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195 Test 2 Flashcards

1
Q

Skin Disease

(signs and symptoms)

A

Pruritis

Rash

Blisters

Unusual moles, spots, nodules, cysts

Uticaria

Xeroderma

Changes in nail bed

Changes in color, texture, turgor

edema, swelling

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2
Q

Integument and Aging

A

Lost of elastin - poor wound healing

Decrease in Langerhans cells - poor immunological response

Epidermis and dermis compress - changes in permeability

Decrease in sweat glands - Poor thermoregulation

Decrease in number of nerve endings - Increase pain tolerance

Decreased vascularization - Poor circulation

Change in basil cells - decreas inflammatory response

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3
Q

Cellulitis

A

Infection of the skin and subcutaneous tissues

Localized Swelling, erythemia, warmth, tenderness

Often in LE, but can occur in UE torso and face

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4
Q

Cold Injuries

A

localized or systemic exposure to cols

Treatment:

Warm gradually, with warm water or against warmer body

Analgesics

Avoid WB

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5
Q

Burns

(definition)

A

Results from exposure to thermal, chemical, electrical, and radiation element

Classified by depth, size, location, age(<3 y.o., >70 y.o.) general health, and mechanism of injury

Superficial - Penetrates the epidermis (sun burn)

Partial-thickness - Pentrates the Dermis

Full-thickness - penetrates Subcutaneous

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6
Q

Superficial burn

A

1st degree

Penetrates the epidermis

Pain relieved with cold

Erythemia, dry, no blisters, skin blanches with pressure

Discomfort for 48 hrs. Heals in 3-7 days

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7
Q

Partial-thickness Burn

A

2nd degree

Penetrates dermis

Large thick walled blisters covering extensive area. Edema, mottled red base, broken epidermis, wet shiny weeping surface

Painful, sensitive to cold

Superficial heals in 14-21 days

Deep heals in 21-28 days

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8
Q

Full-Thickness burn

A

3rd degree

Penetrates subcutaneous

Painless

DRy surface, edema, fat exposed, tissue disrupted

Color varies (dark red, black, white, brown)

Heals with grafting (req’s eschar removal). Small areas can heal without grafting.

Wound contracture and hypertrophic scarring can occur if not prevenaive measure is aken

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9
Q

Rule of Nine’s

A

Head 9%

Torso front/back 18% ea

Arms 9% ea

Genitalia 1%

Legs 18% ea

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10
Q

Role of PT

Burns

A

Increase ROM, strength, mobility (dressings off)

Prevent and minimize deformities

Pulmonary hygiene

Wound care and positioning

Pt on meds, can feel pain but will forget.

* Pt has pain medication but can still feel the pain. They will later forget about it.

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11
Q

Arterial Ulcer

A

Arterial insufficiency

Located on lower leg, dorsal feet, distal toes, and lateral malleouli

Deep, well defined, dry with necrosis

Severe pain that increases with motion and LE elevation

Decreased skin temperature

Thin, shiny skin with hairloss

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12
Q

Venous Ulcer

A

Venous insufficiency

Dark, dusky pigmentation. Dry and Flakey skin

located medially on the LE

Irregular in shape, shallow, superficial, with moderate drainage

Mild to moderate pain, relieved with LE elevation

Increased edema

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13
Q

Pressure Ulcer

A

Located over boney prominences

Results from prolonged immobilization, shear force, medication, muscular atrophy

Stages 1-4

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14
Q

Neuropathic Ulcer

A

Associated with ischemia, and nerve damage

Over plantar surface of feet often over metatarsal head

Well defined wound, prominent callus, round crater like with minimal drainage. Usually deep

Without pain, unless neuropathy is painful

Shiny skin appearance

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15
Q

Lymphatic System

(purpose)

A

Maintain fluid balance within the tissues

Fight infection

Assist in cellular waste removal (destroy foerign bacteria, CA cells)

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16
Q

Lymphedema

A

Swelling of soft tissue from the accumulation of protein-rich interstitial fluid. May be idiopathic (primary) or acquired (secondary)

Primary - malformation of lymph vessels from birth

Secondary - Deformation of lymph vessels d/t trauma, surgery, ect.

