250 Exam 3

Hyperlipidemia: Arteriosclerosis (Nutrition)

(a Peripheral Arterial Disease) a disorder of the arteries characterized by the thickening, loss of elasticity, and calcification of the walls of arteries healthy: blood vessels are very elastic, which allows for rapid changed in cardiac output and blood pressure that are required for activities (exercise) With aging, arteries begin to calcify and lose their elasticity

Hyperlipidemia: Atherosclerosis (Nutrition)

(a form of arteriosclerosis) the buildup of plaque, which is made up of cholesterol (fatty) deposits, in the coronary arteries, leasing to narrowing and reducing blood flow to the myocardium etiology: unkown risk factors: genetic and lifestyle components genetic nature: people who inherit familial hypercholesterolemia (blood contains extremely high levels of cholesterol

Neuropathic Pain

- Results from pathology of somatosensory system - Includes phantom pain - described as burning, sharp, shooting pain without obvious injury or protracted pain that persists from months or years after the initial injury. Resulting from CNS or PNS dysfunction (Carpal Tunnel Syndrome, DIabetic Neuropathy, Postherpetic Neuralgia, Trigeminal Neuralgia)

Obesity: Visceral Adiposity (Nutrition)

-Central fat distribution, higher levels of small LDL molecules; higher risk of heart disease

Obesity: Genetics (Nutrition)

-Chronic inflammation; cellular stress leads to immune & epithelial cells in adipose tissue to produce proinflammatory cytokines

Diagnostics (Nutrition)

-H&H -Iron levels -RBC -X-rays -Lipid levels -Albumin (3.5-5 g/dL) -Total protein (6.0-8.0 g/dL)

Obesity: Insulin Resistance (Nutrition)

-Increased levels of insulin required to keep glucose levels in range; altered function of insulin target cells

Obesity: Genetics (Nutrition)

-Leptin deficiency, impaired satiety

Treatment (Nutrition)

-Medications (PPI, H2 blockers) -Lifestyle changes -Surgery -Nutritional supplements

Obesity: Numerous hormones involved in food intake (Nutrition)

-Orexigenic pathway -Anorexigenic pathway

Obesity: Oxidative Stress (Nutrition)

-Reactive oxygen species (ROS) are unstable molecules, alter signaling pathways - influenced by insulin resistance, inflammation, and hyperlipidemia

Malabsorption Syndromes: Clinical Manifestations (Nutrition)

-Start between 4-10 days after initiation of feeding -Distended abdomen, blood in stools -Lethargy, poor feeding, apnea, vomiting

Cell Growth: Normal cell cycle includes... (Cellular Regulation - Oncology)

3 checkpoints •It is during this cycle that DNA damage can lead to neoplasms

Thyroid: Thyroxine T4 (Hormonal Regulation - Endocrine)

4.5 - 11.5 mcg/mL; Free T4: 1.0 - 2.3 ng/dL

Skin Cancers: Basal Cell Carcinoma (Cellular Regulation - Oncology)

80% of skin cancers; rarely metastasizes but can cause severe disfigurement - UV light exposure, light-colored skin, older age, male gender

Karyotyping (Cellular Regulation Genetics)

A test used to examine the visual appearance of chromosome structure and number This type of genetic testing can identify aneuploidy and triploidy as well as translocations and other gross chromosomal structural abnormalities. However, it cannot detect single-gene mutations

Types of Fibers (involved in pain transmission and modulation)

A-delta C-fibers A-beta

Huntington's Disease (Cellular Regulation Genetics)

AUTOSOMAL DOMINANT: Rare, hereditary, degenerative hyperkinetic movement disorder diffusely involving the basal ganglia and cerebral cortex Onset between 25 and 45 Involuntary fragmentary movements - chorea Cognitive deficits include loss of working memory and reduced capacity to plan, organize and sequence

Tay-Sach's Disease (Cellular Regulation Genetics)

AUTOSOMAL RECESSIVE: 80% of individuals diagnosed are of Jewish ancestry Onset of disease is 4-6 months Symptoms: •Seizures •Developmental repression •Blindness

Malignant Tumor (Cellular Regulation - Oncology)

Abnormal growth and abnormal function, can metastasize - undifferentiated Due to unrepaired errors in multiple cancer-causing genes Cancer cells recruit normal cells to contribute and support proliferation and invasion Tumor angiogenesis - can take nutrients from healthy cells or survive through anaerobic metabolism •Malignancies - Some secrete growth factors impacting other tissues - Angiogenesis

Trait Expression: Dominant (Cellular Regulation Genetics)

Allele effects are expressed

Physiological Consequences of Hypothermia

As core body temperature decreases, compensatory mechanisms are activated, such as shivering to generate heat and vasoconstriction to reduce heat loss. Prolonged vasoconstriction can lead to peripheral tissue ischemia, decreased perfusion, and coagulation abnormalities. In moderate to severe hypothermia, individuals may experience confusion, loss of consciousness, and eventually become unable to regulate their temperature. The physiological effects of hypothermia progress from respiratory alkalosis and hypokalemia in mild cases to respiratory acidosis, impaired blood glucose, renal failure, and metabolic acidosis in severe cases

Single-Gene Mutations - Three Inheritance patterns (Cellular Regulation Genetics)

Autosomal Dominant Autosomal Recessive X-Linked Recessive

Neck / Back / Sciatic Pain

Back and Neck pain - very common Risk factors - lifestyle habits including poor posture, decreased fitness levels, poor body mechanics Specific Back Disorders: Intervertebral disk degeneration - decrease in cushion in disks, nerves can be compressed and swell Herniated/Ruptured disk - when disk ruptures, fluid leaksand impinges on nearby nerves, can lead to sciatica Sciatica - low back pain along the distribution of a lumbar nerve root Neurosensory and motor deficits - tingling, numbness and weakness in various parts of the leg and foot

Hyperlipidemia: Dyslipidemia (Nutrition)

Because atherosclerosis is essentially a result of a buildup of plaque containing primarily cholesterol, the pathogenesis of the disorder requires an understanding of lipid metabolism and transport. Several terms are used to describe lipid disorders. Dyslipidemia is a general term referring to abnormally high or low lipid levels in the blood. The most common form of dyslipidemia is hyperlipidemia, which is defined as an elevated level of blood lipids. More specific terms include hypercholesterolemia (high blood cholesterol levels) and hypertriglyceridemia (high blood triglyceride levels). When medication is used to treat a lipid disorder, the specific drug depends on the type of lipid that is elevated.

