Werner’s A Massage Therapist’s Guide to Pathology...

A Massage Therapist’s Guide to Pathology (Fifth Edition)

Lesson Plans

Chapter 1 — Fundamental Concepts in Pathology

Goals of the Lesson:

Cognitive: Students will be able to understand and define medical terminology by understanding word roots. They will also identify and understand the body’s response to various infectious agents. Motor: N/AAffective: Students will be able to recognize the symptoms of the various infectious agents by the body’s response and identify the proper treatment plan needed.

Learning Objectives:

The lesson plan for each objective starts on the page shown below.

1-1 Identify the meaning of pathology vocabulary based on Greek and Latin word roots.................................................1-2 Define complication and give an example…................................................................................................................1-3 Name three types of bacteria….....................................................................................................................................1-4 Name two viruses of particular concern for healthcare professionals...........................................................................1-5 Name three animal parasites..........................................................................................................................................1-6 Define cleaning, disinfection, and sterilization….........................................................................................................1-7 Name three components of inflammation….................................................................................................................1-8 Name two proinflammatory chemicals.........................................................................................................................1-9 Name two negative outcomes for chronic inflammation..............................................................................................1-10 Name four cardinal signs of inflammation....................................................................................................................

You Will Need:

Gather the following materials and teaching aids for the following lessons:1-1 Projector and transparency of word roots, fill-in-the-blank sheet of word roots. 1-2 Hand-outs listing the terminology definitions with space for the student to fill-in the appropriate term for

each. 1-3 Hand-outs with Figures 1.1 to 1.4 for labeling exercise.

Page 1Copyright © 2013 Wolters Kluwer Lippincott Williams & Wilkins

Selected Key Terms

AcuteChronicComplicationContraindicatedDemographicDiagnosis EndemicEpidemic Idiopathic Incidence Indication Lesion LocalMorbidity MortalityPandemic Prevalence Prognosis Sign Stenosis Subacute Symptom Syndrome Systemic Trauma

A Massage Therapist’s Guide to Pathology (Fifth Edition)Chapter 1— Fundamental Concepts in Pathology

1-6 Hand-outs with terminology

Legend: IR = instructor’s resource; SR = student resource; PPt = PowerPoint.



Objective 1-1

Identify the meaning of pathology vocabulary based on Greek and Latin word roots. Date:

Lecture OutlineFigures, Tables, and Features

Resources andIn-Class Activities

Outside AssignmentsEvaluation Instructor’s Notes

Content Text page

PPt slide

The study of anatomy, physiology, and pathology requires learning a new language. Terminology made up of

Greek and Latin words

Terminology (Tab. 1.1) A- , an-: without Acro-: extremity Adeno-: glandular -Algia: pain Angio-: blood or lymph

vessels Arthr-: joint Brady-: slow Carcin-: crab (cancer) Cardio-: heart Cervi-, cervico- : neck -Cele: swelling, hernia Cep-, Ceph-: head, brain Chole: bile Com-, con-: with, together Contra-: against Cyst: hollow organ

1–6 3-7 Tables1.1: Greek and Latin Word Parts p. 3-5

1.2: Pathology vocabularyp. 6

ResourcesGreek and Latin Root Word Flashcards (SR)

Appendix B: Research Literacy (SR)

Answer to Chapter Objectives (SR)

Answers to Chapter Review Questions (SR)

In-Class ActivitiesStudents will need practice combining the various word parts to form terms. Put students in groups for a timed, competitive exercise. Using only the word parts listed in Table 1.1, have them come up with as many different medical terms as possible giving the proper definition for each.

Outside AssignmentsGreek and Latin Root Word Flash Cards (SR)

EvaluationChapter review questions: Fundamental concepts in pathologyp. 16



Demo-: people Derm-: skin Dia-: through Dys-: difficulty Ecto-, -ectomy: outside,

removal -Emia: blood Endo-: inside Epi- upon Erythr-: red Ex-: out of -Gen: beginning, producing Glyco-: relating to sugar -Graphy: recording, writing Hemo-: blood Hemi-: one-half Hepat-: liver Hydro-: water Hyper-: above, too much. Hypo-: below, too little -Itis: inflammation -Lepsis: seizure Leuko-: white Lipo-: fat Litho-: rock -Logy: study -Lysis, -lyso: destruction Mega-: large Meno-: month Metr-: mother (uterus)

MaterialsProjector, transparency of word roots without their definitions.



