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1. CONCEPT OF
ILLNESS

2. Basic Concepts Related to Disease Causation
I. Theory of Disease Causation
1. Web of Causation
a. Basic Assumption
- Disease is due to imbalance between the agent and
the host.
- The characteristics of the agent & the host are
directly related to each other.
- Disease is always causality.

3. Germ Theory
Description:
- A specific microorganism was capable of causing
infectious disease.
Components:
- Antibiotics, vaccinations, and other treatments were
developed as a result of this theory.
Weakness of this Theory:
- Does not explain causes of all diseases.

4. Biomedical Model
Description:
- Disease is a result of malfunctioning organs or cells.
Components:
- Disease are observable and quantifiable, in that most
findings are objective (called ’signs’) and symptoms are
subjective reports of disease.
Weakness of this Theory:
-Does not account for any other factors specific to each
individual that may also contribute to disease.

5. Multi-causal Theories
Description:
- Factors specific to each client must be examined; an
individual’s lifestyle & genetic background play an
underlying role in the development of disease.
1. Bernard and Cannon’s Theory of Homeostasis
a. Bernard hypothesized that if an organism is to live, it must
have the capacity to maintain its internal environment.
- illness occurs as the result of the imbalance in the body’s
internal environment, & disease is an adaptive effort by the
body to restore its balance.

6. b. Canon developed the concept of feedback mechanism to
explain Bernard;s theory of regulation of the internal
environment.
- Homeostasis is a dynamic equilibrium, flexible and
ongoing that maintains certain factors within a given range,
e.g. body temperature, blood pressure, fluid and
electrolytes balances. The fight-or-flight response prepares
the body to react in an emergency and to move quickly
away from danger.

7. 2. Selye’s Theory of the General Adaptation Syndrome
- a framework to describe how people respond to stress; involves
generalized changes that affect several body systems.
- takes place in a single organ or specific section of the body
(e.g. inflammation)
Theory of the Local Adaptation Syndrome
- Both syndromes develop in 3 Distinct Stages:
a. Alarm Reaction or Fight-or-Flight Response
b. Resistance and c. Exhaustion.
The most important regulators are the central and autonomic
nervous systems, pituitary, & adrenal glands. Disease occurs
when the adaptive capacity of the body is exceeded.

8. Psychosocial Theories
Description:
- integrate physiologic, psychological, and sociologic factors
that explain disease development.
1. Mason’s Theory of Specificity of the Stress Response
- The stress response is dependent on psychological factors
(e.g. a person’s perception of the stressor rather than the
stressor itself)
- Cortisol hormonal responses to stress increase when (a)
we first experience a new stimulus, (b) we learn to avoid
noxious stimuli, and (c) we receive punishment. We can
modify the cortisol response by coping effectively with a
stressor.

9. 2. Lazarus’ Theories of the Stress Response
- The degree of resistance to infection depends on how well a
person copes with stress and general life experiences.
- The brain through one’s perception of the stressor,
appears to be the mediating influence on how the body
responds to stress. Daily hassles are irritating, frustrating
minor life events that everyone experiences, such as losing
things and being delayed in traffic. Daily uplifts are buffers
to daily hassles. People who cope poorly with stress have
significantly impaired immune responses, as shown by
diminished leukocyte activity levels.
Description:

10. 1. Ecologic Triad
a. Agent
b. Host
c. Environment
Agent – Any environmental factor or stressor that by its
presence or absence can lead to illness or disease.
a. Physical Agent – mechanical forces/friction that cause
injury.
> Excessive radiation
> Intense sound
> Intense light
> Intense vibration
> Atmosphere
> Extreme heat or cold
> High humidity or temperature

11. b. Chemical agents
> Drugs
> Dust
> Gases
> Vapor
> Pesticides/herbicides
> Food additives
> Fumes
c. Nutrient agent – could be an excess or a deficiency
d. Biologic agent – all living organism that may cause infection.
e. Genetic agent – chromosomal abnormalities
f. Psychosocial agent – conflicts, problems, & other interpersonal
stresses