Thermoregulation: Newborn Temp / Regulataion

Brown fat - d/t no shivering in infants (Newborns possess a special type of fat called brown adipose tissue, or brown fat, which plays a crucial role in their thermoregulation. Brown fat has a higher metabolic rate compared to white fat, leading to increased heat production) (newborns typically do not shiver when cold. Instead, they rely on a process called non-shivering thermogenesis to generate heat and offset heat loss. This mechanism helps newborns maintain their body temperature without the need for shivering) Dependent on environmental temperature to keep warm - radiant warmer (To prevent hypothermia in newborns, measures such as placing them in a radiant warmer, swaddling them, and promoting skin-to-skin contact (kangaroo care) are commonly employed. These practices help reduce heat loss by radiation, evaporation, and conduction, thereby maintaining the newborn's body temperature within a safe range) Greater risk of heat loss d/t greater body surface area to weight ratio Blood vessels closer to skin (blood vessels in newborns are closer to the skin, further facilitating heat loss.) Thin layer of subcutaneous fat (Newborns are prone to heat loss due to factors such as their greater body surface area to weight ratio and limited insulation provided by a thin layer of subcutaneous fat) to prevent: placing them in a radiant warmer, swaddling them, and promoting skin-to-skin contact (kangaroo care)

Acute Pain

Can last from hours to weeks, associated with acute tissue damage, trauma, inflammation, or brief disease process - Expected en point for the pain Labor Pain - Visceral AND Somatic - Pain due to muscle contractions, stretching of cervical tissue - Increased SNS activity Surgical/ Trauma/ Wound Pain - Can be somatic or visceral depending on area affected - Expectation is pain will stop when healing and/or days to weeks after affected procedure completed onset: sudden ; associated with acute or potential trauma to somatic or visceral tissue described: transient, sharp, and localized to the site of the injury or inflammation duration & intensity: diminish as tissue healing occurs. occurs: a short time after injury

Cell Growth: Cell Cycle (Cellular Regulation - Oncology)

Cells cannot reverse process and go backward •Resting State - G0 •Gap - G1 (interphase) •Synthesis - S •Gap - G2 (interphase) •Mitosis - M (formation of two identical cells) Interphases - chromosomes are copied, cell typically doubles in size

Hyperthermia: Vulnerability of Children

Children, especially those under four or five years old, are particularly vulnerable to hyperthermia due to their limited ability to adapt to high temperatures. Children left unattended in hot vehicles are at risk of heat-related illnesses and even death.

Trait Expression: Genotype (Cellular Regulation Genetics)

Composition of genes (genetic code)

Hormonal Regulation: Feedback Systems (Hormonal Regulation - Endocrine)

Controlled through feedback systems ∙Negative Feedback Most common - hormone level communicated back to gland ∙Positive Feedback Increasing level of hormone triggers further elevation of hormone ∙Biological Rhythms Cortisol CNS Stimulation SNS triggers release of hormones when activated

Histologic Grading (Cellular Regulation - Oncology)

Degree of differentiation - how different it appears from tissue of origin e.g.: Grade I to Grade IV- anaplasia (worst prognosis) Grade IV = poor to undifferentiated differentiation

Cleft Lip/Cleft Palate (Nutrition)

Developmental anomalies of the first brachial arch which occur during embryonic development Caused by multiple gene environment interactions including maternal deficiency of B vitamins, maternal tobacco and alcohol use Evaluation - Prenatal diagnosis with u/s Treatment - surgical correction, speech therapy and ensuring adequate nutrition Difficulty with feeding - in future may have speech difficulties, hearing, and teeth concerns

Hormonal Regulation: 5 Overarching Functions (Hormonal Regulation - Endocrine)

Differentiation of reproductive and CNS systems Sequential growth and development Reproduction Metabolic activity Adaptive responses Focus is on endocrine glands - secrete hormones directly into blood stream that stimulates action in target tissues

Headache/Migraine Pain

Episodic exacerbations of head pain and other associated neurologic symptoms Throbbing, unilateral headache - lasts 4 to 72 hours; nausea, vomiting,sensitivity to light and/or sound Strong genetic component - altered brain excitability, spreads across cortical gray matter, innervate cerebral vessels, and active trigeminal nociceptors Stimulated to release pain-producing chemical mediators including SubstanceP, and neurokinin- results in vasodilation Can have an aura Triggers - Dietary - Environmental - Hormonal - Stress/Anxiety

Thermoregulation: Hyperthermia

Excessive heat production, inadequate ability to cool, or hypothalamic regulator dysfunction Excessive sweating - sodium loss and dehydration Leads to hypotension, tachycardia, reduced perfusion - then cerebral edema Heat Exhaustion - milder, can go on to heat stroke if not treated early with cool environment, rest, and fluid replacement Heat Stroke - Excessively high environmental temperature, physical exertion without proper ventilation - Alteration in mental status, hot and dry skin, nausea, bradycardia, weakness - leads to destruction of cell mitochondria ^37.6 degrees Celsius, due to excessive heat production or inadequate heat dissipation. Factors contributing to hyperthermia include environmental conditions (e.g., high temperature, humidity), physical exertion, and insufficient hydration

Definition and Causes of Fever

Fever is a temporary elevation of body temperature resulting from the release of endogenous pyrogens by the immune system in response to various pathogens such as bacteria, viruses, fungi, toxins, or drugs. These pyrogens trigger the hypothalamus to increase the body's thermostatic set point, leading to a rise in body temperature

Physiological Effects and Symptoms of Fever

Fever is associated with various physiological effects beyond the elevation of body temperature, including protein breakdown and catabolism. Patients with fever commonly experience symptoms such as muscle aches, headache, and malaise, which are attributed to the release of pro-inflammatory cytokines rather than the temperature itself. Despite the discomfort associated with fever, it serves beneficial roles in promoting bactericidal and anti-tumor activity, as high core temperatures are optimal for antimicrobial host defenses. Furthermore, feelings of fatigue, loss of appetite, and lethargy often observed during fever may actually have a survival benefit by reducing overall energy expenditure, allowing the body to allocate resources towards healing and recovery

Immune Response and Fever

Fever is considered a host response aimed at combating potentially harmful antigens. It enhances the body's immune response by increasing the production of white blood cells, which play a crucial role in fighting infections. While fever can also occur due to exaggerated immune responses in conditions such as autoimmune disorders or allergic reactions, its primary purpose is to aid in the body's defense against pathogens

Management of Fever

Fever management typically involves supportive measures such as adequate fluid intake, providing calories, and ensuring oxygenation. Contrary to common belief, efforts to aggressively lower body temperature, such as through cooling measures, are often counterproductive. Cooling the body can stimulate shivering, increase oxygen consumption, and cause physical distress, potentially exacerbating symptoms. Additionally, prolonged exposure to cooling methods during fever may lead to discomfort and numbness in extremities

