Bachelor's degree in Nursing (to qualify as a nurse) (Trento)

Pathophysiology applied at Nursing (2019/2020)

Course code
Barbara Rossi

Teaching is organised as follows:
Unit Credits Academic sector Period Academic staff
INFERMIERISTICA CLINICA 3 MED/45-NURSING See the unit page See the unit page

Learning outcomes

The course introduces the student to the basic concepts of major diseases and the fundamental pathogenetic processes, allowing them to correlate cellular homeostatic mechanisms to alterations of the organ functions and clinical manifestations of disease. Students will understand the basic principles of pharmacology, especially in pharmacokinetic and pharmacodynamic mechanisms, and the benefit and risk profile of the drugs. The course will helps students to develop an approach oriented to prevention, assessment and management of respiratory, urinary and intestinal function alteration and the multidimensional assessment of pain. PHARMACOLOGY: The course aims to provide general knowledge about the functions and the use of drug therapy, in the fields of pharmacodynamics, pharmacokinetics, pharmacoepidemiology and pharmacovigilance. Concepts of pharmacology are essential to the development of the nurse's own skills in management and control of drug therapies, as well in patient education. This course is preparatory to the study of the individual classes of drugs, which starts with anti-inflammatory and antibacterial drugs and will be completed in the clinical pharmacology module. SEMEIOTICS AND PHYSIOPATHOLOGY: The course introduces the student to the fundamental concepts of pathophysiology and semiotics, implicated in the activation of organ damage and in the development of the main diseases. The information necessary for understanding the set of events leading to the disease will be selected using a practical approach. Any further details will be reserved for the lessons that specifically deal with the organ and the apparatus. Every fundamental alteration will be explored within a specific organ and the different peculiar manifestations of the organ itself will be clarified. The lessons will also include the semeiotic part, describing the objective signs that characterize diseases. The treatment of semeiotics will be performed after treating the pathophysiology of the various organs. At the end of the course, students must be able to know the general mechanisms that lead to the disease and to identify their characteristics. CLINICAL NURSING I and II: The course offers the contents and the assistance methodology related to person's needs and to "fundamental" nursing care. The course will helps students to develop an approach oriented to prevention, assessment and management of respiratory, urinary and intestinal function alteration and the multidimensional assessment of pain. During teaching, frontal teaching methods will be privileged associated with sessions of application of the contents treated in care situations (guided exercises, video projections, clinical case analysis, testimony readings will be used to analyze and reflect on the perceptions and needs of the patients and family members). GENERAL PATHOLOGY: The course develops the preparatory contents for understanding the basic mechanisms of diseases. The following contents will be covered: the general principles and disorders of homeodynamics of complex systems, the main pathogenic esogenous and endogenous factors, biological damage, responses to damage, with particular reference to inflammation, the processes of healing and chronicity, immunity , haemostasis and thrombosis, vascular pathology and notions of general oncology. The course aims to help the student to understand the essential links between clinical analysis and fundamental mechanisms, facilitating the reading of the conceptual basis of the disease.


Basic principles in Pharmacology and introduction to the drugs in the market. Definition of drug, active substance, pharmaceutical product, vehicle, eccipient, the placebo effect Evaluation of the drugs’ efficacy: the randomized clinical trial. Different sources of drugs. How the drugs enter in the market. Bioequivalent and biosimilar drugs. The italian market for drugs. The drug prescription: fascia A e C, OTC and SOP drugs, different type of prescriptions. Indications and contraindications. The off-label use. How to measure the drug use: the DDD.
Pharmacodynamic. Basic principles of the mechanism of action of drugs (drug’s receptor, drug-receptor interaction: agonism and antagonism).
Pharmacokinetic. Drug’s absorption. Main characteristics of different drug administration routes: advantages and disadvantages. The bioavailability of drugs. Food-drugs interactions. The drugs’ distribution in the body. Factors that can influence the drugs’ distribution: the blood-brain and placentar barriers. Characteristics of drug metabolism. Enzyme induction and inhibition. Drug’s clearance. Factors that may alter influence drug’s clearance. Definition and meaning of dose, maximum dose, daily dose, dosing, therapeutic index, clearance, half-life, peak blood levels, therapeutic range, toxic concentrations, accumulation. Relationship between plasma concentrations of drugs and their action. Factors to be taken into account in determining the dose of a drug, and in the case of repeated administrations, the dosing interval.
How to calculate pharmaceutical doses.
Pharmacotherapy. Basics of risk/benefit and cost/benefit analyses for drugs. Adverse drug reactions: mechanisms and risk factors. The spontaneous reporting system of adverse drug reactions: regulation and role for nurses. Antibacterial drugs: general issues and characteristics of the main classes of antibacterial drugs. Basics of antivirals and vaccines. Non-steroidal anti inflammatory drugs (NSAIDs).

