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Primary Care for the PT > screening and care of OB and peds patients > Flashcards

screening and care of OB and peds patients Flashcards

1
Q

A pregnant pt comes into your office, what are some questions you may ask her to get general idea of her health ?

A
  • pregnancy complications with previous or current
  • MSK issues before or after the preg or with other pregnancies ?
  • currently having any urinary or anal incontinence?
  • did you stop taking any meds 2/2 preg?
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2
Q

A post partum pt comes into your office, what are some questions you may ask her to get general idea of her health ?

A
  • bed rest during preg?
  • type of delivery
  • complication during delivery? like an episiotomy ?
  • forceps or vacuum extraction used?
  • incontinence
  • current symps present before or during pregnancy?
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3
Q

What are positions to avoid with pregnancy?

A

supine - hypotension can occur, decreased CO can also result in decreased uterine BF
Prone- to be avoided in 2ng/3rd trimester as fetus extends beyond pelvic brim

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4
Q

what should be on your checklist for pregnancy?

A 
Depression
DI disorders 
urogenital 
endocrine 
cardiovascular 
MSK
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5
Q

What types of depression can affect a pregnant women, what measure can you use ?

A
  • prenatal
  • post partum
    Edinburgh post natal depression scale can be used, 10 or higher is +. But this outcome only addresses depression and not anxiety, personality disorder ect
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6
Q

What GI disorders can effect a pregnant women ?

A

General N/V with reflex
hyperemesis gravidarum
gall bladder
constipation

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7
Q

what is hyperemesis gravidarum

A

excess vomiting, nausea, electrolyte loss and weight loss

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8
Q

Your patient who is pregnant and shoulder pain listed on her intake form, what Qs will you ask to follow up?

A

R shoulder?
scapula or thoracic region?
MSK pain can mimic gall bladder pain

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9
Q

why are we concerned about poor motility in preg pts?

A

discomfort, ab bleeding may occur

strain during BM may lead to pelvic floor dysfxn prolapse or hemorrhoids

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10
Q

what are urogenital disorders that should be included in pregnancy screening ?

A 
UTI
acute cystitis (bladder infection)
pyelonephritis (kidney infection)
urinary/ anal incontinence 
organ prolapse
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11
Q

is a patient had a UTI, what would they complain of?

A

pain

urinary frequency

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12
Q

if a patient had a bladder infection, what would they complain of? a kidney infection?

A 
urinary frequency 
burning/pain while voiding 
- supra pubic / sacral pain 
- kidney infection:
- fever nausea vomiting 
costovertebral pain
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13
Q

what are Endocrine Disorders that pregnant patients can experience?

A 
Gestational Diabetes Mellitus 
-Increased risk of HTN or preeclampsia
-May require  C-section
-Increased risk developing type 2 DM 
post-partum
mgmt = changes to the diet and incorporation of exercise

-CV exercise is more effective than just dietary changes
-If IDDM, monitor blood glucose levels before and after exercise
-Upper body exercise recommended-less stress on the trunk
Blood glucose levels decrease following 4 weeks of CV exercise

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14
Q

what is Supine Hypotension Syndrome

A

Due to fetal pressure on Inferior vena cava

  • Supine/reclined or prolonged standing postures increase lordosis
  • More common in third trimester
  • Relieve by tilting, propping to one side with pillows
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15
Q

what should you be concerned about regaridng the CV health of a preg patient?

A

HTN and preclampsia

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16
Q

what is advanced preclmapsia ? what is ecalmpsia ?

A

Typically > 20th week of pregnancy, about 1/2 way through
- Due to BP and protein in urine (kidney problems)

-Eclampsia – onset of seizure activity

Additional signs:
Persistent headache
Blurred vision, sensitivity to light
Edem
Shortness of breath
Low back and/or abdominal pain
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17
Q

what MSK disorder to preg pts present with?

A
  • LBP
  • make sure to screeen for kindey infection
  • provide with LBP postioning and tx techniques
18
Q

what does SI joint pn present as ?

A
  • Direct/postural pressure in low back/SI region
  • Sharp, located in sacral/buttock region
  • May refer to LE/knee/foot
19
Q

what does sacroiliitis present as ?

A
  • inflammation of one/both SI joints
  • SI joint stretch = stress, inflammation
  • Secondary to UTI
20
Q

what does Pubic Symphysis Pathology present as ?

A
  • can be inflammed due to pressure late in preg
  • separation of 10mm< after delivery=
  • Difficult to WB, walk, needs assistance (6 weeks)
  • Joint stabilization, controlled mobilization exercises (6-12 weeks)
  • Possible external brace, pt ed in transfers and body mechanics
21
Q

what does or thoracic Spine, Rib Dysfunction Pathology present as ?

A

Pain from low rib torsion

  • Mostly in 3rdtrimester
  • Assess in sitting or sidelying
  • May persist postpartum
22
Q

what are types of head aches you should look out for in screening a preg patient ?

