Quiz 1 Flashcards
what is wellness?
active process of becoming aware of and making choices towards a healthy and fulfilling life; a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity; condition where all components of health are in good balance
where do PTs fit in wellness?
primary care in rehab
primary and secondary prevention and health promotion
across the lifespan
in all healthcare settings
guiding through safe physical activity
promoting health and wellness among individuals with comorbid health conditions
what is primary care?
prevention and general health promotion
what is secondary care?
decrease the duration, severity, or sequella (secondary impairments) of illness through early intervention
what is tertiary care?
limiting the degree of disability and promoting rehab and restoration of function in clients w/chronic and irreversible disease
what is physical fitness?
the ability to meet life’s demands and still have enough energy to respond to unplanned events.
what are the 5 basic components of wellness?
cardiorespiratory (aerobic) endurance
muscular strength
muscular endurance
flexibility
body composition
what is cardiorespiratory endurance?
the ability to supply and use oxygen over a period of time and in sufficient amounts to perform normal and unexpected activities
what is muscle strength?
the ability of a muscle to generate force over a given # of repetitions
what is muscle endurance?
the ability of a muscle to contract repeatedly or to sustain force for a given period of time
what is muscle power?
the ability of a muscle to generate max force in a short period of time (P=F x D/T
what is flexibility?
ability of a muscle to elongate sufficiently to meet the demands of the underlying joint
what is mobility?
ROM available at a joint which is influenced by several factors
what is body composition?
the relationship b/w the % body fat and lean body mass
what is body composition used for?
to monitor effectiveness of training/diet
to estimate competition weight in weight-category sports
to monitor health status in the prevention of disorders
what is normal body composition?
essential body fat for females=12%
essential body fat for males=3%
total body fat for females=25-28%
total body fat for males=12-15%
what are some ways body composition is measured?
BMI
height and weight tables
waist to hip ratio
bioelectric impedence
skin fold measurements
hydrostatic weighing
what are the stages of change in the stages of change theory?
- pre-contemplation
- contemplation (often deal with ambivalence here)
- preparation (decision and determination)
- action
- maintainence
when are programs more likely to be maintained?
when positive feelings are induced by exercise, feeling good, improved self-esteem, and higher energy levels
what are some tips to maintain exercising?
material reinforcement (not the best)
social reinforcement
joining a group
self motivating
make it fun!
what are some positive interviewing techniques?
active listening
encouragers
paraphrasing
asking probing follow up ?s
what are some negative interviewing techniques?
pushing or persuading patients to make change
how should you respond to ambivalence?
listen
unpack
explore
give pt place to sort it out
reflect change talk
ask ?s
what is sustain talk?
pt communication opposing change or in favor of staying the same
what are the benefits of cardiorespiratory fitness?
increased max O2 consumption (VO2 max)
improved submax exercise efficiency
faster recovery from aerobic exercise session
improved blood lipid profile
enhanced body composition
increased bone density
enhanced ability to cope with stress
decreased susceptibility to and severity of chronic disease like cancers
increased quality of life
what are some benefits of flexibility training?
increased ROM and improved performance
injury prevention
reduction in LBP (Low back pain)
warms deep muscles fibers
prepares you mentally for vigorous activity
maintains joking flexibility an reduces pain as you age
reduced loss of function and inability to perform ADLs and IADLs
what are the benefits of weight training?
manage body weight and fat
improved appearance, body image, and self-concept
increased strength and endurance for work and everyday activities
increased bone-mineral content and bone density
heart health (reduced cardiovascular risks)
less tendency to develop OA, obesity, diabetes
improved geriatric vigor
improved mobility and balance in elderly
improved completion of ADLs
what is pathophysiology?
the structural and functional changes caused by disease or trauma
what some causes of injury?
ischemia
infectious agents
immune reactions
chemical factors
nutritional factors
psychosocial factors
mechanical factors
what is ischemia?
blood flow is insufficient to maintain cell function
obstruction of bronchi–> poor transport of O2 in lungs–> reduced transport of O2 in blood–> inability of cells to use O2
what is hypoxia?
partial reduction in O2
what is anoxia?
total reduction in O2
what does loss of aerobic metabolism lead to?
decreased ATP synthesis which increases ions and fluids in cells which then lowers metabolism and cell function
what are infectious agents?
bacterial/viral infections may lead to cell injury and inflammation
initiate inflammation in an attempt to inactivate the pathogen
what is sepsis?
extreme response to infection leading to widespread inflammation, identified by toxins that are present in the blood
what is clostridium tetani?
releases exotoxins that interfere with inhibitory NTs and cause involuntary muscle contractions
what are immune reactions?
hypersensitivities ranging from a mild allergy to autoimmune disorders
what is a mild allergy?
runny nose due to histamine release
what are moderate reactions?
possible hypoxia due to bronchoconstrictions
what is a severe reaction?
anaphylaxis-life threatening due to whole body reaction
what are autoimmune disorders?
cross reaction b/w foreign and host antigens
what are chemical factors?
toxic substances
direct cell injury
free radical formation
nitric oxide
what is direct cell injury?
heavy metals such as mercury
alkylating agents
what is free radical formation?
formed by the metabolism of food and O2 for energy production
normal O2 loses an electron and the unstable atom steals an electron from a healthy cell creating another unstable atom (chain reaction known as oxidation)
also created unpaired electrons that bind to O2 which binds to H+ to stabilize and creates O2 toxicity
part of normal aging process
what neutralizes free radical formation?
anti-oxidants that have a free electron to give to the unstable atoms
endogenous-w/in the cell
exogenous-outside the body via diet (vit C, E, beta-carotene, etc)
exercise: regular moderate exercise strengthens antioxidant system
what is nitric oxide?
