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BASICS OF PATHOPHYSIOLOGY II

Jassin M. Jouria, MD

Dr. Jassin M. Jouria is a medical doctor, professor of

academic medicine, and medical author. He graduated

from Ross University School of Medicine and has

completed his clinical clerkship training in various

teaching hospitals throughout New York, including

King’s County Hospital Center and Brookdale Medical

Center, among others. Dr. Jouria has passed all

USMLE medical board exams, and has served as a test

prep tutor and instructor for Kaplan. He has developed several medical courses and

curricula for a variety of educational institutions. Dr. Jouria has also served on multiple

levels in the academic field including faculty member and Department Chair. Dr. Jouria

continues to serves as a Subject Matter Expert for several continuing education

organizations covering multiple basic medical sciences. He has also developed several

continuing medical education courses covering various topics in clinical medicine. Recently,

Dr. Jouria has been contracted by the University of Miami/Jackson Memorial Hospital’s

Department of Surgery to develop an e-module training series for trauma patient

management. Dr. Jouria is currently authoring an academic textbook on Human Anatomy &

Physiology.

Abstract

Every disease or injury incurred by the human body creates a chain reaction

of physical responses. Pathophysiology is the study of these changes,

ranging from cellular changes to biomechanical changes. Building on the

information presented in Basics of Pathophysiology I, this course takes a

look at autoimmune disorders, infectious diseases, congenital disorders,

neoplastic diseases, blood and lymphatic disorders, endocrine disorders, and

neurological diseases. Together, these two courses present critical

information for nurses and nurse practitioners to provide early, accurate

diagnosis and appropriate treatment to minimize the chain reaction of effects

and provide a positive patient outcome.


Continuing Nursing Education Course Planners

William A. Cook, PhD, Director, Douglas Lawrence, MA, Webmaster,

Susan DePasquale, MSN, FPMHNP-BC, Lead Nurse Planner

Policy Statement

This activity has been planned and implemented in accordance with the

policies of NurseCe4Less.com and the continuing nursing education

requirements of the American Nurses Credentialing Center's Commission on

Accreditation for registered nurses. It is the policy of NurseCe4Less.com to

ensure objectivity, transparency, and best practice in clinical education for

all continuing nursing education (CNE) activities.

Continuing Education Credit Designation

This educational activity is credited for 2 hours. Nurses may only claim credit

commensurate with the credit awarded for completion of this course activity.

Statement of Learning Need

Nurses at all levels of professional development need an enhanced

understanding of pathophysiology in order to understand patient treatment

and care for certain medical conditions.

Course Purpose

To provide nursing professionals with knowledge of the basic principles of

pathophysiology and associated medical conditions.


Target Audience

Advanced Practice Registered Nurses and Registered Nurses

(Interdisciplinary Health Team Members, including Vocational Nurses and

Medical Assistants may obtain a Certificate of Completion)

Course Author & Planning Team Conflict of Interest Disclosures

Jassin M. Jouria, MD, William S. Cook, PhD, Douglas Lawrence, MA,

Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures

Acknowledgement of Commercial Support

There is no commercial support for this course.

Activity Review Information

Reviewed by Susan DePasquale, MSN, FPMHNP-BC

Release Date: 2/15/2016 Termination Date: 4/11/2018

Please take time to complete a self-assessment of knowledge, on

page 4, sample questions before reading the article.

Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course.


1. What are the two categories that the lymphocytes are divided

into?

a. A cells and B cells

b. B cells and T cells

c. T cells and C cells

d. B cells and D cells

2. Which if the following is the criteria used do diagnose a man

with polycythemia?

a. Hemoglobin >16.5 g/dl

b. Hemoglobin >18.5 g/dl

c. Hemoglobin < 13.5gm/dl

d. Hemoglobin <12.0gm/dl

3. Which of the following is NOT one of the types of diabetes?

a. Type II Diabetes

b. Hashimoto’s Disorder

c. Type I Diabetes

d. Gestational Diabetes

4. The overproduction of thyroid hormones is:

a. Hypothyroidism

b. Hyperparathyroidism

c. Hyperthyroidism

d. Hypoparathyroidism

5. This autoimmune disorder is characterized by chronic

inflammation of the thyroid.

a. Diabetes

b. Rheumatoid arthritis

c. Hashimoto’s Disease

d. Crohn’s Disease


Introduction

Every disease or injury to the human body creates a chain reaction of

physical responses. Pathophysiology is the study of these changes, ranging

from cellular changes to biomechanical changes. Pathophysiology enables

medical professionals to understand diagnosis, treatment, and management

options to achieve a best-case scenario for their patients. The ultimate goal

of pathophysiology is to be able to answer the following questions:

What is the cause/causes of the disease, and why the disease is

developing?

