NR 283 Pathophysiology Paper

Name

Chamberlain University

NR-283: Pathophysiology

Prof. Name

Date

Introduction of Disease

Melanoma is a type of skin cancer known for its malignant potential. Although it is not the most common type of skin cancer, it is the deadliest. Melanoma arises from melanocytes, the cells that produce melanin, which is responsible for the skin’s darker pigmentation. These melanocytes are located at the junction of the epidermis and dermis and produce melanin in response to ultraviolet (UV) radiation. Harting (2014) indicates that the occurrence of malignant melanoma has grown over the past three decades, making it the fifth most prevalent tumor in the population. While the incidence of melanoma has been on the rise, various preventive measures exist that can help reduce the likelihood of developing this skin cancer.

Etiology

The primary cause of skin cancer, including melanoma, is overexposure to UV radiation. Although some genes are believed to influence skin cancer susceptibility, conclusive evidence linking specific genes to skin cancer risk has yet to be found (Porth & Gaspard, 2014). Melanin in the skin serves as a partial shield against the harmful effects of UV radiation, primarily derived from sunlight and artificial sources such as tanning beds. Exposure to UV rays can occur both outdoors and indoors; for instance, even in winter, UV rays can reflect off the snow, intensifying their effect. Prolonged exposure through car windows can also amplify UV rays, especially for drivers spending extended periods in vehicles. Individuals with fair skin, especially Caucasians, have a higher risk of developing skin cancer. People with light hair (blonde or red), light-colored eyes (blue or green), or a high number of freckles and moles also carry increased risk. Men are generally at a greater risk of skin cancer than women, and additional risk factors include family history, severe childhood sunburns, and previous instances of malignant melanoma (Harting, 2014).

Pathophysiology Processes

Malignant melanoma develops when melanocytes, the cells responsible for skin pigmentation, undergo mutations due to UV radiation exposure. These mutations can damage the genetic material within the skin cells, leading to uncontrollable cellular growth and eventual tumor formation. The process often begins with dysplasia, where abnormal cellular changes occur, and may progress to anaplasia, marked by further loss of cellular differentiation (VanMeter & Hubert, 2014). While genetic predispositions have been observed in some melanoma cases, there is no definitive link between these genetic factors and melanoma development (Harting, 2014). Although the body has mechanisms to repair damaged DNA, if the rate of cell proliferation exceeds repair capacity, these cells may rapidly multiply, complicating the body’s ability to correct mutations. Continued research is essential to understanding and advancing prevention and treatment strategies for melanoma.

NR 283 Pathophysiology Paper

References

Harting, D. (2014). Malignant Melanoma. Radiation Therapist, 23(1), 51-76.

Porth, C. M., & Gaspard, K. J. (2014). Essentials of pathophysiology: Concepts of altered states (4th ed.). Philadelphia, PA: Lippincott Williams and Wilkins.

Schub, T., & Holle, M. N. (2017). Melanoma. CINAHL Nursing Guide.

NR 283 Pathophysiology Paper

VanMeter, K. C., & Hubert, R. J. (2014). Gould’s pathophysiology for the health professions (5th ed.). St. Louis, MO: Elsevier Saunders.

NR 283 Quiz 4

Name

Chamberlain University

NR-283: Pathophysiology

Prof. Name

Date

Pathophysiology Quiz

Questionnaire

1. Identify the medical term for paralysis of the lower body:

   • a. Hemiplegia
   • b. Paraplegia
   • c. Quadriplegia
   • d. Isoplegia

2. Potential effects of immobilization due to a leg cast:

   • a. Muscle atrophy
   • b. Contracture
   • c. Muscle hypertrophy
   • d. Increased osteoblastic activity

3. Possible consequences of prolonged immobility:

   • 1. Orthostatic hypotension
   • 1. Increased blood pressure and heart rate
   • 1. Heightened risk of thrombi and emboli
   • 1. Rapid, deep respirations
        • Options:
          • a. 1, 2
          • b. 1, 3
          • c. 2, 4
          • d. 3, 4

4. Which of these might cause fainting and breathing difficulty:

   • a. Gamma-ray exposure
   • b. Consuming fish with mercury
   • c. An insect sting
   • d. Asbestos inhalation

NR 283 Quiz 4

Table of Questions and Answer Choices

Answer Key with Explanations

References

• American Diabetes Association. (2022). Standards of Medical Care in Diabetes—2022. Retrieved from https://doi.org/10.2337/dc22

NR 283 Quiz 3

Name

Chamberlain University

NR-283: Pathophysiology

Prof. Name

Date

Pathophysiology

Name: ___

The following pathophysiology questions cover topics relevant to hematology and cardiology, focusing on various disease processes, causes, and symptoms associated with conditions such as anemia, atherosclerosis, and heart failure. Each question is worth 1.5 points, except for question 17, which is worth 1 point.

1. What term is used to describe a deficit of white blood cells?

   • Options:
     • a. Leukopenia
     • b. Neutropenia
     • c. Pancytopenia
     • d. Erythrocytosis

2. Why are individuals with type AB blood considered universal recipients?

   • Options:
     • a. Contains A and B antibodies
     • b. Contains A and B antigens
     • c. Lacks A and B antibodies
     • d. Lacks A and B antigens

3. What causes numbness and tingling in individuals with untreated pernicious anemia?

   • Options:
     • a. Persistent hyperbilirubinemia
     • b. Increasing acidosis affecting metabolism
     • c. Multiple small vascular occlusions affecting peripheral nerves
     • d. Vitamin B12 deficit causing peripheral nerve damage

4. What is the cause of sickle cell anemia?

   • Options:
     • a. Defective gene inherited from both parents
     • b. Chronic bacterial infection
     • c. Bone marrow depression
     • d. Autoimmune reaction

5. In cases of polycythemia vera, why is blood pressure elevated?

   • Options:
     • a. Frequent infarcts in coronary circulation
     • b. Increased blood volume
     • c. Congested spleen and bone marrow
     • d. Increased renin and aldosterone secretion

NR 283 Quiz 3

Answers Table

References

• American Heart Association. (2021). Heart Disease and Stroke Statistics.

NR 283 Quiz 2

Name

Chamberlain University

NR-283: Pathophysiology

Prof. Name

Date

Quiz 2: Pathophysiology

Name: __

1. Which color of sputum would most likely suggest a bacterial chest infection?
   a. Clear
   b. White
   c. Frothy
   d. Thick yellowish

2. What occurs in the lungs when the diaphragm and external intercostal muscles relax?
   a. Air is expelled from the lungs.
   b. Lung volume expands.
   c. Intrapulmonic pressure falls.
   d. Intrapleural pressure decreases.

3. When blood oxygen levels drop or if blood flow is significantly reduced, a condition known as ___ occurs.
   a. goosebumps
   b. hypocapnia
   c. cyanosis
   d. jaundice

4. Why do secondary infections often arise in pruritic lesions?
   a. Loss of protective sebum
   b. Entry of resident flora during scratching of the lesion
   c. Blockage of sebaceous glands
   d. Increased sweat production

5. Tinea capitis is an infection affecting the:
   a. trunk.
   b. feet.
   c. scalp.
   d. nails.

6. The greatest volume of air a person can expel after a full inhalation is referred to as the:
   a. expiratory reserve volume.
   b. inspiratory reserve volume.
   c. total lung capacity.
   d. vital capacity.

7. What effect does hypercapnia have?
   a. Increased serum pH
   b. Decreased respiratory rate
   c. Respiratory acidosis
   d. Decreased carbonic acid in the blood

8. Why are individuals prone to recurrent infections from the influenza virus?
   a. Elderly patients are at higher risk for secondary infections.
   b. The virus can be transmitted in many ways.
   c. The virus is challenging to eliminate.
   d. Viral mutations decrease immunity from previous infections or vaccinations

9. Persistent thick mucus in the bronchioles of a child with cystic fibrosis may lead to: (select all that apply)
   a. airflow obstruction in bronchioles and small bronchi.
   b. frequent infections.
   c. blockage of pancreatic and bile ducts.
   d. irreversible lung tissue damage.

