DOES NOT IDENTIFY ENEMY

1
TYPES OF IMMUNITY
NON-SPECIFIC
SPECIFIC
DOES NOT IDENTIFY ENEMY
IDENTIFIES ENEMY
INFLAMMATION
PHYSICAL BARRIERS
IMMUNE RESPONSE
NEUTROPHILIS
SKIN
T LYMPHOCYTES
MONOCYTES
NORMAL FLORA
MACROPHAGES
B LYMPHOCYTES
MUCOUS MEMBRANES
2
TISSUE HEALING
Primary union also called healing involves
approximating the edges of the wound. Primary
healing includes the following
1. The incisional line quickly fills with serum
forming a scab. 2. One or two days, new capillari
es begin to bridge the gap between the wound edge
s. 3. Next few days fibroblast grows across the d
eeper wound layers and deposit of collagen form.
4. Then collagen begins to contract, pulling the
wound edges together and forming a scar.
3
DELAYED WOUND HEALING
AGE- Younger people heal more rapidly
SIZE- Smaller wounds heal faster
LOCATION- Epithelial tissue more rapidly
NUTRITION- Good nutritional status promotes h
ealing. IMMOBILITY- Wound tissue heals more rap
idly if it is kept immobile. CIRCULATION- T
issue with good blood supply heals more rapidly.

4
Microorganism that produce disease are called
Pathogenic
Conditions present for microorganisms to cause
an
infection in the host.
1. Area to enter 2. Be resistant enough to surviv
e 3. Enter in great enough number to survive 4.
Overcome the defenses of the immune system

5
A virulent microorganism has an aggressive or
invasive nature. It also has the ability to
produce a
toxin or poison which injures tissues.
6
BACTERIA
STAPHLOCOCCUS
STREPTOCOCCUS ESCHERICHIA COLI ( E COLI )
KLEBSIELLA PSEUDOMONAS SHIGELLA
SALMONELLA
7
VIRUS
FUNGUS
RINGWORM ATHLETES FOOT CANDIDIASIS THRUSH VAG
INITIS
HISTOPLASMOSIS
COMMON COLD HERPES SIMPLEX MONONUCLEOSIS HIV M
EASLES
MUMPS RUBELLA INFLUENZA (FLU)
8
RICKETTSIAL HEIMINTHS
ROCKY MOUNTAIN SPOTTED FEVER
ROUNDWORMS FLATWORMS PINWORMS TAPEWORMS
PROTOZOAN
MALARIA
9
IMMUNE DISEASES
HYPERSENSITIVITY ALLERGY AUTOIMMUNITY ISOIMM
UNITY

IMMUNE DEFICIENCY
AIDS (UNDERREACTION) TO ANTIGEN)
10
Viral Hepatitis A-B-C-D-E
Viral A Epidemics are caused by fecal
contaminated food and water.
Viral B Spread by contact with infected blood,
sexual
with contact with infected person.
Viral C primarily spread through contact with
infected blood
Viral D Only occurs in people infected with hep B
Viral E Most often transmitted through fecal waste
11
Rabies- Fatal virus disease Exposure- bite or
exposure to mucus membrane Transmitted by saliva,
virus moves along nerve pathways to the brain.
Dormant Period Ranges from 10 days -
year Symptoms Fever, headache, numbness muscle
ache severe brain swelling, confusion, coma, de
ath
12
Treatment- 5 shots deltoid muscle days 1,3,7, 14,
28 Prevention- 3 shots day 0, 7, 21 or 28 Anim
al Awareness

