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Cellular Structure and Function, Exams of Nursing

San Diego City College Nursing

An overview of the basic structure and function of cells, including the cytoplasm, nucleus, and cell membrane. It covers key cellular processes such as cell replication, differentiation, and adaptation. The document also discusses various types of cell injury and cell death, as well as the structure and function of blood cells and their role in the immune system. This information is essential for understanding the fundamental principles of pathophysiology and the underlying mechanisms of disease.

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NURS 208 Test 1- Pathology Concepts

Pathology Concepts

Homeostasis

• The tendency to maintain balance/stability internally

• Self-regulating, give-and-take system

• Compensatory mechanisms: strategies that make up for the changes and return the body

to its normal state

• Two feedback systems:

-

Positive feedback: formation of blood clot while bleeding, child birth

-

Negative feedback: control of elevated blood sugar by insulin

Histology: cause or reason for a disease

• May include infectious agents, chemicals, environmental influences, etc.

• Idiopathic: unknown

• Iatrogenic: unintended effect of a medical treatment

-

Predisposing: tendencies that enhances risk for developing certain diseases

o Age, gender, health, diet/nutritional/activity status, genetics, etc.

• Diagnosis: identification of the disease

• Disease duration

-

Acute

-

Chronic

• Clinical Manifestation: evidence of disease

-

Includes signs and symptoms

-

Syndrome: comprises a group of signs and symptoms that occur together

• Remission: when the clinical manifestation of the disease disappears

• Exacerbation: when clinical manifestation increases again

• : likelihood of making a full recovery or regaining normal functioning

• : death or death rate from a particular disease

• : disease state or rate within a population

• : new problems that arise because of a disease or condition

• : strategies used to cure or manage a disease

• : strategies to avoid the development of diseases (e.g., vaccination, lifestyle

change, screening)

Organelle Function

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Pathology Concepts Homeostasis

The tendency to maintain balance/stability internally
Self-regulating, give-and-take system
Compensatory mechanisms: strategies that make up for the changes and return the body to its normal state
Two feedback systems:
- Positive feedback : formation of blood clot while bleeding, child birth
- Negative feedback : control of elevated blood sugar by insulin Histology: cause or reason for a disease
May include infectious agents, chemicals, environmental influences, etc.
Idiopathic : unknown
Iatrogenic : unintended effect of a medical treatment
Predisposing: tendencies that enhances risk for developing certain diseases o Age, gender, health, diet/nutritional/activity status, genetics, etc.
Diagnosis : identification of the disease
Disease duration
Acute
Chronic
Clinical Manifestation : evidence of disease
Includes signs and symptoms
Syndrome: comprises a group of signs and symptoms that occur together
Remission : when the clinical manifestation of the disease disappears
Exacerbation : when clinical manifestation increases again
: likelihood of making a full recovery or regaining normal functioning
: death or death rate from a particular disease
: disease state or rate within a population
: new problems that arise because of a disease or condition
: strategies used to cure or manage a disease
: strategies to avoid the development of diseases (e.g., vaccination, lifestyle change, screening) Organelle Function

Nucleolus Produces ribosomal RNA Endoplasmic reticulum (ER) SER is involved in the production of phospholipids and has many different functions depending on the cells; RER is the site of the synthesis of lysosomal enzymes and proteins for extracellular use Ribosomes (^) Aid in protein production on the RER and polysomes Secretory Vesicles (^) Store protein hormones or enzymes in the cytoplasm awaiting a signal for release Lysosome (^) Recycling center. Combines with food vacuoles and digests materials engulfed by cells Mitochondria (^) Complete the breakdown of glucose, producing nicotine adenine dinucleotide (NADH) and adenosine triphosphate (ATP). Cilia (^) Propel materials along the surface of certain cells Centrioles (^) Help organize spindle apparatus necessary for cell division Chapter 1: Cellular Function Nucleus (^) Contains the genetic information necessary for control of cell structure and function; DNA contains hereditary information. Golgi Complex (^) Sorts, chemically modifies, and packages proteins produced on the RER Food Vacuole (^) Stores ingested material and combines with lysosomes Peroximomes (^) Break down various potentially toxic intracellular molecules. Cytoskeleton (^) Gives the cell internal support, helps transport molecules and some organelles inside the cell, and binds to enzymes of metabolic pathways. Flagella (^) Provide motive force for sperm cells