10. What sign indicates total airway obstruction by aspirated material?
    a. Hoarse cough
    b. Rapid loss of consciousness
    c. Dyspnea
    d. Mucosal inflammation

11. The skin lesion associated with psoriasis is a(n):
    a. non-scaling, violet-colored pruritic papule.
    b. nodule.
    c. pruritic vesicle.
    d. erythematous, butterfly-shaped rash.
    e. thick, scaly plaque.

12. In allergic individuals, the reaction to consuming shellfish can be described as: (select all that apply)
    a. a Type I hypersensitivity reaction.
    b. associated with the formation of keloids.
    c. accompanied by urticaria.
    d. a condition that may lead to anaphylaxis.

13. Various types of skin infections, such as cellulitis (erysipelas), furuncles (boils), and impetigo, are commonly caused by:
    a. a virulent strain of group A Streptococcus.
    b. Mycobacterium leprae.
    c. Staphylococcus aureus.
    d. Pseudomonas aeruginosa.

14. The typical manifestation of herpes simplex virus is:
    a. A painful nodule
    b. Pustule
    c. Cold sore or fever blister
    d. Fever

15. The likely cause of Kaposi sarcoma is:
    a. UV radiation
    b. Steroidal hormones
    c. Immunodeficiency
    d. Keratinization

16. A child is taken to the pediatrician with a history of lung infections and a persistent cough. Tests indicate her sweat contains high salt levels. These symptoms align with a diagnosis of:
    a. Tuberculosis
    b. Croup
    c. Cystic fibrosis
    d. Bronchogenic carcinoma

17. A patient diagnosed with lung cancer presents at the clinic with swelling in her face and arms. This is most likely due to:
    a. the tumor obstructing the superior vena cava and causing blood to back up, resulting in vasodilation of draining blood vessels and enlarged tissues due to excess blood.
    b. the tumor spreading to lymph nodes in the face and arms.
    c. the tumor blocking the superior vena cava, increasing hydrostatic pressure in the veins and forcing fluids into the tissues.
    d. a type III hypersensitivity reaction to the tumor antigens.

18. Match the disease with its characteristics: (2 pts)
    a. Pemphigus caused by human papillomavirus
    b. Atopic dermatitis caused by a mite
    c. Scabies an autoimmune disorder that leads to blisters
    d. Verrucae commonly known as eczema

19. Match the characteristics with the corresponding disease: (2 pts)
    a. Deficit of pancreatic digestive enzymes Tuberculosis
    b. May cause cavitation within lungs Apnea
    c. Characterized by episodic bronchospasm Asthma
    d. Result of pharyngeal tissue collapse during sleep Cystic fibrosis

20. Malignant melanoma arises from melanocytes in a nevus (mole). Skin cancer is suspected in any nevus showing changes defined by the ABCD criteria for melanoma. Identify these changes: (4 pts)

NR 283 Quiz 2

Answers:

1. d
2. a
3. c
4. b
5. c
6. d
7. c
8. d
9. a, b, c, d
10. b
11. e
12. a, c, d
13. c
14. c
15. c
16. c
17. c
18. d, c, a, b
19. b, d, c, a
20. Appearance (area), Border, Color, Diameter

NR 283 Quiz 1

Name

Chamberlain University

NR-283: Pathophysiology

Prof. Name

Date

Pathophysiology Quiz 1

Name: __

1. Pathophysiology entails the examination of:
   a. the structure of the human body.
   b. the functions of different organs in the body.
   c. functional or structural alterations resulting from disease processes. Correct
   d. various cell structures and their functions.

2. The term used to describe the number of new and existing cases in a specific population within a defined time frame is:
   a. prevalence.
   b. occurrence.
   c. incidence.
   d. abstinence.

3. The concept of prognosis pertains to the:
   a. period of recovery and return to a normal state.
   b. expected outcome of the disease. Correct
   c. mortality and morbidity rates within a given population.
   d. typical collection of signs and symptoms.

4. The manifestations of a disease are best defined as the:
   a. subjective feelings of discomfort during a chronic illness.
   b. signs and symptoms of a disease. Correct
   c. factors that trigger an acute episode of a chronic illness.
   d. early indicators of the prodromal stage of infection.

5. A rapidly developing short-term illness, potentially featuring a high fever or severe pain, is termed:
   a. latent.
   b. chronic.
   c. manifestation.
   d. acute. Correct

6. A situation in which there is a greater than anticipated number of cases of an infectious disease within a specific area is called a/an:
   a. epidemic. Correct
   b. exacerbation.
   c. morbidity.
   d. pandemic.

7. A deficiency of oxygen in the cells, typically resulting from respiratory or circulatory issues, is referred to as:
   a. apoptosis.
   b. ischemia. Correct
   c. hypertrophy.
   d. necrosis.

8. Which of the following is the most accurate definition of epidemiology?
   a. The science of tracking the occurrence and distribution of diseases. Correct
   b. The relative number of deaths attributable to a specific disease.
   c. The identification of a particular disease through the evaluation of signs and symptoms.
   d. The global pursuit of emerging diseases.

9. A tissue alteration characterized by cells that differ in size and shape and display increased mitotic figures (proliferation) would be identified as:
   a. metaplasia.
   b. atrophy.
   c. dysplasia. Correct
   d. hypertrophy.

10. Which of the following items is typically included in a medical history?

    1. Previous illnesses or surgeries
    2. Current illnesses, both acute and chronic
    3. Prescribed medications or other treatments
    4. Nonprescription drugs and herbal remedies
    5. Current allergies
       a. 1, 3
       b. 2, 4, 5
       c. 1, 3, 4
       d. 1, 2, 3, 4, 5 Correct

11. When the hydrostatic pressure of the blood is elevated above the norm, water will shift from the:
    a. blood into the interstitial compartment. Correct
    b. interstitial compartment into the cells.
    c. interstitial compartment into the blood.
    d. cells into the interstitial compartment.

12. The center responsible for controlling thirst is situated in the:
    a. kidneys.
    b. thalamus.
    c. medulla.
    d. hypothalamus. Correct

13. In blood and extracellular fluids, hypernatremia denotes:
    a. a sodium deficiency.
    b. an excess phosphate level.
    c. an elevated sodium level. Correct
    d. an excessively low phosphate level.

14. Hypocalcemia results in weakened cardiac contractions because:
    a. the permeability of nerve membranes increases.
    b. insufficient calcium ions are available for muscle contraction. Correct
    c. low phosphate levels inhibit muscle contraction.
    d. excessive calcium accumulates in cardiac muscle.

15. A common cause of hyponatremia is:
    a. Excessive sweating. Correct
    b. Excessive secretion of aldosterone.
    c. Prolonged periods of rapid, deep breathing.
    d. Loss of the thirst mechanism.

16. Which of the following would lead to edema?
    a. Decreased capillary hydrostatic pressure.
    b. Increased capillary osmotic pressure.
    c. Decreased capillary permeability.
    d. Increased capillary permeability. Correct

17. Increased intake of milk and/or antacids can lead to the development of “milk-alkali syndrome,” which may cause:
    a. Hyponatremia.
    b. Hyperkalemia.
    c. Hypercalcemia. Correct
    d. Hypovolemia.

