University of Phoenix

SCI 162 WEEK 2

Task P1,P2,P3 M1
Unit 14: Physiological disorders Task P1, P2, P3 & M1

Introduction

In this assignment, I will be choosing two physiological disorders by explaining why this happen,
which body system it will affect and what happen to our body because of this specific disorders .
During this assignment I will be explaining the symptoms and signs of the disorders, and also how to
diagnose the ways of difficulties in the symptoms of the specific disorders and these will all meet my
Pass task criteria that include the P1, P2 and P3. However for M1 I will be describing the possible
difficulties that include in the diagnose of the disorders from their symptoms and signs.

P1: Explain the nature of two named physiological disorders

Alzheimer’s disease

Dementia is a condition where there is variety of different brain functions such as memory, thinking,
recognition, language, planning and personality deteriorate over time. Dementia is not part of
normal ageing as everyone gets forgetful as they get older; that does mean that they have dementia.
The most common types of dementia is Alzheimer disease, however there are several other types of
dementia. Dementia is common condition that occurs in some elderly people. This is estimated that
there are almost three-quarters of a million people with dementia in the UK and this number is
rising. As people are getting older, the risk of dementia will increase rapidly. It is estimated that one
in six people aged over 80 years has some type of dementia.
Dementia is common condition that about one in every 90 people in the UK has dementia. For
example, in 2008 it was estimated that there were 700,000 people in the UK with dementia and this
will rise to 1 million by 2015. Dementia can sometime happen for people aged below 65 years. About
1 in 20 people over the age 65 has dementia; rising about 1 in 6 of people aged 80 has dementia.
However dementia is becoming more common because the biggest risk factor for dementia is getting
older and people are living longer. About two-third of people with dementia live at home and almost
three-quarters of people living in care homes have dementia as well. People with dementia condition
are often live for many years, as it not uncommon for someone to live seven to ten years after a
diagnosis and then to die of something else. Therefore everyone who has dementia will get worse
over the time and many people will eventually need to be cared for because they cannot live safely
by their own. It is important to recognise when someone may have dementia. A swift and accurate
diagnosis is important while people can still plan their lives and have a say in their treatment. Getting
a diagnosis is also helpful to explain why someone isn’t getting on as well as they used to and
ensures that they get the necessary help. It is also reassuring to be told if you don’t have dementia.
In addition, dementia is a term described that is applied to several different conditions that affect the
brain function. So the most common condition of dementia is Alzheimer’s disease, but they are many
other causes. For example, some types of dementia have similar symptoms that include such as; loss
of memory, problems with thinking and planning, difficulties with language, failure to recognize
people or objects and a change of personality.
The people with Alzheimer condition have a brain with many different functions that brain allow
them to think that is simple task for them to do but in fact this is quite a complex task. To explain
this, I will provide some examples of several different brain functions starting from steps to steps
include; step 1 - We imagine a cup of tea (abstract thinking) and decide to make one (motivation).
Step 2 - We may ask whoever is with us if they want a cup (language). Step 3 - We plan making the
tea ensuring that things are done in the right order, and putting the tea in before the boiling water
(executive function). Step 4- We remember where the tea, sugar and milk are stored (memory). Step
5 - We put the kettle on and gather the ingredients (motor function). Step 6 - We listen for the kettle
(hearing), ensuring that we don’t get distracted with some other task (attention and concentration).
Step 7 - We carefully pour (coordination) just the right amount of water (judgement) on to the tea.
Step 8 - We may then add milk and sugar to the cup, in the right order (planning). Step 9 - We wait
Unit 14: Physiological disorders Task P1, P2, P3 & M1

until has cooled sufficiently (judgement) and we enjoy the tea (taste). Step 10- All the way through
we have probably spoken and acted in a similar manner to how we usually do (personality)
So, these will all show examples how the brain function work with several different brain functions.
When a person has dementia, usually the are several of the different brain functions outlined above
being to go wrong and repeating over the time. Therefore dementia could be defined as; persistent,
progressive problems with more than one aspects of brain function (such as language, planning,
motivation, memory or personality). However each of these following have present for at least 6
months in someone who has no impairment of consciousness; decline in memory, decline in other
cognitive abilities such as judgement, thinking and planning and decline in emotional control (for
example, irritability or motivation)
What causes Alzheimer’s disease?
The process of Alzheimer disease:
Normal brain that the neurons within the brain transmit electrical messages to other parts of the
body is using chemicals called transmitters. But brains with Alzheimer’s disease areas of brain tissue
are damaged and this interferes with message transmission, causing the symptoms of the disease.
There are some risk factors of developing Alzheimer’s disease and that include such as the most
common condition cause of dementia, slightly more common in women than men, Affects 26 million
people worldwide, Over 90 per cent of people with Alzheimer disease are aged over 70, slow start
with very mild symptoms, Memory often affected first, smooth progression and People often live 10
years or even more after diagnosis.
Factors that may increase the risk of getting Alzheimer’s disease are such as:
Age, the risk of developing Alzheimer’s disease increases with age. According to the Alzheimer’s
association (website) 10% of all people over the age of 65 have Alzheimer’s disease, and as many as
50% of people over age 85 have it. Gender can be affected by Alzheimer disease as it affects women
more frequently than men. Family history, less than 1% of people with Alzheimer disease inherited
the condition. Down syndrome, people often with Down syndrome develop Alzheimer disease in
their 30s and 40s. Head injury, the research has shown some link between Alzheimer’ disease and a
significant head injury. Environmental toxins, some researcher’s suspects that increased exposure to
certain substances such as aluminum may make a person more susceptible to Alzheimer’s disease.
Low education level, the reason is not clearly understood why education cause Alzheimer low but
some cases have shown that low education levels can be related to an increased risk for Alzheimer
disease. They are also some other factors that may be risk of developing Alzheimer are having high
cholesterol levels and high blood pressure – these factors will link to heart disease and stroke, and
may also increase the risk for developing Alzheimer’s.
Unit 14: Physiological disorders Task P1, P2, P3 & M1