Micro-: small Myco-: fungus Mye-: marrow or spinal

cord Myo-: muscle Narco-: stupor Necro-: death Neo-: new Nephro-: kidney Neuro-: nerve -Oid: resembles -Oma: tumor Onco-: tumor Orchi-: testes -Osis: pathologic condition Osteo-: bone Para-: alongside, near Peri-: around Phagia-: eating -Philia: affinity Phleb-: vein Phyto-: plants -Plasia: growth -Plasm, -plasma: formed Patho-: disease state Physio-: nature Pseudo-: false Psych-: the mind, mental Ren-: kidney -Rrhagia, -rrhea: flowing



Rhino-: nose Sarco-: flesh Sclero-: hardness, scarring Spondy-: spine -Stasis: stagnation, standing

still Stoma-: an opening; mouth Syn-, Sym-: with Thrombo-: clot Therm-: temperature -Trophy, -trophic: nutrition,

growth Vaso-: blood vessel

Pathology Terms (Tab. 1.2) Acute – rapid onset, brief,

can be severe Chronic – prolonged, long-

term, can be low intensity Complication – process or

event that occurs during the course of a disease that is not an essential part of that disease

Contraindicated – describing an intervention that may have a negative outcome in a given condition

Demographic – an identified group of people about which information is gathered

Diagnosis – determination of the nature of a disease, injury, or defect



Endemic – pattern of disease incidence that is limited to a particular population or area

Epidemic – widespread outbreak of contagious disease

Idiopathic – a disease of unknown origin

Incidence – number of new cases of people falling ill with a specific disease during a specific period within a specific population

Lesion – pathological change in tissue

Local – describing a limited area of the body

Morbidity –disease state; the ratio of sick to well people within a population

Mortality – death rate from a specific disease

Pandemic – contagious disease affecting the global population

Prevalence – number of cases of a disease existing in a given population during a specific period or a particular moment; the proportion of people affected

Prognosis – expected outcome of a disease or disorder

Sign – objectively observable indication of a



disease or disorder Stenosis – abnormal

narrowing of any canal or orifice

Subacute – between acute and chronic; a stage in healing or tissue repair

Symptom – subjective experience relating to a disease or disorder

Syndrome – collection of signs and symptoms associated with a specific disease process

Systemic – describing a whole-body involvement

Trauma – any physical or mental injury




Objective 1-2

Define complication and give an example. Date:




Content Text page

PPt slide

Complication – a process or event that occurs during the course of a disease that is not an essential part of that disease Example: Splenomegaly

(enlarged spleen) is a potential complication of mononucleosis

4, 6 7 ResourcesAudio Glossary (SR)Appendix E: Pathologies in Brief (SR)

In-Class ActivitiesProvide a sheet with the definitions of each term listed, ask students to fill in the appropriate term for each.

MaterialsPrepare hand-outs for each student listing the definitions for the terminology.

Outside AssignmentsChapter 1 Crossword Puzzle (IR and SR)

Ask students to write a fictional case study of a patient using each terminology found in this chapter at least once.

EvaluationChapter review questions: Fundamental concepts in pathology p. 16

Legend: IR = instructor’s resource; SR = student resource; PPt = PowerPoint



Objective 1-3

Name three types of bacteria. Date:




Content Text page

PPt slide

Bacteria Single-celled

microorganisms Can survive outside a host Not all pathogenic; some are

beneficial Pathogenic bacteria attack

cells, release toxic wastes that damage cells

Antibiotics interfere with bacterial reproduction

Slow-growing infections less responsive

Some bacteria have spore: tough waxy coat

Types of bacteria: Cocci: spherical Diplococci (Fig. 1.1) Staphylococci (Fig. 1.2)

o Associated with local skin infections

o Some are becoming antibiotic resistant

Streptococci (Fig. 1.3)o Associated

with systemic infections

7-8 11-13 Figures1.1: Diplococci.p. 7

1.2: Staphylococci.p. 7

1.3: Streptococci.p. 8

1.4: Spirochetes.p. 8

ResourcesAppendix A: Medications

In-Class ActivitiesProvide print-outs of Figures 1-1 to 1-4. Ask students to identify the type of bacteria shown, listing the main characteristics of each.