NO=1 N+1O2
a free radical that is an important regulator of a great # of physiological responses
what are the positive affects of nitric oxide?
assist in LT memory
assist GI mucosa to resist injury by toxins
inhibits virally induced cytokines and chemokines (combats the common cold)
stimulates collagen production, modulates fx healing, useful in Rx of tendinopathy
prevents platelet clumping and helps provide non-stick coating of blood vessels
reduction of physiological stress
what are genetic factors?
alteration in structure and # of chromosomes that induce abnormalities
single mutations of genes that cause change in amount or function of proteins
multifactorial disorders from multiple gene mutations that interact w/environmental factors
what are nutritional factors?
imbalances in essential nutrients and vitamins and minerals can cause cell injury and death
malnutrition
excessive nutrition
what is Kwashiorkor?
protein malnutrition-inhibits replication and healing
what is Marasmus?
malnutrition from generalized dietary deficiencies
what is excessive nutrition?
obesity
vitamin A deficiency
leading cause of preventable blindness
vitamin D deficiency
rickets-inadequate mineralization of bone
vitamin E deficiency
deficiency is rare
vitamin K deficiency
formation of thrombin and other blood clotting factors
B1 thiamine deficiency
Beri-Beri-dry and wet types
- dry: loss of appetite, confusion, loss of coordination
- wet: edema
common in cultures that eat a lot of white rice and raw fish
B2 riboflavin deficiency
ariboflavinosis-after several months of deficiency
magenta inflamed tongue, dry cracked corners of the mouth
niacin deficiency
pellagra-post 2 months niacin deficiency
B6 deficiency
pyridoxine-protein metabolism and NT synthesis
folic acid deficiency
decreased RBCs=anemia
can be caused by alcoholism
found in leafy greens
B12 deficiency
megaloblastic anemia
normally maintains the myelin sheath
nerve damage
found in animal products
pernitious anemia
what are psychosocial factors?
fear, tension, and anxiety may influence threshold values for tissue adaptation and injury
what are mechanical factors?
physical stress theory: changes in relative level of physical stress causes a predictable adaptive response in all biological tissues (Wolff’s Law)
some conditions begin with an inflammatory response and lead to a degenerative response (tendinopathy)
what is cellular aging?
deterioration of cell due to aging leads to organ deficiencies and expression of aging or disease
prime target is the mitochondria (DNA)
- changes in info content of a cell can change function and effect cell homeostasis
what is the wear and tear theory?
in organs that have no cell regeneration
what is the free radical theory?
most popular and widely tested theory
DNA damage and oxidative stress
what is the telomere aging clock theory?
structure at the end of chromosomes
telomere acts as molecular clock and signals senescence (viable non-dividing state of a cell)
what is the inflammation stage?
complex set of overlapping vascular and cellular processes
removal of injurious agents, cellular debris, and marks initiation of the healing process
protective role, but becomes deleterious if it persists
what is acute inflammation?
sudden onset, short duration
exudation of fluid and plasma proteins w/migration of neutrophils and leukocytes
redness, heat, swelling, pain, and reduced function
what is chronic inflammation?
extensive necrosis
inability of cells to regenerate
insulting agent not eliminated
repeated episodes of acute inflammation
persistent immune reaction
chemotaxis of monocytes results in macrophages that modulate lymphocyte function resulting in growth of endothelial cells and fibroblasts
results in granulation tissue and connective tissue scar
what are the characteristics of a well healing wound?
red, beefy tissue
pinpoint red dots
granular surface composed of newly formed collagen
what are the components of the inflammatory reaction?
exudation (escape of fluid from the vascular system into tissue or body cavity)
- high protein concentration, cellular debris, and high specific gravity
transudate (fluid w/low protein count, little/no cellular debris, low specific gravity)
effusion (fluid leaks from blood vessels and accumulates inside an anatomical space such as pleural, pericardial, or peritoneal cavity or joint spaces.
what are neutrophils?
constitute defense against foreign substances (usual bacterial infection)
what are lymphocytes?
produce antibodies, fight tumor cells, respond to viral infections
what are monocytes?
clean up debris after neutrophils have completed tasks
what are eosinophils?
attack parasites and play a role in asthma and allergies
what are basophils?
release histamine during allergic reactions
what chemical mediators of inflammation?
