Week 3: Concept Process Assignment #1 <

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

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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), …

ACTIVE LEARNING TEMPLATES TherapeuTic procedure A1

Basic Concept
STUDENT NAME _____________________________________

CONCEPT ______________________________________________________________________________ REVIEW MODULE CHAPTER ___________

ACTIVE LEARNING TEMPLATE:

Related Content
(E.G., DELEGATION,
LEVELS OF PREVENTION,
ADVANCE DIRECTIVES)

Underlying Principles Nursing Interventions
WHO? WHEN? WHY? HOW?

1. STUDENT NAME:
2. CONCEPT:
3. REVIEW MODULE CHAPTER:
4. Related Content:
5. Underlying Principles:
6. Nursing Interventions:

ACTIVE LEARNING TEMPLATES TherapeuTic procedure A11

System Disorder
STUDENT NAME _____________________________________

DISORDER/DISEASE PROCESS __________________________________________________________ REVIEW MODULE CHAPTER ___________

ACTIVE LEARNING TEMPLATE:

ASSESSMENT SAFETY
CONSIDERATIONS

PATIENT-CENTERED CARE

Alterations in
Health (Diagnosis)

Pathophysiology Related
to Client Problem

Health Promotion and
Disease Prevention

Risk Factors Expected Findings

Laboratory Tests Diagnostic Procedures

Complications

Therapeutic Procedures Interprofessional Care

Nursing Care Client EducationMedications

1. STUDENT NAME:
2. DISORDERDISEASE PROCESS:
3. REVIEW MODULE CHAPTER:
4. Pathophysiology Related to Client Problem:
5. Health Promotion and Disease Prevention:
6. Risk Factors:
7. Expected Findings:
8. Laboratory Tests:
9. Diagnostic Procedures:
10. Nursing Care:
11. Therapeutic Procedures:
12. Medications:
13. Client Education:
14. Interprofessional Care:
15. Alterations in Health:
16. Safety Considerations:
17. Complications:

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Grascia Hinds

July 26, 2019

NR 283

Emphysema and Oxygenation

Emphysema is a type of COPD involving damage to the air sacs

(alveoli) in the lungs. As a result, your body does not get the oxygen it

needs. You may also have a chronic cough and have trouble breathing

during exercise. Emphysema may be caused by a genetic deficiency, air

pollution and manufacturing fumes that irritate your lungs. The most

common cause is cigarette smoking.

In people with emphysema, the lung tissue involved in exchange

of gases are destroyed. Emphysema is grouped as chronic obstructive

pulmonary disease (COPD). There is loss of elastic recoil of the alveoli,

that leads to air not being able to be expelled from the alveoli.

Emphysema goes unnoticed for many years without any signs or

symptoms. Symptoms include shortness of breath; lips and fingernails

turning blue or gray, and chronic cough. Other symptoms that may be

seen are dizziness, difficulty lying down, anxiety, stress, impotence,

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fatigue, lack of concentration, and excessive sleepiness during the day,

difficult sleeping at night, or staying asleep.

Emphysema can’t be cured, but treatments can help relieve

symptoms and slow the progression of the disease. Bronchodilator is

used to help relieve coughing, shortness of breath by relaxing

constricted airways. Corticosteroid drugs inhaled help relieve shortness

of breath. Overuse of this medicine may weaken your bones and

increase your risk of high blood pressure, cataracts and diabetes.

Antibiotics are used to help with bacterial infections that may occur like

bronchitis or pneumonia.

Therapies include pulmonary rehabilitation, which is used for

breathing exercises to reduce breathlessness. Through nutrition

therapy you receive advice about proper nutrition; while early stages of

emphysema need to lose weight and late stages need to gain weight.

Best therapy is to stop smoking completely and avoid harmful chemicals

around you.

To prevent emphysema, don’t smoke and avoid breathing in

secondhand smoke from cigarettes, tobacco, and marijuana. Also if you

work around or with chemical fumes or dust it is best you wear a mask

to protect your lungs.

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Reference:

Hubert, R. & VanMeter, K. (2018). Gould’s pathophysiology for the health professions:
Study Guide (6th ed.). St. Louis, MO: Elsevier.

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