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PT 220 > Kisner ch 24 womens health > Flashcards

Kisner ch 24 womens health Flashcards

1
Q

The ligaments connected to the pelvic organs are more __________ than the ligaments supporting joint structures

A

fibroelastic

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2
Q

Why do women have an increased chance of contracting an UTI during pregnancy?

A

the perpendicular angle of the ureters may cause a reflux of urine out of the bladder and back into the ureter which can cause urinary stasis

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3
Q

How does pregnancy effect the orientation of the ribs?

A

hormones stimulate change in rib position, subcostal angle progressively increases and ribs flare up & out

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4
Q

Why does the diaphragm elevate by 4cm?

A

due to rib change in position (flaring up & out)

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5
Q

What occurs to the respiration rate with pregnancy?

A

RR unchanged but depth of respiration increases, TV & min ventilation increase but total lung capacity stays the same or slightly decreases

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6
Q

There is a natural state of ___________ to meet the oxygen demands of pregnancy

A

hyperventilation (15-20% o2 increase)

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7
Q

What is present during mild exercise as early as 20 weeks into pregnancy because of hyperventilation ?

A

dyspnea

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8
Q

Describe the “physiologic anemia” of pregnancy

A

plasma increase is greater than red blood cell increase; occurs to meet the O2 demands of pregnancy

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9
Q

What occurs to venous pressure in the LEs during standing?

A

increases as a result of increased uterine size & increased venous distensibility

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10
Q

What occurs to cardiac output and blood pressure w/ pregnancy?

A

CO increases, BP decreases

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11
Q

What occurs late in pregnancy especially in the supine position?

A

pressure in the inferior vena cava rises, caused by compression by the uterus just below the diaphragm, some women may experience hypotensive syndrome due to the decrease in CO

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12
Q

What occurs to the heart during pregnancy?

A

The heart size increases and it is more elevated b/c of the movement of the diaphragm

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13
Q

In what position is CO significantly increased during pregnancy?

A

woman is sidelying in which the uterus places the least pressure on the aorta

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14
Q

How many bpm does the HR increase? What % does CO increase during pregnancy?

A

10-20bpm, 30-60%

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15
Q

what occurs to the abdominal muscles (linea alba, retus) during pregnancy and how does that affect their strength?

A

the muscles become stretched, decreasing the ability to generate a strong contraction which decreases their efficiency of contraction

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16
Q

How does the shift in COG affect the abdominal muscles during pregnancy?

A

decreases the mechanical advantage of the muscles

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17
Q

What occurs to the pelvic floor muscles in terms of location during pregnancy?

A

must be able to hold changes in weight (antigravity position), pelvic floor drops 2.5cm

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18
Q

Generally what occurs to the connective tissues and joints during pregnancy?

A

hormones cause a systematic decrease in ligamentous tensile strength, joint laxity increases, ligamentous laxity increases, joint hypermobility

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19
Q

Why does the thoracolumbar fascia lengthen during pregnancy and how does that affect its ability to stabilize and support the trunk?

A

b/c of its attachment to the abdominal wall the fascia is lengthened and this diminishes its ability to support/stabilize the trunk effectively

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20
Q

What occurs to the metabolic rate and head production during pregnancy?

A

both increase

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21
Q

How many calories must be consumed to keep up w/ the increased BMR?

A

300 calories per day

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22
Q

What occurs to the COG during pregnancy?

A

shifts upward & forward b/c of the enlargement of the uterus & breasts

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23
Q

What occurs in the lumbar & cervical spine due to the shift in COG?

A

lordoses increase to compenstae for shift in COG

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24
Q

What occurs in the shoulder girdle and upper back due to the change in COG?

A

become rounded w/ scapular protraction & UE IR b/c breast enlargement

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25
Q

Tightness in the pec muscles and weakness of the scapular stabilizers are due to pregnancy? True or False

A

BOth! it can be due to preexisting conditions or induced by the pregnancy

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26
Q

What may occur in the knees due to the change in COG?

