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Concepts of Concepts of PathophysiologyPathophysiology

Dr Brenda JohnsonDr Brenda Johnson

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Concepts and ComponentsConcepts and Components

ModelsModels DefinitionsDefinitions

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Disease and Health CareDisease and Health Care

1800’s Infectious disease 1900’s Public Health Late 20Late 20thth century century

Age of viruses Resistant organisms

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Present Day Problems & TrendsPresent Day Problems & Trends

Human genomeHuman genome Chronic disease

CardiovascularCardiovascular DiabetesDiabetes OsteoporosisOsteoporosis Alzheimer’sAlzheimer’s CancerCancer

Resurgence of TB/”post-polio Resurgence of TB/”post-polio syndrome”syndrome”

Worldwide travel and Worldwide travel and interspecies infections

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DefinitionsDefinitions

Etiology – Cause of a disease; includes Etiology – Cause of a disease; includes agent as well as intrinsic and extrinsic agent as well as intrinsic and extrinsic factorsfactors GeneticGenetic AcquiredAcquired MultifactorialMultifactorial

Manifestations – Signs or SymptomsManifestations – Signs or Symptoms Sign: an objectively identifiable aberrationSign: an objectively identifiable aberration Lesion: an identifiable structural change Lesion: an identifiable structural change

produced during the course of diseaseproduced during the course of disease Symptom: subjective feelings in response to a Symptom: subjective feelings in response to a

disease processdisease process

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DiseaseDisease

Etiologic Classification (idiopathic, Etiologic Classification (idiopathic, iatrogenic, metabolic, inherited, iatrogenic, metabolic, inherited, neoplastic, immunologic, infectious, etc.)neoplastic, immunologic, infectious, etc.)

Pathogenesis – evolution or natural history Pathogenesis – evolution or natural history of a diseaseof a disease

Sequelae – outcome of a disease; usually Sequelae – outcome of a disease; usually permanentpermanent

Complication – new or separate process Complication – new or separate process secondary to the original diseasesecondary to the original disease

Resolution – return to completely normal Resolution – return to completely normal state without sequelae or complicationstate without sequelae or complication

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Concept of HealthConcept of Health ““We have become increasingly aware We have become increasingly aware

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

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General Principles of DiseaseGeneral Principles of Disease

Trends are more important than Trends are more important than isolated, single measurements of a isolated, single measurements of a biologic function.biologic function.

Normal and abnormal processes Normal and abnormal processes represent different points on the represent different points on the same continuous spectrumsame 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.

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Nursing ScienceNursing Science

Human responsesHuman responses Pathophysiologic responsesPathophysiologic responses Experiential responsesExperiential responses Normal physiologic regulatory responsesNormal physiologic regulatory responses Behavioral responsesBehavioral responses

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OutcomesOutcomes

How are “best practice models” How are “best practice models” currently being used in your currently being used in your facility/practice areas?facility/practice areas?

What types of physiological What types of physiological parameters are used as benchmarks? parameters are used as benchmarks?

What types of What types of symptoms/biophysiological symptoms/biophysiological parameters are used as benchmarks?parameters are used as benchmarks?

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Processes/SymptomsProcesses/Symptoms

PainPain FatigueFatigue NauseaNausea DyspneaDyspnea Confusion/deliriumConfusion/delirium Impaired sleepImpaired sleep

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Physiological ProcessesPhysiological Processes

IschemiaIschemia EdemaEdema InflammationInflammation Immune suppressionImmune suppression Muscle atrophyMuscle atrophy Stress responseStress response Altered clottingAltered clotting

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Pain – a human responsePain – a human response

Describe the phenomenon of pain Describe the phenomenon of pain from each of the four human from each of the four human response perspectivesresponse perspectives PhysiologicPhysiologic PathophysiologicPathophysiologic ExperientialExperiential BehavioralBehavioral

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Stress Response TheoriesStress Response Theories

GASGAS Neuroendocrine response – Neuroendocrine response –

catecholaminescatecholamines Corticotropic response – ACTH and Corticotropic response – ACTH and

endorphinsendorphins Adrenocorticotropic response – Adrenocorticotropic response –

cortisol, aldosterone, cortisol, aldosterone, Cellular response - cytokinesCellular response - cytokines

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Stress/Adaptation & Cause vs. Stress/Adaptation & Cause vs. EffectEffect

A drop in which two A drop in which two hormones are hormones are responsible for responsible for anovulation and anovulation and irregular menstrual irregular menstrual cycles in women and cycles in women and decreased testosterone decreased testosterone and spermatogenesis in and spermatogenesis in men? (may occur as a men? (may occur as a result of sepsis or result of sepsis or severe trauma?)severe trauma?)

Explain how emotions Explain how emotions (e.g. anxiety or feelings (e.g. anxiety or feelings of hopelessness) can be of hopelessness) can be the result of pathological the result of pathological changes in the CNS. changes in the CNS.

CRF (corticotropin CRF (corticotropin releasing factor) and releasing factor) and cortisolcortisol

Immune cells crossing Immune cells crossing the blood brain barrier the blood brain barrier in cancer or hormonal in cancer or hormonal changes of changes of menopause can be the menopause can be the cause of hopelessness cause of hopelessness or mood swings or mood swings (respectively).(respectively).

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Chaos & Complexity TheoryChaos & Complexity Theory

Complexity and randomnessComplexity and randomness Simplicity and orderSimplicity and order Goldberger (1985) Chaos and health Goldberger (1985) Chaos and health

of the CVO systemof the CVO system FractalsFractals Butterfly effectButterfly effect ““Strange attractors”Strange attractors”