Oncology (Cellular Regulation - Oncology)

Genetic Mutations Tumor Suppressor Genes - Normally inhibit cell replication (Tp53, NF1) Proto-Oncogenes - Regulates proliferation of cells - tissue healing Mutator Genes

Sickle Cell Pain

Genetic condition - when gene on chromosome 11 damaged, Hgb can bind oxygen - but when released, cell collapses into a sickle shape Cells prone to grouping/clumping together, causing obstruction and occluding further blood flow and oxygenation

Benign Tumor (Cellular Regulation - Oncology)

Groups of abnormal cells with excessive growth Retain most of morphologic and functional characteristics - well differentiated Capable of replication and mitosis, not metastasis Obstruct body structures - pain, physiological dysfunction, death (brain tumors) Typically termed "adenomas"

Heat Exhaustion vs. Heatstroke

Heat exhaustion is considered a milder form of heat-related illness and typically precedes heatstroke. Symptoms of heat exhaustion include headache, nausea, weakness, and dehydration. Treatment involves fluid and electrolyte replacement. If left untreated, heat exhaustion can progress to heatstroke, characterized by elevated core temperature and neurological symptoms such as confusion, convulsions, and com

Thermoregulation: Temperature Control

Hypothalamus (acting as the body's thermostat, through both neural and hormonal control mechanisms.body's optimal core temp: range is typically between 36 to 38.5 C. Deviations from this range can trigger physiological responses aimed at returning the body to its set point.) Negative feedback system (acceptable core temp range is considered within the thermal effect or threshold zone, where the body functions optimally. Temp extremes, either above or below this range, can lead to physiological changes in the body) Thermoreceptors throughout body (which are sensory receptors that detect temp changes. Central thermoreceptors are more sensitive to warmth, while peripheral thermoreceptors tend to be more sensitive to cold. These receptors relay temp info to body to regulate temp accordingly.)

Physiological Factors Leading to Hypothermia:

Hypothermia can result from excessive heat loss, insufficient heat production, or dysfunction of the body's regulatory mechanisms, particularly those controlled by the hypothalamus. Accidental hypothermia typically occurs due to environmental exposures, such as prolonged exposure to cold weather or immersion in cold water.

Hypothermia: Extent and Duration of Temperature Change

Hypothermia occurs when the core body temperature drops below the normal set point, and its severity depends on the extent and duration of temperature variation. Prolonged exposure to cold temperatures or sudden immersion in cold water can lead to more severe hypothermia.

Chronic Pain

Increases in intensity over time and persists for months or years; associated with chronic diseases or after resolution of acute injury/inflammation - Beyond expected end point Frequently accompanied by fatigue, insomnia, appetite changes, depression, and/or anxiety Chronic Recurrent Pain - Headache/Migraine Pain - Sickle Cell Pain Chronic Progressive Pain - Cancer Pain - Osteoarthritis Pain Chronic Intractable Benign Pain - Neck/Back/Sciatic Pain - Fibromyalgia Pain -> a severe biological condition with profound emotional and cognitive effects. It is affected by a variety of biological, behavioral, environmental, and societal factors. - onset, severity, duration, and response to treatment vary among patients, making it difficult to find a specific treatment plan.

Cellular Regulation Definition (Cellular Regulation Genetics)

Intracellular functions that support functions that support homeostasis including growth, homeostasis including growth, replication & differentiation replication & differentiation

Some patients can have combination of both types (nociceptive and neuropathic pain) of which is referred to as...

Mixed Pain Syndromes ; and (an example) includes fibromyalgia

Differentiation (Cellular Regulation - Oncology)

Most cells are differentiated into a specialized cell type Cell acquires functions different from parent cell Cell-signaling a complex process; normally, when signaling mistakes occur, error is repaired or destroyed If this system not working, malignancy can occur

Fibromyalgia Pain

Most common cause of widespread, musculoskeletal pain Females more commonly affected Chronic, widespread pain lasting longer than 3 months, fatigue, cognitive impairment Widespread areas of tenderness - 18 symmetric tender points (9pairs); sensitive to tactile stimulation May have abnormal nociceptive pathways Exacerbated by physical or emotional trauma and stress

Osteoarthtritis Pain

Most common form of arthritis, affecting 50% of world's population65 and older Idiopathic or secondary Localized or generalized Aging results in cartilage breakdown, allowing bones to rub against each other. Bone spurs lead to pain, inflammation Visible bone degeneration on x-ray Tenderness, swelling, crepitus

Skin Cancers: Malignant Melanoma (Cellular Regulation - Oncology)

Most deadly - originates in melanocytes due to unrepaired DNA damage, lowest layer of epidermis •Changes in tumor suppressor genes

X-linked Recessive (Cellular Regulation Genetics)

Mutations on X chromosome - females pass along to sons °Females have two copies of X chromosome - one of two copies is turned off; do not express disease or only mild symptoms °Males have one copy - will manifest disease °Father cannot pass along - children inherit X chromosome from mother and Y from father

Cancer Pain

Nociceptors stimulated by tissues/organs experiencing pressure from solid tumors, release of chemicals due to ischemia Also caused by inflammation as cancer cells invade healthy tissue▪ Pain can occur at site of primary tumor or distant metastatic lesion Pain can occur due to cancer treatment (chemotherapy, radiation) due to rapid cell death (cancer cells and healthy cells)

Cell Growth (Cellular Regulation - Oncology)

Normally, new cells created at same rate as old cells die Controlled by molecular "stop" and "go" signals Injured cells send "go" signals - activates intracellular proliferation pathways "Stop" signals sent after new tissue formed Errors in process can result in uncontrolled growth (neoplasm) It takes multiple errors compounded over time for cells to become malignant

Osteoporosis (Hormonal Regulation - Endocrine)

Osteoporosis - low bone density due to low intake of nutrients for growth or increase in resorption that occurs with aging Estrogen (females) - Inhibits PTH, slowing osteoclast formation and bone resorption ∙Most common disease that affects bone in adults ∙Foremost cause of fractures in elderly ∙Risks: family history Affects 50% of women age 50 or older (post-menopause) Most common in Asians & Caucasians Can affect elderly males (decreased testosterone & Vit D) Active young athletes Low body fat (fat cells secrete estrogen)

Trait Expression: Phenotype (Cellular Regulation Genetics)