13
Salmonella- is a common cause of food poisoning
and other infectious diseases.
Salmonella- are rod-shaped bacteria that can grow
at a wide range of temperatures and ph levels.
Characterized incubation 6 t0 48 hours
Duration is 2 t0 5 days can last 2weeks Common
results dehydration Prevention- ADEQUATE COOKIN
G, GOOD REFRIGERATION, HAND WASHING
14
Botulism- Endotoxin (bacteria), Often fatal form
food poisoning. Often develops without gastic dis
tress 18 hrs - 1 wk incubation period Cause im
properly canned or cooked foods
15
Measles (viral) also known as Rubeola is one of
the most common and contagious diseases in the wo
rld. Usually victimizes children, killing I mil
lion young people worldwide every year. 1960 be
gan widespread immunization Spread through cont
act with secretions from nose
and throat and inhalation of droplets.
Symptoms develop 7-14 days after exposure fever
, sneezing, sore throat, cough, redness of eyes
Rash appears 1 to 2 days after Kopliks
16
Pediculosis- infestation with blood-sucking lice
Pediculosis pubis- is infestation of the pubic h
air region with lice. Infestation with lice c
auses intense itching, often in secondary bacteri
al infection. Frequently , only
the eggs of lice are seen. Lice are spread by d
irect contact with infested clothing, people, or
toilet seats. Complications- fever, typhus and t
rench fever Treatment- topical shampoo, lotions o
r cream Solution- 0.5 malathion
17
Scabies- a contagious disease caused by itch
mite, characterized by intense itching of the ski
n. Transmitted by close contact with infected hum
ans or domestic animals, Mite burrows into outer
layers of the skin where the female lays eggs. T
wo -4 months after first contact reaction
occurs. Complications- secondary bacterial infect
ions Treatment- sulfur ointment, antihistamines
salicylates
18
HIATUS HERNIA- protrusion of a portion of
stomach wall upward through the diaphragm.
40 population, few or any symptoms, backflow of
acids, x-rays diagnosis Treatment- Reflux OTC
19
Peritonitis-inflammation of the membrane that
lines the abdominal cavity and the organs contain
ed therein. Acute disease most often caused by
introduction of infection from a perforation of t
he bowel, ie rupture appendix/diverticulum. Dis
ease may also be caused by rupture gallbadder
Primary symptoms severe abdominal pain, nausea
aggravated by motion. Fatal if untreated Treatme
nt-antibiotics, IV fluids, underlying cause
20
Jaundice, yellowing of the skin, conjunctivae,
and mucous membranes caused by excessive amounts
of bile pigments in blood tissues. Bilirubin-
the orange-yellow pigment of bile, formed
principally by the breakdown of hemoglobin in
red blood cells after termination of their normal
life-span.
21
Types Hemolytic jaundice- increased production
of bile pigment because of red blood cell damage
. Hyperbilirubinemia- defect in the synthesis o
f the enzyme that breaks down bile to an excreta
ble form. Hepatocellular jaundice- occurs when
liver cells are damaged either by viruses or exc
essive alcohol intake Obstructive jaundice- phy
sical obstruction of the ducts
that transport pigment from liver to intestine.
ie gallstone, tumor or inflammation
22
Cirrhosis- is a chronic progressive disease
occurring most often in women and characterized b
y destruction of small bile ducts, fibrosis of ti
ssues. Characteristic- a chronic loss of normal,
functioning liver cells. Cause Alcohol Numbe
r 1 65-75 Treatment- Transplantation Progn
osis- 5 years survival 80
23
Acute cholecystitis- inflammation of the
gallbladder Risk Factor- infection of the bile
biliary tract common in postoperative infections
Treatment- antibiotics Prognosis - good ,
reoccur
24
Diabetes Mellitus- a complex disorder caused by
the failure of the pancreas to release enough ins
ulin into the body. Prognosis Familial, Sever
e cases blindness, kidney damage, nervous system
, hardening of arteries, foot leg infections, s
kin ulcers and gangrene Diagnosis Sudden in ch
ildren Slow in Type 2 Symptoms Urinate often, i
ncreased thirst, weight loss, increased appetite
Levels of sugar in the blood and urine are high
25
Treatment The goal of treatment is to maintain a
sugar and insulin balance. Mild, early, or late
onset of the disease can often be controlled by d
iet alone. Insulin tablets are sometimes used for
type 2. In more severe diabetes, insulin is giv
en in injections. The diet for diabetes usually
limits sugar or simple carbohydrates. Increase
s in complex carbohydrates, proteins, and unsatur
ated fats.
26
CLASSIFICATION OF DIABETES MELLITUS
Type 1- Insulin dependent, often develops during
childhood Type II- non-insulin dependent, oft
en develops in overweight, formerly Age-Onset Ty
pe III- gestational, glucose intolerance occurs
during pregnancy intolerance may remain but not
be serious enough to be treated.
Type IV- Includes other types associated with
pancreatic diseases and hormonal abnormalities.
27
TERMS Hyperglycemia- too much glucose in the b
lood, can be a result of not enough insulin Dia
betic Coma Hypoglycemia- less-than normal amoun
t of sugar in the blood, can be caused by giving
too much insulin or low food intake Insulin Sh
ock Ketoacidosis- caused by failure to take ins
ulin
28
Chronic Obstructive Pulmonary Disease COPD