Basic needs of the cells: contribution of O2, nutrients and elimination of metabolites, maintaining fluid and electrolyte balance and acid-base intake. Anemia: in particular deficiency anemia, and hemoglobinopathies iporigenerative. • Body fluid and electrolyte balance: maintaining volume and distribution of fluids and their alterations: syndromes overhydration and dehydration, intra-extracellular fluid equilibrium, intra and extracellular buffer systems, maintaining fluid and electrolyte balance and acid-base. Semiotics of hydro electrolytic imbalances. • Endocrine system: hormones with major metabolic activity and the circle adjustment and volumes, hyper and hypofunction of the main endocrine glands and response to stress, diabetes mellitus, hyper- and hypoglycemia. Elements of the endocrine symptomatology. • Respiratory system: a change in ventilation, alveolar-capillary diffusion of gases, the report alveolar ventilation-perfusion. Respiratory failure. Signs of respiratory symptomatology. • Cardiovascular system: control of vascular tone and blood pressure, high blood pressure, ischemic heart disease, right and left heart failure and shock. Semiotics of the heart. • Urinary system: very brief about kidney disease and on the chronic renal failure. • Digestive System: malnutrition, portal hypertension, ascites. Elements of digestive symptomatology • Suffering of the central nervous system as a result of metabolic disorders.

MM: Clinical nursing 1. Breathing General assessment and definition of major alterations Hypoxia, dyspnoea, cyanosis, cough, hematoma, bronchial, sputum and orthopedic obstruction A) Assessment of breathing B) Basic interventions to promote respiration and mucus clarence. Oxygen therapy. Pain A) pain patterns, B) Classification of pain based on etiopathogenesis and localization, C) Achieving chronic and acute pain: guiding principles, assessing pain size, measuring instruments, D) pain from diagnostic / therapeutic and relief procedures E) non-pharmacological interventions.
MM: Infermieristica clinica 2. Body care and nursing management of the self-care deficit. Urinary elimination: nursing assessment and management. Particular focus will be on urinary incontinence, urinary retention and bladder catheter. Objective Examination: methodology and content about data observation, normality indicators, interpretation and main changes. The focus will be on the following devices or organs: head and neuromotor, chest, cardio-respiratory and vascular system, tegumentary and abdomen

Introduction to general pathology. Concepts of homeostasis and functional reserve organ. The disease: definition, causes; concept of pathogenesis. • cellular pathology: General concepts: steady state cell and tissue and its alterations: a) degenerative changes in the cells and cell death. b) Amendments of volumetric cells and their causes c) numerical modifications of cells and their causes d) Alterations of cellular differentiation processes. • Inflammation: General concepts: inflammation as a reaction of the body to harmful agents Types of inflammation: a) Acute inflammation: - General and fundamental moments Features. - Outline of chemical mediators of inflammation - Particular aspects of acute inflammation, and their consequences on the organism - Evolution of acute inflammation b) Chronic inflammation: - Features and pathogenetic mechanisms - The granulomas. - Useful and harmful effects of inflammation - General Manifestations of inflammation • The healing process of a wound: Phases of wound healing: coagulation, formation of granulation tissue scarring. Complications of the healing process: infection, dehiscence, keloid formation. • General oncology: - General characteristics of tumors: benign and malignant tumors. - The neoplastic cell: structural and functional aspects and give the guest mechanisms - Study the causes of cancer: epidemiological and experimental data - Overview of main chemical carcinogens, physical and biological - Overview of genes involved in the determinism of cancer. - Natural history of cancer: initiation, promotion, progression, metastasis - Mechanisms of defense against cancer: relationship between immunity and cancer. - Systematics of neoplasms. • General Hemostasis: General observations about the normal hemostatic mechanisms. A) Deficit of haemostatic mechanisms: bleeding causes of hemorrhage; local manifestations and general of bleeding disorders B) Thrombosis: General characteristics and pathogenesis of venous and arterial thrombosis; Consequences of thrombosis: angina and heart attack embolism signs. • Immunology - Immune response: natural immunity and specific immunity. organs primary and secondary lymphoid. NK cells. - B cells and T. - Concept of antigen. - Antibodies. - Overview of immune deficiencies - Autoimmunity: causes and and examples of autoimmune diseases. - The hypersensitivity reactions: General mechanisms of local and generalized hypersensitivity reactions: Examples of the most common hypersensitivity reactions.

