Advanced Pathophysiology Test

Advanced Pathophysiology Test Health - ANS state of complete physical, mental and social well-being and not merely the absence of disease or infirmary. Disease - ANS acute or chronic illness that one acquires or is born with that causes physiologic dysfunction on the cell/organ/organ system/organismal level Pathophysiology - ANS the physiology of altered health. Loss of homeostatic balance in the body at some level. Etiology - ANS the cause of a disease, or what sets the disease in motion Iatrogenic - ANS caused by clinical treatment of another disease process Pathogenesis - ANS defines how the disease process evolves, the sequence of events following exposure Morphological changes - ANS microscopic and gross anatomic changes that occur with disease Morphology - ANS fundamental structure or form of cells or tissues Histology - ANS study of cells and extracellular matrix of body tissues, diagnostic test used to assess morphological changes Clinical manifestations - ANS signs (observed) and symptoms (subjective) of a disease Syndrome - ANS completion of signs and symptoms that are characteristic of a disease state Complications - ANS adverse extensions of disease or outcomes from treatments Sequelae - ANS lesions or impairments that follow or are caused by a disease Diagnosis - ANS designation as to the nature or cause of a health problem. Requires obtaining a careful history, physical exam and diagnostic testing. Reliability - ANS the extent to which an observation, if repeated, gives the same result. Validity - ANS the extent to which a measurement tool measures what it is intended to measure. Sensitivity - ANS the proportion of people with a disease who are positive for that disease on a given test or observation. (True-positive result) Specificity - ANS the proportion of people without the disease that are negative on a given test or observation (True-negative result) Clinical course - ANS the evolution of the disease. May progress through acute, synchronic and chronic phases and chronic cases may have exacerbations or remissions Preclinical stage - ANS disease is not clinically evident but will eventually progress to clinical stage Subclinical disease - ANS disease is not clinically evident and will not progress to clinical stage Clinical disease - ANS manifested by signs and symptoms Carrier status - ANS person is harboring the disease but is not infected Epidemiology - ANS study of disease occurrence in human populations Patterns of disease - ANS what epidemiology is based on studying, e.g. race, gender, or lifestyles more likely to lead to disease, more concerned with whether something happened or will happen than how it happened Incidence - ANS number of new cases arising within a population at risk during a specified time (number of cases per number of people) Prevalence - ANS measure of existing cases of a disease within a population at a given time point. (existing cases divided by current population) Morbidity - ANS impact of an illness on a persons life Mortality - ANS the death-producing characteristics of a disease Determination of risk factors - ANS can be modifiable or non-modifiable, conditions that are believed to play a role in the development of a disease Cross-sectional studies - ANS use simultaneous collection of information necessary for classification of exposure and outcome status (ex: comparing prevalence of disease in smokers vs. nonsmokers) Case-controlled studies - ANS compare people known to have the outcome of interest (cases) and those known not to have the outcome of interest (controls). Information on exposures or characteristics are collected on both groups (ex: maternal ETOH consumption) Cohort (longitudinal) studies - ANS compare a group of people who were born about the same time or share some characteristics of interest. Natural history of a disease - ANS progression or projected outcomes of the disease without medical intervention Primary prevention - ANS keep disease from occurring by removing risk factors for the disease (healthy lifestyle) Secondary prevention - ANS detects the disease early when it is asymptomatic and treatment measures are effective (Pap smear) Tertiary prevention - ANS designed to reduce complications of a disease after it is diagnosed. Evidence-based practice - ANS making decisions in healthcare based on scientific data that has shown specific ways of managing a disease, symptoms and complaints Physical growth - ANS changes in the body as a whole or in its individual parts Growth and development - ANS process by which an fertilized ovum becomes an adult person Development - ANS embraces the aspects of