Chapter 9 Gastrointestinal, Renal, Endocrine, Immunological System disorders Flashcards
1
Q
Dysphagia and swallowing disorders
Etiologies/types
- Facial paralysis
- Praxis/motor planning deficits
- Sensory impairment of the oral cavity
- Weakness of the tongue/base of tongue structures
- weakness of the elevation of thepharynx during swallow
- vocal cord paralysis
- penetration of the bronchioles/bronchi by the bolus when aspiration occurs
- Clinical aspiration
A
- Facial paralysis - incomplete closure fo the mouth, loss of bolus out of th efron of the oral cavity
- Praxis/motor planning deficits - inability to effectvely chew and coordinate tondue movements to propel the bolus toward the base of the tongue
- Sensory impairment of the oral cavity - lack of awareness of residual food on the side of the mouth that has decreased sensation, Pocketing food
- Weakness of the tongue/base of tongue structures - Inefficient propulsion of bolus at an efficient rate of speed past the base of the tonuge inot the pharyngeal cavitity
- weakness of the elevation of the pharynx during swallow - incomplete triggering of the pharyngeal phase of swallowing
- vocal cord paralysis - inefficient closure of the vocal folds during the pharyngeal phase of swallow
- penetration of the pronchioles/bronchi by the bolus when aspiration occurs - food enters the lun, true aspiration,. can result in introduciton of bacteria, causing pneumonia
- clinical aspiration - food enters the airway, can be cleared by airway coughing or it can silently aspirate when the person does not react ot the bolus entering the lung
2
Q
Dysphagia and swallowing disorders
Bedside swallowing evaluation
A
- Assess level of alterness
- assess sensory and motor components of swallowing
- assess ability to manage own secretions
- assess swallowing function using trial boluses - suggest diet modification as indicated
3
Q
Dysphagia and swallowing disorders
Relationship of swallowing dysfunction to occuaption
A
- Disruption of the person’s role relative to his/her family unit/decreased ability to comfortably eat at the dinner table (modified diet can be infatilizing
- Disruption of ability/decreased comfort level for eating out in public
- Alteration of self-concept concerning life roles and appearance
4
Q
Dysphagia and swallowing disorders
Interventions
A
- Provide/family centered intervention to determine an acceptable dinner tabl ealternaitve to interaction
- work to develop new roles and occupations
- Provide ongoing education and information to family regarding person’s feeding/nutrition
5
Q
Gastric Esophageal Reflux Disease (GERD)
- Symptoms and affects on occupations
- Intervention
A
- Symptoms and affects on occupations -
- Lower esophageal sphincter inefficiently closes, stomach contraction propels acid/acid bolus back into esophagus
- Symptoms of heart burn, indigestion, or dull chest pain
- swallowing problems, sensation of feeling that something is getting stuck in their throat.
- Interventions-
- sleeping with more than one pillow (elevating the head to discourage regurgitation associated with body posture
- diet modification (less spice, small meals on more frequent basis)
- stress management
6
Q
Small bowel obstruction
- Etiology
- Rehab issues
A
- Etiology - secondary to scar tissue, secondary to radiation of the abdomen, result of tumor obstruction
- Rehab issues - self-care aspects of stoma care (colostomy) must be addressed for persons with decreased fine motor skills. Decrease mobility of gros movements that cause traction on the healing scar
- avoid bending, stooping, foot/ lower leg related self-care, dressing, bathinig, nail and foot care.
7
Q
Neruogenic Bowel
- Etiology
- Significance to OT
A
- Etiology - Sympathetic nerve impairment, generally occuring in persons who have spinal cord injury above the T6 level.
- Results in loss of analy sphincter control
- Sensory loss and lack of awareness of feces in bowel
- Flaccidity of muscles results in incontinence
- Significance to OT -
- Autonomic dysreflexia results in an extreme rise in blood pressure.
