Advanced Pathophysiology and Clinical Application
NRNP 6568 – Week 5 Study Notes
Advanced Pathophysiology and Clinical Application
1. Introduction
Pathophysiology is the study of functional changes associated with disease or injury. For Nurse Practitioners (NPs), understanding pathophysiology is essential for accurate diagnosis, safe prescribing, and effective patient education. Week 5 emphasizes integrating disease mechanisms with clinical practice.
2. Cellular and Molecular Basis of Disease
Cell Injury:
Hypoxia → ATP depletion → cell death.
Free radicals → oxidative stress → DNA/protein damage.
Inflammation:
Acute: Redness, heat, swelling, pain.
Chronic: Persistent immune response → tissue damage.
Apoptosis vs Necrosis:
Apoptosis: Programmed cell death, non-inflammatory.
Necrosis: Uncontrolled cell death, inflammatory.
3. Genetic and Epigenetic Factors
Genetic Mutations: Single-gene disorders (e.g., cystic fibrosis).
Chromosomal Abnormalities: Down syndrome, Turner syndrome.
Epigenetics: Environmental influences on gene expression (diet, toxins, stress).
4. Immune System Disorders
Hypersensitivity Reactions:
Type I: Immediate (allergy, anaphylaxis).
Type II: Antibody-mediated (hemolytic anemia).
Type III: Immune complex (lupus).
Type IV: Delayed (contact dermatitis).
Autoimmune Diseases: Rheumatoid arthritis, lupus, type 1 diabetes.
Immunodeficiency: HIV/AIDS, congenital immunodeficiencies.
5. Cardiovascular Pathophysiology
Hypertension: Increased systemic vascular resistance → target organ damage.
Atherosclerosis: Plaque buildup → ischemia, infarction.
Heart Failure:
Left-sided: Pulmonary congestion.
Right-sided: Peripheral edema.
Arrhythmias: Abnormal electrical conduction → tachycardia, fibrillation.
6. Respiratory Pathophysiology
Asthma: Airway hyperreactivity → bronchoconstriction, inflammation.
COPD: Chronic bronchitis + emphysema → airflow limitation.
Pneumonia: Infection → alveolar inflammation, consolidation.
Pulmonary Embolism: Clot obstructs pulmonary artery → hypoxia.
7. Endocrine Pathophysiology
Diabetes Mellitus:
Type 1: Autoimmune destruction of beta cells.
Type 2: Insulin resistance + beta cell dysfunction.
Thyroid Disorders:
Hyperthyroidism: Increased metabolism, weight loss, tachycardia.
Hypothyroidism: Fatigue, weight gain, bradycardia.
Adrenal Disorders:
Addison’s disease: Cortisol deficiency.
Cushing’s syndrome: Cortisol excess.
8. Neurological Pathophysiology
Stroke: Ischemic vs hemorrhagic → neurological deficits.
Parkinson’s Disease: Dopamine deficiency → tremor, rigidity.
Multiple Sclerosis: Demyelination → motor/sensory deficits.
Seizure Disorders: Abnormal neuronal firing → convulsions.
9. Renal Pathophysiology
Acute Kidney Injury (AKI): Sudden decline in renal function.
Chronic Kidney Disease (CKD): Progressive nephron loss → uremia.
Glomerulonephritis: Immune-mediated inflammation of glomeruli.
Nephrotic Syndrome: Proteinuria, hypoalbuminemia, edema.
10. Gastrointestinal Pathophysiology
GERD: Acid reflux → esophageal irritation.
Peptic Ulcer Disease: H. pylori infection, NSAID use.
Inflammatory Bowel Disease: Crohn’s disease, ulcerative colitis.
Liver Disease: Hepatitis, cirrhosis, portal hypertension.
11. Hematologic Pathophysiology
Anemia:
Iron deficiency.
Vitamin B12 deficiency.
Hemolytic anemia.
Leukemia: Malignant proliferation of WBCs.
Clotting Disorders: Hemophilia, DVT, pulmonary embolism.
12. Oncology Pathophysiology
Cancer Development:
Initiation → mutation.
Promotion → proliferation.
Progression → invasion/metastasis.
Hallmarks of Cancer:
Sustained proliferation.
Evading apoptosis.
Angiogenesis.
Metastasis.
13. Integration into Clinical Practice
Diagnostic Reasoning: Link symptoms to underlying pathophysiology.
Treatment Planning: Target disease mechanisms (e.g., ACE inhibitors for hypertension).
Patient Education: Explain disease processes in simple terms.
Monitoring: Track progression and response to therapy.
14. Case Example
Scenario: 55‑year‑old male with chest pain, hypertension, diabetes.
Assessment: ECG shows ischemia, labs reveal hyperlipidemia.
Pathophysiology: Atherosclerosis → reduced coronary blood flow.
Plan: Statins, antihypertensives, lifestyle modification.
Outcome: Reduced risk of myocardial infarction.
15. Summary
Pathophysiology explains why diseases occur and how they progress.
NPs must integrate pathophysiology into diagnosis, prescribing, and patient education.
Mastery of cellular, systemic, and clinical mechanisms ensures safe, effective practice.
Quiz: NRNP 6568 Week 5 (15 Questions)
Instructions: Multiple-choice format. Select the best answer.
Which type of cell death is programmed and non-inflammatory?
a) Necrosis
b) Apoptosis
c) Autolysis
d) Ischemia
Type I hypersensitivity reaction is mediated by:
a) T cells
b) IgE antibodies
c) Complement proteins
d) NK cells
Which condition involves plaque buildup in arteries?
a) Hypertension
b) Atherosclerosis
c) Heart failure
d) Arrhythmia
COPD includes:
a) Asthma + pneumonia
b) Chronic bronchitis + emphysema
c) Pulmonary embolism + asthma
d) Tuberculosis + fibrosis
Type 1 diabetes is caused by:
a) Insulin resistance
b) Autoimmune destruction of beta cells
c) Viral infection
d) Excess cortisol
Which thyroid disorder causes weight loss and tachycardia?
a) Hypothyroidism
b) Hyperthyroidism
c) Hashimoto’s disease
d) Thyroid cancer
Parkinson’s disease involves deficiency of:
a) Serotonin
b) Dopamine
c) Acetylcholine
d) GABA
CKD is characterized by:
a) Sudden decline in renal function
b) Progressive nephron loss
c) Acute infection
d) Kidney stones
GERD is caused by:
a) Acid reflux into esophagus
b) Viral infection
c) Autoimmune inflammation
d) Bacterial overgrowth
Which anemia results from vitamin B12 deficiency?
a) Iron deficiency anemia
b) Pernicious anemia
c) Hemolytic anemia
d) Aplastic anemia
Which hallmark of cancer involves new blood vessel formation?
a) Apoptosis evasion
b) Angiogenesis
c) Metastasis
d) Proliferation
Which immune-mediated condition affects glomeruli?
a) CKD
b) AKI
c) Glomerulonephritis
d) Nephrolithiasis
Which GI disorder is associated with H. pylori infection?
a) GERD
b) Peptic ulcer disease
c) Crohn’s disease
d) Hepatitis
Which hematologic disorder involves malignant proliferation of WBCs?
a) Anemia
b) Leukemia
c) Hemophilia
d) DVT
Which pathophysiologic mechanism underlies myocardial infarction?
a) Atherosclerotic plaque rupture → thrombosis
b) Autoimmune destruction of myocardium
c) Viral myocarditis
d) Genetic mutation