• Ventilatory gas impairments interactions with
  cardivascular and muscular systems
  
• Chronic bronchitis asthma airflow obstruction
  during exhalation as airways become smaller as
  lung volume decreases increased work of
  breathing (breathing muscles weaken) ventilatory
  failure w/ alveolar ventilation, hpoxemia,
  hypercarbia (later stages)
• Alveolar-capillary membrane destruction
• Cardiovascular deconditioning (lactic acid build
  up at low work rates)
  
• Muscular deconditioning and wasting (lack of p.a.
  and malnutrition)

29
Benefits of Exercise COPD

• Cardiorespiratory reconditioning
• Desensitization to dyspnea
• Enhanced body composition
• ventilatory efficiency
• muscle strength
• flexibility
• balance
• body image

30
Asthma

• Reversible obstruction to airflow and increased
  bronchial responsiveness to a variety of stimuli,
  both allergic and environmental
  
• Chronic illness often arises during childhood
• 3 Issues with Exercise Programming
• Individuals vary in severity
• Variability within individual (attacks vs.
  recovery stage)
  
• Interaction between physiological and
  psychological response to exercise

31
Asthma

• Aversions to exercise may develop (prior
  attitudes toward exercise, education, social
  circumstances, personality)
  
• Three categories
• Exercise-induced asthma (EIA) (5-15 min. after
  physical exertion last 30 min. after)
  
• Wheezing, coughing, shortness of breath, chest
  discomfort
  
• Mild asthma (does not strain submaximal
  exercise)
  
• Moderate-severe asthma (ventilatory limitation
  restrains submaximal exercise)

32
Asthma

• Tx use beta-selective sympathomimetic agonist
  prior to exercise (10 min.) beta agonist
  (salmeterol) extend protection period those who
  exercise 30-60 min./day leukotriene-receptor
  antagonists last 24 hours prophylactic meds
  (asthma at rest with EIA) used with beta agonists
  when used reduce susceptibility to EIA when given
  over 1-4 weeks of tx corticosteroids (may
  contribute to psychological disturbances)

33
Cystic Fibrosis

• Most common inherited life-shortening disease in
  white population, 1 in 3,300 live births
  
• Genetic defect, abnormal epithelial transport of
  chloride ions, excessive sodium ion resorption,
  and resulting extracellular dehydration that
  results in abnormally salty sweat and thick mucus
  that clogs ducts, tubes and tubules pancreas
  (mucus prevents digestive enzymes from reaching
  sm. Intestines to digest fats proteins, leading
  to malnutrition and poor growth) and lungs (mucus
  blocks airways - infection, inflammation
  fibrosis (irreversible loss of pulmonary
  function 90 of mortality)

34
Cystic Fibrosis

• Early onset normal exercise responses
• Progression tolerance diminishes lack of gas
  exchange oxyhemoglobin desaturation CO2
  retention heart rate may reach MHR level
  
• Deconditioning and malnutrition may limit
  exercise capacity dyspnea coughing may limit
  exercise
  
• Benefits in work capacity, O2 consumption,
  ventilatory muscle endurance, cardiopulmonary
  efficiency, mucus clearance, pulmonary function

35
Osteoporosis

• Decline in bone formation after age 35
• Diet and p.a. over a lifetime may slow bone loss
  (osteopenia lowered bone mass 18 million
  Americans)
  
• osteoporosis 10 million Americans
• 1 in 2 women and 1 in 8 men will have an
  osteoporotic fracture in lifetime
  
• Women lose bone early in life and 3-5 year
  acceleration bone loss after menopause due to
  estrogen loss
  
• Two types I women aged 50-75 estrogen
  deficiency II vitamin D deficiency (over age
  70) high risk for hip fractures problem exercising