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17
Q

Lymphedema

(signs and smptoms)

A

Commonly presents in the LE, can occur in the UE

Sensation of tightness, fullness

Decreases flexibility in wrist, ankle, hands

Increased limb circumfrence

Postural changes

Discomfort more than pain

Neuromuscualr defects

Increased risk of injury

Increased healing time (decrease oxeygen to the tissue decreases metabolic rate)

Integumet changes (hairloss, loss of sweat glands, Keratotic skin patches)

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18
Q

Lymphedema

(Causes)

A

Surgery

Burns

Crush injury

Raditaion Treatment

Chemotherapy

Paralysis

Severe laceration

Degloving skin injury

Lipedema

Air travel

Liposuction

Chronic venous insufficiency

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19
Q

Lymphedema

(Stages)

A

Stage 0 - Lymph transport capacity reduced. No noticible edema

Stage 1 - Pitting edema, reversible with elevation. (Normal size in the AM) Increases with heat, humidity, activity

Stage 2 - Non pitting edema with connective scar tissue. non reversible, fibrosis present. Skin changes occur in severe stage 2

Stage 3 - Lymphostatic elephantitis. Increase in connective and scar tissue. Severe non pitting edema with atrophich skin changes.

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20
Q

Lymphedema

(complications)

A

Thickening dermal layer

Skin dries and cracks causing poor healing ulcers

Skin folds and flaps develop and become sites of fungal and bacterilal infection.

Postural changes, ROM and functional changes

Changes in sensation, and kinesthetic awareness increasing the risk of injury

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21
Q

Implications form PT

A

Avoid trauma to the skin and minimize the risk of infection

Phase 1 - Skin care, manual lymph therapy, compression bandages, Individual home program

Phase 2 - Compression garments, skin care and exercise

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22
Q

Lipedema

A

Symmetrical swelling and accumulation of fatty tissue of the LE (not including feet)

Stage 1 - Soft and regular with nodular changes felt upon palpation. Subcutaneous tissue has spongy feel

Stage 2 - Tissue more nodular and tough. Pitting edema is common when associated with lymphedema.

Occure primarily in women

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23
Q

Cardiopulmonary

(signs and symptoms)

A

Chest, neck and arm pain

Palpitations

Dyspnea

Syncope

Fatigue

Cough

Cyanosis

Peripheral edema

Claudications

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24
Q

Chest Pain

A

Can radiate to jaw, neck, upper trap, shoulder or arm (commonly left)

Caused by ischemia, MI, pericarditis, endocarditis, mitral valve prolapse

Accompanied by Nausea, vomiting, diaphoresis, dyspnea, fatigue, pallor, syncope

Angina - refers to specific chest pain. Heart not gettin enough oxygen.

