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NPTE Final Frontier > Other Systems 2 > Flashcards

Other Systems 2 Flashcards

1
Q

System interactions in pregnancy

A
  1. Postural changes
  2. HR and BP changes
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2
Q

Side lying in pregnancy

A

LEFT S/L
AVOID Supine hypOtensive Syndrome

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3
Q

Pregnancy complications

A

Pre-eclampsia vs Eclampsia
Gestational DM

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4
Q

Pregnancy exercises

A

Posture
Precautions

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5
Q

Changes w/ Pregnancy

Weight GAIN
How much and why?

A

20-30lbs
ESSENTIAL for baby’s nourishment

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6
Q

Changes w/ pregnancy

MSK System
Talk about posture

A

Posture changes!
Forward head-> kyphosis-> incd lordosis-> APT—think COM moves forward
Postural stress continues post-partum d/t lifting and carrying of baby

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7
Q

Changes w/ pregnancy

MSK Changes
Posture
How do we TREAT this?

A
  • Posture edu., stretch tight mm’s/strengthen weak mm’s, pelvic stab. ex’s, POST. pelvic tilts
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8
Q

CVS Changes: Pregnancy
ALL first…summarized

A
  1. BP LOW in first and second trimesters then INCs last trimester
  2. Supine lying compresses IVC (after 4th mo.)–> NO supine lying after 1st trimester
  3. RHR INCs 10-20bpm
  4. L. S/L== BEST
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9
Q

CVS Changes: Pregnancy
BP

A

LOW in first/second trimesters
INCs last trimester

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10
Q

CVS Changes: Pregnancy
Supine lying

A
  • compresses IVC
  • DEC in CO==> supine hypotensive syndrome
  • NO supine after 1st trimester!!!

In gen, CO INCs, but Decs in supine!!

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11
Q

CVS Changes: Pregnancy
RHR

A

INCs 10-20 bpm

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12
Q

CVS Changes: Pregnancy
LEFT S/L

A
  • BEST!!!
  • DECs compression IVC, maximizes CO, DECs GERD bc int. organs relaxed, improves maternal and fetal circ.
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13
Q

System Interactions in Pregnancy

A

See chart

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14
Q

Practice!
34yo pregnant female doing pelvic floor ex’s in supine. Dizzy, sweating, nausea. Which cond?

A

Supine HypOtensive syndrome bc supine compresses IVC
A: Incd pressure on IVC causing hypOtensive syndrome

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15
Q

Pre-Eclampsia think….

A

Acute HTN!!!
*usually BP inc’s 3rd trimester, but this is acute/sudden HTN

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16
Q

Pre-Eclampsia
How is this dx confirmed??

think pregnancy induced HTN

A

BP reading in excess of 140/90.. THEN
2nd abnorm BP reading 4hrs AFTER first CONFIRMS dx
EMERGENCY!

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17
Q

Pre-Eclampsia
what is it and s/s?

A

Pregnancy induced HTN after the 20th wk of gestation
- S/S: Inc in PRO in urine, hypERreflexia, edema, HA, sudden wt gain

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18
Q

This pregnancy complication is ALWAYS ACCOMPANIED W/ SEIZURE

A

Eclampsia

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19
Q

Practice!
Pt seen AFTER UNcomp’d vaginal delivery of 3rd child. During tx, pt begins to complain of HA, vis. disturbs, suddenly develops SZ. MOST likely cond?

A

A: Eclampsia– AFTER pregnancy, or DURING delivery– ALWAYS assocd w/ SZ
Other answers:
- PREeclampsia== DURING pregnancy– preg induced HTN
- Gestational DM== INC BG during pregnancy, usually returns to NORM (remember FBG >126, Total BG >200)
- Ectopic preg== fert egg implants OUTSIDE uterine cavity

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20
Q

Practice!
PT educating one of their pts regarding effects of pregnancy and implications for positioning and posture. Which is LEAST approp?

A

INAPPROP== small wedge under L. hip during 2nd trimester– WRONG! you want L. S/L!!! (so put it under R hip)
Other answers (all approp):
- Pt w/ preg induced HTN must NOT do high int ex’s
- breath-holding, valsalve’s should be AVOIDED
- Borgs 12-14 during ex is acceptable for UNcomp’d preg

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21
Q

Pregnancy and Contraindications to Ex.