36
Osteoporosis

• Female
• Advanced age
• Caucasian/Asian race
• Family history of disease
• Low body weight for height
• Premature menopause
• Prolonged premenopausal amenorrhea

• Low testosterone levels in men
• Lack of p.a.
• Chronic smoking
• Excessive alcohol consumption
• Low dietary calcium intake
• Chronic use of meds causing bone loss
  (glucocorticoids, anitconvulsants)

37
Tuberculosis

• Bacterial infection, transmitted by
  inhalation/ingestion of infected droplets and
  usually affects the lungs but multiple organs can
  be infected
• Diagnosis via biopsy, stain, sputum and gastric
  cultures, and x-ray studies
  
• Symptoms chest pain, anorexia, fever and weight
  loss (early) night sweats, pulmonary hemorrhage,
  dyspnea
  
• Tx drug therapy checking eyes, kidneys, liver
  and ears for toxicity hospitalized to prevent
  spread first weeks disease absent from sputum no
  longer transmitted
• BCG vaccination (bacille Calmette-Guerin)

38
Systemic Lupus Erythematosus SLE (Lupus)

• Connective tissue (collagen) disorder
• Seen in young women (4xs women than men), no
  cure
  
• Widespread damage to fibrous connective tissue in
  the skin, heart, pleura and pericardium
  kidneys lesions on skin (butterfly rash over
  nose) and nervous system weakness, fatigue,
  weight loss, photosensitivity, fever
• Causes (?) viral infection or maybe dysfunction
  of immune system (autoimmune disease) Tx
  corticosteroid
  
• Death due to kidney failure

39
Emphysema (a blowing)

• Pulmonary system abnormality, overinflation of
  and destruction changes in alveolar walls loss
  of lung elasticity and decreased gas exchange
  linked to later stage asthma and TB alveoli
  overstretched, ruptured or collapse ? produce air
  filled spaces and decreased surface area of
  pulmonary membranes
• Breathing exercises, daily fluid intake 2-3 L,
  activity level to patients tolerance
  
• Symptoms dyspnea (rest), cough, unequal chest
  expansion, tachycardia, elevated body
  temperature, anxiety, confusion, weakness,
  anorexia, hypoxemia, respiratory failure

40
Obesity

• Excess body fat frequently resulting in a
  significant impairment of health
  
• CDC(1999) Overweight 35.3 men 33.2 women
  (increase from 1995 of 14 men and 19 women)
  
• Overweight children increased 27 in last decade
  to reach 13-14 in 1999 ? diabetes declared as an
  epidemic and primary risk of heart disease

41
Obesity

• Problem areas
• Increases
• Fasting insulin
• Insulin response to glucose
• Adrenocortical hormones
• Cholesterol synthesis and excretion
• Decreases
• Insulin sensitivity
• Growth hormone
• Growth hormone response to insulin stimulation
• Hormone-sensitive lipase

42
Obesity

• Men Women
• Minimal fat 5 8
• Below Average 5-15 14-23
• Above Average 16-25 24-32
• At risk 25 32

43
Obesity

• Increases risk and severity of disease
• Distribution of body fat contributes more to
  disease than total body fat
  
• Upper body fat CAD, hypertension,
  hyperlipidemia, diabetes, menstrual dysfunction
  
• Body-fat distribution measured by waist-to-hip
  ratio

44
Obesity

• Waist-to-hip Standards
• lower body fat distribution
• men
• women
• upper body fat distribution
• men 0.913
• women 0.861

45
Obesity

• Dietary objectives
• Reduce total calories
• Reduce fat intake
• Physical activity objectives
• Increase in daily activity
• Physical conditioning
• Medical techniques for extreme obesity
• Starvation diets (Adkinsa), Gastroplasties,
  Jejunoileal bypass, jaw wiring, intragastric
  balloons, fat excision, anti-obesity medications

46
Arthritis

• Over 100 types most common
• Osteoarthritis (degenerative joint disease)
• Rheumatoid arthritis (inflammatory, multijoint,
  multisystem disease) due to pathological
  activity of immune system against joint tissue
  can affect pulmonary and cardiac function no
  exercise acute joint inflammation (red, hot,
  swollen, painful) or uncontrolled systemic
  disease
• Tend to be less active and deconditioned
• Gait abnormalities, pain, stiffness, limited ROM,
  limit rapid repetitive motions, poorly
  supported joints

