Download NR507 / NR 507 Midterm Exam (Latest 2024 / 2025): Advanced Pathophysiology - Chamberlain and more Exams Nursing in PDF only on Docsity!
NR507 / NR 507 Midterm Exam
3 characteristics of bronchitis - ANSWER: bronchial inflammation hypersecretion of mucus chronic productive cough for at least 3 consecutive months for at least 2 successive years 3 layers of the bronchioles - ANSWER: innermost layer middle layer - lamina propria outermost layer Acute Kidney Injury - ANSWER: Sudden decline in kidney function with a decrease in GFR and an increase in plasma creatinine and BUN levels - results in oliguria After air passes through the trachea where does it go? - ANSWER: goes into the left or right bronchi Afterload - ANSWER: the amount of resistance to open the semilunar valves and eject of blood from the ventricle alveolar hyperinflation - ANSWER: When air is unable to move out of the alveolar like it should due to bronchial walls collapsing around possible mucus plug thus trapping air inside anemia risk factors - ANSWER: acute or chronic blood loss, increased hemolysis, inadequate dietary intake or malabsorption, bone marrow suppression, age angiotensin converting enzyme (ACE) - ANSWER: an enzyme that converts angiotensin I to angiotensin II Ascending infection - ANSWER: - urethra to bladder, and then to kidney
- due to: bacteria from residual fecal contamination
Asthma - ANSWER: Chronic disease due to bronchoconstriction and an excessive inflammatory response in the bronchioles average amount of preload? - ANSWER: 120 - 130 mls Azoetmia - ANSWER: presence of elevated plasma creatinine benign prostatic hyperplasia - ANSWER: benign growth of cells within the prostate gland Biventricular failure - ANSWER: unresolved left sided heart failure will increase pressure on the right side of the heart contributing to right sided heart failure as well Bladder anatomy - ANSWER: - ureter
- bladder
- urethra blood cell formation in adults over 20 - ANSWER: red marrow in large bones
- illium, vertebrae, cranium, jaw, sternum, ribs, humerus, and femur Blood cell formation in chidren 0-5 years old - ANSWER: red marrow of all bones to make blood cells blood hydrostatic pressure - ANSWER: the pressure produced by a fluid against a surface BPH (benign prostatic hyperplasia) - ANSWER: Age-associated prostate gland enlargement that can cause urination difficulty. BPH treatment - ANSWER: - Alpha-adrenergic antagonists: terazosin, doxazosin
- 5 - alpha reductase inhibitors: finasteride, dutasteride
- Transurethral prostatectomy
causes of kidney stones - ANSWER: Family HX, chronic dehydration and infection, dietary factors, medications, imobility. Stoned more common in men than women usually ages 30/50. Causes of left sided heart failure - ANSWER: systemic hypertension left ventricle MI LV hypertrophy Aortic SL valve or bicuspid valve damage Secondary to right heart failure Causes of postrenal disease - ANSWER: BPH Calculi Inflammation Tumors Causes of right sided heart failure - ANSWER: - pulmonary disease
- pulmonary hypertension
- RV MI
- RV Hypertrophy
- pulmonary SLV or tricuspid valve damage
- secondary to left heart failure Causes of tubular necrosis - ANSWER: - being post operative
- severe sepsis
- burns
- trauma
- contrast chemical use in medical imaging procedures Chronic kidney disease - ANSWER: progressive, irreversible deterioration in renal function Labs: elevated BUN, Cr Phosphorus. Rx: meds for hypertension, statins, epoetin, diuretics, calcium, LOW protein, low salt, restrict K, phosphorus (no chicken, milk, legumes, carbonated drinks), dialysis. clinical indicators of glomerulonephritis - ANSWER: - proteinuria
- hematuria
- edema
- azotemia
- oliguria
- coagulation cascade activation Conditions associated with renal failure - ANSWER: - congenital abnormalities in the urethral tract development
- kidney and bladder cancer
- infections
- glomerulonephritis
- acute/ tubular necrosis
- AKI cor pulmonale - ANSWER: right-sided heart failure Descending infection - ANSWER: The blood can carry bacteria from a focus of infection in another part of the body to the kidneys. The bacteria then pass with the urine down the ureters to the bladder. Describe how blood flows to become oxygenated - ANSWER: - deoxygenated systemic blood flows from the vena cava to R atrium
- Tricuspid valve opens to flow to R ventricle
- Pulmonary semilunar valve opens and blood flows to the alveolar capillaries for gas exchange from the pulmonary trunk and L & R pulmonary arteries
- blood goes from alveolar capillaries to pulmonary veins to return oxygenated blood to the left atrium
