Health Promotion and Disease Prevention PDF

Health Promotion and Disease Prevention Health promotion Self-responsibility, nutritional awareness, stress reduction, and physical fitness Disease prevention Primary prevention – removing or reducing risk factor Secondary prevention – early detection Tertiary – limitin...

Health Promotion and Disease Prevention Health promotion Self-responsibility, nutritional awareness, stress reduction, and physical fitness Disease prevention Primary prevention – removing or reducing risk factor Secondary prevention – early detection Tertiary – limiting impact of the disease Health Promotion & Disease Prevention Primary Prevention PTAs promote exercise, so what are the benefits of exercise? Increased cardiovascular functional capacity, decreased myocardial oxygen demand Reduced mortality in people with coronary artery disease Favorable change in metabolism of carbohydrates and lipids, including an increase in level of high-density lipoproteins Improved hemodynamic, hormonal, metabolic, neurological, and respiratory function Improved immune function (stressful or excessive exercise can have the opposite effect) Facilitation of biorhythms and thermoregulation; prevention of insomnia Favorable effect on fibrinogen levels in older men Increased sensitivity to insulin Increased bone density; prevention of osteoporosis Greater strength and flexibility; maintenance of muscle mass Improved postural stability; reduction in falls Improved psychologic functioning, self-confidence, and self-esteem Reduction in some type A behaviors Health Promotion & Disease Prevention Secondary Prevention Promote regular doctor visits Promote screening for common pathologies related to the patient Encourage open communication with the patient’s doctor and pharmacists Health Promotion & Disease Prevention Tertiary Prevention For instance: We can tell our patients with diabetes the importance of checking their feet everyday for skin changes We can inform the patients with heart failure the benefits of compression socks to maintain skin integrity We can educate patients with non surgical RTC, the importance of axillary hygiene Chapter 2 Problems Affecting Multiple Systems Systemic Effects of Pathology Acute inflammation What are the systemic effects of acute inflammation? Fever, tachycardia, and hypermetabolic state Chronic inflammation What are the systemic effects of chronic inflammation? Low grade fever, malaise, weight loss, fatigue, leukocytosis, and lymphocytosis Systemic factors influencing healing List out the systemic factors that influence healing: Nutrition, mental state, cardiovascular disease, cancer, hematologic disorders, systemic infections, cancer, DM, chronic use of corticosteroids, immunosuppressive therapy  Acute injury: The hypermetabolic response to injury is characterized by increased blood pressure and heart rate, peripheral insulin resistance, and increased protein and lipid catabolism, which lead to increased resting energy expenditure, increased body temperature, total body protein loss, muscle wasting, and stimulated synthesis. What is the difference between lymphocytosis and leukocytosis? This common type of leukocytosis is caused by an increase in neutrophils, which account for 40–60 percent of the white blood cells in your body. Lymphocytosis. This occurs when you have high levels of lymphocytes, which make up 20–40 percent of your white blood cells The leukocytosis is and increase in neutrophils – those lysising cells can cause damage to normal, healthy tissue Systemic factors – your body needs increased nutrients to heal – this is where the old saying of feed a cold likely comes from. Happiness and laughter have been shown to increase immune system which is what we need in normal recovery. This is why decreasing stress and having a positive outlook is so important to people who are dealing with a chronic disease. Hematologic disorders involve the blood and include problems with red blood cells, white blood cells, platelets, bone marrow, lymph nodes, and spleen. Not only is this our immune system but the red blood cells are vital in taking oxygen to every tissue in the body. Infections that are no longer localized and have spread just affect more organs and put more stress on our bodies DM – the increased sugar in the blood stream slows the speed of the white blood cells, causes nerve damage which leads to sensory loss and wounds. Chronic use of cortiosteriods suppresses our immune system – chron’s disease Immune suppressive therapy - transplants Systemic Effects of Pathology Consequences of immunodeficiency What is the consequence of immunodeficiency? Opportunistic infections Systemic effects of neoplasm What are the local effects? It depends on what tissues the mass is