A double-walled membranous sac that encloses the heart
3 Functions of pericardium
1-prevents displacement of the heart during gravitational acceleration or deceleration 2-serves as a physical barrier to protect the heart from infection and inflammation from the lungs and pleural space 3-contains pain receptors and mechanoreceptors to elicit changes in blood pressure and heart rate
What are the two layers of the pericardium
Pericardial cavity separated the parietal and visceral
What is the function of the pericardial fluid?
lubricates the membrane that lines the pericardial cavity, enabling them to slide over one another with minimal friction as the heart beats
What is the pericardial fluid secreted by
by the cells of the mesothelium
What are the 3 steps that describe the
1-During diastole (relaxation), blood flows into atria, atrioventricular valves are pushed open, and blood begins to fill ventricles.
2-Atrial systole squeezes any blood remaining in atria out of the ventricles
3-During ventricle systole, ventricles contract, pushing blood out through semilunar valves into pulmonary artery (right ventricle) and aorta (left ventricle)
What is the SA node
a specialized bit of heart tissue that controls the heartbeat
What is the function of the SA node
cardiac pacemaker, pacemaker; responsible for heart rhythm
What is the primary determinant of heart rate
the SA node
Where is the SA node located and what is it composed of?
It is a group of cells positioned on the wall of the right atrium, near the entrance of the superior vena cava
What is the AV node
is a part of the electrical control system of the heart, it electrically connects atrial and ventricular chambers
Where is the AV node located
The AV node is an area of specialized tissue between the atria and the ventricles of the heart, It electrically connects atrial and ventricular chambers.
What is the movement of the electrical pulse of the heart?
Contraction of myocytes (heart muscle cells) requires depolarization and repolarization of their cell membranes. Movement of ions across cell membranes causes these events. The cardiac conduction system (and AV node part of it) coordinates myocyte mechanical activity. A wave of excitation spreads out from the SA node through the atria along specialized conduction channels. This activates the AV node. The AV node delays impulses by approximately 0.12s. This delay in the cardiac pulse is extremely important: It ensures that the atria have ejected their blood into the ventricles first before the ventricles contract. This also protects the ventricles from excessively fast rate response to atrial arrhythmias.
What is the bundle of his
The bundle of cardiac muscle fibers that passes from the atrioventricular node to the interventricular septum and then the ventricles
What is the function of the bundle of his
It conducts the electrical impulses that regulate the heartbeat from the right atrium to the left and right ventricles. Gives rise to the right and left bundle branches
What is cardiac output
the volume of blood flowing through either the systemic or the pulmonary circuit per minutes and is expressed in liters per minute (L/min). To determine cardiac output, heart rate (beats per minute) is multiplied by stroke volume (liters per beat)
What is normal cardiac output for a resting adult
5 liters per minute
What is stroke volume
the volume of blood ejected per beat during systole.
What is the thoracic lymphatic duct
Where does the thoracic lymphatic duct drain
Drains lymph into the left subclavian vein
What is Atherosclerosis
characterized by soft deposits of intra-arterial fat and fibrin in the vessel walls harden over time. It is the leading cause of coronary artery and cerebrovascular disease.
What is hypertension
Persistent seated BP levels equal to or greater than 140/90mmHg
What is primary hypertension
Hypertension with no known cause
What is secondary hypertension
Hypertension that develops in response to an identifiable mechanism
What is normal blood pressure
What is orthostatic hypotension
refers to the decrease of blood pressure when moving to a standing position
What is idiopathic/primary orthostatic hypotension (chronic)?
no known cause, some define it as a generalized degenerative CNS disease and some define it
Acute orthostatic hypotension results in
results in altered body chemistry, prolonged immobility, physical exhaustion, dehydration, diuresis
What are the signs and symptoms of acute orthostatic hypotension
dizziness, blurring or loss of vision, and syncope or fainting
increased secretion of urine
a blood clot that remains attached to a vessel wall; , a stationary clot. When it has grown enough to close off a blood vessel, this dangerous event is a thrombosis
a air bubble, a detached blood clot, or a foreign body that travels in the blood stream and is wedged in a blood vessel, resulting in obstruction in the vessels supplying the lungs, brain, or heart. *often a medical emergency
a detached thrombus; , a clot of material that breaks free from a primary site, is transported in the bloodstream and becomes lodged at a secondary site
a condition in which the blood vessels spasm, which result in inadequate blood supply and discoloration of the fingers or the toes, after exposure to changes in temperature or emotional events
a vein in which blood has pooled, producing distended, twisted and palpable vessels.
Chronic venous insufficiency
inadequate venous return over a long period of time that causes pathologic ischemic changes in the vasculature, skin, and supporting tissues.
Coronary artery disease (CAD)
is the result of an atherosclerotic plaque that gradually narrows the coronary arteries or that ruptures and causes sudden thrombus formation.
the cholesterol-rich material that is deposited in the arteries of individuals with atherosclerosis. it consists of cholesterol, smooth muscle cells, fibrous tissue, and eventually calcium
What is the most common cause of morbidity and mortality in individuals with diabetes mellitus?
Coronary artery disease (CAD)
Disruption in or deficiency of coronary artery blood supply, resulting in necrosis of myocardial tissue
What causes Myocardial ischemia
Thrombus or clotting, Shock or hemorrhage
chest pain caused by myocardia ischemia (MI)
Chest discomfort or pain that occurs when myocardial O2 demands exceeds supply
caused by gradual luminal narrowing and hardening of the arterial walls, so that affected vessels cannot dilate in response to increased myocardial demand associated with physical excretion or emotional stress. With rest, blood flood is restored and no necrosis of myocardial cells results
Prinzmetal Angina (Variant angina)
chest pain attributable to transient ischemia of the myocardium that occurs unpredictably and often at rest. Pain is caused by one of more major coronary arteries with or without associated atherosclerosis. The pain often occurs at night during rapid eye movement sleep and may have a cyclic pattern of occurrence.
acute inflammation of the pericardium.