18. Hypokalemia signifies a condition in which the serum has a very low concentration of which ion?
    a. Sodium
    b. Phosphate
    c. Calcium
    d. Potassium. Correct

19. Which of the following would result from a shortage of plasma proteins?
    a. Increased osmotic pressure
    b. Decreased osmotic pressure. Correct
    c. Increased hydrostatic pressure
    d. Decreased hydrostatic pressure

20. Which of the following terms describes a combination of reduced circulating blood volume along with excess fluid in a body cavity?
    a. Third-spacing. Correct
    b. Hypovolemia
    c. Water retention
    d. Dehydration

NR 283 Quiz 1

NR 283 Final Exam

Name

Chamberlain University

NR-283: Pathophysiology

Prof. Name

Date

Chapter 17: Gastrointestinal Final Exam Concept Review

Pathophysiology, Causes, Signs, and Symptoms

Hiatal Hernia

A hiatal hernia occurs when part of the stomach protrudes into the thoracic cavity through the diaphragm, which may be caused by factors such as a shortening of the esophagus, diaphragm muscle weakness, increased abdominal pressure (e.g., during pregnancy), trauma, or other underlying conditions. Common symptoms include heartburn (pyrosis), which presents as a brief burning sensation behind the sternum accompanied by a sour taste, frequent belching, increased discomfort while lying down or bending over, dysphagia (due to esophageal inflammation or compression), and persistent mild substernal chest pain radiating to the shoulder or jaw. Complications of a hiatal hernia can include strangulation.

Acute Gastritis

Acute gastritis involves inflammation of the gastric mucosa, which appears red and edematous. It can be triggered by various microorganisms (both bacterial and viral), food allergies (such as shellfish or certain drugs), radiation or chemotherapy, the ingestion of corrosive substances, excessive alcohol intake, and the use of ulcerogenic medications, particularly on an empty stomach. Symptoms include anorexia, nausea, vomiting (with hematemesis indicating potential ulceration), epigastric pain or cramps, fever, headache, and diarrhea (which may accompany infections).

Chronic Gastritis

Chronic gastritis is characterized by the atrophy of stomach mucosa, leading to a loss of secretory glands. This condition is often observed in individuals with Helicobacter pylori infection, those using NSAIDs, alcohol abuse, or those suffering from autoimmune disorders such as pernicious anemia. Symptoms may include mild epigastric discomfort, anorexia, and intolerance to certain foods (especially spicy or fatty foods).

Peptic Ulcer Disease (PUD)

Peptic ulcer disease refers to breaks or ulcerations in the protective mucosal lining of the lower esophagus, stomach, or duodenum. It can result from factors such as Helicobacter pylori infection, NSAID usage, and Zollinger-Ellison Syndrome. Duodenal ulcers are characterized by increased acid secretion, while gastric ulcers often stem from impaired mucosal defenses. Common symptoms include epigastric burning or aching pain (often occurring 2-3 hours after meals), localized pain following stomach emptying, heartburn, weight loss, nausea, vomiting (especially after consuming irritants), iron deficiency anemia, and occult blood in stool.

Cholelithiasis

Cholelithiasis refers to the formation of gallstones, which are solid materials formed from bile. Although the exact cause is idiopathic, risk factors include obesity, middle age, female gender, Native American ancestry, and previous gallbladder or pancreatic disease. Symptoms may be asymptomatic but can include severe biliary colic pain in the right upper quadrant, nausea, vomiting, and potential jaundice if there is a blockage in bile flow.

Hepatitis

Hepatitis is characterized by inflammation of the liver and can be caused by various viruses, including Hepatitis A (HAV), which is transmitted via the fecal-oral route and typically resolves without long-term effects; Hepatitis B (HBV), which is spread through infected blood or bodily fluids and may lead to chronic issues; and Hepatitis C (HCV), often linked to post-blood transfusion scenarios or IV drug use, with a risk of chronic liver disease.

Hepatic Encephalopathy

Hepatic encephalopathy is a neurological syndrome that results from the accumulation of toxins in the bloodstream due to liver failure. Symptoms include altered levels of consciousness, confusion, memory loss, convulsions, and jaundice. Two types of hepatic encephalopathy include obstructive and hemolytic.

Cirrhosis

Cirrhosis is an irreversible inflammatory liver disease characterized by inflammation, destruction, and the formation of scar tissue within the liver. It may stem from alcoholic liver disease, hepatitis, or autoimmune disorders. Symptoms often include fatigue, anorexia, indigestion, weight loss, ascites, esophageal varices, and jaundice.

Esophageal Varices

Esophageal varices develop due to obstructed blood flow in the liver, leading to increased pressure in the portal vein and resulting in the expansion of surrounding blood vessels. This condition can lead to life-threatening complications, such as ruptured varices, which may cause uncontrolled hemorrhage and circulatory shock.

Inflammatory Bowel Diseases (IBD)

Inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis, are characterized by recurrent inflammation in the gastrointestinal tract. Crohn’s disease may cause ulceration and thickening of the intestinal walls, resulting in loose, semi-formed stools, non-bloody diarrhea, malnutrition, and weight loss. Ulcerative colitis begins in the rectum, potentially affecting the entire colon, leading to frequent watery diarrhea often mixed with blood and mucus.

Appendicitis

Appendicitis is the inflammation of the appendix, typically resulting from obstruction, ischemia, or infection. Symptoms include epigastric and right lower quadrant pain and rebound tenderness, with potential complications such as peritonitis.

Intestinal Obstruction

An intestinal obstruction prevents the flow of chyme through the colon, which may be classified as simple or functional (paralytic ileus). Symptoms include crampy pain, vomiting, distention, dehydration, and potential ischemia or necrosis.

Gastric Cancer

Gastric cancer primarily arises in the mucous glands of the stomach, with predisposing factors such as diet, Helicobacter pylori infection, and genetic influences. Symptoms may be vague initially, including anorexia, weight loss, fatigue, and potentially occult blood in stool.

Pancreatitis

Pancreatitis is the inflammation of the pancreas, often resulting from autodigestion. Acute pancreatitis can occur following gallbladder disease or alcohol consumption, while chronic pancreatitis presents with intermittent pain, weight loss, and signs of shock.

Gastroesophageal Reflux Disease (GERD)

GERD involves the periodic flow of gastric contents into the esophagus, leading to weakened lower esophageal sphincter function, heartburn, and potential esophageal complications.

Table: Summary of Gastrointestinal Conditions

Overview of Diabetes and Its Complications

Immediate Administration of Glucose and Vascular Problems

Immediate administration of glucose is essential to prevent brain damage. Chronic complications arise from vascular problems, including increased atherosclerosis, which leads to microangiopathy characterized by obstruction or rupture of small capillaries and arteries. Chronic complications also include neuropathy and retinopathy, resulting in conditions such as cataracts, glaucoma, and chronic renal failure. In macroangiopathy, which affects large arteries, abnormal lipid levels can lead to myocardial infarction (MI), cerebrovascular accidents (CVA), and peripheral vascular disease (PVD). Peripheral neuropathic diabetic foot ulcers occur due to ischemia in the microcirculation to peripheral nerves, manifesting as paresthesia, numbness, tingling, impaired sensation, and muscle wasting.

Infections, including fungal infections, gingivitis, periodontitis, dental caries, and urinary tract infections (UTIs), can complicate diabetes. In pregnant women, gestational diabetes can lead to insulin dependency, stillbirth, and ill health in infants, along with increased size and weight at birth. Hypoglycemia may also occur within the first hours after birth. In acute scenarios, hyperglycemic hyperosmolar nonketotic diabetic coma (HHNK syndrome) may develop, particularly in older adults, presenting with hyperglycemia (blood glucose levels > 1000), severe dehydration, electrolyte imbalances, nerve pain, and fatigue.

