multisystems Flashcards
rheumatoid arthritis definition
systemic inflammatory autoimmune disease - symmetrical polyarthrtitis
30-45 age onset F>M
rhematoid positive factors in 70% (more severe cases)
ESR and CRP (creatine-reactive proteins) positive during active RA
synovial fluid - cloudy, will clot, less viscous during active inflammation
RA pathophys
inflammation of synovium leads to effusion, pain, stiffness and limited ROM in the joint
chronic inflammation - immune cells break down articular cartilage
synovial overgrowth of granulation tissue (pannus) dissolves articulum
joint space narrows causing psuedo-laxity
tendon sheaths fray, tendons rupture leading to muscle imbalances
granulation tissue results in adhesions, fibrosis or fusion of the joint
x-ray findings RA
joint space narrowing unevenly (cartilage erosion) - secondary OA
bone erosion and peri-articular osteopenia
rheumatoid nodules and swelling
ARC 1987 criteria for classification of RA
need at least 4 of 7 criteria**
criteria 1 to 4 must have been present for 6 weeks**
- morning stiffness =/> 1hr
- soft-tissue swelling/fluid in at least 3 joints simultaneously
- at least 1 area swollen in wrist, MCP or PIP
- symmetrical arthritis
- rheumatoid nodules
- abnormal amounts of serum rheumatoid factor
- erosions or bony decalcification on x-ray wrist and hand
signs/symptoms RA
morning stiffness > 1 hr
generalized stiffness that eases with movement
extreme fatigue (increased resting energy expenditure)
rheumatoid cachexia - loss of lean body mass, muscle wasting
signs of systemic disease - loss of apetite/weight loss, fever, malaise
crepitus
deformity
joint pain
swelling
RA red flags (urgent referrals)
claudication pain pattern
systemic disease signs (fever, weight loss, malaise)
focal or diffuse weakness
history of significant trauma
hot, swollen joint
neurogenic pain (burning, numbness, paresthesia)
*Cord compression signs - neurological signs and cervical radiculopathy (spinal cord compression may come from inflammation in the cervical spine.) URGENT ER
Standardized assessment of joint inflammation (SAJI)
active joint (1 of the following must be present)
STOP - swelling, tenderness, over pressure
1. effusion - 2 thumb technique, 4 finger technique, palpation
2. joint line tenderness
3. stress pain - pain with passive overpressure
damaged joint (1 of the following must be present)
1. subluxation or deformity
2. bone on bone crepitus
3. loss of more than 20% of PROM
4. ligament instability
raynauds disease - triggered cold/stress vasomotor constriction of arteries
nerve compression
contraindications for RA (ACTIVE)
superficial heat - not on inflammed, hot, swollen joints (hot packs, LLLT, paraffin wax, hypdrotherapy)
deep heat - during acute inflammatory stage (ultrasound)
cold - in patients with raynauds disease
stretching
strengthening
lupus definition
autoimmune disorder causing production of antibodies
lupus signs/symptoms
systemic disease signs - fever, malaise, fatigue
skin abnormalities - malar rash (butterfly), discoid rash, photosensitivity
alopecia
oral or nasopharyngeal ulcers
pleuritic chest pain and SOB
pericarditis, hypertension, raynauds
headaches, seizures, psychosis
nonerosive arthritis - symmetrical in PERIPHERAL joints - (not hip or spine)
ANA positive - anti-nuclear bodies *hallmark lab values
SLE/lupus PT management
energy conservation techniques
avoid sun exposure UV light
breathing exercises
modalities for pain/effusion
ROM exercises
NO STRETCHING*
NO STRENGTHENING during acute flare ups
AS Ankylosing Spondylitis definition
seronegative spondyarthropathy chronic inflammatory of the axial spine
M>F age 15-30
HLA-B27 gene
c-reactive protein and ESR increased during active inflammation
insidious onset progressing from caudal to cephalad
AS signs/symptoms
insidious onset progressing from caudal to cephalad
morning stiffness 30-40 mins
nocturnal pain
low back, SIJ, glute pain and stiffness
loss of ROM spine, hips, shoulders
postural abnormalities
tenderness over enthesitis sites - insertion of muscle (plantar fascia, achilles, ischial tuberosity
systemic signs - fatigue, eye anterior uveitis
AS postural changes
increased kyphosis, reduced lumbar lordosis/cervical lordosis, eye upward gaze, fixed thoracic ribcage (restrictive disease), hip and knee flexion
AS x-ray findings
sacroiliitis
syndesmophytes - bone growth inside ligaments “bamboo spine”
increased kyphosis
enthesitis - ITB insertion, plantar fascia insertion
arthritis - hip
AS contraindications
flexion based exercises
thermotherapy on active inflamed joints
Osteoporosis
metabolic bone disease causing reduced bone density & deterioration
typically post-menopausal women
primary osteoporosis - due to post menopause/senile age (70+)
secondary osteoporosis - due to another primary condition (hyperthyroidism) or treatment of another condition (corticosteroids)
Dexa T-score standard deviations
> -1 = normal
-1 to -2.5 = osteopenia
-2.5 = osteoporosis
-2.5 & history of at least 1 osteoporotic # = severe osteoporosis
Osteoporosis PT interventions
postural education - AVOID FLEXION (ant. wedge # common)
WB exercises - walking, squatting, jogging
osteomalacia (all)
metabolic bone disease resulting in softening of bones/decalcification
caused by: inadequate intestinal calcium absorption, increased renal excretion of phosphorus or vitamin D deficiency