pushing on. It could cause compression on nerves and blood supply What might you see with systemic effects of a neoplasm? Weight loss, muscle wasting and eventually cachexia, anoxia, anemia, and coagulation disorders Adverse Drug Events ADEs: Unwanted and potentially harmful effects produced by medications or prescribed drugs What is a drug to drug interaction? Drug to drug – medications interacting in an unfavorable manner What is a drug-disease interaction? Drug disease – medications causing the disease to worsen What are side effects? Side effects – predictable effects, but undesired Adverse Drug Reactions (Cont.) Drugs that most commonly cause adverse drug reactions Corticosteroids Digoxin Aminoglycoside antibiotic Anticoagulants (heparin and warfarin) Insulin overdose Aspirin Tranquilizers (phenothiazines) Sedative-hypnotics Antacids Oral hypoglycemics Pain medications How many different ways are there to administer a drug? https://www.merckmanuals.com/home/drugs/administration-and-kinetics-of-drugs/drug- administration  Drugs are introduced into the body by several routes. They may be 1.Taken by mouth (orally) 2.Given by injection into a vein (intravenously, IV), into a muscle (intramuscularly, IM), into the space around the spinal cord (intrathecally), or beneath the skin (subcutaneously, sc) 3.Placed under the tongue (sublingually) or between the gums and cheek (buccally) 4.Inserted in the rectum (rectally) or vagina (vaginally) 5.Placed in the eye (by the ocular route) or the ear (by the otic route) 6.Sprayed into the nose and absorbed through the nasal membranes (nasally) 7.Breathed into the lungs, usually through the mouth (by inhalation) or mouth and nose (by nebulization) 8.Applied to the skin (cutaneously) for a local (topical) or bodywide (systemic) effect 9.Delivered through the skin by a patch (transdermally) for a systemic effect Common Signs and Symptoms of Adverse Drug Reactions in the Aging Dry mouth (xerostomia) Restlessness Orthostatic hypotension (dizziness, weakness, decreased blood pressure, falls) Depression Confusion, delirium Impaired memory or concentration Nausea Constipation Incontinence Extrapyramidal syndromes (e.g., parkinsonism, tardive dyskinesia) Fatigue PTA responsibilities for ADE Education Remind patient to take medications as prescribed Instruct patient to…… Notifying the doctor – what information do you want to give? Which drug administration route will have altered absorption with exercise? Transdermal, subcutaneous, or intermuscular injections Drug Categories and Effects Nonsteroidal anti-inflammatory drugs (NSAIDs) (aspirin, Celebrex, Vioxx, Bextra, Motrin,Aleve, Advil) Heterogeneous group of drugs that reduce inflammation, provide pain relief, and reduce fever 1. When do PTAs most often see NSAIDS used? 1. Post operative, painful muscles, or RA 2. Where in the body do the most serious side effects occur? 1. GI tract, kidney, and cardiovascular system. NSAIDS can lead to GI bleeds, sodium retention, interact with BP meds, increasing blood pressure due to being a vasoconstrictor, causing kidney dysfunction, and acts as a blood thinner 3. How long does a single dose of aspirin impair clot formation? 1. 5-7 days 4. What are the therapy implications for this drug group? (box 2.3) 1. Bruising, possible hemorrhage, LE edema and increased fluid retention, increased BP Drug Categories and Effects Corticosteroids Naturally occurring hormones produced by the adrenal cortex and gonadal tissue 1. What are glucocorticoids used for? 2. Tell me what you think are the important ADE to know or recognize regarding glucocorticoids. https://www.youtube.com/watch?v=tvivILLAWRI Fluid and Electrolyte Imbalances Name the 13 factors affecting fluid and electrolyte balance in the aging? So What? What are the clinical manifestations? Special Implications? What should the PTA do?  Chapter 3 Injury, Inflammation, and Healing Cell Injury The larger the injury the larger the cell damage No all tissue can regenerate, some may only repair with scar tissue Scar tissue helps to maintain structural integrity but does have any functional properties of the original cells Mechanisms of Cell Tissue Injury Ischemia (lack of blood supply) Genetic factors 1. What does a decrease in blood flow Chromosomal abnormalities such as do? down syndrome, sickle cell, and 2. What is hypoxia verses anoxia? Huntington’s disease Infectious agents Physical factors 1. Name some infectious agents 1. What are the two categories of 2. Define sepsis trauma that can lead to cell death? Immune reactions Chemical factors Mild allergies to anaphylactic Direct or metabolic transformation reactions (whole body reactions) Psychosocial Factors Nutritional factors Influences tissue adaption and injury 1. Who is at risk for