2. Intro to Pathology

3. What comes to mind when you hear the term HEALTH? HEALTH

4. What comes to mind when you hear the term disease? DISEASE

5. Pathology (Key Terms) n Pathology - the study and diagnosis of disease through the examination of organs, tissues, bodily fluids and whole bodies (autopsy). n Disease – any condition that causes extreme pain, dysfunction, distress, social problems, and/or death

6. Causes of Disease n 2 broad groups n (1) Infectious Diseases – can spread from one person to another and are caused by microscopic organisms called pathogens that invade the body. A microorganism’s disease-producing power is called its virulence. »Example: West Nile Virus

7. Causes of Disease n 2 broad groups n (2) Non-infectious diseases – are not communicated from person to person and are not known to involve infectious agents. Some causes include: »Heredity »Lifestyle (diet, stress, etc.) »Example: Diabetes Type II

8. As You already know Body’s Reaction to Disease n When pathogens successfully invade the body, the immune system immediately begins to destroy them n The spleen, lymph nodes, tonsils, thymus, lungs, liver, kidneys and entire lymphatic system gets called into action n Lymphocytes –The specialized white blood cells responsible for combating infectious agents

9. Do you ever feel like you always seem to get sick at the worst times?? Hmm, why do you think that is the case?

10. Stress

11. STRESS Did you know…. n 75% to 90% of all visits to primary care physicians are for stress-related complaints n up to 80% of on-the-job accidents are stress-related n 40% of job turnover is due to stress n Stress accounts for $26 billion in medical and disability payments and $95 billion in lost productivity per year n Over 50% of lost work days are stress related which keeps about 1 million people per day from attending work n 75% of employees believe the worker has more on-the- job stress than a generation ago

12. WHAT IS STRESS? l Stress is your mind and body’s response or reaction to a real or imagined threat, event or change. l The threat, event or change are commonly called stressors. Stressors can be internal (thoughts, beliefs, attitudes) or external (loss, tragedy, change).

13. Different Types of Stress Eustress vs. Distress

14. EUSTRESS Eustress or positive stress occurs when your level of stress is high enough to motivate you to move into action to get things accomplished.

15. DISTRESS Distress or negative stress occurs when your level of stress is either too high or too low and your body and/or mind begin to respond negatively to the stressors.

16. n ***In his work, Selye - 'the father of stress research,' developed the theory that stress is a major cause of disease because chronic stress causes long-term chemical changes. He observed that the body would respond to any external biological source of stress with a predictable biological pattern in an attempt to restore the body’s internal homeostasis. n This initial hormonal reaction is your fight or flight stress response - and its purpose is for handling stress very quickly! The process of the body’s struggle to maintain balance is what Selye termed, the General Adaptation Syndrome.fight or flight General Adaptation Syndrome

17. ALARM STAGE n First reaction to stress: recognizes there’s a danger and prepares to deal with the threat, a.k.a. the fight or flight response. n During this phase the main stress hormones cortisol, adrenaline, and noradrenaline, is released to provide instant energy. n If this energy is repeatedly not used by physical activity, it can become harmful.

18. FIGHT or FLIGHT Response

19. Alarm Stage Continued n The excess production of the cortisol hormone can cause damage to cells and muscle tissues. Stress related disorders and disease from cortisol include cardiovascular conditions, stroke, gastric ulcers, and high blood sugar levels.cortisol hormone n At this stage everything is working as it should – you have a stressful event, your body alarms you with a sudden jolt of hormonal changes, and you are now immediately equipped with enough energy to handle it.

20. Stress Hormones n Cortisol stimulates the release of glucose, fats and amino acids into the bloodstream n Cortisol levels lowest at night, highest when you wake up. n Under ideal conditions, your cortisol levels should be neither consistently high nor low, but fluctuate in a fairly rhythmic pattern.

21. RESISTANCE STAGE n The body shifts into this second phase with the source of stress being possibly resolved. Homeostasis begins restoring balance and a period of recovery for repair and renewal takes place. n Stress hormone levels may return to normal but you may have reduced defenses and adaptive energy left.

22. Resistance Stage Con’t… n If a stressful condition persists, your body adapts by a continued effort in resistance and remains in a state of arousal. n Problems begin to manifest when you find yourself repeating this process too often with little or no recovery. Ultimately this moves you into the final stage.

23. Changes to observe in Resistance stage l Behavior indicators include: lack of enthusiasm for family, school, work or life in general, withdrawal, change in eating habits, insomnia, hypersomnia, anger, fatigue. l Cognitive Indicators include: poor problem solving, confusion, nightmares, hyper- vigilance.

24. Changes to observe in Resistance Stage Emotional indicators include: l tearfulness l fear l anxiety l panic l guilt l agitation l depression l overwhelmed.

25. EXHAUSTION STAGE n Your body’s ability to resist is lost because its adaptation energy supply is gone. Often referred to as overload, burnout, adrenal fatigue, maladaptation or dysfunction n This stage of the general adaptation syndrome is the most hazardous to your health. Chronic stress can damage nerve cells in tissues and organs.