signs/symptoms: pain, aching, fatigue, weight loss, weakness, increased thoracic kyphosis, LE bowing, high risk #’s
interventions: meds/nutrition, strength training, bone protection strategy
pagets disease (all)
metabolic bone disease with abnormal osteoblast/clast activity followed by disorganized remodeling
M>F, > 40 years old
signs/symptoms: pain, misshapen bones, #’s, arthritis
interventions: meds for pain/ regulating osteoclast activity
postural re-ed, strengthening, stretching, aerobic activity – low impact ex’s (caution with running hard, twisting, jogging)
osteomyelitis (all)
inflammation within bone caused by infection
most cases due to bacterial infection, infection through blood stream, open fracture or surgery
signs/symptoms: fever, tenderness/redness/warmth/swelling near site, loss of ROM in affected joints
interventions: antibiotics, surgery, ROM ex’s
skin function layers dermis vs. epidermis
protects against infections, UV rays and fluid loss
temp regulation
sensation
secretion of oils for lubrication
vitamin D synthesis + cosmetics
epidermis: most superficial, avascular, free nerve endings, 5 layers
dermis: deepest layer, contains blood vessels, lymphatics, nerve endings, collagen and elastin fibers and wound healing properties
burns classification 1st degree superficial
characteristics:
pink/red erythema, no blistering
dry
minimal edema
skin barrier to infection intact
mild pain»_space; SUNBURN
depth: damage to epidermis only
rate of healing: 2-3 days, no scarring
burns classification 2nd degree superficial partial thickness
characteristics:
bright pink or red (mottled)
intact blister
dry surface
moist weeping when blister removed
moderate edema
quick capillary refill
very painful - nerve endings damaged
sensitive to changes in temp, air exposure, light touch»_space; SCALD BURN
depth: damage to epidermis and into papillary dermis
rate of healing: 7-10 days, minimal scarring
burns classification 2nd degree deep partial thickness
characteristics:
red or waxy white
blisters broken
wet surface
marked edema
sluggish cap. refill
sensitive to pressure
insensitive to light touch/pinprick - nerve endings destroyed
» IMMERSION SCALD, FLAME BURN, COOKING OIL BURN
depth: damage to epidermis and into reticular dermis
rate of healing: 3-5 weeks, keloid/heterotrophic scar formation (may require grafting)
burns classification 3rd degree full thickness
characteristics:
white, charred, black or red
eschar formation
“parchment-like”
leathery
no blanching with pressure
marked edema
painless
severe infection risk
» FLAME BURN, CHEMICAL BURN
depth: damage to epidermis, dermis and partial into subcutaneous tissue
rate of healing: 3-5 weeks, keloid/heterotrophic scar formation (may require grafting)
burns classification 4th degree subdermal
characteristics:
charred skin
subcutaneous tissue visible
muscle damage
neurological involvement
large exit wound and small entry wound
always severe no matter size of area
» HIGH VOLTAGE ELETRICAL BURN
depth: epidermis, dermis, into subcutaneous tissue, bone, muscle, and large nerves
rate of healing: extensive, requires surgery, debridement, grafting, amputation
signs of inhalation injury
facial burns, singed eyebrows and nasal hairs, harsh cough, hoarse voice, carbonaceous sputum, abnormal breath sounds (wheezing/stridor), respiratory distress, hypoxemia
complications: CO2 poisoning, tracheal damage, upper airway obstruction, pulmonary edema, pneumonia
heterotrophic scar
excessive scar formation that raises above level of adjacent skin
3 R’s (raised, red, and rigid)
keloid scar
heterotrophic scar that extends beyond the boundary of original wound
burns PT interventions
positioning - elongated position or functional, minimize edema, prevent contractures, preserve function (airplane splint, hamburger hands)
splinting
AROM - start on admission for all joints even affected, coordinate with pain meds, stop 3-5 days after graft for joints above/below
PROM - if pt not alert or unable to follow commands, on children, if unable to achieve AROM, stress is gentle gradual and sustained
resistance ex’s - beware abnormal thermoregulation, monitor vitals
conditioning ex’s - monitor vitals, walking, cycling, rowing, stair climbing
ambulation - begin as early as possible, stop after LE grafting, TED stockings, elastic wraps to minimize edema in standing
pressure dressings and massage for scar management - once wound has healed, pressure 25mmHg worn 23 hours/day** 12-18 months, washed daily
diabetes mellitus
metabolic disorders characterized by hyperglycemia due to defective insulin action or secretion
beta cells in pancreas produces insulin
insulin regulates blood glucose levels by promoting glucose uptake by the liver, adipose cells, and skeletal muscle cells for storage as glycogen
diabetes mellitus
metabolic disorders characterized by hyperglycemia due to defective insulin action or secretion
beta cells in pancreas produces insulin
insulin regulates blood glucose levels by promoting glucose uptake by the liver, adipose cells, and skeletal muscle cells for storage as glycogen
type 1 DM
pancreas fails to produce sufficient or any insulin
“insulin-dependent or juvenile diabetes”
typical onset childhood
auto-immune abnormality that damages islet cells of the pancreas
type 2 DM
pancreas fails to produce sufficient insulin, as well as resistance to insulin
“adult-onset diabetes”
causes: OBESITY - BMI > 30, poor diet, abdominal fat, sedentary lifestyle
