GEORGIA BAPTIST COLLEGE OF NURSING
OF
MERCER UNIVERSITY
BIOLOGY/NURSING 215
HUMAN PATHOPHYSIOLOGY
SPRING 2005
COORDINATOR
PROF. SUSAN BLAKEY, RN, MS
GEORGIA BAPTIST COLLEGE OF NURSING
OF
MERCER UNIVERSITY
COURSE SYLLABUS
SPRING 2005 SEMESTER
Course Title: Human Pathophysiology (BIO/N 215)
Course Credits: 4 Semester Hours (4-0-4)
Total Course Hours:
Total Weeks: 16
Weekly Classroom Hours: 4.0
Course Placement: Level II, 2nd year, 1st Semester
Prerequisites: BIO 110 and 120
Course Description: The concepts of pathophysiology are based on previously
presented principles from anatomy and physiology. This course will focus on the
biologic basis for disease. The material will also include the various manifestations
of disease as signs, symptoms, and laboratory findings. A variety of factors (e.g.,
stress, age heredity) will be discussed in relationship to the pathogenesis of the
disease process.
Course Faculty
Faculty Phone
Office
Susan Blakey, RN, MS
Grace Lewis, RN, MS,
Mary Sharpe, RN, MSN, FNP
(678) 547-6734
(678) 547-6782
(678) 547-6738
266
232
253
Course Website
http://faculty.mercer.edu/blakey_sl
Course Objectives: At the completion of BIO/N 215, the successful student will
be able to:
1.
Correlate pathophysiology of the studied systems to disease processes
and related clinical findings.
2.
Relate cellular changes associated with selected diseases to clinical
manifestations and laboratory findings.
3.
Discuss disease in terms of its multifactorial origins and altered
physiologic functioning.
2
4.
Identify the cellular to system level changes that can occur as a result of
stress, heredity, and aging.
5.
Explain how alterations that cause a disruption in normal cellular
processes ultimately can lead to tissue and organ alterations.
Evaluation Methods:
Evaluation will be based on objective testing. Students are responsible for all
material covered in the content outline, objectives, and readings. Students will
be tested on this material. Students will be responsible for any additional
independent research to enhance their understanding of the course material.
Course Grading System:
Exam I
Exam II
Exam III
Exam IV
Exam V
20%
20%
20%
20%
20% (7 cumulative quiz grades)
100%
Exam and quiz grades will be posted within one week of exam date. Test
reviews may be scheduled with individual professors by appointment.
A quiz will be given at the end of each of the nine content units. No make-up
quizzes will be given. At the end of the semester, the two lowest grades will be
dropped. The remaining seven grades will be averaged and will be equivalent to
an exam grade (20%).
Study Guides
Faculty strong encourage students complete all study guides. Study guides are
provided to aid the student in class and exam preparation. Study guides will not
be turned in to faculty.
Missed Exams: See policy
If a student is unable to take a scheduled exam, he/she is expected to notify the
course coordinator before the exam is administered. Dates have been
scheduled near midterm to make-up exams 1 and 2 and near the end of the
semester to make-up exams 3 and 4. The make-up exam will be of a different
format. Approval to take the make-up exam must be obtained from the course
coordinator. A $10.00 fee must be paid to the Bursar’s Office prior to taking the
exam. The student will bring the receipt to the coordinator prior to taking the
exam. If the student does not call the coordinator and does not attend the
scheduled make-up exam on time, he/she will receive a zero (0) for the missed
exam.
3
Inclement Weather:
In the event of inclement weather, a make-up class day will be scheduled.
Classroom Behavior Related to Attendance:
The following policies regarding classroom behaviors have been adopted. This
material is specific to Human Pathophysiology and may be different in other
courses in the curriculum. Attendance in the classroom is a minimum
professional behavior and all students should be punctual for class. If a student
is late for class, respect the group by entering at the break. An attendance roster
will be circulated each class day.
Required Text:
Porth, C.M. (2005). Pathophysiology. Concepts of altered health states (7th Ed.).
St. Louis: Mosby.
Units of Content:
Units of content may be taught in an order different than listed below.
Unit I
Unit II
Unit III
Unit IV
Unit V
Unit VI
Unit VII
Unit VIII
Unit IX
Cellular Dynamics
Cardiovascular
Pulmonary
Renal
Gastrointestinal
Endocrine
Musculoskeletal
Immune
Neurological
A: Syllab. W/97
Revised: 9/96/SEB; rev. 12/96SEB;
Rev. 6/97/SEB; 3/98/GL
Rev. 10/99/DEW; Rev. 8/02/SEB;
Rev. 11/02/SEB; Rev. 12/03/SEB
Rev. 12/04/SEB
4
GEORGIA BAPTIST COLLEGE OF NURSING
OF
MERCER UNIVERSITY
Pathophysiology (BIO/NUR 215)
Unit I: Cellular Dynamics
Unit Objectives: At the completion of this unit, the student will
1.
Describe the cellular adaptations made in each of the following
processes: atrophy, hypertrophy, hyperplasia, dysplasia, and
metaplasia.
2.
Cite the reasons for the changes that occur with the wet and dry
forms of gangrene.
3.
Describe cell changes that occur with cellular injury.
4.
Relate free radical formation to cell injury and death.
5.
Differentiate between the effects of ionizing and nonionizing
radiation in terms of their ability to cause cell injury.
6.
Explain the effects of malnutrition; ischemia and oxygen
deprivation; impaired immune and inflammatory responses; and
infection, wound separation, and foreign bodies on wound
healing.
7.
Define neoplasm and explain how neoplastic growth differs from
the normal adaptive changes seen in atrophy, hypertrophy, and
hyperplasia.
8.
Distinguish between cell proliferation and differentiation.
9.
State at least five ways in which benign and malignant neoplasms
differ.
10.
Describe the mechanisms of tumor invasion.
11.
Explain intracellular changes that occur in cancer cells.
12.
Describe the general effects of cancer on body systems.
13.
Describe the role of proto-oncogenes and anti-oncogenes in the
transformation of a normal life line to a cancer cell line.
State how life style can contribute to the cancer risk through
exposure to carcinogenic agents.
14.
5
15.
Cite the evidence for immunologic defense against tumors.
16.
Discuss genetic factors that have been associated with the
causation of childhood cancers.
17.
Explain how ADH regulates the urine concentrating ability of the
kidneys.
18.
Compare the pathology and manifestations of diabetes insipidus
and the syndrome of inappropriate ADH.
19.
Describe the effects of fluid volume deficit on the skin, brain, and
circulatory, nervous, urinary, and gastrointestinal systems.
20.
Cite the causes of hyponatremia and hypernatremia in terms of
altered intake, output, and regulation mechanisms.
21.
Relate the functions of sodium to the clinical manifestations of
hyponatremia and hypernatremia.
22.
State the causes of hypokalemia and hyperkalemia in terms of
intake, output, and intracellular versus extracellular distribution
mechanisms.
23.
Relate the functions of potassium to the clinical manifestations of
hypokalemia and hyperkalemia.
24.
Describe the causes of hypocalcemia in terms of altered gastrointestinal tract absorption, mobilization of bone stores, and renal losses.
25.
Relate the manifestations of hypophosphatemia and hyperphosphatemia to the functions of the phosphate.
Required Readings:
Porth, C.M. (2005). Pathophysiology. Concepts of altered health states 7th Ed.).
(Ch. 4 pp. 63-94, Ch. 5 pp. 95-113, Ch. 8 pp. 149-178, CH. 33 pp. 693734). St. Louis: Mosby.
Suggested Readings:
Cohen, H., Madhavan, S., & Alderman, M. (2001). High and low serum
potassium associated with cardiovascular events in diuretic-treated
patients. Journal of Hypertension, 19(7), 1315-23.
6
Edwards, S. (2001). Regulation of water, sodium, and potassium: Implications for
practice. Nursing Standard, 15(22), 36-44.
Hawkins, R. (2001). Mastering the intricate maze of metastasis. Oncology
Nursing Forum, 28(6), 959-65.
Huckleberry, Y. (2001). Intravenous fluids: Why solution and why? Support Line,
23(1), 12-3, 16.
Innerarity, S. (2000). Hypomagnesemia in acute and chronic illness. Critical Care
Nursing Quarterly, 23(2), 1-19.
Kraft, P. (2000). The osmotic shift. Journal of Intravenous Nursing, 23(4), 220-4.
Kugler, J., & Hustead, T. (2000). Hyonatremia and hypernatremia in elderly.
American Family Physician, 61(12), 3623-30, 3547-50.
Michael, K. (2000). Relationship of skeletal muscle atrophy to functional status.
Biological Research for Nursing, 2(2), 117-31.
Ogden, G. (2001). Magnesium in health and disease. Support Line, 23(2), 3-10.