26. Elevated levels of stress hormones: n Obesity n Heart disease n Depression/anxiety n Alzheimer’s disease n Diabetes n Osteoporosis n Fibromyalgia n Chronic fatigue syndrome

27. STUDENT STRESS RATING SCALE The following are events that occur in the life of a student. Place a check in the left-hand column for each of those events that has happened to you during the last 12 months. ___ Death of a close family member - 100 points ____ Jail term - 80 points ____ Final year in high school or first year in college - 63 points ____ Pregnancy - 60 points ____ Severe personal illness or injury - 53 points ____ Marriage - 50 points ____ Any interpersonal problems - 45 points ____ Financial difficulties - 40 points ____ Death of a close friend - 40 points ____ Arguments with your roommate (more than every other day) - 40 points ____ Major disagreements with your family - 40 points’ ____ Major change in personal habits - 30 points ____ Change in living environment - 30 points ____ Beginning or ending a job - 30 points ____Problems with your boss or professor - 25 points ____ Outstanding personal achievement - 25 points ____ Failure in some course - 25 points ____ Final exams - 20 points ____ Increased or decreased dating - 20 points ____ Changes in working conditions - 20 points ____ Change in your sleeping habits - 18 points ____ Several-day vacation - 15 points ____ Change in eating habits - 15 points ____ Family reunion - 15 points ____ Change in recreational activities - 15 points ____ Minor illness or injury - 15 points ____ Minor violations of the law - 11 points Score: _________________

28. INTERPRETING YOUR SCORE l Less than 150 points : relatively low stress level in l relation to life events l 150 - 300 points : borderline range l Greater than 300 points : high stress in relation to life l events l Note: From Girdano, D.A., Everly, G. S., Jr., & Dusek, D. E. (1990). Controlling stress and tension (3rd edition), ENnglewood Cliffs, NJ: Prentice Hall.

29. I’M IN CONTROL - DISTRESS RELIEF STRATEGIES Feeling good about yourselves can be an effective buffer against stress. Eliminate unnecessary worries. Most worries are either passed on to us by another or conjured up in our imagination. GET PHYSICAL 1. Relax neck and shoulders 2. Take a stretch 3. Get a massage 4. Exercise GET MENTAL 5. Count to 10 6. Control your thoughts 7. Fantasize 8. Congratulate yourself 9. Ignore the problem if appropriate, after evaluation 10. Perform self maintenance 11. Talk to a counselor GET SPIRITUAL 12. Meditate 13. Pray 14. Remember your purpose USE YOUR BODY AND MIND TOGETHER 15. Take a break 16. Get hug therapy 17. Try progressive relaxation 18. Try yoga 19. Try aroma therapy 20. Laugh DEVELOP NEW SKILLS 21. Prioritize daily tasks 22. Learn something 23. Practice a hobby

30. MORE STRATEGIES l “ What is Stress” Web Site. http//www.teachhealth.com l How to reduce and relieve stress “Web Site. http//www.family.com l “Stress Relievers” Web Site. http//www.residentassistant.com l “Massage” Downing, G. (1972). Massage Book. New York: Random House. l “Aromatherapy” Web Site. http//www/aromaweb.com/articles/wharoma.as l “Yoga” Web Site. http//www.kevala.co.uk/yoga/overview.htr

31. Group work time! n Work in groups of 4 and answer the following questions on chart paper Be prepared to share your answers with the class 1. List the top 10 causes of teen stress 2. Define what nutrition means to you 3. Define what exercise means to you 4. How can proper nutrition and exercise help manage stress? 5. Why is it important to consider proper nutrition and exercise when studying pathology? 6. Consider what you know about Canadian's health care system, do you think we are headed towards a healthy future? What changes would you like to see, if any, within our health care system here in Ontario?

32. Steps in Diagnosing an Infection

33. 1. Examine the Patient 2. Obtain One or More Specimens 3. Examine the Specimen Directly 4. Culture the Specimen 5. Determine the Culture’s Antibiotic Sensitivity 6. Treat the Patient as Ordered by the Physcician

34. STEP 1: EXAMINE THE PATIENT Interviewing a Patient, Taking a History & Documentation

35. Interviewing Skills n Effective listening n Being aware of nonverbal clues and body language n Using a broad knowledge base n Summarizing to form a general picture

36. Interviewing Successfully n 1) Do your research before the patient interview n 2) Plan the interview n 3) Approach the patient and request the interview n 4) Make the patient feel at ease n 5) Deal with sensitive topics with respect n 6) Do not diagnose or give a diagnostic opinion n 7) Formulate the general picture n 8) Conduct the interview in private without interruptions

37. Methods of Collecting Patient Data Effective n Open-ended questions n Hypothetical questions n Mirroring & Verbalizing n Focusing on patient n Encouraging patient to take the lead n Encouraging patient to provide additional information n Encouraging patient to evaluate his situation Ineffective n Closed-ended questions n Asking leading questions n Challenging patient n Probing n Agreeing or disagreeing with patient

38. 6 Cs of Charting n Client’s words n Clarity n Completeness n Conciseness n Chronological order n Confidentiality

39. Methods of Charting n Most charting methods are based on a series of steps to document information n SOAP Method n 1) Subjective data: obtained through conversation with patient. Thoughts, feelings, and perceptions n 2) Objective data: apparent and measurable. Vital signs and test results n 3) Assessment: the physicians diagnosis or impression of the patient’s problem n 4) Plan of action: Options for treatment

40. Good Interview Technique n Start with INTRODUCTION (age, previous illnesses, surgical history, allergies, medication history and family medical history n PQRST Technique P = Provoke or Palliative Q = Quality or Quantity R = Region or Radiation S = Severity Scale T = Timing

41. Health History Form n (1) Personal Data – Name and D.O.B. n (2) Chief Complaint – Main reason patient came to office n (3) History of present Illness – medications taken, pain scale n (4) Past medical History – any and all past and present illnesses and surgeries n (5) Family History – can help lead practitioner to a diagnosis n (6) Social and occupational history – marital status, occupations n (7) Review of symptoms

42. CASE STUDIES S.O.A.P Method of Documentation