What are the mechanisms responsible for disease onset, progression,

and recovery?

What are the mechanisms responsible for development of symptoms

and signs of disease?

Building on the information presented in Basics of Pathophysiology I, this

course takes a look at autoimmune disorders, infectious diseases, congenital

disorders, neoplastic diseases, blood and lymphatic disorders, endocrine

disorders, and neurological diseases. Together, these two courses present

critical information for nurses and nurse practitioners to provide early,

accurate diagnosis and appropriate treatment to minimize the chain reaction

of effects and provide a positive patient outcome.

The Basics of Pathophysiology I course provided a thorough overview of

cellular biology, including cellular function and the role of genetics. The

course also provided descriptions and key terms for pathology and

physiology. This course is intended for individuals who have already

completed the Basics of Pathophysiology I course and assumes the reader

has already received the introduction to cellular biology, pathology, and


physiology. To review these basics, refer to the Introduction section of the

Basics of Pathophysiology I course.

Autoimmune Disorders

Autoimmune disorders occur when an individual’s immune system is unable

to differentiate between antigens and healthy body tissue.1 When this

happens, the immune system triggers an immune response that attacks the

healthy tissue and damages or destroys it.2 In most instances, this causes a

hypersensitivity reaction that mimics an allergic reaction.3 It is difficult to

identify what causes the immune system to be unable to differentiate

between antigens and healthy tissue, but a common theory is that the

disorder is triggered by a microorganism or drug response.4 Depending on

the type of autoimmune disorder, one of the following may occur:1

The destruction of one or more types of body tissue

Abnormal growth of an organ

Changes in organ function

The most common organs and tissues affected by autoimmune disorders

include:3

Blood vessels

Connective tissues

Endocrine glands such as the thyroid or pancreas

Joints

Muscles

Red blood cells

Skin


It is possible for an individual to experience more than one autoimmune

disorder at a time. In fact, some patients may be prone to multiple

disorders.1 The following is a list of the most common autoimmune

disorders:2

Addison's disease

Celiac disease - sprue (gluten-sensitive enteropathy)

Dermatomyositis

Graves disease

Hashimoto's thyroiditis

Multiple sclerosis

Myasthenia gravis

Pernicious anemia

Reactive arthritis

Rheumatoid arthritis

Sjogren syndrome

Systemic lupus erythematosus

Type I diabetes

Acquired Immunity

Acquired immunity refers to any immunity that is not innate. These

immunities can be acquired naturally through the development of antibodies

that result from contact with an infectious disease.5 Immunities can also be

acquired through the transmission of antibodies from mother to child, which

occurs through placental transmission or through colostrum and breast

milk.6 Immunities can also be transmitted artificially through vaccinations or

immune gamma globulin.5


Lymphocytes

The lymphocytes are the primary cells responsible for the maintenance of

the immune system. There are approximately one trillion lymphocytes in the

human body.7 The lymphocytes are divided into two primary categories:8

T Cells – processed within the thymus – interact directly with targets

to attack the cells that have been taken over by viruses or malignant

cells.

B Cells – grow independently of the thymus – secrete antibodies

directly into the body’s fluids.

