ABG Value pCO2

35-45

ABG value pH

7.35-7.45

pH range of blood

7.35-7.45

ABG value pO2

80-100

ABG value SaO2

97%-100%

Leukocytosis

:a generic term meaning the condition of too many WBCs in the blood; can develop in many disease processes.

4. A client presents for a scheduled Papanicolaou (Pap) smear. The clinician who will interpret the smear will examine cell samples for evidence of: A) Changes in cell shape, size, and organization B) The presence of unexpected cell types C) Ischemic changes in cell samples D) Abnormally high numbers of cells in a specified field

A child has been experiencing hypoglycemic episodes. "How does the body know when to secrete insulin and when to stop secreting it?" The best response by the nurse, explaining the physiologic background, would be: A) "The body knows that if the blood glucose level falls, it will inhibit insulin secretion and release glycogen to release glucose from the liver." B) "It's just a big guessing game; first we give sugar like orange juice, and then we withhold the carbohydrates if the blood glucose level is too high." C) "Your pituitary gland in the brain is the 'master gland,' and it controls and regulates all the hormones." D) "Once the child starts getting confused, the brain will send a message to the pancreas to stop producing insulin."

A large, high-calorie meal has resulted in the intake of far more energy than a person requires. What will the individual's body do with the excess carbohydrates provided by this meal? A) Convert them into glucose and store them in the liver and muscles B) Excrete most of the excess polysaccharides through the kidneys C) Convert the carbohydrates into amino acids in preparation for long-term storage D) Create structural proteins from some of the carbohydrates and store the remainder as triglycerides

A lung biopsy and magnetic resonance imaging have confirmed the presence of a benign lung tumor in a client. Which of the following characteristics is associated with this client's neoplasm? A) The tumor will grow by expansion and is likely encapsulated. B) The cells that constitute the tumor are undifferentiated, with atypical structure. C) If left untreated, the client's tumor is likely to metastasize. D) The tumor is likely to infiltrate the lung tissue that presently surrounds it.

Arterial blood gases of a client with a diagnosis of acute renal failure reveal a pH of 7.25, HCO3- level of 21 mEq/L, and decreased PCO2 level accompanied by a respiratory rate of 32. This client is most likely experiencing which disorder of acid-base balance? A) Metabolic acidosis B) Metabolic alkalosis C) Respiratory acidosis D) Respiratory alkalosis

Of the following clients, which would be at highest risk for developing hyperkalemia? A) A male admitted for acute renal failure following a drug overdose B) A client diagnosed with an ischemic stroke with multiple sensory and motor deficits C) An elderly client experiencing severe vomiting and diarrhea as a result of influenza D) A postsurgical client whose thyroidectomy resulted in the loss of some of the parathyroid glands

When working with a client who has end-stage renal disease (ESRD) and is receiving peritoneal dialysis, the concept of diffusion can be explained by which of the following statements? A) "If your potassium level is high, then K+ particles will move from your peritoneal cavity into the dialysis solution, where the concentration of K+ is lower." B) "You will need to give yourself a potent diuretic so that you can pull the potassium into your blood stream and filter the potassium out in your kidneys." C) "Your potassium molecules are lipid soluble and will dissolve in the lipid matrix of your cell membranes." D) "If you can get very warm in a sauna, you will heat up your K+ particles, and the kinetic movement of the particles will increase and pass through the cell membranes faster."

Which of the following clients would be an example of cellular atrophy? A) A middle-aged female experiencing menopause due to loss of estrogen stimulation B) A postnephrectomy client whose remaining kidney enlarges to compensate for the loss C) A hypertensive, noncompliant client who has developed a progressive increase in left ventricular mass D) A female client with the change in uterine size as a result of pregnancy

77-year-old woman has been brought to the emergency department by her daughter because of a sudden and unprecedented onset of confusion. The client admits to ingesting large amounts of baking soda this morning to treat some "indigestion." How will the woman's body attempt to resolve this disruption in acid-base balance? A) Increase the depth of inspiration B) Increasing renal H+ excretion C) Increased renal HCO3- reabsorption D) Hypoventilation

A child accidentally ingests an insecticide with the ingredient cyanide. Knowing that cyanide suppresses the actions of cytochrome oxidase in the electron transport chain, what is a likely sign or symptom you would expect and why? (see page 2 of metabolic pathway concept map and use your critical thinking skills) a. Ketonuria due to increased glycogenesis. b. Confusion due to glycolysis. c. Mild euphoria due to enhanced production of ATP. d. Shortness of breath due to decreased ATP to use for the work of breathing.

A female client with a history of chronic renal failure has a total serum calcium level of 7.9 mg/dL. While performing an assessment, the nurse should focus on which of the following clinical manifestations associated with this calcium level? A) Complaints of shortness of breath on exertion with decreased oxygen saturation levels B) Difficulty arousing the client and noticing she is disoriented to time and place C) Heart rate of 120 beats/minute associated with diaphoresis (sweaty) D) Intermittent muscle spasms and complaints of numbness around her mouth

A teratogenic environmental agent can cause birth defects when: A) Inherited as a recessive trait B) Intense exposure occurs at birth C) Disjunction occurs during meiosis D) Exposed during early pregnancy

As other mechanisms prepare to respond to a pH imbalance, immediate buffering is a result of increased: A) Intracellular albumin B) Hydrogen/potassium binding C) Sodium/phosphate anion absorption D) Bicarbonate/carbonic acid regulation

The syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by: A) Increased osmolality level of 360 mOsm/kg B) Excessive thirst with fluid intake of 7000 mL/day C) Copious dilute urination with output of 5000 mL/day D) Low serum sodium level of 122 mEq/L

Which of the following statements is true of autosomal recessive disorders? A) Onset is typically late in childhood or early in adulthood. B) Symptomatology is less uniform than with autosomal dominant disorders. C) Mitochondrial DNA is normally the site of genetic alteration. D) Effects are typically the result of alterations in enzyme function.

