Exam 3 Flashcards
Define Preload
how much volume can get in before contraction. End Diastolic volume, venous return.
Define Afterload
pressure in the aorta that the LV has to overcome. stiff aorta gives more resistance so harder for blood to get out. stenosis of aortic valve
Define contractility
how well the left ventricle can contract. Frank Starling relationship. amount of volume left.
What is cardiac output? How do SV and HR affect it.
CO= SV(x)HR
Cardiac Output is the amount of blood the heart can pump in a unit of time. normal is 4-8L/ min
Name 3 abnormal HR responses to activity.
- bradychardia- a slow HR
- in ability to elevate HR
- inability to achieve 85% of HR max
- delayed recovery of HR post exercise. <12 bpm
Define appropriate hemodynamic responses to activity using: HR, BP, SpO2, RR)
HR: should increase. anywhere resting (60-100) to Max.
BP: it depends but usually should increase
RR: should increase
SpO2: normal to stay the same. up is good too.
List 4-5 things that can cause an abnormal HR response to activity.
- older age
- presence of CAD
- smoking
- exercise intolerance
- LV dilation
- Ischemia
- SA or AV node dysfunction
- issue w/ modulating autonomic tone
- stiffness/ hypertrophy of myocardium
Discuss Frank Starling curve. Length/ tension of myocardium and how it affect cardiac performance.
As preload (or initial volume in the ventricles) increases the stroke volume will increase as well to a limit. When myocardium is streched by the ventricles being filled more, it will contract more forcefully and the amount of blood ejected, or SV will increase. There is an optimum length for cardiac sarcomeres. (In normal systolic function this happens)
discuss the normal response to standing from a supine position.
- .5 to 1L pooling in legs
- reduced venous return to heart
- reduced CO and BP
- reduced arterial baroreceptors & ^ sympathetic activity
- increased venous return, PVR, & CO
- limits fall in SBP to ~5-10mmHg, & ^HR (10-25 bpm)
What is orthostasis? what are potential causes.
with position change from supine to standing SBP drops >20mmHg, and/ or DBPdrops >10 mmHg within 3 minutes of standing or at least 60* on tilt table
What are the 4 most common barriers to wound healing?
- Inadaquete microcirculation
- prolonged pressure from interstitial edema
- bacterial infection
- the absence of an adaquete electrical potential
What other factors impair wound healing? (9)
- Tissue perfusion and oxygenation
- nutritional status
- presence or absence of infection
- DM
- corticosteroid administration
- immunosuppression
- aging
- other systemic factors
- Topical therapy
Pressure Ulcer: MOI, staging/ classification, optimal goal to promote wound healing
pressure usually over a bony prominence, or a combination of pressure with sheer and or friction. STAGED/ DTI/ unstageable. Frequent repositioning
Venous insufficiency ulcer: MOI, staging/ classification, optimal goal to promote wound healing
muscle pump failure causing: pericapillary fibrin deposits resulting in thrombosis, obstruction, dilation, hemoragge.
Partial/ full thickness. use of compression.
arterial insufficiency ulcer: MOI, staging/ classification, optimal goal to promote wound healing
caused by inadaquete blood supply. low ABI. Partial/ full thickness. To promote wound healing: establish adaquete circulation and exercise and mobility.
diabetic/ neuropathic ulcer: MOI, staging/ classification, optimal goal to promote wound healing
combination of: minor trauma, PVD, peripheral neuropathy, and biomechanical abnormalities. Wagner Scale. Off load pressure/ total contact cast and good glucose control.
Name 3 out of 4 techniques to maintain skin health and prevent wounds.
- keep skin clean and dry
- daily personal hygiene
- clean skin with warm/ tepid water
- moisturize skin
Name 4/5 techniques to reduce exposure to irritants and prevent wounds.
- clean immediately after incontinence
- apply skin protectants
- keep linens clean/ wrinkle free
- check fit of braces, splints, medical devices, and skin underneath
- maintain enviornmental humidity
What’s the difference b/wn slough, eschar, and necrotic tissue?
slough is yellow, stringy and looks like snot- comes off on its own.
eschar is thick- black or brown dry leather like tissue.
necrotic is non viable
What’s the difference between tunnelling and undermining?
undermining are areas eroded below and behind the wound edge. “Tissue loss parallel to the skin surface.”
tunnelling is a deep open space with defined walls
8 characteristics to include when documenting a wound?
- Exact location
- shape
- size
- stage- if pressure ulcers
- full/ partial is burn….
- wagner’s if diabetic
- tunnelling
- exudate
- odor
Discuss the importance of fluid balance in the environment of healing. edema vs dry wound.
You don’t want a dry wound because “optimal wound fluid” contains optimal rations of endogenous enzymes, cytokines and growth factors. basically allows for efficient healing….but if moisture progresses to the point of edema where there is interstial fluid accumlation tissues will be damaged with functional impairments.
Describe lab values that describe renal function.
