Fluent Essays

RUA: Pathophysiological  PurposeThis project is an in-depth investigation of a health condition. It will allow for the expansion of knowledge and the ability to generalize larger concepts to a variety of health conditions.  Ebook: Hubert, R. & VanMeter, K. (2018). Gould's pathophysiology for the health professions (6th ed.). Elsevier. Course outcomes:   This assignment enables the student to meet the following course outcomes. 1. Explain the pathophysiologic processes of select health conditions. (PO 1) 2. Predict clinical manifestations and complications of select disease processes. (PO 1, 8) 3. Correlate lifestyle, environmental, and other influences with changes in levels of wellness. (PO 1, 7) APA format (7th ed.) and is free of errors        Grammar and mechanics are free of errors free of Plagiarism    References: Use your book, the outside source must be within the last 5 yrs, Scholarly Articles,s or Nurse journals within the last 5 yrs. Purpose This project is an in-depth investigation of a health condition. It will allow for the expansion of knowledge and the ability to generalize larger concepts to a variety of health conditions. Course outcomes: This assignment enables the student to meet the following course outcomes. 1. Explain the pathophysiologic processes of select health conditions. (PO 1) 2. Predict clinical manifestations and complications of select disease processes. (PO 1, 8) 3. Correlate lifestyle, environmental, and other influences with changes in levels of wellness. (PO 1, 7) Due date: Your faculty member will inform you when this assignment is due. The Late Assignment Policy applies to this assignment. Total points possible: 100 points Preparing the assignment Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions. 1) Select a disease process that interests you. 2) Obtain approval of the selected disease process from the course faculty. a. Faculty will share how to submit your topic choice for approval. 3) Write a 2-3-page paper (excluding title and reference pages). 4) Include the following sections about the selected disease process (detailed criteria listed below and in the Grading Rubric). a. Introduction of disease - 10 points/10% · One paragraph (approximately 200 words) · Includes disease description · Includes epidemiology of disease b. Etiology and risk factors - 20 points/20% · Common causes of the disease or condition · Risk factors for the disease or condition · Impact of age · Prevalence based on gender, · Influence of environment · Genetic basis of disease · Lifestyle influences · All information supported by current literature c. Pathophysiological processes - 20 points/20% · Describes changes occurring at the cellular, tissue, and/or organ level that contribute to the disease process. · Describes adaptation of the cells and body in response to the disease. · Relates disease processes to manifested signs and symptoms. d. Clinical manifestations and complications - 20 points/20% · Describes the physical signs and symptoms that are important in considering the presence of the disease. · Identifies signs that contribute to diagnosis of the condition · Identifies symptoms that contribute to diagnosis of the condition. · Identifies complications of the disease. · Discusses the implications to the patient when complications are left untreated. e. Diagnostics - 10 points/10% · Includes list of common laboratory and diagnostic tests used to determine the presence of the disease. NR283 Pathophysiology RUA: Pathophysiological Processes Paper Guidelines NR283 Pathophysiology RUA: Pathophysiological Processes Paper Guidelines © 2021 Chamberlain University. All Rights Reserved NR283_Pathopysiological_Processes_Paper_Guidelines_V5_DRAFT 1 © 2021 Chamberlain University. All Rights Reserved NR283_Pathopysiological_Processes_Paper_Guidelines_V5_SEP21 1 · Discusses the significance of test findings in relation to the disease process. f. Interview - 10 points/10% · Once the student has become familiar with the disorder, it is their responsibility to locate an individual living with the disease process to interview (interviewee). It is recommended that you find an individual first, then complete research and writing on the topic prior to performing the interview. · The interviewee must be at least 18 years old and able to answer questions by themselves · The interviewee must currently have the chronic disease/disorder. If an interviewee has been diagnosed with a disease/disorder but has NO manifestations or complications related to the disorder they DO NOT qualify for the assignment. · Acute infections/diseases DO NOT qualify (pneumonia, urinary tract infection, flu, colds). · The interviewee cannot be a patient from the clinical setting or a patient from your work environment (hospitals, doctor’s office, LTC facility, home health, etc.) · The interviewee may be a relative, friend, colleague, or stranger. · Please use the individual’s own words in relation to their experience with the disease/disorder. · NOTE: This assignment is for educational purposes only. Students are NOT to provide any medical/nursing advice or education to interviewees. Refer interviewee questions to their physician. · Interview Questions · What is