Study Topics for NURS 345 Exam #1

. Differentiate between the different types of Immunglobulins; IgG, IgA, IgM, IgE,
IgD and their primary function in the immune system.
Wk 2 Adaptive:
IgG: most abundant class of immunoglobulins, During pregnancy maternal IgG is
transported across the placenta and protects the newborn child during the first 6
months of life. Accounts for most of the protective activity against infections
Transported across the placenta

IgA: found in the blood and in bodily secretions, protect against degradation by
enzymes also found in secretions. primary role of IgA is to prevent the attachment
and invasion of pathogens through mucosal membranes, such as those of the
gastrointestinal, pulmonary, and genitourinary tracts.

IgM: largest immunoglobulin, first antibody produced during the initial, or primary,
response to antigens. IgM is usually synthesized early in neonatal life, but may be
increased as a response to infection in utero.

IgD: low concentrations in the blood. Its primary function is as an antigen receptor
on the surface of early B cells.

IgE: specialized functions as a mediator of many common allergic responses and in

the defense against parasitic infections.
 Function
 Provides protection from large parasites
 Initiates an inflammatory reaction to attract eosinophils
 When produced against innocuous environmental antigens, they are a
common cause of allergies

. What is an autoimmune disorder? What are the most common types of

autoimmune disorders and what are their manifestations?
Primary
 Genetically determined deficiencies
 About 75-80% known
 Manifests due to component of immune system that is absent
 Humoral
 Cellular
 Combination of both
Secondary
 Systemic disorders
 Prolonged serious illness
 DM
  Hepatitis
 Certain drugs
 Prednisone
 Cytotoxic chemotherapy
 DMARDs

3. Know what the humoral response is.

Wk 2

4. Know the difference between an allergy, autoimmunity, anaphylaxis, and

alloimmunity, immune, and hypersensitivity. Histamine?????
Wk2
5. Understand Dr. Selye’s General Adaptation Syndrome (GAS) regarding stress and
how it has been shown to affect the body through his research and differentiate
between the stages and the responses of GAS.
Wk1: stress
Alarm Stage: Alarm Reaction. The alarm reaction includes increased secretion of glucocorticoids (cortisol) by the adrenal cortex and
increased secretion of epinephrine and small amounts of norepinephrine from the adrenal medulla. (pic on left)
• Stressor triggers the hypothalamic-pituitary-adrenal HPA) axis nervous system (sympathetic branch
of the autonomic nervous system), the endocrine system (pituitary and adrenal glands)
• Activates sympathetic nervous system:
• Arousal of body defenses
• emergency reaction that prepares the body to fight or flee from threat.
• involves secretion of hormones and catecholamines to support physiologic/metabolic activity) and
boosts the immune system to thwart infection and disease

Resistance/adaptation stage
• Adrenal hormones release
• Mobilization can contribute to fight or flight.
• requires continued mobilization of the body's resources to cope and overcome a sustained
challenge

Exhaustion stage (allostatic overload)

• Occurs only if stress continues & adaptation is not successful
• Leads to stress-related disorders. Wear and tear
• body's physiologic and immune systems no longer effectively cope with the stressor and marks the
onset of diseases (diseases of adaptation).
• when stress continues unabated and adaptation is not successful, body organs that are
weak, such as the heart and kidney, may no longer function and lead to death.

6. What are the physiologic responses to stress in regards to

the sympathetic
nervous system and how the body is affected?
Wk1: stress
7. Understand the differences between genotype and phenotype.
Wk1: Genes
 Genotype is the combination of alleles an organism inherits
from its parents.
 RR, Rr, or rr
 Two letters, one copy from each parent
 Phenotype is the organisms appearance.