S&S types:

Local vs systemic acuity and timing

Examples of glycogen storage diseases -- abnormalities in glycogenesis or glycogenolysis

McArdles disease Type I diabetes

Type I diabetes: gluconeogenesis taken to extreme

people with Type I diabetes mellitus do not make insulin--> without insulin, blood glucose levels increase --> without insulin, glucose is not able to get into cells and body turns to sustained gluconeogenesis (BACK-UP PLAN #2) as its main energy pathway. b. this is ok for awhile, but eventually sustained gluconeogenesis causes ketone over-accumulation, resulting in hyperketonemia (high levels of ketones in the blood)

example of autosomal dominant disorder

polycystic kidney disease (PKD)

adaptation

process of accommodating to a new situation the body is undergoing, or creating a new state to accommodate changes in environment / situation ; can be temporary or permanent

what ARE free radicals?

radicals can be thought of as a separate molecular "species," because they don't behave like "normal" atoms & molecules. b. they act differently because they are a "spin-off" of abnormal, accelerated, and/or uncontrolledreactions, especially certain oxidation/ reduction ("redox") reactions

S&S are local

redness, swelling, heat, rash, & lymphadenopathy in a particular area

atrophy

reduction in cell size

nosocomial

result as consequence of being in hospital environment • ex— urinary tract infection is called a ____ infection if it developed while patient was in the hospital

What do glycogenolysis result in?

results in a higher blood sugar, correcting the hypoglycemia & making glucose available to the cells for energy use. b) many times a day if our body needs some glucose & we cannot immediately take it orally, glycogenolysis takes place as a "stop gap measure" till we can take in glucose.

metaplasia

reversible replacement of one mature cell by another type of less differentiated (less specialized) mature cell; happens when cells are being subjected to chronic injury or irritation

if we did lab work on someone with fluid volume overload or excess (B-T)what would we find?

see a low serum osmolality (we would consider this patient's blood to be hypoosmolar, hypotonic, have low oncotic pressure, and low osmotic pressure—all similar terms-- compared to normal blood

clinically we can measure the solute concentration of the plasma compartment (ie, blood) by doing a ____ ___ & thus have an idea about what fluid shifts to anticipate since osmolality (concentration) rules osmosis.

serum osmolality

example of autosomal recessive disorder

sickle cell anemia

example of inherited disorders dz

sickle cell disease is caused by an inherited, altered (AKA, "mutated") gene

Single-gene disorders

single-gene disorders are usually due to an inherited mutated gene b. since genes code for proteins, when a gene mutates so that its protein product can no longer carry out its normal function, a disorder can result.

HYPERPOLARIZED states

situations in which membranes of cells have been reset to a LESS positive number than normal, lengthening the polar gap status & making them less sensitive

respiratory alkalosis

state of high pH caused by hyperventilation—increased rate of breathing results in "blowing off" more CO2— less CO2 in the blood = LESS ACID GANG = higher pH

Cells must have constant supply of nutrients, H2O, O2, and exist in narrow pH & temperature range. Maintaining homeostasis is essentially a balancing act-- the body is always trying to "right itself" when homeostasis is challenged by changes. These challenges to the body's balance are sometimes called

stressors

symptoms

subjective manifestations that can only be reported by the person experiencing them-- pain, nausea, fatigue

tumor markers

substances in the body produced by cancer cells or released by cancer-damaged tissue that can be found in blood, spinal fluid, or urine

S&S are systemic

such as fever, urticaria (hives), malaise ("I feel dragged out" or "awful all over"), systemic lymphadenopathy

oma

suffix used to identify a benign growth

What is an example of a free radical?

superoxide, which at times is created in our own body during the especially rapid redox reactions of the electron transport chain.

etiology

the cause of a disease; includes all factors that contribute to development of dz; examples: a. AIDS: HIV (human immunodeficiency virus) b. rheumatic heart disease: autoimmune reaction c. TB (tuberculosis): mycobacterium

Clinical manifestations (i.e. S&S)

the demonstration of the presence of a sign and/or symptom of a disease

oncogene

the genetic mutation that sets cancer into motion is often called an

cell proliferation

the multiplication or reproduction of cells, resulting in the rapid expansion of a cell population. 2. this is part of normal growth and development of cells

Which mechanism causes the body to diurese when vascular volume increases excessively-- the natriuretic peptides system or the RAAS & ADH

the natriuretic peptides system

Prognosis

the predicted outcome of a dz based on certain factors: a. the usual course of that particular dz b. individual's characteristics; ex: 1) AGE: patients at either end of age spectrum -- infants & elderly are at higher risk for a poor prognosis due to immature or "worn out" immune systems, respectively. 2) PRESENCE OF COMORBIDITIES- two or more coexisting medical conditions; this increases chance of poor prognosis ex— "The patient's comorbidities of heart disease and lung disease contributed to his poor prognosis in recovering from pneumonia."

osmotic pressure

the pressure exerted by all the solutes in a compartment; it correlates with osmolality —ie, the higher the osmolality, the higher the osmotic pressure

malignancies are named according

to cell type of origin like benign tumors, but in addition to "oma," usually has root words "carcino" or "sarco," or "blasto" there are quite a few exceptions

mini concept map of multifactoral genetic disorders:

various cancers such as lung cancer: begins by smoke & toxins irritating bronchial tissue→ one or more genes in cells of that tissue begin to be deranged—oncogenes created → code for wild, uncontrolled growth of cells. b. many common diseases such as hypertension (HTN), coronary artery disease (CAD) & diabetes mellitus (DM) are now known to be caused or highly influenced by a mix of environmental and inherited components.

What types of diseases can cause pathologic water loss or gain?

water loss: inadequate intake and increased output (T-B) water gain: excess intake of fluid and decreased/low output (B-T)

rule of osmosis

water will always want to move from a more dilute compartment to a more concentrated compartment—ie, from a compartment of less % of solutes to one with greater % of solutes (the body wants to return to having the compartments equally concentrated.)

the body has certain intrinsic hormonal compensatory mechanisms to correct fluid volume deficit (and/or low blood pressure).

RAAS—Renin-Angiotensin-Aldosterone System ADH-- antidiuretic hormone secretion assists RAAS

Terms relating to elements leading up to a disease

Risk factors precipitating factor

A patient has advanced liver disease. Blood tests reveal that his serum albumin (albumin is one of the protein molecules found in the blood) level is very low. What eventually happens in this patient situation? a. Water would shift from blood (B) to tissue (T) because of decreased plasma oncotic pressure. b. There would be an increased intravascular volume due to increased plasma oncotic pressure. c. There would be dehydrated brain cells due to fluid shifting from T to B. d. Water would shift from T to B because of increased osmolality of the vascular space.

A patient is diagnosed with metabolic acidosis. Which compensatory response would you expect? a. Hyperventilation --increased respiratory rate (RR)-- to "blow off" CO2; this is the lungs' way to get rid of acids. b. Hypoventilation—decreased RR-- to "hold onto" CO2, since CO2 is an alkali that will counteract the acidosis. c. Kidneys will excrete more HCO3 into the urine to get rid of acidic byproducts. d. By hyperventilating and blowing off CO2, the body will bring the pH down to normal range.

