LPN Expert Guides: Pathophysiology PDF
Preview LPN Expert Guides: Pathophysiology
8957 FM.qxd 8/19/08 4:39 PM Page i LPN EXPERT GUIDES Pathophysiology 8957 FM.qxd 8/19/08 4:39 PM Page ii STAFF The clinical treatments described and recommended in this publication are EXECUTIVEPUBLISHER based on research and consultation with Judith A. Schilling McCann,RN, MSN nursing, medical, and legal authorities. To EDITORIALDIRECTOR the best of our knowledge, these pro- cedures reflect currently accepted practice. William J. Kelly Nevertheless, they can’t be considered CLINICALDIRECTOR absolute and universal recommendations. Joan M. Robinson, RN, MSN For individual applications, all recommen- dations must be considered in light of the SENIORARTDIRECTOR patient’s clinical condition and, before ad- Arlene Putterman ministration of new or infrequently used EDITORIALPROJECTMANAGER drugs, in light of the latest package-insert information. The authors and publisher Catherine E. Harold disclaim any responsibility for any adverse CLINICALPROJECTMANAGER effects resulting from the suggested pro- Eileen Cassin Gallen, RN, BS cedures, from any undetected errors, or from the reader’s misunderstanding of the COPYEDITORS text. Heather Ditch, Amy Furman, © 2007 by Lippincott Williams & Wil- Dona Perkins kins. All rights reserved. This book is pro- tected by copyright. No part of it may be DESIGNERS reproduced, stored in a retrieval system, Debra Moloshok (book design), or transmitted, in any form or by any Matie Anne Patterson (project means—electronic, mechanical, photo- manager) copy, recording, or otherwise—without DIGITALCOMPOSITIONSERVICES prior written permission of the publisher, Diane Paluba (manager), except for brief quotations embodied in critical articles and reviews and testing Joyce Rossi Biletz, Donna S. Morris and evaluation materials provided by the MANUFACTURING publisher to instructors whose schools Patrica K. Dorshaw (director), have adopted its accompanying textbook. Beth J. Welsh Printed in the United States of America. For information, write Lippincott Wil- EDITORIALASSISTANTS liams & Wilkins, 323 Norristown Road, Megan L. Aldinger, Karen J. Kirk, Suite 200, Ambler, PA 19002-2756. Linda K. Ruhf LPNPatho010306 DESIGNASSISTANT Georg Purvis 4th Library of Congress Cataloging-in-Publication Data INDEXER Dianne Prewitt LPN expert guides. Pathophysiology. p. ; cm. Includes bibliographical references and index. 1. Pathology—Handbooks, manuals, etc. 2. Practical nursing—Handbooks, manuals, etc. I. Lippincott Williams & Wilkins. II. Title: Pathophysiology [DNLM: 1. Pathophysiology—Hand- books. 2. Nursing, Practical—methods— Handbooks. WY 49 L9245 2006] RB30.L66 2006 616'.07—dc22 2005034580 ISBN 1-58255-895-7 (alk. paper) 8957 FM.qxd 8/19/08 4:39 PM Page iii Contents Contributors and consultants v 1 Pathophysiology basics 1 2 Cancer 12 3 Infection 48 4 Immune system 74 5 Genetics 107 6 Endocrine system 141 7 Respiratory system 179 8 Cardiovascular system 231 9 Neurologic system 281 10 Gastrointestinal system 320 11 Genitourinary system 361 12 Musculoskeletal system 390 Less common disorders 416 Selected references 429 Index 430 iii 8957 FM.qxd 8/19/08 4:39 PM Page iv 8957 FM.qxd 8/19/08 4:39 PM Page v Contributors and consultants Katrina D. Allen, RN, MSN, CCRN Nursing Instructor Faulkner State Community College Bay Minette, Ala. Janice W. Chapman, RN, MSN Health Careers Site Coordinator & Instructor Reid State College Atmore, Ala. Tricia Duff, LPN, I.V. certified Coumadin Nurse Concord (N.H.) Hospital Richard R. Gibbs, LVN Staff Nurse, Rehab Unit Mesquite (Tex.) Community Hospital Charla K. Hollin, RN, BSN Nursing Program Director Rich Mountain Community College Mena, Ark. Donna Kearns, LPN, BEd, MEd, EdD Chair, Special Services Department University of Central Oklahoma Edmond, Okla. Noel C. Piano, RN, MS Instructor Lafayette School of Practical Nursing Williamsburg, Va. v 8957 FM.qxd 8/19/08 4:39 PM Page vi vi ■ Contributors and consultants Dina Nicole Salvatore, LPN Charge Nurse Windemere Nursing & Rehabilitation Center Oak Bluffs, Mass. Kendra S. Seiler, RN, MSN Nursing Instructor Rio Hondo Community College Whittier, Calif. Georgia A. Simmons, RN, BSN Practical Nursing Instructor Ivy Tech State College Madison, Ind. Julie Traynor, MSN, RN Director, Dakota Practical Nursing Program Lake Region State College Devils Lake, N.D. 895701.qxd 8/19/08 4:09 PM Page 1 1 P ATHOPHYSIOLOGY BASICS Understanding cells The cell is the body’s basic building block, the smallest living com- ponent of an organism. Millions of cells form highly specialized units that function together as: ■ tissues, such as muscle, blood, and bone ■ organs, such as the brain, heart, and liver ■ integrated