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Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)
Lesson Plans
Chapter 5 — Circulatory System Conditions.
Goals of the Lesson:
Cognitive: Students will be able to understand the general functionality of the circulatory system, as well as the circulatory system conditions and blood disorders. Motor: N/AAffective: Students will be able to aid in the early detection of circulatory conditions as well as identify the proper modality treatments required.
Learning Objectives:
The lesson plan for each objective starts on the page shown below.
5-1 Name two deficiencies that may cause nutritional anemia...........................................................................................3415-2 Define hemophilia.........................................................................................................................................................3505-3 Name the most likely destination for loose blood clots on the venous side of the systemic circuit.............................3455-4 Name three possible destinations for loose blood clots or other debris on the arterial side of the systemic
circuit.............................................................................................................................................................................3475-5 Name two signs or symptoms of deep vein thrombosis................................................................................................3645-6 Name the tissue that is damaged first in chronic hypertension.....................................................................................3785-7 Name three controllable risk factors for the development of atherosclerosis...............................................................3715-8 Name the difference between primary and secondary Raynaud syndrome..................................................................3825-9 Name two factors that determine the severity of a heart attack....................................................................................3885-10 Describe how right-sided heart failure can develop as a result of left-sided heart failure............................................395
You Will Need:
Gather the following materials and teaching aids for the following lessons:5-2 Print-outs of table 1.1.5-5 Freshly cut stalks of celery, glasses half full of water, and dark food coloring..
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
Objective 5-1
Name two deficiencies that may cause nutritional anemia. Date:
Lecture OutlineFigures, Tables, and Features
Resources andIn-Class Activities
Outside AssignmentsEvaluation Instructor’s Notes
Content Text page
PPt slide
Circulatory System Conditions Blood Disorders
o Anemiao Embolism,
thrombuso Hematomao Hemophili
ao Leukemiao Malariao Myelomao Sickle cell
diseaseo Thrombop
hlebitis, deep vein thrombosis
Vascular Disorderso Aneurysmo Atheroscle
rosiso Hypertensi
ono Raynaud
syndromeo Varicose
veins Heart Conditions
o Heart attack
o Heart failure
341–342
10–13 FeaturesAnemia p. 341
ResourcesAnswer to Chapter Objectives (SRCD)
Answers to Chapter Review Questions (SRCD)
In-Class ActivitiesThrough discussion, provide a list of symptoms describing a blood disorder, asking students to identify the appropriate disorder.
Outside AssignmentsCertain kinds of nutritional anemia can be prevented or treated through diet. Have students research iron deficiency anemia, listing foods that counteract, as well as those foods that can continue the deficiency.
EvaluationChapter review questions: Circulatory System Conditions. p. 399
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
Objective 5-2
Define hemophilia. Date:
Lecture OutlineFigures, Tables, and Features
Resources andIn-Class Activities
Outside AssignmentsEvaluation Instructor’s Notes
Content Text page
PPt slide
Hemophilia = Genetic disorder characterized by absence of various clotting factors Affects about 18,000 men in
US About 400 new cases/year
o Carried on X-chromosome: women are carriers who pass it to their sons
About one-third of cases are spontaneous mutations
It is possible but rare for women to have hemophilia
Hemophilia, page 350
Etiology Hemophilia A (80% of
cases)o Deficiency
in clotting factor VIII Hemophilia B (also called
Christmas disease) (15% of cases)o Deficiency
in clotting factor IX Other: much rarer than A or
B Person with hemophilia has
difficulty forming solid,
350–64
29–33 FeaturesHemophiliap. 350
Modality Recommendations for Hemophiliap. 352
Sidebars5.1: Von Willebrand Disease: An Equal Opportunity Mutationp. 351
ResourcesAnswer to Chapter Objectives (SRCD)
Answers to Chapter Review Questions (SRCD)
In-Class ActivitiesThe word hemophilia is formed from the word roots “hemo” and “philia.” Pair students into groups of two providing each group with a print-out of Table 1.1. Ask the groups to come up with as many different medical terms as possible using either “hemo” or “philia.”
