WEEK 2 - MECHANISM OF DISEASE
Roles of genetics and cellular injury disease:
Cancer in Canada: Males - 45% ; Females - 42%
Proliferation - Uncontrolled cell growth and division; they are not
specialized cells
- Cancer cells are the body’s own cells that are growing out of
control. As more abnormal cells grow and divide, they form tumors
(neoplasms) w/c are growths of tissue that serve no purpose.
- Cancer cells ignore signals that normally tell cells to stop dividing
or begin the process of programmed cell death (apoptosis); result
of acquired gene mutations (is a permanent alteration in the
DNA sequence that makes up a gene, such that the sequence
differs from what is found in most people.
- Gene mutation is a change of genetic sequence in the cell.
Happen when:
1. Born with a mutated gene that is either inherited from a parent or
that develops in an embryo
2. Exposed to something around us that damages our genes
3. Age
- Breast Cancer Gene 1 (BRCA1) - normally found in the body and
is considered a tumor suppressing gene.
Bacterial Infections
Pathogens - disease causing microbes
- bacteria : replicate at various rates; lead to bacterial infections
- Virus : tend to mutate during replication; may alter host cell
chromosomes -> cancer; lead to viral infections
Main routes of Transmissions:
1. Contact - direct (people-people), indirect (object), droplet
2. Vehicle - blood through contaminated items
3. Airborne - droplet particles, dust
Nosocomial Infections - (Hospital Acquired Infection)
- Patient must be admitted for reasons other than the infection
- Risk factors: ICU stay, compromised immune system, elderly and
young, hospital staff not following proper infection control
procedure
Antimicrobial Resistance - resistant to infection
- Not necessary to use drugs to treat
- Increased use of antimicrobials
- New emerging disease and superbugs
Antibiotic Resistance - the resistant bacteria proliferate
Factors: overprescribing, incorrect prescription/dosage, not
specific to bacterial infection, failure to follow dosage/reducing
treatment, antibiotics in food, antibacterial agents sprayed on
fruits/veg
Stages of Tissue Healing:
1. Acute stage - inflammatory reaction ( up to 6 days)
2. Subacute - proliferation (3-21+ days)
3. Chronic - Maturation ( end of proliferation up to 1+ year)
WEEK 3 - MECHANISM OF HEALING AND RECOVERY
The Immune System
skin - protective barrier secretes antimicrobial proteins
Thymus - small organ in upper chest where T cells mature
Bone Marrow - produces most white blood cells (leukocytes)
Bloodstream - immune cells circulate, patrolling for antigens
Lymphatic system - network of vessels and tissues; includes lymph
nodes that filter lymph looking for antigens
innate /Natural Immunity: built-in present at birth; non-specific &
nonadaptive
Phagocytes - go into tissues in w/c infection has developed and
consume any foreign substances/ pathogens; digest the
pathogens, antigenic material appears on their surface to identify
them as foreign invaders.
T-cells - type of lymphocyte
Macrophages - type of phagocytes
Antigens - foreign substances on the surfaces of pathogens and
other foreign substances
acquired /Adaptive Immunity: specific and adaptive (has
memory)
B- cell - secretes antibodies that directly destroys the antigen
Antibodies - proteins that recognize and bind to antigens and
destroy them.
