Multisystem Conditions Flashcards
Male and female top cancers
Male: prostate, lung, colon
Female: breast, lung, colon
TMN cancer staging
0: carcinoma in situ
1-3: extend beyond where it has developed
4: spread to different organs
Chemotherapy side effects?
Alopecia, mucositis, pulmonary fibrosis, cardio toxicity, renal failure, sterility, myalgia, neuropathy
Radiation side effects
Skin irritation, scar tissue, hair loss, temp change in skin colour, Fatigue, swallowing discomfort
5 main treatments for cancer
Surgery Chemotherapy Radiation Hormone replacement sx Biological or genetic tx
Clinical presentation of patient with Cancer
- ROM limitation
- Fatigue
- Myalgia
- Arthralgia
- chemo induced peripheral neuropathy
- ## deconditioned
PT management of Cancer
- Fatigue management
- fxn and mobility management
- physical symptoms management
- psychological symptom management
Rehab: preventative, supportive, restorative
Acute sitting: mobility (equipment), strength, bed positioning
Exercise precautions for a cancer patient
Swollen ankle, fatigue, committing and diarrhea, unexplained weight loss/gain, SOB with low levels of exertion
Contraindications to exercise for Cancer patient
- racing pulse, fever, pain in back, neck, bones, calf pain, Chest pain, nauseated while exercising, confused or disorientated, dizzy/faint, blurred vision, sudden SOB, very weak and tired
If a person has Mets what Q’s need clarifying?
- Weight bearing orders (not just AAT)
- neurological symptoms ( b/b, pain)
Normal Hb levels for male and females
At what level does exercise need to be scaled back?
Male: 14-18 g/dl
Female: (12-16 g/dl)
Precaution when Hb is
What is the effect of Anemia?
Effects amount of O2 that can be carried to the cells
What is Neutropenia?
Decrease in WBC related to body’s ability to fight infection
Neutropenia: normal WBC #, point of infection risk.
Exercise precautions
Normal WBC >1000mcL
Infection risk increase if absolute neutrophils
Thrombocytopenia
- Low platelet count (normal = 150-400,000 mcL) increases bleeding/ bruising risk
Exercises dependent of platelet levels
If
What is the function of lymphatic system
Removal of fluids, proteins, bacteria, viruses
- smooth mm in walls contract to move lymph
Differentiate the two types of lymphodema
Primary:
- rare, inherited condition that development problems occur in lymph vessels
Secondary:
- D/T damage to or obstruction to normally functioning lymph vessels and nodes
Risk factors for Lymphedema
Radiation
- Axillary node dissection
- arm infection/virus (primary)
- wight gain since operation
- obesity (bmi >25)
- older age
How to measure Lymphedema
- circumferential (>2cm)
- water deplacement
- perometer and bioelectrical impedance
What are the goals of Palliative care, what can we help with?
Goal: comfort, support, maximize independence
Can aid with: respiratory, stress reduction, education
Ways that HIV AIDS is transmitted
- blood, saliva, semen, CSF, breast milk, vaginal secretions, mucous membrane, mother to child during pregnancy
Not by: urine, sweat, vomit
Common conditions associated with AIDS
Pneumonia, TB, malignancy, encephalitis, meningitis, dementia, herpes zoster
treatment for AIDS?
Med Rx:
- multiple antiviral therapy
- symptomatic tx: nutrition, functional mobility, education
PT management:
- mod aerobic & strength
- avoid exhaustion
- energy and stress management if acute
Pathology of autoimmune disorder Guillain-barre
Antibody mediated demyelination of Schwann cells in PNS from spinal nerves to terminating fibres
- possible hospitalization of 6-8 months
Cause: immune disorder (2/3 from recent illness)
GB s/s
- Rapid ascending motor weakness and distal sensory loss (starts in legs and spreads to arms, trunk, face)
- ataxia
- stocking and glove pattern of loss
- paralysis
- absent DTR
- may require ventilation
GB management
Medical: Plasmaphoresis, immunoglobin
PT:
- positioning to decrease ulcers
- joint protection
- chest Rx, mobilization
- strength
- ROM (opposite progression of ALS)
What is Lupus erythematosus?
A system autoimmune connective tissue disorder involving the skin and other systems ( kidney, CNS, Cardiac, pulmonary)
Lupus erythematosus s/s
- skin rash (butterfly)
- localized erythema
- localized edema
- arthritis
- alopecia
- photo sensitivity
- mucous ulcers
- Raynaud’s
- joint effusion
Dx: +ve serum “antinuclear antibodies” symmetric arthritis
What is Sclerodema (systemic sclerosis)
- Chronic disease primarily affecting skin, characterized by sclerosis (hardening of skin) via a massive fibrotic tissue response.
