3P: exam 1

atrophy

decrease in cell size

stimuli that causes atrophy

nerve loss, malnutrition, aging, decreased workload

hypertrophy

can be adaptive or maladaptive

increase in cell size that is not due to increase in influx of H₂O (cellular edema)

volume is primarily due to an increase in contractile proteins and mitchondria

causes of hypertrophy

hypertension, aortic stenosis, and diastolic overload

skeletal muscle ____ occurs in individuals who engage in weight training or taking anabolic steroids

hyperplasia

increase in cell number and can also be adaptive or maladaptive

only occurs in rapidly dividing tissues, such as: epithelial and glandular tissues, some cases smooth muscle cells

example causes of hyperplasia

adaptive: liver damage or partial hepatectomy, compensatory hyperplasia of the liver can result in significant regeneration of total organ mass and function

maladaptive: inappropriate endometrial cell mitosis and implantation outside the uterus occurs in endometriosis, similarly prostatic hyperplasia

dysplasia

abnormal change in cell size, shape, and organization, usually in epithelial cells

not considered adaptive but can be reversible

also occurs in pathologies of the gut, bone, respiratory epithelium, brain, and retina

metaplasia

involves replacement of a mature cell type with another cell type, often follows injury or insult and occurs in a variety of tissue types

considered an adaptation to external stimuli, such as bronchial and alveolar ____ in people exposed to cigarette smoke, and is not typically associated with increased risk of cancer

causes of metaplasia

complex, and believed to involve reprogramming of undifferentiated stem cells

types of cellular injuries

hypoxic, free radical, chemical, radiation, and physical

hypoxic injury

not enough O₂ getting to the tissues

perfusion problems cause this

free radical injury

occurs when unstable molecules with unpaired electrons damage cellular lipids, proteins and DNA

ex: cardiovascular disease, inflammatory cells

chemical injury

occurs when toxic agents, corrosive substances or metabolic poisions disrupt normal cellular homeostasis leading to structural damage, dysfunction or cell death

ex: cigarette smoke, lead, organic solvents, carbon monoxide

radiation injury

occurs when ionizing energy breaks molecular bonds or creates reactive free radicals that disrupt normal cellular function

ex: x-rays, alpha or beta particles

physical injury

direct mechanical trauma

ex: heat → burn, pressure → fracture

types of cellular death

apoptosis and necrosis

apoptosis

programmed cell death

cell has done its job, no inflammation occurs

skin and lining turn over

immune system regulation, when the body is done fighting infection the extra WBCs undergo apoptosis

necrosis

not programmed cell death, not planned, results from cellular injury and death, causes inflammation and problems

ex: MI, stroke, gangrene

homeostasis

cells are the basic unit of life and heredity, maintenance of health and ordered physiology is contingent on cellular integrity and optimal function

plasma membrane

semi-permeable membrane, allowing some molecules to pass from the extracellular space into the cytoplasm and prevent others

role of plasma membrane

tightly regulate the intracellular environment, which is a key element of homeostasis

Na⁺/K⁺ pump

specialized proteins called Na⁺/K⁺-ATPase pumps actively more K⁺ into the cell while pushing Na⁺ out

inside the cell (homeostasis)

98% of the body’s total K⁺ is located inside the cell (intracellular fluid), where the concentration is roughly 120 to 150 mEq/L

outside the cell

2% of the body’s K⁺ is in the extracellular fluid and blood plasma, with a normal concentration of just 3.5 to 5.0 mEq/L

types of cellular metabolism

anaerobic and aerobic respiration

anaerobic respiration

without O₂, releases very little energy (ATP) for cellular processes → inefficient, produces lactic acid (which can be harmful to cells and can lead to acidosis)

aerobic respiration

occurs when O₂ is present, releases the most energy (ATP) for important cellular processes, efficient

nonprescription (OTC) drugs

available without a prescription; used for minor health issues

*used for self-treatable conditions, OTC drugs can still have side effects and interactions, proper usage is essential to avoid complications

