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
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
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
4
Q
Why does the diaphragm elevate by 4cm?
A
due to rib change in position (flaring up & out)
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
6
Q
There is a natural state of ___________ to meet the oxygen demands of pregnancy
A
hyperventilation (15-20% o2 increase)
7
Q
What is present during mild exercise as early as 20 weeks into pregnancy because of hyperventilation ?
A
dyspnea
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
9
Q
What occurs to venous pressure in the LEs during standing?
A
increases as a result of increased uterine size & increased venous distensibility
10
Q
What occurs to cardiac output and blood pressure w/ pregnancy?
A
CO increases, BP decreases
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
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
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
14
Q
How many bpm does the HR increase? What % does CO increase during pregnancy?
A
10-20bpm, 30-60%
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
16
Q
How does the shift in COG affect the abdominal muscles during pregnancy?
A
decreases the mechanical advantage of the muscles
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
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
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
20
Q
What occurs to the metabolic rate and head production during pregnancy?
A
both increase
21
Q
How many calories must be consumed to keep up w/ the increased BMR?
A
300 calories per day
22
Q
What occurs to the COG during pregnancy?
A
shifts upward & forward b/c of the enlargement of the uterus & breasts
23
Q
What occurs in the lumbar & cervical spine due to the shift in COG?
A
lordoses increase to compenstae for shift in COG
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
25
Tightness in the pec muscles and weakness of the scapular stabilizers are due to pregnancy? True or False
BOth! it can be due to preexisting conditions or induced by the pregnancy
26
What may occur in the knees due to the change in COG?
genu recurvatum will shift the weigh toward the heels in an attempt to counteract the anterior pull of the fetus
27
What occurs to the suboccipital muscles w/ the change of COG ?
maintain appropriate eye level (optical righting reflex), moderate forward head posture to go w/ the protracted scapula
28
Post pregnancy why might a women still have some of the postural changes that occur during pregnancy?
Some postures become habits, many child care activities contribute to persistence postural faults & asymmetry
29
What are some compensatory strategies the body will use to help redistribute weight and help w/ balance during pregnancy?
walks w/ wider BOS, increased ER of hips
30
describe shapes/layers of the pelvic floor musculature
sling/hammock orientation, figure eight orientation of the muscles around the orifice of the urethra/vagina & anal spinchter, funnel shape of the pelvic muscles
31
The pelvic floor musculature is composed of 3 layers in a _________ orientation w/ boney attachments to _______ &______.
The pelvic floor musculature is composed of 3 layers in a funnel shaped orientation w/ boney attachments to the pubic bone & coccyx
32
What is the prime mover of the pelvic floor
levator ani
33
What type tissues form the pelvic diaphram?
levator ani & coccygeus
34
What are the superficial muscles of the pelvic floor?
superficial transverse perineal muscles , ischiocavernosus, bulbocavernouss , external anal sphincter
35
The combined action of the pelvic floor muscles create what type of motion and in what direction?
superior force toward the heart and a puckering or drawstring motion around the spincters
36
What are the essential roles of the pelvic floor?
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
37
What nerve supply the perineal tissues including their terminal branches?
pudendal nerve (3 terminal branches: dorsal, perineal, rectal), levator ani nerve, direct branches from the sacral nerve roots
38
how does muscle injury during vaginal birth affect vaginal closure pressure and the pelvic floor complex?
it diminished the maximal closure pressure of the pelvic floor complex, makes the pfc more vulnerable to increased abdominal pressure & may lead to prolapse
39
What is an episiotomy?
an incision made in the perineal body & is considered a 2nd degree laceration (forceps assisted delivery)
40
What is a prolapse?
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
41
As the prolapse progresses what symptoms may the pt experience?
perineal pressure & heavyness, low back pain, abdominal pressure or pain, difficulties w/ defecation
42
What are the statistics for urinary incontinence and is is mostly affected?
15million ppl, women are twice as likely than men to have symptoms : suffer from social discomfort, anxiety regarding leakage & hygiene concerns
43
describe how strengthening of the pelvic floor can aide in preventing urinary incontinence and other pelvic floor dysfunctions
it improves structural support of the organs & connective tissue in addition to facilitating more effective recruitment of motor units & more consistent, proficient contractions
44
What are other factors that contribute to pelvic floor dysfunction for women who have never been pregnant
excessive straining b/c of chronic constipation, smoking, chronic cough, obesity, hysterectomy, (possibly the depletion of estrogen)
45
Why is patient education so important for pelvic floor impairments?
pt should understand all 3 dimensions of the complex, teach the patient the muscular orientation, provide verbal/detailed instructions
46
Describe the 3 dimensions of the pelvic floor muscle complex
sling/hammock fibers, the figure 8 orientation of the musculature, "funnel" configuration extending inferiorly to the outlet
47
What motion does the circumferential fibers produce in the pelvic floor?
drawstring or "pucker" effect
48
Why is neruomuscular reeducation essential for pelvic floor re-education?
b.c they usually have significant disuse atrophy, proprioceptive deficits of the pelvic floor muscles
49
What type of exercises can the pt do initially to facilitate the pelvic floor musculature and why?
