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22 Φεβ 2014 (πριν από 3 χρόνια και 5 μήνες)

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CH. 5

GOODMAN

Goodman

CH.5


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

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)

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)


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


Chronic inflammation (continued)


Systemic effects> low grade fever, malaise,
weight loss, anemia, fatigue, leukocytosis,
lymphocytosis


Inflammation is reflected by increased
erythrocyte sedimentation rate (ESR)


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 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)

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




Immunodeficiency (continued)


Non
-
specific causes:


Aging


Autoimmune conditions


Diabetes mellitus


Cancer
-

myeloma, lymphoma, leukemia


Chronic diseases


Cancer treatment
-

chemotherapy and radiation


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 neoplasm (continued)


Systemic> weight loss, muscle weakness,
anorexia, anemia, coagulation disorders,
cachexia

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

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”


Monitoring…….

Mobilizing…….

Comforting a patient…

Bringing a smile to a
face…….

Recovering from open
heart surgery…..

Recovering from an
illness….

Andrea C. Mendes PT, DPT

Good luck on the final!