the age of the individual being interviewed? What is the relationship of the individual to you? How long have they had the disorder? · What clinical manifestations of the disorder does the individual experience? How does it compare to what you discovered in your resources? · What complications of the disorder does the individual experience? How does this compare to what you discovered in your resources? · What other medical conditions/disorders has the individual been diagnosed with? Do their other medical conditions have any effect on the chosen disorder? · How does the disease affect the individual’s daily living/activities? (repeat hospitalizations, has to take a lot of meds, any activity restrictions, a lot of appointments?) · How does the disease/disorder affect the individual’s outlook on life? (Feel like a burden to family, do they have good family support, feel hopeless, optimistic, good coping mechanisms?) · What did you learn from interviewing the individual? g. APA Style and Organization - 10 points/10% · References are submitted with assignment. · Uses current APA format and is free of errors. · Grammar and mechanics are free of errors. · Paper is 2-3 pages, excluding title and reference pages. · At least two (2) scholarly, primary sources from the last 5 years, excluding the textbook, are provided. For writing assistance, visit the Writing Center. Please note that your instructor may provide you with additional assessments in any form to determine that you fully understand the concepts learned. Grading Rubric Criteria are met when the student’s application of knowledge within the paper demonstrates achievement of the outcomes for this assignment. Assignment Section and Required Criteria (Points possible/% of total points available) Highest Level of Performance High Level of Performance Satisfactory Level of Performance Unsatisfactory Level of Performance Section Not Present Introduction of Disease (10 points/10%) 10 points 9 points 8 points 4 points 0 points Required criteria 1. One (approximately 200 words) paragraph 2. Includes disease description 3. Includes epidemiology of disease Includes 3 requirements for section. Includes 2 requirements for section. Includes no less than 1 requirement for section. Present, yet includes no required criteria. No requirements for this section presented. Etiology and Risk Factors (20 points/20%) 20 points 18 points 16 points 7 points 0 points Required criteria 1. Common causes of the disease or condition 2. Risk factors for the disease or condition 3. Impact of age 4. Prevalence based on gender 5. Influence of environment 6. Genetic basis of disease 7. Lifestyle influences 8. All information supported by current literature Includes 8 requirements for section. Includes 7 requirements for section. Includes 6 requirements for section. Includes 5 or fewer requirements for section. No requirements for this section presented. Pathophysiological Processes (20 points/20%) 20 points 18 points 16 points 7 points 0 points Required criteria 1. Describes changes occurring at the cellular, tissue, and/or organ level that contribute to the disease process. 2. Describes adaptation of the cells and body in response to the disease. 3. Relates disease processes to manifested signs and symptoms. Includes 3 requirements for section. Includes 2 requirements for section. Includes no less than 1 requirements for section. Section present yet includes no required criteria. No requirements for this section presented. NR283 Pathophysiology RUA: Pathophysiological Processes Paper Guidelines © 2021 Chamberlain University. All Rights Reserved NR283_Pathopysiological_Processes_Paper_Guidelines_V5_SEP21 1 Clinical Manifestations & Complications (20 points/20%) 20 points 18 points 16 points 7 points 0 points Required criteria 1. Describes the physical signs and symptoms that are important in considering the presence of the disease. 2. Identifies signs that contribute to diagnosis of the condition 3. Identifies symptoms that contribute to diagnosis of the condition. 4. Identifies complications of the disease. 5. Discusses the implications to the patient when complications are left untreated. Includes 4 requirements for section. Includes 3 requirements for section. Includes 2 requirements for section. Includes 1 or fewer requirements for section. No requirements for this section presented. Diagnostics (10 points/10%) 10 points 4 points 0 points Required criteria 1. Includes list of common laboratory and diagnostic tests used to determine the presence of the disease. 2. Discusses the significance of test findings in relation to the disease process. Includes 2 requirements for section. Includes 1 requirement for section. No requirements for this section presented. Individual Interview (10 points/10%) 10 points 9 points 8 points 4 points 0 points Required criteria 1. What is the age of the individual being interviewed? What is the relationship of the individual to you? How long have they had the disorder? 2. What clinical manifestations of the disorder does the individual experience? How does it compare to what you discovered in your resources? 3. What complications of the disorder does the individual experience? How does this compare to what you discovered in your resources? 