Active: naturally from environmental exposure or artificially by
vaccination
Passive: transfer of antigen (mother to baby, medication)
Pain - unpleasant sensory and emotional experience
associated with actual/potential damage
Learning someone’s pain: location, severity, alleviating factors,
aggravating factors, descriptive quality, duration, functional impact
Acute pain - sudden onset, resolves with healing of underlying
cause
Chronic pain - persistent, >3 months, resistant to treatments
Types of pain:
- Nociceptive: somatic - injury to skin, ms, bones, jt, connective
tissue
visceral - internal organs/ tissues
- Neuropathic - nervous system that sustain pain even after an injury
heals
- Psychogenic - psychological disturbance
Pain Management
Gate control Theory - built into normal pain pathways that can
modify the entry of pain stimuli into the spinal cord and brain;
stimulation of A-beta fibers (non-nociceptive)
Ex. deep pressure, ES, compression, traction
Mirror therapy, desensitization, exercise (ROM, Stretching,
endurance)
Non-opioid analgesics - reduce production of prostaglandins
(acetaminophen, ibuprofen) s/e: constipation, liver damage,
>bleeding risk
Opioid - work in the brain to change how the body feels &
responds to pain (morphine, fentanyl) s/e: drowsiness, nausea,
constipation, addiction
WEEK 4 - DISEASES OF MSK SYSTEM
Hip Fracture - 1 in 3 women & 1 in 5 men, osteoporosis, 2 Mil
canadians, 80% overall fx, 1 in 3 pt re-fracture in 1 yr, mid 30s,
28% - women, 37% - men will die
Occurs in: intertrochanteric, subtrochanteric, shaft, extracapsular,
intracapsular, femoral neck, subcapital, femoral head
Risk factors:
aging - dec bone density, dec strength, flexibility, balance, vision,
cognition, meds
Falls - high risk of incidence of falls
pelvis /hip Fx- 90% of fx assoc. With falls
Mortality usually due to respiratory failure
Falls:
Environmental r/f: poor bldg design, slippery floors & stairs, looser
rugs, insufficient lighting, cracked or uneven sidewalks
socioeconomic : low income & edu level, inadequate housing, lack
social interaction, limited access to health & social services, lack of
community resources
Behavioral : multiple med use, excess alcohol intake, lack of
exercise, inappropriate footwear
Biological : age, gender, race, chronic illness, physical, cognitive
capacities
Open reduction internal fixation - intramedullary nail fixation,
dynamic hip screw
OTA - ms activation PTA - strengthening
Osteoporosis (bone porous) - dec mineral content, weak
bone, no symptoms
T-score bone mineral density scan, high risk for fx (wrist, hips,
spine)
Osteopenia - low bone density
Primary - not related to other med condition
r/f: age, postmenopausal, caucasian, fam hx, sedentary, low in
calcium & vit D
Degenerative Disc Disease & Spinal Stenosis
End plate - flattened appearance,allows the disc to migrate in to
the vertebral body
Annulus Fibrosus - resists rotation, develops clefts or fissures w/c
allows the nucles to migrate outward, less able to withstand load
Nucleus polposus - dehydrates & thins, becomes more fibrous and
stiff, less able to withstand load
Neural foramen - narrowing due to flattening of discs and boney
overgrowth
Central canal - narrowing due to intrusion of the disc or other
spinal structures.
Spinal stenosis: (1) central canal stenosis - narrowing of space
around spinal cord; put pressure on spinal cord. (2) foramen
stenosis - narrowing of the foramen; pressure on the nerve roots.
Both result in back & leg pain, numbness, weakness in legs.
Herniated Discs. (1) Herniation - nucleus polpusus extends
through the outer rings of the annulus fibrosis (2) Bulge - Nucleus
buges
Week 8 - Autoimmune diseases
Rheumatoid Arthritis - A systematic, inflammatory, autoimmune,
disease that results in pain, swelling, stiffness and loss of function
in the joints (attacks frequently wrist, hands, elbows, knees, and
ankles)
Risk factors: F, 40-60 yo, Genetics, Pathogens, Smoker
Hallmark Characteristics of RA:Inflammation, Cartilage destruction,
Bone erosion
Pathophysiology
Inflammation results from abn activation of WBC (T & B cells)
which release cytokines (cell signaling molecules that aid cell to
cell communication). Cytokines cause synovial cells to release
destructive substances and synovial membrane to grow new blood
vessels (angiogenesis). New blood vessels & inflammatory cells
facilitates growth of pannus (thickened synovium) -> invades &
destroys areas of cartilage and bone. Increased chondrocyte (main
cellular component of cartilage) activity -> further cartilage
destruction & inc. osteoclast activity -> contributes to bone erosion.
Ssx: Hallmark characteristics leads to jt swelling, damage,
deformity and ankyloses in some cases which contributes to pain
and motion loss
Other ssx: Tenosynovitis, peripheral neuropathy, periarticular
osteoporosis, fatigue, occasional fevers, loss of energy, sjogren’s
syndrome, rheumatoid nodules, pericarditis, pleuritis
MM: NSAIDS - inhibit enzymes that are active in the inflammatory
process, Corticosteroids - immunosuppresive and inflammatory
effects
DMARDS: suppress overactive immune system
Biologics: Target cytokines
Jt replacement, tendon reconstruction, arthrodesis (fusion),
synovectomy
Rehab Mgt: jt protection techniques and devices, ROM, stretching,
strengthening, ms endurance ex.
