Download GCU NUR 634 Midterm EXAM LATEST 2025/2026 ACTUAL SUMMER-FALL SEMESTER EXAM GRADED A cell and more Exams Nursing in PDF only on Docsity!
GCU NUR 634 Midterm EXAM LATEST 2025/2026 ACTUAL SUMMER-
FALL SEMESTER EXAM GRADED A
cell stressors tissue ischemia, extreme temperature exposures, radiation exposure, physical tissue damage, chemical toxins, microorganisms, abnormal accumulation of metabolites in cells, nutritional deficits effects of hypoxic cell injury
- ATP depletion: anaerobic metabolism - until glycogen stores are depleted, Na/K ATPase & Ca ATPase are affected, increased intracellular Na & Ca, H2O follows Na - Cell swelling, RER swelling - ribosomes detach - decrease in protein synthesis
- Increased Intracellular Calcium: Ca activates intracellular catabolic enzymes, decrease in ATP, membrane damage, DNA damage, Increase in mitochondrial permeability - increase in ROS
- Oxygen-derived free radicals = ROS: destruction of cell membrane & nucleus
- Defects in Membrane Permeability: Leakage of intracellular enzymes, can be detected in the blood cellular adaption allows the stressed tissue to survive or maintain function such as: atrophy, hypertrophy, hyperplasia, metaplasia, dysplasia Hypertrophy increase in cell size Hyperplasia increase in number of cells the enlargement of an organ or tissue because of an abnormal increase in the number of cells in the tissues Metaplasia Mature cell type is replaced by a different mature cell type
Dysplasia abnormal development or growth of cells, tissues, or organs Necrosis tissue death Types of Necrosis coagulation, liquefaction, caseous Coagulative necrosis Cell proteins are altered or denatured - coagulation Liquifactive necrosis necrotic tissue has dissolved and is gone a the of necrosis with liquefaction of neurons and glial cells in the brain as a result of ischemic injury or bacterial infection Caseous necrosis degeneration and death of tissue with a cheese-like appearance Fat necrosis Fatty tissue is broken down into fatty acids Gangrenous necrosis death of tissue from severe hypoxic injury death of tissue from hypoxia, commonly from arteiosclerosis and affecting lower leg; may be be classified as dry, where the skin appears brown and wrinkled, or wet, where the skin appears cold, swollen and black as a result of liquefactive necrosis occurring at the site Dry necrosis a form of coagulative necrosis that develops in ischemic tissue, where the blood supply is inadequate to keep tissue viable
Klinefelter Syndrome (XXY) an extra X chromosome causes physical abnormalities and infertility underdeveloped sex organs, breast development, large hands, and long arms and legs Dwarfism FGFR mutation Achondroplasia. Two variants (also called mutations) in the FGFR3 gene cause more than 99 percent of cases of achondroplasia, which is the most common form of short-limbed dwarfism Achondroplasia A form of human dwarfism caused by a single dominant allele; the homozygous condition is lethal Edema swelling What causes Edema? not enough proteins to draw the fluid from between the cells back into the bloodstream -reduced concentration of plasma proteins -increased permeability of capillary wall -increased venous pressure -blockage of lymph vessels Capillary Hydrostatic Pressure facilitates the outward movement of water from the capillary to the interstitial space pressure within the capillary beds Capillary Osmotic pressure inward pulling force of particles in vascular fluid favors movement of water into the capillary (reabsorption) Interstitual fluid hydrostatic pressure pressure pushing fluid back into the capillary beds
Interstitual Fluid osmotic pressure the total pressure that causes the reabsorption of fluids or the movement of fluid from the interstitial fluid back into the capillaries. Osmotic concentration gradients are responsible for osmotic pressure How does ADH play a role in electrolyte balance ADH plays a role in lowering osmolarity (reducing sodium concentration) by increasing water reabsorption in the kidneys, thus helping to dilute bodily fluids. To prevent osmolarity from decreasing below normal, the kidneys also have a regulated mechanism for reabsorbing sodium in the distal nephron ADH and fluid balance keeps water in blood; plasma volume decreases causing hemoconcentration (blood becomes more dense) and increase in osmolarity. activates osmoreceptors in hypothalamus, stimulates posterior pituitary and acts on kidney to increase H2O reabsorption. keeps water in blood stream rather than urine Aldosterone and Fluid Balance helps control the amount of water your kidneys reabsorb; this increases blood volume and also impacts blood pressure. Atrial Natriuretic hormone and fluid balance a hormone with the physiological characteristics of a regulator of body fluid volume. It is potent, has a short duration of action, and responds to a physiologically relevant stimulus in a negative feedback- controlled system. ANH (atrial natriuretic hormone) from the heart; stimulates loss of sodium and water BNP brain natriuretic peptide What does BNP do?
muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon reflexes, shallow respirations, emergency! Hypocalcemia deficient calcium in the blood CATS Convulsions, Arrythmias, Tetany, spasms and stridor hypercalcemia vs hypocalcemia -Hypercalcemia -excess of blood calcium -muscle weakness and sluggish reflexes, cardiac arrest ~ mg/dL -Hypocalcemia -deficiency of blood calcium -muscle spasms, tremors or tetany ~6 mg/dL -laryngospasm and suffocation ~4 mg/dL SIADH vs DI SIADH "Soaked Inside" DI "Dry Inside" SIADH: Too much ADH prevents the production of urine and leads to the retention of excess water in the body DI: Not enough ADH or resistance to ADH leads to increased urine output and dehydration SIADH VS DI
- DI = High and dry (hypernatremia, dehydration)
- SIADH = Low and wet (hyponatremia, water retention) SIADH urine osmolality high Urine osmolarity of syndrome of inappropriate ADH Secretion vs Diabetes Inspidus
The typical patient with SIADH has a plasma osmolality of less than 270 mOsm/kg and a urine osmolality that is higher than the plasma. In contrast, a patient with diabetes insipidus has a plasma osmolality greater than 320 mOsm/kg and a urine osmolality less than 100 mOsm/kg. Serum Osmolarity of Dehydration Osmolality increases when you are dehydrated and decreases when you have too much fluid in your blood. Your body has a unique way to control osmolality. When osmolality increases, it triggers your body to make antidiuretic hormone (ADH). Urine Osmolarity of Dehydration dehydration with a concentrated urine as defined by any urine osmolality (UOsm) ≥700 mOsmol/kgH2O or urine specific gravity (USG) ≥1. An osmolality urine test is performed to measure the concentration of particles in urine. Greater than normal results may indicate conditions such as Addison disease, congestive heart failure or shock. checking their urine color may help. Urine tends to be darker and has higher specific gravity when a person does not drink enough fluids. In the setting of dehydration, the urine osmolality should exceed the plasma osmolality 3- to 4-fold. The following are associated with increased urine osmolality: Dehydration. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Serum Osmolarity of Hypernatremia vs Hyponatremia Hypernatremia is a common electrolyte problem that is defined as a rise in serum sodium concentration to a value exceeding 145 mmol/L. It is strictly defined as a hyperosmolar condition caused by a decrease in total body water (TBW) relative to electrolyte content Serum Osmolarity of Hypernatremia vs Hyponatremia Hyponatremia in the presence of normal serum osmolality (285 to 295 mOsm/L) is referred to as pseudohyponatremia. Under physiologic conditions, 93% of the total plasma volume is an aqueous phase that contains the electrolytes, and the remaining 7% is a solid phase composed primarily of lipids and proteins.
compensated respiratory alkalosis normal pH low CO low HCO uncompensated respiratory alkalosis high pH, low PaCO2, normal HCO compensated metabolic alkalosis Normal pH, normal CO2, high HCO uncompensated metabolic alkalosis high pH, normal PaCO2, high HCO Alkalosis and Acidosis are result of calcium and potassium imbalance Anion gap An anion gap blood test is a way to check the acid-base balance (pH balance) of your blood. It tells you if your blood is too acidic or not acidic enough. The test uses the results of another blood test called an electrolyte panel. Anion gaps in compensated respiratory acidosis The normal anion gap is 12. Therefore, values greater than 12 define an anion gap metabolic acidosis. Respiratory compensation is the physiologic mechanism to help normalize a metabolic acidosis, however, compensation never completely corrects an acidemia Anion gaps in uncompensated respiratory acidosis Uncompensated respiratory acidosis occurs when respiratory acidosis is present, with pH acidic (under 7.35) and PaCO₂ acidic (over 45) mmHg; but the metabolic system does not act to correct it, marked by HCO₃ in the normal range (22 - 26 mEq/L)
Anion gaps in compensated metabolic acidosis The normal anion gap is 12. Therefore, values greater than 12 define an anion gap metabolic acidosis. Respiratory compensation is the physiologic mechanism to help normalize a metabolic acidosis, however, compensation never completely corrects an acidemia. Anion gaps in uncompensated metabolic acidosis the anion gap helps determine the cause of the metabolic acidosis. An elevated anion gap metabolic acidosis can be caused by salicylate toxicity, diabetic ketoacidosis, and uremia (MUDPILES). Non-Gap metabolic acidosis is due to GI loss of bicarbonate (diarrhea) or a failure of kidneys to excrete acid Major types of Leukemia Acute myelogenous leukemia (AML) Acute lymphocytic leukemia (ALL) Chronic myelogenous leukemia (CML) Chronic lymphocytic leukemia (CLL) Acute Myelogenous Leukemia (AML) form of leukemia that arises from immature bone marrow cells rapidly progressive neoplasm of cells committed to the myeloid line of development Acute Lymphocytic Leukemia (ALL) Immature lymphocytes (lymphoblasts) predominate. This form is seen most often in children and adolescents; onset is sudden the most common form of leukemia in adults over 70 years of age; characterized by overproduction of lymphocytes Chronic Myelogenous Leukemia (CML) Too many blood cells made in bone marrow both mature and immature granulocytes are present in large numbers in the marrow and blood excess mature yet hypofuncitonal neutrophils Chronic lymphomatic Leukemia (CLL)
