GI, renal, endocrine, immunological, integumentary systems Flashcards
conditions that impact swallowing
- facial paralysis
- praxis/motor planning deficits
- sensory impairment in oral cavity
- weakness of tongue and pharynx
- vocal cord paralysis
- clinical aspiration
swallowing dysfunction observation
- person coughs during or after drinking water
- face changes color
- sometimes can visualize the obstruction and remove it
aspiration
needs immediate action!
- heimlich maneuver
- BLS if LOC
bedside swallowing eval
- assess level of alertness, ability to follow directions, level of awareness, orientation to activity
- assess sensory and motor components of swallowing
- assess ability to manage own secretions
Modified barium swallow study (MBSS)
- person upright on radiology table
- needs sitting balance
- administer trial boluses of mixed food consistences laced with barium
- video records moving x-ray of swallow
Fiberoptic endoscopic esophageal swallow (FEES)
- food consistences are laced with green food coloring
- given a variety of consistencies to swallow
- endoscopic catheter with mini video camera
OT eval and intervention with swallowing disorders
should include collaboration with the person (and SLP, dietitians, nurses, fam members)
consider their roles socially and with family around eating
small bowel obstruction
- from scar tissue, radiation, tumor
- surgical treatment
- rehab: self-care aspects of stoma care must be addressed (consider cog status)
- abdominal precautions
neurogenic bowel
- sympathetic nerve impairment, usually with SCI above T-6
- loss of control of anal sphincter
- sensory loss –> lack of awareness of feces in the bowel
- flaccidity of muscles
autonomic dysreflexia can occur*
kidney disease - risk factors
- diabetes
- hypertension
- systemic lupus erythmatosus
- dehydration, smoking, alcohol, medications, physical inactivity, salt and sugar
stages of kidney disease
1-5, worsening of glomerular filtration rate
Medical management during each stage:
Stage 1. prevention of progression
Stage 2. management of health conditions
Stage 3. management of anemia and bone loss
Stage 4. education of further management (dialysis)
Stage 5. for life to be sustained, must have dialysis or kidney transplant
s/s chronic kidney disease
vomiting, loss of appetite, fatigue and weakness, sleep problems, changes in urination output and color, muscle cramps, swelling, persistent itching, HTN
stress incontinence
after having children, morbid obesity, weakening of musculature with normal aging
- kegels/strengthen pelvic floor
- timed routines for emptying bladder to prevent spillage
- medications
cancer risk factors and prevention
- hereditary
- envrionmental
- habit or lifestyle related
- screening tests
- avoid environmental contributing factors
- avoid/change contributory habits
cancer stages
Stage 1: tumor present, no perceived spread, good prognosis, operable
Stage 2: localized spread of the tumor, limited and usually responds well to tx
Stage 3: tumor spread to other organs in the body, some can be operated, including lymphatics
Stage 4: inoperable primary lesion, multiple metastases
scleroderma
- rheumatic, connective tissue disease associated with impaired immune response
- vascular, fibrotic, and autoimmune
2 types: limited (skin involvement with good prognosis) or systemic (internal organs, life threatening - lesions can later occur in spine/brain)
CREST syndrome
Calcinosis (calcium in the skin)
Raynaud’s
Esophageal dysfunction
Sclerodactyly of fingers and toes
Telangiectasis (red spots)
Acquired Immunodeficiency Syndrome (AIDS)
infection from HIV
- attacks the lymphatic system
- 4 stages: acute, asymptomatic, symptomatic, advanced (AIDS)
- fatigue, neurological, ADL impairments, sensory, vision
*Protease inhibitors work to suppress the viral load; must be taken consistently on time or effectiveness is lost
hepatitis
viral infection (has a prev vaccine)
risk factors: type A - contaminated seafood, types B&C - body and blood exposure
*contact precautions for healthcare workers
MRSA
mild skin infections or more serious infections in surgical wounds/skin
risk factors: weakened immune system, being in the hospital, close quarters, skin contact from someone else
antibiotic tx
*contact precautions for healthcare workers
rehab for immunological system disorders
- preventative, restorative, supportive, and/or palliative
- psychological disorders may develop
- counsel about screening, personal goals for lifestyle changes
- activity level problems: self-care (adaptations and energy conservation), work modifications, rest/sleep
example intervention for scleroderma
- alter grasp/pinch patterns and level of upper extremity demand
- alter size of feeding utensils and tooth brushes to accommodate decreased ability to open mouth
- prevent shearing forces on skin during specific personal ADL tasks
acute hospitalization phase
- early mobilization
- preservation of function
- positioning
- psych/emotional support
- prevent long term disability
inpatient rehab phase
- eval and restoration of functional abilities
- ADLs, IADLs, energy conservation, work simplification
- use of Pizzi Assessment of Productive Living (PAPL) for adults with HIV
- activity/exercise tolerance
- home care and goals
- quality of life, roles
- community based care (return to work, school)
diabetes
type 1: insulin dependent (autoimmune, genetic)
type 2: non-insulin dependent, 95% of cases (old age, obesity, fam history, impaired glucose tolerance, physical inactivity)
gestational: during pregnancy, usually resolves but may get type 2 later in life
hypoglycemic symptoms
*metabolic emergency
- vagueness, dizziness, tachycardia, pallor, weakness, diaphoresis, seizures, coma
- if the person is conscious, immediately provide carbohydrates in the form of hard candy, fruit juice, or honey
- unconscious: call for emergency medical care
ketoacidosis signs
- dehydration, rapid and weak pulse, acetone breath
hyperosmolar coma signs: stupor, thirst, polyuria, neurologic abnormalities
*call for emergency med services immediately - IV fluids and insulin are required
lyme disease
impairs the immune response and affects the neurological and orthopedic systems
tx: antibiotics
rehab: treat joint pain and swelling, arthritic flares, nervous system abnormalities and pain
bell’s palsy
heat stroke
characterized by hot, dry red skin, body temp higher than 104, slow and deep respiration, tachycardia, dilated pupils, confusion, progressing to seizures an possible LOC
while waiting for EMS, try to lower their body temp (cooler area, ice packs on arterial pressure points)
heat cramps and exhaustion
usually do not require hospitalization
- loosen clothing
- lay in cool place
- replace fluid with fruit juice/balanced electrolyte drinks
- massage muscles if cramps are severe
- IV fusions and O2 may be needed if severe symptoms
Poor tongue control
can’t make a bolus, will pocket food in cheeks
Hyperactive gag
put food on tip of tongue
Bite reflex
want to inhibit – put pressure on bottom of mouth (or up/down side/side never circular)
hardest thing to swallow
THIN LIQUIDS. Someone with dysphagia should not be given water
Thromboangiitis obliterans: Buerger’s disease
diminished temperature sense, paresthesia, pain, cold extremities (common in young men who smoke) – at risk for burns – water temp too hot
raynauds tx
dressing in layers of clothing for neutral warmth
biofeedback, guided imagery to concentrate on improving distal circulation
encourage skin inspection
activity modifications to prevent trauma to fingers and toes
contracture tx in scleroderma
splinting at optimal resting length for hands/wrists to attempt to slow progressive dev
silicone gel in palms of hands
electrical vibration (muffled) to stimulate rapidly adapting nerve fibers and decrease burning sensation