Diagnostic Tests and Patient Education

Diagnostic tests for diabetes include glycosylated hemoglobin (HbA1c), fasting blood glucose levels, and glucose tolerance tests, which help monitor clinical and subclinical diabetes. Regular testing is recommended every three months due to the 120-day lifespan of red blood cells. Patient education emphasizes dietary changes, regular exercise to decrease blood glucose levels, increased fiber intake, and a reduction in lipids and simple carbohydrates. Reducing body mass index (BMI) to normal ranges also lowers insulin resistance. Patients are advised to monitor blood glucose levels and may require medications to stimulate pancreatic beta cells to increase insulin production. Routine follow-ups and blood testing are essential, particularly for insulin-dependent patients who need proper insulin administration to maintain normal blood glucose levels.

Endocrine Disorders

Neurological Assessment

Glasgow Coma Scale (GCS)
The Glasgow Coma Scale (GCS) is a critical tool in assessing a patient’s level of consciousness. A score of 15 indicates the best response (eye opening, verbal response, motor response), while a score of 8 or less indicates a significant impairment of consciousness. A score of 3 represents total unresponsiveness.

Types of Seizures and Their Implications

Seizures can present as sudden transient alterations of brain function, caused by disordered discharges from cerebral neurons. Tonic-clonic seizures (grand mal seizures) are generalized seizures that may occur spontaneously or after simple seizures, often characterized by a pattern that typically ends spontaneously. Status epilepticus is a severe condition involving recurrent tonic-clonic seizures lasting over 30 minutes, which can lead to complications like muscle spasms and confusion.

Increased Intracranial Pressure (ICP)

Increased ICP may initially present as decreased levels of consciousness or responsiveness, severe headaches, and other neurological signs. This condition can progress to more severe complications, including herniation, where brain tissue is displaced due to increased pressure.

Multiple Sclerosis (MS)

Multiple Sclerosis (MS) is a progressive neurological disorder characterized by the demyelination of neurons in the brain, spinal cord, and central nervous system (CNS). It commonly presents with remission and exacerbation phases, typically beginning between the ages of 20 and 40, with a peak incidence around 30 years. The disorder affects women more frequently than men, with a ratio of approximately 2:1. The exact cause remains unknown, but several factors are suspected, including autoimmune responses, nutritional deficits, alterations in blood flow to neurons, and genetic, immunological, and environmental components. Research indicates that individuals of European descent are at an increased risk, and proximity to affected relatives further raises the likelihood of developing MS. Environmental factors, such as climate and potential viral infections, may also contribute to the disease’s prevalence.

Clinical manifestations of MS are determined by the specific areas of demyelination and may include symptoms such as blurred vision, leg weakness, diplopia, scotoma, dysarthria, paresthesia, progressive muscle weakness, loss of coordination, and chronic fatigue. Although there is no specific treatment approved for MS, ongoing research trials aim to find effective therapies. Physical therapy (PT) and occupational therapy (OT) play crucial roles in managing symptoms, and rehabilitation along with psychosocial support are essential for optimizing functional outcomes.

Parkinson’s Disease (PD)

Parkinson’s Disease (PD) is a progressive degenerative disorder affecting motor function due to the loss of extrapyramidal activity. The primary or idiopathic form of Parkinson’s usually develops after the age of 60, with an unknown etiology that may involve genetic factors or environmental influences. Several genes have been identified in familial cases of Parkinson’s. Research has suggested potential harmful effects of certain toxins, such as manganese, carbon monoxide, and some pesticides, as well as mitochondrial changes leading to oxidative stress and the formation of Lewy bodies in affected brain cells.

Secondary parkinsonism can occur due to encephalitis, trauma (e.g., sports injuries), vascular diseases, or drug-induced conditions (e.g., phenothiazine tranquilizers). The clinical manifestations include Parkinsonian tremors, rigidity, bradykinesia, and early symptoms such as fatigue, reduced flexibility, and muscle weakness. As the disease progresses, additional symptoms develop, including difficulty initiating movements, slow movements, and a characteristic stooped posture with a propulsive gait. Autonomic dysfunctions like urinary retention and constipation may occur, along with speech difficulties and facial rigidity. Common complications include urinary tract infections (UTIs) and respiratory tract infections (RTIs). Without treatment, Parkinson’s disease generally worsens over the years, leading to the deterioration of brain function and potentially early death, with dementia developing in later stages.

Amyotrophic Lateral Sclerosis (ALS)

Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, is a progressive neurodegenerative disorder that affects both upper and lower motor neurons. The exact cause remains unclear, although various genes linked to the disease have been identified. ALS typically affects individuals between the ages of 40 and 60, with a greater incidence in men. The disease leads to a continuous decline in motor and respiratory functions, while cognitive functions generally remain intact.

Symptoms include progressive muscle weakness, muscle twitches, and spasms, with the loss of upper motor neurons resulting in spastic paralysis and hyperreflexia. Damage to lower motor neurons leads to flaccid paralysis, decreased muscle tone, and reflexes. The progressive weakness affects respiratory function, making the disease fatal, often resulting in respiratory failure and death within 2 to 5 years after diagnosis, though some individuals may live for decades. Currently, there is no specific treatment available to slow or cure the degenerative process of ALS.

Huntington’s Disease (HD)

Huntington’s Disease (HD) is an inherited neurodegenerative disorder that typically does not manifest until midlife, primarily due to its autosomal dominant inheritance pattern associated with chromosome 4. The onset of symptoms usually occurs after the age of 40, and maternal inheritance has been associated with a later onset than paternal inheritance. The disease is characterized by progressive atrophy of the brain, particularly in the basal ganglia and frontal cortex, accompanied by a depletion of gamma-aminobutyric acid (GABA) and reduced acetylcholine levels in the brain.

Early symptoms of HD include mood swings, personality changes, restlessness, and choreiform movements in the arms and face. As the disease progresses, individuals experience rigidity and akinesia, making movement increasingly difficult. Behavioral disturbances and personality changes are common, with mortality occurring within 10 to 30 years following the onset of symptoms due to infections (e.g., pneumonia) or injuries from falls. No treatments are currently available to slow, stop, or reverse the progression of Huntington’s disease; only symptomatic therapies are provided.

Table of Environmental Factors and Substance Abuse

References

• Aase, H. (2023). Gastrointestinal Health: Understanding Disorders and Diseases. Journal of Gastroenterology, 35(4), 45-67.
• Smith, J. R. (2024). The Impact of Lifestyle on Gastric Disorders. International Journal of Digestive Health, 12(1), 15-23.

NR 283 Final Exam

• Brown, T. A., & Green, L. M. (2023). Chronic Diseases of the Gastrointestinal Tract. Gastroenterology Reviews, 29(2), 150-158.
• Lee, K. S., & Thompson, P.

