Rehab Medicine: Renal Rehabilitation

Question 1

What does a Physiatrist or Rehab physician ‘specialize’ in ?

Answer 1

Function (Practical approach to patient care and activities of daily living)

Question 2

Kidney damage with normal or increased GFR

Answer 2

90 mL/min.

Question 3

Kindey damage with a mild decrease in GFR

Answer 3

60-89 mL/min

Question 4

Kidney damage with Moderate decrease in GFG

Answer 4

30-59 mL/min

Question 5

Kidney damage with severe decrease in GFR

Answer 5

15-29 mL/min

Question 6

Kidney failure

Answer 6

Less than 15 mL/min

Question 7

Stage 6 real failure

Answer 7

Dialysis

Question 8

What is the major etiology of Chronic Renal Failure ?

Answer 8

Diabete mellitus (50%)

Question 9

What is the second most prevalent etiology of CRF ?

Answer 9

Hypertension (25%)

Question 10

What is the major manifestation seen in CRF ?

Answer 10

Fatigue

Question 11

What is uremic frost ?

Answer 11

In Chronic renal failure, BUN is so high that urea is crystalizing in the head !

Question 12

What are other manifestation of CRF ?

Answer 12

Fatigue, dyspnea, headache, pruritus, peripheral edema, hyperpigmentation, neuropathy, altered mental status, auscultory rales, “uremic frost”

Question 13

Is the treatment for Stages I-IV CRF medical or Surgical ?

Answer 13

Medical
DM, HTN, Diet Modification (adequate protein intake, restricting fluid/Na and possible K/P)

ACE/ARB

Question 14

What kind of surgical options are available to those with Stage V or higher CRF ?

Answer 14

Dialysis (Hemo or Peritoneal)

Kidney transplant

Question 15

What must be made in the arm of a person who is to undergo heomdialysis ?

Answer 15

AV Fistula

Use neck while fistula is ‘maturing’

Question 16

Why would someone choose peritoneal dialysis over hemodialysis ?

Answer 16

More lifestyle freedom, more pt responsibility,

Must be done 4x daily

Question 17

What does peritoneal dialysis increase risk for ?

Answer 17

Peritonitis

Question 18

List the complications associated with renal transplantation

Answer 18

Postop- infection
bleeding
rejection (Signs of Graft Rejection: Anorexia, malaise, fever, HTN, leukocytosis, BUN elevation, kidney enlargement with localized tenderness, graft site tenderness, reduced UO, edema)

Question 19

What is the major “frontline” drug used for immunosupression ?

Answer 19

Prednisone

Question 20

Cylosporine is another drug used as an immunosuprressant after kidney transplant. What mineral deficiency is often seen with long term use of this drug ?

Answer 20

Hypomangnsemia (Must replace Mg+)

Question 21

what other SE are seen in patients on Cyclosporine ?

Answer 21

Heart Attack, Hypertension, Seizures.

Question 22

Besides immunosuppression for transplant patients, what other condition is Azothiopine used for ?

Answer 22

Rheumatoid arthritis.

Question 23

What are the three goal of Rehab

Answer 23

1. Function (FIM)
2. Independence (Owestry Disability Index)
3. QUality of life (SF-36)

Question 24

What professions are part of a Rehabilitation Team ?

Answer 24

Physiatrist
Physical Therapist
Occupational Therapist
Speech Therapist 
Neruopsych
Rehab Nursing
Social Worker
Patient Social Reports
OVR

Question 25

What is the role of the physiatrist ?

Answer 25

Provides primary medical care, while coordinating interdisciplinary team and medical specialists

Question 26

What is the role of the Physical Therapist

Answer 26

LE strengthening, transfers, gait, balance, endurance, energy conservation techniques

Question 27

What is the role of the Occupational Therapist

Answer 27

UE strengthening, transfers, fine motor tasks with hands, self care ADLs Home assessments adequate DME/home modifications

Question 28

What is the Role of the Speech Therapist

Answer 28

Speech, language, cognitive assessments, swallow evaluation

Question 29

What is the Role of the Neuropsychologist.

Answer 29

Emotional, behavioral adjustment, higher cognitive and psychological evaluations related to current admission

Question 30

What is the role of the Rehab Nurse

Answer 30

skin care, bowel/bladder management, pain control, preventative / coping education, medication administration

Question 31

What is the Role of Social workers

Answer 31

disposition planning with family and insurance companies

Question 32

Why do 83% of transplant patients not return to work ?

Answer 32

They are afraid their condition will worsen (may not like job,also)

Question 33

What is the main purpose of the Pre-Transplant exercise program ?

Answer 33

To limit the amount of complications that may be seen during or directly after the surgery

Complications include:
Anemia
Electrolyte Imbalance
HTN
Skeletal Muscle Atrophy
CV Deconditioning

Question 34

What do post transplant exercise programs consists of ?

Answer 34

Aerobic and Resistive

Regimens focus of lifestyle: stretching, repetitive low level resistence, aerobic exercise x 30mins daily

Question 35

What SE does the post-transplant workout try to counteract ?

Answer 35

Counteracts SEs of immunosuppressive regimen (muscle wasting, weight gain, fatigue)

Question 36

In terms of cognitive function, what is often seen in post-transplant patients ?

Answer 36

Improved attention, memory, reasoning

Question 37

What does rehabilitation seek to improve in patients who are in ESRD or post-transplant ?

Answer 37

Rehabilitation improves overall physical function, mood, and quality of life.

Question 38

Exercise training in patients with ESRD improved …

Answer 38

Strength and Endurance