PATHOPHYSIOLOGY

AND DISEASE
CATHERINE C. SIOSON, RN, MD
AUG 2022
 OBJECTIVES
After completing this chapter, students must be able to:

● State the World Health Organization definition of health.

● Define pathophysiology, and the following terms: health, disease,
etiology, pathogenesis, morphology/histology, clinical manifestations,
diagnosis, and clinical course.
● Define the term epidemiology.
● Compare the meaning of the terms incidence and prevalence as they
relate to measures of disease frequency.
● Differentiate primary, secondary, and tertiary levels of prevention.
 Physiology of altered health.
Pathology
(from the Greek pathos, meaning “disease”)
deals with the study of the structural and functional changes in cells,
tissues, and organs of the body that cause or are caused by disease.

Physiology
deals with the functions of the human body.
 Pathophysiology
● mechanisms of the underlying disease
● provides information to assist with planning preventive
as well as therapeutic health care measures and
practices:

○ healthy diet,
○ exercise,
○ compliance with prescribed medications
 Health
● determined by many factors including genetics, age,
gender, cultural, and ethnic differences, as well as
individual, group, and governmental expectations.
 Health
● “State of complete physical, mental, and social well-
being and not merely the absence of disease and
infirmity.”
 Health
The U.S. Department of Health and Human Services in Healthy
People 2020 describes the determinants of health:

1. Attain lives free of preventable disease, disability,

injury, and premature death
2. Achieve health equity and eliminate disparities
3. Promote good health for all
4. Promote healthy behaviors across the life span
 Disease
● A disease is considered an acute or chronic illness
that one acquires or is born with that causes
physiological dysfunction in one or more body system.

The aspects of the disease process:

etiology, pathogenesis, morphologic changes, clinical
manifestations, diagnosis, and clinical course.
 Etiology
● The cause of a disease

Among the recognized etiologic agents are biologic agents

(e.g., bacteria, viruses), physical forces (e.g., trauma, burns,
radiation), chemical agents (e.g., poisons, alcohol), one’s
genetic inheritance, and nutritional excesses or deficits.
 Risk
Conditions suspected of contributing to the development of
a disease are called risk factors. They may be inherent to
the person (high blood pressure or overweight) or external
(smoking or drinking alcohol).
 Pathogenesis
● explains how the disease process evolves

● pathogenesis is the sequence of cellular and tissue

events that take place from the time of initial contact
with an etiologic agent until the ultimate expression of a
disease.
 Morphology and Histology
Morphology refers to the fundamental structure or form of
cells or tissues.

Histology deals with the study of the cells and

extracellular matrix of body tissues. The most common
method used in the study of tissues is the preparation of
histologic sections—thin, translucent sections of human
tissues and organs—that can be examined with the aid of a
microscope.
 Clinical Manifestations
Diseases can manifest in a number of ways. Sometimes the
condition produces manifestations, such as fever, that make
it evident that the person is sick.
Signs and symptoms are terms used to describe the
structural and functional changes that accompany a
disease.
 Clinical Manifestations
A symptom is a subjective complaint that is noted by the
person with a disorder, whereas a sign is a manifestation
that is noted by an observer.