Terpstra, T. (2000). Syndrome of inappropriate antidiuretic hormone secretion:
Recognition and management. Med Surg Nurisng, 9(2), 61-70.
cellular.f98
revised 9/96/SEB; reve. 6/97/SEB; rev. 9/97/SEB;
Rev. 8/98/SEB; Rev. 5/02/SEB;
Rev. 4/03/SEB; Rev. 12/03/SEB
Rev. 12/04/MSS
7
Alteration in Cellular Function
Alteration in Electrolytes
Alteration in Cellular Proliferation
STUDY GUIDE
HUMAN PATHOPHYSIOLOGY
1.
List the major components of cell as well as their function.
2.
Discuss the mechanisms of Passive Movement (osmosis, diffusion, and
facilitated diffusion) and Active Transport.
3.
Discuss the extracellular tissue components.
4.
Listed below are types of cellular adaptation. Define each of the adapt
changes, including causes and the underlying physiologic mechanism
adaptive change.
A.
Atrophy
B.
Hypertrophy
C.
Hyperplasia
D.
Metaplasia
E.
Dysplasia
5.
Discuss the following biochemical actions responsible for causing cell
injury and death. Include examples of these biochemical actions:
A.
B.
C.
Free radical formation
Hypoxia and ATP depletion
Disruption of intracellular calcium homeostasis
6.
Contrast the following types of necrosis:
A.
Liquefication necrosis
B.
Coagulation necrosis
C.
Caseous necrosis.
D.
Gangrene
7.
Describe factors that control fluid exchange between the vascular and
interstitial fluid compartments and relate them to the development of
edema and third spacing ECF.
8.
Describe the manifestations and treatment of edema.
8
9.
Explain the control of cell volume and the effect on the following cell size:
A.
Isotonic solutions
B.
Hypertonic solutions
C.
Hypotonic solutions
10.
For each of the following electrolyte imbalances, identify blood level,
pathophysiologic causes, and clinical manifestations:
A.
Hyponatremia.
B.
Hypernatremia
C.
Hypokalemia
D.
Hyperkalemia
E.
Hypocalcemia
F.
Hypercalcemia
G.
Hyperphosphatemia
H.
Hypophosphatemia
I.
Hypermagnesemia
J.
Hypomagnesemia
11.
Describe the action of antidiuretic hormone (ADH).
12.
Discuss the renin-angiotensin-aldosterone system (RAAS) in maintaining
fluid balance.
13.
Distinguish between the process of cell proliferation and differentiation.
14.
Define oncogene, proto-oncogenes, tumor suppressor gene,
apoptosis genes. Explain the role each plays in cancer cell growth.
15.
Discuss those cellular characteristics and cell functions that distinguish
cancer cells from normal cells.
16.
17.
Define and discuss the following terms: invasion, metastasis, seeding and
angiogenesis.
Describe methods used in detection and diagnosis of cancer,
including the Papanicolaou smear, tissue biopsy, and tumor
markers.
18.
Compare methods of grading and staging cancers.
19.
Briefly discuss the different types of cancer treatment.
Cellular.sg
Dev. 5/00/SEB
Rev. 12/04/MSS
9
and
GEORGIA BAPTIST COLLEGE OF NURSING OF
MERCER UNIVERSITY
BION 215 Pathophysiology
Unit II: Cardiovascular System
Unit Objectives: At the completion of this unit, the student will
1.
Explain how vessel radius, vessel length, blood viscosity, and blood
pressure affect blood flow.
2.
Define mean arterial blood pressure and state the rationale for its use.
3.
Compare the structure of arteries, arterioles, veins, and capillaries.
4.
List five mechanisms of blood vessel obstruction.
5.
Describe vessel changes that occur in atherosclerosis.
6.
List three established risk factors in atherosclerosis.
7.
Describe the pathology involved in venous thrombosis.
8.
Differentiate between essential, secondary, and malignant hypertension.
9.
Describe the possible influence of age, race, obesity, salt, and other cation
(potassium, calcium, and magnesium) intake, alcohol consumption, stress,
and oral contraceptive medications on the development of essential
hypertension.
10,
Explain the blood pressure changes that accompany normal pregnancy
and describe four types of hypertension that can occur in pregnancy.
11.
Define orthostatic hypotension.
12.
Define the terms preload and afterload.
13.
Using Starling’s law of the heart, explain the effects that increased and
decreased venous return to the heart have on cardiac output.
14.
Compare the manifestations of acute pericarditis with those of chronic
pericarditis with effusion and constriction.
10
15.
Relate the cardiac compression that occurs with cardiac tamponade to the
clinical manifestations of the disorder, including pulsus paradoxus.
16.
State the physiological cause of myocardial ischemia.
17.
Distinguish among classic angina, variant angina, unstable angina, silent
myocardial ischemia, and myocardial ischemia in terms of
pathophysiology and symptomatology.
18.
Compare the heart changes that occur with the cardiomyopathies.
19.
Compare the effects of myocarditis, rheumatic fever, bacterial
endocarditis, and Kawasaki’s disease on cardiac structures and function.
20.
Compare the effects of stenotic and regurgitant mitral and aortic valvular
heart disease on cardiovascular function.
21.
Explain the causes of fluid retention and edema; nocturia; dyspnea and
cough; fatigue, weakness, and confusion; hepatomegaly and liver
dysfunction, anoerexia, and cardiac cahcexia in person with congestive
heart failure.
22.
Relate the effect of left ventricular failure to the development of pulmonary
edema.
23.
Describe the clinical picture of pulmonary edema.
24.
Explain the pathophysiology and clinical manifestations of cyanotic and
acyanotic congenital heart defects.
Required Readings:
Porth, C.M. (2005). Pathophysiology. Concepts of altered health states (7th Ed.).
(pp. 449-473, 475-502, 505-531, 535-577, 581-599, 603-629). St. Louis:
Mosby.
Suggested Readings:
Beevers, G., Lip, G., & O’Brien, E. (2001). ABC of hypertension: The
pathophysiology of hypertension. BMJ, 322(7291), 912-6.
Braun, L., & Rosenson, R. (2001). Assessing coronary heart disease and
managina lipids. Nurse Practitioner: American Journal of Primary
Healthcare, 26(12), 30-2, 34, 37-43.
11
Echegaray, M., & Riveria, M. (2001). Role of Creative Kinase isoenzymes on
muscular and cardiorespiratory endurance: Genetic and molecular
evidence. Sports Medicine, 31(13), 919.-34.
El-Mitwalli, A., & Malkoff, D. (2001). Intracerebral hemorrhage. Internet Journal of
Emergency and Intensive Care Medicine, 5(1), 24.
Futterman, L., & Lemberg, L. (2001), The critical role of the endothelial cell in
acute coronary events. American Journal of Critical Care, 10(3), 191-9.
Gale, C., Ashurst, H., & Powers, H. (2001). Antioxidant vitamin status and
carotoid atherosclerosis in the elderly. American Journal of Clinical
Nutrition, 74(3), 402-8.
Jairath, N. (2001). Implications of gender differences on coronary artery disease
risk reduction in women. AACN Clinical Issues: Advanced Practice in
Acute and Critical Care, 12(1), 17-28.
Kim, S. (2000). Measurement of the rennin-angiotensin system in heart failure.
Biological Research for Nursing, 1(3), 210-26.
Kirkness, C., Mitchell, P., & Burr, R. (2001). Cerebral autoregulation and
outcome in acute brain injury. Biological Research for Nursing, 2(3), 17585.
Kunimoto, B. (2001). Assessment of venous leg ulcers. Ostomy/Wound
Management, 47(5), 38-42, 44-9, 52-3.
Lilly, T., & Rupp, T. (2001). Sac attack: Pathophysiology, assessment, and
prehospital treatment of cardiac tamponade. Journal of Emergency
Medical Services, 26(4), 58-60, 62-4, 66-75.
MacKay, d. (2001). Hemorrhoids and varicose veins. Alternative Medicine
Review, 6(2), 126-40.
Moyers, S., & Bailey, L. (2001). Fetal malformations and folate metabolism.
Nutrition Reviews, 59(7), 215-24.
Niemann, J. (2001). Ability of troponin I to predict cardiac events in patients
admitted from the emergency department. Annals of Emergency Medicine,
38(5), 611.
Perry, M. (2001). Impact of smoking on people with diabetes. Journal of Diabetic
Nursing, 5(4), 107-10.
12
Sing, K. Bnaa, K., & Jacobsen, B. (2001). Prevalence of and risk factors for
abdominal aortic aneurysms in a population-based study: The Trom’s
study. American Journal of Epidemiology, 154(3), 236-44.
Thompson, A., Shea, B, & Welch, V. (2001). Calcium-channel blockers for
Raynaud’s phenomenon in systemic sclerosis. Arthritis & Rheumatism,
44(8), 1841-7.
Trotto, N. (2000). Staying up-to-date on pericardial disease. Patient Care, 34(19),
20-2, 25, 29-30.
Urbano, F. (2001). Raynaud’s phenomenon. Hospital Physician, 37(9), 27-30.
Varma, C., & Becker, S. (2001). Predictors of mortality in acute myocardial
infarction. Lancet, 358(9292), 1473-4.