4. What other medical conditions/disorders has the individual been diagnosed with? Do their other medical conditions have any effect on the chosen disorder? 5. How does the disease affect the individual’s daily living/activities? (repeat hospitalizations, must take a lot of meds, any activity restrictions, a lot of appointments?) 6. How does the disease/disorder affect the individual’s outlook on life? (Feel like a burden to family, do they have good family support, feel hopeless, optimistic, good coping mechanisms?) 7. What did you learn from interviewing the individual? Includes answers to 7 question sets. Includes answers to 6 question sets. Includes answers to 5 question sets. Includes answers to 1-4 question sets. No question sets answered or section not present. APA Style and Organization (10 points/10%) 10 points 9 points 8 points 4 points 0 points Required criteria 1. References are submitted with assignment. 2. Uses current APA format and is free of errors. 3. Grammar and mechanics are free of errors. 4. Paper is 2-3 pages, excluding title and reference pages 5. At least two (2) scholarly, primary sources from the last 5 years, excluding the textbook, are provided Includes 5 requirements for section. Includes 4 requirements for section. Includes 3 requirements for section. Includes 1-2 requirements for section. No requirements for this section presented. Total Points Possible = 100 points 1 3 Scholarly Paper Phase 1 Your Name (without credentials) Chamberlain University College of Nursing Course Number: Course Name Name of Instructor Assignment Due Date Title of Your Paper in Upper and Lower Case (Centered, Bold) Type your introduction here and remove the instructions. Although the first paragraph after the paper title is the introduction, no heading labeled “Introduction” is used. Refer to your assignment instructions for the headings to be used for the body of the paper. There are additional resources located in your courses and the Chamberlain Library. Level 1 Paper Heading (Bold and centered) Begin to type the body of your paper here. Use as many paragraphs as needed to cover the content appropriately based on the assignment instructions. Level Two Heading (If required) (Bold and starts at left margin) Type additional content here if a section with a subheading is needed. Next Level Two Heading Continue to add content in this section. Next Level 1 Heading Levels of headings will depend on the length and organization of your paper. Use as many headings as necessary and required to organize your paper. Short papers may only have level 1 headings. Longer papers may require more organizational detail. See your APA Manual for additional instructions on formatting multiple levels of headings. Conclusion Papers should end with a conclusion or summary. The assignment directions will specify which is required. It should be concise and contain no new information. No matter how much space remains on the page, the references always start on a separate page (insert a page break after the conclusion so that the references will start on a new page). References (centered, bold) Type your reference here using hanging indent and double line spacing (under “Paragraph” on the Home toolbar ribbon). See your APA Manual and the resources in the APA section of Resources for reference formatting. SEC TION I Pathophysiology: Background and Overview, 1 CHAPTER 1 Introduction to Pathophysiology, 1 CHAPTER 2 Fluid, Electrolyte, and Acid-Base Imbalances, 14 CHAPTER 3 Introduction to Basic Pharmacology and Other Common Therapies, 40 CHAPTER 4 Pain, 53 SEC TION I I Defense/Protective Mechanisms, 65 CHAPTER 5 Inflammation and Healing, 65 CHAPTER 6 Infection, 88 CHAPTER 7 Immunity, 114 SEC TION I I I Pathophysiology of Body Systems, 142 CHAPTER 8 Skin Disorders, 142 CHAPTER 9 Musculoskeletal System Disorders, 161 CHAPTER 10 Blood and Circulatory System Disorders, 184 CHAPTER 11 Lymphatic System Disorders, 213 CHAPTER 12 Cardiovascular System Disorders, 223 CHAPTER 13 Respiratory System Disorders, 272 CHAPTER 14 Nervous System Disorders, 325 CHAPTER 15 Disorders of the Eyes, Ears, and Other Sensory Organs, 385 CHAPTER 16 Endocrine System Disorders, 400 CHAPTER 17 Digestive System Disorders, 427 CHAPTER 18 Urinary System Disorders, 488 CHAPTER 19 Reproductive System Disorders, 514 SEC TION I V Factors Contributing to Pathophysiology, 545 CHAPTER 20 Neoplasms and Cancer, 545 CHAPTER 21 Congenital and Genetic Disorders, 565 CHAPTER 22 Complications of Pregnancy, 579 CHAPTER 23 Complications of Adolescence, 588 CHAPTER 24 Complications of Aging, 597 Section V Environmental Factors and Pathophysiology, 606 CHAPTER 25 Immobility and Associated Problems, 606 CHAPTER 26 Stress and Associated Problems, 611 CHAPTER 27 Substance Abuse and Associated Problems, 617 CHAPTER 28 Environmental Hazards and Associated Problems, 624 Appendices, 631 Glossary, 654 Index, 663 GOULD'S Pathophysiology for the Health Professions SIXTH EDITION Evolve Student Resources for Gould’s Pathophysiology for the Health Professions, Sixth Edition, include the following: t� "OJNBUJPOT� t� "OTXFS�,FZ�GPS�4UVEZ�2VFTUJPOT�JO�UIF�CPPL� Activate the complete learning experience that comes with each textbook purchase by registering at http://evolve.elsevier.com/Hubert/Goulds/ YOU’VE JUST PURCHASED MORE THAN A TEXTBOOK! REGISTER TODAY! You can now purchase Elsevier products on Evolve! Go to evolve.elsevier.com/html/shop-promo.html to search and browse for products. 