Pain, difficulty in breathing, and dizziness are symptoms

of a disease. An elevated temperature, a swollen extremity,
and changes in pupil size are objective signs that can be
observed by someone other than the person with the
disease.
 Syndrome
● a compilation of signs and symptoms (e.g., chronic
fatigue syndrome) that are characteristic of a specific
disease state.
 Diagnosis
● A diagnosis is the designation as to the nature or cause
of a health problem (e.g., bacterial pneumonia or
hemorrhagic stroke). The diagnostic process requires a
careful history, physical examination (PE), and
diagnostic tests.
 Clinical course
● The clinical course describes the evolution of a disease.
● A disease can have an acute, subacute, or chronic course.
● An acute disorder is one that is relatively severe, but self-
limiting.
● Subacute disease is intermediate or between acute and
chronic. It is not as severe as an acute disease and not as
prolonged as a chronic disease.
● Chronic disease implies a continuous, long-term process.
 Health and
Disease
In Populations
 Epidemiology and patterns of disease
● Epidemiology is the study of disease occurrence in
human populations.
● Epidemiology looks for patterns of people affected
with a particular disorder, such as age, race, dietary
habits, lifestyle, or geographic location. In contrast to
biomedical researchers who study the mechanisms of
disease production, epidemiologists are more
concerned with whether something happens than how it
happens.
 Incidence and Prevalence
● Measures of disease frequency are an important
aspect of epidemiology.
● They establish a means for predicting what diseases are
present in a population and provide an indication of the
rate at which they are increasing or decreasing.
● A disease case can be either an existing case or the
number of new episodes of a particular illness that is
diagnosed within a given period.
 Incidence
● reflects the number of new cases arising in a population
at risk during a specified time.
● The population at risk is considered to be people
without the disease but who are at risk for developing
it.
● It is determined by dividing the number of new cases of
a disease by the population at risk for development of
the disease during the same period (e.g., new cases per
1000 or 100,000 people in the population who are at
risk).
 Prevalence
● is a measure of existing disease in a population at a
given point in time (e.g., number of existing cases
divided by the current population)
● The prevalence is not an estimate of risk of developing
a disease because it is a function of both new cases
and how long the cases remain in the population.
 Morbidity and Mortality
● Morbidity and mortality statistics provide information
about the functional effects (morbidity) and death-
producing (mortality) characteristics of a disease.
● These statistics are useful in terms of anticipating health
care needs, planning of public education programs,
directing health research efforts, and allocating health
care budget.
Disease Prevention
PATHOPHYSIOLOGY