A patient is diagnosed with sickle cell disease (SSD). Which genetic scenario would result in the inheritance of this disease? a. aa b. a heterozygous pairing c. AA d. Different alleles on a gene locus

A patient says she has read that free radicals might be partly responsible for the development of her disease process. She wants to know more information and if there is anything that can counteract free radicals. The nurse's explanation will be based on understanding that all of the following statements are true EXCEPT a. an example of a free radical is cytochrome oxide. b. free radical molecules initiate harmful reactions such as lipid peroxidation, which damages the lipids of cell membranes. c. the body's way to counteract free radicals include enzymes such as superoxide dismutase. d. free radicals are molecules that are in a highly reactive state and can be calmed by taking certain vitamins.

A patient's ABG results are pH:7.20; HCO3:17. What might be the cause of this acid base imbalance? a. Large amount of alcohol consumedà break down of alcohol causes a lot of acid byproducts à excess acid accumulation in the blood à metabolic acidosis b. Hypoxiaà cells must continuously go through aerobic glycolysisà excess pyruvate accumulation à less ATP production. c. Gastrointestinal fluà diarrheaà loss of HCO3 in the diarrheaàHCO3 goes upàcausing the pH to go down. d. Kidney failure àincreased HCO3 productionà body compensates by decreasing respiratory rate (hypoventilation)à metabolic alkalosis.

A patient, diagnosed with cancer, has a poor appetite and has lost 80 pounds. Upon assessment (examination), the nurse notes generalized edema and a low serum protein level. Which mini-concept map accurately relates the relationship of the patient's serum protein level with the presence of edema? a. hypoproteinemia-> concentration in blood is now lower than the normal concentration of fluids inside cells-> fluid goes from B to T. b. hypoproteinemia-> concentration in blood is now higher than the normal concentration of fluids inside cells-> fluid goes from B to T. c. hypoproteinemia-> blood is now hyperosmolar compared to the cells ->fluid goes from T to B. d. hyperproteinemia->blood now has lower oncotic pressure than normal-> fluid goes from T to B.

After not eating since breakfast 6 hours ago, a student taking a test notices a period of hunger and fatigue. He doesn't have access to food because he is taking the test. About 10 minutes later, though, he begins to feel ok again and finishes the test with flying colors. What has happened in his body? a. A compensatory response called glycogenolysis allowed him to access stored glucose for energy. b. A decompensatory response occurred, in which adrenalin increased and caused more blood flow to the brain. c. Since his blood sugar was likely low, the heart underwent a compensatory response known as hypertrophy in order to increase blood flow to central organs. d. Using a control mechanism known as hyperventilation, the student was able to "blow off" excess CO2 and thus have a clearer thinking process.

An RN is taking care of a cocaine addict who has just given birth to a baby with a teratogenic defect. A student nurse asks him what the probable etiology was. The RN shows understanding of genetic disorders when he says a. "It's hard to know the exact cause, but it's likely that fetal chromosomal development was impaired by the mom's intra-pregnancy cocaine ingestion." b. "The baby inherited a structural chromosomal defect that resulted in a problem called aneuploidy." c. "The baby inherited a gene that caused a defect called trisomy 21." d. "Since the little guy was born with the Philadelphia chromosome, he will be a life-long Phillies fan."

Link the genetic etiology with the S&S of CML (chronic myelocytic leukemia): a. Genes on a defective chromosome malfunction and code for extreme leukocytosis. b. Myelocytic leukocytes attack cells in the blood and cause changes known as The Philadelphia Story. c. A genetic defect causes cancerous changes in the blood vessels, producing hemangiosarcomas. d. Genes on an extra chromosome malfunction and cause defects in leukocyte development, resulting in leukopenia.

Which mini concept map best describes thermoregulation? a. Body temperature decreases à hypothalamus sends a signalà vasoconstriction of superficial arteries à blood stays "warm" in the center of the body (core). b. Body temperature rises à hypothalamus sends a signal à vasoconstriction of superficial arteries à blood stays "cool" in the center of the body (core). c. Body temperature rises à brain stem sends a signal à skin produces sweat à heat loss through evaporation. d. Body temperature rises àthe brain over heats à no compensatory mechanisms existà a heat stroke occurs.

Which serum osmolar state will NOT cause edema? a. hypertonicity of the plasma space. b. hypotonicity of the plasma space. c. hypoosmolality of the blood. d. diminished osmotic pressure of the blood.

broad definition of "genetic disorders

a disease caused by abnormalities in an individual's genetic material

Glucagon

a hormone secreted by the pancreas for hypoglycemia

an autosomal recessive disorder occurs when?

a mutated ("diseased"), recessive ("weak") gene partners up with an allele that is also recessive & diseased; those alleles are notated with two lower-case letters. (aa) 2) the protein that they code for will then malfunction & an abnormality/ disease/ disorder will occur that relates to that "bad" protein

Phenotype of sickle cell:

a person who has an ss genotype will HAVE the disease sickle cell anemia—ie, their phenotype is having the S&S caused by the above genotype and patho development: --decreased O2 being carried to tissues of the body; this decreased carrying capacity is because of: (1) anemia: less numbers of RBCs to carry the Hgb which in turn carries the O2 (2) deformed Hgb simply cannot carry the usual numbers of O2 molecules b) ischemic pain, especially in the joints; patho of this type of pain: 1. the deformed RBCs "clog" up the capillaries that usually carry O2-rich blood to the tissues 2. this results in distal tissues that are starved to O2 & "cry out" in pain.

teratogenic disorders

a teratogen is any influence — eg, drugs, radiation, viruses-- that can cause congenital defect

locations of malignant tumor

a) can occur in a specific site; ex-- local malignant tumor such as cancerous skin lesion b) and/or metastasis can occur (1) refers to propensity of malignant cells to invade sites distant to immediate area (2) metastasis is major cause of illness and death resulting from most human malignant dz

very earliest steps of inflammation, which occurs at microcellular level immediately post-injury: 1) no matter what the cause of the injury, the result is almost always some level of disruption to metabolic pathway 2) sequelae of this disruption:

a) cellular swelling & leakage b) cellular function abnormalities or complete shut-down

metabolic acidosis caused by?

