Intro & SCD Flashcards
What is the OT process?
- Evaluation (which starts with referral)
- You evaluate their patient’s occupations and learn about them through the occupational profile.
- Based on the setting and your skills, ask yourself if you should accept the patient.
- You need background knowledge about the diagnosis to use clinical reasoning to develop an intervention plan that will help the patient function. - Intervention plan
- based on evaluation, diagnosis, and patient desires - Outcomes
- based on the patient’s current performance, did they achieve the appropriate outcome or should you reevaluate
What are the core values of OT?
- altruism
- dignity
- equality
- freedom
- justice
- truth
- prudence
What is altruism?
unselfish concern for the welfare of others (understanding)
ex: listening to the patient’s story even though you’re busy
What is dignity?
valuing worth and uniqueness of each person (empathy and respect)
EX: asking patient about their hobbies
What is equality?
individuals have the same rights and opportunities (fairness and impartiality)
EX: treating all people with no bias
What is freedom?
Allowing clients to have a choice, independence, initiative, and self direction
EX: allowing patient to choose between tasks
What is justice?
upholding moral and legal principles (equity, truth, objectivity)
EX: easy wheelchair access
What is truth?
faithfulness to facts and reality (accountable, honest, accurate)
EX: being honest with patient about likely outcomes
What is prudence?
ability to self govern and discipline
EX: supervising an unstable patient from sitting to standing
What are the 5 domains?
- Occupations
- Performance skills
- Client factors
- Performance patterns
- Contexts and environment
What is clinical reasoning?
the combination of knowledge of body systems and diagnoses, the OT profile, and the setting, combines with the core values of OT
Illness vs Disease
Disease: medical classification; something an organ has
Illness: personal factors, perception of suffering; something a man has
Cassell uses illness to mean “what a patient feels on the way to the doctor” and disease to mean “what a patient has on the way home.”
What are predisposing factors?
- heredity
- CF, some cancers, sickle cell - age
- young: tonsillitis, otitis media (earache)
- old: arthritis, senile dementia - gender
- prostate cancer, osteoporosis, CMC arthritis - environment
- rural vs city, noise, toxins - lifestyle
- diet, alcohol, drugs, stress
Epidemiology
study of the cause and distribution of the disease
Etiology
the cause of disease, agent, or event
- genetics
- acquired
- multifactorial
Pathophysiology
mechanism - what does the disease do? does it destroy or weaken the muscles?
biology
Clinical manifestations
physical signs, patient reports
what the patient tells you
Outcome
expected course of the disease
- prognosis: is the patient going to die in 6 weeks
- actual outcome
- remission: disease is still present but not progressing
Clinical intervention
healthcare professional
Prevention
Identify risk factors and reduce them
Treatment
optimal outcome, often therapy
Precautions
discomfort, injury, death
contraindications: risk outweighs the benefit
- hot pack on shoulder of patient with breast cancer might make shoulder feel better, but can cause the cancer to metastasize
What are the components of the disease process?
- epidemiology
- etiology
- pathophysiology
- clinical manifestations
- outcome
- clinical intervention
- prevention
- treatment
- precautions
How do diseases/disorders occur?
- Trauma
- Hereditary
- Chromosomal
- Idiopathic
- Iatrogenic
- Nosocomial
- Multifactorial
- Infection and inflammation related
- Physical agents
- Cancers/ neoplasm
- Immunity related
Inflammation
Natural response to tissue damage necessary for the healing process
- changes pressure to slow internal bleeding
- causes pain to tell the body to stop
May or may not come with infection
Lack of inflammatory response can indicate a disease such as AIDS
Occurs with trauma, allergy, heat, and bacteria
Acute or chronic
For the most part, if you are hurting the patient, you are doing more harm than good.
Classic signs:
- redness, edema, heat, pain
Infection
An invasion of a pathogenic microorganism that disturbs homeostasis
A foreign substance has invaded and is attacking. Infection is always a problem.