MaterialsPrepare hand-outs with Figures 1-1 to 1-4 for labeling exercise.

Outside AssignmentsAt the highest level, antibiotics can be classified as either bactericidal or bacteriostatic. Ask students to research the antibiotics used to treat the different types of bacteria, categorizing them and identifying pros and cons associated with their treatments.




Bacillio Elongated,

rod shapedo Most

likely to form spores Spirochetes (Fig. 1.4)

o Spiral Mycoplasma

o Very tiny




Objective 1-4

Name two viruses of particular concern for health care professionals. Date:




Content Text page

PPt slide

Infections Agents Resistance is based on

genetics, virulence, and lifestyle habits

Five basic classes Prions

o No DNA, RNA

o Grow within CNS

o Spread through eating contaminated tissue BSE (mad cow

disease), Creutzfeldt-Jakob disease, kuru

o Affect the nervous system

o All are eventually fatal

Viruseso Packets of

DNA, RNAo Reprogram

target cell to produce viruso Infected

cells rupture, releasing viral copies

2-7 8-10 Related ChaptersFor more information on herpes simplex, hepatitis B, and hepatitis C, see Chapters 2 and 8, respectively.

In-Class ActivitiesDiscuss the differences between the stable and the unstable viruses, and the proper steps to avoid contamination by both.

Outside AssignmentsStable viruses like herpes simplex, hepatitis B, and hepatitis C are most commonly encountered by massage therapists. Ask students to research each, creating an in-depth fictional case study for each virus by following it as it passes between four different patients. Then discuss ways to avoid the transmittance in the future.




o Cannot replicate outside a host

o Many disintegrate outside a host

o Some are stable, especially herpes simplex, hepatitis B, hepatitis C

o Most common to encounter are herpes simplex , Hepatitis B, and Hepatitis C




Objective 1-5

Name three animal parasites. Date:




Content Text page

PPt slide

Animal Parasites Single-cell or multicellular

organisms Live in or on a host Can be vector for other

diseaseso Protozoa

(Fig. 1.5)o Helminths

and roundwormso Anthropod

s Head lice, crab lice,

miteso Others

(Figs. 1.6, 1.7) Mosquitoes Ticks Fleas

Don’t live on or in host but can spread disease

8-9 15-16 Figures1.5: Giardiap. 8

1.6: Mosquito: vector for West Nile virus.p. 9

1.7: Flea: vector for bubonic plague.p. 9

Related ChaptersArthropods are discussed in detail in Chapter 2.

In-Class ActivitiesDifferent animal parasites live in different environments. Through discussion, provide a list of environmental elements and ask students to name the parasite that best fits those criteria.

Outside AssignmentsParasites evolve in response to the defense mechanisms of their hosts. Ask students to research one animal parasite, citing evidence of its evolution in response to its host.





Objective 1-6

Define cleaning, disinfection, and sterilization. Date:




Content Text page

PPt slide

Hygienic Practices for Massage Therapists

Definition of Terms Cleaning = removal of soil

through manual or mechanical means, often in preparation for disinfection or sterilization

Disinfection = destruction of pathogenic microorganisms or their toxins by direct exposure to chemical or physical agents

Disinfectants are described as low level (not effective against stable viruses or spores), intermediate level (not effective against spores), and high level (effective against some spores and all other bacteria, fungi, and viruses)

Sterilization = destruction of all microorganisms in a given field. It is accomplished with baking,

9-12 17-27 ResourcesAudio Glossary (SR)

In-Class ActivitiesPrepare a document of the terms without their definitions. Pair students, and ask them to fill-in the definitions, citing an example for each.

MaterialsPrint and copy a document of the vocabulary terms for the fill-in-the-blank exercise.

