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A concise review of advanced pathophysiology concepts relevant to nursing practice. It covers key topics such as action potentials, cellular adaptations (hyperplasia, hypertrophy, atrophy), cellular injury, necrosis, apoptosis, and cancer metastasis. The material is presented in a question-and-answer format, making it useful for exam preparation and quick review. It also includes information on fluid and electrolyte balance, oncogenes, tumor suppressor genes, and paraneoplastic syndromes. Designed to help nursing students and professionals reinforce their understanding of pathophysiology principles and their clinical applications, focusing on key concepts and mechanisms underlying disease processes. It is a valuable resource for quick review and exam preparation, offering a structured approach to mastering complex topics in pathophysiology.
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15-20 mV (threshold potential) to reach -55 to -65 mV."
muscle disease or electrolyte imbalances." "What is the main protein responsible for maintaining the correct balance of extracellular Na
is at -70 to -85 mV."
potential which the cell membrane resists stimulation and it cannot depolarize"
in tissue mass after damage or partial resection, allowing the organ to regenerate Ex - removal of part of the liver and the cells regenerating, uterine and mammary gland enlargement occur during pregnancy to meet the demands of the increased work load, callus on foot Ex: (Hormonal) Breast and uterine enlargement during pregnancy."
normal cells usually caused by increased hormonal stimulation Ex - endometrial hyperplasia (imbalnce in estrogen & progesterone with increase in estrogen - risk for cancer), Benign prostatic hyperplasia (BPH), thyroid enlargement - thyroid goiters"
cardiomegaly"
kidney is removed and the other kidney steps in to function as both and increases in size"
during childhood, uterus decreasing in size after childbirth Disuse - skeletal muscle atrophy that occurs from a person being immobilized or bed ridden for a period of time (arm in a cast,"
blood supply, nutrition, hormonal stimulation, or nervous stimulation"
homeostasis with the result being disease. May or may not be reversible. This is dependent on the type of cell, level of differentiation, ability to adapt and the type, severity and duration of the injury."
molecular oxygen formed as natural oxidant species in cells during mitochondrial respiration & energy generation. -This form of injury is called oxidative stress"
membrane structure, organelle swelling, mitochondrial dysfunction. Leads to local cell death and autolysis. Outcome for common injuries (ischemia, toxin exposure, infections, trauma). Swelling, accidental cell death Cell Size - Swelling Nucleus - Pyknosis, karyorrhexis, Karyolysis Plasma Membrane -Disrupted Cellular Contents - Enzymatic digestion; may leak out of cell Adjacent inflammation - Frequent Physiologic or pathologic role - usually pathologic (culmination of irreversible cell injury)"
"dropping off" of cellular fragments (apoptotic bodies). Reduced (shrinking), plasma membrane intact Cell Size - Shrinking Nucleus - Fragmentation into nucleosome-size fragments Plasma Membrane - Intact; altered structure, especially orientation of lipids Cellular Contents - Intact; may be released in apoptotic bodies Adjacent inflammation - No Physiologic or pathologic role - often physiologic, means of eliminating unwanted cells; may be pathologic after some forms of cell injury, especially DNA damage"
to distant tissues and organs through the body."
for the transposition of the cancer cells"
cells changes to one which can metastasize"
Node Involvement Presence of Distant Metastasis"
to secrete growth factors that stimulate their own growth which is known as"
translocations, gene amplification"
proliferation -These are proto-oncogenes that have mutated -Cancer cells contain these"
growth and proliferation of cancer cells -Stop cell division in damaged cells & prevent mutations"
*2 of these genes in each cell must be turned off by the cancer to halt their effects"
caretaker genes, maintain integrity of the genome. -Produces proteins that repair damaged or mutated DNA. Controls initiation of cellular senescence (stop cell division), apoptosis, and suppresses cell division until DNA is repaired"
pancreatic, breast cancer"
are ignited by cancer but are not caused by direct local effects of tumor mass -Typically triggered by the release of substances from a tumor"
barrier dysfunction, the release of proinflammatory mediators, release of acute thermogenesis, weight loss and muscle wasting"
Conduction -Acid Base Balance -Cellular Chemical Processes -Cell Membrane Transport Systems"
mechanical force of fluid against the walls of a compartment (blood pressure)"
compartment Contributes to osmotic pressure and exerted by plasma proteins (Albumin is the main plasma protein)."
space which perfuses organs and tissues. -Volume changes in the extracellular fluid compartment will cause changes to this"
deficit, sodium excess or ↓ BP Causes kidneys to reabsorb water to ↑ plasma volume"
Hemoglobin"
Lactic Acid Sulfuric Acid Phosphoric Acid Ketone Bodies"
Is a byproduct of aerobic metabolism"
ribonucleotides which are used as an energy source"
-The value is inversely proportional to the concentration of hydrogen ions in the blood."