Trauma
an injury or wound caused by external force or violence
Physical and chemical agents
extremities of heat and cold
Types:
1. burns
- 1st degree: suburn
- 2nd degree: blister
- 3rd degree: damage to epidermis and dermis
- 4th degree: damage to underlying bone and or muscle
- frostbite
- radiation
- electric shock - runs through arteries, veins, and muscle
- bites
Neoplasia and cancer
Neoplasm - means new growth or formation
- may form a tumor (clump of tissue)
- can be in blood (leukemia)
Benign - small to large, but stays within its margins
Malignant - spreads to other cells or tissues close by
Metastasis - spread to other unrelated parts by way of blood or lymphatic stream
Describe immunity related diseases/disorders and the different types.
the body’s ability to fight off invasion
Types:
1. Natural and acquired
- natural: genetic - race, sex, genetics
- acquired: when the body develops an immunity
- active (when you got it)
- passive (immunization; maternal immunity occurs until baby is 8 weeks)
- Allergy
- malfunction of the immunity system- anaphylaxis: life threatening
- Autoimmunity
- the body attacks itself- IDDM (type I diabetes) and lupus
- Immunodeficiency
- impaired immune system- AIDS
What is sickle cell disease?
A group of inherited (genetic) disorders that impact red blood cells
- abnormal hemoglobin (carries O2)
- normal RBCs live 120 days, are round, soft, and flexible; but with SCD they life 20 days, are sticky, brittle, and crescent shaped which leads to O2 loss, pain, and stoke
Sickle cell inheritance
Each person has a hemoglobin A trait from EACH parent
- If you have one that is the SCT, you are a carrier
- If you have TWO- you have SCD
- If you have NONE- you do not have the trait and cannot have or pass on the disease
What are the different types of SCD?
Type depends on the type of hemoglobin
Most common is hemoglobin (SS)
- most severe
- inherit one sickle gene from each parent
Other types:
Hemoglobin SB
Hemoglobin SB+
Hemoglobin SB 0
Hemoglobin SD, SE, SO
Where is SCD most common and why?
Most common in Africa, India, Latin America, the Middle East, and the Mediterranean
There is a link between SCD and malaria
Roughly 100,000 in the US
- 1 million carriers
- Genetic counseling can help stop the spread
7% of the world carries the trait
Signs, symptoms, and complications of SCD
Slowing or blockage of blood to any part of the body
Pain crisis: miss 1-14 days of work/school, but are experiencing symptoms everyday
Dactylitis: inflammation of digits
- blood vessels are smaller so it’s easier for a sickle cell to turn and blood blood and lymph flow
Wounds: if an area doesn’t receive enough blood it will rot
Spleen (infection): spleen helps with immune system, infection, and RBCs
Respiratory and cardio systems: asthma and chest pain
Strokes
- Silent stroke: not noticeable, but seen on MRI
- Overt stokes:
- ischemic: lack of oxygen; SNAPCHAT blocks blood flow
- hemorrhagic: occurs after ischemic due to aneurism
* Thrombosis is a blood clot stuck to the vessel wall. If a piece breaks off, the piece is called an embolism. If the thrombosis keeps collecting RBCs, it will cause an ischemic stroke. The walls of the vessel will expand. This expansion is called an aneurism. If the aneurism ruptures, a hemorrhagic stroke can occur.
Visual deficits: retinopathy
- retina is affected, can cause blindness
Avascular necrosis
- bone loses blood, bone dies
- often in femur and lunate
How does SCD impact function?
Slower to hit milestones
- higher resting energy expenditure
- smaller and slower to hit puberty
Miss opportunities
- 4-6 days per year in hospital
Intellectual deficits from stroke
Social impact
- ADHD and behavioral issues
- psychosocial factors (depression)
- labeled as “sick kid” and often the outcast among peers
Long term impact
- diminished executive function (planning, decision making, organization)
- memory showed decline faster than adults without SCD
- higher unemployment since they have to take sick days more often
Systemic issues for those with SCD
Access to medical care
- health care and disparity
Testing
- went wrong in the 70s
- became mandatory in 1989
Less funding for research
Come from lower education levels and lack healthcare literacy
Job discrimination
Drug seekers
- often have medication for pain; if they go to a new doctor, they could be accused of drug seeking
Mortality and management of SCD
In the US, most live to adulthood, but shortened by 10 years.
