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NU 320
PATHOPHYSIOLOGY I

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NU 320
Course Description
This course focuses on pathophysiologic concepts
related to the functional and structural changes that
accompany disease processes. The course emphasizes
concepts of pathophysiology, mechanisms of disease,
and the application of the basic concepts to body
systems and selected disease processes

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NU 320 Course Prerequisites
The course builds on the learner’s background from
normal Anatomy, Physiology, Biology and Microbiology.
Slide 4
NU 320 Course Bibliography
Required:

Huether, S.E. & McKance, K.L. (2017). Understanding

Pathophysiology,(6th ed.). St. Louis:
Elsevier/Mosby.

Slide 5 NU 320 Course Bibliography

Recommended:

Berkowitz, A. (2007). Clinical pathophysiology made

ridiculously simple (1st ed.). Miami: MedMaster Inc.

Zerwekh, J., Claborn, J. & Gaglione, T. (2014). Mosby’s

pathophysiology memory notecards. (4nd ed.). St. Louis:
Elsevier Mosby.

Links:

http://www.pathguy.com

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NU 320 Course Methodology

Classroom lecture, written assignments, faculty-

student review sessions and examinations
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Course Coordinator:
Sue T. Unruh, MSN, RN
Assistant Professor

Office: PC 203
Office Phone: 785-783-2041
Cell Phone: 316-303-4895
E-mail: [email protected]

Slide 8 NU 320 Course Requirements

Please refer to the “Course Policies” in syllabus.

1. Preparation for and participation in classroom

discussions and activities is expected.

2. You are expected to attend class.

Instructors reserve the right to withdraw a student for

non-attendance in class after due notice. In such
cases the grade of F is recorded after the eighth
week of a semester or the midpoint of a summer
session or short term class.

Slide 9 NU 320 Course Requirements

3. You are expected to be present for
examinations at the scheduled times.

4. If illness or family emergency prevents you from

attending class or taking an exam, you must
notify the instructor by:

(1) phone voice mail or cell phone

(2) in person, if appropriate.

See the course syllabus for the make-up exam policy.

Slide 10
CALL !!!

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PLEASE!!!

Slide 12 NU 320 Methods of Evaluation (example)

Pathophysiology

Patho Content Area Quizzes (5 @ 10 pts each) 50 Pts

Patho Content Area Exams (4 @ 50 points each) 200 Pts

Patho Comprehensive Final Exam (50 points) + 50 Pts

Total Points* = Total Quizzes + Exams

(+ any other assignments) 300 Pts

Successful completion of the course requires a 75%

average score on the quizzes, the exams, the
comprehensive final, and any pop quizzes given.
Slide 13 NU 320 Methods of Evaluation

Calculating the final course grade:

Step 1:Pathophysiology Quiz and Exam Points

The points achieved in course section NU 345 on the pathophysiology
quizzes, unit specific exams, the comprehensive final (if given) and any
pop quizzes are calculated.

Step 2: Pathophysiology Assignments/Worksheets Points

The points achieved on any homework assignments (if given) are
calculated.

Step 3: Total Course Points = Total Pathophysiology Quiz and Exam

Points + any Pathophysiology Homework Points.

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NU 320 Methods of Evaluation

* No make up pop quizzes will be offered.

Slide 15
NU 320 Course Requirements

The faculty reserves the right to make

changes in the course syllabus, schedule
and handouts as necessary in order to
facilitate the most comprehensive learning
experiences for the students.
Slide 16
UNIT I

BASIC CONCEPTS
OF
PATHOPHYSIOLOGY

Slide 17 Understanding is owning---Learn it

forever!
RULE 1

Learn it forever!

Slide 18 Our analytical mind (“left brain”) can

RULE 2 be our worst enemy!
The more education we get, the more
Don’t “overthink”! likely we will “overthink” something
that is perfectly clear into something
totally incomprehensible…
Slide 19 Inquiring minds WANT to know! It is
RULE 3
my job to make these concepts
CLEAR—ask questions!
Ask, ask,
and ask again!

Slide 20
RULE 4
Whoopee!
Have fun! This is EASY!

