CLINICAL DECISION MAKING

SECTION 1: THE CELL

1-1 Discuss why proteins and lipids in plasma membranes are dynamic and asymmetrically
distributed.
They control the composition of the space. Membranes can stop or allow different types of molecules
to be transported. Their influence on metabolic pathways by controlling substance movement is very
strong. The membranes also have markers that identify the cell to other cells. Protein receptor cells
need their membrane to identify hormones and other types of chemical signals. They have excess
hydrophilic units at the surface and hydrophobic units inside. They both help cell to cell recognition
and carry out many different functions. The composition of plasma membranes are lipids and proteins,
it is the percentage of lipids and proteins that differentiate them from other cells.

1-2 Explain how cells are connected to form tissues and organs.
The cells are held together by plasma membranes. Extracellular matrix is a mesh of fibrous proteins
composed of a gel like substance made of carbohydrates. Collagen is what provides resistance for
longitudinal type stress. Elastin is like rubber where it can stretch and contract. Fibronectin allows the
cell to anchor and to glue to necessary components. There are adhesions from cell to cell that are
made by an extracellular matrix. Cell junctions also hold cells together. The junctions also allow small
molecules to pass from cell to cell allowing communication and coordination of specific activities. The
three junctions are desmosomes, tight junctions and gap junctions.

1-3 Why is cellular communication important to the survival of cells?

They need to communicate to maintain and specific and stable environment. To regulate growth and
development and to coordinate necessary functions. Organization is also a role of cells and
communication in necessary for this. There are three ways that cells communicate: gap junctions,
receptors and chemical signaling. Gap junctions are protein channels that coordinates cell function,
receptors display a plasma-membrane bound molecule and chemical signaling is for communication
with cells that are some distance away from each other. Without communication, cell would have to
work independently of each other and the complex processes cells do would not be possible.

1-5 Explain the difference between osmosis, osmolality and osmolarity.

Osmosis is the movement of water down a gradient. It moves down a semipermeable membrane from
a region of higher concentration to region of lower concentration. It is not affected by particle size or
weight. osmolality is the number of milliomoles per kilogram of water and osmolarity is the measure of
the number of milliomoles per liter. The change of the amount of water versus the amount of solute
affects the difference of osmolarity and osmolality. If the particles are greater than the amount of
water, the osmolality will be greater, if the water amount is higher than the particle amount, the
osmolarity will be greater.

2-1 Why are the neurons of the CNS one of the first tissues to demonstrate the effects of systemic
hypoxic conditions.
The neurons of the CNS are very active tissues and their needs of oxygen and glucose are very high. If
these needs are not met, systemic hypoxic conditions occur quickly. All of the body needs oxygen in
various amounts depending on the cells and their function at their time of oxygen need. The central
nervous system is always busy sending and receiving messages making the need for oxygen great all
the time. When oxygen or glucose needed is less than the amount sent, communication is disrupted to
all cells in the body. The CNS communicates with the whole body so disruption in the oxygen to the
CNS may show up all over the body but can be traced to the central nervous system.

2-2 Is a nutritional deficiency the only form of nutritional imbalance?

No, hyperglycemia and hyperlipidemia are an overabundance and not a nutritional deficiency.
Hyperglycemia is an overabundance of blood sugar in the body. Diabetes types I and II can cause this
imbalance. The body is not able to utilize the glucose due to lack of insulin or insulin resistance.
Hyperglycemia can also lead to obesity. Hyperlipidemia is an abundance of lipoproteins in the blood.
This causes fat deposits in the tissues of the heart, liver and muscle. Too much vitamin A can cause
lysis of the plasma membrane.

2-3 How does a medical laboratory practitioner provide laboratory evidence to a physician that
cellular injury is taking place?
Blood tests can be taken to determine that cells are leaking contents of themselves. For instance, a
troponin levels that are high in the blood indicate cell death in the tissue of the heart. Liver enzymes
also indicate injury or cell death. A lab tech can also make a microscopic slide of the affected tissue to
show the change or injury in cells. The slides can also be dyed to better visualize cell fragments or
certain types of tissue damage. A complete blood count can be done to assess any discrepancies of
changes in the blood which can also indicate cell death.

2-5 A male patient has been smoking on pack of cigarettes a day for 20 years. Describe the
possible cellular changes that have occurred in his bronchial linings that can make him more
prone to URI.
Smoke produces an irritating chemical injury to your lungs making your body produce more sputum.
Your lungs have to work harder due to injury. The excess mucus makes a great spot for bacteria and
viruses to hang out making you more prone to infection. Your membranes in your lungs thicken,
making them less efficient absorbing oxygen and shedding CO2. Tar builds up in your lungs covering
the lining and adding to the stress of the lungs. Since elasticity is lost from smoking your lungs
become even more inefficient. The more stress you put on your body the more likely you are to
develop infections.

3-1 The microscopic and chemical analysis of a urine sample demonstrates hematuria and a
specific gravity of 1.003. Predict the possible appearance of the red blood cells in the solution.
The urine will be cloudy and might have a red tinge to a totally red color. The color with this specific
gravity will more likely only be tinged red. The appearance of the blood cells may be whole or
fragmented depending on where their source is. Hematuria is bleeding anywhere long the urinary tract.
If the blood passes through any narrow opening or past stones, the blood cells can be fragmented. If
they travel directly to the bladder without passing any narrowing or rough area the cells can be whole.
Infection, kidney or bladder stones and trauma are all factors that cause hematuria. A history will have
to be taken to make a better guess as to the appearance of the blood cells.

3-5 A female has had a right foot infection for 2 months and has continuously had 3+ edema in
the area. Why do wounds heal slower when edema surrounds the area.
Edema is caused by the capillaries leaking lymph. The presence of lymph cuts down an blood flow to
the affected area and in turn slows healing. Water in the affected tissue is also a type of edema. Edema
is not in itself a disease, it is an underlying symptom to diseases such as kidney, heart and liver
problems. Blood flow brings nutrients and other things to all areas of the body. When there is edema
in an area, the blood flow is decreased. With less blood flow, the lack of nutrients and healing factors
like white blood cells slow down healing. The lowered blood flow slows down the removal of the
lymph and the water, causing a loner heal time.

3-6 A female has been diagnosed with hypernatremia. The nursing student assigned to her
believes is is because the female pt eats McDonald's French fries three times a week with extra
salt. How would you explain the disease process to the student.
I would first indicate that rarely is salt intake the reason for hypernatremia. I would tell the student that
not enough water intake and too much saline intake are more common for this problem. The possibility
of dehydration is the first problem that needs to be addressed with the patient. A history of possible
reasons need to be discussed with the patient. Has the patient been drinking enough water, has the
patient been urinating a lot? Is the patient having problems with diarrhea? Has the patient recently
been to the hospital and had saline given to her? Has the patient ingested a lot of seawater? I would
also recommend that the nursing student stay in school for a while longer.
3-7 What are the clinical manifestations associated with hypocalcemia.
Depolarization of nerves and muscles start occurring. The threshold potential approaches levels close
the resting membrane potential. The Chvostek and Trousseau signs appear. One is the twitch of a lip or
nose and the other is hand and finger contractions. There is a possibility of neuromuscular irritation.
The irritation can be minor mouth numbness, or severe, seizures. Anxiety and depression have been
know in patients with hypocalcemia. Surprisingly, severe cases can have no neurological symptoms at
all. Severe signs are convulsions and muscle spasms. There is also the probability of
hyperexcitability of peripheral neurons. Some patients are very irritable.