Fibromyalgia - a chronic syndrome of unknown cause charac. By
widespread pain and other symptoms
Ssx: ms and jt pain (radiating & diffuse),
Tender points, poor sleep, chronic fatigue, fibro fog (impairment in
memory & thinking)
Pathophysio: research suggests FB is a d/o of abn central
processing of nociceptive pain input
Chronic pain: activation of glial cells -> neuroinflammation, cellular
destruction, inc activation of SNS & hypothalamic-pituitary complex
How diagnosed? Specific score range on widespread pain index
and symptom severity, symptoms present at a similar level atleast
for 3 mos, exclusion of other d/o that may be source of pain.
Tx:medication, cognitive&behavioral therapy, exercise
Week 9 - Respiratory Disease
COPD - lung d/o charac by long-term airway obstruction, making it
difficult to breathe
Most common forms: Emphysema & Chronic Bronchitis
CB - a chronic productive cough for 3 mos in each of two
successive yrs in whom other causes of chronic cough have been
excluded. // charac by obstructed airway d/t inflammation of the
bronchi & excessive mucus production// Pathophysio: lining of
bronchial tubes is constantly irritated and inflamed, causing a long
term cough with excessive mucus
Emphysema - abn & permanent enlargement of the airspaces
(alveoli) distal to terminal bronchioles that is accompanied by
destruction of the airspace walls w/out obvious fibrosis// elastin
gets destroyed which affects the recoil of alveoli (elastin makes
walls of alveoli snap - recoil)
COPD
Cardinal signs: Dyspnea, chronic cough, mucus production
Ssx: wheezing, cachexia, pursed lip breathing, accessory ms use,
tripod position
Modified borg scale://RF: smoking, smoke from factory,
genetics//Single best variable for airflow obstruction - hx of >40
pack yrs of smoking//MM: bronchodilators (short&long acting- relax
ms in airways, clear mucus),anti inflamm(steroids)-reduce
inflamm,vaccination(reduce risk of flu and pneumonia)// PTA mgt:
pursed lipped, diaphragmatic, rollator walke//OTAmgt: energy
conservation, pacing strat, use of AD
Week 11 - Respiratory system
Virus - infective agent that cannot reproduce by itself
Common cold, influenza, COVID-19: RNA virus
Common cold: rhinovirus, respiratory synctial virus, coronavirus;
infect nose & throat
Influenza: caused by influenza A&B virus(MC);infect
nose,throat&lungs
COVID-19:novel 2019 coronavirus,called severe acute respiratory
syndrome coronavirus 2, or SARS-CoV-2, affect
nose,throat,lungs,organs,tissues
All 3 result in nasal congestion, sore throat,cough (nose&throat
affected)
Influenza&COVID-19: systemic ssx: fever,body aches,fatigue//can
be mild,severe,fatal: lung injury is common in COVID-19
Prognosis: recover few days to <2weeks. Some develop
pneumonia, lung infections can be life threatening and result in
death. RF:old age, compromised immune sys, multiple comorbidit
Transmission: contact of infected surfaces & droplets in air
COVID-19: also spread through airborne
Transmission is less likely D & A when >6ft from source
Stopping: PPE,handwashing,>6ft/2m,meds
Pneumonia: infection in one or both lungs (specifically alveoli) that
develops in response to a pathogen (bacteria, virus, fungi)
Types:
Bacterial: caused by streptococcus (MC), staphylococcus, bacteria
already present in the body or enters body, tx: antibiotics
Viral: caused by virus (eg influenza A, respiratory syncytial virus
(RSV), SARS-CoV-2, resolves on its own but some may take
antivirals, may be complicated by bacterial pneumonia
Types:
Community-acquired: MC type, caused by bacteria or develops
after cold/flu
Nosocomial (hospital-acquired): acquired in hospitals or other hc
facilities within a specific timeframe, higher risk: on ventilator &
after surgery
Aspiration pneumonia: after inhaling particles into lungs; higher
risk: swallowing issues or vomiting
Opportunistic pneumonia: affects people with weak immune sys
(HIV,COPD,organ transplant)
Ssx & Why
Dyspnea - decreased gas exchange
Chest pain- inflammation of the alveoli
Cough- reflex mechanism to rid of body secretions
Fever- inc temp to decrease viral replication
X-ray findings:
Consolidation- area of inc opacity (whiteness) indicating lung is
filled w/ dense material (pus in pneumonia) or other fluid
(blood/cell
Pleural effusion-a collection of fluid in the pleural space, reducing
ability to expand lungs
- Indicator of an underlying dse (heart failure,
malignancy, pulmonary embolism,pneumonia)
- Tx: tx of underlying condition or surgery
Pneumonia tx:
Percussion: alternately clapping with both hands on pt’s chest wall
with a cup hand
Vibration: shaking motion with a flat hand firmly against the pt’s
chest wall
Acute Respiratory Distress Syndrome (ARDS)
Acute, diffuse, inflammatory lung injury charac by pulmonary
edema (fluid build up in alveoli), inflammatory molecules cause the
capillaries to leak fluid which goes into the alveoli, making it
difficult for gas exchange, caused by trauma/damage to the alveoli
by factors such as: sepsis, smoke inhalation, near drowning
Hallmark: hypoxemia (low oxygen), bilat. Radiographic opacities,
diffuse alveolar damage
What happens: Fluid filled alveoli results in:
Hypoxemia
Inc lung stiffness- difficult for lungs to inflate
Inc work of breathing - difficult to get air into lungs
Can’t carry work of breathing & low oxygen -> respiratory failure
Ssx of Pulmonary edema in ARDS:
● Coughing up blood or bloody froth
● Diff breathing when lying down (orthopnea)
● Feeling of “air hunger” or “drowning” (paroxysmal
nocturnal dyspnea) that often causes client to wake up
and try to catch breath
● Grunting, gurgling, or wheezing sounds with breathing
● Problems speaking in full sentences because of SOB
Some pts will develop a pneumothorax
Pneumothorax: presence of air/gas in the pleural cavity causing
collapse of the lung, commonly result of a tear on the surface of
the lung or existing dse.
Tx: Chest tubes:
● Drains fluid and air from pleural space and helps re-
expand the lung
● Avoid tube kinks, pinching beneath patient or b/w bed
rails
● Collection chamber must always be kept below chest
level for proper drainage
● Watch for bubbling in the tube (leak)
Tx:
Diuretics - inc urination to get rid of fluid
Mechanical ventilation - pushes air into lungs and forces some of
the fluid out of the alveoli
Antibiotics- treats underlying infection
OTAPTA tx for critically ill: ROM, ambulation, pedal ergometer,
deep breathing
Prognosis for ARDS:
30-50% will die from resp failure, underlying med problems
(pneumonia, kidney failure) or complications (sepsis, multiorgan
failure, blood clots)
Prolonged hospital stay
Prolonged recovery w/ inc morbidity
People who survive - memory loss or QOL problems d/t brain not
getting enough O2
Week 12 - Respiratory
Cystic Fibrosis - an inherited, incurable, chronic dse charac by
buildup of thin, sticky mucus that can damage many of the body’s
organs//MC fatal genetic dse among canadian children&adults
Etiology: mutation in the cystic fibrosis transmembrane
conductance regulator (CFTR) gene results in CF.