Angina and Heart Attack

Heart attack is a pain from the heart that is caused by narrowing of the coronary arteries of the
heart. The disorder heart attack, kill more than 20,000 people in the UK, this is more common in
men’s than women. It also common in people over the age of 50 years and sometime younger age
occurs in the UK. The general name that could be given for disease such as angina and heart attack is
coronary heart disease and for shorter it called CHD. The disorders that caused angina and heart
attack is simple to understand because; the heart is powerful muscle that maintains life by pumping
blood round the body, to function properly, the heart requires a good blood supply and this is
provided by the coronary arteries. Disease of the coronary arteries interferes with the normal blood
supply of the heart and can lead to angina and the heart attacks.
The heart is mainly made of special muscle. The heart pumps blood into arteries which take the
blood to every part of the body, therefore the heart muscle needs a good blood supply. The coronary
arteries take blood to the heart muscle. They are the first arteries to branch off the aorta. This is the
large artery taking blood from the heart to the rest of the body. The coronary artery disease can
cause numbers of problem for the heart; it will result in insufficient oxygen reaching the heart
muscle. Anginas, heart attack, heart failure, irregularities of heart rhythm are all most common
because that is being caused by the coronary artery disease. However they are some other causes of
heart problems that could be result of coronary artery disease. Some of these heart problems may
include such as congenital heart disease, cardiomyopathies and valvular heart disease. The CHD is
less common in country such as Africa, however is most common in northern Europe, North America
and Australia. This is seems to be related in some ways of lifestyle, because when people move from
developing countries to a more affluent culture as they get the CHD diseases much more often than
they would have done at home. This is particularly noticeable among immigrants from the Indian
subcontinent who come to the UK and they are even more likely to get CHD disease than people who
born here. Here is Statistics Database of CHD that is caused death in the UK men’s and women’s
health.

This graph shows the regional variations, this shows that in Europe there are major differences
between countries and even within one country. In southern Europe, CHD is generally much less
common in the UK and Scandinavia; and this may be one of reasons for the popularity of the
Mediterranean diet. However many people believe that changing their diet plan may help them to
protect against heart attack such as eating lots of fresh fruit vegetables, salad, fruit and fish and
relatively little red meats or daily produce.
Unit 14: Physiological disorders Task P1, P2, P3 & M1

This
shows
the
death
rate
from
CHD by area in the
UK, the colour
describe how each
city has high
frequency of death
from CHD.

This table
portrays the
comparative death
rate from CHD by some countries. The CHD is
normally higher in the more wealthy
countries than in developing nations. The table
also shows the comparative death rates for men and women in some selection countries.

What causes Angina and Heart Attack?

Angina normally is a symptom of coronary heart disease (CHD). This means that the underlying
causes of angina generally are the same as the underlying cause of CHD. Research suggested that the
CHD start when certain factors damage the inner layers of the coronary arteries. These factors
include such as; smoking, high level of cholesterol and fats in the blood, high blood pressure and high
amounts of sugar in the blood that is due to insulin resistance or diabetes.
Plaque may begin to build where the arteries are damaged; therefore when plaque builds up in the
arteries, the condition is called atherosclerosis. If the plaque narrows or blocks the arteries, this can
reduce blood flow to the heart muscle. Some plaque is hard and stable and causes the arteries to
become narrow and stiff. This will impressively reduce blood flow to the heart and cause angina. But
other plaque is soft and more likely to break open and cause blood clots. Blood clots can partially
block the coronary arteries and cause angina or a heart attack. In addition they are many factors that
Unit 14: Physiological disorders Task P1, P2, P3 & M1

can trigger angina pain, depending on the type of angina you have. Stable anginas for example,
include cause such as emotional stress, exposure to very hot or cold temperatures, heavy meals and
smoking.
P2: Explain the signs and symptoms related to two named physiological disorders

Alzheimer’s disease

Dementia is usually a progressive disease that affects people in different ways. This is because the
symptoms and the way in which they develop reflect personality, lifestyle, quality of relationships,
and mental and physical health. Symptoms vary with the different types of dementia but there are
some broad similarities between them all. The most common are loss of memory and loss of
practical abilities leading to a loss of independence and affecting social relationships.

