ModuleI

V:Vit
alsigns,Lif
estyl
e/Hypokineti
cdiseasesanditsmanagement
Vi
talsi
gns-Pul
serat
e,Respir
atoryrate,
Bloodpressure,Bodytemperature,
Diseases-Diabet
es,
Hypert
ensi
on,Obesi
ty,
Osteoporosis,CHD,Backpain.Fi
tnessassessment -Bodymassi ndex,Wai
st
toHipRatio,
VITALSIGNS,PULSERATE,RESPI RATORYRATE, BLOODPRESSURE, BODYTEMPERATURE
Vi talsi gnsar eagr oupoft he4t o6mosti mpor tantsi gnst hati ndicat et hest at usof
thebody ’sv ital (life-sust aining)f unct ions.Thesemeasur ement sar et akent ohel passess
thegener alphy sicalheal thofaper son, giv ecl uest opossi bledi seases, andshowpr ogr ess
towar dr ecov er y .Thenor malr angesf oraper son’ sv i
talsi gnsv arywi thage, wei ght , gender ,
andov eral lheal th.Ther ear ef ourpr imar yv italsi gns: Pul ser ate,Respi rat or yr ate,Bl ood
pressur e, Bodyt emper atur e.
Pulser ate:Thepul sei st her at eatwhi cht hehear tbeat swhi l
epumpi ngbl oodt hrought he
arter i
es, recor dedasbeat spermi nut e( bpm) .Itmayal sobecal led" hear trat e".Thepul sei s
commonl yt akenatt hewr i
st( radi alar ter y).Al ternat ivesi tesi ncl udet heel bow ( br achi al
arter y),t he neck ( car ot id ar tery ),behi nd t he knee ( popl i
tealar tery ),ori nt he f oot
(dor sal i
spedi sorpost eriort ibial ar t
er ies) .Thepul ser at ecanal sobemeasur edbyl ist eni ng
direct l
y t o t hehear tbeatusi ng ast et hoscope. The pul se v ar ies wi th age:
anewbor nori nf antcanhav eahear trat eof130–150bpm,aki dof100–120bpm,anol der
childof60–100bpm, anadol escentof80–100bpm, andanadul tof50–80bpm.
Respi rator yr at e;Va ri
eswi thage,butt henor malr ef erencer angef oranadul ti s16–20
breat hspermi nut e.Thev al ueofr espi rator yr ateasani ndi cat orofpot ent ialr espi rat or y
dysf unct i
onhasbeeni nv est i
gat edbutf indi ngssuggesti ti sofl imi tedv al ue.Respi rat or y
ratei sacl eari ndi cat orofaci dot i
cst at es,ast hemai nf unct ionofr espi rat i
oni sr emov alof
CO2l eav ingbi car bonat ebasei nci rcul ation.
Bloodpr essur e;t hebl oodpr essur ei sr ecor dedast wor eadi ngs:ahi ghsy stol i
cpr essur e,
whi choccur sdur ingt hemaxi malcont ract i
onoft hehear t, andt hel owerdi ast olicorr est ing
pressur e.Anor malbl oodpr essur ewoul dbe120bei ngt hesy stol icov er80,t hedi ast olic.
Usual l
yt hebl oodpr essur ei sr eadf r
om t hel eftar m unl esst her ei ssomedamaget ot he
arm.Thedi ffer encebet weent hesy st olicanddi ast olicpr essur ei scal l
edt hepul sepr essur e.
The measur ement of t hese pr essur es i s now usual ly done wi th ananer oi dor
elect roni csphy gmomanomet er . The cl assic measur ement dev ice is
amer cur ysphy gmomanomet er ,usi ngacol umnofmer cur ymeasur edof fi nmi ll
imet er s.
