Pathophysiology Foundations – Week 1-2 Video Lecture

Exam 1 Logistics & Format

• 50 questions, paper-and-pencil
  • Mostly standard multiple-choice
  • 2 “Select-all-that-apply” items
  • 1 NGN matrix item (e.g. match osteoarthritis vs. rheumatoid arthritis to symptoms)
• Time per item will be either 1.5 or 3 min; most questions can be answered within
  \le1.5 min
• No dosage calculation on Exam 1 (content moved out until Intro course covers it)
• Focus is cue recognition
  • No treatment/diagnostics/nursing-intervention content
  • Heavy on definitions (e.g. metaplasia, anaplasia) and hallmark signs/manifestations

Course Redesign & Module Map

• Transitioned to concept-based model rather than system-by-system
  • Chapters revolve around concepts (e.g. Inflammation) that contain many diseases; you will only be tested on diseases the Road Map lists
• Many lengthy case studies & discussions are hidden for 1st-quarter students (may return later)
• Supplemental tools still open: “NCLEX Practice”, “Walk With Me”, “Pulse Check”
• Working document: Road Map to Success (under “Syllabus / Prep-U”)
  • Treat as an evolving study guide; faculty will post condensed version grouping exactly “what you must know” by concept

Reading & Slide Targets (Exam 1 = Modules 1-3)

• Chapter numbers use VanMeter/Lise (WK) 10e Patho text
• Module 1 (last week)
  • Ch 1 Terminology – epidemiology, signs, symptoms, etc.
  • Ch 2 Cell + Tissue injury (specified tables only)
  • Ch 8 (Fluid & Electrolytes) – dehydration only; skip cirrhosis, hypo-parathyroidism
  • Ch 13 Endocrine feedback removed (retain only + / – feedback & homeostasis basics)
• Module 2 (this week)
  • Ch 3 Inflammation (skin, burns, arthritis emphasized)
  • Ch 4 Immunity (entire chapter applies to Exam 1)
  • Ch 5 Infection – Figures 5-10 (chain of infection) & 5-11 (phases) only; “very basic level”
  • Ch 7 Neoplasia (select parts) applies to both Modules 1 & 2
  • Ch 19 Aging – osteoporosis only (other aging topics lectured for context)
• Module 3 (next week prior to exam)
  • Skin, Musculoskeletal, Cancer wrap-up
• Module 4 material (heme) starts after Exam 1 (may get preview recording if time)

Inflammation & Tissue Repair (Ch 3)

Three Lines of Defense

1. Skin & mucous membranes (IgA in tears/saliva)
2. Inflammatory response – immediate, non-specific
   • Vasodilation + ↑ capillary permeability ⇒ redness & swelling
   • Chemical mediators + phagocytes (“phago = eat”) engulf invaders
3. Adaptive immunity (B- and T-cells) when inflammation insufficient

Acute vs. Chronic Inflammation

• Acute: triggered by tissue injury (trauma, pathogens, chemicals) → goals:
  • Deliver blood (vasodilation) & defensive cells
  • Clear debris & set stage for repair
• Chronic: persistent (> weeks–months) when acute response fails; examples rheumatoid arthritis, chronic cellulitis

Key Chemical Mediators

• Cell-derived : WBCs, platelets, endothelial cells
• Plasma-derived : Complement cascade, kinins, clotting factors

5 Cardinal Manifestations (KNOW)

1. Pain
2. Heat/warmth
3. Redness (erythema)
4. Swelling (edema)
5. Loss of function (incapacitation)

Local vs. Systemic

• Local : above 5 signs at site
• Systemic : fever, leukocytosis (↑ WBC), fatigue, anorexia, ↑ CRP/ESR

Basic Care Measures (not tested as interventions but useful context)

• Elevation/ice/compression to reduce flow
• Anti-inflammatories (e.g. ibuprofen) block mediators

Burns (Skin + Inflammation Focus)

Etiologies

• Thermal, chemical, electrical, lightning, radiation

Depth Classification (replace 1° / 2° / 3° terminology)

• Superficial (epidermis)
  • Red, painful, warm, mild edema
• Partial Thickness (epidermis + dermis)
  • Superficial PT: above signs only
  • Deep PT: + blistering (vesicles), serous exudate
• Full Thickness (through sub-Q ± bone)
  • Red/white/brown/black, no pain (nerves destroyed), eschar, massive exudate

Rule of Nines (Adult TBSA)

• Head/neck =9\%\,(4.5\%\text{ front}+4.5\%\text{ back})
• Each arm =9\%
• Each leg =18\%
• Anterior trunk =18\%
• Posterior trunk =18\%
• Genitals =1\%

Burn Priorities (ABC — then fluids/pain)

1. Airway (edema, inhalation injury)
2. Breathing
3. Circulation (fluid & electrolyte resuscitation)
4. Aggressive IV analgesia

