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PT 640 Lecture 1

Pathophysiology

QuestionAnswer
Define Pathophysiology The study of how normal physiological processes are altered by disease (Taber, 1993) The study of disordered or altered functions e.g. the physiological changes caused by disease in a living organism (Price and Wilson, 1997)
Define disease A pathologic condition of the body that presents a group clinical signs, symptoms and laboratory findings peculiar to it and that sets the condition apart as an abnormal entity differing from other normal of pathological states
Define illness perception and response of a person to not being well
define health a state of complete physical, mental, and social well being; not merely the absence of disease; reflects a person’s biological, psychological, spiritual, and sociological state
define holistic health views patient as a whole person (social, sexual, emotional, spiritual, etc.)
What is the health continuum anything from wellness to illness (death)
Define homeostasis The body’s tendency to maintain a steady state (internal environment) in the face of continual environmental (external) variation
What factors affect homeostasis temperature, cardiac output, blood pressure, oxygen, CO2 levels acid-base, fluid volume, electrolyte composition are all closely regulated to maintain homeostasis
Define etiology cause
Define pathogenisis mechanism of development
What are morphological changes structural alterations induced in the cell and organs
Define clinical significance functional consequences of the morphological changes
what is the progression of cellular response due to increased pathophysiological stress? Cellular adaptation (hypertrophy, atrophy) Reversible cell injury Irreversible cell injury Cell death
Define sequela Outcome of the disease such as a movement disorder; a condition following and resulting from the disease (Taber, 1993).
define complications A new or separate process that may arise secondarily to the original process. e.g. surgery complicated by pneumonia; pulmonary embolism and bedrest; aspiration due to decreased swallowing following a CVA (stroke)
What are the stages of illness? acute sub-acute chronic
Define acute Relatively rapid onset and short duration
The healing time of an acute illness is dependent on what? Time since onset Overall health of the individual Type and extent of disease Present environment and access to appropriate care
What are the stages of acute illness 1. Physical symptoms: SOB, fatigue, fever 2. Cognitive awareness: it has some meaning to the patient 3. Emotional response: denial, fear, anxiety 4. Sick role: person realizes that they need medical assistance 5. Dependency:
Define a sub-acute illness Between acute and chronic Longer than a few days, less than a few months
Chronic conditions include an illness with one of what three characteristics? Permanent impairment or disability Residual physical or cognitive disability Need for special rehab or long-term medical management
Chronic illnesses fluctuate in intensity due to what? acute exacerbations
Define Body functions and structures: physiologic or psychologic functions of body systems or anatomic parts
Define Impairments: problems in body function or structure
Define Activity: execution of specific tasks or actions by an individual
Define Activity limitations: difficulties that individual might have in executing activities
Define Participation: individual’s involvement in life situations
Define Participation restrictions: problems the individual might have in real life situations
Define Primary Prevention: risk factor identification and management to prevent occurrence of the disease
Define Secondary Prevention: early detection and treatment of disease with goal of minimizing the progression of the disease
Define Tertiary Prevention: reduction of disability through treatment and rehabilitation
What risk factors? 1. Conditions that place the person at higher risk than if risk factors didn’t exist 2. Modifiable or non-modifiable
Types of Risk factors Heart disease Lung cancer Chronic obstructive pulmonary disease (COPD) Diabetes HIV Accidents Obesity Emotional/Psychological: eating disorder, domestic violence
Healthy People 2020 Physical activity Overweight and obesity Tobacco use Substance abuse Responsible sexual behavior Mental health Injury and violence Environmental quality Immunization Access to Health Care
What individual beliefs impact behavior and Decision making? Cultural Religious Personal Psychological
What are the steps toward a behavior change? Pre contemplative Contemplative Preparation Action Maintenance
clinical manifestations of substance abuse associated with spousal and child abuse increased sexually transmitted disease teen pregnancy motor vehicle crashes multiple medical sequelae can impair or slow the rehab process
clincal manifestations of eating disorders electrolyte imbalance edema and dehydration cardiac abnormalities kidney disfunction neurological abnormalities endocrine dysfunction weakness emotional disturbance
clinical manifestations of obesity increase in mortality and morbidity associated with CV disease, cancer and DM