Ther ei snonat ur al'nor mal 'v aluef orbl oodpr essur e,butr at herar angeofv aluest haton
i
ncr easi ngar eassoci at edwi thi ncr easedr isks.Thegui del ineaccept abl er eadi ngal sot akes
i
nt oaccountot herco- fact or sf ordi sease.Ther ef ore, elev at edbl oodpr essur e( hy pert ensi on)
i
sv ar iousl ydef inedwhent hesy stolicnumberi sper sist ent lyov er140–160mmHg.Low
bloodpr essur ei shy pot ensi on.Bl oodpr essur esar eal sot akenatot herpor tionsoft he
extremi ties.These pr essur es ar e cal ledsegment albl ood pr essur esand ar e used t o
evaluat ebl ockageorar ter i
al occl usioni nal imb.
Temper atur Temper
e: atur er ecor dinggi v esani ndi cat i
onofcor ebodyt emper atur ewhi chi s
nor mal l
yt ight l
ycont r
ol led( ther mor egul at i
on)asi taf fect st her at eofchemi calr eact i
ons.
Bodyt emper at ur ei smai nt ainedt hroughabal anceoft heheatpr oducedbyt hebodyandt he
heatl ostf rom t hebody .Temper atur ecanber ecor dedi nor dert oest abl i
shabasel inef or
thei ndi v i
dual '
snor malbodyt emper at ur ef ort hesi t
eandmeasur ingcondi tions.Themai n
reasonf orchecki ngbodyt emper atur ei st osol i
citanysi gnsofsy stemi ci nfect ionor
i
nf l
ammat ioni nt hepr esenceofaf ev er( temp>38. 5° C/ 101. 3° Forsust ainedt emp>
38° C/ 100. 4° F) ,orel ev at edsi gni fi
cant lyabov et hei ndi vidual 'snor malt emper atur e.Ot her
causes of el ev ated t emper atur e i ncl udehy per ther mi a. Temper at ure depr essi on
(hypot her mi a)al soneedst obeev al uat ed.I tisal sonot ewor thyt or ev i
ew t het rendoft he
pat i
ent '
st emper at ure.Af ev erof38° Ci snotnecessar i
lyi ndicat eanomi noussi gni ft he
pat i
ent '
spr ev i
oust emper atur ehasbeenhi gher .
Li
fest
yle/
Hypoki
net
icdi
seases
Diseasesl
inkedwiththewaypeopleli
vetheirl
if
e.Thisiscommonlycaused
byal
cohol
,dr
ugandsmoki ngabuseaswel
laslackofphysi
calacti
vit
yandunheal
thyeati
ng.
Di
seasest
hatimpactonourli
festy
lear
ehear
tdisease,st
roke,obesi
tyandt
ypeIIdiabet
es.
Thedi seasesthatappeartoincreaseinfrequencyascount riesbecomemor eindust
ri
alized
and peopl e l iv
e l onger. They can i ncludeAlzheimer'
s di sease, arthr i
ti
s
atherosclerosi
s,asthma,cancer
, chr
oni
c l iv
er di sease,chroni
c obst r
ucti
ve pulmonar y
disease,type 2 di abetes,heart di sease,met aboli
c sy ndrome,chroni
c r enal
fail
ure,osteoporosi
s,st
roke,depressi
on,obesit
yandv ascul
ardementia.