Can cause:
- joint contractures, pulmonary fibrosis, HTN
- renal, GI dysmotility (esp esophageal), Raynaud’s
Differentiate b/w Dermatomyositis and polymyositis
- Dermatomyotositis = skin+ muscle, photosensitive skin rashes, purplish erythematous eruption over face & UE
- Polymyositis = muscle only
- inflamed connective tissue disorder characterized by proximally limb girdle weakness, often without pain
What are 3 causes of hemophilia?
Hereditary bleeding disorder
1) vascular abnormalities
2) platelet abnormalities
3) coagulation cascade abnormalities
Discuss type A hemophilia?
- most common of hereditary clotting factor deficiencies
X-linked recessive = males have condition, females carry the gene
- if mom is carrier & father doesn’t: 50% chance male will have disorder, 50% female will be carrier
If mother is not carrier & father has hemophilia: male not affected/ can’t carry gene. Female child will be a carrier known as an Oblagate carrier
Hemophilia S/S?
1 = bleeding in the joint
- large bruises
- bleeding into muscles and joints
- prolonged blending after a cut
- big trauma = big organ bleed
S/S of patient with a joint bleed (hemophilia)
What can happen if not treated?
Stage 1) Joint tightness, no pain
2) tightness,pain , no bleeding
3) swollen hot to touch, hard to move joint
4) all ROM last + night splint
No Tx can lead to Arthritis
Tx= factor VIII infusion, desmopressin
Q’s to ask if querying a rheumatic disease?
1)Red flags:- #, septic arthritis, malignancy, central cord s/s, muscle weakness, burning/ numbness parasthesia
2) inflammation IN or AROUND joint?
- if in: effects multiple ROM, swelling is common, but no focal TOP
3) Focal or widespread?
4) Acute or chronic duration
Is the condition “inflammatory” or “non-inflammatory” via s/s?
Inflammatory:
- worse in AM, mod-severe swelling, occasional erythema, warmth, morning stiffness =/>1hr, systemic features sometimes present, frequent increase in ESR erythrocytes sedimentation rate [RA])
Non inflammatory:
- pain worse after use, mild swelling, not red, not warm, stiffness
Main feature of RA?
- pathology + leads to..
Synovitis (symmetrical pattern)
- synovium swells and cells proliferate:
1. Dense cellular membrane (pannus) spreads over articular cartilage
2. Erosion of bone and cartilage
3. w/ time pannus extends to opposite articular surface creating: 1) fibrous scar, 2) adhesions, 3) bony ankylosing
Leads to:
- immobility + consolidation of a joint
- bones become osteopenic
- ligaments/ tendons become damaged or ruptured
- mm deteriorating causing joint instability & deformity
Criteria for RA diagnosis?
- morning stiffness >1hr
- arthritis in >3 joints (6 weeks)
- arthritis in hands
- symmetrical arthritis
- rheumatoid nodules
- serum rheumatoid factors
- radiograph if changes
- abnormal antibody (HLA-DR4 [80% those w. RA])
HLA-DR4 also commonly found in pt with interstitial lung disease, hepatitis, pulmonary fibrosis,normal aging,
S/S of RA?
- pain, fatigue, stiffness (dec ROM), swelling, joint deformity, mm atrophy, extra cellular features.
How is RA managed?
MEDs:
- DMARDS/ Biologics to stop disease process
- Methotrexate to prevent permanent joint damage
- NSAIDs: Tylenol, cortisone = to dec inflammation and pain, help ROM
REHAB!
Lifestyle
Surgery
Discuss RA rehab?
Acute phase:
- energy conservation, ice, splints, gentle ROM (no stretching… May stretch the synovial membrane and cause irreversible damage)
Chronic phase:
- relieve pain: Heat/ice, modalities
- splints, exercise (ROM)
- relaxation/rest
- dec stiffness (ROM)
- endurance exercises (in water?)
- prevent deformity
- fall prevention
- physically active
4 R’s of sugery
Remove (MTP resection)
Re-align (tendon rupture)
Rest (arthrodesis)
Replace (arthroplasty)
Basics of a joint count Ax?
-indicator of RA disease activity via STOP method
- Joint effusion :2 or 4 finger technique
- Joint line tenderness
- Stress pain
Commonly affect joints in RA?
