Nursing Lecture Week 1 and 2 Study Practice Flashcards

Core Academic Introduction and Professional Standards

Instructor's Philosophy: Dr. Iwakim emphasizes the role of the instructor as a witness and facilitator in the process of students becoming nurses. The primary motivation for teaching nursing over many years is the goal of preparing a new generation to care for preceding generations and future children.
Scope of Instruction: Information is not limited to exam prep; it is profession-focused. The instructor states that what is learned in these sessions is $100 \times$ broader than what is required for exams or quizzes.
Selection Principles: Content is filtered based on clinical relevance. If a concept (e.g., the quality square mentioned in Week 1) has no application for a Registered Nurse (RN), it is deprioritized, whereas essential clinical concepts are highlighted regardless of their presence on exams.

Cancer and Tumors: Characteristics and Classifications

Benign Tumors: * Defined as "kind" or not typically harmful, but they can be lethal depending on location. * Examples of dangerous benign tumors: Locations such as the brain, the heart, or sitting directly on a nerve. * Characteristic: Generally encapsulated and well-differentiated.
Malignant Tumors (Cancer): * Described as "evil" due to their ability to travel (metastasize). * Characteristics: * Metastasis: The ability to spread from the primary site to distant locations. * Growth Rate: High-speed, rapid growth. * Capsulation: Unencapsulated (lacks a distinct border). * Differentiation: Undifferentiated (cells do not look like the parent tissue). * Clinical Status: Life-threatening and potentially fatal.
Manifestations of Tumors: * Nerve Interaction: A tumor sitting on a nerve causes nerve irritation and pain. This leads to functional impairment where the nerve conduction is interrupted, potentially causing paralysis. * Metabolic Impact: Cancer acts like a parasite, consuming nutrients and energy for its rapid growth. This leads to unintentional weight loss in the patient.
Cancer Specific Risk Factors: * Skin Cancer: Primary risk factor is exposure to sunlight. * Lung Cancer: Risk factors include smoking and asbestos exposure. * Bladder Cancer: Smoking is a primary risk factor. While the bladder is designed for fluid and electrolytes ( $Na^{+}$ , $K^{+}$ , $Ca^{2+}$ ), it cannot handle nicotine carried through the blood, which causes wall irritation. * Cervical Cancer: Linked strongly to the Human Papillomavirus (HPV). Detection is managed via Pap smears. * Breast Cancer: High correlation with family history/genetics and hormonal factors (e.g., estrogen replacement therapy).

Cellular Adaptation and Terminology

Hyperplasia: An increase in the number of cells within a tissue. High production levels of cells.
Hypertrophy: An increase in the size of individual cells. Examples include muscle development in bodybuilders, heart failure, prostatic enlargement, and hyperactive or lazy thyroid glands (hormonal stimulation).
Atrophy: The shrinkage or decrease in cell size. Examples include the thymus after childhood, muscles in a cast, or immobility leading to muscle wasting.
Dysplasia: A precancerous state where cells start to look abnormal in shape or size.
Anaplasia: Undifferentiated cells; a hallmark of malignancy where cells lose the specialized features of their tissue of origin.
Metaplasia: The reversible replacement of one mature cell type with another mature cell type that does not belong in that location. * Example 1: Smoker's airway, where columnar ciliated cells are replaced by squamous cells. * Example 2: Barrett's esophagus resulting from GERD (Gastroesophageal Reflux Disorder).

Cell Death: Apoptosis vs. Necrosis

Apoptosis: * Programmed, intentional cell death. * Occurs due to abnormality, aging (e.g., red blood cells die after $120 \text{ days}$ ), or reaching the appropriate number of cells.
Necrosis: * Unpredictable, accidental, and irreversible cell death. * Usually caused by a lack of oxygenation (hypoxia) leading to cellular trauma.
Infarction: The death of a significant area of tissue (hundreds of thousands of cells). * Progression: $\text{Hypoxia} \rightarrow \text{Ischemia} \rightarrow \text{Necrosis} \rightarrow \text{Infarction}$ . * Ischemic Pain: Pain serves as the body's alarm for low oxygen in a localized area. * Visual Indicators of Ischemia/Necrosis: 1. Normal/Pink. 2. Pale (decreased flow). 3. Cold (decreased flow). 4. Blue (Cyanosis). 5. Black (Necrosis/Death).
Gangrene and Ulcers: Necrosis can lead to skin breakdown and ulcers, such as pressure ulcers occurring from weight-induced ischemia at the lower back.