Di etandl i
fest y l
ear emaj orf actor st houghtt oi nfluencesuscept ibilityt omanydi seases.Dr ug
abuse, tobaccosmoki ng,andal coholdr inki ng,aswel lasal ackofexer cisemayal soi ncr easet he
ri
skofdev elopi ngcer tai ndi seases,Bet ween1995and2005813, 000Aust r
al ianswer ehospi talized
due t o al cohol .In manyWest erncount ries, peopl e began t o consume mor e meat ,dai ry
product s, veget abl eoi ls, tobacco, sugar yf oods, Coca- Col a, andal cohol i
cbev er agesdur ingt hel at t
er
hal foft he20t hcent ur y.Peopl eal sodev el opedsedent ar yl ifesty lesandgr eat err at esofobesi ty.In
2014,11. 2 mi llion Aust ral i
ans wer e ov er wei ghtorobeseRat es ofcol or ectalcancer ,br east
cancer , prost atecancer , endomet rialcancerandl ungcancerst ar tedi ncr easi ngaf tert hi sdi etar y
change.Peopl ei ndev el opi ngcount ri
es, whosedi et sst i
lldependl ar gel yonl ow- sugarst ar chyf oods
wit hl ittl
emeatorf athav el owerr atesoft hesecancer s.Causesar enotj ustf r om smoki ngand
alcoholabuse.Adul tscandev elopl i
f est yledi seasest hr oughbehav i
our alf act or st hati mpacton
them.Thesecanbeunempl oyment ,unsaf el ife, poorsoci alenv i
ronment ,wor kingcondi ti
ons, st ress
andhomel if
ecanchangeaper son’ sl i
f est ylet oi ncreaset hei rr iskofdev el opingoneoft hese
diseases
DIABETESMELLI TUS
Commonl yr ef er redt oasdi abet es,i sagr oupofmet abol icdi sor der si nwhi cht her ear ehi gh
blood sugarl ev els ov era pr olonged per iod.Sy mpt oms ofhi gh bl ood sugari nclude f requent
urinat ion,i ncr eased t hi rst,and i ncr eased hunger .Ifl ef tunt reat ed,di abet es can cause many
compl i
cat i
ons.Acut ecompl icat ionscani ncl udedi abet i
cket oaci dosi s, hyper osmol arhy per gly cemi c
stat e,ordeat h.Ser ious l ong- ter m compl icat ions i ncludecar diov ascul ardi sease, stroke, chr onic
kidneydi sease, footul cer s,anddamaget ot heey es.Di abet esi sduet oei thert hepancr easnot
produci ngenoughi nsul inort hecel lsoft hebodynotr espondi ngpr oper l
yt ot hei nsul i
npr oduced.
Ty pesofdi abet esmel li
tus.
Ty pe1DM r esul tsf rom t hepancr eas' sf ailur et opr oduceenoughi nsul in.Thi sf orm waspr ev iousl y
refer redt o as" i
nsul i
n- dependentdi abet esmel li
tus"( IDDM)or" juv eniledi abet es" .
Thecausei s
unknown.
Ty pe2DM begi nswi thi nsul i
nr esi stance,acondi tioni nwhi chcel lsf ailt or espondt oi nsul i
n
proper ly.Ast hedi seasepr ogr essesal ackofi nsul inmayal sodev el op.Thi sf orm waspr ev iousl y
refer redt oas" noni nsul in-dependentdi abet esmel lit
us"( NI DDM)or" adul t-onsetdi abet es" .The
mostcommoncausei sexcessi vebodywei ghtandnotenoughexer cise.
Pr ev entionandt reat menti nvol vemai ntai ningaheal thydi et ,regul arphy si calexer ci se,a
nor malbodywei ght ,andav oidinguseoft obacco.Cont rolofbl oodpr essur eandmai nt ainingpr oper
footcar ear ei mpor t
antf orpeopl ewi tht hedi sease.Ty pe1DM mustbemanagedwi thi nsul i
n
i
nj ect i
ons.Ty pe2DM maybet reat edwi t
hmedi cat ionswi thorwi thouti nsul in.I nsul i
nandsomeor al
medi cat ionscancausel owbl oodsugar .Wei ghtl osssur ger yint hosewi thobesi t
yi ssomet imesan
effect ivemeasur ei nt hosewi tht y pe2DM.Gest at ionaldi abet esusual lyr esol v esaf tert hebi rthof
thebaby .Asof2015,anest i
mat ed415mi llionpeopl ehaddi abet eswor ldwi de, wi tht y pe2DM
maki ngupabout90%oft hecases.Thi sr epr esent s8. 3%oft headul tpopul at ion, wi thequalr atesi n
bot hwomenandmen. Asof2014,t rendssuggest edt her atewoul dcont inuet or i
se.Di abet esat
l
eastdoubl esaper son' sr iskofear lydeat h.Fr om 2012t o2015,appr oximat ely1. 5t o5. 0mi ll
ion
deat hseachy earr esul tedf rom di abet es.
CAUSESOFDM
*.Genet icFact or *.Obesi ty * .Impai redPancr eases *. Unheal thy Li fe
Sty l
e
*.St ress *.Hy pert ensi on * .Smoki ng *.Sedent aryl i
feSt yle
*.Ov ereat ing *.LackofPhy sical Act ivi
ty.