differentiation, such as changes in body function and psychosocial behavior Prenatal period - ANS begins with implantation of the blastocyst, divided into embryonic and fetal periods Embryonic period - ANS 2nd-8th week, formation of germ layers, early tissue differentiation, development of major organs and systems of the body Fetal period - ANS 9 weeks to birth, rapid growth and differentiation of tissues, organs, and body systems First stage of embryonic development - ANS growth occurs by increase in cell numbers and elaboration of cell products Second stage of embryonic development - ANS morphogenesis (development of form) occurs, including mass cell movement Third stage of embryonic development - ANS stage of differentiation or maturation of physiologic processes Low birth weight - ANS less than 2500g at birth Small for gestational age (Intrauterine growth retardation) - ANS birth weight more than 2 standard deviations below the mean for gestational age or below 10 percent Large for gestational age - ANS birth weight greater than two standard deviations above the mean or greater than 90th percentile Assessment measures for gestation - ANS prenatal or postnatal assessment Prenatal assessment - ANS careful menstrual history, physical milestones during pregnancy, prenatal test for maturity Postnatal assessment - ANS examination of external physical and neuromuscular characteristics, Ballard method, or Dubowitz method Criterion for APGAR score - ANS Heart rate, respiratory effort, muscle tone, reflex irritability, color Common health problems for newborns - ANS Distress at birth and APGAR score, neonatal hypoglycemia, neonatal jaundice, birth injuries, congenital malformations caput succedaneum - ANS swelling of newborn's scalp after delivery cephalhematoma - ANS accumulation of blood between the periosteum and the skull of the infant brachial plexus injury - ANS injury to spinal nerves the innervate the shoulder, arm and hand Klumpke paralysis - ANS partial palsy of the lower brachial plexus Special needs of the premature infant - ANS Respiratory problems, intraventricular hemorrhage, necrotizing enterocolitis, infection and sepsis Health problems of the infant - ANS issues r/t nutrition, irritable infant syndrome of colic, FTT, SIDS, Infectious diseases Failure to thrive - ANS inadequate growth of the child due to inability to obtain or use essential nutrients (organic or inorganic) Early childhood - ANS 18 months-5 years, toddler and preschool stages, development of locomotion and language, learning is ongoing and progressive Health risks of early childhood - ANS injuries, infectious diseases, child maltreatment Middle Childhood - ANS 6-12 years, growth av. 3-3.5 kg and 6cm per year, muscle strength, coordination, and stamina increase. Ability to perform complex movements increases, can consider several factors simultaneously, can evaluate self and perceive others' evaluations Health risks of middle childhood - ANS Respiratory infections, accidents, dental caries, infections involving bacterial and fungal agents, surfacing go acute and chronic problems Adolescent period - ANS 13-19, rapid changes can occur in body size and shape, as well as physical and psychological functioning, hormones and sexual maturation interact with social structures. Adolescent growth and development - ANS CNS-mediated hormonal activity, physical growth occurs simultaneously with sexual maturation, growth patterns: arms, legs, hands, feet, and neck, followed by hips and chest, then shoulder width and depth and trunk length Adolescent developmental tasks - ANS independence from parents, adopting peer codes, making lifestyle choices, forming and adapting to body image. Health risks of adolescents - ANS unintentional injuries (sports, accidents, drownings), intentional injuries (homicide or suicide), sexual activity, substance abuse Subgroups of the elderly - ANS young-old (65-74), middle-old (75-84), old-old (85+) Gerontology - ANS a discipline that studies aging and the aged from a biologic, psychological and sociological perspectives Goals of gerontology - ANS to explore the dynamic process of complex physical changes, adjustments to psychological functioning, and alterations in social identity, and to assist older adults to maximize functional ability and prevent and minimize illness and disability. Developmental-genetic theories - ANS changes that occur with aging are genetically programmed and can be altered through mutations Stochastic theories - ANS changes that occur with aging result from an accumulation of random events or damage from environmental factors Muscular changes in aging - ANS Reduction in muscle size and strength; decrease