The distinctive molecules present on the cell surface are what differentiate

lymphocytes. These molecules indicate whether the cell is a B Cell or a T

Cell. The molecules also serve as identifiers of the subsets of cells that

comprise the lymphocyte.7

Antibodies/Immunoglobins

Antibodies, also known as immunoglobins, are proteins that are produced by

B Cells to identify and neutralize foreign objects that infiltrate the body.9

The most common foreign bodies are bacteria and viruses. Antibodies seek

out antigens and use paratopes to attach to the epitopes that are part of

antigens. This binds the antibody to the antigen, thereby allowing the

antibody to identify an infected cell for attack by the immune system. In

some instances, the antibody can directly neutralize the foreign object.6

Immune System Suppression

One method of treating autoimmune diseases is though suppression of the

immune system. Immune system suppression is initiated through the use of


drugs. In some instances this treatment has proven effective. However,

recent research shows that this may not be the best method to treat

autoimmune diseases.10

Infectious Diseases

Pathogenic microorganisms are the direct cause of infectious diseases, which

can be spread directly or indirectly. Four different germs cause infectious

diseases:11

Bacteria

One-celled germs that multiply quickly and may release chemicals,

which may cause illness

Viruses

Capsules that contain genetic material and use the body’s own cells to

multiply

Fungi

Primitive plants, like mushrooms or mildew

Protozoa

One-celled animals that use other living things for food and a place to

live

Transmission

Infectious diseases are primarily transmitted through direct contact,

especially person-to-person contact. Some diseases can be transmitted from

a pregnant mother to her unborn child through the placenta. Infectious

diseases can also be transmitted through indirect contact, such as

contaminated objects, long-term airborne transmission, contaminated blood

products and medical supplies, insects, and food and water. In some

instances, infectious diseases may be transmitted from an animal to a


person. This is especially common with animal bites and scratches. Another

area of indirect transmission is through environmental reservoirs. Some

organisms are present in soil, water, and vegetation.12

Pathogenic Bacteria

Pathogenic bacteria cause diseases in the host, even when the environment

is sterile. There are a number of pathogenic bacteria, but some are quite

rare and do not pose a significant risk of infection.13 Depending on the type

of bacteria, the patient will experience a variety of symptoms and

conditions. Therefore, there is no specific physical reaction that occurs when

a person comes into contact with pathogenic bacteria.14 The following is a

list of the most common types of pathogenic bacteria:

Staphylococcus

The staphylococcus group of bacteria is a common cause of infection in

individuals. In most instances, the bacteria colonize on the skin and mucous

membranes of individuals, but do not cause infection.15 However, if certain

conditions are present, the staphylococci will produce both superficial and

systemic infections. These infections can take different forms, but tend to

present as impetigo, boils, and folliculitis.16 In more extreme cases, the

bacteria will develop into pneumonia and infections of the bone and

wounds.17

Streptococcus

Streptococcus pneumoniae is the bacterium that causes pneumococcal

pneumonia, which is a severe form of pneumonia. Pneumococcal pneumonia

is characterized by its sudden, severe onset.18 Many patients will experience

a sudden, severe chill followed by the following symptoms:19


High fever

Cough

Shortness of breath

Rapid breathing

Chest pains

Nausea

Vomiting

Headache

Tiredness

Muscle aches

Pneumococcal pneumonia is especially common in unvaccinated children

under the age of five and the elderly. The risk of contracting the illness

increases significantly when an individual remains unvaccinated.

Meningococcus

Meningococcus is the bacteria that causes meningococcal meningitis, which

is an infection of the lining of the brain and the spinal cord.20 In some

instances, the bacteria can also cause other illnesses such as bloodstream

infections.21 The bacteria is spread through respiratory secretions.20

Unvaccinated individuals are at risk of developing severe, life-threatening

complication from the bacteria. However, those who are vaccinated have

minimal risk.22

Antibiotic Therapy

Antibiotic therapy is commonly used to treat infectious diseases. Antibiotics

are known to significantly reduce illness and death from infectious disease

when prescribed and administered correctly. However, due to overuse of

antibiotics in recent years, many infectious organisms have developed


resistance to them through mutation.23 Therefore, many individuals with

infectious diseases will not respond effectively to antibiotic treatment.24

The onset and duration of antibiotic therapy is dependent on the type and

severity of illness. Critically ill patients will require immediate treatment to

avoid long-term or permanent damage, even if diagnostic lab reports have

not confirmed the strain of bacteria that is causing the infection. These

patients will receive empiric antibiotic therapy.25 This often occurs when

patients present with septic shock, febrile neutropenia, and bacterial

meningitis.

Patients who are experiencing less severe infections can delay treatment

until after diagnostic test results confirm the type and strain of bacteria.

These patients will receive definitive antimicrobial therapy.26 This will ensure

that the patient’s treatment is appropriate for the infecting organism.

Treatment of Viral Disease

Most viral infections are not treatable with medications. Therefore, treatment

of viral infections typically involves relief of the symptoms caused by the

infection.6 General treatments for viral infections include:27

Acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) for fever, body

aches, and pain

Drinking extra fluids

Getting extra rest and sleep

Maintaining good nutrition

However, in some instances, other treatment methods will be employed to

minimize complications from the virus. For example, antiretroviral

medication is used with individuals with human immunodeficiency virus.


Antiretrovirals do not eliminate the virus, but they are able to successfully

slow the progression. Other antiretroviral drugs are used to treat influenza,

shingles, and other viral conditions.28

Congenital And Genetic Disorders

Congenital and genetic disorders occur at conception or during fetal

development. In some instances, though, congenital disorders will develop in

the months following birth. Congenital disorders are defined as those that

involve structural deformities that cause defects or damage in the

developing fetus.29 Congenital disorders can be caused by a variety of

factors, including genetic abnormalities, infection, intrauterine complications,

or errors of morphogenesis.30

Genetic disorders include a range of conditions that vary in their

presentation and impact on the individual. Many genetic conditions develop

at conception when gene pairs form, although they may not appear for a

number of years.31 Other genetic conditions are caused by the aging of cells

or exposure to external factors such as chemicals or radiation.

Congenital Disorders

The primary causes of congenital disorders are genetics, intrauterine

damage and infection, and multifactorial or unidentified factors. The type of

congenital disorder an individual develops will depend on which of the

factors is present.