*R/O muscle pain with contraction and mvmnt through full range

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25
**Dyspnea**
Breathlessness, SOB DOE - May be caused by poor L ventricle function causing pulmonary congestion. May progresss to dyspnea on rest, dyspnea at night, orthopnea, and sudden unexplained episodes of SOB.
26
**Cough**
Associated with pulmonary complications of cardiovascular disease Associated with poor L ventricle function resulting in pulmonary edema Fluid in lungs
27
**Peripheral edema**
Indicates R ventricle failure, renal failure and CHF Usually bilateral and may be accompanied by jugular venous distention, cyanosis, and abd distention.
28
**Claudication**
Cramping or leg pain associated with activity. Indicated PVD Usually associated with skin discoloration and trophic skin changes. (Thin, dry, hairless skin) Accompanied by decrease in peripheral pulses and skin changes during/after exercise. \*Walking takes more oxeygen which causes more pain
29
**Cardiopulmonary and Aging**
Less blood circulated to the skin Heart works harder, and vascular system loses elasticity Cardiovascualr stsem is less able to respond to demands (decreased reserve capacity) Effects are lessened by physical activity and regular exercise D/t sedentary lifestyles and complications of disease, treatment, ect.
30
**Ischemic Heart Disease**
CAD and CHD Narrowing and hardening of the arteries Arterirosclerosis - thickening and lose of elasicity of the arterial walls Athersclerosis - thickening of arterial wall through the build up of lipids and cells
31
**Ischemis Heart Disease** **(Risk Factors)**
Modifiable - Smoking, poor nutrition, excess ETOH, stress, HTN, Obesity, inactivity, Elevated LDL and HDL Non-modifiable - Age, Male, Family HX, ethnicity, infection
32
**Ischemic Heart Disease** **(Medical Management)**
Decrease LDL levels before arteries are damaged Exercise, Diet, Modify risk factors, cholesterol lowerinf drugs. Treatment Surgery, PTCA (with stint), CABG Cardiac rehab - prescribed ex program I) in-patient II) Out-patient III) intermediate IV) long term rehab
33
**Ischemic Heart Disease** | (**Exercise**)
Increase exercies - lengthy and intense. Total Caloric expenditure is more important than short or long period of exercise
34
**Sternal Precautions**
Place hands on chest and ask pt to cough. Asymetry = unstable No pulling up in bd Hand held assist during mobilization No pulling/pushing/lifting more than 10 lbs - 6 wks post op No driving motorized vehicles or sitting shotgun - 4 wks post op Avoid H. ABD extreme ER Full neck, shld, torso ROM permitted with stable sternum. Skin of muscle flap present limits flex.abd 90 degrees
35
**Hypertensive Cardiovascular Disease**
Increased BP leads to arteriosclerosis which leads to HTN Cardiovasular Disease Persistant elevation of systoli \>140 or diastolic \>90 or both. Measured at least 2 wks apart
36
**Hypertensive Cardiovasular Disease** **(Risk factor)**
Modifiable - High sodium intake, obesity, sedentary lifestyle, personality traits, DM, smoking Nonmodifiable - Family HX, age, gender, ethnicity
37
**Hypertensive Heart Disease** **(Medical Managment)**
Prevention Activity, Weight control, Decrease sodium and ETOH intake, Alt modifiable risk factors Medication Beta blockers, calcium channel blockers, ACE inhibitors, Diuretics Exercise - Health beneofts for HTN can be achieved with fitness, and increase in activity
38
**Myocardial Infarction**
Developement of ischemia with heart muscle necrosis Exercise begins within 24 hrs, in uncomplicated cases, to decrease complications/effects of bedrest and to begin retraining the heart (pacing with periods or rest)
39
**CHF**
Heart can't pump enought blood to supply the bodies needs L ventricle failure R ventricle failure - cause by pulmonary emboli and L ventricular failure Common complication of HTN and ischemis Heart Disease
40
**CHF** **(exercise)**
Monitor vitals Aerobic capacity decreased Position (fowler's, head elevated 20 degrees) Mod intensity exercise for 2-6 mins followed by 2 min rest Note: Decrease in aerobic activiyy
