1. 11/19/20151 Concepts of Pathophysiology Dr Brenda Johnson

2. 11/19/20152 Concepts and Components Models Models Definitions Definitions

3. 11/19/20153 Disease and Health Care 1800’s Infectious disease 1800’s Infectious disease 1800’s Infectious disease 1800’s Infectious disease 1900’s Public Health 1900’s Public Health 1900’s Public Health 1900’s Public Health Late 20 th century Late 20 th century Age of viruses Age of viruses Age of viruses Age of viruses Resistant organisms Resistant organisms Resistant organisms Resistant organisms

4. 11/19/20154 Present Day Problems & Trends Human genome Human genome Chronic disease Chronic disease Chronic disease Chronic disease Cardiovascular Cardiovascular Diabetes Diabetes Osteoporosis Osteoporosis Alzheimer’s Alzheimer’s Cancer Cancer Resurgence of TB/”post-polio syndrome” Resurgence of TB/”post-polio syndrome” Worldwide travel and interspecies infections Worldwide travel and interspecies infectionsinterspecies infectionsinterspecies infections

5. 11/19/20155 Definitions Etiology – Cause of a disease; includes agent as well as intrinsic and extrinsic factors Etiology – Cause of a disease; includes agent as well as intrinsic and extrinsic factors Genetic Genetic Acquired Acquired Multifactorial Multifactorial Manifestations – Signs or Symptoms Manifestations – Signs or Symptoms Sign: an objectively identifiable aberration Sign: an objectively identifiable aberration Lesion: an identifiable structural change produced during the course of disease Lesion: an identifiable structural change produced during the course of disease Symptom: subjective feelings in response to a disease process Symptom: subjective feelings in response to a disease process

6. 11/19/20156 Disease Etiologic Classification (idiopathic, iatrogenic, metabolic, inherited, neoplastic, immunologic, infectious, etc.) Etiologic Classification (idiopathic, iatrogenic, metabolic, inherited, neoplastic, immunologic, infectious, etc.) Pathogenesis – evolution or natural history of a disease Pathogenesis – evolution or natural history of a disease Sequelae – outcome of a disease; usually permanent Sequelae – outcome of a disease; usually permanent Complication – new or separate process secondary to the original disease Complication – new or separate process secondary to the original disease Resolution – return to completely normal state without sequelae or complication Resolution – return to completely normal state without sequelae or complication

7. 11/19/20157 Concept of Health “We have become increasingly aware of the importance of preventative measures against noninfectious conditions, especially cancer and coronary heart disease. There is no better way to prevent disease and maintain health than by leading a healthy life, and increasingly, it will be the individual who is responsible for ensuring a healthy passage through life.” “We have become increasingly aware of the importance of preventative measures against noninfectious conditions, especially cancer and coronary heart disease. There is no better way to prevent disease and maintain health than by leading a healthy life, and increasingly, it will be the individual who is responsible for ensuring a healthy passage through life.” Porth, p. 12 (2005) Porth, p. 12 (2005)

8. 11/19/20158 General Principles of Disease Trends are more important than isolated, single measurements of a biologic function. Trends are more important than isolated, single measurements of a biologic function. Normal and abnormal processes represent different points on the same continuous spectrum Normal and abnormal processes represent different points on the same continuous spectrum Disease is dynamic, not static! Disease is dynamic, not static! The body has a great deal of reserve. The body has a great deal of reserve.

9. 11/19/20159 Nursing Science Human responses Human responses Pathophysiologic responses Pathophysiologic responses Experiential responses Experiential responses Normal physiologic regulatory responses Normal physiologic regulatory responses Behavioral responses Behavioral responses

10. 11/19/201510 Outcomes How are “best practice models” currently being used in your facility/practice areas? How are “best practice models” currently being used in your facility/practice areas? What types of physiological parameters are used as benchmarks? What types of physiological parameters are used as benchmarks? What types of symptoms/biophysiological parameters are used as benchmarks? What types of symptoms/biophysiological parameters are used as benchmarks?

11. 11/19/201511 Processes/Symptoms Pain Pain Fatigue Fatigue Nausea Nausea Dyspnea Dyspnea Confusion/delirium Confusion/delirium Impaired sleep Impaired sleep

12. 11/19/201512 Physiological Processes Ischemia Ischemia Edema Edema Inflammation Inflammation Immune suppression Immune suppression Muscle atrophy Muscle atrophy Stress response Stress response Altered clotting Altered clotting

13. 11/19/201513 Pain – a human response Describe the phenomenon of pain from each of the four human response perspectives Describe the phenomenon of pain from each of the four human response perspectives Physiologic Physiologic Pathophysiologic Pathophysiologic Experiential Experiential Behavioral Behavioral

14. 11/19/201514 Stress Response Theories GAS GAS Neuroendocrine response – catecholamines Neuroendocrine response – catecholamines Corticotropic response – ACTH and endorphins Corticotropic response – ACTH and endorphins Adrenocorticotropic response – cortisol, aldosterone, Adrenocorticotropic response – cortisol, aldosterone, Cellular response - cytokines Cellular response - cytokines

15. 11/19/201515 Stress/Adaptation & Cause vs. Effect A drop in which two hormones are responsible for anovulation and irregular menstrual cycles in women and decreased testosterone and spermatogenesis in men? (may occur as a result of sepsis or severe trauma?) A drop in which two hormones are responsible for anovulation and irregular menstrual cycles in women and decreased testosterone and spermatogenesis in men? (may occur as a result of sepsis or severe trauma?) Explain how emotions (e.g. anxiety or feelings of hopelessness) can be the result of pathological changes in the CNS. Explain how emotions (e.g. anxiety or feelings of hopelessness) can be the result of pathological changes in the CNS. CRF (corticotropin releasing factor) and cortisol Immune cells crossing the blood brain barrier in cancer or hormonal changes of menopause can be the cause of hopelessness or mood swings (respectively).

16. 11/19/201516 Chaos & Complexity Theory Complexity and randomness Complexity and randomness Simplicity and order Simplicity and order Goldberger (1985) Chaos and health of the CVO system Goldberger (1985) Chaos and health of the CVO system Goldberger (1985) Chaos and health of the CVO system Goldberger (1985) Chaos and health of the CVO system Fractals Fractals Fractals Butterfly effect Butterfly effect “Strange attractors” “Strange attractors”