MaterialsPrint-outs of table 1.1.
Outside AssignmentsHemophilia is sometimes called “the royal disease.” Ask students to write a report researching the derivation of this nickname.
EvaluationChapter review questions: Circulatory System Conditions. p. 399
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
Objective 5-3
Name the most likely destination for loose blood clots on the venous side of the systemic circuit. Date:
Lecture OutlineFigures, Tables, and Features
Resources andIn-Class Activities
Outside AssignmentsEvaluation Instructor’s Notes
Content Text page
PPt slide
Embolism: traveling clot
Embolism, Thrombus, page 345
Platelets flow through circulatory system; activated by any rough spot or inflammatory chemicals
Clots form at sites of damage, areas of slow, irregular blood flow
Emboli travel until vessel is too small
Pulmonary embolism The lungs are the one and
only destination for clots or debris anywhere on the venous side of the systemic circuit.o unless the
heart has patent foramen ovale
From a clot that forms on venous side of systemic circuit (Fig. 5.4)
650,000 pulmonary emboli/year
200,000 deaths Often related to deep vein
345–368
19–23 Figures5.3: A thrombus is alodged clot; an embolus is amoving clot.p. 345
5.4: Sources of pulmonary embolism.p. 346
ResourcesAnswer to Chapter Objectives (SRCD)
Answers to Chapter Review Questions (SRCD)
In-Class ActivitiesThe signs and symptoms of pulmonary embolism can look like a heart attack. Through discussion, ask students to identify key differentiating factors between the two.
Outside AssignmentsThe term “embolism” was coined in 1848 by Rudolph Carl Virchow. Ask students to research Virchow and his significance in the study of pathologies.
EvaluationChapter review questions: Circulatory System Conditions. p. 399
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
Objective 5-4
Name three possible destinations for loose blood clots or other debris on the arterial sideof the systemic circuit. Date:
Lecture OutlineFigures, Tables, and Features
Resources andIn-Class Activities
Outside AssignmentsEvaluation Instructor’s Notes
Content Text page
PPt slide
Arterial embolism Complication of
atherosclerosiso Could also
be from bacterial infection, atrial fibrillation, rheumatic heart disease
Emboli are usually clotso Can also
be plaque, bone chip, bubble, knot of cancer cells
When septum is intacto All venous
emboli travel to lungs Arterial emboli can
go anywhere except the lungs
Coronary artery (heart attack)
Carotid/ cervical artery (stroke)
Renal artery (renal infarction)
Femoral artery (muscle infarction)
Other
Signs and Symptoms
347-348
24–26 FeaturesModality Recommendations for Embolism, Thrombusp. 348
ResourcesAnswer to Chapter Objectives (SRCD)
Answers to Chapter Review Questions (SRCD)
Related ChaptersCerebral aneurysms are discussed in the section onstroke in Chapter 4.
In-Class ActivitiesMost modality recommendations for embolism are contraindicated except PNF/MET/Stretching. Through discussion, ask students to identify why this modality is considered supportive.
Outside AssignmentsThe most commonly used method to predict clinical probability of pulmonary embolism is the Wells score. Ask students to research how this prediction rule has evolved since 1995.
EvaluationChapter review questions: Circulatory System Conditions. p. 399
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
Objective 5-5
Name two signs or symptoms of deep vein thrombosis. Date:
Lecture OutlineFigures, Tables, and Features
Resources andIn-Class Activities
Outside AssignmentsEvaluation Instructor’s Notes
Content Text page
PPt slide
Thrombophlebitis, Deep Vein Thrombosis = Veins have become obstructed with clots Usually calves, thighs, pelvis Thrombophlebitis = lesser,
greater saphenous veins DVT = popliteal, femoral,
iliac veins
Demographics Often unrecognized,
untreated DVT may happen 2 million
times Diagnosed in 600,000
o 200,000 deaths
Up to 5% population may have a DVT at some point
Etiology Thrombi = stationary clots;
can fragment and travelo Usually to
lung → pulmonary embolism
o (exception with patent foramen ovale; cross over to arterial side)
Virchow triado Injury to
364–368
58–68 FeaturesCase History 5.1: Deep Vein Thrombosisp. 367
Modality Recommendations for Thrombophlebitis, Deep Vein Thrombosis, p. 368
Figures5-6: A. blood clotlodged in a vein can causedistal edema.p. 366
ResourcesAnswer to Chapter Objectives (SRCD)
Answers to Chapter Review Questions (SRCD)
In-Class ActivitiesSimilar to the way our blood flows through our veins and arteries, a piece of celery uses a process called transpiration. Divide the class into small groups. Provide each group with a clear glass, water, dark food coloring, and a stalk of celery. Have the groups add the food coloring to the water, then place the stalk of celery in the water with the leafy side facing up. Throughout the class, have the students check the progress of the colored water throughout the celery’s “vascular bundle.”