Energy NOT required
E.g., insulin transporting glucose into cell
Active transport
Requires carrier protein molecule and energy (ATP)
Lower concentration to an area of higher concentration, against a concentration gradient
E.g., Na-K pump: in order to move the ions (Na+ and K+) against their gradients, energy is required o Na-K pump moves potassium ions into the cell while simultaneously moving sodium ions out of the cell
Endocytosis
Cell membrane engulfs substances bringing into the cell
Phagocytosis
Cell eating, solid particles
Pinocytosis
Cell shrinkage
Exocytosis
Release of substances from the cell
Hormone secretion from glands Action Potential
Brief, long distance signals within a neuron (does not decay over distance)
Total amplitude of about 100mV (-70mV to +30mV)
Depolarization is followed by repolarization, and a short period of hyperpolarization
An AP or nerve impulses are generated only on axons
Changes permeability of neuron membrane by opening specific voltage-gated channels on axon
No voltage channel, no AP
Initially activated by graded potential current that spread toward axon along dendritic and cell body membranes Generating AP

Resting state: all voltage gates Na+ K+ channels are closed

Only leakage channels are open, maintaining resting membrane potential
Voltage gated Na+ channels have two gate and alternate between three different states: closed, opened, inactivated
Voltage gated K+ channels have one gate and two different states: closed or opened

Depolarization: voltage gated Na+ channels open

Depolarization is caused by rushed Na+ flowing into cell, producing sharp upward spike of AP
Depolarization reaches critical threshold level between - 55 and - 50 mV
Becomes self-generating, urged on by positive feedback
Positive feedback cycle : increase Na+ permeability due to increased channel openings leads to greater depolarization, which increases Na+ permeability and so on

Responsible for the rising (depolarizing) phase of AP

Repolarization: Na+ channel are inactivated, and voltage gated K+ channels open

As Na+ entry declines, voltage gated K+ channels open and K+ rushes out of cell, following its electrochemical gradient leading to repolarization
Both the abrupt decline of Na+ permeability and the increased permeability of K+ contribute to repolarization

Hyperpolarization: Some K+ channels remain open, and some Na+ channels reset

Hyperpolarization caused by K+ continuing to leave cell Threshold and the All-or-None Phenomenon
Not all local depolarization event produce AP, threshold must be reached to “fire” AP
Threshold is the membrane potential at which outward current created by K+ movement is equal to inward current of Na+ movement
Depolarization represents unstable equilibrium
Recall: local depolarization is graded potential and magnitude increase as stimuli becomes more intense
Critical factor is total amount of current that flow through membrane during stimuli
Strong stimuli depolarize membrane to threshold
Weak stimuli must be applied for longer periods to provide crucial current flow
Very weak stimuli do not trigger AP because current flow dissipates before threshold can be reached
All-or-None phenomenon: it either happens completely or not at all
If number of Na+ ions entering cell is too low to achieve threshold, then no AP will occur Propagating AP
In bare plasma membrane, voltage decays
Without voltage-gated channels, voltage decays because current leaks across membrane
In non-myelinated axons, conduction is slow (continuous conduction)
Voltage gated Na+ and K+ channels regenerate the AP at each point along the axon, so voltage does not decay
Conduction is slow because it take time for ions and for gates of channel proteins to move, and this must occur before voltage can be regenerated
In myelinated axons, conduction is fast (salutatory conduction)
Myelin keeps current in axons (voltage doesn’t decay much)
AP generated only in myelin sheath gaps and appear to jump rapidly from gap to gap Refractory Period
Absolute refractory period follows stimulation during which no additional AP can be evoked
Begins with the opening of Na+ channels, and ends when Na+ channel reset to resting state
Ensure separate AP, all or none event
Enforce one-way transmission of AP, propagating AP away from origin

Cellular Adaptation

Adaptation
- Cells attempt to prevent their own death from environmental changes that can cause damage through adaptation
- May modify their size, numbers, and/or types to maintain homeostasis
- Modifications may be normal or abnormal, permanent or reversible
- Types: o Atrophy ▪ Degeneration of cells ▪ Occurs due to decrease work demands on the cell → cells ↓ or ↑ in size and number → utilize less O2 → organelles ↓ or ↑ in size and number ▪ E.g., disuse of muscle, postmenopausal women ovary shrinkage o Hypertrophy (we like big sized trophies) ▪ Increase in the size of cells ▪ Occurs due to increase work demand ▪ E.g., cardiac and skeletal muscle o Hyperplasia (-plasia = “growth”) ▪ Increase in the number of cells ▪ Often occurs together with hypertrophy ▪ Usually a result of normal stimuli (e.g., menstruation, BPH, skin warts) o Metaplasia ▪ Cell replaced by another cell type ▪ Usually initiated by chronic irritation and inflammation (e.g., smoking) ▪ Does not necessarily lead to cancerous change o Dysplasia ▪ Cell mutation to a different size, shape, and appearance ▪ Abnormal, potentially reversible by removing trigger ▪ Often implicated as precancerous cells