Genetics

Genetics can cause congenital anomalies. This occurs when the fetus inherits

abnormal genes from one of the parents.32 In other instances, the germ cells


can experience mutations that will affect the fetus.33 All genetic disorders

are considered congenital. However, many genetic disorders will not appear

until years after birth. There are a number of different types of genetic

disorders, including:34

Single-gene defects

Multiple-gene disorders

Chromosomal defects

Intrauterine Injuries

Intrauterine injuries are known to cause congenital defects, although they

are less common than other causes of congenital disorders. In some cases,

intrauterine injuries will occur when the environment is damaged through

external forces such as blunt impact, accidents, domestic violence, or other

events that cause damage to the region. In other instances, complications

resulting from illness or improper nutrition can impact the intrauterine

environment, thereby impacting the developing fetus.29

Multifactorial Inheritance

While a number of causes of congenital disorders have been identified, there

are still a number of disorders that have no known cause. Of these,

approximately 25% have a multifactorial cause, which means that they have

been caused by a complex interaction of a number of smaller genetic

anomalies as well as environmental risk factors.34

Genetic Disorders

While all congenital disorders are genetic disorders, there are a number of

genetic disorders that are not congenital. Therefore, genetic disorders are

examined separately from congenital disorders.


Genetic disorders occur when an individual experiences a mutation in one or

more genes. These mutations can occur at conception, or they can occur at

some point during the individual’s lifetime.35 When mutations occur during

an individual’s lifetime, they are typically caused by the aging of cells or

exposure to external factors such as chemicals or radiation.36 In many

instances, these mutations will be repaired by the cells and will cause no

damage. However, in some instances, these mutations cannot be repaired.

In these instances, the patient will experience adverse effects such as illness

or disability.37 When a gene mutation occurs at conception, the mutation

becomes part of the individual’s genetic make up. In these instances, the

mutation cannot be repaired by the cell.38

To understand how genes mutate, it is necessary to understand the basics of

how genetic patterns are formed. DNA is comprised of four primary

chemicals:

Adenine

Thymine

Cytosine

Guanine

These chemicals bind together to create genetic patterns within the cell. The

DNA, which contains the genetic material, binds together to form

chromosomes. Typically, a cell contains 23 pairs of chromosomes. When

cells replicate, the genetic material is transferred to the new cells.32 If the

genetic material is already damaged or mutated, there is a chance that the

individual will develop mutated genes. This is determined by the dominant or

recessive status of the genes.


There are more than 4,000 diseases that can be caused by gene mutations.

When an individual experiences a mutation in a dominant gene, he or she

will typically experience the condition and/or symptoms associated with the

mutation.39 Examples of common conditions caused by dominant gene

mutations include:40

Achondroplasia

Marfan syndrome

Huntington disease

When an individual experiences a mutation in a recessive gene, he or she

will not typically develop the condition associated with the mutation. The

individual will be a carrier of the mutation, but will not develop the condition

because one of the two genes in the pair will still be healthy.33 However, if

an individual receives mutated genes from both the X chromosome and the

Y chromosome, he or she will develop the condition associated with the

recessive gene.32 Examples of common conditions caused by mutated

recessive genes include:38

Cystic fibrosis

Sickle cell anemia

Tay-Sachs disease

Prenatal Diagnosis

Many genetic disorders and congenital defects can be identified prenatally

through the use of advanced diagnostic testing. The following is a list of the

non-invasive and invasive techniques used to diagnose genetic and

congenital disorders:31


Noninvasive techniques

Fetal visualization

Ultrasound

Fetal echocardiography

Magnetic resonance imaging (MRI)

Radiography

Screening for neural tube defects (NTDs) - Measuring maternal serum

alpha-fetoprotein (MSAFP)

Screening for fetal Down syndrome

Measuring MSAFP

Measuring maternal unconjugated estriol

Measuring maternal serum beta-human chorionic gonadotropin (HCG)

Measuring inhibin

Separation of fetal cells from the mother's blood

Assessment of fetal-specific DNA methylation ratio

Invasive techniques

Fetal visualization

Embryoscopy

Fetoscopy

Fetal tissue sampling

Amniocentesis

Chorionic villus sampling (CVS)

Percutaneous umbilical blood sampling (PUBS)

Percutaneous skin biopsy

Other organ biopsies, including muscle and liver biopsy

Preimplantation biopsy of blastocysts obtained by in vitro fertilization

Cytogenetic investigations

Detection of chromosomal aberrations


Fluorescence in situ hybridization

Molecular genetic techniques

Linkage analysis using microsatellite markers

Restriction fragment length polymorphisms (RFLPs)

Single nucleotide polymorphisms (SNPs) - DNA chip, dynamic allele-

specific hybridization (DASH)

Prenatal diagnosis is a beneficial tool for identifying developmental risks and

determining how to progress with the pregnancy and subsequent birth (if

applicable). In many instances, treatment for the disorder can begin

prenatally, which will improve the outcome after birth.