Outside AssignmentsMethods of sterilization and disinfection have changed throughout history. Ask students to research the evolution of sanitation and discuss its impact on healthcare over time.




steam under pressure, or chemicals under pressure

Sanitation = use of measures designed to promote health and prevent disease; it usually refers to creating a clean environment but does not specify the level of cleanliness

Plain soap = any detergent that contains no antimicrobial products or only small amounts of antimicrobial products to act as preservatives

Antimicrobial soap = a detergent that contains antimicrobial substances

Alcohol-based hand rub = contains 60% to 95% alcohol (usually ethanol, isopropanol, or both)

Universal and standard precautions = a set of protocols that were introduced in 1987 to create uniformity in how medical professionals, especially dentists, should limit contact with potentially harmful body fluids in the working environment

o Potentially infectious fluids: semen,



vaginal secretions, breast milk, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, amniotic fluid, blood, blood-tinged saliva, and vomit (emesis)

o Sweat is described as a noninfectious fluid

Applications for Massage Therapists

Handwashingo Work to

preserve lipid layer, skin health Transient bacteria:

superficial, easy to remove

Resident bacteria: deep, harder to remove

Running warm water, plain soap, 30 seconds Liquid soap is

preferable Antimicrobial

soap more likely to cause allergic reaction

Alcohol-based gel Alcohol-soaked

towelettes not adequate Moisturizing lotions

are important

Other hand careo Hangnails

and other lesions



Cuticle nippers, cover sores

Trim, clean fingernails

Care of surfaces and equipment

o Goal: create an environment where nothing that one client touches directly or indirectly touches another client before it is cleaned

Fabricso All

surfaces touched by client or therapist must be cleaned or replaced with each appointment Linens, face cradle

covers, bolster/pillow covers, etc.

Therapist’s clothing: consider changing shirt or apron with each client

Other equipmento Swab

massage tables, face cradles, vinyl-covered furniture

The massage environmento Curtains,

upholstery, carpets probably not major vectors

o Other



surfaces should be cleaned frequently

o Cash is often contaminated




Objective 1-7

Name three components of inflammation. Date:




Content Text page

PPt slide

The Inflammatory Process What is inflammation

o Response to tissue damage or the threat of invasion by antigens Triggered by:

Physical trauma

Invasion with foreign bodies

Hormonal changes

Autoimmune activity

Purposeo Protect

from pathogenic invasiono Limit

range of contaminationo Prepare

damaged area for healing

Outcomeo Complete

resolution with no scar tissue

o Accumulation of scar tissue

o Formation

12-14 28-35 Figures1.8: Many cellular changes happen with the inflammatory response to protect the body from infection and prepare the area for healing.p. 13

ResourcesAppendix A: Medications (SR)

Animation (SR)

In-Class ActivitiesInflammation is the body’s reaction to damage or threat of invasion and occurs as a chain reaction. Discuss the steps of the inflammatory process as it would occur.

VideoView the video about inflammation at thePoint.lww.com/Werner5e

Outside AssignmentsInflammation can be triggered by different situations. Ask students to compare and contrast the differences between inflammation that occurs from an invasion with a foreign body versus inflammation occurring from a hormonal change, citing specific examples.




of cysts/abscesseso Chronic

inflammation

Components of inflammation: vascular activity

Vasoconstriction o Protective

response, o Short lived

Vasodilationo Chemicals

released by damaged endothelium and mast cells Increase

permeability of capillaries

Reinforce capillary dilation

Attract platelets Slow blood flow

away from area May last several minutes to

hours or days

Components of inflammation: cellular activity

Many cells are recruited to manage tissue damage and contamination risk with injury

Endothelial cellso Release

chemicals to activate platelets, allow white blood cells to migrate out of capillaries

o Proliferate



to grow new capillary beds in later stages

Plateletso Become

jagged and sticky, adhere to damaged area

o Release chemicals to bind with plasma proteins to create fibrin, blood clots

While blood cellso Several

types involved Granulocytes

o Smallest, fastest

o Neutrophils first on the scene for bacterial infection, musculoskeletal injury

o Eosinophils for allergies, parasites

o Basophils for allergies and histamine release

Mast cellso In tissues

vulnerable to injuryo Release

histamine to prolong inflammatory response

Monocytes and macrophageso Monocytes

= large, mobile white blood cells

o Can become permanently fixed macrophages

o Associated with late-stage



inflammation to clean up debris

Lymphocyteso Work with

macrophages to clean up debris, promote scar tissue, angiogenesis

Fibroblastso Produce

collagen, extracellular matrix

o Drawn to local blood clots, may proliferate to form more scar tissue




Objective 1-8

Name two proinflammatory chemicals. Date:




Content Text page

PPt slide

Chemical mediators Many sources of chemical

mediators that help coordinate cellular activityo Suspended

in plasma, from platelets, mast cells, basophils, endothelial cells

Stages of Healing Acute Stage

o Damaged cells release chemicals

o Edema develops

o Platelets, early white blood cells arrive

o Tissue exudate begins to form

o Time: depends on severity (usually 1–3 days)

Subacute Stageo Also called

the proliferative stageo Cells

accumulate to fill in damaged area

14-15 36-39 ResourcesAnimation (SR)

In-Class ActivitiesAll cells involved in inflammation are coordinated by chemical messages. Discuss the chemical interactions throughout each stage of healing.

Outside AssignmentsOne inflammatory indicator, C-reactive protein, has been drawing attention lately. Have students research the substance and discuss its history as well as its current and possible future diagnostic uses.




o Slower white blood cells arrive to start cleanup

o Time varies; 2–3 weeks

Prosacute Stageo Also called

the maturation stageo Collagen

becomes denser and aligns according to force




Objective 1-9

Name two negative outcomes for chronic inflammation. Date:




Content Text page

PPt slide

Chronic Inflammation Inflammatory process is not

successfulo Pathogens/

irritants not removedo Immune

system continues to attack tissue

o Musculoskeletal structures never regain full function

Complications Autoimmune process

o Cysts, abscesses Risk of rupture and

infectiono Accumulat

ion of scar tissue Interfere with organ

function Block digestive

tract and pathways Fistulas,

sinuses Musculoskeletal tissues

Tendinosis Keloid scarring

15 40 Related ChaptersChapter 3 discusses tendinopathies in greater detail.

In-Class ActivitiesChronic inflammation can lead to various conditions and diseases. Through discussion, provide a list of symptoms, asking students to diagnose the possible condition or disease.

Outside AssignmentsCrohn Disease is one chronic condition that is getting more and more common. Ask students to research the disease, identifying possibilities of why the disease is becoming more common using specific evidence to support the claims.







Objective 1-10

Name four cardinal signs of inflammation. Date:




Content Text page

PPt slide

Signs and Symptoms Pain, heat, redness, swelling,

and sometimes loss of function

Itching, clotting, pus formation in some caseso Vasodilati

on causes redness, heat and swelling by drawing extra blood

o Pain and itching result of edematous pressure, damaged nerve endings, irritating pathogenic toxins, or inflammatory chemicals

Terminology Dolor (pain) Calor (heat) Rubor (redness) Tumor (swelling) Functio laesa (loss of

function)

Treatment Anti-inflammatory drugs Massage

o Acute

15 41-43 ResourcesAppendix A: Medications (SR)

In-Class ActivitiesThrough discussion, list the symptoms of inflammation, asking the students to identify the appropriate source(s).

Outside AssignmentsInflammation can be treated through anti-inflammatory medication as well as massage. Ask students to compare and contrast these two treatments, citing specific conditions.


EvaluationCreate an exam for Chapter 1 using the Brownstone Test Generator on the IR.

Have students practice for the exam using the interactive quiz bank on the SR.

Chapter 1 crossword puzzle, robotman, and



local infections locally contraindicate circulatory massage

o Post acute stage, maturation phase can benefit from fluid turnover, mechanical influence on scar tissue

Body Modalities Deep tissue massage/

Myofascial release Lymphatic drainage Polarity therapy

o Reiki Proprioceptive

neuromuscular facilitation/ muscle energy technique/ stretching

Reflexology Shiatsu Swedish massage Trigger point therapy

game show (SR and IR)



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Werner’s A Massage Therapist’s Guide to Pathology...

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