Cardio.f98
Revised 9/98/SEB; Rev. 12/96/SEB
Rev. 6/97/SEB; Rev. 6/98/SEB;
Rev. 8/98/SEB; Rev. 5/02/SEB; Rev. 12/03/SEB
Rev. 12/04/SEB
13
GEORGIA BAPTIST COLLEGE OF NURSING
OF
MERCER UNIVERSITY
PATHOPHYSIOLOGY – BIO/N 215
CARDIOVASCULAR
1.
Trace the blood flow during a normal cardiac cycle.
2.
Describe the pathway of the conduction system through the heart.
3.
Explain the Frank-Starling Law of the heart.
4.
Define preload and afterload.
5.
Discuss factors involved in neural control of total peripheral resistance.
6.
Discuss the role of the Renin- Angiotensin cycle in blood pressure
maintained.
7.
Identify 3 mechanisms that influence total plasma volume.
8.
List things that affect blood flow.
9.
Discuss the pathologic events that lead to atherosclerosis:
10.
Discuss differences between primary and secondary hypertension.
11.
Identify factors associated with primary hypertension.
12.
Identify factors, which contribute to the development of secondary
hypertension.
13.
Explain the differences among myocardial ischemia, injury, and infarction.
14.
Name factors that contribute to myocardial ischemia.
15.
Discuss the pathophysiology of pericarditis.
16.
Trace the flow of blood in mitral stenosis.
17.
Trace the flow of blood in mitral regurgitation.
18.
Explain how stenosis and regurgitation affect cardiac output.
14
19.
Discuss the differences among right-sided, left-sided, high-output, and 10
heart failure.
20.
Describe the effect cardiac dysrhythmias have on cardiac output.
Dew: 4/00
15
GEORGIA BAPTIST COLLEGE OF NURSING OF
MERCER UNIVERSITY
Pathophysiology (BIO/NUR 215)
Unit III: Pulmonary System
Unit Objectives: At the completion of this unit, the student will
1.
Describe the normal anatomy and physiology of the respiratory system as
related to pulmonary pathophysiology.
2.
Differentiate between ventilation and perfusion.
3.
Relate Boyle's law to inspiration and expiration.
4.
Define inspiratory reserve, expiratory reserve, vital capacity, and residual
volume.
5.
State the definition of lung compliance.
6.
Explain the exchange of gases in the alveoli.
7.
Explain the difference between PO2 and hemoglobin- bound oxygen.
8.
Describe the transport of oxygen by hemoglobin.
9.
Describe the function of chemoreceptors in regulation of ventilation.
10.
Describe the transmission of the common cold from person to person.
11.
Differentiate between primary TB and reactivated TB on the basis of their
pathophysiology.
12.
State the mechanism for the transmission of fungal lung infections.
13.
List the characteristics of pleural pain.
14.
Explain why tension pneumothorax is a life-threatening emergency.
15.
Relate the pathophysiologic changes that occur with pleural effusion to the
production of signs and symptoms.
16.
Differentiate between primary and secondary atelectasis.
17.
Differentiate between chronic obstructive pulmonary disease, bronchial
asthma, and emphysema to include chief manifestations and
predisposing factors.
16
18.
Describe the genetic abnormality responsible for cystic fibrosis and state
its effect upon lung function.
19.
Explain the difference between chronic obstructive pulmonary diseases
and interstitial lung diseases.
20.
Describe the current theory for the pathogenesis of most interstitial lung
diseases and major manifestations of them.
21.
State the immediate effects of pulmonary embolism.
22.
List three causes of pulmonary hypertension.
23.
Describe the alterations in cardiovascular function that are characteristics
of cor pulmonale.
24.
Describe Cheyne-Stokes breathing.
25.
Define dypnea and list three conditions in which it occurs.
26.
List at least three categories of drugs that can depress respiratory
function.
27.
Discuss sleep apnea as related to four sleep stages, diagnosis, and signs
and symptoms.
28.
Cite four general causes of hyperventilation syndrome and list its signs
and symptoms.
29.
Relate the alterations in arterial carbon dioxide levels to the production of
altered body function in hyperventilation syndrome.
30.
Differentiate between the terms hypoxia, hypoxemia, and hypercapnia,
including causes and manifestations of each.
31.
Explain why cyanosis may not be an accurate diagnostic criterion for
hypoxemia.
32.
Define acute respiratory failure.
33.
Describe the pathologic lung changes occurring in ARDS and relate them
to its clinical manifestations.
34.
Describe the relationship between hydrogen ions and acid-base balance.
17
35.
Describe the three forms of carbon dioxide transport and their contribution
to acid-base balance.
36.
Compare the role of the kidneys and the respiratory system in regulation
of acid-base balance.
37.
Differentiate between the body buffer systems.
38.
Compare corrective and compensatory mechanisms for regulating body
pH.
39.
Describe how hydrogen ions and potassium ions interact in pH regulation.
40.
Differentiate between metabolic acidosis, metabolic alkalosis, respiratory
acidosis, and respiratory alkalosis.
41.
List the common causes of metabolic acidosis, metabolic alkalosis,
respiratory acidosis, and respiratory alkalosis.
42.
Compare the neurologic manifestations of acidosis and alkalosis.
43.
Compare the contrast the clinical manifestations of acidosis and alkalosis.
Required Readings:
Porth, C.M. (2005). Pathophysiology. Concepts of altered health states (7th Ed.).
(pp. 633-657, 659-687, 689-722). St. Louis: Mosby.
Suggested Readings:
Adrogu, H. E., & Adrougu, H. J. (2001). Acid-base physiology. Respiratory Care,
46(4), 328-41.
Brooks, J. (2001). Postoperative nosocomial pneumonia. AACN Clinical Issues:
Advanced Practice in Acute and Critical Care, 12(2), 305-23.
Epstein, S., & Singh, N. (2001). Respiratory Acidosis. Respiratory Care, 46(4),
366-83.
Goolsby, M. (2001). Viral upper respiratory infections. Journal of the American
Academy of Nurse Practitioners, 13(2), 50-4.
Haynes, J. & Kallet, R. (2001). Lung collapse during low tidal volume ventilation
in acute respiratory distress syndrome. Respiratory Care, 46(5), 489-90.
18
Hills-Wright, P., & Brett, S. (2001). CT scanning in the acute respiratory distress
syndrome. Care of the Critically Ill, 17(4), 129-32.
MacIntyre, N. (2001). Chronic obstructive pulmonary disease management.
Respiratory Care, 46(11), 1294-303.
Miller, A. (2001). The etiologies, pathophysiology, and alternative/complementary
treatment of asthma. Alternative Medicine Review, 6(1), 20-47.
No author. (2002). TB rates among blacks get an overdue look: As a region,
Southeast’s rates highest in nation. TB Monitor, 9(1), 10-1.
Parkin, D. (2001). Global cancer statistics in the year 2000. Lancet Oncology,
2(9), 533-43.
Ray, D., & Rohren, C. (2001). Characteristics of patients with upper respiratory
tract infection presenting to a walk-in clinic. Mayo Clinic Proceedings,
76(2), 169-73.
Sheik, S., & Sethi, S. (2001). Management of infections exacerbation of COPD.
Home Health Care Consultant, 8(5), 21-7.
Swenson, E. (2001). Metabolic acidosis. Respiratory Care, 46(4), 342-53.
VanSoren, M., Diehl-Jones, W., & Maykut, M. (2000). Pathophysiology and
implications for treatment of acute respiratory distress syndrome. AACN,
Clinical Issues: Advanced Practice in Acute and Critical Care, 11(2), 17997, 331-5.
rev. 9/96/GL/SEB; rev. 12/96/SEB;
rev. 6/97/SEB; rev. 6/98/SEB;
rev. 8/98/SEB; Rev. 5/02/SEB; Rev. 12/03/SEB
Rev. 12/04/SEB
19
PULMONARY STUDY GUIDE
HUMAN PATHOPHYSIOLOGY
1.
State the differences among Functional Residual Capacity (FRC).
Residual Volume (RV) and Tidal Volume (Vt).
2.
Discuss the neurochemical controls of ventilation.
3.
Describe how the elastic properties of the lung and chest wall affect
ventilation.
4.
Identify the four steps in gas transport.
5.
Define ventilation and perfusion and discuss the relationship
6.
Explain the oxyhemoglobin dissociation curve.
7.
Describe the pathophysiology of a pneumothorax and its effect on
ventilation.
8.
Identify pathophysiologic factors that contribute to Acute Respiratory
Failure.
9.
Name the identifying characteristics of Emphysema, Chronic Bronchitis,
and Bronchial Asthma.
10.
State factors that contribute to the impact of a pulmonary embolus.
11.
Identify 4 causes of secondary pulmonary hypertension.
12.
Discuss metabolic acidosis.
13.
Discuss metabolic alkalosis.
14.
Discuss respiratory acidosis.
15.
Discuss respiratory alkalosis.
Dew:4/00
20
GEORGIA BAPTIST COLLEGE OF NURSING OF
MERCER UNIVERSITY
Pathophysiology (BIO/NUR 215)
Unit IV: Renal System
Unit Objectives: At the completion of this unit, the student will
1.
