NR283 Worksheet 1 (Newest 2023/2024) Verified Content

NR283 Worksheet 1 (Newest 2023/2024) Verified Content Worksheet 1 NR283 Worksheet 1 (Newest 2023/2024) Verified Content Questions: 1. Define Pathophysiology. • The study of diseases; what is taking place (or what happens) when things go wrong; it builds on anatomy. 2. Define Diagnosis, Cause, Predisposing factors, and Pathogenesis. • Diagnosis  Refers to the identification of a specific disease through the evaluation of signs and symptoms, laboratory tests (see inside cover and Ready Reference 5 in the Appendix). • Causes  The causative factors of a disease. Some agents include congenital defects, inherited or genetic disorders, microorganisms such as viruses and bacteria, immunologic dysfunction, metabolic derangements, degenerative changes, malignancy, burns or other trauma, environmental factors, and nutritional deficiencies. o Idiopathic  When the cause of a disease is unknown. o Iatrogenic  When a treatment, a procedure, or an error causes a disease.  Examples: A bladder infection following catheterization, or bone marrow damage caused by a prescribed drug. • Predisposing factors  A condition that triggers the onset or exacerbation of a disease. • Pathogenesis  The early stages in the development of a disease or the sequence of events involved in the tissue changes related to the specific disease process. 3. Define Acute Disease, Chronic Disease, Incubation Period, Prodromal Period, Manifestations, Convalescence, Prognosis and Remission. • Acute Disease  A short-term illness that develops very quickly with marked signs like a high fever or sever pain. o Example: Acute appendicitis • Chronic Disease  A milder condition developing gradually, but persists for a long time and usually causes more permanent tissue damage. It is marked by intermittent acute episodes. o Example: Rheumatoid arthritis • Incubation Period  The time between the initial exposure to the infectious agent and the appearance of the first signs of infection. • Prodromal Period  The initial period in the development of a disease before acute symptoms occur; when a person is aware of a change in their body, but the signs are nonspecific; laboratory tests are negative during this period, thus making it difficult to confirm a diagnosis. o Example: Fatigue, loss of appetite, or headache. • Manifestations  The clinical evidence or effects and the signs and symptoms of a disease. o Example: Redness and swelling, which can be local or found at the site of the problem. • Convalescence (Rehabilitation)  The period of recovery and return to the normal healthy state; it may last for several days or several months. • Prognosis  The probable outcome of a disease. • Remission and Exacerbations  May mark the course or progress of a disease. In remission, the manifestations of the disease subside, whereas in exacerbations the signs increase. o Example: In Rheumatoid arthritis, there are typically periods when swelling and pain are minimal, alternating with acute periods when swelling and pain are severe. 4. Describe atrophy. Provide an example. • Atrophy  Refers to a decrease in the size of cells, resulting in a reduced tissue mass. • Examples: A decrease in the size of a leg after being in a cast for 6 weeks; the changes that occur in the lower extremities of someone paralyzed below the waist; a pressure area under a poorly fitting denture; the effect of decreased pituitary function on the adrenal gland. 5. Describe the cellular adaptation dysplasia. Provide an example. • Dysplasia  The term applied to a tissue in which the cells vary in size and shape, large nuclei are frequently present, and the rate of mitosis is increased. o Is considered the most dangerous cellular adaptation because it may be a forerunner for neoplasia. • Examples: The changes responsible for an abnormal Pap smear; the thyroid gland’s response to a hypersecretion of thyroid-stimulating hormone. 6. Describe the cellular adaptation metaplasia. Provide an example. • Metaplasia  Occurs when one mature cell type is replaced by a different mature cell type. • Examples: The changes that often occur over years in the respiratory tract of a smoker; the thyroid gland’s response to hypersecretion of thyroid-stimulating hormone. 7. Describe hyperplasia. Provide an example. • Hyperplasia  An increased number of cells resulting in an enlarged tissue mass. In some cases, hypertrophy and hyperplasia occur simultaneously, as in the uterine enlargement that occurs during pregnancy. • Examples: Breast enlargement at puberty; the liver’s response to prolonged drug intoxication (like chronic alcohol abuse); the thyroid gland’s response to decreased iodine intake; the development of a callus on the hands of an individual involved in heavy physical labor. 8. Discuss clinical manifestations of dehydration. 