What is the most common cardiovascular complication of HIV
What happens to the pericardial membranes in acute pericarditis
Pericardial membranes become inflamed and roughened, and a pericardial effusion may develop that can be serous, purulent, or fibrinous
Symptoms of acute pericarditis
Symptoms may follow several days of fever and usually begin with the sudden onset of severe retrosternal chest pain that worsens with respiratory movements and when assuming a recumbent position. The pain may radiate to the back as a result of irritation of the phrenic nerve as it traverse the pericardium. Individuals with acute pericarditis also report dysphagia, restlessness, irritability, anxiety, weakness, and malaise. Physical exam shows low-grade fever and sinus tachycardia.
What can be auscultated for acute pericarditis
A friction rub may be heard at cardiac apex.
a condition in which one or more of the heart's valves becomes narrow, stiff, thickened, fused, or blocked, and blood does not flow through it smoothly.
The valve orifice is constricted and narrowed, so blood cannot flow forward and the workload of the variac chamber proximal to the diseased valve decreases.
a condition in which one or more of the heart's valves does not close properly, producing a backflow of blood.
The valve leaflets or cusps, failt to shut when the valve is presumably closed.
inadequate venous return over a long period. Symptoms may include edema of the lower extremities and hyperpigmentation of the skin of the feet and ankles.
Valve leaflets do not completely seal when a valve is closed so regurgitation of blood occurs.
impairs the flow of blood from the left atrium to the left ventricle
Is mitral stenosis more commmon in women or men
40% of individuals with a history of rheumatic heart disease have
In mitral stenosis which heart sound is often delayed because of incrased left atrial pressure
The first heart sound (S1)
results from an inability of the aortic valve leaflets to close properly during diastole because of abnormalities of the leaflets, the aortic root and annulus, or both. Can be congenital or acquired
most common vascular abnormality, affecting 2% of adults older than 65 years of age; the narrowing or stricture of the left ventricle outlet, causing resistance of blood flow from the left ventricle to the aorta.
What are the common cuases of aortic stenosis
1.Congenital bicuspid valve
2.Degeneration with aging
3.Inflammatory disease caused by rheumatic heart disease
permits backflow of blood from the left ventricle into the left atrium during ventricular systole, producing a holosystolic murmur heard best at the apex, which radiates into the back and axilla
What causes mitral regurgitation
mitral valve prolapse, rheumatic heart disease, infective endocarditis, MI, connective tissue diseases (Marfan syndrome), and dilated cardiomyopathy
What is anaphylactic shock
results from a widespread hypersensitivity reaction known as anaphylaxis
Begins with exposure of a sensitized individual to an allergen (insect venoms, shellfish, peanuts, latex, medications, etc)
What are the clinical manifestations of anaphylactic shock
dizziness, difficulty breathing, stridor, swollen lips and tongue, abdominal cramping
What is Septic Shock
begins with an infection that progresses to bacteremia, then systemic inflammatory response syndrome( SIRS), then sepsis, then severe sepsis, the septic shock, and finally multiple organ dysfunction syndrome(MODS)
Septic shock is a common cause of death in what area of the hospital?
What are the most common sources of septic shock
the lungs, urinary tract, GI tract, wounds, and indwelling vascular catheters
How does most septic shock begin?
when bacteria enters the bloodstream to produce bacteremia. These bacteria may directly stimulate an inflammatory response or release toxic substances into the blood stream.
multiple organ dysfunction syndrome (MODS)
The progressive dysfunction for two or more organ systems resulting from an uncontrolled inflammatory response to a severe illness or injury
What can MODS progress to?
organ failure and death
What is the most common cause of death in the ICU?
What is the most common cause of MODS
What type of person is at a much higher risk for congenital heart disease?
Individuals with down syndrome. As a comparison: the incidence of congenital heart disease in the general population is 0.8 percent. The incidence of congenital heart disease in children with Down syndrome is between 40-60 percent.
Tetralogy of Fallot
decreased pulmonary blood flow
Cyanosis due to unoxygenated blood is pumped into systemic circulation
Decreased pulmonary circulation occurs due to pulmonary stenosis
Requires surgical repair
The four defects of Tetralogy of Fallot
Ventricular septic defect
Right ventricular hypertrophy
What are the signs and symptoms of tetralogy of fallot
"Tet" spells or hypoxic episodes; relieved when child is in a squatting or knee to chest position
Failure to gain weight
coarctation of the aorta
a condition in which the aorta narrows in the area where the ductus arteriosus inserts. Narrowing usually occurs preductal in children and postductal in adults.
narrowing or stricture of the pulmonary valve that causes resistance to blood flow from the right ventricle to the pulmonary artery. Generally moderate to severe stenosis causes right ventricular hypertrophy.
patent ductus arteriosis
failure of the fetal ductus arteriosus (artery connecting the aorta and pulmonary artery) to close within the first few weeks of life
If it remains patent (open), oxygenated blood from the aorta returns to the pulmonary artery
Increased blood flow to the lungs causes pulmonary hypertension
May require administration of Indomethacin or surgical repair
Signs and symptoms of patent ductus arteriosis
Working hard to breathe
Poor feeding and poor weight gain
Sweating with exertion, such as while feeding
What is the most common congenital heart defect
Ventricular septal defect
What can occur if ventricular septal defect is left untreated
Low oxygen levels in the blood
ventricular septal defect
large hole between two ventricles lets venous blood pass from the right to the left ventricle and out to the aorta without oxygenation
failure of the tricuspid valve to develop, consequently, there is no communication from the right atrium to the right ventricle
there is complete mixing of unoxygenated and oxygenated blood in the left side of the heart
What are tricuspid atresia clinical manifestations
a murmur is noted and cyanosis is usually seen in the newborn period
What is the function of the cilia located in the nasopharynx
Propel mucous blanket and entrapped particles toward oropharynx, where they can be swallowed or expectorated
the movement of blood into and out of the capillary beds of the lungs to body organs and tissues
the movement of air into and out of the lungs
the continuous motion by which the blood travels through all parts of the body under the action of the heart
movement of gases between air spaces in the lungs and the bloodstream
Where does diffusion of respiratory gases take place
diffusion of oxygen from the alveoli into the capillary blood
What are the 2 peural membranes
Visceral and parietal membrane
Visceral pleural membrane
the membrane covering the lungs
Parietal pleural membrane
the lining of the thoracic cavity
What are the functions of the pulmonary system
Ventilates the alveoli
Diffuses gases into and out of the blood
Perfuses the lungs so that the organs and tissues of the body receive blood that is rich in oxygen and low in carbon dioxide
Where is the respiratory contral center located
in the brainstem (medulla)
How does the body compensate if they are retaining too much CO2
Using accessory muscle to breath, ineffective breathing pattern, activity intolerance
Normal CO2 range
Respiratory acidosis CO2 level
Respiratory alkalosis CO2 level
A lipoprotein with detergent-like effect that separated the liquid molecules inside the alveoli
What occurs with increased work of breathing
hypoventilation, respiratory acidosis
How is oxygen transported in the body
What the 3 ways that CO2 is transferred in the body
dissolved in plasma as Pco2
Bound to hemoglobin (forming carbominohemoglobin) and plasma proteins, binds to amino groups on the polypeptide chain of hemoglobin and plasma proteins
As bicarbonic ions; enters RBC in capillaries to combine with water.