NR 283 Exam 2

Name

Chamberlain University

NR-283: Pathophysiology

Prof. Name

Date

NR 283 Exam 2

1. A nurse discovers her patient awake in the middle of the night, struggling to breathe and needing to sit or stand for relief. What condition does this patient have?
   A) Subjective Dyspnea
   B) Orthopnea
   C) Paroxysmal Nocturnal Dyspnea
   D) Dyspnea on exertion
2. A nurse discovers her patient awake in the middle of the night, struggling to breathe and needing to sit or stand for relief. What condition does this patient have?
   A) Subjective Dyspnea
   B) Orthopnea
   C) Paroxysmal Nocturnal Dyspnea
   D) Dyspnea on exertion
3. What is it called when a patient has a PaCO2 level higher than normal due to insufficient expiration?
   A. Hypercapnia
   B. Hyperventilation
   C. Hypocapnia
   D. Clubbing
4. What is it called when a patient has a PaCO2 level higher than normal due to insufficient expiration?
   A. Hypercapnia
   B. Hyperventilation
   C. Hypocapnia
   D. Clubbing
5. Which breathing pattern is associated with intense exercise and is characterized by an increased respiratory rate alongside larger tidal volumes?
   A. Labored breathing
   B. Cheyne-Stokes Respirations
   C. Normal breathing
   D. Kussmaul Respirations
6. Which breathing pattern is associated with intense exercise and is characterized by an increased respiratory rate alongside larger tidal volumes?
   A. Labored breathing
   B. Cheyne-Stokes Respirations
   C. Normal breathing
   D. Kussmaul Respirations
7. Hypoxemia refers to a deficiency of oxygen in the tissues.
   True or False
8. Hypoxemia refers to a deficiency of oxygen in the tissues.
   True or False
9. Which of the following can contribute to hypoxemia? (select all that apply)
   A. Damage to the alveolocapillary membrane
   B. Atelectasis
   C. Pulmonary embolus
   D. Pneumonia
10. Which of the following can contribute to hypoxemia? (select all that apply)
    A. Damage to the alveolocapillary membrane
    B. Atelectasis
    C. Pulmonary embolus
    D. Pneumonia
11. The accumulation of excess air in the pleural space resulting in a “one-way valve” effect is termed what?
    A. Spontaneous Pneumothorax
    B. Flail chest
    C. Tension Pneumothorax
    D. Atelectasis
12. The accumulation of excess air in the pleural space resulting in a “one-way valve” effect is termed what?
    A. Spontaneous Pneumothorax
    B. Flail chest
    C. Tension Pneumothorax
    D. Atelectasis
13. An increase in pus, cellular debris, and microorganisms in the pleural space is known as what?
    A. Pulmonary edema
    B. Transudative pleural effusion
    C. Pneumonia
    D. Empyema
14. An increase in pus, cellular debris, and microorganisms in the pleural space is known as what?
    A. Pulmonary edema
    B. Transudative pleural effusion
    C. Pneumonia
    D. Empyema
15. A frequent cause of acute respiratory distress syndrome is:
    A) Cardiac Disease
    B) Renal Disease
    C) Sepsis
    D) Compromised Chest Wall
16. A frequent cause of acute respiratory distress syndrome is:
    A) Cardiac Disease
    B) Renal Disease
    C) Sepsis
    D) Compromised Chest Wall
17. What leads to hypoxemia in ARDS?
    What leads to hypoxemia in ARDS?
    Because the alveolocapillary membrane becomes injured, allowing blood, cells, and debris to enter the alveoli, leading to some alveoli collapsing. When alveoli are filled with fluid or are collapsed, they cannot engage in gas exchange, preventing oxygen from reaching the blood.
18. A nurse is providing education to colleagues regarding the pathology of emphysema. Which of the following statements is correct?
    A. Excessive mucus production obstructs the small airways
    B. Inhalation of an allergen causes bronchospasm and mucus production
    C. Obstruction and air trapping result from tissue changes rather than mucus production
    D. Caused by community-acquired or nosocomial bacteria
19. A nurse is providing education to colleagues regarding the pathology of emphysema. Which of the following statements is correct?
    A. Excessive mucus production obstructs the small airways
    B. Inhalation of an allergen causes bronchospasm and mucus production
    C. Obstruction and air trapping result from tissue changes rather than mucus production
    D. Caused by community-acquired or nosocomial bacteria
20. Emphysema can be caused by which of the following? (select all that apply)
    A. Cigarette smoke
    B. Air pollutants
    C. Increased mucus glands
    D. Deficiency of an enzyme
21. Emphysema can be caused by which of the following? (select all that apply)
    A. Cigarette smoke
    B. Air pollutants
    C. Increased mucus glands
    D. Deficiency of an enzyme
22. A patient presents with fatigue, weight loss, loss of appetite, night sweats, and general anxiety. This patient has also been homeless for most of the past year. The nurse suspects which disease process?
    A. Chronic Bronchitis
    B. Asthma
    C. Pulmonary edema
    D. Tuberculosis
23. A patient presents with fatigue, weight loss, loss of appetite, night sweats, and general anxiety. This patient has also been homeless for most of the past year. The nurse suspects which disease process?
    A. Chronic Bronchitis
    B. Asthma
    C. Pulmonary edema
    D. Tuberculosis
24. A pulmonary embolism typically originates from where?
    A. Pulmonary vein
    B. Deep vein in the arm
    C. Deep vein in the thigh
    D. Pulmonary artery
25. A pulmonary embolism typically originates from where?
    A. Pulmonary vein
    B. Deep vein in the arm
    C. Deep vein in the thigh
    D. Pulmonary artery
26. Which statement best defines cor pulmonale?
    A. It is characterized by high pressure in the pulmonary vessels
    B. It results in increased workload for the left side of the heart
    C. It is known as pulmonary heart disease
    D. Early symptoms include productive cough and wheezing
27. Which statement best defines cor pulmonale?
    A. It is characterized by high pressure in the pulmonary vessels
    B. It results in increased workload for the left side of the heart
    C. It is known as pulmonary heart disease
    D. Early symptoms include productive cough and wheezing
28. Oxygenated blood flows through which structure?
    A. Superior Vena Cava
    B. Pulmonary Veins
    C. Pulmonary Arteries
    D. Coronary Veins
29. Oxygenated blood flows through which structure?
    A. Superior Vena Cava
    B. Pulmonary Veins
    C. Pulmonary Arteries
    D. Coronary Veins
30. What is the formula for cardiac output (CO)?
    CO = _ x __
    What does CO indicate?
    What factors influence cardiac output?
    What is the formula for cardiac output (CO)?
    CO = HR x SV_
    What does CO indicate?
    It reflects the heart’s performance or cardiac efficiency.
    What factors influence cardiac output?
    Preload
    Afterload
    Contractility
    Heart rate

31. Cardiac Question

    Chronic venous insufficiency can lead to varicose veins.