2015v1.0 GOULD’S Pathophysiology for the Health Professions SIXTH EDITION Robert J. Hubert, BS Laboratory Coordinator Iowa State University Department of Animal Sciences Ames, Iowa Karin C. VanMeter, PhD Independent Consultant, Biomedical Sciences Ames, Iowa 3251 Riverport Lane St. Louis, Missouri 63043 GOULD’S PATHOPHYSIOLOGY FOR THE HEALTH PROFESSIONS, SIXTH EDITION ISBN: 978-0-323-41442-5 Copyright © 2018, 2014, 2011, 2006, 2002, 1997 by Saunders, an imprint of Elsevier Inc. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions Senior Content Development Manager: Luke Held Content Development Specialist: Jennifer Wade Publishing Services Manager: Julie Eddy Senior Project Manager: Richard Barber Design Direction: Brian Salisbury Printed in Canada Last digit is the print number: 9 8 7 6 5 4 3 2 1 Notices Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. ISBN: 978-0-323-41442-5 We would like to dedicate this book to the memory of Barbara E. Gould, MEd. We hope that this book, the legacy of her work, will instill her passion for teaching and learning and will continue to inspire health profession students and educators worldwide. Robert Hubert Karin VanMeter This page intentionally left blank vii Reviewers Julie Alles, MSCTE, RHIA Assistant Professor/Program Director Health Information Management Allied Health Sciences Grand Valley State University Grand Rapids, Michigan Zoe Atamanchuk Canada Janet Ballard, Med., BSN, RN Director of Allied Health and Practical Nursing EHOVE Adult Career Center Allied Health Department Milan, Ohio Jason Berry, MSN, RN Nursing Instructor Nursing Department Winston Salem State University Winston Salem, North Carolina Bonnie Carmack, MN, ARNP, NP Adjunct Faculty Seminole State College Department of Health Sciences Sanford, Florida Teresa Cowan, DA, BS, MS Department Chair of Health Sciences Baker College of Auburn Hills Health Sciences Department Auburn Hills, Michigan Heather Duval-Foote, BAS, RDMS Instructor/Clinical Coordinator Diagnostic Medical Sonography The University of Findlay Diagnostic Services Department College of Health Professions Findlay, Ohio Daniel F. Muñoz González, MSMLS, MLS(ASCP) CMPBT MB Assistant Professor of Medical Laboratory Sciences, Clinical Chemistry, and Molecular Diagnostics Department of Medical Laboratory Sciences School of Health Professions Andrews University Berrien Springs, Michigan Marina Hdeib, MA, RDMS Clinical Associate Professor School of Health Professions University of Missouri-Columbia Department of Clinical and Diagnostic Sciences Columbia, Missouri Lily Mauer, RPh, BSc. Pharm. PEBC Registered Pharmacist Instructor NorQuest College Allied Health Careers, Faculty of Health and Community Studies Edmonton, Alberta, Canada Susan Stout, MHS, BS, RN Program Director of Science Baker College of Muskegon, Michigan Department of Health Science Muskegon, Michigan viii Preface This textbook provides an introduction to pathophysiology for students in a variety of academic programs for the health professions at colleges and universities. Major disorders are described as well as selected additional diseases with the intention of providing information on a broad spectrum of diseases with one or more distinguish- ing features for each. It is anticipated that additional information and resources pertinent to the individual’s professional needs may be added to classroom presenta- tions and assignments. We trust that students will enjoy studying these topics and proceed with enthusiasm to more detailed studies within their individual specialties. Organization The textbook is organized into five major sections followed by the appendices: Section I—Basic Concepts of Disease Processes ~ Introduction to pathophysiology includes medical terminology and basic cellular changes. ~ Topics such as fluid, electrolyte, and acid-base imbal- ances, basic pharmacology and pain are covered. ~ The core information for each topic is complemented by the inclusion of a specific disease/condition as an immediate clinical application at the end of each chapter. Section II—Defense/Protective Mechanisms ~ Topics such as inflammation and healing, infection, and immunity are covered. ~ Specific areas included are a review of body defenses, healing involved in specific trauma such as burns, basic microbiology, review of the immune system components, and mechanisms. Section III—Pathophysiology of Body Systems ~ Selection of specific disorders is based on incidence and occurrence, as well as on the need to present a variety of pathophysiological processes and etiologies to the student. ~ For major disorders, information is provided on pathophysiology, etiology, clinical manifestations, significant diagnostic tests, common treatment modali- ties, and potential complications. ~ Other selected diseases are presented in less detail, but significant, unique features are highlighted. Section IV: Factors Contributing to Pathophysiology ~ Normal physiological changes