Outward expression of our genotype

Nociceptive Pain

Pain caused by activation of nociceptive afferent fibers secondary to tissue trauma or inflammation refers to the normal functioning of the somatosensory system in response to noxious stimuli or tissue injury it is perceived as painful and can be described using various descriptions such as aching, cramping, or throbbing

Menopause (Hormonal Regulation - Endocrine)

Perimenopause - transitional period, lasts 1-8 years; cycle variability Menopause - twelve consecutive months of amenorrhea - Typically occurs age 50 - Loss of ovarian function with low estrogen and progesterone levels, high FSH and LH levels Expected decline in ovarian function and decrease in ovarian hormone secretion ∙Hormonal changes increases risk of: Breast cancer Osteoporosis Heart disease

Neuropathic Pain

Phantom Pain - Paresthesias: numbness, tingling sensations - Described as shooting, stabbing, burning - Phantom sensations: sensations of movement, twitching of the amputated limb - Telescoping: sensation that the distal part of missing limb is approaching the limb stump Changes in neural pathways secondary to amputation is responsible for this type of pain Lower threshold for activation of nociceptors Reduction in number or activity of inhibitory neurons When no sensory input received from amputated limb/body part, sensory cortex remaps to associate with another area of body

Hormonal Regulation: Definition (Hormonal Regulation - Endocrine)

Physiologic mechanisms that regulate the secretion and action of hormones associated with the endocrine system that support metabolism, perception, interception, and response to internal and external stimuli

Thermoregulation: Heat Production / Conservation

Produced through metabolic activity by chemical reactions occurring in cells Muscles and liver - greatest amount of activity Basal metabolic rate decreases as we age Shivering - way to produce heat through muscle contraction Epinephrine - increases metabolic rate Conservation - peripheral vasoconstriction

Proliferation (Cellular Regulation - Oncology)

Production of new cells

Thermoregulation: Hypothermia

Reduced perfusion in microcirculation leading to ischemia - increased viscosity of blood, coagulation Efforts eventually fail - causing vasodilation and accelerating heat loss A condition of mild to profound heat loss in which the body is unable to maintain the lower limits of the core temp set to range that are required for metabolic, enzymatic, and other physiological functions. Below 36C. Accidental Hypothermia - environmental exposures Induced - Targeted Temperature Management (TTM):intentionally set to reduce metabolism and preserve tissue by preventing ischemia, particularly after a cardiac arrest and traumatic brain injury. Stabilizes calcium and glutamate release reducing cell death of neurological cells.

Turner Syndrome (Cellular Regulation Genetics)

Sex chromosome aneuploidy °Female with one X chromosome °(X) °Short stature °Infertility °Cardiac abnormalities

Klinefelter Syndrome (Cellular Regulation Genetics)

Sex chromosome aneuploidy °Males with two X chromosomes and Y chromosome (extra) °(XXY) Have a male appearance but usually infertile 50% develop female-like breasts (gynecomastia) Sparse body hair, small testicles

Staging - TNM System (Cellular Regulation - Oncology)

Staging - TNM System (solid tumors); I-IV with IV representing advanced disease •T - tumor size and invasiveness •N - spread to regional Nodes •M - Metastasis to distant sites

Carcinogenesis: Initiation (Cellular Regulation - Oncology)

Step 1: Cancer-causing damages DNA Unsuccessful attempt at repair Permanent damage (mutation) to the cell

Carcinogenesis: Promotion (Cellular Regulation - Oncology)

Step 2: Carcinogen (promoter) introduced to cell Clonal Expansion Acquired mutation Benign tumor forms

Carcinogenesis: Progression (Cellular Regulation - Oncology)

Step 3: Accumulation of mutations Continued cellular transformation Malignant tumor forms

Hyperthermia Physiological Responses

Sweating is the body's primary response to elevated temperature, aimed at dissipating heat through evaporation. However, excessive sweating can lead to dehydration and electrolyte imbalances. Prolonged hyperthermia can result in physiological changes such as hypertension, tachycardia, decreased cardiac output, decreased perfusion, coagulation abnormalities, and neurological symptoms

Thermoregulation: Fever

Temporary elevation in temperature Immune system's response to pyrogens (fever-producing agents) - triggers the hypothalamus in the brain in increase the set point - Exogenous pyrogens: bacterial endotoxins, viruses - Endogenous pyrogens: produced by our WBCs

Thermoregulation Definition

The balance between heat produces and lost from the body in an effort to maintain an average core body temperature of 37C or 98.6 F - normothermia

Pain Definition

The unpleasant sensory and emotional experience associated with actual or potential tissue damage supported by the client's expression of the experience

Therapeutic Hypothermia:

Therapeutic hypothermia, also known as targeted temperature management, involves intentionally reducing the body's temperature to reduce metabolic rate and tissue ischemia. This approach is used in medical settings, such as after a heart attack, to protect tissues and promote healing.

Trait Expression: Heterozygous (Cellular Regulation Genetics)

Traits/alleles are different

Trait Expression: Homozygous (Cellular Regulation Genetics)

Traits/alleles are the same

C Fibers

Transmit dull, aching, or burning sensations and are slower in transmitting signals. They are associated with the prolonged, lingering aspects of pain.

A-Delta Fibers

Transmit rapid, sharp, and localized impulses, often associated with reflexive responses such as pulling away from a hot surface.

A-Beta

Transmit sensations of vibration and touch but do not directly participate in transmitting pain signals. Instead, they play a role in pain modulation, such as in techniques like transcutaneous electrical nerve stimulation (TENS) or applying ice for pain relief.

Hyperthermia Treatments & Complications

Treatment for heat exhaustion involves cooling measures and rehydration. However, if symptoms persist or worsen, individuals should be considered as having heatstroke. Hyponatremia (low sodium levels) can occur if individuals overhydrate with water, leading to neurological symptoms and potentially life-threatening complications. Heatstroke represents an uncompensated conflict between the body's efforts to dissipate heat and maintain blood pressure, resulting in elevated core temperature and potential neural damage

Cell Growth: Mitosis vs Meiosis (Cellular Regulation - Oncology)

Two types of normal division Mitosis - all cells capable of this (except egg and sperm) • Duplication - two identical "daughter" cells produced from single "parent" cell • Develop normal tissue or replace lost of damaged normal tissues Meiosis - only cells that will become eggs in females and sperm in males • Generates "daughter" cells distinct from one another and from "parent" cell • Utilized for sexual reproduction

Thermoregulation: Heat Loss

Warmer surfaces lose heat to cooler surfaces Currents - wind, air Vasodilation - increased heat loss through conduction Perspiration

When we think about pain, we start with a stimulus and then what happens?