SYMPTOMS
*.Fr equentur inat ion.* .Unquenchabl et hi rst. * .Blur redv ision *.Const anthunger .
*.Fat igue *.Nausea. * .Fr equenti nf ect ion. *.Slowheal ingwounds.
*.Excesssweat ing * .Wei ghtl oss * .Br eat hsmel lsl i
kenai l pol i
sh.
MANAGEMENT
*.Li fest ylemodi fication *.Appr opr iat edi et * .Regul arphy sical act ivity
*.Medi cat i
oni fr equi red. * .Mai ntenanceofbodywei ght .
 HYPERTENSI ON
Also known ashi gh bl ood pr essur e( HBP)i s al ong- t
er m medi calcondi tioni n whi ch t hebl ood
pressur ei nt hear ter iesi s per sistent ly el ev ated.Hi gh bl ood pr essur e usual l
y does notcause
sympt oms.Long- ter m hi ghbl oodpr essur e,howev er ,isamaj orr iskf actorf orcor onar yar tery
disease, st roke, hear tfailure, per ipher al vascul ardi sease, v i
si onl oss, andchr onicki dneydi sease.
CAUSES
*.Sedent aryl ifeSt yle* .Obesi ty *.I ncr easedage *.St ress * .Genet icFact or
*.Excessi veal cohol * .Tobacco * .Hi ghchol est er ol * .Di abet es * .Hi ghint akeofsal t
*.Lowcal cium&pot assi um i nf ood * .Cor onar yar ter ydisease
SYMPTOMS
*.Excessi veper spirat i
on *.Muscl ecr amp * .Weakness
*.Fr equentur ination. *.Rapi dori rregul arhear tbeat .
MANAGEMENT
*.Medi tat i
on *.Pr anay ama *.Sav asana * .Losewei ght
*.Suf ficientsl eep *.Qui tsmoki ng *.Heal thydi et *.Reducesal t
i
nt ake
*.Lifest ylemodi fi
cat i
on *.Cutdownal cohol * .Regul arphy si cal act iv i
ty
OBESI TY
Obesi tyi samedi calcondi ti
oni nwhi chex cessbodyf athasaccumul at edtot heext entt hati t
mayhav eanegat i
v eef fectonheal th.Peopl ear egener allyconsi der edobesewhent hei rbodymass
i
ndex( BMI ),ameasur ementobt ainedbydi v i
dingaper son' swei ghtbyt hesquar eoft heper son' s
2 2
height ,i sov er30kg/ m ,wi tht her ange25–30kg/ m def inedasov er wei ght .Obesi tyi ncr easest he
l
ikelihood ofv ari
ous di seases and condi t
ions, par ticul arlycar diov ascul ar di seases, type 2
diabet es, obst ructivesl eepapnea,cer taint y pesofcancer ,ost eoar thritisanddepr essi on.Obesi tyi s
mostcommonl ycaused bya combi nat ion ofexcessi vef ood i ntake,l ackofphy si calact i
v it
y,
andgenet ic suscept ibili
ty.A f ew cases ar e caused pr imar il
y bygenes, endocr in
disor der s, medi cat i
ons,orment aldi sor der .Obesi tyi smost lypr event abl et hr oughacombi nat i
onof
soci alchangesandper sonalchoi ces.Changest odi etandexer ci
si ngar et hemai nt reat ment s.Di et
qual itycanbei mpr ov edbyr educi ngt heconsumpt ionofener gy -densef oods, suchast hosehi ghi n
fatandsugar s,andbyi ncreasi ngt hei ntakeofdi et aryf iber .Medi cat i
onsmaybeused,al ongwi t ha
suitabl edi et , tor educeappet iteordecr easef atabsor pt i
on.I fdi et, exer cise, andmedi cat i
onar enot
effect iv e, agast ri
cbal loonorsur ger ymaybeper f ormedt or educest omachv olumeorl engt hoft he
i
nt est ines, leadi ngt of eel i
ngf ullear lierorar educedabi li
tyt oabsor bnut rient sf r
om f ood.Obesi tyi s
aleadi ngpr ev ent abl ecauseofdeat hwor ldwi de, wi thi ncr easi ngr atesi nadul tsandchi l
dr en.I n2015,
600mi lli
onadul t
s( 12%)and100mi lli
onchi ldrenwer eobese.Obesi t yi smor ecommoni nwomen
thanmen.Aut horitiesv iewi tasoneoft hemostser iouspubl i
cheal thpr obl emsoft he21stcent ury.