related to cancer, adolescence, pregnancy, and aging, with their relevance and effect on disease processes and the treatment of the affected individual, are described. ~ Specific disorders associated with cancer and the developmental stages are discussed. Section V: Environmental Factors and Pathophysiology ~ Factors such as immobility, stress, substance abuse, and environmental hazards are the major components in this section. ~ Effects of the various environmental factors on the various body systems and potential complications beyond physical pathologies are discussed. ~ New research and data are included as these are areas of increasing concern with regard to pathophysiology and patient health. Appendices—additional information: ~ Ready References include lists of anatomic terms, abbreviations and acronyms, a selection of diagnostic tests, an example of a medical history, a disease index, and drug index. ~ A glossary and a list of additional resources complete this resource. Format and Features The basic format as well as the straightforward, concise approach remains unchanged from the previous editions. Some material has been reorganized to improve the flow of information and facilitate comprehension. Many features related to the presentation of information in this textbook continue as before. ~ Generic learning objectives are included in each chapter. Instructors may modify or add applicable objectives for a specific professional program. P R E FA C E ix What’s New? ~ Information on specific diseases has been updated throughout. ~ The specific disorders for each body system have been expanded to reflect current trends and research. ~ A broader emphasis on all allied health professions has been incorporated. ~ Sections and chapters have been reorganized to present the student with a building block approach: basic science and how it relates to human biology, the body’s various mechanisms that respond to the disorders/diseases, the general overview of body systems and their specific disorders, other biological factors outside of the physiology of each system that contribute to instances of disorders/disease and, finally, those environmental factors not directly attributed to a biological function or condition that may contribute to pathophysiology throughout a number of body systems. ~ Figures have been updated with new photographs and illustrations to help in the recognition and identification of the various concepts and specific disorders. ~ Tables have been updated with new information that has been made available since the previous edition. ~ Additional resources have been expanded and updated. ~ Study questions and Think About questions have been reviewed and updated to cover new material in the chapter. The Apply Your Knowledge questions have replaced the Challenge questions in the previous editions. ~ The Study Guide associated with this text has been updated to reflect the most recent information regard- ing various disorders. Guidelines for Users Certain guidelines were developed to facilitate the use of this textbook by students with diverse backgrounds studying in various health science programs. As well as ongoing general changes, some professional groups have developed unique practice models and language. In some disciplines, rapid changes in terminology have occurred, creating difficulty for some students. For example, current terms such as chemical dependency or cognitive impairment have many synonyms, and some of these are included to enable students to relate to a more familiar phrase. To avoid confusion, the common, traditional terminology has been retained in this text. ~ The recipient of care or service is referred to as a patient. ~ When a disease entity refers to a group of related disorders, discussion focuses on either a typical rep- resentative of the group or on the general characteristics of the group. ~ Key terms are listed at the beginning of the chapter. They are presented in bold print and defined when initially used in the chapter. Key terms are not indicated ~ Cross-references are included, facilitating access to information. ~ In the discussion of a particular disorder, the pathophysi- ology is presented first because this “sets the stage,” describing the basic change(s) in the body. Once the student understands the essence of the problem, he or she can easily identify the role of predisposing factors or causes and relate the resulting signs and symptoms or complications. Diagnostic tests and treatment also follow directly from the pathophysiology. ~ Changes at the cellular level are included when significant. ~ Brief reviews of normal anatomy and physiology are presented at the beginning of each chapter, to remind students of the structures and functions that are fre- quently affected by pathological processes. A review of basic microbiology is incorporated into the chapter on infections. Additional review material, such as the pH scale or the location of body cavities, may be found in the Appendices. ~ Numerous illustrations, including flow charts, schematic diagrams, and photographs, clarify and reinforce textual information, as well as offer an alternative visual learning mode, particularly when complex processes are