-Decrease in muscle mass -Decrease in ability to regulate sodium and water balance -Decrease in renal function -Elderly are very susceptible to dehydration d/t increased insensible water loss"
(dissolved in the blood) and reflects ventilation. -The higher this level is, the faster the respirations are and vice versa."
blood. -It reflects the metabolic component of acid base balances, specifically the kidney."
amount of oxygen content that is dissolved in the arterial blood."
and the hematocrit. -It represents the amount of anions available for buffering."
for respiratory acidosis"
Hyperkalemia, Vasodilation, tremors, disorientation, restlessness, muscle twitching, and seizures, H/A, blurred vision, hypotension"
when there is an increase in alveolar hyperventilation - lungs are blowing off too much CO2."
and PNS - neuro s/s: dizziness, confusion, paresthesia's, seizures, and coma"
congestive heart failure, high altitudes, fever, gm negative sepsis, or severe anemia, psychogenic hyperventilation, hepatic failure, salicylate overdose, drugs such as catecholamines, methylphenidate3, nicotine, progesterone, or mechanical ventilation."
Actual genes specific to the individual"
is a persons observable characteristics"
normal"
No"
cytosine)"
fragment at original site, but inverted. ABCDE would be ABDCE. No apparent physical effect; but off spring may have genetic issues (chromosomal deletions or duplications)."
chromosomes. Usually no physical problems, but offspring can have genetic problems."
chromosomes & the material is exchanged. Carrier's gametes can be normal, carry the translocation, or have duplications & deletion."
breaks & gaps d/t cultured in folate deficient medium. No apparent relationship to disease. Except fragile X syndrome - substantial cognitive impartment"
particular trait Ex: two dominant or two recessive alleles (EE or ee)"
Ee"
affected by the mutation (for the person to actually have the disease) if only one , then they are a carrier and will not manifest the disease"
homozygote aa"
because of anatomic differences. Uterine & testicular defects."
Male pattern baldness, breast cancer."
affected autosomal - both sexes have equal chances of being affected"
Repolarization Hyperpolarization"
(more positive charge) Voltage gated Na channels open and allow Na to enter the cell -> voltage inside the cell moves towards zero"
negative polarity of the inside of the cell is restored back to its baseline of -70 to -85 mV -Na channels close, K channels open"
greater than -85mV. Is less excitable, because there is a greater distance between the resting membrane potential and the threshold potential."
respond to ANY stimulus no matter how strong."
and will only respond to a very strong stimulus."
-Imbalance between protein synthesis and degradation, , reduction of the intracellular contents, also includes a self-eating process called autophagy. -Example: aging brain cells, malnutrition, uterus decreasing in size after childbirth"
the size of the organ -Etiology: triggers include repetitive stretching, chronic pressure, volume overload -Pathophysiology: hormonal stimulation or increased functional demand, which increases the cellular protein in the plasma membrane, endoplasmic reticulum, myofilaments, and mitochondria"
results from an increased rate of cell division, it can only happen in cells that are capable of mitosis * -Etiology: results from the production of growth factors which stimulate cells to produce new cellular contents and divide"
mature cells due to persistent, severe cell injury or irritation -Disordered cell growth and is mainly found in epithelial tissue of the uterine cervix, the endometrium, GI and respiratory tract mucosa, -Ex: pap smears often show dysplastic cells of the cervix, uterine cells"
size, shape, and organization of mature cells due to persistent, severe cell injury or irritation"
another adult cell -Etiology: found in tissue damage, repair, and regeneration -Results from the exposure of the cells to chronic stressors, injury, or irritation. If the influences that cause the cellular changes remain present, they can induce a malignant change in the cells -Ex: most common is the change from columnar cells to squamous cells - this occurs in chronic smokers or gastroesophageal reflux (GERD)"
direct mechanical trauma, genetics, nutrition, infections, immunologic reactions and inflammation."
-Oxygen and Oxygen derived free radicals -Intracellular Calcium and loss of calcium steady state"
Iintracellular calcium -The more damage which is done, the higher the calcium concentration becomes. The elevated calcium level causes damage to the cell membrane. It also causes damage to the intracellular contents by activating enzymes which cause the damage directly."