clinical manifestations of domestic violence injuries: contusions, fxs, lacerations subdural hematomas GI disturbances
How are symptoms detected? Patient’s subjective information What they “complain” (c/o) about
What is the best way to get a history? Listen Ask directed and clarifying questions
Keys to developing good interview skills 1. Accurate clinical hypothesis 2. Good Examination and intervention approach t 3. Recognizing signs and symptoms 4. Particip. in the clinical decision-making process appropriate diagnostic testing
A good examination approach has what considerations? o meet the individual’s culture, communication, anatomical , and physiological needs and abilities
Why are recognizing signs and symptoms important? In order to know if their problem is within your scope of practice or if they need to be referred to another health care provider
What skills are necessary for patient interview communication Active listening nonverbal communication patient centered
Keys to a patient centered interview Start with open ended questions Funnel to closed ended questions Avoid biased questions Ask one question at a time Speak slowly Ask brief questions Periodically restate and summarize Use the patient’s own words when appropriate Do not use jargon
Radiology Rays found on electromagnetic spectrum (x-rays) pass through object, leaving signal on plate of sensors behind it that is then converted to images
Why is radiology the first study ordered? due to low cost, ease of imaging and speed of results
Nuclear radiology Patient administered radionucleotide agent with radioactive tracer that has affinity for body tissues  CT scan
What is good about nuclear radiology? bad? good measure of function, poor detail (cardiac imaging, bone scans, etc)
MRI Uses strong magnetic field to disturb atomic nuclei and then records their response to radio signals as they emit specific radio frequencies  collected and images created
Scopes Non-invasive flexible tube with small camera
Types of scopes done Athroscopy: joints Bronchoscopy: lung Colonoscopy: colon Cystoscopy: bladder Endoscopy: esophagus Gastroscopy: stomach
Catheterization Arterial (cardiac, renal, carotid, UE or LE) or urinary procedure Deploy stents to open up arteries or other obstructions
What is important to know about PTs treatment implications with someone with a catheter or recent catheterization? 4-8 hours after on bed rest
Ultrasound Uses high-frequency sound waves to visualize soft tissue structures
EKG?ECG Records electrical activity of the cardiac tissue
EKGs are valuable to assess what? Cardiac rhythms Conduction abnormalities Detecting myocardial ischemia Specific pathologies: (COPD), cardiomyopathy, pericarditis, among others
Electroencephalogram Multiple electrodes attached to patient’s head and then to computer to monitor electrical activity of the brain
EEGs are helpful in diagnosing what? Seizures (epilepsy) Brain function and activity after head injury, degenerative disease, stroke, etc
What is a biopsy? Removal of small piece of tissue anywhere throughout the body for further examination
Open vs needle biopsy? Needle biopsy: needle passes through syringe to extract tissue Open biopsy: surgical procedure under anesthesia or conscious sedation
Abbreviations BP: PA: CVP: A-line: BP: blood pressure PA: pulmonary artery CVP: central venous pressure A-line: arterial line
Other Abbreviations PWP PCOP PCWP CO CI SVR PVR PWP (pulmonary wedge pressure), PCOP (pulmonary capillary occlusive pressure) or PCWP (pulmonary capillary wedge pressure) CO (cardiac output) CI (cardiac index) SVR (systemic vascular resistance) PVR (pulmonary vascular resistance
PT implications of Telemetry no contraindications
peripheral IV Used to deliver medications or fluids through venous system
What is the purpose of an air filter on the IV? Air filter on IV tubing for patent forarem ovale (PFO) to decrease risk of air bubbles, which can cause air embolus and stroke
PICC line Peripherally Inserted Central Catheter (PICC) LINE
What is the reason for a PICC line? Used for extended antibiotics or medications, chemotherapy or total parenteral nutrition (TPN
Where is the PICC Line placed? why? Usually placed in cephalic, basilic or brachial vein  tip advanced through larger veins until tip rests in superior vena cava or cavo-atrial junction
What happens if the tip of the catheter is advanced to far into the atrium? If tip of catheter is advanced too far into right atrium, can cause arrhythmias due to irritation  location confirmed by chest film
foley catheter Tube placed in bladder to drain urine Drains by gravity
surgical drains Tube placed in surgical or infection site to drain fluid Many operate via a suction mechanism
chest tube? function? Includes any tube placed into the chest Drains blood, fluid or air to re-expand the lung
What does bubbling indicate in a chest tube? Bubbling in the water of the CT can indicate an airleak or a pneumothorax in some systems. It is important to know this prior to treating the patient and to note any changes during or after the treatment.
