1. CH. 5 GOODMAN

2. CH.5  “Many conditions and diseases seen in the rehabilitation setting can affect multiple organs or systems.”

3. 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)

4. 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)

5. 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

6. Chronic inflammation (continued)  Systemic effects> low grade fever, malaise, weight loss, anemia, fatigue, leukocytosis, lymphocytosis  Inflammation is reflected by increased erythrocyte sedimentation rate (ESR)

7. 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

8. 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)

9. 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

10. Immunodeficiency (continued)  Non-specific causes: ◦ Aging ◦ Autoimmune conditions ◦ Diabetes mellitus ◦ Cancer- myeloma, lymphoma, leukemia ◦ Chronic diseases ◦ Cancer treatment- chemotherapy and radiation

11. 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

12. Systemic effects of neoplasm (continued)  Systemic> weight loss, muscle weakness, anorexia, anemia, coagulation disorders, cachexia

13. 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

14. 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”

16. Monitoring…….Mobilizing…….

17. Comforting a patient… Bringing a smile to a face…….

18. Recovering from open heart surgery….. Recovering from an illness….

19. Good luck on the final!