These symptoms of a person in the early stage of Alzheimer may include such as becoming forgetful,
especially of things that have just happened. Losing their sense of time leading to miss
appointments, showing loss of interest and poor concentration, losing their motivation, becoming
more withdrawn, having language problems with difficulty findings (the right word), shown odd
behaviour, being different from their old self and showing mood changes and can be depressed.

The middle stage is a time when it clear that a person has dementia and that it is affecting everyday
functioning and ability to live independently. This can give arise to changes in behaviour often
through frustration and lack of understanding on the part of the person with the dementia and the
career.

So the person with dementia at this stage may; become more forgetful and might forget their
members of family name, wandering out of the house and get lost, not be able to work the
difference between the day and night and have difficulty sleeping, having difficulties understanding
of what is being said, having problems with household tasks such as cleaning and cooking, may need
help with dressing, washing and reminding about going to toilet, losing things and blame others for
taking them, becoming aggressive, experiencing hallucinations

Late stage is where the person with dementia has very serious memory problems and becomes
completely dependent on others for their physical care. These symptoms may include; having great
difficulty communicating, having poor or no recognition of family and friends, not understand what is
said to them or what is going on around them, need help with eating, being incontinent of urine and
faeces, having difficulty walking, having difficulty swallowing and Being in a chair or bed always. At
this stage can last months or years depending on the physical health of the person and the quality of
the care that the person is receiving.

At the final stage, the person will be unable to speak or move properly; he/she will need full care
including help with eating and drinking. Often swallowing in last stage becomes difficult even at this
late stage the person may have some awareness of his/her surroundings and people around. This is
not known about how much people can understand in this situation. Almost certainly he/she will be
able to feel pain such as toothache or constipation and will feel uncomfortable if they are hungry or
dehydrated.

Alzheimer disease affects a person’s ability to look after themselves when they are unwell, so
another health condition can develop rapidly if left untreated. A person with Alzheimer’s may also be
unable to tell someone if they feel unwell or uncomfortable. Alzheimer’s disease can shorten life-
expectancy. This is often caused by those affected developing another condition, such as pneumonia,
Unit 14: Physiological disorders Task P1, P2, P3 & M1

as a result of having Alzheimer’s disease. In some case Alzheimer’s disease may not be actual cases
of death, but it can be a contributing factor.

Angina and Heart attack disease

Although all people with coronary heart disease (CHD) have the same underlying problems,
narrowing of the coronary arteries, they don’t all get the same symptoms. Some people may develop
angina, while others may have a heart attack. A small proportion of people develop heart failure
without having any other warning symptoms. There is no evidence about why it affects these people
in different ways. You must dial 999 immediately if you suspect that you or someone else is having a
heart attack. Symptoms included; Chest pain: usually this is located in the centre of your chest and
can feel like a sensation of pressure, tightness or squeezing. Pain in other parts of the body: you may
feel as if the pain is travelling from chest to your arms, jaw, neck, back and abdomen. Shortness of
breath and feeling sick. Being sick and an overwhelming sense of anxiety. Feeling light headed,
coughing and wheezing.

Chest pain/angina

Not all the chest pain is caused by CHD, no-one would think that they had heart disease after failing
and bruising their ribs, for example, and most of us have had indigestion which can sometimes give
pain in the chest to. To recognise a heart pain you may have a dull pain that does not feel worse
when you breathe in. in the middle of the chest but may spread to left side, into both arms or up into
the neck or jaw. The chest pain could be described as heavy and burning pain in the middle of chest.
These are some main features of how to recognise heart pain. In angina, the pain comes from the
muscle fibres in the heart, which don’t have enough oxygen for the work that they are doing. Angina
pectoris is simply Latin for pain in the chest. It is usually brought on by exercising, going away with
rest. In angina, the pain usually lasts for about two – three and generally for no longer than ten.

Unstable angina

In general, angina is fairly predictable, but if the coronary artery narrows still further or a clot forms
on its surface, then the disease can enter a new phase – unstable angina – and this lead to a heart
attack. You may suddenly find that you can walk only a short distance before developing pain, or you
may develop pain doing light work around the house or even going upstairs to bed. Sometimes you
may woke from sleep by an attack of angina. A change in the pattern of pain is an important
development and should be reported to your doctor as soon as possible.

Heart attack

The pain is the same as angina, but, instead of easing off when you rest, it gets worse. People often
say it is the worst pain they have ever felt in their lives. Someone who is having a heart attack may
look grey and sweaty, and feel cold to the touch. They often feel sick and may vomit. Some people
who have heart attacks have never had any symptoms of heart disease – it just comes out of the
blue. Most, however, will have had some pain off and on for weeks or months before as the blood
vessels gradually narrowed, although they may not have realised that it was coming from the heart.
In about 20 per cent of cases, the symptoms of a heart attack may be quite mild and are often
mistaken for indigestion. This particularly true for elderly people and those with diabetes, perhaps
because the pain fibres to the heart are not as sensitive as in young people.
Unit 14: Physiological disorders Task P1, P2, P3 & M1

The stages of coronary heart disease

Pleurisy

Chest infections such as pneumonia can give

rise to quite bad chest pain called pleurisy.
The pain is usually sharp, only on one side of
the chest, and is worse when you cough or
take a deep breath. This is quite different from
the dull constant pain from the heart which
spreads right across the chest.

