Human Diseases and Conditions

1
Human Diseases and Conditions

• Human disease threatens persons ability to adapt
  to internal and external stressors and to
  maintain a state of well-being

2
Homeostasis internal stability of the body

• Any disruption of the bodys equilibrium produces
  degenerative changes at the cellular level that
  may produce signs and symptoms of disease

3
Signs and Symptoms

• Signs of diseases include abnormal objective
  findings (you can put a number or defining
  quality to this) example would be a fever of
  101 degrees, or a BP of 200/126
• Symptoms of diseases include non-objective
  findings, such as pain in lower back
• Signs and symptoms of a disease often signal a
  disruption of the bodys homeostasis

4
Mechanisms of disease

• Predisposing factors
• Access to preventative healthcare
• Genetic diseases
• Infection
• Inflammation/repair
• Neoplasms (ex tumor or growth of new tissue)
• Physical trauma
• Chemical agents
• Malnutrition
• Immune disorders
• Aging
• Psychological factors
• Mental disorders

5
Predisposing factors (risk factors) makes a
person/group more vulnerable to disease

• Age
• Gender
• Lifestyle such as smoking, drinking, and lack
  of exercise
• Environment
• Heredity

6
Inflammation/repair

• Acute inflammation is the bodys protective
  response to tissue injury/disease
• Accompanied by
• Redness
• Pain
• Heat
• Swelling
• Loss of function

7
More Inflammation

• Bodys response to inflammation includes
  diapedesis
• Vascular changes allow fluid to leak into the
  site
• Fluid includes phagocytes
• Attempts to prevent spread of infection
• Blood tests (CBC) may show elevated WBC count or
  elevated ESR
• Inflammatory response can cause damage to the
  affected tissue that can inhibit the healing
  process

8
More Inflammation

• Acute response (sharp or severe in effect
  intense) the initial response to inflammation
• Chronic response (continuing a long time or
  recurring frequently) ongoing response to
  inflammation

9
Infection

• Caused by pathogens
• Cardinal signs of infection
• Redness
• Swelling
• Heat
• Pain
• Fever
• Pus
• Enlarged lymph glands
• Red streaks

10
Infection

• Cause disease by
• Invasion and local destruction of living tissue
• Intoxication (production of substances that are
  poisonous to the body
• Sources of infection endogenous (from within
  the body), or exogenous (from outside of the
  body)

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Infection

• Modes of transportation
• Direct/indirect physical contact
  (communicable/contagious )
• Inhalation/droplet
• Ingestion of contaminated substances
• Inoculation by an insect/animal

12
Infection

• Pathogenic agents
• Virus
• Bacteria such as staphylococcus and
  streptococcus
• Fungi
• Protozoa

13
Infection

• Natural defense system of the body
• Natural mechanical and chemical barriers (ex
  skin, pH)
• The inflammatory response
• The immune response example - active immunity
  results when a person naturally contracts a
  disease, helping to build immunity to this
  disease in the future
• Bodys defense mechanisms dont always work

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Infection

• Medical intervention includes
• ID the organism
• Antimicrobial tx antibiotics, antifungals,
  antiparasitics, antivirals
• Analgesics for pn
• Antipyretic agents for fever
• Fluids
• Rest
• Infection control measures

16
Infection

• Virulent antigen resistant strains of bacteria
  (superbugs), such as MRSA
• Methicillin resistant staphylococcus aureus
• Hospitals, jails, assisted living, other
  community environments
• Turn into abscesses
• Can be fatal
• Cause pneumonia, bone infections, septicemia

17
Genetic diseases

• Remember the 23 prs of chromosomes? One of each
  pair is from mother, and the other from the pair
  is from the father
• XY chromosomes are sex chromosomes
• Other 22 chromosomes are autosomes

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Genetic diseases

• Produced by abnormality/mutation of genetic code
  in a single gene
• Caused by several abnormal genes
• Caused by the abnormal presence or absence of
  entire chromosome or by alteration in the
  structure of chromosomes
• Mutation means that that are changes in the
  genetic code of a cell

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Genetic diseases

• Modes of inheritance
• Autosomal dominant (Marfans syndrome,
  Huntingtons disease)
• Autosomal recessive (CF/Cystic Fibrosis,
  PKU/phenylketonuria)
• X-linked (Duchennes muscular dystrophy,
  hemophilia A)

20
Genetic diseases

• Some people are carriers of the defective gene
• Congenital diseases (existing at, and usually
  before, birth) vary, and may or may not be fatal,
  could be genetic or from other causes