A

genu recurvatum will shift the weigh toward the heels in an attempt to counteract the anterior pull of the fetus

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27
Q

What occurs to the suboccipital muscles w/ the change of COG ?

A

maintain appropriate eye level (optical righting reflex), moderate forward head posture to go w/ the protracted scapula

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28
Q

Post pregnancy why might a women still have some of the postural changes that occur during pregnancy?

A

Some postures become habits, many child care activities contribute to persistence postural faults & asymmetry

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29
Q

What are some compensatory strategies the body will use to help redistribute weight and help w/ balance during pregnancy?

A

walks w/ wider BOS, increased ER of hips

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30
Q

describe shapes/layers of the pelvic floor musculature

A

sling/hammock orientation, figure eight orientation of the muscles around the orifice of the urethra/vagina & anal spinchter, funnel shape of the pelvic muscles

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31
Q

The pelvic floor musculature is composed of 3 layers in a _________ orientation w/ boney attachments to _______ &______.

A

The pelvic floor musculature is composed of 3 layers in a funnel shaped orientation w/ boney attachments to the pubic bone & coccyx

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32
Q

What is the prime mover of the pelvic floor

A

levator ani

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33
Q

What type tissues form the pelvic diaphram?

A

levator ani & coccygeus

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34
Q

What are the superficial muscles of the pelvic floor?

A

superficial transverse perineal muscles , ischiocavernosus, bulbocavernouss , external anal sphincter

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35
Q

The combined action of the pelvic floor muscles create what type of motion and in what direction?

A

superior force toward the heart and a puckering or drawstring motion around the spincters

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36
Q

What are the essential roles of the pelvic floor?

A

provide support to pelvic organs, able to withstand increased intra abdominal pressure, help stabilize the spine/pelvis, maintain continence at the urethral/anal sphincters, sexual resonse & reproductive function

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37
Q

What nerve supply the perineal tissues including their terminal branches?

A

pudendal nerve (3 terminal branches: dorsal, perineal, rectal), levator ani nerve, direct branches from the sacral nerve roots

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38
Q

how does muscle injury during vaginal birth affect vaginal closure pressure and the pelvic floor complex?

A

it diminished the maximal closure pressure of the pelvic floor complex, makes the pfc more vulnerable to increased abdominal pressure & may lead to prolapse

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39
Q

What is an episiotomy?

A

an incision made in the perineal body & is considered a 2nd degree laceration (forceps assisted delivery)

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40
Q

What is a prolapse?

A

Supportive impairment, descent of any of the pelvic viscera out of their normal alignment b/c of muscular, fascial, and/or ligamentous deficits & b/c of increased abdominal pressure

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41
Q

As the prolapse progresses what symptoms may the pt experience?

A

perineal pressure & heavyness, low back pain, abdominal pressure or pain, difficulties w/ defecation

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42
Q

What are the statistics for urinary incontinence and is is mostly affected?

A

15million ppl, women are twice as likely than men to have symptoms : suffer from social discomfort, anxiety regarding leakage & hygiene concerns

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43
Q

describe how strengthening of the pelvic floor can aide in preventing urinary incontinence and other pelvic floor dysfunctions

A

it improves structural support of the organs & connective tissue in addition to facilitating more effective recruitment of motor units & more consistent, proficient contractions

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44
Q

What are other factors that contribute to pelvic floor dysfunction for women who have never been pregnant

A

excessive straining b/c of chronic constipation, smoking, chronic cough, obesity, hysterectomy, (possibly the depletion of estrogen)

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45
Q

Why is patient education so important for pelvic floor impairments?

A

pt should understand all 3 dimensions of the complex, teach the patient the muscular orientation, provide verbal/detailed instructions

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46
Q

Describe the 3 dimensions of the pelvic floor muscle complex

A

sling/hammock fibers, the figure 8 orientation of the musculature, “funnel” configuration extending inferiorly to the outlet

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47
Q

What motion does the circumferential fibers produce in the pelvic floor?