8. Know when a dominant gene is expressed and when a recessive gene is

expressed.
Wk1: Genes
Dominant Recessive

¼ of children will be affected

 Exhibit A: rare occurrence that 2/4 will be carriers but not affected
both parents are affected by
autosomal dominant = ¾
children will be affected

Exhibit B: half of children will be

affected and have will be normal

9. Be able to differentiate between Turner’s and Klinefelter’s syndromes-

genotypes, subjective findings, and manifestations?
Wk1: Genes
Turner’s Klinefelter’s
(45,X) Monosomy of X Chromosome
IQ: Not considered to be intellectually disabled,
although some impairment of spatial and
mathematical reasoning ability is found
Found only in females
Short stature common, characteristic webbing of neck,
widely spaced nipples, reduced carrying angle at
elbow
(47,XXY) XXY Condition
IQ: Moderate degree of mental impairment may be
present
Have a male appearance but usually sterile; 50%
develop female-like breasts (gynecomastia); occurs in
1 : 1000 male births
Voice somewhat high pitched voice
Sparse body hair, sterile, small testicles

Coarctation (narrowing) of aorta, edema of feet in

newborns, usually sterile and have gonadal streaks
rather than ovaries; streaks are sometimes susceptible
to cancer

About 15-20% of spontaneous abortions with

chromosome abnormalities have this karyotype, most
common single-chromosome aberration; highly lethal
during gestation, only about 0.5% of these conceptions
survive to term
75% inherit X chromosome from mother, thus caused
by meiotic error in father; frequency low compared
with other sex chromosome aneuploidies (1 : 5000
newborn females); 50% have simple monosomy of X
chromosome; remainder have more complex
abnormalities; combinations of 45, X cells with XX or
XY cells common
50% of cases the result of nondisjunction of X
chromosomes in mother, frequency rises with
increasing maternal age; also involves XXY and XXXY
karyotypes with degree of physical and mental
impairment increasing with each added X
chromosome; mosaicism fairly common with most
prevalent combination of XXY and XY cells

10. How do bacteria and viruses reproduce?

Wk3:
Bacteria reproduce by binary fission. In this process the bacterium, which is a
single cell, divides into two identical daughter cells. Binary fission begins when
the DNA of the bacterium divides into two (replicates).
Viral Reproduction—A Lytic Infection
Most viruses reproduce through a process called lytic infection. During lytic
infection, a virus enters the host cell, makes a copy of itself, and causes the cell
to burst, or lyse.

11. Be able to differentiate between the different stages of the inflammation process
and its protective properties, the manifestations that may occur, and how to
determine whether a patient is suffering from an acute versus chronic inflammatory
process.
Wk 2: Inflammatory
Stage of Acute Inflammation
Vascular
- Movement of protein rich fluids from vascular to interstitial spaces causes a
decrease in capillary osmotic pressure and increase in the interstitial
osmotic pressure.
Cellular
- Margination and adhesion to endothelium
-Transmigration across endothelium
-Chemotaxis
-Complement System
-Activation and phagocytosis

Cellular components:
 Erythrocytes
 Platelets
 Leukocytes
Granulocytes
Monocytes
Lymphocytes

12. What is the role of endorphins in the body?

Wk 1 or 2:
Endorphin: (endogenous morphine) are produced in the brain. The best studied
endorphin is β-endorphin, which binds to µ receptors and is purported to produce
the greatest sense of exhilaration as well as substantial natural pain relief (pain
relief or analgesia)

13. What is the pathophysiology behind allodynia?

Wk2: Pain
Allodynia: induction of pain by normally nonpainful stimuli, neuropathic pain
- from several nerve-related conditions. When you're experiencing it, you feel pain
from stimuli that don't normally cause pain. For example, lightly touching your skin
or brushing your hair might feel painful.

14. Differentiate between chronic and acute pain, different types of pain i.e.
somatic, visceral, etc, and what manifestations may appear in patients with pain.
Wk2 Pain:
Acute Pain: Begins suddenly and relieved after pain stimulus removed. Transient
Somatic: from skin, joints, and muscles, well localized
Visceral: in the internal organs and cavity lining; Poorly localized, aching, gnawing,
throbbing, intermittent cramping; often radiates or “referred” (Pain that is present
in an area removed or distant from its point of origin, area of referred pain is
supplied by the same spinal segment as the actual site)

Chronic Pain: persistent or intermittent, sudden or develop insidiously, lasting at

least 3 to 6 months, significant behavior and psychologic changes
Neuropathic pain: chronic, Amplification of pain without stimulation

15. Know where temperature is mediated in the body?

Wk2:
 Heat production and conservation
 Chemical reactions of metabolism
 Skeletal muscle contraction
 Chemical thermogenesis
 Vasoconstriction
 Shivering
 Voluntary mechanisms

Pyrogens act directly on the hypothalamus (bodys thermostat).