Vitamin C deficiency in the US? Cellular Adaptions in Chronic Cell Injury – (Fill in the term or definition) ? Reduction in cell and organ size Hypertrophy ? Hyperplasia ? Metaplasia Change in the cell’s make-up and function ? Increase in the cell numbers and alterations in cell form and cell organization Factors Influencing Healing (Box 3.4) Name some factors that influence healing and why? Physiologic variables – growth factors (regulate cell proliferation, differentiation and migration) General health of individual – vascular supply Presence of comorbidities – disease associated with decreased oxygen (anemia , CHF, COPD,) DM due to impaired immune cells and granulation tissue formation, cancer, incontinence, Alzheimer’s , neurologic impairment, immobility Tobacco, alcohol, caffeine – use of theses actually impeded healing Nutrition Good nutrition can improve healing and poor nutrition can impede it – vitamin C is necessary for collagen to form Local or systemic infection – due to severe and prolonged inflammatory reaction Type of tissue – some tissue only scars like the heart Medical treatment – medications such as chronic use of steroids Phases of Healing Hemostasis and degeneration Inflammation Proliferation and migration Remodeling and maturation Hemostasis and Degeneration Illustration of the hemostasis process: (a) vascular spasm and stypsis: vascular damage immediately stimulates vasoconstriction, to restrict blood flow out of the vessel. (b) Platelet plug formation: platelets are activated, and they adhere to bleeding sites, forming an initial platelet plug. (c) Coagulation cascade: the intrinsic and extrinsic pathways are individually activated, and they work together to convert fibrinogen into fibrin strands, ultimately reinforcing the weak platelet plug. This plug is eventually broken down as fibroblasts start to fill in the area. Inflammation Please watch 1. What are the 4 signs of inflammation? 2. What is the suffix used in the 3. What chemicals are released with injury to tissue? 4. What does the mast cells release? a. What does this cause? 5. What is margination? 6. A leukocycte leaving the blood vessel and entering the https://www.youtube.com/watch?v=FXSuEIMrPQk interstitial space is called what?  Let the Healing Begin! Proliferation and Migration phase Remodeling and Maturation Starts 2 days after injury and can Myofibroblasts contract and help last weeks shrink the tissue Endothelial cells multiple Excessive shrinkage of healing Inflammatory cells decreases tissue is called contracture Fibroblasts, endothelial cells and Arthrofibrosis – excessive keratinocytes synthesis growth contracted tissue within a joint factors Regeneration verses repair Knowing which tissues regenerate verses repair helps us anticipate return to function Decreasing scaring helps to improve function Specific Tissue or Organ Repair Heart Skeletal muscle Central Nervous System Muscle injury Muscle regeneration Lung Muscle stiffness Digestive tract Motor control and muscle Peripheral nerves inhibition Bone Tendon and Ligaments Cartilage Disks  Repair Heart CNS 8-12 weeks to scar, the Scars – body can scar area is non accommodate by contractile making new pathways in the brain  Regeneration – if the right conditions Peripheral Nervous Lung Digestive Tract Liver Skin Muscle System Scarring and Basement membrane Up to 18 months to Both regeneration and Basement membrane Basement membrane regeneration must be intact heal scarring must be intact must be intact depending on damage Repair can take up to 8 weeks  Regeneration Surgery assist may be needed Tendons Ligaments Meniscus Disks 12-16 weeks Depends on Depends on age Depends on age before it can location and and location and location handle stress blood supply Special Implications for the PTA Education Name 4 things you should educate your patients on Prevention What 3 things should you address with the patient? Rehabilitation of repaired soft tissues Know which tissues are injured and their healing time Protection during ______ phase with slow progression to allow for other stages of healing to progress – Name the other stages Special Implications for the PTA Tendon or muscle rupture What activity is allowed during the proliferative phase (5-28 days) What phase starts around 4 weeks? What activities can you start then? Do you know what position a pt would be in for gravity eliminated shoulder flexion? How about hip flexion? Muscle strain When can a patient think about returning to sports? Medications What is a side effect of NSAIDs? What are the side effects of pain medication? Special Implications for the PTA Immobilization What are the effects of immobilization to ligament insertion sites? Meniscus? Heart? Lungs? Blood? DVT What are the signs and symptoms of a DVT?