a) excess accumulation of H+ (and other acids) in the body b) not enough excretion of H+ in the urine. c) not enough HCO3 being made. d) too much HCO3 being excreted in the urine. 2) any of the above can create a state of _LOW pH and low HCO3

metabolic alkalosis

a) excess accumulation of HCO3 in the body b) not enough excretion of HCO3 in the urine. c) too much acid (H+ and others) being excreted in the urine or lost in other metabolic ways. d) not enough acid being made 2) any of the above can create a state of HIGH pH and HIGH HCO3

examples of teratogenic disorder

a) fetal alcohol syndrome (FAS) occurs because toxicity of alcohol causes gene mutations during gestational development. b) "thalidomide babies" - born with abnormal arms and legs due to mothers taking the drug thalidomide for nausea during early pregnancy.

acidosis can cause variety of S&S,

a) headache, disorientation b) nausea, vomiting c) muscle pain, cramps. d) shortness of breath e) low blood pressure (BP), shock f) organ failure, death

s&s of PKD

a) hematuria (blood in urine), proteinuria, frequent kidney infections b) pain at costovertebral angles and abdomen c) kidney stones

other examples of processes that may result in metabolic acidosis:

a) kidney failure: because sick kidneys can't excrete H+ or make HCO3--> acid accumulation--> acidosis. b) diabetic ketoacidosis: ketones have accumulated because body is in sustained gluconeogenesis_ c) poisons, drug overdose, alcohol: breakdown products are acidotic

some causes of metabolic alkalosis

a) large amount of vomiting. b) over-ingestion of bicarbonate (HCO3).

exceptions to malignancy naming rules

a) malignancy of lymph tissue called lymphoma; ex-- Hodgkin's lymphoma is NOT benign; it is a type of lymphatic cancer. b) malignant skin cancer-- melanoma c)malignancy of hematological tissue: ex--leukemia (leuk = "white")—cancer of WBCs (leukocytes); several categories, according to type of WBC & its stem cell origin

disuse atrophy

a) patient in bed for a long time or immobilized in some way b) having a cast, for example—those cells shrink up while cast is on, then grow slowly back to normal when cast is off & the cells are "stimulate to "work" again.

examples of acute ischemia

a. arterial embolus: clot that travels in the arteries till it suddenly gets lodged in a smaller blood vessel (arteriole or capillary)--> distal tissues quickly become hypoxic. b. sickle cell crisis: abnormally shaped RBCs get stuck in capillaries & decreases blood supply to joints, etc-->ischemia--> ischemic pain.

if there is hypoxia

a. cellular metabolism has to "recycle" through glycolysis rather than continue down the usual aerobic pathway b. this is because glycolysis is the only step that can operate under normal, aerobic conditions, AND can also operate under anaerobic conditions

counteracting free radicals:

a. certain vitamins like vitamins C & E can stop the wild molecular behavior of free radicals b. also, the body can "defuse" free radicals such as superoxide by using specialized enzymes such as superoxide dismutase

underlying mechanism of ischemia is

a. narrowed and/or blocked arteries - this narrowing or blockage can be acute or chronic

cancer treatment

a. radiation b. surgery c. vaccines against viruses like HPV. d. chemotherapy—use of cytotoxic drugs

how free radicals cause problems: once created in above situations, free radicals such as superoxide can destroy cells throughout the body by:

a. reacting with the lipids in cell membranes & causing lipid peroxidation damage to the cell membrane--- "leaky" cells b. attacking proteins such as transmembrane proteins needed for ion pumps c. damaging DNA-- altered protein synthesis & causing gene mutations d. damaging mitochondria-- alterations in metabolism e. damaging DNA--altered protein synthesis & cause gene mutations, sometimes leading to cancers

natriuretic peptide system (NPS)

a. when fluid volume is high, the right atrium and left ventricle detect that too much fluid is reaching them. b. they secrete ANP (atrial natriuretic peptide) & BNP (b-type natriuretic peptide --> these peptides reach the kidneys via the circulation & stimulate them to increase urination (diuresis)-->fluid volume goes down. c. when fluid volume is low, this system is suppressed.

mitochondrial DNA disorders

a.majority of DNA is found in nucleus of cells but small bits of DNA are also found in mitochondria b. disorders of this DNA are very uncommon & won't be discussed futher.

Dysplasia

abnormal cells that may become cancer cells

dysplasia

abnormal changes in size, shape, & organization of mature cells due to persistent, severe cell injury or irritation ex—PAP smears can reveal dysplastic cells of cervix that often must undergo laser-type treatment or close watching to make sure they do not deteriorate into a cervical cancer

What causes abnormal ABG values? How does the body compensate?

acid/base imbalances lungs or kidneys are used to restore normal balance metabolic-> lungs respiratory-> kidneys

tumor

an abnormal mass of tissue 1) used interchangeably with neoplasm. 2) ex: malignant tumor or benign tumor; malignant neoplasm or benign neoplasm.

Immobility

an alteration in mobility as a result of an acute (recent surgery, bone fracture, pneumonia, or new disease state) or chronic illness (sequela from a stroke/BA or long-standing disease).

McArdle's disease

an autosomal recessive disease in which which normal ability to breakdown glycogen (glycogenolysis) is diminished. b. S&S that might occur in a person with this kind of disease-- muscle weakness & cramps during exercise because of no energy reserves.

sequela of iron deficiency?

anemia s&s: weakness, fatigue, SOB

congenital defects

are abnormalities that are either detectable at birth and/or can be attributed to fetal development "glitches."

genotype and patho of sickle cell anemia:

at a certain locus on a certain pair of chromosomes, a pair of alleles has the job of coding for the creation of normally shaped hemoglobin (Hgb) b) but if during fertilization a person inherits a sickle-cell disease gene from mom - ie, a recessive, mutated Hgb-coding gene - and ALSO inherits a sickle-cell disease gene from dad: (1) this person would have a homozygous genotype of the recessive sickle cell genes: dd (2)those abnormal recessive alleles will code for abnormallyshaped Hgb (sickle-shaped), which will make the RBCs sickle-shaped (there are ~300 Hgb molecules per RBC, so enough sickled Hgbs in an RBC will deform the RBC too) (3) because these RBCs do not have the usual round & smooth shape, they are more easily damaged as they go through the blood stream; ultimately this results in lessthan-normal numbers of RBCs—this is the definition of anemia.

A patient is admitted to the hospital with a serum osmolality of 165. As an intervention to return the patient to normal serum osmolality, the nurse is likely to hang an IV bag of _______ because once the fluid is distributed in the blood it will __________ and help return fluid compartment status to homeostasis. Normal tonicity = 0.9% (normal saline or NS) a. 0.45 NaCl: cause water to shift from tissue (T) to blood (B). b. 3% NaCl : cause water to shift from T to B. c. 0.25 NaCl : shift water from B to T. d. NS : shift water from B to T.

