Final Exam Study Guide
Cells
Atrophy- Decrease in cell size- reduced tissue mass-result of insufficient blood flow-reversible.
Hypertrophy- increase in cell size- enlarged tissue mass- because of increased workload- weight
lifter.
Hyperplasia- increased number of cells- enlarged tissue mass- breast tissue at puberty.
Metaplasia-mature cell is replaced by a different mature cell type that can better endure the
stress or change.
Dysplasia-cells vary in size, shape, and appearance- dysplasia on a pap smear.
Anaplasia- undifferentiated cells with variable nuclear and cell structures. -used to measure
aggressiveness or a tumor- seen in most malignant tumors
Neoplasia-new growth- known as a tumor. Benign vs malignant (aggressive growing masses of
cancer)
Aptosis- Programmed Cell death- Red Blood cells live for 120 days.
Necrosis- Death of one or more cells, tissue, or organs due to oxygen deprivation
Ischemia- Decreased oxygen in the cells
Hypoxia- reduced oxygen in tissues
Fluid Electrolytes
Potassium – 3.5-5 – Main electrolyte in electrical function of the heart
Hypokalemia- Decreased K+ concentration in the blood
Caused by- Vomiting, prolonged diarrhea (significant loss of potassium), NGT suction, diuretics,
Signs-anorexia, muscle weakness, decreased DTR’s, ventricular dysrhythmia, shallow
respirations, postural hypotension, Serum PH Elevates causing Alkalosis.
Hyperkalemia-Increased K+ concentration in the blood
Caused by- Renal Failure, Severe infection, burns, crush injury/trauma.
Signs- Peak t waves, wide QRS complex, v fib, cardiac arrest, nausea, diarrhea, muscle twitching,
parathesis, Serum PH decreases causing acidosis
Calcium- 8.5-10.5 total calcium 4.5-5.6 Ionized calcium Calcium controls the muscles.
Hypocalcemia-decreased Ca2+ in the blood
Caused by- Hypoparathyroidism, renal failure, thyroidectomy, Vit D deficiency, pancreatitis.
Signs- hyperactive reflexes, Trousseau’s sign, Chvostek’s sign, seizures paresthesia,
confusion/irritability, tetany
Hypercalcemia-Increased Ca2+ in the blood
Caused by- Hypoparathyroidism, malignant cancers, overuse of calcium antacids (tums)
prolonged immobilization.
Signs- lack of coordination, anorexia, nausea, confusion, decreased neuro excitability, cardiac
issues, heart block.
Sodium-135-145 Sodium Controls Neuro
Hyponatremia- Decreased Na+ in the blood
Caused by- vomiting, excessive water intake, burns, diuretics, SIADH
Signs- confusion, muscle cramps, headaches, seizures
Hypernatremia- To much Na+ in the blood
Caused by- Diabetes insipidus, Alka-Seltzer over use, inadequate water intake
Signs- dehydration, tachy, weak thready pulse, agitation, decreased reflexes, disoriented.
Causes of Edema
Increased capillary hydrostatic pressure- Caused increased volume- force causes increase in
fluid out of capillaries into tissues-( pulmonary edema, heart failure, renal failure)
Loss of plasma proteins- mostly decreased albumin which then causes decreased plasma
osmotic pressure.
Obstruction of lymphatic system- Excessive fluid is not returned and in normal circulationCaused by a blockage or enlarged lymph nodes.
Increased capillary permeability- localized edema- caused by infection, burns. Is an
inflammatory response.
Net hydrostatic pressure- based on the difference between the hydrostatic pressure within the
capillary compared to the pressure of the interstitial fluid as well as the relative osmotic
pressure within the blood and interstitial fluid.
Fluid Volume Deficit- Dehydration- hypovolemia
Decrease in body fluids.
Caused by- Vomiting diarrhea, sweating, fever, heat stroke, thyroid crisis, severe burns.
Serious dehydration seen in infants and elderly- lack reserve and lack ability to conserve
quickly.
Signs- dry mucus membranes, dry skin, low blood pressure, weak pulse, tachy, lethargy and
weakness
Hypovolemic Shock- hemorrhaging out- loss of whole blood cells.
Asthma
Asthma is a chronic inflammatory disorder in the pathways of the lungs. Bronchi and
Bronchiole. It comes and goes with flares known as asthma attacks that are reversible.
