Epidemiology and Pathophysiology: Disease Prevention, Immunity, and Renal Disorders, Exams of Nursing

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1. Review the difference between homeostasis and allostasis. Allostasis is the overall process of

adaptive change necessary

2. What is epidemiology?. Epidemiology the branch of medicine that deals with the study of the causes,

distribution, and control of disease in populations ….Review the different levels of disease prevention such

as primary- preventionintermsofimprovednutrition,economy,housing,andsanitation

Secondary - prevention that lead to the early diagnosis of disease and, in some cases, cure tertiary -

prevention -once a disease becomes established, treatment

as well as examples for each. Epidemiology the branch of medicine that deals with the study of the

causes, distribution, and control of disease in populations.

P rima ry - preventionintermsofimprovednutrition,economy,housing,andsanitation… Secondary -

prevention that lead to the early diagnosis of disease and, in some cases, cure … Tertiary prevention -

once a disease becomes established, treatment

3. Review the differences between the sympathetic vs the parasympathetic nervous systems. What

happens to the body during “fight-or-flight” response? Sympathetic- stressful stimulus and release of

norepinephrine. Parasympathetic-rest/relax

4. Review the functions of the various organelles of the cell such as the nucleus , mitochondria,

ribosome, lysosome , endoplasmic reticulum - cytoplasm of a eukaryotic cell, has

ribosomes attached and is involved in protein and lipid synthesis. peroxisome- breakdown of

very long chain fatty acids through beta oxidation golgi apparatus - a complex of vesicles and

folded membranes within the cytoplasm of most eukaryotic cells, involved in secretion and

intracellular transport.protein molecules in sacs called cisternae and the transport of synthesized

proteins in vesicles to the

5. Review the difference between active and passive immunity, know examples for each type.

Ac ti ve immunity -va c ine o c urswhenindividualsareexposedtoantigen,which conferslong-term protectionbut

maytakeseveralw e kstodevelop.)and ( Passive immunity - Newborns receive IgA antibodies through breast

milk. serotherapy, involves direct injection of antibodies into an unprotected person

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6. What is edema? swelling Review the various factors that can contribute to edema-- heart

failure, kidney problems

7. What is a hypersensitivity? Review the four different types of hypersensitivities: Type I

(Anaphylactic)- (IgE)immediate hypersensitivity, allergic reaction Type II (Cytotoxic)- ABO transfusion

reactions, hemolytic disease of the newborn, myasthenia gravis, hyperacute graft rejection, and

autoimmune hemolytic anemia, IgM or IgG. Type III (Immune complex)-- inflammatory reaction to

the antibody–antigen complex, , IgM and IgG, Immune complex- example Systemic Lupus E,

Type IV (Delayed cell-mediated)--- (Delayed cell-mediated- example tuberculin reaction. Know

examples and mediating factors for each type. Type IVa – Allergic Contact Dermatitis, Type IVa –

Tuberculin-Typ….. Know examples and mediating factors for each type.

8. Review the differences between benign and malignant tumors.

9. Review signs and symptoms of pep ti c ulcer disease. epigastricburningpainthatisusua l yrelievedbythe

intakeo f ood(especia l ydairyproducts)orantacids.GIbl e ding,mayo c urinpatientswithnowarning burning stomach pain, bloating or belching, Heartburn

10. Review signs and symptoms of appendicitis. Generalized periumbilical pain accompanied by nausea

and, & diarrhea. Pain-“migrating”orlocalizingtothelowerRIGHTabdomen // / How do we assess for this

condition? Low fever, nausea, anorexia, RIGHT quad pain, elevate WBC, rebound pain or tenderness

at McBurney point

11. Review signs and symptoms of liver disease. Bruising,increasedbl e ding Jaundice,

Hepatomegaly, Splenomegaly,Varices, Anemia,Weakness,fatigue,anorexia,weightloss,muscle

wasting,fever,Ascites / Review complications of liver disease such as ascites - a c umulationof

fluidintheperitonealcavity. hepatic encephalopathy — Confusion, subtle behavioral changes,

Drowsy, clear behavioral changes, flap present Stuporous, confusion, slurred speech, Coma TX.

