EXAM 2 Flashcards
RA
Systemic in nature; can develop in the heart, lungs, blood vessels or eyes
Characterized by remissions and exacerbations
Chronic systemic inflammatory disease of the synovium.
bilateral/symmetrical
morning stiffness less than 1 hr
etiology unknown, (monocyclic, polycyclic, or progressive)
OA
Chronic disease involving the joints especially weight bearing joints (i.e. DIP, PIP, Thumb CMC, MTP, Knee, Hip)
Characterized by destruction of articular cartilage, overgrowth of bone, spur formation, and impaired function
Occurs as a result of aging – affects 10% of the older population
Typically asymmetrical and does not present with nodules
genetic from defect in collagen production, trauma, wear and tear, progressive
common arthritic joint deformities
Nodules/synovial thickening, trigger finger
Tendon rupture
Ulnar drift
Palmar subluxation Intrinsic plus hand Thumb deformities (Nalebuff Classification) Gamekeeper Zig zag deformity
Boutonniere - DIP extension, PIP flexion, lateral band volar
Swan Neck Deformity - DIP flexion, PIP extension, lateral band dorsal
rheumatic disease evaluation procedures
ROM, Soft tissue, Pain, Sensation, UE strength, Dexterity, ADLs, Endurance, Treatment plan, Living situation
classifications for Global Functional Status in RA
Class 1: Completely able to perform usual activities of daily living
Class 2: Able to perform usual self-care and vocational activities but limited avocational activities
Class 3: Able to perform usual self-care activities, but limited in vocational and avocational activities
Class 4: Limited in ability to perform usual self-care, vocational and avocational activities
Vocational: Work, school, homemaking
Avocational: recreation or leisure
Systemic Lupus Erythematosus (SLE)
No uniform pattern of symptoms
Fever, weakness, fatigue, weight loss, skin rash on face or neck or arms
Raynaud’s
Joint pain in the hands, wrists, elbows, knees, or ankles
Muscle aches, swollen glands, lack of appetite, low grade fever, hair loss and nausea and vomiting
Depression or inability to concentrate
Photosensitivity
scleroderma (localized and generalized - CREST)
cause unknown
- localized: Morphea, hard, localized, oval patches on the skin
Linear, a line of thickened skin on the arms, legs or forehead. It can extended deep into the skin and affect the bones and muscles underneath
- generalized: Limited (CREST) – calcinosis, Raynaud’s phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia
Diffuse, occurs throughout the entire body
s/s scleroderma
Skin – hardening and thickening, ulcers on the fingers, decrease in hair over affected area, change in skin color
Swelling – fingers and toes look and feel swollen, shiny skin, tight skin, lack of skin creases, numbness and tingling
Sclerodactyly – skin of fingers and toes becomes hard and shiny, difficulty bending fingers leading to contractures
Raynaud’s phenomenon
Telangiectasia
Calcitosis – white lumps under the skin that can break through and leak a chalky white fluid
Arthritis and muscle weakness – painful and swollen joints, general fatigue, weak muscles in shoulder or hip
Sjogren’s Syndrome – deceased secretions of mucosal surfaces
Digestive, heart, lung, kidney problems
psoriatic arthritis (5 types)
- Symmetric Psoriatic arthritis – progressive and destructive. Resembles RA, but generally milder. Affects matching pairs of joints on both sides of the body
- Asymmetric Psoriatic Arthritis – involves 1-3 joints large or small.
- Distal Interphalangeal Predominant (DIP)
- Spondylitis – inflammation and stiffness in the neck, lower back, spine
- Arthritis Mutilans – severe, deforming, and destructive. Primarily affects small joints in the fingers and toes closest to the nail, but also is associated with lower back and neck pain. Uncommon.
psoriatic arthritis s/s
Gray scaly spots on the scalp
Pitting or detachment of fingernails or toenails
Pain in one or more joints
Skin problems occur months or years before swelling and pain
Swelling of fingers and/or toes that gives them a sausage like appearance
Ankylosing Spondylitis
More common in males than females, onset 16-35
Presentation: inflammation causes pain and stiffness progressively up the back. The whole spine begins to fuse together. Can also affect the hips, knees, and ankles, and some patients have eye inflammation (25%)
It is very important that patients keep their back in good position to avoid fusing in an undesirable position. Leaning back against a wall is a good way to ensure good posture.
