Multisystems Flashcards
What is hemophilia
A bleeding disorder in which a person’s blood does not clot normally leading to delays in coagulation after an injury
What is the most common manifestation of hemophilia
Hemarthrosis
Which is bleeding into the joint space
What is obesity and how is it diagnosed?
excess body fat that may impair health
BMI = kg (mass) / m2 (height)
*does not take into account body comp
What are the main values for BMI?
very severely underweight <15
Normal 18.5-25
Overweight 25-30
Obese >30
What is the etiology of obesity?
Diet
Sedentary lifestyle - burning and not enough muscle mass
Medications
Genetics
Secondary to other illness (hypothyroidism)
What are the associated health problems of obesity?
Cancers
CVD
gall bladder dysfunction
metabolic syndrome
obstructive sleep apnea
OA
type II DM
What are some bariatric considerations?
Bariatric equipment
care environment
patient, family, caregiver training
physical assistance
ulceration risk
overheating
What are some obesity interventions?
Lifestyle modification
Diet
exercise
bariatric surgery
pharmacological management
What are the exercise parameters?
F = >5 days/ week
I - moderate (40-60% HRR) to vigourous (50-75% HRR)
T - 30-60 minutes
T - aerobic, large muscle groups - consider overheating and impact on joints
What is HIV?
A virus attacks the immune system, specifically T cells with CD4 receptors - progressively weakens the host systems
increases susceptibility to opportunistic infections and cancers
What is the mode of transmission for HIV? Including body fluids not infectious
unprotected sex
shared needles or equipment
mother to child (in utero, during birth, breast milk)
occupational exposure
blood and blood products
feces, urine, salvia, sweat and tears
What are the universal precautions for HIV?
Use for all patients with risk of blood exposure - do not use unnecessary precautions
use gloves (and change) may come in contact with blood, body fluids, mucous membranes, non-intact skin
use mask and eye protection for droplets of blood or other body fluids
use gown with splashes of blood or other body fluids
refrain from direct patient care if you have open wound or skin lesions
How do you diagnose HIV
blood antibody tests - ELISA or western blot test
CD4 test (normal 500-1500)
Viral load test - 50-500,000/mL
*6- 12 weeks to be detectable
What is AIDS?
advanced HIV progression
CD4 count <200 and 1 or more of 26 indicators
What is the medical management of HIV?
HAART - highly active antiretrociral therapy
-interferes with virus life cycle
-decreases viral load
-preserves CD4 count
*needs high compliance - lifetime commitment or else drug resistance forms
What are the side effects to HAART?
mitochondrial toxicity
-redistribution of fat store to abdomen, posterior cervical spine (buffalo hump) or viscera
-increase risk of CVD
-increase risk of acue pancreatitis
mitochondrial myopathy
cardiomyopathy
hepatic steatosis (fatty liver)
peripheral neuropahty - distal to proximal, symmetrical
hyperlacatemia
cytopenia
skin rash
GI - diarrhea, nausea, abdominal pain
Dyslipidemia
osteopenia / OP
osteonecrosis
What is the PT management for HIV?
education - energy conservation, expectations, pain
symptoms management
management secondary complications - deconditioning, weakness, fatigue
exercise prescription - rom, aerobic, resistance
What is fibromyalgia syndrome? Including epidemiology and etiology
A syndrome characterized by widespread chronic pain and increased pain response to pressure with no other cause
F>M, onset during reproductive years
Unknown, genetic and environmental factors
What are the S + S of fibromyalgia?
Chronic widespread pain
allodynia
headache
fatigue
sleep disturbances
cognitive dysfunction “fibro fog”
anxiety and/or depression
IBS
How do you diagnose fibromyalgia?
through exclusion
What are the ACR 1990 diagnosis criteria for fibromyalgia?
widespread chronic pain >3 months affected all 4 quadrants
occiput
low cx (anterior)
trapezius
supraspinatus
2nd rib
lat epicondyle
gluteal
greater trochanter
knee (medial)
*doesn’t go below knee
What is the 2010 ACR revised diagnosis for fibromyalgia?
widespread pain index and symptoms severity scare instead of tender points
What are the interventions for fibromyalgia?
medical - analgesics (nsaids, opiods), antidepressants, anticonvulsants
PT - education ,CBT, exercise, sleep hygiene
*active treatment as much as possible
What is lymphedema?
Abnormal accumulation of lymph fluid in tissue sapce
What is the job of the lymphatic system?
Collect and transport fluid from interstitial space back into venous circulation
also involved with immune function
What are the types of lymphedema?
Primary - congenital and insufficient develop
Secondary - surgical dissection of lymph nodes, inflammation and infection, obstruction or fibrosis, chronic venous insufficiency
What is dependent edema?
in the line of gravity (below the level of the heart) - fluid moves downward
What are the qualitative observations of edema?
Pitting, brawny and weeping
What are the S + S of lymphedema?
Increase size of limb
sensory disturbances
decrease ROM
skin changes (fibrosis / brownish pigment)
What are the interventions for lymphedema?
Manual lymphatic drainage
compression - low stretch / compression garments
elevation
exercise - arom, stretching, low intensity resistance, low intensity CV/ pulmonary endurance
skin and nail care
What are the two phases for complex decongestive therapy program
Phase I
-manual lymphatic drainage
-compression - low stretch
-exercise
-skin and nail
Phase II
-self manual lymphatic drainage
-compression - compression garment during day, low stretch at night
-exercise
-skin and nail care
What is the etiology of breast cancer related lymphatic dysfunction?
-surgical - mastectomy, breast conserving (lumpectomy, segmental mastectomy)
-radiation
What are impairments and complications related to breast cancer treatment?
Postop pain - incisional, post cervical and shld girdle apin
post op complications - DVT, pneumonia, atelectasis
Lymphedema
chest wall adhesions
decrease shld mobility
weakness of involved UE
postural malalignment
fatigue and decreased endurance
What are some interventions for breast cancer related lymphedema
complex decongestive therapy
postural education
shoulder and UE ROM and strengthening- avoid excess tension on incision or blanching of scar during shld ROM, avoid exercises of arms in dependent position, progress graded exercise program slowly
gentle massage of scar and adhesions
aerobic exercise and functional activities
What may pregnancy related back pain be due to?
postural changes
hormonal influences (up to 3 to 5 months postpartum)
increased ligament laxity
decreased abdominal muscle function
What are the characteristics of pregnancy related back pain?
worse with muscle fatigue (static postures or as day progresses)
relieved with rest or change of position
physically fit women have less