Sepsis, SIRS, Obesity, pregnancy, diastasis recti abdominis

Question 1

What is sepsis

Answer 1

presence of whole body inflammatory state (SIRS) + presence of known or unknown infection

Question 2

What is septic shock? What does it cause?

Answer 2

• severe sepsis but hypoperfusion abnormalities in spite of adequate fluid resuscitation
• immune system spirals out of control
• normal response to infection is local but then causes widespread vasodilation and vascular permeability

Question 3

What is shock? What is the effect of shock in the body?

Answer 3

poor distribution of blood at the microcirculation level

Decreased tissue perfusion = not meeting cellular needs = cell death

Question 4

4 types of shock + what they are

Answer 4

• hypovolemic (blood loss)
• cardiogenic (heart damage)
• distributive (hypotension and general tissue hypoxia)
• obstructive (great vessels of heart, usually goes with cardiogenic shock)

Question 5

What is SIRS

Answer 5

Systemic inflammatory response syndrome - a whole body inflammatory state

Question 6

SIRS Dx

Answer 6

WITH body temp, HR, RR, WBC count

2 or more following signs

• (HR>90)
• temp >38 or <36
• RR>20 OR PaCo2 < 32
• WB count > 12000 or < 4000

Question 7

What are the corresponding BMI for:

• Overweight
• Obese
• Morbidly obese

Answer 7

25-29.9
> or = to 30
> or = to 40

Question 8

What finding on the skin calliper test is considered excess

Answer 8

> 1 inch

Question 9

Obesity causes

Answer 9

• excess calorie intake
• psych/enviro factors
• genetic factors
• endocrine and metabolic disorders

Question 10

Health risks associated with obesity

Answer 10

• HTN, hyperlipidemia, type 2 diabetes, cardiovascular disease, glucose intolerance
• gallbladder disease, menstrual irregularities, infertility, cancer
• Abdominal Obesity: independent predictor of morbidity and mortality

Question 11

Obesity Rx

Answer 11

• lifestyle modifications, behavior therapy, pharmacology, surgery
• EXERCISE

Question 12

Exercise prescription for someone with obesity

Answer 12

Moderate intensity 40-60% progress to 50-70% HRR, 5-7d/wk, 45-60mins, circuits or aquatics

Question 13

Exercise precautions for someone with obesity

Answer 13

mindful of response to heat (used therapeutically) or in response to exercise
• excess fat leads to heat insulation - lead to overheating

Question 14

What is normal weight gain with pregnancy

Answer 14

20-30lbs

Question 15

How long is pregnancy

Answer 15

40 weeks

Question 16

What is the PT role is pregnancy

Answer 16

Relaxation + breathing exercises

Education

Question 17

What is the PT antepartum (pre birth) concerns

Answer 17

• antepartum bleed
• preterm labor (irritable uterus) - “mini contractions”
• ruptured membrane - slow trick of fluid (not water breaking)
• incompetent cervix/changes

Question 18

Postural changes seen with pregnancy

Answer 18

• Increased thoracic kyphosis
• forward lean in C-spine (HFP)
• Increased lumbar lordosis
• Increased breast size
• shoulder protraction
• Decreased form and force closure - pelvic floor on stretch
• balance change
• lig laxity (hypermobile SI - teach jt protections)

Question 19

What is the % of people who experience incontinence following vaginal delivery

Answer 19

67%

Question 20

What is diastasis recti abdominis

Answer 20

Lateral separation/split of rectus abdominus

Question 21

When does diastasis recti abdominis occur

Answer 21

2nd trimester

Question 22

Effects of diastasis recti abdominis

Answer 22

• weak abdominal wall
• decreased support for back and viscera
• related to lumbo-pelvic pain

Question 23

diastasis recti abdominis Rx

Answer 23

• education (what you can improve and what you can’t improve)
• posture and body mechanics
• movement patterns and recruitment strategies
• exercises (TA, multifidus, pelvic floor)
• abdominal binders (proprioceptive feedback)
• recovering usually 2-6 months, surgery in severe cases