A patient is hospitalized in renal failure. Because of her kidneys' inability to excrete water, she has generalized edema & a serum sodium of 129. Because the kidneys have also lost the ability to appropriately regulate potassium, she also has a serum potassium of 5.9. These lab results show: Normal labs: Na+: 135 to 145 K+: 3.5 - 5.0 a. hypernatremia & hypokalemia. b. hyperkalemia & hyponatremia. c. hyperosmolality & hypernatremia. d.hypoosmolality & hypocalcemia.

A patient who just came out of general anesthesia has lab work done. The serum osmolality is 165. The nurse taking care of this patient suspects that the _____ is due to _________. Normal osmolality = 280- 295 a. hyperosmolality: dehydration. b. hypoosmolality: syndrome of inappropriate ADH (SIADH). c. hypertonicity: SIADH. d. high oncotic pressure: a state of hyperpolarization inside the cells.

A patient with a serum calcium of 6.0 (norm = 8.5- 10.5) is most likely to ______ because_______. a. be lethargic: the cells are hypopolarized. b. have muscle spasms: more Na+ has entered the cells. c. be weak: more Na+ has left the cells. d. have hyperirritable muscles: the cells are hyperpolarized.

A young, otherwise healthy patient is admitted to the hospital with a diagnosis of heart failure of unknown cause. The etiology of the heart failure would be termed a. iatrogenic. b. idiopathic. c. nosocomial. d. acute.

An 80-year-old patient has experienced a massive blood loss following an accident. His vital signs are: Blood pressure/BP 80/50 (normal ~ 120/80), heart rate/HR 120 (norm = 60-100), respiratory rate/RR 20 (norm = 12 to 20), temperature/T 98.6° (norm ~ 98.6°). In assessing this patient, the nurse understands that the abnormal HR is a. probably the etiology for the patient's low BP. b. due to the patient's heart compensating for low blood volume by pumping faster. c. the normal compensatory response of shunting blood volume to the periphery. d.due to multiple risk factors.

Expected signs and symptoms for a patient with a serum osmolality of 300 would include____. Normal osmo = 280- 295 a. signs of cerebral edema such as irritability b. signs of cerebral cell dehydration such as confusion c. pitting edema d. crackles in the lungs upon auscultation

The parents of a new baby with Down's syndrome ask their nurse what to expect. She bases her answer on her understanding that the child will have a. developmental problems brought on by a sex-linked monosomy. b. developmental problems brought on by the pathologic interaction of 3 chromosomes where there should be only two. c. a phenotype based on defective mitochondrial protein synthesis that created aneuploidy. d.the phenotype of diminished IQ and physical differences that are caused by a single-gene disorder

Glycogenolysis

breakdown of glycogen to glucose

A patient has advanced liver disease and is found to have a decreased serum albumin (albumin is one of the protein molecules found in the blood) level and edema. Identify the physiologic process underlying their edema. a. "concentration calls" fluid into hypoosmolar compartments from hyperosmolar ones. b. the principle of diffusion results in albumin molecules going from lower to higher concentration. c. "concentration calls" fluid into compartments with higher oncotic pressure from compartments with lower oncotic pressure. d. the proteinemia means that protein molecules will diffuse throughout the blood and tissue.

A patient has been vomiting copiously for 3 days. He is probably in ___ because _____. a. metabolic acidosis : vomiting often leads to hyperventilation. b. respiratory alkalosis : vomiting often leads to hyperventilation c. metabolic alkalosis : vomiting of the normal acidic digestive secretions of the stomach eventually depletes the body's acids. d. metabolic acidosis : vomiting of the normal acidic digestive secretions of the stomach eventually depletes the body's acids.

A patient that has been recently diagnosed with a neuroma on the sole of his foot is very anxious. Of the following, which information shows that the nurse understands the nomenclature of neoplasms when explaining the situation to the patient? a. "You should have the neuroma removed, as this is a cancer that will spread to other parts of the body." b. "This is most likely a malignancy that will metastasize to your lymph nodes." c. "Neuromas are benign growths that usually will not spread." d. "You will soon have the irresistible urge to put on tap shoes and dance in a Broadway musical."

A patient who smokes expresses concern to his nurse about the metaplastic changes of the bronchi that were seen during his bronchoscopy. The nurse bases her response on the knowledge that this type of cellular change is __________________ a. an irreversible cellular adaptation pattern. b. considered a precancerous cellular change. c. reversible if the change agent is removed. d. due to a physiologic hyperplasia.

A patient with hyposecretion of ADH (less secretion of antidiuretic hormone) would MOST LIKELY have the following: Normal osmo = 280- 295 a. serum osmolality of 270. b. oliguria (low urine output). c. serum osmolality of 300. d. edema.

Your patient has gout. Can you explain the cause/patho/treatment of this disease?

caused by accumulation of uric acid (AKA urates); mechanism of action: normally purines break down to uric acid, most of which is processed by liver & excreted in urine; in people with gout, cannot appropriately process uric acid->hyperuricemia-> uric acid settles in joints; need diet low in purines

hypertrophy is cased by what?

caused by hormonal stimulation or increased functional demand, which results in accumulation of cellular proteins, NOT cellular fluid

example of genetic markers

chronic myeloid (AKA myelocytic or myelogenous) leukemia (CML) develops because of a translocation (exchange) of pieces of chromosome; in this case, one chromosome gets shortened (sort of "squashed") in this process—this short chromosome is called the Philadelphia chromosome 2) genes at this site on the chromosome code for creation of white blood cells (leukocytes) 3) so when the chromosome gets "squashed," this causes disruption of normal coding, resulting in overproduction of leukocytes in the bone marrow & their release to the blood --extreme leukocytosis (too many white blood cells in blood)à leukemia. 4) CML diagnosis is "clinched" when a bone marrow sample is taken and the Philadelphia chromosome is seen in the WBCs.

multifactorial genetic disorders

combination of environmental triggers and variations / mutations of genes, plus sometimes inherited tendencies;

The return to homeostasis after being challenged by a stressor is called

compensation

Compensation is achieved by the body's use of

control mechanisms, also called compensatory mechanisms.

Direct causes of cellular injury (mechanical trauma)--can result in?

contusions (bruises); hematomas (collection of blood in soft tissues or an enclosed space); abrasions (scrapes); lacerations (tear or rip in the skin).