prescription drugs

require a healthcare provider’s authorization; used for treating specific conditions, used for more serious or complex conditions

controlled substances

regulated due to potential for abuse; categorized into schedules I to V

herbal/dietary supplements

not regulated as strictly; may interact with other medications

brand name

manufacturer’s marketed name

generic name

standardized name of the active ingredient (e.g., ibuprofen); you can see the name appear on multiple different medications that may include the medication. i.e. acetaminophen in Theraflu, Tylenol, pain medications

typically less expensive, but must meet same standards for safety and efficacy as brand-name drugs

pharmacologic action

how a drug works at a cellular or molecular level and the mechanism by which a drug produces it effects

ex: beta-blockers reduce heart rate by blocking stress hormones like adrenaline and noradrenaline from binding to receptors on the surface of cells

therapeutic uses

clinical goal or disease it is meant to treat

adverse drug reactions (ADRs)

unintended, harmful reactions to a drug at normal doses

types of ADRs

side effects, allergic reactions, and idiosyncratic

side effect definition

predictable and often avoidable

allergic reaction definition

immune responses ranging from mild to severe

idiosyncratic reactions

unpredicatble and rare

tolerance

reduced response to drug over time, requiring higher doses

cumulative effect

increased effect due to the body’s inability to metabolize or excrete the drug efficiently

toxicity

harmful effects due to excessice drug levels, can be acute or chronic

foundational principles of health assessment

data collection, clinical judgment, and evaluation

data collection

gathering both subjective data (what the patient reports, such as pain or nausea) and objective data (measurable observations like vital signs, lab results, and physical exam findings). The nurse uses both primary sources (the patient) and secondary sources (family, health records, and other providers) to gather data systematically

clinical judgment

____ ____ is the process that nurses use to make decisions based on data collection and clinical reasoning. Tanner's ____ ____ Model breaks it into four steps:

• Noticing (recognizing significant data),

• Interpreting (analyzing the data)

• Responding (taking action)

• Reflecting (reviewing outcomes)

This judgment underpins safe, effective, and patient-centered care.

evaluation

It determines whether the goals set in the care plan were achieved. Nurses compare patient outcomes with expected results and revise the plan of care as needed. It ensures continuous improvement and individualized care.

*comprehensive vs. focused assessment

Comprehensive Assessment: A full, head-to-toe evaluation often performed on admission. It includes a complete health history and physical exam.

Focused Assessment: A problem-specific exam tailored to the current complaint or condition, such as assessing lung sounds in a patient with respiratory distress.

*plan of care

A plan of care is developed collaboratively based on the nursing diagnosis and patient-centered goals. It includes:

• Identifying priorities

• Establishing measurable outcomes

• Selecting evidence-based interventions

• Evaluating progress toward goals

*health record

The health record (or Electronic Health Record - EHR) is a digital or physical document containing the patient’s history, assessments, diagnoses, treatments, and outcomes. It:

• Facilitates interdisciplinary communication

• Supports continuity of care

• Provides legal documentation

• Aids in quality improvement and research

*skills

Nursing skills are divided into:

• Technical/Clinical skills: Performing procedures like IV insertion, medication administration, and wound care.

• Communication skills: Building rapport with patients and teamwork.

• Cognitive skills: Critical thinking and decision-making under pressure.

Skill acquisition is a key part of nursing education and requires practice, feedback, and reflection.

*body systems

Nurses use knowledge of body systems to guide assessments and interventions. The major systems include:

• Cardiovascular

• Respiratory

• Gastrointestinal

• Musculoskeletal

• Neurological

• Integumentary

• Endocrine

• Urinary

• Reproductive

safety

• Client & Nurse Safety: Always a priority during assessments

• Environment: Safe, clean, private, and culturally respectful

infection control

Standard Precautions Include:

• Hand hygiene

• PPE use

• Respiratory etiquette

• Safe injections & sharps handling

• Sterile/clean equipment & surfaces

Hand Hygiene

• When to Perform:

Before/after client contact, invasive procedures, glove use, or contact with surfaces.