DO NOT EX when…

A
  • Hemodynamically sig. heart dis/comps
  • Restrictive Lung Disease
  • INcompetent cervix- EARLY dilation of cervix BEFORE full term
  • Vaginal bleeding- esp 2nd/3rd trimesters
  • Placenta previa after 26wks gestation- placenta in descended pos and may detach before delivery
  • Preeclampsia or preg induced HTN
  • Rupture of membranes–lose amniotic fluid
  • Premature labor- labor before 37th week of preg
  • Maternal T1DM- Diabetic ketoacidosis
  • Severe anemia- HbG lvls low
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22
Q

Practice!
20yo female after UNcomp’d delivery has 3cm diastasis recti w/ weak abs. what ex is MOST approp?

Diastasis Recti Guidelines

A

A: Head lifts w/ arms bracing abdomen
Guidelines:
- >2cm –> abd bracing + exercise
- 3cm–> Abd bracing + Head lift (just lift head); Progression= Abd bracing + Head lift + PPT
- 4cm–> Abd bracing + NO exercises!
- Split < 2cm–> Bracing not important, do head lifts + PPT

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23
Q

More on Tx for Diastasis Recti

Head lifts and Pelvic tilts

A
  • Head lift: Hook-lying and cross arms around stomach for support–> Exhale and lift only head off floor while simultaneously using hands to gently approximate rectus mms towards midline–> lower head and relax
  • Head lift w/ Pelvic tilt (progression): Hooklying pos–> arms over diastasis for support as in “head lift”–> slowly lift head while approx. rectus mm’s and perform PPT– lower head and relax

NOTE: ALL abd contractions w/ exhale to minimize intra-abd pressure

24
Q

GU recap

A
  • tx for functional incont?– prompted voiding, strengthen LE, cueing
  • Incont seen w/ DM– Overflow (dribbles, distended bladder)
  • BP changes in preg?– LOWER 1st/2nd trimesters, HIGHER 3rd
  • Ex to AVOID w/ diastasis? double leg lifts, crunches, scissors, curl-ups
25
Q

GastroEsophageal Reflux Dis (GERD)
Sx’s, Complications

A

Reflux of gastric content of the gastroduodenal contents INTO esophagus
Sx’s:
- Heart burn– 30mins AFTER eating & @ night lying down
- Dysphagia, sour taste, hoarse voice, Atyp pain head/neck

Comps:
- Aspiration PNA, asthma
- Esophagitis

26
Q

Practice!
All of following are guidelines in Tx pts w/ GERD except….

A

WRONG: encourage R S/L to sleep for noturnal reflex— NO, we want LEFT S/L
Other answers:
- Anything in supine should be scheduled BEFORE meals and avoided after just eating
- Encourge LEFT S/L for nocturnal reflex (bc GI organs relaxed when LEFT– think anatom pos of stomach) Nocturnal reflex== regurg. @ night
- Mod of pos twrds more UPRIGHT pos is req’d

27
Q

Tx of GERD:

A
  • maintain UPRIGHT
  • Eat 3-4hrs before sleep
  • AVOID supine- tends to straighten esophagus
  • Sleep on L. side– prevents nocturnal reflex (regurg @ night)
  • Exercise comp’d 2-3hrs after eating or BEFORE meals
  • AVOID spicy, chocolate, fatty, peppermint
  • Drugs: Antacids, H2 receptor blockers, Proton pump inhibitors
28
Q

Practice!
44yo male excessive amts of alcohol referred for knee pain. During Tx pt reports R. sided shoulder pain. Which structure MOST likely source of referred pain?

