NURS 340 exam 1 content (tamu)

physiology

normal functions of the body

pathology

structural and functional changes in cells, tissues and organs of the body. these cause or are caused by disease

why do we study pathophysiology?

So we know...

- why a disease has a clinical manifestation

- why certain medications work

- why certain side effects occur

- why complications occur

- why nursing interventions work

health

a "state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity" (WHO 1948)

what are the different aspects health varies based on?

-age

-genetics

-gender

-environment

-social factors

what does it mean to always consider a patients baseline?

before they came in to us, what were they able to do?

disease

the body is no longer functioning normally

acute disease

occurs and resolves quickly (like a cold) is temporary

chronic disease

occurs over a longer time, may never resolve, but may be manageable (longterm)

insidious

gradual, le notable onset- easily overlooked

exacerbation

acute worsening

remission

signs and symptoms may lessen for a period, but disease is still present

remission in cancer

disease isn't detecible?

health and disease are on a ____

continuum

congenital

present at birth (deafness)

hereditary

transmitted across generations

genetic

caused by abnormalities in genes (down syndrome)

inflammatory

triggered by body's defenses (systemic lupus erythematosus)

degenerative

caused by deterioration (osteoarthritis)

metabolic

problem with biochemical processes

neoplastic

uncontrolled proliferation (cancer)

Clinical Manifestations

signs and symptoms or evidence of disease

signs of disease

-objective - things I can measure or witness

-measurable - BP, HR, pallor, lab values

symptoms of disease

-subjective - inside the patient, they tell us

-patient reported - pain, nausea, dizziness

prognosis

likelihood of full recovery or retaining previous functioning

mortality

death rate from a particular disease

morbidity

disease rates in a population OR suffering from a disease or medical condition

co-morbidity

presence of one of more additional disorders co-occurring with a primary disease or disorder (ex: coronary artery disease + diabetes mellitus II)

complication

a pathological process or event occurring during a disease that is not an essential part of the disease (ex: pneumonia developing in a 74 year old patient after surgery)

idiopathic

we don't know exactly what causes it

predisposing factors

risk factors

etiology

study of disease causation. disease can be caused by infectious agents, chemicals

pathogenesis

the step by step of how the disease develops (ex: the etiology is a bacteria causing a urinary tract infection. the pathogenesis is how the bacteria effects the epithelial lining of the urethra and the body's subsequent inflammatory response causing s/s of a UTI)

cellular adaptation

-mechanisms the body develops to prevent injury and death (ex: when we go into the mountains our body makes more RBC to help with O2)

-can be normal or abnormal, it should cease when the stimulus is removed

proliferation

cell division

differentiation

specializing in terms of types, function, and structure

atrophy

shrinking of cells

hypertrophy

enlarging of cells (lifting weights or heart muscle working harder)

hyperplasia

excess number of cells (start to watch for cancer)

metaplasia

cells not look the same way, worry about cancer- usually precancerous

dysplasia

cancerous, cells mutated completely

cell injury

-reversible up to a certain point

-caused by:

-physical (cut/car accident)

-chemical (chemical burns)

-biologic (virus)

-deficiencies (in vitamins)

-free radicals (excess O2)

hypoxia

-major cause of premature death

-an absence of enough oxygen in the blood to sustain bodily function (ex: someone with pneumonia- brain, heart, lungs need more O2)

ischemia

-major cause of premature death

-decreased blood supply to an organ (causes heart attack, no O2 or nutrients to tissues)

apoptosis

-normal/programmed cell death

necrosis

premature/abnormal death, due to injury (ex: necrotic limbs)

cells shrink down during ___

apoptosis

cells swell and burst in ___

necrosis

what happens with necrotic cells burst?