9. Define hypokalemia. Discuss common effects of hypokalemia. • Hypokalemia  When the serum level of potassium is less than 2mmol/L or 3.5mEq/L. • Causes: • Effects: 10. Define hyperkalemia. Discuss common effects of hyperkalemia. • Hyperkalemia  When the serum level of potassium is greater than 2.6mmol/L or 5mEq/L. • Causes: • Effects: SIGNS OF POTASSIUM IMBALANCE 11. Define hyponatremia. Discuss common effects of hyponatremia. • Hyponatremia  When the serum sodium concentration is below 3.8-5mmol/L or 134mEq/L. • Causes: • Effects: 12. Define hypernatremia. Discuss common effects of hypernatremia. • Hypernatremia  When the serum sodium concentration is more than 145mEq/L. • Causes: • Effects: SIGNS OF SODIUM IMBALANCE 13. Define hypocalcemia. Discuss common effects of hypocalcemia. • Hypocalcemia  When the serum calcium level is less than 2.2mmol/L or below 4mEq/L. • Causes: • Effects: 14. Define hypercalcemia. Discuss common effects of hypercalcemia. • Hypercalcemia  When serum levels of calcium is greater than 2.5mmol/L or 5mEq/L • Causes: • Effects: SIGNS OF CALCIUM IMBALANCE 15. Define normal serum pH, normal CO2, and normal HCO3-. • Normal serum pH  7.35-7.45 • Normal CO2  35-45 • Normal HCO3-  22-26 16. List two causes of respiratory acidosis. Explain why these conditions cause respiratory acidosis. What would the labs look like (pH, CO2, HCO3-)? • Respiratory Acidosis Causes  Respiratory congestion, slow shallow respirations from drugs (Opiate drugs) or by anything that causes the body to try to hold on to CO2, like in COPD patients because they are not capable of blowing off CO2, acute problems like pneumonia where there are airway obstructions, and from any chest injuries. • pH Less than 7.35 • CO2 More than 45 • HCO3- 17. List two causes of respiratory alkalosis. Explain why these conditions cause respiratory alkalosis. What would the labs look like (pH, CO2, HCO3-)? • Respiratory Alkalosis  From breathing too fast (hyperventilation), like when having an anxiety attack because it causes rapid and fast breathing that releases too much CO2, by drug overdoses of Aspirin, or high fever. • pH More than 7.35 • CO2 Less than 35 • HCO3- 18. List two causes of metabolic acidosis. Explain why these conditions cause metabolic acidosis. What would the labs look like (pH, CO2, HCO3-)? • Metabolic Acidosis Causes  Excessive loss of bicarbonate ions from diarrhea or from intestinal secretions, if BP decreases causes accumulated lactic acid and insufficient oxygen for the cells, in diabetic patients whom produce large amounts of ketoacids that use up bicarbonate ions, renal disease or failure where there is both a decrease in excretion of acids and production of bicarbonate ions, and in someone with cardiac arrest or someone with severe diarrhea because they may develop an additional factor that interferes with compensation that causes them to become so dehydrated that they kidneys receive little blood and are not able to function adequately. **Shock, diabetic ketoacidosis, renal failure, diarrhea** • pH Less than 7.35 • CO2 • HCO3- Less than 22 19. List two causes of metabolic alkalosis. Explain why these conditions cause metabolic alkalosis. What would the labs look like (pH, CO2, HCO3-)? • Metabolic Alkalosis Causes  Anything that causes an increase in serum bicarbonate ion that commonly follows with the loss of hydrochloric acid from the stomach, like in early stages of vomiting or with drainage from the stomach, from hypokalemia, excessive ingestion of antacids, • pH More than 7.45 • CO2 • HCO3- More than 26 20. Give an example of an autosomal (not a sex chromosome) recessive disorder. • Cystic fibrosis  • Sickle Cell Anemia  • Tay-Sachs Disease  • Phenylketonuria  21. Give an example of an autosomal dominant disorder. • Adult Polycystic Kidney Disease  • Huntington’s Chorea  • Familial Hypercholesterolemia  • Marfan Syndrome  22. Give an example of a chromosomal disorder. • Down Syndrome (Down Syndrome)  • Monosomy X (Turner Syndrome)  When only 1 sex chromosome, the X chromosome, is present. Only 45 chromosomes are present, resulting in a variety of physical abnormalities and lack of ovaries. • Polysomy X (Klinefelter Syndrome)  When an extra X chromosome is present (XXY), resulting in 47 chromosomes present. Not all males show signs and are diagnosed, but typically, the testes are small and sperm are not produced. • Trisomy 18 (Edwards Syndrome)  23. Define Trisomy 21. List five clinical manifestations of Trisomy 21. • Trisomy 21  A common chromosomal disorder known as Down Syndrome, which results in numerous defects in physical and mental development. • 5 Clinical Manifestations: The head is small and has a flat facial profile; the eyes are slanted and the irises contain Brushfield spots; the mouth tends to hang open, revealing a large, protruding