bluish discoloration of skin and mucous membranes caused by increased amounts desaturated or reduced hemoglobin in the blood
Dyspnea when a person is lying down
hyperpnea( Kussmel respirations)
Deep, rapid respirations commonly seen in conditions causing acidosis
a subjective experience of breathing discomfort; shortness of breath
temporary cessation of breathing
characterized by alternating periods of deep and shallow breathing. Apnea lasting for 15 to 60 seconds followed by ventilations that increase in volume until peak is reached; then ventilation decreases again to apnea.
expectoration of blood or bloody secretions (coughing up blood)
reduced oxygenation of arterial blood(reduced Pao2)
reduced oxygenation of cells tissues
a condition in which purulent material is persistently discharged into the pleural space because of complications of bacterial infections
incomplete valve closure
inadequate alveolar ventilation in relation to metabolic needs. Occurs when minute volume (tidal volume times respiratory rate) is reduced; caused hypercapnia; results in respiratory acidosis; (less than 12 breaths per minute)
alveolar ventilation exceeding metabolic needs; hypocapnia; results in respiratory alkalosis; (higher than 20 breaths per minute)
excessive water in the lungs
the passage of food and solid particles into the lung
acute respiratory distress
Caused by impaired gas exchange processes or airway obstruction (ex. choking).
SIGNS AND SYMPTOMS
dyspnea, respiratory alkalosis
sepsis and trauma, CAU
what conditions are classified as COPD
bronchiolitis, chronic bronchitis, pulmonary emphysema, chronic asthma, and bronchiectasis
chronic inflammatory disorder of the bronchial mucosa that causes hyper reactiveness and constriction of the airways
hyper secretion of mucus and chronic productive cough for at least three month of the year(usually winter months) for two consecutive years; obstruction results from mucus production and inflammation, "Blue Bloater"
abnormal permanent enlargement of gas-exchange airways; obstruction results from changes in lung tissues, "Pink puffer"
inflection of the lower respiratory tract caused by bacteria, viruses, fungi, protozoa, or parasites
What is the 6th leading cause of death in the US
An acute laryngotracheobronchitis and almost always occurs in children between 6 months and 5 years of age with a peak incidence at 2 years old.
inflammation of the larynx and trachea and bronchial passageways
What is viral croup caused by
subglottic inflammation and edema from the infection
Signs and symptoms of croup
sore throat, low-grade fever, rhinorrhea
obstructive sleep apnea
partial or intermittent complete upper airway obstruction with disruption of normal ventilation and sleep patterns
The most common cause for childhood obstructive sleep apnea
What are the clinical manifestations of obstructive sleep apnea
Snoring and labored breathing during sleep
Chronic mouth breathing
How is obstructive sleep apnea treated
tonsillectomy and adenoidectomy, or CPAP
a shrinking, drawing back, pulling apart
Located in the chest/ribs
also known as chronic lung disease(CDL) of infancy, used to describe persistent lung disease following neonatal lung injury, usually associated with premature birth and perinatal respiratory support; infants need supplemental oxygen at 36 weeks for at least 28 days after birth
a common viral lower respiratory tract infection that occurs almost exclusively in infants and young toddlers
begins with rhinorrhea followed by a slight cough over the next few days along with decreased appetite, lethargy, and fever
the most common cause of pneumonia in children
viruses, followed by bacteria and atypical microorganisms
Signs and symptoms of asthma
Coughing, wheezing, and shortness of breath
auto recessive inherited disease
persistent cough or wheeze, recurrent or severe pneumonia
What is the primary cause of death in children
Treatment for cystic fibrosis
chest PT, techniques to promote mucus clearance, primary focus is nutrition and pulmonary health; antibiotics
Sudden death of an infant under 1 year age
How is SIDS prevented
parents should learn CPR, lay baby in a supine sleeping position on a firm surface
What is the cause of SIDS
the cause is unknown
When does incidence of SIDS increase
Incidence is low in the first month of life but increases in the 2nd month and peaks at 3 to 4 months of age.
respiratory distress occurs exclusively in
what causes respiratory distress
caused by surfactant deficiency
Poor lung structure and lack of adequate surfactant
How can respiratory distress be treated?
Prevention of preterm birth
Mechanical ventilation, surfactant administration, glucocorticoid administration to women in preterm labor
collapse of an expanded lung (especially in infants)
Sweat pores; found all over skin, especially on soles of feet and hands; activated the the SNS in response to stress or fear
Axillae and anogenital areas mix with bacteria and fatty organic acids producing body odor
found in the dermis area; function to keep hair and skin moist; absent on soles of feet and hands; stimulated by androgens; secrete sebum
also known as the hypodermic; not a true layer; subcutaneous tissue or super fascial of varying thickness connects dermis to underlying muscle; contains macrophages, fibroblasts, fat cells, nerves, blood vessels, lymphatics, and hair follicle roots
Sebaceous glands and their relation to androgens
SEBUM PRODUCTION is stimulated by androgens, key in the development of acne vulgaris. The presence of acne in prepubertal girls and sebum production in both sexes correlate with serum dehydroepiandrosterone sulfate (DHEAS) levels. Dehydroepiandrosterone sulfate is an adrenal precursor for synthesis of more potent androgens, such as testosterone and dihydrotestosterone (DHT). This raises the question of whether there is an increased local production of androgens within the sebaceous gland (SG) of patients with acne vulgaris that leads to increased sebum secretion.