47
Arthritis

• Exercise benefits
• Cardiorespiratory endurance
• Muscle strength
• Flexibility
• Muscular endurance
• Decreased joint swelling pain
• Increased social and physical activity in daily
  life
  
• Reduced depression and anxiety
• Elevated pain threshold
• Curbs osteoporosis onset

48
Alzheimers Disease

• Chronic degenerative disorder most often cause of
  dementia among older people no cure 4 million
  Americans age 65 affected people doubles with
  every decade of life age 85 and over highest
  rate more common women than in men
• Meds to slow process or prevent in at risk
  populations
  
• Entorhinal cortex, hippocampus (degeneration ?
  short term memory fails ? spreads to other
  regions of brain cerebral cortex (atrophy) ?
  language and reason fails
• No data on exercise response hard to test get
  agitated

49
Lower Back Pain Syndrome

• 80 of population experiences back pain in their
  life
  
• May occur suddenly major trauma, multiple
  microtraumas, muscular and joint pain, single or
  multiple sites, persist for weeks, months or
  lifetime
• Sensory, emotional, cognitive and behavioral
  components
  
• Exercise standing or sitting could exacerbate
  pain prevent client from reaching best effort

50
Coronary Heart Disease

• Also known as coronary artery disease (CAD)
  abnormal condition that may affect the hearts
  arteries and produce various pathologic effects,
  especially the reduced flow of oxygen and
  nutrients to the myocardium
• Most common CAD is coronary ahterosclerosis, 1
  cause of death in USA
  

51
CAD

• Symptoms/Tx angina (nytroglycerin or
  propranolol (beta-blocker) or calcium-channel
  blocker) CABG surgery, angioplasty, insertion of
  stents prevention is key (reduce calories by
  obese patient, lower salt, fats, and cholesterol
  intake regular exercise no smoking manage
  stress

52
Myocardial Infarction (MI)

• Necrosis of a part of cardiac muscle caused by
  obstruction in a coronary artery through either
  atherosclerosis, a thrombus or a spasm (heart
  attack)
• Characterized by crushing vice-like chest pain
  that may radiate to left arm, neck or jaw
  (disguised as acute indigestion or gallbladder
  attack) ashen, clammy, short of breath,
  nauseated, faint, and anxious feel death is
  immenent tachycardia, cant find pulse, low BP,
  elevated body temperature, arrhythmia

53
MI

• Complications pulmonary or systemic embolism,
  pulmonary edema, congestive heart failure (CHF
  abnormal condition that reflects impaired cardiac
  pumping failure of ventricles to eject blood
  efficiently results in volume overload), shock,
  ventricular tachycardia, cardiac arrest (sudden
  sensation of cardiac output and effective
  circulation delivery of oxygen and removal of
  CO2 stop)
• Immediate CPR is critical to prevent heart, lung,
  kidney and brain damage and death

54
Angina or cardiac pain

• Spasmodic, cramplike choking feeling, suffocation
  or crushing pressure and pain
  
• Usually results from atherosclerosis or spasm of
  the coronary arteries
  
• Usually related to exertion, emotional stress,
  eating, and exposure to intense cold
  
• Pain relieved by rest and vasodilation of the
  coronary arteries by medication, such as
  nitroglycerin

55
Silent Ischemia

• An asymptomatic form of myocardial ischemia that
  may damage the heart muscle
  
• Occurs during the first 6 hours after a person
  awakens in the morning
  
• Triggered by mental arousal in more than 75 of
  patients

56
Peripheral Vascular Disease (PVD)
Atherosclerosis or Arteriosclerosis

• Any abnormal condition that affects the blood
  vessels and lymphatic vessels, except those that
  supply the heart
  
• Different types and degrees of PVD are
  characterized by a variety of signs and symptoms,
  such as numbness, pain, elevated blood pressure,
  and impaired arterial pulsations
• Causes obesity, smoking, stress, sedentary
  occupation, numerous metabolic disorders
  
