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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.
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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.
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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.
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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
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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
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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
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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
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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
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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
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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
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
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
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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.
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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
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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.
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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.
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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
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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
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
Fluorescence in situ hybridization

Molecular genetic techniques

Linkage analysis using microsatellite markers

Restriction fragment length polymorphisms (RFLPs)

Single nucleotide polymorphisms (SNPs) - DNA chip, dynamic allelespecific 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.
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
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
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
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
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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
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
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
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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
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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
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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
The body does not produce insulin. Some people may refer to this type
Diabetes
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
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Type 2
The body does not produce enough insulin for proper function, or the
Diabetes
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
This type affects females during pregnancy. Some women have very high
Diabetes
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 bloodglucose-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.
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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
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
Grave’s Disease – autoimmune disorder that is caused when thyroidstimulating 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
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
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.
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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
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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 nonsteroid 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.
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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.
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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
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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
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Correct Answers:
1. b
6. b
2. b
7. a
3. b
8. c
4. c
9. b
5. c
10. b
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The reference section of in-text citations include published works intended as
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