NURS 3123 Exam 1 Study Guide
NURS 3123 Exam 1 Study Guide NURS 3123
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This 9 page Study Guide was uploaded by Hope Gulley on Monday September 14, 2015. The Study Guide belongs to NURS 3123 at Auburn University taught by Dr. Ramona Lazenby; Dr. Edward Campbell in Fall 2015. Since its upload, it has received 84 views. For similar materials see Nursing Pathophysiology in Nursing and Health Sciences at Auburn University.
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Date Created: 09/14/15
Nurs 3123 Fall 2015 Module 1 Focus Areas for Exam 1 This is intended to be GENERAL areas of focus for Module 1 It is not enough to know the information you must UNDERSTAND the conceptrationale and be able to APPLY the information Study for UNDERSTANDING and not just for knowledge 1 Differentiate between aerobic and anaerobic metabolism based on how energy is provided to the body a Anaerobic lnfo Anaerobic metabolism aka gycoysis is used as a temporary energy source for cells when they are deprived of oxygen doesn t need 02 doesn t make 02 It is also a vital source of energy for cells lacking mitochondria Process A 6Carbon glucose molecule splits into 2 3 Carbon pyruvic acid molecules This split uses up 2 ATP but produces 2 ATP one metabolized or quotsplit upquot glucose molecue2 ATP So overall 4 ATP were made but 2 ATP were used so a net gain of 2 ATP From here the pyruvic acid molecules are converted into lactic acid b Aerobic lnfo Aerobic metabolism requires oxygen and supplies 90 of the body s energy needs This reaction takes place in the mitochondria In the big picture hydrogen and carbon molecules from carbs proteins and fats combine with oxygen carbon dioxide and water as energy is released Process 1 Part OnelCitric Acid Cycle First a shortened version of gycoysis takes place Rather than being turned into lactic acid the two molecules of pyruvic acid are transported to the mitochondria Once in the mitochondria they join with acetylcoenzyme to for acetylcoenzyme A This joining sparks a reaction which released C02 and transfers electrons from hydrogen atoms to NADH or FADH By now each glucose molecule has yielded 4 new molecules of ATP 2 from gycoysis 2 from citric acid cycle 2 Part TwoEectron Transport Chain The electrons carried by NADH and FADH2 are oxidized via enzymatically catalyzed reactions in the mitochondria electron transport chain The protons H combine with oxygen to form water Large amounts of energy are released and are used to add higher energy phosphate bonds to ADP thus converting is to ATP 3 The End The over net yield of aerobic metabolism is 36 ATP molecules per glucose molecule 2 from glycolysis 2 from citric acid cycle 32 from electron transport chain The net amount of ATP is greatest from fat then glucose then protein 2 What is the signi cance of mitochondria a It is the location of ATP synthesis and is thus referred to as the quotpower house of the cellquot 3 Differentiate between osmosis diffusion facilitated diffusion and active transport Give an example of each a Osmosis The movement of water across an impermeable membrane from an area of lesser concentration to an area of greater concentration Ex if you put several raisins into a cup of water and leave overnight the water will go into the raisins and cause them to swell from low to high concentration b Diffusion The movement of molecules from an area of greater concentration to an area of lesser concentration Ex The tea in a teabag diffuses into a cup of hot water from high concentration to low c Facilitated diffusion Movement down a protein s electrochemical gradient d Active Transport Must have metabolic energy aka ATP e Passive Transport Does not need metabolic energy aka no ATP 4 Differentiate between atrophy hypertrophy hyperplasia and dysplasia What are some factors that may cause each a Atrophy The decrease in the size of a tissueorgan caused by a decreased number of cells or reduction in the size of individual cells Causes could include decreased need for muscle function broken leg malnutrition and decreased blood supply decrease in trophic hormones pressure bedsores b Hypertrophy Increase in the size of cells without cell division Causes increased muscle use compensation of R leg if L leg is broken resistance training or pathologically to compensateadapt as the result of disease conditions c Hyperplasia Increase in the number of cells Causes proliferation chronic in ammatory response hormonal break and uterine enlargement during pregnancy compensation for damage or disease somewhere else in the body d Dysplasia Deranged cell growth of a speci c tissue that results in cells that vary in size shape and organization Causes chronic irritation in ammation it is strongly implied to be a precursor of cancer 5 How do free