Muscle pain

Along the back and between the ribs there are

muscles that play an important part in
breathing and, like all muscles, they can be
subject to rheumatic pain. This pain is usually
confined to a fairly small area of the chest,
either at the front or at the back. It is worsen
when sitting or lying in certain positions or
when you turn round. It can last from a few
hours to a few days and then may disappear before returning a few
weeks later.

Chest pain not related to the heart

Chest pain can be alarming and often causes people to believe that they are having a heart attack.
However, there are many other, less serious, causes of chest pain. The level of the pain can vary
significantly from person to person. For many people the pain is severe and it has been described as
feeling ‘an elephant sitting on my chest’. For others, pain can be minor and similar to that
experienced during indigestion. Also, people with diabetes, some women, and older people do not
experience any chest pain at all. The level of chest pain is important in determining whether you are
having a heart attack, it’s the overall pattern of symptoms that is important for the patient. If you
have doubt about whether your symptoms indicate you are having a heart attack, then assume that
you are having a heart attack and dial 999 to ask for an ambulance immediately. If you not have
allergic to aspirin and aspirin is easily available, slowly chew and then swallow an adult size tablet
(300 mg) while you are waiting for the ambulance to arrive. This will help to thin your blood and
restore blood to your heart.

Ventricular arrhythmia can lead to the heart, from first going into spasm and then stopping beating
together. This is known as sudden cardiac arrest. Signs and symptoms suggesting a person has gone
into cardiac arrest include; they appear to not be breathing, they are not moving and they do not
respond to any stimulation, such as being touched or spoken to.

If someone has gone into cardiac arrest then do not access to equipment called an automated
external defibrillator, so you should perform chest compressions as this can help to restart the heart.
To carry out a chest compression, place the heel of your hand at the centre of the person’s chest, in
between their chest. Place your other hand on top of your first hand and interlock your fingers. Using
your body weight, press straight down onto their chest. Aim to do the chest compressions at a rate of
100 compressions a minute.
Unit 14: Physiological disorders Task P1, P2, P3 & M1

Key Facts

 When the heart muscle is short of oxygen, the result is chest pain- angina

 Severe chest pain is a heart attack until proved otherwise

 Angina pain usually comes on when you exercise or are under stress

 Indigestion is not usually brought on by exercise; if in doubt seek advice

P3: Describe the investigations that are carried out to enable the diagnosis of these physiological
disorders

Alzheimer’s disease

There is no simple test to make the diagnosis of dementia. A diagnosis is made by taking a carful
account from the person with problem and, even more importantly, from a close relative or friend.
So the first step of getting a diagnosis is to see a doctor, this often takes some courage. Often the
people with dementia do not see themselves as having any problems, so it may be necessary for
someone to accompany them to the doctor. If someone needs to see a doctor but refuses, then
consider speaking directly with general practitioner on his or her behalf. Often the GP will ask some
questions about memory and difficulties with day-to-day tasks. They may organise some tests
themselves but it may speed things up if they refer on to a local specialist. The specialist referral will
be usually being to an; old age psychiatrist, a neurologist and also a geriatrician

These will depend on the age which exactly specialist someone is referred to, what symptoms they
have and what services are available for them. Sometime it will be necessary for a person to see
more than one specialist; for example, a neurologist may ask an old age psychiatrist for a second
opinion if symptoms of depression present. The specialist may see the person in a ‘memory clinic’ or
hospital outpatient or go to see the person at their home. Old age psychiatrists, often see patient at
home in the first instance. Seeing someone at home is not only usually more convenient for the
patient but it also allows the doctor to assess the home environment and gauge how well someone is
coping at home. However sometime the doctor may want someone else (such as relative/friend) for
their account, they may want to speak to the person alone to begin with.

The doctor will normally ask questions about the following; such as the symptoms, how they affect
life and day-to-day tasks, the person’s past history including medical history and medication,
Description of the person’s previous personality, Family history and the patient’s views about the
symptoms

The doctor should take assessment and the assessment will include a physical examination to check
that the heart and lungs are working properly, to check for signs of neurological illness such as
Parkinson’s disease or stroke, and assess the risk of falls. A psychological assessment should check for
symptoms of depression, anxiety and psychosis (for example having hallucinations).

Memory (cognitive) tests

It is common to carry out a simple memory test. One of the most commonly used is the Mini- Mental
State Examination (MMSE), but several others are used. Most tests take about 10 minutes. The
doctor asks a series of questions including the date and where the person is now, and a test of
comprehension, concentration and memory. He or she also asks the person to repeat a phrase again.
The doctor may also do some other tests such as naming animals or guessing heights of things. In
Unit 14: Physiological disorders Task P1, P2, P3 & M1

many cases the doctor refer for a more in-depth test of memory and thinking (this is called
neuropsychometry), which this usually done by a psychologist. These facts will then take up to an
hour and give detailed profile of changes in brain function and help map which parts of the brain are
most affected in an individual. This can also estimate whether there has been a decrease compared
with what would be expected for that individual.

