readings Flashcards
heart failure
effects of beta blockers on HR and BP with rest and exercise
HR and BP both decrease with rest and exercise
heart failure
effects of nitrates of HR and BP with rest and exercise
rest: increase HR; decrease BP
exercise: increase/no change HR; decrease/no change BP
(Dilates vessels)
heart failure
effects of calcium channel blockers of HR and BP with rest and exercise
CC blockers: end with “dipine”
both decrease with rest and exercises
heart failure
effects of digitalis of HR and BP with rest and exercise
HR: decrease in pts with aFib and possibly HR
BP: no change with rest and exercise
heart failure
effects of diuretics of HR and BP with rest and exercise
HR: no change with rest and exercise
BP: no change or decrease with rest and exercise
heart failure
effects of vasodilators of HR and BP with rest and exercise
HR: increase/stay the same with R and E
BP: decrease with R and E
heart failure
effects of ACE inhibitors, Angiotensin II Blockers, and Alpha Adrenergic Blockers of HR and BP with rest and exercise
HR: no change with R and E
BP: decrease with R and E
heart failure
effects of nicotine of HR and BP with rest and exercise
HR: increase/stay the same with R and E
BP: increase with R and E
heart failure
left sided heart failure
- pathology of the LV reduces cardiac outpu leading to a backup of fluid into the LA and lungs.
- the increased fluid in the lungs produces 2 hallmark pulmonary signs of left sided HF:SOB and cough
right sided heart failure
- occurs from direct insult to the RV caused by conditions that increase PA pressure.
- increased oressure within the PA subsequently increases afterload, thereby placing greater demands on the RV and causing it to go into failure
- blood is not effectively ejected from the RV and backs up into the RA and venous vasculature, producing 2 hallmark peripheral signs: jugular venous distention and peripheral edema
ejection fraction norm range
EF: 55-75%
terminology difference of compensated vs decompensated HF
compensated: the pt’s congestive symptos can be relieved by medical intervention
decompensated: shows s/s of congestion and requires medical and pharmacological readjustment
common s/s of CHF
fatigue
dyspnea
edema (pulmonary and peripheral)
weight gain
presence of S3 heart sound
renal dysfunction
other symptoms:
- paroxysmal nocturnal dyspnea
- orthopnea
- bendopnea
describe S3 heart sound
low frequency heart sound heart in early diastoleand occrs due to poor ventricular compliance and sibsequent turbulence of blood within the ventricle
- correlated with increase left ventricular end diastolic pressures and pulmonary capillary wedge pressure
paroxysmal nocturnal dyspnea vs orthopnea vs bendopnea
- paroxysmal nocturnal dyspnea: sudden episodes of SOB occuring in the night
- orthopnea: increased SOB in the recument position
- bendopnea: presence of SOB when the pt bends fwd
NYHA heart failure classifications
- class 1: pts with cardiac disease but without resulting limitations of physical activity. ordinary physical activity does not cause undue fatigue, palpitation, dyspnea or anginal pain
- class 2: pts with cardiac disease resulting in slight limitation of physical activty. they are comfortable at rest. ordinary physical activity results in fatigue, palpitations, dyspnea, and aginal pain
- class 3: pts with cardiac disease resulting in marked limitations of physicalactivity. they are comfortable at rest. less than ordinary physical activity causes fatigue, palpitations, dyspnea or anginal pain
- class 4: pts with cardiac disease resulting in inablity to carry on any physical activity without discomfort. symptoms of cardian insuffiencey or of the anginal syndrome may be present even at rest. if any physical activity is undertaken, discomfort is increased
dyspnea scale
0- no dyspnea
1- mild, noticeable
2 - mild, some difficulty
3 - mod difficulty but can continue
4 - severe difficulty, cannot continue
angina scale
0 - no angina
1 - light, barely noticeable
2 - moderate, bothersome
3 - severe, very uncomfortable: preinfarction pain
4 - most pain ever experienced; infarction pain
hypoxemia vs hypercapnea
hypoxemia- decreased amount of oxygen in the aterial blood to the tissue
hypercapnea - increased amount of co2 within the arterial blood will develop
cor pulmonale
increased pulmonary vascular resistance 2/2 capillary wall damage and reflex vasoconstriction in the presence of hypoxemia results in pulmonary HTN and RV hypertrophy
most common type of restrictive lung disease
pulmonary fibrosis
AKA
usual interstitial pneumonia
classic signs and symptoms of interstitial lung disease
symptoms: dyspnea w activity and persistant non productive vough
signs: rapid shallow breathing, limited chest expansion, inspiratory crackles, especially over the lower lung fields, digital clubbing and cyanosis
clincal significane for a 6MWT
25-35 meters
clinical significance for gait speed
0.05m/sec
common congenital disease of lymphedema
milroys disease
pitting edema
pressure on the edematous tissues with the fingertips causes an indentation of the skin that persists for several seconds after the pressure is removed.