- Blood Urea Nitrogen (BUN)
- Creatinine ( liberated from muscle and exreted at a constant rate.
- Electrolytes:NA+/ K+
- Glomerular Filtration Rate
Risk Factors for UTI (7)
- women
- pregnancy
- older adults
- catheterization
- instrumentation
- sexual intercourse
- obstruction
List 8 clinical manifestations of UTIs
- Aneuria or oliguria
- Dysuria
- nocturia
- hematauria or pyria
- increased frequency/ urgency
- intermittency/ post void dribbling
- chronic retention or voiding issues
- pain: shoulder, back, flank, pelvis lower abdomen
- costovertebral tenderness
- fever, and/ or chills
3 red flags regarding a patient with a UTI to stop a PT session.
- fevers or chills
- pain that is not reproducible
3.
What is measured to define chronic kidney disease?
Glomerular Filtration rate
Describe the process by which osteodystrophy can occur in patients with chronic kidney failure.
the body no longer porduces calcitrol, a form of vitamin D. so the body can no longer absorb calcium from food and will start removing it from bone.
Clinical manifestations of chronic renal failure in each of the following systems:
- integument
- hematologic
- body fluids
- ENT
- pulmonary
- cardiovascular
- GI
- genitourinary
- skeletal
- neurologic
- integument: itching, hyper pigmentation, bruising
- anemia, impaired platelet aggregation.
3. - blurry, dry, red. or conjunctival calcifications.
- pulmonary: pulmonary edema, dyspnea on exertion,
- CV: CAD, HTN, HF, pericariditis
- n/v, anorexia
8. - renal osteodystrophy, joint calcifications
- vibratory sensory loss, reduced DTR, paraesthesia, headache, seizure, coma, lethrgy, sleep disturbances, muscle cramps, muscle twitch, foot drop
Implications for patients with chronic kidney disease
Increased risk for DM and HTN
Types of hemodialysis access. state 2 associated precautions.
home, clinic
List 4 types of dialysis and briefly describe each
- continuous veno-venous hemofiltration- loses the same amount of volume over the course of 24hrs.
- continuous renal replacement therapy
- continuous ambulatory peritoneal dialysis
- continuous cycling peritoneal dialysis - overnight
- intermittent peritoneal dialysis- extended CCPD 36-42 hrs/wk
4 complications associated w/ dialysis
- graft infections
- peritonitis
- dialysis dementia
dialysis disequilibrium
Cause of dialysis dementia
Aluminum accumulation in the blood (dialysis can’t remove Al) causes accumulation in two sites- brain and bone. Al in the brain can lead to DD.
etiology of dialysis disequilibrium
antibiotics and increased osmotic pressure in the brain
List 10 risk factors for cancer.
How do they relate to PT?
- age >50
- family Hx of CA
- Previous Hx of CA
- ethnicity
- skin color
- smoking
- chemical exposure
- urban dwelling
- ETOH
- sedentary lifestyle
For both men and women which type of cancer will lead to the most new diagnosis of cancer this year as well as most deaths from cancer this year.
Deaths: lung & bronchus both men and women
new diagnses: men- prostate. women: breast
Pathogenesis of cancer
neoplasm originates from single cell with a genetic change. chromosomal aberation leads to tumor cell proliferation.
What is a metastatsis? How likely is it that a patient will have metastsatic lesions?
tumor cells are shed into blood stream from tumor. 30% of patients w/ newly diagnosed Ca have clinically detectable mets. 30-40% have hidden mets.
6 common bony metastatic sites.
femur, hip, ribs, vertebrae, pelvis, humerus
List the 5 common metastatic sites and state why?
These are highly vascularized areas.
pulmonary, hepatic, bone, CNS, lymphatic system
Which metastatic sites will PTs most likely note and why?
skeletal, CNS, pulmonary, heaptic
4 types of interventions for cancer and complications w/ each.
- Radiation skin redness, irritation, itching, poor wound healing
- Chemotherapy- N/V, hairloss, immunosuppresion, bleeding
- Surgery, bleeding, inability to remove all the tumor cells, infection
- biologic response modifiers- few
- hormones- depends on the expected response of the hormone used
State the early warning signs for cancer.
- changes in bowel or bladder
- A sore that doesn’t heal in 6 weeks
- unusual bleeding or discharge
- Thickening of lump- breast or elsewhere
- Indigestion or difficulty in swallowing
- obvious change in wart or mole
- nagging cough or hoarseness
- supplemental S/S: rapid unintentional weightloss, changes in vital signs, frequent infections… night pain, pathologic fx, proximal muscle weakness, change in DTRs)
ABCs of detecting melanoma.
Assymetry- uneven edges
Border- irregular, poorly defined
Color- black, shades of brown, red, white
Diameter- larger than 6 mm
Elevation/ evolving- raised above skin surface, uneven
Areas of focus for a PT when treating a patient w/ cancer
Pain Endurance/ fatigue Therex modalities current or future tx patient and family ed. patient and family goals