Neoplasm (Tumor)

A new and abnormal cellular growth due to a mutation
Benign : non cancerous
Malignant : cancerous
- Usually undifferentiated
Cancer is the disease state associated with rapid, uncontrolled cell growth with loss of differentiation - Second leading cause of death in the US - 78% of all cancer diagnoses are people ≥ 55 years - Overall incidence: men > women
: agents that initiate or promote malignant transformation or substances that can cause cancer (e.g., radiation, asbestos, tobacco, UV light etc.)
Other causes of cancer: oncogenes, age, lifestyle behaviors, nutritional status, hormonal balance, stress response, etc.
Carcinogenesis: process of cancer development
- Initiation: exposure of the cell to a substance or event that causes DNA damage or mutation
- Promotion: mutated cells’ exposure to factors that promote growth
- Progression: tumor invades, metastasizes, and becomes drug resistant
Anaplasia : loss of differentiation that occurs with cancer Diagnosis
Grading system: 1 to 4 scale, in order of clinical severity
TNM staging system evaluates the tumor size, nodal involvement, and metastatic

progress

Goal of treatment may be either:
- Curative (eradicate the disease)
- Palliative (treat symptoms to increase comfort)
- Prophylactic (prevent the disease)
Remission refers to a period when the cancer has responded to treatment and is under control
Prognosis refers to the patient’s likelihood for surviving the cancer
Heavily dependent on the cancer’s ability to metastasize Genetic and Congenital Alterations
Genetic defect/diseases
A condition that is caused by an abnormality in genes
Inherited by biological parents
May or may not be recognized at birth
Congenital defect/diseases
Also called birth defects
A condition developed during the prenatal phase of life and present at birth or shortly thereafter
May or may not be genetic o May be from insult to the embryo or fetus which occurred at a very specific time during in utero development Genetics
A gene is a segment of deoxyribonucleic acid (DNA) that serves as a template of protein synthesis
DNA is a long double-stranded chain of nucleotides called chromosomes
Each nucleotide consists of a five-carbon sugar (deoxyribose), a phosphate group, and

one of four nitrogen bases (cytosine, thymine, guanine, or adenine)

Chromosomes
- Thread-like structure of tightly coiled DNA carries genetic information in the form of genes
- 46 total chromosomes
Allosome : one pair of sex chromosome (XX, XY)
Autosomes : 22 paired chromosomes, numbered
Karyotype : a person’s unique set of chromosomes (count, appearance, male?, female?)
Allele : a variant form of a gene (e.g., eye color: blue, brown, green)
Genotype : actual set or specific combination of alleles for a given gene
Phenotype : the physical expression of the genes (e.g., blue eyes) Pattern of Inheritance
Alleles : variant forms of a gene, only two alleles are present in each gene copy (e.g., A, B, O blood type)
Homozygous : when both copy of alleles are identical for the gene (e.g., AA, BB, OO), may be dominant or recessive
Heterozygous : when the two copy of alleles are different for the gene (e.g., AO, BO, or AB)
Dominant : the more powerful allele, more likely to be expressed in the offspring

au lait spots (brown pigmented birthmarks), and freckling

Type 2 Neurofibromatosis o Mutations in the NF2 gene on chromosome 22 o NF2 provides instructions for making a protein called merlin that acts to suppress tumor development o Defect: effects CN VIII hearing loss Autosomal Recessive Disorders