this reflects significant but short duration edema with little or no fibrotic changes in the skin or subcutanous tissue
brawny edema
pressure on the edematous areas feels hard with palpation. this reflects a more severe form of interstitial swelling with progressive, fibrotic changes in subcutaneous tissues
brawny as in the paper towel guy - hes hard/tough
weeping edema
represents the most severe and long duration form of lymphedema. fluid leaks from cuts or sores; would healing is significantly impaired. exclusively in the LE
rare
stemmer sign
positive - indication of late stage 2 or stage 3 lymphedema
- indicitive of worsening condition
stage 1 pressure injury
non blanchable erythema of intact skin
- intact skin w/ a localised area of non blanchable erythema which may appear differently in darkly pigmented skin
- presence of blanchable erythema or changes in sensation, temperature, or firmess may precede visual change.
- colors do not include purple or maroon - this may indicate deep tissue pressure
stage 2 pressure injury
partial thickness skin loss with exposed dermis
- partial thickness loss of skin with exposed dermis
- the wound bed is viable, pink, or red, moist and may also present as an intact or ruptured serum filled blister
- granulation, slough and eschar are NOT present
stage 4 pressure injury
full thickness skin and tissue loss
- with exposed or directly palpable fascia, mm, tendon, ligament, cartilage, or bone in the ulcer.
unstageable pressure injury
obscured full thickness skin and tissue loss
- obsucred by slough or eschar
stage 3 pressure injury
full thickness skin loss
- adipose tissue is visible in the ulcer and granulation tissue and epibole are often present
- slough and eschare may be present
- undermining may occur
- fascia, mm, tendon, ligament and cartilage, bone are not exposed
ASIA A
complete
- no motor or sensory function presered in the sacral segments S4-S5
ASIA B
sensory incomplete
- sensory but not motor function is preserved below the neurological level and includes the sacral segment S4-S5
- no motor function is preserved more than 3 levels below the motor level on either side
ASIA C
motor incomplete
- motor fx is preserved at the most caudal sacral segments for voluntary anal contraction OR the patient meets the criteria for sensory incomplete status and has some sparing of motor function more than 3 levels below the ispsilateral motor level on either side of the body
- less than half of key mm functions below have a >=3
ASIA D
motor incomplete
- motor fx is preserved at the most caudal sacral segments for voluntary anal contraction OR the patient meets the criteria for sensory incomplete status and has some sparing of motor function more than 3 levels below the ispsilateral motor level on either side of the body
- **more than half of key mm functions below have a >=3 **
brown sequard syndrome
stab or gunshot wound
ipsilateral side:
- sensory loss (proprioception, light touch, vibratory) due to DCML tract paralysis
- paralysis due to the CST (lateral) tract
contralateral side
- loss of sense of pain and temp due to STT tract damage
- the loss begins several dermatome segments below the level of injury
can achieve good functional gains during inpatient rehab
anterior cord syndrome
related to flexion injuries to the c/s
- loss of motor function (CST) below the level of injury
- loss of sense of pain and temp (STT) below the level of injury
- DCML is preserved (priorprioception, light touch, vibratory)
longer length of inpatient rehab
central cord syndrome
most common syndrome
- occurs from hyperextension in the c/s or congenital/degenerative
- UE > LE
- motor > sensory
- normal sexual, b/b are retained
typically recover ambulation
cauda equina injuries
areflexic b/b and saddle anesthesia
considered peripheral nerve injuries (LMN)
conus medullaris syndrome
mixture of LMN and UMN
occurs very distal portion of spinal cord gets damaged
symptoms of autonomic dysreflexia
HTN
bradycardia
HA
profuse sweating
increased spasticity
vasodilation (flushing) above the level of lesion
constricted pupils
nasal congestion
piloerection (goosbumps)
blurred vision
normal BP for a person with an SCI