Medications:
* prophylactic penicillin: for those under 5 because they can’t communicate how they’re feeling
* opioids: during pain crisis
* hydroxyurea: cancer drug to build up RBCs
* contraception: progestin only are safe
* immunizations
* supplements (non iron based)
Worldwide die by the age of 5
Pediatric hematologists should be established in the first year and seen regularly. The issue with that is there are only 1,900 to 2,100 total in the US.
Interventions for SCD
Ultrasound/MRI
- problem is they are expensive and hard to come by
Blood transfusions
- gold standard to prevent CVAs
- hemosiderosis (iron overload) is a possible side effect
Splenectomy
- removal after recurring splenomegaly (spleen inflammation)
Joint replacement
- after avascular necrosis
Bone marrow transplant
- experimental and has many risks
Gene therapy and stem cell options
Interventions for SCD
Ultrasound/MRI
- problem is they are expensive and hard to come by
Blood transfusions
- gold standard to prevent CVAs
- hemosiderosis (iron overload) is a possible side effect
Splenectomy
- removal after recurring splenomegaly (spleen inflammation)
Joint replacement
- after avascular necrosis
Bone marrow transplant
- experimental and has many risks
Gene therapy and stem cell options
Impact of SCD of occupational performance
ADLs - mostly independent
- impacted by acute pain, strokes, wounds, and avascular necrosis
IADLs
- executive functions
- supporting the client and parents
Spirituality and prayer
- patients who are spiritual have fewer hospitalizations
- area of acceptance
Health and management
- medication adherence routines and habits
- exercise and activity that fits them (avoid strenuous due to higher resting energy expenditure)
Sleep management
Education
Work
Play and leisure
What are occupations?
- ADLs, BADLs, IADLs
- sleep, work, play, leisure, social participation
What are performance skills?
- motor (ROM, strength), process and social skills (comfort, anxiety)
- building blocks of occupation
What are client factors?
body function, structure, values, beliefs, personality
What are performance patterns?
habits, routines, roles
What are contexts and environments? (domain)
physical, personal, social, temporal, and virtual
What is hereditary?
- dominant, recessive, sex linked genetic material
- sickle cell
- happens before conception
What is chromosomal?
- defect in a chromosome (after conception)
- trisomy of chromosome 21 (downs syndrome)
- fragile x (worse in boys)
What is idiopathic?
random
What is iatrogenic?
- caused by an intervention
- pt with cancer does radiation and gets leukemia
What is nosocomial?
- get it from hospital
- in hospital for heart attack, gets COVID
What is multifactorial?
- partly genetic, partly environmental
- arthritis
What are physical agents?
- trauma
- chemical burns
What are the various methods of transmission of infections?
- fungi - through contact
- histoplasmosis, thrush, ringworm - rickettsial - bites from live, ticks, unsanitary conditions
- rocky mountain spotted fever, lyme disease - protozoa - single celled microorganism
- malaria, trichomoniasis - viruses
- smallest microorganism (hardest to deal with)
- can be dormant for long period of time
- chicken pox, hepatitis, flu - bacteria - single celled
- can be useful
- TB, whooping cough, syphilis - parasites
- requires a host
- internal and external
- lice, pin worms
Types of trauma
Types:
1. head trauma
- TBI or CHI (closed head injury)
- concussion, cerebral contusion, skull, nose, jaw, or eardrum
- chest trauma
- penetrating injuries
- nonpenetrating injuries (rib fracture, aorta rupture) - abdominopelvic trauma
- penetrating or nonpenetrating
- any trauma to the guts - neck and spine
- fracture, dislocation, contusion, compression
- occurs at levels: osteological (what’s broken), functional, neurological (where you feel it) - Extremities
- fractures
- tendon (muscle to bone), ligament (bone to bone), nerves (supply electricity for muscles to move), cartilage (lines articular surfaces and acts as shock absorber)