CFTR gene- provides instructions for making a protein called
CFTR, protein fxn as channel across the membrane of cells that
produce mucus, sweat, saliva, tears and digestive enzymes,
transports chloride ions into and out of the cell
Chloride- helps control movt of water which is necessary for
production of thin, freely flowing mucus
Pathophysio: mutation-> chloride ions cannot move freely -> organ
produce mucus that is thick and sticky -> obstructs airways and
glands
Ssx:
Sinuses - Rhinosinusitis
Pancreas - Diabetes
Skin - Salty sweat
Reproductive organs - male infertility
Small intestine - malnutrition
Large intestine - intestinal impaction & obstruction (abdomen pain,
distention, nausea)
Lung - Pneumonia, Hemoptysis
Ms weakness, high risk for osteoporosis
Meds: Mucolytic (pulmozyne), antibiotics, bronchodilators,
hydrators, CFTR modulators (correct defective protein CFTR)
Airway/mucus clearance: Postural drainage (use gravity
dependent position to drain mucus from lungs), Percussion
(tapping in certain areas in diff positions), vibration
Pulmonary fibrosis: an interstitial lung dse in which lung
tissue becomes scarred, over time thickens and becomes
widespread
Pathophysiology: repeated injury to alveoli -> stimulates
inflammatory response ->normal healing becomes uncontrolled &
unregulated -> fibrotic tissue is formed
Ssx: gradual onset
SOB during or after physical activity
Spasmodic, dry cough
Gradual, unintended weight loss
Fatigue and weakness
Chest discomfort
Clubbing d/t buildup of tissue
Prognosis: progressive, survival rate: 3-5 yrs after diagnosis
MM: lifestyle changes, RF management, supplemental O2,
medications (anti-fibrotics,steroids), vaccinations
Lung transplantation: surgical procedure in which lungs are
replaced w/ healthy lungs from a donor
PF- leading indication for lung transplant
Risk of LT: Organ rejection, infections, airway problems, disease
Pulmonary Rehabilitation: an exercise & educational program
designed for people with lung dse goal of improving symptoms,
restoring fxn and QOL.
Asthma: chronic inflammatory d/o of the airways that is charac. By
bronchial hyperresponsiveness and variable airflow obstruction.
Types:
Allergic: young age of onset, respond better to tx
Nonallergic: adult onset,assoc w/other comorb,less responsiveto tx
Ssx: recurrent episodes of chest tightness, wheezing, coughing,
dyspnea (night or morning)
Meds:
Long term (corticosteroids/LABAs) - taken regularly to control
chronic symptoms and prevent asthma attcks, reduce inflammation
Quick relief (Short acting beta agonists) - taken as needed for
rapid,short term relief of symptoms - used to prevent or treat an
asthma attack, relax bronchial tubes (dilate)
Week 13 - Integumentary system
Cellulitis - serious bacterial infection (streptococcus &
staphylococcus) enter through a crack/break in the skin, common
in lower legs//ssx: red area that tends to expand, swelling,
tenderness, pain, warmth, fever, blisters, skin dimpling//RF: skin
injury (cut/burn), skin cond. (eczema,shingles), chronic swelling of
arms&legs that causes skin to crack, IV drug use, weak immune
s.// MM: antibiotics, wash wound daily w/ soap&water, protective
cream&ointment, protect wound w/ bandage, monitor signs of
worsening infection
Burns- permanent destruction of tissue cause by released of
energy from an external agent//thermal injuries caused by:
flames,steam,hot liquids,hot
metals,electricity,radiation,toxicchemicals,extereme cold
Extent of burns = %TBSA
Burn depth: superficial (E), partial thickness (E&D), full thickness
(E,D,all underlying structures)
Burn rehab: compression sleeves(reduce edema and manage scar
tissue formation), splints (red. Contracture formation), use of AD to
improve fxn, PROM (early phase), self stretching, ms endurance,
strengthening ex.
Surgical wounds - Surgical sites
Hydrocholloid technology - comfort & flexility
Hydrofiber tech- micro contours to wound bed, eliminating voids
where bacteria grow, locks in wound exudate and removes it from
wound bed
Ionic silver infusion - sustained antimicrobial activity for 7 days
Polyurethane film - waterproof barrier that helps viral and bacterial
infection
Ssx:
Care: handwashing, dont scrub/rub infection, dont remove tape
strips or dressing unless instructed to, avoid use of lotions or
power on unhealed incisions, avoid prolonged exposure to
sunlight, prevent incision from getting wet
Normal ssx: soreness,tenderness, redness, warmth,tingli
ng/numbness,mild oozing, numbness
Other types: avulsion (sharp pointy object),abrasion(skin partially
or completely torn away),puncture(superficial scraping or wearing
away), laceration(tearing or cutting of tissue)//Woundhealing:
Hemostatis: body’s reaction to injury to stop bleeding,
Inflammation: WBC protect body from pathogens,
Proliferation:fibroblast form new collagen in 2-3days, angiogenesis
(blood vessels start to regrow)
Remodeling: granulation tissue matures into scar and tissue
strength is inc.