above T6 level
systolic: 90-110 mmHg
what level of SCI can drive with adaptive controls
C6
differences between fibromyalgia and myofascial pain syndrome
fibro
- tender points at specific sites
- no referred patterns of pain
- no tight bands of mm
- fatigue and waking unrefreshed
myofascial pain
- trigger points in mm
- referred patterns of pain
- tight band of mm
- no related fatigue complaints
characteristics of fibromyalgia
- first symptoms can occur at any age but usually appear during early to middle adulthood
- pain is reported in the scapula, head, neck chest and low back
- fluctuations of symptoms
Most common characteristics of an ACA
Contra lateral hemiparesis
Sensory LE>UE
Most common characteristics of a MCA
Contra lateral spastic hemiparesis
Sensory loss in the face and UE>LE
Most common occlusion in a stroke
Middle cerebral artery
cellulitis
connective tissue skin infection
- poorly defined and widespread
- can be contagious
- skin is red/hot/ edematous
shingles
cn 3 involvement; eye pain; corneal damage; loss of vision with cn 5 involvment
epidermal burn
erythematous pink or red; irritated dermis
- no blisters, dry surface; delayed pain, tender
superficial partial thickness burn
- bright pink or red, mottled red; inflammed dermis; erythematous WITH BLANCHING AND BRISK CAPILLARY REFILL
- intact blisters, moist weeping or glistening surface when blisters are removed; very painful
- sensitive changes in temperature, exposure to air currents, light tough
- mod edema; spontanous healing
deep partial thickness
- mixed red, waxy white; blanching WITH SLOW CAPILLARY REFILL
- broken blisters, wet surface; sensitive to pressure by insensitive to ligh touch touch or soft pin prick
full thickness burn
- white ischmic, charred, tan, fawn, mahogany, black, red; NO BLANCHING, poor distal circulation
- ## parchment like, leathery, rigid, dry, body hair easily pulled out
subdermal burn
- charre
- subcutaneous tissue evident, mm damage, nuerological involvement
the deeper the injury, the ___it will appear
the deeper the injury, the whiter the sking will appear
autolytic debridement
natural debridement promoted under occlusice or semiocclusive moisture-retentive dressings that result ins in solubilizations
contraindications:
- infected wounds
- woulds of immunospressedd ind.
- dry gangrene or dry ischemic wounds
selective debridement
chemical debridement that promots liquefication of necrotic tissue by applying topical prepartion of collagenolytic enzymes to those tissues
indications:
- all moist necrotic wounds
- eschar after cross-hatching
- homebound ind.
- people who cannot toleratte surgical debridment
contraindications:
- ischemic wounds unless adequate vascular status has been determined
- dry gangrene
- clean, granuluated wounds
selective debridement
mechanical debridment
removes foreign material to devitalized or contaminated tossue by physical forces (wet-dry dressing, pulsatile lavage) but also may remove healthy tissue
indications:
- wounds with moist nectrotic tossue or forerign material present
contraindications:
- clean, granulated wounds
non-selective debridement
sharp debridment
indications:
- scoring and/or excision of leathery eschar
- excision of moist necrotic tissue
contraindications:
- cellulitis with sesis
- when infections threathens the ind.’s life
- ind on anticoagulant therapy
selective debridement
transparent fils
indications:
- stage 1-2 pressure ulcers
- autolytic debridement
advantages:
- impermeable to external fluids and bacteria
- promotes autolytic debridmnet
- min friction
disadvanatges:
- not to be used with fragile surrounding skin or infected wounds
hyrdocolloids
form gelatinous mass over the wound bed; available in paste f orm that can be used as a filler for shallow cavaity wounds
indications:
- protection of partial thickness wounds
- autolytic debdiement of necrosis or slough
- wounds with mild exudate
advantages:
- maintains moist enviroment
- nonadhessive to healing tissue
containdications:
- non transparent
- may soften or change shape with heat or friction
- not recommended for wounds with heavy exudate, sinus tractm or infections; wounds that expose bone or tendon