HEALTH IN CHILDREN
CATHERINE C. SIOSON, RN, MD
AUG 2022
 OBJECTIVES
After completing this section of the chapter, students should be able
to:
● Describe the major events that occur during prenatal development
from fertilization to birth.
● Describe the causes and manifestations of neonatal
hypoglycemia.
● Explain how the common health care needs of the premature
infant differ from the health care needs of the term newborn or
infant.
● Discuss the common health problems of early childhood, middle
to late childhood.
● Characterize the physical and psychosocial changes that occur
during adolescence.
 Growth and Development
● Human development is
considered to begin with
fertilization, the union of sperm
and ovum resulting in a zygote.
● The process begins with the
intermingling of a haploid number
of paternal (23, X or Y) and
maternal (23, X) chromosomes in
the ampulla of the oviduct that
fuse to form a zygote.
 Growth and Development
● Within 24 hours, the unicellular
organism becomes a two-cell
organism and, within 72 hours, a
16-cell organism called a
morula. This series of mitotic
divisions is called cleavage.
During cleavage, the rapidly
developing cell mass travels
down the oviduct to the uterus
by a series of peristaltic
movements.
 Growth and Development
● Shortly after entering the uterus
(about 4 days after fertilization),
the morula is separated into two
parts by fluid from the uterus.
● The outer layer gives rise to the
placenta (trophoblast), and the
inner layer gives rise to the embryo
(embryoblast). The structure is
now called a blastocyst.
● By the 6th day, the blastocyst
attaches to the endometrium. This
is the beginning of implantation,
and it is completed during the 2nd
week of development
 Growth and Development
● Embryonic, period begins during
the 2nd week and continues
through the 8th week after
fertilization.
● During the embryonic period,
the main organ systems are
● developed, and many function at
a minimal level.
● Fetal period, begins during the
9th week. During the fetal period,
the growth and differentiation
of the body and organ systems
occur.
 Infancy
● Infancy is defined as the time from birth to
approximately 12 months of age.
● The first 4 weeks of an infant’s life is specifically
referred to as the newborn or neonatal period.
 Gastrointestinal system
● The infant’s gastrointestinal system is immature, and
most digestive processes are poorly functioning until
approximately 3 months of age.
● The newborn’s first stool is called ______. It is dark
black-green in color and is composed of amniotic fluid,
intestinal secretions, shed mucosal cells, and
sometimes blood from ingested maternal blood or minor
bleeding of intestinal tract vessels.
 Gastrointestinal system
● Passage of meconium should occur within the first 24
to 48 hours in healthy term newborns, but may be
delayed for up to 7 days in preterm newborns or in
newborns who do not receive enteral nutrition because
of illness.
● If a meconium stool is not passed within the
recommended time frame after delivery, then a
congenital anomaly may be suspected.
 Gastrointestinal system
● At birth, sucking may be poor and require several days
to become effective. The tongue thrust reflex is present
and aids in sucking, but it disappears at approximately 6
months of age.
● Stomach capacity for the newborn holds approximately
60 to 90 mL, but because of the limited capacity and
rapid emptying, infants require frequent feeding.
 Genitourinary system
● functionally immature at birth
● The kidneys do not concentrate urine well until
approximately 6 weeks of age.
● The first void should occur within 24 hours of birth
and is typically small in amount; the urine is light in color
and odorless.
● Totally daily volume of urine output increases during
the first week, from 30 to 300 mL.
 Nervous System
● The most rapid period of fetal brain growth is
between 15 and 20 weeks, gestation, at which time
there is a significant increase in neurons.
● A second increase occurs between 30 weeks’ gestation
and 1 year of age.
● Around 12 months, the weight of the infant brain is
two times heavier than it was at birth and is about 2/3
that of the adult size.
 Nervous System
● Most of the neurologic reflexes are primitive reflexes.
● Normal newborn reflexes can be used to evaluate the
newborn and infant’s developing CNS; several of
these reflexes include: palmar (grasp), Moro (startle),
rooting (sucking), and stepping (placing) reflexes.
 Health Problems of the Neonate
Distress at Birth and the Apgar Score
● The Apgar score, devised by Dr. Virginia Apgar, is a
scoring system that evaluates infant well-being at birth.
 Health Problems of the Premature infant
Respiratory Problems
● The respiratory distress syndrome is the most common
complication of prematurity.
● The primary cause of RDS is the lack of surfactant in the
lungs. At 24 weeks’ gestation, there are small amounts of
surfactant and few terminal air sacs (i.e., primitive alveoli),
with underdeveloped pulmonary vascularity. If an infant is
born at this time, there is little chance of survival.
● By 26 to 28 weeks, there usually is sufficient
surfactant and lung development to permit survival.
 Health Problems of the Neonate
Birth Injuries
● Injuries sustained during the birth process are responsible for less than
2% of neonatal mortality and morbidity.
● Cranial Injuries. The contour of the head of the newborn often reflects
the effects of the delivery presentation.
● Fractures. Fractures can occur and more often following a forceps
delivery or severe contraction of the pelvis associated with prolonged,
difficult labor.
● The clavicle is the most frequently fractured bone during the birth
process. It occurs when delivery of the shoulders is difficult in vertex (i.e.,
headfirst) or breech presentations.
Health Problems of the Neonate
 Health Problems of the Premature infant
Neonatal Infection and Sepsis
● There may be a history of obstetric complications,
such as prolonged rupture of membranes, prolonged
second stage of labor, or leaking membranes.
● Infants with this type of sepsis frequently present with
respiratory failure, shock, meningitis, disseminated
intravascular coagulation, acute tubular necrosis, and
symmetrical peripheral gangrene.
 Health Problems of the Premature infant
● The two organisms that may cause up to 80% of early-
onset infections are group B beta hemolytic
streptococcus (GBS) and Escherichia coli (E. coli).
● GBS remains the most frequent pathogen in term
infants and E. coli the most significant pathogen in
preterm infants.
● Late-onset infection is commonly acquired via person-
to-person transmission or from contaminated
equipment. It may be caused by the same pathogens
as early-onset sepsis or by viral agents.
 Health Problems of the Infant
Nutritional Disturbances
● Some infants may experience difficulties in consuming
mother’s milk or infant formulas that are based on cow’s
milk because of lactase deficiency.
● Lactase is an enzyme that breaks down lactose, the
carbohydrate found in human milk and cow’s milk.
 Health Problems of the Infant
Irritable Infant Syndrome or Colic
● Colic is usually defined as paroxysmal abdominal pain
or cramping in an infant and usually is manifested by
inconsolable crying, drawing up of the legs to the
abdomen, and extreme irritability.
 Health Problems of the Infant
Irritable Infant Syndrome or Colic
● Colic has often been described by the rule of three—
crying for more than 3 hours per day, for more than 3
days per week, for more than 3 weeks.
● There is no single etiologic factor that causes colic.
Some reasons for the crying are related to feeding
problems including hunger, air swallowing,
gastroesophageal reflux, and food intolerance.
 Health Problems of the Infant
Failure to Thrive
● a term that refers to the failure to meet expected
standards of growth for infants and young children due
to the inability to obtain or use essential nutrients.
 Health Problems of the Infant
Sudden Unexpected Infant Death/Sudden Infant Death Syndrome
● SUIDS may be attributed to metabolic disorders,
hypothermia or hyperthermia, neglect or homicide,
poisoning, or accidental suffocation.
● SIDS is similar in definition, except that the cause of
death is inconclusive and remains unexplained after
autopsy, investigation of the death scene, and review of
the child’s medical and family history.
 Health Problems of the Infant
Sudden Unexpected Infant Death/Sudden Infant Death Syndrome
● SIDS is rare during the first month of life, increases to a
peak between 2 and 4 months of life, and then declines.
● Factors associated with an increased risk of SIDS
include sleeping in the prone position, particularly on
soft bedding; prematurity and LBW; overheating; African
American or Native American race; and exposure to
environmental cigarette smoke.
 Early Childhood
● Encompasses the period from 12 months through 4
years of age, is a period of continued growth and
development.
● The major achievements are the development and
refinement of locomotion and language, which take
place as children progress from dependence to
independence.
 Early Childhood: Common Health Problems
Injury
● Unintentional injuries are the leading cause of death
in children between the ages of 1 and 4 years, with
drowning being cited as the most prevalent cause for
this age group.
● Locomotion and curiosity, combined with a lack of
awareness of danger, place toddlers and preschoolers
at special risk for injuries.
● Rates for drowning, fires, burns, falls, and poisoning
were highest for children 4 years and younger.
 Early Childhood: Common Health Problems
Infectious Diseases
● Immaturity of immune system.
● This also may be the time when children first enter day
care, which increases their exposure to other children
and infectious diseases.
● Common cold, influenza, varicella, gastrointestinal
tract infections, and otitis media
 Early Childhood: Common Health Problems
Child Maltreatment
● The most common cause for death in cases of
maltreatment include head injury, followed by abdominal
injuries, and deliberate suffocation.
● Child maltreatment includes physical abuse, emotional
abuse, sexual abuse, and neglect.
 Middle to Late childhood
● Middle to late childhood years (5 to 12 years) are those
during which the child begins school through the
beginning of adolescence.
 Middle to Late childhood:
Common Health Problems