Describe the normal anatomy and physiology of the kidney as related
to renal pathophysiology.
2.
Differentiate between glomerular filtration, tubular reabsorption, and
tubular secretion.
3.
Describe the determinants and effects of blood flow in the kidneys.
4.
Describe the relationship between the renal and endocrine systems in
regulating electrolytes.
5.
Describe the methods used in cystoscopic examination of the urinary tract,
ultrasound studies of the urinary tract, CT scans, MRI studies, and renal
angiography.
6.
Discuss the clinical significance and limitations of blood urea nitrogen and
urine/serum creatinine measurements.
7
List the parameters that are assessed during urinalysis and briefly indicate
their clinical significance.
8.
List the microscopic urinalysis findings indicative of renal dysfunction.
9.
Discuss the cause and effects of obstructions in various locations within
the urinary tract.
10.
Describe the following two types of renal neoplasms: Wilm's tumor and
adult kidney cancer.
11.
Discuss the etiology, infectious agents, manifestations, and complications
of urinary tract infections.
12.
Compare and contrast acute and chronic pyelonephritis.
13.
Identify the causes of glomerulonephritis and the resulting changes in
glomerular structure and function.
21
14.
Discuss the similarities and differences between acute, rapidly
progressive, and chronic glomerulonephritis.
15.
Diagram the pathophysiology of nephrotic syndrome from causation
through complications.
16.
Discuss physiologic changes which occur in acute tubular necrosis.
17.
Differentiate between prerenal, intrarenal, and postrenal causes of acute
renal failure.
18.
Diagram the cellular abnormalities and resultant multiple system
manifestations of chronic renal failure.
Required Readings:
Porth, C.M. (2005). Pathophysiology. Concepts of altered health states (7th Ed.).
(pp. 727-742, 789-807, 809-831, 833-848, 851-866). St. Louis: Mosby.
Suggested Readings:
Barr, R., chalmers, d., & DePauw, S. (2000). Health-related quality of life in
survivors of Wilm’s tumor and advanced neuroblastoma: A cross-sectional
study. Journal of Clinical Oncology, 18(18), 3280-7.
Bevan, M. (2001). Renal disease in older people. Nursing Older People, 13(6),
21-6.
Korevaar, J., Jansen, M., & Dekker, F. (2001). When to initiate dialysis: Effect of
proposed U.S. guidelines on survival. Lancet, 358 (9287), 1046-50.
Landray, M., Thambyrajah, J., & McGlynn, F. (2001). Epidemiological factors of
known and suspected cardiovascular risk factors in chronic renal
impairment. American Journal of Kidney Diseases, 38(3) 537-46.
Lang, M., & Towers, C. (2001). Identifying poststreptococcal glomerulonephritis.
Nurse Practitioners American Journal of Primary Healthcare, 26(8), 34,
37-8, 40-2.
Letrilliart, L., Guiguet, M., & Hanslik, T. (2001). Postdischarge nosocomial
infections in primary care. Infection Control and Hospital Epidemiology,
22(8), 493-8.
Lopez-Abente, G., & Escolar, A. (2001). Tobacco consumption and bladder
cancer in non-coffee drinkers. Journal of Epidemiology and Community
Health, 55(1), 68-70.
22
Maloney, G., Wehrum, H., & Fraser, W. (2001). Kidney complications: Examining
the disease process and prehospital management of patients with ESRD.
Journal of Emergency Medical Services, 36(7), 50-2, 54-65.
Manthey, D., & Teichman, J. (2001). Nephrolithiasis. Emergency Medicine
Clinics of North America, 19(3), 633-54.
Roth, C., & Culp, K. (2001). Renal osteodystrophy in older adults with end-stage
renal disease. Journal of Gerontological Nursing, 27(7), 46-51.
Ruggenenti, P., Schieppati, A., & Remuzzi, G. (2001). Progression, remission,
regression of chronic renal diseases. Lancet, 357(9268), 1601-8.
Russell, T. (2000). Acute renal failure related to rhabdomyolysis:
pathophysiology, diagnosis, and collaborative management. Nephrology
Nursing Journal, 27(6), 567-577.
Schneiderman, H., & Pazmino, P. (2001). What’s your diagnosis?…Nephrotic
syndrome. Consultant, 41(7), 1017-8.
Szymanski, N. (2001). Infection and inflammation in dialysis patients: Impact on
laboratory parameters and anemia. Nephrology Nursing Journal, 28(3),
337-40.
renal.w97
rev. 9/96/GL/SEB; rev. 12/96/SEB;
rev. 6/96/SEB; rev. 6/98/SEB;6/99/SEB;
Rev. 5/02/SEB; Rev. 12/03/SEB
Rev. 12/04/SEB
23
Alteration in Renal Function
STUDY GUIDE
HUMAN PATHOPHYSIOLOGY
1.
Identify the components of a nephron.
2.
Discuss blood flow through the renal system, beginning with renal
arteries.
3.
How much blood do the kidneys receive per minute? What percentage of
cardiac output is this amount?
4.
What factors determine glomerular filtration rate (GFR)?
5.
An hormonal regulator of renal blood flow is the renin-angiotensin system.
Explain what happens in this system when renin is released.
6.
Discuss the functions of the following nephron segments.
A.
Proximal tubule
B.
Loop of Henle
C.
Distal tubule
D.
Collecting duct
7.
Why do individuals with chronic renal failure (kidney cells have become
nonfunctional) have anemia?
8.
What effect does loss or damage of nephrons have on GFR? What effect
does this change in GFR have on:
A.
plasma creatinine
B.
blood urea nitrogen
9.
Discuss the normal findings of a urinalysis, including
A.
color
B.
turbidity
C.
protein
D.
pH
E.
specific gravity
F.
sediment
10.
How does renal function change across the life span?
11.
What physiologic and pathophysiologic disorders predispose an individual
to formation of renal calculi of differing compositions- calcium, struvie, and
uric acid culi?
24
12.
Discuss the clinical manifestations of nephrolithiasis.
13.
What effect does urinary obstruction have on glomerular filtration, urinary
stasis, and infection.
14.
Discuss diagnosis and manifestations of renal tumors.
15.
Identify three factors that protect an individual against urinary tract.
infections.
16.
Discuss causative factors and manifestations of acute pyelonephritis.
17.
How do the various forms of glomerulonephritis affect the permeability of
the basement membrane?
18.
What laboratory and clinical findings suggest a diagnosis of nephrotic
syndrome?
19.
How do prerenal, intrarenal, andpostrenal types of acute renal failure differ
in etiology and clinical manifestations.
20.
What are the characteristic clinical and laboratory findings in chronic.renal
failure?
21.
What is uremia? What are the systemic effects of uremia?
Dev.5/00/SEB
25
GEORGIA BAPTIST COLLEGE OF NURSING OF
MERCER UNIVERSITY
Pathophysiology (BIO/N 215)
Unit V: Gastrointestinal and Hepatobillary Systems
Unit Objectives: At the completion of this unit, the student will
1.
Describe the physiologic function of the four parts of the digestive system.
2.
Describe the physiology of peristalsis.
3.
Trace a bolus of food through the stages of swallowing.
4.
Describe the function of the gastric secretions in the process of digestion.
5.
Describe the site of gastric acid and pepsin production and secretion in
the stomach.
6.
Describe the function of the gastric mucosal barrier.
7.
Compare the absorption of carbohydrates, fats, and proteins.
8.
Describe the physiologic mechanisms involved in anorexia, nausea, and
vomiting.
9.
Relate the causes of gastroesophageal reflux disease and clinical
manifestations.
10.
Cite the proposed role of Helicobacter pylori in the development of
chronic gastritis and peptic ulcer.
11.
Describe the factors that contribute to the gastric mucosal barrier.
12.
Differentiate between the causes and manifestations of acute and chronic
gastritis.
13.
Describe the predisposing factors in the development of peptic ulcer and
cite three complications of peptic ulcer.
14.
State the diagnostic criteria for irritable bowel syndrome.
15.
Compare the characteristics of Crohn's disease and ulcerative colitis.
26
16.
Relate the use of a high-fiber diet in the treatment of diverticular disease
to the etiologic factors involved in the development of the condition.
17.
Describe the rationale for the symptoms associated with appendicitis and
its complications.
18.
List the risk factors associated with colorectal cancer.
19.
List the functions of the liver and the signs of disruption of these functions.
20.
Compare hemolytic jaundice and obstructive jaundice with reference to
their clinical manifestations.
21.
State the origin of ammonia and describe the function of the liver in terms
of its detoxification.
22.
Explain the rationale for the use of laboratory measures of serum
aminotransferse activity in diagnosis and management of persons with
liver disease.
23.
Compare hepatitis A, B, C, D, and E in terms of source of infection,
incubation period, development of chronic disease, and the carrier state.
24.
Characterize postnecrotic chirrhosis and biliary cirrhosis.
25.