- dressing edges may occur
considerations:
- allow 1-1.5in margin of healthy tissue around the edges
think pimple patch style
hyrdogels
indications:
- partial and full thickness wounds
- wounds with necrosis or slough
- burns and tissue damaged by radiation
advantages:
- soothing and cooling
- fill dead space
- rehydrate wounds
- conform to wound bed
containdications:
- require secondary dressing
- not used for heavy exudating wounds
- may dry out and then adhere to the wound bed
- may macerate the skin
considerations:
- dressing changes 8-48 hours
foams
semipermeable membranes
indications:
- partial and full thickness wounds with minimal to moderate exudate
- secondary dressing for wounds with oacking to provide additional absorption
- provide protection and insulation
advantages:
- insulate wounds
- provide some padding
- manage min to heavy exudate
containdications:
- non transperant
- require secondary dressing
- poor conformability to deep wounds
- not for use with dry eschar or wounds with no exudate
alginates
soft, absorbent, nonwoven dressings derived from seeweed
indications:
- wounds with moderate to large amounts of exudate
- wounds with combination of exudate and necrosis
- wounds that require packing and absorption
- infected and noninfected excuding
advantages:
- absorb 20x their weight in drainage
- fill dead space
containdications:
- require secondary dressing
- not recommended for dry or lightly exciding wounds
- can dry wound bed
gauze dressing
indications:
- wounds with dead space, tunneling, or sinus tract
- wounds wiht combination excudate or nerotic tissue
advantages:
- readily available
- cost effective
- can be used on in infected wounds
containdications:
- delayed healing if used impromperly
- pain on removal
considerations:
- if too wet, dressings will macerate surrounding skin
herpes zoster
CN 3 and 5 affected
you can provide TENS
no heat
presents mostly unilateral
raised palpation <2mm
pink with silvery white appearance
blisters:
vesicles:
wheals:
pustules:
blisters: sac with fluid
vesicles: fluid filled, domed shaped, >=0.5cm
wheals: hives
pustules: pus filled
dressings from mild exudate to heavy exudate
selective vs nonselective examples
selective:
- sharp
- enzymatic
- autolytics
nonselective:
- wet to dry
- wound irrigation
- hydrotherapy
when do you chose selective vs nonselective
at least 50% = selective
thermal modalities effects
cyrotherapy application effects
hot pack settings
- temp: 160-170 deg
- time: 20-30min
- 6-8 layers
- peaks at 5 min
cold pack settings
- stored at 25 deg
- time: 10-20min
- can be applied every 1-2 hrs
- stages of cold: cold-burning-aching-numb
we want numb and so these are normal reactions
containdications for thermotherapy and cyrotherapy
parameters for e-stim
pulse frequency: quick/higher=comfortable
pulse duration: more uncomfortable the longer they are (larger mm need it to be longer to reach desired mm)
ratio: 1:5
ramp: at least 2 seconds
high voltage pulsed galvanic current
wound care
negative - infected
positive - healing
pulse frequency regardless: 60-125 pps
pulse duration: 40-100
wound care
iontophoreses meds
(neg/pos)
“ISAD”
types of TENS
ultrasound characteristics
ultrasound decision making tree
when do you place the pt in supine when applying lumbar distraction
interverterbral joints, facet joints, mm elongation
when do you place the pt in prone when applying lumbar traction
posterior disc herniation
you want to apply lumbar traction on L5-S1 intervertebral space, how much hip flexion do you need
45-60deg
you want to apply lumbar traction on L3-4 intervertebral space, how much hip flexion do you need
75-90deg
you apply 25% of bodyweight during lumbar traction - what area are you working on?
disc protrusions, spasms, elongation
you apply 50% of bodyweight during lumbar traction - what area are you working on?
joint distraction
you initially want to get your pt set up on cervical traction, how many pounds do you start with
7-9lbs
you apply 11-15lbs of bodyweight during cervical traction - what area are you working on?
disc protrusion, spasms, elongation
```
~~~
you apply 20-29lbs of bodyweight during cervical traction - what area are you working on?
