NURS 336-Alterations in Physiological Functioning II: Exam 2 Study Guide

General Information:
Exam 2: 3/29/12 from 10:30 a.m. to 12:00 p.m., Dykes Testing Center Content Covered: Alterations in Cardiovascular, Respiratory, & Urinary/Renal Function (chapters 22-30) 100 questions distributed as follows: o Cardiovascular: 36 questions o Respiratory: 45 questions o Urinary/Renal: 19 questions

ALTERATIONS IN CARDIOVASCULAR FUNCTION (Ch. 22-24) (36 questions) Know Cardiovascular anatomy and physiology (Ch. 22: Structure & Function of the Cardiovascular & Lymphatic Systems) o Chambers of the heart o Cardiovascular blood flow o Cardiac conduction system (SA node, AV node, bundle of His, bundle branches, Purkinje fibers): structure, flow of electrical impulses through the system o Effects of cardiac innervation by the SNS and PSNS o Structure of myocardial cells Actin, myosin, and troponin-tropomyosin complex Know the different bands (e.g. I band, A band) and lines (e.g. Z line, M line) and how these lines are affected by myocardial contraction o Myocardial contraction (i.e. cross-bridge theory of muscle contraction) o Excitation-contraction coupling Know the factors that affect cardiac performance (i.e. cardiac output) o preload o afterload o stroke volume o heart rate o myocardial contractility Understand neural control of the heart o Especially the baroreceptor reflex: location, function, mediators, sequence of events Understand ECGs o How the ECG tracing correlates to the cardiac cycle o What different intervals represent (e.g. PR interval, QRS interval) Understand RAAS and where the different steps of the process occur (e.g. conversion of Angiotensin I to Angiotensin II) Know diseases of the veins (e.g. varicose veins, chronic venous insufficiency, Superior Vena Cava Syndrome) including their definitions, causes, pathophysiology, and clinical manifestations Know about hypertension: o Different types: Primary hypertension (aka essential or idiopathic HTN), Secondary hypertension, Isolated Systolic Hypertension (ISH) o Causes o Epidemiology o Pathophysiology o Clinical Manifestations o Complications of sustained hypertension Know about orthostatic hypotension (e.g. pathophysiology, clinical manifestations, causes of acute vs. chronic) Know about aneurysms (e.g. pathophysiology, common sites, clinical manifestations)

Be aware of the pathophysiologic continuum of coronary artery disease, myocardial ischemia, and acute coronary syndromes o Coronary Artery Disease (CAD) (e.g. risk factors [modifiable vs. nonmodifiable], common causes) o Myocardial ischemia Stable Angina Pectoris (e.g. pathophysiology, clinical manifestations) o Acute Coronary Syndromes (e.g. definition, pathophysiology, clinical manifestations) Myocardial infarction Note: Be familiar with laboratory tests used to evaluate for MI Unstable Angina Be familiar with valvular dysfunctions (e.g. pathophysiology, clinical manifestations): see table 23-7 on printed page 641 o Mitral stenosis o Mitral regurgitation o Aortic stenosis o Aortic regurgitation o Tricuspid regurgitation Know about heart failure (e.g. pathophysiology, causes/predisposing conditions, clinical manifestations) o Left Heart Failure (aka Congestive Heart Failure [CHF]) Systolic Diastolic o Right Heart Failure Know about shock (e.g. types of shock [hypovolemic, cardiogenic, neurogenic, anaphylactic], mechanisms operating in each type/pathophysiology, causes, clinical manifestations) Know about multiple organ dysfunction syndrome (MODS): definition, pathophysiology, nature of the oxygen supply and demand imbalance (i.e. supply-dependent oxygen consumption) Know about congenital heart defects (types, including most common types, characteristics of each defect)

ALTERATIONS IN PULMONARY FUNCTION (Ch. 25-27) (45 questions) Pulmonary anatomy and physiology including the primary function of the respiratory system (Ch. 25: Structure & Function of the Pulmonary System) o Lung receptors (irritant receptors, stretch receptors, j-receptors): factors that stimulate the different types of receptors, effects of stimulation o Pulmonary volumes and capacities (see Figure 25-9, printed page 700) Be familiar with the definitions for the bold terms throughout the chapter Be familiar with the Law of Laplace in relation to the alveoli Know the partial pressures of the various gases in the air Be able to determine the partial pressure of oxygen in the lung given the percentage of oxygen in the air and the barometric pressure Understand work of breathing (e.g. factors that can cause increased work of breathing, effects of increased work of breathing) Review the Distribution of Ventilation and Perfusion in your textbook as well as Figure 25-14 on printed pg. 707 Review oxygen transport (i.e. how oxygen is transported in the body) Be familiar with Control of Pulmonary Circulation on printed page 711 Be familiar with abnormal breathing patterns (e.g. Kussmaul respirations, Cheyne-Stokes respirations, hypoventilation, hyperventilation, etc.) Be familiar with the V/Q ratio and V/Q mismatching (Figure 26-2, printed page 718) Be familiar with atelectasis (the two types, pathophysiology of each type, clinical manifestations) Be familiar with the different types of pneumothorax and their clinical manifestations Be familiar with pleural effusions (i.e. different types of fluid involved) Know asthma (e.g. definition, classification scheme, pathophysiology) Know COPD (e.g. disorders included under COPD umbrella, pathophysiology, clinical manifestations) Know pneumonia (e.g. pathophysiology, types of pneumonia, causes of the various types, clinical manifestations Be familiar with tuberculosis (e.g. pathophysiology, infection transmission, clinical manifestations)

Be familiar with pulmonary embolism (e.g. risk factors, pathophysiology, clinical manifestations) Know pulmonary hypertension (e.g. pathophysiology, types, causes of the different types, clinical manifestations) Know lung cancer (e.g. pathophysiology, 2 major categories, clinical manifestations) o Note: See Table 26-3 on printed page Know childhood pulmonary disorders (i.e. risk factors, pathophysiology, causes, clinical manifestations, most common age of occurrence [if discussed in text]): o Croup o Respiratory Distress Syndrome (RDS) o Bronchopulmonary dysplasia o Bronchiolitis o Pneumonia (know the different types, see text including Table 27-2 on printed page 755) o Asthma o Cystic fibrosis o Sudden Infant Death Syndrome (SIDS) (also know prevention strategies)

ALTERATIONS IN URINARY/RENAL FUNCTION (Ch. 28-30) (18 questions) Know Urinary/Renal anatomy & physiology (Chapter 28: Structure and Function of the Renal and Urologic Systems) o Be familiar with renal blood flow Neural regulation of renal blood flow Hormonal regulation of renal blood flow RAAS o Understand glomerular filtration rate (GFR) and tubuloglomerular feedback o Be familiar with tubular transport (i.e. active transport in renal tubules, factors that can affect this process) Disorders of Urinary/Renal Function (i.e. pathophysiology, clinical manifestations) o Renal calculi o Cystitis o Pyelonephritis o Glomerular Disorders Glomerulonephritis (including different types, esp. acute, RPGN, chronic) Also see Table 29-7 on printed page 796 Nephrotic Syndrome o Renal failure Acute vs. Chronic Be familiar with lab values that would be used to evaluate renal failure Review Table 29-12 on printed page 804 o Urinary/Renal Disorders in Children (e.g. pathophysiology, clinical manifestations, prognosis [if applicable]) Structural abnormalities Hypospadias Epispadias (anterior vs. posterior) and bladder exstrophy Renal Agenesis (unilateral vs. bilateral) Glomerular disorders Glomerulonephritis Nephrotic syndrome Urinary tract infections Renal cancer Nephroblastoma (Wilms tumor)