A

drawstring or “pucker” effect

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48
Q

Why is neruomuscular reeducation essential for pelvic floor re-education?

A

b.c they usually have significant disuse atrophy, proprioceptive deficits of the pelvic floor muscles

49
Q

What type of exercises can the pt do initially to facilitate the pelvic floor musculature and why?

A

initially emphasis is on isometric contractions of the pelvic floor b/c many pts exhibit excessive accessory muscle recruitment such as gluteals, hip adductors, abdominals

50
Q

what is a manual technique to help re-educate the levator ani muscle?

A

manual stretch facilitation (a proprioceptive neuromuscular facilitation technique)

51
Q

after coordination improves of the pelvic floor, what would be the next progression of exercise?

A

integration of pelvic floor activity w/ ADLs, lumbar stabilization, other functional exercises

52
Q

What are some examples of instruments used to produce sensory biofeedback?

A

pressurized objects that allow for isotonic strengthening, traditional surface electromyography (SEMG) sensors & provide isometric resistance to the muscular contraction.

53
Q

Why is SEMG useful in the treatment of pelvic floor dysfunction in the female population?

A

provides immediate visual/auditory feedback regarding pelvic floor activity which improves patient comprehension, appropriate recruitment patters and proprioceptive awareness

54
Q

What is diastasis recti and how does it occur?

A

separation of the rectus abdominis muscles in the midline at the linea alba - the continuity and integrity of the abdominal musculature is disrupted (cause unknown)

55
Q

What is the finger length separation of the rectus abdominis muscle that is considered significant?

A

larger than 2 finger widths

56
Q

current recommendations for weight gain during pregnancy based on kisner

A

25-35lbs

57
Q

How do you examine a pt for diastasis recti?

A

pt in supine hook lying, pt raises their head & shoulders off the floor, reaching their hands toward their knees, spines of scapula should leave the floor. PTA places fingers of 1 hand horizontally across the midline of the abdomen at the umbilicus if their is a separation the fingers will sink into the gap btw the rectus muscles or their will be a visual budge btw the rectus bellies

58
Q

What exercise is recommended for diastasis recti?

A

pt lying supine hook lying, pt exhales raises head off floor at the same time gently approximates the rectus muscle toward the midline by pulling the w/ the arms crossed (can use a sheet wrapped around trunk)

59
Q

When can any progression of postpartum abdominal strengthening occur if the pt suffers from diastasis recti?

A

These exercises should be postponed until the diastasis has been corrected two 2finger widths (2cm) or less

60
Q

List some interventions for low back pain during pregnancy

A

proper body mechanics, postural instructions, improvement in work techniques, along w/ superficial modality application

61
Q

What is the common cause of back pain during pregnancy?

A

postural changes due to the pregnancy, ligamentous laxity, hormonal influences, decreased abdominal muscle function

62
Q

Describe the location of sacroiliac pain

A

pain localized to the posterior pelvis & is described as stabbing deep into the buttock distal & lateral to L5/S1

63
Q

Describe the symptoms of sacroiliac pain

A

pain w/ prolonged sitting, standing, walking, climbing stairs, turing in bed, unilateral standing, torsion activites

64
Q

True or False: pubic symphysis dysfunction may occur alone or in combination w/ sacroiliac symptoms and includes significant tenderness to palpate at the symphysis, radiating pain into the groin & medial thigh, pain w/ wb’ing

A

True

65
Q

How are pelvic girdle/sacroiliac symptoms treated?

A

modification or elimination of activities that may further aggravate sensitive tissue, stabilization exercises, use of belts/corsets to provide external support to the pelvis

66
Q

Describe how the activity of getting into a car can be modified to help reduce pain

A

sitting down first, pivoting both legs & trunk into the car, keeping the knees together

67
Q

How can sidelying be modified to reduce pain?