Occupational therapist

When another person gets involved in the assessment they may be an occupational therapist, who
may conduct an assessment at home or in a special area in hospital. This can be useful in assessing
skills with activities of daily living and areas where a person may need help or adaptions. It can
assess the environment and identify what changes or equipment may help maintain independence
and reduce risks. The assessment should check whether there are risks (for example, getting lost or
tripping on stairs) and whether the person is getting enough food and can prepare meals.

Social worker

A social worker may be involved in the assessment. The social worker can assess what practical help
as person needs and arrange for this to be supplied or provide advice and information to help meet
those needs. People with dementia are at a risk of financial exploitation; as finances may need
safeguarding, through either appointeeship or the court of protection- something else that a social
worker can help with.

Other investigations

Many people suspected of having dementia will have other investigations that are usually arranged
by the specialist. These may include; brains scan by CT (computed tomography), MRI (magnetic
resonance imaging) and PET (positron emission tomography)

These scans will provide detailed images of the brain and can show areas of shrinkage or damages
such as MRI

Magnetic Resonance Imaging (MRI)

Magnetic Resonance Imaging (MRI) uses powerful magnets to align the

atoms in the part of the body being studied. Radio wave pulses break the
alignment, causing signals to be emitted from the atoms. These signals
can be measured and a detailed image built up of the tissues and organs.

Computed Tomography (CT)

Computed Tomography (CT) fires x-ray

through the brain at different angles. The x-ray is picked up by
receivers and the information is analysed by a computer to create a
picture of the brain.

A CT scan uses a small dose of X-rays to create pictures of the brain.

Although not as detailed as an MR scan, the image can still be useful.
It takes only a few minutes to do a CT scan.

Positron Emission Tomography (PET)

Unit 14: Physiological disorders Task P1, P2, P3 & M1

A radionuclide is introduced into the body which is taken up by the

nerve cells of the brain. The PET scan detects the emissions and
using a computer builds up a picture of the brain’s functioning.

A PET scan involves injecting a tiny amount of radioactive substance

into a vein and using this to create an image of how the brain is
working. PET scans are less common than MR and CT scans but may
be used where diagnosis is not clear.

All these scans involve lying on a small trolley and being moved into
the scanner. The MRI use a strong magnetic pulse to visualise the
structure of the brain and can produce very detailed images. An MR scan take about half an hour; it
is important to lie still and it can feel quite claustrophobic and noisy. The results of these scans can
take some weeks to get back. The doctor will order some blood tests to check for anaemia,
inflammation, vitamin levels, the health of the thyroid gland, and
kidney and liver function. These results are normally back in a few
days. Other tests may include a brain-wave trace (such as EEG).
This involves wearing something like a swimming cap with lots of
wires coming off it. These traces can sometimes help distinguish
different types of dementia but are not done often.

Electroencephalography (EEG)

By attaching small electrodes to the patient’s scalp, a doctor can

use an electroencephalography machine to monitor the brain
activity. The patient’s brain waves are displayed on the screen

When all the tests are finished the specialist should sit down and be prepared to discuss the
diagnosis with the person. This may be helpful if they have a friend or family member with them. The
doctor should ask whether the person wants to hear the diagnosis and, if he or she goes then, should
explain this clearly and simply. This is a good opportunity also to discuss treatments that include (for
example) what help you needed, and what practical, emotional and financial support is available. It is
also helpful to discuss plans for the future such as appointing welfare attorneys and writing advance
decisions. It is usually difficult to take everything in at one go so follow-up appointment with a
counsellor or the doctor can be useful.

Key Facts

 Getting a diagnose is the first step to getting help and support

 Everyone with dementia should be offered the chance to hear the diagnosis
 The assessment should include checking physical, psychological and social factors
 About two-thirds of people in the UK with dementia never get properly assessed or receive a
diagnosis

Angina and Heart attack

There are many possible causes of chest pain and the most important clue lies in the nature of the
pain itself and when it comes on. Doctors are usually able to distinguish between the different types
of pain in the chest. It may be clear, simply from what you tell the doctor, that the pain is coming
from your heart or has some other cause. The pain from a heart attack or from angina is often
unmistakable. However, there are other times when diagnosis is less clear cut and the doctor then
Unit 14: Physiological disorders Task P1, P2, P3 & M1

has to make decision based upon how likely it is that you might have coronary heart disease (CHD).in
a young woman, chest pain is much more likely to be indigestion than angina than indigestion.

