NSG 214: Pathophysiology for the Professional Nurse - Exam 2 Comprehensive Review

Comprehensive vocabulary flashcards covering NSG 214 pathophysiology lecture content: cellular biology, fluid and electrolyte balance, acid-base regulation, GI and hepatic pathologies, bariatric nursing, renal-urinary mechanics, and respiratory disorders.

Pathophysiology

The study of the structural and functional characteristics in the cell, tissues, and organs of the body that cause or are caused by disease.

Homeostasis

The ability of the body to respond to and maintain physiologic and psychological stability during rapidly changing conditions in the internal and external environments.

Cell Organelles (Factory Analogies)

The functional structures within a human cell compared to factory operations: nucleus (main office), nucleolus (factory manager), ribosomes (assembly teams), rough/smooth endoplasmic reticulum (conveyor belts), Golgi apparatus (mailing room), mitochondria (power generators), lysosomes (janitor), vacuoles (loading docks), and the cell membrane (walls with guarded windows and doors).

Aerobic Metabolism

An oxygen-based metabolic pathway (the Krebs cycle) occurring in the mitochondria that supplies the necessary oxygen to metabolize carbohydrates first and triglycerides second.

Anaerobic Metabolism

A glucose-based metabolic pathway that utilizes glycolysis for temporary energy production when the $O_2$ supply is diminished, yielding lactic acid as an end product while converting glucose to ATP.

Stem Cells

Reserve cells possessing characteristics of a differentiated cell that can divide to replace damaged cells, where one part maintains itself as the differentiated daughter cell.

Permanent Tissues

Tissues composed of cells that do not divide or proliferate, specifically exemplified by heart muscle and brain tissue.

Osmosis

The movement of fluids across a semipermeable membrane in order to maintain osmotic pressure.

Tonicity

The effect of a solution on the change in size of red blood cells when immersed, classified as isotonic (cell size remains the same), hypotonic (cell size increases), or hypertonic (cell size decreases).

Diabetes Insipidus

A condition resulting from a deficiency of antidiuretic hormone (ADH) that causes excessive water loss through urine, characterized clinically by high serum sodium levels and dehydration.

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

A disorder characterized by increased ADH secretion causing pathological water retention and edema, marked by low serum sodium levels and weight gain.

Hyponatremia

A low serum sodium level below $135\,\text{mEq/L}$; it is the most common electrolyte imbalance in hospitalized patients, is common in the elderly, and is often related to elevated blood glucose osmotic effects across euvolemic, hypovolemic, or hypervolemic states.

Hyperkalemia

A serum potassium level above $5.0\,\text{mEq/L}$, often related to decreased renal function or reduced aldosterone secretion; early signs include paresthesia, general weakness, and cardiac dysrhythmias.

Trousseau's Sign

A clinical test for latent tetany indicative of hypocalcemia (serum calcium below $8.5\,\text{mg/dL}$), elicited by inflating a blood pressure cuff on the upper arm to observe for carpopedal spasms.

Chvostek's Sign

A clinical test indicating hypocalcemia elicited by tapping the facial nerve over the cheek to trigger unilateral facial muscle twitching.

Basal Metabolic Rate (BMR)

The rate of metabolism by which the body breaks down carbohydrates, proteins, and fats to produce energy at rest, calculated using weight in kilograms ($\text{lbs}/2.2$), height in centimeters ($\text{inches} \times 2.54$), and age in years.

Metabolic Acidosis

An acid-base imbalance of metabolic origin characterized by a primary decrease in bicarbonate ($HCO_3^- < 22\,\text{mEq/L}$) and a drop in blood pH ($< 7.35$), accompanied by a compensatory decrease in carbon dioxide ($CO_2$).

Respiratory Acidosis

An acid-base disorder caused by carbon dioxide retention ($CO_2 > 45\,\text{mm Hg}$) resulting in an indirectly proportional decrease in blood pH ($< 7.35$), which triggers a compensatory increase in renal bicarbonate ($HCO_3^-$) retention.

Gastrointestinal Wall Layers

The four structural tissue layers of the GI tract wall: the inner mucosa (epithelium, lamina propria, muscularis mucosa), the submucosa, the muscularis externa (circular and longitudinal muscle layers), and the outermost serosa (connective tissue and mesothelium).