A

placing a pillow btw the knees and under the abdomen to help keep joints more symmetrical

68
Q

How could sexual positions be altered to help reduce sacroiliac/pelvic pain?

A

avoid full range of hip abduction

69
Q

What activities should be avoided for pt’s that are pregnant and suffer from sacroiliac/pelvic girdle pain?

A

Single leg wb’ing, excessive abduction or hyperextension, sitting on soft surfaces, also use caution when climbing more than 1 step at a time, swinging 1 leg out of bed at a time and crossing legs when sitting

70
Q

What must you teach your patients with pelvic girdle pain todo when transitioning from one position to another or lifting in order to stabilize the pelvis ?

A

activate the pelvic floor and transverse abdominals

71
Q

How does pregnancy increase varicose veins?

A

increased uterine weight, venous statuses in the legs, increased venous distensibility

72
Q

What symptoms accompany varicose veins?

A

heaviness or aching discomfort, especially in dependent leg positions, intensity may increase w/ pregnancy

73
Q

What type of interventions can help decrease pain with varicose veins during pregnancy?

A

modify exercise so that minimal dependent positioning of the legs occur, elastic support stockings to provide external pressure gradient against distended veins, pad or belt to help counter pressure w/ vulvar varicosities

74
Q

What type of exercise modifications could be suggested w/ a pt who is pregnant or post w/ focus on joint laxity

A

exercises that decrease excessive joint stress, nonwb’ing or less stressful aerobic exercise such as swimming, walking, biking

75
Q

What may cause thoracic outlet syndrome (TOS) or carpal tunnel syndrome (CTS) during pregnancy?

A

postural changes in the neck and upper quarter, fluid retention, hormonal changes, circulatory compromise

76
Q

What may cause nerve compression syndromes (ex: lateral femoral cutaneous nerve)?

A

weight of fetus, fluid retention, hormonal changes, circulatory compromise

77
Q

Describe interventions for nerve compression syndromes

A

postural correction exercises, manual techniques, ergonomic assessment, modalities, splints maybe used for carpal tunnel syndrome

78
Q

What concerns are raised during aerobic exercise during pregnancy?

A

reduction in blood flow may decrease the O2 and nutrition to the fetus and uterine contractions & preterm labor maybe stimulated

79
Q

Where does the blood flow during aerobic exercise and why might this be a problem

A

the blood flows towards the working muscles and away from the internal organs (possibly uterus) and this may cause concern for decreased O2 to the fetus

80
Q

What occurs to stroke volume, cardiac output, blood volume, vascular resistance during steady state aerobic exercise?

A

SV: increases , CO: increases, BV: increases, vascular resistance: decreases

81
Q

Describe what occurs with the respiratory rate during pregnancy

A

during moderate/max exercise the RR does not adapted proportionately and the pregnant women reaches a mx exercise capacity at a lower work level than a non pregnant women b/c of the increased oxygen requirement of exercise

82
Q

What occurs to the hematocrit level during pregnancy and during exercise?

A

hematocrit level is lowered during pregnancy, but rises up to 10% w/in 15min of vigorous exercise, cardiac reserve is decreased during exercise (occurs up to 4weeks postpartum)

83
Q

How does inferior vena cava compression occur? And what can it lead to?

A

compression of the vessel by the uterus can occur after the 4th month of pregnancy, this leads to cardiac output and orthostatic hypotension

84
Q

In what position does inferior vena cava compression most likely occur in?

A

supine or static standing positions

85
Q

What is the recommended calorie intake for a pregnant women who exercises to reduce the likely hood of hypoglycemia?

A

additional 500 calories per day

86
Q

Why is increased core temperature a concern for pregnant women who may exercise?

A

vigorous activity and dehydration through perspiration leads to increase core temp, increased core temp may cause neural tube defects of the fetus

87
Q

Studies show that physically fit women during pregnancy actually have increased or decreased core temperature?

