1
Q
WHO Definition of Health
A
- A state of complete physical, mental, and social well being, and not merely the absence of disease and infirmity
- This means every aspect of the body and spirit (a pretty lofty definition)
2
Q
What are the determinants of health?
A
An Interaction Between:
- Individual Biology and Behavior
- Physical and Social Environment
- Government Policies and Interventions
- Access to quality health care
3
Q
Health is what the individual ____
A
perceives it to be
4
Q
Disease
A
- Any deviation from or interruption of the normal structure or function of a part, organ, or system of the body that is manifested by a characteristic set of symptoms or signs
- In regard to structure or in function; and whole body or part of the body
5
Q
Organic Disease
A
When there is a structural change in the body
ex: Brain lesion, Tumor
6
Q
Functional Disease
A
No morphological abnormalities, but characteristic signs/symptoms
ex: IBS
7
Q
Asymptomatic
A
- Disease present (abnormal physical findings) but NOT associated with symptoms or discomfort
- Unaware they have it
ex: Hypertension before a diagnosis
8
Q
Symptomatic
A
- Disease present WITH associated symptoms
ex: Cold, Ovarian Cancer (this could start asymptomatic but eventually become symptomatic)
9
Q
Pathology and Physiology
A
- The study of the structure and function of cells, tissues, and organs in the body
- pathology is a microscopic look of structure, while physiology is how the body functions
10
Q
Pathophysiology
A
- The pathology and physiology of disease (altered health)
- Focus on mechanisms underlying disease
- Look at changes, but also effect on total body function
- Provides the basis for preventative and therapeutic health measures and nursing practice
11
Q
Etiology
A
- Study of the cause, set of causes, or manner of causation of a disease or condition
- !!! Describes what sets the disease process into motion
12
Q
Etiologic Factors
A
Root causes of disease
13
Q
What things do etiologic factors include?
A
- Biological Agent
- Physical Forces
- Chemical Agents
- Nutritional Expresses or Deficits
14
Q
Most diseases are ____.
A
Multifactorial (have many causes)
15
Q
Congenital (Risk Factors)
A
- Present at birth (genetic)
ex: Cleft Palate
16
Q
Acquired Deficits (Risk Factors)
A
- Caused by events after birth
ex: Concussion
17
Q
Framingham Study
A
- cohort study
- Studied risk of developing coronary heart disease in the 1950s
18
Q
Nurse’s Health Study
A
- Cohort Study
- Explored Oral contraceptives and breast cancer links
19
Q
5 Disease Risk Factor Categories
A
- Genetic
- Disease Associated (past illnesses that increase risk)
- Treatment Association (No treatment is risk free)
- Environmental
- Lifestyle/Behavioral
20
Q
Pathogenesis
A
- Sequences of cell and tissue events from initial contact with risk agent until expression of disease
- ITS THE EVOLUTION OF THE DISEASE PROCESS / describes how disease process evolves (this is different from etiology)
21
Q
Morphology
A
- Refers to fundamental structure (form) of cells or tissues
- Both gross anatomical and microscopic changes from disease
22
Q
Histology
A
Study of the cells and extracellular matrix of body tissues
23
Q
Lesion
A
- Represents a pathological or traumatic discontinuity of a body organ or tissue
- Sometimes microscopic sometimes gross anatomic
ex: Pimple, Tumor, Freckle - ANYTHING ABNORMAL
24
Q
Sign
A
- Objective manifestation of illness or disorder
- can be heard, seen, measured, or felt
ex: Fever, rash, wheezing
25
Symptom
Subjective evidence of an illness or disorder
ex: pain, dizziness, different breathing
26
Syndrome
- Compilation of signs and symptoms characteristic of a specific disease state
- There is no recognizable cause or special treatment for a syndrome
27
Complications
Possible adverse extensions of a disease or outcomes from treatment
28
Sequelae
- Lesions or impairments that follow or are caused by a disease
- Arise from previous disease (Chronic like a scar)
29
Diagnosis
- Designation as to the nature or cause of a health problem
| - Involves weighing possibilities and selecting the more likely one
30
What is diagnosis based on?
1. Health History (Subjective)
| 2. Physical Examination (Objective)
31
Deductive Reasoning
- General to specific
- Concerned with rules for determining when an argument is valid
- Syllogism: A-->B;B-->C; so A-->C
ex: Blue Lips --> Need Oxygen
32
Inductive Reasoning
- From specific to general
- concerned with the soundness of inferences for which the evidence is not conclusive
- "Probability Theory" - the probability conclusion is true based on evidence given
ex: Sore Throat --> could be a scratch or possibly strep or something else
33
Validity
- Accuracy
| - Does the measurement tool measure what it should
34
Reliability
- Consistency
| - Does it give similar/same results when repeated
35
Sensitivity
Refers to the proportion of people with a disease who are positive on a test (True Positive)
36
Specificity
Refers to the proportion of people without a disease who are negative on a test (True Negative)
37
True/False - Positive/Negatives
- Test Positive + Disease Present = True Positive
- Test Negative + Disease Present = False Negative
- Test Positive + Disease Absent = False Positive
- Test Negative + Disease Absent = True Negative
38
Prevalence
Number of new and old cases of a disease present in a population at a given time (occurrences at a given time)
39
How many SD are reference ranges within to be healthy?