Gastroesophageal Reflux Disease (GERD)

A digestive disorder where a weak or incompetent lower esophageal sphincter permits gastric reflux, causing mucosal injury; non-pharmacological management includes sitting upright after meals and avoiding 'CATS' (Caffeine and carbonation, Alcohol and Acidic foods, Tobacco products, and Spicy foods).

Barrett Esophagus

Metaplastic cellular changes in the esophageal mucosal lining caused by chronic gastroesophageal reflux disease, which can advance into esophageal adenocarcinoma.

Esophageal Varices

Distended, fragile collateral veins in the esophagus typically caused by portal hypertension in cirrhosis; rupture produces massive bright red bleeding and is a medical emergency managed with blood replacement and direct pressure via a Minnesota tube.

Curling Ulcer

A form of acute gastrointestinal stress ulcer that develops as a clinical consequence of major burn trauma.

Cushing Ulcer

A form of acute peptic stress ulcer that develops secondary to severe head injuries or intracranial trauma.

Cholelithiasis

The presence of gallstones composed of cholesterol, bilirubin, or mixed contents that obstruct the cystic or bile duct, leading to biliary colic characterized by pain radiating to the right scapula or shoulder following a fatty meal.

Portal Hypertension

Pathological elevation of pressure within the portal venous system due to liver cirrhosis, resulting in ascites, portosystemic collateral channel formation (esophageal varices, caput medusae, hemorrhoids), intestinal toxin shunting leading to hepatic encephalopathy, and splenomegaly (causing anemia, leukopenia, and thrombocytopenic bleeding).

Borborygmus

Audible, high-pitched, hyperactive peristaltic rushes or sounds generated by fluid and gas movement against an early mechanical bowel obstruction.

Peritonitis

Inflammation of the peritoneal lining that causes abdominal wall muscles to reflexively tighten into a 'board-like abdomen', resulting in paralytic ileus and shallow breathing due to decreased movement of the diaphragm and accessory muscles.

Celiac Disease

A genetic T-cell-mediated autoimmune enteropathy associated with the MHC II allele wherein gluten triggers antibody production and intestinal mucosal inflammation, leading to nutrient malabsorption, weight loss, and steatorrhea (fatty stools).

Crohn's Disease

An inflammatory bowel disease with typical onset in the teens that can occur anywhere along the GI tract, characterized by steatorrhea and a palpable mass; managed dietary-wise with a low-residue, high-protein, high-calorie diet.

Ulcerative Colitis

An inflammatory bowel disease with typical onset in the 20s or 30s that begins in the rectum and spreads continuously through the colon, presenting with bloody, mucus-filled stools and treated with a high-fiber, high-protein, high-calorie diet.

Bariatric Surgery Eligibility Criteria

Clinical guidelines requiring a Body Mass Index ($\text{BMI}$) of $40$, or $35$ in the presence of an underlying medical comorbidity.

Circulating Nurse

An intraoperative surgical nurse responsible for non-sterile duties including pre-procedure verification/time-out, equipment management, surgical safety protocols, and environmental monitoring.

Scrub Nurse

An intraoperative surgical nurse who works within the sterile field, responsible for sterile field maintenance, instrument tracking, and surgical flow management.

AWET-ED

A mnemonic representing the primary homeostatic functions of the kidney: Acid-base balance, Water removal, Erythropoiesis, Toxin removal, Blood pressure control, Electrolyte balance, and Vitamin D activation.

Serum Creatinine

A metabolic byproduct of muscle metabolism excreted primarily by the kidneys that serves as an essential indicator of renal function, with normal reference ranges of $0.6\text{ to }1.2\,\text{mg/dL}$ for adult males, $0.5\text{ to }1.1\,\text{mg/dL}$ for adult females, and a general average of $\approx 0.8\,\text{mg/dL}$.

Micturition Neural Regulation

The autonomic neural balance controlling urination, where the sympathetic nervous system (originating in the thoracic region) mediates the storage phase, and the parasympathetic nervous system (originating in the sacral region) mediates the voiding phase by contracting the detrusor muscle and relaxing the sphincters.

Wilms Tumor

A rare malignant renal tumor occurring primarily in children, linked to genetic and familial factors, presenting with an unpalpated painless kidney mass, hypertension, and failure to thrive.

Potter Facies

A distinct neonatal facial presentation characterized by prominent epicanthic folds and downward-slanting eyes, caused by oligohydramnios and physical compression in utero secondary to polycystic kidney disease or bilateral renal agenesis.