Surgery is rarely done
Fibromyalgia
90% moderate to severe fatigue
Decreased exercise endurance
Numbness and tingling in the hands, arms, feet, legs and sometimes face
Tenderness of at least 11 of the 18 areas identified.
sternal precautions
No weight-bearing on UE No pushing, pulling or lifting for 12 weeks-- 5 Ibs x8 weeks; 10 Ibsx 8-12 Use pillow when coughing DO AROM exercises Log roll
phases of sternectomy rehab
Phase 1: Inpatient phase (3-7 days) – review sternal precautions, initiate physical activity and provide home exercise/activity guidelines.
Phase 2: Acute outpatient (up to 12 weeks) – comprehensive program including individually prescribed and monitored exercise, and individual and group educational sessions aimed at reducing risk factors and secondary events.
Phase 3: Follows phase 2 (6 months or more) – a continuation of phase 2 but patients no longer receive continuous telemetry monitoring during exercise and are more independent.
Understand the concept of a joint only being a small percentage of the whole body
Take a single joint measurement of a finger, look up the impairment of finger percentage, look up the relationship of impairment of the finger to impairment of the hand, look up the relationship of impairment of hand to impairment of upper extremity, look up the relationship of the upper extremity to impairment of the whole person.
Recognize the process that is carried out to obtain a percentage disability
Not done until pt has maxed out all treatment that would improve their condition
Functional history, clinical tests, and medical history all considered
Needs of pt, physician, lawyer, and insurance companies all considered
OT completes eval, which is reviewed by independent medical examiner
Recognize tools that could be used to assess the functional status of a client.
AMA evaluation of permanent impairment= main test
Evaluation tests: RIM, QuickDash, COPM, grip strength, sensation testing, etc
causes of COPD
Emphysema- Progressive and irreversible destruction of alveoli walls
Chronic Bronchitis- Excessive sputum production and cough of at least 3 months in duration occurring 2 years in a row
Increase risk of COPD: smoking, exposure to lung risk environment, allergens
Identify signs of COPD and stages in which they occur including expected survival rates based on Forced Expiration Volume (FEV)
FEV1 is the volume of air that can be forcefully expelled in 1 second. In COPD the FEV1 is directly related to severity and thus prognosis of the disease.
FEV > 1.5 is considered mild with a prognosis of 10-20 years.
FEV from 1-1.25 is considered moderate with a prognosis of 6-10 years.
FEV < 0.75 is considered severe with a prognosis of 2-6 years.
treatment methods for COPD
Bronchodilators: Adrenergic agents, anti-cholinergic agents, methylxanthines, corticosteroids, mucolytics, diuretics
*Know what kind of medications they may be on
Other treatments: weigh daily (excess weight could mean fluid retention), eat a low salt diet (to prevent fluid build up), be as active as possible without over exertion, vitamin D
Rancho Los Amigos Dyspnea Scale
0: pt unaware of need to breathe 1+: slight awareness 2+: aware, breathes mid-sentence 3+: breathing rapid and deep 4+: can’t carry conversation
Facilitate all aspects of the treatment process for COPD patients
Encourage as much moderate exercise as possible without over-exertion→ increase functional endurance
Work on UE function
Work simplification and energy conservation
Education about energy conservation, relaxation techniques
Evaluate breathing patterns (what muscles are they using?). Teach breathing techniques
Stop treatment is they have chest pain, fever, or nausea
burn depths
1st deg: epidermis
2nd deg: dermis
3rd deg: subcutaneous tissue
4th deg: mx or bone
Demonstrate understanding of percentage burn chart
TBSA: total body surface area. Percentage of skin around body that’s affected