Heart tracing

Resting ECG

The most common test for heart conditions is the

electrocardiograph or ECG for short. It is simple, painless test that
takes about 10 minutes and can be done by your GP or practice
nurse. Every time the heart beats, it causes natural electrical
changes that can be picked up by electrodes placed at various points
around the body. These electrodes, covered in a sticky gel to ensure
good contact, are usually put on the ankles, wrists and across the
chest. The racing records the heart and rhythm and whether the
muscle is conducting electricity normally. Damaged muscle or
muscle that is short of oxygen will result in a different appearance.
The ECG tracing gives the doctor a lot of information about the
heart, but, like most tests, the ECG is not infallible. If you have angina, your heart trace may still be
normal if it is recorded at rest when free of pain. In this case, you may need an exercise ECG.

Exercise ECG

Any form of exercise can be used to provoke angina. In the UK, they
generally use a treadmill test, but in Europe they often use a bicycle.
ECG electrodes are attached just as for the resting ECG, but the wires
are attached carefully to the chest so that they don’t come loose
while you are working. The treadmill usually starts at a slow pace on
the flat and then increases every two or three minutes to a faster
speed on an increasing slope so that you are effectively walking
uphill. The test is stopped if you develop pain, if there are major ECG
changes or, of course, if you become tired or too breathless. The
helpful thing about the exercise ECG is that it gives two bits of
information to the doctor. The first is that, if the test produces pain
and ECG changes, it confirms the diagnosis of angina. The second
and just as important is that, if you manage to walk a fair distance
before the pain comes on, it tells the doctor that the angina is mild and further tests may not be
necessary. The test is done as a hospital outpatient and takes about 40 minutes.

Radioactive isotope tests

These tests use of chemicals, or isotopes, which give out very small amounts of radioactivity that can
be picked up by a special camera. Different tissues around the body take up different isotopes. For
the heart various isotopes are used, the most common being thallium and technetium. Both these
are taken up by heart muscle with a normal blood supply but would not be taken up by muscle that
has a poor blood supply. So where there is a narrowing or blockages of a coronary artery, that area of
heart muscle will not show up. Isotopes are radioactive, but the amount of radioactivity given in
these tests is small and equivalent to most standard X-rays procedures. The isotopes breaks down
quickly in the body and some of it is passed in the urine, but it does not pose any danger to you or
anybody else. The isotopes scan is carried out in two stages, once when the heart is stressed and
once again when it is rest, and the two images are compared. The stress pictures are usually taken
Unit 14: Physiological disorders Task P1, P2, P3 & M1

after a treadmill test but, for those who can’t exercise, the heart
can be stimulated by drugs, such as adenosine, dipyridamole
and dobutamine. At the end of the exercise test or after
receiving drug, an injection of isotope is given and you then lie
under the camera for 10-15 minutes while the pictures are
taken.

Sometimes, the isotope scan is better at picking up

abnormalities than the exercise ECG, and it is useful after
bypass surgery when the arterial supply to the heart can
become quite complicated. It is also the only way to study the
heart in people who can’t manage the treadmill or bicycle, for
example, because of arthritis or bad lung disease.

Stress echocardiography

This is technique that is similar in principles to the isotope test,

expect that no radioactivity is involved. Echocardiography is the
name given to the scanner, which uses sound beams to take
pictures of the heart and is just the same as the ultrasound
scanner used in pregnancy. With this type of scanner, it is
possible to see the heart muscle contracting and to pick out any
parts that are contracting poorly because the blood supply has
been cut off. As in the isotope study, the heart can be
stimulated either by exercise or by the injection of drugs and
the heart is scanned before, during and after the stress. The pictures are then analysed in detail and
can give good information as to which arteries may be blocked and how badly.

Echocardiography

An instrument called a transducer, which produces a beam of sound, is held against the chest. A
picture of the heart is created by the reflected sound
beams.

Coronary angiography

The most direct ways of findings out what is wrong

with the heart in CHD is to undertake special X-rays of
the coronary arteries, called angiograms. A dye
that can be seen on an X-rays is injected into the
coronary arteries. As the heart is moving all the time,
the X-rays have to be taken on digital video, so it
requires expensive equipment
that at one time was available only
in a few large hospitals. With
modern technology, fortunately
these facilities are more widely
available and most district
hospitals now undertake
angiography. In order to
take a picture of these small
Unit 14: Physiological disorders Task P1, P2, P3 & M1

arteries, the dye needs to be injected directly into them. To do this, a fine tube called a catheter has
to be passed to the heart, usually from an artery in the groin, or sometimes from an artery in the
wrist. A little local anaesthetic is injected under the skin to numb it. The catheter is then passed up
along artery towards the heart. When doing this, you will not be aware of this happening, although
when the tube reaches the heart you may have a few palpitations. This is quite normal. Once the
catheter is in the coronary artery, dyes is injected and pictures taken from various angles. While this
is being done, you will be asked to hold your breath for perhaps five or ten seconds. The dye may
cause a little flushing which passes off quickly. Coronary angiography is a safe and routine procedure.
Serious complications are rare-less the one in 1,000. The most important risk, which is fortunately is
very uncommon, is that the angiograms can provoke a heart attack or stroke. If this should happen,
emergency surgery may be needed. Less serious complication are an allergy to the dye or damage to
the artery at the puncture site.