21
Cancer (general information)

• Many different diseases with numerous possible
  causes
• Group of diseases characterized by uncontrolled
  cell proliferation
• Leads to tumors (neoplasms) may be malignant or
  benign

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Types of cancers

• Carcinoma
• Cancer of epithelial cells (Thin, flat cells
  found in layers or sheets covering surfaces such
  as skin)
• Sarcoma
• Cancer of the supporting tissues of the body
  (bone/muscle)
• Cancer of the lymph nodes and tissues of the
  immune system
• Leukemia/cancers of blood cells
• Melanoma (most serious form of skin cancer)

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Benign vs Malignant

• Benign
• Tend to remain encapsulated
• Take up space where they dont belong
• Resemble tissue of origin
• May recur after removal

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Benign vs Malignant

• Malignant can be serious threat to pt
• Cancer cells variable in appearance, disorderly,
  cause irreversible changes in structures
• Do not resemble tissue of origin
• Tend to infiltrate other tissue (enter blood
  stream of lymph vessels and lead to tumor growth
  in other areas of the body) (metastases)
• Tend to bleed, ulcerate, become infected
• May spread to distant sites in the body

25
Cancer

• Causes vary, external carcinogens, hormones,
  immune conditions, genetics
• Frequency increases with age

26
Preventions

• Low fat, high-fiber diet
• Eliminate smoking
• Limit exposure to sunlight
• Avoid heavy use of alcohol
• Avoid excess radiation
• Evaluation of ERT (estrogen replacement therapy)
• Avoid carcinogens
• Increase physical activity

27
Cancer

• Diagnosis
• About 1.3m American diagnosed yr
• About 300,000 die each yr
• 14 deaths is cancer related

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Detection

• Med hx
• Lab screening tests
• Screening exams (ie mammogram)
• Screening tests for lab markers (ex CA125)
• High-tech imaging (ex MRI)

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After diagnosis

• Evaluate stage of neoplasm (tumor size and tumor
  spread)
• Staging determines treatment options and
  prognosis
• Standardized world wide
• Staging may require surgical removal first

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Staging

• TNM staging system assesses neoplasm in three
  different areas
• Size or extent of primary tumor (T)
• Extent of regional lymph node involvement (N)
• Number of distant metastases (M)
• After all parameters are assessed, they are
  combined to assign a stage number of I, II, III,
  IV to the cancer
• I early stage tumor. IV most advanced stage

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Cancer

• Prognosis - reported statistically as percent of
  patients still alive after a certain period of
  time (usually 5 yrs)
• Pt may have cure, remission, still undergoing
  treatment

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Grading

• Determined thru micro exam of tumor/biopsy
  (excision of tissue for micro examination)
• Well-differentiated means it still has certain
  features of the tissue cells from where they
  derive
• Poorly-differentiated means they do not resemble
  the original tissue cells
• 1 is best grade, 5 is worst
• Important indicator of prognosis (ex prostate
  cancer)

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Gleason score

• Sum of both scores, Score is 2 to 10
• Correlates with extent of disease thru body, and
  prognosis

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Treatment goals

• To eradicate every cancer cell in the body
• Tx options
• Localized surgery, radiation
• Systemic chemotherapy, hormone therapy,
  immunotherapy
• Neoadjuvant therapy shrink tumor prior to
  surgery
• Hospice compassionate, holistic care (focus on
  needs of whole person) for terminal pt

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Immune disorders

• Result of breakdown in bodys defense system that
  may generate
• Hypersensitivity (allergy)
• Autoimmune diseases
• Immunodeficiency disorders

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Allergies

• Hypersensitivity to a substance (allergen) that
  is normally harmless
• Inhalants ex. Mold, dust
• Food
• Drugs
• Chemicals
• Physical agents like cold

37
Allergies

• Allergen acts like an antigen and stimulates the
  production of IgE antibodies, sensitizing the
  person
• Subsequent exposures trigger the allergic
  response (antigen/antibody reaction)
• Releases histamines and other chemicals
• Reactions can be mild (ex sneezing, coughing) or
  severe (ex anaphylaxis)

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Allergies

• Steps to control
• Dx
• Elimination
• Antihistamines/Bronchial dilators/Corticosteroids
• Desensitization by injection

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Allergies

• Anaphylaxis (shock), serum sickness, arthralgia
  (pain in the joints), and status asthmaticus
• Severe systemic manifestations of allergic
  response
• Causes include insect stings, food, latex,
  medications
• Susceptible individuals should carry epi-pen