Stress Response and Physiology

Hormones of Stress: * Epinephrine and Norepinephrine: Released by the sympathetic nervous system. * Cortisol: Known as the primary stress hormone; it suppresses the immune response. * ADH (Antidiuretic Hormone): Retains water. This can lead to edema and hyponatremia ( $\text{hypo-Na}$ ) because the abundance of water dilutes the sodium level. * Aldosterone: Part of the RAAS (Renin-Angiotensin-Aldosterone System); retains sodium and water to increase blood pressure.
Physical Complications of Stress: * Increased glucose levels (hyperglycemia). * Hypertension (high blood pressure). * Risk of stroke and cardiac disease. * Depressed immunity leading to infection.
Stress Cycles: Stress triggers cortisol, which lowers immunity, leading to infection. Infection is a physical stressor, which in turn triggers more stress, creating a cycle.
Stressors Categories: Physical (hot weather, injury, pain), Psychological (anxiety), Financial, and Social (divorce).

Genetic Disorders

Down Syndrome (Trisomy 21): * Pathophysiology: An extra chromosome at pair $21$ . * Risk Factors: Advanced maternal age ( $> 35 \text{ years old}$ ). * Manifestations: Cognitive impairment, intellectual disability, slanted eyes, flat nose, and a high risk for leukemia. * Alzheimer's Link: Individuals with Down syndrome have a higher risk of developing Alzheimer's early, often after age $40$ . * Diagnostics (Invasive): PUBS (Umbilical blood sampling), CVS (Chorionic villi sampling), and Amniocentesis. These carry risks of infection and miscarriage.
Inheritance Patterns: * Autosomal Dominant: Requires only $1$ copy of the gene to be affected. * Probability: $50/50$ chance of being affected or normal. * Carriers: No carriers exist in dominant inheritance. * Examples: Huntington's disease and Marfan syndrome. * Autosomal Recessive: Requires $2$ copies (one from each parent). * Probability: $25/100$ affected, $25/100$ normal, $50/100$ carriers. * Examples: Cystic Fibrosis and Sickle Cell Anemia. * X-linked: Linked to the sex chromosomes; gender plays a significant role in expression.

Hypersensitivity and Immunity

Types of Hypersensitivity: * Type 1 (Immediate): IgE-mediated. Involves mast cells and histamine. Examples: Allergies, asthma, and Anaphylaxis. Anaphylaxis features narrowed airways and vasodilation (hypotension). * Type 2 (Cytotoxic): Antibody-mediated. Classic example: Blood transfusion incompatibility. * Type 3 (Immune Complex): Autoimmune mediated. Examples: Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE). * Type 4 (Delayed): T-cell mediated. Examples: Poison Ivy, TB skin test (results read at $48-72 \text{ hours}$ ), and organ transplant rejection.
Nursing Education - Cross-Reactivity: * Patients with allergies to avocado or bananas may have a cross-reactive latex allergy. * Patients with shellfish or shrimp allergies may be allergic to the iodine in contrast dye used in procedures like cardiac catheterization.
Classifications of Immunity: * Active Natural: Result of contracting a disease (e.g., chicken pox) and producing one's own antibodies (AB). * Active Artificial: Result of a vaccine; the body is prompted to produce its own AB. * Passive Natural: AB passed from mother to baby via the placenta or breastfeeding. * Passive Artificial: Receiving antibodies made in another human/animal (e.g., antivenom for snake bites, immunoglobulins for rabies).

Questions & Discussion

Q: Will this information be on the exam? * A: The instructor emphasizes that while the exam is a sample of knowledge, the information provided is essential for the nursing profession itself. If it is used by an RN, it is taught.
Q: Can you write down the cycle of RAAS? * A: Renin-Angiotensin-Aldosterone System (RAAS) will be detailed further in Week 4, but its connection to stress involves epinephrine-induced vasoconstriction and subsequent blood pressure increases.
Q: How do we differentiate Hyperplasia from Hypertrophy in a clinical setting? * A: Differentiation typically requires a biopsy to see if the cells have increased in number or size; it cannot be determined by gross observation alone.