2 SD (95.5% of people)
40
Where is abnormality in reference ranges?
- More than 2SD away from the mean
| - So, 5% of the population (2.5% on each side)
41
Acute Disorder
- Self limiting and relatively severe with a cure being sought
ex: a cold
42
Chronic Disorder
- Implies a long term process
- continuous symptoms and severity with exacerbation and remissions
- lasts 3 months or more with no cure being looked for unlike acute disorder
43
Exacerbations
Varying degrees of aggravation of symptoms and severity of disease
44
Remissions
Period during which there is a decrease in severity and symptoms
45
Subacute Disease
- Between acute and chronic (not as severe as acute, not as prolonged as chronic)
- Not clinically apparent, needs an antibody/culture test done
ex: Tuberculosis
46
Preclinical Stage
- Disease not clinically evident but it is destined to progress to overt disease
ex: Hep C
47
Subclinical Stage
- not clinically apparent and not destined to become apparent
ex: immune system handles it
48
Clinical Disease
- Characterized by signs and symptoms
| - classic disease
49
Carrier Status
- Individual harboring organism but without manifestations of disease
- May not have disease, but can infect others
ex: Typhoid Mary
50
Congenital/Hereditary Disease
- Genetic Abnormality
- Intrauterine Injury
- (or) genetic and environmental factor interaction based
51
Inflammatory Disease
non specific reaction to an injurious agent
52
Degenerative Disease
Deterioration of various parts of the body
53
Metabolic Disease
Disturbances of cellular energy processes
54
Neoplastic Disease
- characterized by abnormal cell growth
| - benign or malignant
55
Incidence
reflects number of new cases arising in a population at risk during a certain time
56
Natural History of a disease
Progression and projected outcome of a disease without medical intervention
57
Prognosis
probable outcome and prospect of recovery from a disease
58
Stress (concept definition)
- Transactional or Interactional concept
- State of affairs arising when a person relates to situations in certain ways (adapt or maladapt resulting in disease)
- State manifested by a specific syndrome of the body developed in response to stimuli (stressors)
59
People are ____ disturbed by situations per say, but rather by ____
- People are NOT disturbed by situations per say, but rather by THE WAY THEY APPRAISE/REACT TO SITUATIONS
- the stressor may be real or perceived
60
The body handles a stressor based on ...
how it is perceived. not necessarily how severe it is
61
Homeostasis
Purposeful maintenance of a stable internal environment maintained by coordinated physiologic processes that oppose change
62
Physiologic control systems that oppose change are composed of?
1. Sensor (detects change)
2. Integrator/Comparator (sums and compares incoming data with a set point)
3. Effector System (returns the sensed function to within the set point range (reverse change))
63
Cannon's General features of Homeostasis
1. Constancy requires mechanisms to maintain it
2. Steady state conditions need a change to be opposed with factors resisting change
3. Regulating system of homeostasis has mechanisms acting simultaneously or successively
4. Homeostasis NOT BY CHANCE (allostasis)
64
Control Systems
- Interconnected components that function to keep a physical/chemical parameter of the body relatively constant
- Many help maintain homeostasis
65
3 Functions of Control Systems
1. Regulate cellular Functions
2. Control life processes
3. Integrates functions of different organ systems
66
Stress Response
Physical, emotional, and behavioral reactions to stressors put together
67
Negative Feedback
- Maintains stability in the system
| - Going above/below the set point makes it return to set point
68
Positive Feedback
- Interjects instability in the system
| - Makes a cycle where stimulus produces more of the same response
69
Most of the body's feedback mechanisms are ____
Negative
70
Endogenous
- Internal stimuli/stressors
| - Arising from within the body
71
Exogenous
- External stimuli/stressors
| - Arising from outside the body
72
Who made G.A.S.
- Hans Selye
73
What does G.A.S. stand for
General Adaptation Syndrome
- General - effect is a general system reaction
- Adaptation - response is in reaction to a stressor
- Syndrome - physical manifestations are coordinated and dependent on each other
74
EP and NEP work through the ...