41
**Orthostatic Hypotension**
Decrease in 20 mmHg systolic or Decrease in 10 mmHg in both systolic and diastolic with an increase of 15 bpm when going from sit to stand Caused by Medicine side effects, prolonged immobilization, malnutrition, valsalva maneuver, venous pooling
42
**Orthostatic Hypotension** **(Treatment)**
Slow rise from bed to stand ankle pumps raise hands over head with deep breaths Abd compression (binders, stockings) Increase HR, BP
43
**PVD**
Disease of the blood vessles suppling the extremities and abd organs(commonly intestines and kidneys) Inflammatory Arterial occlusive Venous Disorder Vasomotor Disorder
44
**Thrombophlebitis**
PVD (Venous disorder) Partial or complete occlusion of a vein by a clot along with an inflammatory reaction in the wall of the vein. Superficial (vericose, IV) Deep (DVT)
45
**DVT**
Increases risk for pulmonary emboli Caused by venous stasis, abn coagulation, injury to vein wall Usually occurs in the LE, may be in UE (Edema without pain) Many are asymptomatic. Symptomatic would include tightness, edema, calf pain Diagnosed through doppler.
46
**DVT** **(Medical Managemnet)**
Goals Prevent progression of emboli limit damage to vein prevent the development of another clot Treatment Anticoagulation therapy Elastic stockings Prevenative (early mobilization, anti-coag tx)
47
**DVT** **(Risk Factors)**
Immobility - bedrest, cardiac failure, travel Trauma - Vericose veins, surgery, fx, childbirth Lifestyle - smoking, hormonal status Hypercoagulation - hereditary thombotic disorder, increased levels of coagulation Other - DM, Obestiy, older than 60, prev dvt
48
**Raynaud's Disease**
PVD (vasomotor disorder) intermittent vasospasms of distal extremities in reponse to cold exposure or strong emotion Takes long for hands to warm
49
**Chronic Venous Insufficiency**
PVD (Venous disorder) Inadequate venous return over a long period of time. Chronic pooling of the blood prevents adequate oxygen and waste removal which can lead to skin ulcers
50
**Chronic Venous Insufficiency** **(Risk Factors)**
Leg trauma varicose veins Prev DVT
51
**Chronic Venous Insufficiency** **(Implications for PT)**
Prevention of ulcers exercise compression therapy education
52
**Alpha Adrenergic Blockers**
**_Decrease BP_** by dilating peripheral blood vessels which reduce peripheral resistance. Smooth Muscle relaxer Side effects: Headache, palpitations, dizziness, fatigue, nausea, fainting, weakness, drowsiness
53
**ACE Inhibitors**
1st line of defense for HTN Prevents the constriction of blood vessles and retention of sodium and fluid Improves HR during exercise in early phase of MI to prevent Heart Failure Side effects: Insomia, Headache, weakness, dizziness, rash, dry cough, palpitations, fainting, abd/feet swelling, numbness and tingling in hands, feet, and lips
54
**AT-II receptor antagonistic agents**
Vasodilate arterioles and enhace renal clearance of water and sodium Side effects: Myalgia, dizziness, insomnia, anxiety, hypotension, visual changes, cough
55
**Antiarrhythmic agents**
Alter conduction patterns in the heart Side effects: Nausea, vomiting, rash, electrolyte imbalance, insomnia, dizziness, SOB, swollen ankles, coughing blood
56
**Beta Blockers**
Relaxes blood vessels of the heart which reduce HR, BP, dysrhythmias, angina and myocardial oxygen demands Side effects: Decrease rest/ active HR, DIB, chest tightness, syncope, orthastic Hypotension, weakness, Asthmatic attacks, dizziness, nausea, fatigue, insomnia
57
**Nitrate**
Treats angina, CHF, HTN, pulmonary edema Dilate coronary arteries to decrease blood flow to the heart Side effects: Headache, dizziness, orthostatic hypotension, tachycardia
58
**Statins** **(Lipid lowering drugs)**
Blocks tge absorption of Cholesterol. Helps increase HDL and slightly lowe LDL Side effects: Nause, Vomiting, Diarrhea, constipation, myalgia, rhabdomyolysis, neuropathy
59
**Rhabdomyolysis**
Inflammation of the muscles causing skeletal break down. Large particles that get released in to the blood stream which can cause kidney damage.