Rheumatoid Arthritis vs. Osteoarthritis

• RA = systemic, autoimmune destruction of synovium
  • Triggering factors: genetics, viral infections, etc.
  • Pannus = granulation tissue → cartilage erosion → fibrosis → ankylosis
  • Course: remissions & exacerbations
  • Symmetrical joint involvement (both knees/hands, etc.)
  • Deformities: ulnar deviation, swan-neck, boutonnière; pain, heat, swelling
• OA = localized “wear-and-tear” cartilage degeneration; may involve single joints; patho different (mechanical)

Age-Related Changes & Osteoporosis (Ch 19 excerpts)

General Theories

• Oxidative stress / free radicals damage DNA & proteins
  • Antioxidants (berries, leafy greens, green tea, etc.) neutralize free radicals

Common Physiologic Changes

• Skin: ↑ dryness, ↓ elasticity, mottled pigmentation, wrinkles
• Hair: thinning, graying
• Metabolic: ↓ BMR, intolerance to cold
• Immune: ↓ T-cell function → ↑ infection & cancer risk
• Renal: GFR decline; BUN/Creatinine trend ↑ with “normal” aging
• Neuromuscular: slowed reflexes, dulled sensation, sarcopenia (loss of lean mass)
• Skeletal: kyphosis (vertebral compression), ↓ height

Osteoporosis Pathophysiology

• Imbalance in bone remodeling: osteoclast resorption > osteoblast formation
• Classified
  • Primary: post-menopause, age, genetic (Caucasian/Asian, petite frame)
  • Secondary: endocrine disorders, medications, immobilization

Risk Factors

• Female, Caucasian/Asian ancestry
• Family history
• Estrogen/testosterone deficiency (natural or surgical)
• \downarrow Calcium & Vit D intake or malabsorption
• Smoking; excessive alcohol
• Sedentary lifestyle (lack of weight-bearing stimulus)

Manifestations

• Silent until fracture
• Common fracture sites: hip & vertebrae
• Kyphosis (“dowager’s hump”); height loss; back pain

Screening & Prevention

• Gold standard = DEXA of hip + spine (heel scans unreliable)
• Lifestyle: weight-bearing exercise, Ca 1200 mg + Vit D \ge800 IU/day, stop smoking, limit EtOH
• Meds (context only): bisphosphonates, SERMs, calcitonin, monoclonal antibodies

Infection Fundamentals (Ch 5 key figures)

Chain of Infection (Figure 5-10)

1. Etiologic agent / pathogen (bacteria, virus, fungus, parasite)
2. Reservoir (people, equipment, food, water)
3. Portal of exit (secretions, droplets, blood, skin)
4. Mode of transmission (contact, droplet, airborne, vector)
5. Portal of entry (mucous membranes, GI/GU, broken skin)
6. Susceptible host (immunosuppressed, burns, elderly, diabetics, neonates)

• Break any link → interrupt infection (hand hygiene, PPE, sterilization, isolation precautions)

Phases of Infection (Figure 5-11)

1. Incubation – pathogen replicates; host asymptomatic but contagious
2. Prodrome – vague mild symptoms (fatigue, low-grade fever)
3. Clinical illness – characteristic signs & symptoms appear
4. Convalescence – containment; tissue repair; decline of symptoms

Foundational Terminology (Ch 1)

• Pathophysiology – functional changes caused by injury/disease
• Etiology – cause of disease
• Pathogenesis – mechanism of disease development
• Incidence – number of new cases in defined time
• Prevalence – total existing cases at a point in time
• Signs (objective) vs. Symptoms (subjective); combined = Clinical manifestations
• Diagnosis – label identifying disease
• Prognosis – predicted outcome/clinical course (good ▸ poor/guarded)
• Evidence-Based Practice (EBP) – interventions supported by current research

Study & Exam Preparation Tips

• Start with Road Map tables: “If it lists a table – KNOW IT up, down, backward, forward.”
• Use NCLEX practice, Walk-With-Me, Pulse-Check quizzes for self-testing
• Expect a faculty-posted condensed study guide separating key “What to know” within each concept (Inflammation, Infection, Immunity, etc.)
• Strategy for Select-All-That-Apply
  • Treat each option as T/F; do not assume preset number of correct choices
• Paper exam cautions: changing answers later frequently lowers score—trust first instinct!

Numerical/Statistical References

• Exam 1 question count =50
• Rule-of-Nines TBSA percentages (see Burns section)
• Calcium + Vit D daily goals (prevention) Ca^{2+}=1200\,mg ; Vit\,D\ge800\,IU

Ethical & Practical Implications Discussed

• Reducing cognitive overload for 1st-quarter students by hiding complex case studies
• Removing dosage calc until taught prevents inequity in assessment
• Encouraging transparency via Road Map so “this group does not want to fail”
• Urged to streamline studying: focus on concept mastery vs. memorizing entire chapters