Assessment methods and criteria

Writing test with multiple choice questions
Writing exam (Multiple choice test), eventual oral exam Books: Pontieri G.M., Patologia Generale e Fisiopatologia Generale, 2007, Ed. Piccin II edizione: Padova. Howland R. D., Mycek M.J. Le basi della farmacologia, 2007, Zanichelli Anglani A. Farmacologia e Tossicologia, 1995, McGraw-Hill: Milano Clayton,Stock: Fondamenti di Farmacologia per infermieri II Ed. 2007, EdiSES - Napoli Cella S.G., Di Giulio A.M., Gorio A., Scaglione F. Farmacologia generale e speciale per le lauree sanitarie, 2010, Piccin Padova Saiani L. e Brugnolli A. (2011). Trattato di cure infermieristiche, Ed. Sorbona Napoli Miller M.J. Fisiopatologia. Principi della Malattia. Ed. Ambrosiana, Milano. Raffaele Antonelli Incalzi “Medicina Interna per scienze infermieristiche” 2012 by Piccin Nuova Libreria S.p.a. Padova
------------------------ MM: Infermieristica clinica 1 ------------------------ The evaluation of the course will be carried out both in written form with short-term open questions where it is required to motivate data, select data and support them, assist them and motivate them using sources and physiopathological mechanisms. Multiple-choice test questions, response questions "to completion" small situations with options of choice. Oral mode may also be proposed. The examination will be divided into 2 modules of Clinical Nursing I and II The final vote, if positive, may also include elements of active participation during the lessons and adherence to the pre-reading mandates of the text. MM: Clinical nursing 1 The contents of the evaluation relate to the topic: * Breathing - General assessment and definition of major alterations. Respiratory, evaluation and care management of hypoxia, dyspnoea, cyanosis, cough, hematoma, bronchial, sputum and orthopedic obstruction Basic interventions to facilitate respiration and clarary mucus ciliary (postural change, humidification, effective cough, position) Oxygen therapy, both hospital and long-term, systems and careers for delivery, attention, and monitoring elements on the patient. * Acute, Post-Operative, Procedural, Oncological and Chronic Pain - recurrent, breakthrough pain, chronic and acute pain detection, scales and instruments for measurement, pain from diagnostic / therapeutic and relief procedures and non-pharmacological interventions ------------------------ MM: Infermieristica clinica 2 ------------------------ Written test
Writing test.

Reference books
Author Title Publisher Year ISBN Note
Anna Maria DI Giulio, Silvano Gabriele Cella Farmacologia generale e speciale per le lauree sanitarie (Edizione 2) Piccin 2018 9788829929429
Taglialatela Conforti Cuzzolin Leone Mattioli Moretti Pignataro Vanzetta Farmacologia per le lauree triennali e magistrali II Edizione (Edizione 2) Sorbona 2019
G. M. Pontieri Elementi di Fisiopatologia Generale Piccin-Nuova Libraria 2018 8829929085
E. Albi, F.S. Ambesi-Impiombato, F. Curcio, B. Moncharmont, A . Palese Le basi cellulari e molecolari delle malattie - per le lauree triennali e magistrali (Edizione 1) Idelson-Gnocchi - Sorbona 2018
Anna Brugnolli, Luisa Saiani Medicina e infermieristica un approccio di cure integrate (Edizione 1) Idelson Gnocchi 2017 9788879476379

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