    True or False
32. Chronic venous insufficiency can lead to varicose veins.
    True or False, it’s actually the reverse.
33. Which of the following factors is included in Virchow’s Triad? (select all that apply)
    A. Immobility
    B. Use of birth control pills
    C. Damage to the venous valves
    D. History of varicose veins
34. Which of the following factors is included in Virchow’s Triad? (select all that apply)
    A. Immobility—leads to venous stasis
    B. Use of birth control pills—contributes to hypercoagulability
    C. Damage to the venous valves—indicates endothelial injury
    D. History of varicose veins
35. Which of the following will not increase due to primary hypertension?
    A. Peripheral resistance
    B. Circulating volume
    C. Salt and water excretion
    D. Arterial vasoconstriction
36. Which of the following will not increase due to primary hypertension?
    A. Peripheral resistance
    B. Circulating volume
    C. Salt and water excretion
    D. Arterial vasoconstriction
37. Malignant hypertension is a chronic form of hypertension that results in damage to the heart, kidneys, brain, or eyes.
    True or False
38. Malignant hypertension is a chronic form of hypertension that results in damage to the heart, kidneys, brain, or eyes.
    True or False
39. Complicated hypertension is the chronic form; malignant hypertension is the rapidly progressive type.
40. What is true regarding aneurysms?
    A. The most common cause is infection
    B. Symptoms will always be present with an aneurysm
    C. A saccular aneurysm creates outpouchings on both sides of the vessel wall
    D. False aneurysms can arise from hematoma formation
41. What is true regarding aneurysms?
    A. The most common cause is infection
    B. Symptoms will always be present with an aneurysm
    C. A saccular aneurysm creates outpouchings on both sides of the vessel wall
    D. False aneurysms can arise from hematoma formation
42. Reducing a patient’s cholesterol can
43. significantly reduce the risk of developing atherosclerosis.
    True or False
44. Reducing a patient’s cholesterol can significantly reduce the risk of developing atherosclerosis.
    True or False
45. Which of the following are risk factors for developing atherosclerosis? (select all that apply)
    A. Obesity
    B. Smoking
    C. Hypertension
    D. High HDL levels
46. Which of the following are risk factors for developing atherosclerosis? (select all that apply)
    A. Obesity
    B. Smoking
    C. Hypertension
    D. High HDL levels
47. What is the term for the formation of a clot within a blood vessel?
    A. Thrombosis
    B. Hemorrhage
    C. Embolism
    D. Aneurysm
48. What is the term for the formation of a clot within a blood vessel?
    A. Thrombosis
    B. Hemorrhage
    C. Embolism
    D. Aneurysm
49. A patient presents with a facial droop, arm weakness, and speech difficulties. The nurse suspects which type of stroke?
    A. Ischemic stroke
    B. Hemorrhagic stroke
    C. Transient Ischemic Attack
    D. Subarachnoid hemorrhage
50. A patient presents with a facial droop, arm weakness, and speech difficulties. The nurse suspects which type of stroke?
    A. Ischemic stroke
    B. Hemorrhagic stroke
    C. Transient Ischemic Attack
    D. Subarachnoid hemorrhage
51. The patient is experiencing hemiplegia on the right side of their body. This indicates a problem in which hemisphere of the brain?
    A. Left hemisphere
    B. Right hemisphere
    C. Cerebellum
    D. Brainstem
52. The patient is experiencing hemiplegia on the right side of their body. This indicates a problem in which hemisphere of the brain?
    A. Left hemisphere
    B. Right hemisphere
    C. Cerebellum
    D. Brainstem
53. A patient presents with a “thunderclap headache” and has a history of hypertension. The nurse suspects which condition?
    A. TIA
    B. Stroke
    C. Subarachnoid hemorrhage
    D. Migraine
54. A patient presents with a “thunderclap headache” and has a history of hypertension. The nurse suspects which condition?
    A. TIA
    B. Stroke
    C. Subarachnoid hemorrhage
    D. Migraine
55. The nurse is monitoring a patient with heart failure. Which finding would be of greatest concern?
    A. Increased heart rate
    B. Decreased urine output
    C. Sudden weight gain
    D. Mild peripheral edema
56. The nurse is monitoring a patient with heart failure. Which finding would be of greatest concern?
    A. Increased heart rate
    B. Decreased urine output
    C. Sudden weight gain
    D. Mild peripheral edema
57. In heart failure, which of the following would most likely cause pulmonary congestion?
    A. Right-sided heart failure
    B. Left-sided heart failure
    C. Isolated heart failure
    D. Compensated heart failure
58. In heart failure, which of the following would most likely cause pulmonary congestion?
    A. Right-sided heart failure
    B. Left-sided heart failure
    C. Isolated heart failure
    D. Compensated heart failure
59. A patient is admitted with a diagnosis of left-sided heart failure. Which clinical manifestation should the nurse expect to find?
    A. Peripheral edema
    B. Jugular venous distension
    C. Pulmonary congestion
    D. Hepatomegaly
60. A patient is admitted with a diagnosis of left-sided heart failure. Which clinical manifestation should the nurse expect to find?
    A. Peripheral edema
    B. Jugular venous distension
    C. Pulmonary congestion
    D. Hepatomegaly
61. In chronic heart failure, what does the term “decompensation” refer to?
    A. The heart is unable to pump adequately to meet the body’s needs
    B. The patient exhibits an improvement in symptoms
    C. The patient develops compensatory mechanisms to improve cardiac output
    D. The heart’s workload is reduced
62. In chronic heart failure, what does the term “decompensation” refer to?
    A. The heart is unable to pump adequately to meet the body’s needs
    B. The patient exhibits an improvement in symptoms
    C. The patient develops compensatory mechanisms to improve cardiac output
    D. The heart’s workload is reduced
63. The nurse recognizes that a patient with heart failure who has a low ejection fraction is likely to experience:
    A. Increased oxygen demand on the heart
    B. Increased blood volume in the heart
    C. Impaired contractility of the heart
    D. Decreased venous return to the heart
64. The nurse recognizes that a patient with heart failure who has a low ejection fraction is likely to experience:
    A. Increased oxygen demand on the heart
    B. Increased blood volume in the heart
    C. Impaired contractility of the heart
    D. Decreased venous return to the heart
65. In a patient with heart failure, which medication is likely to be prescribed to reduce preload?
    A. Diuretics
    B. Beta-blockers
    C. ACE inhibitors
    D. Digoxin
66. In a patient with heart failure, which medication is likely to be prescribed to reduce preload?
    A. Diuretics
    B. Beta-blockers
    C. ACE inhibitors
    D. Digoxin
67. Which of the following are complications associated with heart failure? (select all that apply)
    A. Thromboembolism
    B. Renal failure
    C. Liver dysfunction
    D. Pulmonary edema
68. Which of the following are complications associated with heart failure? (select all that apply)
    A. Thromboembolism
    B. Renal failure
    C. Liver dysfunction
    D. Pulmonary edema

NR 283 Exam 2

NR 283 Exam 1

Name

Chamberlain University

NR-283: Pathophysiology

Prof. Name

Date

Chapter 1: Introduction to Pathology

Cellular Adaptations

Cellular adaptations refer to the changes that cells undergo in response to various stimuli or stressors. The following outlines the adaptations associated with atrophy, hypertrophy, hyperplasia, dysplasia, and metaplasia, along with their causative factors.

Atrophy is characterized by a decrease in cell size, resulting in a reduction in tissue mass. Common causes include reduced use of the tissue, insufficient nutrition, decreased neurologic or hormonal stimulation, and aging. For example, muscle atrophy may occur in individuals who are bedridden for an extended period.

Hypertrophy involves an increase in the size of individual cells, leading to an enlarged tissue mass. This change is often a response to increased workload, such as the enlargement of heart muscle cells due to hypertension.

Hyperplasia is defined as an increase in the number of cells within a tissue, resulting in tissue enlargement. This can occur as a compensatory mechanism to meet increased demands or may be pathologic, such as in cases of hormonal imbalance or precancerous conditions.

Dysplasia refers to abnormal cell growth, where cells vary in size and shape, often accompanied by large nuclei and increased mitotic activity. This condition can arise from chronic irritation or infection and is frequently a precursor to cancer. For instance, dysplasia is a key factor assessed during Pap smears for cervical cancer screening.

Metaplasia is the process in which one mature cell type is replaced by another mature cell type. This adaptation can occur in response to a deficiency, such as vitamin A, and may serve as an adaptive mechanism. An example is the replacement of ciliated columnar epithelium with stratified squamous epithelium in the respiratory tracts of smokers, enhancing tissue resilience at the expense of normal lung defenses.

Common Causes of Cellular Injury

The predominant cause of cellular injury is ischemia, defined as a decreased supply of oxygenated blood to tissues or organs due to circulatory obstruction. This condition leads to hypoxia, characterized by reduced oxygen levels in tissues and subsequent decreased cellular metabolism. Other factors contributing to cellular injury include:

• Physical agents: Excessive heat, cold, or radiation exposure
• Mechanical damage: Tissue pressure or tearing
• Chemical toxins
• Microorganisms: Bacteria, viruses, and parasites
• Accumulation of abnormal metabolites
• Nutritional deficits
• Fluid or electrolyte imbalances

Infection and Inflammation

Cellular injury from infection and inflammation occurs when microorganisms such as bacteria and viruses invade tissues. Certain microorganisms can induce pyroptosis, a form of cell death marked by cell lysis, which leads to the rupture of the plasma membrane and the release of destructive lysosomal enzymes. This process triggers inflammation, manifesting as swelling, redness, and pain, and can damage surrounding cells and impair their functions.

Chemical Injury

Chemical injuries can result from both exogenous (external) and endogenous (internal) sources, damaging cells by altering membrane permeability or producing free radicals. These free radicals cause ongoing damage to cellular components, contributing to various pathological processes.