Single-gene mutation that are passed from an affected parent to an offspring regardless of sex
Occur only in homologous allele pairs; heterozygous pair are carriers only
Disease is recessive
Healthy is dominant
A person needs two copies of the diseased gene to develop the disorder
Disorders occur only in homozygous recessive allele pairs
Cystic fibrosis (CF)
Hereditary disease that affects the lungs and digestive system
The body produces thick and sticky mucus that can clog the lungs and obstruct the pancreas
Can be life-threatening, and people with the condition tend to have a shorter than normal life span
Phenylketonuria (PKU)
Deficiency of phenylalanine hydroxylase leading to toxic levels of phenylalanine in the blood, causing CNS damage
If untreated, PKU leads to severe intellectual disability
All newborns are screened for PKU by testing for high serum phenylalanine levels
Tay-Sachs Disease (TSD)
Mutation in the HEXA gene on chromosome 15
HEXA is responsible for metabolizing lipids. Accumulation of these lipid can gradually destroy and demyelinate nerve cells
Nerve cell damage leads to progressive mental and motor deterioration, often causing death by 5 years old
Three forms based on symptom onset—infantile (most common), juvenile, and adult (extremely rare)
This genetic disorder is diagnosed by a thorough history and PE as well as deficient serum and amniotic HEXA level
No cure Sex-Linked Disorders
Occurs when genes located on the sex chromosomes cause genetic disorders
Mostly X-linked, may be dominant or recessive
Affected people are mostly males in X-linked disorders
Females are frequently carriers due to having two X chromosomes
Hemophilia
Condition where blood does not clot
Lacking Factor VIII

Fragile X Syndrome
- The repeating FMRI gene o Affecting synapses, critical for nerve impulses
- Causes intellectual disability Chapter 2: Immunity Stress
Physical, mental, or emotional strain or tension that can negatively affect the body’s homeostasis state
Universal experience
Result of both positive and negative experiences
May contribute directly to the development or exacerbation of disease and negative behaviors (e.g., smoking, drug abuse)

Non specific
Provides immediate protection against all invaders Innate Defenses
Barriers
Physical: Skin, mucous membranes
Chemical: HCl stomach acid, saliva and tear (lysozymes—dissolve bacterial cell walls)
Inflammatory response
Response by the body to disease and injury
Mass cells release mediators including histamine, bradykinin, prostaglandins, and cytokines (messengers) → phagocytes activated → digest and destroy the invading pathogen
Physical effects: blood vessels dilate allowing increasing blood flow to the area → gaps appear in the cell walls → allows fluid and immune cells to pass out of capillaries → immune presence is strengthened
Redness, swelling, and pain
Pyrogens
Fever-producing molecules
Released by macrophages exposed by bacteria
Create an unpleasant environment for bacterial growth
Interferons
Type of a cytokine released from virus-infected cells
Bind to nearby uninfected cells
The uninfected cells release an enzyme that prevents viral replication
Named for their ability to "interfere" with viral replication
Complement system
Group of blood plasma proteins in the blood stream that enhance the ability to clear pathogens
Comes into effect only when activated by invasion of pathogen
Stimulates the activation of cytokines, stimulate vasodilation
Opsonization: identifying the invading particle to the phagocyte → phagocytosis
Create membrane attack complex (MAC): forms channels which disrupts the cell membrane of target cells, leading to cell lysis (burst) and death
Macrophages (WBC)
Natural killer cells: cytotoxic, react nonspecifically and destroy primarily tumor cells and virus-infected cells, releases granzyme and perforins to induce apoptosis
Dendritic cells: sensor and antigen presenting cells, enhance the uptake of antigens and present it on the MHC II complex to activate T cells Adaptive (acquired) Immunity
Antigen-specific defense mechanism
Has to be created
Created in response to exposure to antigens
Mediated by T and B cells Adaptive Defenses
Cellular immunity

Defense approach that is mediated by T cells, which recognize the presence of the antigen, bind to the antigen, and trigger a response by other immune cells
T cells work to protect the body against viruses and cancer cells , and they are responsible for hypersensitivity and transplant rejection
Two types of T cells:
1. Regulator cells o (Helper T cells) + (Suppressor T cells) o Helper cells activate B cells to produce antibodies o Suppressor cells turn the antibody production off
2. Effector cells (Killer cells) o Killer (cytotoxic) cells destroy cells infected with viruses by releasing lymphocytes that degrade cell walls
Humoral Immunity
B cells mature in bone marrow
B cells differentiate into memory cells or antibody-secreting plasma cells o B cells = plasma cells o Antibody (Ab) = Immunoglobulin (Ig) o These cells eliminate bacteria, neutralize bacterial toxins, prevent viral reinfection, and produce immediate inflammatory response
B cells have receptor sites for a specific antigen and are activated when in contact with the antigen; B cells multiply into antibody-producing cells or memory cells reaction resulting in acquired immunity Acquired Immunity
Active acquired immunity
Gained by actively engaging with the antigen
Longer process
Getting the varicella infection and does not have it again and the case in which a person receives the varicella vaccine and never has the condition
Passive acquired immunity
Gained by receiving antibodies made outside of the body
Immediate protection
Mother-to-fetus transfer of antibodies

same species and is of similar tissue type, but is not identical o Most transplants use allogeneic tissue