Tooth Decay
● The most prominent dental issue in middle childhood is
tooth decay
● Related to inadequate dental care and a high amount
of dietary sugar.
● Health promotion includes teaching about reducing the
amount of dietary sugar, proper tooth brushing, and
appropriate dental care.
 Middle to Late childhood:
Common Health Problems
Injury and Illness
● The chief cause of mortality in this age group is
unintentional injury, primarily due to motor vehicle
accidents.
● Falls are the leading cause for nonfatal injuries in
children of all age groups less than 15 years of age.
 Middle to Late childhood:
Common Health Problems
Overweight and Obesity
● There are several factors that contribute to childhood
overweight/obesity, including genetics, amount of
calories consumed in food and drinks, and the amount
of energy expended with metabolism, growth, and
physical exercise.
● Participating in physical activity is important for children
because of its beneficial effects not only on weight
but also on blood pressure and bone strength.
 Adolescent
● The adolescent period, which extends from 11 to 12
through 18 to 21 years of age, is a time of rapid
changes in body size and shape and physical,
psychological, and social functioning.
● Adolescence is a time when hormones and sexual
maturation interact with social structures in fostering
the transition from childhood to adulthood.
 Adolescent: Common Health Problems
Injury
● The adolescent often is unable to recognize potentially
dangerous situations, possibly because of a
discrepancy between physical maturity and cognitive
and emotional development.
● They also have a strong desire to “fit in” with the peer
group. Adolescents exhibit a type of risk-taking behavior
and have a need to experiment with potentially
dangerous situations or behaviors.
 Adolescent: Common Health Problems
Suicide
● Risk factors for suicide in adolescents include
substance abuse, personal or family history of
depression, anxiety disorders, problems at school,
problems communicating with parents, having a friend
or peer who committed suicide, and family ownership of
a handgun.
 Adolescent: Common Health Problems
Cancer
● The fourth major cause of death in adolescents and
the young adult, ages 15 to 24, is due to cancer
● According to the National Cancer Institute, the highest
incidence of cancer in adolescents between 15 and 19
years old includes lymphoma, germ cell tumors in
males (i.e., testicular cancer), and carcinomas (thyroid)
in females, followed by leukemia.
 Adolescent: Common Health Problems
Risky Sexual Behavior and Adolescent Pregnancy
● The increasing prevalence of sexual activity among
adolescents has created unique health problems. These
include adolescent pregnancy, sexually transmitted
infections, and human immunodeficiency virus (HIV)
transmission.
● Health care providers must not neglect discussing
sexual activity with the adolescent: Nonjudgmental,
open, factual communication is essential for dealing
with an adolescent’s sexual practices.
 Adolescent: Common Health Problems
Risky Sexual Behavior and Adolescent Pregnancy
● Associated problems include substance abuse, such as
alcohol, tobacco, inhalants, and other illicit drugs.
PATHOPHYSIOLOGY