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Autoimmune diseases

• Disorders that are caused by an inappropriate or
  excessive response of the bodys defense system
• Antibodies develop and begin to destroy the
  bodys own cells
• Body becomes self-destructive
• Body cannot distinguish self-antigens from
  foreign antigens
• Ex Rheumatoid arthritis/Lupus

41
Immunodeficiency disorders

• Result from depressed or absent immune response
• Factors include decreased numbers of T cells and
  B cells
• Body unable to defend itself against infections
  and tumors
• May be a secondary response to disease/infection
• HIV/AIDs is response to infection w/virus
• Can result in opportunistic infections because
  the immune system is deficient

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Trauma/chemical agents

• Physical trauma
• Major cause of death in children/young adult
• Care includes triage/assessment, minimize insult
  to body, combat shock/hemorrhage, restore
  homeostasis
• Chemical agents
• Include poisons, drugs, various chemicals,
  electric shock, heat, cold, insect/snake bites

43
Malnutrition

• Disorders of nutrition
• Deficient diet
• Various disease conditions

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Aging

• Sucks
• Gradual diminishment of body functions
• Screening exams ex serum cholesterol
• Geriatrics is care of the elderly
• Issues include financial, functional, substance
  abuse, overmedication, loss of mental acuity,
  depression, nutrition, falls, relocation, loss of
  normal roles in life, death of loved ones, drug
  therapy, adverse drug reactions (changes in body
  composition result in changes in the way
  medications are tolerated)

45
Physiologic/mental disorders

• Physiologic
• Reactions to disease cause different
  psychological responses
• Chronic disease affects self-esteem/behavior
• Patients diagnosed w live-altering diseases go
  thru stages of anxiety, shock, denial, anger,
  depression, withdrawal
•  
• Mental Disorders
• Clinically significant behavioral or
  psychological syndromes associate w psychic
  pain/distress, or impairment of function

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DIAGNOSIS OF DISEASE

• Pt seeks medical care
• Telephone triage at doctor
• Med hx, risk factors, allergies, symptoms
  assessed
• PE includes inspection, auscultation, palpation,
  percussion (class to define)
• Dx studies include
• Micro exam
• Chemical analysis - ex blood work, stool
  studies, sputum tests, urine
• Radiographic studies - ex x-rays
• Endoscopies
• Ultrasounds
• Physical testing ex EKG, treadmill
• Comparison of results w normal findings
• Inclusion of history , risk factors, etc
• Formulation of dx, tx plan, prognosis, prevention
• Pt teaching, pertinent information, appropriate
  referrals

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TREATMENT OF DISEASE

• Assessment/dx complete
• Implement appropriate medical intervention
• Plan of treatment
• Cure
• Control sx
• Support
• Combination of the above
• Therapeutic elements of conventional medicine
• Prevention
• Procedures
• Meds
• Surgery
• PT
• Diet changes
• Psychotherapy
• Pt ed
• Follow-up care

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Treatment

• Typical to involve pt in choices of tx
• Team approach involving family, pt med personnel,
  community support for complicated case (holistic
  care that focuses on the pt as a whole person,
  considering social, emotional, intellectual,
  cognitive, spiritual components)
•  

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CULTURAL DIVERSITY

• Language and religious views
• Life experiences
• Views on health issues
• Knowledge of cultural diversity important in
  todays healthcare

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GENE THERAPY

• Experimental intervention or adding, repairing,
  blocking the expression of specific genes to tx
  a disease
• Therapeutic gene is delivered using a vector (a
  chaperone molecule that accompanies and aids in
  safe delivery of the DNA)
• Ex vivo/en vivo meaning outside of/inside the
  body
• Ex vivo cells to be modified are removed from
  the body, modified, and returned to the pt
• En vivo tx w gene delivery vehicle that will
  target the desired cells for the gene
  modification
• To tx autosomal of X-linked recessive genes by
  adding a copy of the defective gene attempt to
  inhibit or repair defective gene
• Current vectors involve primarily viruses
• In research, not much clinical value has been
  seen to date

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STEM CELL RESEARCH

• Called regenerative medicine, is for repairing
  damaged tissue
• Stem cell is an unspecialized cell that has the
  potential to give rise to cells specialized for
  any tissue in the body
• Stem cell divides, daughter cell has potential
  to become another stem cell, or to change into
  specific kind of cell, such as liver or lung
• As long as a person is alive their stem cells can
  divide and replenish
• Specialized cells can only divide and replenish
  specialized cells
• Bone marrow transplant is a stem cell transplant
• Holds exciting promise of novel therapies