A

LIVER! – refers to RUQ/R. shoulder
Others:
- Prostate: refers to low back
- Appendix: refers to RLQ
- Kideny: refers to Mid back, I/L shoulder

Remember: R= Liver/gallbladder, appendix; L= stomach

29
Q

Pain referral patterns:

ALL FIRST

A

Mid-back/Scapula: esophagus, gallbladder, stomach, pancreas
Shoulder
- L: heart, diaphragm, spleen, tail of pancreas
- R: gallbladder/liver, head of pancreas (head is always RIGHT)

Pelvis/Low back/Sacrum: colon, appendix, pelvic viscera
Pancoast Tumor (upper lung tumor): pain referred in C8-T2 nerve distribution; Mimics TOS

30
Q

Pain Referral Patterns:

Midback/Scapula

A

esophagus, gallbladder, stomach, pancreas

31
Q

Pain Referral Patterns:

Shoulder:
LEFT shoulder

A

Heart, diaphragm, spleen, tail of pancreas

32
Q

Pain Referral Patterns:

Shoulder:
RIGHT shoulder

A

Liver/gallbladder, head of pancreas (head is always RIGHT)

33
Q

Pain Referral Patterns:

Pelvis/Low Back/Sacrum

A

Colon, appendix, pelvic viscera

34
Q

Typical Pain Patterns: Quadrants

ALL first

A

RUQ: peptic ulcers, gallbladder patho, head of pancreas
RLQ: appendix, Chron’s
LLQ: diverticulitis, ulcerative colitis, IBS
LUQ: tail of pancreas, spleen patho

35
Q

Typical Pain Patterns: Quadrants

RUQ “Good Luck Hot Pack”
RLQ “Air Conditioning”

A

RUQ: “Good Luck Hot Pack”
- Gallbladder, Liver, Head of pancreas, Peptic ulcers

RLQ: “AC (Air Conditioning)”
- Appendix, Chron’s

36
Q

Typical pain patterns: Quadrants

LUQ “Dont Banana Split”
LLQ “DUI”

A

LUQ: “Dont Banana Split
- Diaphragm, Body/tail pancreas, Spleen

LLQ: “DUI”
- Diverticulitis, Ulcerative colitis, IBS

37
Q

Practice!
44yo male evald by PT. Referred pain in the L. shoulder (spleen, heart, diaphragm, tail of pancreas). Dx of +Kehrs sign (SPLEEN) All causes of this?

A

Recent laproscopy, intra-abd bleed, rupture of spleen
NOT a cause–> trauma to Head of pancreas (remember Head is always RIGHT (RUQ and R shoulder)
Kehrs Sign==> pain in LEFT shoulder caused by air or blood in abd cavity; +Test= perform SLR & causes L shoulder pain

38
Q

Hernia and Refer pain

Hiatal hernia (the one to know!!!) causes _ pain. What else to know?

A

Shoulder!
Hiatal hernia think weak diaphragm, L shoulder pain

Sx’s similar to GERD

39
Q

Hernia referral pain

Femoral vs Inguinal vs Umbilical

A

Femoral–> Lateral pelvic wall + groin pain
Inguinal–> Groin pain
Umbilical–> Pain around umbilical ring in mid-lower abdomen

40
Q

Practice!
44yo male eval’d. Underwent hernia repair 3wks ago. AVOID which activity?

A

A: Stretching ANTERIOR spinal and hip mm’s BEFORE incision healed
DO NOT DO THIS!— stretching posterior is ok!
Remember: Hiatal hernia think WEAK diaphragm, L. shoulder pain

41
Q

Cholecystitis
think gallbladder

A

Blockage or impaction of gallstones in cystic duct resulting in inflamm of gallbladder
- Pain in RUQ (Good Luck Hot Pack), radiates to R shoulder
- nausea, vom, low grade fever
- PAIN INCS WITH INGEST OF FATTY FOOD!
-

42
Q

Cholecystitis:
Special Test?