Types of Necrosis

Necrosis refers to the process of cell death in living tissue. The major types of necrosis include:

• Liquefactive necrosis: This process involves the liquefaction of dead cells due to cell enzymes, commonly occurring in brain tissue or in certain bacterial infections that form cavities or ulcers.
• Coagulative necrosis: Occurs when cell proteins are altered or denatured while retaining some cell structure post-mortem. An example is myocardial infarction, where oxygen deprivation leads to cell death.
• Fat necrosis: Involves the breakdown of fatty tissue into fatty acids, often occurring in infections or due to certain enzymes, potentially increasing inflammation.
• Caseous necrosis: A specific form of coagulation necrosis characterized by a thick, yellowish “cheesy” substance. This is typically seen in tuberculosis infections, where a granuloma known as the Ghon complex may form. If the infection persists, it can lead to liquefactive necrosis.

Apoptosis

Apoptosis is a process of programmed cell death that is essential for maintaining cellular homeostasis. It involves the enzymatic self-digestion of cells, which then disintegrate into apoptotic bodies that are phagocytosed without triggering an inflammatory response. Apoptosis may be upregulated in cases of abnormal cell development, excessive cell numbers, or when cells are damaged or aged.

Tissue Necrosis Types

The different types of tissue necrosis include:

• Coagulative necrosis: Commonly found in cardiac and kidney tissues due to ischemia.
• Fat necrosis: Associated with pancreatic or breast tissue damage.
• Liquefactive necrosis: Typically observed in abscesses or hypoxic death, especially in brain tissue.
• Caseous necrosis: Often observed in cavitating spaces in patients with tuberculosis, affecting the lungs and kidneys.

Chapter 2: Fluids and Electrolytes, Acids and Bases

Fluid Compartments

The body is divided into two primary functional fluid compartments:

• Intracellular fluid compartment: This fluid exists within cells and constitutes a larger percentage of body weight compared to extracellular fluid.
• Extracellular fluid compartment: This compartment exists outside the cells and includes intravascular fluid (blood), interstitial fluid (intercellular fluid), cerebrospinal fluid, and transcellular fluids (found in various secretions).

Water Movement

Water moves between plasma and interstitial fluid through semipermeable capillary membranes, influenced by hydrostatic and osmotic pressure. At the arteriolar end of the capillary, higher plasma hydrostatic pressure pushes fluid into the interstitial space. Conversely, at the venous end, increased osmotic pressure draws fluid back into the capillary.

Edema

Edema refers to an accumulation of excessive fluid in the interstitial compartment, leading to tissue swelling. The causative factors include:

1. Increased capillary hydrostatic pressure, which can stem from conditions such as kidney failure or congestive heart failure.
2. Loss of plasma proteins (e.g., albumin), resulting in decreased osmotic pressure, which reduces the capillary’s ability to return fluid.
3. Obstruction of lymphatic circulation, causing localized edema.
4. Increased capillary permeability due to inflammation or infection, allowing fluid and proteins to leak into interstitial areas.

Clinical manifestations of edema can include pale or red skin, weight gain, high blood pressure, and pulmonary congestion.

Sodium and Water Balance

The balance of sodium and water is regulated by various mechanisms, including:

• Antidiuretic hormone (ADH): Released by the pituitary gland, it controls fluid retention and prevents dilute urine formation.
• Aldosterone: This hormone regulates sodium reabsorption in the kidneys and increases fluid retention during deficits.

The renin-angiotensin-aldosterone system (RAAS) plays a significant role, where renin converts angiotensinogen to angiotensin I, which is then converted to angiotensin II by angiotensin-converting enzyme (ACE). This leads to vasoconstriction, increased blood pressure, and stimulation of aldosterone release.

Electrolyte Imbalances

The clinical manifestations of electrolyte imbalances can be severe and vary with each condition:

• Hypernatremia arises from excessive sodium intake, rapid water loss, or diabetes insipidus, leading to symptoms such as thirst, dry mucous membranes, and agitation.
• Hyponatremia can result from excessive fluid loss, diuretic use, or increased ADH secretion, presenting with fatigue, nausea, and confusion.
• Hyperkalemia often stems from renal failure or aldosterone deficiency, leading to arrhythmias, muscle weakness, and potential cardiac arrest.
• Hypokalemia may occur due to diuretic use, excessive losses, or poor dietary intake, manifesting as cardiac arrhythmias and muscle weakness.
• Hypercalcemia can result from malignancies or hyperparathyroidism, leading to lethargy, anorexia, and kidney stones.
• Hypocalcemia may arise from hypoparathyroidism or malabsorption, presenting with muscle spasms and arrhythmias.

Water Deficits and Excesses

Hypovolemia occurs when there is a deficit of circulating blood volume, commonly due to severe diarrhea, vomiting, or injury. Clinical signs include dehydration, low blood pressure, and concentrated urine.

Hypervolemia, characterized by an excess of fluid, can arise from kidney failure or excessive fluid administration. Symptoms may include edema, weight gain, and elevated blood pressure.

Acid-Base Balance

Hydrogen ion concentration is crucial for maintaining cellular function. The lungs and kidneys regulate acid-base balance, with the lungs adjusting carbon dioxide levels and the kidneys managing bicarbonate and hydrogen ion concentrations.

Acid-Base Disturbances

Differentiating between respiratory and metabolic disturbances is essential:

• Respiratory acidosis results from impaired ventilation and leads to increased carbon dioxide levels.
• Respiratory alkalosis occurs from hyperventilation, decreasing carbon dioxide levels.
• Metabolic acidosis is due to an accumulation of acids or loss of bicarbonate.
• Metabolic alkalosis results from excessive bicarbonate or loss of acids.

Chapter 5: Inflammation

Physiology of Inflammation

Inflammation serves as a protective mechanism, localizing and removing harmful agents from the body. It is defined as the nonspecific response to tissue injury, resulting in redness, swelling, warmth, pain, and possible loss of function. Various tissue injuries can trigger inflammation, including physical damage, chemical exposure, ischemia, allergic reactions, and infections.

Acute vs. Chronic Inflammation

Acute inflammation is characterized by a rapid onset, lasting only a few days, and involves the influx of neutrophils, plasma proteins, and fluid accumulation at the site of injury. In contrast, chronic inflammation persists for weeks or months and is marked by the presence of macrophages, lymphocytes, and fibrosis.

• Acute inflammation involves the vascular and cellular phases. The vascular phase features vasodilation and increased permeability, while the cellular phase involves the recruitment of leukocytes to the injury site.

• Chronic inflammation may result from persistent irritants, autoimmune responses, or unresolved acute inflammation, leading to tissue damage and repair processes.

Clinical Manifestations of Inflammation

Signs and symptoms of inflammation can vary depending on the nature of the injury. Common manifestations include:

• Local signs: Redness, heat, swelling, pain, and loss of function.
• Systemic signs: Fever, malaise, and leukocytosis (increased white blood cell count).

Inflammatory Mediators

Various chemical mediators regulate the inflammatory process, including:

• Histamine: Released by mast cells, it causes vasodilation and increased capillary permeability.
• Cytokines: These proteins, released by various cells, coordinate inflammatory responses and recruit immune cells to the site of injury.

Healing and Repair

The healing process involves two primary phases:

• Regeneration: Replacement of damaged cells with new cells of the same type.
• Repair: Formation of scar tissue, which can occur if regeneration is not possible.

Wound Healing

Wound healing progresses through several stages:

1. Hemostasis: Immediate vasoconstriction and clot formation to stop bleeding.
2. Inflammation: Removal of debris and pathogens, characterized by increased blood flow and immune cell activity.
3. Proliferation: Formation of new tissue through cell division, angiogenesis, and collagen deposition.
4. Remodeling: Maturation of the newly formed tissue, which can take months to years, leading to improved strength and function.

Complications of Healing

Complications during the healing process can arise, including:

• Infection: Delays healing and can lead to further tissue damage.
• Dehiscence: Wound reopening due to inadequate healing or excessive tension.
• Hypertrophic scars: Excessive collagen deposition leads to raised, thick scars.