- bicuspid valve opens to allow blood to go to left ventricle
- aortic semilunar valve opens and blood goes to the aorta
- aorta pushes oxygenated blood out to the body development of anemia due to gastrectomy - ANSWER: loss of intrinsic factor from surgery results in the loss of protein necessary for vitamin B12 absorption an can lead to anemia Effect of hyperinflation of the alveolar - ANSWER: - expanded thorax and hypercapnia (retention of CO2)
- respiratory acidosis
20% of the blood that goes through the glomerulus is passed as filtrate into the bowman's capsule depends on the hydrostatic and oncotic pressures/ starling forces between the glomerulus and bowman's capsule hydrostatic pressure: a lot higher in the glomerulus (move into the nephron/bowman's capsule) oncotic pressure: higher in the blood/glomerulus than in the bowman's capsule (move into the blood/glomerulus) hydrostatic pressure is greater so there will be movement into bowman's capsule usually favors the filtrate to go into the bowman's capsule each persons full body is filtered about every 40 minutes function of hemoglobin - ANSWER: In red blood cells, carries oxygen from the lungs to body's tissues and returns carbon dioxide from tissues back to lungs. It also maintains the shape of red blood cells. glomerulonephritis - ANSWER: inflammation of the glomeruli of the kidney heart failure - ANSWER: cardiac dysfunction caused by the inability of the heart to provide adequate CO resulting in inadequate tissue perfusion Hematopoiesis - ANSWER: formation of blood cells hematopoietic stem cells - ANSWER: The stem cells that give rise to RBC WBC and platelets through the process of haematopoiesis. hemolytic anemia - ANSWER: premature destruction of RBCs
hemolytic anemia is what kind of anemia - ANSWER: normocytic normochromic anemia High output failure - ANSWER: inability of the heart to pump sufficient amounts of blood to meet the circulatory needs of the body despite normal blood volume and cardiac contractility How does a hematopoietic stem cell produce a red blood cell - ANSWER: hematopoietic stem cells produces an unndifferentiated hemocytoblast
- erythropoietin binds to it and createsa a proerythroblast
- cell develops into an erythrocyte 7 days later How does Aortic SL valve or bicuspid valve damage lead to heart failure - ANSWER: damage leads to back flow into the left atrium or ventricle after ejection how does chronic bronchitis lead to respiratory acidosis? - ANSWER: hyperinflation of the alveoli causes CO2 retention How does heart failure progress from hypertension? - ANSWER: - high systemic vascular pressure causes high after load requires the left ventricle to increase contraction force to eject the blood
- damage causes reduced ejection fraction and left ventricle gets tired and becomes unable to eject normal amount of blood
- increased amount of blood remaining in left ventricle and increased left ventricle preload causes the left atrium unable to eject the normal amount of blood into the left ventricle
- blood volume and pressure backs up into the pulmonary veins
- increased pressure will force fluid from the pulmonary capillaries into the pulmonary tissues how does hyperinflation occur? - ANSWER: the ongoing inflammatory process of asthma produces mucus and pus plug that the bronchial walls collapse around
acetylcholine which binds to the cholinergic receptors of the respiratory tract to cause bronchial constriction = decreased airflow
- blocking the cholinergic receptors prevents acetylcholine binding preventing the bronchial constriction most common irritant with bronchitis is? - ANSWER: tobacco product smoke Nephron Anatomy - ANSWER: 1. glomerulus
- bowman's capsule
- collecting duct
- tubule
- capillary normocytic normochromic anemia - ANSWER: Characterized by red cells that are relatively normal in size and hemoglobin content but insufficient in number Pathogenesis of bronchitis - ANSWER: - Exposure to airborne irritants
- Irritant activates bronchial smooth muscle constriction and mucus secretion
- Triggers release of inflammatory mediators from immune cells located in the lamina propria pathogenesis of primary glomerulonephritis - ANSWER: - infection triggers of immune response to cause formation of antibodies
- antibodies form complexes with the pathogen that should be rapidly phagocytized by WBC
- in glomerulonephritis the Ag-Ab complexes are not phagocytized in a timely manner and continue to circulate in the blood stream
- the Ag-Ab complexes get trapped in the narrow vasculature of the glomerular capillaries
- build up of the Ag-Ab complexes signals that immune system and the complement system and WBC infiltration of the site