1) Atlanto-Axial joint:
- Transverse ligament: s/s = clunking in repositioning in sharp purser test, dysphagia, dizziness, blurred vision
2) TMJ: end stage = fusion of open bite
3) shoulder: humeral head migrates superior ply
4) AC joint
5) elbow: flexion deformity
- superior radio-ulnar joint involved= erosion of radial head
6) hip: groin pain, flexion deformity
7) knee: baker’s cyst, flexion deformity, valgus deformity, quad wasting
Classic RA Deformities
- Hallux valgus
- MTP subluxation
- Claw toe
- hammer toe
- mallet toe
- swan neck
- boutonnière
- ulnar drift
- Thumb: 90/90 or swan neck
- DRUJ instability
What is Hallux valgus? + effect on foot
1st MTP synovitis, big toe is lateral, lig laxity + erosion
- subluxation, dislocation leads to proximal phalanx drifting laterally causing pronation of mid foot
Discuss MTP subluxation
- Synovitis causing displacement of flexors, then unopposed extensors pull the proximal phalanx into hyperextension. Metatarsal head prolapsed and get dislocation and Lat drift of toes
Sign: callouses
What is claw toe?
MTP synovitis, MTP ext, PIP+DIP flexion
- often all toes except big toe
What is a hammer toes
- MTP & PIP synovitis (usually 2nd toe), leads to flexion of PIP and hyperextension of DIP (similar to boutonnière)
What is mallet toe?
Flexion of DIP (usually of longest toe)
Features of a swan neck deformity.
- Flexion of MCP, hyperextension of PIP, flexion of DIP
Test & Rx for a SND
Test: Bunnel littler
Rx: able to actively flex & ext deformed joints, stretch interosseous muscles
What is a boutonnière deformity? How do you test for it?
Zig Zag defomity: MCP hyperextension, flexion of PIP, hyper extension of DIP
Test: central slip
Features of an ulnar drift deformity
- most common hand deformity
- involves synovitis of MCP + structural differences cause collar subluxation of MCP in radial collateral ligaments
Ulnar drift deformity: test + Rx?
Test:
- radial collateral ligament test
- extensor subluxation test
Rx: radial finger walking, joint protection.
Common thumb deformities & tests
90/90 thumb, or SND
Test: grind, crank test
Feature of DRUJ instability
Synovitis at joint, stretches ulnar carpal ligaments, ulnar head will sublux dorsally, ECU is displaced and may become a flexor tendon
Test: ballottement tests
What is Gout?, common joints + Rx
- genetic disorder of Purine metabolism
Increased uric acid, forms crystals and deposits into joints
Knee + great toe most common
Rx: Meds: NSAIDS, cox2-inhibitor, CS, ACTH, Aspiration!
PT Rx: injury prevention, education
OA: pathology + Risk factors
Release of enzymes + abnormal bio-mechanical forces = fibrillation + articular cartilage damage resulting in cartilage loss + increased bone turn over = osteophytes
Risks:
- Age, F>M, obesity, physical inactivity, injury, joint stress
OA: main joints affected
Spine: osteophytes in facet joint of L-spine = stenosis
Hand:
- PIP = Bouchard node
- DIP = Hebenen’s node
- CMC joints (thumb)
Knee: varus, flexion contracture, crepitus
Hip: trendelenberg, groin pain, osteophyte, flexion deformity
Foot: 1st MT = osteophytes cause Hallux valgus + rigidus + bunions
Uncommon:
- shoulder/elbow, wrist (except if have scaphoid # or avacular necrosis) ankle
OA: Dx
- 4 main X ray findings
- 4 important Q’s
- tests indicative of knee OA
X-ray: kellgren-Lawrence
1) joint space narrowing
2) Osteophytosis
3) subchondral cysts
4) subchondral sclerosis
Q’s
- Pain most days of the month?
- pain over the last year?
- worse with activity, over doing it?
- relieved with rest but have “gelling” after inactivity
Knee tests:
- flexion contracture, abnormal gait, swipe test/ patellar tap +ve
OA:
- sources of pain?