Obesi tyi sst igmat iz edi nmuchoft hemoder nwor l
d( par ticular l
yi nt heWest ernwor l
d) ,thoughi t
wasseenasasy mbolofweal thandf er t
ilit
yatot hert imesi nhi stor yandst i
llisinsomepar t
soft he
wor ld.I n2013, theAmer icanMedi cal Associ at i
oncl assi fiedobesi tyasadi sease.
CAUSES
*.Genei c40- 80%i fbot ht hepar ent sar eobese *.Agel ower edbasal met abol i
cr at e
*.Foodhabi t *.I ncr easei nt henumberandsi zeoff atcel lsi nt he
body .
*.Sedent aryl ifest y le *.Mal funct ionofendocr inegl ands( pituitar y,t
hy roid)
MANAGEMENT
*.Heal t hydi et *.St arv i
ng *.Sur ger y * .Medi cat ion
*.Lifest ylemodi fi
cat i
on *.Appr opr i
at ephy sical activity.
OSTEOPOROSI S
Ost eopor osi si sadi seasewher ei ncr easedboneweaknessi ncr easest her iskofabr okenbone.I ti s
themostcommonr easonf orabr okenboneamongt heel der ly.Bonest hatcommonl ybr eaki ncl ude
thev ert ebr aei nt hespi ne, t
hebonesoft hef orear m, andt hehi p.Unt i
labr okenboneoccur st her e
aret y pical lynosy mpt oms.Bonesmayweakent osuchadegr eet hatabr eakmayoccurwi t hmi nor
stressorspont aneousl y.Chr oni cpai nandadecr easedabi l
ityt ocar ryoutnor mal act ivi
tiesmay
occurf ollowi ngabr okenbone. Ost eopor osi smayal sooccurduet oanumberofdi seasesor
treat
ment si
ncl
udingalcoholi
sm,
anorexia,
hypert
hyroi
dism,ki
dneydisease, andsur gi
cal
remov al
oftheovari
es.Certai
nmedicati
onsincr
easetherat
eofbonel ossincluding
somechemot her
apy,protonpumpinhibi
tor
s,sel
ecti
veserot
oninreuptakeinhibitors,
andglucocorti
cost
eroi
ds.Notenoughexer ci
seandsmokingar ealsori
skfactor
s.
Preventi
onofosteopor
osisi
ncludesapr operdi
etdur
ingchildhoodandeffort
stoav oi
d
medicati
onsthatcausethecondit
ion.Effor
tstopr
eventbrokenbonesi nt
hosewi t
h
osteoporosi
sincl
udeagooddiet,exerci
se,andfal
lpr
evention.Li
festy
lechangessuchas
stoppi
ngsmoki ngandnotdri
nkingalcoholmayhelp.
CAUSE
*.Sedent ar yli
fe *.Smoki ng
*.Sexhor monesi nf requentmenst rual cy clesandest rogenl oss * .Lackofcal cium &Vi taminD
*.Genet icf actorwomen’ saremor epr onet oost eopor osi s. * .Lowbodywei ght
*.Bodysi zesmal l,t
hi nbondedwomenar eatgr eaterr isk * .Lackofappr opriateexer cise
MANAGEMENT
*.Medi cat on *
i .St rengt ht r
aining * .Av oidsmoki ng *.Av oidal cohol *.I
mpr ov e
nutrit
ion* .Cal ci
um suppl ement ation *.Consumpt ionofv itami nD * .Hormone
replacementt her apy
Cor onar yHear tDisease( CHD)
Coronar yhear tdi sease( CHD)i sanar rowi ngoft hesmal lbloodv essel sthatsuppl ybl oodand
oxygent ot hehear t
.CHDi sal socal l
edcor onaryarter ydi sease.Cor onar yhear tdisease( CHD)i st he
l
eadi ngcauseofdeat hi ntheUni tedSt at esf ormenandwomen.