A 55-year-old man with emphysema (a type of lung disease) who has smoked 2 packs of cigarettes per day for 40 years is hospitalized for acute onset of cough with bloody sputum. After a few days of testing and treatment, the patient's nurse reads a physician's note on the chart: "I have told the patient that the etiologies of his presenting problem are: 1) exacerbation of his chronic emphysema and 2) the new diagnosis of lung cancer. The onset of both was contributed to by his longstanding smoking." The patient asks the nurse for more information about his illness. Based on all the information you have on the patient, which statement is most likely correct? a. The patient has a poor prognosis because of the comorbidities of lung cancer and cigarette smoking. b. Lung cancer was a sequela of the bloody sputum. c. A precipitating factor for the acute hospitalization was overexertion when the patient started an exercise class. d. Heavy cigarette smoking was a risk factor in the patient's developing emphysema and lung cancer.

A busy student, with very few financial resources, has body aches, a fever, cough and nasal congestions and difficulty breathing through their nose. The direct pathophysiologic etiology of these symptoms is most likely related to a. not eating green vegetables. b. lung failure. c. lack of oxygen. d. exposure to a microbe.

A child is brought to her healthcare provider. Her parents state that no matter how much she eats, she keeps losing weight. She appears quite thin. Her blood sugar is markedly elevated. She is diagnosed with type I diabetes mellitus (DM 1). Which explanation bests links the pathophysiology with the S&S? In DM 1 the pancreas _____ a. quits producing glucagon so that glycogen stores are inaccessible, thus causing weight loss. b. increases insulin production so that glucose stays in the blood, causing hyperglycemia. c. quits producing insulin so that glycogenolysis is stimulated and too much glucose enters the blood. d. quits producing insulin so that glucose cannot be used as energy in the cells, thus causing the body to burn up fat and protein for energy.

A child with sickle cell anemia presents with pain all over, especially the joints. Which option best links the patho with S&S? a. Cyst formation in the kidneys leads to blood spillage from the circulation into the urine, thus causing anemia. b. A single-gene mutation causes malfunction of genetic coding for clotting properties, leading to bleeding and ischemic pain of the joints. c. Chromosomal aberrancy causes malformation of RBCs in the blood supply to the joints and subsequent pain due to lack of oxygen. d. A single-gene mutation causes malfunction in RBC O2-carrying capacity, leading to ischemic pain in the joint tissues.

All of the linkages below are correct EXCEPT a. cancer-related angiogenesis leaches nutrition from our cells->cachexia, weakness. b. cancer injures prostate cells-> release into blood of high levels of a tumor marker called PSA (prostate-specific antigen) c. ingestion of foods high in preservatives-> increase genetic "hits"->increased risk of cancer. d. age-related wear and tear of cells-> increased risk of cancerous lesions such as lipomas.

Which sets of information are correctly linked? a. a patient with decreased RBC production: erythropoietin injections are needed to counteract overproliferation of red blood cells. b. arterial embolus blocks blood flow: decrease in venous circulation to tissue with resultant hypoxia of cells. c. gout: caused by diet high in urea. d. carbon monoxide: binds to Hgb in oxygen's place.

lower-than-normal numbers of K in blood is called

hypokalemia.

lower than normal sodium (Na) in blood

hyponatremia

if the RMP is reset to a MORE positive number than normal, it will shorten the polar status, making it more sesntive —this is called

hypopolarization

if ANY ischemic situation, acute or chronic, is not treated, can lead to_____-- cell death (necrosis) that is specifically caused by lack of arterial blood supply to an area

infarction

no matter what part of the continuum, the commonality of all injury to cells/tissue is

inflammation, which is one of the first steps to healing

tonicity

interchangeable with the term "salinity" (the "saltiness" of a fluid, how much of it is made of salt, ie NaCl)

"normal death"-- apoptosis

is a form of "programmed death," or cell "suicide" 2) our bodies create & kill 10 billion new cells a day-- if cells didn't die, we would have gigantic and/or distorted bodies. 3) also, body has to get rid of cells that have been worn out, developed improperly, or have genetic damage

osmolality

is a measurement of how CONCENTRATED a compartment is (ie, the proportion of solutes-to-water that are in that compartment's fluid)--concentration and osmolality are almost the same thing!

osmosis

is the movement of water from one compartment to another via a semi-permeable membrane (basically this is the membrane lining the blood vessels or cells).

respiratory alkalosis compensation?

is via kidneys, by _decreasing amount of HCO3 made or increasing its excretion.

metabolic alkalosis compensation

is via lungs, by decreasing rate & depth of respirations.

If cells are not getting enough oxygen and it is due to a circulatory malfunction, the problem is called

ischemia

is oxygen deprivation to cells (hypoxia) due to decrease in arterial circulation to the area

ischemia

Pain in the tissue that is not getting enough oxygen is called

ischemic pain

positive side to anaerobic glycolysis

it can give 2 molecules of ATP per molecule of glucose to give energy to the cell. b. thus, it is a temporary stop-gap measure that keeps your body going until the cells can get more O2 so that aerobic metabolism can be re- established.

What is down syndrome?

it is a "glitch" that occurs in very early cellular division and chromosomal distribution of a fertilized egg: instead of ending up with the normal number--46 chromosomes-- the fetus ends up with 47 3) the extra chromosome occurs at site #21 -- the 21st chromosome set has three chromosomes instead of two. a) thus the other name for this type of Down's is trisomy 21. b) phenotype of trisomy 21 includes mental retardation and typical physical characteristics such as low-set ears, epicanthic fold to the eyes, short limbs, and a larger-than-normal tongue.

Basic definition of "shock:"

low BP plus S&S of not getting enough blood to different parts of the body (ex—confusion from not getting blood to brain). cool, pale extremities

Anaerobic

low or absent O2

the primary means of compensating for metabolic acidosis is via the

lungs

erythropoietin:

made by the kidneys, it is important in stimulating growth and development of RBCs. No erythropoietin = less RBCs = anemia. Anemia is a state of low numbers of RBCs & results S&S of SOB, fatiuge

sarcoma

malignant tumor

signs

manifestations that can be objectively identified by a trained observer

M = metastasis ("mets") —spread to other tissues beyond local lymph nodes (ex: colon cancer spreading to liver) M0= no metastasis M1-M3=

mets present; increasing severity & poorer prognosis with higher #.

Provide an example of the four different types of Genetic disorders

mitochondrial DNA, multifactorial, chromosomal, single-gene.