- Complement protein with enzymes released by phagocytic cells attack the complexes and cause collateral damage to the glomerular area
- Damage weakens thee glomerular structure and plasma proteins with blood leak into the tubular system and pass out into the urine
Pathophysiology of asthma (5) - ANSWER: - airway inflammation, bronchial hyper-reactivity and smooth muscle spasm
- excess mucus production and accumulation
- hypertrophy of bronchial smooth muscle
- airflow obstruction
- decreased alveolar ventilation Pathophysiology of tubular necrosis - ANSWER: - ischemia or nephrotoxin exposure occurs to the renal tubules
- inflammation and tubular injury occur
- cast formation and tubular obstruction occurs
- tubular injury, leakage, increased glomerular pressure causes decreased capillary perfusion further decrease in GFR occurs
- oliguria results Perfusion - ANSWER: The supply of oxygen to and removal of wastes from the cells and tissues of the body as a result of the flow of blood through the capillaries. polycystic kidney disease - ANSWER: - Mutant PKD genes cause fluid accumulation in kidney tubules "cysts"
- The cysts can be the size of grapes or oranges and compress and destroy nephrons polycythemia vera - ANSWER: condition characterized by too many erythrocytes; blood becomes too thick to flow easily through blood vessels postrenal disease - ANSWER: obstruction in the lower urinary tract that prevents urine flow from the kidneys Potter syndrome - ANSWER: Syndrome characterized by bilateral renal agenesis and incompatibility of live birth Prerenal disease - ANSWER: decreased blood flow to and through the kidney prerenal disease causes - ANSWER: - hypotension
chronic hypoxemia right sided heart failure - ANSWER: inability of the right ventricle to provide adequate blood flow into the pulmonary circulation Right to left shunting - ANSWER: when blood passes from the right ventricle through the lungs and to the left ventricle without perfusion Role of macrophages - ANSWER: - In Innate:
- Phagocytosis PRR or opsonization w/ complement
- Secrete Cytokines: Recruit more cells, inflammation, fever, etc.
- Phagocytosis: opsonization with complement or Abs
- Secrete cytokines: recruit more cells etc.
- Antigen presentation: peptides from the broken down pathogen are displayed on surface of the cell. secretion (kidney) - ANSWER: movement of solutes from blood to filtrate anywhere besides bowman's capsule able to secrete salts, acids, bases and urea directly into the tubule via active or passive transport what is secreted into the tubule depends on what the body needs at that time ex. eating a lot of protein nitrogen waste is a product of protein metabolism (ammonia) liver converts ammonia to urea and the kidneys secreted urea into the tubule for secretion also possible to eliminate products that are in excess in the blood -- potassium, hydrogen, metabolites or medications can secrete things that were too larger to fit through the glomerulus's pore
signs and symptoms of right sided heart failure - ANSWER: jugular vein distension hepatosplenomegaly peripheral edema sliding filament theory - ANSWER: theory that actin filaments slide toward each other during muscle contraction, while the myosin filaments are still Stenosis of a heart valve, may result in what? - ANSWER: Narrowing of the heart valves means that blood moves with difficulty out of the heart. Results may include chest pain, edema in the feet or ankles, and irregular heartbeat. and hypertrophy Stenosis of heart valve - ANSWER: A narrowing of the valve opening, causing turbulent flow and enlargement of the emptying chamber Stimulation of what set a resting HR (chronotropic state) - ANSWER: parasympathetic system structure of the lamina propria - ANSWER: embedded with connective tissue cells and immune cells Troponin-Calcium Binding - ANSWER: Calcium binds to troponin on the thin filament tubular necrosis - ANSWER: the renal tubules cells are highly sensitive to low oxygen levels or presence of toxins and leads to tubular necrosis vesicoureteral reflux - ANSWER: Abnormal ureter-bladder connection allowing retrograde flow of urine from bladder to ureters and/or kidneys What acid-base disorder is seen in chronic bronchitis? - ANSWER: respiratory acidosis What are 5 s/s of asthma - ANSWER: coughing