Osmotic diuretics or antibiotics .. esophageal varices-- result of cirrhosis attributable to alcoholism or viral

hepatitis--- complication of portal hypertension… How are esophageal varices managed/treated? To

lower blood pressure and decrease risk of bleeding(control bleeding) -Propranolol. Nadolol

12. What role does albumin play in the blood? 60% of the total protein in the blood, keep fliud from leaking

out of blood vessels, nourishes tissues, and transports hormones, vitamins, drugs throughout the body. What

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water,andelectrolytes( 3 )secretionofwastesorexce s substances… How do we assess for renal

disorders?? BUN levels are used to monitor the progression of renal disease or to screen for occult renal

insufficiency. Creatinineclearanceisfrequentlyusedtoa s e s GFR BUN andcreatininearemeasured together,andtheratioisdetermined.AcutechangesinGFRarereflectedinahigherBUN-to-creatinine ratio,usuallygreaterthan2 0 : 1

What is cystic kidney disease? polycystic kidney disease, where cysts form in the kidneys. Genes code for

proteins associated with the primary cilium 2types- autosomal-recesive(infant)andautosomal-

dominant(adult)commonlyfoundinmen….What causes this condition? end stage renal disease

Review the following terms: nephrons- performingallfiltration,reabsorption,andsecretoryfunctions hematuria--

proteinuria- for biopsy, renal disease check.. nephrolithiasis-- -(stone) crystal ag

regatescomposedoforganicandinorganicmaterials20and30years,loweramongAfrican

AmericansandMexican…..pyelonephritis- -Chronic: smallatrophiedkidneyswithdiffusescaring

andblunting.obstruction or ureteral reflux that allows contaminated urine to enter the kidney…

cystitis-- inflammation of the bladder lining, may result from bacterial, fungal, or parasitic infections

13. Review signs and symptoms of acute kidney injury (AKI). Review causes of AKI including prerenal -

S/S- fluid volume overload, oliguria, low urinary sodium.. Intrinsic - S/S: declining urine output.

postrenal. - Obstruction of the normal outflow of urine, more common in the elderly.Know examples

of each type of injury.

14. What is compartment syndrome? trauma to soft tissue caused

Why does it occur and what are the signs? decreased compartment size, increased compartment

content, or externally applied pressure…. Remember the 5 P’s -- Pain. Pressure. Paresthesia

(numbness). Paralysis. Pulselessness

15. What are pressure ulcers? bedsores , are localized damage to the skin and/or

underlying tissue.. How are the staged and how can we prevent them? Stage I :The skin

is intact, Stage II : An open wound, Stage III : A deep wound- Deep damage may expose a fat

layer, Stage IV : Large scale tissue loss- exposes bone, muscle or tendons.

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16. What are electrolyte reservoirs? Electrolytes come from the food and liquids you

consume. What electrolytes are found stored in bones? Ca

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destructionoftheadrenalcortexthroughidiopathicorautoimmunemechanismstuberculosis,

trauma,Hyperpigmentation

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23. Review the differences between hypothyroidism--- intrinsic dysfunction of the thyroid gland, Congenital

hypothyroidism, developmentmayberefe r edtoas cr et i ni sm and hyperthyroidism — increasedsynthesis

andsecretionofT 4 andT 3 , , Gravesdisease .What labs can be drawn to determine if an individual is

suffering from a thyroid disorder? TSH

24. Review the di fference between Type 1 diabetes characterizedbydestructionoftheβcellsofthe

pancreas-,verproductionofglucagonbypancreaticαcellsstimulatesglycogenolysis ( type II - need