- RX:
- pain from: bone, soft tissue, inflammation, mm spasm
Rx:
- weight loss: 1lb weight loss= 4lb less through knee
- Exercise: 30 min mod aerobic + LE resistance
- protective aids, Tylenol, modalities…tens
Two type of FAI? + features
Cam: “bigger femoral head and neck”
- w/ hip flexion the abnormal femoral head drives into the acetabulum usually in young men
Pincer: deeper acetabulum
- impingement when femoral neck pushes against overarching acetabulum usually affect women 30-40
Spondyloarthritis: characteristics
Spine inflammation = spondylitis and sacroilitis
Synovitis –> unilateral peripheral joints
Eye inflammation = iritis/ uveitis & conjuctivitis
- No rheumatoid factor (seronegative)
- can be hereditary: HLA-B27
Psoriatic Arthritis:
- characteristics
- types
- Rx
Chronic, erosive, inflammation affecting fingers and axial skeleton
- Dactylitis: sausage like fingers d/t swelling
- Enthesitis: usually in heels and back
Med Rx: acetaminophen, NSAID, DMARD, CS, Biologics
PT Rx: joint protection, maintain joint mechanics, endurance
Enteropathic Spondylits:
- related to…
Related to inflammatory conditions of the bowel
- Ulcerative Colitis: affects lower half of bowels
- Crohn’s disease: worse/ affect whole digestive system
Increase bowel disease = increase arthritis
Affects spine, SI, limbs
Reactive arthritis:
- triggers
- characteristics
Triggered by: infection (STI) in bowel or GI tract
Features:
- hot swollen joints: LE + symmetrical
- may go away and return
Ankylosing Spondylits:
- Onset before 40, M>F
- low back pain + sacroiliitis
- kyphotic deformity of Csp,Tsp, dec lumbar lordosis
- Diagnosis: HLA-B27
- Meds: NSAIDs, CS, Biologics,cytotoxic
- PT goals: trunk flexibility, endurance,increase Resp fxn.
Ankylosing spondylitis (AS): features
Sacroiliitis: SI joint pain, may cause deep dull buttock pain
Enthesitis:
- Entheses inflammation: where tendon, lig + joint capsule attach to bone
- results in bony erosion + overgrowth
- Osteopenia –> osteoporosis + fusion/rigidity = inc fracture risk
- affects rib cage + decrease chest expansion
- Syndesmophytes –> Bony Spurs on 2 sides of joint causing fusion and rigidity
Synovitis:
- usually affects peripheral joints: shoulders, hips, knees, ankles
Heart, lungs, eyes, bowel… Inflammation and scaring
Ankylosing Sondylitis:
- clinical criteria
1) LBP + stiffness >300: improves with exercise, worse with rest
2) AM stiffness:
3) Altered posture/ muscle imbalances: deformity/ instability
- HFP, Tsp kyphosis, flattening of anterior chest wall, protrusion of abdomen, flattening of lumbar lordosis, slight hip flexion
4) dec strength –> deconditioned
5) dec Lsp ROM in saggital + frontal planes –> flexed posture
6) Altered breathing mechanics –> dec chest expansion, dec vital capacity
7) fatigue due to disease process
Ankylosing Spondylitis:
- physical assessment:
- Rx
Ax:
- Smythe test
- Modified schobers
Rx: - DMARDS, NSAIDs, CS, Biologics PT: - control/ dec inflammation - P management - reduce stiffness/ inc ROM - posture - strength, endurance , cardio
AS: outcome measures
BASFI: impact of disease on fxn in last week
BASDAI: how disease is managed
Differentiate mechanical vs inflammatory back pain.
- duration
- age
- pain
- type
- xray
Inflammatory:
- 12-40 y.o. Last >60 min, worse in AM, chronic, Xray = scroiliitis, syndesmophyte, spinal ankylosis.
Mechanical:
- 20-65 y.o. Lasting
Juvenile idiopathic arthritis:
- s/s
- Ax
S/s:
- pain, dec fxn, AM stiffness, dec ROM + strength + flexibility, growth abnormalities, asymmetrical posture + movement patterns,
- eyes: uveitis
- affects synovium, tendons sheath, entheses
Ax:
- Pain, ROM, joint count, mm strength and length, fatigue,
Juvenile idiopathic arthritis:
Dx
Rx
Dx:
- s/s must be present for 6 months. Subtype determined by presentation in 1st 6months
Rx:
- get child as activate as possible.
