GI, renal, endocrine, immunological, & integumentary dis (ch 9) Flashcards
Bedside swallowing evaluation
- assess level of alertness, ability to follow directions, level of awareness of impairment, orientation to activity
- assess sensory and motor components of swallowing
- assess ability to manage own secretions (auscultation of neck to hear elongation of the oropharyngeal structures and listen for gurgling- a sign of insufficient swallow)
- assess swallowing function using trial boluses. Recommend further testing PRN.
Tx for GERD
- sleep with more than one pillow (elevation of head discourages regurgitation)
- drug therapy
- diet modification (less spices, small meals more frequently, lower alcohol intake)
- stress management
what is neurogenic bowel?
sympathetic nerve impairment, generally in people with SCI above T6; loss of control of anal sphincter; sensory loss resulting in lack of awareness of feces in bowel; motor loss, decreased or lost ability to self-initiate or control bowel movement. flaccidity of muscles results in incontinence. With autonomic dysreflexia an extreme rise in blood pressure can result.
risk factors for kidney disease (3)
- diabetes! (10-40% with type 2 DM develop severe kidney disease and End Stage Renal Disease)
- HTN
- systematic lupus erythematosus
impact of renal disease on performance skills/client factors
- motor dysfunction (fatigue, muscle pain, edema limiting mobility, weakness)
- sensory system function (neuropathy, vision loss)
- cognitive dysfunction (alteration of body image, delusions due to sepsis or toxicity, dementia: multi-infarct or metabolic)
- perceptual/neurobehavioral dysfunction (dementia: infarct related; stroke related)
- psychological/emotional dysfunction (anxiety disorder, depression, mood/adjustment disorder, poor management of psych disorder can increase risk of cardiac arrest; drug therapy maybe needed.
impact of renal disease on performance in areas of occupation
- self-care (alteration in urination, need for sanitation with self-dialysis, adhere to diet, sexual problems, need for AE, energy conservation, altered mobility)
- IADLS (housework, community mobility, meal prep for diet, finances, leisure/sports
4 diagnostic stages of cancer
- tumor present; no perceived spread (operable lesion; good prognosis)
- localized spread of tumor (operable lesion; usually responds well to tx chemo/radiation/immuno-therapy)
- extensive evidence of primary tumor that has spread to other organs (tumor can be surgically debulked, but some cells may remain behind; deeper spread of tumor cells in lymphatics)
- inoperable primary lesion; multiple metastases. (survival dependent on depth and extent of the tumor spread as well as the ability to have the tumor respond to therapy… less than 5% survival rate past 5 years.)
Scleroderma (etiology; what is it?)
Unknown etiology. Rheumatic, connective tissue disease associated with impaired immune response. Hardening/tightening of skin and connective tissue (can affect BV’s, organs, digestive tract).
3 components:
-Vascular (Raynaud’s phenomenon; constant recurrent constriction of small bv’s leading to pulmonary hypertension)
-Fibrotic- scar tissue resulting from excess collagen (protein) causing thickness of skin and a burning sensation in the skin. In lungs causes restrictive lung disease.
-Autoimmunity- B-cell-produced antibodies
What is Raynaud’s phenomenon?
when cold temperatures or strong emotions cause blood vessel spasms- blocks blood to fingers, toes, ears, and nose.
Intervention for Raynaud’s phenomenon
keep fingers and toes warm
dress in layers
drug therapy (vasodialators)
biofeedback
Intervention for pulmonary artery problems
drug therapy (coagulants) nasal oxygen
Intervention for fibrosis of the skin
protective gloves (cotton, insulated, mildly compressive) drug therapy
Sequelae of scleroderma (and recommendations)
- poor circulation/Raynaud’s (dressing; biofeedback; education on skin inspection; activity modifications to prevent trauma
- contractures (splinting; silicone gel in palms of hands; electrical vibration)
- facial disfigurement and alteration in body image/self identity (allow client to choose adaptations to ease adjustment; support groups)
- thoracic spinal lesions causing paraparesis, neurogenic bowel/bladder, altered mobility, altered ADLs (neurorehab and biomechanical approaches PRN)
- space occupying lesions in the brain produce stroke-like symptoms (rehab for functional deficits)
sequelae of HIV
- generalized lymphadenopathy (fatigue, weight loss, general malaise)
- fever
- diarrhea
- …decreased activity tolerance and lack of energy
- neurological impairment (cognitive impairment; affect changes; sensory changes; ADL impairment, myelopathy, peripheral neuropathy, visual impairment)
Methicillin-Resistant Staphylococcus Aureus (MRSA)
usually mild infections (pimples/boils) on skin; or more serious infections on skin; or infection in surgical wounds. Infection can be locally confined or systemic. Is spread with contact with infected body part of another or shared item (towel) used by infected person.
Rehab for immunological system disorders:
interventions for impairment level problems
- counsel patient to be compliant with screening and tx
- set personal goals to invest behaviorally in health
- provide support to those dealing with chronic illness
- provide support counseling and social support for psych disorders that can develop (anxiety, depression)
- refer to physician for drug tx for physical and psych disorders
Rehab for immunological system disorders:
interventions for activity level problems
- self care… adaptations and training tasks for ease and using energy conservation
- work… work capacity evals; modifications to allow participation; counseling for transition to disease status when work isn’t possible anymore.
- leisure/sports… modify specific tasks; eval interests and skills to introduce new leisure or sports activities to replace others that aren’t possible anymore
- rest… sleep positioning; sleep habits/relaxation techniques
Rehab for immunological system disorders:
interventions for participation problems
- needs assessment to determine issues with mobility, social, or political access to environments
- identify and facilitate system changes to allow person access/ability to participate as contributing member of society.
Diabetes type 1
insulin-dependent (5-10% of all diagnosed cases of diabetes)
autoimmune, genetic, environmental factors
Diabetes type 2
non-insulin-dependent (90-95% of all diabetes)
obesity, family hx, prior hx of gestational diabetes, impaired glucose tolerance, physical inactivity, race
Gestational diabetes
2-5% of all pregnancies; 40% may go on later to develop type 2 diabetes later in life. Usually resolves after pregnancy; obesity is risk factor
Signs/symptoms of diabetes
frequent urination; excessive thirst; unexplained weight loss; extreme hunger; visual changes; sensory changes in hands/feet (tingling/numbness); fatigue; very dry skin; slow healing of wounds; increased infection rate.
Sequelae/complications of diabetes
- fatigue/decreased activity tolerance
- urinary disturbance
- visual loos, low vision, blindness
- peripheral neuropathy (and amputations)
- propensity to develop wounds
- poor general health/ more infections
- hypoglycemia
- hyperglycemic crisis (ketoacidosis; hyperosmolar coma)
what is ketoacidosis?
because of lack of insulin, body starts burning fatty acids which produces excess ketone bodies. Symptoms: dehydration, rapid and weak pulse, and acetone breath (fruity smell). More common in type 1.