• How to Perform:

• Soap & water: 15–30 sec with friction.

• Alcohol-based rub: 20–30 sec if hands not visibly soiled.

• Nail Hygiene: Short, no artificial nails.

Personal Protective Equipment (PPE)

• Includes: Gloves, masks (surgical/N95), gowns, face shields, goggles.

• Purpose: Protect nurse and client from infection

client-centered care

Privacy

• Physical Privacy:

• Use drapes, minimize exposure.

• Quiet setting for auscultation.

• Respect cultural/gender/religious needs.

• Personal Privacy:

• Confirm identity with name & DOB.

• Use correct pronouns and preferred names.

Confidentiality

• Definition: Legal and ethical duty to protect personal health information.

• HIPAA: Governs how, when, and with whom information is shared.

Inclusive Care

• Transgender Clients:

• Respect gender identity and pronouns.

• Provide nonjudgmental, individualized care.

• Use gender-inclusive terms (e.g., “partner”).

Mandated Reporting

• Required by Law: Report any suspected abuse or neglect.

• Applies to: Children, adults, older adults.

• Types: Physical, emotional, psychological, sexual abuse, and neglect.

nursing process

assessment, analysis (nursing diagnosis), planning, implementation, evaluation

assessment

nurse collects data from:

subjective sources (patient-reported symptoms, perceptions, and history)

objective sources (measurable data like vital signs, physical exam findings, and disgnostic results)

sources include: patient interviews, physical examinations, diagnostic tests and labs, medical records

critical thinking is essential to: identify relevant vs. irrelevant data, recognize patterns and trends, seek additional info when needed, and organize data using frameworks

unexpected findings should be further assessed and reported to the appropriate provider or supervising RN

analysis (nursing diagnosis)

Registered nurses analyze data to identify:

• Actual problems (e.g., impaired gas exchange)

• Potential or risk problems (e.g., risk for infection)

This is a collaborative process with the patient and, when appropriate, their family. Accurate diagnosis is crucial to guide goal setting and interventions.

planning

The ____ phase focuses on:

• Prioritizing patient problems (often using Maslow’s hierarchy, ABCs, or acute vs. chronic)

• Setting SMART goals (Specific, Measurable, Achievable, Relevant, Time-bound)

• Selecting evidence-based interventions

____ is a collaborative process that respects patient preferences, needs, and cultural values.

implementation

In this phase, the RN:

• Carries out interventions as outlined in the care plan

• Monitors the patient’s response to treatment

• Provides teaching, adjusting strategies based on the patient’s readiness, learning barriers (e.g., anxiety, literacy), and environment

• Coordinates with interdisciplinary team members

Implementation is dynamic and may require flexibility based on patient condition changes.

evaluation

____ is a continuous process:

• Have the goals been met, partially met, or not met?

• Is the care plan effective?

• Are revisions needed?

If outcomes are not achieved, the process cycles back to assessment for further data collection or intervention modification. clinical decision-making:

• Recognize Cues

• Gather information from physical observations, health records, lab values

• Distinguish relevant from irrelevant data

• Analyze Cues

• Connect data points to draw inferences

• Prioritize Hypotheses

• Identify and prioritize client problems

• Generate Solutions

• Consider evidence-based interventions

• Take Action

• Implement the best-fit interventions

• Evaluate Outcomes

• Assess results and determine effectiveness

nursing assessment (what changes and whats the order)

inspection, palpation, percussion, auscultation

for abdomen: I.A.P.P.