Previous exposure memory and IGE
Inflammation causes the airway to swell and produce mucus and so that inflammation makes
the airways more sensitive to certain asthma attacks.
Extrinsic Asthma- Occurs with type I hypersensitivity- Acute episodesIntrinsic Asthma- adult onset-hyperresponsive airway initiates attacks- attack stimuliRespiratory infections-stress-cold exposure-inhalation of irritants-exercise-drugs.
Inflammation
Type 1- (Immediate hypersensitive reaction) Allergies, atopic dermatitis, anaphylaxis. IGE,
Asthma
Type 2- (Antibody-mediated immune reaction) Cytotoxic- blood transfusion Anti -A or Anti-B
antibodies will destroy A, B, IgG
Type 3- (Immune complex reactions) Immune complex- Inflammation and tissue destructionautoimmune disorders- Lupus, RA, Hashimoto’s.
Type 4- (Cell mediated/ Delayed hypersensitivity) TB skin test, transplant rejection.
Skin Changes
Atopic Dermatitis- Excezma- allergies
Contact Dermatitis- pruritic rash
based on contact with irritants.
Psoriasis-Inflammatory skin disorder
Dry silvery scales.
Impetigo- highly contagious staph in children
Sometimes adults
Herpes simplex- cold sores- genital herpes
Fungal Infection
Tinea pedis- athletes foot
Tinea Capitis- Scalp
Tinea Corpus- Rest of body- Ringworm
Tinea Unguium- Infection of the nail
Basal Cell Carcinoma- Most common type
Of skin cancer. Grows Slow
Squamous Cell Carcinoma- Painless malignant Epidermis
Good prognosis when lesion is removed
Malignant Melanoma- Highly metastatic skin cancer mole that changes
A- Changes in appearance and is asymmetrical
B- Change in border
C- Change in Color
D- Increase in Diameter
E- Evolution
Respiratory Disease
Respiratory alkalosis- panic attack- loss of carbon dioxide- Hyperventilating
Respiratory acidosis is the retention of carbon dioxide- Hypersleep apnea, CNS depressants,
head truma, COPD, Asthma, Pneumonia causes mental status changes. Hypercapnia- Increased
carbon dioxide levels in the blood. Causes respiratory acidosis- nervous system depression
Older adults have impaired ciliary action- sense of smell will be decreased.
Circulatory and Blood Disorders
Shock- Decreased perfusion, vasoconstriction. Can cause skin to appear pale, ashen
Iron Deficiency Anemia- Decreased hemoglobin production- Spoon shaped nail- tired-Blood
loss- Check hemoglobin level.
Pernicious Anemia- Deficient of intrinsic factor B12
Aplastic Anemia- Red bone marrow failure
Sickle Cell Anemia- Cells are sickle shaped causing infarctions and pain. Genetic
Hematocrit- measuring the blood that reflects the percent of erythrocytes present in the
plasma.
Inadequate absorption of phosphorus is associated with Vit D deficiency.
CML-Stem Cell - Adults age 30-50- Chronic
AML- Stem Cell- Acute
CLL- Chronic -B lymphocyte
ALL- Acute- Children-B lymphocyte
Ecchymosis-Large purplish areas on the skin from bleeding.
Hematuria- Blood in the urine
Hemoptysis- Coughing up blood
Petechia- pinpoint or flat red spots on skin a mucus membraned bleeding of a capillary or small
arterial.
Congestive Heart Failure
Left sided CHF- caused by infarction of left ventricle, aortic valve stenosis, hypertension,
hyperthyroidism- Causes- Decreased cardiac output and pulmonary congestion- signs weight
gain, peripheral edema, JVD, acitis, fatigue, weakness, exercise intolerance, cold intolerance.
Right Sided CHF- caused by a weak heart from Infarction of right ventricle, pulmonary valve
stenosis, pulmonary disease- causes decreased cardiac output, systemic congestion, edema of
legs and abdomen, fatigue, weakness and cold and exercise intolerance, orthopnea.
Coronary Artery Disease
Collect data like elevated serum cholesterol, elevated blood pressure, blood glucose levels
above 100. Cigarette smoking. Daily activity level, obesity, length of any hormone replacement
therapy.
Cardiac Arrest is cessation of all cardiac activity and function. NO ventricular contractions. No
cardiac output and no circulating blood volume.