60
**Pulmonary Disease** **(Signs and symptoms)**
Cough Cyanosis Chest Pain Clubbing Dyspnea Alt breathing patterns/sounds Rate, depth, regularity, effort, use of accessory muscles, Adventitious breath sounds.
61
**Adventitious Breath Sounds**
Identified via auscultation. typical of airway constriction or fluid accumulation crackles rales rhonchi wheezing stridor dimished breath sounds Absent breath sounds
62
**Diagnostic Procedures** **(Pulmonary)**
PFT ABG - Measures O2 and CO2 in alt blood, arterial PH Cultures and sensitivity- Presence, type of microorganisms Thoracentesis - Remove pleural fluid Bronchoscopy - Direct visualization of bronchioles CT and MRI Pulse Oximetry - Measure O2 saturation
63
**Pulmonary Funtion Tests**
Screen for specific pulmonary dieases. Reveal abnormalities Tests - Static lung volumn, dynamic breathing, physiologic tests Values recorded VC, IC, IRV, ERV, FRC, RV, TLC, Vt, f
64
**Aging and the Pulmonary**
Infections, environmental/occupational pollutants and the normal aging process is what decreases lung function Aging causes structural changes in upper and lower resp system Leads to increase work to breath Decrease in muscle strength Decrease movement of cilia Increased chest wall stiffness Loss of elastic recoil Surface area for gas diffusion changes
65
**Pneumonia**
Inflammation of the lungs or alveoli Bacterial, fungal, viral, mycoplasmal Inhale toxi or caustic chemical, smoke, dust, grease Aspiration of food, fluids, vomit
66
**Pneumonia** **(Signs)**
Sudden sharp chest pain aggrevated by mvmt Hacking, productive cough-rust/green colored Dyspnea Tachypnea + decreased excursion cyanosis Headache fatigues Fever, chills General aches and pains Myalgia
67
**Pneumonia** **(Implications)**
Early ambultion Potisioning Adequate hydration pulmonary hygeine (deep breathing, coughing, ect)
68
**Pulmonary Tuberculosis**
Inflammatory systemic disease Bacterial infection in the lungs effecting the upper lobe Risk factors Pt with HIV, poor population, prisonors, DM, older than 65, infants, druggies, end stage renal disease, immunocompromised. Commonly transmitted by inhalation
69
**Emphysema**
Pathalogical accumulation of air in the lungs particularly found in pt's with COPD Signs Dyspnea, cough, Wheezing Chronic allergies, liver problems, asthma that does not respond to treatment
70
**Asthma**
Obstructive lung disease Inflammation and increase of smooth muscle reaction of airways to various stimuli Symptoms: Coughing, chest tightness, wheezing, SOB Treatment: Fowler's position Encourage pursed lip, deep breathing
71
**Near Drowning**
Survived the effects of fluid submersion. (lack of O2 effects blood acidosis) Leads to cognitive and motor deficiency
72
Peripheral Edema
INdicates r ventricular failure and CHF Usually bilateral and dependant . May be accompanied by jugular venous distention, cyanosis and abd distention
73
Ischemia
Obstruction in blood flow to tissue causing hypoxia on a cellular level Precursor to infarction
74
Hypoxia
Decrease oxygen to a cell
75
Infarction
Cell death
76
Pulmonary Embolism and infarction
Obstruction to the blood supply to the lings due to a blood clo in the pulmonary artery. Most common cause of DVT
77
Pulmonary embolism and infarction | (Risk Factors)
Contraceptive DVT occuring after surgery
78
Pulmonary embolism and infarction | (Implications for PT)
Ankle pumps post op Do not message leg cramp Avoid - Restrictive clothing, crossing legs, prolonged sitting/standing Elavate legs, knees bent, hip \<90
79
Pleural Effusion
Collection of fluid in pleural space. Commonly caused by heart failure and lymphatic obstruction. Asymmtomatic, DOE, CP(sharp, stabbing) Implications: Deep breathing, position changes (carefully)
80
COPD
Chronic airflow limitation. Not fully reversible. Caused by environmental irritants (ie. smoking) Preventable, no cure
81
COPD | (Implications for PT)
exercise Smoking Cessation Nutrition/ wt control Breathing exercises Monitor vitals (pulse ox)
82
Atelectasis
