PROBLEMS AFFECTING MULTIPLE

SYSTEMSCH. 5

GOODMAN

GoodmanCH.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)

SYSTEMIC EFFECTS OF PATHOLOGY

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)

SYSTEMIC EFFECTS OF PATHOLOGY

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

SYSTEMIC EFFECTS OF PATHOLOGY

Chronic inflammation (continued) Systemic effects> low grade fever, malaise,

weight loss, anemia, fatigue, leukocytosis, lymphocytosis

Inflammation is reflected by increased erythrocyte sedimentation rate (ESR)

SYSTEMIC EFFECTS OF PATHOLOGY

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 EFFECTS OF PATHOLOGY

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)

SYSTEMIC EFFECTS OF PATHOLOGY

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

SYSTEMIC EFFECTS OF PATHOLOGY

Immunodeficiency (continued) Non-specific causes:

◦ Aging◦ Autoimmune conditions◦ Diabetes mellitus◦ Cancer- myeloma, lymphoma, leukemia◦ Chronic diseases◦ Cancer treatment- chemotherapy and radiation

SYSTEMIC EFFECTS OF PATHOLOGY

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 PATHOLOGY

Systemic effects of neoplasm (continued) Systemic> weight loss, muscle weakness,

anorexia, anemia, coagulation disorders, cachexia

SYSTEMIC EFFECTS OF PATHOLOGY

PT IMPLICATIONS

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

PT IMPLICATIONS

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”

Physical therapist performing bedside intervention in the ICU

Monitoring……. Mobilizing…….

Dogs can help too!

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

Dogs have a role!

Recovering from open heart surgery…..

Recovering from an illness….

Andrea C. Mendes PT, DPTGood luck on the final!