Cardiac output- the amount of blood pumped by each ventricle in 1 minute.
Stable Angina Pectoris- often relieved with rest or administration of vasodilator like
nitroglycerin.
Valvular defects- failure of valve to close completely allowing blood to regurgitate or leak
backwards.
Hypertension- tired or fatigued. Over long-time increased blood pressure causes damage to the
arterial walls and they become hard and thick. Causing a narrowing of the lumen. Blood supply
is reduced and then leads to ischemia and necrosis and then loss of function. Most frequent
damaged areas are brain, kidneys, and retina.
Peripheral Vascular disease- abnormalities in the arteries and veins outside of the heart that
prolong vasoconstriction- poor pedal pulses, paresthesia, intermittent claudication, fatigue or
weakness of the leg, feeling of heavy in the leg or foot, poorly perfused areas, cyanotic when
elevated.
Vasoconstriction-a stimulation of the sympathetic nervous system that is a stress response.
Results in elevated heart rate, blood pressure and increased respiratory rate and reduces the
flow of oxygen and blood flow to GUT.
Digestive Disorders
Peptic ulcers- gastric and duodenal- epigastric burning or aching 2-3 hours after meals at night.
Relieved by ingestion of food or antacids. Occult blood in stool or IDA are diagnostic indicators.
– Can cause hemorrhage rupture or obstruction.
Stress ulcers- cause by trauma, head injury, hemorrhage or sepsis.
Colorectal cancer screening- 55+ with family history of colorectal cancer.
Inflammatory Bowel Diseases
Crohn’s Disease- located in the terminal ileum and sometimes the colon- lesions on all layers.
Called skip lesions, loose semi formed stools, fistulas and abscesses are common complications.
Causes pain, malabsorption, and malnutrition.
Ulcerative Colitis- located in the colon and rectum- lesions on mucosa and are diffuse- frequent
watery stools with blood and mucus
Visceral pain
Burning sensation-inflammation and ulceration of upper digestive tract
Dull Aching pain- stretching of liver capsule.
Cramping or diffuse pain- inflammation, distention, stretching of intestines
Colicky severe pain- recurrent smooth muscle contractions or spasms. Severe inflammation or
an obstruction.
Urinary Disorders
Incontinence
Stress- pressure or stress causes urine to spill out- coughing, laughing, sneezing, running,
jumping.
Urge- sudden urge to urinate- neurogenic bladder.
Overflow- leads to dribbling urine- incomplete emptying.
Functional- Cognitive dysfunction- forgets to go
Urinalysys- can show large amounts of protein, blood, bacteria, pus
Dark color can be blood, too much bilirubin or a sign of dehydration
Odor can signal infection.
Acute Renal Failure- caused by- sever shock, burns, nephrotoxins, acute bilateral kidney
infection. Onset is sudden and acute. Signs are oliguria and increased serum urea.
Chronic Renal Failure- Caused by Diabeties, longterm nephrotoxin exposure, chronic bilateral
kidney infection or polycystic kidney disease. Onset is slow- signs are plyurea with diluted urineanemia, fatigue, hypertension.
Liver and Pancreas Disorders
Liver- breaks down and builds up many biological molecules, stores vitamins and iron. Destroys
old blood cells and produces bile to aid in digestion.
Pancreatitis- Lipase and amylase for diagnosis
Ascites and esophageal varices for Cirrhosis complications
Bone and Joint Disorders
Bone Disorders
Osteoporosis- Decrease in mass and density of the matrix. Mostly in Vertebrae and femoral
neck. Bone reabsorption exceeds bone formation. Causing thin fragile fractures.
Both men and women though woman are more at risk
Causes kyphosis and scoliosis.
Calcium and Vit D deficiency take both and fluoride to help
Rheumatoid Arthritis- Auto immune-Caused by antibodies against IGG- causes inflammation,
joint swelling, and stiffness.
Gout- uric acid deposits- genetic- causes inflammation and pain.
Types of Fractures
Pain
Referred pain- Paint that is far from the source of the problem. Cardiac- Shoulder and arm.
Gallbladder shoulder.
Phantom pain- pain in an area that is no longer there- lost R leg and still have pain like it’s
there.
Acute pain- Sudden onset sever and has a physical and emotional response.