Syngenic transplants use tissue from the identical twin of the host
Autologous transplants use host and donors are the same person o Someone storing up his or her own blood prior to a scheduled surgery
Xenogenic transplants use tissue from another species o Use of pig heart valves to replace diseased valves in a human

Types of Rejection 1. Hyperacute tissue rejection o Occurs immediately to 3 days after transplant o Recipient has antibodies against the donor tissue o Triggers a systemic inflammatory reaction o The response is so quick that often the tissue has not had a chance to establish vascularization; as a result, the tissue becomes permanently necrotic 2. Acute tissue rejection o Most common o Occur between 4 days and 3 months following transplant o Cell mediated and result in transplant lyses or necrosis o Patient exhibits manifestations of the inflammatory process including fever, redness, swelling, and tenderness at the graft site and impaired functioning of the transplanted organ 3. Chronic tissue rejection o Occurs 4 months to years after the transplant o Most likely due to an antibody-mediated immune response o Antibodies and complement molecules become deposited in the transplanted tissue vessel walls o Resulting in decreased blood flow and ischemia
Rejection reaction classifications:

Host vs Graft rejection host fighting graft
Graft vs Host rejection graft fighting host ▪ Life threating ▪ Occurs only in bone marrow transplants

Autoimmune
Immune system loses the ability to recognize self and becomes self-destructive
Affect women more often than men
Can affect any tissue or organ in body
Characterized by frequent, progressive periods of exacerbations and remissions
Systemic lupus erythematosus o Chronic autoimmune disorder o Cause is unclear, but it’s thought that B cells are overactivated to produce autoantibodies and autoantigens that combine to form immune complexes which attack the body’s own tissues o Result in inflammation of connective tissues in any body organ

o Tx: symptom management, immunosuppressant, anti-inflammatory agents o 11 criteria used for diagnosing (SOAP BRIAN MD) ▪ S erositis (inflammation of the serous membranes that line the lungs [pleura], heart [pericardium], and inner abdomen [peritoneum]) ▪ O ral ulcers ▪ A rthritis ▪ P hotosensitivity ▪ B lood disorders (low counts of white or red blood cells, or platelets) ▪ R enal involvement (abnormal amounts of urine protein or clumps of cellular elements, called casts, which are detectable with a urinalysis) ▪ I mmunologic phenomena ▪ A ntinuclear antibodies ▪ N eurologic disorder (e.g., brain irritation manifested as seizures or psychosis) ▪ M alar rash (“butterfly” rash over the cheeks of the face) ▪ D iscoid rash (patchy redness that can cause scarring)

Immunodeficiency
- A diminished or absent immune response
- Increase susceptibility to infections
- Primary cause : reflecting a defect with the immune system o Genetic or congenital
- Secondary/acquired cause : reflecting an underlying disease or factor that is sup- pressing the immune system o Infection, drug therapy, stress, malnutrition
- Increase risk of opportunistic infections
- How do you ↓ risk of infection: o Reverse isolation precautions: hand washing, limiting visitors, and avoiding fresh flowers to limit the person’s exposure to pathogens
HIV/AIDS
- Acquired immunodeficiency syndrome
- Deadly, sexually transmitted disease caused by human immunodeficiency virus (HIV)
- HIV is a retrovirus
- Retrovirus single-stranded RNA viruses that uses reverse transcriptase to convert the viral RNA to DNA, replicate through B cell (CD4+) by Attacking and destroying it, uses CD4 to gain entry into B cell
- HIV- 1 is the most prevalent strain in U.S.
  - Transmission: ▪ Bodily fluids, Blood products, sharing needles and syringes, needle- stick exposure, during pregnancy, delivery
  - Category 1 refers to a CD4 cell count ≥ 500 cells/mm
  - Category 2 of HIV infection progression refers to a CD4 cell count of 200 to 499 cells/mm

Cellular Structure and Function, Exams of Nursing

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one of four nitrogen bases (cytosine, thymine, guanine, or adenine)