involved. Illustrations are fully labeled, including anatomical structures and pathologic changes. Different colors may be used in a figure to distinguish between the various stages or factors in a process. ~ Tables summarize information or offer comparisons, which are helpful to the student in selecting the more significant information and for review purposes. ~ Brief reference to diagnostic tests and treatment measures promotes understanding of the changes occurring during a disease. ~ Questions are found in boxes throughout the text to stimulate application and review of new concepts. “Apply Your Knowledge” questions are based on review of normal physiology and its application, “Think About” questions follow each small section of informa- tion, and “Study Questions” are located at the end of each chapter. Questions may relate to simple, factual information, potential applications, or the integration of several concepts. These questions are helpful in alerting a student to points initially overlooked and are useful for student self-evaluation before proceeding to the next section. These features may also serve as a tool for review and test preparation. Brief answers are provided on the Evolve website. ~ Brief, adaptable case studies with questions are incor- porated at the end of many chapters and are intended to provide a basis for discussion in a tutorial, an assignment, or an alternative learning mode. It is expected that specific clinical applications may be added by instructors for each professional group. ~ Chapter summaries precede the review questions in each chapter. x P R E FA C E as such in subsequent chapters, but may be found in the glossary at the back of the book. ~ Italics are used to emphasize significant words. ~ It is assumed that students have studied anatomy and physiology prior to commencing a pathophysiology course. ~ Concise, readable style includes sufficient scientific and medical terminology to help the student acquire a professional vocabulary and appropriate communica- tion skills. An effort has been made to avoid over- whelming the student with a highly technical approach or impeding the learning process in a student who comes with little scientific background. ~ The presence of numeric values within textual informa- tion often confuses students and detracts from the basic concepts being presented; therefore, specific numbers are included only when they promote understanding of a principle. ~ Suggested diagnostic tests and treatments are not individualized or necessarily complete but are pre- sented generally to assist the student’s application of the pathophysiology. They are also intended to provide students with an awareness of the impact of certain diseases on a client and of possible modifications in the individualized care required. Diagnostic tests increase student cognizance of the extent of data collection and sifting that may be necessary before making a diagnosis, as well as the importance of monitoring the course of a disease or the response to treatment. ~ A brief introduction to pharmacology is included in Section I and specific drugs are referred to during the discussion of certain disorders. Drugs are identified by generic name, followed by a trade name. Examples provided in the appropriate chapter are not recom- mendations, but are suggested only as frequently used representatives of a drug classification. A drug index with references to the applicable chapter is located in the appendices. ~ Information regarding adverse effects of drugs or other treatment is included when there may be potential problems such as high risk for infection or special precautions required of members of the health care team. ~ Every effort has been made to present current informa- tion and concepts simply but accurately. This content provides the practitioner in a health profession with the prerequisite knowledge to recognize and under- stand a client’s problems and the limitations and implications of certain treatment measures; to reduce exacerbating factors; to participate in preventive programs; and to be an effective member of a health care team. The student will develop a knowledge base from which to seek additional information. Individual instructors may emphasize certain aspects or topics, as is most appropriate for students in a specialty area. Resources In the textbook: ~ Selected additional resources are listed in the appen- dices in Ready Reference 9. ~ Reference tables are located inside the front book cover. These comprise common normal values for blood, cerebrospinal fluid, and urine; a pH scale for body fluids; a list of blood clotting factors; and diagnostic tests. ~ The chapter introducing pharmacology and therapeu- tics is limited in content, but combined with the brief references to treatments with individual disorders, is intended to complement the pathophysiology. This chapter also introduces a few traditional and non- traditional therapeutic modalities to facilitate the student’s understanding of various therapies and of the impact of diverse treatments on the patient and on care by all members of the health care team. Also included are brief descriptions of a few selected forms of therapy, for example, physiotherapy, in