Chronic pain- insidious- becomes part of everyday life. ADLs are affected.
Neurological Disorders
Ischemic stroke- Clot- caused by- Athrosclerosis in cerebral artery
Hemorrhagic stroke- bleeding in the brain- cased by arteriosclerosis and hypertension
Meningitis- Caused by infection, head trauma, and Lupus- Bacterial meningitis is most
contagious- viral is most common and most tested. Lumbar puncture is the test
Signs are headache, stiff ridged neck, high temp, photophobia, altered LOC, bulging fontanelle
of a baby, Kernig sign and Brudzinski sign.
Spinal cord injuries
Paraplegia- waist down
Quadriplegia shoulders down. (depends on where the injury is)
Substance Abuse
Overdose- to much of a substance that can cause significant damage
Narcan For narcotic overdose
Flumazenil for Benzodiazepines
Withdrawal- Physical dependence
Irritability, tremors, nausea, vomiting, stomach cramps, High BP, psychotic episodes ( they are
very sick)
Treatments
Heroine-methadone
Alcohol deterrent- disulfiram
Vitamin Replacement
Endocrine Disorders
Adrenal- Cortisol
Hypo
Addison’s Disease
Signs- Low Blood sugar, poor stress response, fatigue, weight loss, infection, low Na+,
hypotension, hyperpigmentation, Hyperkalemia
Treat- replacement therapy
Hyper
Cushing’s Disease
Signs- High blood sugar, fragile skin, round puffy face, obesity in the abdomen and trunk,
hypertension, unusual hair growth
Pancreas- Insulin
Hypo
Diabetes type 1- Autoimmune in childhood. Some adults can develop. Low beta cells so body
does not produce insulin
Signs- Polyuria, Polydipsia, polyphagia, High blood sugar, glucosuria.
Treatment- Diet and exercise and Sub Q insulin
Complications- DKA- Diabetic Keto Acidosis- Caused by infection-Very high blood sugar, ketones
in urine, metabolic acidosis, dehydration, low urine output, kussmals respirations, lethargy.
Hyper
Diabetes type 2- Happens to order adults- obesity, sedentary lifestyle, and diet- Insulin
resistance due to few insulin receptors working.
Signs- Polyuria, Polydipsia, polyphagia, High blood sugar, glucosuria
Treatment- oral meds, exercise, diet (In the hospital insulin)
Complications- HHS- hyperosmolar hyperglycemic state- caused by infection and taking into
many carbs-blood sugars over 600, no ketones, speech issues, lethargy, dehydrated,
Pituitary- ADH
Hypo
Diabetes insipidus- Caused by head injury or damage to the brain
Signs- high urine output, diluted urine, polyuria, no glucose in urine, polydipsia, decreased
blood pressure,
Treatment- Vasopressin -ADH
Hyper
SIADH- Syndrome of inappropriate Anti Diuretic Hormone- Caused by- small cell lung cancer,
severe brain trauma, sepsis infection of the brain like meningitis.
Signs- Low Na+, decreased LOC, confusion, weight gain, low urine output, edema, seizures,
hypoosmolality
Treatment- decrease fluid level with diuretics and Na+
Thyroid- T3 T4
Hypo- Low and Slow
1st – Low T4 Low T3 High TSH
2nd – Low T3 Low T4 Low TSH
Low Iodine
Hashimoto’s- Autoimmune disease
Signs- Low metabolism, weight gain, cold intolerance, lethargy, slow brain, hair loss, dry skin
Treatment- replacement therapy- levothyroxine
Complications- Myxedema Coma- low RR causing respiratory failure, non-pitting facial edema,
hypothermic, hypoglycemia, hypotensive
Hyper- Graves’ Disease 1st - High T3 High T4 Low TSH
2nd – High T3 High T4 High TSH
Hyperplasia- To many thyroid cells- Women over 30 and causes exophthalmos- Bulging eyes
Signs- Goiter, High BP, Weight loss, High HR, increased appetite, jittery, heat intolerance,
(Sympathetic nervous system overdrive)
Treatment- Radioactive iodine, removal of thyroid, anti- thyroid meds. (these will kill thyroid so
thyroid replacement will then be needed.)
Complications- Thyroid Storm- Thyrotoxicosis- hyperthermia, CHF, Tachy, delirium,
hypertension crisis.