ANS
75
Stages of G.A.S
1. Alarm
2. Resistance/Adaptation
3. Exhaustion
76
Alarm Stage
- CNS aroused and body defenses mobilized
| - EP and NEP are released to increase heart rate, contraction force, O2 intake, and mental activity
77
Resistance/Adaptation Stage
- SNS response; Fight or flight
- Body responds to stressor and attempts to return to homeostasis
- Coping mechanisms employed
78
Exhaustion Stage
- continuous stress causes breakdown of compensatory mechanisms
- Body can no longer produce hormones and organ damage begins marking disease onset
79
2 Factors determining the nature of the stress response
1. properties of the stressor
| 2. Condition of the person being stressed: physical, psychological, emotional, social states
80
3 properties of the stressor that are important?
1. Type (eustress/Distress)
2. Intensity or Severity
3. Duration
81
Conditioning factors
- Influence of the adaptive capacity of the person
- Development of stress related pathological process in-part depends on these
- Can be internal (sex,age,predisposition) or external (exposure to environmental agents, experience, diet, social support)
82
Stress Response is mediated by ...
- the combined efforts of the nervous, endocrine, and immune systems
- Integrate signals from neurosensory pathways and mediators in the blood
83
Allostatic Load / Overload
Persistence or accumulation of the allostatic changes of the body
84
2 Systems the neuroendocrine response mediates?
1. HPA Axis
| 2. SNS
85
EP and NEP are ____
Catecholamines
86
What mediates the HPA axis?
- Cortisol
| > These are glucocorticoids secreted by the ADRENAL CORTEX
87
What mediates SNS?
EP and NEP
| > these are catecholamines secreted by the ADRENAL MEDULLA
88
What does HPA stand for?
- Hypothalamic-Pituitary-Adrenal
| > its the ANTERIOR PITUITARY
89
HPA Axis Structure?
Stress --> Hypothalamus (releases CRH/F into the hypophyseal portal) --> Anterior Pituitary (releases ACTH into the blood) --> Adrenal Cortex (releases Cortisol) --> Cortisol (functions in the stress response AND negatively feeds back into this cycle to mediate the HPA axis)
90
3 Bad Effects of chronic Cortisol from chronic stress
1. Increased Blood Glucose
2. Depressed Immune System
3. Broken down into cholesterol
91
Major body Glucocorticoids
Cortisol
92
Functions of Cortisol in the Stress Response
1. Helps break muscular protein into AA, and lipids into FA, and glycerol
2. Uses FA,AA, and glycerol to promote hepatic gluconeogenesis
3. Inhibits tissues from utilizing glucose, thus giving the brain more available glucose
93
Permissive Action of Cortisol
- Allows a small amount of glucose to be used for lipolysis and bronchodilation for stress response
- Inhibits immune response to prevent gland exhaustion
- Metabolism. Lipolysis, and Bronchodilation !!!!!!!
94
What is CRF/H?
- Corticotropin Releasing Factor/Hormone
- Secreted by PVN of the hypothalamus
- Mediates pituitary gland and induces its release of ACTH, while stimulating the adrenal gland to make cortisol/glucocorticoids
95
ACTH
- Adrenocorticotropic Hormone
| - Released by the anterior pituitary to stimulate adrenal cortex to release cortisol/glucocorticoids
96
SNS
- Sympathetic Nervous System
- fight or Flight
- Has many nerves controlling its functions
97
PNS
- Parasympathetic nervous System
- Rest and digest
- Has one nerve controlling it/few (Vagus X)
- works slower due to longer nerve
98
Things the SNS does in the stress response?
- dilates pupils
- inhibits saliva
- relaxes bronchii
- accelerates the heart
- inhibits digestion
- stimulates glucose release by the liver
- secretion of EP/NEP from the adrenal gland
- relaxes the bladder
- contracts the rectum
99
Things the PNS does in the stress response?
- constricts pupils
- stimulates salivation
- inhibits heart rate
- constricts bronchii
- stimulates digestion
- stimulates the gall bladder
- contracts bladder
- relaxes rectum
100
Adrenal Catecholamines
- NEP and EP
| - Almost all NEP becomes EP
101
Alpha Receptors
- Stimulated by NEP and EP
- Found in arteries and smooth muscles
- Causes vasoconstriction of arteries to help blood return to the heart
102
Beta 1 Receptors
- located in the heart
| - when stimulated by NEP/EP they make the heart beat faster and contract more forcefully to increase cardiac output
103
Beta 2 Receptors
- found in the lungs (2 lungs)
| - when stimulated by NEp/EP they cause bronchodilation
104
NEP and EP purpose in the stress response
- keep blood glucose levels high, thus inhibiting metabolic activities
> also vasoconstriction, bronchodilation, and increased heart rate
105
EP causes what during stress
- preparation for fight or flight response
| - mobilizes energy stores and increases blood glucose and Fatty acid levels
106
Cortisol causes what during stress?
mobilizes energy stores by increasing blood glucose, FA, and AA
107
Major Hormonal Changes in the stress response?