Coronary angiography

A catheter is passed from an artery in the groin to the heart. A dye is injected into the coronary
arteries. The dye is revealed by an X-ray camera that is able to produce moving images.

Coronary angiography is a day-case procedures and takes 30 to 60 minutes. You must remain in
hospital overnight but you will need to lie down for three – four hours afterwards to reduce the risk
of any bleeding from the groin or wrist. The area used for the test
will often be bruised and may be a little tender for a few days.
Although coronary angiography is the best way of looking at the
coronary arteries, it is necessary for everyone with angina or CHD.
Most doctors will use a mainly when they think that it is likely that
you might benefit from heart surgery or angioplasty.

Key facts

•The most common test for heart disease is the ECG, but it is not infallible
•If the resting ECG is normal, a treadmill exercise test is a good way to show angina and see how
serious it is
•For anyone who can’t exercise, radioisotope testing or echocardiography may be used instead
•Coronary angiography is the best way of identifying which arteries are affected, but is not needed
by everyone with CHD.
M1: Assess possible difficulties involved in the diagnosis of the disorders from their signs and
symptoms

Alzheimer’s disease

Diagnosing Alzheimer disease, they are no single definitive medical test for identifying Alzheimer’s
disease, arriving at the correct diagnosis can take time and patience. A diagnosing Alzheimer’s
requires a detailed evaluation, which includes; a thoroughly history of symptoms from the patient
and spouse or family, including the past and present information. This can help the doctor to
eliminate other causes of Alzheimer’s symptoms, and also distinguish Alzheimer’s from other forms
of dementia. A physical and neurological exam, this include cognitive tests to assess such things as
orientation, attention span, speed of information processing, working memory and mood and
personality. And other tests, such as brain imaging and blood tests, this is to rule out other medical
causes
Unit 14: Physiological disorders Task P1, P2, P3 & M1

However to diagnose Alzheimer disease from the symptoms, a doctor should look for; significant
memory problems in immediate recall, short-term, or even long term memory. Significant thinking
deficits in at least one to four areas; expressing or comprehending language; identifying familiar
objects thorough the senses; poor coordination and the executive functions of planning, ordering,
and making judgements. Declining severe enough to interfere with relationships and/or work
performance. Symptoms that appear gradually and becomes steadily worse over time and other
causes to be ruled out to ensure memory and cognitive symptoms are not the result of another
medical condition or disease, such as mild cognitive impairment.

The three Stages of Alzheimer’s disease

Stage 1 – Mild/Early (Last 2-4Yrs) – At this stage they will experience memory loss,
particularly of recent conversations and events. Repeated questions, some problems
expressing and understanding language. Writing and using objects becomes difficult because
of the mild coordination problems. Depression and apathy can occur, accompanied by mood
swings. They may need remainders for daily activities, and may have difficulty with driving.

Stage 2- Moderate/Middle (Last 2-10Yrs) – At this stage they can no longer cover up
problems. They will have forgetfulness about their personal history and inability to recognize
friends and family. They may have problems with rambling speech, unusual reasoning, and
confusion about current events, time and place. People with dementia at this time, they are
more likely to become lost in familiar settings, experience sleep disturbances, and changes in
mood and behaviour, which can be aggravated by stress and change. They may also need
experience3 delusions, aggression, and uninhibited behaviour. Mobility and coordination is
being affected by slowness, rigidity, and tremors. So they may need structure, remainders,
and assistance with the activities of daily living.

Stage 3- Severe/Late (Last 1-3+Yrs) – At this time you may confused about past and present. They
will experience loss of ability to remember, communicate, or process information. A dementia
patient may have incapacitated with severe to total of verbal skills. They will be unable to care for
themselves and falls and immobility likely to happen. They may come across with problems such as
swallowing, incontinence, and illness. However a dementia person at this stage may have extreme
problems with mood, behaviour, hallucinations, and delirium. Therefore at this stage, the patient will
need full intensive support and needs as they are no longer capable to take care of themselves.

Communication

Communicating with a person who has Alzheimer’s disease can be very challenge. As the both
professional and patient have to understand of what being said as, being understood may be difficult
sometime for the patient. However communicating with them in best ways can help them to feel
encourage and safe.

Losing the ability to communicate can be one of the most frustrating and difficult problems for
people with dementia. As this illness progresses, a person with dementia experiences a gradual
lessening of their ability to communicate. They will find it more and more difficult to express
themselves clearly and to understand what others says. But each patient with dementia is unique for
difficulties in communicating thoughts and a feeling is very individual. There are many causes of
dementia, and each affecting the brain in different ways. Some changes you might notice may
include such as: difficulty in finding a word. A related word might be given instead of one they cannot
remember. They may speak fluently, but not make sense. They may not be able to understand what
you are saying or only be able to grasp part of it. Writing and reading skills are also deteriorate. They
Unit 14: Physiological disorders Task P1, P2, P3 & M1

may lose the normal social conventions of conversations and interrupt or ignore a speaker, or fail to
respond when spoken to and they have difficulty expressing emotions appropriately.