What complications can occur when your patient is immobile?

muscle atrophy and skin break down (decubitus/stasis ulcers).

compensatory mechanisms to correct fluid overload

natriuretic peptide system (NPS)

T= size of tumor T0=

no cancer cells

N = extent of lymph nodes involvement N0=

no lymph node involvement

N = extent of lymph nodes involvement N1-N3=

nodes involved (usually the ones closest to the cancer site; increasing severity & poorer prognosis with higher #.

iatrogenic

occurs as result of medical treatment • ex—if kidney failure is due to improper use of antibiotics prescribed by a healthcare provider you could say "the etiology of the kidney failure was ____."

precipitating factor

a. a condition or event that triggers a pathologic event or disorder .... the "kick-off"

A client has received too much morphine (narcotic) in the postsurgical recovery room. Blood gas results reveal the patient has developed respiratory acidosis. Which of the following assessment findings correlate with acute primary respiratory acidosis? Select all that apply. A) Irritability B) Tingling/numbness in the fingers and toes C) Muscle twitching D) Respiratory depression E) Cardiac palpitations

A,C,D

The newborn has been born with distinctive physical features of trisomy 21, Down syndrome. The mother asks the nurse, "What is wrong? My baby looks different than his brother." The nurse assesses the infant and notes which of the following characteristics that correlate with trisomy 21? Select all that apply. A) Upward slanting of eyes B) Large, protruding ears C) Large tongue sticking out the mouth D) Long fingers with extra creases E) Flat facial profile

A,C,E

What S&S would you, the nurse, expect to identify when your patient has an altered RMP?

hypopolarized: hyperresponsiveness: muscle spasms, twitching, tetany, positive Chvostek's hyperpolarized: · hyporesponsiveness: sluggishness, weakness, mental slowness and/or confusion, bradycardia, etc.

if the tonicity of the blood is lower than 0.9%

hypotonic and/or hypoosmolar...either way, the blood is in some way LESS concentrated than usual.

acute ischemia

hypoxia to tissues from sudden lack of blood supply

autosomal dominant disorders

occurs when a person inherits a mutated, diseased gene that is dominant 2) ie, the gene that codes for a certain disease characteristic is dominant, and the gene that codes for the normal characteristic is recessive (exactly opposite of autosomal recessive)

example of a type of patient that nurses often see who would be high risk for vitamin deficiencies: an alcoholic. Why?

often an alcoholic has very poor diet—obtains minimal iron and B vitamins such as thiamine (as well as countless other deficiencies)

When explaining the function of glycolysis as it relates to anaerobic metabolism, the faculty will mention which of the following key points? Select all that apply. A) Glycolysis requires the use of oxygen to begin the process. B) Glycolysis occurs in mitochondrion-lacking cells. C) Glycolysis provides the majority of the body's energy needs. D) Pyruvic acid is an end result from a series of reactions that converts

B,D

A 55-year-old man with emphysema (a type of lung disease) who has smoked 2 packs of cigarettes per day for 40 years is hospitalized for acute onset of cough with bloody sputum. After a few days of testing and treatment, the patient's nurse reads a physician's note on the chart: "I have told the patient that the etiologies of his presenting problem are: 1) exacerbation of his chronic emphysema and 2) the new diagnosis of lung cancer. The onset of both was contributed to by his longstanding smoking." The patient asks the nurse for more information about his illness. Which explanation, by the nurse, indicates a full understanding of the patient's situation? a. "You have a disease process that was iatrogenically caused by cigarette smoking." b. "You have a sudden onset of a chronic lung disease that was brought on by lung cancer." c. "The coughing up of blood is caused by a worsening of a disease you've had for a long time, plus a new problem-- lung cancer." d. "These diseases have been creeping up on you for probably 20 years; it just goes to show that you should never have taken up smoking."

A breast cancer client has just learned that her tumor clinical stage is T3, N2, M0. After the physician leaves, the client asks the nurse to explain this to her again. The nurse will use which of the following statements in his or her answer? Your: A) Tumor is very small and has zero number of mitoses. B) Tumor has metastasized to at least three distal sites and you have cancer in your lymph nodes. C) Tumor is large and at least two lymph nodes are positive for cancer cells. D) Extent of disease is unknown, but it looks like your cancer has stayed intact and not spread to the bloodstream.

A child is brought to her healthcare provider. Her parents state that no matter how much she eats, she keeps losing weight. She appears quite thin. Her blood sugar is markedly elevated. She is diagnosed with type I diabetes mellitus (DM 1). If ABGs were done on this patient, you would expect all the following EXCEPT: a. a blood pH of 7.32 because sustained gluconeogenesis causes acidic byproducts to accumulate. b. a HCO3 of 20 because the high numbers of acids in her body "take over" and "overcome" the HCO3, which then diminishes in number. c. a HCO3 of 30 because the low numbers of acids in her body stimulate an increase in HCO3. d. this acid/base imbalance to be called metabolic acidosis because it is an acidotic state caused by a metabolic disorder.

A client with diabetes and severe peripheral vascular disease has developed signs of dry gangrene on the great toe of one foot. The client asks, "How this can happen?" Which of the following pathophysiologic processes should the nurse explain to this client? "More than likely, your gangrene is caused by: A) Inappropriate activation of apoptosis, which means death of your cells." B) Bacterial invasion into the foot and toe." C) Impaired arterial blood supply to your toe." D) Metaplastic cellular changes in your toe."

An 80-year-old patient has experienced a massive blood loss following an accident. His vital signs are: Blood pressure/BP 80/50 (normal ~ 120/80), heart rate/HR 120 (norm = 60-100), respiratory rate/RR 20 (norm = 12 to 20), temperature/T 98.6° (norm ~ 98.6°). The patient would also most likely have all of the following EXCEPT a. S&S of cool feet and hands from the body's compensatory response to blood loss. b. S&S of feeling faint and weak from blood loss. c. a risk factor of shock. d. a more guarded (ie, "poorer") prognosis because of his age.