We have transduction that occurs with tissue damage and that's going to result in the release of chemical mediators from damaged cells like prostaglandins, bradykinin, substance P, glutamate, and other chemical mediators are released from damaged cells and that activates the nociceptors

Particulate Thermic

When an individual loses the ability to maintain their internal body temperature, they are referred to as particulate thermic. This condition can lead to hypothermia or hyperthermia if not addressed promptly.

Fragile X Syndrome (Cellular Regulation Genetics)

X-LINKED INHERITANCE: Associated with intellectual disability Affects 1 in 4000 males and 1 in 8000 females Females who inherit the mutation do not necessarily express the disease condition but can pass it on Males who inherit the disease on the x chromosome expresses the condition because only has one X chromosome

Muscular Dystrophy (Cellular Regulation Genetics)

X-LINKED RECESSIVE: Common in boys (1 in 3500) Caused by mutation in the dystrophin gene - poorly anchored fibers tear themselves apart under repeated stress of contraction Muscle weakness, difficulty walking and large calves Weakness worsens over years with a loss of ability to ambulate by 8-13 years old

Iron-Deficiency Anemia: Manifestations (Nutrition)

can occur through either a reduction in dietary iron or a loss of iron A reduction in dietary iron can occur through malabsorption of iron through the gastrointestinal tract or through reduced dietary intake . The loss of iron most commonly occurs through hemorrhage, menstrual blood loss in females, and gastrointestinal bleeding in males and females.

Nociceptors

cells of free nerve endings in the skin and peripheral organs that receptors for the sensation of pain Found in all tissues except CNS activated by tissue injury to transmit pain information to somatosensory system (nociception)

A-Delta and C transmit....

different types of pain sensation - transmits to thalamus and midbrain

Hyperlipidemia (Nutrition)

elevated level of blood lipids Dysplidema major consequences: MI, Stroke, PAD Excess nutrition (characterized by an elevation of serum lipids (cholesterol, triglycerides, and or/ phospholipids) individuals thought to have genetic predisposition to hyperlipidemia primarily affects adults but can occur associated with chronic inflammation and childhood obesity

The brain can modulate the pain experience by releasing...

endorphins, serotonin, and other substances to try and inhibit pain impulses in the dorsal horn of the spinal cord - these substances help to regulate and alleviate the sensation of pain

Skin Cancers: Squamous Cell Carcinoma (Cellular Regulation - Oncology)

incidence increased 200% - •Damaged, unrepaired DNA in nucleus of squamous cells in epidermis, TP53 mutation - UV damage triggers

Chronic Intractable Benign Pain

is characterized by continuous pain but with varying levels of intensity. An example of chronic benign pain is continuing low back pain. - Neck/Back/Sciatic Pain - Fibromyalgia Pain

Chronic Progressive Pain

is characterized by continuous pain that increases in intensity. An example of chronic progressive pain is cancer pain that worsens as the disease nears its terminal phase - Cancer Pain - Osteoarthritis Pain

Chronic Recurrent Pain

is characterized by repeated and intense episodes of pain separated by pain-free periods. A common example of chronic recurrent pain is migraine headaches. - Headache/Migraine Pain - Sickle Cell Pain

May not be family history if .. (Cellular Regulation Genetics)

mutation is new

when multiple errors occur.... (Cellular Regulation - Oncology)

mutations become fixed leading to neoplasia and formation of tumors Benign Malignant

Pain can be described as...

nociceptive or nonnociceptive

Reduced penetrance (Cellular Regulation Genetics)

not everyone who inherits gene mutation will have the same clinical symptoms

when those chemical mediators attach to the membrane of the nociceptors that can result in the.....

opening of sodium channels that can cause action potential allowing that to move

Pain is perceived and interpreted based on..

past experiences, beliefs, attitudes, and meaning - via efferent pathways (escaping the brain)

Carcinogenesis (Cellular Regulation - Oncology)

process where normal cells develop intro cancer cells Initiation Promotion Progression

Apoptosis (Cellular Regulation - Oncology)

programmed and normal cell death

Gene (Cellular Regulation Genetics)

segment of DNA; codes for production of certain for production of certain proteins proteins composed of a double DNA helix; compacted to make up chromosomes Bookshelf (chromosome) Instruction manuals (genes) Letters to write instruction manual (DNA) 46 chromosomes in cells; grouped in 23 pairs (one from each parent) 23rd pair - sex chromosome (XX - female; XY - male)

Somatic Pain (nociceptive)

sharp, aching, or throbbing pain, localized to a specific area (cancer pain, labor pain) Pain that rises from the skin, ligaments, muscles, bones, or joints (abs, pelvis, thorax) as result of an acute injury or chronic degenerative disease (burns, arthritis, fracture) onset: sudden and usually related to a specific time and activity, such as a fall. duration: related to the degree of tissue trauma

After the pain signals ascend from the spinal cord to the thalamus and midbrain, the signals are relayed to the...

somatosensory cortex in the parietal lobe (where they are perceived as pain) the limbic system (involved in emotion and memory) plays a role in interpreting the contextualizing the pain experience based on pas experiences, beliefs, attitudes, and meaning.

Differentiation (Cellular Regulation - Oncology)

specification of cellular functions

Genetics (Cellular Regulation Genetics)

study of individual genes and impact on inheritance and on single-gene and chromosomal disorders Two types of cell division Mitosis - all cells capable of this (except egg and sperm cells) °Duplication - two identical "daughter" cells produced from single "parent" cell °Develop normal tissue or replace lost of damaged normal tissues Meiosis - only cells that will become eggs in females and sperm in males °Generates "daughter" cells distinct from one another and from "parent" cell °Utilized for sexual reproduction Genetic Mutations - uncorrected can pass on through generations °Deletions °Duplications °Inversions °Insertions °Translocations Aneuploidy - wrong number of chromosomes - Nondisjunction - don't separate correctly; wrong number of chromosomes into cell •Extra - trisomy •Missing - monosomy •Trisomy 21, 13, 18 Sex chromosome aneuploidy •Males with two X chromosomes and Y chromosome (extra) •Females with one X chromosome (missing)

Genomics (Cellular Regulation Genetics)

study of structure, function, and analysis of the human genome

if body temperature rises above the set point..

sweating and vasodilation help dissipate heat and cool the body down

This transmission occurs as... (pain stimulus)

the potential moves to afferent (away from injury/sensation) nerve fibers that carry impulses to spinal cord (then goes up the track to the thalamus and midbrain) different fibers: A-Delta and C

Normothermia

the usual range of core body temperature, which is between 36-38.5 C for adults

If body temperature falls below the set point..

vasoconstriction occurs to conserve heat, while shivering generates additional heat