To communicate in better way you should minimize distractions and noise – such as the television or
radio, to help the person to focus on what you are saying. Making eye contact and call the person by
their name, making sure you have his/her attention before speaking. Allow enough time for a
response and be careful to not interrupt. If the person with Alzheimer’s is struggling to find a word or
communicate a thought, gently try to provide the work he/she is looking for. Try to frame questions
and instructions in a positive way. Be open to the person’s concerns, even if she/he find hard to
understand. Be patient and supportive and offer comfort and reassurance. Encourage unspoken
communication and focus on feelings, not facts.

However you must make sure that you don’t argue, as this makes the situation even worse, don’t
order the person around. Don’t tell them what they can’t do and instead what they can do. Don’t be
condescending as a condescending tone of voice can be picked up, even if the words are not
understand. Don’t ask a lot of direct questions that rely on a good memory. Don’t talk about people
in front of them as if they are not there

It is always important to check that they hearing and eyesight are not impaired. Glasses or a hearing
aid may help some people. Make sure you check the hearing aids are functioning correctly and
glasses are cleaned regularly.

Communication is made up of three parts that include:

55% is body language which is the message we give out by our facial expression, posture and
gestures. 38% is the tone and pitch of our voice and 7% is the words we use.

These statistics will highlight the importance of how families and carers present information
themselves to a person with dementia. Negative body language such as sighs and raised eyebrow can
be easily picked up.

People maintain their feelings and emotions even though they may not understand what is being
said, it is important to always maintain their dignity and self-esteem. Being flexible will always allow
plenty of time for a response. Where appropriate, use touch to keep the person’s attention and to
communicate feelings of warmth and affection. So it is always a best ways of talking and making sure
that communicating is going well with dementia patients. Examples of this could be that; remain
calm and talk in a gentle, matter of fact way. Keeping sentences short and simple, focusing on one
idea at a time. Always allow plenty of time for what you have said to be understood and It can be
useful to use orienting names whenever you can, for example ‘’ your son James’’. These are examples
to show how to communicate with them in very best way so that you both are understood of each
other. Although you may need to use hand gestures and facial expression to make yourself
understood. Pointing or demonstrating can help. Touching and holding their hand may help keep
their attention and show that you care. A warm smile and shared laughter can often communicate
more than words can.

Heart attack

Warning signs vary from person to person and they may not always be sudden or severe. Although
chest pain or discomfort is the most common symptoms of a heart attack, some people will not
experience chest pain at all, while others will experience only mid chest pain or discomfort. When
having a heart attack you may experience pain, pressure, heaviness or tightness in one or two parts
of your upper body, in combination with other symptoms. The other warning signs of a heart attack
Unit 14: Physiological disorders Task P1, P2, P3 & M1

include; chest, shoulders, neck, arms, jaw and back pain. You may also feel nauseous, feel dizzy or
light-headed, have a cold sweat and feel shortness of breath. Symptoms can come on suddenly or
develop over minutes and get progressively worse. Symptoms can usually last for at least 10 minutes.
Common triggers of angina is that angina attack can be prompted by exertion or physical exercise,
when the hard-working heart muscle requires greater amount of oxygen. The pain usually fades
away with rest. Others triggers of angina may include; high emotion, such as anger, cold
temperatures or eating a large meal.

A heart attack patient may also lose their ability to speak and/to understand what is being said in
some ways as some people unable to speak English therefore this will affect them because the
patient may not be able to talk about symptoms properly. So communication is also important for
them to. They may feel frustrated, angry and cross or very emotional about the fact of
communication problems that may occur if a patient is unable to explain their symptoms and sighs of
heart attack. However communication problems can also affect; your sense of independence, your
role within family/close relationships, your confidence in social activities and how you fee; about
yourself such as depression.

An heart attack patients has to take tests such as blood test and scanner such as MRI or ECG,
however some patient may find it difficult to communicate well with professional as they are unable
to explain about the fact that they wouldn’t like a male doctor to see them as it their religion belief
and they prefer a woman doctor to do all sorts of tests to treat the heart attack. Unfortunately this
happen for some woman in the UK as they have language barrier problems, so they can’t speak
English to tell the professional about their symptom and signs that happen for her. Moreover this is
example of how religion/cultural barrier may affect a patient who is unable to communicate with
professional and explain their health condition in formal English language.

Bibliography

http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=260

http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=1408

http://www.fightdementia.org.au/services/managing-changes-in-communication.aspx

http://www.nlm.nih.gov/medlineplus/ency/article/000760.htm

http://www.nia.nih.gov/alzheimers/topics/diagnosis

http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=130

http://www.helpguide.org/elder/alzheimers_disease_symptoms_stages.htm

https://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/signs.html

http://www.nimh.nih.gov/health/publications/depression-and-heart-disease/index.shtml

http://www.mayoclinic.org/diseases-conditions/heart-attack/basics/symptoms/con-20019520

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Angina

http://www.chss.org.uk/stroke/how_stroke_affects_you/thinking_problems.php
Unit 14: Physiological disorders Task P1, P2, P3 & M1

http://www.nhs.uk/Conditions/Angina/Pages/Complications.aspx