PROBLEMS AFFECTING MULTIPLE SYSTEMS
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Transcript of PROBLEMS AFFECTING MULTIPLE SYSTEMS
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PROBLEMS AFFECTING MULTIPLE
SYSTEMSCH. 5
GOODMAN
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GoodmanCH.5
“Many conditions and diseases seen in the rehabilitation setting can affect multiple organs or systems.”
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1. Systemic effects of acute inflammation initial response of tissue to injury involves vascular and cellular responses Local signs> redness, warmth, swelling, pain,
loss of function Systemic effects> fever, tachycardia,
hypermetabolic state Characteristic changes in blood>>elevated
serum protein levels (C-reactive protein, coagulation factors) + increased WBCs (leukocytosis)
SYSTEMIC EFFECTS OF PATHOLOGY
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2. Systemic effects of chronic inflammation Result of persistent injury, repeated
episodes of acute inflammation, infection, cell-mediated immune responses and foreign body reactions
Tissue response to injury> accumulation of lymphocytes, plasma cells and macrophages (mononuclear inflammatory cells) and production of fibrous connective tissue (fibrosis)
SYSTEMIC EFFECTS OF PATHOLOGY
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Chronic inflammation (continued) Fibroblasts, small blood vessels and
collagen fibers > constitute fibrosis Fibrous tissue is light gray with a dense,
firm texture that causes contraction of normal tissue
This may cause progressive tissue damage and loss of function
SYSTEMIC EFFECTS OF PATHOLOGY
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Chronic inflammation (continued) Systemic effects> low grade fever, malaise,
weight loss, anemia, fatigue, leukocytosis, lymphocytosis
Inflammation is reflected by increased erythrocyte sedimentation rate (ESR)
SYSTEMIC EFFECTS OF PATHOLOGY
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3. Systemic factors influencing healing (Box 6-4)
Physiologic variables (age, vascular sufficiency) General health of the individual; immunocompetency;
psychological/emotional/spiritual well-being
Presence of comorbidities (examples)◦ Diabetes mellitus◦ Decreased O2 perfusion (CHF,COPD,CAD)◦ Hematologic disorders◦ Cancer◦ Incontinence◦ Alzheimer’s disease◦ Neurologic impairment◦ Immobility
SYSTEMIC EFFECTS OF PATHOLOGY
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Systemic factors influencing healing (continued)
Tobacco, alcohol, caffeine, other substance use/abuse
Nutrition Local or systemic infection; presence of
foreign bodies Type of tissue Medical treatment (prednisone,
chemotherapy, radiation therapy)
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4. Consequences of immunodeficiency Immunodeficiency predisposes the affected
individual to infections ; there is a failure of one or more of the functions of the immune system
Therapists are most likely to encounter those with acquired immunodeficiency and those with non-specific causes such as:◦ Those that occur with viral (and other) infections◦ Malnutrition◦ Alcoholism
SYSTEMIC EFFECTS OF PATHOLOGY
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Immunodeficiency (continued) Non-specific causes:
◦ Aging◦ Autoimmune conditions◦ Diabetes mellitus◦ Cancer- myeloma, lymphoma, leukemia◦ Chronic diseases◦ Cancer treatment- chemotherapy and radiation
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5. Systemic effects of neoplasm Due to the destructive nature and spread of
malignancy, there can be local and systemic effects
Local> necrosis, ulceration, compression, obstruction, hemorrhage
**pain is more likely if cancer invades near nerves/ nerve cells
**secondary infections often occur and can lead to death
SYSTEMIC EFFECTS OF PATHOLOGY
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Systemic effects of neoplasm (continued) Systemic> weight loss, muscle weakness,
anorexia, anemia, coagulation disorders, cachexia
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PT IMPLICATIONS
Physical therapists at work…..
Ambulating a patient on a vent……
Increase in the number of aging population…..medical advances…….increase in physical therapy scope of practice>>>
Physical therapists must be ready and able to assess patients/clients with multi-system problems!!
Even in critically-ill patients, interventions such as mobilization, positioning, exercise and pulmonary hygiene are indicated in order to maximize O2 transport
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PT IMPLICATIONS
Physical therapists at work…..
In the Intensive Care Unit
Physical therapists need to be able to provide careful and close monitoring of cardiopulmonary status of patient/client
Hematological monitoring is necessary
Knowledge of lab values is critical
Need to have advanced knowledge of the “whole picture”
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Physical therapist performing bedside intervention in the ICU
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Monitoring……. Mobilizing…….
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Dogs can help too!
Comforting a patient… Bringing a smile to a face…….
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Dogs have a role!
Recovering from open heart surgery…..
Recovering from an illness….
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Andrea C. Mendes PT, DPTGood luck on the final!