Prenatal diagnosis is recommended in the following cases:31

The pregnant woman is 35 years or older at the time of delivery.

She or her parents have had a previous child with a chromosomal

abnormality.

She has a history of recurrent abortions, or her husband's previous

wife experienced several miscarriages.

A history of parental consanguinity (common ancestry) is present.

The couple is known to be carriers of a chromosomal translocation.

The pregnant woman is affected with type 1 diabetes mellitus,

epilepsy, or myotonic dystrophy.

She is exposed to viral infections, such as rubella or cytomegalovirus.

The mother is exposed to excessive medication or to environmental

hazards.

In the mother’s or her spouse's family, Down syndrome or some other

chromosomal abnormality is present.

A history of single gene disorder is present in her or her spouse's

family.


The mother’s male relatives have Duchenne muscular dystrophy or

severe hemophilia.

She is suspected of having some other harmful gene on her X

chromosomes.

The fetus is diagnosed in utero to have some hereditary error of

metabolism.

The fetus is detected to be at increased risk for a NTD.

Neoplastic Diseases

Malignant neoplasms, also called cancer, grow relatively rapidly and may

metastasize, or spread, to other body parts. The malignant cells multiply

excessively and can invade or infiltrate normal tissue, making the condition

life threatening if untreated.41 The cancerous cells interfere with normal cell

growth and draw nutrients away from body tissue.

Compared with normal tissue, cancerous cells appear disorderly and do not

look like the tissue of origin.42 Patients with malignant conditions may

experience:43

Anorexia

Abnormal bleeding or bruising

Difficulty swallowing

Indigestion

Malaise

Fever

Sores that do not heal or that change to the appearance of a wart or

mole

Bladder and bowel habit changes

Mass growth in the breast or other body site

Persistent cough


Weight loss

To determine whether a patient has a tumor, various laboratory tests and

procedures, such as endoscopies, magnetic resonance imaging (MRI),

computed tomography (CT) scans, X-rays, and ultrasound, are used. A

biopsy, or the removal of tissue for pathological examination, is completed

to differentiate between malignant and benign tumors.44

Treatment

Treatment for neoplasms will vary depending on a number of factors,

including the type of tumor, whether it is cancerous or noncancerous, the

location of the tumor, and the medical status of the patient. With benign

tumors, there is a chance that no treatment will be needed. If the benign

tumor is in a safe location and is causing no symptoms, there is often little

reason to remove it.42 However, in some instances, benign tumors will be

removed for cosmetic reasons or because they pose a threat to other parts

of the body due to their location (i.e., proximity to brain).

Malignant tumors can be treated in a variety of ways. The most common

forms of treatment include chemotherapy, radiation, and surgery. In many

instances, a patient will receive a combination of the treatments listed

above.43

Blood And Lymphatic Disorders

The human circulatory system is comprised of two primary fluids: blood and

lymph. Lymph is the fluid that is found in the lymphatic vessels that are part

of the lymphatic system. The specific composition of the fluid will vary

depending on the area of the body it is from. Lymph from some areas of the


body (i.e., bone marrow, spleen, thymus) have high concentrations of white

blood cells.45 This is because the lymph has absorbed the white blood cells

intended to fight infection. Other types of lymph will have higher

concentrations of other components. For example, intestinal lymph is

typically high in fat. This is because the fat is absorbed during digestion.46

The most common disorders and diseases of the blood and lymphatic system

include:45

Anemia

Burkitt lymphoma

Gaucher disease

Hemophilia A

Leukemia, chronic myeloid

Niemann-Pick disease

Paroxysmal nocturnal hemoglobinuria

Porphyria

Thalassemia

Anemia

Anemia is one of the most common blood disorders, affecting approximately

3 million Americans.47 Anemia occurs when there is a deficit of red blood

cells or when the red blood cells are not functioning properly. An anemia

diagnosis is made when blood tests show the following results:48

Man – hemoglobin value < 13.5gm/dl

Woman – hemoglobin value <12.0gm/dl

There are a number of different types of anemia that can occur. They are

defined based upon the cause and impact on the body. The following is a list

of the most common types of anemia:49


Iron deficiency anemia

Vitamin deficiency anemia

Pregnancy-related anemia

Aplastic anemia

Hemolytic anemia

Sickle cell anemia

Anemia caused by other diseases

Polycythemia and Thrombocytopenia

Polycythemia

Polycythemia occurs when there is an increase in the number of red blood

cells in the blood. In these instances, one of the following components will

appear elevated when measured as part of the complete blood cell count:50

Hemoglobin

Hematocrit

Red blood cell

A diagnosis is made based upon the following numbers:51

Men:

Hemoglobin >18.5 g/dl

Hematocrit > 52

Women:

Hemoglobin >16.5 g/dl

Hematocrit > 48

Polycythemia can occur as a result of internal problems related to the

production of red blood cells. This type of polycythemia is called primary


polycythemia. In some instances, other underlying medical conditions can

cause polycythemia. This form of polycythemia is called secondary

polycythemia. Most cases of polycythemia are secondary.52

Thrombocytopenia

Thrombocytopenia refers to a decreased amount of platelets in the blood.