- complete remission in 75% of kids under 16
Stages:
1) acute –> maintain ROM and fxn
2) subacute –> ROM And strength
3) chronic –> complex activities/ balance
Exercises in RA and OA:
RA:
- affects MCP + PIP, rheumatoid cachexia (break down of mm fibres), fatigue
OA:
- affects weight bearing joints: hip, spine, stretching/ROM
Contraindications/ red flags:
- inc pain, fatigue, AM stiffness
- sudden pain at joint or joint deformity
- joint becomes Red hot swollen after exercise (24hrs)
- dec mm strength and lengh
- Neurological s/s (cv involved)
- SOB one mild exercise
Precautions:
- innapropriate exercises, swollen joints at risk for capsular stretch
- OP bone at risk of #
- use machines and bands rather than free weights
Insulin function
Regulates glucose levels
- promotes glucose uptake into the cells for storage
- -> mm, liver, adipose tissue
Differentiate b/w type 1 and 2 diabetes
Type 1: insulin deficient
- juvenile onset
- requires insulin
- immune mediate attach to islet cells in pancreas thereby reducing circulating insulin
- Presentation:
- ->weight loss, increase urination, dehydration
Type 2: Insulin resistant
- adult onset
- pt don’t require insulin, peripheral tissues do not respond to it.
- Presentation:
- -> Obese, HTN, hyper pigmented skin (acanthosis, nigrican)
DM:
- Hypoglycaemia vs hyperglycaemia presentation
Hypo:
- dizzy, blurred vision, sweating profusely (r/o ortho static hypotension), fatigue, irritability, confusion, fainting
Hyperglycaemia:
- blurred vision, fatigue, thirst, urination, weakness, abnormal breathing, acetone breath
Long term effects:
- damage to small blood vessels (retinopathy and diabetic nephropathy)
- damage to large blood vessels via abnormal glucose metabolism causes increased cholesterol levels –> vessel wall damage –> atherosclerosis or MI, or Stroke, gangrene
- damage to peripheral nerves, diabetic neuropathy
DM:
- normal glucose levels
- Long term consequences
- normal fasting plasma glucose: 5.6 - ulcers–> amputation
- kidney: diabetic nephropathy–>CHF–> swelling –> HTN –> protein urea
- eyes: diabetic retinopathy (blind)
- heart: MI, stroke, atherosclerosis
- infections
DM:
- Rx
Diet +meds to stimulate insulin secretion
- exercise! But caution with night exercise cuz of diabetic coma from hypoglycaemia when sleeping
Chronic pain signals fired via what fibres?
- A Delta: high threshold, sharp, localized, fast adapting
- -> meds work well
- C Fibres: low threshold, dull aching, slow and persistent
- -> meds do not work
pain:
- Pathology
- conduction
Tissue damage (stimulates nociceptors), inflammatory mediators released cause swelling + inflammation. - release of cells in plasma (bradykinin, prostaglandins, sub p) stimulate pain receptors
Conduction via LST-tract to thalamus and to the cortex
- periaqueductal grey –> releases endorphins –> inhibits sub P + glutamate release to reduce pain
Chronic pain: pathology
- Actual chemical changes occur in the tissue and the limbic system of brain
- receptors become hypersensitive –> allodynia or hyperalgesia cause increase actiivty in pain pathways
Rx:
- have to desensitize the area
- educate them that it’s not in their head
- restore normal function to the area
- -> medication, electro therapy, cryogenic/thermotherapy, exercise/ stretch can reduce pain caused by mm spasm
Chronic fatigue syndrome:
- Dx
- Rx:
Dx: via exclusion
- persistent or relapsing fatigue for >6months
- not resolved with bed rest
- reduces daily activity by 50%
Rx:
- analgesic, anti-inflammatories, NSAIDs, nutrition, psych
- exercise
Fibromyalgia
- defined
- s/s
- Rx
- chronic pain syndrome of unknown ethology affecting mm + soft tissue (non- articular rheumatism)
S/s:
- headache,sensitivity, fatigue,myalgia, aching, sleep disturbances, anxiety/depression
- 11/18 points –> occiput, low cervical (c5-7), traps, supraspinatus, 2nd rib, lateral epicondyle, gluteal, greater T, knee
Rx:
- energy conservation + pool, anti-inflamm, pain meds, psych, nutrition, heat, dry needling
Sepsis:
- defined
- septic shock
Presence of systemic inflammatory response syndrome + infection
Septic shock:
- severe sepsis but hypoperfusion abnormalities in spite of adequate fluid resuscitation
- immune system spirals out of control
- ” normal response to infection is local but then causes widespread vasodilation and vascular permeability”
Shock
- defined
- types
Poor distribution of blood at the microcirculation level = dec perfusion –> potential cell death
Types:
- hypovolemic (blood loss)
- cardiogenic ( heart damage)
- distributive (hypotension and general tissue hypoxia)
- obstructive (Great vessels of heart)
SIRS = systemic inflammatory syndrome:
- defined
- Dx
- whole body inflammatory state
Dx: via body temp, HR, RR, WBC count
- HR >90
- temp >38 o4 20 or PaCO2 12000 or
Obesity:
- FITT
40-60% HRR, 5-7day/ week, 45-60min of. Circuits or aquatics
- caution to not over heat.