Azotemia

The accumulation of nitrogenous waste products in the blood, clinically identified by elevated blood levels of Blood Urea Nitrogen (BUN) and creatinine.

Hydronephrosis

The pathological dilation of the renal pelvis resulting from urine outflow obstruction caused by calculi or tumors, presenting with severe colicky flank pain, hematuria or cloudy urine, and decreased urine output.

Chronic Kidney Disease Complications

Systemic multisystem consequences of chronic renal impairment lasting more than $3\,\text{months}$, including sodium and water retention (hypertension, edema, heart failure), hyperkalemia, uremia (pericarditis, coagulopathies), anemia (decreased erythropoietin), acidosis (skeletal buffering), and hypocalcemia/hyperparathyroidism (osteodystrophies).

Lung Compliance

The ease with which lungs inflate, determined by elastin and collagen fibers, water content, and surfactant-mediated reduction of surface tension; a decrease in compliance is manifested by an increased work of breathing.

Epiglottitis

A medical emergency characterized by acute swelling of the epiglottis commonly caused by Haemophilus influenzae type b (Hib) or Streptococcus, presenting without a cough; treated with oxygen and IV antibiotics while strictly avoiding nebulized epinephrine and steroids.

Croup

An upper airway disorder involving swelling of the laryngeal structures that presents with a characteristic barking cough; managed clinically with nebulized epinephrine, corticosteroids, and oxygen.

Ventilation-Perfusion (V/Q) Mismatch

An imbalance between alveolar ventilation and pulmonary capillary blood flow, categorized into 'perfusion without ventilation' (shunt, as seen in ARDS) and 'ventilation without perfusion' (dead space, as seen in pulmonary embolism).

Acute Respiratory Distress Syndrome (ARDS)

A severe pulmonary disorder caused by fluid accumulation within the alveoli secondary to shock, trauma, sepsis, or COVID, progressing through three clinical phases: the exudative phase, the proliferative phase, and the fibroproliferative phase.

Emphysema

A form of chronic obstructive pulmonary disease (COPD) characterized by destruction of lung elasticity, alveolar hyperinflation, and air trapping of $CO_2$ during exhalation; patients ('pink puffers') present with tachypnea, barrel chest, and respiratory acidosis.

Chronic Bronchitis

A form of chronic obstructive pulmonary disease (COPD) characterized by hyperplasia of mucus glands and chronic productive cough with airway narrowing; patients ('blue bloaters') develop bronchospasms, severe hypercarbia, hypoxemia, cor pulmonale, and peripheral edema.

Cystic Fibrosis

An inherited autosomal recessive disorder of inhalation caused by a lack of the CFTR protein, preventing normal chloride and water transport within cells; results in thick mucus plugging airways, collapsed alveoli, salty skin, fecal impactions, and fat-soluble vitamin (A, D, E, K) deficiencies.

Mediastinal Shift

A life-threatening clinical finding characterized by lateral tracheal deviation, absent unilateral breath sounds, and pulseless electrical activity (PEA), requiring emergency decompression via chest tubes or thoracotomy.

Respiratory Failure

The pathological end result of severe pulmonary decompensation (such as advanced COPD or ARDS), clinically defined by an arterial partial pressure of oxygen ($P_{a}O_2$) below $50\,\text{mm Hg}$ or an arterial partial pressure of carbon dioxide ($P_{a}CO_2$) above $50\,\text{mm Hg}$.

Osmosis

The passive movement of fluid across a semipermeable membrane down a concentration gradient to maintain osmotic pressure balance.

Tonicity

The osmotic effect that a solution exerts on the volume and physical size of red blood cells ($\text{RBCs}$) when immersed.

Hypotonic Solution

A solution with lower effective osmolality than intracellular fluid that causes water to shift into red blood cells, thereby increasing cell size.

Hypertonic Solution

A solution with higher effective osmolality than intracellular fluid that pulls water out of red blood cells, thereby decreasing cell size.

Colloidal Osmotic Pressure

The pulling force exerted by large plasma proteins and circulating red blood cells that draws fluid from interstitial spaces into the vascular bed.

Antidiuretic Hormone (ADH)

A regulatory hormone that controls effective circulating blood volume by stimulating renal water reabsorption in response to osmolality changes.