- Medical emergency if not reversed
- complication of a spinal cord injury
8
Q
Kidney disease
- general symptoms/impact on performance
- Motor dysfunction
- Sensory system function
- cognitive dysfunction
- Perceptual/neuro behavioral dysfunciton
A
- General symptoms/ impact on performance skills and client factors -
- Motor dysfunciton - fatigue, muscle pain, edema limiting mobility, weakness
- Sensory system function -
- Neuropathy (diabetes related, toxicity related )
- vision loss (diabetes related)
- cognitive dysfunction - alteration of body image due to dialysis or post transplant, delusions due to sepsis or toxicity
- Perceptual/neuro behavioral dysfunction - dementia or stroke related
*
9
Q
Kidney disease
Intervention/impact on areas of occupation
- self care
- instrumental ADL -
- Social context
A
- self care - alteration in urination, need for sanitary technique with self dialysis, adherence to restrictive diet, alteration in secuality (impotence, alteration of self image, need for use of adaptived equipment, (tub bench, build-ups, reaching assistive devices,
- instrumental ADL - housekeeping, need for ligher work load, altered role in family, community mobility (adapted vehicles) meal prep (training to change habits for dietary limiations), problem solve with client on how they can participate in chose ov acitivity with minimal rsk an dawareness of precautions for participation.
10
Q
Stages of cancer
- Stage 1
- Stage 2
- Stage 3
- Stage 4
A
- Stage 1 -
- tumor present, no percieved spread of disease, leasion operalble
- Prognosis: good
- stage 2 -
- localized spread of the tumor, lesion is operable and can be removed with margins. responds well to treatment (chemo, immunotherapy)
- Prognosis : 50% survival in 5 years
- Stage 3 -
- Extensive evidence of a primary tumor that has spread to other organs in the body, tomor can be surgically debulked but some cells may remain behind, deeper spread of tumor cells in teh lymphatics
- Prognosis: 20% survival
- Stage 4 -
- inoperable primary lesion. Multiple metastases
- Prognosis: <5%
11
Q
Cancer
Rehabilitation Pre-operative Intervention
A
- pre operative functional assessments
- client and caregiver educaiton concerning recovery and follow up care/functional expectations and client enagement
12
Q
Cancer
Rehabilitation post-operative Intervention
A
- Intervention planning is based on medical status
- Precautions related to structural change from surgery (dependent on location of the tomor, if joint is replaced, abdominal precautions when the tumor ois in the abdominal cavity, regional precautions when there is an incision near a joint
13
Q
Cancer
Rehabilitation Convalecence Intervention
A
- rehabilitation of motor impairements, sensory impairments, cognitive impariemtns, neurobehaviroal impairements
- provide suppor to enhance coping ability during recover from cancer treatment phase
- Liminality - self recognition of vulnerability and self sense of mortality
- Occupational rol and body image adjustment
- development of health supporting behaviors with follow-up support (diet, exercise, stress management, vocational skill support
14
Q
Cancer
Rehabilitiation End of life care (hospice)
A
- support quality of life as desease advances and fucntional status declines
- privde client with as much control as the can and desire to have
- listen and counsel as possible concerning progression of disease and sense of liminalrity
- encourage planning for deat, control over goodbyes, funeral arrangements, advenced directives
- empower life celebration oand life reflection
15
Q
Scleroderma
- 3 main componenets
- Types
A
- 3 main components -
- Vascular - Raynaud’s phenomenon, constant recurrent constriction of small blood vessels leading to pulmonary hypertension.
- Fibrotic - Scar tissue resulting from excess collagen causing thickness of skin and burning sensation in the skin. Fibrosis of the lungs causing restrictive lung disease
- Autoimmunity - cell-porduced antibodies
- Types -
- Limited - Skin involvement (with good prognosis)Linear scleroderma (Bands of thicker skin with good prognosis
- Systemic - Sclerosis of internal organs (life threatening), CREST with good prognosis