When a patient is diagnosed with a benign tumor, it can be assumed that the tumor is: (Select all that apply) (Cellular Regulation - Oncology)

well encapsulated well differentiated

Nociceptive Pain (in process of pain perception)

when the brain then receives and interprets that information as an unpleasant, painful sensation. Nociceptive pain is a protective mechanism to alert the brain to potential or actual tissue damage

Visceral Pain (nociceptive)

within body cavity, response to stretching, selling, oxygen deprivation, can have radiating pain (Chron's disease, ulcerative colitis, pancreatitis) pain originating from inflammation or obstruction of internal organs (appendicitis, gallbladder disease, kidney stones) onset: gradual or sudden described: squeezing, pressure, cramping, and distention with a dull quality Frequently accompanied: nausea, vomiting, diarrhea, and loss of appetite

Autosomal Recessive (Cellular Regulation Genetics)

°Non-sex chromosome °Both parents are carriers of gene mutation °25% chance of passing along mutation Cystic fibrosis Sickle Cell Anemia

Autosomal Dominant (Cellular Regulation Genetics)

°Only one copy of mutated gene required to cause disease °50% chance of passing along mutation Huntington's disease Hereditary nonpolyposis colon cancer syndrome

Leukemia (Cellular Regulation - Oncology)

•4 types - determined from cell of origin and degree of differentiation •Acute Lymphocytic •Chronic Lymphocytic •Acute Myelogenous •Chronic Myelogenous

Initiators and Promoters: Carcinogens Risk Factors (Cellular Regulation - Oncology)

•Age •Smoking/tobacco •Infectious agents •Genetics •Exposure to environmental carcinogens such as sunlight; pollutants in the air, soil, water, or food; or medical treatments such as medications or radiation •Poor nutrition •Sedentary lifestyle

Trait Expression: Recessive (Cellular Regulation Genetics)

•Allele effects are suppressed UNLESS traits are homozygous

Obesity: Binding of... (Nutrition)

•Binding of leptin to receptors leads to peptides increasing food intake

Blastoma (Cellular Regulation - Oncology)

•Blastoma - cancer caused by malignancies in precursor cells (blasts) •Nephroblastoma (Wilm's tumor) - most common kidney cancer in children •Associated with many genetic abnormalities •Abdominal mass, swelling •Survival rate 90%

Non-Hodgkin's Lymphoma (Cellular Regulation - Oncology)

•Broad category of all other lymphomas that do not contain Reed-Sternberg cells •Can impact B cells or T cells/NK cells •Risk factors - Host (decreased immune response, viral infections) and environment (exposure to herbicides, solvents, chemicals) •Genetic mutations occur - translocations to proto-oncogenes and inactivation of tumor suppressor genes •Tend to form solid tumors - congregate in lymphatic tissue •Painless, enlarged lymph nodes; GI tract symptoms; can also impact other organs such as oral cavity, respiratory system and bones.

Oncology: Diagnostics (Cellular Regulation - Oncology)

•CBC •BMP - basic metabolic panel •Pathology/Biopsy •Tumor markers

Colon Cancer (Cellular Regulation - Oncology)

•Can occur anywhere along GI tract •Adenomas (polyps) - benign tumors formed from glandular structures in intestinal epithelium •Precursor to cancer •Result of genetic abnormalities and environmental factors (smoking, diet, obesity, lack of exercise) •Mutated tumor suppressor genes and oncogenes •Change in bowel habits, fatigue, weight low, abdominal pain

Manifestations (Cellular Regulation - Oncology)

•Change in bowel or bladder habits •A sore that does not heal •Unusual bleeding or discharge •Thickening or lump in breast or any part of body •Indigestion or difficulty swallowing •Obvious change in mole •Nagging cough or hoarseness •Local effects - increase in size of tumor and pressure it exerts on surrounding organs/tissues •Systemic effects - tumor secretion of cytokines (IL-6, TNF-a) which cause fever, cachexia, and fatigue. •Paraneoplastic syndromes - malignancy produces hormones, peptides, or reacts with normal tissue to cause symptoms distant from tumor site (i.e., hypercalcemia, SIADH)

Oncology: Treatment (Cellular Regulation - Oncology)

•Chemotherapy •Radiation •Surgery •Biologic therapies •Stem cell transplantation

Trait Expression: Locus (Cellular Regulation Genetics)

•Chromosome that houses genes •Alleles are various forms of a gene at a given locus

Iron-Deficiency Anemia: Classification (Nutrition)

•Classified by morphology or cause -Decreased in production of RBCs -Reduction in survival time of RBCs -Loss of erythrocytes through blood loss -Functional changes in structure

Obesity (Nutrition)

•Dramatic increase over the past 20 years •Impacts 33% of US population

Diet-Related Congenital Abnormalities: Fetal Alcohol Syndrome (Nutrition)

•Encompasses a spectrum of disorders; FAS being most severe -Alcohol crosses the placenta -Amniotic fluid acts as reservoir thus prolonging fetal exposure •Alcohol consumption during pregnancy -Interferes with embryonic and fetal development -Decreased weight and height -Facial abnormalities -Abnormalities in nervous system development -Poor suck reflex and feeding, irritability, lethargy at birth

Trait Expression: Multifactoral (Cellular Regulation Genetics)

•Environmental influence of gene expression

Immune Thrombocytopenic Purpura (ITP) (Cellular Regulation - Oncology)

•Fairly common autoimmune disease •Destruction of platelets by antiplatelet antibodies - mainly occurs in spleen •IgG immunoglobulins are directed against host platelet antigens •Thrombocytopenia •Chronic disease with relapses •Purpura, epistaxis, retinal hemorrhage can occur, spontaneous intracranial bleeding •IV immunoglobulin infusions administered for treatment •Splenectomy

GERD (Nutrition)

•Gastroesophageal reflux disease •Chronic reflux of gastric contents back into esophagus •Normally, LES receives signals and becomes tighter to prevent gastric contents from refluxing •GERD - Decreased lower esophageal sphincter tone; allows acid, pepsin, and bile into esophagus •Erosions and ulcerations •Manifestations - epigastric pain, heartburn, injury to tooth enamel, sore throat, can lead to erosive esophagitis and esophageal cancer •Risk factors: increased intra-thoracic pressure -Obesity -Hernias -Pregnancy -Older age

Prostate Cancer (Cellular Regulation - Oncology)

•Grows slowly - rarely causes serious harm •Screening important to prevent late stages as it can metastasize to bones and lymph nodes •Tends to develop on periphery of gland - leads to reduced symptoms •Symptoms - urinary frequency, weak flow, blood in urine, pain or burning on urination