Slide 21 DEFINITIONS
• Health, Homeostasis and Disease
• Pathophysiology
• Etiology
• Pathogenesis
• Clinical Manifestations
• Diagnosis and Prognosis
• Clinical Course
• Epidemiology
• Morbidity and Mortality
• Risk Factors
Slide 22 Health and disease maybe considered
HEALTH two extremes of a continuum
“Health is a state of complete physical,
mental and social well-being and not Health is a state of complete physical
merely the absence of disease or
infirmity.” and mental well-being.
World Health Organization
1948

Slide 23 If Health is a state of complete

Homeostasis physical and mental well-being,
Homeostasis - A steady state in the then Health is also the maintenance of
internal environment of the body,
maintained by various feedback and
internal homeostasis
control mechanisms.

Homeostasis – (Gr.) homoios, “the

same” and stasis, “standing”.
--a dynamic steady state. A state of
balance, a state of adaptation and
continuous self-regulation.
Homeostasis is a steady state in the
internal environment of the body,
maintained by various feedback and
control mechanisms.
Key players are the nervous and
endocrine systems. Each cell
contributes to, and benefits from,
normal regulatory processes.
This balance continues unless one or
more of the systems becomes
disrupted. Moderate dysfunction leads
to illness. Severe dysfunction leads to
death.
Slide 24 Disease is a disruption in
DISEASE
homeostasis.
Dis-ease = discomfort Homeostasis can be disrupted by
processes that interfere with the
Any deviation from or interruption of the
normal structure or function of a part, function of homeostatic sensors and
organ, or system of the body that is
manifested by a characteristic set of regulatory centers, or effectors.
signs and symptoms.
Alterations in “normal” structure or
A disruption in homeostasis. function of an organ or system may be
the result of factors other than
disease. Age, gender, genetic,
geographic, and time of day may
influence “normal” parameters.
Disease can have cultural significance
– e.g. – one single CNS defect may
produce significant reading disability –
“disease” or “abnormality”. But in a
culture where reading is not an
important aspect of everyday life – it
might not even be noticed.
Disease = dis – ease or discomfort.
What may be “normal” for one
individual may cause discomfort for
another.
The complex nature of the disease
process includes the interplay
between injury and and reaction to
injury.
Sx and symptoms may change daily
as compensatory mechanisms are
brought into play and the biological
equilibrium shifts.
Every disease has a range of
manifestations and a natural history
that varies from individual to individual.
Slide 25 Factors Affecting Determination
of Normality

 Genetic variations
 Cultural considerations
 Age
 Gender
 Adaptive mechanisms
 Time
 Lab testing methods
 Baseline

Slide 26 Etymology: Gk, pathos, disease,

Pathophysiology
physis, nature, logos, science
Pathophysiology - the study of the
body’s response to dysfunction or PATHOPHYSIOLOGY – study of how
disease.
disease affects normal body function
Pathos (Gr) - “disease”
Physiology - the study of the processes and
functions of the human body
Pathology: the structural and
Disease - the interruption, cessation, or
disorder of a body system or organ
functional manifestations of disease.
structure.
• Etiology, pathogenesis, morphologic changes, clinical
Physiology – the study of the
manifestations, diagnosis, clinical course
processes and functions of the human
body.
Pathophysiology – is the study of the
cellular and organ changes that occur
with disease and the effects these
changes have on total body function.
Pathophysiology does not deal directly
with the treatment of disease. Rather,
it explains the processes within the
body that result in the signs and
symptoms of a disease.
Slide 27 EXAMPLE: The “job description” of a
Most disease arises from: ceiling fire sprinkler.
a loss
of a normal regulatory system When an appropriate stimulus triggers
or a normal regulatory system—things
normal activation are GOOD! (fire=sprinkler activated)
of a regulatory system
under abnormal circumstances When an appropriate stimulus fails to
or trigger a normal regulatory system—
BOTH things are BAD! (a fire = sprinkler not
activated)
When an inappropriate stimulus (the
lighted match = sprinkler activated)
triggers a normal regulatory system---
Things are still BAD!

Slide 28 Physiology and Pathophysiology Are

Cellular Processes
• Disturbances in cell-to-cell and cell-to-
environment interactions are the basis of
disease.
• Course will focus on understanding cell
physiology, intercellular communication, and
intracellular processes.
• Emphasis on membrane
physiology,
where cell-to-cell and
environmental
interactions occur.