in type II muscle fibers, type I stay constant. Can be slowed with exercise Decrease in bone mass - ANS renewal of bone is slower, estrogen decreased in postmenopausal women Focal weakness in trabecular bone - ANS Head of femur, head of radius, and vertebral body Joint degeneration - ANS osteoarthritis in synovial joints CV function in the elderly - ANS aorta and arteries are stiffer and more distensible with age, leading cause of morbidity and mortality, 40% elderly adults have hypertension Respiratory function - ANS decline in maximal oxygen consumption, loss of elastic recoil in the lung, calcification of soft tissues of the chest wall resulting in increased workload of respiratory muscles, loss of alveolar structure that decreases the surface area of gas exchange (increase in residual lung volume and functional reserve capacity, decline in vital capacity) Neurological function - ANS decrease in weight of the brain, loss of neurons in brain and spinal cord, changes in neurons and supporting cells, impaired synaptic connections, diminished electrochemical reactions, neural dysfunctions, sensorimotor changes, overall cognitive abilities remaining intact Vision changes - ANS visual acuity and color discrimination decline, opthomalgic diseases are more common Hearing changes - ANS presbycusis is common, cerumen impaction Gastrointestinal changes - ANS tooth loss common, changes in esophageal function, achlorhydria occurs, atrophic gastritis and decreased sensations of intrinsic factor are more common, diverticula of colon are more common Renal function - ANS decreased reserve capacity, decline in kidney mass, steady decline in total renal blood flow, decline in renal tubular function, decreased creatinine in urine not indicative of renal disease GU changes - ANS changes in the bladder, atrophy of perineal structures in women, BPH in men, IADL's (Instrumental) - ANS more complex tasks necessary to function in society, shopping,cleaning, cooking, reading, writing, etc. Transient Urinary Incontinence - ANS not established, can be caused by medication Chronic Urinary Incontinence - ANS established; failure of bladder to store or empty urine (urge, stress, or neurogenic) Symptoms in the elderly - ANS depressed mood, irritable, loss of interest, appetite and weight changes, sleep disturbance, psychomotor agitation, fatigue and loss of energy, feelings of worthlessness or self-reproach, excessive guilt, diminished ability to think, suicidal ideation Criteria for selection of screening tools to measure function - ANS purpose of data collection, population to be assessed, availability and applicability of instruments, reliability and validity of tools, setting or environment Mini-mental state examination (MMSE) - ANS series of questions: memory, orientation, attention, constructional abilities Dementia - ANS acquired, persistent cognitive impairment Characteristics of dementia - ANS insidious onset, symptoms present for a long period of time, inaccurate answering of orientation questions, may try to conceal deficits, performs poorly on tasks of similar difficulty, mood and behavior labile, may have neurological symptoms Pseudodementia of depression - ANS rapid onset, short duration, lack of interest in answering questions, may emphasize deficits, marked variability in performing tasks of similar difficulty, mood consistently depressed, neurologic symptoms not present Delirium - ANS acute confusional state, presents with other underlying disorders (MI, PNA, CA, Hyperthyroidism, drug toxicity) Drug therapy in older population - ANS polypharmacy, increased likelihood of toxic and adverse reactions, avoid centrally acting drugs and drugs with long half-lives, educate about drug use for accuracy in administration and compliance Factors contributing to adverse effects of drugs in elderly - ANS noncompliance, errors, poor manual dexterity, poor eyesight, lack of understanding, attitudes and beliefs about medication use, mistrust of healthcare providers, forgetfulness or confusion Changes in Blood pressure regulation - ANS SBP increases with age, DBP plateaus or declines after age 50. Consequence of arterial stiffness. Aggressive treatment can prevent CVA, MI, heart failure, renal failure. Normotensive DBP with Elevated SPB cases - ANS dramatic increase in pulse pressure, which is a indicator for future coronary events Orthostatic hypotension in elderly - ANS occurs because compensatory CV mechanisms are delayed or insufficient. Decline in GFR is not accompanied by an increase in creatinine - ANS because the production of creatinine is reduced as muscle mass decline with age Serum creatinine is used to measure - ANS GFR