Leukemias and Lymphomas (Cellular Regulation - Oncology)

•Hematologic cancers - genetically abnormal cells resulting in immature or ineffective hematopoietic cells •All blood cells derived from multipotent hematopoietic stem cells - can differentiate into any of 10 blood cell lines •Erythrocytes, platelets, neutrophils, eosinophils, basophils, monocytes, T lymphocytes, B lymphocytes, natural killer cells, and dendritic cells •Lymphomas - originate in lymphatic tissues •Leukemias - originate in bone marrow or blood

Obesity: Hypothalamus... (Nutrition)

•Hypothalamus - regulates appetite •Peptides that stimulate and suppress •Hormonal signals and neural afferents signal to higher brain centers to regulate pleasurable aspects of food ingestion

Failure to Thrive (Nutrition)

•Inadequate growth from inability to obtain or use calories for growth -Inadequate caloric intake -Inadequate absorption -Increased metabolism -Defective -Often impacts preterm and low-birth weight infants

Hyperlipidemia: Injury to _______ cell (Nutrition)

•Injury to endothelium cell •Inflammation •Macrophages adhere to injured area and release cytokines •Smooth muscle cells proliferate, produce collagen, form fibrous plaque

Cellular Regulation Definition (Cellular Regulation - Oncology)

•Intracellular functions that support homeostasis including growth, replication & differentiation

Iron-Deficiency Anemia: Levels (Nutrition)

•Iron levels - decreased •Ferritin levels - decreased •Transferrin - increased •TIBC - increased •RBC, H&H - decreased •Mean corpuscular volume (MCV) - 80-100 fL - decreased, microcytic •Mean corpuscular hemoglobin (MCH) - 27-34 pg - decreased

Iron-Deficiency Anemia (Nutrition)

•Iron required for successful proliferation of red blood cells •Reduced intake or usability of iron •Most common cause through blood loss - must be resupplied through diet •Higher pH of GI tract impacts absorption •Microcytic and hypochromic RBCs •Risks - pregnancy, older age

Lung Cancer (Cellular Regulation - Oncology)

•Leading cause of cancer deaths - more than prostate, breast, and colon cancer combined •Uncontrolled cell growth of lung tissues - non-small cell lung cancer most common type •Long-term exposure to cigarette smoke (85-90% of cases) •Linked to DNA mutations that damages p53 suppressor gene •Hemoptysis, shortness of breath, weight loss •Paraneoplastic syndromes - secretion of PTH leading to hypercalcemia

Hodgkin's Lymphoma (Cellular Regulation - Oncology)

•Leads to large, malignant B lymphocytes - Reed-Sternberg cells - most cases impact B lymphocytes •Risk factors - viral exposures, immune suppression •Manifestations - enlarged lymph node (neck - most common), splenomegaly, hepatomegaly, fatigue, weight loss, night sweats

Obesity: Leptin.. (Nutrition)

•Leptin - product of the obesity gene and expressed primarily by adipocytes, acts on the hypothalamus to suppress appetite and functions to regulate body weight within a fairly normal range •Leptin resistance - disrupts hypothalamic satiety and promotes overeating, and excessive weight gain •Associated with insulin resistance and the CV complications of obesity

Metabolic Syndrome (Nutrition)

•Must have three of the five following criteria -Increased waist circumference (women > 35; men > 40) -Elevated triglyceride level (> 150) -Elevated blood pressure (> 130/85) -Elevated fasting blood glucose (> 100) -Reduced HDL level (women < 50; men < 40) Inflammation and oxidative stress play major role; adipose tissue has endocrine functions and excess fat has a role in all of these disease states

Malabsorption Syndromes (Nutrition)

•NEC •Ischemic, inflammatory condition that causes bowel necrosis and perforation -Damage to mucosal cells lining bowel wall -Diminished blood supply leads to cell death - stop secretion of protective mucus, bowel wall attacked by enzymes -Gas-forming bacteria enter in damaged areas •Most common severe neonatal GI emergency •Most common in preterm infants •Intestinal immaturity, altered regulation of intestinal blood flow

Hyperthyroidism (Hormonal Regulation - Endocrine)

•Primary hyperthyroidism: Graves Disease - most common cause, autoimmune condition - autoantibodies against TSH receptor •Manifestations - goiter, forward displacement of eyes, thickening of skin on shins, dysrhythmias, anxiety, weight loss

Malabsorption Syndromes: Short Bowel Syndrome (Nutrition)

•Resection of the small intestine - decreased mucosal surface area for absorption •Can occur as a treatment for NEC and other intestinal complications such as malrotation •Requires parenteral nutrition at first, then gradual increase to general diet •Risk of malabsorption of some vitamins (fat-soluble)

Nutrition Definiton (Nutrition)

•The interaction of nutrients and other substances in food in relation to maintenance, growth, reproduction, repair, and health of an organism •Ingestion •Digestion •Absorption •Metabolism •Two major concerns -Insufficient Nutrition -Excess Nutrition

Breast Cancer (Cellular Regulation - Oncology)

•Tp53 Gene •BRCA1 and BRCA2 gene mutation •Risk factors - age, gender, family history, obesity, smoking, overuse of alcohol •Breast cancer cells with damaged DNA do not die off; continue replicating and comes a malignancy •Mass - hard, fixed, non-mobile, dimpling of skin, inverted nipple, red, scaly rash •ER+ and PR+ - assist in guiding treatment

Trait Expression: Polygenic (Cellular Regulation Genetics)

•Traits that occur as result of several genes acting together

Sarcoma (Cellular Regulation - Oncology)

•Type of cancer that originates in the connective tissue •Osteosarcoma - type that affects the bone •Rare but do grow fast and metastasize quickly •Occurs mainly in femur, tibia, and humerus •Risk factors •may be connected to periods of high bone growth or bone overstimulation •Adolescents and young adults •Radiation and bone marrow transplant increase risk •Leads to osteomyelitis - bone breakdown, fractures •Tumor destroys bone tissue, interferes with bone blood supply •Deep bone pain, worse at night; muscle weakness and atrophy

Adenocarcinoma (Cellular Regulation - Oncology)

•Type of cancer that starts in the epithelial cells of glands that line the inside of the organs •Occurs with the glands that line the organs grow out of control •Common type of colon cancer, breast cancer, prostate cancer, and lung cancer •Most breast cancers are adenocarcinomas - starts in the glands of the breast where milk is secreted

Trait Expression: Penetrance (Cellular Regulation Genetics)

•Variable forms of expression (complete vs incomplete)