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Primary Aspects of the Disease -Pathogenesis refers to the
Process

• Etiology
development of the disease or the
• Pathogenesis sequence of events involved in the
• Pathology/Morphologic tissue changes related to the specific
changes
disease process
• Clinical manifestations
-Clinical manifestations of a disease
• Diagnosis
are the clinical evidence or effects, the
signs and symptoms, of disease.
-Signs are objective indicators of
disease that are obvious to someone
other than the affected individual.
Examples of a sign are a fever or a
skin rash.
-Symptoms are subjective feelings,
such as pain or nausea.
-Diagnosis refers to identification of a
specific disease through evaluation of
signs and symptoms, laboratory tests,
 or other tools. For example, a
diagnosis of diabetes mellitus could be
confirmed following considerations of
the patients signs and blood tests.

Slide 30 Etiology – the study of the cause of

What Is Etiology? disease.
What causes the disease? Etiologic factors - include biological
– Genetic/Congenital
– Environmental
agents, physical forces, nutritional
– Impaired signals excesses and deficits – and
– Stress
– Injury, inflammation, immune
inheritance and environmental factors.
disorders
– Neoplasia
Idiopathic – cause unknown
Iatrogenic – result of medical
treatment
Nosocomial – disease
acquired as the result of
hospitalization

Slide 31 Classifications of Disease by Etiology

.
 Inherited and Congenital
 Nutritional/Metabolic/Endocrine
 Stress related
 Physical–agent induced
 Infectious
 Immunologic
 Neoplastic
 Degenerative
 Psychogenic
 Iatrogenic
 Idiopathic
Slide 32 Pathogenesis – how the disease
What Is Pathogenesis?
process evolves--process of how
How does the disease develop/evolve? disease gets started.
• Sequence of cellular and tissue events that that
take place from the time of the initial contact with
the etiologic agent until the ultimate expression of
the disease

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What Is Pathology?
The study of cell and tissue changes associated with disease.

• These studies are often valuable in establishing

the cause of a disease.

Slide 34 What are Clinical Manifestations?

Describe structural and functional

changes that accompany a disease

• Symptom - a subjective complaint

• Sign - physical manifestation noted by an observer
• Syndrome - a compilation of s/s
• Complication - adverse extension of a disease or outcomes
from treatment
• Sequelae - a pathological condition resulting from a
disease. A secondary consequence or result.
Slide 35 Clinical Manifestations – Signs and
Clinical Manifestations
Symptoms
 Subjective symptoms Symptoms are SUBJECTIVE
 Objective clinical signs
 Laboratory tests and
Signs are OBJECTIVE – a
procedures manifestation/aberration that is noted
Principles
by an observer
of Diagnosis
.

Slide 36
What is a Diagnosis?
• A designation as to the nature of a health problem
• Confirmed by abnormalities in
– Lab tests, x-rays, CT, MRI
– Reliability validity
– Sensitivity proportion of people with
disease that have positive test results
– Specificity proportion of people without the
disease that have negative test results

Slide 37 -Clinical Course is the series of

Additional Aspects of the Disease
Process events in a disease incident in a
patient. It may be acute, subacute,
•Clinical Course
chronic, intermittent or recurrent
•Prognosis
acute course 1 or 2 days.
•Therapy
subacute course up to a week
•Convalescence
•Remissions and exacerbations
chronic course more than 1 week.
intermittent course periods of
normality of a few minutes or hours.
recurrent course periods of normality
of weeks to months.
-Prognosis defines the probability for
recovery. The probability figures used
in prognosis are based on averages,
and there may be considerable
variation among affected individuals.
-Complications are new secondary or
additional problems that arise after the
original disease begins. For example,
 following a heart attack, a person may
develop congestive heart failure, a
complication.
-Therapy or therapeutic interventions
are treatment measures used to
promote recovery or to slow the
progress of a disease. These
measures may include surgery, drugs,
or behavior modification.
-Sequelae describe the potential
unwanted outcomes of the primary
condition, such as paralysis following
recovery from a stroke.
-Convalescence is the period of
recovery and return to the normal
healthy state; it may last for several
days or months.
- Remissions and exacerbations
may mark the course or progress of a
disease. During a remission, the
manifestations of the disease subside,
whereas during an exacerbation the
signs increase

Slide 38 The Mechanisms of

Disease

Guessin’
Isn’t
Guesswork
Slide 39 What is the Mechanism of the Disease????

(I’m “GuESSI4N?”)

