Basic Pathophysiology

1. Identify Signs and Symptoms Related to Acute or Chronic Illness

Acute Illness: Acute illness refers to conditions that develop suddenly and have a rapid onset. These conditions may last for a short period, from a few hours to a few weeks. Examples of acute illnesses include infections (e.g., influenza, pneumonia), trauma (e.g., fractures, burns), and sudden cardiovascular events (e.g., heart attack, stroke).

Key Characteristics of Acute Illness:

• Rapid Onset: Symptoms develop suddenly and progress quickly.
• Severe Symptoms: Acute illnesses typically present with more intense, immediate symptoms that demand urgent attention.
• Short Duration: Most acute illnesses resolve within a short period (e.g., hours to weeks).
• Predictable Course: With appropriate treatment, many acute illnesses will improve or resolve.

Common Signs and Symptoms of Acute Illness:

1. Fever:
   • A fever is a common response to infection and inflammation. It occurs when the body’s thermostat in the hypothalamus is reset at a higher level.
   • It is usually a response to infection (bacterial, viral) or inflammation (e.g., autoimmune diseases).
2. Pain:
   • Pain is a frequent symptom in acute illnesses, often linked to tissue injury, inflammation, or infection. For example, a patient with acute appendicitis may experience sharp abdominal pain in the lower right quadrant.
3. Cough and Shortness of Breath:
   • Respiratory infections or acute cardiovascular events may present with difficulty breathing, wheezing, or a productive cough.
   • Pneumonia and asthma exacerbations often cause these symptoms.
4. Chest Pain:
   • Acute chest pain is commonly associated with myocardial infarction (heart attack), pericarditis, or pulmonary embolism.
   • Chest pain that radiates to the arm, jaw, or back, accompanied by sweating, nausea, and shortness of breath, could indicate a heart attack.
5. Dizziness or Confusion:
   • Acute illness affecting the brain (e.g., stroke, hypoglycemia) can cause confusion, altered mental status, or dizziness. These symptoms may be linked to reduced oxygen supply to the brain or electrolyte imbalances.
6. Nausea and Vomiting:
   • Gastrointestinal infections or other acute conditions (e.g., gallstones, appendicitis) can cause nausea and vomiting.
   • These symptoms could also result from metabolic disturbances, such as kidney failure or liver disease.
7. Diarrhea or Constipation:
   • Gastrointestinal disturbances, such as infections or inflammatory bowel diseases (IBD), commonly present with diarrhea or constipation. The acute nature of these symptoms may require prompt investigation.
8. Fatigue:
   • Acute illness, especially infections, may result in profound fatigue, weakness, or malaise. This can also be seen in post-operative patients as they recover.

Pathophysiology of Acute Illness:

Acute illnesses often result from sudden disruptions in homeostasis, such as infections, tissue injury, or blood loss. The body’s immediate response to these disruptions typically involves:

• Inflammatory Response: This includes vasodilation, increased capillary permeability, and the release of pro-inflammatory cytokines to combat infection or injury.
• Immune Response: The innate and adaptive immune systems engage to protect the body. In acute infections, white blood cells (WBCs) and antibodies act to fight off pathogens.

Chronic Illness: Chronic illness refers to conditions that develop over a long period and are typically persistent or long-lasting, often lasting for months or years. These conditions include heart disease, diabetes, arthritis, and chronic respiratory diseases.

Key Characteristics of Chronic Illness:

• Gradual Onset: Symptoms of chronic illnesses develop over time and worsen gradually.
• Prolonged Duration: Chronic illnesses often last for years or are lifelong.
• Ongoing Symptoms: Symptoms may fluctuate between periods of stability and exacerbation.
• Impact on Quality of Life: Chronic conditions often affect a person’s daily functioning, mental health, and overall quality of life.

Common Signs and Symptoms of Chronic Illness:

1. Fatigue and Decreased Energy:
   • Fatigue is a hallmark of many chronic diseases, such as cancer, diabetes, and heart failure. It may result from anemia, metabolic dysfunction, or the body’s inability to meet energy demands.
2. Pain:
   • Chronic conditions, especially musculoskeletal diseases (e.g., osteoarthritis) or autoimmune disorders (e.g., rheumatoid arthritis), often cause long-term, persistent pain.
3. Dyspnea (Shortness of Breath):
   • Chronic respiratory conditions such as chronic obstructive pulmonary disease (COPD) or asthma can cause shortness of breath, particularly during exertion or exacerbations.
4. Weight Loss or Gain:
   • Weight changes can be a significant indicator in chronic illnesses. Unexplained weight loss may indicate metabolic diseases like hyperthyroidism or cancer, while unexplained weight gain could be due to heart failure or hypothyroidism.
5. Edema:
   • Swelling of the limbs or abdomen (ascites) is common in chronic conditions like heart failure, liver disease, or chronic kidney disease.
6. Cognitive Changes:
   • Chronic illnesses such as Alzheimer’s disease or Parkinson’s disease often present with cognitive decline, memory loss, and difficulty with executive function.
7. Mood Changes:
   • Chronic illness can have a profound impact on mental health, contributing to anxiety, depression, and frustration as patients cope with long-term symptoms.