insulin, 2diabetesme l itusareresistan t otheactionofinsulinonperipheralti s ues

25. What are signs and symptoms of hyperglycemia - Blurred vision. Fatigue. Weight loss. Poor or

delayed wound heali n g. ( hypoglycemia-- hunger,visualdisturbance,weakne s ,paresthesias,

confusion,agitation,coma,anddeath ( What are the three Ps? po lyu ria, pol yd ips ia an d

polyphagia

26. Review the difference between primary and secondary brain injury. TBI, primary injuries result

immediately from the initial trauma…Secondary injury is an indirect result of the injury. It results from

processes initiated by the trauma.. What is a reperfusion injury? Ce l deathresultingfrom ischemia

occurs and blood supply to the tissues has been restored called reperfusion injury

27.Review causes of intracranial pressure; how does it lead to impaired neurological function? LOC,

decrease motor function, speech issues, sbp ^ & pulse down, headache…(cause

Aneurysm rupture , Encephalitis, Hydrocephalus (increased fluid around the brain)

28. What are signs or increased ICP? The signs of increased ICP include: headache,

increased blood pressure, confusion , double vision, pupils that don’t respond to

changes in light, loss of consciousness, coma

29. Review the Glasgow coma scale, what is it used to assess? checks for impairment of conscious level in

response to defined stimulus. Eye opening, Verbal response, Motor response,

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37. Be able to identify normal versus abnormal ABG values— What is the normal pH range of blood?

ph7.35-7.45 CO2 34-45 HCO3 23-30.

Re s pir a tory acid o sis : l o w p H , hig h CO 2

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Re s pir a tory alk alos i s : hig h p H, l o w CO 2

• Me tab o lic acid o sis : l o w p H , l o w HCO 3 -

• Me tab o lic alk alo sis : hi g h p H , hig h HCO 3 -

• Comp e ns a t e d re s pir ator y acid o sis : no rma l p H, hig h CO 2

• Comp e ns a t e d me t ab olic acid o sis : no rma l p H, l o w H CO 3 -

• Comp e ns a t e d re s pir ator y alk alos i s : no rma l pH , l o w CO 2

• Comp e ns a t e d me t ab olic alk alos i s : no rma l pH , hi g h HCO 3 -

38. Review conditions that affect the lungs such as: asthma - Asthma is a condition in which

your airways narrow and swell and produce extra mucus…. mycobacterium tuberculosis--

tubercle bacillus bacteria, spread by droplets .. COPD - Chronic bronchitis and emphysema can

clog the airways and damage lungs making It difficult to breath, incurable disease.. cystic fibrosis

— Cystic fibrosis (CF) is an inherited disease of the mucus(Sticky) clogs the lungs, causing

breathing problems and making it easy for bacteria to grow is a genetic disorder, which means

you get if from your parents at birth. ARDS— Acute respiratory distress syndrome causes fluid

to leak into your lungs, keeping oxygen from your organs life-threatening pneumonia —

Pneumonia is an infection that inflames the air sacs in one or both lungs. Caused by Bacteria,

viruses, or fungi

39. What are signs of ARDS? Breathing rate increase, cyanosis, Grunting on exhales, Nose flaring, Sweating,

Wheezing

40. What is a tension pneumothorax, how is it treated? air escapes into the pleural cavity,

increasing air pressure in the pleural cavity causes progressive collapse

of the lung. TX-by Needle in chest remove excess air

41. What is Virchow’s Triade? named for (Rudolf Virchow) contribute to thrombosis,

Hypercoagulability Hemodynamic changes (stasis, turbulence) Endothelial injury/dysfunction

How do these factors increase a patient’s risk for developing a pulmonary embolus? Beccuase

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42. What are different causes/types of emboli? ( pulmonary embolism- deep vein thrombosis or

DVT), lodges in one of the arteries of the lungs. Types-- brain embolism, fat embolism, air embolism. Causes-- smoking and heart disease-- cancer, previous surgery, a broken leg or hip

