Multisystem conditions cont. Flashcards
In what trimester of pregnancy does carpal tunnel and/or de quervains normally develop? What causes this?
2nd trimester
D/T increased fluid & pressure, hormone changes, poor lifting/carrying technique of toddler or newborn
Carpal tunnel syndrome and de quervains Rx in pregnancy
- education (what to avoid, ergonomics, movements strategies)
- ice, electrotherapy, stretching
- good prognosis
Varicose veins S&S
- heaviness, dull pain/ache in legs with standing and walking, may be incapacitating pain
- apparent vein distension, reported tenderness, usually in lower legs (can be uvular)
Varicose veins Rx
- posture, positioning elevation, limit cross legged time
- pressure graded stockings/tights/underwear, circulatory exercises
What causes incontinence
- injury to connective tissue
- damage to pelvic nerves and muscles
- direct injury to urinary tract
- changes in pelvic floor anatomy
- urethral weakness
- vaginal relaxation
Incontinence Rx
- PF exercises (10 second holds, 10 contractions, 2-3x per week) incorporate w/ functional tasks
- co-contraction of TA and PF
- posture and body mechanics (poor lifting technique)
- urgency techniques (perch, PF contractions, walk to bathroom)
- diet changes (coffee intake, water, gradually increase time between urination from 2-4 hrs)
What is gestational diabetes, when does it occur?
What is the risk of
Abnormal blood sugar reading 1st seen during pregnancy
undetected or mismanaged can lead to very high risk to baby and to mom
Things to avoid during pregnancy
OVERALL RX- things to avoid:
- Valsalva, exercise techniques that stress the PF and abdominals
- rapid uncontrolled movements
- positions of inversion
- Deep heat modalities or electrical stimulation
- manual therapy (or take care with end feels)
- positioning: supine is not contraindicated for short periods of time, prone is not well tolerated
- give posture tips in lying, standing, sitting, lifting/carrying
- glut strategy for rolling and sit to stands
What are 3 red flags for reproductive problems
- change in B&B function, sexual function, often, not always at condition onset
- non mechanical low back pain
- suprapubic or groin pain (may or may not occur with the above)
What is the herniation of bladder into vagina called
cystocele
What is the herniation of the rectum into vagina called
rectocele
What is the bulge of uterus into vagina called
Uterine prolapse
S&S of a prolapse or herniation
- Increase with activity/at end of day
- Pelvic pain
- Urinary incontinence
- pain with sexual intercourse
- Heaviness in saddle region,
- incomplete B&B emptying
PT Rx for prolapse or organ herniation via pelvic floor
if unresolved in 6 weeks
PT= pelvic floor mm ex, postural re-education, pessary, surgery
What is preeclampsia
pregnancy induced, acute HTN after 24wks gestation
Preeclampsia S&S
HTN, edema, headache, visual disturbance, hyperreflexia PT to AX
PT Rx following C-section
- TENS for incision pain
- breathing ex
- gentle ab ex
- pelvic floor ex
- postural ex, ambulation
- prevent incisional adhesions (scar massage)
Thickness = Appearance of a 1st degree burn
Superficial, erythema appearance
Thickness = Appearance of a 2nd degree burn
Partial Thickness, blistering appearance
Thickness = Appearance of a 3rd degree burn
Full thickness, necrosis (black, part of skin falling off)
What is the rule of 9s used to determine - include the areas/scoring
to determine body surface area involvement (don't include 1st degree burns) head = 9 torso = 36 each arm = 9 each leg = 18 pubic area = 1
What is the rule of 9s in kids
same torso and same arms but head = 18, each leg = 14
With what type of burn is there scaring
those with significant damage to dermis - 3rd degree
What is occurring during the inflammatory stage for burn healing
vascular and cellular effects to eliminate the necrotic tissue and deliver materials for healing
What is occurring during the proliferative stage for burn healing
rebuild the dermis and epidermis, fibroplasias and neovascularization that produce granulation tissue (early angiogenesis)
What is occurring during the remodelling stage for burn healing
wound contracts and increases strength, scar
What are 3 descriptors used to classify wound healing
- acute vs chronic
- partial vs full thickness
- primary (closed by surgery) vs secondary intention healing (wound left to heal on own)
What are 3 zones used in wound healing
Zone of coagulation
ZOne of stasis
Zone of hyperemia
What is the zone of coagulation
point of maximum damage, irreversible tissue loss
What is the zone of stasis
Decreased tissue perfusion, potentially salvageable
What is the zone of hyperemia
Increased perfusion perfusion, will recover unless sepsis occurs
What is the effect of burns on the CV system
- Increased capillary permeability: interstitial edema
- peripheral vasoconstriction
- hypovolemia
- myocardial depression : hypotension and decreased organ perfusion
- Decreased cardiac output
What is the effect of burns on the Resp system
- bronchoconstriction
- ARDS
- carbon monoxide (dec O2 carrying capacity of blood)
What is the effect of burns on the metabolic system
increased 3x
What is the effect of burns on the immune system
immunocompromised
What is the effect of burns on the renal system
b/c of loss of fluids: vasoconstriction, decreased GFR, increased myoglobin gets processed by kidneys and can block tubules
What are signs of an inhalation injury
singed eyebrows/nasal hairs/burnt face, black oral/nasal discharge, swollen lips, hoarse voice, abnormal oxygenation, history of being enclosed in closed room
What is the inhalation injury process
w/in 24hrs upper airway obstruction/pulmonary edema
- 24-48 just pulmonary edema; 48 hrs plus bronchiolitis, alveolitis, pneumonia, ARDS
What is the management for an inhalation injury
early mobilization, breathing ex’s, post drainage
PT Burn Rx
- keep wound moist, electrotherapy (HVPC), good health (diet, exercise (for circulation)
- debride wounds (whirlpool), pain management,
- first 2-3 weeks AROM and PROM to maintain range, positioning, edema management, encourage ambulation
- scar management BECAUSE as early as 1-4 days can get a scar tissue contracture
Contraindications to exercise with burn patients
exposed joint, fresh skin graft, DVT, compartment syndrome
2 types of skin graft
Split thickness and full thickness
What is a split thickness skin graft
uses skin graft, stitched, glued or sutured in place; immobile for 5 days
What is a full thickness skin graft
Skin transplant
Skin graft Rx
- scar massage, sun protection, ROM, pressure garments
- strengthening can begin in 3-4 weeks
What are the 3 stages of scars from burns and their type periods
- 0-4 weeks fibroblastic/proliferative
- 4-12 weeks early remodeling
- 12-40 weeks late remodeling/maturation
4 factors that influence scars from burns
- age
- smoking
- type of tissue
- nutrition
Therapeutic management of scars from burns
pressure garments
massage
moisture