A

Murphy Sign
- palp near R subcostal margin, deep breath, if pain/tender during insp==> (+) Test

43
Q

Peptic Ulcers
(2):
Think…

A

RUQ
“Good Luck Hot Pack”
1. Gastric (stomach) ulcers
2. Duodenal

44
Q

Peptic Ulcers:
Gastric (stomach) ulcers

A
  • In stomach–> chronic use NSAIDs, stress, anxiety, H pylori bacteria
  • Pain INCs w/ presence of food–> acid secretion–> pain after eating (acid burns ulcer)
  • Pain relieved w/ antacids, med tx of H pylori
45
Q

Peptic Ulcers
Duodenal ulcers

A
  • Ulcerative lesions in duodenum–> MAIN cause H pylori
  • Pain incs w/ absence of food (bc duodenum, not stomach), early mornings, in bw meals
  • Pain relieved by med tx of H pylori
46
Q

Peptic Ulcers
More characteristics

A
  • Pain=> burning, cramping in epigastric area, refers to R shoulder, RUQ
  • Coffee ground emesis (both types) and melena (dark) tarry stools (more duodenal)==> peptic ulcer dis.
47
Q

Inflammatory Bowel Disease
2 components

A
  1. ULcerative Colitis– LLQ (DUI)
  2. CRohn’s Disease– RLQ (AC)
48
Q

Inflammatory Bowel Disease
1. Ulcerative colitis

A
  • ONLY Lg intestine & rectum
  • CONTINUOUS lesions
  • S/S: rectal pain, bleeding, bloody diarrhea w/ mucus/pus, fecal urgency, wt loss, LBP
  • LLQ– ULcerative
49
Q

Inflammatory Bowel Disease
2. Crohn’s Disease

A
  • Autoimmune, think pass gas, aggravated w/ stress
  • Occurs ANYWHERE in GI tract
  • Skip lesions=> lesions “skip” around
  • S/S: pain relieved by passing gas, abdom pain, Wt loss (same as UC), jt reactive arthritis
  • RLQ– CRohn’s
50
Q

Practice!
Pt c/o L lower abdom pain (LLQ= DUI). Pt reports LBP accompanied w/ wt loss, nausea, vom, bloody stool lately. MOST LIKELY dx?

A

A: Ulcerative colitis
Others:
- CRohns== RLQ (AC)
- Appendicitis== RLQ (AC)
- Acute pancreatitis== R (Good Luck Hot Pack) or LUQ (Dont Banana Split)

51
Q

IBS
Irritable Bowel Syndrome
LLQ= “DUI” bc where do you get DUI? in the LLQ!

IBS think “Your colon is nervous/spastic

A

Spastic, nervous or irritable colon
- Causes: Emo. stress, anxiety, high fat, lactose foods
- Pain relieved by defecation (rememer Crohns relieved by passing gas)
- Sx’s disappear while sleeping
- Ribbon like stools– bc spastic colon
- LLQ
- Tx: Stress reduce, diet mods, Exercise**

52
Q

Appendicitis:

A

Inflamm of appendix–progress leads to swollen/gangrenous appendix
- Perforated==> peritonitis (fluid in abdomen)
- RLQ (AC)
- Tender @ McBurneys pt, Rovsing’s sign (opp palp of McBurneys) for pain migration, Blumber’s sign for Rebound tenderness

IMMEIDATE MEDICAL ATTENTION!

53
Q

Speaking of Appendicitis and RLQ
More tests on this?

A

Psoas sign= pain w/ passive hip EXT
Obturator sign= pain w/ passive hip IR
Hop sign= hop
Markel sign= heel raise & lower= heel raise pain

54
Q

McBurneys Pt vs Rovsing’s for Appendicitis

A

see pics
Note that Rovsings is just palpating OPP of Mcburneys but getting pain @ McBurney’s

55
Q

Practice!
30yo w/ R lower abom pain (RLQ= AC). PT performs “pinch-an-inch” test which is +. Which cond?

A

Appendicitis–> +Pinch-an-inch in RLQ
Others:
Diverticulitis (LLQ)– Pinch-an-inch + in LLQ== divertic
Crohn’s== RLQ
IBS== LLQ (DUI)

56
Q

GI Recap

A
  • stools seen w/ duodenal ulcer? Black (melena), tarry
  • Cond’s w/ pain in RLQ (AC)– appendicitis, crohns
  • Referred pain for diaphragm– LUQ, L shoulder (Dont Banana Split)
  • Pain incs after ingest fatty food? Cholecystitis (Gallbladder–> R shoulder/R scapula, RUQ: “Good Luck Hot Pack)

NPTE Final Frontier (19 decks)

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