MaterialsFreshly cut stalks of celery, glasses half full of water,
Outside AssignmentsDeep vein thrombosis has been nicknamed “economy class syndrome.” Ask students to research and write a report on this nickname.
EvaluationChapter review questions: Circulatory System Conditions. p. 399
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
Objective 5-6
Name the tissue that is damaged first in chronic hypertension. Date:
Lecture OutlineFigures, Tables, and Features
Resources andIn-Class Activities
Outside AssignmentsEvaluation Instructor’s Notes
Content Text page
PPt slide
Hypertension = High blood pressure Persistently above 140/90
Hypertension, page 379
Demographics 65 million people in US
o 1 in 3 adults
Men > women until menopause, then men = women
African Americans more than other races
Age: half of people 60 years or older have hypertension
Other factorso Obesity,
smoking, high cholesterol, atherosclerosis, water retention
o Genetic predisposition
Etiology Blood pressure variables
o Pressure inside vessels
o Pressure
378–382
80–88 Figures2.45: First-degree Burn.p. 75
2.46: Second-degree Burn.p. 75
2.47: Third-degree Burn.p. 76
Tables5.1: Blood Pressure Ratingsp. 379
FeaturesModality Recommendations for Hypertensionp. 382
ResourcesAnimation 5 (SRCD)
Answer to Chapter Objectives (SRCD)
Answers to Chapter Review Questions (SRCD)
In-Class ActivitiesSalt is a highly absorptive substance. Divide the class into small groups providing each with the materials to conduct an experiment illustrating the absorptive properties of table salt. Each group will need a container of salt, and three different liquids varying in chemical makeup (milk, soda, water). Instruct each group to pour a small amount of each liquid into separate bowls, pouring a mound of salt on top. The groups should document the time differences in the absorption, applying
Outside AssignmentsSodium is an environmental factor of hypertension that relieves a lot of attention. Ask students to research how salt consumption can affect a person’s bloodstream.
EvaluationChapter review questions: Circulatory System Conditions. p. 399
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
Objective 5-7
Name three controllable risk factors for the development of atherosclerosis. Date:
Lecture OutlineFigures, Tables, and Features
Resources andIn-Class Activities
Outside AssignmentsEvaluation Instructor’s Notes
Content Text page
PPt slide
Atherosclerosis = hardening of the arteries from any cause. Subtype of arteriosclerosis Hardening of arteries due to
plaqueo Damage
causes spasm, blood clotso Diameter
is occluded (Fig. 5.9) Coronary artery disease
(CAD) = atherosclerosis at coronary arteries (Fig. 5.11)
Atherosclerosis, page 372
Etiology Multifactorial process
o Influenced by gender, age, race, diet, others
Basic progressiono 1.
Endothelial damage Carbon monoxide;
high levels of low-density lipoproteins (LDLs) and triglycerides; high iron
Occurs most readily at branches or sharp curves
371–378
72–79 Figures5-9: Atherosclerosis.p. 372
5-10: Coronary artery disease.p. 373
5-11: Arterial infarction sites.p. 377
Sidebar5.4: Heart Disease in the United States: Sobering Statisticsp. 374
5.5: A brief Digression on Cholesterolp. 375
FeaturesModality Recommendations for Atherosclerosisp. 378
ResourcesAnimation 4 (SRCD)
Answer to Chapter Objectives (SRCD)
Answers to Chapter Review Questions (SRCD)
ResourcesAnswer to Chapter Objectives (SRCD)
Answers to Chapter Review Questions (SRCD)
In-Class ActivitiesPair students in groups of two, asking each group to come up with as many risk factors for arteriolosclerosis as possible. Through discussion, ask the class as a whole to classify each factor as unchangeable or modifiable.