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Pain

• Subjective, individualized, perceived only by
  individual experiencing it
• Terms of pain description include throbbing,
  cramping, burning (typically nerve pn), dull,
  aching, shooting, stabbing, stinging
• Use of a pn scale here is helpful either using
  numbers (how bad is pain, using scale of 1 10,
  10 being the worst pn you have ever had), or
  pictures (see pg 26)
• Physiology of pn involves the stimulation of
  nociceptors (specialized nerve endings)
• Nociceptors in superficial skin, some tissues of
  internal/visceral organs, joint capsules,
  periosteum of bones around the walls of vessels,
  certain deep tissue

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Pain

• Pain result of tissue insult from harmful
  stimuli temperature extremes, mechanical damage,
  chemicals, hypoxia, ischemia to tissue, muscle
  spasms
• Pn impulse travels from nerve ending thru spinal
  cord, to thalamus in brain, then to sensory
  cortex in the parietal lobe of the brain (top of
  the brain)
• Receptors respond to pain as long as the stimulus
  remains
• Pain is signal to help locate and
  eliminate/reduce the source of tissue damage
• Pn can be part of healing process
• Possible to have pn without physical injury
  (psychological pn)

54
Pain

• Stress can alter perception and response to pn
  response requires cerebral cortex to be
  functioning correctly
• Some body areas do not have nociceptors
• Referred pn neuron from specific organs may
  travel along the spinal nerve cause the pain to
  projected elsewhere in the body (cx pn radiating
  to jaw, L arm)

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Pain classification

• Acute
• Sudden unset/severe in intensity
• Pt may guard area, cry, moan
• BP/P increase
• May cause shock
• Diaphoresis may occur

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Pain classification

• Chronic
• Less severe, duration longer than 6 months
• May result in wt changes, altered sleep patterns,
  decreased activities, guarded movements,
  depression

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Misc Pain Info

• Intractable - hard to treat, relieve, or cure
• Superficial, deep, visceral
• Pain relief
• narcotics/opioid-related drugs, PCA (pt
  controlled) pump
• Acetaminophen, steroids, NSAIDs, TENS unit,
  surgery, PT, massage, acupuncture
•  

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PREVENTATIVE HEALTH CARE

• Emphasis on strategies to prevent disease/injury
• Positive personal health behaviors
• Modification of lifestyle
• Infection control measures in healthcare
  facilities (nosocomial infections, MERSA)
• Wellness programs definitely on the rise w
  insurance companies
• Vaccines

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NONTRADITIONAL MEDICINE

• CAM complementary and alternative medicine
• Integrated medicine - alternative medicine
  combined w traditional medicine
• Osteopathy stimulation of bodys natural
  process by manipulation
• Chiropractics - based on concept that bodys
  nervous system is foundation of health, and undue
  pressure on NS may result in pn and disease
• Reflexology massage of feet/hands targeting
  zones
• Aromatherapy using essential oils to promote
  wellness and healing

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NONTRADITIONAL MEDICINE

• Herbal medicines professed to tx many diseases,
  but do not have FDA approval
• Diet/nutritional thereapy
• Acupuncture attempts to adjust chi by inserting
  needles in acupuncture points, includes insertion
  and manipulation of fine needles
• Acupressure
• Therapeutic touch (laying of hands)
• Shiatsu mat on floor, pressure to accupoints
• Magnetic therapy used a lot in vet medicine
  believed they increase circulation to the area
  being tx
• Hypnosis/hypnotherapy
• Reiki hot hands, transfer healing energy from
  practitioner to pt
• Homeopathy

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PATIENT ED

• State codes may regulate who may educate pt
• Principles of pt ed based on pt centered care,
  ongoing, interactive, directed toward pts plan
  of care
• Goals of pt ed encourage pt to comply (ex htn
  has no sx, pt need to understand why meds are
  needed), guidance, support and instruction to pt
  and family, develop trust w pts, give pt
  knowledge to take responsibility
• Reasons lessen anxiety, confidence, etc
• Address pts concerns
• Pre-op and post-op care

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SPECIAL CONSIDERATIONS FOR PT W LIFE-THREATENING
DISEASE

• Address special needs
• Keep pt and family from feeling abandoned
• Written and verbal instructions
• Feedback from pt on aspects of care plan
• Encourage discussions abt SE of meds/therapy
• Review warning signs w pt so they know when to
  contact HCP
• Address physical, psychological, social,
  spiritual aspects of care
• Pn and burden to others are two main fears of pt
• Referrals for support/hospice
• Palliative care if curative tx offers no help
• Address care givers concerns