Slide 40 10 Classifications of Disease by Pathophysiology

(“GuESSI4N?”)
• Genetic or U are born with it – Congenital)
• Environmental (fluid & electrolyte imbalances,
nutritional excesses or deficits, metabolic)
• Signal Failure (hormone imbalances, enzyme
imbalances, cell to cell communication failure)
• Stress
• I4 (Injury, Infection, Inflammation, Immunologic)
• Neoplasia
• ???? (Idiopathic)

Slide 41
(I’m “GuESSI4N?”)

Genetic
(Inherited)
UR born with it
(Congenital)
Slide 42 Genetic Control of Most cells of the human body
Cell Function and Inheritance reproduce.
Cell’s Gotta
Most nucleated cells reproduce.
Live and Reproduce! Exceptions – neurons.
Neurons stop reproducing shortly after
birth. Because of this, some parts of
the brain have more neurons at birth
than later in life because neurons die
but are not replaced. While neurons
do not reproduce, research has shown
that new connections between
neurons form throughout life.
Mature RBCs do not contain a nucleus
and therefore do not reproduce.
Because of the lack of nuclei and
organelles, mature red blood cells do
not contain DNA and cannot
synthesize any RNA, and
consequently cannot divide and have
limited repair capabilities

Slide 43
(I’m “GuESSI4N?”)

Environmental
Nutritional
& Metabolic
Slide 44 Cellular Environment

Where salt
goes…

Slide 45 Cellular Metabolism

Cell metabolism is the process by
which individual cells process nutrient
Aerobic Cell’s Gotta molecules. Metabolism has two
Breathe!
distinct divisions:
Anaerobic
catabolism, in which the cell breaks
Cell’s Gotta Catabolism
Eat! down complex molecules to produce
energy and reducing power, and
Anabolism anabolism, in which the cell uses
energy and reducing power to
construct complex molecules and
perform other biological functions.
Complex sugars consumed by the
organism can be broken down into a
less chemically complex sugar
molecule called glucose.
Once inside the cell, glucose is broken
down to make adenosine triphosphate
(ATP), a form of energy, through two
different pathways.
Slide 46 (I’m “GuESSI4N?”)

Signal Failure

Slide 47 Mechanism of Disease -

Impaired cell signaling

Cell’s gotta
communicate!

Slide 48 The endocrine system includes eight

Cell Signaling
major glands throughout the body.
These glands make hormones.
Hormones are chemical messengers.
They travel through the bloodstream to
tissues or organs. Hormones work
slowly and affect body processes from
nervous head to toe. These include
Growth and development
Metabolism - digestion, elimination,
breathing, blood circulation and
maintaining body temperature
Sexual function
Reproduction
Mood
If hormone levels are too high or too
low, there may have a hormone
disorder. Hormone diseases also
 occur if your body does not respond to
hormones the way it is supposed to.
Stress, infection and changes in your
blood's fluid and electrolyte balance
can also influence hormone levels.
In the United States, the most
common endocrine disease is
diabetes mellitus. There are many
others. They are usually treated by
controlling how much hormone your
body makes. Hormone supplements
can help if the problem is too little of a
hormone.

Slide 49 Cytokine Signaling

nervous

Slide 50
(I’m “GuESSI4N?”)

Stress
Slide 51 Diseases Associated with Stress
 CV: Stroke, CAD, HTN,
 Connective Tissue: RA
 Pulmonary: Asthma, Hay fever
 GIT: Irritable bowel syndrome
 Endocrine: Diabetes Mellitus

51

Slide 52
(I’m “GuESSI4N?”)

Injury,
Inflammation,
Immunity &
Infection

Slide 53 Mechanism of Disease -

Injury
Slide 54
Inflammation

Slide 55
Immunity

Slide 56
Infection
Slide 57
(I’m “GuESSI4N?”)

Neoplasia
Uncontrolled
Cell Division
(DNA abnormality)

Slide 58
(I’m “GuESSI4N?”)

Idiopathic

Slide 59 10 Mechanisms of Disease

(“GuESSI4N?”)
• Genetic or U are born with it – Congenital)
• Environmental (fluid & electrolyte imbalances,
nutritional excesses or deficits, metabolic)
• Signal Failure (hormone imbalances, enzyme
imbalances, cell to cell communication failure)
• Stress
• I4 (Injury, Infection, Inflammation, Immunologic)
• Neoplasia
• ???? (Idiopathic)
Slide 60

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