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
what is a manual technique to help re-educate the levator ani muscle?
manual stretch facilitation (a proprioceptive neuromuscular facilitation technique)
51
after coordination improves of the pelvic floor, what would be the next progression of exercise?
integration of pelvic floor activity w/ ADLs, lumbar stabilization, other functional exercises
52
What are some examples of instruments used to produce sensory biofeedback?
pressurized objects that allow for isotonic strengthening, traditional surface electromyography (SEMG) sensors & provide isometric resistance to the muscular contraction.
53
Why is SEMG useful in the treatment of pelvic floor dysfunction in the female population?
provides immediate visual/auditory feedback regarding pelvic floor activity which improves patient comprehension, appropriate recruitment patters and proprioceptive awareness
54
What is diastasis recti and how does it occur?
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
What is the finger length separation of the rectus abdominis muscle that is considered significant?
larger than 2 finger widths
56
current recommendations for weight gain during pregnancy based on kisner
25-35lbs
57
How do you examine a pt for diastasis recti?
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
What exercise is recommended for diastasis recti?
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
When can any progression of postpartum abdominal strengthening occur if the pt suffers from diastasis recti?
These exercises should be postponed until the diastasis has been corrected two 2finger widths (2cm) or less
60
List some interventions for low back pain during pregnancy
proper body mechanics, postural instructions, improvement in work techniques, along w/ superficial modality application
61
What is the common cause of back pain during pregnancy?
postural changes due to the pregnancy, ligamentous laxity, hormonal influences, decreased abdominal muscle function
62
Describe the location of sacroiliac pain
pain localized to the posterior pelvis & is described as stabbing deep into the buttock distal & lateral to L5/S1
63
Describe the symptoms of sacroiliac pain
pain w/ prolonged sitting, standing, walking, climbing stairs, turing in bed, unilateral standing, torsion activites
64
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
True
65
How are pelvic girdle/sacroiliac symptoms treated?
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
Describe how the activity of getting into a car can be modified to help reduce pain
sitting down first, pivoting both legs & trunk into the car, keeping the knees together
67
How can sidelying be modified to reduce pain?
placing a pillow btw the knees and under the abdomen to help keep joints more symmetrical
68
How could sexual positions be altered to help reduce sacroiliac/pelvic pain?
avoid full range of hip abduction
69
What activities should be avoided for pt's that are pregnant and suffer from sacroiliac/pelvic girdle pain?
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
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 ?
activate the pelvic floor and transverse abdominals
71
How does pregnancy increase varicose veins?
increased uterine weight, venous statuses in the legs, increased venous distensibility
72
What symptoms accompany varicose veins?
heaviness or aching discomfort, especially in dependent leg positions, intensity may increase w/ pregnancy
73
What type of interventions can help decrease pain with varicose veins during pregnancy?
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
What type of exercise modifications could be suggested w/ a pt who is pregnant or post w/ focus on joint laxity
exercises that decrease excessive joint stress, nonwb'ing or less stressful aerobic exercise such as swimming, walking, biking
75
What may cause thoracic outlet syndrome (TOS) or carpal tunnel syndrome (CTS) during pregnancy?
postural changes in the neck and upper quarter, fluid retention, hormonal changes, circulatory compromise
76
What may cause nerve compression syndromes (ex: lateral femoral cutaneous nerve)?
weight of fetus, fluid retention, hormonal changes, circulatory compromise
77
Describe interventions for nerve compression syndromes
postural correction exercises, manual techniques, ergonomic assessment, modalities, splints maybe used for carpal tunnel syndrome
78
What concerns are raised during aerobic exercise during pregnancy?
reduction in blood flow may decrease the O2 and nutrition to the fetus and uterine contractions & preterm labor maybe stimulated
79
Where does the blood flow during aerobic exercise and why might this be a problem
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
What occurs to stroke volume, cardiac output, blood volume, vascular resistance during steady state aerobic exercise?
SV: increases , CO: increases, BV: increases, vascular resistance: decreases
81
Describe what occurs with the respiratory rate during pregnancy
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
What occurs to the hematocrit level during pregnancy and during exercise?