Diabetes Insipidus

A disorder caused by antidiuretic hormone ($\text{ADH}$) deficiency that leads to profound urinary water loss, hypernatremia, and severe dehydration.

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

A condition characterized by excessive, non-physiologic secretion of $\text{ADH}$, leading to water retention, volume expansion, weight gain, edema, and dilutional hyponatremia.

Serum Sodium ($\text{Na}^+$) Reference Range

The normal physiological extracellular concentration of sodium in the blood, defined as $135 - 145\,\text{mEq/L}$.

Hypernatremia

An elevated serum sodium concentration exceeding $145\,\text{mEq/L}$ that produces hypertonicity, increased serum osmolality, dehydration, and intense thirst or dry mouth.

Hyponatremia

A subnormal serum sodium level below $135\,\text{mEq/L}$; recognized as the most common electrolyte imbalance in hospitalized and elderly patients, often precipitated by hyperglycemia-induced osmotic shifts.

Serum Potassium ($\text{K}^+$) Reference Range

The normal circulating serum concentration of potassium, measuring $3.5 - 5.0\,\text{mEq/L}$, which is primarily regulated by the mineralocorticoid aldosterone.

Hyperkalemia

A dangerous elevation in serum potassium ($> 5.0\,\text{mEq/L}$) often related to decreased renal excretion, clinically presenting early with paresthesias, generalized muscle weakness, and cardiac dysrhythmias.

Hypokalemia

A serum potassium deficiency ($< 3.5\,\text{mEq/L}$) commonly caused by diuretic therapy or inadequate intake that exacerbates digitalis toxicity and induces muscle cramping and dysrhythmias.

Serum Calcium ($\text{Ca}^{2+}$) Reference Range

The physiological blood concentration of calcium, measuring $8.5 - 10.0\,\text{mg/dL}$, which is regulated by parathyroid hormone ($\text{PTH}$) and requires vitamin D and sunlight for gastrointestinal absorption.

Chvostek Sign

A clinical assessment sign for hypocalcemia marked by involuntary unilateral twitching of facial muscles elicited by tapping the facial nerve over the cheek.

Trousseau Sign

A clinical manifestation of hypocalcemia consisting of carpal spasm provoked by inflating a blood pressure cuff above systolic blood pressure for three minutes.

Basal Metabolic Rate (BMR)

The minimal continuous caloric energy expenditure required to sustain essential physiological metabolic functions at complete rest without food intake.

Normal Blood pH

The physiological homeostatic acid-base balance of human arterial blood, maintained tightly between $7.35$ and $7.45$, with an ideal central set point of $7.4$.

Metabolic Acidosis

A primary metabolic disturbance defined by a subnormal bicarbonate level ($\text{HCO}_3^- < 22\,\text{mEq/L}$) and arterial $\text{pH} < 7.35$, with compensatory respiratory hyperventilation lowering $\text{PaCO}_2$.

Metabolic Alkalosis

A primary acid-base disorder marked by elevated bicarbonate ($\text{HCO}_3^- > 26\,\text{mEq/L}$) and $\text{pH} > 7.45$, triggering compensatory hypoventilation that elevates arterial $\text{PaCO}_2$.

Respiratory Acidosis

An acid-base imbalance arising from alveolar hypoventilation and carbon dioxide retention ($\text{PaCO}_2 > 45\,\text{mm\,Hg}$), resulting in decreased arterial $\text{pH} < 7.35$ and renal bicarbonate retention.

Respiratory Alkalosis

An acid-base disturbance caused by alveolar hyperventilation that excessively eliminates carbon dioxide ($\text{PaCO}_2 < 35\,\text{mm\,Hg}$), driving arterial $\text{pH} > 7.45$ alongside renal bicarbonate excretion.

GI Tract Wall Layers

The four concentric anatomical layers comprising the alimentary canal: inner mucosa (epithelium, lamina propria, muscularis mucosae), submucosa, muscularis externa (circular and longitudinal muscle), and serosa.

Esophageal Atresia

A congenital anatomical malformation where the esophagus fails to form a continuous conduit to the stomach, presenting as newborn feeding difficulty requiring surgical reconstruction.

Dysphagia

Difficulty or discomfort in swallowing that can arise from mechanical obstructions (tumors, food boluses) or neurological deficits (stroke), frequently serving as the initial warning sign of esophageal cancer.

