i bc27f85be50b71b1 (112 page)

ONCOLOGY 361

22. Martiasson A. Discussion: bl:Jddcr and pelvic floor muscle tmining for

overactive bladder. Urology 2000;55(SuppI 5A):12-16.

23. Lewey J, Ltlas L. Electrical stimularion of the overactive bladder. Prof

Nurse 1999;15(3):211-214.

24. Cammu H, Van Nylen M, Am)' JJ. A 10-year follow-up after Kegel pelvic floor muscle exercises for genuine stress incontinence. BJU Int 2000;85(6):655-658.

25. Gibbons G. Skin care and incontinence. Community Nurse 1996;

2(7):37.

26. Mure MM, Sacr MG, Oishi AJ. Pancreatic cancer. CA Cancer J Clin

1994;44:304-318.

27. Brunner TB, Grabenbauer GG, Baum U. et al. Adjuvant and neoadjuvanr fadlochcmothcrapy in ductal pancreatic carcinoma. Strahlenther Onkol 2000 JUIl; 176(6):265-273.

28. Schwarz A, Beger HG. Biliary and gastric bypass or stenting in nonrcsccrahle pcnampullary cancer: analysis on the basis of controlled trials.

Int J Pancrearol 2000;27( I ):51-58.

29. Reese JL. Head and Neck Cancers. In R McCorkle, M Gram, M Frank

Stromberg, S Baird (cds), Cancer Nursing: A Comprehensive Textbook

(2nd cd). Philadelphia: Saunders, 1996;567.

30. Haskell CM (cd). Cancer Treatment (4th cd). Philadelphia: Saunders,

199.\;343,457.

31. Rohllls P, Kopf A. Squamous Cell Carcinoma Ipamphlet]. New York:

Skill Cancer �oundanon, 1990; 1.

6

Vascular System and Hematology

Michele P. West and Jaime C. Paz

Introduction

Alterations in the integrity of the vascular and hematologic systems

can alter a patient's activity tolerance. The physical therapist must

be aware of the potential impact that a change in blood composition

or blood flow has on a multitude of body functions, including cardiac Output, hemostasis, energy level, and healing. The objectives of this chapter are to provide the following:

1.

A review of the structure and function of blood and

blood vessels

2.

A review of vascular and hematologic evaluation, includ-

ing physical examination and diagnostic and laboratory tests

3.

A description of vascular and hematologic diseases and

disorders, including clinical findings, medical and surgical management, and physical therapy inrervenrion

363

364

ACUTE CARE HANDBOOK FOR PHYSICAL 1l-1ERAPISTS

Structure

The network of arteries, veins, and capillaries comprises the vascular system. Living blood cells and plasma within the blood vessels are the structures that comprise the hemarologic system. The lymphatic system assists the vascular system by draining unabsorbed plasma from tissue spaces and returning this fluid (lymph) ro the

heart via the thoracic duct, which empties into the left jugular

vein. The flow of lymph is regulated by intrinsic contractions of

the lymph vessels, muscular contractions, respiratory movements,

and gravity.'

Vascular System Structure

All blood vessels are composed of three similar layers. Table 6-1

describes the strucrural characteristics of the three different blood vessel layers. Blood vessel diameter, length, and wall thickness vary according ro location and function. Table 6-2 describes the unique

characteristics of arteries, veins, and capillaries.

Table 6-1. Blood Vessel Layers

Layer

Description

Function

Tunica intima

Innermost layer

Provides a smooth sur

Endothelial layer over a

face for laminar blood

basement membrane

now

Tunica media

Middle layer

Constricts and dilates for

Smooch muscle cells and

blood pressure regulation

elastic connective tissue with sympathetic

innervation

Tunica adventitia Outermost layer

Protects and attaches

Composed of collagen

blood vessels to

fibers, lymph vessels,

nearby structures

and (he blood vessels

that supply nutrients

to the blood vessel

Source: Dam from The Cardiovascular System: Blood Vessels. In EN Marich, Human

Anatomy and Physiology (3rd cd). Redwood City, CA: Benjamin-Cummings, 1995.

VASCULAR SYSTEM AND HEMATOLOGY

365

Table 6-2. Characteristics of Blood Vessels

Vessel

Description

Artery

Small, medium, or large in diameter.

Larger arteries are located closer to the heart.

Thick tunica media layer allows arteries to readily

accommodate to pressure changes from the heart.

Vein

Small, medium, or large in diameter.

Thin runica media and thick tunica adventitia.

Valves prevenr back flow of blood to maintain venous

return to the heart.

Capillary nerwork

The inrerface of the arterial and venous systems where

blood cells, fluids, and gases are exchanged.

Capilbry beds can be open or closed, depending on the

circulatory requiremenrs of the body.

Source: D:lt:1 from The C1rdiovascular Syslem: Blood. In EN Maricb, Human Anatomy

and Physiology (3rd cd). Redwood Cicy, CA: Benjamin·Cummings, 1995.

Hematologic System Stmctllre

Blood is composed of living cells in a nonliving plasma solution and

accounts for 8% of total body weight, or 4-5 liters in women and

5-6 liters in men. Table 6-3 describes the characteristics of the different blood cells. Plasma is composed almost completely of water and contains more than 100 dissolved substances. The major solutes

include albumin, fibrinogen, protein globules, nitrogenous substances, nutrients, electrolytes, and respiratory gases.2

Function

The function of the blood vessels is to carry blood throughout the

body to and from the heart. Normal alterations in the vessel diameter

will occur depending on circulating blood volume and the metabolic

needs of the tissues.

The following are the seven major functions of blood2:

I .

The transport of oxygen and nutrients to body cells from

the lungs and gastroinrestinal organs, respectively