Describe the physiologic basis for portal hypertension and relate it to the
development of ascites, esophageal varices, and splenomegaly.
26.
State the reason for the poor prognosis in persons with hepatocellular
cancer.
27.
Describe the formation of gallstones.
28.
Describe the clinical manifestations of acute pancreatitis.
29.
State risk factors for pancreatic cancer.
30.
Discuss congenital defects of the gastrointestinal system.
Required Readings:
Porth, C.M. (2005). Pathophysiology. Concepts of altered health states (7th Ed.).
(pp. 815-830, 831-858, 859-888, Ch. 38 pp. 871-884, Ch. 39 pp. 885913, Ch. 40 pp. 917-947). St. Louis: Mosby.
27
Suggested Readings:
Andrew, A. (2001). Portal hypertension: A review. Journal of Diagnostic Medical
Sonography, 17(4), 193-202.
Beltrami, E., Alvardao-Ramy, F., & Critchley, S. (2001). Updated U.S. public
health service guidelines for the management of occupational exposures
to HBV, HCB, and HIV and recommendations for postexposure
prophylaxis. MMWR: Morbidity and Mortality Weekly Report, 50(11), 1-52.
Chutkan, R. (2001). Inflammatory bowel disease. Primary Care: Clinics in Office
Practice, 28(3), 539-56.
Heitkemper, M., & Jarrett, M. (2000). Irritable bowel syndrome: Causes and
treatment. Gastroenterology Nursing, 23(6), 256-63.
Kane, S. (2001). Caring for women with inflammatory bowel disease. Journal of
Gender-Specific Medicine, 4(1), 54-9.
Kalloo, A., & Kantsevoy, s. (2001). Gallstones and biliary diseases. Primary
Care: Clinics in Office Practice, 28(3), 591-606.
Krige, J. (2001). ABC of diseases of liver, pancreas, and biliary system: Portal
hypertension, ascites, encephalopathy, and other conditions. BMJ,
322(7283), 416-8.
Marinella, M., & Mustafa, M. (2000). Acute diverticulitis in patiens 40 years of age
and younger. American Journal of Emergency Medicine, 18(2), 140-2.
Mason, I. (2001). Inflammatory bowel disease. Nursing Times, 97(9), 33-5.
McConnell, E., (2001). Appendicitis: What a pain! Nursing 2001, 3(4), 1-3.
Redden, M., & Wotton, K. (2001). Clinical decision making by nurses when faced
with thuid-space fluid shift: How well do they fare? Gastroenterology
Nursing, 24(4), 182-91.
Vlodov, J., & Tenner, S. (2001). Acute and chronic pancreatitis. Primary Care:
Clinics in Office Practice, 28(3), 607-28.
Rev. 8/98/SEB; Rev. 5/02/SEB; Rev. 12/03/SEB, Rev. 12/04/MSS
28
Georgia Baptist College of Nursing
of
Mercer University
BIO/N 215 – Gastrointestinal/Hepatobiliary
Study Guide
1.
Discuss the roles of gastrin and cholecystokinin in gastric motility.
2.
Name the 3 factors that stimulate acid secretion by parietal cells.
3.
Identify the function of pepsinogen in the breakdown of proteins.
4.
Describe the breakdown of carbohydrates, proteins, and fats in the
digestive system.
5.
Discuss the functions of the liver, bile, gallbladder, and the pancreas in the
digest process.
6.
Identify some physiologic factors that contribute to ulcer formation.
7.
Contrast the pathophysiology of ulcerative colitis and Chron's disease.
8.
orrelate varices, splenomegaly, ascites, and hepatic encephalopathy
with portal hypertension.
9.
Describe the various pathophysiologic mechanisms leading to ascites.
10.
Discuss the pathophysiology of the development of jaundice.
11.
Contrast the different types of Hepatitis.
12.
Describe the role of alcohol in the development of cirrhosis.
13.
Discuss the imbalance of fluids and electrolytes with an intestinal
obstruction
14.
State the impact of an intestinal obstruction on the respiratory system.
dew: 4/00
29
GEORGIA BAPTIST COLLEGE OF NURSING OF
MERCER UNIVERSITY
Pathophysiology (BIO/NUR 215)
Unit VI: Endocrine System
Unit Objectives: At the completion of this unit, the student will:
1.
Discuss normal anatomy and physiology of the endocrine system and
various pathophysiologic conditions.
2.
Relate the specific endocrine gland and hormone to a principle site of
action and principle process affected.
3.
State the function of hormone receptor and the difference between cell
surface hormone receptors and intracellular hormone receptors.
4.
Describe the relationship between hormones and target cells.
5.
Explain the regulation of hormone release.
6.
Discuss the metabolism and deactivation of hormones.
7.
Relate receptor sites and target cells to the mechanism of hormone
action.
8.
Describe the regulation of hormone levels as related to the hypothalamus
and pituitary gland.
9.
Differentiate between positive and negative feedback as endocrine
control mechanism.
10.
Discuss methods used to diagnose alterations in the endocrine system.
11.
Differentiate between the growth alterations dwarfism, gigantism,
acromegaly, citing hormone alterations and clinical manifestations.
12.
Compare and contrast mineral corticoid and glucocorticoids as related to
the major effects on the body.
13.
Differentiate between the clinical manifestations of Addison's Disease,
Acute Adrenal Crisis and Cushing's Syndrome.
14.
Compare and contrast clinical manifestations of hyperthyroidism and
hypothyroidism as related to cardiovascular, metabolic, neuromuscular,
mental/emotional and gastrointestinal effects.
30
15.
Differentiate between Graves' Disease and Thyroid Storm. Differentiate
between the characteristics of insulin dependent diabetes mellitus, noninsulin dependent diabetes mellitus and gestational diabetes mellitus.
16.
Discuss diabetic ketoacidosis, hyperosmolar non-ketotic coma, and
hypoglycemia and manifestations related to specific glucose metabolism
alterations.
17.
Identify the cycle of events related to the Somogyi phenomenon.
18.
Compare and contrast clinical manifestations related to the chronic
complications of diabetes mellitus.
19.
Identify general treatment modalities for select endocrine system
alterations.
Required Readings:
Porth, C.M. (2005). Pathophysiology. Concepts of altered health states (7th Ed.).
(Ch. 41 pp. 951-960, Ch. 42 pp. 961-984, Ch. 43 pp. 987-1014). St. Louis:
Mosby.
Suggested Readings:
Bacoka, j. (2001). Action stat. Thyroid storm. Nursing, 31(2), 88.
Bisschop, P., deMetz, J., & Ackermans, T. (2001). Dietary fat content alters
insulin-mediated glucose metabolism in health men. American Journal of
Clinical Nutrition, 73(3), 554-9.
Bowering, C. (2000). Foot ulcers in patients with diabetes mellitus. Critical
Reviews in Physical and Rehabilitation Medicine, 12(1), 25-49.
Dorn, L., & Cerrone, P. (2000). Cognitive function in patients with Cushing
syndrome: A longitudinal perspective. Clinical Nursing Research, 9(4),
420-40.
Kirsten, D. (2000). The thyroid gland: Physiology and pathophysiology. Neonatal
Network: Journal of Neonatal Nursing, 19(8), 37-40.
LoBuono, C. (2001). Keeping older patients healthy. Managing geriatric
endocrine disorders. Patient Care for the Nurse Practitioners, 4(11), 26,
29-31, 35-6.
Murphine, P. (2001). Macrovascular disease etiology and diabetic foot ulceration.
Journal of Wound Care, 10(4), 103-7.
31
Nayback, A. (2000). Hyponatremia as a consequence of acute adrenal
insufficiency and hypothryoidism…Addison’s disease. Journal of
Emergency Nursing, 26(2), 130-3.
Sabol, V. (2001). Addisonian crisis: This life-threatening condition may be
triggered by a variety of stressors. American Journal of Nursing, 101(7),
24AAA, 24CCC-DDD.
Samuels, M. (2001). The use of tests for the diagnosis and monitoring of thyroid
disease. Laboratory Medicine, 32(5), 257-9.
Shagam, Y. (2001). Thyroid disease: An overview. Radiologic Technologic,
73(1), 25-40, 42-4.
Wein, T., & Albers, J. (2001). Diabetic neuropathies. Physical Medicine and
Rehabilitation Clinics of North American, 12(2), 307-20.
endocr.f98
rev. 9/96/GL/SEB; rev 12/96/SEB;
rev. 6/97/SEB; rev. 9/97/SEB;
rev. 8/98/SEB;Rev. 5/02/SEB; Rev. 12/03/SEB
32
Alteration in Hormonal Regulation
STUDY GUIDE
HUMAN PATHOPHYSIOLOGY
1.
Hormonal secretion is controlled by regulatory mechanisms, including
feedback circuits. How do negative feedback mechanisms control the
secretion of hormones?
2.
How does the solubility of a hormone (water or lipid soluble) affect its
transport into the bloodstream?
3.
The sensitivity of the target cell to a particular hormone is related to the
number of receptors per cell. Discuss "up regulation" and "down
regulation" in relation to target cell sensitivity.