A

decreased core temp, more fit better at regulating their body temperature

88
Q

What is the fear of increased exercise and women that are at risk for premature labor?

A

exercises causes an increase in norepinephrine & epinephrine which increase the strength & frequency of uterine contractions

89
Q

According to Kisner, a healthy fetus is able to tolerate brief episodes of asphyxia w/ no detrimental results (True or False)

A

True, brief submax exercise can cause fetal bradycardia (indicating fetal asphyxia) during maternal exercise

90
Q

What % of fetal blood flow reduction puts the fetus at risk ?

A

50% or greater (no human studies have shown this % to decrease to such levels w/ pregnant women)

91
Q

How can the fetus dissipate heat?

A

it has no mechanism to dissipate heat, but fit women are able to dissipate heat & regulate their core temperature reducing the fetus risk of overheating

92
Q

What are some potential structural and functional impairments during/post pregnancy ?

A

urinary or fecal incontience, organ prolapse, hypertonus, poor episiotomy healing, poor proprioceptive awareness & disuse atrophy

93
Q

What are some recommendations for supine positioning for a pregnant patient?

A

do not exceed 5 min of supine positioning at anyone time after the 1st trimester to avoid vena cava compression by the uterus, small wedge or rolled towel under the right hip to lessen effects of uterine compression on the abdominal vessels & improve cardiac output, always rise slowly from the supine position to reduce orthostatic hypotension

94
Q

What occurs if the pt holds their breath thus eliciting a valsalva maneuver?

A

This may lead to an undesirable downward force on the uterus & pelvic floor, stressed the cardiovascular system: increased BP & HR

95
Q

What are some recommendations for fluid replenishment and reliving oneself?

A

break frequently for fluid replenishment, completely empty the bladder to reduce possible stress on already weakened pelvic floor

96
Q

What recommendations should be given in terms of stretching/flexibility?

A

avoid ballistic movements, only ROM, caution w/ adductor/hamstring stretches b/c over stretching these muscles can lead to pelvic instability

97
Q

What are some signs/symptoms of overexertions or possible pregnancy complications and are reasons to discontinue exercise & contact a Dr.?

A

persistent pain (chest, pelvic girdle, low back), leakage of amniotic fluid, uterine contractions that keep coming, vaginal bleeding, persistent SOB, irregular HB, Tachycardia, dizziness/faintness, swelling/pain in calf, difficulty walking, decreased fetal movements

98
Q

What are the recommendations for fitness exercise for pregnant women w/ no maternal or fetal risk factors

A

mild/moderate exercise 15-30min/session, most days of the week, modify exercise intensity according to tolerance, Borg scale 12-14, exercise up to fatigue do not exercise to exhaustion, avoid contact sports, non wb’ing aerobic exercise minimizes risk of injury, adequate caloric intake/hydration, joint protection 4-6weeks post

99
Q

What is the recommendation for the resumption of pre pregnancy exercise routines post pregnancy?

A

gradually increase exercise intensity, initial exercises should be pelvic floor strengthening to help prevent incontinence ~6weeks post baby~

100
Q

Absolute contraindications to exercise during pregnancy

A

incompetent cervix, vaginal bleeding (2nd-3rd trimester), placenta previa, multiple gestation, preeclampsia, rupture of membranes (loss of amniotic fluid b4 labor), premature labor, maternal heart disease, thyroid disease, serious respiratory disorder, maternal type 1 diabetes, intrauterine growth retardation

101
Q

What is placenta previa

A

placenta is located on the uterus in a position in which it may detach before the baby is delievered

102
Q

What are the precautions to exercise during pregnancy

A

gestational diabetes, severe anemia, systemic infection, extreme fatigue, musculoskeletal complaints, overheating, extreme obesity or underweight, diastatic recti

103
Q

What muscles can be gently stretched with caution during pregnancy?