body systems, such as the central nervous system (CNS), cardiovascular system, and digestive system. CELL COMPONENTS Each cell contains structures known as organelles,each with specific functions. (See A look at cell components, page 2.) Organelles are held in an aqueous substance called cytoplasm, which is bounded by the cell membrane. The nucleusis the largest organelle. It controls cell activity and stores deoxyribonucleic acid (DNA), which carries genetic material and is responsible for cellular reproduction, also known as division. Other organelles include: ■ ribosomesand the endoplasmic reticulum,which synthesize pro- teins and metabolize fat inside the cell ■ the Golgi apparatus, which contains enzymes that function in cel- lular metabolism ■ lysosomes,which contain digestive enzymes that permit cytoplas- mic digestion ■ mitochondria,which make adenosine triphosphate, the energy that fuels cellular activity. 1 895701.qxd 8/19/08 4:09 PM Page 2 2 ■ Pathophysiology basics A look at cell components This illustration shows cell components and structures. Each part helps maintain the cell’s life and homeostasis. Cytoplasm (protoplasm surrounding nucleus) Lysosome (contains digestive enzymes) Mitochondrion (makes cellular energy) Golgi apparatus (processes and packages proteins) Nucleus (brain of the cell) Endoplasmic reticulum (transports protein and lipid components) Ribosome (site for protein synthesis) Cell membrane (encloses the cell) CELL DIVISION AND REPRODUCTION Cell reproduction occurs in two stages. In the first stage, called mitosis,the nucleus and genetic material divide. In the second stage,called cytokinesis,the cytoplasm divides, starting during late anaphase or telophase. At the end of cytokinesis, the cell produces two daughter cells. (See Phases of cell reproduction.) Before it divides, a cell must double its mass and content. This occurs during the growth phase, called interphase.Chromatin—the small, slender rods that give the nucleus its granular appearance— begins to form. Replication and duplication of DNA occur during the four phases of mitosis: 1. prophase 2. metaphase 3. anaphase 4. telophase. 895701.qxd 8/19/08 4:09 PM Page 3 Understanding cells ■ 3 Phases of cell reproduction These illustrations show the phases of cell reproduction. PROPHASE Spindle Centrioles Chromosomes (each Centromere composed of two chromatids) METAPHASE Centromeres divide Chromosomes and pull the chromo- somes apart, and then the centromeres align in the middle of the spindle. ANAPHASE Centromeres separate and pull chromosomes toward opposite sides of the cell. TELOPHASE A new membrane forms around chromosomes, and the cytoplasm divides. Cleavage furrow CYTOKINESIS Cytokinesis completes the division of the cell into two daughter cells. 895701.qxd 8/19/08 4:09 PM Page 4 4 ■ Pathophysiology basics Prophase In this first phase of cell division, chromosomes coil and shorten, and the nuclear membrane dissolves. Each chromosome is made up of a pair of strands called chromatids,which are connected by a spin- dle of fibers called a centromere. Metaphase In metaphase, centromeres divide, pulling the chromosomes apart. The centromeres then align in the middle of the spindle. Anaphase Centromeres now begin to separate and pull the newly replicated chromosomes toward opposite sides of the cell. By the end of anaphase, 46 chromosomes are present on each side of the cell. Telophase During telophase, a new membrane forms around each set of 46 chromosomes. The spindle fibers disappear, cytokinesis occurs, and the cytoplasm divides, producing two identical new daughter cells. CELL INJURY A person’s state of wellness and disease is reflected in the cells. In- jury to any of the cell’s components can lead to illness. One of the first indications of cell injury is a biochemical lesion that forms on the cell at the point of injury. This lesion changes the chemistry of metabolic reactions inside the cell. When cell integrity is threatened—by toxins, infection, physi- cal injury, or deficit injury—the cell reacts in one of two ways: ■ by drawing on its reserves to keep functioning ■ by adapting or becoming dysfunctional. If enough cellular reserve is available and the body doesn’t de- tect abnormalities, the cell adapts. If there isn’t enough cellular re- serve, cell death (necrosis) occurs. Necrosis is usually localized and easily identifiable. Toxic injury Toxic injuries may result from factors inside the body (endogenous factors) or outside the body (exogenous factors). Common endoge- nous factors include: ■ genetically determined metabolic errors ■ gross malformations ■ hypersensitivity reactions. Exogenous factors include:
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