The average platelet count is between 150,000 and 400,000 per micro liter

(one millionth of a liter) of blood. When a platelet count falls below 150,000

the individual is diagnosed with thrombocytopenia.53 Platelet counts less

than 150,000 are termed thrombocytopenia.

Decreased platelet levels do not typically impact the function of the

platelets. However, the decrease in the number of platelets can impact other

areas of the body. In some instances, a low platelet count can result in

spontaneous bleeding as the normal clotting process is impacted.54

The most common causes of a decrease in platelets are:55

Decreased platelet production (caused by infection, disease,

medications)

Increased platelet destruction or consumption (caused by immune and

non-immune related medical conditions, medications, pregnancy

complications, infections, injury to blood vessels)

Increased splenic sequestration/capturing of circulating platelets in the

spleen (caused by advanced liver disease, hypertension, blood cancer)

In some instances, severe bleeding and the subsequent transfusion of a

significant amount of red blood cells over a short period of time can cause

thrombocytopenia. In rare instances, a patient may experience

pseudothrombocytopenia, which occurs when platelets clump together. This


will produce a false condition in diagnostic testing. Sometimes,

thrombocytopenia will occur at birth. In most instances, neonatal

thrombocytopenia will occur as the result of one of the factors listed above.

However, the condition my also occur as the result of rare genetic

disorders.56

Lymphatic Disorders

Lymphatic disorders occur when there are is an infection or other condition

that occurs in the lymphatic system. The most common lymphatic disorder is

lymphadenitis, which is an inflammation of the lymph nodes that occurs

when microorganisms become trapped and destroyed within the lymph

nodes.45 In some instances, this can lead to blood poisoning.

Other lymphatic disorders can occur when infections attack the lymphatic

system. Lymphomas are also a common lymphatic disorder. Lymphomas are

neoplasms that develop within the lymphatic tissue.57 The lymphomas are

divided into two distinct categories:

Hodgkin’s Disease

Non-Hodgkin’s Lymphoma

Most lymphomas begin as an enlarged mass within the lymph nodes. These

enlarged masses can compress surrounding structures and initiate

complications in other regions of the body. They also impact the immune

system, causing the patient to be more susceptible to infections.

Lymphomas are typically treated using radiation and medication.58


Endocrine Disorders

The endocrine system (endo- means “within,” and -crin means “secrete”)

consists of several different internal groups of glands and structures that

produce or secrete hormones. Hormones are chemical substances produced

by the body to keep organs and tissues functioning properly. Each hormone

has a specific function.

When chemical changes occur in the body, hormone release may be either

increased or decreased, provided that the organ producing the hormone is

functioning properly. Also, when endocrine body structures do not function

properly, hormones are not released.59

Diabetes

Diabetes is a group of metabolic diseases that are caused by increased blood

glucose levels due to insufficient insulin production or improper cellular

response to insulin. Initial symptoms of diabetes typically include polyuria,

polydipsia, and polyphagia.60 However, blood work will be conducted to

provide a definitive diagnosis. The following table provides definitions of the

three types of diabetes:

Type 1

Diabetes

The body does not produce insulin. Some people may refer to this type

as insulin-dependent diabetes, juvenile diabetes, or early-onset diabetes.

People usually develop type 1 diabetes before their 40th year, often in

early adulthood or teenage years.

Patients with type 1 diabetes will require insulin injections for duration of

their lives. They must also ensure proper blood-glucose levels by

carrying out regular blood tests and following a special diet.61


Type 2

Diabetes

The body does not produce enough insulin for proper function, or the

cells in the body do not react to insulin (insulin resistance).

Approximately 90% of all cases of diabetes worldwide are of this type.

Some people may be able to control their type 2 diabetes symptoms by

losing weight, following a healthy diet, doing plenty of exercise, and

monitoring their blood glucose levels. However, type 2 diabetes is

typically a progressive disease, and the patient will probably require

insulin at some point.