immune function, epidermal macrophages that help activate the immune system;
an abscess larger than a boil, usually with one or more openings draining pus onto the skin. It is usually caused by bacterial infection, most commonly Staphylococcus aureus, or Streptococcus pyogenes, which can turn lethal. However, the presence of carbuncles is actually a sign that the immune system is working. The infection is contagious and may spread to other areas of the body, or other people; those living in the same residence may develop carbuncles at the same time.
synthesize pigment melanin
Stages of Pressure Ulcers
Stage1. Nonblanchable erythema of intact skin
Stage 2. Partial thickness skin lose involving epidermis or dermis
Stage 3.Full-thickness skin lose of the subcutaneous tissue that does not extend through fascia
Stage 4. Full thickness skin lose with damage to muscle, bone, or supporting structures
Keloids and which population it affects primarily
elevated, rounded, and firm; common in dark pigmented skin types and burn scars
Acetylcholine & its relation to pruritus
Acetylcholine is a peripheral itch mediator that relieves pruritus (itching)
most common skin inflammatory disease; inflamed follicle on faces, chest and upper back, shoulders; Acne conglobata=serve form-cystic
found in young adults during winter months; viral cause; circular, salmon pink lesion usually on the trunk area
Urticarial lesions and what causes them
C/B hypersensitivity reactions to allergens and physical causes such as cold and heat; Drugs, PCN, ASA; strawberries and shellfish; histamine release causes endothelial cells of skin blood vessels to contract; Causes leakage from vessels as wheal, welts, hives; may be few or entire body
Shingles; latent-lays in the trigeminal or dorsal root ganglia; pain and parasthesia; follows a dermatone( the cutaneous area served by a single spinal nerve); 20% post herpetic neuralgia
normally found on the skin, GI tract, and vagina; can change to pathogen status
can progress from skin to internal organs; deposits of collagen, inflammation, vascular changes, fiboris & capillary dilation;skin hard. taut and tightly connected to underlying tissue; tapered & flexed fingers, nails and finger atrophy; 50% of patients die within 5 yrs
moles; form from malanocytes; predispose to melanoma
Basal Cell cancer
most common; generally do not invade or lymph; depressed centers & rolled borders, UV light and skin exposed at risk; arsenic, genetic factors, and alterations in tumor suppressor genes
Tumor of the epidermis, in situ & invasive, more malignant if left untreated; sunlight (UV) exposure; 10% other than common areas, arsenic, X-rays, tumor suppressor genes
Cutaneous; malignant tumor of skin originating from the melanocytes; genetic predisposition, solar radiation, sunlight is a promotional factor; suspicious mole; ABCDE rule
Vascular malignancy associated with immune deficiency states; transplant patients taking immune rejection drugs; rapid progression w/ AIDS; common in Mediterranean decent, Jewish decent, and African men near equator
Rare, autoimmune blistering disease-skin and oral MM, IgG autoantibodies attack cell surface adhesion molecule in epidermis-destroys cell to cell adhesion; most common type is Pemphigus Vulgaris
involves only epidermis, sunburns, causes blisters~24 hours after
Second degree-superficial to deep Partial thickness
Superficial invokes: partial dermis; fluid filled blisters within minutes, nerve endings exposed; extreme pain
Deep involves: entire dermis; spares glands and follicles, look waxy, pale appearance and minimal exudate, may require surgery
Third Degree-Full Thickness
destruction of all three skin layers and subcutaneous areas; dry, leathery appearance, painless, nerves destroyed, escharotomies
loss of hair (especially on the head) or loss of wool or feathers
Also referred to as tumor; new growth
grow slowly; well-defined capsule; not invasive; well differentiated; low mitotic index; do not metastasize(spread)
grow rapidly; not encapsulated; invasive; poorly differentiated; high mitotic index; can spread distantly( metastasis)
malignant tumor that occurs in epithelial tissue
malignant tumor of connective tissue
malignant epithelial tumors
cancers of lymphatic tissue
substances produced by cancer cells or that are found on the plasma cell membranes, in the blood, CSF, or urine; hormones, enzymes, genes, antigens, antibodies; they are used to identify individuals at high risk for cancer, diagnose specific types of cancer; Downfall-false positives and negatives
viruses and cancer
Hepatitis B and C; Epstein-Barr virus(EBV); Kaposi sacroma herpesvirus(KSHV); Human papillomavirus (HPV)
bacterial causes of cancer
Helicobacter pylori; chronic infections are associated with peptic ulcer disease, stomach carcinoma, mucosa-associated lymphoid tissue lymphomas
4 Steps of Staging
Stage 1-No metastasis
Stage 2- Local invasion
Stage 3-Spread to regional structures
Stage 4-Distant metastasis
Environmental Risk: Tobacco
Multipotent carcinogenic mixture
Linked to cancers of the lung, lower urinary tract, upper aerodigestive tract, liver, kidney, pancreas, cervix uterus
Linked to myeloid leukemia
Secondhand smoke (ETS) contains many toxic chemicals
Cigar and pipe smoking equally harmful
Cigarette smoking is carcinogenic and remains the most important cause of cancer
Environmental Risk: UV radiation
Causes basal cell carcinoma, squamous cell carcinoma, and melanoma (increased incidence )
Principal source is sunlight
Ultraviolet A (UVA) and ultraviolet B (UVB)
Released TNF in epidermis
Promotes skin inflammation and release of free radicals
Environmental Risk: Alcohol Consumption
Risk factor for oral cavity, pharynx, hypopharynx, larynx, esophagus, and liver cancers
Substantial alcohol consumption (i.e., three or more drinks per day) has been associated with head and neck cancers
Environmental Risk:Physical activity
Reduces cancer risk (breast, colon, other)
Decreases insulin and insulin-like growth factors
Decreases inflammatory mediators and free radicals
Increases gut motility
Environmental Risk: Chemicals and occupational hazards
Upper respiratory passages, lung, bladder, peritoneum
Substantial number of occupational carcinogenic agents:
Asbestos (mesothelioma and lung cancer )
Dyes, rubber, paint, explosives, rubber cement, heavy metals, air pollution, etc.