Thyroid: Thyroid-Stimulating Hormone (TSH) (Hormonal Regulation - Endocrine)

∙0.35 - 5.5 microinternational units/mL

Adrenal Glads (Hormonal Regulation - Endocrine)

∙Adrenal Medulla Catecholamines - norepinephrine, epinephrine, and dopamine Pheochromocytoma ∙Adrenal Cortex Aldosterone - promotes water and Na+ resorption and excretion of K+ (RAAS) Glucocorticoids - cortisol: increased gluconeogenesis, suppresses immune system, and promotes anti-inflammatory mechanisms

Pituitary Gland (Hormonal Regulation - Endocrine)

∙Anterior -ACTH - Stimulates production of glucocorticoids by adrenal cortex -Growth Hormone - Promotes growth of body tissues (dwarfism or acromegaly) -TSH -FSH and LH ∙Posterior -Anti-diuretic Hormone (ADH) - Causes conservation of body water by promoting water resorption by renal tubules (increased collecting duct permeability) -Oxytocin

Myxedema coma (Hormonal Regulation - Endocrine)

∙Associated with severe hypothyroidism ∙From lack or insufficient treatment of hypothyroidism Hypothermia without shivering, hypoventilation, hypotension, hypoglycemia, and lactic acidosis May occur in patients with severe vascular disease or after overuse of narcotics/sedatives in patients with hypothyroid

Adrenocortical Excess (Hormonal Regulation - Endocrine)

∙Cushing Syndrome - develops over years ∙Excess of cortisol and glucocorticoids ∙ACTH independent (ACTH decreased, cortisol increased) -Chronic exposure to excess exogenous medications -Endogenous overproduction ∙Cushing Disease - results from pituitary corticotropic adenoma (rare) ∙ACTH dependent (cortisol and ACTH increased)

Hyperthyroidism: ∙Thyroid Storm (thyrotoxicosis) (Hormonal Regulation - Endocrine)

∙Due to extreme levels of thyroid hormone - life-threatening ∙From lack or insufficient treatment of hyperthyroidism, excessive stress, or manipulation of gland during thyroid surgery ∙Hyperthermia (103-105), tachycardia, HTN, heart failure, agitation, delirium, N, V, D ∙Can cause cardiac collapse & death

Hyperthyroidism: Primary Hyperthyroidism (Hormonal Regulation - Endocrine)

∙Increase in thyroid stimulation leads to an increase in T3 and T4 secretion ∙Pituitary attempts to stop with negative feedback by decreasing TSH ∙Diagnosis - decreased TSH and increased T3 and T4 ∙Primary Hypothyroidism - Hashimoto's Thyroiditis ∙Most common - destruction of thyroid gland d/t autoimmune dysfunction ∙Autoantibodies directed to thyroglobulin leading to fibrosis ∙Decreased T3 and T4, increased TSH

Diabetes Insipidus (Hormonal Regulation - Endocrine)

∙Neurogenic - Central DI Insufficient secretion of ADH, rapid onset; ADH levels low ∙Nephrogenic DI Inadequate response of renal tubules to ADH (can be genetic of caused by kidney injury), slower onset; ADH levels normal or increased ∙Diagnosis - low urine osmolality - unable to concentrate urine, hypernatremia, and continued diuresis (water deprivation testing) ∙Manifestations - polyuria, polydipsia (continuous thirst)

SIADH (Hormonal Regulation - Endocrine)

∙Paraneoplastic Syndrome - ectopic production of ADH from cancerous tumors ∙Surgery - fluid and volume changes ∙Manifestations - thirst, anorexia, fatigue, decrease in Na+ level (confusion, lethargy) ∙Diagnosis - serum hypoosmolality and hyponatremia along with urine hyperosmolality; urine Na+ excretion matches intake

Adrenocotrical Insufficiency (Hormonal Regulation - Endocrine)

∙Primary Disorder: Addison's Disease - autoimmune disorder ∙Deficiencies of cortisol and aldosterone ∙Diagnosis - increased levels of ACTH, low cortisol levels ∙Secondary Disorder: Dysfunction of anterior pituitary leading to loss of ACTH (surgery, damage to pituitary); chronic glucocorticoid use (taper dose d/t suppression of ACTH) ∙Diagnosis - insulin induced hypoglycemia results in decreased ACTH and cortisol ∙Manifestations: fatigue, weakness, N/V, hypoglycemia, hyponatremia, hyperkalemia ∙Adrenal crisis - acute insufficiency that is life-threatening - dehydration, fever, hyperkalemia; precipitated by stressors

(Hormonal Regulation - Endocrine)

∙Primary hyperaldosteronism - Conn syndrome Aldosterone producing adenoma ∙Diagnosis - elevated aldosterone, suppressed renin levels ∙Manifestations - hypertension, weakness, headaches, polydipsia, polyuria ∙ ∙Secondary hyperaldosteronism - Renin dependent Aldosterone secreted d/t excess secretion of renin Usually response to hypovolemia - retention of fluid and increase in blood pressure ∙Diagnosis - elevated aldosterone, elevated renin levels

Thyroid (Hormonal Regulation - Endocrine)

∙Produces the following primary hormones ∙T3 - triiodothyronine ∙T4 - thyroxine ∙Production of Calcitonin (Thyroid) - Osteoblastic - lowers serum calcium ∙Production of PTH (Parathyroid) - Osteoclastic - raises serum calcium ∙Dysfunction: 1) Primary - occurs in thyroid 2) Secondary - occurs in pituitary ∙Needed for brain development, neurologic function, metabolism

Tertiary Hypothyroidism (Hormonal Regulation - Endocrine)

∙Rare - tumors or trauma to hypothalamus ∙Decreased TRH, TSH, T3 and T4

Thyroid: Triiodothyronine T3 (Hormonal Regulation - Endocrine)

∙T3: 80 -200 ng/dL

Hyperthyroidism: Secondary Hyperthyroidism (Hormonal Regulation - Endocrine)

∙pituitary adenoma, etc. ∙Diagnosis - normal or high TSH and elevated T3 and T4 ∙Secondary Hypothyroidism ∙Rare - tumors or trauma to pituitary ∙Normal or increased TRH, decreased TSH and decreased T3 and T4

Neuromatrix Theory

▪ Brain produces patterns of nerve impulses drawn from various inputs including psychologic and cognitive experiences ▪ Promoted new thinking about chronic pain conditions that do not have an obvious cause

Gate Control Theory

▪ Non-painful input closes "pain gates" to dorsal horn, prevents transmission to CNS ▪ Non-noxious stimuli, such as rubbing injured body part, or TENS therapy, can decrease transmission of pain