Genetic disorders that involve a single-gene trait are characterized by: A) Multifactorial gene mutations B) Chromosome rearrangements C) Mendelian patterns of transmission D) Abnormal numbers of chromosomes

The client is found to have liver disease, resulting in the removal of a lobe of his liver. Adaptation to the reduced size of the liver leads to which phenomenon in the remaining liver cells? A) Metaplasia B) Organ atrophy C) Compensatory hyperplasia D) Physiologic hypertrophy

Which of the following statements is true of genetic mutations? A) Errors in DNA duplication are normally irreparable. B) Mutations that occur in somatic cells are inheritable. C) Mutations may result from environmental agents. D) Errors in DNA replication are most often fatal.

client has experienced significant decreases in mobility and stamina during a 3-week hospital stay for the treatment of a femoral head fracture. Which of the following phenomena most likely accounts for the client's decrease in muscle function? A) Impaired muscle cell metabolism resulting from metaplasia B) Dysplasia as a consequence of inflammation during bone remodeling C) Disuse atrophy of muscle cells during a prolonged period of immobility D) Ischemic atrophy resulting from vascular changes while on bedrest

Decreased blood osmolality (pathologic water GAIN or protein LOSS), most common mechanisms?

pathologic amount of excess water and/or loss of solutes (in particular we will look at protein loss) (B-T)

What is an example of chromosomal disorders: alteration to NUMBER of chromosome

Down's syndrome is a disorder of abnormal numbers of chromosomes and is sometimes associated with pregnancies of women >35 years old.

Several ways to categorize genetic disroders:

Inherited Spontaneous Mitochondrial DNA disorder Multifactoral Chromosomal Single-gene

genotype & patho development for PKD

if during fertilization a person inherits a kidney tissue gene that has a mutation, that gene will "want" to code for abnormal kidneys. c) in a dominant disease such as PKD, the mutated gene is the strong one, so even if it is paired with a normal allele, it will override the normal allele's coding. d) in PKD, this results in the kidney tissue developing cysts, which can reduce various kidney functions and lead to kidney failure as a person goes through life.

Aerobic

O2 is present (this is the ideal, "normal" situation).

genotype of PKD

if we use the letter "P" to designate PKD, the genotype for someone that HAS the disease would look like this: PP or Pp. b) only a person with a genotype of pp (homozygous recessive) would NOT have the disease

glomerulonephritis

in certain diseases, the glomeruli of the kidneys lose the ability to appropriately keep protein molecules in the blood where they belong, and large numbers of proteins "spill out" into the urine (proteinuria)

hypertrophy

increase in cell size

hyperplasia

increase in number of cells resulting from increased rate of cell division a. physiologic example-- certain organs can regenerate using hyperplasia; ex—removal of part of liver leads to hyperplasia of liver cells (hepatocytes); even with removal of 70% of liver, regeneration is complete in 2 weeks. b.pathologic hyperplasia— benign prostatic hyperplasia (BPH); as a man gets older, prostate enlarges from increase numbers of cells

hypertrophy

increase in size of cells & consequently size of organ physiologic examples: 1) heavy work, working out-hypertrophy of skeletal muscles 2) kidney removed- other kidney increases function & size of cells c. pathologic example 1) hypertrophy of left ventricle: from trying to "fight against" hypertension (HTN)

RAAS—Renin-Angiotensin-Aldosterone System

increased renin secreted by the kidneys--> renin stimulates secretion of angiotensin 1--> becomes angiotensin II with help of ACE

*** "Concentration" of any solution correlates with the percent, or ration, of solute particles in that solution:

high concentration = more solutes, less H2O; low concentration = less solutes, more H2O

higher than normal calcium (Ca) in blood

hypercalcemia

examples of states in which cells become hyperpolarized

hypercalcemia - high Ca hypokalemia- low K hyponatremia- low Na

higher-than-normal numbers of K in blood is called

hyperkalemia

high numbers of sodium (Na) in blood

hypernatremia

if the tonicity of the blood is higher than 0.9%

hypertonic and/or hyperosmolar...either way, the blood is in some way MORE concentrated than usual

lower than normal calcium (Ca) in blood

hypocalcemia

examples of states in which cells become hypopolarized:

hypocalcemia -low Ca hyperkalemia -high K hypernatremia- high Na

When your patient doesn't eat, what happens to their glucose levels?

hypoglycemic if not enough glucose & more glucose unavailable ->"back-up" plans of glycogenolysis (first), & gluconeogenesis (2nd) used

If the body is unable to appropriately meet the challenge of stressors-- for example, if the control mechanisms are "exhausted"-- compensation can deteriorate either rapidly or slowly into

decompensation— the failure to compensate, adapt, heal, etc.

Hypoxia

decrease in amount of oxygen to cell or ability to use oxygen appropriately

atrophy

decrease or shrinkage in cellular size a. physiologic—occurs in early development; ex—thymus gland b. pathologic 1) often occurs as result of decreases in "work load"—an area or an organ is no longer stimulated very much to do its "work," so the cells shrink

S&S of SIADH

decreased urine output (oliguria) because your body is holding onto water inappropriately, & other fluid volume excess S&S

as programmed by their genetic makeup, cells have different degrees of

differentiation (synonyms: "organization" and/or "specialization").

Increased blood osmolality (pathologic water LOSS) simple diagram

disease causing a continuing water loss from body--> water loss from blood--> increased blood osmolality--> water loss from cells --> overall dehydration.

altered cell proliferation includes

disease processes such as cancer

idiopathic

dz with unidentifiable cause

there is a spectrum from fairly rudimentary all the way to highly differentiated cells, such as nerve cells and cardiac cells. This development is helped along by many hormones such as

erythropoetin and other growth mediators

Terms relating to causes of a disease

etiology idiopathic iatrogenic nosocomial

oncotic pressure

exactly the same principle as osmotic pressure, but refers specifically to protein molecules.

How does the body compensate for fluid abnormalities?

fluid volume deficit-RAAS fluid volume overload/excess-NPS

Glycogenesis

formation of stored glucose

Gluconeogenesis

generation of energy source from non-carbs substance

genetic markers

genetic abnormalities that are found in some people that predict odds of having certain types of cancers

if glucose is either unavailable or cannot get into the cell to participate in the metabolic pathway, and glycogenolysis has already exhausted a person's store of glycogen, the body breaks down fats and protein. this is called?

gluconeogenesis--the use of any other substance besides carbohydrates for cellular energy; this means breaking down fats and proteins for energy

What does the body do when glycogen stores are depleted (we will review the "G" words)?

gluconeogenesis-uses fat and proteins for cellular energy-> ketones-> offer some energy->causes acidosis, cant be used by brain cells

stored glucose substance

glycogen

if you don't eat, the body takes the first step in its "back-up plan:" the counterregulatory hormones stimulate the conversion of glycogen to glucose This process is called what?

glycogenolysis

is systemic disease caused by buildup of uric acids in the blood-hyperuricemia

gout

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Debate Final 2017-2018 sem 1