they release the by-products of death into interstitial spaces and trigger inflammation

genetics

the study of genes and their role in transmitting traits from one generation to the next

genomics

-encompasses the whole collection of an individuals genes- the genome

-the interaction of genes with one another and with environmental factors

genes

segments of DNA found on chromosomes that carry information for protein production and are responsible for the inheritance of specific traits

different functions of genes

-may say which protein to make and how to make it

-may control protein making activity by saying when to make it and how much to make

single-gene traits

-when one gene controls the expression of a specific structure, protein, or function

single gene trait examples

-A, B, O blood groups

-blood clotting factors

-color vision

-dimples

-earlobe position

-hair texture

single gene disorder examples

-cystic fibrosis

-classic hemophilia

-Huntington disease

-marfan syndrome

-sickle cell disease

-sickle cell trait

alleles

-variation of a gene at a specific location

-two alleles together control how that gene is expressed

-alleles are paired with chromosomes

-we inherit one chromosome from each parent

-the 'specific location' is referred to as the locus

dominant gene

expressed whether 2 gene alleles are identical (homozygous) or different (heterozygous)

recessive gene

expressed only when both gene alleles for the trait are identical (homozygous)

genotype

-the genetic constitution of a cell, an organ, or an individual

-a list of inherited instructions that may or may not have an observable effect on the organism

phenotype

-the physical and behavioral characteristics of an organism

-both gene and environment typically contribute

pedigree

-a diagram that shows the occurrence and appearance (phenotypes) of a particular gene or organism and its ancestors from one generation to the next (done with diseases carried on- cancer)

-most used in humans, show dogs, and racehorses

expressivity

-the degree of trait expression a person has when a dominant gene is present

-affects phenotype and can range from mild to severe

-personal issue (rather than a population issue)

-genes always expressed but at different levels

-characteristics of affected individuals differ from person to person

-EX: neurofibromatosis

penetrance

-represents the ability of a gene to express its function

-how often, within a population, a gene is expressed when present

-calculated by examining a population of people known to have the gene mutation= % of people expressing the gene (penetrant)

sex-linked inheritance

-the gene is found on the X or Y chromosome- presence or absence is linked to an organism's gender

hemophilia

a medical condition that severely reduces the ability of blood to clot, resulting in severe bleeding even from minor injuries (typically caused by hereditary lack of the coagulation factor VIII)

chromosomal disorders

-any change in the normal structure or number of chromosomes, often resulting in physical or mental abnormalities

-ex: down syndrome/trisomy 21, tuner syndrome, Klinefelter syndrome

multifactorial inheritance disorder

-associated with effects of multiple genes in combination with lifestyle and environmental factors

-ex: heart disease and diabetes

down syndrome

1. trisomy 21 (nondisjunction) accounts for 95% of cases- 50% of children born have atrial septal defect (cardiac defect), 15% of children have hypothyroidism

2. translocation accounts for ~4%

3. mosaicism accounts for ~1% - some cells are diploid, some are haploid

-all types are associated with varying levels of intellectual disability (mild to moderate), characteristic facies: slanting eyes, small chin, round face, flat nasal bridge, abnormal outer ears; hypotonia in infancy (weak muscle tone)

Klinefelter Syndrome (XXY)

-abnormal testicular development accompanied by the presence of one or more extra X chromosomes more than the normal male XY complement

-extra X results from nondisjunction during meiotic division in one of the parents`

tuner syndrome (X)

-an absence of all or part of the X chromosome

-the female is typically short in stature, but her body proportions are normal

-variations in syndrome with abnormalities

multifactorial causes to obesity

social status, gut microbiota, food abundance, technological progress, medical treatment, pollution, hormones, psychology, peer pressure, in utero environment, viruses, nutrition, exercise

multifactorial influences on the development of children's brain

1. genetic variations in genes related to neural signaling molecules (excluding: serotonin, glutamate, BDNF, COMT)

2. prenatal- poor fetal growth, substance use, maternal anxiety, maternal depression

3. intrapartum- variations in oxygenation levels

4. postnatal- low SES, parenting quality, maternal depression

5. modifications in brain structure and function -> behavioral dysfunctions and risk for mental health problems

transcription

-provides the instructions for making a protein molecule

-def: the synthesis of RNA from a DNA template

-purpose: makes RNA copies of individual genes that the cell can use in the biochemistry

-products: mRNA, tRNA, noncoding RNA (micro RNA)

-location: nucleus

-initiation: occurs when RNA polymerase protein binds to the promoter in DNA and forms a transcription initiation complex. promoter directs the exact location for the initiation of transcription

translation

-process that makes proteins

-def: the synthesis of a protein from an mRNA template

-purpose: synthesize proteins

-products: proteins

-location: cytoplasm

-initiation: occurs when ribosome subunits, initiation factors and tRNA bind the mRNA near the AUG start codon

what are the 9 body systems?

neurological, musculoskeletal, respiratory, cardiovascular, hematologic, gastrointestinal, reproductive/genitourinary, endocrine, immune

what info is crucial about each drug?