hopes of clarifying the roles of different members of a health care team. ~ The appendices at the back of the textbook are intended to promote effective use of study time. They include: ~ A brief review of anatomical terms describing body cavities and planes with accompanying illustrations as well as basic body movements ~ Selected numerical conversions for temperature, weights, and volumes ~ Lists of anatomical terms and combining forms, common abbreviations, and acronyms; because of the broad scope of pathophysiology, a medical dictionary is a useful adjunct for any student in the health-related professions ~ A brief description with illustrations of common diagnostic tests such as ultrasound and magnetic resonance imaging ~ An example of a medical history, which can be modified to fit the needs of a particular professional group ~ A disease index, with a brief description and references to the relevant chapter ~ A drug index, identifying the principal action and references to the appropriate chapters ~ A list of additional resources; websites consist primarily of health care groups or professional organizations that will provide accurate information and are likely to persist. Additional specific journals and websites are available for individual professions. ~ A glossary, including significant terms used to describe diseases as well as key words ~ Accompanying this textbook and developed for it, the ancillaries available include: A study guide for students provides learning activities such as complex test questions, matching exercises, crossword puzzles, diagrams to label, and other assignments P R E FA C E xi The interactive Evolve web site includes self-evaluation tools, and can be found at http://evolve.elsevier. com/Hubert/Goulds/ We appreciate the time and effort of reviewers and users of this text, of sales representatives, and of the editors, who have forwarded comments regarding the first four editions. We have attempted to respond to these suggestions while recognizing that comments come from a variety of perspectives, and there is a need to respect the primary focus of this textbook, space constraints, and student concerns. We hope that teachers and students will enjoy using this textbook, and that it will stimulate interest in the acquisition of additional knowledge in this dynamic field. Robert Hubert Karin VanMeter xii Acknowledgments The authors would like to acknowledge and dedicate this edition to the original author, Barbara E. Gould, who passed away. Dr. Gould always kept “student learning” in the forefront as the guideline for writing this book. We also would like to thank all the editorial and produc- tion staff at Elsevier for their support and encouragement. Furthermore, we would like to thank the reviewers for their valuable input. I would first like to thank my co-author and friend Karin VanMeter. This is our third major project together and it is her continued dedication to education and professionalism that has contributed so much to the overall teamwork and fun working relationship that we enjoy. I would also like to thank Dr. Joan Cunnick and all of the faculty and staff in the microbiology program at Iowa State University for all of your encouragement and support. As with any and all challenges I have tackled in my life, I give my love and thanks to my family—my parents, John and Ann, and my sister Donna, for their unwavering love and support throughout my life. Finally, I lift up my thanks to Jesus Christ, my Lord and Savior, who makes this all possible—to Him be the glory and honor forever. Robert J. Hubert My special thanks goes to my co-author Rob Hubert. He has been my friend and collaborator for many years and I am looking forward to many years of working together. Without him all the projects we have done together would have lacked his incredible insight into the topics we have addressed in this new edition. I also would like to thank my mother, Theresia, and my brother, Hermann, and his family for the love, support, and understanding. To my children, Christine and Andrew—thanks for your continu- ous love. Karin C. VanMeter xiii SEC TION I Pathophysiology: Background and Overview, 1 CHAPTER 1 Introduction to Pathophysiology, 1 What Is Pathophysiology and Why Study It?, 1 Understanding Health and Disease, 2 Concept and Scope of Pathophysiology, 2 Beginning the Process: A Medical History, 4 New Developments and Trends, 4 Basic Terminology of Pathophysiology, 5 Introduction to Cellular Changes, 8 Terms Used for Common Cellular Adaptations, 8 Cell Damage and Necrosis, 9 CHAPTER 2 Fluid, Electrolyte, and Acid-Base Imbalances, 14 Fluid Imbalance, 15 Review of Concepts and Processes, 15 Fluid Excess: Edema, 16 Fluid Deficit: Dehydration, 20 Third-Spacing: Fluid Deficit and Fluid Excess, 21 Electrolyte Imbalances, 21 Sodium Imbalance, 21 Potassium Imbalance, 24 Calcium Imbalance, 26 Other Electrolytes, 28 Acid-Base Imbalance, 29 Review of Concepts and Processes, 29 Control of Serum pH, 30 Acid-Base Imbalance, 32 Treatment of Imbalances, 36 CHAPTER 3 Introduction to Basic Pharmacology and Other Common Therapies, 40 Pharmacology, 40 Basic Principles, 40 Drug Effects, 41 Administration and Distribution of Drugs, 42 Drug