Origination of cancers in children
Most originate from the mesodermal germ layer
Layer gives rise to connective tissue, bone, cartilage, muscle, blood, blood vessels, gonads, kidneys, and the lymphatic system
Most common malignancy in children
Children with Down syndrome have a 10 to 20 times greater risk for developing
malignant tumor of the kidney occurring in childhood
malignant tumor containing embryonic nerve cells
malignant ocular tumor of retinal cells
Muscle cells can generate forces that produce motion
The chief function of nerve cells. Conduction as a response to a stimulus is manifested by a wave of excitation, an electrical potential that passes along the surgace of the cell to reach its other parts
All cells can take in and use nutrients and other substances from their surroundings
Certain cells, such as mucous gland cells, can synthesize new substances from substances they absorb and then secrete the new substances to serve as needed elsewhere
All cells can rid themselves of waste products resulting from the metabolic breakdown of nutrients. Membrane-bound sacs (lysosomes) within cells contain enzymes that break down, or digest, large molecules, turning them into waste products that are released from the cell
Cells absorb oxygen, which is used to transform nutrients into energy in the form of ATP. Cellular respiration, or oxidation, occurs in organelles called mitochondria
Tissue growth occurs as cells enlarge and reproduce themselves. Even without growth, tissue maintenance require that new cells be producted to replace cells that are lost normally through cellular death. Not all cells are capable to of continuous division
Communication is vital for cells to sruvive as a society of cells. Appropriate communication allows the maintenance of a dynamic steady state
Cells in direct physical contact with neighboring cells are often interconnected at specialized plasma membranes regoins called cell junctions
Clusters of communicating tunnels or connexons (joining proteins that extend outward from each of the adjacent plasma membranes) that allow small ions and molecules to pass directly from inside of one cell to the insside of another cell
Role of ATP
The energy stored in ATP can be used in various energy-requiring reactions and in the process is generally converted to adenosine diphosphate (ADP) and inorganic phosphate (Pi). The energy available as a result of this reaction is about 7kcal/mol (kilocalories/mole). The cell uses ATP for muscle contraction and active transport of molecules across cell membranes. ATP not only stores energy but also transfers it from one molecule to another
Functions of ATP
What are the 3 phases of catabolism?
Digestion, Glycolysis and Oxidation, Citric acid cycle (Kreb's cycle, tricarboxylic acid cycle)
Large molecules are broken down into smaller subunits: proteins into amino acids, polysaccharides into simple sugar like monosaccharides, and fats into fatty acids and glycerol. These processes occur outside the cell and are activated by secreted enzymes.
Glycolysis and Oxidation
The most important part of phase 2 is glycolysis, the splitting of glucose. Glycolysis produces two molecules of ATP per glucose molecule through oxidation, or the removal and transfer of a pair of electrons. The total process is called oxidative cellular metabolism and involves nine biochemical reactions.
Citric acid cycle (Krebs cycle, tricarboxylic acid cycle)
Most of the ATP is generated during this final phase. It begins with the citric acid cycle and ends with oxidative phosphorylation. About two thirds of the total oxidation of carbon compounds in most cells is accomplished during this phase. The major end products are carbon dioxide and two dinucleotides, reduced nicotinamide adenine dinucleotide (NADH) and the reduced form of flavin adenine dinucleotide (FADH2), that transfer their electrons into the electron-transport chain.
The movement of a solute molecule from an area of greater solute concentration to an area of lesser solute concentration. If the concentration of particles in one part of the solution is greater than that in another part, the particles distribute themselves evenly throughout the solution.
The movement of water "down" a concentration gradient- that is, across a semipermeable membrane from a region of higher water concentration to one of lower concentration. For osmosis to occur, 1) the membrane must be more permeable to water than to solutes and 2) the concentration of solutes on one side of the membrane must be greater than that on the other side so that water moves easily. Osmosis is directed related to both hydrostatic pressure and solute concentration but not to particle size or weight. For example, particles of the plasma protein albumin are small but are more concentrated in body fluids than the larger and heavier particles of globulin. Therefore albumin exerts a greater osmotic force than does globulin.
The mechanical force of water pushing against cellular membranes. In the vascular system, hydrostatic pressure is the blood pressure generated in vessels when the heart contracts.
The protein transporter moves molecules against, or up, the concentration gradient. Requires the expenditure of energy. Many, but not all, active mediated transport systems, or pumps, have ATP as their primary energy source. Some use the electrochemical gradient of Na+ across the membrane (Figure 1-22). Energy in the form of ATP, however, is required for activation of the Na+ gradient (Box 1-1). MORE ON PP. 18
How many strands are in DNA
DNA is double stranded
What are the components of DNA?
What are nitrogenous bases?
Four total and are known as the complemental base pairing which include Adenine (A), Thymine (T), cystine(c), guanine(G) which make up the ladder rungs that become the codes read by the cells, known as genes.
How many amino acids are made up from the four nitrogenous bases?
Which nitrogenous bases are single carbon rings?
Cytosine and Thymine are single carbon rings
What are nitrogenous bases with single carbon rings called?
Which nitrogenous bases are double carbon-nitrogen rings?
Adenine and Guanine
What are nitrogenous bases with double carbon-nitrogen rings called?
What diests the synthesis of all the body's proteins?
How many strands are in RNA?
RNA is single stranded
What are the components of RNA?
What are the RNA nitrogenous bases?
adenine(A), cytosine (c), guanine (G) and uracil (u)
What does uracil pair with?
What does RNA do?
Forms subsequent proteins through process of transcription and translation
Responsible for certain biologic reactions and protein syntehsis
What is mRNA?
RNA carrying genetic code to build proteins at the ribosomes
RNA is synthesized from a DNA template which forms the mRNA. This occurs due to the DNA inside the cell being too large to pass through to the cytoplasm on its own. The RNA polymerase will bind to promoter sites which will be the start of a DNA gene. Once the RNA has separated a small amount of the DNA strand will provide a template for the sequences of mRNA nucleotides to begin and essentially "copies or transcribes" the information.
RNA directs the synthesis of a polypeptide, interacting with transfer RNA (tRNA). It takes place outside the cell to the ribosome and will be "translates" by the ribosomes into an (protein) amino acid sequence which will link to form a new chain.
What video is helpful to drive home transcription and translation?