radicals damage cells a Free radicals are highly reactive chemical species with an unpaired electron in the outer orbit of the molecule They are highly unstable and can react nonspeci cally with molecules in its vicinity They react with proteins lipids and carbs Therefore they can damage cell membranes inactivate enzymes and damage nucleic acids that make up DNA Oxidative stress occurs when the generation of free radical exceeds the ability of the body to neutralize or rid itself of the radicals This can lead to oxidation of cell components activation of signal transduction pathways DNA damage and changes in gene expression Free radicals are most commonly taken outinhibited by antioxidants 6 How does hypoxia impact cells a Hypoxia deprives cells of oxygen and interrupts oxidative metabolism and the generation of ATP The amount of irreversible cell damage depends on the degree of oxygen deprivation and the metabolic needs of the cell For example the brain requires a lot of oxygen so damage begins after 4 to 6 minutes of 02 deprivation Hypoxia can result from respirator disease ischemia anemia edema or a decrease in 02 in the air Hypoxia causes a power failure in the cell 02 tension in the cell falls oxidative metabolism ceases anaerobic metabolism is put into use cellular pH fall as lactic acid accumulates in the cell low pH alters cell membranes causing chromatin clumping and cell shrinkage 7 Differentiate between primary and secondary intention wound heaHng a Primary Intention A sutured surgical incision is an example b Secondary Intention Larger wounds that have greater loss of tissue and contamination heal by secondary intention Healing is slower than healing by primary intention and results in the formation of larger amount of scar tissues 8 Describe the 3 phases of wound healing a In ammatory Phase This is a critical period because it prepares the wound environment for healing There are two processes i First is the hemostatic process The hemostatic processes are activated immediately at the time of the injury This includes constriction of injured blood vessels initiation of blood clotting by way of platelet activation and aggregation After a brief moment of vasoconstriction the same vessels dilate and capillaries increase their permeability which allows plasma and blood components to leak into the injured area In small surface wounds the clos loses uid and becomes hardscab ii Second is the cellular process The neutrophils are the rst cells to arrive and are usually gone by day 3 or 4 The ingest bacteria and cellular debris Within 12 days macrophages enter the wound area and remain for a while They release growth factors that stimulate epithelial cell growth angiogenesis and attraction of broblast They also perform phagocytosis When there is a larger wound neutrophil and macrophages are require to remove the debris and facilitate wound closure Fun fact wound healing can occur without neutrophils but not without macrophages b Proliferative Phase Usually begins within 2 to 3 days of injury and may last up to 3 weeks in wounds healing by primary intention The main process here is the building of new tissue to ll the wound space They key cell in this phase is the broblast The broblast is a CT cell that synthesize and secretes collagen and other intercellular elements needed for wound healing They also produce growth factors that induce angiogenesis and endothelial cell proliferation and migration Fibroblasts and vascular endothelial cells begin proliferation to form the granulation tissue that serves as the foundation for scar tissue development The tissue is fragile and bleeds easily bc of new capillary buds leakyallow plasma proteins and WBC into the wound Wounds healing by secondary intention have more necrotic debris and exudate that needs to be removed and they involve larger amounts of granulation tissue The nal stage is epithelialization This is the migration proliferation and differentiation of epithelial cells at the wound edges to form a new layer that is similar to what was destroyed In primary intention wounds this could take 12 days In secondary intention wounds the epithelial cell migration is slowed because it requires a moist surface and requires a bed of granulation tissue to be laid down before it begins Towards the end of this phase accumulation of collagen and proliferations of broblasts continues lt reaches its peak within 57 days and continues for several weeks c Remodeling Phase Begins around 3 weeks and can continue for over 6 months This involved continual remodeling of scar tissue by simultaneous synthesis of collagen by broblasts and lysis by collagenase enzymes This gives the scar tensile strength For primary intention the wound is sutured After one week the sutures are taken out and the wound has 10 strength This can