tongue and a high-arched palate; the hands are small and have a single palmer crease, the muscles tend to by hypotonic, the joints are loose, cervical abnormalities and instability are often evident, and stature is short; development stages are delayed; all children are cognitively impaired, but the severity of impairment varies with the individual, and early stimulation programs are helpful; sexual development is often delayed or incomplete; usually other problems are present, including visual problems (cataracts, strabismus), hearing problems, obstructions in the digestive tract, celiac disease, congenital heart defects, decreased resistance to infection (immune deficit); they have a high risk for developing leukemia; they are at an increased risk for developing Alzheimer’s disease after the age of 40 24. Define amniocentesis. What is the purpose of this test? • Amniocentesis  The removal of a small amount of amniotic fluid from around the fetus for examination and diagnosis • Purpose: Amniocentesis is used for chorionic villus sampling to confirm any potential abnormalities of a pregnancy, such as spina bifida or Down Syndrome 25. Discuss local signs of infection. • Local Signs of Infection  Inflammation, pain or tenderness, swelling, erythema (redness), and warmth, lymphadenopathy, ESR (erythrocyte sedimentation rate), and often tissue necrosis is likely to occur, too. • Caused by Bacteria  A purulent exudate (or pus) is usually present. • Caused by Viruses  A serous (clear) exudate is usually present. • In Respiratory Tract  Signs include coughing or sneezing and difficulty in breathing. • In the Digestive Tract  Signs include vomiting or diarrhea. 26. Discuss systemic signs of infection. • Systemic Signs of Infection  Include signs and symptoms common to significant infections in any area of the body such as fever, fatigue and weakness, headache and arthralgia, leukocytosis, elevated ESR, anorexia, and nausea. • Severe Infection of the Nervous System  Results in confusion or disorientation, seizures (convulsions), or loss of consciousness. 27. List two benefits of staging a tumor. • Staging helps describe the extent of the disease at the time and therefore, it provides a basis for treatment and prognosis. 28. What three factors does the TNM system use to stage a tumor? • Size of the Tumor, extent of involvement of regional lymph Nodes, and the spread (invasion or Metastasis) of the tumor. 29. List two substances that mast cells release during degranulation. • They release chemical mediators such as histamine in connective tissue; serine proteases, such as tryptase and chymase; serotonin; proteoglycans, mainly heparin (active as an anticoagulant) and some chondroitin sulfate proteoglycans; they can be fixed in tissues or wandering; they originally are basophils that migrated from the blood and entered tissue to become mast cells. 30. Identify some of the more common areas of the body that contain normal indigenous (resident) flora and the benefits that humans receive as a result of the microorganisms. • Most Common Areas Resident Flora are Found  Skin, nose, pharynx, mouth, colon, rectum, vagina, distal urethra, and perineum. • Areas that are Sterile Under Normal Circumstances  Blood, cerebrospinal fluid, lungs, uterus, fallopian tubes, ovaries, bladder, and the kidney. • Upper Respiratory Tract  Streptococci, Haemophilus, and staphylococci. • Skin  Staphylococcus and Candida. • Some Benefits of Resident or Indigenous Flora  Various resident flora in the intestinal tract provide the synthesis of Vitamin K and assistance in some digestive processes; helpful in preventing other organisms from establishing a colony. 31. Briefly describe T and B cells and the roles they play in cellular immunity. • T Cells (T Lymphocytes)  They are WBC’s that rise from stem cells, which are incompletely differentiated cells held in reserve in the bone marrow and then travel to the thymus for further differentiation and development of cell membrane receptors. Cell-Mediated Immunity develops when T Cells with protein receptors on the cell surface recognize antigens of the surface of target cells and directly destroy the invading antigens. T cells then reproduce, creating an ‘army’ to battle the invader, as well as activating other T and B Cells. o Cytotoxic (Killer) T Cells  Destroy antigens, cancer cells, and virus-infected cells. o Memory T Cells  Remember antigens and can quickly stimulate immune response on re-exposure. o Helper T Cells  Active B and T cells combines that control or limit specific immune responses. o Suppressor T Cells  • B Cells (B Lymphocytes)  Are responsible for humoral immunity through the production of antibodies or immunoglobulins. They mature in the bone marrow and then proceed to the spleen and lymphoid tissue. Once exposed to antigens, they become antibody-producing plasma cells via the assistance of T Cells. They act primarily against bacteria and viruses that are outside body cells. o Memory B Cells  Also a form during humoral immune responses, and they provide repeated production of antibodies. 