HEALTH IN ELDERLY
CATHERINE C. SIOSON, RN, MD
AUG 2022
 Functional Assessment
● One of the more commonly used tools is the Index of
Activities of Daily Living. Developed by Katz in 1963 and
revised in 1970, it summarizes performance in six
functions:
○ Bathing
○ Dressing
○ Toileting
○ Transferring
○ Continence
○ Feeding
 Functional Assessment
● The Lawton Instrumental Activities of Daily Living (IADL) Scale
assesses skills necessary for independent living. It reflects
how the person is functioning currently and can be used to
identify new disabilities and prompt further assessment of
vulnerable older adults.
○ Ability to use the telephone
○ Shopping
○ Food preparation
○ Housekeeping
○ Laundry
○ Mode of transportation
○ Responsibility for own medication
○ Ability to handle finances
 Urinary incontinence
Etiology:
● A decrease in bladder capacity, in bladder and sphincter tone,
and in the ability to inhibit detrusor (i.e., bladder muscle)
contractions, combined with the nervous system’s increased
variability in interpreting bladder signals, can cause incontinence.
● Impaired mobility and a slower reaction time also can aggravate
incontinence.
● Numerous medications, such as long-acting sedatives and
hypnotics, psychotropics, and diuretics, can induce incontinence.
● Conditions such as diabetes mellitus and spinal cord injury.
 Urinary incontinence
Treatment
● Educating and providing reinforcement for effort and
progress.
● Techniques include bladder training, timed voiding or
habit training, prompted voiding, pelvic floor muscle (i.e.,
Kegel) exercises, and dietary modifications.
 Instability and Falls
Instability and Falls
● Accidents are the fifth leading cause of death among
older adults, with falls ranking first in this category.
● Wrist fractures are common and frequently sustained
from forward or backward falls onto an outstretched
hand. Hip fractures can result from a sideways fall and
are one of the most feared complications from a fall. Hip
fractures predominate in the 75 years and older age
group.
 Instability and Falls
Instability and Falls: Preventing Falls
● Assessment of sensory, neurologic, and musculoskeletal
systems; direct observation of gait and balance; and a careful
medication inventory can help identify possible causes.
● Vitamin D supplementation has also shown promising results
and may have an independent role in the prevention of falls.
● A recent examination of systematic reviews and meta-
analyses of vitamin D supplementation for prevention of hip
fractures revealed a beneficial effect to high-dose vitamin D
supplementation combined with calcium.
 Dementia
● Dementia is a syndrome of acquired, persistent
impairment in several domains of intellectual function,
including memory, language, visuospatial ability, and
cognition (i.e., abstraction, calculation, judgment, and
problem solving).
● The cognitive changes are sufficient to impair social and
occupational function.
● Mood disturbances and changes in personality and
behavior often accompany the intellectual deterioration.
 Delirium
● Delirium can occur in any age group. However, older
adults, especially demented older adults, are far more
likely to become delirious.
● Delirium is defined by the DSM-IV-TR as an organic
mental syndrome featuring a global cognitive impairment,
disturbances of attention, reduced level of consciousness,
increased or decreased psychomotor activity, and a
disorganized sleep–wake cycle.
● It is important to differentiate dementia from delirium, also
referred to as acute confusional state.
 THANK
YOU!
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