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
How does inferior vena cava compression occur? And what can it lead to?
compression of the vessel by the uterus can occur after the 4th month of pregnancy, this leads to cardiac output and orthostatic hypotension
84
In what position does inferior vena cava compression most likely occur in?
supine or static standing positions
85
What is the recommended calorie intake for a pregnant women who exercises to reduce the likely hood of hypoglycemia?
additional 500 calories per day
86
Why is increased core temperature a concern for pregnant women who may exercise?
vigorous activity and dehydration through perspiration leads to increase core temp, increased core temp may cause neural tube defects of the fetus
87
Studies show that physically fit women during pregnancy actually have increased or decreased core temperature?
decreased core temp, more fit better at regulating their body temperature
88
What is the fear of increased exercise and women that are at risk for premature labor?
exercises causes an increase in norepinephrine & epinephrine which increase the strength & frequency of uterine contractions
89
According to Kisner, a healthy fetus is able to tolerate brief episodes of asphyxia w/ no detrimental results (True or False)
True, brief submax exercise can cause fetal bradycardia (indicating fetal asphyxia) during maternal exercise
90
What % of fetal blood flow reduction puts the fetus at risk ?
50% or greater (no human studies have shown this % to decrease to such levels w/ pregnant women)
91
How can the fetus dissipate heat?
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
What are some potential structural and functional impairments during/post pregnancy ?
urinary or fecal incontience, organ prolapse, hypertonus, poor episiotomy healing, poor proprioceptive awareness & disuse atrophy
93
What are some recommendations for supine positioning for a pregnant patient?
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
What occurs if the pt holds their breath thus eliciting a valsalva maneuver?
This may lead to an undesirable downward force on the uterus & pelvic floor, stressed the cardiovascular system: increased BP & HR
95
What are some recommendations for fluid replenishment and reliving oneself?
break frequently for fluid replenishment, completely empty the bladder to reduce possible stress on already weakened pelvic floor
96
What recommendations should be given in terms of stretching/flexibility?
avoid ballistic movements, only ROM, caution w/ adductor/hamstring stretches b/c over stretching these muscles can lead to pelvic instability
97
What are some signs/symptoms of overexertions or possible pregnancy complications and are reasons to discontinue exercise & contact a Dr.?
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
What are the recommendations for fitness exercise for pregnant women w/ no maternal or fetal risk factors
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
What is the recommendation for the resumption of pre pregnancy exercise routines post pregnancy?
gradually increase exercise intensity, initial exercises should be pelvic floor strengthening to help prevent incontinence ~6weeks post baby~
100
Absolute contraindications to exercise during pregnancy
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
What is placenta previa
placenta is located on the uterus in a position in which it may detach before the baby is delievered
102
What are the precautions to exercise during pregnancy
gestational diabetes, severe anemia, systemic infection, extreme fatigue, musculoskeletal complaints, overheating, extreme obesity or underweight, diastatic recti
103
What muscles can be gently stretched with caution during pregnancy?
upper neck extensors, scalene, scapular protractors, shoulder IR, levator scapula, low back extensors, hip flexors adductors hamstrings (caution) , ankle plantarflexors
104
What muscles should be strengthened during pregnancy (Resistance exercises)?
upper neck flexors, lower neck & upper thoracic extensors, scapular retractors/depressors, shoulder ER, trunk flexors, hip extensors, knee extensors, ankle dorsiflexors
105
What is the progression of corrective exercises for the diastasis recti?
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
What type of breathing breathing pattern should be achieved during exercise?
slow controlled breathing, exhale during the exertion phase of exercise
107
Name some dynamic trunk exercises that can preformed while pregnant and are beneficial of improving proprioceptive awareness as well as lumbar, pelvic, hip mobility
pelvic tilt exercises (quadruped), pelvic clock (supine hook lying), trunk curl ups/downs (early stages of pregnancy & no diastasis recti present), diagonal curls
108
Name some modified UE strengthening exercises that can be performed while pregnant
standing push ups, supine bridging (alternately felt & extend UE to emphasize stab function of hip extensors & trunk musculature, scapular retraction (sitting/standing)
109
Name some modified LE strengthening exercises for a pregnant patient
quad leg raising (ppt then slowly lift 1 leg), modified squats (wall slides)
110
why is LE strengthening important during pregnancy?
strengthen hip & knee extensors also helps stretch the perineal area for flexibility during the delivery process
111
Examples of pt self stretching to help prepare the legs & pelvis for childbirth
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
Name pelvic floor exercises that help the patients awareness and motor learning
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
What compensations must you for with the contract relax exercise for pelvic floor awareness
substitution with the gluteals, abdominals or hip adductors
114
Why is pelvic floor relaxation important?
linked to effective breathing, inability to relax may lead to impairments such as hypertonus, pain w/ intercourse or voiding dysfunction
115
What are some unsafe postures/exercises during pregnancy?
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
What exercises can be initiated during the postpartum period?
pelvic floor strengthening (increase circulation & aid in healing), corrective exercise for diastasis recti, aerobic exercise, light resistance training can increase gradually
117
Suggested activities for the pt following a cesarean section?
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
If the POC sates enhance incisional circulation and healing; prevent adhesion formation what should the intervention be?
gentle abdominal exercise w/ incisional support,scar mobilization & friction massage
119
What is pregnancy-related hypertension or preeclasmsia?
hypertension, protein in urine & severe fluid retention it can progress to maternal convulsions, coma & death if it become severe (this is known as eclampsia)