It is one of the Aneuploidy cells (an abnormal number of chromosomes). This contains 3 copies of the chromosomes, making it "trisomic". It effects the 21st chromosome and is the best known example of aneuploidy
What is the frequency of down syndrome
1:800 live births
What is a factor that will increase risk for down syndrome?
Maternal age >35
What are the characteristics of down syndrome?
Mental retardation (IQ of 20-70), males are sterile, low nasal bridge, epicanthal folds, protruding tongue, poor muscle tone (aka hypotonia), and a short stature
Affects only females, presence of a single X chromosome (a condition known as homologous) which is a chromosome abnormality occurs during pregnancy. (pic on page 44)
What are the characteristics of turner syndrome?
Sterility due to the absence of ovaries,
Short stature (~ 4'7")
Widely spaced nipples / underdeveloped breasts,
High number of aborted fetuses (in those females who MAY have ovaries)
75% inherit the X chromosome from the mother. (not considered a condition that causes mental disorders).
Usually affects men, a disorder in which an individual has at least two X chromosomes and one Y. (some may have XXY, or XXXY and abnormalities increase with each additional X). (pic on page 45)
Characteristics of Klinefelter syndrome
Male like appearance
Development of female-like breast
Sparse body hair
Other female like characteristics (not so deep voice, lack of facial hair etc.)
An autosomal recessive genetic disorder of the exocrine glands. Caused by a mutation in the CF transmembrane regulator gene that causes impairment in chloride transfers across cell membranes and subsequent chloride and water accumulation in the organs, especially the lungs.
Characteristics of Cystic Fibrosis
A thick mucus buildup /secretion that blocks ducts and forms cysts
What is the nursing priority for patients with cystic fibrosis?
Suction and oxygen
What do patients with cystic fibrosis usually have eposides of?
Other respiratory issues
When is screening normally done for cystic fibrosis?
Muscular Dystrophy (Duchenne)
Affect Males, common X-Linked recessive genetic disorder in which fat and fibrous tissue infiltrate and weaken muscle tissue in the legs, pelvis, lungs, and heart (the voluntary muscles).
Progresses over time and eventually causes total function loss
What is the only method of preventing muscular dystrophy?
There is no known cure can only be prevented through sex control
X-Linked Recessive disease (Page 47-50)
Causes a disease in a male because of only one X chromosome. The Y will not have or carry the normal allele to counteract the effects of the disease. Males are known to be hemizygous for genes on this particular chromosome.
Autosomal dominant disease
Are rare diseases occurring fewer than 1:500 individuals p.47
When it is dominant, the parent will actively have it
Two sexes exhibit the trait in approximately equal proportions and males and females are equally likely to transmit to kids
No generations are skipped; if one individual has the trait a parent must also have it and vice versa if they do not have it, then parents also do not carry it.
Affected heterozygous individuals transmit the trait to half their kids
What is the most common autosomal dominant disease?
It is a neurologic disorder whose main features are progressive dementia and uncontrollable limb movement. It has a delayed onset and not seen until ~ the age of 40+
Autosomal recessive disease
Also a rare condition but there can be several individuals whom are carriers. Cystic fibrosis is the most common lethal recessive disease (seen in Caucasian kids) occurs in about 1:2500 births.
Death occur before the age of 40
Males and females are equally affected
Consanguinity (marriage between relatives) will usually be present in offspring
1/4 of the offspring of carrier parents will be affected
Usually both parents are heterozygous carriers when this occurs
a decrease or shrinkage in cellular size
What does atrophy cause?
Age, immobility, and decreased protein synthesis.
What causes atrophy?
Ischemia, nerve damage, normal aging, disuse, hormones
Increase in cell or organ size. Stretch/growth.
"Loss of one kidney will cause the other kidney to increase in size and cell numbers to compensate for the organ lost" is an example of?
What does hypertrophy affect?
Muscles, sex organs, heart, and brain
Loss of structural differentiation within a cell or groups of cells; its cancerous cells.
Reversible replacement of one mature cell type by another
New cells less differentiated
"Prolonged smoking: Bronchial epithelial cells replaced by squamous cells " is an example of?
Is the metaplasia from prolonged smoking reversible?
YES!!! QUIT SMOKING PEOPLE
Are the cells from metaplasia cancerous?
Not always, but they are abnormal cells
changes in size, shape, organization of the cells (ie: cervical) cells response to infection & inflammation (atypical hyperplasia)
Are the mild and morderate dysplasia's reversible?
Cervial and repiratory epithelial dysplasia is strongly associated to:
an increase in the number of cells resulting from an increased rate of cellular division
cell division= response to tissue loss
hormone-responsive cells (breast, uterus, & prostate)
tissue injury or excessive hormonal stimulation (ie: can affect menstrual flow due to great surge of estrogen causing excessive bleeding)
a lack of sufficient oxygen, strong association with heart attack patient due to Ischemia or Anoxia. Single most common cause of cellular injury
Reduced blood supply
Total lack of oxygen
What are the cellular responses to being hypoxic?
Decrease in ATP, causing failure of Na -K pump & Na-Ca exchange. Cellular swelling. Vacuolation.
Formation of vacuoles
results from the generation of highly reactive oxygen intermediates (oxygen stress)
______ is a contributing factor to aging, Parkinson's, and Alzheimers
Electrically uncharged atoms that damage and alter: lipids, proteins, DNA, mitochondria
What injuries can be cause by Sharps?
Incised, stab, puncture, chopping
Blunt force injuries
Application of mechanical energy to the body
What are examples of blunt force injuries?
Contusion (bruise) vs. hematoma
Contact range entrance wound - Imprint is noticeable; gun to skin contact. Gun is held so muzzle rests on or presses into skin surface. Cause severe tearing and disruption of tissue. Wound is gaping and jagged, known as blow back.
caused by a failure of cells to receive or use oxygen
What regions of the body are affected most by asphyxial?
Kidneys, heart, and adrenal gland are the ones affected, especially due to alcohol.
Suffocation, choking asphyxiation, strangulation (hanging, ligature, manual), drowning, chemical asphyxiants (CO2), are examples of:
The most common asphyxial is
chemical asphyxiants (CO2)
Pathogenicity of a microorganism
What are the 3 disease-producing potentials of infectious injuries?
Invasion and destruction (clostridium)
Production of hypersensitivity reactions
Increased capillary permeability (direct injury/ release of free radicals)
What do chemical injuries cause?