Gastroesophageal Reflux Disease (GERD)

A disorder where weakness or incompetence of the lower esophageal sphincter allows gastric contents to reflux into the esophagus, requiring avoidance of CATS dietary triggers (caffeine/carbonation, alcohol/acidic foods, tobacco, spicy foods).

Barrett Esophagus

Pathological metaplastic cellular transformation of the distal esophageal squamous epithelium into columnar tissue secondary to chronic GERD, predisposing to adenocarcinoma.

Esophageal Varices

Fragile, tortuous collateral submucosal veins developing in the lower esophagus as a result of portal hypertension; their rupture causes massive, life-threatening bright red hemorrhage treatable with a Minnesota tube.

Hiatal Hernia

An anatomical defect wherein a portion of the stomach herniates upward through the diaphragmatic hiatus into the thoracic cavity, trapping chyme and air.

Curling Ulcer

An acute mucosal stress ulceration of the stomach or duodenum that develops secondary to severe physical systemic stress from extensive burn injuries.

Cushing Ulcer

A stress-induced acute peptic ulceration associated specifically with severe head trauma, brain surgery, or elevated intracranial pressure.

Cholelithiasis

The formation of gallstones composed of cholesterol, bilirubin, or mixed matrices that precipitate biliary colic, right scapular/shoulder pain, clay-colored stools, and jaundice.

Portal Hypertension

Sustained high blood pressure within the portal venous system commonly driven by cirrhotic scar tissue, manifesting with ascites, caput medusae, esophageal varices, hemorrhoids, and splenomegaly.

Hepatic Encephalopathy

A central nervous system toxicity syndrome resulting from advanced liver cirrhosis and portosystemic shunting, allowing un-detoxified intestinal ammonia and toxins into the cerebral circulation.

Acute Pancreatitis

Sudden enzymatic autodigestion and inflammation of the pancreas most frequently precipitated by biliary duct cholelithiasis, which causes tissue leakage of lipase, trypsin, and elastase.

Borborygmus

Loud, high-pitched, hyperactive intestinal rumblings or peristaltic rushes auscultated when bowel segments work violently against a mechanical obstruction.

Peritonitis

Diffuse inflammation of the peritoneal lining resulting in marked abdominal wall muscular rigidity (board-like abdomen), reflex paralytic ileus, and shallow splinted respirations.

Celiac Disease

A genetically determined autoimmune enteropathy linked to the MHC Class II allele wherein ingestion of gluten triggers T-cell-mediated mucosal blunting, malabsorption, and steatorrhea.

Crohn Disease

A chronic transmural inflammatory bowel disease typically diagnosed in adolescence that can affect any segment of the GI tract, featuring skip lesions, a palpable abdominal mass, and steatorrhea.

Ulcerative Colitis

A continuous inflammatory bowel disease presenting in young adulthood ($20\text{s} - 30\text{s}$) that originates in the rectum and confines itself to the colon mucosa, characterized by recurrent bloody, mucus-laden diarrhea without palpable masses.

Diverticulitis

The acute inflammation and micro-perforation of pre-existing mucosal outpouchings (diverticula) in the colon, presenting with localized abdominal pain and risks of peritonitis.

Appendicitis

Acute inflammatory swelling of the vermiform appendix characterized by localized right lower quadrant ($\text{RLQ}$) pain, rebound tenderness, fever, and elevated white blood cell counts.

Bariatric Surgery Eligibility Criteria

Clinical guidelines requiring a minimum body mass index ($\text{BMI}$) of $40$, or a $\text{BMI}$ of $35$ in patients presenting with co-existing medical comorbidities.

Scrub Nurse

The intraoperative surgical nurse dedicated to sterile field maintenance, instrument tracking, and direct management of the surgical procedure flow.

Circulating Nurse

The non-sterile intraoperative nurse responsible for conducting pre-procedure verifications/time-outs, equipment management, surgical safety protocols, and general environmental monitoring.

AWET-ED Mnemonic

A clinical mnemonic delineating the core functional roles of the kidneys: Acid-Base balance, Water removal, Erythropoiesis, Toxin removal, Blood pressure control, Electrolyte balance, and Vitamin D activation.

Renal Corpuscle

The primary blood filtration unit of the nephron, composed of glomerular capillary endothelial cells and the enclosing Bowman capsule epithelium separated by a shared basement membrane.