inspection

symmetry, skin tone, smell, shape, deformities, mood of client, tell client what parts are being observed

start with head to toe, visibility, privacy, and comfort

tools: light, source to perform proper hygiene, pen light (pupils), tape measure, pulse oximeter, tongue depressor

palpation

act of using dorsal surface of hands and fingertips to feel areas of the body for various findings: temp, moisture, or unexpected findings

when ____: fluid, crepitus, size, consistency of masses and pulses; ____ using palmar surfaces of fingers and finger pads, not tips

if checking vibration: ulnar surface of hands

slow organized, gentle pressure, palpate tender areas last

sensation: soft end (cotton tip) and sharp end (wooden stick) for sharp and dull sensations

percussion

not done by entry-level nurses

tapping of client’s skin with a short quick motion to determine vibrations and sounds depending on underlying structure

help to determine density of area (air, fluid or solid filled)

auscultation

listening to sounds of heart, lungs, stomach, intestines, and arteries

most common assessment technique, most difficult to master

first learn expected sounds

tools: requires stethoscope (clean after every use)

*comfort warm surface of diaphragm and bell

diaphragm: used to listen to high-pitched sounds, breaths, bowel, heart

bell: soft, low-pitched sounds, heart murmurs

intracellular fluid

within cells (2/3 make up of fluids)

extracellular fluid

outside cells (1/3 make up of fluids)

what does extracellular fluid include

intersitial (between cells) → surrounds tissue cells (75% of extracellular fluid)

intravascular (in blood vessels) → in blood (plasma, 25% of extracellular fluid)

transcellular (third space) → 1% of fluid (pleural, peritoneal, joints)

osmolality

concentration of solutes in a solution (# of solute particles/kg)

assess hydration status and condition

used for osmotic pressure of body fluids like blood or urine and electrolyte balancing

hyperosmality

concentrations of solutes are higher than normal relative to water

cause: deghydration, diabetes, certain drugs

hypoosmality

concentration lower than normal

cause: excessive water intake, hormone disregulation, certain drugs, kidney disorder

iso-osmality

unit of volume is equal

tonicity

actual solution of cell

change in tonicity affects cell function

hypertonicity

cells shrink (H₂O out)

cause: dehydration, high solute concentration, high blood glucose

hypotonicity

cells swell (H₂O in)

cause: excessive H₂O intake, medical conditions

isotonicity

equilibrium, no change

osmotic equilibrium

when concentration of solutes in and out of semi-permeable membrane is equal this is achieved when outside pressure of solution = hydrostatic pressure of solution

hydrostatic pressure: push

pressure created by water in vascular space (capillaries)

osmotic pressure: pull

pull for fluid into the vascular space created by solutes there

PO

by mouth

SL

under the tongue

Bucc

between cheek and gum

IV

intravenous

IM

intramuscular

ID

intradermal

SubQ

subcutaneous

pharmacokinetics

how the drug travels through the body

pharmacokinetics steps

absorption, distribution, metabolism, excretion

pharmaceutics

how various drug forms affect the dissolution of a drug, absorption rate, and onset of action

oral

tablet, capsule, powder, liquid

enteric coated: popular with aspirin, for people with stomach ulcers, on PPI, acid reflux → dissolves in small intestine (delayed onset)

extended release (delay onset) is used because toxicity can occur when crushing or chewing medication

parenteral/injectible

IV: liquid or reconstituted powder (mix), immediate onset, into vein

SQ, IM: absorption speed depends on 3 things → water solubility, blood flow into injection site, and lipid solubility

topical/transdermal

absorbs slowly through skin: slower onset, longer duration, localized or systemic effects overtime

skin, eyes, ears, nose, rectum, vagina, lungs

timeline of pharmacokinetics

drug half life, onset, peak, duration, trough level

drug half life

time it takes for drug to decrease in amount by half

ex: 100mg of metoprolol (half life: 4hrs) → after 4hrs = 50mg in body

onset

amount of time for drug to produce measurable therapeutic response

peak

point in time where drug is at its highest level

max effect, max concentration in blood stream, need to know ____ time

antibodies and anti-epileptic requires monitoring

duration

amount of time for drug to demonstrate full therapeutic effect

trough level

point in time where drug is at lowest level (monitor doses for patients)

antibodies and anti-epileptic requires monitoring

pharmacodynamics

biochemical changes that occur in the body