A

upper neck extensors, scalene, scapular protractors, shoulder IR, levator scapula, low back extensors, hip flexors adductors hamstrings (caution) , ankle plantarflexors

104
Q

What muscles should be strengthened during pregnancy (Resistance exercises)?

A

upper neck flexors, lower neck & upper thoracic extensors, scapular retractors/depressors, shoulder ER, trunk flexors, hip extensors, knee extensors, ankle dorsiflexors

105
Q

What is the progression of corrective exercises for the diastasis recti?

A

pt is hook lying, arms crossed, pt lifts head off floor while approximating the rectus muscles & performing a ppt, contractions done on exhalation to reduce intraabdominal pressure

106
Q

What type of breathing breathing pattern should be achieved during exercise?

A

slow controlled breathing, exhale during the exertion phase of exercise

107
Q

Name some dynamic trunk exercises that can preformed while pregnant and are beneficial of improving proprioceptive awareness as well as lumbar, pelvic, hip mobility

A

pelvic tilt exercises (quadruped), pelvic clock (supine hook lying), trunk curl ups/downs (early stages of pregnancy & no diastasis recti present), diagonal curls

108
Q

Name some modified UE strengthening exercises that can be performed while pregnant

A

standing push ups, supine bridging (alternately felt & extend UE to emphasize stab function of hip extensors & trunk musculature, scapular retraction (sitting/standing)

109
Q

Name some modified LE strengthening exercises for a pregnant patient

A

quad leg raising (ppt then slowly lift 1 leg), modified squats (wall slides)

110
Q

why is LE strengthening important during pregnancy?

A

strengthen hip & knee extensors also helps stretch the perineal area for flexibility during the delivery process

111
Q

Examples of pt self stretching to help prepare the legs & pelvis for childbirth

A

pt supine or side lying abduct the hips and pull knees toward the sides of their chest & hold position for as long as comfortable; sitting on a short stool w/ hip abducted pt flex forward gently pressing knees outward w/ hands for an additional stretch

112
Q

Name pelvic floor exercises that help the patients awareness and motor learning

A

contract relax (gather the pelvic floor as if attempting to stop urine flow or hold back gas 3-5sec 10X), quick contractions (type II muscle response important to withstand pressure form coughing/sneezing), “elevator exercises” (more “floors” go up increase squeeze for greater contraction

113
Q

What compensations must you for with the contract relax exercise for pelvic floor awareness

A

substitution with the gluteals, abdominals or hip adductors

114
Q

Why is pelvic floor relaxation important?

A

linked to effective breathing, inability to relax may lead to impairments such as hypertonus, pain w/ intercourse or voiding dysfunction

115
Q

What are some unsafe postures/exercises during pregnancy?

A

bilateral SLR (stress on abdominal muscles &low back), fire hydrant (sacroiliac joint & lumbar vertebrae stress), quad hip extension (unsafe can cause low back pain-stay in rom of hip joint), unilateral wb’ing activities (balance problems, sacroiliac joint dysfunction, asymmetries)

116
Q

What exercises can be initiated during the postpartum period?

A

pelvic floor strengthening (increase circulation & aid in healing), corrective exercise for diastasis recti, aerobic exercise, light resistance training can increase gradually

117
Q

Suggested activities for the pt following a cesarean section?

A

ankle pumping , LE ROM, walking (to increase circulation and prevent venous stasis), pelvic floor exercises, deep breathing & coughing or huffing (“ha”), non stressful muscle setting techniques, teach posture correction, reinforce deep diaphragmatic breathing techniques for pulmonary ventilation, wait 6-8 weeks b4 rigorous exercise

118
Q

If the POC sates enhance incisional circulation and healing; prevent adhesion formation what should the intervention be?

A

gentle abdominal exercise w/ incisional support,scar mobilization & friction massage

119
Q

What is pregnancy-related hypertension or preeclasmsia?

A

hypertension, protein in urine & severe fluid retention it can progress to maternal convulsions, coma & death if it become severe (this is known as eclampsia)

PT 220 (3 decks)

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