a condition in which the air sacs of the lungs are damaged and enlarged, causing breathlessness. Chronic Brochitis increase CO2 levels, decrease O2 levels,(usually the O2 and CO2 level off at 50/50 called blue bloater give 24-28% O2 alway less than 35-40%) inflammation of the bronchi and bronchioles due to chronic exposure to irritants Tuberculosis An infectious disease that may affect almost all tissues of the body, especially the lungs an infectious disease that most often affects the lungs and is caused by a type of bacteria. It spreads through the air when infected people cough, sneeze or spit. Tuberculosis is preventable and curable Valley Fever Coccidioidomycosis a sickness of the lungs caused by inhaling fungal spores from dusty climates Pneumonia An inflammation of lung tissue, wherer the alveoli in the affected areas fill w/fluid Asthma A chronic allergic disorder characterized by episodes of severe breathing difficulty, coughing, and wheezing. Acute Bronchitis infection and inflammation of bronchial airways a temporary inflammation of the mucous membranes that line the trachea and bronchial passageways; causes a cough that may produce mucus Cystic Fibrosis Different Causes of Anemia
-Loss of RBCs (bleeding) -Decrease in RBC production -Increased destruction of RBCs -Develops slowly overtime; pt becomes used to anemia (asymptomatic). -If develops quickly, the more serious the condition and symptoms Normocytic Normochromic anemia Characterized by red cells that are relatively normal in size and hemoglobin content but insufficient in number Normocytic Hyperchromic anemia sickle cell anemia Normocytic Hypochromic anemia uncommon, some regenerative anemias The characterization of the red blood cells that are normal in size but low in color Macrosytic Normochromic anemia Prothombin time (PT) 11-12.5 sec test of the ability of the blood to clot Activated partial thromboplastin time (aPTT) 30-40 seconds blood test used to monitor anticoagulation therapy for patients taking heparin, an intravenous anticoagulant medication Platelet count and anemia Anemia and thrombocytopenia cause low levels of red blood cells and platelets. This can cause fatigue and bleeding problems. Thrombocytopenia is a low platelet count. Platelets, also known as thrombocytes, are small blood cells that bone marrow produces
Echocardiogram ultrasound of the heart Tropnin 1 CK - MB Creatine Kinase-Muscle Breakdown STEMI treatment
- Aspirin + Ticagrelor, prasugrel, or clopidogrel
- Morphine
- PCI (percutaneous coronary intervention) door to balloon time < 90 minutes
- Alteplase tPA, Reteplase,or Streptokinase followed by heparin + PPI
- Beta blocker
- ACE-I
- Statins N STEMI a non-segment elevation MI is a heart attack that is not diagnosed on the EKG but is diagnosed by an elevated troponin on blood test Angina (stable and unstable) mild to moderate substernal chest pain lasting less than 20 min due to transient ischemia brought on by increased demands on heart
- stable angina: exertional angina relieved with rest or sublingual nitroglycerin
- unstable angina: risk for MI or death, presents with low level activity or rest; exercise contradindicated Left sided congestive heart failure Think Left "L" Lungs DOE Dry cough, crackles, wheezing Paroxysmal nocturnal dyspnea-sob when lying down Cheyne-Stokes respirations Tachypnea and cardia if the left ventricle pumps inefficiently, blood backs into the lungs
S/S: pulmonary edema usually leads to right sided failure right side congestive heart failure fluid builds up in tissues as peripheral edema raises right atrial pressure and produces systemic congestion and edema hypertrophic cardiomyopathy heart muscle becomes enlarged and blocks blood flow Cor pulmonale right ventricular hypertrophy and heart failure due to pulmonary hypertension hypertrophic obstructive cardiomyopathy a genetic disease resulting in abnormal heart muscle Systolic dysfunction LHF due to decreased ventricular contractility (ischemia) cardiomyopathy Dystolic dysfunction When the muscles of the heart become stiff, they can't relax properly, creating a condition known as diastolic dysfunction. This inflexibility prevents the heart's ventricles from filling completely, causing blood to back up in the organs Septic Shock a serious condition that occurs when an overwhelming bacterial infection affects the body hypovolemic shock A condition in which low blood volume, due to massive internal or external bleeding or extensive loss of body water, results in inadequate perfusion.