- EP, Cortisol, Glucagon levels increase
- RAA/ADH levels increase
- Insulin levels decrease
108
RAA System Purpose
- Renin Angiotensin Aldosterone System
- increases with stress
- purpose is to conserve salt and water
- it increases plasma volume
- it increase arteriolar vasoconstriction to maintain/elevate blood pressure
109
ADH System purpose
- Antidiuretic Hormone System, or Vasopressin
- increases with stress
- increases plasma volume (controls water)
- increases arteriolar vasoconstriction to maintain/elevate blood pressure
110
RAA works mostly due to...
Low flow states to the kidney
111
How does the RAA system work?
Low flow state to the kidney --> Kidney (renin moves into the blood to the liver's angiotensinogen) --> Renin cleaves angiotensinogen causing it to become activated Angiotensin I (which moves into the blood toward the lungs)--> ACE in the lungs turns Angiotensin I into Angiotensin II (and II moves through the blood to the adrenal cortex) --> The Adrenal cortex releases Aldosterone --> Aldosterone holds Na+ in the Distal Convoluted Tubule, water follows the sodium, and iand increase in circulating volume and vasoconstriction occur
112
RAA Controls?
- Sodium via aldosterone (but NOT WATER)
| - water just follows sodium
113
ADH Controls?
- Water
| - Antidiuresis gets the kidneys to hold back water to increase vasoconstriction and circulating volume in the arteries
114
ADH is released by?
The Posterior Pituitary (1 of 2 hormones)
115
HPA Axis Function in Stress?
secretion of cortisol to mobilize energy stores to increase blood glucose levels, AA levels, and FA levels
116
SNS Function in Stress
EP release facilitated by cortisol leading to an icnrease in blood glucose, FA, and vasoconstriction thru alpha receptors thus leading to RAA initiation due to lower flow state
117
RAA and ADH allow for what 2 things?
1. Increased Circulating Volume
| 2. Elevated Blood Pressure (helps the body respond to stress)
118
How does immunity relate to neuroendocrine?
- Immune system can help modulate neuroendocrine functions
| - but increases increased stress = decreased immunity
119
Cerebral Cortex Neuroendocrine involvement?
vigilance, cognition, focused attention
120
Limbic System Neuroendocrine Involvement?
emotional response (fear, excitement, rage, anger)
121
Thalamus neuroendocrine involvement?
- it is the relay center for sensation
| > important in receiving, sorting, distributing sensory input
122
Hypothalamus neuroendocrine involvement?
Cxoordinated responses of endocrine system and ANS
123
Pituitary Gland Neuroendocrine involvement?
releases hormones that govern vital processes
124
Reticular Activating System (RAS) neuroendocrine involvement?
modulates mental awareness
125
Stress pathways of neuroendocrine System?
See slide 49/64 on stress slides
126
Stress (neuroendocrine definition)
state manifested by symptoms arising from coordinated activation of neuroendocrine and immune systems
127
The stress response is meant to be ...
acute and self limited in response
128
Pathophysiologic Changes (Failure of Adaptation) occur due to stress when...
1. A component of stress response fails
2. Neural/Hormonal connections are dysfunctional
3. Chronic or severe stressors that overwhlem systems
4. Exhaustion occurs when these things fail
129
Physiological Stress
chemical or physical disturbance in the cells or tissue fluid produced by a change, in either the environment or within the body that needs a response to counteract it
130
Components of Physiological Stress
1. Exogenous and Endogenous Stressors initiating disturbances
2. Chemical and Physical disturbances due to stressor
3. Bodys adaptational response to the disturbance
131
Adaptation
- ability to respond to challenges of physical or psychological homeostasis and return to a balanced state
- Influenced by individual differences
132
What individual differences influence adaptation?
- appraisal of the event
| - coping mechanisms/strategies
133
Physiologic Reserve
- Adaptive capacity exceeding normal requirements
| ex: save money for a rainy day
134
Hardiness
- A positive forward moving outlook on life allowing a high adaptive capacity to cope
- Also allows for a healthy perception of stressors as challenges rather than threats
135
PTSD
- Disorder of stress response
- "battle fatigue" or "shell shock"
- caused by a major traumatic event
136
Major Characteristics of PTSD
1. Intrusion
2. Avoidance
3. Hyperarousal
137
Treatments for Stress Disorders
1. Relaxation
2. Imagery
3. Music Therapy
4. Massage Therapy
5. Biofeedback
NURS351-Pathophysiology I
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