4.
Identify the target tissue and action of the following hypothalamic
hormones:
A.
Thyroid-releasing hormone (TRH)
B.
Somatostatin
C.
Growth hormone-releasing factor (GRF)
D.
Corticotropin-releasing hormone (CRH)
5.
List two hormones secreted by the posterior pituitary.
6.
Discuss the effects that a 25% decrease in intravascular volume has on
the secretion of ADH. (IncIude effect on secretion of ADH, effect on distal
renal tubules and collecting ducts, and effect on urine output.)
7.
Identify the target organ and functions of the following anterior pituitary
tropic hormones:
A.
beta- endorphins
B.
Follicle stimulating hormone (FSH)
C.
Lutenizing hormone (LH)
D.
Thyroid-stimulating hormone (TSH)
E.
Growth hormone (GH)
F.
Adrenocorticotropic hormone (ACTH)
8.
Identify at least 8 functions of thyroid gland hormones (T3) triiodothyronine
and (T4) thyroxine.
9.
What hormone is produced by the parathyroid gland? What is one of the
most important functions of this hormone?
10.
What effect does an elevated serum calcium have on PTH secretion?
11.
Where is insulin produced? Discuss actions of insulin.
33
12.
Briefly contrast the actions on insulin and glucagon. What is the action of
glucagon on the liver?
13.
Discuss at least five actions of glucocorticoids.
14.
What are the etiology and clinical findings of antidiuretic hormone
(ADH) exceeds and deficit?
15.
What are the etiology and clinical findings of growth hormone (GH) excess
and deficit?
16.
What are the etiology and clinical manifestations of thyroid hormone
excess and deficit?
17.
What are the differentiating characteristics of type I and type II diabetes
mellitus?
18.
Explain the pathophysiologic basis associated with the following
manifestations of type I diabetes mellitus:
A.
polyuria
B.
polydipsia
C.
polyphagia
19.
Contrast clinical manifestations of hypoglycemia and hyperglycemia.
20.
What clinical findings are associated with Diabetic Ketoacidosis (DKA) and
how, do they differ from those of Hyperosmolar Hyperglycemic Nonketotic
Syndrome (HHNKS)?
21.
Explain what is meant by counterregulatory hormones and describe
actions of glucogon, epinephrine, growth hormone, and the adrenal
cortical hormones in regulation of blood glucose levels.
22.
Explain the reason foot ulcers may occur in the individual with
diabetes mellitus.
5/00/SEB
34
GEORGIA BAPTIST COLLEGE OF NURSING OF
MERCER UNIVERSITY
Pathophysiology (BIO 210)
Unit VII: Musculoskeletal System
Unit Objectives: At the completion, the student will:
1.
Identify the structural elements of bone.
2.
Describe the maintenance of bone integrity, including bone remodeling
and repair.
3.
Discuss the metabolism of muscle.
4.
List the classifications of joints and their functions.
5.
Differentiate the various types of bone fractures.
6.
Explain the pathophysiology of dislocations and subluxations.
7.
Discuss the etiology of myoglobinuria and related complications.
8.
Identify risk factors and pathophysiology related to osteoporosis.
9.
Cite possible causes and manifestations of osteomyelitis.
10.
Describe the pathologic characteristics of Osteoarthritis.
11.
Differentiate Osteoarthritis and Rheumatoid Arthritis.
12.
State the cause of gouty arthritis and clinical manifestations.
13.
List precipitating factors of fibromyalgia.
14.
Discuss the pathophysiology of Duchenne Muscular Dystrophy and
clinical manifestations.
Required Readings:
Porth, C.M. (2005). Pathophysiology. Concepts of altered health states (7th Ed.).
(1257-1366, 1367-1389, 1393-1414, 1417-1439). St. Louis: Mosby.
35
Suggested Readings:
Birchfield, P. (2001). Osteoarthritis overview. Geriatric Nursing, 22(3), 124-31.
Dessien, P., Shipton, E., & Budd, K. (2000). Nocieptive and non-nociceptive
rehematological pain : Recent developments in the understanding of
pathophysiology and management in rheumatoid arthritis and
fibromyalgia. Pain Reviews, 7(2), 67-79.
Lawson, M. (2001). Evaluation and managing osteoporosis in men. Nurse
Practitioner: American Journal of Primary Health Care, 26(5), 26, 29-30,
32-36.
Lind, M., Sballe, K., & Obergaard, S. (2000). Stimulated bone healing. Critical
Reviews in Physical and Rehabilitation Medicine, 12(4), 313-43
Michael, K. (2000). Relationship of skeletal muscle atrophy to functional status: A
systematic research review. Biological Research for Nursing, 2(2), 117-31.
Nakamura, T., Ishimaru, J., & Mizui, T. (2001). Osteosarcoma metastatic to the
mandible. Oral Pathology, Oral Radiology, and Endodontics, 91(4), 452-4.
Sato, Y., Asoh, T., & Kondo, I. (2001). Vitamin D deficiency and risk of hip
fractures among disabled elderly stroke patients. Stroke, 32(7), 1673-7.
Snyder, R., Cohen, M., & Sun, C. (2001). Osteomyelitis in the diabetic patients:
Diagnosis and treatment. Ostomy/Wound Mangemet, 47(3), 24-6.
Swezey, R. (2000). Osteoporosis: Diagnosis, pharmacological, and rehabilitation
therapies. Critical Reviews in Physical and Rehabilitation Medicine, 12(3),
229-69.
8/98/SEB;Rev. 5/02/SEB; Rev. 12/03/SEB; Rev. 12/04/SEB
36
Alteration in Musculoskeletal Function
STUDY GUIDE
HUMAN PATHOPHYSIOLOGY
1.
What are the functions of osteoblasts and osteoclasts in bone
remodeling?
2.
What is the process and duration of normal bone healing after a fracture?
(Discuss stages)
3.
Why is articular cartilage particularly susceptible to degenerative
changes?
4.
How does the striated structure of skeletal muscle relate to its contractile
function?
5.
Discuss the impact of aging on the Musculoskeletal system.
6.
Discuss differences in the following types of fractures:
A.
Closed fracture
B.
Open fracture
C.
Comminuted fracture
D.
Spiral fracture
E.
Compression fracture
F.
Pathologic fracture
G.
Greenstick fracture
H.
Stress fracture
7.
Discuss the differences between dislocation and subluxation.
8.
Contrast sprain and strain.
9.
Identify at least six risk factors associated with the development of
osteoporosis.
10.
Discuss manifestations of osteoporosis.
11.
Compare and contrast osteoporosis, osteomalacia, and ricketts.
12.
What is the pathophysiologic basis for osteomyelitis? What are clinical
manifestations?
13.
How are osteoarthritis and rheumatoid arthritis differentiated on the basis
of etiology and clinical manifestations?
37
14.
What is the pathophysiologic basis for gouty arthritis?
15.
Describe contractures and reasons they may develop.
16.
Discuss pathophysiology and clinical manifestations of
compartment syndrome.
5/00/SEB
38
GEORGIA BAPTIST COLLEGE OF NURSING OF
MERCER UNIVERSITY
Pathophysiology (BIO/NUR 215)
Unit VIII: Immune System
Unit Objectives: At the completion of this unit, the student will
1.
Describe the normal anatomy and physiology of the immune system,
as related to immune pathophysiology.
2.
List the layers of the skin and describe their function.
3.
Describe the concept of host-microorganism interaction.
4.
Use the concepts of incidence, portal of entry, source of infection,
symptomatology, disease course, site of infection, agent and host
characteristics to explain the mechanisms of infectious diseases.
5.
Differentiate between incidence and prevalence and among endemic,
epidemic, and andemic.
6.
Describe the stages of an infectious disease after the point at which the
potential pathogen enters the body.
7.
List the systemic manifestations of infectious disease.
8.
Explain the difference between culture, serology, and antigen or
metabolite detection methods for diagnosis of infectious disease.
9.
State the purpose of inflammation.
10.
List the five cardinal signs of acute inflammation and describe the
physiologic mechanisms involved in production of each.
11.
Describe the hemodynamic and cellular phases of the inflammatory
response.
12.
Name and state the function of the granulocytes.
13.
Explain the significance of the major histocompatibility complex (MHC)
and the human leukocyte antigen (HLA).
14.
State the functions of the five classes of immunoglobin.
15.
Describe the function of the macrophage.
39
16.
Describe the characteristics of an antigen.
17.
Differentiate between active and passive immunity.
18.
Contrast the humoral and cell-mediated immunity.
19.
Relate the complement system to the immune process.
20.
Relate the actions of the cytokines to the immune response.
21.
Characterize the changes in the immune response that occur in the
elderly.
22.
List categories of immunodeficiency disease and state one example of
each category.
23.
Compare the immune mechanisms involved in type I, II, III, and IV
hypersensitivity immune reactions.
24.
Discuss the rational for matching of HLA and MCH types of organ
transplantation.
25.
Compare the immune mechanisms involved in transplant rejection and
graft-versus-host disease.
