N461 Final Exam Study guide 1

UHM N461-Pathophysiology and Neuro

FINAL EXAM STUDY GUIDE

(Spring 2017)

The final exam will be on Tuesday, May 09, 2016 at 4:15 PM. You can expect to take
your exam via ExamSoft. Please arrive early (10 minutes or more prior to 415PM). Be
ready to take exam promptly at 415 PM. (Ready means that you have gone to the
restroom, turned your cell phone off, placed your belongings to the front of the class, and
that you are seated with your fully charged laptop and have exam ready to take on your
screen.). Late comers will not be given additional test time. Please refer to course
syllabus_ Accommodations for examinations section listed under course expectations.

Exam will be available to download late evening on Monday, May 08th.

The examination will be composed of multiple-choice (brief-case-based scenario type,

similar to your cardiac quiz with some basic knowledge) questions totaling 100 points.
Expect approximately 70-75 questions. Questions will come from the lecture notes
(PowerPoints) and additional materials specified; use the objectives listed below as your
study guide. Be sure to UNDERSTAND the notes for each objective. Questions are
straightforward but you will be required to think. Whatever you dont understand from
the lecture notes, use the book to help you. Exam is timed; you will have 1.5 minutes per
question. Late comers will not be given additional test time: Please see syllabus for
additional expectations pertaining to testing.

Review the following study objectives under each listed organ system:

(2 questions) INFLAMMATION & (1 question) STRESS

2. Discuss the sequence of events that occur in an acute inflammatory response in the
areas of:

a. Vascular response
b. Cellular response;

3. Discuss the microscopic findings in inflammation and relate those to the macroscopic
manifestations of an inflammatory response;

4. Describe the role of the mast cell in the activation of inflammation;

6. Discuss each of the cell types involved in the inflammation response by role and
relative importance to the process (for example, macrophage, neutrophil, mast cell);
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10. Discuss the physiological basis of the stress response; the systems/organs involved,
the substances released, and their subsequent actions in the body (see illustrations
included in slide set): In other words: Know signs and symptoms of the effect of the
following substances: NE, E, GLUCOSE, CORTISOL, ADH, & ALDOSTERONE on the
body

(4) ENDO
5. Discuss the pathoschematic (causes, pathophysiology, signs & symptoms) of Graves
disease;

6. Discuss the pathoschematic (causes, pathophysiology, signs & symptoms) of

hypothyroidism;

17. Identify the normal function of the islets of Langerhans in the pancreas and the action
of the hormones insulin and glucagon;

18. Discuss the similarities and differences between the two types of diabetes mellitus
(DM) type 1 and 2;

19. Discuss the pathophysiologic mechanisms and major clinical signs and symptoms and
laboratory findings expected in a person with diabetes mellitus (KNOW about TYPE
1 & TYPE 2); and

20. What are the signs and symptoms of hypoglycemia?

(4) CARDIAC
3. The vessel changes that occur in atherosclerosis;

7. The pathology involved in thrombus and embolus formation;

12. The pathogenesis and clinical manifestations (signs and symptoms) of coronary artery

disease, chronic ischemic heart disease (partial blockage of blood flow to heart), and

acute coronary syndromes (partial or complete blockage of blood flow to heart); also,

know med management/treatment of angina and MI (just know whats listed on slide

and no more).
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13. The pathophysiologic mechanisms involved in heart failure (to include compensatory

mechanisms);

14. The clinical manifestations of the various types of heart failure (as delineated in

lecture notes (i.e., left versus right)

Fluid & electrolytes (1)

3. Know the causation, pathophysiologic process, and clinical manifestations of sodium,
potassium, and calcium imbalances Know the causes of hyperkalemia. What effect does
hyperkalemia have on the heart? Note: Hypokalemia also affects heart but will not test on
hypokalemia.

(4) RESP
5. The etiology, pathogenesis, and clinical manifestations of the following condition:

b. Pneumonia;

6. The comparisons and contrasts in the etiology, pathophysiology, and clinical

manifestations of the obstructive pulmonary diseases (asthma, chronic bronchitis,
emphysema); and

(2) GI
6. Study the clinical manifestations and pathophysiologic rationale for GERD

9. Know the major complications of liver dysfunction, liver failure: portal hypertension,
ascites, hepatic encephalopathy, jaundice. (i.e., Review slide labeled Dysfunctions seen
due to lack of normal functions in GI set; you can skip the parts about estrogen and MSH
levels. Also, review slides thats labeled In a nut-shell: Liver failure. Skip the special
considerations part)
(1) MS

4. Describe the etiology, pathophysiology and clinical manifestations of osteoporosis as

an example of a metabolic bone disease;

(5) Renal
5. Understand the pathophysiology and signs and symptoms of lower urinary tract
infections (cystitis). Be aware of clinical manifestations in older adults;
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8. Discuss the clinical manifestations (including laboratory, urinalysis, and EKG

findings), treatment, special considerations, age and clinical alerts, and complications of
acute renal failure (acute kidney injury); and

9. Explain the cellular abnormalities and resultant multiple system manifestations of

chronic renal failure (chronic kidney disease); include laboratory, urinalysis, and EEG
findings; treatment, special considerations. In other words, be able to explain the
systemic effects of kidney disease and uremia.