43. What are causes of anemia? blood loss, decreased production of RBC, and destruction of

RBC. What are complications of anemia? tissue hypoxia. Shock , hypotension , or coronary and

pulmonary insufficiency What is the goal in treating anemia? treated based on the cause

44. Review the following conditions of the blood including causes: (polycythemia- red cells are present in

excess, increasing blood viscosity thrombocytopenia Caused by: lung and heart diseases, sleep apnea,

tumors, dehydration,) (Disseminating intravascular coagulation (DIC)--- hemorrhagic syndrome in

which both clotting and bleeding occur simultaneously. How do we treat DIC- Replacementofdepleted

clo t ingfactorswithfreshfrozenplasma,packedredbl o dcells,platelets,orcryoprecipitate

45. What hormone plays a role in RBC production? erythropoietin (EPO). What organ produces this

hormone? Kidney(Formation in the bone marrow)

46. Review the difference between Hodgkin’s - dx’s Is early stages treatable, also begins in the upper body neck ,

armpits chest vs Non-Hodgkin’s lymphoma -begins in lymph nodes dx’s Is later stages harder to treat..

How are these cancers diagnosed?

47. Review modifiable- Dietary factors, Sedentary lifestyle, Obesity/weight gain// nomodifiable— Family

history,Age,Ethnicity/Genetics risk factors for hypertension. How is hypertension

managed/treated? What medications are often prescribed to manage HTN? What are complications

of hypertension if left unmanaged? Stroke, atherosclerosis, MI, organ damage

48. What is the role of renin-angiotensin-aldosterone system in managing blood pressure? restore blood

volume, Angiotensin 1 not strong enough Instead, converted to angiotensin II, much more powerful hormone to change blood act directly on blood vessels.

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49. What is coronary artery disease? major blood vessels that supply your heart with blood, oxygen and

nutrients (coronary arteries) become damaged or diseased

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57. Review the signs and symptoms of shock. Review the causes of different types of shock including:

anaphylactic shock - Antibiotic therapy, Peanuts and tree nuts, Insect stings, Snake bites cardiogenic shock --

Loss of consciousness, Pallor of the skin hypovolemic shock -- elevated HR, vasoconstriction, increased

contractility obstructive shock - Confusion or lack of alertness, Loss of ability to

concentrate, Unconsciousness, Chest pain. septic shock--- Activation of clotting cascade,

DIC, Hypotension, Cellular hypoxia, Increased capillary permeability with edema formation ( Distributive

shock )--- abnormal distribution of blood flow, not enough oxygen-carrying blood

Neurogenic shock---- massive vasodilation, spinal cord sympathetic nerves damage

58. What are complications of shock? They are Disseminated Intravascular Coagulation occurs in

septic shock Immune activation of the clotting.. Acute Renal Failure - Kidneys undergo long periods

of hypoperfusion. Vasoconstriction causes decreased glomerular blood flow.. Multiple Organ

Dysfunction Syndrome (MODS) Occurs when 2 or more organ systems are affected

59. What are the stages of hemostasis?- initial , interaction between platelets and the endothelium of the

injured blood vessel. The secondcomponentofprimar he m os t as is isformationofaplateletplug-formationof

afibrinclot,orcoagulation.Clot retraction, the final stage of clot formation, This stage takes

approximately 1 hour

60. What medications can affect hemostasis? vascularpurpuraincludesremovalofcausativeagentifoneis

identified(e.g.,penici l in).extensivebl e dingtocontrolth bleedingarenecessary.

61. What is hemophilia? most common severe inherited coagulation disorder. Excessive bleeding adevelop

bleeding) Review the differences between Hemophilia A --- is a bleeding disorder associated with a

deficiency of factor VIII, a protein necessary for blood clotting TX - administration of cryoprecipitate or other

preparations of factor VIII concentrate desmopre s inandantifibrinolytic .. Hemophilia B- results from

factor deficiency or the abnormal function of factor IX, TX-- administration of fresh or fresh frozen plasma or

cryoprecipitate What is the treatment for each?