Pathophysiology of Chronic Illness:

• Cellular Damage: Chronic illness often results from long-term cellular damage. For example, the progression of diabetes leads to vascular damage and changes in the function of insulin-producing cells.
• Inflammation: Chronic inflammation plays a role in many diseases, including rheumatoid arthritis, where the immune system constantly attacks the synovial membranes, leading to joint damage.
• Organ Dysfunction: Many chronic illnesses, such as heart failure or chronic kidney disease, lead to progressive organ dysfunction and a decline in the organ’s ability to function properly over time.

2. Consider General Principles of Client Disease Process When Providing Care

The general principles of disease processes involve understanding how diseases affect the body and how the body responds to disease. This knowledge allows nurses to anticipate complications, monitor for changes, and provide optimal care.

Injury and Repair:

The process of injury and repair occurs when the body experiences trauma or damage. This process involves:

1. Inflammatory Response: When injury occurs, the body initiates an inflammatory response, which includes vasodilation and increased permeability of blood vessels to allow immune cells to reach the site of injury.
2. Cellular Repair: After inflammation, the body begins to repair the damaged tissue. In the case of superficial injury, this may involve regeneration of epithelial cells, while deep injuries may require scar tissue formation.
3. Fibrosis: In some cases, especially in chronic injury, the body may replace damaged tissue with fibrous scar tissue, which can impair normal function.

Immunity:

Immunity refers to the body’s defense system against harmful agents, including bacteria, viruses, and abnormal cells. The immune system involves both:

1. Innate Immunity: The body’s first line of defense, which includes physical barriers (skin, mucous membranes), phagocytic cells (neutrophils, macrophages), and proteins (e.g., complement system).
2. Adaptive Immunity: This includes the activation of lymphocytes (T-cells and B-cells), which recognize specific antigens and produce antibodies to neutralize or eliminate them.
3. Immune Response: Infections, autoimmune diseases, and allergies are examples of conditions that affect the immune system. Chronic activation of the immune system can result in autoimmune disorders (e.g., lupus, rheumatoid arthritis).

Cellular Structure:

Cellular structure is the foundation of the body’s function. When cells become damaged or abnormal, it can lead to disease. Key points to consider:

1. Cellular Adaptation: Cells can adapt to stress or injury through processes like hypertrophy (increase in cell size), atrophy (decrease in cell size), hyperplasia (increase in cell number), and metaplasia (reversible change in cell type).
2. Cellular Death: When cells are unable to adapt or repair, they may undergo necrosis (uncontrolled cell death) or apoptosis (programmed cell death).
3. Cancer: Cancer occurs when cellular DNA is damaged, leading to uncontrolled growth and division of cells. Tumors can form, and the cancer cells may metastasize (spread to other parts of the body).

3. Apply Knowledge of Pathophysiology to Monitoring Client for Alterations in Body Systems

Monitoring clients for alterations in body systems involves understanding the typical physiological response to disease and identifying early signs of complications.

Monitoring for Respiratory Alterations:

• Pathophysiology: Conditions like COPD, asthma, pneumonia, or heart failure can impair oxygen exchange and lead to respiratory insufficiency.
• Signs to Monitor: Respiratory rate, oxygen saturation levels, signs of cyanosis (blue color around lips or fingertips), wheezing, cough, or crackles.
• Interventions: Administer oxygen therapy, nebulizer treatments, and monitor respiratory effort.

Monitoring for Cardiovascular Alterations:

• Pathophysiology: Heart failure, myocardial infarction, arrhythmias, and hypertension can disrupt normal heart function.
• Signs to Monitor: Blood pressure, heart rate, presence of chest pain, shortness of breath, or edema in the lower extremities.
• Interventions: Provide antihypertensives, manage fluid balance, and monitor cardiac rhythm.

Monitoring for Renal Alterations:

• Pathophysiology: Chronic kidney disease, acute kidney injury, or nephritis can lead to fluid and electrolyte imbalances.
• Signs to Monitor: Urine output, serum creatinine, blood urea nitrogen (BUN), electrolyte levels (especially potassium), and signs of fluid retention (edema).
• Interventions: Monitor renal function tests, restrict fluid intake as needed, and manage electrolyte imbalances.