• Tx Emboli occlude peripheral vessels
  amputation may result due to gangrene

57
Valvular Heart Disease

• Acquired or congenital disorder of cardiac valve
• Stenosis (constriction or narrowing of a vessel)
  and obstructed blood flow and by valvular
  degeneration and regurgitation of blood
  
• Aortic and mitral valves most common may be
  caused by congenital defects, bacterial
  endocarditis, syphilis or commonly rheumatic fever

58
Hypertension Silent Killer

• High blood pressure 50 million Americans have
  elevated BP or are taking antihypertensive meds
  
• In individuals ages 18-65, 95 of cases no known
  cause primary, essential or idiopathic (most
  common type) risks increase due to obesity, high
  cholesterol, family history, high sodium level
  higher in men African-Americans are 2xs as
  likely

59
Hypertension

• 3 stages (systolic (heart beating)/diastolic
  (heart at rest)
  
• 140-159/90-99 mmHg
• 160-179/100-109 mmHg
• 180/110 mmHG
• Mild/moderate headaches (rising), palpitations,
  lightheadedness
  
• Sustained hypertension arterial walls thicken,
  inelastic, and resistant to blood flow left
  ventricle becomes enlarged and hypertrophied due
  to its efforts to maintain normal blood flow
  angina
• Tx meds vasodilators, diuretics, calcium channel
  blockers
  

60
Multiple Sclerosis (MS)

• Progressive disease characterized by disseminated
  demyelination of nerve fibers of the brain and
  spinal cord.
  
• Begins in young adulthood and progresses
  throughout life with flare ups and remission
  
• Signs abnormal sensation in extremities or on
  one side of face muscle weakness, vertigo,
  visual problems (double vision or partial
  blindness)
• Later signs emotional instability, ataxia (cant
  coordinate movement), abnormal reflexes and
  difficulty urinating
  
• Difficult to diagnose no specific Tx
  (corticosteroids other drugs to treat symptoms)
  physical therapy may postpone disabilities

61
Cerebralvascular Accidents (CVAs) Stroke or
brain attack

• Occurs secondary to vascular insufficiency in the
  brain
  
• Causes thrombosis, embolism, hemorrhage
  secondary to aneurysm
  
• Cell death occurs results in impairment of CNS
  function
  
• 750,000 Americans per year with 66 survival
  rate most occur in elderly 60s, 70s 80s 20
  in those younger than 65 30 have history of
  previous stroke
• Risk factors hypertension, diabetes, smoking,
  alcoholism, CAD, obesity, high cholesterol

62
Stroke

• Physical disabilities are common along with
  muscle weakness, limited ROM and impaired
  sensation balance issues behavioral and
  cognitive disturbances, agitation, confusion,
  impulsiveness, inattention, memory loss, apathy,
  learning deficits

63
Parkinsons Disease

• Slowly progressive degenerative neurological
  disorder characterized by resting tremor (head
  and legs), pill rolling of the fingers, increased
  by fatigue, excitement and frustration (drooling,
  increased appetite, intolerance to heat, oily
  skin, emotional instability, defective judgment)
  shuffling gait, forward flexion of trunk, loss of
  postural reflexes, and muscle rigidity and
  weakness
• Usually strikes after age 60

64
Chronic Fatigue Syndrome (CFS)

• Condition characterized by disabling fatigue,
  accompanied by a group of symptoms, including
  muscle pain, multijoint pain without swelling,
  painful cervical adenopathy, sore throat,
  headache, impaired memory or concentration, and
  unrefreshing sleep
• Cause not sure may be due to Epstein- Barr
  virus, infection or immune system malfunctioning
  
• Therapy to relieve symptoms psychiatric
  intervention to relieve depression or anxiety

65
Fibromyalgia (FM)

• Most common rheumatological disorder
  characterized by musculoskeletal pain, spasms,
  morning stiffness, fatigue, depression, anxiety,
  and severe sleep disturbances 6 million people
  in USA women ages 20 55 unknown cause
• Pain or stiffness sites lower back, neck,
  shoulder, arms, hands, knees, hips, thighs, legs
  and feet (trigger points)
  
• Physical therapy, nonsteroidal anti-inflammatory
  drugs, muscle relaxants provide temporary relief