Mild elevation in temperature can be beneficial to killing off some pathogens.
However, high temperature should be treated.
Shift to the left is indicative of leukocytosis with greater number of immature bands
present—clinical application

16. Differentiate between the types of cellular adaptation. (i.e. metaplasia, etc.)
Wk 3

17. Understand the difference between the types of leukemia and their
manifestations.
Wk 4

18. Differentiate between the different types of tumors/cancer and where they are
found in the body (from what tissue, etc. do they originate and their names i.e.
connective tissue, etc.), and what tumor markers are.
19. Understand causes of cancer and what cancer patients are at risk for and how
do we are nurses advocate for them?
Wk 4

20. Understand the difference between benign and cancerous tumors and how
cancer may spread.
Wk 4

21. Differentiate the types of cells (i.e. lymphocyte, macrophage, T- cell, B- cell,
phagocytes, neutrophils, eosinophils, natural killer T cells, RBCs, etc.).
Wk 2: Innate
lymphocyte
macrophage
T- cell
B- cell,
phagocytes
neutrophils
eosinophils
natural killer
T cells
RBCs

22. Differentiate between primary and secondary or acquired immunodeficiencies

and when they would occur.
Differentiate between the causes of primary and secondary immunodeficiencies.
-A primary immunodeficiency (congenital immunodeficiency) is an inborn error
that affects one or more immune system factors and leads to deficient immunity.
They are genetic disorders. Primary immunodeficiencies can develop from defects
in humoral immunity, cellular immunity, or innate immunity.
-Patients tend to experience recurring, persistent, and severe infections, often
caused by opportunistic pathogens

-Secondary immunodeficiencies (acquired immunodeficiencies) are much more

common than primary immunodeficiencies. A person with this type of
immunodeficiency doesn't have an inborn error in the immune system, but starts
out with a normal immune system and then experiences a decline in immune system
rigor.

Causes of secondary immunodeficiencies

-Age
-Certain infectious agents
-Medical interventions
-Systemic disorders (e.g., diabetes, malnutrition, alcoholism, hepatitis)
Examples of medical interventions that cause secondary immunodeficiencies:
-Cancer treatments (e.g., radiation and chemotherapy)
-Steroid anti-inflammatory drugs (e.g., corticosteroids)
-Anti-seizure medications
-prescribed drugs

23. The process of heat stroke- when does it occur, in what population, and how is
the body affected by this disease process?
Wk2: temperature
Heat stroke:
 Potentially lethal result of an overstressed thermoregulatory center
 Cardiovascular and thermoregulatory centers may cease functioning with
higher temperatures
 With very high core temperatures (>40° C; 104° F), the regulatory center
ceases to function and the body's heat loss mechanisms fail
 Elderly, infants
 caused by exertion, by overexposure to environmental heat, or from
impaired physiologic mechanisms for heat loss

Heat Exhaustion:
 Result of prolonged high core or environmental temperatures
 Profound vasodilation and profuse sweating
 Dehydration, depressed plasma volumes, hypotension, decreased
cardiac output, tachycardia
 Manifestations:
 Dizziness, weakness, nausea, confusion, and syncope

24. Differentiate between pain perception, threshold, and tolerance.

Wk2: Pain
Nociception:
- perception of pain. originating from a known physiological cause. The perception
of a noxious stimuli
Threshold:
- Point at which a stimulus is perceived as pain
- lowest intensity that an individual can recognize.
- Substance P, glutamate, calcitonin are excitatory neurotransmitters in the brain
and spinal cord. They sensitize nociceptors by decreasing the activation threshold.
Tolerance:
- Duration of time or the intensity of pain that a person will endure before initiation
of pain responses
- generally decreases with repeat exposure to painful stimuli.
25. Know the causes of cell injury are; how to characterize apoptosis occurs, and
when it occurs.

26. Differentiate between the different types of skin cancers.

Basal cell carcinoma
least maligent, most common

squamous cell carcinoma

second most common
treated with radiation

melanoma
most dangerous
treated by surgical excisions