1. pharmaceutics- how does it work?

2. pharmacokinetics- how does it move?

3. pharmacodynamics- how long does it take, special characteristics?

4. expected pharmacologic and therapeutic effects- what does it do?

5. adverse drug reactions- side effects?

6. contraindications- reasons not to take?

7. precautions- what to be mindful of?

8. interactions- drug-drug, drug-food, drug-person

what does NURSE stand for in pharm?

name, usage/used for, responsibilities (as the nurse), side effects, education (to provide to patient- safety, nutrition, education)

special drug considerations

-drug-drug interactions

-drug-food interactions

-drug tolerance (ex: tolerance to pain meds)

-cumulative effect (ex: antidepressants- take for a while for best outcome)

-drug toxicity (drug building up in the body)

-populations (pregnant women, children, older adults)

-patient teaching (making sure there isn't misuse)

drug categories

-act in the same way (ex: betablockers, ending in same suffix= typically same class of drug)

-share therapeutic effects

-share adverse drug reactions, contraindications, precautions, and administration considerations

-we study the prototype drug (1st drug created)

what is in the name of a drug?

-official name -> generic name (not capitalized)

-brand/trade name -> capitalized and may vary based on the manufacturer

-ex: acetaminophen (generic) vs tylenol (brand)

-need FDA approval for being interchangeable

prescription drugs

must be obtained with a prescription

nonprescription drugs

"over the counter drugs"

how drugs work/pharmaceutics

-form of the drug can impact: dissolution, absorption rate, onset of action

-routes/form: oral, parenteral (injectable- IV or SUBQ), topical or transdermal

fastest to slowest absorption rate of oral drugs

liquid, suspension, powder, capsule, tablet, coated tablet, enteric-coated tablet

parenteral drugs

-intravenous (IV, fastest-straight to bloodstream)

-subcutaneous (SUBQ)

-intramuscularly (IM, most vaccinations)

-forms: liquid or powder that needs a liquid to reconstitute it

intravenous (IV) drugs

absorption: immediate and complete

onset: immediate

subcutaneous (SUBQ) drugs

absorption: rapid if highly water soluble and good circulatory flow. slow if poorly water soluble and/or circulatory blood flow is slow or impaired

onset: variable

topical or transdermal drugs

-apply to: skin, eyes, ears, nose, rectum, vagina, lungs

-constant amount of drug over time

-slower onset of action

-longer duration of action

pharmacokinetics

-administration/absorption: IV, SUBQ, oral, transdermal, inhalation

-distribution/metabolism: blood, gut->liver->blood

-elimination: feces, urine, sweat, exhaled air

drug half-life

the amount of time it takes for a drug to decrease by half in the body (helps base dosing of meds)

onset of action of drug

how long the drug takes to work

duration of action of drug

How long the drug remains in therapeutic range

peak level of drug

-therapeutic dose is highest

-drawn 30min-1hour after administration

trough level

drawn when the drug is at its lowest in the bloodstream right before the next dose is given

pharmacodynamics

biochemical changes that occur in the body

therapeutic effects

the intended effects of the drug (ex: benadryl- allergies)

adverse drug reactions

-unintended effects of a drug (ex: benadryl- sleep/drowsiness, dry mouth, confusion, dizziness, convulsions, hyperactivity in children)

-affect doesn't have to be negative, it is just not intended to happen

-nontherapeutic, unintended effects. predictable and unpredictable. mild to life threatening. allergic reaction (milk to severe)

agonist

drugs that enhance the action of the cells (morphine activates opioid receptors in the brain for pain)

antagonist

drugs that decrease the action of the cells (Narcan cuts off opioid receptors)