What can extreme vagal response result in? - ANSWER: life threatening bradycardia What can uncontrolled tachycardia lead to? - ANSWER: reduced stroke volume and fatigue What causes blood to move from the atria to the ventricles - ANSWER: gravity and atriole systole What causes the S1 heart sound? - ANSWER: Bicuspid/Mitral and Tricuspid valves closing What causes the S2 heart sound? - ANSWER: closing of semilunar (aortic and pulmonary) valves What causes the semilunar valves to close? - ANSWER: ventricles relax and intraventricular pressure falls, blood flows back from the arteries, and fill the cusps of the semilunar valves What causes the semilunar valves to open? - ANSWER: As ventricles contract and intraventricular pressure rises, blood is pushed up against the SL valves, forcing them to open what decreases cardiac muscle contraction - ANSWER: low ATP levels; ischemia hypoxia or acidosis What do anticholinergics do in the lungs? - ANSWER: These drugs block the effects of the parasympathetic nervous system
- increasing bronchodilation What does angiotensin II do? - ANSWER: increases blood pressure by vasoconstriction What does fluid in the pulmonary tissue result in - ANSWER: the areas are flooded and results in pulmonary edema and dyspnea what does long term exposure to irritants promote in bronchitis? (5) - ANSWER: - smooth muscle hypertrophy
- hypertrophy and hyperplasia of goblet cells
- epithelial cell metaplasia
- migration of more WBC to site
- thickening and rigidity of bronchial basement membrane What does smooth muscle hypertrophy do in lungs? - ANSWER: causes increased bronchoconstriction What does the innermost layer of the bronchioles contain - ANSWER: columnar epithelial ells and mucus producing goblet cells What does the migration of WBCs to the bronchials do? - ANSWER: increases inflammation of the cite and causes fibrosis in the bronchial wall What does the outermost layer of the bronchioles contain - ANSWER: smooth muscle cells what does the outermost layer of the bronchioles do - ANSWER: control the airways ability to constrict and dilate What does the parasympathetic system do? - ANSWER: It releases acetycholine which decreases heart rate and causes vasodilation What does the sympathetic system promote in the cardiac system - ANSWER: vasoconstriction and increased HR What effects amount of water and solute reabsorption - ANSWER: ADH and aldosterone What electrolytes are used for cardiac muscle contraction? - ANSWER: sodium potassium and calcium What happens in renal failure when the coagulation cascade is activated - ANSWER: fibrin is deposited in the glomerular structure and decreases capillary perfusion by causing blockages and further decreases GFR further What happens when cardiac fibers overstretch during diastole? - ANSWER: decreased contraction due to fibers being unable to snap back What increases cardiac muscle contraction - ANSWER: sympathetic stimulation; fear anxiety and increased thyroxine
high HR = lower fill time = lower stroke volume When fibers stretch during diastole how does that effect contraction? - ANSWER: contraction is stronger Where does air enter the body? - ANSWER: naso and oropharynx (mouth and nose) Where does air flow after the bronchi? - ANSWER: into the smaller bronchioles Where does air flow after the bronchioles? - ANSWER: into the alveoli Where does air go after it passes through the nose and mouth? - ANSWER: it passes through the trachea Where does blood cell formation occur in a fetus - ANSWER: 3 weeks - yolk week 8 - fetal liver and spleen 5th month - bone marrow Where is most of the solute reabsorbed? - ANSWER: proximal convoluted tubule Why are kidneys and bladders at high risk for cancer - ANSWER: - UT is the route of excretion for many toxins and contains highly mitotic cells Why does hepatosplenomegaly develop in right sided heart failure - ANSWER: the large volume of blood flow through the liver and spleen causes these areas to be engorged why does peripheral edema occur in right sided heart failure - ANSWER: Increased pressure forces fluid from the systemic capillaries into the peripheral tissues and flood those areas Why is there azoetmia with renal failure? - ANSWER: Decreased GFR means waste is remains in the bloodstream and is not excreted
Why is there cyanosis with chronic bronchitis - ANSWER: there is hypoxia due to unfavorable conditions for gas exchange Why is there edema with glomerulonephritis - ANSWER: the loss of albumin from the bloodstream reduces plasma oncotic pressure and results in edema Why is there oliguria with renal failure? - ANSWER: when the glomerual structure has sustained enough damage the nephron structure is no longer functional as a filtration unit Wilms tumor - ANSWER: - Embryonal kidney tumor associated with defective tumor (WT) genes
- Tumors are typically not clinically diagnosable until age 1-5 even though they are present at birth