Overweight and obese people have a much higher risk of developing type

2 diabetes compared to those with a healthy body weight.62

Gestational

Diabetes

This type affects females during pregnancy. Some women have very high

levels of glucose in their blood, and their bodies are unable to produce

enough insulin to transport all of the glucose into their cells, resulting in

progressively rising levels of glucose. The majority of gestational

diabetes patients can control their diabetes with exercise and diet.

Between 10% to 20% of them will need to take some kind of blood-

glucose-controlling medications. Undiagnosed or uncontrolled gestational

diabetes can raise the risk of complications during childbirth. The baby

may be bigger than he/she should be.63

Pituitary Disorders

Pituitary disorders can be caused by a variety of factors, including tumors,

infections, and autoimmune conditions. Pituitary tumors are the primary

cause of pituitary disorders.64 Some tumors will cause an increase in

hormone production. However, the majority of tumors do not cause an

overproduction of hormones.


When hormone production does occur, the consequence is often severe

endocrine complications such as acromegaly, Cushing’s syndrome, or

prolactinoma.65 When disorders are caused by other factors such as

infections and autoimmune conditions, the pituitary gland is often affected

and the patient will experience headaches, visual complications and

hormonal abnormalities.66

Thyroid and Parathyroid Disorders

Thyroid and parathyroid disorders are caused by an overproduction or

underproduction of hormones. The parathyroid glands are responsible for

producing parathyroid hormone, which regulates the levels of calcium and

phosphorous in the body. The thyroid is responsible for producing

triiodothyronine and thyroxine, which regulate metabolism, brain

development, respiration, cardiovascular and nervous system functions,

body temperature, muscle development and strength, menstrual cycles,

body weight, and cholesterol levels.67 The production of hormones in the

thyroid is regulated by the thyroid-stimulating hormone.68

The following conditions will develop if there is an overproduction or

underproduction of the hormones listed above.67

Parathyroid Disorders:

Hyperparathyroidism – overproduction of parathyroid hormone

Hypoparathyroidism – underproduction of parathyroid hormone

Thyroid Disorders:

Hyperthyroidism – overproduction of thyroid hormones

Hypothyroidism – underproduction of thyroid hormones


Grave’s Disease – autoimmune disorder that is caused when thyroid-

stimulating immunoglobulin (TSI) are produced and attach to the

thyroid cells. The TSI stimulates hormone production in the thyroid,

causing the thyroid to produce too much.

Hashimoto’s Disease – autoimmune disorder characterized by chronic

inflammation of the thyroid gland. The inflammation causes damage

to the thyroid that results in hypothyroidism.

Neurological Diseases

Neurological Infections

Neurological infections are common causes of neurological disorders. The

type and severity of infection will vary depending on the infecting organism.

However, most require immediate treatment to prevent subsequent

complications. Most neurological infections are caused by bacterial

organisms.69 However, in some instances they may be caused by animal

parasites or fungi. Most neurological infections cause pain, swelling, redness,

impaired function, and fever. However, some patients may experience

additional symptoms such as drowsiness, confusion, and convulsions.70

When a patient develops a neurological infection as the result of a virus, the

route of transmission is typically directly through the bloodstream. Viral

neurological infections are either acute or chronic.71 The most common

neurological infections include:69

Encephalitis

Meningitis

Fungal infections

Parasitic infections

Prion diseases


Bacterial infections such as Lyme disease, tuberculosis, syphilis

Brain abscess

Viral Infections

Brain Tumors

Brain tumors are caused by abnormal tissue growth in the brain. In some

instances, the tumor will develop directly in the brain. However, in other

instances, the tumor will develop in another region of the body and travel to

the brain.72 These are mestatic tumors, and they are very common in

instances of lung cancer, breast cancer, melanoma, and colon cancer.73

Brain tumors can be either benign or malignant. Benign tumors pose little

threat, other than potentially impacting regions of the brain due to growth

and/or swelling. Therefore, benign tumors are typically removed. Once they

have been removed, benign tumors do not pose any additional risk.

Malignant tumors are more concerning as they grow quickly and are

cancerous. Therefore, they are treated using a combination of surgery,

radiation, and medication. Many brain tumors will cause long-term

complications.72

Nerve Injury

Nerve injuries can occur as the result of a number of factors. Most nerve

injuries occur after some sort of head trauma and are quite common in blunt

and penetrating trauma situations. In both instances, nerves will be

damaged. However, the causes of damage will differ.74 Blunt trauma is

caused by a blunt impact to the head that does not penetrate the skull. In

these situations, the injury is caused directly by the force of impact.


In penetrating trauma, the damage is caused when an object penetrates the

skull. In these instances, the object severing the nerves typically is the

cause of the injury. Both forms of trauma can produce significant damage

and may require extensive repair.75

Peripheral Nerve Disorders

There are a number of different types of peripheral neuropathy. In general,

neuropathy is a disturbance in the function of a nerve or a group of nerves.