increase up to 70 over the next few weeks 9 Identify factors that may negatively impact wound healing a Poor Nutritional status wound healing needs proteins carbs fats vitamins and minerals Malnutrition would slow the healing process by causing wounds to heal inadequately i Poor protein prolonged in ammatory phase impaired broblast proliferation collagen and protein matrix synthesis angiogenesis and wound remodeling ii Poor carbs no energy for WBC no prevention of using amino acids for fuel iii No fats no cell synthesis iv Vitamin C needed for collagen synthesis Wo it improper sequencing of amino acids occurs improper linking of amino acids byproducts of collagen synthesis are nor removed from the cell new wounds don t heal properly old wounds would fall apart v Vitamin A stimulates and supports epithelialization capillary formation and collagen synthesis It also counteracts the antiin ammatory effects of corticosteroid drugs vi Vitamin B important cofactors in enzymatic reactions that help with wound healing vii Vitamin K prevents bleeding disorders b Poor Blood Flow and 02 Delivery These are needed to supply the necessary nutrients and to remove the resulting waste local toxins bacteria and other debris 02 is required for collagen synthesis and killing bacteria by phagocytic WBC Poor blood ow02 can lead to infections poor performance from neutrophils and macrophages no digestion of phagocytized microorganisms no signaling systems when injury occurs c Impaired In ammatory and Immune Response Can be caused by disorders in phagocytic function diabetes mellitus and therapeutic administration of corticosteroid drugs Two types i Extrinsic Impairs the attraction of phagocytic cells to the wound site prevents engulfment of bacteria and foreign agents by the phagocytic cells and causes suppression of the total number of phagocytic cells ii Intrinsic The results of enzymatic de ciencies in the metabolic pathway for destroying the ingested bacteria by the phagocytic cell These can include granulomatous disease an xlinked inherited disease d Infection Wound Separation and Foreign Bodies all delay wound heaHng i Infection prolongs in ammation impairs formation of granulation tissue and inhibits proliferation of broblasts and deposition of collagen bers Caused by trauma large wounds or greatly contaminated wounds ii Wound Separation large gaping wounds heal slowly Mechanical factors like pressure or torsion can cause wounds to pull apart 10 Give examples of each a Positive Feedback If there is decreased good increase the 11 12 term allostasis psychoneuroimmunology apoptosis homeostasis adaptation colloid osmotic pressure a Allostasis the interactive physiological changes in the iii Foreign Bodies tend to incite bacterial contamination and delay healing These can include wood steel glass and other compounds that could have entered the skin by force Differentiate between positive and negative feedback production of good i Example if the temperature outside is increasing the body will activate the compensatory mechanisms to increase body temperature rather than decrease it Negative Feedback If there is too much of a good invoke the compensatory mechanism to stop or block the production of that good i Example An increase in blood glucose activated the increase in insulin which enhances the removal of glucose from the blood When glucose has been taken up by cells and blood glucose levels fall insulin secretion is blocked inhibited and glucagon is released to stimulate the release of glucose from the liver Therefore blood glucose levels go back to normal De ne stress Differentiate between acute and chronic Stress a state manifested by a speci c syndrome of the body developed in response to any stimuli that made an intense systemic demand on it Acute Stress The timelimited natures of acute stress renders the accompanying catabolic and immunosuppressive effects advantage Includes facilitation of neural pathways mediating arousal alertness vigilance cognition focused attention and appropriate aggression Chronic Stress Can be caused by neural or hormonal connections among the components of acute stress are dysfunctions when the original stimulus of the activation of the system is prolonged or of such magnitude that it overwhelms the ability of the system to respond appropriately Can include chronic illnesses health disorders disease of CV GI immune neuro depression alcoholism drug abuse eating disorders accidents and suicide oral disease normal ora of mouth become invasive herpes simplex virus type 1 comes with fevers cold sores poor rest emotional instability UV radiation and u susceptibility De ne the following and have an understanding of each neuroendocrine autonomic and immune systems that occur in 13 ghtor ight sympathetic nervous system cortisol catecholamines etc