NEW SERIES: Pathophysiology
- Pathophysiology and the basis of illness
- Cell and body tissue physiology
- The nervous system and associated disorders
- Inflammation, immune response and healing
- The heart and associated disorders
- The vascular system and associated disorders
- The respiratory system and associated disorders
- The blood and associated disorders
- The neurological system and associated disorders
- The renal system and associated disorders
- The gastrointestinal system and associated disorders
- Nutrition and associated disorders
- Pain and pain management
- The skin and associated disorders
- The ear and associated disorders
- The nose and associated disorders
- The throat and associated disorders
- The eyes and associated disorders
- The musculoskeletal system and associated disorders
- Fluid and electrolyte balance and associated disorders
- The endocrine system and associated disorders
- The reproductive systems and associated disorders
Athorough understanding of pathophysiology is essential for the provision of holistic, patient-centred, safe and effective nursing practice. The BJN is commencing a new series to provide readers with an understanding of pathophysiology and the altered pathophysiology that can occur during the disease process.
The word patho originates from the Greek pathos which means to suffer and logos implies a discourse or to study. Pathophysiology is the study of changes in body physiology at molecular, cellular and organ level that results from injury or disease resulting in suffering (McCance and Huether, 2018).
Pathophysiology applied to nursing integrates content from a number of areas, including anatomy, physiology, biology and chemistry. This knowledge base is used by the nurse to build a framework for understanding disease processes and the ways in which nurses can address the prevention, symptom management and the treatment of health conditions.
Understanding pathophysiology demands an awareness of the complexity of disease, and the difficulties that are encountered when making a diagnosis and providing treatment, along with the potential implications that arise from a list of signs and symptoms (clinical manifestations) or a prognosis. The clinical manifestations are the evidence of disease. A diagnosis is made by amassing the evidence presented:
- The clinical manifestations
- Health and medical history
- Physical examination
- Results of laboratory test
- Outcomes of imaging undertaken.
The prognosis concerns the expected likely outcome of a disease. Prognosis is also related to acute and chronic outcomes, remission, exacerbation, complications and sequalae.
A variety of sophisticated diagnostic tests are available to help clinicians make clinical decisions. However, their availability depends on the geographic location of individuals, including the ability to access large, well-equipped medical facilities. Where there are limited resources this can limit the number of diagnostic tests available to a patient, or there may be a long waiting period before testing is undertaken and treatment commences. When a nurse understands the pathophysiology, the manifestations and the possible complications of a disease, treatment usually follows. A solid knowledge base enables the nurse to meet the increased demands of patients and their families, and provide them with appropriate information and support.
Prevention of disease
Disease prevention is a key focus in health care. The known causes of, and factors that predispose a person and communities to, specific diseases are being used in developing more effective preventive programmes, to address the risk factors. It is important to continue to try to detect additional significant factors and gather epidemiological data to further decrease the incidence of certain diseases, and the nurse is ideally placed to do this, in collaboration with other health professionals.
The Office for Health Improvement and Disparities (OHID) is responsible for putting prevention at the heart of health care, helping people live longer, healthier and happier lives (OHID, 2021). The OHID has a significant role in the collection of data about all types of disease to provide evidence-based recommendations for prevention, including activities such as maintaining routine vaccination programmes. Prevention requires primary, secondary and tertiary approaches (Table 1).
Table 1. Approaches to disease prevention
|In a primary approach to disease prevention, the goal is to protect healthy people from developing a disease or experiencing an injury in the first place. For example:
|These are those interventions that happen after an illness or serious risk factors have already been diagnosed. The aim here is to halt or slow the progress of disease (if possible) in its earliest stages; in the case of injury, goals may include limiting long-term disability and preventing re-injury. For example:
|The focus is on helping people manage complicated, long-term health problems, for example, diabetes, heart disease, cancer and chronic musculoskeletal pain. The goals include / prevention of further physical deterioration and maximising the person's quality of life. For example:
As more community health programmes develop and with the increase in information available online, nurses and other health professionals are becoming more involved in responding to questions from a number of sources, and have an opportunity to promote appropriate preventive measures with individuals and their communities. A sound knowledge of pathophysiology is the basis for preventive teaching.
Developments in all areas of health care are occurring at a rapid rate, which is predominantly due to changes in technologies. New causes of disease and more detail concerning the pathophysiology of a disorder are constantly being revealed, diagnostic tests are improving and more developments are being made in pharmacology. The landscape of treatment options for a number of conditions is therefore changing, with implications for clinical discussions concerning what were previously untreatable disorders.
The improvement of diagnostic technology has revolutionised the clinical response to a number of diseases. Advances being made in genetic technology, for example, are having a major impact in the care setting, which means the role and scope of genetic testing are changing. Genomic testing brings with it more opportunity for diagnosis or prediction of future diagnoses, but it also increases the possibility of uncertain or unexpected findings, which may have implications for members of an individual's family. Previously, genetic testing was seldom able to deliver rapid results; however, increasing availability and speed of testing continues to change, and genomic information is increasingly influencing decisions concerning patient care in the acute setting. The point of access to testing is also changing, with increasing provision enabling the nurse to refer the patient outside the formal healthcare setting.
Extensive research endeavours continue in attempts to prevent, control or cure many disorders. A recent example of advanced scientific endeavour has been the development of a vaccine effective against SARS-CoV-2. It does not provide 100% prevention and other health prevention behaviours need to be maintained.
There are other matters that may affect the nurse and professional practice. Contemporary technology provides an opportunity to prolong life through the use of various devices, advances in surgery (for example robotics) and organ transplantation. There are professional, legal and ethical issues concerning the transplantation of fetal tissue, the use of stem-cell therapies, administration of experimental drugs or treatments and genetic engineering can all be difficult topics to address. The primary goal in areas that continue to develop is to reduce the prevalence of disease and enhance recovery rates. There is unease about new medical and health technologies, for example, issues regarding access to therapy, costs and risk versus benefits of new treatments and the perennial allocation of health care resources for new therapies which are often costly.
A skilled, educated nurse is essential in the use and interpretation of any technology that is being used or is being considered for use, and it must always be remembered that the needs of the patient must be put at the heart of all that is done. Technology has greatly altered many aspects of health care and nurses are required to keep up to date with changing information and knowledge (Nursing and Midwifery Council, 2018).
The BJN pathophysiology series
It is essential that clinicians continually check for new information, making use of reliable, accurate resources, for example, professional websites, accessing journals or attending educational meetings and seminars. It is anticipated that there will continue to be a number of changes in the provision of health care as electronic devices are used more frequently by both patients and clinicians.
The BJN, on a monthly basis, will bring you a series that focuses on the pathophysiology of a number of diseases (see panel on p72). A systems approach and case studies are used to encourage application of the theory to practice. The first of the series will appear in issue 4. Reflective questions are included at the end of each article that can be used to support revalidation.
Pathophysiology, aetiology and clinical management are essential components of nursing practice at both undergraduate and graduate levels. Pathophysiology is an ever-changing field as new developments and discoveries are made. Grasping the importance of pathophysiology empowers nurses, equipping them with the knowledge of how and why disease develops, in turn informing their clinical decision-making to ensure the delivery of the safest and highest quality of patient care.