Mechanisms and Receptors, 45 Responses, 46 Drug Classifications and Prescriptions, 46 Traditional Forms of Therapy, 48 Physiotherapy, 48 Occupational Therapy, 48 Speech/Language Therapy, 48 Nutrition/Diet, 48 Registered Massage Therapy, 48 Contents Osteopathy, 48 Chiropractic, 49 Complementary or Alternative Therapies, 49 Noncontact Therapeutic Touch, 49 Naturopathy, 49 Homeopathy, 49 Herbal Medicine, 49 Aromatherapy, 49 Asian Concepts of Disease and Healing, 49 CHAPTER 4 Pain, 53 Etiology and Sources of Pain, 53 Structures and Pain Pathways, 54 Physiology of Pain and Pain Control, 55 Characteristics of Pain, 57 Signs and Symptoms, 57 Young Children and Pain, 57 Referred Pain, 57 Phantom Pain, 57 Pain Perception and Response, 57 Basic Classifications of Pain, 59 Acute Pain, 59 Chronic Pain, 59 Headache, 59 Central Pain, 60 Neuropathic Pain, 60 Ischemic Pain, 61 Cancer-Related Pain, 61 Pain Control, 61 Methods of Managing Pain, 61 Anesthesia, 62 SEC TION I I Defense/Protective Mechanisms, 65 CHAPTER 5 Inflammation and Healing, 65 Review of Body Defenses, 66 Review of Normal Capillary Exchange, 67 Physiology of Inflammation, 67 Definition, 67 Causes, 67 Steps of Inflammation, 67 Acute Inflammation, 69 Pathophysiology and General Characteristics, 69 Local Effects, 70 Systemic Effects, 71 Diagnostic Tests, 71 Potential Complications, 72 xiv C O N T E N T S Chronic Inflammation, 72 Pathophysiology and General Characteristics, 72 Potential Complications, 73 Treatment of Inflammation, 73 Drugs, 73 First Aid Measures, 75 Other Therapies, 75 Healing, 75 Types of Healing, 75 Healing Process, 76 Factors Affecting Healing, 76 Complications Due to Scar Formation, 78 Example of Inflammation and Healing, 78 Burns, 78 Classifications of Burns, 79 CHAPTER 6 Infection, 88 Review of Microbiology, 89 Microorganisms, 89 Types of Microorganisms, 90 Other Agents of Disease, 99 Resident Flora (Indigenous Normal Flora, Resident Microbiota), 99 Principles of Infection, 100 Transmission of Infectious Agents, 100 Host Resistance, 101 Virulence and Pathogenicity of Microorganisms, 102 New Issues Affecting Infections and Transmission, 102 Control of Transmission and Infection, 103 Physiology of Infection, 105 Onset and Development, 105 Patterns of Infection, 106 Signs and Symptoms of Infection, 106 Methods of Diagnosis, 107 Treatment and Antimicrobial Drugs, 107 Example of Infection: Influenza (Flu), 110 CHAPTER 7 Immunity, 114 Review of the Immune System, 115 Components of the Immune System, 115 Elements of the Immune System, 115 Immune Response, 118 Diagnostic Tests, 119 Process of Acquiring Immunity, 120 Outcome of Infectious Disease, 121 Emerging and Reemerging Infectious Diseases and Immunity, 121 Bioterrorism, 121 Tissue and Organ Transplant Rejection, 121 Rejection Process, 122 Treatment and Prevention, 122 Hypersensitivity Reactions, 122 Type I: Allergic Reactions, 123 Type II: Cytotoxic Hypersensitivity, 126 Type III: Immune Complex Hypersensitivity, 127 Type IV: Cell-Mediated or Delayed Hypersensitivity, 127 Autoimmune Disorders, 128 Mechanism, 128 Example: Systemic Lupus Erythematosus, 128 Immunodeficiency, 131 Causes of Immunodeficiency, 131 Effects of Immunodeficiency, 132 Acquired Immunodeficiency Syndrome, 132 SEC TION I I I Pathophysiology of Body Systems, 142 CHAPTER 8 Skin Disorders, 142 Review of the Skin, 143 Resident Microbial Flora, 144 Skin Lesions, 144 Diagnostic Tests, 146 Skin Inflammatory Disorders, 146 Contact Dermatitis, 146 Urticaria (Hives), 147 Atopic Dermatitis, 147 Psoriasis, 148 Pemphigus, 149 Scleroderma, 149 Skin Infections, 150 Bacterial Infections, 150 Viral Infections, 152 Fungal Infections, 154 Other Infections, 155 Skin Tumors, 157 Malignant Melanoma, 157 Kaposi Sarcoma, 158 CHAPTER 9 Musculoskeletal System Disorders, 161 Review of the Musculoskeletal System, 162 Bone, 162 Skeletal Muscle, 164 Joints, 166 Diagnostic Tests, 166 Trauma, 167 Fractures, 167 Bone Disorders, 172 Osteoporosis, 172 Rickets and Osteomalacia, 173 Paget Disease (Osteitis Deformans), 173 Osteomyelitis, 173 Abnormal Curvatures of the Spine, 173 Bone Tumors, 174 Disorders of Muscle, Tendons, and Ligaments, 175 Muscular Dystrophy, 175 Primary Fibromyalgia Syndrome, 176 Joint Disorders, 176 Osteoarthritis, 176 Rheumatoid Arthritis, 178 Juvenile Rheumatoid Arthritis, 180 Infectious (Septic) Arthritis, 180 Gout (Gouty Arthritis), 180 Ankylosing Spondylitis, 181 Other Inflammatory Joint Disorders, 182 CHAPTER 10 Blood and Circulatory System Disorders, 184 Review of the Circulatory System and Blood, 185 C O N T E N T S xv Anatomy, Structures, and Components, 185 Blood Vessels, 185 Blood, 186 Blood Dyscrasias, 195 Anemias, 195 Blood-Clotting Disorders, 204 Myelodysplastic Syndrome, 207 Neoplastic Blood Disorders, 208 Polycythemia, 208 Leukemias, 208 CHAPTER 11 Lymphatic System Disorders, 213 Review of the Lymphatic System, 213 Structures and Function, 213 Composition and Production of Lymph, 215 Lymphatic Disorders, 217 Lymphomas, 217 Multiple Myeloma or Plasma Cell Myeloma, 220 Lymphedema, 220 Elephantiasis (Filariasis), … Hello Dr. Professor, Topic I choose: Arthritis There are many types of arthritis, but in my paper will be writing about the most common one “Osteoarthritis”. Thank you,