26.
Discuss the role of the suppressor and helper T-cells in the regulation of
self-tolerance.
27.
State the virus responsible for AIDS and explain how it differs from
most other viruses.
28.
Describe the alterations in immune function that occur in people with
AIDS.
29.
Relate the altered immune function in people with AIDS to the
development of opportunistic infections, tuberculosis, and Kaposis
sarcoma.
30.
Discuss the vertical transmission of HIV from mother to child and the
impact of the epidemic on infants and children.
31.
List the cells and tissues of the hematopoietic system.
32.
Define the terms leukopenia, neutropenia, granulocytopenia, and
aplastic anemia.
40
33.
State two causes of neutropenia.
34.
Describe complications of acute leukemia.
35.
Compare and contrast the signs and symptoms of Hodgkin's disease and
non-Hodgkin's lymphoma.
Required Readings:
Porth, C.M. (2005). Pathophysiology. Concepts of altered health states (7th Ed.).
(pp. 278-285, 287-298, 321-336, 341-363, 365-385, 387-401, 403-426,
427-443). St. Louis: Mosby.
Suggested Readings:
Bowers, J. (2001). Cytokines: A review. Support Line, 23(5), 8-12, 15.
Carroll, P. (2001). Anaphylaxis. RN, 64(12), 45-50.
Cashman, L. (2001). The immune system: A review. Support Line, 23(5), 3-7.
Corwin, E. (2000). Understanding cytokines: Implications for nursing research
and practice. Biologic Research for Nursing, 2(1), 41-8.
Jacoby, R., Ournigs, J., & Holmes, J. (2001). Platelet activation and function after
trauma. Journal of Trauma: Injury, Infection, and Critical Care, 51(4), 63947.
Nielsen, P., Nissen, D., & Skov, P. (2000). Assessment of IgE allergen specificity
among latex-allergic health care workers. Annals of Allergy, & Asthma, &
Immunology, 85(6), 489-94.
Immune.f98
rev. 9/96/GL/SEB; rev 12/96/SEB;
rev. 6/97/SEB;9/97/SEB;
rev. 8/98/SEB; Rev. 5/02/SEB; Rev. 12/03/SEB
Rev. 12/04/SEB
41
IMMUNITY STUDY GUIDE
HUMAN PATHOPHYSIOLOGY
1.
Define humoral immunity and cell-mediated immunity. Discuss the
differences between the 2 types of immunity.
2.
Identify the 5 molecular classes of immunoglobulins. Discuss how the
classes differ.
3.
Identify the 5 types of T-cells and list the primary function of each type.
4.
List 5 types of cytokines.
5.
Describe the stages of the inflammatory process and discuss what occurs
in stage.
6.
Discuss the differences between the 2 pathways of the clotting system.
7.
Name the function of bradykinin.
8.
Identify the roles of macrophages in the inflammation and immunity
processes.
9.
Discuss the 3 phases of the healing process.
10.
Define allergy, autoimmunity, and alloimmunity.
11.
Discuss the differences between the 4 types of hypersensitivity reactions.
12.
Describe the role IgE.
13.
Discuss the pathophysiology of Systemic Lupus Erythematosus (SLE).
14.
Identify factors that influence a pathogen's ability to infect the host.
15.
State some differences between bacterial infection/injury and viral
infection/injury.
16.
Discuss the trends in the United States of HIV infection in relation to age,
mortality.
42
17.
State some reasons why the pharmacological and vaccine treatments for
HIV have not been successful.
Dew: 4/00
43
GEORGIA BAPTIST COLLEGE OF NURSING OF
MERCER UNIVERSITY
Pathophysiology (BIO/N 215)
Unit IX: Neurological System
Unit Objectives: At the completion of this unit the student will
1.
State the difference between the central nervous system (CNS) and the
peripheral nervous system (PNS).
2.
Name and describe the anatomy of the three parts of a neuron.
3.
State the function of the supporting cells of the nervous system.
4.
Describe the interaction of the presynaptic and postsynaptic terminals.
5.
Briefly describe how neurotransmitters are synthesized, stored, released,
and inactivated.
6.
Name the three somatosensory modalities.
7.
State the significance of the dermatomes in a neurologic examinatiom.
8.
Differentiate between the specificity and pattern theories of pain.
9.
Explain the gate control theory of pain.
10.
Describe the function of nociceptors in response to pain information.
11.
Differentiate acute pain from chronic pain.
12.
Describe the mechanisms of referred pain, and list the common sites of
referral for cardiac and other types of visceral pain.
13.
Cite common physiologic manifestations of pain.
14.
State how the pain response may differ in children and elderly people.
15.
Describe the synthesis and metabolism of acetylcholine.
16.
State the effect of interruption of ANS innervation on the eye and vision,
circulatory system, control of blood flow and blood pressure,
gastrointestinal system, and gastrointestinal function.
17.
Describe the functions of the pyramidal versus extrapyramidal systems.
44
18.
Describe the pathology associated with Duchenne muscular dystrophy.
19.
Relate the clinical manifestations of myasthenia gravis to its etiology.
20.
Compare the manifestations of upper motoneuron (UMN) and lower
motoneuron (LMN) injury.
21.
State the pathology associated with amyotrophic lateral sclerosis (ALS).
22.
Briefly state the mechanisms of neural injury in spinal cord injury (SCI).
23.
Describe the alterations in ventilation/communication, autonomic nervous
system function, sensorimotor integrity, bowel and bladder function, and
sexual functioning that occur following SCI.
24.
Cite the origin and function of the cranial nerves.
25.
Differentiate between cerebral hypoxia and cerebral ischemia.
26.
Define cerebrovascular occlusive disease and compare the characteristics
of transient ischemic attacks and stroke.
27.
State the complications associated with subarachnoid hemorrhage.
28.
Describe the compensatory mechanisms used to prevent large changes in
intracranial pressure (ICP) from occuring when there are changes in brain,
blood, and CSF volume.
29.
Describe the postural changes that occur with decorticate and decrebrate
rigidity.
30.
Compare the pathology of meningitis and encephalitis.
31.
State two criteria for diagnosis of brain death.
32.
Compare the manifestations of simple partial seizures and complex partial
seizures and those of absence seizures and tonic-clonic seizures.
33.
List the symptoms of keratitis.
34.
Explain the mechanism of pupillary constriction and dilation.
35.
Compare closed-angle and open-angle glaucoma.
36.
Describe the visual changes that occur with a cataract.
45
37.
Describe the function of the retina and its photoreceptors.
38.
Relate the phagocytic function of the retinal pigment epithelium to the
development of retinitis pigmentosa.
39.
Describe the pathogenesis of diabetic retinopathy.
40.
Explain the pathology and visual changes associated with macular
degeneration.
41.
Discuss the cause of retinal detachment.
42.
Define amblyopia and explain its pathogenesis.
43.
List the structures of the external, middle, and inner ear and state their
functions.
44.
Explain why infants and young children are more prone to develop otitis
media.
45.
List three common symptoms of otitis media.
46.
Describe the disease process that occurs with ostosclerosis and relate this
to the hearing loss that occurs.
47.
Differentiate between conductive and sensorineural hearing loss.
48.
List at least three drug groups that have potential ototoxicity.
49.
Describe the pathology associated with Meniere's disease.
50.
Describe the changes in brain tissue that occur with Alzheimer's disease.
51.
Use the three stages of Alzheimer's disease to describe its progress.
52.
Explain the symptoms of Parkinson's disease with reference to the
extrapyramidal system.
53.
Differentiate between the actions of cholinergic drugs and dopamine
agonists in controlling the symptoms of Parkinson's disease.
54.
Explain the significance of demyelinization and plaque formation in
multiple sclerosis.
55.
Describe the manifestations of multiple sclerosis.
46
56.
Describe the general manifestations of brain tumors.
57.
Discuss the etiology and clinical manfestations of schizphrenia and mood
disorders.
Required Readings:
Porth, C.M. (2005). Pathophysiology. Concepts of altered health states (7th Ed.).
(pp. 1113-1157, 1159-1189, 1193-1225, 1227-1261, 1282-1286, 12911326, 1329-1352). St. Louis: Mosby.
Suggested Readings:
Blous, W. (2001). Systems and diseases: Exploring normal anatomy and
physiology. Nervous System 7. Nursing Times, 97(10), 41-4.
Borrell, E. (2000). Hypokinetic movement disorders. Journal of Neuroscience
Nursing, 32(5), 254-5.
Bodyen, K. (2000). The pathophysiology of demyelination and the ionic basis of
nerve conduction in multiple sclerosis: An overview. Journal of
Neuroscience Nursing, 32(1), 49-53.
Boyne, L. (2001). Meningococcal infection. Nursing Standard, 16(7), 47-55.
Bush, M. (2001). Dementia: Current research and future hopes. Nurse
Practitioner Forum, 12(1), 56-70.
Byrd, L., Marks, W., & Starr, P. (2000). Deep brain stimulation for advanced
Parkinson’s disease. AORN Journal, 72(3), 385-387-90.
