CH. 5
GOODMAN
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“Many conditions and diseases
seen in the rehabilitation setting
can affect multiple organs or
systems.”
Goodman
CH.5
1. Systemic effects of acute inflammation
 initial response of tissue to injury
 involves vascular and cellular responses
 Local signs> redness, warmth, swelling, pain,
loss of function
 Systemic effects> fever, tachycardia,
hypermetabolic state
 Characteristic changes in blood>>elevated
serum protein levels (C-reactive protein,
coagulation factors) + increased WBCs
(leukocytosis)
2. Systemic effects of chronic inflammation
 Result of persistent injury, repeated episodes
of acute inflammation, infection, cellmediated immune responses and foreign
body reactions
 Tissue response to injury> accumulation of
lymphocytes, plasma cells and macrophages
(mononuclear inflammatory cells) and
production of fibrous connective tissue
(fibrosis)
Chronic inflammation (continued)
 Fibroblasts, small blood vessels and collagen
fibers > constitute fibrosis
 Fibrous tissue is light gray with a dense, firm
texture that causes contraction of normal
tissue
 This may cause progressive tissue damage
and loss of function
Chronic inflammation (continued)
 Systemic effects> low grade fever, malaise,
weight loss, anemia, fatigue, leukocytosis,
lymphocytosis
 Inflammation is reflected by increased
erythrocyte sedimentation rate (ESR)
3. Systemic factors influencing healing (Box 6-4)

Physiologic variables (age, vascular sufficiency)
General health of the individual; immunocompetency;
psychological/emotional/spiritual well-being

Presence of comorbidities (examples)
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Diabetes mellitus
Decreased O2 perfusion (CHF,COPD,CAD)
Hematologic disorders
Cancer
Incontinence
Alzheimer’s disease
Neurologic impairment
Immobility
Systemic factors influencing healing
(continued)
 Tobacco, alcohol, caffeine, other substance
use/abuse
 Nutrition
 Local or systemic infection; presence of
foreign bodies
 Type of tissue
 Medical treatment (prednisone,
chemotherapy, radiation therapy)
4. Consequences of immunodeficiency
 Immunodeficiency predisposes the affected
individual to infections ; there is a failure of
one or more of the functions of the immune
system
 Therapists are most likely to encounter those
with acquired immunodeficiency and those
with non-specific causes such as:
◦ Those that occur with viral (and other) infections
◦ Malnutrition
◦ Alcoholism
Immunodeficiency (continued)
 Non-specific causes:
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Aging
Autoimmune conditions
Diabetes mellitus
Cancer- myeloma, lymphoma, leukemia
Chronic diseases
Cancer treatment- chemotherapy and radiation
5. Systemic effects of neoplasm
 Due to the destructive nature and spread of
malignancy, there can be local and systemic
effects
 Local> necrosis, ulceration, compression,
obstruction, hemorrhage
 **pain is more likely if cancer invades near
nerves/ nerve cells
 **secondary infections often occur and can
lead to death
Systemic effects of neoplasm (continued)
 Systemic> weight loss, muscle weakness,
anorexia, anemia, coagulation disorders,
cachexia
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Increase in the number of
aging population…..medical
advances…….increase in
physical therapy scope of
practice>>>
Physical therapists must be
ready and able to assess
patients/clients with multisystem problems!!
Even in critically-ill patients,
interventions such as
mobilization, positioning,
exercise and pulmonary
hygiene are indicated in
order to maximize O2
transport
Physical therapists at
work…..
Ambulating a patient on
a vent……
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Physical therapists need
to be able to provide
careful and close
monitoring of
cardiopulmonary status
of patient/client
Hematological
monitoring is necessary
Knowledge of lab values
is critical
Need to have advanced
knowledge of the “whole
picture”
Physical therapists at
work…..
In the Intensive Care Unit
Monitoring…….
Mobilizing…….
Comforting a patient…
Bringing a smile to a
face…….
Recovering from open
heart surgery…..
Recovering from an
illness….
Andrea C. Mendes PT, DPT
Good luck on the final!