NURS 2090 Lecture Notes - Neoplasm, Menopause, Cryosurgery

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16 Apr 2013
Department
Course
Cellular Adaptation and Response to Stress
Causes of Disease (according to Heather Helpard)
1. Adaptation
2. Injury: adaptation is no longer helpful and there is a perm change. ** inflammation/infection
3. Death
4. Neoplasms: cancer
5. Aging
Response to Change - Cellular Adaption
Occurs in response to physiologic or pathophysiologic changes
Adaptive responses to cellular changes are usually only temporary enlargement of uterus,
Cell injury may be reversible or irreversible - ARF
Cell injury may cause different clinical and pathophysiological manifestations - LVH
Cellular aging inevitable and normal
Major Adaptive Reactions to Persistent Stress
1. Atrophy
2. Hypertrophy
3. Hyperplasia
4. Metaplasia
5. Dysplasia
6. Intracellular deposits
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Atrophy: decrease in size of a cell
The decrease due to:
a) A decrease in functional demand (immobilized limb)
b) A decrease in oxygen supply or ischemia (blockage in arterial blood supply)
c) Decreased hormone and/or neural signals (menopause; innervation to a muscle)
d) Chronic nutritional deprivation
e) Aging processes
Cerebral Atrophy:
- A reduction in size of the cells in the cerebellum of the brain, leading to a reduction in the brain
tissue itself.
- There will be more gaps and holes, which will increase the level of cognitive impairment and
increase communication problems in the brain, along with an unsteady gait.
- With atrophy of the nerves, there are significant issues, because they will be more susceptible
to injury because they do not have as much protection.
Clinical Manifestations:
As neurons decrease in size, communication is further impaired as the distance between neurons
increases
Frontal/Temporal Lobes- cognitive impairment
Hippocampus and Cerebral Cortex- Alzheimer’s Disease
Basal Ganglia- movement disorders; lack of the production of neurotransmitter
dopamine
Neuronal insult- cerebral palsy for example during the prenatal, perinatal or postnatal
periods (range from mild to moderately severe involving motor skills, coordination and
balance and seizure activity). This depends largely on where the injury is, as each
person’s case is different.
Diagnosis and Treatment
Early diagnosis is critical due to limited reserve to restore function
Medical hx: signs and symptoms, onset, duration, severity, physical examinations and
screening, MRI
Supportive care; physical, speech and occupational therapy; pharmacologic measures
Treatment is individualized based on diagnosis and type of brain atrophy involved with
goal of maximizing function and minimizing continued pathology.
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2. Hypertrophy: An increase in cell size (increased organ size, usually heart & kidneys)
Increase in size associated with increase in protein without an increase in cellular fluid
Example: Adenoid tissue at the back of the nasal passage can enlarge and result in the
blockage of the nasal passage with upper respiratory infections (e.g. Stuffy nose)
** there are not additional cells, just increased expansion in cell due to proteins
Caused by:
a. specific hormone stimulation/functional demand (breastfeeding/pregnancy) (Positive
adaptation)
b. increase in growth signals (puberty) (Positive adaptation)
c. Strength building exercises (Positive adaptation)
d. Increased demand
Cardiac Hypertrophy:
A disease of cardiac muscle that results from excessive workload and functional demand. The
increase in blood pressure makes hypertrophic cells, but the fibers eventually will degenerate and
lose contractile elements.
Primary Vascular Disease= genetic, under 30
Secondary Vascular Disease= starts with high BP
- Hypertrophy can occur in RV due to increase pressure in pulm circ. OR LV due to
increased pressure in systemic. (happens with hypertension)
Clinical Manifestations
Symptoms are based on severity and can include shortness of breath, chest pain and
syncope (fainting)
Can lead to irregular heart rates and rhythm as the cardiac conducting cells become
altered, disrupting neurologic signalling in the heart
Diagnosis and Treatment
Genetic testing (for primary)
Blood pressure screening
12 Lead ECGs; Holter monitor
Two dimensional echocardiogram
Exercise stress testing
Physical exam
Treatment: antihypertensive medications, such as beta blockers, surgery to replace heart valves,
activity prescriptions
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