histamine: quick and short acting
- inactivated in < 30’
- causes endothelial contraction-causes gaps in blood vessels increasing vessel permeability
- potent vasodilator and bronchoconstrictor
platelet activating factor: potentiates activity of other inflammatory mediators
arachidonic acid derivatives: cleavage of AAD from cell membrane leads to…
- cyclooxygenase enzyme or a lipooxygenase enzyme further metabolizes the arachidonic acid
- cyclooxygenase pathway leads to production of several types of prostaglandins which mediate fever and pain associated with inflammation
cytokines: interleukin 1 and TWF raises production of prostaglandin producing fever –> increased systemic metabolisma nd O2 consumption–>decreased systemic vascular resistance–>hypertension leads to decreased systemic vascular resistance causing increased HR
what do corticosteroids do?
block production of arachidonic acid
Prednisone, dexamethasone, triamcinolone, kenalog
what do NSAIDS do?
block production of prostaglandins and cyclooxygenase
ASA, ibuprofen
what do cyclooxygenase-2 (Cox-2) inhibitors do?
block production of cyclooxygenase
celebrex, meloxicam, mobic
what is the blood coagulation/clot formation stage of healing?
formed by plasma proteins
balance b/w coagulation (clot formation) and lysing (clot dissembling)
protects against hemorrhage and catastrophic clotting
platelets circulate always ready to engage any damage
w/injury:
- prothrombin converted to thrombin which converts fibrinogen to fibrin (essential component of blood clots)
- fibrin forms meshwork at site of insult and stops bleeding, traps, exudate, and microorganisms
what is the 1st stage of healing?
inflammation
what is the role of the inflammation stage?
break down necrotic tissue w/phagocytes and enzymes
what are the components of healing?
fibronectin: provides scaffolding, tensile strength, binds cells
proteoglycans/elastin: binds to fibronectin and collagen and stabilizes tissue undergoing repair, aids in hydration of tissues
collagen: glue producer, provides tensile strength and structural support for most tissues and organs
- type 1: most common, structurally strong; main component of mature scars and predominant in tissues such as tendon and bone
- type 2: thin filaments found in cartilage
- type 3: elastic filaments found in skin and blood vessels; 1st to be laid down in healing tissue
what are the 4 stages of healing in order?
hemostasis and degeneration
inflammation
proliferation and migration
remodeling and maturation
what is the hemostasis/degeneration stage of healing?
process of stopping blood flow through the locally damaged vessels into the injury site via coagulation
shortest phase
characterized by:
- vasoconstriction followed by vasodilation
- influx of platelets creates clots
- damage to lymph vessels
- chemotactic factors to summon inflammatory cells
- degeneration: formation of hemotoma, necrosis of dead cells, start of inflammatory cell response
what is the inflammatory stage of healing?
vascular and cellular response that eliminates microbes in preparation for repair
increased neutrophils, macrophages that phagocytize microbes and mesenchymal cells which become fibroblasts.
inactivate the injurious agents, break down and remove dead cells, initiate healing
allow inflammation but minimize it
1-3 days and sometimes up to 10 days post injury
goal: replace damaged tissue w/healthy tissue, fibrous scar, or both
characterized by:
- chemicals released to attract other cells and chemicals to the area
- cytokines: express GHs, attract macrophages, fibroblasts, and neutrophils, stimulate neovascularization
- platelet release: fibronectin, growth factor, fibrinogen
debris removal 5-6 hours post injury
neutrophils and polymorphonuclear leukocytes (PMN)
inflammatory exudate formed
chemotaxis
histamine release
prostaglandins (PG)
what are the signs of inflammation?
redness, edema, pain, increased temp, loss of normal functioning
what is the proliferation phase of healing?
increased fibroblasts, decreased PMNs=transition from inflammation to proliferation
excessive growth of epithelial cells beneath scab
deposition of collagen fibers by fibroblasts
growth of blood vessels (neovascularization/angiogenesis)
- leaky at first
cell migration occurs
what is the remodeling/maturation phase of healing?
scar tissue reduced and remodeled
can cause contractures near joints or organs
returns to more natural skin color
reduced capillary and fibroblast density
scab sloughs off
more organized collagen, fibroblasts decreased, blood vessels restored to normal
what is arthrofibrosis?
local/global periarticular scarring from surgery or trauma
thickened fibrotic capsule can inhibit motion
common in shoulders and knees
caused by prolonged immobilization, infection, graft malposition post reconstruction
collagen transition in remodeling stage of healing
type 3 collagen replaced by type 1 collagen
type 1 is more insoluble and resistant to destruction
strength increases w/more optimal arrangement of fibers
- more parallel= increased cross linking
what factors affect healing?
growth factors
nutrition
what is rheumatoid arthritis?
example of how chronic inflammation can damage healthy tissue
diagnosed by erythrocyte sedimentation rate and rheumatoid factor (antibody that attacks antibodies)
edema, loss of cartilage, resorption of bone, capsular laxity leading to deformity
autoimmune reaction and inflammation
synovial fluid hyperplasia
endothelial cell activation
bone and cartilage destruction