Chronic ETOH-liver inflammation, fatty liver, hepatitis, cirrhosis
Oxidative stress-cell membrane phospholipid depletion
What are examples of chemical injuries?
Carbon tetrachloride, Lead, Carbon monoxide, Ethanol, Mercury
Social &street drugs
Histamine, antibodies, lymphokines, complement, and proteases are examples of:
Immune and inflammatory substances
What do Immune and inflammatory substances do?
Cellular accumulations (infiltrations) (Water, Lipids and carbohydrates, Glycogen, Proteins)
Due to edema or water
Bleeding into skin or underlying tissues
What is the bruising progression?
Bruising ->Extravasated red cells ->phagocytosis of red cells by macrophages->hemosiderin & iron free pigments
What is the color progression of bruising?
Purple to blue to green to yellow
ENTER SOMETHING HERE
Cell Death of a certain area (ie: hand or foot) Sum of cellular changes after local cell death & the process of cellular autodigestion
What happens to ATP production during necrosis?
ATP production decreases
Usually due to infarction or chemical injury (Alcohol)
Causes protein denaturation
What glands of the body does Coagulation necrosis affect?
Affects kidneys, heart, and adrenal glands
Infarction or infection
Neurons and glial cells (brain)
Bacterial infection (Staphylococci, streptococci, and Escherichia coli)
Related to Respiratory Infection
Tuberculosis pulmonary infection
Combination of coagulative and liquefactive necrosis
Breast, pancreas, and other abdominal organs
Action of lipases
Death of tissue from severe hypoxic injury
Dry vs. wet gangrene
Gas gangrene (Clostridium)
programmed cellular death
death of the entire person
Occur 6-14hrs after death, body shiftiness
How are body fluid distributed?
among functional compartments or spaces
What are the function of body fluids?
Provide a transport medium for cellular and tissue function
Total Body Water (TBW)
About 60% of body weight in adults
What is the total volume of bodty water for a 70kg person?
About 42 liters
The 60-40-20 Rule
60 % of body weight is water
40% of body weight is intracellular fluids
20% of body weight is extracellular fluid
Intracellular fluid (ICF)
40% fluid inside the cell, about 2/3 TBW (~25 L)
Extracellular fluid (ECF)
fluid outside the cell; 1/3 of TBW (~15 L); 20% of body weight divided into interstitial fluid and intravascular
The space between cells and outside the blood vessels (15%)
BLOOD plasma (5%)
Lymph and transcellular fluids, such as synovial, intestinal and cerebrospinal fluid; sweat; urine; and pleural, peritoneal, pericardial, and intraocular fluids (~1-2 L) are examples of:
What does aging do to the distribution of fluid?
Decreased percent of total body water
Increase adipose and decrease muscle mass
Diminished thirst perception
Name the 3 ways water moves between ICF and ECF
Net filtration (Difference between the oncotic and hydrostatic pressures at vascular bed)
What is responsible for the ECF osmotic balance?
What is responsible for the ICF osmotic balance?
Patients with what conditions have edema?
Kidney diseases and heart related problems
Causes of Edema
Accumulation of fluid within the interstitial spaces
Increase in capillary hydrostatic pressure
Decrease in plasma oncotic (or osmotic) pressure
Increases in capillary permeability
Lymph obstruction or leakage
There is water and sodium* (they work hand in hand)
What causes the secretion of ADH
fear, pain, or acute infections
anesthetics or analgesics (morphine or Demerol)
acute stress (such as trauma or a major operation)
What are the 3 steps of dehydration? (p104 figure 4.7)
Loss of fluid and electrolytes is balanced. Most of the loss is sustained by ECF compartment (most common type of dehydration)
deficit of fluid greater than the deficit of electrolytes. fluid shifts out of the ICF -> ECF space (cell shrinks) but neurologic disturbance become evident (Hallucination)
Electrolyte deficit is greater than fluid deficit. ECF -> ICF space (cell swells). ECF volume decreases. Severe with hypotonic dehydration
Normal Lab Value for Serum Osmolality
Normal Lab Value for Sodium
Normal Lab Value for Hemoglobin
Normal Lab Value for Hematocrit
Normal Lab Value for Space Gravity
Normal Lab Value for Potassium
3.5 - 5.5
Extracellular cation; Regulates osmatic forces; normal range 135-145 mEq/L
Intracellular cation; Regulates ICF volume; normal range 3.5 - 5.5
the concentrations of non-carbonic acids increase or bicarbonate is lost from ECF or cannot be regenerated by the kidney
Metabolic Acidosis Occurence
Quickly in lactic acidosis caused by poor perfusion or hypoxemia
Slowly over extended time, as in renal failure or diabetic ketoacidosis
Excessive loss of metabolic acids occur, bicarbonate concentration increases. Acid loss is caused by vomiting; renal compensation is not very effective.
Metabolic alkalosis Signs and Symptoms
Hypernatremia Normal Range
Excessive amounts of sodium in the blood (Serum sodium more than 147 mEq/L)
Related to sodium gain or water loss
Water movement from ICF -> ECF (Intracellular dehydration)
What are the clinical signs and symptoms of Hypernatremia?
abnormally low level of sodium in the blood (Serum sodium level less than 135 mEq/L)
Sodium deficits cause decreased plasma concentration and cellular swelling
a serum sodium that is low not because of an absolute lack of sodium but because of an excess of water
What are the signs and symptoms of hyponatremia?
Neurologic changes, lethargy, confusion, apprehension, depressed reflexes, seizures, and coma.
higher than normal levels of potassium in the circulating blood (elevation of ECF potassium concentration above 5.5 mEq/L)
What are the signs and symptoms of hyperkalemia?
Increased neuromuscular irritability (Tingling of lips and fingers, restlessness, intestinal cramping, & diarrhea)
Cause serious cardiac dysrhythmias, may progress to cardiac arrest; death
What does hyperkalemia do to cells?
Causes them to be unable to repolarize, resulting in muscle weakness, loss or muscle tone, flaccid paralysis
What causes hyperkalemia?