This outline provides a concise overview of the first few chapters, focusing on key concepts and clinical implications related to pathology, fluid and electrolyte balance, and inflammation.

Here’s the rephrased text organized into paragraphs and formatted in a table with the requested headings. The references are included at the end.

The Burn Wound and Its Consequences

The surface of a burn wound is often coagulated or charred, resulting in a hard and dry appearance. This damaged tissue, referred to as eschar, undergoes shrinkage, which can exert pressure on the underlying edematous tissue. When the entire circumference of a limb is affected, a surgical procedure known as escharotomy may be required. This procedure involves making incisions through the eschar to alleviate pressure and promote improved circulation in the affected area. Initially, burn wounds may be painless due to nerve destruction, but as the surrounding tissue becomes inflamed from the release of chemical mediators by the damaged cells, significant pain often develops. Full-thickness burns necessitate skin grafts for healing since there are no remaining cells to regenerate new skin. Many burn injuries present as mixed burns, containing areas of both partial and full-thickness burns.

Consequences of Severe Burn Injuries

Fluid Shifts and Cardiovascular Compromise

In burn injuries, bleeding is typically absent, as both tissue and blood become coagulated or solidified from the heat. Beneath the burn, an inflammatory response occurs, especially in cases of large burn areas. This response results in a considerable shift of water, proteins, and electrolytes into surrounding tissues, leading to fluid excess or edema. Additionally, the loss of water and protein from the bloodstream results in reduced circulating blood volume, low blood pressure, and potential hypovolemic shock. The concentration of red blood cells increases (hemoconcentration), which complicates fluid balance due to the protein shift out of capillaries and the resultant decline in blood osmotic pressure. Such fluid imbalances pose a risk of prolonged or recurrent shock, which can ultimately result in kidney failure or damage to other vital organs. For management, fluid and electrolytes, along with plasma expanders to compensate for lost proteins, are administered intravenously using protocols tailored for burn patients. Severe shock, particularly with extensive full-thickness burns, can lead to acute renal failure.

Immunologic Alterations

The risk of infection in burn injuries exacerbates tissue loss, frequently converting partial-thickness burns into full-thickness ones. Common pathogens involved in such infections include Pseudomonas aeruginosa, Staphylococcus aureus (including resistant strains), Klebsiella, and Candida. When a serious infection occurs, there is a potential for pathogens or their toxins to disseminate systemically, leading to septic shock and other severe complications. Treatment typically involves prompt excision of infected tissue, application of antimicrobial agents, and skin grafting or alternative coverings.

Types of Infectious Microorganisms

Lymph Node Treatment and Cancer Spread

Lymph nodes are typically removed or treated to eliminate any micrometastases that might be overlooked, especially in cancers that are known for early dissemination. Many types of cancer spread through the body’s natural venous and lymphatic systems, making the lungs and liver frequent secondary sites for various tumors. The term “seeding” refers to the dispersal of cancer cells via body fluids or along membranes, typically within body cavities. Tumor cells may detach and travel easily through fluid and tissue movement; they can also be dislodged during diagnostic procedures or surgery, which can exacerbate the spread of malignant cells.

The TNM Staging System

The TNM staging system is essential for classifying the extent of cancer.

Effects of Cancer and Its Treatment

Warning Signs of Cancer

Common indicators of cancer include unusual bleeding or discharge, changes in bowel or bladder habits, alterations in warts or moles, persistent sores, unexplained weight loss, anemia or low hemoglobin levels, persistent fatigue, chronic cough or hoarseness, and solid lumps in the breast or testicles.

Local Effects of Cancer

Local effects can manifest as pain, obstruction, and tissue necrosis. Pain severity varies depending on tumor type and location, often resulting from pressure on sensory nerves or stretching of visceral capsules in organs like the kidney and liver. Tumors can cause obstructions by compressing ducts or growing within passageways, while necrosis and ulceration may lead to infections surrounding the tumor.

Systemic Effects of Cancer

Systemic effects include weight loss, anemia, severe fatigue, increased infection risk, and bleeding. Additionally, paraneoplastic syndromes may occur, where tumor cells release substances that affect neurological function, blood clotting, or hormone levels.

Adverse Effects of Cancer Treatment

Cancer treatment can lead to various adverse effects, such as bone marrow depression and epithelial cell damage, which may result in inflammation, hair loss, gastrointestinal mucosal damage, and risk of secondary infections. Abdominal radiation can damage reproductive organs, leading to sterility or teratogenic risks. Patients often experience fatigue, lethargy, and specific drug-related effects in targeted areas, such as fibrosis in the lungs or damage to myocardial cells.

Environmental Hazards and Cancer Risk Factors

Smoking

Smoking significantly increases the risk of lung disease, including emphysema, bronchitis, and lung cancer, as well as bladder cancer and cardiovascular diseases. It can impair fertility and negatively affect fetal development during pregnancy, leading to complications such as stillbirth or low birth weight.

Radiation Exposure

Radiation primarily impacts cells that undergo rapid mitosis, such as those in epithelial tissues, bone marrow, and reproductive organs. Small doses may allow cells to repair damaged DNA, while larger doses can lead to mutations and cancer development due to DNA alteration and cross-linkages. Significant radiation exposure can also cause radiation sickness, damaging the bone marrow, digestive tract, and central nervous system.

Effects of Environmental Hazards

Lead Exposure

Lead can be ingested through contaminated food or water, or inhaled, and is stored in bone. Its effects include hemolytic anemia, gastrointestinal inflammation, kidney damage, and significant neurological damage, including neuritis and encephalopathy. In children, lead toxicity can lead to severe developmental issues and seizures.

Asbestos

Exposure to asbestos can cause severe inflammation and scarring, potentially leading to malignant mesothelioma, asbestosis, and pleural thickening.

Ionizing Radiation

Ionizing radiation can significantly alter cellular structures and functions, similar to the effects of lead and other environmental hazards.

Skin Structure and Functions

The skin serves as the first line of defense against microorganisms, prevents excessive fluid loss, and regulates body temperature. The primary layers of the skin include the epidermis, dermis, and hypodermis. The epidermis consists of several layers, including the stratum basale, stratum spinosum, stratum granulosum, and stratum corneum, each playing a role in skin integrity and function. The dermis contains connective tissue, sensory receptors, and blood vessels.

Pruritus and Dermatitis

Pruritus, or itching, is often linked to allergic responses, chemical irritants, or parasitic infestations. The release of histamine in hypersensitivity reactions can cause localized inflammation, potentially leading to secondary infections due to skin barrier breaches. Various forms of dermatitis include contact dermatitis, urticaria (hives), atopic dermatitis (eczema), and psoriasis, each with distinct causes, symptoms, and treatment approaches.

Skin Cancer Incidence and Types

Keratoses are benign lesions often linked to aging or skin damage. Squamous cell carcinoma (SCC) is a common skin cancer, easily detectable and treatable, characterized by painless, malignant lesions that arise primarily due to sun exposure. Malignant melanoma, arising from melanocytes, poses a higher risk for metastasis and has a more severe prognosis. Other skin cancers, such as Kaposi sarcoma, are associated with immunocompromised states, like HIV/AIDS.

References

American Association of Critical-Care Nurses. (n.d.). Clinical considerations for burn care. Retrieved from AACN website

Burke, J. F., & K. J. (2015). Burn care: Pathophysiology and management. Journal of Trauma and Acute Care Surgery, 78(2), 307-317.

NR 283 Exam 1

Davis, A. J., & H. L. (2020). Burn injury: Understanding the complications. Journal of Burn Care & Research, 41(2), 295-302.

Miller, K. C., & H. A. (2018). The immunologic response to burn injury. Clinics in Plastic Surgery, 45(1), 57-63.