32. Define allergy, and provide examples of environmental allergens. • Allergy  An antigen that can initiate an allergic reaction. • Examples of environmental allergies: Occurs when the body’s immune system overacts to a substance in the environment, such as dust mites, pollen, pet dander, or mold. 33. Define autoimmunity, and provide examples of autoimmune disorders. • Autoimmunity  The development of antibodies to self-antigens because the immune system can no longer recognizes self from non-self and begins to attack its own cells and structures and organs. • Examples of autoimmune disorders: Systemic Lupus Erythematosus (SLE) that affects many systems; facial rash on nose and cheeks resembling a marking of a wolf and referred to as a ‘butterfly rash’; affects primarily women between the ages of 20 and 40 years; higher occurrence in African Americans, Hispanics, and Native Americans. It is characterized by the presence of large numbers of circulating autoantibodies against DNA, platelets, erythrocytes, various nucleic acids, and other ANAs. Common manifestations of SLE: polyarthritis, butterfly rash, photosensitivity, glomerulonephritis with inflammation and progressive renal damage, pleurisy that causes chest pain, carditis, Raynaud’s phenomenon in fingers and toes, psychoses, depression, mood changes, seizures, anemia, leukopenia, and thrombocytopenia. 34. Define alloimmunity, and provide examples of this type of hypersensitivity response. • Alloimmunity (isoimmunity)  An immune response to non-self-antigens from members of the same species, which are called alloantigen’s or isoantigens with two major types including blood group antigens and histocompatibility antigens. • Examples of this type of hypersensitivity response: An immunologic reaction against transplant tissue or from blood transfusions. 35. Describe factors that influence the capacity of a pathogen to cause disease. 36. Identify the following for type I hypersensitivity responses: name, rate of response development, class of antibody involved, principal effector cells involved, participation of complement, and examples of disorder. • Name  Type I: Allergic Reactions • Rate of Response Development  Immediate inflammation and pruritus • Class of Antibody Involved  IgE • Principal Effector Cells Involved  Mast cells, when IgE binds to them they release histamine and chemical mediators • Participation of Complement  • Examples of Disorder  Hay Fever or Allergic Rhinitis 37. Identify the following for type II hypersensitivity responses: name, rate of response development, class of antibody involved, principal effector cells involved, participation of complement, and examples of disorder. • Name  Type II: • Rate of Response Development  Cell lysis and phagocytosis. • Class of Antibody Involved  IgG or IgM. • Principal Effector Cells Involved  Antigens on cell-complement becomes activated by reacting with IgG or IgM. • Participation of Complement  • Examples of Disorder  ABO Blood Incompatibility 38. Identify the following for type III hypersensitivity responses: name, rate of response development, class of antibody involved, principal effector cells involved, participation of complement, and examples of disorder. • Name  Type III: • Rate of Response Development  Inflammation and vasculitis • Class of Antibody Involved  • Principal Effector Cells Involved  Antigen-antibody complex deposits in tissue-complement activated. • Participation of Complement  • Examples of Disorder  Autoimmune disorders like SLE or glomerulonephritis. 39. Identify the following for type IV hypersensitivity responses: name, rate of response development, class of antibody involved, principal effector cells involved, participation of complement, and examples of disorder. • Name  Type IV: • Rate of Response Development  Delayed inflammation. • Class of Antibody Involved  • Principal Effector Cells Involved  The antigen binds to T Cells and the sensitized lymphocyte releases lymphokines. • Participation of Complement  • Examples of Disorder  Contact dermatitis or a transplant rejection. 40. Describe the difference between active and passive immunity, and provide examples of each. • Active Immunity  Known as natural immunity and is acquired by direct exposure to an antigen. o Examples: When a person has an infection and then develops antibodies. • Passive Immunity  Known as artificial immunity and it develops when a specific antigen is purposefully introduced into the body, stimulating the production of antibodies. o Examples: A vaccine, immunizations, or a booster.