types of enteric feeding tubes Ng tube Gastric feeding tube I-tube
NG tube? how long? Tube placed through nares  esophagus  stomach Usually short-term nutrition or placed to suction to remove all stomach contents (i.e. ileus or bowel obstruction)
Gastric Feeding Tube (G-Tube) or Percutaneous Endoscopic Gastrostomy Tube (PEG) Tube placed through abdomen directly into stomach Long-term nutrition in patients with normal gastric emptying
J-tube Through abdomen into 1st part of jejunum Long-term nutrition
Partial Parentral Nutrition Peripheral vein Subsidizes regular diet Usually combination of lipids, amino acids and/or dextrose solutions
Total Parentral Nutrition Central vein Long-term, intensive nutritional support Usually combination of proteins and dextrose Electrolytes, minerals, insulin are added as needed for each patient Useful in non-functioning bowel tracts
Hemodialysis Method for removing waste products from blood stream for patients in renal failure
Pain Controlled Analgesia Self administered pain medication
Vac Dressing? function? System provides negative pressure to wound to approximate wound edges Decreases edema Increases perfusion Promotes granulation tissue formation
Venodyne boots Promotes LE circulation via air pumping through boots Reduces risk for DVT in immobile patients
VITAL SIGNS Blood pressure (BP) Heart Rate (HR) Respiratory Rate (RR) Oxyhemoglobin saturation (SpO2)
implication of Na levels 1 Usually Na+ retention  H2O retention & loss of Na+  loss of H2O (unless rapid shift as in profuse sweating)
Implications of K levels Excitable cells  especially cardiac muscle (hyper- or hypokalemia leads to sudden cardiac death)
Implications of Cl levels Follows Na+ and H2O
Implications of BUN levels Rises with decreased kidney function due to decreased renal flow (reflects balance of nitrogen added to blood & excreted by kidney)
Implications of Cr levels Normal waste product of (muscle) cell metabolism that is excreted at stable rate. Rises due to decreased glomerular filtration rate.
Implications of HCO3 levels Critical to acid-base relationship  buffer that maintains homeostasis with direct effects on metabolic and/or respiratory status
Implcations of Mg levels Regulation of excitable cells, especially when low patients can have arrhythmias, weakness, muscle spasms and numbness
Exercise and hypoglycemia Activity requires glucose If increased activity with low levels, will continue to decrease
Exercise and hyperglycemia If blood sugar is high  no available insulin to assist with metabolism If exercise, will INCREASE these levels, progressing toward ketoacidosis due to metabolism that occurs with activity
Hepatic function tests Ammonia Albumin Bilirubin Alanine amino transferase (ALT) Alkaline phosphatase (ALP) Aspartrate aminotransferase (AST)
Implicaitons of ammonia result great variability in normal values, intermediate byproduct, with severe liver injury there is inability to convert ammonia into urea (excreted by the kidney)  hepatic encephalopahty (confusion, lethargy, tremors, deteioration of fine motor skills)
Implications of albumin levels looks at the ability of the liver to synthesize proteins (good indication of nutrition)
Implications of bilirubin levels total (liver disease, bile duct occlusion, hemolytic anemia) and indirect
Implications of ALT levels enzyme in liver, primary test for detecting hepatitis
Implications of ALP levels bile ducts
Implications of AST levels in liver, heart and skeletal muscles and has been used to assist with diagnosis chest pain
creatine kinase Enzyme found in heart, brain skeletal muscle that assists with muscle contraction
CK-MB is cardiace muscle specific form of CK
Troponin Cardiac specific proteins that regulate muscle contractions
Creatine kinase and myocardial infarction Begins to rise 4-6 hrs after injury, peak at 18-24 hrs and normalizes in 2-3 days
CK-MB and myocardial infarction ratio of total muscle damage to cardiac muscle Rise at 3-4 hrs, peaks 18-24 hrs and normal within 24 hrs
Troponin and myocardial infarction Elevate within 3-4 hours and can stay elevated for 10-14 days
Cholesterol identifies a risk of what? cardiac disease
Brain nateuretic peptide (BNP or NT-proBNP) Assists with regulating blood volume, increases as left ventricle stretches and increased demand
D-dimer test? diagnoses what? Detects fibrin as degradation products diag: PE and DVY
Erythrocyte sedimentation rate (ESR), measures what? Non-specific test for inflammatory disorders Measures how quickly RBCs sink to bottom of test solution
An increase ESR indicates? Increased rate  faster sinking  more clumping of cells  inflammation
Urine analysis Analysis of: protein, sugar, sodium, volume, culture and sensitivity (C&S)
cultures Assists with identifying infection source so correct medication can be prescribed to treat it
What fluids are sued for cultures Body Fluids: urine, feces, sputum Cereborspinal fluid Wound drainage
Created by: 696592119