CAUSE
Coronar yhear tdi seasei scausedbyt hebui l
dupofpl aquei nt hear teriest oy ourhear t
.Thi smay
alsobecal l
edhar deni ngoft hear ter ies. Fat tymaterialandot hersubst ancesf orm apl aquebui l
d- up
ont hewal lsofy ourcor onar yar teries.Thecor onaryar teriesbr ingbl oodandoxy gent oy ourhear t.
Thisbui ldupcausest hear t
eriest ogetnar row.Asar esul t,bloodf lowt ot hehear tcansl owdownor
stop.
Ar i
skf actorf orhear tdi seasei ssomet hingt hatincr easesy ourchanceofget ti
ngi t.Youcannot
changesomer i
skf act orsf orhear tdi sease,butot her sy oucanchange.See:Hear tdi sease-r isk
factors
SYMPTOMS
Itmaybev erynot i
ceabl e,butsomet imesy oucanhav et hedi seaseandnothav eanysy mptoms.
Thisi sespeci al
lyt ruei nt heear l
yst agesofhear tdisease.Chestpai nordi scomf ort(angi na)ist he
mostcommonsy mpt om.Youf eelt hi spai nwhent hehear ti snotget tingenoughbl oodoroxy gen.
Howbadt hepai ni sv ariesf rom per sont oper son.I tmayf eelheav yorl ikesomeonei ssqueezi ng
yourhear t.Youmayf eeli tundery ourbr eastbone( ster num) ,butal soi ny ourneck,ar ms,st omach,
orupperback.Thepai nusual lyoccur swi thactivityoremot ion,andgoesawaywi thr estora
medi cinecal ledni trogl yceri
n.Ot hersy mpt omsi ncl
udeshor tnessofbr eat handf ati
guewi thactivit
y
(exerti
on) .Women, elder l
ypeopl e,andpeopl ewithdi abet esar emor el ikelyt ohav esy mpt omsot her
thanchestpai n,suchas:
*.Fatigue *.Shor tnessofbr eat h *.Gener al weakness
BACKPAI N

Backpai niscommonwi thaboutni

neoutoftenadul tsexper ienci
ngi tatsomepoi nti
nt heir
l
ife,andf i
veoutoft enwor ki
ngadult
shavingi teveryy ear.Howev er ,i
tisrar
ef orittobe
per manentl
ydisabl
ing, andinmostcasesofher ni
ateddi sksr est,i
njecti
onsorsur ger
yhav e
si
mi l
argeneralpai
nr esol
uti
onoutcomesonav erageaf teroney ear.IntheUnitedSt ates,
acut elowbackpaini sthefif
thmostcommonr easonf orphy sici
anv i
sitsandcauses40%of
mi sseddaysoffwor k.Additi
onal
ly,
iti
sthesingleleadingcauseofdi sabil
it
yworldwide.
CAUSES
*.Acci dent * .Lif
ti
ngheav yobject*.Improperbending *.St
ress
*.St r
ain *.Overstret
ching *.Suddenjerk *.I
mpr operwar
m up
*.Badpost ur
e* .Weakbackmuscl e* .Poorfit
nesslevel
*.Injurytothemuscl e,bone,ornervesoft heSpain
MANAGEMENT
*.Wal k30mi nutesdaily
*.Docor eexercise2-3ti
mesperweek
*.Appl y15mi nheatinthemor ningand15mi niceintheeveni
ng
*.Getupf r
om t hechairever
y30mi n
FI
TNESSASSESSMENT
Car diorespir
atoryfuncti
on 12mi nrunorwal kt
est
 Coopertest
Bodycompositi
on ski
nfoldtest
Abdominalmusculart
est modif
iedsitup
Fl
exibi
l
ity si
tandreacht est
Muscularst
rengt
h handgri
pst r
ength/gr
ipdy
namomet
ert
est