Pathophysiology: Functional Alterations in Human Health

546 Pages·2006·12.05 MB·English

by  Carie Ann Braun

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Functional Alterations
in Human Health
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Functional Alterations
in Human Health
Carie A. Braun, PhD, RN
Assistant Professor of Nursing
College of St. Benedict/St. John’s University
St. Joseph, Minnesota
Cindy M. Anderson, PhD, WHNP, IBCLC
Assistant Professor
College of Nursing
University of NorthDakota
Grand Forks, NorthDakota
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Printed in the United States of America
Library of Congress Cataloging-in-Publication Data
Braun, Carie.
Pathophysiology : functional alterations in human health / Carie
Braun, Cindy Anderson.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-7817-6250-2
ISBN-10: 0-7817-6250-2
1. Physiology, Pathological. 2. Health—Miscellanea. I. Anderson,
Cindy, PhD. II. Title
[DNLM: 1. Pathology. 2. Physiology. QZ 4 B825p 2007]
RB 113.B73 2007
616.07-dc22
2006011451
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To Dr. Kathleen Twohy, who ignited the spark,
to Dr. Cindy Anderson, for giving of her precious
time to help me build a magnificent campfire, and
to Craig, Alex, and Peyton, who wouldn’t allow
the flame to burn out.
—Carie A. Braun
To my students who provide a constant source of
enthusiasm and motivation;
to Dr. Carie Braun, a kindred spirit whose vision
provided the inspiration for this project;
to my husband Kevin and daughters Rachel,
Amy, and Michelle who have given me uncondi-
tional support, motivation, and love.
—Cindy M. Anderson
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Preface
This text represents a novel approach to teaching and learning pathophysiology for
those within the health professions. Students from a variety of health care disciplines,
including nursing and pre-professional programs, will find the text engaging and rel-
evant to their future work as health care providers. As with any course in pathophys-
iology, a strong background in anatomy, physiology, microbiology, chemistry, and
even physics is helpful. However, do not despair. The text supports the student
learner in many ways, including remediating vital information as needed and provid-
ing the student direction for further independent review. Three major features distin-
guish this text from others: a conceptual approach, a focus on the student learner
through the facilitation of critical thinking and application of knowledge, and an ex-
ploration of culture and gender diversity as it relates to pathophysiology.
The first unique feature is the introduction and persistence of a conceptual
approach. Concept has been defined as “an abstract or generic idea generalized
from particular instances” (Merriam-Webster, 2004). A conceptual approach in
pathophysiology requires taking current knowledge related to human disease and
clustering this knowledge into meaningful and useful ideas. In pathophysiology, a
conceptual approach dictates that students learn general mechanisms of disease or al-
terations in human function and then apply these processes to specific conditions.
The goal is application versus rote memorization.
The development of the selected pathophysiologic concepts was based on
extensive research, planning, and implementation of this approach within one under-
graduate-nursing curriculum. A group of nursing educators analyzed and clustered
human health conditions with high prevalence, incidence, and severity of impact on
human function. Clusters were formed based on these questions: “What aspect of
physiology, or body function, is impacted when disease is present?” and subsequently
“What is the result of this impact?” The process resulted in the identification of 16
basic concepts of altered human function:
1. Basic alterations in cells and tissues
2. Inflammation/cellular repair/healing
3. Immune alterations
4. Infection
5. Environmental exposures/injury
6. Genetic/developmental disorders
7. Altered cellular proliferation and differentiation
8. Fluid/electrolyte/acid/base alterations
9. Altered nutrition
10. Altered elimination
11. Altered ventilation
12. Altered tissue perfusion
13. Altered neuronal transmission
14. Altered sensory function and pain perception
15. Degeneration
16. Altered hormonal/metabolic processes
The first eight concepts are similar to those found in other texts. The major dif-
ference is the persistence of this approach by continuing with functional alterations
throughout the remaining chapters. For those transitioning from a body systems per-
spective, some overlap exists between functional alterations and diseases within body
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viii Preface
systems. For example, altered ventilation is concerned with problems within the res-
piratory system that affect the effective uptake and use of oxygen. Altered elimination
is concerned with how waste products get out of the body and overlaps removal of
urine, feces, and other substances. Within each concept is the presentation and dis-
cussion of clinical models. Selection of the clinical models, or representative diseases
that illustrate the concept, was based on prevalence, incidence, and severity criteria
based on U.S. and World Health data. In addition, life span consideration is repre-
sented through select clinical models most affecting children or the elderly.
Advantages
There are many advantages to focusing on general concepts. First, concepts are basic
and can be applied to any condition. The conceptual approach provides the student
with the tools for discovering basic processes and then figuring out what happens
when a newly discovered condition occurs. The conceptual approach recognizes that
it is impractical to talk about every disease in existence during a one-semester, three-
to four-credit pathophysiology course. It makes more sense to learn about altered
cellular proliferation and differentiation (i.e., cancer) in general and then allow the
student to explore: so what if the cancer is in the pancreas? Or lungs? Or skin? This
text allows the course instructor the freedom to develop student critical thinking skills
through the application that is expected in this type of format.
Secondly, the conceptual approach is advantageous in that diseases can rarely be
isolated to one body system. Rather, diseases can affect multiple systems. Diseases
can be found in more than one system (such as cancer) or affect more than one
system (such as diabetes). The traditional approach to pathophysiology texts is to
present an illness, such as pneumonia, under respiratory disorders. The reconceptu-
alization that is proposed looks more broadly at ventilation as a problem of the se-
lected prototype conditions. The approach then emphasizes that altered ventilation
has repercussions that go beyond the respiratory system. Poor ventilation (from the
pneumonia, for example) results in deoxygenation, which affects every cell in the
body. Therefore, this text details the mechanisms of disease and demonstrates how
each process affects multiple “systems.”
Third, the conceptual approach is advantageous in that it challenges the student to
continuously build on previously gained knowledge. Through this approach, students
are less likely to memorize and forget after the exam. To achieve the goal of applica-
tion of knowledge, the order of the chapters has been crafted carefully in a building-
block progression. The concepts begin with those most general processes that
consistently affect every aspect of the body and become more specific and focused as
the text progresses. The text will consistently draw the reader back to previous con-
cepts to see how these relate and build on the new concept. This building block pro-
gression leads to the final chapter, which is an integration of all concepts presented.
The clinical model selected for the final chapter is diabetes mellitus. Here the focus is
not only on providing students with the essential information needed to understand
diabetes but the tools to apply all concepts to this condition. Use of such a text is best
suited to considering how previous knowledge applies to new knowledge.
These points have attempted to illustrate the advantages to the conceptual
approach and benefits to student learning. Another unique feature of this text is the
exploration of diversity as it relates to pathophysiology. Smith and Winfrey (1998) in-
dicated “pathophysiology is the study of deviation from normal physiology and the
70-kilogram white male that remains the standard by which all else is compared”
(p. 19). The same authors go on to state, “In evaluating pathophysiology texts and
supportive materials, subtle but distinct biases readily become apparent. Content
found in textbooks and information gleaned from current epidemiologic and research
studies should match, but unfortunately this is not always the case” (pp. 19–20).
Smith and Winfrey (1998) noted that one text never mentioned race, gender, or