Outside AssignmentsThe terms “arteriosclerosis,” “arteriolosclerosis,” and “atherosclerosis” are very similar, yet distinct, in both spelling and meaning. Ask students to research the differences comparing and contrasting the three.
EvaluationChapter review questions: Circulatory System Conditions. p. 399
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
Objective 5-8
Name the difference between primary and secondary Raynaud syndrome. Date:
Lecture OutlineFigures, Tables, and Features
Resources andIn-Class Activities
Outside AssignmentsEvaluation Instructor’s Notes
Content Text page
PPt slide
Raynaud Syndrome Primary Raynaud disease:
vasoconstriction in extremities (also nose, ears, lips)
Secondary Raynaud phenomenon: complication of underlying disorder
Raymaud Syndrome, page 382
Demographics Primary: mostly women 15–
40 years old Some kind of Raynaud
syndrome may affect 5–10% of general population
Etiologyo Arterioles
spasmo Temporary
episodes, can become permanent
o Chemical components: tunica intima secretes chemicals that affect vasospasm, viscosity of blood
o May be
382–384
89–95 Figures5-12: Raynaud syndrome.p. 383
FeaturesModality Recommendations for Raynaud Syndromep. 384
ResourcesAnswer to Chapter Objectives (SRCD)
Answers to Chapter Review Questions (SRCD)
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.
EvaluationChapter review questions: Circulatory System Conditions. p. 399
In-Class ActivitiesNot all chest pain means heart attack. Read a list of the duration, trigger, activity and causes from Compare and Contrast 5.2, asking students to identify the feature.
Outside AssignmentsWHO criteria have classically been used to diagnose myocardial infarction. Ask students to identify the criteria, providing a specific plan for a possible treatment.
EvaluationChapter review questions: Circulatory System Conditions. p. 399
Werner’s A Massage Therapist’s Guide to Pathology (Fourth Edition)Chapter 5— Circulatory System Conditions.
Objective 5-10
Describe how right-sided heart failure can develop as a result of left-sided heart failure. Date:
Lecture OutlineFigures, Tables, and Features
Resources andIn-Class Activities
Outside AssignmentsEvaluation Instructor’s Notes
Content Text page
PPt slide
Heart Failure = Progressive loss of heart function Not cardiac arrest
Demographics 3 million in the United
States have heart failure 400,000 new diagnoses/year
o Mostly among survivors of heart attacks, CAD, aneurysm, etc.
Men> women till age 75; then men = women
African Americans two times more than others
1 million hospitalizations/year
Etiology Heart pumps 2,000 gal/day If resistance develops, heart
compensateso Heart
grows (cardiomegaly)o Ventricles
become stiff, inelastic Stress hormones boost short-
term function, damage in long-term
Heart may fibrillate →
395–399
112–117
Figures5-16: Left-sided heart failure leads to pulmonary edema.p. 397
5-17: Right-sided heart failure leads to systemic edema.p. 398
FeaturesHeart Failurep. 395
Modality Recommendations for Heart Failurep. 399
ResourcesAnimation 6 (SRCD)
Answer to Chapter Objectives (SRCD)
Answers to Chapter Review Questions (SRCD)
In-Class ActivitiesThrough discussion, provide a list of possible symptoms of heart failure asking the students to identify each as a symptom of left, right or biventricular heart failure.
Outside AssignmentsThere is no gold standard for diagnostic criteria of heart failure, but a few commonly used systems are the "Framingham criteria,” the "Boston criteria," the "Duke criteria," and the "Killip class.” Ask students to compare and contrast 2 of those systems.
EvaluationChapter review questions: Circulatory System Conditions. p. 399