Collapse of the lung tissue at the structural level due to obstruction of the bronchus by mucus, tumor, foreign body, shallow breathing (hyperventilation, after coma...) Secondary effect to thoracic, abd and cardiac surgery
83
Atelectasis | (Implications for PT)
Frequent, gentle position changes Depp breathing Coughing Early ambulation Pot op treatment: Once atelectasis occurs, remove the cause
84
Pulmonary Edema
Excessive fluid in the lungs that accumulates in the interstitial tissure and/or air space Commonly caused by L sided heart failure, acute HTN, mitral valve disease, or other non-cardiac diseases
85
Pulmonary Edema | (signs)
Asymptomatic restlessness, anxiety cough dyspnea diaphoresis, intolerance to exercise Adventious breath sounds Paroxysmal noctural dyspnea
86
Pneumothorax
Accumulation of air and gas in the pleural cavity. leads to collapsed lung on affected side Symptoms: dyspnea, Sudden sharp chest pain decreases BP weak rapid pulse
87
Pneumothorax | (Implications for PT)
Monitor vital signs (BP, Pulse)
88
Endocrine system Rule and function
System of gland responsible to the formation and release of hormones used to regulate cell and organs. Works with the nervous system to regulate homeostasis. Functions: Differentiate btwn reproductive and CNS of fetus Stimultaion of sequential gorwth and development during childhood and adolescence Coordintaion of male/female reproductive systems Maintain optimal internal environment Inititate and coordination of response to emergencies
89
Aging and the endocrine system
Influences production, metabolism, and action of hormones changes in tissue makeip of a gland Decrease in hormone secretion (organs themselves change in size, secretions themselves are the same in relation to size) Lessened response/inability to turnoff response
90
Cushing's Syndrome
Excess production of the glucocorticoid from th adrenal gland. Results of pituitary adenoms -\> secrete excess ACTH -\> overstimultaion of the sdrenal gland; or from large doses of cortisol or corticol derivitives Signs: Protuberant abd Stretch marks Poor wound healing Thinning of skin Gen m. weakness Osteoporosis Moon face
91
Addison's Disease
Pituitary adrenal insufficiency with insifficient cortisol release. Idiopathic or auto immune Risk factors: Surgery pregnancy Acc/ injury/ trauma Infection Salt loss from profuse diaphoresis Medically managed with pharmacology. Moitor vitals
92
Gigantism and Acromegaly
Results from GH secreting adenomas. Gigantism - overgrowth of long bones. Developes in children Acromegaly - Increased bone thickeness and hypertrophy of the soft tissue. Effects face, jaw, hands, feet of adults Implications: Post op: Vital signs and neurologic status is to be monitored. Alt LOC, visual acuity, decreased pulse and increased BP. Blood glucose Acromegaly - Weakenss, changes in jt mobility, poor exercise tolerance
93
Hypothyroidism
Thyroid hormone deficiency -\> slowed body metabolism -\> slowed GI motility, bradycardia, decreased heat production, increase serum cholesterol and triglyceride levels
94
Hypothyroidiams Symptoms
Fatigue Mild sensitivity to cold Mild wt gain Forgetfulness Depression Dry skin/hair Advanced: myxederma, flexor tenosynovitis, CTS, proximal m weakness, poor peripheral circulation
95
Hypothyroidism Exercise
Activity intolerance Weakness (d/t m. loss) Changes in jt synovium (similar to arthritis) Assoc with rhabdomyolysis
96
Hyperthyroidism
Excessive secretion of thyroid hormone -\> generalized elevation of the body's metabolism Immunologic or genetic derived Implications: Exercise and heat intolerance Fatigue increase in norm HR
97
Grave's Disease
Most common form of hyperthyroidism. Autoimmune over function of the entire gland Syptoms: Enlarged thyroid Nervousness Heat intolerance Wt loss with increased appitite Diarrhea Tremor Palpitations
98
Grave's Disease Implications for PT
Proximal m. weakness with myopathy exercise and heat intolerance Fatigue Increased or norm HR
99
Adenoma
Benign tumor of glandular origin

PTA Patho (4 decks)

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