joint distraction
or 7% bodyweight
difference of when to place the electrodes close vs far
close = mm relaxation
far = mm re-ed
early heel off =
early toe off =
early heel off = tight PFers
early toe off = tight hip flexors
what does a backwards trunk lean in swing mean
what happens to COM when theres an amputation to the UE and/or LE
UE= COM lowers
LE= COM is higher
amputations
low walls =
high walls =
low walls = weak mm
high walls = tight mm
elevated triglycerides
150 mg/dl or higher
low HDL
men: less than 40
women: less than 50
example of hypothyroidism
hashimotos disease
symptoms of hypothyroidism
- weight gain
- mental and physical lethargy
- dry skin and hair
- low blood pressure
- constipation
- intolerance to cold
- goiter
example of hyperthyroidism
graves disease
symptoms of hyperthyroidism
- nervousness
- hyperreflexia
- tremor
- hunger
- weight loss
- heat intolerance
- palpitations
- tachycardia
- goiter
- diarrhea
s/s for addisons disease
- increased bronze pigmentation of skin
- weakness, decreased endurance
- anorexia, dehydration, weight loss, GI disturbances
- anxiety, depression
- decreased tolerance to cold
- intolerance to stress
difference between addisons disease and cushing’s syndrome
addisons: decrease production of cortisol and aldosterone
cushings: excessive production pf cortisol
s/s for cushings syndrome
- decreased glucose tolerance
- round “moon” face
- obesity
- decreased testosterone/mentstrual periods
- muscular atrophy
- edema
- hypokalemia
- emotional changes
how hot should the pool be for rehab exercises
91-93 F
(33-34 C)
difference between OA and RA
contraindications vs precautions for pool therapy
referral patterns
- liver
- gall bladder
- stomach
- heart
- pancreas
appendicitis
pain is abrupt at onset, localized to the epigastric or periumbilical area; intensity increases over time
- rebound tenderness (Blumberg’s sign) is present in the response to depression if the abdominal wall at the site distance from the painful area
- point tenderness is located at McBurnerys point (1.5-2in above ASIS) in R LQ
- rovsing’s sign elicits pain in the RLQ
- obtruator sign: RLQ pain with IR and flexion to 90 deg of the R hip with 90deg of knee flex
- markle’s sign: pain elicited in the RLQ when a patient drops from standing on toes to the heels with a jarring landing
- psoas sign: pain in the RLQ occurs w hip ext from inflammation of the peritoneum overlaying the psoas mm
stages of cancer
stage 0: carcinoma in situ
stage 1: tumor is localized, equal to or less than 2 cm; has not spread to lymph nodes
stage 2: tumor is advancedl 2-5cm with or without lymph node involvement
stage 3: tumor is locally more advanced; spread to lymph nodes; cancer is designated stage 3 or 4 depending upon specific type of cancer
stage 4: the tumor has metestasized or spread to the other ograns throughout the body
contraindications for exercising with an ind with cancer
lab values/ranges
platelet count
normal: 150k - 450k
some limitations: 50k-150k
mod exercise: 30k-50k
light exercise: 20k-30k
ROM, ADLs, walking with physcian approval: <20k
lab values/ranges
CPC: white blood count
normal: 4800-10,800
light exercise: >5000
no exercise: <5000 with fever
no exerise + protective mask required: < 1000
lab values/ranges
hemoglobin
women: 12-16
men: 13-18
regular exercise: >10
light exercise: <8-10
no exercise: <8
lab values/ranges
hematocrit
women: 37-48%
men: 45-52%
light or regular exercise: > 25%
no exercise: <25%
posterior leaf spring
aids with PF
“springs fwd” to lift foot off floor
prevents foot drop
needs little to minimal sagittal plane restriction
hinged AFO
limits sagittal plane mvmts, facilitating progression to foot flate position in early stance
ground reaction orthosis
to allow for control at both ankle and knee. prevents the knee from collapsing into flexion during the stance phase by restricting DF at the ankle.
used for pts who have: knee bucking during stance phase or present with a crouched gait
in order for the GRAFO to be effective, the pt should have at least 3/5 mmt of the quads