Pregnancy:
- posture changes
- % of incontience
- HFP
- inc thoracic kyphosis
- inc lumbar lordosis
- breast size
- shoulder protraction
- dec form and force closure –> pelvic floor stretch
- lig laxity
- balance changes
Incontinence –> 67% from vaginal delivery
Pregnancy:
- PT antepartum concerns
- antepartum bleed
- preterm labor (irritable uterus) : “mini contraction”
- ruptured membrane: slow trickle of fluid (no water break)
- incompetent cervix/ changes
Diastasis Rectus abdominus:
- defined
- effects
- Rx:
- lateral separation/ split of Rectus abdominus (>2.5 cm is sig, usually detected in 2nd trimester) Effects: - weak abdominal wall - dec support for back and viscera - related to lumbo-pelvic pain
Rx:
- education, posture and mechanics, movement pattern and recruitment strategies
- EXERCISE: TA, Multifidus, PF
- abdominal binders
- recovery 2-6 months, surgery if severe
Varicose veins:
- define
- s/s
- Rx:
Veins that are enlarged + twisted + poor valve closure,
S/s:
- heaviness, dull ache in legs with standings get and walking. Veins distension, tenderness, LE most common
Rx:
- posture, positioning in elevation, limit crossed legged time, pressure graded clothing, circulatory exercises.
Pregnancy: incontinence
- inc risk in vaginal delivery. Dec abdominal recruitment with inc intra abdominal pressure or strong need to urinate when on toilet.
Causes:
- injury to CT, pelvic nerves and mm
- injury to urinary tract, changes in PF anatomy
- urethral weakness/ vaginal relaxation
Rx:
- PF exercises (10sec hold, 10 contraction 2-3x/week) w/ fxn tasks
- co-contraction of TA + PF
- posture and body mechanics
- urgency techniques (perch, PF contractions, walk to bathroom)
- diet changes (less coffee etc)
Gestational diabetes:
- what to avoid during RX
- Red flags for reproductive problems
Avoid:
- valsalva/ exercises that stress PF + abdominals
- rapid uncontrolled movements
- positions of inversion
- deep heating modalities
- manual therapy?
- positioning? Supine only short periods
- **give posture tips and STS strategies using glutes
REDFLAGS:
- changes in BnB fxn, sexual fxn,
- non-mechanical lbp
- suprapubic or groin pain
PF disorders:
- causes
- types
- s/s
- PT Rx
Due to stretch–> ca lead to partial or total organ prolapse
- Cytocele: herniation of bladder into vagina
- Rectocele: herniation of rectum into vagina
- Uterine prolapse: bulge of uterus into vagina
S/s:
- pelvic pain, urinary incontinence, pain with intercourse, heaviness in saddle region, incomplete emptying. Worse with activity or EDL of day
PT Rx:
- PF mm exercises, postural re-Ed, pessary, surgery
Preeclampsia:
- define
- s/s
- pregnant induced acute HTN after 24 weeks gestation
S/s:
- HTN, edema, headache, visual disturbances, hyper-reflexia
C-section
- PT tx
- TENS for incision pain
- breathing exercises
- gentle ab exercises
- PF
- posture, ambulation
- scar massage
Burns:
- severity
- rule of 9
1st: superficial, erythema
2nd: partial thickness, blistering appearance
3rd: full thickness, necrosis (skin falling off)
Rule of 9: to determine body surface area involvement (except 1st degree)
- head = 9 (18)
- torso = 36
- arm = 9
- leg = 18 (kids 14)
Burns:
- phases of wound healing
- classification of wound healing
1) inflmamation (
Burns:
- zones
- effects of body tissue
Zone of coagulation: point of max damage, irreversible tissue loss
Zone of stasis: dec tissue perfusion, maybe salvageable
Zone of hyperemia: inc profusion, we’ll recover unless sepsis occurs
Effects:
- CVS: inc capillary permeability = interstate edema. Peripheral vasoconstriction, hypovolemia, myocardial depression, dec CO
- Resp: bronchoconstriction, ARDS, Carson monoxide (low O2 cc)
- metabolism: increase 3x’s
- immune system: compromised
- Renal: loss of fluid –> vasoconstriction, dec GFR, inc myoglobin gets processed by kidneys and can block tubules.