12. Host – person(s) who may or may not be at risk of acquiring
a disease.
Host Factors in Disease:
a. Genetics – inherited resistance
b. Age
c. Gender/Sex
Female Diseases:
Hypo/hyperthyroidism
Cholecistitis
Arthritis
Psychoneurosis
Male Diseases:
Peptic ulcers
Inguinal hernia
Atherosclerosis

13. d. Ethnic/Racial
Ex: Black People – sickle cell anemia, TB, rickets
Japanese – gastric cancer
White – congenital heart disease
e. Religion
f. Family size
g. Marital status
h. Occupation
Miners: Pneumoconiosis
Farmers: Schisto, Tetanus,
Snake bites
Factory Workers: Lung
cancers, RT disease
CEO & drivers:
Ulcers, Heart disease

14. i. Behavior
Health-seeking behaviors
 Vices
 Addiction
Gambling
Hygiene
j. Recreation
k. Interpersonal relationships

15. l. Resistance
Specific resistance – immunity
- increase resistance to particular infectious agent
Inherent resistance – ability to resist disease,
independent of abnormalities on specifically tissue
responses
Example:
•Intact skin or mucous membranes
•Reflexes: diarrhea, lacrimation, frequent urination,
coughing, sneezing, vomiting, gastric activity

16. Environment – All factors external to the host that may or
may not predispose the person to the development of disease.
a. Physical environment – includes climate, living
conditions, sound (noise) levels, and economic level.
b. Social environment – includes interactions with others
and life events such as the death of loved ones.

17. I. The Natural History of Disease Model
A. Prepathogenesis/Susceptibility
Description:
The preliminary interaction of the human host, potential
disease agent, and environmental
factors in disease production
* Cellular Changes Resulting From Adaptation or Injury:
1. Swelling – a transient, abnormal elevation or enlargement of
a body part or area, usually on the surface, that is not caused by
new growth or proliferation of cells; may be due to injury,
inflammation, or edema.

18. 5. Calcification – the hardening of an organic substance by a
deposit of calcium salts within it.
3. Free radicals & Reperfusion Injury
4. Pigmentation – the deposit of pigment in any of the body
tissues, especially when abnormal or excessive.
- Oxygen free radicals or superoxide radicals are by-products of
energy production. They are highly reactive in nature.
2. Lipid accumulation – release of fatty acids and neutral fats
from trauma

19. * Cellular Changes Caused by Injurious Stimuli:
1. Atrophy – a decrease in the size of a cell or tissue.
- an adaptive response that occurs when there is a
decrease in the workload of a cell or tissue.
- Occurs as a result of disuse state, decreased hormonal
or neural stimulation of a cell or tissue, a response to
nutritional deficiency, or insufficient blood supply to
cells,

20. 2. Hypertrophy – the increase in the size of a cell or tissue.
- an adaptive response that occurs when there is an
increase in the workload of a cell.
Three Types:
a. Physiologic hypertrophy – occurs as a result of a
health increase in the workload of a cell (i.e. increased
muscle bulk through exercise).
b. Pathologic hypertrophy – occurs in response to a
disease state.
c. Compensatory hypertrophy – occurs when cells grow
to take over the role of other cells that have died.

21. 3. Hyperplasia – the increase in the cell number occurring in an
organ as a result of increased mitosis.
- seen in cells stimulated by an increased workload, by
hormonal signals,k or by signals produced locally in
response to a decrease in tissue crowding.
- can only occur in the cells that undergo mitosis such as
liver, kidney, and connective tissues.
Three Types:
a. Physiologic hyperplasia – occurs monthly on uterine
endometrial cells during follicular stage of the menstrual cycle.
b. Pathophysiologic hyperplasia – occurs with excessive
hormonal stimulation.
c. Compensatory – occurs when cells of a tissue reproduce to
make up for a previous decrease in cells.

22. 4. Metaplasia – is the change in the cell from one subtype to
another.
- occurs in response to some continual irritation or
injury that results in chronic inflammation of the
tissue.
5. Dysplasia – a derangement in cell growth that results in cells
that differs in shape, size, and appearance from their
predecessors.
- appears to occur in cells exposed to chronic irritation
or inflammation.

23. A. Pathogenesis
Description:
- is the mechanism by which an etiological factor
causes the disease.
- step by step development of a disease due to a series of
changes in the structure and /or function of a
cell/tissue/organ being caused by a microbial , chemical or
physical agent.