A

XMigraines

  • Seldom start during pregnancy, may continue
  • Prepregnancy history may decrease due to increased estrogen

Tension

  • Postural/mechanical cause
  • Stress-induced

Other Causes

  • Stress, dehydration, poor sleep, low blood sugar
  • Pregnancy-induced HTN/Preeclampsia
  • Ischemic/hemorrhagic stroke
  • Arterial dissection

Persistent Postpartum
-Possible subdural hematoma s/p spinal anesthesia-
Refer for treatment

23
Q

what is diastasis recti ?

A 
2+finger width separation between rectus abdominis bellies
-Measured via horizontal palpation w/curl-up
Intrarater reliability (not interrater)
-Transverse abdominis weakness pre-pregnancy linked to DR
-Tendinous linea alba, may not return to normal length post partum
-Recovery=improved urogenital and musculoskeletal health
-Low evidence for exercise and taping to reduce diastasis
-Transverse abdominis strengthening
24
Q

what can a 0-12 month old do?

A

Most rapid physical development, significant growth rate,

crawl>sit>stand>start walk, explore environment

25
Q

what can a 1-4 year old do ?

A

Physical development slows to ½ infancy
growth spurts
neurologic system matures>gross & fine motor skills, language

26
Q

what growth does a preschooler 4-6 year old undergo?

A 
Doubles birth weight
height approx equal weight
 LE rapidly grow and child thins
 erect posture
advance gait and gross motor
27
Q

what developmental changes can you expect to see in a 6-12 yr old

A
  • Weight +5-7lb/yr, height +3”/yr,
  • continued growth spurts
  • normalized gait
  • vision 20/20
  • inc strength and coordination
  • high energy levels
28
Q

when does puberty begin to start?

A

10-11 and peaks at 14-16

  • after 2 years of puberty, menarche begins and by age of 16
  • Critical dietary intake needed to maintain reproductive system, supply energy, promote bone and tissue health, achieve stature, etc.
29
Q

what is the Female Athlete Triad ?

A

Decreased bone mineral density
Eating disorders
Amenorrhea

30
Q

what are some Cardiovascular and Pulmonary risks that children have - up to 40% of them will have..

A 
Obesity
Physical inactivity
Diabetes
Environmental stress
Aerobic metabolism
65 to 70% of the total aerobic capacity to that of adults
31
Q

what is the avg age children are dx’s with cancer

A

6

32
Q

what are Specific Adolescent Screens for Cancer

A 
An unusual lump or swelling
Unexplained pallor and lethargy 
Easy bruising
An ongoing pain in one area of the body
Sudden unexplained weight loss
Limping
Unexplained fever or illness that doesn’t go away
Frequent headaches, often with vomiting
Sudden eye or vision change
33
Q

what are Neoplasms signs and symps

A
  • Constant pain for malignant tumors
  • Transient pain for benign tumors
  • Local swelling, tenderness and joint pain
  • Red flag is onset of pain in the absence of trauma
  • located at the end of long bones
34
Q

what is Osteochondrosis

A

derangement- ossification in the epiphysis.

May result from:

  • Repetitive trauma
  • Synovitis
  • Infection
  • Granulation tissue disrupting blood flow
35
Q

what is a specific type of Osteochondrosis in the elbow?

A

panners disease:

Osteochondrosis of the capitulum
-Pain, swelling and ROM limitations
-Differential Dx
Tendon injury at and 
Ligament injury in the lateral elbow
36
Q

what is a specific type of Osteochondrosis in the hand?

A

Kienbock’s Disease:

  • Osteochondrosis of lunate bone
  • Onset due to repetitive microtrauma
  • Pain with end range wrist extension
37
Q

what is a specific type of Osteochondrosis in the hip?

A

Legg-Calve Perthes Disease
Painful PROM
ROM restrictions with hip IR
Trendelenburg gait

38
Q

what is a specific type of Osteochondrosis in the foot?

A

Freiberg’s Disease

  • Osteochondrosis of the distal epiphysis, 2nd/ 3rdmetatarsal
  • Pain at MTP joint, increases with WB and toe extension during gait
39
Q

what is a specific type of Osteochondrosis in the back?

A

Scheuermann’s

  • Different growth rate in vertebra, post>ant
  • Resultant kyphosis
  • Resolves with approp exercises
  • Brace can be used, surgery is rare
40
Q

Osteochondritis Dissecan- what is it?

A

Fragment of the epiphysis becomes separated and then avascular

  • Most commonly occurs in: Medial femoral condyle
  • Posterior surface of the patella
  • Femoral head
  • Dome of the talus
  • Capitulum of the humerus

Conservative vs surgical management:

  • Conservative: fragment will eventually be resorbed
  • Surgical: Necrotic segment of bone can be surgically removed or repaired
41
Q

Idiopathic Scoliosis nuggets:

A 
Adams forward bending test is not a reliable test
-Curves progress in:
19% of girls 
Only 1% of boys
-Management of Idiopathic Scoliosis

Observation – curve is < 25 degrees
Bracing – curve is progressing beyond 25 –30 degrees
Surgery – curve 45-50 degrees or signs of spinal instability or risk to CV/Pulm systems

Primary Care for the PT (6 decks)

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