Burns:
- signs of inhalation injury
- Rx
S/s:
- singed eyebrows/ face, swollen lips, hoarse voice, poor SpO2
- w/in 24hrs–> upper airway obstruction/ pulmonary edema
- 24-48: pulmonary edema, 48+ bronchiolitis, alveoli this, pneumonia, ARDS
Tx: mobilize, breathing ex, postural drainage
PT Rx:
- keep wound moist, HVPC, good health/diet, de bride wounds, ROM, positioning, edema management. Scar management (1-4 days) for scar tissue contracture.
Conditions that are contraindicated to exercise:
- exposed joint, fresh skin graft, DVT, compartment syndrome
Skin graft:
- types
- Rx:
Split thickness skin graft:
- stiches, glue, suture, immobile for 5 days
Full thickness:
- skin transplant
Rx:
- scar massage, sun protection, ROM, pressure garments
- strengthing in 3-4 weeks
Scar from burns stages
0-4 weeks: fibroblastic/proliferative
4-12 weeks: early remodelling
12-40 weeks: late remodelling/maturation
-age, smoking, type of tissue, nutrition influence scar
Rx: pressure garment, massage, moisture
4 stages of wounds:
1) reddened
2) skin is broken, small crater
3) deep crater, ?infection, ? Black from necrosis
4) deep through mm to the bone or joint
Describe:
- location, size, wound base, edges, surrounding skin, stage photo
Wounds:
- education for clients
- Rx:
- Look at skin 2x/day,
- monitor temp, colour, text, erythema, discolouration
- Braden scale of ax risk
Rx:
- multidisciplinary team, dressings, mobility restrictions
- PT: HVPC level 1 evidence for wound healing
Psoriasis:
- definition
- Cardinal signs
Autoimmune disease that affects the skin
- faulty signals that speed up the growth cycle of skin cells causing profound cutaneous inflammation and epidermal hyperplasia.
5 signs:
- plaque (raised lesion)
- well circumscribed margins
- bright salmon red
- silvery micaceous scale
- Symmetrical distribution
Psoriasis:
- complications:
- Rx
- physical (Pruitis,bleeding of lesion
- emotional and psychological (isolation, loss of self esteem)
- economic: cost of meds, time away from work
- severe psoriasis is associated with CVD, and arthritis
Rx:
- Topical creams containing glucocorticoids
- Tars
- Vitamin D or A
- Phototherapy with UV light
- Systemic therapy with immunosuppressive drug
Eczema:
- define
- features
- types
Dermatitis/inflammation of the epidermis
- itchy, red scaly disorder
Types: Atopic dermatitis (endogenous) or contact dermatitis
Atopic Dermatitis:
- defined
- presentation
- phases
- Rx
Itchy inflammatory disorder associated with atopy in people predisposed to certain allergic hypersentivity.
- Itchy (Pruitis), linchenification (thickened skin lines), excoriation (scratching), crusting
Phases:
1) infantile: facial and extensor distribution
2) Childhood: dry skin, flexural distribution (knee/ elbow creases)
3) adult: improves with age, primarily affects the hands
Rx:
- avoid irritants, UV therapy, moisturizers, topical glucocorticoids, antihistamines,
Contact dermatitis:
- types + features
- Rx
Allergic contact dermatitis:
- immune hypersentivity to an allergen in contact with skin (nickel, poison ivy)
Irritant contact dermatitis:
- contact causing direct local irritation (harsh detergents, chemicals)
Rx: topical steroids
Seborrheic dermatitis:
- what is it?
- where?
- features
- Rx
“Dandruff”
- occurs in high oily areas (high sebaceous gland activity) due to an excessive immune response to yeast
- ill defined areas of erythema with greasy appearing scale
Seen in: PD, Stoke, TBI, SCI, HIV (with low mobility)
Rx: antifungals
Liver:
- main 3 functions
- s/s of illness
Producing:
- albumin (fluid transmission)
- Clotting factors (bleeding)
- Ammonia metabolism (breaks down protein by-product –>urea–>excreted by kidneys
S/s: yellow, itching (Pruitis), big belly (ascites), bleeding, esophageal varices
Hepatitis A:
- transmission
- risk factors
- s/s
- virus transmitted by fecal oral route
Risk factors: international travel, daycare
- vaccine is available
S/s: jaundice, fatigue, weakness, anorexia, nausea, vomiting, abdominal pain
Note: kids are usually asymptomatic
Hepatitis B:
- transmission
- risk factors
- complications
- Rx
Infection of liver, can become chronic and lead to cirrhosis and hepatocellular carcinoma.