This contributes to cellular swelling, decreased protein synthesis, and impairs cellular membrane transport systems. All of these changes impair cellular membrane integrity."
cells results in the production of activated oxygen species (free radicals, H2O2, NO) which destroy the cell membranes and structures."
hemoglobin, diseases, etc. Heart attack, etc"
oxygenation, ↓ATP, Na-K & Na-Ca pumps fail -> ↑ intracellular Na & Ca -> K to diffuse out of cell -> acute cellular swelling (from ↑ Na in cell), anaerobic glycolysis, ↑Lactate, necrosis"
syndromes of heart, liver, GI, kidneys, and cerebrum."
affected, causing neutrophil adhesion to endothelium Serious complication in transplantation and ischemic diseases"
reactive oxygen intermediates (hydroxyl radical & hydrogen peroxide -> cell membrane damage & mitochondrial Ca overload). -WBC function is impaired as result of injury. * Xanthine dehydrogenase -> converts to xanthine oxidate -> creates massive amounts of free radicals, superoxide & hydrogen peroxide -> etc... apoptosis"
that contains a single unpaired electron in an outer orbit
Pyruvate to be changed to LA, Oxaloacetate -> malate, this prevents gluconeogenesis -> fasting hypoglycemia. Also Glyceraldehyde-3-phosphate -> glycerol 3- phosphate combines with fatty acides to form triglycerides -> hepatosteatosis. Also ↓ citric acid cycle production of NADH -> utilization of Acetyl-CoA for ketogenesis -> ketoacidosis & lipogenesis -> hepatosteatosis"
enlargement of liver, interruption of microtubular transport of proteins & their secretions, ↑ intracellular water, ↓ fatty acid oxidation in mitochondria, ↑ membrane rigidity, development of liver necrosis."
mitochondria of the hepatocytes. Occurs as a result of the unavailability of glucose."
in the liver: metabolism, detoxification, and protein synthesis"
organelles (mitochondrion, singular) that generate most of the chemical energy needed to power the cell's biochemical reactions. Chemical energy produced by the mitochondria is stored in a small molecule called adenosine triphosphate (ATP)"
During starvation & uncontrolled diabetes, these levels are insufficient bc it is completely used by gluconeogenesis- The depletion of ______________ increases the amount of acetyl-CoA -> acetyl-CoA is processed by hepatocytes -> undergoes transformation to 3 ketone bodies: acetoacetate, acetone, β- hydroxybutyrate = basis for ketoacidosis"
found on tumor plasma membranes or in the blood, spinal fluid, or urine. An elevated tumor marker may suggest a specific diagnosis, but it is not used alone as a definitive diagnosis test."
cell cancers"
Pancreatic, Lung, and Breast cancers"
prostate cancer"
spread locally or to distant sites and are well encapsulated."
look like the tissue or origin, rapid cell growth, and can metastasize to local tissues or distant sites. Not encapsulated, anaplasia, pleomorphic (various shapes/sizes). Are named after the cell of origin but in addition to the "oma" they have the root words "carcino" or "sarco"."
paraneoplastic syndromes"
-Aldosterone Deficiency -Acidosis -Strenuous Exercise"
membrane. Consists of cytosol and fluid in cell nucleus."
Tissue space that surrounds cells in body Contains 20% of body water"
(glucose and ions). It's the fluid inside blood cells and blood plasma. Contains 20% of body water"
-renin -> angiotensin -angiotensin -> angiotensin 1 -ACCE converts angiotensin1-> angiotensin II -> causes art VC -> release of aldosterone -> stimulates renal Na reabsorption and K excretion"
Natriuretic Hormones -promote urinary excretion of Na and water"
or retention of Na & water"
decreased plasma protein production"
proximal tubule"
stimulates RAAS"
volume replacement with NaCl"
ducts"
tubule, loop of henle, and distal tubules (proximal tubule cells produce NH4+)"
ketoacidosis acute or chronic renal failure"
diarrhea large volumes of saline admin medications such as NSAIDS, ace inhibitors, trimethoprim"
which progresses to confusion and coma in severe, Kussmauls respirations (form of hyperventilation that are deep and rapid), anorexia, N/V, diarrhea, abd discomfort"
myocardial contractility, decreased CO, and catecholamine resistant hypotension, and hyperkalemia"
acid production -loss of bicarbonate -diminished renal excretion of hydrogen."
and a low arterial pH."
ions. High pH, high HCO3"
gastric suctioning), diuretic use (thiazide diuretics), diarrhea (laxative abuse), antacid ingestion, excess aldosterone"
hypocalcemia, cardiac arrhythmias from hypokalemia, hypoventilation, and a elevated PCO2, tetany, paresthesias"
aldosterone and consequently increased reabsorption of Na+ and HCO3- in the proximal tubule in response to the hypovolemia and hypokalemia. -occurs with diuretic use"
serum bicarbonate and a process which prevents the renal excretion of serum bicarbonate must both occur."