Use of "potassium-sparing" diuretic drugs
Leakage of IC K+ into the ECF in patients with tissue damage
Displacement of K+ prolonged or severe acidosis
low levels of potassium in the blood (potassium level falls below 3.5 mEq/L)
Diuresis with certain diuretics
Fatigue and muscle weakness
Paresthesias - numbness
Anorexia & Nausea
Increased urine output
Renal Water Loss
Most common cause of pure water deficit (water loss aka hypertonic dehydration)
Impaired tubular function or the inability to urine, occurs in diabetes insipidus.
What makes up the buffering system pair?
Respiratory; lower number mean higher pH
Metabolic matches the pH
In the hospital what indicates the patient has a fluid overload
The high bmp level on the monitor
What organ deals with anything metabolic?
What is the range of the acid and base scale?
What is number is neutral on the acid base scale? What is an example of a neutral fluid?
7, Pure Water
What is the normal body pH?
Between 7.35 - 7.45
If H+ are high in number, then pH is
What does decreased pH do to the central nervous system
What can H+ high in number do to a patient?
It can lead to loss of consciousness
If H+ are low in number, then pH is
What will increased pH do to a patient?
It can cause over-excitability
Tingling sensations, nervousness, muscle twitches
How is pH measured?
Arterial blood gas
What is a base?
It is a molecule that can accept or combine with a hydrogen ion (H+)
More (OH-) in the fluid
What effect do bases have on acids?
Bases ACCEPT, COMBINE & NEUTRALIZE acids
What processes result in bases?
Result of metabolic processes=bicarbonate
Bicarbonate also transported in form of C02 in body
Kidneys manufacture and regulate bicarbonate
What are examples of bases?
What is an acid?
Molecule that can RELEASE a hydrogen ion (H+)
Result of metabolic processes/ byproducts
What is carbonic acid (H2CO3)
A weak acid
Carbonic acid buffer system
Eliminated by the lungs/ respiratory system
How are metabolic acids derived?
dietary proteins (amino acids), fats, and glucose
Ex: sulfuric acid
How are metabolic acids eliminated?
not eliminated by lungs
buffered by proteins, bicarbonate
less than 7.35; hypoventilation; Need to get rid of PCO2
What are the symptoms of respiratory acidosis?
Restlessness, apprehension, lethargy, disorientation, muscle twitching, tremors, convulsions, coma
Headaches, sleepiness, confusion, muscular weakness, seizures, increased heart rate, coughing and SOB (shortness of breath)
What are the causes of respiratory acidosis
Decreased ventilation (inadequate respirations) caused by overdose of sedatives
Disease of the central nervous system
Weakness of respiratory muscles
Obstruction of the airway
What are the primary changes of respiratory acidosis?
HCO3 NO CHANGE
Greater than 7.45; Hyperventilation; Need more PCO2
What is the cause of respiratory alkalosis?
Hypoxemia from pulmonary disease, heart failure or high altitude
Hyperventilation from fear, pain, anxiety
Hypermetabolic states (fever, anemia, thyrotoxicosis)
What are the signs and symptoms for respiratory alkalosis?
Dizziness, parestesias, Muscle spasms, seizures, coma
What are the primary changes of respiratory alkalosis?
HCO3 NO CHANGE
Infectious Mono (kissing disease)
Acute, self-limiting infection of B lymphocytes transmitted by saliva through personal contact
granular white blood cells that attack parasites and also help to control and limit the inflammatory response.
Swelling of one or more lymph nodes because of bacterial or viral infection, Hodgkin lymphoma, non-Hodgkin lymphoma, or unknown causes.
The most abundant type of white blood cell. Neutrophils are phagocytic and tend to self-destruct as they destroy foreign invaders, limiting their life span to a few days.
a blood disease characterized by an abnormally small number of platelets in the blood
tiny, disk-shaped bodies in the blood, important in blood clot formation
an agranular leukocyte that is able to migrate into tissues and transform into a macrophage
White blood cells with irregularly shaped, multilobed nuclei and cytoplasmic granules. There are three types of granulocyte: neutrophils, eosinophils, and basophils. They are also known as polymorphonuclear leukocytes.
the two types of white blood cells that are part of the body's immune system: B lymphocytes form in the bone marrow and release antibodies that fight bacterial infections; T lymphocytes form in the thymus and other lymphatic tissue and attack cancer cells, viruses, and foreign substances.
a disorder characterized by an abnormal increase in the number of red blood cells in the blood
Blood cells that enter damaged tissues and enhance the inflammation process and contain histamine and heparin
Characterized by red cells that are relatively normal in size and hemoglobin content but insufficient in number
form of anemia due to hemolysis, the abnormal breakdown of red blood cells (RBCs), either in the blood vessels (intravascular hemolysis) or elsewhere in the human body (extravascular)
Acute blood loss from the vascular space
Anemia of chronic disease
form of anemia seen in chronic illness; seen in patients w/ AIDS, hepatitis, lupus, renal failure
Sickle cell anemia
an autosomal recessive disorder characterized by RBCs that assume an abnormal, rigid, sickle shape
large, normal color cells. vitamin b12 or folic acid deficiency
progressive anemia that results from a lack of intrinsic factor essential for the absorption of vitamin B12
Folate deficiency anemia
Absorption of folate occurs in the upper small intestine; Not dependent on any enzyme or other facilitating factor; Folic acid is stored in the liver; It is essential for RNA and DNA synthesis within erythrocytes; Similar symptoms to pernicious anemia except neurologic manifestations are generally not seen; Treatment requires daily oral administration of folate
anemia characterized by small, pale red blood cells that lack adequate hemoglobin to carry oxygen; can be caused by deficiency of iron or vitamin B6
Iron deficiency anemia
a form of anemia due to lack of iron in the diet or to iron loss as a result of chronic bleeding
Malignant transformation of a lymphocyte and proliferation of lymphocytes, histiocytes, their precursors, and derivatives in lymphoid tissues;
Two major categories: Hodgkin lymphoma, Non-Hodgkin lymphoma
Characterized by the presence of Reed-Sternberg cells in the lymph nodes
Non-Hodgkin lymphomas are linked to chromosome translocations, viral and bacterial infections, environmental agents, immunodeficiencies, and autoimmune disorders
Presence of undifferentiated or immature cells, usually blast cells
leukemia characterized by enlargement of lymphoid tissues and lymphocytic cells in the circulating blood
Leukemia affecting the bone marrow