- high risk in 3rd world countries
- high risk of spread mother to child, less so via sex/ drugs
Rx: antiviral, vaccine, no cure
Hepatitis C:
- transmission
- complication
- Rx:
Transmission:
- percutaneously (needles and drugs)
- non percutaneously (sex)
- hemodialysis
- high risk of chronic complications (more than hep B)
Rx: interferon and anti-viral agents
Grave’s disease:
- pathology
- s/s
- Rx:
“Hyperthyroidism” F>M
- autoantibodies stimulate the thyroid (TSH receptor), T3, T4 to inhibit the secretion of TSH.
S/s: goiter, bulging eyes, fever, weight loss, exercise intolerance, tachycardia,
Rx:
- beta blockers for HR, anti-thyroid drug therapy, radioactive idione, Sx removal thyroid.
Hashimoto Thyroiditis: hypothyroidism
“Hypothyroid”, F>M
- autoimmune destruction of thyroid gland, T3, T4 low, TSH high
S/s:
- wt gain, cold tolerence, round puffy face, bradycardia, constipation, depression
Rx: thyroid hormone replacement
Addison’s disease:
- define
- s/s
- Rx
Autoimmune process against the adrenal cortex, fatal if not treat, good prognosis if treated.
S/s: weakness, fatigue, anorexia, hyponatremia, hypoglycaemia, hypopigmentation
Rx:
- replace missing adrenal hormone with aldosterone and cortisol
Cushing’s disease:
- define
- s/s
- Rx
Chronic glucocorticoid (cortisol) excess
S/s: moon face, central obesity, abdominal striation
Rx:
- surgical if caused by tumor (pituitary or adrenal gland)
Two types of inflammatory bowel diseases
- complications
- S/s
- Rx:
- Crohns: gum to bum
- Ulcerative colitis: colon and rectum
Affects the entire GI tract: gum to bum
- ulcers, fissures, fistulas, you get alterations in digestion and absorption = malnutrition
- s/s:
- Abdominal pain and cramping
- Diarrhea
- Weight loss (unable to absorb nutrients)
- Nausea & vomiting
- Blood in stool
- Fever
- Fatigue
Rx:
- anti-inflammatory drugs for bowel, prednisone (immunosuppressant), antibiotics
Main concern from a transplant?
- donor factor (disease?)
- coagulation products at time of transplant (will they bleed out?)
- function, immuno suppression, rejection, infection
Lung tumor quick facts: spread, origin, met?
- small cell
- squamous (non small cell)
- adenocarcinoma
- large cell
Small cell:
- 25 % develop into bronchial cell mucosa, rapid spread, met early
Squamous:
- slow spread, arise in central portion near hilum, met late
Adenocarcinoma:
- 40%, slow-mod spread, early mets through lung/brain/other organ
Large cell:
- rapid wide spread mets, kidney, liver, etc, poor prog
Connective tissue tumors: quick facts
- osteosarcoma
- synovial sarcoma
- Osteoid osteoma
- prostate
Osteosarcoma: end of long bones, moth eaten appearance, can occur in youth
- synovial sarcoma: larger joints, swelling + instability, surgery +/- chemo/radiation, ?met to bone. Origin: breast, lung, prostate, thyroid
- Osteoid osteoma: Benign tumor, exercise related bone pain and tenderness, abolition of symtoms with ASA, Tx = ablation, ethanol, laser
- Prostate: men >50, tx = surgery, laser, androgen deprivation
Brain tumors: quickly
- intra cerebral metastic
- intra spinal
- low grade astrocytoma
- medulloblastoma
- neuromas
- intra cerebral metastatic: from lungs/breast/prostate. Compensate by dec brain tissue/ CSF, blood flow volume
- Intraspinal: nerve root pain, worse at night, cough, radicular pain,
- low grade astrocytoma: benign, good survival with early tx
- medulloblastoma: frequent meds to other areas of brain and spine
- neuromas: schwannoma –> CN 8, headache, seizures, vomit, cognition
Skin tumors: quick
- Basal cell carcinoma
- Squamous cell
- malignant
- BCC: most common, low risk of spread, translucent and red in color
- Squamous cell: solid skin color, volcano shaped, high risk of mets
- malignant melanoma: most dangerous, high risk of mets