Chan, L, Takata, G., & SheKeele, P. (2001). Evidence assessment of
management of acute otitis media. Pediatrics, 108(2), 239-47.
Charles, T., & Swash, M. (2001). Amyotrophic lateral sclerosis: Current
understanding. Journal of Neuroscience Nursing, 33(5), 245-53.
DeKosy, S. (2001). Epidemiology and pathophysiology of Alzeheimer’s disease.
Cornerstone, 3(4), 15-26, 71-6.
Ebell, M (2001). Do vitamins C and E prevent the formation of cataracts?
Evidence-Based Practice, 4(2), 2P, 4.
Fitzgerald, D. (2001). Perilymphatic fistula nad Meniere’s disease. Annals of
Otology, Rhinology, and Laryngology, 110(5), 430-6.
47
Glenn, S. (1999). Pathophysiology of diabetic eye disease. Journal of Diabetes
Nursing, 3(6), 178-80.
Kartenbach, A. (2000). Neurophysiologic mechanisms of tinnitus. Journal of the
American Academy of Audiology, 11(3), 125-137.
Kammerman, S., & Wasserman, L. (2001) Seizure disorders; Part I.
Classification and diagnosis. Western Journal of Medicine, 175(2), 99-103.
Krisher, K. (2001). Case studies. Viral meningitis. Laboratory Medicine, 32(11),
698-9.
Ogedegbe, H. (2001). Autoimmune diseases: A spectrum of disease processes.
Laboratory Medicine, 32(11), 674-9.
Ress, B. (2000). Irreversible sensorineural hear ing loss as a result of
azithromycin ototoxicity: A case report. Annals of Otology, Rhinology, and
Laryngology, 109(4), 435-7.
Richardson, C., & Poole, H. (2001). Chronic pain and coping: A proposed role for
nurses and nursing models. Journal of Advanced Nursing,34(5), 659-67.
Ruhl, J. (2000). Myasthenia grav’s: A baffling neuromuscular disorder. Nursing
Spectrum, 10(12), 10-2.
Seewoodhary, R. (2001). Degenerative myopia. Opthalmic Nursing: International
Journal of Opthalmic Nursing, 4(4), 14-7.
Yao, M., & Messner, A. (2001). Fungal malignant otitis externa due to
Scedosporitum apiospermum. Annals of Otology, Rhinolgy, and
Laryngology, 110(4), 377-80.
Yoo, T., Shea, J., & Ge, X. (2001). Presence of autoantibodies in the sera of
Meniere’s disease. Annal of Otology, Rhinology, and Laryngology, 110(5),
425-9.
neuro.w97
rev. 9/96/SEB; rev. 12/96/SEB; rev. 6/97/SEB;
rev. 6/98/SEB
rev. 8/98/SEB; Rev. 5/02/SEB; Rev. 12/03/SEB
Rev. 12/04/SEB
48
Alteration in Neurologic Function
STUDY GUlDE
HUMAN PATHOPHYSIOLOGY
1.
How is the CNS protected and supported?
2.
What structures are located in each of the four principal areas of the
forebrain (prosencephalon), midbrain (mesencephalon), hindbrain
(rhombencephalon), and medulla oblongota (myelencephalon)?
3.
Discuss differences in preganglionic neurons and postganglionic neurons?
4.
List the function of the cranial nerves:
A.
Olfactory
B.
Optic
C.
Oculomotor
D.
Trochlear
E.
Trigeminal
F.
Adbucens
G.
Facial
H.
Vestibulocochlear
I.
Glossopharyngeal
J.
Vagus
K.
Spinal accessory
L.
Hypoglossal
5.
Discuss sympathetic nervous system functions that occur in "fight or flight
response.”
6.
Explain the purpose of the following diagnostic tests in diagnosing 11
disorders:
A.
Computerized tomography (CT)
B.
Magnetic resonance imaging (MRl)
C.
Positron emission tomography (PET) scan.
D.
E.
F.
G.
Cerebral angiography
Cerebrai spinal fluid (CSF) analysis
Myelography
Electrencephalography (EEG)
7.
Contrast acute and chronic pain.
8.
Discuss the manifestations of the following types of acute pain:
A.
Somatic pain
.
B.
Visceral pain
49
C.
Referred pain
9.
How do open angle and closed-angle glaucoma differ?
10.
What are the causes and manifestations of conjunctivitis, keratitis
cataract, retinopathy?
11.
How do conductive and sensorineural hearing loss differ?
12.
What "are the causes and "manifestations of otitis extema; otitis media, o
toscle and ototoxicity?
13.
Explain the tests for oculocephalic and oculovestibular responses that aid
in 1 confirmation of brain death?
14.
Contrast the following levels of coma:
A.
Confusion
B.
Disorientation
C.
Lethargic
D.
Obtundation
E.
Stupor
F.
Coma
15.
Discuss the pathophysiologic basis for seizures; including manifestations.
16.
Discuss the proposed pathophysiologic theories associated with
Alzheimer's disease. Discuss manifestations related to the three stages of
Alzheimer's disease.
17.
How do meningitis and encephalitis differ with regard to infective organism
CSF analysis and clinical manifestations.
18.
What is the etiology and clinical manifestations of a cerebral vascular
acid (CVA)?
19.
What are the similarities and differences between multiple sclerosis and
amyotrophic lateral sclerosis?
20.
What are the proposed neurotransmitter alterations in Parkinson's
disease? What are the manifestations of the disease?
Rev. 5/00/SEB
50
GEORGIA BAPTIST COLLEGE OF NURSING OF
MERCER UNIVERSITY
H.I.P.A.A. Background Information
In 1996, Congress enacted the Health Insurance Portability and Accountability
Act, or H.I.P.A.A. The primary purpose was continuity of health insurance
coverage if you change jobs, but it also provided standards for health information
transactions and confidentiality and security of patient data. This confidentiality
portion affects the day-to-day education process of nursing students. Permission
must be received from the patient prior to ANY disclosure.
H.I.P.A.A. Enforcement
The Privacy Rule was published in April 2001 and will be enforceable in April
2003. The Office of Civil Rights will enforce it. There are civil penalties of
$100/violation up to $25,000/year. Criminal penalties are also possible including
$50,000 and/or 1 year in prison for wrongful disclosure or $250,000 and/or 10
years in prison for the intent to sell information.
As health care providers, we all have a responsibility to uphold confidentiality for
patients. In a busy education or hospital setting it can be difficult. Classroom
discussions and clinical conferences and assignments lead to discussions of
client's confidential health information. While these oral and written discussions
are acceptable in the educational setting, they are not acceptable in common
areas such as the cafeteria, or in the written form without preventing the
disclosure of the patient's name. The person next to you in line could be a
patient's friend, relative, or media member that is not entitled to this privileged
information. If clinical/classroom papers are lost or transmitted electronically
without safeguards, the general public would have access to confidential patient
information.
Confidentiality is the basis of the nurse-patient relationship. If the patient is
uneasy about disclosing pertinent and privileged information, the ability of the
nurse to provide holistic adequate care is severely compromised. It should be
made clear to the patient that this information will not be disclosed unless
required by law. The medical record is to be kept private with certain exceptions
including:
- Treatment of minors
- Transportation Safety
- HIV+ Patients
- Abuse of a Child or Adult
- Duty to report harm/wound
51
GEORGIA BAPTIST COLLEGE OF NURSING OF
MERCER UNIVERSITY
STUDENT NAME:
COURSE:
DATE:
HONOR SYSTEM CREED
As a member of the Georgia Baptist College of Nursing community, I am bound by honor
to uphold standards of honesty and integrity; to pursue full intellectual, ethical, spiritual,
and moral development; and to accept my personal, academic, professional
responsibilities in the community. To attain these ideals, I embrace this Honor System
as my way of life.
H.I.P.A.A. Statement
It is the policy of Georgia Baptist College of Nursing of Mercer University to adhere to all
Health Insurance Portability and Accountability Act (H.I.P.A.A.) guidelines. All
discussions and/or documents related to confidential patient/client health information
shall be held in strict confidence. Information will only be written or electronically
transmitted using the client/patient initials. Further, this information will only be shared
with faculty involved in the student’s education process. Client/patient discussions will
only be held in designated areas of the university or clinical facility.
Permission for Posting Grades
In accordance with the Buckley Amendment to the Family Educational Rights and
Privacy Act of 1974, we cannot post any exam or course grades without the express
permission of the student. Therefore, we would like to ask each of you to indicate
whether or not you desire to have your grades posted in a public place.
I would like to have grades for the above course posted by an identification
number on a designated bulletin board. YES__________
NO___________
Signature:__________________
Code Number:______________
(Choose a four digit number; which
will be followed by three (3) zeros.)
Statement of Understanding
I have read the Course Outline for the above stated course. I understand the objectives
and requirements of this course and have no questions regarding them. I also have
read the Honor System Creed, the H.I.P.A.A. Statement, and the Permission for Posting
Grades Statement. I understand the purposes and requirements of the above
statements.
Signature:____________________________________
52