a The neuroendocrine systems integrate signals received along response to either real or perceived challenged to homeostasis The persistence of allostatic changes has been called an allostatic load used to measure the cumulative effects of stress on humans Psychoneuroimmunology The study of the interaction between the consciousness brain CNS and the body s defense against external infection and abnormal cell division Apoptosis programmed cell death or quotcell suicidequot This is a normal process in the body which removes unwanted tissue or oldworn out cells These cells activate their enzymes within the cell which digests their cell proteins and DNA is then destroyed by WBC s Due to the quickness of apoptosis the in ammation process is not elicited May be caused by DNA damage activating the p53 protein mitochondrial damage inside the cell or the signaling factor attached to the quotdeath domainquot of the cell surface receptors Colloid Osmotic Pressure The pressure exerted by the plasma proteins which draw uid into the capillary It is highest in veins Hydrostatic pressure is highest in the arteries Discuss the pathophysiological impact of stress Include neurosensory pathways from circulating mediators that are carried in the bloodstream The Fight or Flight Response is the most rapid of the stress responses It increases the sympathetic activity in the brain and increases attention and arousal and therefore intensi es memory The heart and respiratory rates increase hands and feet become moist pupils dilate mouth becomes dry and GI tract activity decreases i Catecholamine norepinephrineepinephrine released from locus sceruleus and adrenal medulla Epinephrine goes to liver and skeletal muscle but cannot cross the BBB So it stimulates alphaadrenergic and betaadrenergic receptors norepinephrine binds primarily to alpha Produces a decrease in insulin release and an increase in glucagon release resulting in increased glycogensis gluconeogenesis lipolysis proteolysis and decrease glucose uptake by the peripheral tissues in an increase in heart rate cardia contractility and vascular smooth muscle contraction and relaxation of bronchial smooth muscle ii Cortisol quotthe stress hormonequot It helps regulate the stress response It diverts metabolism from building tissues to supplying energy for dealing with stress It also causes signs and symptoms of chronic stress The primary 14 15 16 17 iv glucocorticoid steroid hormone is released when ACTH stimulates adrenal cortex to increase adrenocortical secretion This circulates as protein bound and free the unbound and free is the most biologically active This metabolizes substances necessary for cellular metabolism and stimulates gluconeogenesis the formation of glycogen from noncarb sources like aminofatty acids in the liver This enhances elevation of blood pulse promoted by epi noraepi somatiotropic growth hormone inhibits uptake and oxidation of glucose action on protein metabolism increased blood glucose stronger sympathetic system effect on HR decrease in nonessential energyusing actives like hormone production bone formation redwhite blood cell formation immune system become depressed ADH causes vasoconstriction by making the kidneys absorb water from urine to blood Endorphins release in response to stressful stimuli The regulate ACTH secretion and inhibit hypothalamic CRF secretion Growth hormone somatotropin release from anterior pituitary glad and affects protein lipid and carb metabolism Directly affects immune cells Prolonged stress can suppress GH and other growth factors Requires more intense stimuli than those leading to increases in catecholamine What are some manifestations of stress subjective and objective a Posttraumatic stress disorder PTSD pathophysiology risk factors clinical manifestations a See handout What are some functions of adipocytes Of adipose tissue a Adipocytes maintain a large intracellular space They store large quantities of triglycerides and are the largest depository of energy in the body b Adipose Tissue helps ll spaces between tissues and helps to keep organs in place the subcutaneous fat helps to shape the body insulation Has two forms Unilocular white adipose tissue Composed of cells in which the fat is contained in a single large droplet in the cytoplasm Multilocular brown adipose tissue Composed of cells that contain multiple droplets of fat and numerous mitochondria Obesity how is it diagnosed Different types Risk factors Possible complications with associated rationale a See handout 18 Differentiate between kwashiorkor and marasmus a See handout 19 What are possible complications associated with anorexia nervosa and bulimia nervosa a See handout 20 Differentiate between bulimia nervosa and bingeeating a See handout
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