Peripheral neuropathy is one form of neuropathy, and it mostly occurs in the

feet and legs.76 The most common causes of peripheral neuropathy are:77

Diabetes

Genetic predispositions

Exposures to toxic chemicals

Alcoholism

Malnutrition

Inflammation

Injury

Nerve compression

Medications (i.e., cancer and HIV antiretroviral)

Pain Management

Neuropathic pain is typically chronic and is often accompanied by tissue

injury. In most instances, the nerve fibers will be damaged, dysfunctional, or

injured. When such damage occurs, the nerve fibers send incorrect signals

to other pain centers throughout the body, resulting in an increase in pain in

various locations other than the injured area.78 Most neuropathic pain will

radiate into other regions. Typically, nerve fiber injury will have an impact


on the nerve function at the location of the injury, as well as the areas

around the injury.79

In most instances, neuropathic pain can be relieved through the use of non-

steroid anti-inflammatory drugs such as ibuprofen or naproxen sulfate.

However, in more severe instances, the individual may require a stronger

painkiller that contains morphine.80 Occasionally, patients will respond well

to the use of anticonvulsants or antidepressants. Patients can also relieve

symptoms by treating the medical cause of the neuropathy. This is especially

useful with conditions such as diabetes.

In extreme cases that do not respond to the treatment options listed above,

a pain specialist may be consulted to administer an implantable device that

will manage the pain.81 Other kinds of treatments can also help with

neuropathic pain. Some of these include:82

Physical therapy

Working with a counselor

Relaxation therapy

Massage therapy

Acupuncture

Summary

Pathophysiology is the study of disease function and processes. It enables

medical professionals to understand diagnosis, treatment, and management

options to achieve a best-case scenario for their patients. Recognizing

disease and disorder manifestations will assist nurses and nurse practitioners

with early diagnosis to improve patient outcomes.


Building on the information presented in Basics of Pathophysiology I, this

course provided an overview of autoimmune disorders, infectious diseases,

congenital disorders, neoplastic diseases, blood and lymphatic disorders,

endocrine disorders, and neurological diseases. Together, these two courses

present critical information for nurses and nurse practitioners to provide

early, accurate diagnosis and appropriate treatment to minimize the chain

reaction of effects and provide a positive patient outcome.

Please take time to help NurseCe4Less.com course planners evaluate

the nursing knowledge needs met by completing the self-assessment

of Knowledge Questions after reading the article, and providing feedback in the online course evaluation.

Completing the study questions is optional and is NOT a course

requirement.


1. What are the two categories that the lymphocytes are divided

into? a. A cells and B cells

b. B cells and T cells

c. T cells and C cells

d. B cells and D cells

2. Which if the following is the criteria used do diagnose a man

with polycythemia? a. Hemoglobin >16.5 g/dl

b. Hemoglobin >18.5 g/dl

c. Hemoglobin < 13.5gm/dl

d. Hemoglobin < 12.0gm/dl

3. Which of the following is NOT one of the types of diabetes?

a. Type II Diabetes

b. Hashimoto’s Disorder

c. Type I Diabetes

d. Gestational Diabetes

4. The overproduction of thyroid hormones is:

a. Hypothyroidism

b. Hyperparathyroidism

c. Hyperthyroidism

d. Hypoparathyroidism

5. This autoimmune disorder is characterized by chronic inflammation of the thyroid.

a. Diabetes

b. Rheumatoid arthritis

c. Hashimoto’s Disease

d. Crohn’s Disease


6. When an individual experiences a mutation in a recessive gene,

he or she will a. typically develop the condition associated with the mutation

b. *not typically develop the condition associated with the mutation

c. pass on the gene mutation only to a female child

d. pass on the gene mutation only to a male child

7. True or False. Autoimmune disorders occur when an individual’s

immune system is unable to differentiate between antigens and healthy body tissue.

a. *True

b. False

8. Severe bleeding and the subsequent transfusion of a significant

amount of red blood cells over a short period of time can cause

__________________. a. anemia

b. blood transfusion reaction

c. *thrombocytopenia

d. low platelet count

9. Polycythemia occurs when there is a(n) _____________ in the

number of red blood cells in the blood, measured by the hemoglobin, hematocrit and red blood cell count.

a. decrease

b. *increase

c. reduced cell size

d. none of the above

10. True or False. Malignant tumors are more concerning as they

grow quickly and are cancerous. Therefore, they are treated only with surgery.

a. True

b. *False


Correct Answers:

1. b

2. b

3. b

4. c

5. c

6. b

7. a

8. c

9. b

10. b

References Section

The reference section of in-text citations include published works intended as

helpful material for further reading. Unpublished works and personal

communications are not included in this section, although may appear within

the study text.

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