24. * Conditions Undermining Adaptive Mechanism
1. Ischemia - is a restriction in blood supply, generally due to
factors in the blood vessels, with resultant damage or
dysfunction of tissue.
- an absolute or relative shortage of the blood supply to an
organ. Relative shortage means the mismatch of blood
supply (oxygen delivery) and blood request for adequate
oxygenation of tissue. Ischemia results in tissue damage
because of a lack of oxygen and nutrients.

25. 2. Thrombosis - is the formation of a blood clot (thrombus)
inside a blood vessel, obstructing the flow of blood through the
circulatory system.
When a blood vessel is injured, the body uses platelets and
fibrin to form a blood clot, as the first step in repairing it
(hemostasis) to prevent loss of blood. If that mechanism
causes too much clotting, and the clot breaks free, a thrombus
is formed.

26. > Thrombosis
Causes:
a. Hypercoagulabilty
b. Endothelial cell injury
c. Hemostasis

27. > Embolism
- occurs when an object (the embolus, plural emboli)
migrates from one part of the body (through
circulation) and causes a blockage (occlusion) of a
blood vessel in another part of the body.
a. Thromboembolism e. Tissue embolism
b. Fat embolism f. Foreign body embolism
c. Air embolism g. Amniotic fluid embolism
d. Septic embolism
Classification:

28. > Infarction
- is the process resulting in a microscopic area of necrotic tissue
in some organ caused by loss of adequate blood supply.
- is commonly associated with atherosclerosis, where an
atherosclerotic plaque ruptures, a thrombus forms on the
surface occluding the blood flow and occasionally forming an
embolus that occludes other blood vessels downstream.
Classification:
a. White infarction
b. Red infarction

29. > Necrosis
- the death or decay of tissue in a particular part of the body, as
from loss of blood supply, burning, etc.
Causes:
a. Injury
b. Infection
c. Cancer
d. Infarction
e. Poisons
f. Inflammation

30. > Somatic Death
- is characterized by the discontinuance of cardiac activity
and respiration, and eventually leads to the death of all body
cells from lack of oxygen
- the permanent, irreversible death of an
organism

31. Levels of Prevention
1. Primary Prevention
- Involves health promotion activities that provide protection
against the occurrence of a specific illness or disease.
- Does not include therapeutic treatment or identification of
symptoms.
- It does include health promotion (e.g. teaching clients about
health lifestyle behaviors) and specific protection
interventions (e.g. immunizations) to decrease vulnerability to
illness or dysfunction.

32. 2. Secondary prevention
- refers to health behavior that promotes the early detection
(case-finding or screenings) and prompt treatment of
disease, and limitation of disability.
- directed toward rehabilitation after a disease or condition
already exists to minimize disability and help the client
learn to live productively with limitations.
3. Tertiary prevention
- is used when disability is permanent and irreversible.

33. 1. To which of the following behaviors is an example of secondary
level of prevention?
a. Maintaining ideal body weight
b. Self-monitor blood pressure for hypertension
c. Have a regular dental care
d. Have a breast reconstruction

34. 2. Mrs. January, 40-year old, a homemaker is conscious about the
effects of radiation and is therefore avoids overexposure to the sun.
The level of prevention associated with this behavior is:?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Pre-school prevention

35. 3. Muscle and joint degeneration and metabolic and circulatory
disturbances occur when a client is immobile for any length of
time. Identifying immobility as an actual diagnosis permits
development of rehabilitation plan and restoration to high level
wellness. This is:
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Pre-school prevention

36. 4. Mr. Zonrox, 76-year old, retired teacher is a stroke patient. He
was scheduled for a speech therapy. This is an example of:
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Pre-school prevention

37. 5. Mr. Muscle, 46-year old, a farmer for 10 years has chronic TB
and angina pectoris. He has productive cough, hemoptysis, low-
grade fever, shortness of breath, chest pain, and cold-clammy skin.
He shows signs of depression and desparity about his condition
and prefers not to talk to any person. The theory that best portrays
his condition is:
a. Germ theory
b. Biomedical theory
c. Multi-causal theory
d. Psychosocial theory

38. Thank You!!!