(2) CANCER and HEME

3. Describe the multistep theory of cancer development;

12. For leukemia, just know the basic patho and symptoms. Understand how the
symptoms relate to the patho

(27) Approx total from aforementioned headings

NEURO & NEUROBIOLOGY

20 Neuro, Neuropsy 28 (please note: for neuropsy, I will focus your attention in lecture
on what you need to know as nurses. In addition to that, Ive added additional notes under
headings [in this studyguide] to clarify the specifics of what you need to know)

1. Have a general knowledge of the areas of the brain emphasized as being pertinent to
the topics covered (e.g., stroke);

2. Know the causes & pathophysiology of cerebral edema and know examples of the
pathophysiology producing each;

3. Pertaining to increased intracranial pressure:

a. Know the compensatory mechanisms used to prevent large changes in
intracranial pressure (ICP)
b. Know the different causes for development of increased ICP
c. Discuss nursing assessment and management of increased ICP
d. Know the mechanisms and manifestations of herniation syndromes under:
supratentorial;

4. Pertaining to the pathophysiology of head injury:

a. Be able to differentiate between epidural hematoma, subdural hematoma, and
intracerebral hematoma
b. Know the effects of coup and contrecoup injuries
c. Know the clinical manifestations of concussion, contusion, and focal vs. diffuse
axonal injuries (DAI);
d. Discuss treatment options and special considerations for brain injury;
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5. Regarding the pathophysiology of seizures:

a. Know the causes of seizures (be familiar, but keep in mind that anyone can
have a seizure)
b. Know the differences between clonic and tonic as they relate to seizure activity
c. Be able to compare the manifestations of the different types of seizures (know
the difference between partial (focal) and generalized; you do not need to focus on
types of partial seizures for exam_ you can save that info to review later/as you
move through your other courses);
6. Know the pathophysiologic events that occur with the different types of spinal cord
injuries:

a. Understand the pathophysiologic events that occur with autonomic dysreflexia;

7. Know & understand the risk factors, pathophysiology, clinical manifestations,

complications, management, and special considerations for strokes caused by:
thrombosis, embolism and intracranial hemorrhage. (Note: The risk factors and clinical
manifestations to keep in mind will be emphasized class);

8. Know the pathogenesis, signs and symptoms, complications, treatment, special

considerations, clinical alert of the following infectious processes occurring in the CNS
(Meningitis_ bacterial and viral);

9. Describe the causes, pathophysiology, clinical manifestations, complications,

management, and special considerations of Alzheimers disease;
10. Know the etiology, pathogenesis, clinical manifestations, Parkinson disease and
hydrocephalus

13. Discuss the causes and neurobiology, clinical manifestations, pharmacologic and
nonpharmacologic management of the following psychotic illness:
a. Schizophrenia:
i. Please note the following regarding the pathology:
1. Whats important to know here is that Gamma-
aminobutyric acid (GABA) is a neurotransmitter thats
reduced in schizophrenia (In the dorsal prefrontal cortex of
schizophrenic brains, glutamic acid decarboxylase, the
major enzyme in GABA biosynthesis, is diminished, which
likely impairs synaptic performance and cognitive and
behavioral functions associated with this brain region).
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2. Be familiar with the neuroanatomic and associated

functional abnormalities pertaining to the thalamus and
temporal lobe
i. RE: medications: Neurotransmitter receptor thats blocked by
antipsychotic drugs is dopamine (The dopamine hypothesis
initially suggested that abnormal elevation in dopaminergic
transmission contributes to the onset of schizophrenia. This
hypothesis was based on pharmacologic studies showing that
antipsychotic drugs are potent blockers of brain dopamine
receptors)
b. Major depressive disorder (MDD):
i. Please note the following regarding the pathology:
1. Hypothalamic-pituitary-adrenal (HPA) system
abnormalities percentage of persons with MDD. Excessive
HPA activationelevated glucocorticoid secretion
(cortisol): contribute to the patho of depression (e.g.,
depressed persons continue to exhibit elevated plasma
cortisol levels throughout the evening and early morning
hours)
2. Excessive presynaptic uptake of serotonin or stress-
regulated downregulation of postsynaptic receptors low
levels of CNS serotonin-> depression

ii. Also, know the nursing concerns for patients hospitalized with
Major Depression; teaching implications for patients taking
antidepressants in general and those taking MAOIs. In addition:
know about ECT (nursing responsibilities during the procedure,
medications administered during procedure, therapeutic effect of
procedure, and side effects of procedure); understand purpose of
cognitive behavioral therapy with depressed clients
1. Therapeutic effect of ECT: acts like a Tricyclic
antidepressant (TCA) which acts on monoamine
systems which improves dopaminergic, serotonergic, and
adrenergic neurotransmission
2. ECT is used when individuals fail to respond to
antidepressants or when they are severely depressed,
pregnant, suicidal, or psychotic
3. Know the common side effects of SSRIs
4. Know reason patients are advised to restrict foods
containing tyramine when taking MAOIs)
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c. Bipolar disorders: re pharmacologic management, know about lithium

drug therapy
i. Key point to consider: Lithium is normally removed from the
kidneys; however, when the body is sodium depleted, the kidneys
reabsorb sodium along with lithium.
15. Discuss suicide prevention. Use the following link for assistance
http://www.integration.samhsa.gov/clinical-practice/suicide-prevention
Understand the nursing process in care of suicidal clients and risk factors for adult
patients who are suicidal
16. Discuss the etiology and neurobiology clinical manifestations and management of
nonpsychotic disorders: Panic disorder and generalized anxiety disorder (GAD).
a. Patho: Neurotransmitter inhibited in panic disorder and generalized anxiety
disorder: GABA
b. Treatment: Panic disorder and generalized anxiety disorder (GAD) can be
effectively treated with cognitive behavioral therapy